Lessons from the COVID-19 pandemic: remote coaching in bariatric surgery

Background: The development of fast internet connection has stimulated different types of video-assisted teaching programs. However, a remote mentoring with the proctor not on site has never been reported in bariatric surgery. We described our experiences with remote telementoring for laparoscopic sleeve gastrectomy. Methods: A qualified general surgeon at the beginning of his bariatric practice performed a series of 8 laparoscopic sleeve gastrectomies (LSG) while tutored by an experienced bariatric surgeon connected from a different city through a specific videoconferencing platform. Data on demographics at baseline, operative time, hospital stay, intraoperative early, and late complications were collected. Results: Mean age and BMI of patients were 36.9 ± 9.6 years old and 41.8 ± 1.7 kg/m2. All procedures were carried out without conversion to open or complications. Mean operative time was 112.4 ± 21.9 min while the hospital stay was 3.5 ± 0.5 days. Operative time significantly decreased after the fourth operation. Conclusions: Remote coaching appears to be possible and safe for LSG

The comparison of FLOTAC, FECPAK and McMaster techniques for nematode egg counts in cattle

AbstractThree methods, FLOTAC, FECPAK and McMaster were compared for accuracy and sensitivity for counting numbers of nematode eggs in faeces of naturally infected cattle with high or low nematode egg counts. Only FLOTAC gave positive results for 12 replicates from pooled samples with low egg counts making it more sensitive than FECPAK (67%) and McMaster (41.7%). FLOTAC resulted in generally higher egg counts and lower coefficients of variation than the other two methods used. The reliability of FECPAK and McMaster is depended on the area under the slide counted. All three methods can be used for making decisions whether to treat but FLOTAC or Mini-FLOTAC should be used for faecal egg count reduction tests when lower egg counts are present

Mapping, cluster detection and evaluation of risk factors of ovine toxoplasmosis in Southern Italy

Toxoplasmosis, an important cause of reproductive failure in sheep, is responsible for significant economic losses to the ovine industry worldwide. Moreover, ovine meat contaminated by the parasite Toxoplasma gondii is considered as a common source of infection for humans. The aim of this study was to develop point and risk profiling maps of T. gondii seroprevalence in sheep bred in Campania Region (Southern Italy) and analyse risk factors associated at the flock-level. We used serological data from a previous survey of 117 sheep flocks, while environmental and farm management information were obtained from an analysis based on geographical information systems and a questionnaire purveyance, respectively. An univariate Poisson regression model revealed that the type of farm production (milk and meat vs only meat) was the only independent variable associated with T. gondii positivity (P<0.02); the higher within-flock seroprevalence in milking herds suggests that milking practices might influence the spread of the infection on the farm. Neither environmental nor other management variables were significant. Since a majority of flocks were seasonally or permanently on pasture, the animals have a high exposure to infectious T. gondii oocysts, so the high within-flock seroprevalence might derive from this management factor. However, further studies are needed to better assess the actual epidemiological situation of toxoplasmosis in sheep and to clarify the factors that influence its presence and distribution

Canine faecal contamination and parasitic risk in the city of Naples (southern Italy)

BACKGROUND: Dogs are associated with more than 60 zoonotic diseases among which, parasitosis and, in particular, helminthosis, can pose serious public-health concerns worldwide. Many canine gastrointestinal parasites eliminate their dispersion elements (eggs, larvae, oocysts) by the faecal route. The quantity of canine faeces deposited on public and private property in cities worldwide is both a perennial nuisance and an important health issue. Public sites such as playgrounds, parks, gardens, public squares and sandpits may be an important source of human infection. The aim of this study was to evaluate the extent of both canine faecal contamination in the city of Naples (southern Italy), and presence of canine parasitic elements, with particular regard to those which are potential agents of zoonosis. A regular grid of sub-areas (1 km × 700 m) was overlaid on the city map using a Geographical Information System (GIS). In each sub-area the straightest 1 km transect was drawn and digitalized on-screen in the GIS. Between February and May 2005 canine faeces were counted along the 1 km transects in 143 sub-areas, and 415 canine faecal samples were collected and submitted to coprological examinations. Negative binomial regression models and Gaussian random effects models were used to analyze the association between faeces count and human population density taking into account for extraPoisson variability. Logistic regression model was used to evaluate the association between positivity to parasitic elements and number of canine faeces. RESULTS: Out of the 143 studied sub-areas, 141 (98.6%) contained canine faeces. There was a strong spatial gradient with 48% of the total variability accounted by between neighbourhood variability; a positive association between the number of faeces and the human population density was found. Seventy (over 415, 16.9%) canine faecal samples were positive for parasitic elements. There was no association between positivity to parasitic elements and the number of canine faeces. Eggs of Toxocara canis, Toxascaris leonina, Ancylostoma caninum and Trichuris vulpis were found, as well as oocysts of Isospora canis. CONCLUSION: In conclusion, the results of the present study, conducted using GIS both for planning and sampling and for evaluation and presentation of findings, showed the presence of canine faecal contamination in the city of Naples, and the presence of canine parasitic elements, some of which are potential agents of zoonosis

Relative echogenicity of tendons and ligaments of the palmar metacarpal region in foals from birth to 4 months of age: A longitudinal study

The objective of this study was to evaluate relative echogenicity of superficial and deep digital flexor tendons, the accessory ligament of the deep digital flexor tendon and interosseous muscle of the metacarpal region in foals ages 1 week to 4 months; and assess the association between echogenicity and sex or side/laterality. Seven Standardbred trotter foals were examined. Right and left metacarpal regions (palmar surface) were ultrasonographically investigated, and four regions of interest were assessed. A significant increase in echogenicity was seen in superficial and deep digital flexor tendons, accessory ligament of deep digital flexor tendon, and interosseous muscle during growth from 1 week to 4 months of age. Echogenicity of examined tendons and ligaments was not influenced by gender nor laterality. Reference values for tendon and ligament echogenicity could function as a tool to discriminate between physiological and abnormal conditions such as congenital contractural conditions

Spatial epidemiology of Toxoplasma gondii infection in goats in Serbia

A major risk factor for Toxoplasma gondii infection is consumption of undercooked meat. Increasing demand for goat meat is likely to promote the role of this animal for human toxoplasmosis. As there are virtually no data on toxoplasmosis in goats in Serbia, we undertook a cross-sectional serological study, including prediction modelling using geographical information systems (GIS). Sera from 431 goats reared in 143 households/farms throughout Serbia, sampled between January 2010 and September 2011, were examined for T. gondii antibodies by a modified agglutination test. Seroprevalence was 73.3% at the individual level and 84.6% at the farm level. Risk factor analysis showed above two-fold higher risk of infection for goats used for all purposes compared to dairy goats (P = 0.012), almost seven-fold higher risk for goats kept as sole species versus those kept with other animals (P = 0.001) and a two-fold lower risk for goats introduced from outside the farm compared to those raised on the farm (P = 0.027). Moreover, households/farms located in centre-eastern Serbia were found to be less often infected than those in northern Serbia (P = 0.004). The risk factor analysis was fully supported by spatial analysis based on a GIS database containing data on origin, serology, land cover, elevation, meteorology and a spatial prediction map based on kriging analysis, which showed western Serbia as the area most likely for finding goats positive for T. gondii and centre-eastern Serbia as the least likely. In addition, rainfall favoured seropositivity, whereas temperature, humidity and elevation did not

Flotac and Mini-Flotac for uro-microscopic diagnosis of Capillaria plica (syn. Pearsonema plica) in dogs

Background: Capillaria plica (syn. Pearsonema plica) is a nematode that resides in the urinary bladder and rarely in ureters or in the kidney pelvis of various carnivores, especially foxes and dogs. Urine sedimentation technique is actually the only diagnostic tool that permits the identification of C. plica eggs, but its sensitivity is low and when an infection is suspected (or when it is necessary to confirm treatment efficacy) more than one examination of urine sediment should be performed. The present paper reports a clinical case of natural C. plica infection in a dog from southern Italy. In addition, two new techniques, FLOTAC and Mini-FLOTAC, were used for the diagnosis of C. plica in dog urine and compared with the technique of sedimentation. Results: Using FLOTAC with fresh urine and sodium chloride as flotation solution, were obtained the best results for the diagnosis of C. plica in dog urine in term of eggs counted (mean eggs per 10 ml of urine = 70.3 FLOTAC vs 40.3 Mini FLOTAC vs 32.8 sedimentation) and coefficient of variation (CV%) (6.2 FLOTAC vs 13.4 Mini-FLOTAC vs 32.9 sedimentation). Conclusions: The FLOTAC was the more sensitive method, but also the Mini-FLOTAC could be a valid alternative diagnostic method because gave better results than the classical sedimentation and can be used in place of the FLOTAC in laboratories where the centrifugation step cannot be performed. © 2014 Maurelli et al.; licensee BioMed Central Ltd

Idiopathic pulmonary fibrosis and coronary artery disease

Idiopathic pulmonary fibrosis (IPF) is defined as a chronic fibrosing interstitial disease of unknown cause, limited to the lungs, and associated with the histopathologic and/or radiologic pattern of usual interstitial pneumonia (UIP); it generally progresses into respiratory failure and death. Although progression of the disease is the most common cause of death, there are increasing reports of its association with other pathologies has been reported: e.g., IPF patients seem more susceptible to cardiovascular diseases. Therefore, other pathologies might also influence the natural course. In this paper, we describe a case of IPF and coronary artery disease (CAD). We emphasize the importance of cardiopulmonary exercise test (CPET) as a useful procedure to monitor disease progression in IPF patients. We also stress the importance of a careful analysis of variables measured for an accurate interpretation of the clinical picture and an improvement of the clinical management of patients. Moreover, we suggest that a careful assessment of CPET parameters may additionally help in the early detection of high cardiovascular ischemic risk

The basic reproduction quotient (Q0) as a potential spatial predictor of the seasonality of ovine haemonchosis

Haemonchus contortus is a gastrointestinal nematode parasite of small ruminants, which feeds on blood and causes significant disease and production loss in sheep and goats, especially in warmer parts of the world. The life cycle includes free-living immature stages, which are subject to climatic influences on development, survival and availability, and this species therefore exhibits spatio-temporal heterogeneity in its infection pressure based on the prevailing climate. Models that better explain this heterogeneity could predict future epidemiological changes. The basic reproduction quotient (Q0) was used as a simple process-based model to predict climate-driven changes in the potential transmission of H. contortus across widely different geo-climatic zones, and showed good agreement with the observed frequency of this species in the gastrointestinal nematode fauna of sheep (r = 0.81, P <0.01). Averaged monthly Q0 output was further used within a geographical information system (GIS) to produce preliminary haemonchosis risk maps for the United Kingdom (UK) over a four-year historical span and under future climate change scenarios. Prolonged transmission seasons throughout the UK are predicted, especially in the south although with restricted transmission in peak summer due to rainfall limitation. Additional predictive ability might be achieved if information such as host density and distribution, grazing pattern and edaphic conditions were included as risk layers in the GIS-based risk map. However, validation of such risk maps presents a significant challenge, with georeferenced observed data of sufficient spatial and temporal resolution rarely available and difficult to obtain

New endoscopic capsule vs upper gastrointestinal endoscopy in preoperative work-up of obese candidate for bariatric surgery: Relevance of a pilot study in the COVID-19 era

: Background and study aims  Obesity represents a major health concern; bariatric surgery is the most effective treatment reducing and maintaining weight loss. The role of a routine esophagogastroduodenoscopy (EGD) prior bariatric surgery is still debated. Moreover, in this scenario of COVID-19 pandemic, EGD is even more questionable due to the procedural risk of viral transmission. A new model of video-endoscopic capsule (VEC) recently has been introduced as a good alternative to the EGD. The aim of this study was to determine if this new capsule is an adequate diagnostic alternative to EGD in the work-up of patients selected for bariatric surgery, particularly in the setting of COVID-19. Patients and methods  From January to November 2020, 27 patients selected for bariatric surgery were enrolled in this pilot study to assess for noninferiority of VEC compared to EGD in detection of upper gastrointestinal disease. Results  VEC had sensitivity, specificity, and positive and negative predictive values in identification of significant lesions of 91.3 %, 83.33 %, 98.01 %, and 51.57 %, respectively, compared with EGD as the standard criterion. The accuracy was 90.51 % (95 % CI, 73.75 %-98.18 %) and the chi-square statistic is 0.1153 ( P  = 0.73). Conclusions  Our report confirms the diagnostic noninferiority of VEC in preoperative work-up of patients selected for bariatric surgery, compared to EGD. This is very important, particularly during the COVID-19 pandemic, given the high risk of contamination with EGD. Larger multicenter studies are required to confirm our preliminary results