RESUMO
Vibrio parahaemolyticus is the leading cause of seafood-related foodborne illness globally. In 2018, the U.S. federal, state, and local public health and regulatory partners investigated a multistate outbreak of V. parahaemolyticus infections linked to crabmeat that resulted in 26 ill people and nine hospitalizations. State and U.S. Food and Drug Administration (FDA) laboratories recovered V. parahaemolyticus, Salmonella spp., and Listeria monocytogenes isolates from crabmeat samples collected from various points of distribution and conducted phylogenetic analyses of whole-genome sequencing data. Federal, state, and local partners conducted traceback investigations to determine the source of crabmeat. Multiple Venezuelan processors that supplied various brands of crabmeat were identified, but a sole firm was not confirmed as the source of the outbreak. Travel restrictions between the United States and Venezuela prevented FDA officials from conducting on-site inspections of cooked crabmeat processors. Based on investigation findings, partners developed public communications advising consumers not to eat crabmeat imported from Venezuela and placed potentially implicated firms on import alerts. While some challenges limited the scope of the investigation, epidemiologic, traceback, and laboratory evidence identified the contaminated food and country of origin, and contributed to public health and regulatory actions, preventing additional illnesses. This multistate outbreak illustrates the importance of adhering to appropriate food safety practices and regulations for imported seafood.
Assuntos
Doenças Transmitidas por Alimentos , Vibrioses , Vibrio parahaemolyticus , Humanos , Estados Unidos/epidemiologia , Filogenia , Venezuela/epidemiologia , Doenças Transmitidas por Alimentos/epidemiologia , Vibrioses/epidemiologia , Surtos de DoençasRESUMO
RATIONALE: A large portion of asthma morbidity occurs in low- and middle-income countries, and Peru suffers particularly high asthma prevalence. Ambient air exposures are also high, and likely play a role. Most studies of environmental exposures focus on understanding contributors to health care utilization or mortality risk; however, less severe outcomes may still impact quality of life (QOL). OBJECTIVES: To study the association between multiple pollutants and several asthma domains in Peruvian children. METHODS: A total of 484 children aged 9-19 years with asthma were followed for 6-9 months, and evaluated for asthma control, asthma-related QOL, missed school days, and health care utilization. We used geographically distributed monitors to estimate air pollutant concentrations and multivariable generalized linear mixed models to model asthma outcomes as a function of pollutants. RESULTS: A total of 67% of children had moderate to severe persistent asthma. In multipollutant models, higher particulate matter less than 2.5 µm in aerodynamic diameter (PM2.5), black carbon, and nitrogen dioxide concentrations were independently associated with worse asthma control. For each interquartile range increase in PM2.5 or nitrogen dioxide concentration, there was a 59% or 34% higher odds of uncontrolled asthma, respectively. If the proportion of PM2.5 that was black carbon increased, there were increased odds of uncontrolled asthma. Similarly, pollutants were independently associated with worse asthma-related QOL, and PM exposure was associated with increased risk of health care utilization. CONCLUSIONS: Our study highlights the importance of pollutant exposures on multiple domains of asthma morbidity among Peruvian children, including not only acute exacerbations, but also on general asthma burden, such as worse asthma symptom control and QOL.
Assuntos
Poluição do Ar/efeitos adversos , Asma/epidemiologia , Material Particulado/efeitos adversos , Adolescente , Asma/etiologia , Criança , Progressão da Doença , Monitoramento Ambiental , Feminino , Seguimentos , Humanos , Masculino , Morbidade/tendências , Dióxido de Nitrogênio/efeitos adversos , Peru/epidemiologia , Prognóstico , Qualidade de Vida , Adulto JovemRESUMO
Introduction: There is a long history of pre-deployment PTSD prevention efforts in the military and effective pre-deployment strategies to prevent post-deployment PTSD are still needed. Materials and Methods: This randomized controlled trial included three arms: heart rate variability biofeedback (HRVB), cognitive bias modification for interpretation (CBM-I), and control. The hypothesis was that pre-deployment resilience training would result in lower post-deployment PTSD symptoms compared with control. Army National Guard soldiers (n = 342) were enrolled in the Warriors Achieving Resilience (WAR) study and analyzed. The outcome was PTSD symptom severity using the PTSD Checklist - Military version (PCL) measured at pre-deployment, 3- and 12-month post-deployment. Due to the repeated measures for each participant and cluster randomization at the company level, generalized linear mixed models were used for the analysis. This study was approved by the Army Human Research Protection Office, Central Arkansas Veterans Healthcare System Institutional Review Board (IRB), and Southeast Louisiana Veterans Health Care System IRB. Results: Overall, there was no significant intervention effect. However, there were significant intervention effects for subgroups of soldiers. For example, at 3-months post-deployment, the HRVB arm had significantly lower PCL scores than the control arm for soldiers with no previous combat zone exposure who were age 30 and older and for soldiers with previous combat zone exposure who were 45 and older (unadjusted effect size -0.97 and -1.03, respectively). A significant difference between the CBM-I and control arms was found for soldiers without previous combat zone exposure between ages 23 and 42 (unadjusted effect size -0.41). Similarly, at 12-months post-deployment, the HRVB arm had significantly lower PCL scores in older soldiers. Conclusion: Pre-deployment resilience training was acceptable and feasible and resulted in lower post-deployment PTSD symptom scores in subgroups of older soldiers compared with controls. Strengths of the study included cluster randomization at the company level, use of iPod device to deliver the resilience intervention throughout the deployment cycle, and minimal disruption of pre-deployment training by using self-paced resilience training. Weaknesses included self-report app use, study personnel not able to contact soldiers during deployment, and in general a low level of PTSD symptom severity throughout the study. In future studies, it would important for the study team and/or military personnel implementing the resilience training to be in frequent contact with participants to ensure proper use of the resilience training apps.
Assuntos
Terapia Cognitivo-Comportamental/normas , Retroalimentação , Frequência Cardíaca , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Veteranos/psicologia , Adaptação Psicológica , Adolescente , Adulto , Arkansas , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Louisiana , Masculino , Pessoa de Meia-Idade , Militares/psicologia , Militares/estatística & dados numéricos , Monitorização Fisiológica/métodos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/estatística & dados numéricos , Guerra/psicologiaRESUMO
OBJECTIVES: Antimicrobial resistance (AMR) is a priority for surveillance in bacterial infections. For leprosy, AMR has not been assessed because Mycobacterium leprae does not grow in vitro. We aim to obtain AMR data using molecular detection of resistance genes and to conduct a prospective open survey of resistance to antileprosy drugs in countries where leprosy is endemic through a WHO surveillance network. METHODS: From 2009 to 2015, multi-bacillary leprosy cases at sentinel sites of 19 countries were studied for resistance to rifampicin, dapsone and ofloxacin by PCR sequencing of the drug-resistance-determining regions of the genes rpoB, folP1 and gyrA. RESULTS: Among 1932 (1143 relapse and 789 new) cases studied, 154 (8.0%) M. leprae strains were found with mutations conferring resistance showing 182 resistance traits (74 for rifampicin, 87 for dapsone and 21 for ofloxacin). Twenty cases showed rifampicin and dapsone resistance, four showed ofloxacin and dapsone resistance, but no cases were resistant to rifampicin and ofloxacin. Rifampicin resistance was observed among relapse (58/1143, 5.1%) and new (16/789, 2.0%) cases in 12 countries. India, Brazil and Colombia reported more than five rifampicin-resistant cases. CONCLUSIONS: This is the first study reporting global data on AMR in leprosy. Rifampicin resistance emerged, stressing the need for expansion of surveillance. This is also a call for vigilance on the global use of antimicrobial agents, because ofloxacin resistance probably developed in relation to the general intake of antibiotics for other infections as it is not part of the multidrug combination used to treat leprosy.
Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/genética , Hanseníase/epidemiologia , Mycobacterium leprae/efeitos dos fármacos , Mycobacterium leprae/genética , Antibacterianos/efeitos adversos , Proteínas de Bactérias/genética , Biópsia por Agulha , Brasil/epidemiologia , Colômbia/epidemiologia , DNA Girase/genética , Dapsona/uso terapêutico , Doenças Endêmicas/estatística & dados numéricos , Monitoramento Epidemiológico , Saúde Global , Humanos , Índia/epidemiologia , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Testes de Sensibilidade Microbiana , Mutação , Ofloxacino/uso terapêutico , Reação em Cadeia da Polimerase , Estudos Prospectivos , Recidiva , Rifampina/uso terapêutico , Vigilância de Evento Sentinela , Pele/microbiologia , Pele/patologia , Inquéritos e Questionários , Organização Mundial da SaúdeRESUMO
BACKGROUND: Air pollution exposure may contribute to rhinoconjunctivitis morbidity in children with underlying airways disease. Prior studies have not assessed rhinoconjunctivitis-related quality of life (QOL) in children with asthma chronically exposed to air pollution. METHODS: Children ages 9-19 years with asthma from peri-urban Peru, self-reporting rhinoconjunctivitis symptoms (n = 484), were administered the Rhinoconjunctivitis QOL Questionnaire (RQLQ) at repeated intervals over one year, with scores dichotomized into bothered (>0) and not bothered (= 0). Individual weekly exposures to particulate matter<2.5µm (PM2.5) and its black carbon (BC) component were estimated by inverse distance weighted methods. Generalized estimating equations, adjusting for covariates, estimated associations of PM2.5 and BC with QOL. RESULTS: Participants were on average 13 years old, 55% female, and majority were atopic (77%). Mean (SD) PM2.5 and BC concentrations were 21(3.2) µg/m3 and 4.4(1.5) µg/m3, respectively. In adjusted multi-pollutant models, each 10µg/m3 increase in PM2.5 was associated with increased odds of worse rhinoconjunctivitis QOL (OR;[95% CI]: 1.83;[1.33,2.52]). A 10% increase in the BC proportion was associated with higher rhinitis burden (OR;[95% CI]: 1.80;[1.22,2.66]), while increases in the non-BC component of PM did not significantly impact rhinoconjunctivitis QOL. Associations were similar regardless of atopy. CONCLUSION: Higher PM2.5 and BC exposure is associated with worse rhinitis QOL among asthmatic children.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Rinite/fisiopatologia , Adolescente , Asma/fisiopatologia , Criança , Pré-Escolar , Exposição Ambiental/efeitos adversos , Monitoramento Ambiental/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Material Particulado/efeitos adversos , Peru , Qualidade de Vida , Adulto JovemRESUMO
BACKGROUND: Cigarette smoking plays a major role in cardiovascular diseases. The acute effects of cigarette smoking produce central nervous system-mediated activation of the sympathetic nervous system. The overactive sympathetic nervous system stimulates the secretion of serotonin (5-HT) and catecholamine into blood at supraphysiological levels. The correlation between these pathological conditions induced by smoking and the increased risk of thrombosis has not been thoroughly investigated. The goal of our study was to explore cigarette smoking-associated changes in platelet biology mediated by elevated 5-HT and catecholamine levels in blood plasma. METHODS AND RESULTS: Using blood samples collected from healthy nonsmokers and smokers (15 minutes after smoking), we determined that cigarette smoking increased the plasma 5-HT/catecholamine concentration by several fold and the percent aggregation of platelets 2-fold. Liquid chromatography-tandem mass spectrometry analysis of proteins eluted from platelet plasma membranes of smokers and nonsmokers demonstrated that GTPase-activating proteins and proteins participating in the actin cytoskeletal network were differentially and significantly elevated in smokers' platelet membranes compared with those of nonsmokers. Interestingly, Matrix-assisted laser desorption/ionization-mass spectrometry analyses of the glycans eluted from platelet plasma membranes of the smokers demonstrated that the level and structures of glycans are different from the nonsmokers' platelet surface glycans. Pharmacological blockade of 5-HT or catecholamine receptors counteracted the 5-HT/catecholamine-mediated aggregation and altered the level and composition of glycan on platelet surfaces. CONCLUSIONS: Based on our findings, we propose that smoking-associated 5-HT/catecholamine signaling accelerates the trafficking dynamics of platelets, and this remodels the surface proteins and glycans and predisposes platelets to hyperactive levels. Smokers' platelets also had correspondingly higher resting concentrations of intracellular calcium and transglutaminase activity. These findings suggest a link among smoking, platelet 5-HT, catecholamine signaling, and their downstream effectors-including phospholipase C and inositol-1,4,5-triphosphate pathways-resulting in an increased tonic level of platelet activation in smokers.
Assuntos
Plaquetas/metabolismo , Membrana Celular/metabolismo , Epinefrina/sangue , Ativação Plaquetária , Serotonina/sangue , Transdução de Sinais , Fumar/sangue , Antagonistas Adrenérgicos beta/farmacologia , Adulto , Plaquetas/efeitos dos fármacos , Cálcio/sangue , Estudos de Casos e Controles , Membrana Celular/efeitos dos fármacos , Cromatografia Líquida de Alta Pressão , Humanos , Masculino , Ativação Plaquetária/efeitos dos fármacos , Agregação Plaquetária , Inibidores da Agregação Plaquetária/farmacologia , Polissacarídeos/sangue , Transporte Proteico , Antagonistas do Receptor 5-HT2 de Serotonina/farmacologia , Transdução de Sinais/efeitos dos fármacos , Fumar/efeitos adversos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Espectrometria de Massas em Tandem , Fatores de Tempo , Transglutaminases/sangue , Regulação para CimaRESUMO
OBJECTIVE: To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH). STUDY DESIGN: A reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31 weeks) receiving mechanical ventilation (n = 185) had â¼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH. RESULTS: Severe IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5 minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH. CONCLUSION: Elevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants.