Routine Surveillance Programs Research Articles

Colonization of a hand washing sink in a veterinary hospital by an Enterobacter hormaechei strain carrying multiple resistances to high importance antimicrobials

BackgroundHospital intensive care units (ICUs) are known reservoirs of multidrug resistant nosocomial bacteria. Targeted environmental monitoring of these organisms in health care facilities can strengthen infection control procedures. A routine surveillance of extended spectrum beta-lactamase (ESBL) producers in a large Australian veterinary teaching hospital detected the opportunistic pathogen Enterobacter hormaechei in a hand washing sink of the ICU. The organism persisted for several weeks, despite two disinfection attempts. Four isolates were characterized in this study.MethodsBrilliance-ESBL selective plates were inoculated from environmental swabs collected throughout the hospital. Presumptive identification was done by conventional biochemistry. Genomes of multidrug resistant Enterobacter were entirely sequenced with Illumina and Nanopore platforms. Phylogenetic markers, mobile genetic elements and antimicrobial resistance genes were identified in silico. Antibiograms of isolates and transconjugants were established with Sensititre microdilution plates.ResultsThe isolates possessed a chromosomal Tn7-associated silver/copper resistance locus and a large IncH12 conjugative plasmid encoding resistance against tellurium, arsenic, mercury and nine classes of antimicrobials. Clusters of antimicrobial resistance genes were associated with class 1 integrons and IS26, IS903 and ISCR transposable elements. The blaSHV-12, qnrB2 and mcr-9.1 genes, respectively conferring resistance to cephalosporins, quinolones and colistin, were present in a locus flanked by two IS903 copies. ESBL production and enrofloxacin resistance were confirmed phenotypically. The isolates appeared susceptible to colistin, possibly reflecting the inducible nature of mcr-9.1.ConclusionsThe persistence of this strain in the veterinary hospital represented a risk of further accumulation and dissemination of antimicrobial resistance, prompting a thorough disinfection of the ICU. The organism was not recovered from subsequent environmental swabs, and nosocomial Enterobacter infections were not observed in the hospital during that period. This study shows that targeted routine environmental surveillance programs to track organisms with major resistance phenotypes, coupled with disinfection procedures and follow-up microbiological cultures are useful to control these risks in sensitive areas of large veterinary hospitals.

A comparison of the risk of acute myocardial infarction in patients receiving hemodialysis and peritoneal dialysis: A population-based, propensity score-matched cohort study

Background and aimsAcute myocardial infarction (AMI) remains the major cause of morbidity and mortality in the dialysis population. Traditional cardiovascular (CV) risk factors are unable to fully account for the high incidence of AMI in the dialysis population. In this study, we investigated whether dialysis modalities could be one of the uremia-specific risk factors for AMI. MethodsUsing the National Health Insurance Research Database, we recruited all incident dialysis patients from the period January 1, 1998 to December 31, 2010. The propensity score matching method was applied to form the matched pairs of hemodialysis (HD) and peritoneal dialysis (PD) patients. Incidence rate (IR), cumulative incidence rate (CIR) and multivariable subdistribution hazards models were employed to compare the risk of AMI in the HD and PD groups. ResultsOf the 86,215 incident dialysis patients, 5,513 matched pairs of HD and PD patients were identified. The HD patients had a higher IR of AMI than the PD patients (9.71 vs. 8.35 per 1000 patient-years, respectively, p = 0.01). The CIR was also higher in the HD patients than in the PD patients (0.09 vs. 0.05), especially 4 years after dialysis therapy was initiated (p = 0.04). In the subdistribution hazards models, HD was still significantly associated with a higher risk of developing AMI (adjusted hazard ratio:1.30, 95% confidence interval:1.02–1.65). The results remained unchanged in various stratifications as well as in the analysis of the unmatched cohorts. ConclusionsCompared to PD, HD was significantly associated with higher risk of developing AMI, especially after 4 years since dialysis was initiated. Prevention and routine surveillance programs for AMI should be individualized according to dialysis modalities and vintage.

Prosocial polio vaccination in Israel

Regions with insufficient vaccination have hindered worldwide poliomyelitis eradication, as they are vulnerable to sporadic outbreaks through reintroduction of the disease. Despite Israel's having been declared polio-free in 1988, a routine sewage surveillance program detected polio in 2013. To curtail transmission, the Israel Ministry of Health launched a vaccine campaign to vaccinate children-who had only received the inactivated polio vaccine-with the oral polio vaccine (OPV). Determining the degree of prosocial motivation in vaccination behavior is challenging because vaccination typically provides direct benefits to the individual as well as indirect benefits to the community by curtailing transmission. However, the Israel OPV campaign provides a unique and excellent opportunity to quantify and model prosocial vaccination as its primary objective was to avert transmission. Using primary survey data and a game-theoretical model, we examine and quantify prosocial behavior during the OPV campaign. We found that the observed vaccination behavior in the Israeli OPV campaign is attributable to prosocial behavior and heterogeneous perceived risk of paralysis based on the individual's comprehension of the prosocial nature of the campaign. We also found that the benefit of increasing comprehension of the prosocial nature of the campaign would be limited if even 24% of the population acts primarily from self-interest, as greater vaccination coverage provides no personal utility to them. Our results suggest that to improve coverage, communication efforts should also focus on alleviating perceived fears surrounding the vaccine.

Human Blood Feeding by Aedes aegypti (Diptera: Culicidae) in the Florida Keys and a Review of the Literature.

Aedes aegypti L. is considered to have a proclivity for feeding on human blood even when other hosts are available. However, few studies have demonstrated host use by this mosquito in the continental United States, where local transmission of dengue, Zika, and chikungunya viruses has been recently documented. This study investigated the bloodmeal sources of female Ae. aegypti in the subtropical city of Key West and the surrounding county in Florida with the goal of identifying preferred hosts. Blood-engorged Ae. aegypti mosquitoes were collected from BG Sentinel traps used as part of a routine surveillance program in the Florida Keys (Monroe County, Florida). Bloodmeal samples were analyzed using PCR assays, sequencing, and comparison with reference sequences in GenBank. Aedes aegypti females from Key West fed predominantly on humans (79.6%) and did not differ statistically from females collected from the rest of the Florida Keys (69.5%). Culex quinquefasciatus Say (Diptera: Culicidae), considered a host generalist, was collected and analyzed from the same sites for comparative purposes. Females of Cx. quinquefasciatus fed predominantly (70.7%) on birds and nonhuman mammals in the Florida Keys, corroborating the validity of molecular assay breadth and demonstrating that given the same group of available hosts Ae. aegypti selects humans. Our results indicated that Ae. aegypti has a high rate of human-biting in a subtropical area within the United States, supporting its role in recent local transmission of dengue and other viruses.

Mexico: Lessons learned from the 2009 pandemic that help us fight COVID-19.

In April 2009, Mexican, American, and Canadian authorities announced a novel influenza that became the first pandemic of the century. We report on lessons learned in Mexico. The Mexican Pandemic Influenza Preparedness and Response Plan, developed and implemented since 2005, was a decisive element for the early response. Major lessons-learned were the need for flexible plans that consider different scenarios; the need to continuously strengthen routine surveillance programs and laboratory capacity and strengthen coordination between epidemiological departments, clinicians, and laboratories; maintain strategic stockpiles; establish a fund for public health emergencies; and collaboration among neighboring countries. Mexico responded with immediate reporting and transparency, implemented aggressive control measures and generous sharing of data and samples. Lessons learned induced changes leading to a better response to public health critical events.

Routine surveillance for diagnosis of venous thromboembolism after pleurectomy for malignant pleural mesothelioma

ObjectiveThe purpose of this study was to determine the incidence of venous thromboembolism and utility of a routine surveillance program in patients undergoing surgery for mesothelioma. MethodsPatients undergoing pleurectomy from May 2016 to August 2018 were included. A standardized surveillance program to look for venous thromboembolism in this group included noninvasive studies every 7 days postoperatively or earlier if symptomatic. All patients received external pneumatic compression sleeves in addition to prophylactic heparin. If deep vein thrombosis or pulmonary embolus was discovered, heparin drip was initiated until conversion to therapeutic anticoagulation. ResultsA total of 100 patients underwent pleurectomy for mesothelioma. Seven patients were found to have preoperative deep vein thrombosis, and as such only 93 patients were included for analysis. The median age of patients at surgery was 71 years (30-85 years). During the study, 30 patients (32%) developed evidence of thrombosis; 20 patients (22%) developed only deep vein thrombosis without embolism, 3 patients (3%) developed only pulmonary embolism, and 7 patients (7%) developed both deep vein thrombosis and pulmonary embolus. Of the 27 patients who developed deep vein thrombosis, 9 (33%) were asymptomatic at the time of diagnosis, and none of these developed a pulmonary embolus or other bleeding complications. There were 2 (2%) events of major postoperative bleeding related to therapeutic anticoagulation. ConclusionsThe incidence of venous thromboembolism is high (32%) among patients undergoing surveillance after pleurectomy for mesothelioma. Up to 33% of patients with deep vein thrombosis are asymptomatic at the time of diagnosis, and the incidence of complications related to anticoagulation is low. Routine surveillance may be useful to diagnose and treat deep vein thrombosis before it progresses to symptomatic or fatal pulmonary embolus.

Diagnostic accuracy of two DNA-based molecular assays for detection of porcine circovirus 3 in swine population using Bayesian latent class analysis.

Molecular-based tools sometimes are the only laboratory techniques available to detect a recently discovered agent, and their validation without the existence of previously described 'gold standard' methods poses a challenge for the diagnosticians. A good example within this scenario is the recently described porcine circovirus 3 (PCV-3) in the swine population worldwide, from which only few PCR methods have been described. Therefore, the primary objective of this study was to estimate the diagnostic accuracy of a direct PCR (dPCR) and a real-time qPCR (qPCR) for detection of PCV-3 in Italian swine population. Bayesian latent class analysis approach was used to rigorously assess their features and applicability in routine diagnostic activity. Data on dPCR and qPCR were available from 116 domestic pigs, which were randomly selected from 55 farms located at different regions in Northern Italy. The sensitivity (Se) estimates of dPCR (94%; posterior credible interval (PCI%) 84-100) and qPCR (96%; PCI% 90-100) were high and similar. The estimated specificity (Sp) of both dPCR and qPCR assays was around 97%. dPCR and qPCR assays showed a high and comparable Se and Sp estimates for the detection of PCV-3 in Italian swine population. SIGNIFICANCE AND IMPACT OF THE STUDY: The continuous discovery of new pathogens poses a challenge in the development and evaluation of adequate diagnostic tools. In fact, since molecular-based tools sometimes are the only available laboratory techniques, it is typically difficult to evaluate their diagnostic performances in the absence of a gold standard. The present study assesses this issue, demonstrating the excellent performances of two PCR-based assays for porcine circovirus 3 (PCV-3) detection using a Bayesian latent class analysis approach. Therefore, the molecular tests evaluated under this study constitute reliable tools for the routine diagnosis and surveillance programs of PCV-3 circulating in swine populations.

Monitoring Silent Spillovers Before Emergence: A Pilot Study at the Tick/Human Interface in Thailand.

Emerging zoonoses caused by previously unknown agents are one of the most important challenges for human health because of their inherent inability to be predictable, conversely to emergences caused by previously known agents that could be targeted by routine surveillance programs. Emerging zoonotic infections either originate from increasing contacts between wildlife and human populations, or from the geographical expansion of hematophagous arthropods that act as vectors, this latter being more capable to impact large-scale human populations. While characterizing the viral communities from candidate vectors in high-risk geographical areas is a necessary initial step, the need to identify which viruses are able to spill over and those restricted to their hosts has recently emerged. We hypothesized that currently unknown tick-borne arboviruses could silently circulate in specific biotopes where mammals are highly exposed to tick bites, and implemented a strategy that combined high-throughput sequencing with broad-range serological techniques to both identify novel arboviruses and tick-specific viruses in a ticks/mammals interface in Thailand. The virome of Thai ticks belonging to the Rhipicephalus, Amblyomma, Dermacentor, Hyalomma, and Haemaphysalis genera identified numerous viruses, among which several viruses could be candidates for future emergence as regards to their phylogenetic relatedness with known tick-borne arboviruses. Luciferase immunoprecipitation system targeting external viral proteins of viruses identified among the Orthomyxoviridae, Phenuiviridae, Flaviviridae, Rhabdoviridae, and Chuviridae families was used to screen human and cattle Thai populations highly exposed to tick bites. Although no positive serum was detected for any of the six viruses selected, suggesting that these viruses are not infecting these vertebrates, or at very low prevalence (upper estimate 0.017% and 0.047% in humans and cattle, respectively), the virome of Thai ticks presents an extremely rich viral diversity, among which novel tick-borne arboviruses are probably hidden and could pose a public health concern if they emerge. The strategy developed in this pilot study, starting from the inventory of viral communities of hematophagous arthropods to end by the identification of viruses able (or likely unable) to infect vertebrates, is the first step in the prediction of putative new emergences and could easily be transposed to other reservoirs/vectors/susceptible hosts interfaces.

Efficient technique for quantification of chlorantraniliprole residue in/on vegetables and soil using GC-MS/MS

An analytical method for the determination of chlorantraniliprole residue in brinjal, capsicum, chilli, cucumber, tomato and soil samples using GC-MS/MS was developed and validated to fulfil the requirements of the SANTE/11813/2017 to support compliance with ISO/IEC 17025. The objective of the validation was to evaluate all required parameters, such as linearity of analytical curves, instrument and method limits of detection and quantification, matrix effects, accuracy (trueness and precision) using modified QuEChERS method. The overall recoveries of the method ranged between 84-98% for the vegetable and soil samples, spiked at 0. 005, 0. 01, 0. 05, 0. 1 and 0. 2 μg / ml. GC-MS/MS parameters were tuned up to optimize limits of quantification (0. 005 μg /mL for vegetables and 0. 01 μg /mL for soil). Repeatability and reproducibility of method was excellent (RSD>10%) for all evaluated matrices. Hence, a fast and efficient gas chromatography-tandem mass spectrometry method with acceptable performance was achieved for routine monitoring and surveillance programme for chlorantraniliprole in soil and vegetable matrices.

DOZ047.113: Outcome of routine esophagogastroduodenoscopy, high-resolution manometry (HRM), and pH-(impedance) measurement in esophageal atresia patients according to international guidelines

Abstract Background Evidence-based guideline recommendations for follow-up of patients with esophageal atresia (EA) include regular surveillance esophagogastroduodenoscopy (EGD) with biopsies and a pH(-impedance) measurement (pH-MII) to evaluate gastroesophageal reflux disease (GERD) in asymptomatic patients. In addition, high-resolution manometry (HRM) is considered useful to assess esophageal dysmotility. Additional testing is recommended when symptoms are present. Our aim was to evaluate the diagnostic and clinical yield of these tests. Methods All EA patients who underwent EGD, pH-MII, and HRM according to EA guideline recommendations in 2017 and 2018 were included. Results Seventy-eight patients (53% male, 78% type C, median age 5 (0–17) years) were included. Thirty-one patients had EGD (n = 30), pH-MII (n = 11), and/or HRM (n = 7) as part of a routine surveillance program. Forty-seven patients had EGD (n = 47), pH-MII (n = 26), and HRM (n = 9) for symptom evaluation. Symptoms at the time of testing included dysphagia (51%), regurgitation (41%), and heartburn (24%). Results and consequences of the surveillance and clinically indicated tests are shown in Tables 1 and 2, respectively. Macroscopic EGD findings included stricture (21%), signs of eosinophilic esophagitis (EoE, 3%), and signs of reflux esophagitis (3%). Histological findings included EoE (13%) and reflux esophagitis (17%). Clinical implications of EGD results included medication alteration (GERD/EoE), esophageal dilation, antireflux surgery, or diet change. MII-pH was performed in 37 patients; 15 (41%) were on acid suppressive medication during measurement. Clinical implications of MII-pH results were: start or adjustment of acid suppressive therapy (30%), start or increase of other medication (22%), ceasing of acid suppressive therapy (14%), and referral for fundoplication (3%). HRM was performed in 16 patients (21%, n = 2 uninterpretable due to continuous crying) and showed absent peristalsis in 8/14 (50%), ineffective peristalsis in 4/14 (25%), and fragmented peristalsis in 2/14 patients (12.5%). Clinical implications of manometry results included referral for contrast esophagram (n = 1), increased gastrostomy feeding (n = 1), and gastrostomy placement (n = 1). Conclusion EGD, MII-pH, and HRM reveal multiple abnormalities that have clinical consequences when performed as per recommended surveillance guidelines, which highlights their importance. In most symptomatic patients, additional testing demonstrates underlying pathology. Abnormal diagnostic tests can help guide clinical management in asymptomatic and symptomatic EA patients.

A qualitative study about the experience, knowledge and application of complementary therapies and integrative medicine in pediatrics

The purpose of this study was to determine the incidence of venous thromboembolism and utility of a routine surveillance program in patients undergoing surgery for mesothelioma.Patients undergoing pleurectomy from May 2016 to August 2018 were included. A standardized surveillance program to look for venous thromboembolism in this group included noninvasive studies every 7 days postoperatively or earlier if symptomatic. All patients received external pneumatic compression sleeves in addition to prophylactic heparin. If deep vein thrombosis or pulmonary embolus was discovered, heparin drip was initiated until conversion to therapeutic anticoagulation.A total of 100 patients underwent pleurectomy for mesothelioma. Seven patients were found to have preoperative deep vein thrombosis, and as such only 93 patients were included for analysis. The median age of patients at surgery was 71 years (30-85 years). During the study, 30 patients (32%) developed evidence of thrombosis; 20 patients (22%) developed only deep vein thrombosis without embolism, 3 patients (3%) developed only pulmonary embolism, and 7 patients (7%) developed both deep vein thrombosis and pulmonary embolus. Of the 27 patients who developed deep vein thrombosis, 9 (33%) were asymptomatic at the time of diagnosis, and none of these developed a pulmonary embolus or other bleeding complications. There were 2 (2%) events of major postoperative bleeding related to therapeutic anticoagulation.The incidence of venous thromboembolism is high (32%) among patients undergoing surveillance after pleurectomy for mesothelioma. Up to 33% of patients with deep vein thrombosis are asymptomatic at the time of diagnosis, and the incidence of complications related to anticoagulation is low. Routine surveillance may be useful to diagnose and treat deep vein thrombosis before it progresses to symptomatic or fatal pulmonary embolus.

Status of Antibiotic Residues in Poultry Meat of Nepal

Antibiotic residues in livestock products are the burning issue in animal production as well as public health sector. Imprudent use of antibiotics in poultry production increases the risk of antibiotic resistance thus increasing risk in both animals and humans. To determine the trend of antibiotic residues presence in poultry meat, a study was conducted from June 2016 to May 2017 in Kathmandu, Kaski, and Chitwan districts of Nepal. A total of 92 breast samples of broilers ( Kathmandu-30, Kaski-40 and Chitwan-22) were collected randomly from different selling outlets of the study areas and tested for residues of commonly used antibiotic viz. Enrofloxacin (EX), Ciprofloxacin (CIP), Streptomycin (STR) and Chloramphenicol (CHL) using the Enzyme Linked Immunosorbent Assay (ELISA) technique. Out of 92 samples, 57 (62%) samples were found positive for antibiotics residue of which 38% samples were positive for STR residue, 15.2% for CIP and 8.7% for EX. However, none of the samples showed positivity for CHL residue. The level of STR was determined to be higher in all districts in comparison to other antibiotics. The meat samples from Kaski were found to contain higher level of STR (56.1%) while highest percentage of CIP (16.1%) was detected in Kathmandu. Also, presence of EX was found highest in Kathmandu compared to other districts. The study concluded that antibiotics residues have been abundantly found in poultry meat which can have serious effect in human health. Hence, to mitigate this, routine antibiotics residues monitoring and surveillance programmes in food animal products should be conducted to ensure the consumer safety.

Isolation, Characterisation and Antibiogram Profile of Staphylococcus aureus in the Urine of Tertiary Care Hospital Patients of District Quetta, Pakistan

Background: Urinary tract infection (UTI) is one of the most common infectious diseases in community practice and a significant public health problem regarding morbidity and financial cost worldwide.
 Objectives: This study was conducted to determine the prevalence of Staphylococcus aureus (S. aureus) among UTI patients of District Quetta Pakistan and to observe the antibiogram profile of the bacterial isolates.
 Materials and Methods: One hundred urine samples were collected from both male and female UTI patients. These mid-stream urine samples were taken early in the morning in sterile, wide mouth containers from the pathological section of a tertiary care hospital (Bolan Medical College Hospital BMCH), District Quetta. Samples were further processed at the Microbiology laboratory of Centre for Advance Studies in Vaccinology and Biotechnology (CASVAB), University of Balochistan from August to December 2011.
 Results: Only five samples were found positive for S. aureus on methyl red, Voges-Proskauer, catalase and coagulase, while negative on indole, citrate and motility. Positive samples showed cream and yellow coloured colonies on Staphylococcus medium 110 and mannitol salt agar, respectively. Infection was more common in female (60%) as compared to males (40%); while the overall infection rate was highest in the age group of 26-45 years (80%). During antibiotic sensitivity test, gentamycin showed 100% susceptibility against S. aureus.
 Conclusion: It was concluded that only 5% of patients of UTI were caused by S. aureus that can be eliminated by treating the patients with antibiotic gentamycin. In the local scenario, routine urine culture tests and surveillance program is encouraged to be implemented.

Comparison of excision, swabbing and meat fluid sampling techniques on the prevalence and detection of Salmonella from beef in Namibia

Salmonellabacteria cause major challenges in food production and public health because of their ability to cause foodborne disease known as salmonellosis. The microbiological safety of food can be ensured through routine surveillance programs with a view to detect the presence of pathogenic bacteria such as Salmonella. However, the rate of Salmonelladetection in food may be affected by the sampling technique used leaving the product unsafe for human consumption. In order to assess the effectiveness of sampling techniques for Salmonelladetection, atotal of 9508 of beef samples were collected from the local slaughter houses over a period of two years starting from January 2008 to December 2009. Samples used were routine samples collected using three different sampling techniques; excision, swabbing and meat fluid.Samples were pre-enriched in Buffered Peptone Water followed by enrichment in the Rappaport Vissiliadis and Selenite Cystine broths. The isolation of Salmonellawas done on Xylose Lysine Desoxycholate and Brilliant Green agars followed by biochemical confirmation and serotyping according to Kauffman-White scheme. The statistical analysis by Chi square showed that there was a significant difference (p <0.05) on the prevalence of Salmonellabetween the swabbing sampling techniques (2.67 %) with excision (0.50 %) and meat fluid (0.43 %) sampling technique.However, there was no significant difference (p > 0.05) between the excision and meat fluid sampling techniques. The findings suggest that the three samplingtechniques could produce different results when used for sampling beef for Salmonella detection. The swabbing sampling technique showed a higher detection rate of Salmonellaand could be the best choice as compared to other techniques. The significant detection rate of the swabbing sampling technique as compared to other techniques could probably be due to the large surface area employed in this technique as a result of uneven distribution of microorganisms.

High prevalence of early onset anaemia amongst Aboriginal and Torres Strait Islander infants in remote northern Australia

AbstractObjectivesTo describe baseline growth and prevalence of anaemia in Aboriginal and Torres Strait Islander infants and young children enrolled in a nutrition promotion and anaemia prevention program in remote northern Australia.DesignRetrospective review of most recent growth parameters and haemoglobin records during the 3 months prior to and 1 month after recruitment into a prospective study conducted between 25 May 2010 and 6 May 2012.SettingPrimary health care clinics in six remote Aboriginal communities (east Kimberley, Western Australia (n = 1); Northern Territory (n = 4); Cape York, Queensland (n = 1)).ParticipantsTwo hundred and sixty‐two of the estimated 311 (84%) Aboriginal and Torres Strait Islander infants and young children aged 6–24 months residing in participating communities.Main outcome measuresPrevalence of anaemia, stunting, underweight and overweight at recruitment.ResultsAt recruitment, 42% of participants were anaemic, 18% stunted, 5% underweight and 5% overweight. Anaemia prevalence was higher than estimates (26–27%) in routine surveillance programs in remote communities and substantially higher than estimates (1.8–4.9%) in the general Australian population. One‐quarter of participants were anaemic prior to 6 months of age.ConclusionsThe unexpectedly high prevalence of anaemia and stunting in these communities highlight the need for continued preventive health programs focused on ensuring adequate nutrition amongst infants, young children and their mothers. The early onset of anaemia and stunting suggests a comprehensive anaemia prevention approach is needed, including greater emphasis on maternal and pre‐pregnancy health and nutrition to increase infants’ iron stores at birth and sustain these to 6 months of age.

Clinical Significance of Diminutive Colonic Polyps in Elderly Patients.

Background and Objectives:Colorectal cancer is the third leading cause of cancer-related death. Excision of premalignant polyps has a significant impact on reducing colorectal cancer mortality and morbidity. Colonoscopy is considered to be the gold standard for the diagnosis and affords an opportunity for treatment of colonic polyps. In recent years, serious debates have taken place because of the biological characteristics of diminutive polyps (DPs), polypectomy complications, and serious costs. There has not yet been a consensus on the management of DPs. The objectives of this study were to demonstrate the real clinical importance of DPs smaller than 5 mm in diameter, which are frequently seen in geriatric patients by new endoscopic techniques, and to help in determining screening and surveillance programs.Methods:The patients who underwent colonoscopy and were found to have a diminutive colorectal polyp (<5 mm from September 1, 2016 through September 1, 2017), were classified into 3 groups according to the imaging method used: flexible spectral imaging color enhancement (FICE), narrow band imaging (NBI), or I-SCAN. In all groups, demographic data were compared according to Paris classification (morphologic) and Kudo classification (correlation between the prediction of endoscopic diagnosis and final pathological examination) in terms of sensitivity, specificity, and negative and positive predictive values.Results:Two hundred sixty-seven patients were included in the study: 97 in the NBI group, 83 in the FICE group, and 87 in the I-SCAN group. There were no statistically significant differences between NBI, FICE, and I-SCAN in differentiating neoplastic and nonneoplastic polyps, according to the Kruskal-Wallis test (P = .809).Conclusions:The estimated progression rates of DPs to advanced adenomas or colorectal cancer (CRC) are very low. Missing these polyps or not excising them may lead to failure to diagnose some cancers. There is a need for further comprehensive studies of removing all polyps to determine whether non–high-risk lesions require further pathologic examination and to re-examine routine surveillance programs.

The natural history of perforated marginal ulcers after gastric bypass surgery.

Although perforated marginal ulcers (pMU) following Roux-en-Y Gastric Bypass (RYGB) represent a surgical emergency, the epidemiology and outcome of this condition is not well understood. The purpose of this study was to evaluate incidence of pMU following RYGB and assess the natural history of this complication. The SPARCS administrative database was used to identify patients undergoing RYGB between 2005 and 2010. With the use of a unique identifier, we followed patients up to 2014 for subsequent admission and re-intervention (repair or revision) for perforated MU. Groups were compared using Chi square tests with exact p values based on Monte Carlo simulation, t test with unequal variances, and the Wilcoxon rank-sum test when appropriate. We identified 35,080 RYGB patients; 292 patients (0.83%) developed pMU 937 (443-1546) days following RYGB [Median (Q1-Q3)]. Among these 292 patients, tobacco use was present in one-third of patients. Repair of the perforation was performed in 115 patients, while anastomotic revision was reported in 64. Patients who underwent revision were more likely to have respiratory complications. Hospital length of stay was significantly longer for patients managed with RYGB revision (Median, Q1-Q3:7, 5-14, vs 6, 4-7, days, p=0.001). Recurrence of marginal ulcer was common after either intervention (26.09% for repair and 29.69% for revision, p=0.726). Following RYGB, the incidence of pMU is small. Anastomotic revision for pMU is associated with prolonged length of stay compared to repair alone. Importantly, recurrence after intervention of pMU is common, suggesting possible value of a routine surveillance program for patients following pMU.

Short-term air pollution exposure decreases lung function: a repeated measures study in healthy adults

BackgroundDaily changes in ambient concentrations of particulate matter, nitrogen oxides and ozone are associated with increased cardiopulmonary morbidity and mortality, with the lungs and their function being a vulnerable target.MethodsTo evaluate the association between daily changes in air pollution and lung function in healthy adults we obtained annual lung function measurements from a routine worker health surveillance program not designed for research purposes. Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), FEV1/FVC and Peak Expiratory flow (PEF) from a cohort of 2449 employees were associated with daily measurements of PM10, NO2 and ozone at a nearby monitoring station in the North of Belgium. Repeated measures were available for the period 2011–2015.ResultsThe mean (SD) PM10 concentration on the day of the lung function test was 24.9 (15.5) μg/m3. A 10 μg PM10/m3 increase on the day of the clinical examination was associated with a 18.9 ml lower FVC (95% CI: -27.5 to −10.3, p < 0.0001), 12.8 ml lower FEV1 (−19.1 to −6.5; p < 0.0001), and a 51.4 ml/s lower PEF (−75.0 to −27.0; p < 0.0001). The FEV1/FVC-ratio showed no associations. An increase of 10 μgNO2/m3 was associated with a reduction in PEF (−66.1 ml/s (−106.6 to −25.6; p < 0.001)) on the day of the examination.ConclusionsWe found negative associations between daily variations in ambient air pollution and FVC, FEV1 and PEF in healthy adults.

Ethics Considerations in Global Mobile Phone-Based Surveys of Noncommunicable Diseases: A Conceptual Exploration.

Mobile phone coverage has grown, particularly within low- and middle-income countries (LMICs), presenting an opportunity to augment routine health surveillance programs. Several LMICs and global health partners are seeking opportunities to launch basic mobile phone–based surveys of noncommunicable diseases (NCDs). The increasing use of such technology in LMICs brings forth a cluster of ethical challenges; however, much of the existing literature regarding the ethics of mobile or digital health focuses on the use of technologies in high-income countries and does not consider directly the specific ethical issues associated with the conduct of mobile phone surveys (MPS) for NCD risk factor surveillance in LMICs. In this paper, we explore conceptually several of the central ethics issues in this domain, which mainly track the three phases of the MPS process: predata collection, during data collection, and postdata collection. These include identifying the nature of the activity; stakeholder engagement; appropriate design; anticipating and managing potential harms and benefits; consent; reaching intended respondents; data ownership, access and use; and ensuring LMIC sustainability. We call for future work to develop an ethics framework and guidance for the use of mobile phones for disease surveillance globally.

Assessment of the ability of Aedes species mosquitoes to transmit feline Mycoplasma haemofelis and ' Candidatus Mycoplasma haemominutum'.

Objectives The objective of this study was to evaluate wild-caught mosquitoes for evidence of hemotropic Mycoplasma species DNA and to determine whether the feline hemoplasmas, Mycoplasma haemofelis (Mhf) and ' Candidatus Mycoplasma haemominutum' (Mhm), can be transmitted by Aedes aegypti mosquitoes in a laboratory setting. Methods Wild-caught mosquito pools (50 mosquitoes per pool, 84 pools) utilized in routine public health department disease surveillance programs were tested for hemotropic Mycoplasma species DNA using PCR with primers designed to amplify all known hemoplasmas. Additionally, mosquitoes were trapped in the vicinity of known feral cat colonies, pooled (50 mosquitoes per pool) and tested (84 pools). Purpose-bred cats housed in a research facility were infected with Mhf or Mhm and then colonized laboratory A aegypti were fed upon the bacteremic cats. After a 7 day incubation period, mosquitoes previously fed on infected cats were allowed to feed again on naive cats, which were monitored for bacteremia for 10 weeks. Results Mycoplasma wenyonii DNA was confirmed in one wild-caught mosquito pool by DNA sequencing. While 7% of cats tested in feral colonies were hemoplasma positive, none of the mosquitoes trapped near colonies were positive. Hemoplasma DNA was amplified from A aegypti by PCR immediately after the infectious blood meal, but DNA was not detected at 7 and 14 days after feeding. Although evidence for uptake of organisms existed, hemoplasma DNA was not amplified from the experimentally infested cats in the 10 week observation period. Conclusions and relevance While wild-caught mosquitoes contained hemoplasma DNA and laboratory reared A aegypti mosquitoes take up hemoplasmas during the blood meal, there was no evidence of biologic transmission in this model.