Role of Imaging Studies in Evaluating Patients Post Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

A 77-year-old male presented to the ED with a new onset of acute abdominal pain, nausea, and vomiting. He had a previous surgical history of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for an appendiceal tumor. Despite the repeated reassuring abdominal examinations, CT abdomen showed high-grade bowel obstruction and perforation. He was urgently taken to the operating room and underwent resection of 70 cm segment of small ischemic bowel with primary anastomosis. His postoperative course was complicated with atrial fibrillation (AF) requiring cardioversion and medical therapy. Later, he was discharged home under stable conditions. Relying on abdominal signs, an abdominal exam in a patient with a previous history of extensive peritonectomy and post-HIPEC surgery is challenging due to the altered peritoneal anatomy. As a result, the abdominal examination findings can be benign and misleading. This can lead to delayed surgical intervention, thereby increasing morbidity and mortality significantly. Therefore, a detailed evaluation with a low threshold for abdominal imaging studies like abdominal X-rays and CT abdomen series is warranted in this subset of patients

Presence of Antibiotic-Resistant Escherichia coli in Wastewater Treatment Plant Effluents Utilized as Water Reuse for Irrigation

Providing safe water through water reuse is becoming a global necessity. One concern with water reuse is the introduction of unregulated contaminants to the environment that cannot be easily removed by conventional wastewater treatment plants (WWTP). The occurrence of ampicillin, sulfamethoxazole, ciprofloxacin, and tetracycline-resistant Escherichia coli through the treatment stages of a WWTP (raw sewage, post-secondary, post-UV and post-chlorination) was investigated from January to May 2016. The highest concentrations of antibiotic resistant E. coli in the effluent were detected in April after rainfall. Ampicillin-resistant E. coli was the most common at the post UV and chlorination stages comprising 63% of the total E. coli population. The minimum inhibitory concentration (MIC) analysis showed that one in five isolates was resistant to three or more antibiotics, and the majority of these E. coli were resistant to ampicillin, followed by sulfamethoxazole and ciprofloxacin. The highest MIC was detected at the finished water after application of multiple disinfection methods. Tetracycline resistance was the least observed among others, indicating that certain drug families may respond to wastewater treatment differently. Currently, there are no policies to enforce the monitoring of antibiotic-resistant pathogen removal in WWTP. Better guidelines are needed to better regulate reuse water and prevent health risk upon exposure to antibiotic-resistant bacteria

Presence of Antibiotic-Resistant \u3cem\u3eEscherichia coli\u3c/em\u3e in Wastewater Treatment Plant Effluents Utilized as Water Reuse for Irrigation

Providing safe water through water reuse is becoming a global necessity. One concern with water reuse is the introduction of unregulated contaminants to the environment that cannot be easily removed by conventional wastewater treatment plants (WWTP). The occurrence of ampicillin, sulfamethoxazole, ciprofloxacin, and tetracycline-resistant Escherichia coli through the treatment stages of a WWTP (raw sewage, post-secondary, post-UV and post-chlorination) was investigated from January to May 2016. The highest concentrations of antibiotic resistant E. coli in the effluent were detected in April after rainfall. Ampicillin-resistant E. coli was the most common at the post UV and chlorination stages comprising 63% of the total E. coli population. The minimum inhibitory concentration (MIC) analysis showed that one in five isolates was resistant to three or more antibiotics, and the majority of these E. coli were resistant to ampicillin, followed by sulfamethoxazole and ciprofloxacin. The highest MIC was detected at the finished water after application of multiple disinfection methods. Tetracycline resistance was the least observed among others, indicating that certain drug families may respond to wastewater treatment differently. Currently, there are no policies to enforce the monitoring of antibiotic-resistant pathogen removal in WWTP. Better guidelines are needed to better regulate reuse water and prevent health risk upon exposure to antibiotic-resistant bacteria

Sources of Microbiological Contamination in Sachet Water From Ghana

Sachet water is one of the primary sources of drinking water in rapidly growing countries. A study to assess the microbiological quality of sachet water in 21 different brands was conducted in Ghana. Culturable total coliform was positive in 87% of the samples collected, where Escherichia coli colonies were absent. The analysis of quantitative polymerase chain reaction results indicated the presence of E. coli genes in 44.6% of the samples, with the highest concentration up to 3,166 CCE/100 ml. Microbial source tracking analyses showed that the source of E. coli genes did not originate from sewage contamination because the human-associated HF183 marker was not detected. Of the 175 samples tested, 71% did not mention any water treatment before filling the packages. These results suggest non-human sources of contamination, such as biofilm formation in the pipelines used to fill these packages due to poor disinfection. Our study shows an urgent need for increased regulation and standardized manufacturing of sachet water to ensure safe drinking water

Advancing patient care through the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR)

Recent advances in rare disease research are accelerated by the work of consortia that have been supported by the National Institutes of Health. Development of such consortia rely on multidisciplinary relationships and engagement with patient advocacy groups, as well as the National Institutes of Health and industry and academic partners. In this rostrum we present the development of such a process that focuses on eosinophilic gastrointestinal diseases. Principal investigators, patient advocacy groups, research assistants, and trainees work together to perform natural history studies that promote clinical trial readiness tools, conduct clinical trials, train a new generation of investigators, and perform innovative pilot studies