Pilot istraživanje Clostridium difficile infekcija u bolesnika s proljevom u zdravstvenim ustanovama u Tbilisiju, Gruzija

Background: Clostridium difficile infection (CDI) is the most frequent cause of healthcare-associated diarrhoea and is increasingly recognized in the community. The epidemiology of CDI in Georgia is unknown. Methods: Pilot surveillance for CDI among patients with diarrhoea was conducted in four hospital ICUs, and three outpatient clinics in Tbilisi, Georgia. Demographic, clinical and treatment data of patients with CDI were collected from medical records. A CDI diagnosis was made if the stool sample was positive for C. difficile toxin A and/or B by nucleic acid amplification test or enzyme immunoassay, or by culture of a toxin-producing C. difficile. Results: A total of 131 patients with new onset diarrhoeal illness were recruited. Of these, laboratory confirmed CDI was found in 24% (31/131): 32% (17/53) of adult and 20% (11/55) of paediatric ICU patients, 22% (2/9) adult and 7% (1/14) of paediatric outpatients. Presenting symptoms were fever (>380C) and diarrhoea with a median duration 7 days. Most CDI cases received antibiotics before diagnosis; 94% of adults and 91% of children diagnosed in the ICU (median: 12 days); the majority receiving simultaneously two or more antibiotics. In the outpatient settings, 100% of CDI case-patients received an antibiotic for a median duration of 7 days. Conclusions: This pilot surveillance demonstrated that C. difficile is a common cause of diarrhoea in hospitalized and community patients in Georgia. It highlights the need to improve the knowledge of medical providers regarding the burden of CDI and to establish diagnostic testing at hospital laboratories.Uvod: Infekcije uzrokovane Clostridium difficile (CDI) najčešći su uzrok proljeva povezanog sa zdravstvenom skrbi i sve se više prepoznaju u zajednici. Epidemiologija C.difficile infekcija u Gruziji nije poznata. Metode: Pilot istraživanje C.difficile infekcija kod bolesnika s proljevom provedeno je u četiri bolničke jedinice za intenzivno liječenje (JIL) i tri ambulantne klinike u Tbilisiju u Gruziji. Podaci o demografskim i kliničkim karakteristikama te liječenju bolesnika s CDI prikupljeni su iz povijesti bolesti. Dijagnoza C.difficile infekcije postavljena je ukoliko je uzorak stolice bio pozitivan na C. difficile toksin A i/ili B testom amplifikacije nukleinskih kiselina ili metodom enzimskog imunoeseja ili nalazom C. difficile koji proizvode toksine u kulturi. Rezultati: U istraživanje je bio uključen 131 bolesnik s novonastalom dijarealnom bolesti. Od toga je laboratorijski dokazana CDI utvrđena kod 24% (31/131) bolesnika: u 32% (17/53) odraslih i 20% (11/55) djece liječene u JIL-u, 22% (2/9) odraslih i 7% (1/14) pedijatrijskih ambulantnih bolesnika. Simptomi su bili povišena tjelesna temperatura (> 38 ° C) i proljev s prosječnim trajanjem od 7 dana. Većina bolesnika s CDI primila je antibiotik prije postavljanja dijagnoze; 94% odraslih i 91% djece liječene u JIL-u (medijan: 12 dana); većina je istodobno primala dva ili više antibiotika. U ambulantnom okruženju, 100% bolesnika s CDI primilo je antibiotik u prosječnom trajanju od 7 dana. Zaključak: Ovo pilot istraživanje pokazalo je da je C. difficile čest uzrok proljeva u hospitaliziranih i izvanbolničkih pacijenata u Gruziji. Ono naglašava potrebu za poboljšanjem znanja pružatelja zdravstvenih usluga vezano uz probleme koje nose infekcije uzrokovane C. difficile te uspostavom dijagnostičkih testova u bolničkim laboratorijima

Cortical Thickness Related to Compensatory Viewing Strategies in Patients With Macular Degeneration

Retinal diseases like age-related macular degeneration (AMD) or hereditary juvenile macular dystrophies (JMD) lead to a loss of central vision. Many patients compensate for this loss with a pseudo fovea in the intact peripheral retina, the so-called “preferred retinal locus” (PRL). How extensive eccentric viewing associated with central vision loss (CVL) affects brain structures responsible for visual perception and visually guided eye movements remains unknown. CVL results in a reduction of cortical gray matter in the “lesion projection zone” (LPZ) in early visual cortex, but the thickness of primary visual cortex appears to be largely preserved for eccentric-field representations. Here we explore how eccentric viewing strategies are related to cortical thickness (CT) measures in early visual cortex and in brain areas involved in the control of eye movements (frontal eye fields, FEF, supplementary eye fields, SEF, and premotor eye fields, PEF). We determined the projection zones (regions of interest, ROIs) of the PRL and of an equally peripheral area in the opposite hemifield (OppPRL) in early visual cortex (V1 and V2) in 32 patients with MD and 32 age-matched controls (19–84 years) by functional magnetic resonance imaging. Subsequently, we calculated the CT in these ROIs and compared it between PRL and OppPRL as well as between groups. Additionally, we examined the CT of FEF, SEF, and PEF and correlated it with behavioral measures like reading speed and eccentric fixation stability at the PRL. We found a significant difference between PRL and OppPRL projection zones in V1 with increased CT at the PRL, that was more pronounced in the patients, but also visible in the controls. Although the mean CT of the eye fields did not differ significantly between patients and controls, we found a trend to a positive correlation between CT in the right FEF and SEF and fixation stability in the whole patient group and between CT in the right PEF and reading speed in the JMD subgroup. The results indicate a possible association between the compensatory strategies used by patients with CVL and structural brain properties in early visual cortex and cortical eye fields

A clinical test for visual crowding

Crowding is a major limitation of visual perception. Because of crowding, a simple object, like a letter, can only be recognized if clutter is a certain critical spacing away. Crowding is only weakly associated with acuity. The critical spacing of crowding is lowest in the normal fovea, and grows with increasing eccentricity in peripheral vision. Foveal crowding is more prominent in certain patient groups, including those with strabismic amblyopia and apperceptive agnosia. Crowding may lessen with age during childhood as reading speed increases. The range of crowding predicts much of the slowness of reading in children with developmental dyslexia. There is tantalizing evidence suggesting that the critical spacing of crowding indicates neural density (participating neurons per square deg) in the visual cortex. Thus, for basic and applied reasons, it would be very interesting to measure foveal crowding clinically in children and adults with normal and impaired vision, and to track the development of crowding during childhood. While many labs routinely measure peripheral crowding as part of their basic research in visual perception, current tests are not well suited to routine clinical testing because they take too much time, require good fixation, and are mostly not applicable to foveal vision. Here we report a new test for clinical measurement of crowding in the fovea. It is quick and accurate, works well with children and adults, and we expect it to work well with dementia patients as well. The task is to identify a numerical digit, 1-9, using a new “Pelli” font that is identifiable at tiny width (0.02 deg, about 1 minarc, in normal adult fovea). This allows quick measurement of the very small (0.05 deg) critical spacing in the normal adult fovea, as well as with other groups that have higher critical spacing. Preliminary results from healthy adults and children are presented

Geo-temporal patterns to design cost-effective interventions for zoonotic diseases -the case of brucellosis in the country of Georgia

IntroductionControl of zoonosis can benefit from geo-referenced procedures. Focusing on brucellosis, here the ability of two methods to distinguish disease dissemination patterns and promote cost-effective interventions was compared.MethodGeographical data on bovine, ovine and human brucellosis reported in the country of Georgia between 2014 and 2019 were investigated with (i) the Hot Spot (HS) analysis and (ii) a bio-geographical (BG) alternative.ResultsMore than one fourth of all sites reported cases affecting two or more species. While ruminant cases displayed different patterns over time, most human cases described similar geo-temporal features, which were associated with the route used by migrant shepherds. Other human cases showed heterogeneous patterns. The BG approach identified small areas with a case density twice as high as the HS method. The BG method also identified, in 2018, a 2.6–2.99 higher case density in zoonotic (human and non-human) sites than in non-zoonotic sites (which only reported cases affecting a single species) –a finding that, if corroborated, could support cost-effective policy-making.DiscussionThree dissemination hypotheses were supported by the data: (i) human cases induced by sheep-related contacts; (ii) human cases probably mediated by contaminated milk or meat; and (iii) cattle and sheep that infected one another. This proof-of-concept provided a preliminary validation for a method that may support cost-effective interventions oriented to control zoonoses. To expand these findings, additional studies on zoonosis-related decision-making are recommended

Setting a baseline for global urban virome surveillance in sewage

The rapid development of megacities, and their growing connectedness across the world is becoming a distinct driver for emerging disease outbreaks. Early detection of unusual disease emergence and spread should therefore include such cities as part of risk-based surveillance. A catch-all metagenomic sequencing approach of urban sewage could potentially provide an unbiased insight into the dynamics of viral pathogens circulating in a community irrespective of access to care, a potential which already has been proven for the surveillance of poliovirus. Here, we present a detailed characterization of sewage viromes from a snapshot of 81 high density urban areas across the globe, including in-depth assessment of potential biases, as a proof of concept for catch-all viral pathogen surveillance. We show the ability to detect a wide range of viruses and geographical and seasonal differences for specific viral groups. Our findings offer a cross-sectional baseline for further research in viral surveillance from urban sewage samples and place previous studies in a global perspective

Senescent changes in photopic spatial summation

Previous studies have demonstrated an inverse relation between the size of the complete spatial summation area and ganglion cell density. We hypothesized that if this relation is dynamic, the spatial summation area at 6° nasal would expand to compensate for age-related losses of retinal ganglion cells but not in the fovea where age-related loss in ganglion cell density is not significant. This hypothesis was tested by measuring contrast thresholds with a series of Gabor patches varying in size. The spatial summation area was defined by the intersection of the segments of a two-branched, piece-wise linear function fitted to the data with slopes of -0.5 and 0 on a plot of log threshold vs. log area. Results demonstrate a 31% increase in the parafoveal spatial summation area in older observers with no significant age-related change in the fovea. The average foveal data show a significant increase in thresholds with age. Contrary to the foveal data, age comparisons of the parafoveal peak contrast thresholds display no significant difference above [corrected] the summation area. Nevertheless, as expected from the increase in summation area, expressing the parafoveal thresholds as contrast energy reveals a significant difference for stimuli that are smaller than the maximal summation area

Senescent changes in photopic spatial summation.

Previous studies have demonstrated an inverse relation between the size of the complete spatial summation area and ganglion cell density. We hypothesized that if this relation is dynamic, the spatial summation area at 6° nasal would expand to compensate for age-related losses of retinal ganglion cells but not in the fovea where age-related loss in ganglion cell density is not significant. This hypothesis was tested by measuring contrast thresholds with a series of Gabor patches varying in size. The spatial summation area was defined by the intersection of the segments of a two-branched, piece-wise linear function fitted to the data with slopes of -0.5 and 0 on a plot of log threshold vs. log area. Results demonstrate a 31% increase in the parafoveal spatial summation area in older observers with no significant age-related change in the fovea. The average foveal data show a significant increase in thresholds with age. Contrary to the foveal data, age comparisons of the parafoveal peak contrast thresholds display no significant difference above [corrected] the summation area. Nevertheless, as expected from the increase in summation area, expressing the parafoveal thresholds as contrast energy reveals a significant difference for stimuli that are smaller than the maximal summation area

Seroprevalence and risk factors of Leptospira sp. among different groups in the Jordanian population: first study

BACKGROUND: Leptospirosis is re-emerging as a major public health problem worldwide. However, there are limited data on the disease from the Middle East, including from Jordan, despite recent outbreaks occurring in Jordan's neighbouring countries. METHODS: Sera samples from 809 participants in 11 governorates were tested for Leptospira sp. seropositivity to determine the seroprevalence and risk factors of Leptospira sp. in Jordan. RESULTS: Overall, 3.3% (95% confidence interval [CI] 2.2 to 4.8) of individuals tested were seropositive for Leptospira antibodies. Individuals who drink surface water (spring or rain water) had 5.69 (95% CI 2.57 to 12.60) higher odds of seropositivity compared with individuals who used municipal or filtered water, after controlling for age and practicing horticulture. CONCLUSIONS: This is the first seroprevalence study of Leptospira sp. in Jordan and included important data on environmental and animal exposures