Development and use of a new medium to detect yeasts of the genera Dekkera/Brettanomyces

Aims: The objectives of this work were to develop a selective and/or differential medium able to effciently recover Dekkera/Brettanomyces sp. from wine-related environments and to determine the relationship between these yeasts and the 4-ethylphenol content in a wide range of wines. Methods and Results: The selectivity of the developed medium was provided by the addition of ethanol, as single carbon source, and cycloheximide. The inclusion of bromocresol green evidenced acid-producing strains. The inclusion of p-coumaric acid, substrate for the production of 4-ethylphenol, enabled the differentiation by smell of Dekkera/Brettanomyces sp. from all other yeast species growing in the medium. The medium was used either by plating after membrane filtration or by the Most Probable Number (MPN) technique. In 29 white and 88 red randomly collected wines, these yeasts were found only in red wines at levels up to 2500 MPN ml±1, but constituted less than 1% of the total microbial flora. In red wines, 84% showed detectable amounts of 4-ethylphenol up to 4430 lg l±1 while 28% of the white wines showed detectable levels up to 403 lg l±1. Conclusions: The use of the medium proposed in this work evidenced the presence of low relative populations of Dekkera/Brettanomyces sp. even in wines contaminated by fast-growing yeasts and moulds. Significance and Impact of the Study: Further ecological studies on Dekkera/Brettanomyces sp. should take into account the use of highly specific culture media in order to establish their true occurrence in natur

Factors affecting the production of 4-ethylphenol by the yeast Dekkera bruxellensis in enological conditions

"Food Microbiology" article in PressThe conversion of p-coumaric acid into 4-ethylphenol was studied in Dekkera bruxellensis ISA 1791 under defined conditions in synthetic media. The production of 4-ethylphenol occurred roughly between mid-exponential growth phase and the beginning of the stationary phase. This behaviour was observed when glucose was the only energy and carbon source, the conversion rate being close to 90%. Ethanol, as the single energy source, yielded conversion rates close to 80% while in the presence of trehalose and acetic acid conversion rates lower than 10% were obtained. The production of 4-ethylphenol was not observed when the cells were maintained in buffer solution without carbon and energy sources. The precursor of 4-ethylphenol, p-coumaric acid, was not utilized as energy and carbon source. Furthermore, it was shown that 4-vinylphenol may be used as a precursor of 4-ethylphenol in the absence of pcoumaric acid. Growth and 4-ethylphenol production were inhibited by increasing concentrations of ethanol, being fully prevented at 13% (v/v) ethanol. The cultivation of strain ISA 1791 in mixed culture with Saccharomyces cerevisiae, in synthetic medium, showed that the cell numbers of D. bruxellensis increased from 104 cfu/ml to 5 109 cfu/ml. Laboratory microvinifications of white and red juices inoculated with as low as 10 cfu/ml of D. bruxellensis and 107 cells/ml of S. cerevisiae showed growth of D. bruxellensis to levels of about 5 108 cfu/ml. In addition, 4-ethylphenol production by D. bruxellensis was observed only after complete fermentation of the grape juice

Daily rainfall disaggregation for Tocantins State, Brazil

In order to design effective Brazilian hydraulic structures, it is necessary to obtain data relating to short-duration intense rainfall from historical series of daily rainfall. This recurring need can be fulfilled by rainfall disaggregation methodology. The objective of this study was to determine the intense rainfall disaggregation constants for the State of Tocantins and to compare these constants with those obtained for other regions of Brazil. For the modeling of the frequency of intense rainfall of different durations of less than 24 hours, the Gumbel probability distribution (GPD) was employed using rainfall series from 10 locations in Tocantins state. The results showed that the GPD was adequate by the Kolmogorov-Smirnov and Chi-square tests. The disaggregation constants presented low variability values for different return periods (from 10 to 100 years); the values for Tocantins state are: h12h/h24h=0.93, h6h/h24h=0.86, h4h/h24h=0.82, h3h/h24h=0.78, h2h/h24h=0.72, h1h/h24h=0.61, h50min/h1h=0.92, h40min/h1h=0.83, h30min/h1h=0.68, h20min/h30min=0.76 e h10min/h30min=0.46. The comparison of the results with those from studies developed for other Brazilian regions showed variations of up to -62.30%, allowing us to conclude that the use of local constants is important in the process of rainfall disaggregation.Para o dimensionamento da estrutura hidráulicas do Brasil, é necessário a obtenção de dados de chuvas intensas de curta duração a partir de séries históricas de chuva diária. Esta situação recorrente pode ser atendida pela metodologia de desagregação de chuvas. Objetivou-se neste trabalho determinar constantes de desagregação de chuvas intensas para o Estado do Tocantins e proceder a comparação destas constantes com aquelas obtidas para outras regiões do Brasil. Para a modelagem da frequência das chuvas intensas de diferentes durações, foi empregada a distribuição de probabilidades Gumbel, tendo sido utilizadas séries pluviográficas de 10 localidades do estado do Tocantins. Os resultados mostraram que a distribuição de probabilidades Gumbel foi considerada adequada pelos testes Kolmogorov-Smirnov e Qui-quadrado. Observou-se que as constantes de desagregação apresentaram valores praticamente invariáveis para tempos de retorno entre 10 e 100 anos, tendo sido obtidas as seguintes constantes médias para o estado do Tocantins: h12h/h24h=0,93, h6h/h24h=0,86, h4h/h24h=0,82, h3h/h24h=0,78, h2h/h24h=0,72, h1h/h24h=0,61, h50min/h1h=0,92, h40min/h1h=0,83, h30min/h1h=0,68, h20min/h30min=0,76 e h10min/h30min=0,46. A comparação dos resultados com os de estudos desenvolvidos para outras regiões brasileiras mostrou variações de até -62,30%, permitindo se concluir que a utilização de constantes locais é importante no procedimento de desagregação de chuvas

Enteroparasitoses em uma região da Amazônia ocidental

Introduction: intestinal parasites are diseases that present a worldwide health problem, causing major nutritional problems, where their occurrence varies according to the climate of each region and socioeconomic conditions. Regions that have tropical climates with humidity, high levels of rainfall and high temperatures associated with a lack of information on entero-parasitosis deserve attention. Objective: the present work sought to evaluate the types of intestinal parasites between the years 2018 to 2020 in a portion of the population of a municipality in the Western Amazon, more specifically, (i) to evaluate the types of entero-parasitosis that affect the population between periods of flooding and drought; (ii) to evaluate the influence of entero-parasitosis in individuals according to gender and age group over three years. Methodology: data collection was carried out between the years 2018 to 2020, through analysis of spreadsheets provided by the clinical analysis laboratory LABSUL. Results: 4236 stool exams were evaluated, of which only 1396 were positive for entero-parasitosis. Most of which were caused by protozoa (58.69%) that mainly affected women, young people and children during flood periods. Conclusion: in view of this, the data showed that intestinal parasites frequently affect a portion of the local population. In addition to bringing information that can reinforce the need to implement the basic sanitation system, together with population awareness campaigns regarding the routes of contamination and the way in which these infections spread.Introdução: as parasitoses intestinais são doenças que apresentam um problema de saúde mundial, causando grandes problemas nutricionais, onde sua ocorrência varia de acordo com o clima de cada região e condições socioeconômicas. Regiões que apresentam climas trópicos com umidade, altos índices de chuvas e temperaturas elevadas associadas com a falta de informações sobre as enteroparasitoses merecem atenção. Objetivo: o presente trabalho buscou avaliar os tipos de enteroparasitoses entre os anos de 2018 a 2020 em uma parcela da população de um município da Amazônia Ocidental, mais especificamente, (i) avaliar os tipos de enteroparasitoses que acometem a população entre os períodos de inundação e estiagem; (ii) avaliar a influência das enteroparasitoses em indivíduos de acordo com o gênero e a faixa etária ao longo de três anos. Metodologia: as coletas de dados foram realizadas entre os anos de 2018 a 2020, por meio de análises de planilhas concedidas pelo laboratório de análises clinicas LABSUL. Resultados: foram avaliados 4236 exames de fezes, sendo que apenas 1396 foram positivos para enteroparasitoses. Dos quais a maior parte foi causada por protozoários (58,69%) que acometeram principalmente Mulheres, jovens e crianças nos períodos de inundação. Conclusão: diante disso, os dados demonstraram que as enteroparasitoses acometem com frequência uma parcela da população local. Além de trazer informações que podem reforçar a necessidade da implementação do sistema de saneamento básico, juntamente com campanhas de conscientização populacional a respeito das vias de contaminação e da forma de propagação dessas infecções

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013