Detection of dermatophytes in the environment of a podiatry clinic

Poster abstract publicado em: Mycoses. 2017;60(Suppl. S2):228-229. Disponível em:http://onlinelibrary.wiley.com/doi/10.1111/myc.12675/epdfObjectives: Podiatry is a healthcare profession that specializes in the management of disorders of the lower limb and foot. Podiatric treatments have the potential to generate substantial concentrations of organic dusts. Occupational exposure to bioaerosols in podiatry clinics has been studied, but it was never accessed in a deeply manner for fungi. The detection of dermatophytes in podiatric clinics is a matter of concern since the environmental presence of these fungi can contribute to spread the infection to podiatry workers and to other patients consulted in the podiatry clinics. The aim of the present study was to characterize the dermatophyte burden during podiatric activities by the use of cultural methods but also molecular methodologies for fungal DNA detection directly from the collected samples. Methods: During the period of 4 weeks, environmental samples from a podiatric clinic were collected for both conventional and molecular methodologies. For culture, 44 air samples and 39 swabs from surfaces were inoculated in Mycosel agar. Fourteen air samples from the same sampling sites were collected for direct detection of fungal DNA. Air samples ranging from 88 to 300L were collected using a calibrated impinger device (Midget ImpingeR WITH Universal Sample Pump, SKC (PA, USA), at 2.2L/min airflow rate. Five milliliters of the collection liquid was used for DNA extraction using the ZR Fungal/Bacterial DNA MiniPrep Kit Detection of dermatophytes species (in general) and Trichophyton rubrum (in particular) were both achieved by using the Dermatophyte PCR kit, (SSI Diagnostica, Herredsvejen Hillerød, Denmark). PCR amplifications were performed using 2 μL and 5 μL of the extracted DNA. Results: In the first week, 1 out of 17 samples had a positive result for Trichophyton rubrum (detected in an air sample), whereas in the remaining weeks, no dermatophytes were identified in the remaining 129 samples (weeks 2, 3 and 4). The molecular detection of dermatophytes was performed in the 14 air samples using two different DNA volumes: 2 and 5 µl. Using 2 µl of the extracted DNA, 1 out 14 samples gave a positive result for T. rubrum and none of the PCR reactions was inhibited. Using a 5 µl volume of DNA, 5 samples were positive for T. rubrum but the PCR reaction was inhibited in 6 of them (Table 1). Globally, 5 out of the 14 (36%) samples analyzed showed positive results for the detection of T. rubrum DNA. Conclusions: Giving the ratio of positive/inhibited PCR reactions, we cannot rule out the hypothesis of more positive samples. Nevertheless, the obtained results emphasize the importance of the application of new methodologies for an air quality assessment approach and reinforce the complementarity of both cultural and conventional methodologies. To our knowledge, this study presents for the first time, the application of the Dermatophyte PCR kit for dermatophyte DNA detection directly from environmental samples (air). The promising results indicate the need of optimization of this procedure specifically in this type of samples in order to use this methodology in a routine basis, for occupational and indoor air quality exposure assessments.Funding was provided from: The Committee of the Directorate of Education, The College of Podiatry, UK.info:eu-repo/semantics/publishedVersio

Thermoregulatory effects of swaddling in Mongolia: A randomised controlled study

Objective To investigate thermal balance of infants in a Mongolian winter, and compare the effects of traditional swaddling with an infant sleeping-bag in apartments or traditional tents (Gers).Design A substudy within a randomised controlled trial.Setting Community in Ulaanbaatar, Mongolia.Subjects A stratified randomly selected sample of 40 swaddled and 40 non-swaddled infants recruited within 48 h of birth.Intervention Sleeping-bags and baby outfits of total thermal resistance equivalent to that of swaddled babies.Outcome measure Digital recordings of infants’ core, peripheral, environmental and microenvironmental temperatures at 30-s intervals over 24 h at ages 1 month and 3 months.Results In Gers, indoor temperatures varied greatly ( 25°C), but remained between 20°C and 22°C, in apartments. Despite this, heavy wrapping, bed sharing and partial head covering, infant core and peripheral temperatures were similar and no infants showed evidence of significant heat or cold stress whether they were swaddled or in sleeping-bags. At 3 months, infants in sleeping-bags showed the ‘mature’ diurnal pattern of a fall in core temperature after sleep onset, accompanied by a rise in peripheral temperature, with a reverse pattern later in the night, just before awakening. This pattern was not related to room temperature, and was absent in the swaddled infants, suggesting that the mature diurnal pattern may develop later in them.Conclusions No evidence of cold stress was found. Swaddling had no identifiable thermal advantages over sleeping-bags during the coldest times, and in centrally heated apartments could contribute to the risk of overheating during the daytime.Trial registration number ISRTN01992617

Bidirectional Charging Panel

The invention relates to a bidirectional charging panel (BCP). The BCP includes a relay for controlling a combustion engine and a battery voltage sensor for monitoring a battery voltage. The BCP also includes a grid switch to transfer continuous power between the battery and a grid interface, where the grid interface further includes a grid voltage sensor for monitoring a grid voltage of a grid of devices and a grid direct current outlet to transfer power to and from a grid of devices. The BCP also includes a controller to manage the flow of power between the battery and the grid of devices, where the controller uses the relay to start or stop the combustion according to the battery voltage and uses the grid interface to transfer power from the grid of devices to the battery in response to determining the battery voltage is lower than the grid voltage.US 11,296,506 B

Occupational exposures to organic dust in Irish bakeries and a pizzeria restaurant

Project EXPOsE, nº 23222 (02/SAICT/2016)For decades, occupational exposure to flour dust has been linked to a range of respiratory diseases, including occupational asthma, thought to result from exposure to fungi present in the flour. Antifungal resistance is of increasing prevalence in clinical settings, and the role of occupational and environmental exposures, particularly for specific fungal species, is of concern. Occupational exposure to flour dust can occur in a range of occupational settings, however, few studies have focused on restaurant workers. The objective of this study was to measure occupational exposure to the flour and microbial contamination, including azole resistance screening, in two small commercial bakeries and in a pizzeria. Personal full shift inhalable dust measurements were collected from workers and were analyzed for inhalable dust and fungi, bacteria, azole resistance, and mycotoxins. Samples of settled dust were collected, and electrostatic dust cloths (EDC) were deployed and analyzed for microbial contamination, including azole resistance screening, and mycotoxins. Geometric mean exposures of 6.5 mg m-³ were calculated for inhalable dust, however, exposures of up to 18.30 mg m-³ were measured-70% of personal exposure measurements exceeded the occupational exposure limit for flour dust of 1.0 mg m-³. The air and EDC fungal counts were similar to those reported in previous studies for similar occupational environments. The fungi were dominated by Penicillium genera, however Aspergillus genera, including Fumigati and Flavi sections, were observed using culture-based methods, and the Fumigati section was also observed by molecular tools. Both Aspergillus sections were identified on the azole resistance screening. Mycotoxins were also detected in the settled dust samples, dominated by deoxynivalenol (DON). The role of environmental exposure in both the development of antimicrobial resistance and the total mycotoxin body burden is a growing concern; therefore, the presence of azole-resistant fungi and mycotoxin contamination, although low in magnitude, is of concern and warrants further investigation.info:eu-repo/semantics/publishedVersio

Evidence accumulation rate moderates the relationship between enriched environment exposure and age-related response speed declines

Older adults exposed to enriched environments (EEs) maintain relatively higher levels of cognitive function, even in the face of compromised markers of brain health. Response speed (RS) is often used as a simple proxy to measure the preservation of global cognitive function in older adults. However, it is unknown which specific selection, decision, and/or motor processes provide the most specific indices of neurocognitive health. Here, using a simple decision task with electroencephalography (EEG), we found that the efficiency with which an individual accumulates sensory evidence was a critical determinant of the extent to which RS was preserved in older adults (63% female, 37% male). Moreover, the mitigating influence of EE on age-related RS declines was most pronounced when evidence accumulation rates were shallowest. These results suggest that the phenomenon of cognitive reserve, whereby high EE individuals can better tolerate suboptimal brain health to facilitate the preservation of cognitive function, is not just applicable to neuroanatomical indicators of brain aging but can be observed in markers of neurophysiology. Our results suggest that EEG metrics of evidence accumulation may index neurocognitive vulnerability of the aging brain. Significance Statement Response speed in older adults is closely linked with trajectories of cognitive aging. Here, by recording brain activity while individuals perform a simple computer task, we identify a neural metric that is a critical determinant of response speed. Older adults exposed to greater cognitive and social stimulation throughout a lifetime could maintain faster responding, even when this neural metric was impaired. This work suggests EEG is a useful technique for interrogating how a lifetime of stimulation benefits brain health in aging

Cancer Incidence of 2,4-D Production Workers

Despite showing no evidence of carcinogenicity in laboratory animals, the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) has been associated with non-Hodgkin lymphoma (NHL) in some human epidemiology studies, albeit inconsistently. We matched an existing cohort of 2,4-D manufacturing employees with cancer registries in three US states resulting in 244 cancers compared to 276 expected cases. The Standardized Incidence Ratio (SIR) for the 14 NHL cases was 1.36 (95% Confidence Interval (CI) 0.74–2.29). Risk estimates were higher in the upper cumulative exposure and duration subgroups, yet not statistically significant. There were no clear patterns of NHL risk with period of hire and histology subtypes. Statistically significant results were observed for prostate cancer (SIR = 0.74, 95% CI 0.57–0.94), and “other respiratory” cancers (SIR = 3.79, 95% CI 1.22–8.84; 4 of 5 cases were mesotheliomas). Overall, we observed fewer cancer cases than expected, and a non statistically significant increase in the number of NHL cases

Electronic learning can facilitate student performance in undergraduate surgical education: a prospective observational study

BACKGROUND: Our institution recently introduced a novel internet accessible computer aided learning (iCAL) programme to complement existing surgical undergraduate teaching methods. On graduation of the first full cycle of undergraduate students to whom this resource was available we assessed the utility of this new teaching facility. METHOD: The computer programme prospectively records usage of the system on an individual user basis. We evaluated the utilisation of the web-based programme and its impact on class ranking changes from an entry-test evaluation to an exit examination in surgery. RESULTS: 74.4% of students were able to access iCAL from off-campus internet access. The majority of iCAL usage (64.6%) took place during working hours (08:00–18:00) with little usage on the weekend (21.1%). Working hours usage was positively associated with improvement in class rank (P = 0.025, n = 148) but out-of hours usage was not (P = 0.306). Usage during weekdays was associated with improved rank (P = 0.04), whereas weekend usage was not (P = 0.504). There were no significant differences in usage between genders (P = 0.3). Usage of the iCAL system was positively correlated with improvement in class rank from the entry to the exit examination (P = 0.046). Students with lower ranks on entry examination, were found to use the computer system more frequently (P = 0.01). CONCLUSION: Electronic learning complements traditional teaching methods in undergraduate surgical teaching. Its is more frequently used by students achieving lower class ranking with traditional teaching methods, and this usage is associated with improvements in class ranking

Development of Core Outcome Measures sets for paediatric and adult Severe Asthma (COMSA)

BACKGROUND: Effectiveness studies with biological therapies for asthma lack standardised outcome measures. The COMSA (Core Outcome Measures sets for paediatric and adult Severe Asthma) working group sought to develop Core Outcome Measures (COM) sets to facilitate better synthesis of data and appraisal of biologics in paediatric and adult asthma clinical studies.METHODS: COMSA utilised a multi-stakeholder consensus process among patients with severe asthma, adult, and paediatric clinicians, pharmaceutical representatives and health regulators from across Europe. Evidence included a systematic review of development, validity, and reliability of selected outcome measures plus a narrative review and a pan-European survey to better understand patients' and carers' views about outcome measures. It was discussed using a modified GRADE Evidence to Decision framework. Anonymous voting was conducted using predefined consensus criteria.RESULTS: Both adult and paediatric COM sets include forced expiratory volume in 1 s (FEV1) as z scores, annual frequency of severe exacerbations and maintenance oral corticosteroid use. Additionally, the paediatric COM set includes the Paediatric Asthma Quality of Life Questionnaire, and Asthma Control Test (ACT) or Childhood-ACT while the adult COM includes the Severe Asthma Questionnaire and the Asthma Control Questionnaire-6 (symptoms and rescue medication use reported separately).CONCLUSIONS: This patient-centred collaboration has produced two COM sets for paediatric and adult severe asthma. It is expected that they will inform the methodology of future clinical trials, enhance comparability of efficacy and effectiveness of biological therapies, and help assess their socioeconomic value. COMSA will inform definitions of non-response and response to biological therapy for severe asthma.</p

Tandem amplification of SCCmec can drive high level methicillin resistance in MRSA

Hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) strains typically express high-level, homogeneous (HoR) beta-lactam resistance, whereas community-associated MRSA (CA-MRSA) more commonly express low-level heterogeneous (HeR) resistance. Expression of the HoR phenotype typically requires both increased expression of the mecA gene, carried on the staphylococcal cassette chromosome mec element (SCCmec), and additional mutational event(s) elsewhere on the chromosome. Here the oxacillin concentration in a chemostat culture of the CA-MRSA strain USA300 was increased from 8 mu g/ml to 130 mu g/ml over 13 days to isolate highly oxacillin-resistant derivatives. A stable, small-colony variant, designated HoR34, which had become established in the chemostat culture was found to have acquired mutations in gdpP, clpX, guaA, and camS. Closer inspection of the genome sequence data further revealed that reads covering SCCmec were similar to 10 times overrepresented compared to other parts of the chromosome. Quantitative PCR (qPCR) confirmed &amp;gt;10-fold-higher levels of mecA DNA on the HoR34 chromosome, and MinION genome sequencing verified the presence of 10 tandem repeats of the SCCmec element. qPCR further demonstrated that subculture of HoR34 in various concentrations of oxacillin (0 to 100 mu g/ml) was accompanied by accordion-like contraction and amplification of the SCCmec element. Although slower growing than strain USA300, HoR34 outcompeted the parent strain in the presence of subinhibitory oxacillin. These data identify tandem amplification of the SCCmec element as a new mechanism of high-level methicillin resistance in MRSA, which may provide a competitive advantage for MRSA under antibiotic selection