Avaliação quantitativado risco de Salmonella spp. em frango e em ovos produzidos sob inspeção oficialno Brasil

Atualmente, o Brasil é líder na exportação mundial de frango e alcançou uma produção recorde de frango e ovos, nos últimos anos. Salmonella spp. é um dos principais patógenos de alimentos em nível mundial, sendo frequentemente transmitida por carne de frango e ovos. No presente estudo, foram realizadas avaliações quantitativas de risco de salmonelose, devido ao consumo de frango e ovos produzidos sob inspeção oficial no Brasil. Para tanto, informações provenientes de uma revisão sistemática de bibliografias científicas, dados obtidos do Ministério da Agricultura, Pecuária e Abastecimento (MAPA), informações vindas de indústrias e outros setores da cadeia produtiva e da população brasileira foram considerados. Modelos de microbiologia preditiva foram elaborados, considerando a multiplicação de alguns dos princiapais sorovares de Salmonella spp. na carne de frango brasileira. A multiplicação de Salmonella em ovos foi modelada através de software de microbiologia preditiva. As informações foram utilizadas para construir um modelo matemático para calcular o risco de salmonelose através de carne de frango, o qual considerou 21 módulos, desde o abate até o consumo nas residências e 20 módulos, desde o abate até o consumo em serviços de alimentação brasileiros. Na avaliação de risco para ovos, foram identificados 13 módulos, desde a produção até o consumo em residências, e 10 módulos desde a produção até o consumo em serviços de alimentação. As modelagens matemáticas foram realizadas no programa @RISK, utilizando o modelo de Monte Carlo, com 100.000 iterações para cada modelagem. A revisão sistemática demostrou que a prevalência de Salmonella spp. em carne de frango no Brasil foi de 14,96% e em ovos foi de 2,10%. Foram coletados 60.166 dados de tempo e temperatura na cadeia de carne de frango brasileira, os quais demonstraram adequação das temperaturas refrigeradas e congeladas. Também foram coletados 14.159 dados de tempo e temperatura na cadeia de ovos, demonstrando que a produção e distribuição ocorreram em temperatura ambiente. Esses dados foram utilizados para modelar os 15 cenários da cadeia produtiva de frangos e 10 cenários da cadeia de ovos, objetivando identificar estratégias de mitigação de risco de salmonelose. Um trabalho foi publicado, abordando as boas práticas e hábitos de consumo na população brasileira e demonstrou que 96,79% dos respondentes consumiam carne de frango e 97,54% consumiam ovos, pelo menos, 2 vezes na semana, em uma refeição diária. Considerando a dose infectante de apenas 1 UFC de Salmonella, o risco de infecção devido ao consumo de carne de frango nas residências foi de 8,092 em 1.000 exposições e, nos serviços de alimentação, foi de 7,95 casos em 1.000 exposições. O risco inicial de infecção devido ao consumo de ovos em casa ou em serviços de alimentação foi de 6 casos em 100 exposições. Os cenários modelados demonstraram que a redução de contaminação cruzada dentro das cozinhas de residências e serviços de alimentação, após cocção adequada da carne de frango e a redução na prevalência inicial de Salmonella spp. foram as estratégias mais eficazes para redução do risco, sendo que a redução das concentrações desse microrganismo não afetaram o risco. Métodos de redução da contaminação dentro da indústria, como lavagem de carcaças, ausência de contaminação cruzada na depenagem e evisceração, não reduziram o risco de salmoneloses na população, porém foram considerados importantes para reduzir a concentração e possivelmente a prevalência de Salmonella spp. das carcaças de frango e ovos liberadas para o comércio interno e exportação. As avaliações de risco desenvolvidas nessa Tese podem auxiliar no desenvolvimento de estratégias de intervenção e gestão para mitigar os riscos de salmonelose pelo consumo de frangos e ovos no Brasil.Currently, Brazil is the world leader in chicken exports and, in recent years, has achieved the record production of chicken and eggs. Salmonella spp. is one of the main food pathogens in the world, being frequently transmitted by chicken meat and eggs. In the present study, quantitative risk assessments of salmonellosis were performed, due to the consumption of chicken meat and eggs produced under official inspection in Brazil. For this, information from a systematic review of scientific literature, data obtained from the Ministry of Agriculture, Livestock and Supply (MAPA), information from industries and other sectors of the production chain and the Brazilian population were considered. Predictive microbiology models were developed, considering the multiplication of some of the main serovars of Salmonella spp. in Brazilian chicken meat. The multiplication of Salmonella in eggs was modeled using predictive microbiology software. The information was used to build a mathematical model to calculate the risk of salmonellosis through chicken meat, which considered 21 modules, from slaughter to consumption in homes and 20 modules, from slaughter to consumption in Brazilian food services. In the risk assessment for eggs, 13 modules were identified, from production to consumption in homes, and 10 modules from production to consumption in food services. The mathematical models were performed using the @RISK program, by the Monte Carlo model, with 100,000 iterations for each model. The systematic review showed that the prevalence of Salmonella spp. in chicken meat in Brazil it was 14.96% and in eggs it was 2.10%. 60,166 time and temperature data were collected in the Brazilian chicken meat chain, which demonstrated the adequacy of chilled and frozen temperatures. 14,159 time and temperature data were also collected in the egg chain, demonstrating that production and distribution occurred at room temperature. These data were used to model the 15 scenarios of the chicken production chain and 10 scenarios of the egg chain, aiming to identify risk mitigation strategies for salmonellosis. A study was published, addressing good practices and consumption habits in the Brazilian population and showed that 96.79% of respondents consumed chicken meat and 97.54% consumed eggs at least twice a week, in a daily meal. Considering the infective dose of only 1 CFU of Salmonella, the risk of infection due to the consumption of chicken meat in homes was 8.092 in 1,000 exposures and, in food services, it was 7.95 cases in 1,000 exposures. The initial risk of infection due to the consumption of eggs at home or in food services was 6 cases per 100 exposures. The modeled scenarios demonstrated that the reduction in crosscontamination inside home kichen and food services, after adequate chicken meat cooking, and reduction in the initial prevalence of Salmonella spp. it was the most effective strategy for reducing risk, and reducing the concentrations of this microorganism did not affect the risk. Methods for reducing contamination within the industry, such as carcass washing, absence of cross contamination in plucking and evisceration, did not reduce the risk of salmonellosis in the population, but were considered important to reduce the concentration and possibly the prevalence of Salmonella spp. of chicken and egg carcasses released for domestic and export trade. The risk assessments developed in this Thesis can assist in the development of intervention and management strategies to mitigate the risks of salmonellosis due to the consumption of chickens and eggs in Brazil

Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia

BACKGROUND: While gastrointestinal problems are common in ICU patients with multiple organ failure, gastrointestinal failure has not been given the consideration other organ systems receive. The aim of this study was to evaluate the incidence of gastrointestinal failure (GIF), to identify its risk factors, and to determine its association with ICU mortality. METHODS: A retrospective analysis of adult patients (n = 2588) admitted to three different ICUs (two ICUs at the university hospital Charité-Universitätsmedizin Berlin, Germany and one at Tartu University Clinics, Estonia) during the year 2002 was performed. Data recorded in a computerized database were used in Berlin. In Tartu, the data documented in the patients' charts was retrospectively transferred into a similar database. GIF was defined as documented gastrointestinal problems (food intolerance, gastrointestinal haemorrhage, and/or ileus) in the patient data at any period of their ICU stay. ICU mortality, length of stay, and duration of mechanical ventilation were assessed as outcome parameters. RESULTS: GIF was identified in 252 patients (9.7% of all patients). Only 20% of GIF patients were identifiable at admission. GIF was related to significantly higher mortality (43.7% vs. 5.3% in patients without GIF), as well as prolonged length of ICU stay (10 vs. 2 days) and mechanical ventilation (8 vs. 1 day), p < 0.001, respectively. Patients' profile (emergency surgical or medical), APACHE II and SOFA scores and the use of catecholamines at admission were identified as independent risk factors for the development of GIF. Development of GIF during ICU stay was an independent predictor for death. CONCLUSION: Gastrointestinal failure represents a relevant clinical problem accompanied by an increased mortality, longer ICU stay and mechanical ventilation

Lessons and implications from a mass immunization campaign in squatter settlements of Karachi, Pakistan: an experience from a cluster-randomized double-blinded vaccine trial [NCT00125047]

OBJECTIVE: To determine the safety and logistic feasibility of a mass immunization strategy outside the local immunization program in the pediatric population of urban squatter settlements in Karachi, Pakistan. METHODS: A cluster-randomized double blind preventive trial was launched in August 2003 in 60 geographic clusters covering 21,059 children ages 2 to 16 years. After consent was obtained from parents or guardians, eligible children were immunized parenterally at vaccination posts in each cluster with Vi polysaccharide or hepatitis A vaccine. Safety, logistics, and standards were monitored and documented. RESULTS: The vaccine coverage of the population was 74% and was higher in those under age 10 years. No life-threatening serious adverse events were reported. Adverse events occurred in less than 1% of all vaccine recipients and the main reactions reported were fever and local pain. The proportion of adverse events in Vi polysaccharide and hepatitis A recipients will not be known until the end of the trial when the code is broken. Throughout the vaccination campaign safe injection practices were maintained and the cold chain was not interrupted. Mass vaccination in slums had good acceptance. Because populations in such areas are highly mobile, settlement conditions could affect coverage. Systemic reactions were uncommon and local reactions were mild and transient. Close community involvement was pivotal for information dissemination and immunization coverage. CONCLUSION: This vaccine strategy described together with other information that will soon be available in the area (cost/effectiveness, vaccine delivery costs, etc) will make typhoid fever control become a reality in the near future

Epilepsy, hippocampal sclerosis and febrile seizures linked by common genetic variation around SCN1A

Epilepsy comprises several syndromes, amongst the most common being mesial temporal lobe epilepsy with hippocampal sclerosis. Seizures in mesial temporal lobe epilepsy with hippocampal sclerosis are typically drug-resistant, and mesial temporal lobe epilepsy with hippocampal sclerosis is frequently associated with important co-morbidities, mandating the search for better understanding and treatment. The cause of mesial temporal lobe epilepsy with hippocampal sclerosis is unknown, but there is an association with childhood febrile seizures. Several rarer epilepsies featuring febrile seizures are caused by mutations in SCN1A, which encodes a brain-expressed sodium channel subunit targeted by many anti-epileptic drugs. We undertook a genome-wide association study in 1018 people with mesial temporal lobe epilepsy with hippocampal sclerosis and 7552 control subjects, with validation in an independent sample set comprising 959 people with mesial temporal lobe epilepsy with hippocampal sclerosis and 3591 control subjects. To dissect out variants related to a history of febrile seizures, we tested cases with mesial temporal lobe epilepsy with hippocampal sclerosis with (overall n = 757) and without (overall n = 803) a history of febrile seizures. Meta-analysis revealed a genome-wide significant association for mesial temporal lobe epilepsy with hippocampal sclerosis with febrile seizures at the sodium channel gene cluster on chromosome 2q24.3 [rs7587026, within an intron of the SCN1A gene, P = 3.36 × 10−9, odds ratio (A) = 1.42, 95% confidence interval: 1.26-1.59]. In a cohort of 172 individuals with febrile seizures, who did not develop epilepsy during prospective follow-up to age 13 years, and 6456 controls, no association was found for rs7587026 and febrile seizures. These findings suggest SCN1A involvement in a common epilepsy syndrome, give new direction to biological understanding of mesial temporal lobe epilepsy with hippocampal sclerosis with febrile seizures, and open avenues for investigation of prognostic factors and possible prevention of epilepsy in some children with febrile seizure

Escherichia coli o157 em água de irrigação: detecção, multiplicação e sobrevivência ao hipoclorito de sódio

A água de irrigação têm sido considerada a principal fonte de contaminação microbiológica de vegetais, em nível primário de produção. Escherichia coli produtoras de toxina Shiga (STEC), principalmente do sorogrupo O157, têm causado graves surtos alimentares, envolvendo muitos alimentos, dentre eles os vegetais. No Brasil, E. coli O157:H7 foi recentemente isolada na água de irrigação de propriedades rurais da região Sul, demonstrando risco de contaminação do produto final. Após esse isolamento, foi desenvolvido o projeto “Baseline study about irrigation water in Brazil and Spain: Impact of microbial quality, sources, type of irrigation systems and the type of crop on the food safety of fresh products”. O estudo realizado na presente dissertação faz parte desse projeto e teve por objetivo investigar a contaminação por E. coli O157 na água de irrigação de alfaces no Sul do Brasil. Além disso, objetivou-se analisar a multiplicação desse patógeno em amostra de água de irrigação bem como sua sobrevivência ao hipoclorito de sódio. Os resultados obtidos demostram que E. coli O157 foi isolada em 19,65 % das 56 amostras coletadas. A prevalência de E. coli O157 não foi correlacionada ao sistema de cultivo, a fonte de irrigação e ao método de irrigação. E. coli O157 isoladas de diferentes locais foram capazes de se multiplicar na amostra indicativa de água de irrigação, atingindo populações de 6,30 ± 0,177 log UFC/mL, após 48 h, em temperatura ambiente. Esses resultados demonstraram que altas contagens desse microrganismo podem ocorrer em açudes utilizados para irrigar folhosos. A exposição dos isolados de E. coli O157 a soluções contendo 2, 7 e 20 mg/L de cloro livre, ao longo de 45 min, reduziu aproximadamente 1,30 ± 0,66 log UFC/mL, o que não possibilitou atingir de níveis seguros para esse patógeno. Este estudo demonstrou a presença de E. coli O157 na água de irrigação no Sul do Brasil e sua capacidade de multiplicação nessas águas. Além disso, evidenciou que a cloração com até 20 mg/L não foi suficiente para controlar esse perigo biológico em condições possíveis de serem alcançadas nas propriedades rurais. Tais resultados reforçam a necessidade de adoção de Boas Práticas Agrícolas (BPA) para prevenir a contaminação das fontes de água de irrigação, nessas propriedades.Irrigation water have been considered the main source of microbial contamination in vevegatbles at the primary level of production. Shiga-toxin producing Escherichia coli (STEC), mainly O157 serogroup, have caused severe food outbreaks involving many foods, including vegetables. In Brazil, E. coli O157: H7 was recently isolated in the water irrigation farms in the southern region, demonstrating risk of contamination in the final product. After this isolation, it was developed the project "Baseline study about irrigation water in Brazil and Spain: Impact of microbial quality, sources, type of irrigation systems and the type of crop on the food safety of fresh products". The study in this thesis is part of this project and aimed to investigate contamination by E. coli O157 in irrigation water of lettuce in southern Brazil. In addition, the objective was to analyze the multiplication of pathogens in irrigation water sample and its survival to sodium hypochlorite. The results demonstrate that E. coli O157 was isolated in 19.65 % of the 56 samples collected. The prevalence of E. coli O157 was not correlated to the cultivation system, the source of irrigation and irrigation method. E. coli O157 isolated from different sites were able to multiply in the sample indicative of irrigation water reaching populations of 0.177 ± 6.30 log CFU/mL after 48 h at room temperature. These results demonstrate that high counts of this microorganism can occur in reservoirs used to irrigate leafy. Exposure of E. coli O157 isolated from solutions containing 2, 7 and 20 mg/L of free chlorine over 45 min, reduced approximately 1.30 ± 0.66 log CFU/mL, which is not allowed to reach safe levels for this pathogen. This study demonstrated the presence of E. coli O157 in the irrigation water in southern Brazil and its multiplication capacity in these waters. Moreover, it showed that the chlorination up to 20 mg/L was not enough to control this biological hazard in conditions likely to be achieved in rural properties. These results reinforce the need for adoption of Good Agricultural Practices (GAP) to prevent contamination of irrigation water sources in these properties

Escherichia coli o157 em água de irrigação: detecção, multiplicação e sobrevivência ao hipoclorito de sódio

A água de irrigação têm sido considerada a principal fonte de contaminação microbiológica de vegetais, em nível primário de produção. Escherichia coli produtoras de toxina Shiga (STEC), principalmente do sorogrupo O157, têm causado graves surtos alimentares, envolvendo muitos alimentos, dentre eles os vegetais. No Brasil, E. coli O157:H7 foi recentemente isolada na água de irrigação de propriedades rurais da região Sul, demonstrando risco de contaminação do produto final. Após esse isolamento, foi desenvolvido o projeto “Baseline study about irrigation water in Brazil and Spain: Impact of microbial quality, sources, type of irrigation systems and the type of crop on the food safety of fresh products”. O estudo realizado na presente dissertação faz parte desse projeto e teve por objetivo investigar a contaminação por E. coli O157 na água de irrigação de alfaces no Sul do Brasil. Além disso, objetivou-se analisar a multiplicação desse patógeno em amostra de água de irrigação bem como sua sobrevivência ao hipoclorito de sódio. Os resultados obtidos demostram que E. coli O157 foi isolada em 19,65 % das 56 amostras coletadas. A prevalência de E. coli O157 não foi correlacionada ao sistema de cultivo, a fonte de irrigação e ao método de irrigação. E. coli O157 isoladas de diferentes locais foram capazes de se multiplicar na amostra indicativa de água de irrigação, atingindo populações de 6,30 ± 0,177 log UFC/mL, após 48 h, em temperatura ambiente. Esses resultados demonstraram que altas contagens desse microrganismo podem ocorrer em açudes utilizados para irrigar folhosos. A exposição dos isolados de E. coli O157 a soluções contendo 2, 7 e 20 mg/L de cloro livre, ao longo de 45 min, reduziu aproximadamente 1,30 ± 0,66 log UFC/mL, o que não possibilitou atingir de níveis seguros para esse patógeno. Este estudo demonstrou a presença de E. coli O157 na água de irrigação no Sul do Brasil e sua capacidade de multiplicação nessas águas. Além disso, evidenciou que a cloração com até 20 mg/L não foi suficiente para controlar esse perigo biológico em condições possíveis de serem alcançadas nas propriedades rurais. Tais resultados reforçam a necessidade de adoção de Boas Práticas Agrícolas (BPA) para prevenir a contaminação das fontes de água de irrigação, nessas propriedades.Irrigation water have been considered the main source of microbial contamination in vevegatbles at the primary level of production. Shiga-toxin producing Escherichia coli (STEC), mainly O157 serogroup, have caused severe food outbreaks involving many foods, including vegetables. In Brazil, E. coli O157: H7 was recently isolated in the water irrigation farms in the southern region, demonstrating risk of contamination in the final product. After this isolation, it was developed the project "Baseline study about irrigation water in Brazil and Spain: Impact of microbial quality, sources, type of irrigation systems and the type of crop on the food safety of fresh products". The study in this thesis is part of this project and aimed to investigate contamination by E. coli O157 in irrigation water of lettuce in southern Brazil. In addition, the objective was to analyze the multiplication of pathogens in irrigation water sample and its survival to sodium hypochlorite. The results demonstrate that E. coli O157 was isolated in 19.65 % of the 56 samples collected. The prevalence of E. coli O157 was not correlated to the cultivation system, the source of irrigation and irrigation method. E. coli O157 isolated from different sites were able to multiply in the sample indicative of irrigation water reaching populations of 0.177 ± 6.30 log CFU/mL after 48 h at room temperature. These results demonstrate that high counts of this microorganism can occur in reservoirs used to irrigate leafy. Exposure of E. coli O157 isolated from solutions containing 2, 7 and 20 mg/L of free chlorine over 45 min, reduced approximately 1.30 ± 0.66 log CFU/mL, which is not allowed to reach safe levels for this pathogen. This study demonstrated the presence of E. coli O157 in the irrigation water in southern Brazil and its multiplication capacity in these waters. Moreover, it showed that the chlorination up to 20 mg/L was not enough to control this biological hazard in conditions likely to be achieved in rural properties. These results reinforce the need for adoption of Good Agricultural Practices (GAP) to prevent contamination of irrigation water sources in these properties