Drainage Samples Research Articles

1221. Stenotrophomonas maltophilia Outbreak Associated with Sink Drains in an Intensive Care Unit

Abstract Background Stenotrophomonas maltophilia (SMA) is an opportunistic pathogen that causes significant morbidity and mortality and has been associated with outbreaks in various hospital environments. We describe an outbreak of SMA in our intensive care unit (ICU) and highlight the sink drain as the probable source of SMA. Methods Clinical surveillance for hospital-acquired infections due to SMA was instituted in December of 2017, when a cluster of cases was identified in our ICU. We first performed an environmental survey in random sites in our ICU rooms: high-touch surfaces, drains in handwashing sinks, clean water, enteral feeding, and ice machines. SMA was only found in the sink drain. We then performed an environmental survey focused on sink drains and the surrounding areas. We identified rooms where patients positive for SMA were previously hospitalized. Sampling sites were standardized for all rooms: bed rail, sink drain, splash zone, and air near sinks. Bed rails were swabbed with sponge-swabs and sink drains with flocked swabs with liquid Amies transport media. Swab samples were cultured in broth and solid media. Splash zone samples were collected using MacConkey agar plates left for four hours immediately adjacent and at one foot from the sink. Air samples were also collected for 10 minutes onto MacConkey agar plates using EMD Millipore MAS-100 NT impactor air sampler. All media was incubated aerobically at 35-37°C. Identification of all isolated gram-negative organisms was performed using MALDI-TOF MS. Results Five rooms were surveyed (Table 1). All rooms were found to have medical supplies within the splash zone. 100% (5/5) of sink drain samples had SMA recovered in culture, compared to 10% (1/10) of splash zone samples, 20% (1/5) of air samples, and 20% (1/5) of bed rails. In addition, we isolated other gram-negative organisms. We repeated the environmental survey after placing a sink drain cover in rooms found to have SMA in areas other than the drain. In the follow-up survey, we found no growth in cultures except for air samples (Table 2). Conclusion Sink drains pose a risk for SMA, possibly via contamination of medical supplies near sinks. Further investigation, including sequencing of environmental and clinical isolates, is needed to understand the mode of transmission. Disclosures All Authors: No reported disclosures.

Tracing tectonic processes from Proto- to Paleo-Tethys in the East Kunlun Orogen by detrital zircons

The East Kunlun Orogen (EKO), a crucial Tethys composite accretionary belt in the northern Tibetan Plateau, experienced a polyphase tectonic history during an orogenic evolution from the Proto-Tethys to the Paleo-Tethys oceans. It is thus an ideal natural laboratory for tracing the Tethys orogenic cycles. Although numerous studies have been done on the geologic evolution of the East Kunlun Orogen, the timing of initial subduction, final closure, and the transition from the Proto-Tethys to the Paleo-Tethys still remain controversial. This study presents U-Pb-Hf isotopic analyses of 794 detrital zircons from three modern river drainage samples and two sedimentary samples in the EKO. The analysed zircons cluster in five age groups: 2900–2100 Ma, 1900–1300 Ma, 1200–730 Ma, 550–370 Ma, and 290–200 Ma, in which almost 67 % are of Phanerozoic age. The εHf(t) values of the 550–370 Ma detrital zircons have a broad range from −28.8 to + 15.9 and exhibit a trend towards positive values, suggesting that subduction of the Proto-Tethys Ocean initiated at ca. 550 Ma and accretion of the continental arc occurred with increasing addition of mantle material. The εHf(t) values (−8 to + 13) of 290–200 Ma detrital zircons have no obvious evolutionary trend, reflecting the continuous crust-mantle interaction during the evolution of Paleo-Tethys arc. Our results, combined with previous research, reveal two discontinuous and distinct orogenic cycles from the Proto-Tethys to the Paleo-Tethys in the EKO: the Proto-Tethys orogenic cycle from oceanic subduction to continental collision and orogenic collapse at ca. 550–370 Ma, and orogenesis of the Paleo-Tethys Ocean at ca. 290–200 Ma in the EKO, with a gap of ∼ 80 Myr, during which time there was no subduction, and the extensional setting resulted in rare identifiable zircon record.

Characterization of Salmonella Strains and Environmental Microorganisms Isolated From a Meat Plant With Salmonella Recurrence

Salmonella entericais a leading cause of foodborne illness in the United States. In this study, 3S. enterica strains (serovars Cerro, Montevideo, and Typhimurium) were isolated from a beef processing plant with a history of Salmonella recurrence. Floor drains of the hotbox area and storage cooler of the same plant were sampled for environmental microorganisms. Biofilm formation on stainless steel (SS) by the microorganisms recovered from the drains and surface colonization by the isolated S. enterica strains were assessed. Pathogen survival and community compositions after sanitization (quaternary ammonium compound [QAC]) were examined. Alone the Cerro strain exhibited greater (P<0.05) surface attachment (5.4 log10CFU/SS chip) than the Montevideo or Typhimurium strains (4.6 and 4.8 log10CFU/SS chip, respectively). The Typhimurium strain was the most QAC tolerant (0.3 log reduction), whereas the Cerro and Montevideo strains exhibited similar sensitivities (1.6 log and 1.1 log reduction, respectively). The environmental microorganisms from the drain samples all developed biofilms ranging from 5.7 to 6.0 log10CFU/SS chip. All S. enterica strains were efficiently integrated into the drain biofilms where the Montevideo and Typhimurium strains ranged from 3.8 to 4.7 log10CFU/chip and the Cerro strain 4.0 to 5.8 log10CFU/chip. Enhanced QAC tolerance was only exhibited by the Montevideo strain when integrated into the drain biofilms. Metagenomic analysis of the drain biofilms showed that the most abundant genus was Pseudomonas (57.7%), followed by Brochothrix (28.6%), Serratia (7.2%), Lactococcus (4.2%), and Carnobacterium (1.1%), with all varying significantly among the different biofilm samples and their response to QAC treatment. Thus,various factors underlie the survival advantages of the S. enterica strains, allowing them to tolerate stress as well as out-compete and coexist with environmental companion bacteria for protection, which might lead to pathogen prevalence and recurrent product contamination.

Application of nano remediation of mine polluted in acid mine drainage water using machine learning model

Acid mine drainage (AMD) is the term used to describe drainage from coal mines with high sulfur-bearing rocks. The oxidative weathering of metal sulfides leads to AMD. The acidic environment corrodes more harmful compounds in the soil, which is spread throughout the working area. One such significant metal is copper, which is extracted in massive quantities from ores rich in sulfide. A copper-extraction resin might be created by combining diatomaceous earth (DE) particles with polyethyleneimine (PEI), which is shown to have great selectivity and affinity for copper. In this effort, PEI-DE particles’ copper absorption level was examined by using synthetic and actual acid mine drainage samples at varied pH values. The findings of the copper uptake particles have been examined through the Support Vector Machine (SVM) model. Using the n-fold 14 cross-validation approach, the quantities of parameters and C are estimated to be 0.001 and 0.01, respectively. The SVM analysis was correct, and the findings indicated that copper could bind to the material efficiently and preferentially at pH 4. Subsequent water elution studies at a pH value of 1 confirmed the pH-reliant interaction between dissolved Cu and PEI by demonstrating full release of the adsorbed Cu. In this research, the copper absorption of PEI-DE particles from synthetic and genuine AMD specimens was studied based on several pH conditions. The findings suggest that copper may attach to the material effectively and preferentially at pH 4. Studies of filtering water at pH1 later confirmed that all of the adsorbed Cu was released. This shows that the interaction between PEI and dissolved Cu depends on PH.

Association between bacterial growth in chest tube and anastomotic leakage after esophageal resection: prospective cohort study.

The aim of this study was to examine whether collagenase producing bacteria could be detected, in fluid collected from chest tubes, before clinical presentation of anastomotic leakage after esophageal resection. We conducted a prospective single-center study of patients who underwent resection of the gastroesophageal junction. All patients had a chest tube placed in the pleural cavity perioperatively. Drain fluid was collected and cultured from the first post-operative day and at time of routine removal of the drain (days 3-5). From January 2018 to July 2019, a total of 84 patients were included in the study. Twenty (36%) patients experienced severe complications with a Clavien-Dindo score of 3b-5. Eleven (13%) patients were diagnosed with anastomotic leakage which occurred after 8days (mean, range 2-13). Twenty patients (24%) had drain samples with significant growth of microbes. Among the 11 patients with anastomotic leakage, we found 2 with microbe growth at POD 2 and POD 4, the remaining 9 samples were negative (p = 0.638). Thirty-day mortality rate was zero. Cultured fluid from the pleural cavity of asymptomatic patients following esophageal resection did not indicate a significant association with anastomotic leakage.

Respuesta biológica en las pacientes con cáncer de mama tratadas con radioterapia intraoperatoria

IntroductionBreast conserving surgery with radiotherapy is the treatment of choice in patients with early breast cancer. Due to a better understanding of tumour radiobiology, the current trend is to use accelerated partial irradiation techniques, among which intraoperative radiotherapy (RIO) stands out. MethodsProspective multicentre study divided into two comparative groups with consecutive cases of patients who have undergone conservative surgery for breast cancer associated or not with RIO. The relation of this therapy with the values of proteins involved in the biological response (IL6, IL8, CXCL10, IL1β y TNF- α) is assessed in serum samples preoperative and 24 hours after surgery, and surgical drainage samples at 6 and 24 hours after surgery. ResultsA significant decrease in IL6 and IL8, as well as an increase in CXCL10 favourable for the fight against tumour progression (p-value < 0.05) was observed in patients treated with RIO. Immune system alterations are manifested in both serum and surgical drainage debit at 6 and 24 hours after surgery. ConclusionsRIO modifies the biological response in breast cancer patients. Although more lines of research need to be developed, the understanding of the mechanisms of tumour development opens a new stage in the development of perioperative treatments directed at specific targets that compensate for the harmful consequences of surgery.

Emergence of K1 ST23 and K2 ST65 hypervirulent klebsiella pneumoniae as true pathogens with specific virulence genes in cryptogenic pyogenic liver abscesses Shiraz Iran.

Hypervirulent Klebsiella pneumoniae (hvKp) pathotype is emerging worldwide in pyogenic liver abscesses (PLAs). However, the role of virulence factors in pathogenicity remains unclear. On the other hand, the epidemiology of PLAs in Iran is unknown. From July 2020 to April 2022, bacterial species were isolated and identified from the drainage samples of 54 patients with PLAs. K. pneumoniae as the most common pathogen of pyogenic liver abscesses was identified in 20 (37%) of the 54 patients. We analyzed the clinical and microbiological characteristics of K. pneumoniae-related pyogenic liver abscesses. Antibiotic susceptibility testes and string test were performed. 16S rRNA, antibiotic resistance, and virulence genes were determined by polymerase chain reaction amplification. Clonal relatedness of isolates was identified by multilocus sequence typing. Virulence levels were assessed in the Galleria mellonella larval infection model. Four hvKp isolates (K1/K2) were found to be responsible for cryptogenic PLAs, and 16 classical K. pneumoniae isolates (non-K1/K2) were associated with non-cryptogenic PLAs. Three capsular serotype K1 strains belonged to sequence type 23 (ST23) and one K2 strain to ST65. Meanwhile, the non-K1/K2 strains belonged to other STs. ST231 was the most common strain among the classical K. pneumoniae strains. Compared with the non-K1/K2 strains, capsular serotypes K1/K2 strains were less resistant to antibiotics, had positive string test results, and had more virulence genes. In Galleria mellonella, a concentration of 106 colony-forming units of the K1 hvKp strain resulted in 100% death at 24 hours, confirming the higher virulence of the hvKp strain compared with cKp. K. pneumoniae isolates represented that the acquisition of any plasmid or chromosomal virulence genes contributes to pathogenicity and high prevalence in PLAs. Meanwhile, hvKp isolates with a specific genetic background were detected in cryptogenic PLAs.

Removal of toxic metals and anions from acid mine drainage (AMD) by electrocoagulation: The case of North Mathiatis open cast mine

The present study aims to investigate the efficiency of the electrocoagulation (EC) process on the removal of heavy metals from real acid mine drainage (AMD) samples derived from the abandoned open-cast of North Mathiatis mine (Nicosia, Cyprus). EC process was applied with the use of aluminum electrodes in 0.5 L reactors and the removal ability of several heavy metals (Fe, Zn, Mn, Cu, Ni, Cd, Cr), and anion compounds (B−, SO42−, Cl−, NO3−) detected in real AMD water was examined. The reactors agitated to avoid the mass transport over the potential of the EC reactor and different parameters such as initial pH of samples, current density (20 mA/cm2), agitation speed (600 rpm), and EC time were examined. EC process resulted in high metal removal (Fe (99,9%) > Zn (99,9%) > Mn (99,9%) > Cu (99,9%) > Ni (98%) > Cd (96%) > Cr (88%)), but with variation on-time treatment. In the case of anions, the examined process achieved also to remove B− and SO42−. Lime neutralisation was also investigated to remove the dissolved metals in AMD and to evaluate liming with the EC process. The results revealed that metal removal efficiency is dependent on the final pH achieved in the solution. Furthermore, the combination of the processes showed improvement of treatment time and removal efficiency to lime and EC process.

Chemical modification of Macadamia-derived activated carbon for remediation of selected heavy metals from wastewater

In this study, Macadamia-derived activated carbon was utilized for the remediation of selected heavy metals from wastewater samples. The selected heavy metals include Pb (II), Fe (III), Cd (II), and Zn (II). The activated carbon used in the study was modified with KMnO4 and HNO3 to increase the content of the oxygen-containing functional groups on the adsorbent surface. Both the unmodified activated carbon (UAC) and modified activated carbon (MAC) adsorbents were employed throughout the study for comparative purposes in a multi-metallic system. The adsorbents were characterised using Fourier-transform infrared (FTIR) spectroscopy, scanning electron microscopy coupled with energy dispersive X-ray (SEM/EDX) analysis, and elemental (CHNS) analysis. Elemental analysis revealed an increased oxygen content from UAC to the MAC adsorbent from 8.34 % to 22.87 %. Scanning electron microscopy revealed a morphological contrast in the surfaces of both adsorbents. Optimal conditions for the carbon sorbents were observed at a pH 5, adsorbent mass of 0.2 g, initial concentration of 50 mg L-1, 4 h contact time, and a temperature of 298 K. Overall performance in removal efficiencies were recorded to be 74.74 % for UAC and 87.39 % for MAC. The MAC displayed superior removal efficiencies for Pb (II), and Fe (III) as compared to Cd (II) and Zn (II). Both adsorbents were applied in the treatment of acid mine drainage and leachate samples and the results indicated successful heavy metal remediation using the MAC adsorbent. Two-parameter and three-parameter adsorption isotherm models were fit to the experimental data, and it was found that the Langmuir model was better suited to the equilibrium data as opposed to the other models. The adsorption kinetics were best described using the pseudo-second-order model. Maximum adsorption capacities produced for UAC and MAC were found to be 3.00 and 3.50 mg g−1 respectively.

Impact of surface-applied liquid manure on the drainage resistance profile of an agricultural tile-drained clay till field.

Dissemination of antibiotic resistance genes (ARGs) in aquatic environments is a concern due to human and animal health. Application of liquid manure on agricultural land is an important source of ARGs, where pathogens, antibiotic-resistant bacteria, and selective agents are released. To improve our understanding of ARGs spreading through soils, our main objective was to evaluate the effectiveness of the soil as a barrier protecting water resources. Over the course of a year, profiles and abundances of ARGs and mobile genetic elements in soil and drainage from an agricultural tile-drained clay till field were investigated upon liquid pig manure application by applying high-throughput quantitative polymerase chain reaction targeting 143 genes. The findings were as follows: (a) 97 genes were detected, where only the transposon gene tnpA-03/ IS6 was shared between the genes detected in drainage and those in acidified liquid manure or fertilized soils, indicating that liquid manure application had a limited impact on the drainage resistance profile; (b) intI1 gene was present in ∼60% of drainage samples in concentrations up to 1,634intI1 ml-1 ; and (c) evapotranspiration from barley (Hordeum vulgare L., 'KWS Irina') and a low groundwater table appeared to reduce preferential transport to drainage during the first 3 mo of liquid manure application. Interestingly, the first preferential transport to drainage was observed immediately after the harvest of spring barley. Overall, during the monitoring year we found the soil to be an effective barrier against the spread of fecal ARGs even though the occurrence of the intI1 gene questions the barrier effect from previous years.

Rainfall leads to elevated levels of antibiotic resistance genes within seawater at an Australian beach

Anthropogenic waste streams can be major sources of antibiotic resistant microbes within the environment, creating a potential risk to public health. We examined patterns in the occurrence of a suite of antibiotic resistance genes (ARGs) and their links to enteric bacteria at a popular swimming beach in Australia that experiences intermittent contamination by sewage, with potential points of input including stormwater drains and a coastal lagoon. Samples were collected throughout a significant rainfall event (40.8 mm over 3 days) and analysed using both qPCR and 16S rRNA amplicon sequencing. Before the rainfall event, low levels of faecal indicator bacteria and a microbial source tracking human faeces (sewage) marker (Lachno3) were observed. These levels increased over 10x following rainfall. Within lagoon, drain and seawater samples, levels of the ARGs sulI, dfrA1 and qnrS increased by between 1 and 2 orders of magnitude after 20.4 mm of rain, while levels of tetA increased by an order of magnitude after a total of 40.8 mm. After 40.8 mm of rain sulI, tetA and qnrS could be detected 300 m offshore with levels remaining high five days after the rain event. Highest levels of sewage markers and ARGs were observed adjacent to the lagoon (when opened) and in-front of the stormwater drains, pinpointing these as the points of ARG input. Significant positive correlations were observed between all ARGs, and a suite of Amplicon Sequence Variants that were identified as stormwater drain indicator taxa using 16S rRNA amplicon sequencing data. Of note, some stormwater drain indicator taxa, which exhibited correlations to ARG abundance, included the human pathogens Arcobacter butzleri and Bacteroides fragilis. Given that previous research has linked high levels of ARGs in recreationally used environments to antimicrobial resistant pathogen infections, the observed patterns indicate a potentially elevated human health risk at a popular swimming beach following significant rainfall events.

Molecular microbiological approaches reduce ambiguity about the sources of faecal pollution and identify microbial hazards within an urbanised coastal environment

Urbanised beaches are regularly impacted by faecal pollution, but management actions to resolve the causes of contamination are often obfuscated by the inability of standard Faecal Indicator Bacteria (FIB) analyses to discriminate sources of faecal material or detect other microbial hazards, including antibiotic resistance genes (ARGs). We aimed to determine the causes, spatial extent, and point sources of faecal contamination within Rose Bay, a highly urbanised beach within Sydney, Australia's largest city, using molecular microbiological approaches. Sampling was performed across a network of transects originating at 9 stormwater drains located on Rose Bay beach over the course of a significant (67.5 mm) rainfall event, whereby samples were taken 6 days prior to any rain, on the day of initial rainfall (3.8 mm), three days later after 43 mm of rain and then four days after any rain. Quantitative PCR (qPCR) was used to target marker genes from bacteria (i.e., Lachnospiraceae and Bacteroides) that have been demonstrated to be specific to human faeces (sewage), along with gene sequences from Heliobacter and Bacteriodes that are specific to bird and dog faeces respectively, and ARGs (sulI, tetA, qnrS, dfrA1 and vanB). 16S rRNA gene amplicon sequencing was also used to discriminate microbial signatures of faecal contamination. Prior to the rain event, low FIB levels (mean: 2.4 CFU/100 ml) were accompanied by generally low levels of the human and animal faecal markers, with the exception of one transect, potentially indicative of a dry weather sewage leak. Following 43 mm of rain, levels of both human faecal markers increased significantly in stormwater drain and seawater samples, with highest levels of these markers pinpointing several stormwater drains as sources of sewage contamination. During this time, sewage contamination was observed up to 1000 m from shore and was significantly and positively correlated with often highly elevated levels of the ARGs dfrA1, qnrS, sulI and vanB. Significantly elevated levels of the dog faecal marker in stormwater drains at this time also indicated that rainfall led to increased input of dog faecal material from the surrounding catchment. Using 16S rRNA gene amplicon sequencing, several indicator taxa for stormwater contamination such as Arcobacter spp. and Comamonadaceae spp. were identified and the Bayesian SourceTracker tool was used to model the relative impact of specific stormwater drains on the surrounding environment, revealing a heterogeneous contribution of discrete stormwater drains during different periods of the rainfall event, with the microbial signature of one particular drain contributing up to 50% of bacterial community in the seawater directly adjacent. By applying a suite of molecular microbiological approaches, we have precisely pinpointed the causes and point-sources of faecal contamination and other associated microbiological hazards (e.g., ARGs) at an urbanised beach, which has helped to identify the most suitable locations for targeted management of water quality at the beach.

Toward a Closure of Catchment Mass Balance: Insight on the Missing Link From a Vegetated Lysimeter

AbstractPlant transpiration plays a significant role in the terrestrial cycles, but the spatiotemporal origins of water used by plant remains highly uncertain. Therefore, the missing link to fully characterize the water mass balance, for any control volume including significant vegetated surfaces, is identifying and quantifying the key factors that control the age of water used by plants. Here, we bring together an age‐based (tran‐SAS) and a physically based (HYDRUS‐1D) model contrasting information gleaned from soil, drainage, and xylem samples at stand scale. In particular, we focus on the relative role of advection, dispersion, and root distribution on the age of water uptake and drainage. We suggest that the interplay of advective and dispersive forces, subsumed by the local Péclet number, drives the age composition of drainage even in the case of extreme uptake rates. The vegetation influence on the age of drainage is mainly exerted by diversifying the subsurface transport pathways resulting in large dispersivity and spatial heterogeneity of soil hydraulic parameters. We introduce a uniform‐equivalent root length for vegetation and show that its ratio to the effective size of the subsurface water storage controls the age selection of water uptakes. Our results are suggestive of a route forward toward a general toolbox to upscale mass balance closures for catchments embedding large and diverse plant assemblages.

Performance of a novel biochar-clamshell composite for real acid mine drainage treatment

Composites from clamshell (CS) and low-cost biochar (BC) that was derived from coconut shell (CoS) were successfully produced. The BC-CS composites were prepared under two conditions, namely, solid–solid and solid–liquid, in ratios of 1:1 and 7:3. The metal sorption abilities of Al, Ca, and Mg were characterized using ICP and tested under batch conditions at pH values of 2.7, 6.8, and 8. The obtained XRD patterns showed that CoS and BC had crystalline and amorphous structures. XRF analysis showed that CoS and BC had high CaO and K2O contents while CS and BC-CS contained no K2O. The ICP analysis showed that the examined acid mine drainage sample had high Al, Ca, and Mg concentrations. BC and BC-CS successfully removed Al. According to the results of this study, low-cost-modified pyrolysis of BC-CS is a promising and inexpensive sorbent material for removing Al ions from acid mine drainage.

Quantitative lateral flow immunoassay for rapid detection and monitoring of cerebrospinal fluid leakage following incidental durotomy

Cerebrospinal fluid (CSF) leakage due to incidental durotomy is an inherent complication of spine surgery. With appropriate treatment, complications of CSF leakage, such as headache and even meningitis, can be reduced. CSF leakage could be detected on the basis of correlated clinical symptoms; diagnosis should be based on these symptoms and appropriate imaging studies. However, the diagnosis of CSF leakage remains a challenge, especially if incidental durotomy is unrecognized during surgery; even if incidental durotomy is detected and repaired intraoperatively, the severity of the leakage and quality of the primary dural repair are difficult to evaluate postoperatively. Rapid, inexpensive, and safe methods of detecting CSF-containing samples are currently lacking; hence, the development of a point-of-care test (POCT) method to improve diagnostic efficiency is necessary. We developed a high-sensitivity lateral flow immunoassay with a stacking pad (sLFIA) for quantitative detection of β-trace protein (BTP), a specific CSF marker. The BTP concentration in 39 clinical samples was calculated using a calibration equation for test-line intensity and evaluated by a standard laboratory method. To avoid the hook effect, we diluted each sample prior to testing. The correlation coefficient between the enzyme-linked immunosorbent assay and our BTP sLFIA method was 0.991 A 75-fold sample dilution was applied owing to the hook effect point, identified as 175 ng mL−1. We established an optimal sample-specific cutoff point at a value of 4.0 μg mL−1 for CSF leakage in subfascial drainage samples following spinal posterior decompression. The sensitivity and specificity of the BTP sLFIA method were 90% and 97%, respectively, according to a receiver operating characteristic curve analysis. In addition, clinical samples from patients who underwent primary dural repair intraoperatively were tested, and CSF leakage was successfully diagnosed using our method. Finally, the quantitation of BTP in samples collected daily provided an accurate assessment of the severity of the residual leakage. Our results demonstrate that the BTP sLFIA method possesses the potential to serve as a POCT method for screening and monitoring postoperative CSF leakage.

Diagnostic value of procedural images in CT-guided interventions

PurposeWe hypothesize procedural images of CT-guided interventions may contain diagnostic findings not present in the reference images. MethodA retrospective review of CT-guided interventions performed at our hospital, from 01 April 2017 to 08 May 2020. Two radiologists independently reviewed the procedural CT images for presence of diagnostic findings in comparison to the reference images (CT, MRI, or PET/CT). ACR RADPEER score was assigned to all findings. The Findings were categorized into new finding, characterization of prior finding or change of prior finding. The results of biopsy and drainage samples were also reviewed. ResultsThe prevalence of diagnostic findings in procedural CT images was found to be 6.1% (81/1336); 32 new, 8 characterization, and 41 change findings. Having CT as reference image, procedure in the chest and having drainage were associated with presence of findings (p < 0.05). Increase time interval between the reference image and the procedure increases the odds of having diagnostic findings (p < 0.001). Age, sex, or whether in-patient or out-patient, malignant pathology result or infectious collection were not related to presence of findings (p > 0.05). The majority of findings were likely clinically significant (73%) and the majority were not documented in the procedure report (63%). ConclusionClinically relevant diagnostic findings in procedural images of CT-guided interventions are not uncommon and are underreported. Time delay between the reference image and the procedure is the most significant factor associated with presence of diagnostic findings.

Nutritional, Physiological, and Morphological Effects on Almond Trees Grown by Fertigation with the Nitrification Inhibitor 3, 4-DimethylpyrazoleSuccinic Acid

Nitrogen fertilization is key to improve crop yield. However, due to the harmful environmental effects of fertilizers, farmers and governments are searching agronomic practices that provide nutrients to the crops with minimal environmental impact, as for example the use of nitrification inhibitors. These compounds act on ammonium reducing its oxidation to nitrate, and soil´s nitrogen remains longer in the form of ammonium helping prevent nitrate lixiviation. The objective of the experiment was to evaluate the effect of a new nitrification inhibitor (DMPSA) in almond trees. We studied the effect of three solutions on vegetative growth, nutrition, and physiology on Alvijor almond plants irrigated with one of three possible study solutions i) 3:1 nitrate:ammonium rate solution ii) 1:1 nitrate:ammonium rate solution, or iii) 1:1 nitrate:ammonium rate solution plus a nitrification inhibitor (3,4-dimethylpyrazolesuccinic acid). Plants were grown in a greenhouse in calcareous and alkaline soil from the Spanish Levante area. Macro and micronutrients were determined from drainage samples collected throughout the experiment. At the end of the experiment, gaseous exchange and chlorophyll fluorescence parameters were measured and plants harvested to analyse morphological characteristics (leaf, stem and root fresh and dry weight, aerial part rate, and trunk diameter) and N, P, K, Ca, and Mg content in the leaves. We found higher levels of ammonium and lower nitrates in the roots and higher vegetative growth with the irrigation solution containing the nitrification inhibitor in comparison with treatment solutions 1:1 and 3:1. The drainage showed that NI reduces the level of nitrates in the leachate, limiting its discharge to the subsoil. In conclusion, the nutrient solution with the nitrification inhibitor has a positive impact on Alvijor almond plants and the environment.

The Occurrence of Klebsiella pneumoniae in Drainage Fluid After Pancreaticoduodenectomy: Risk Factors and Clinical Impacts.

To investigate the risk factors and clinical impacts of the occurrence of Klebsiella pneumoniae isolated from drainage fluid in patients undergoing pancreaticoduodenectomy (PD). Clinicopathological data of all patients who underwent PD from January 2018 to March 2021 were analyzed retrospectively. The univariate and multivariate analyses were performed to identify independent risk factors for the occurrence of K. pneumoniae in drainage fluid and its clinical impacts on postoperative complications. Of the included 284 patients, 49 (17.2%) patients isolated K. pneumoniae in drain samples after PD. Preoperative biliary drainage (OR = 1.962, p = 0.037) independently predicted the contamination of K. pneumoniae in drain samples after PD. The rate of clinically relevant postoperative pancreatic fistula (CR-POPF), major complications (Clavien–Dindo Grade ≥ III), post-pancreatectomy hemorrhage (PPH), organ/space surgical site infection (SSI), and biliary leakage (BL) were significantly higher in K. pneumoniae positive group both in the univariate and multivariate analyses. Preventive measures and treatments for combating K. pneumoniae contamination may be beneficial to the perioperative outcomes of patients after PD.

Development of Moore Swab and Ultrafiltration Concentration and Detection Methods for Salmonella Typhi and Salmonella Paratyphi A in Wastewater and Application in Kolkata, India and Dhaka, Bangladesh.

Enteric fever is a severe systemic infection caused by Salmonella enterica serovar Typhi (ST) and Salmonella enterica serovar Paratyphi A (SPA). Detection of ST and SPA in wastewater can be used as a surveillance strategy to determine burden of infection and identify priority areas for water, sanitation, and hygiene interventions and vaccination campaigns. However, sensitive and specific detection of ST and SPA in environmental samples has been challenging. In this study, we developed and validated two methods for concentrating and detecting ST/SPA from wastewater: the Moore swab trap method for qualitative results, and ultrafiltration (UF) for sensitive quantitative detection, coupled with qPCR. We then applied these methods for ST and SPA wastewater surveillance in Kolkata, India and Dhaka, Bangladesh, two enteric fever endemic areas. The qPCR assays had a limit of detection of 17 equivalent genome copies (EGC) for ST and 25 EGC for SPA with good reproducibility. In seeded trials, the Moore swab method had a limit of detection of approximately 0.05–0.005 cfu/mL for both ST and SPA. In 53 Moore swab samples collected from three Kolkata pumping stations between September 2019 and March 2020, ST was detected in 69.8% and SPA was detected in 20.8%. Analysis of sewage samples seeded with known amount of ST and SPA and concentrated via the UF method, followed by polyethylene glycol precipitation and qPCR detection demonstrated that UF can effectively recover approximately 8, 5, and 3 log10 cfu of seeded ST and SPA in 5, 10, and 20 L of wastewater. Using the UF method in Dhaka, ST was detected in 26.7% (8/30) of 20 L drain samples with a range of 0.11–2.10 log10 EGC per 100 mL and 100% (4/4) of 20 L canal samples with a range of 1.02–2.02 log10 EGC per 100 mL. These results indicate that the Moore swab and UF methods provide sensitive presence/absence and quantitative detection of ST/SPA in wastewater samples.

Detection of SARs-CoV-2 in wastewater using the existing environmental surveillance network: A potential supplementary system for monitoring COVID-19 transmission.

The ongoing COVID-19 pandemic is caused by SARs-CoV-2. The virus is transmitted from person to person through droplet infections i.e. when infected person is in close contact with another person. In January 2020, first report of detection of SARS-CoV-2 in faeces, has made it clear that human wastewater might contain this virus. This may illustrate the probability of environmentally facilitated transmission, mainly the sewage, however, environmental conditions that could facilitate faecal oral transmission is not yet clear. We used existing Pakistan polio environment surveillance network to investigate presence of SARs-CoV-2 using three commercially available kits and E-Gene detection published assay for surety and confirmatory of positivity. A Two-phase separation method is used for sample clarification and concentration. An additional high-speed centrifugation (14000Xg for 30 min) step was introduced, prior RNA extraction, to increase viral RNA yield resulting a decrease in Cq value. A total of 78 wastewater samples collected from 38 districts across Pakistan, 74 wastewater samples from existing polio environment surveillance sites, 3 from drains of COVID-19 infected areas and 1 from COVID 19 quarantine center drainage, were tested for presence of SARs-CoV-2. 21 wastewater samples (27%) from 13 districts turned to be positive on RT-qPCR. SARs-COV-2 RNA positive samples from areas with COVID 19 patients and quarantine center strengthen the findings and use of wastewater surveillance in future. Furthermore, sequence data of partial ORF 1a generated from COVID 19 patient quarantine center drainage sample also reinforce our findings that SARs-CoV-2 can be detected in wastewater. This study finding indicates that SARs-CoV-2 detection through wastewater surveillance has an epidemiologic potential that can be used as supplementary system to monitor viral tracking and circulation in cities with lower COVID-19 testing capacity or heavily populated areas where door-to-door tracing may not be possible. However, attention is needed on virus concentration and detection assay to increase the sensitivity. Development of highly sensitive assay will be an indicator for virus monitoring and to provide early warning signs.