Association between rainfall and Escherichia coli in live bivalve molluscs harvested in Sardinia, Italy

Rainfall is generally accepted as one of the most important factors associated with an increased level of E. coli in bivalve molluscs. Performing microbiological risk assessment is relevant to official control authorities to determine the sanitary status of harvesting areas and, therefore, develop monitoring strategies and identify management practices that could be used to improve the quality and safety of the final product. The present study aimed to investigate the impact of rainfall on the content of E. coli in bivalve molluscs farmed in Sardinia (Italy). Enumeration of E. coli was performed according to the Most Probable Number (MPN) method (ISO 16649-3) on 1,920 bivalve samples collected from 7 regional counties between 2018 and 2020. Bivalve molluscs samples included 955 mussels (Mytilus galloprovincialis), 500 oysters (Crassostrea gigas), 325 clams (Ruditapes decussatus), 94 warty venus (Venus verrucosa), and 46 lagoon cockles (Cerastoderma glaucum). Rainfall data were obtained by the Department of Meteorology of the ARPA Sardegna. For each sampling site, GPS coordinates were used to identify gauge stations within catchment areas. Cumulative rain (mm) was recorded 1, 3, 5, 7, and 15 days before sampling, among which the 7-day cumulative rain was the strongest predictor of E. coli counts. Several thresholds of 7-day cumulative rain (from <10 mm up to >300 mm) before sampling were used to estimate the chances of a non-compliant sample (E. coli levels above the limit for sanitary class A; 230 MPN/100 g). The 7-day cumulative rain was positively associated with the chances of non-compliance. When the 7-day cumulative rain before sampling was >300 mm, 80.5 % of the samples were non-compliant, and the odds of a non-compliant sample were 23.6 times higher, as compared to samples harvested when the 7-day cumulative rainfall was <10 mm. Precipitation data could be a useful tool for interpreting anomalous results from official control authorities and reduce the costs that originate from closure of production areas.

PR and QRS intervals in basal electrocardiogram as a useful tool in screening family members for diagnosis of Brugada Syndrome

Funding Acknowledgements

Type of funding sources: None.

Introduction

Diagnosis of Brugada Syndrome (BrS) requires documentation of a spontaneous or pharmacologically induced type 1 Brugada pattern. In individuals with normal basal electrocardiography, screening methods could be challenging. The aim of the study was to detect if other parameters in basal ECG could be a tool to predict the diagnosis of BrS in family members.

Methods

Prospective analysis of 78 patients with family history of BrS and referenced for screening. Basal electrocardiogram was performed in all patients. Patients with spontaneous type 1 Brugada pattern in basal ECG were initially excluded. Definitive diagnosis required a presence of a type 1 ECG pattern or conversion of a type 2 to type 1 following provocative test. The Mann-Whitney U test was used for median comparison between groups as univariate analysis. Analysis of the receiver operating characteristic (ROC) curves were performed to evaluate the predictive values of ECG parameters.

Results

6% (n=5) had spontaneous type 1 Brugada syndrome. 53% were male (n=41); mean age of 28,9±15,3 years. 31% (n=24) had confirmative diagnosis of BrS. 27% (n=21) were carriers of SCN5A mutation. Mean duration of intervals on basal ECG were: RR 871,2±156,0ms; PR 159,3±34,1ms; QRS 91,4±13,4ms; QTc 404,2±32,0. Syncope occurred in 5% of patients (n=5), 94% were asymptomatic.

By univariate analysis the distribution of PR and QRS intervals was significantly different. Wider PR interval was found in patients with BrS (p&lt;0,01) with a median of 200ms (variance of 1269) versus healthy individuals (median of 150ms and variance of 601). Wider QRS intervals were also found in BrS patients compared with healthy individuals (p&lt;0,01) (100ms (288) versus 80ms (204)). The cut-off point, with the most sensitivity (S) and specificity (E) obtained using the Youden index (YI) for PR interval was 170ms (YI 0,5389; Sensitivity (S)≈65% and Specificity(E)≈89%) and for QRS interval was 97ms (YI 0,5148; Sensitivity (S)≈70% and Specificity(E)≈82%).

Conclusion

Higher PR and QRS intervals were associated with BrS diagnosis comparing to healthy family members which may pose a cost-effective screening tool. More studies are needed to validate this hypothesis.

Palliative care interventions for people with multiple sclerosis

BACKGROUND

People with multiple sclerosis (MS) have complex symptoms and different types of needs. These demands include how to manage the burden of physical disability as well as how to organise daily life, restructure social roles in the family and at work, preserve personal identity and community roles, keep self-sufficiency in personal care, and how to be part of an integrated care network. Palliative care teams are trained to keep open full and competent lines of communication about symptoms and disease progression, advanced care planning, and end-of-life issues and wishes. Teams create a treatment plan for the total management of symptoms, supporting people and families on decision-making. Despite advances in research and the existence of many interventions to reduce disease activity or to slow the progression of MS, this condition remains a life-limiting disease with symptoms that impact negatively the lives of people with it and their families.

OBJECTIVES

To assess the effects (benefits and harms) of palliative care interventions compared to usual care for people with any form of multiple sclerosis: relapsing-remitting MS (RRMS), secondary-progressive MS (SPMS), primary-progressive MS (PPMS), and progressive-relapsing MS (PRMS) We also aimed to compare the effects of different palliative care interventions.

SEARCH METHODS

On 31 October 2018, we conducted a literature search in the specialised register of the Cochrane MS and Rare Diseases of the Central Nervous System Review Group, which contains trials from CENTRAL, MEDLINE, Embase, CINAHL, LILACS, Clinical trials.gov and the World Health Organization International Clinical Trials Registry Platform. We also searched PsycINFO, PEDro and Opengrey. We also handsearched relevant journals and screened the reference lists of published reviews. We contacted researchers in palliative care and multiple sclerosis.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and cluster randomised trials were eligible for inclusion, as well as the first phase of cross-over trials. We included studies that compared palliative care interventions versus usual care. We also included studies that compared palliative care interventions versus another type of palliative interventions.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures. We summarised key results and certainty of evidence in a 'Summary of Finding' table that reported outcomes at six or more months of post-intervention.

MAIN RESULTS

Three studies (146 participants) met our selection criteria. Two studies compared multidisciplinary, fast-track palliative care versus multidisciplinary standard care while on a waiting-list control, and one study compared a multidisciplinary palliative approach versus multidisciplinary standard care at different time points (12, 16, and 24 weeks). Two were RCTs with parallel design (total 94 participants) and one was a cross-over design (52 participants). The three studies assessed palliative care as a home-based intervention. One of the three studies included participants with 'neurodegenerative diseases', with MS people being a subset of the randomised population. We assessed the risk of bias of included studies using Cochrane's 'Risk of Bias' tool.We found no evidence of differences between intervention and control groups in long-time follow-up (> six months post-intervention) for the following outcomes: mean change in health-related quality of life (SEIQoL - higher scores mean better quality of life; MD 4.80, 95% CI -12.32 to 21.92; participants = 62; studies = 1; very low-certainty evidence), serious adverse events (RR 0.97, 95% CI 0.44 to 2.12; participants = 76; studies = 1, 22 events, low-certainty evidence) and hospital admission (RR 0.78, 95% CI 0.24 to 2.52; participants = 76; studies = 1, 10 events, low-certainty evidence).The three included studies did not assess the following outcomes at long term follow-up (> six months post intervention): fatigue, anxiety, depression, disability, cognitive function, relapse-free survival, and sustained progression-free survival.We did not find any trial that compared different types of palliative care with each other.

AUTHORS' CONCLUSIONS

Based on the findings of the RCTs included in this review, we are uncertain whether palliative care interventions are beneficial for people with MS. There is low- or very low-certainty evidence regarding the difference between palliative care interventions versus usual care for long-term health-related quality of life, adverse events, and hospital admission in patients with MS. For intermediate-term follow-up, we are also uncertain about the effects of palliative care for the outcomes: health-related quality of life (measured by different assessments: SEIQoL or MSIS), disability, anxiety, and depression.

Assessment of relative uptake by mandibular condyles in a "normal" population

Hyperplasia of the mandibular condyle is self-limiting, but can lead to facial asymmetry, malocclusion, pain, and dysfunction of the temporomandibular joint (TMJ). Bone scintigraphy, particularly with single photon emission computed tomography (SPECT), is effective in assessing relative condylar uptake, but we know of no standardised methods or values. Our aim, therefore was to validate the values currently used to measure relative condylar uptake in our population. Between December 2015 and June 2018 44 patients had skull SPECT (15 male and 29 female patients, whose ages ranged from 4-33 years). They were having bone scans (hydroxydiphosphonate (HDP) -^99MTc, 740 MBq ev) for unrelated reasons and had no known abnormalities of the head, facial asymmetry, or symptoms of the TMJ. Two research workers measured the relative uptake between the condyles using the summed transaxial images. The Hospital Ethics Committee approved the investigation. The maximum difference in condylar uptake was 8.33% with research worker 1 and 8.77% with research worker 2, and the mean (SD) differences were 3.03 (0.17) % and 3.29 (0.18) %, respectively. Data were tested for normality, and the t test and one-way ANOVA were used to assess the significance of differences. None was found in total counts either between sexes or age groups, and there were none between the total counts measured by the two research workers. We conclude that our results are within the published ranges, and the variation in condylar uptake was less than 5% in 37/44 patients, and in none was it 9% or more. When the results indicate less than 10%, but there is a high clinical suspicion of active hyperplasia, surgeons should use their clinical judgement to decide whether condylar surgery is required.

LRP5 gene polymorphisms and radiographic joint damage in rheumatoid arthritis patients

Rheumatoid arthritis (RA) is characterized by increased bone resorption and impaired bone formation. Osteoblast function is regulated by the canonical LRP5/Wnt/β-catenin pathway. Bone mineral density and RA joint destruction are partially inherited. In line with this, we found significant associations between LRP5 SNPs (p.A1330V, p.N740N, p.V667M) and RA radiographic damage severity.

INTRODUCTION

Increased bone resorption and impaired bone formation characterize rheumatoid arthritis (RA). Canonical Wnt/β-catenin pathway, signalled by lipoprotein receptor-related protein-5 (LRP5), regulates osteoblast function. Since bone mineral density (BMD) and RA joint destruction are partially inherited, we studied their association with LRP5 single nucleotide polymorphisms (SNPs).

METHODS

Clinical data and peripheral blood for biomarkers assessment and LRP5 genotyping were collected from 208 RA patients. Hands and feet X-rays were scored [modified Sharp/van der Heijde Score (SHS), joint space narrowing (JSN), and erosion scores]. Lumbar spine, total left proximal femur, and left hand BMD were assessed by dual-energy X-ray absorptiometry (DXA).

RESULTS

TT genotypes for p.A1330V and p.N740N LRP5 SNPs associated with total SHS, erosion score, and hands erosion score; the same for p.A1330V with feet JSN score and p.N740N with hands total score. AG genotype for p.V667M associated with sclerostin and hands JSN score. Femoral BMD associated with TC genotype for p.N740N. Multiple test correction precluded a few of these associations. Among V667M-N740N-A1330V haplotypes: GTT associated with higher feet JSN score (OR = 3.80; p = 0.016) and ATT with higher JSN score (OR = 4.60; p = 0.032), hands total score (OR = 5.65; p = 0.022), and total SHS (OR = 6.74; p = 0.024).

CONCLUSION

Significant associations between LRP5 SNPs (p.A1330V, p.N740N, and p.V667M) and the severity of radiographic damage reinforce the evidence of bone destruction heritability in RA.

Profile of the Illegal Import of Products of Animal Origin to Brazilian Cities at the Border with Argentina and Uruguay

International food transit is a risk to public and animal health when not subject to legal importation sanitation procedures. Due to the extensive border area, illegal food import in Brazil is a common practice, especially in Rio Grande do Sul (RS), a state that borders with Argentina and Uruguay. The objective of this study was to evaluate the profile of Brazilians living in cities in RS that border with Argentina (BR-AR) or Uruguay (BR-UR) regarding the practice of illegal import of products of animal origin and to determine associations between the population characteristics and illegal import. A questionnaire with information related to the personal profile, habits of acquisition of imported food, and knowledge of health risks deriving from the consumption of the imported products was elaborated. The questionnaire was administered in six cities in RS (three cities bordering Argentina and three cities bordering Uruguay) and responses were obtained from 744 individuals. The variables city, sex, level of education, and knowledge were subjected to the chi-square test to verify the association between these variables and food import. Part of the interviewees admitted to illegally importing products of animal origin at both BR-AR (65.17%) and BR-UR (76.28%) borders. Dairy products were the main imported goods, followed by raw and processed meat. The study revealed that illegal import is common at the frontier region of RS, especially that of products of animal origin, dairy, and raw and processed meat. Although illegal importation occurs at all the cities under study, it was higher at the BR-UR border. Also, knowledge of the health risks influences the decision to import food or not.

Incidental finding of a monostotic form of Paget Disease of the scapula in a lung cancer patient

Paget Disease of the bone is a metabolic disorder which leads to a profound alteration of the bone's architecture. It may be asymptomatic and, since its radiological features mimic those of bone metastases, may present a diagnostic dilemma during the evaluation of a cancer patient. We illustrate an uncommon monostotic form of the disease, affecting solely the scapula, diagnosed during the staging of a lung cancer patient.

Assessing the potential biological implications of recreational inshore fisheries on sub-tidal fish communities of Azores (north-east Atlantic Ocean) using catch and effort data

Recreational inshore fishing activities practiced on Faial and Pico Islands (Azorean archipelago) were surveyed between October 2004 and September 2005. Recreational inshore fishers employ three main methods of fishing (shore angling, spear fishing and intertidal collecting). The method that demanded the highest fishing effort (number of fishing operations) was shore angling, followed by intertidal collecting and spear fishing. Shore angling produced the highest diversity of catch composition (38), which is in part explained by the seven fishing techniques used by shore anglers. The estimates of annual catch were higher for shore angling than spear fishing (51·2 and 6·3 t) even though they were lower than commercial artisanal fishing (442 t). The weighted mean trophic level and vulnerability index values in the fish catch were higher for spear fishing (3·4 and 50·9) than for shore angling (3·1 and 44·5). Cumulative pressure by different recreational fishing activities was detected on species already subject to a heavy pressure from Azorean commercial fishing, and on vulnerable and top-predator species. There are important biological and ecological implications whereby fishery managers should implement additional regulations such as prohibiting catches of the most vulnerable species.

Cleaning conveyor belts in the chicken-cutting area of a poultry processing plant with 45°c water

Conveyor belts are widely used in food handling areas, especially in poultry processing plants. Because they are in direct contact with food and it is a requirement of the Brazilian health authority, conveyor belts are required to be continuously cleaned with hot water under pressure. The use of water in this procedure has been questioned based on the hypothesis that water may further disseminate microorganisms but not effectively reduce the organic material on the surface. Moreover, reducing the use of water in processing may contribute to a reduction in costs and emission of effluents. However, no consistent evidence in support of removing water during conveyor belt cleaning has been reported. Therefore, the objective of the present study was to compare the bacterial counts on conveyor belts that were or were not continuously cleaned with hot water under pressure. Superficial samples from conveyor belts (cleaned or not cleaned) were collected at three different times during operation (T1, after the preoperational cleaning [5 a.m.]; T2, after the first work shift [4 p.m.]; and T3, after the second work shift [1:30 a.m.]) in a poultry meat processing facility, and the samples were subjected to mesophilic and enterobacterial counts. For Enterobacteriaceae, no significant differences were observed between the conveyor belts, independent of the time of sampling or the cleaning process. No significant differences were observed between the counts of mesophilic bacteria at the distinct times of sampling on the conveyor belt that had not been subjected to continuous cleaning with water at 45°C. When comparing similar periods of sampling, no significant differences were observed between the mesophilic counts obtained from the conveyor belts that were or were not subjected to continuous cleaning with water at 45°C. Continuous cleaning with water did not significantly reduce microorganism counts, suggesting the possibility of discarding this procedure in chicken processing.

Gravitational energy-momentum density in teleparallel gravity

In the context of a gauge theory for the translation group, a conserved energy-momentum gauge current for the gravitational field is obtained. It is a true spacetime and gauge tensor, and transforms covariantly under global Lorentz transformations. By rewriting the gauge gravitational field equation in a purely spacetime form, it becomes the teleparallel equivalent of Einstein's equation, and the gauge current reduces to the Moller's canonical energy-momentum density of the gravitational field.

[Multiple vertebro-basilar infarcts and cardio-embolism]

INTRODUCTION

Stroke characteristics do not inform much about its etiology, even if they can suggest a specific mechanism. We thought that multiple vertebrobasilar infarcts could be related with embolism, namely cardioembolism.

PATIENTS AND METHODS

From a hospital prospective registry of stroke we retrieved 73 cases of acute non-lacunar vertebrobasilar infarcts, without previous episodes of stroke in any territory or vertebrobasilar transient ischemic accidents (TIA). Two groups were compared: patients with single cerebral posterior artery infarct (49) and patients with multiple vertebrobasilar infarcts (24), in respect to conventional risk factors for cerebrovascular disease, ancillary procedures performed, and associated pathologic conditions, as possible infarct pathogenesis.

RESULTS

Proportions of risk factors and ancillary procedures performed were similar in both groups, except for hypercholesterolemia, which was more frequent in multiple infarcts, and for transcranial Doppler, which was performed more frequently in multiple infarcts. In multiple infarct group, cardioemboligenic pathology was more frequent, as were medium-high emboligenic risk cardiac diseases and atrial fibrillation, although the difference did not reach statistical significance.

CONCLUSIONS

Our results support the hypothesis that multiple non-lacunar vertebrobasilar infarcts, from a first ever stroke event, suggest cardioembolic etiology, and recommend performing an exhaustive cardiac investigation.

Principles for Sustainable Governance of the Oceans

Pressures being exerted on the ocean ecosystems through overfishing, pollution, and environmental and climate change are increasing. Six core principles are proposed to guide governance and use of ocean resources and to promote sustainability. Examples of governance structures that embody these principles are given.