Quantitative Microbial Risk Assessment for Listeria Monocytogenes on Fresh Baby Spinach Leaves

The increase in foodborne illness outbreaks associated with leafy green vegetables can be attributed to the minimal processing required of this group of fresh produce. Neglecting effective microbial elimination steps result in leafy green vegetables that naturally contain microorganisms such as pathogens microorganisms. This quantitative microbial risk assessment describe the change of L. monocytogenes concentration in fresh baby spinach from farm to table. This model also consists of several scenarios to evaluate decontamination treatments, cross-contamination, and temperature abuse. Cross-contamination was the biggest issue when ensuring safety of leafy green vegetables. Temperature abuse also increased the risk of listeriosis. On the other hand, irradiation treatment with Modified Atmosphere Packaging reduced the number of annual cases of listeriosis by 99.99%. In addition, the validation of L. innocua used as a surrogate for L. monocytogenes in fresh baby spinach was evaluated based on reductions by washing (water and chlorine) treatments and growth at temperatures between 5 and 36oC. According to the results of the washing treatments, the concentration of L. innocua was reduced by almost 0.5 log CFU/g. This is more than that of L. monocytogenes. Furthermore, the effect of natural background microflora on the growth of L. monocytogenes and L. innocua in fresh baby spinach was determined. The results showed that the growth of L. innocua was affected more than that of L. monocytogenes at temperatures 10> T >30^(o)C. Although L. innocua and L. monoctogenes are genetically similar, their behavior changes under stress conditions. Ultimately, the dynamic growth models for L. monocytogenes in fresh baby spinach was presented. These models can be used to estimate the growth of L. monocytogenes in fresh baby spinach during distribution, storage or market, and potential growth at a consumer level

Understanding and Quantifying the Role of Aqueous Solutions on the Antimicrobial Effectiveness of Electron Beam Irradiation Applied to Fresh Produce

The main aim of this study was to enhance the safety if fresh produce in general, and grape tomatoes in particular, by the combined treatments of electron beam (e-beam) irradiation and hydrogen peroxide (Hv2Ov2) aqueous solution. For the achieving this aim, this study was divided into three steps. At first and second steps, the effect of culture media used for the preparation of inoculum and water quality parameters, respectively, on the effectiveness of e-beam irradiation to inactivate Salmonella Typhimurium were evaluated. At final step, the decontamination ability of the combined treatment of ebeam and Hv2Ov2 for the inactivation of Salmonella spp. in whole grape tomatoes was evaluated. In the first step, the radiation sensitivity (Dv10 value) of the pathogen in deionized (DI) water decreased (P 0.05) the Dv10 value calculated for S. Typhimurium in DI water. In addition, the presence of hydroxyl radical scavengers, ethanol and polyethylene glycol (PEG), provided a protection to S. Typhimurium cells. The radiation sensitivity of the pathogen in buffer solution decreased (P 0.05) the Dv10 value calculate for the bacterium in buffer solution. In the second step, the pH ranged from 5.5 to 8.5 and alkalinity (≤ 500mg/l) did not affect (P > 0.05) the radiation sensitivity of S. Typhimurium in buffer solution. Nevertheless, the radiation sensitivity of S. Typhimurium in buffer solution increased (P < 0.05) when fulvic acid (100 mg/l ≤) and nitrate (≥ 100 mg/l) was added into buffer solution as organic and inorganic substances, respectively. In addition, the radiation sensitivity of S. Typhimurium in buffer solution increased (P < 0.05) regardless of Hv2Ov2 concentration. In the third step, it is found that this integrated treatment was effective to inactivate Salmonella spp. in grape tomatoes. The calculated Dv10 value for Salmonella spp. on grape tomatoes was 0.25 kGy. In addition, this system improved uniform dose distribution throughout tomatoes. Furthermore, the e-beam dose up to 1.25 kGy did not affect the quality of tomatoes. Ultimately, the present study demonstrated that the combined treatments of ebeam and Hv2Ov2 aqueous solution could be a promising alternative to conventional processes and should enhance the safety of fresh produce

Evaluation of left ventricular systolic function with pulsed wave tissue Doppler in rheumatic mitral stenosis

Background: Mitral stenosis (MS) is still the most common complication of acute rheumatic fever in Turkey. Rheumatic carditis affects not only cardiac valves but also myocardium. In this study, we aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction and contraction of short and long axial circumferential and longitudinal fibers by pulsed wave tissue Doppler in rheumatic MS patients who have preserved LV systolic function in 2D echocardiography.Methods: Fifteen severe, 20 moderate rheumatic MS patients hospitalized for mitral balloon valvuloplasty, and 15 patients who had normal echocardiographic findings were included in the study. After routine conventional transthoracic echocardiographic examination, LV myocardial systolic velocities were evaluated with pulsed wave tissue Doppler in the short and long axis with simultaneous electrocardiographic monitoring.Results: Long axis first systolic velocity (SW1) of mild-moderate and severe MS was much lower than normal group (10.7 ± 2.3 in normal group vs. 7.9 ± 1.3 in mild-moderate MS group vs. 6.2 ± 1.4 in severe MS group, p &lt; 0.001). Long axis Q-SW1 duration was longer in mild-moderate MS group (145 ± 32 in normal group vs. 199 ± 43 in mild-moderate MS group, p = 0.001). Short axis Q-SW2 duration was longer in normal group compared to mild-moderate and severe MS groups (298 ± 41 in normal group vs. 245 ± 37 in mild-moderate MS group vs. 234 ± 26 in severe MS group, p &lt; 0.001). Significant correlation between mitral valve area and SW1, Q-SW1 was determined (p = 0.01).Conclusions: Even if LV functions are normal with conventional 2D echocardiography, subclinical systolic dysfunction exists in MS. Also, there is a dyssynchrony between contraction of longitudinal and circumferential myofibrils

Relationship between CHA2DS2-VASc and CHADS2 scores with pulmonary hypertension in patients with acute pulmonary embolism

Introduction: Pulmonary hypertension (PH) is the most important prognostic factor after acute pulmonary embolism (PE). Therefore, determination of patients who will develop PH after acute PE is crucial.  The aim of the present study was to evaluate the predictive value of the CHADS2 and CHA2DS2-VASc scores for PH in patients with acute PE.Material and methods: Seventy-nine adults who presented with acute PE, had an admission systolic pulmonary artery pressure (sPAP) measured on echocardiogram and no previous history of PE, were retrospectively identified from the computerized database. 31 patients who had sPAP ≤ 40 mm Hg were categorized as a  “normal pulmonary pressure” group, whereas 48 patients who had sPAP &gt; 40 mm Hg were categorized as a “PH” group.Results: SPAP was &gt; 40 mm Hg in 48 patients (60.8%), with a mean sPAP of 60.9 ± 16.1 mm Hg (median = 60, min–max = 41–100 mm Hg). In multivariate logistic regression models adjusted for CHADS2 and CHA2DS2-VASc score components, only age was found to be related with the development of PH. SPAP was weakly positively correlated with CHADS2 (p = 0.047; r = 0.224) and CHA2DS2-VASc (p = 0.023; r = 0.256) scores. SPAP values were increasing with the severity of the scores.Conclusions: Both CHADS2 and CHA2DS2-VASc scores could be useful in the determination of which patients should be closely followed up in order to prevent the development of PH after acute PE

Cardiac Involvement in Glycogen Storage Disease Type IV: Two Cases and the Two Ends of a Spectrum

Glycogen storage disease type IV (GSD IV) is an autosomal recessive disorder due to the deficiency of α 1,4-glucan branching enzyme, resulting in an accumulation of amylopectin-like polysaccharide in various systems. We describe two cases, a 23-year-old girl with dilated cardiomyopathy who presented with progressive dyspnea and fatigue and a 28-year-old girl with hypertrophic cardiomyopathy who was asymptomatic, secondary to the accumulation of amylopectin-like fibrillar glycogen, in heart. In both patients, the diagnosis was confirmed by enzyme assessment. Our patients showed that GSD IV is not only liver or skeletal muscle disease, but also it can be presented in different form of the spectrum of cardiomyopathy from dilated to hypertrophic and from asymptomatic to decompensated heart failure. Also, to our knowledge, this is the first hypertrophic cardiomyopathy case due to GSD IV in the literature

The relationship between functional capacity and ultrasonic tissue characterization in patients with idiopathic dilated cardiomyopathy

Background: Ultrasonic tissue characterization (UTC) has been widely used to investigate left ventricular (LV) dysfunction in various cardiac disorders. The aim of this study was to investigate the correlation between functional capacity and UTC in patients with idiopathic dilated cardiomyopathy (IDCM).Methods and Results: Treadmill test according to modified-Bruce protocol was performed in 48 patients with IDCM to assess their functional capacity. Baseline clinical and echocardiographic variables were obtained and UTC was performed on images obtained from septum and posterior wall (PW). Cyclic variation (CV) index of mean gray level (MGL) was calculated according to the formula: [(MGLdiastole − MGLsystole) ÷ MGLdiastole] × 100.PW and septum CV indices were correlated with exercise duration (r = 0.63, p = 0.001 and r = 0.67, p = 0.0001, respectively) and “MET” level (r = 0.80, p = 0.0001 and r = 0.83,p = 0.0001, respectively). The ROC curve analysis revealed that the PW CV index was a strong indicator of good exercise capacity (&gt; 8 METs) with an AUC of 0.97 (95% CI0.90–1.0), as the interventricular septum (IVS) CV index (AUC = 0.97, 95% CI 0.89–1.0). Sensitivity, specificity, positive predictive value, and negative predictive value to identify good exercise capacity for IVS CV index were 90%, 88%, 82%, and 94%, respectively and for the PW CV index, 90%, 88%, 82%, and 94%, respectively.Conclusions: In this particular study, we found out that in patients with severe LV dysfunction good exercise capacity was related to septum and PW CV indices measured by UTC, and these indices may be used as an indirect prognostic marker in heart failure

The Definition of Sarcomeric and Non-Sarcomeric Gene Mutations in Hypertrophic Cardiomyopathy Patients: A Multicenter Diagnostic Study Across Turkiye

Background: Hypertrophic cardiomyopathy is a common genetic heart disease and up to 40%-60% of patients have mutations in cardiac sarcomere protein genes. This genetic diagnosis study aimed to detect pathogenic or likely pathogenic sarcomeric and non-sarcomeric gene mutations and to confirm a final molecular diagnosis in patients diagnosed with hypertrophic cardiomyopathy. Methods: A total of 392 patients with hypertrophic cardiomyopathy were included in this nationwide multicenter study conducted at 23 centers across Turkiye. All samples were analyzed with a 17-gene hypertrophic cardiomyopathy panel using next-generation sequencing technology. The gene panel includes ACTC1, DES, FLNC, GLA, LAMP2, MYBPC3, MYH7, MYL2, MYL3, PLN, PRKAG2, PTPN11, TNNC1, TNNI3, TNNT2, TPM1, and TTR genes. Results: The next-generation sequencing panel identified positive genetic variants (variants of unknown significance, likely pathogenic or pathogenic) in 12 genes for 121 of 392 samples, including sarcomeric gene mutations in 30.4% (119/392) of samples tested, galactosidase alpha variants in 0.5% (2/392) of samples and TTR variant in 0.025% (1/392). The likely pathogenic or pathogenic variants identified in 69 (57.0%) of 121 positive samples yielded a confirmed molecular diagnosis. The diagnostic yield was 17.1% (15.8% for hypertrophic cardiomyopathy variants) for hypertrophic cardiomyopathy and hypertrophic cardiomyopathy phenocopies and 0.5% for Fabry disease. Conclusions: Our study showed that the distribution of genetic mutations, the prevalence of Fabry disease, and TTR amyloidosis in the Turkish population diagnosed with hypertrophic cardiomyopathy were similar to the other populations, but the percentage of sarcomeric gene mutations was slightly lower.Sanofi TurkeyThe authors thank Cagla Ayhan, MD, and Prof Sule Oktay, MD, PhD., from KAPPA Consultancy Training Research Ltd, Istanbul, who provided editorial support funded by Sanofi Turkey, and Canser Boz, MD, from Istanbul University Cerrahpasa Faculty of Health Sciences for his contributions in statistical analysis

Understanding and Quantifying the Role of Aqueous Solutions on the Antimicrobial Effectiveness of Electron Beam Irradiation Applied to Fresh Produce

The main aim of this study was to enhance the safety if fresh produce in general, and grape tomatoes in particular, by the combined treatments of electron beam (e-beam) irradiation and hydrogen peroxide (Hv2Ov2) aqueous solution. For the achieving this aim, this study was divided into three steps. At first and second steps, the effect of culture media used for the preparation of inoculum and water quality parameters, respectively, on the effectiveness of e-beam irradiation to inactivate Salmonella Typhimurium were evaluated. At final step, the decontamination ability of the combined treatment of ebeam and Hv2Ov2 for the inactivation of Salmonella spp. in whole grape tomatoes was evaluated. In the first step, the radiation sensitivity (Dv10 value) of the pathogen in deionized (DI) water decreased (P 0.05) the Dv10 value calculated for S. Typhimurium in DI water. In addition, the presence of hydroxyl radical scavengers, ethanol and polyethylene glycol (PEG), provided a protection to S. Typhimurium cells. The radiation sensitivity of the pathogen in buffer solution decreased (P 0.05) the Dv10 value calculate for the bacterium in buffer solution. In the second step, the pH ranged from 5.5 to 8.5 and alkalinity (≤ 500mg/l) did not affect (P > 0.05) the radiation sensitivity of S. Typhimurium in buffer solution. Nevertheless, the radiation sensitivity of S. Typhimurium in buffer solution increased (P < 0.05) when fulvic acid (100 mg/l ≤) and nitrate (≥ 100 mg/l) was added into buffer solution as organic and inorganic substances, respectively. In addition, the radiation sensitivity of S. Typhimurium in buffer solution increased (P < 0.05) regardless of Hv2Ov2 concentration. In the third step, it is found that this integrated treatment was effective to inactivate Salmonella spp. in grape tomatoes. The calculated Dv10 value for Salmonella spp. on grape tomatoes was 0.25 kGy. In addition, this system improved uniform dose distribution throughout tomatoes. Furthermore, the e-beam dose up to 1.25 kGy did not affect the quality of tomatoes. Ultimately, the present study demonstrated that the combined treatments of ebeam and Hv2Ov2 aqueous solution could be a promising alternative to conventional processes and should enhance the safety of fresh produce