Norovirus outbreak among primary schoolchildren who had played in a recreational water fountain

BACKGROUND: A gastroenteritis outbreak was associated with playing in a norovirus-contaminated recreational fountain. OBJECTIVE AND STUDY DESIGN: A retrospective cohort study was performed to estimate the magnitude of the outbreak and identify its source. Epidemiological investigation included standardized questionnaires about sex, age, school, class, risk exposures, and illness characteristics. Stool samples and environmental water samples were analyzed for the presence of bacteria, viruses, and parasites. RESULTS: Questionnaires were returned for 191 schoolchildren (response rate, 83%) with a mean age of 9.2 years, of whom 47% were ill (diarrhea and/or vomiting). Children were more likely to have been ill if they had played in the recreational fountain (relative risk, 10.4). Norovirus (Birmingham) was detected in 22 (88%) stool specimens from ill children and in 6 (38%) specimens from healthy children. The water sample from the fountain contained a norovirus strain that was identical to the RNA sequence found in stools. CONCLUSIONS: Recreational water may be the source of gastroenteritis outbreaks. Adequate water treatment can prevent these types of outbreak.     

A Foodborne Norovirus Outbreak Due To Manually Prepared Salad, Austria 2006

Abstract Background: Norovirus is increasingly being recognized as a leading cause of foodborne disease. Nevertheless, welldocumented foodborne outbreaks due to norovirus are rarely found in the literature. Material and Methods: A retrospective cohort study was conducted for identifying the source of a gastroenteritis outbreak. A total of 325 persons were identified as the atrisk group. Results: The overall attack rate was 56% (182/325). Of the four working days of possible foodborne exposure to norovirus (Monday till Thursday), Wednesday (risk ratio [RR]: 18.82; 95%CI 11.82–29.96) and Thursday (RR 2.14; 95%CI 1.65–2.79) turned out to be the most likely days on which infections with norovirus occurred. The day-by-day food specific cohort analyses yielded consumption of salad on Wednesday (adjusted RR 2.82; 95%CI 1.0–7.94) to be associated with highest risk of illness. The most likely source of food contamination is a kitchen assistant having prepared salad manually. She fell ill with symptoms of gastroenteritis on Wednesday during the early working hours and continued working. Human stool samples obtained from five out of six outbreak cases, including the sick kitchen assistant, were RT-PCR positive for norovirus genotype GGII.7 (Leeds-like). Conclusion: This foodborne norovirus outbreak underlines the drastic consequences of neglecting the rules of basic kitchen hygiene. Food handlers working despite manifest diarrhea or vomiting – often in fear of job loss – are a common cause of foodborne norovirus outbreaks.     

Different risk of deep vein thrombosis and pulmonary embolism in carriers with factor V Leiden compared with non-carriers, but not in other thrombophilic defects. Results from a large retrospective family cohort study

The term factor V Leiden (FVL) paradox is used to describe the different risk of deep vein thrombosis and pulmonary embolism that has been found in carriers of FVL. In a thrombophilic family-cohort, we estimated differences in absolute risks of deep vein thrombosis and pulmonary embolism for various thrombophilic defects. Of 2,054 relatives, 1,131 were female, 41 had pulmonary embolism and 126 deep vein thrombosis. Annual incidence for deep vein thrombosis in non-carriers of FVL was 0.19% (95%CI, 0.16–0.23), and 0.41% (95%CI, 0.28–0.58) in carriers; relative risk (RR) 2.1 (95%CI, 1.4–3.2). For pulmonary embolism these incidences were similar in carriers and non-carriers 0.07%, respectively; RR 1.0 (95% CI, 0.4–2.5). When co-inheritance of other thrombophilic defects was excluded the RR for deep vein thrombosis in FVL carriers was 7.0 (95%CI, 2.3–21.7) compared to non-carriers and 2.8 (95%CI, 0.5–14.4) for pulmonary embolism. For other thrombophilic defects no such effect was observed. Thus the FVL paradox was confirmed in our study. However, a similar paradox in carriers of other thrombophilic defects was not observed.     

Dyspepsia and irritable bowel syndrome after a Salmonella gastroenteritis outbreak: one-year follow-up cohort study

BACKGROUND & AIMS: It has been reported that some patients develop functional digestive disorders, particularly irritable bowel syndrome (IBS), after acute gastroenteritis (AGE). However, the presence of dyspepsia has not been specifically addressed. We prospectively evaluated development of dyspepsia and IBS during a 1-year follow-up in a cohort of adult patients affected by a Salmonella enteritidis AGE outbreak. METHODS: Questionnaires were sent to 1878 potential participants at baseline and 3, 6, and 12 months; 677 had experienced a Salmonella enteritidis AGE on June 23, 2002, and 1201 had not (randomly selected controls, matched for village of residence, age, and sex). At 12 months, 271 patients and 335 controls returned the questionnaires. Data permitted the establishment of dyspepsia and IBS diagnosis by Rome II criteria. RESULTS: Before the AGE outbreak, the prevalence of dyspepsia was similar in cases and controls (2.5% vs 3.8%); the prevalence of IBS was also similar (2.9% vs 2.3%). At 3, 6, and 12 months, the prevalence of both dyspepsia and IBS had increased significantly in exposed compared with unexposed subjects. Overlap between dyspepsia and IBS was frequent. At 1 year, the relative risk for development of dyspepsia was 5.2 (95% confidence interval, 2.7-9.8) and for IBS was 7.8 (95% confidence interval, 3.1-19.7). Prolonged abdominal pain and vomiting during AGE were positive predictors of dyspepsia. No predictive factors for IBS were found. CONCLUSIONS: Salmonella gastroenteritis is a significant risk factor not only for IBS but also for dyspepsia; at 1 year of follow-up, 1 in 7 and 1 in 10 subjects developed dyspepsia or IBS, respectively.     

The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

Although obesity is associated with the development and progression of atrial fibrillation (AF), an obesity paradox may be present, illustrated by seemingly protective effects of obesity on AF‐related outcomes. Body mass index (BMI) has an impact on outcomes in AF patients using oral anticoagulants. After searching Medline and Embase, meta‐analysis of results of four randomized and five observational studies demonstrated significantly lower risks of stroke or systemic embolism (RR 0.80, 95%CI [0.73–0.87]; RR 0.63, 95%CI [0.57–0.70]; and RR 0.42, 95%CI [0.31–0.57], respectively) and all‐cause mortality (RR 0.73, 95%CI [0.64–0.83]; RR 0.61, 95%CI [0.52–0.71]; and RR 0.56, 95%CI [0.47–0.66], respectively) in overweight, obese and morbidly obese anticoagulated AF patients (BMI 25 to <30, ≥30 and ≥40 kg/m², respectively) compared to normal BMI anticoagulated AF patients (BMI 18.5 to <25 kg/m²). In contrast, thromboembolic (RR 1.92, 95%CI [1.28–2.90]) and mortality (RR 3.57, 95%CI [2.50–5.11]) risks were significantly increased in underweight anticoagulated AF patients (BMI <18.5 kg/m²). In overweight and obese anticoagulated AF patients, the risks of major bleeding (RR 0.86, 95%CI [0.76–0.99]; and RR 0.88, 95%CI [0.79–0.98], respectively) and intracranial bleeding (RR 0.75, 95%CI [0.58–0.97]; and RR 0.57, 95%CI [0.40–0.80], respectively) were also significantly lower compared to normal BMI patients, while similar risks were observed in underweight and morbidly obese patients. This meta‐analysis demonstrated lower thromboembolic and mortality risks with increasing BMI. However, as this paradox was driven by results from randomized studies, while observational studies rendered more conflicting results, these seemingly protective effects should still be interpreted with caution.     

An outbreak of hepatitis E tracked to a spring in the foothills of the Himalayas, India, 2005

In July 2005, cases of hepatitis were reported from three villages in Nainital district, Uttarakhand, India. We investigated this cluster to identify the source and propose recommendations. A door-to-door search for cases of acute hepatitis was carried out in the three villages. We described the outbreak by time, place and person and conducted a cohort study to identify the source of infection. In addition, sera from cases were tested. We identified 205 cases among 1238 persons (attack rate: 16%, no deaths) between May and September 2005. Of the 23 sera tested, 21 were positive for IgM antibodies against hepatitis E virus. The attack rate was highest among 15–44 years old (19%). Cases began on May 3, 2005, peaked in July and decreased rapidly. The incidence was highest (23%) in one of the villages predominantly using water from an unprotected spring, which was distributed after stone bed filtration alone. In this village, the attack rate increased from 9% among those not using the spring, to 13.8% among those partly using it (RR [95% CI] 1.6 [0.8–3.4]), and to 29% among those exclusively using it (RR [95% CI] 3.4 [2.0–6.0]). Untreated drinking water from an unprotected spring may have been the source of this outbreak in a rural area. Sources of water supply must be protected and treated, including with chlorination. Reporting and investigation of smaller outbreaks in rural areas should be improved.     

Pelvic masses after surgery for immature ovarian teratoma: A 10-year experience of Western China

There are debates on the management of immature ovarian teratoma and its recurrence. This study aimed to report the incidence of pelvic masses after surgery for immature ovarian teratoma and to identify prognostic factors of disease-free survival after surgery, discussing aspects of primary treatment and postoperative management.Data on the diagnosis and treatment of patients with immature teratomas were collected. Follow-up data were acquired from clinic visits and telephone interviews. Disease-free survival was defined as the time interval between the initial surgery for immature ovarian teratoma and the diagnosis of a new pelvic mass. Survival curves were drawn using the Kaplan-Meire method, and multivariate analysis was performed using the Cox proportional hazard regression model using PASW statistics software.The estimated 5-year disease-free survival and overall survival were 74.3% (95%CI 63.9%–84.7%) and 96.5% (95%CI 91.6%–100.0%), respectively. The incidence of growing teratoma syndrome and immature teratoma relapse at a median follow-up of 46 months were 20.0% and 7.7%, respectively. Two patients died of repeated relapses or repeated growing teratoma syndrome. Rupture of initial lesions (RR 4.010, 95%CI 1.035–5.531), lymph node dissection (RR 0.212, 95%CI 0.051–0.887) and adjuvant chemotherapy (RR 0.143, 95%CI 0.024–0.845) were independent prognostic factors for disease-free survival.The development of growing teratoma syndrome is more prevalent than relapse after treatment of immature ovarian teratomas. Lymph node dissection and chemotherapy are recommended to reduce recurrence. Close surveillance and active surgical intervention are important for the diagnosis and appropriate management of new pelvic masses.     

Traveler's diarrhea at sea: three outbreaks of waterborne enterotoxigenic Escherichia coli on cruise ships

Enterotoxigenic Escherichia coli (ETEC) has become the leading bacterial cause of gastroenteritis outbreaks on cruise ships. Investigation of recent outbreaks of ETEC gastroenteritis on 3 cruise ships indicated that all were associated with consuming beverages with ice cubes on board the ship (relative risk [RR], 1.4, 95% confidence interval [CI], 1.0-1.9, P=.02; RR, 1.9, 95% CI, 1.3-2. 9, P<.001; and RR, 1.3, 95% CI, 1.0-1.6, P<.01), and 2 were associated with drinking unbottled water (RR, 2.7, 95% CI, 1.8-4.1, P<.001; RR, 1.7, 95% CI, 1.3-2.3, P<.001). Multiple ETEC serotypes were detected in patients' stool specimens in each of the 3 outbreaks, and 12 (38%) of 32 isolates were resistant to > or =3 antimicrobial agents. ETEC appears to be emerging as a waterborne pathogen on cruise ships. Water bunkered in overseas ports was the likely source of ETEC infection in these outbreaks. To ensure passenger safety, cruise ships that take on water in foreign ports must ensure that water treatment and monitoring systems function properly.     

Influence of the JAK2 V617F mutation and inherited thrombophilia on the thrombotic risk among patients with essential thrombocythemia

It is uncertain whether the JAK2 V617F mutation increases the thrombotic risk in patients with essential thrombocythemia, and it is unknown whether inherited thrombophilia is an additive risk factor in mutated subjects. We studied 132 patients with essential thrombocythemia, 38 of them (29%) with a history of thrombosis. The JAK2 mutation was present in 83 (63%), and inherited thrombophilia in 7. The mutated patients <60 years had a relative risk (RR) for thrombosis at any time of 3.83 (95%CI 1.27–11.49) in comparison with wild-type patients; in those with both the mutation and thrombophilia the RR was 2.23 (95%CI 1.57–3.18) and 7.66 (95%CI 2.66–22.03) in comparison with mutated or wild-type patients without thrombophilia, respectively. During the follow-up, only the homozygotes for JAK2 V617F were more prone to thrombosis (RR 17.25, 95%CI 2.33–127.4). Among the patients >60 years, no increase in RR was associated with the JAK2 mutation. In conclusion, in the younger patients with ET the thrombotic risk is higher in the JAK2 V617F-mutated and is further increased by the presence of inherited thrombophilia.     

Percutaneous coronary intervention and 30‐day unplanned readmission with chest pain in the United States (Nationwide Readmissions Database)

Percutaneous coronary intervention (PCI) improves anginal chest pain in most, but not all, treated patients. PCI is associated with unplanned readmission for angina and non‐specific chest pain within 30‐days of index PCI. Patients with an index hospitalization for PCI between January–November in each of the years 2010–2014 were included from the United States Nationwide Readmissions Database. Of 2 723 455 included patients, the 30‐day unplanned readmission rate was 7.2% (n = 196 581, 42.3% female). This included 9.8% (n = 19 183) with angina and 11.1% (n = 21 714) with non‐specific chest pain. The unplanned readmission group were younger (62.2 vs 65.1 years; P < 0.001), more likely to be females (41.0% vs 34.2%; P < 0.001), from the lowest quartile of household income (32.9% vs 31.2%; P < 0.001), have higher prevalence of cardiovascular risk factors or have index PCI performed for non‐acute coronary syndromes (ACS) (OR:3.46, 95%CI 3.39–3.54). Factors associated with angina readmissions included female sex (OR:1.28, 95%CI 1.25–1.32), history of ischemic heart disease (IHD) (OR:3.28, 95%CI 2.95–3.66), coronary artery bypass grafts (OR:1.79, 95%CI 1.72–2.86), anaemia (OR:1.16, 95%CI 1.11–1.21), hypertension (OR:1.13, 95%CI 1.09, 1.17), and dyslipidemia (OR:1.10, 95%CI 1.06–1.14). Non‐specific chest pain compared with angina readmissions were younger (mean difference 1.25 years, 95% CI 0.99, 1.50), more likely to be females (RR:1.13, 95%CI 1.10, 1.15) and have undergone PCI for non‐ACS (RR:2.17, 95%CI 2.13, 2.21). Indications for PCI other than ACS have a greater likelihood of readmission with angina or non‐specific chest pain at 30‐days. Readmissions are more common in patients with modifiable risk factors, previous history of IHD and anaemia.     

The epidemiology of enteric caliciviruses from humans: a reassessment using new diagnostics

In the United States, acute gastroenteritis is one of the most commonly noted illnesses on hospital discharge records and death certificates, yet few of these cases have an etiologic diagnosis. The application of new molecular diagnostic methods has shown caliciviruses (previously referred to as the Norwalk family of viruses or small round structured viruses) to be the most common cause of acute gastroenteritis (AGE) outbreaks in the United States, and they may emerge as a common cause of sporadic cases of AGE among both children and adults. Novel molecular methods have permitted outbreak strains to be traced back to their common source and have led to the first identification of virus in implicated vehicles of infection-water, shellfish, and foods contaminated both at their source and by food handlers. The broad application of these methods to routine diagnosis in hospitals and public health laboratories is advancing our appreciation of the full burden of calicivirus-associated diarrhea, and it is opening new avenues for its prevention and control.     

Outbreak of Salmonella Newport linked to imported frozen cooked crayfish in dill brine,Sweden, July to November 2019

In autumn 2019, the Public Health Agency of Sweden identified a cluster of Salmonella Newport cases by whole genome sequencing (WGS). Cases’ distribution in place and time indicated a nation-wide ongoing outbreak. An investigation was initiated to identify the source and prevent further cases. We conducted a case–case study based on notified salmonellosis cases and a Salmonella trawling questionnaire, comparing 20 outbreak cases and 139 control cases. Food exposures were compared by adjusted odds ratios (aOR) with 95% confidence interval (CI) using logistic regression. Implicated foods were sampled. Outbreak cases were more likely to have consumed crayfish (aOR = 26; 95% CI: 6.3–105). One specific brand of imported frozen, pre-cooked whole crayfish in dill brine was identified as the source. Salmonella Newport was later detected in different batches from retail and in one sample from border control. Isolates from food samples clustered with the human outbreak strain by WGS. Although the retailer made a complete recall, two more cases were identified long afterwards. This investigation demonstrated the successful use of a case–case study and targeted microbiological testing to identify the source. The immediate action taken by the retailer was important to confirm the source and stop the outbreak.     

Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery

BACKGROUND & AIMS: Postinfectious irritable bowel syndrome (PI-IBS) is a common clinical phenomenon. To better define its incidence and epidemiology, a large cohort study was initiated after the contamination of a municipal water supply led to a large outbreak of acute Escherichia coli 0157:H7 and Campylobacter jejuni gastroenteritis. METHODS: Local residents were invited to undergo structured assessments at research clinics established 2 years after the outbreak. Permanent adult residents with no prior history of inflammatory bowel disease or IBS were eligible. Standardized questionnaires defined past and current health. The cohort was divided into controls without gastroenteritis, subjects with clinically suspected gastroenteritis, and subjects with only self-reported gastroenteritis that could not be substantiated by another source. A modified Bowel Disease Questionnaire identified IBS according to Rome criteria. The incidence and epidemiology of PI-IBS was characterized. Risk factors were assessed using multiple logistic regression. RESULTS: There were 2069 eligible study participants. Rome I criteria were met by 71 of 701 controls (10.1%) vs 249 of 904 subjects with self-reported gastroenteritis (27.5%) and 168 of 464 subjects with clinically suspected gastroenteritis (36.2%) (all comparisons, P < 001). Independent risk factors for PI-IBS included younger age, female sex, bloody stools, abdominal cramps, weight loss, and prolonged diarrhea. PI-IBS was more likely than sporadic IBS to show diarrhea-predominant features. CONCLUSIONS: PI-IBS is common after gastroenteritis from water contamination and often is diarrhea-predominant. Characteristics of the acute illness identify patients at increased risk for PI-IBS.     

Effectiveness of seasonal influenza vaccinations against laboratory‐confirmed influenza‐associated infections among Singapore military personnel in 2010–2013

Background

Limited information is available about seasonal influenza vaccine effectiveness (VE) in tropical communities.

Objectives

Virus subtype-specific VE was determined for all military service personnel in the recruit camp and three other non-recruit camp in Singapore''s Armed Forces from 1 June 2009 to 30 June 2012.

Methods

Consenting servicemen underwent nasal washes, which were tested with RT-PCR and subtyped. The test positive case and test negative control design was used to estimate the VE. To estimate the overall effect of the programme on new recruits, we used an ecological time series approach.

Results

A total of 7016 consultations were collected. The crude estimates for the VE of the triavalent vaccine against both influenza A(H1N1)pdm09 and influenza B were 84% (95% CI 78–88%, 79–86%, respectively). Vaccine efficacy against influenza A(H3N2) was markedly lower (VE 33%, 95% CI −4% to 57%). An estimated 70% (RR = 0·30; 95% CI 0·11–0·84), 39% (RR = 0·61;0·25–1·43) and 75% (RR = 0·25; 95% CI 0·11–0·50) reduction in the risk of influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B infections, respectively, in the recruit camp during the post-vaccination period compared with during the pre-vaccination period was observed.

Conclusions

Overall, the blanket influenza vaccine programme in Singapore''s Armed Forces has had a moderate to high degree of protection against influenza A(H1N1)pdm09 and influenza B, but not against influenza A(H3N2). Blanket influenza vaccination is recommended for all military personnel.     

Tuberculosis risk factors in a silicotic cohort in Hong Kong.

SETTING: Hong Kong silicotic patients are followed regularly at the Pneumoconiosis Clinic. OBJECTIVE: To quantify the incidence of tuberculosis disease that occurs after the date of diagnosis of silicosis (DOD), and to identify the risk factors for its development. DESIGN: Retrospective analysis of a Hong Kong silicotic cohort with DOD from 1 January 1988 to 31 December 1993. RESULTS: Of 718 subjects whose records were identified, 11 were excluded from the study. The incidence of tuberculosis (TB) after DOD was 3019 patients per 100,000 population, approximately nine times that of the local population matched for age and sex. Twelve factors were subject to univariate analysis followed by logistic regression. Four TB risk factors were identified: 1) no anti-tuberculosis treatment before DOD (relative risk [RR] 4.51, 95% confidence interval [CI] 2.46-8.24), 2) progressive massive fibrosis (PMF) (RR 3.78, 95%CI 2.25-6.36), 3) small opacities exceeding 1.5 mm (RR 2.17, 95%CI 1.38-3.42), and 4) caisson work (RR 1.56, 95%CI 1.01-2.41). Relative risks were calculated for patient subgroups stratified according to TB risk factors. CONCLUSION: This study has reaffirmed the strong association of tuberculosis and silicosis, and has identified several TB risk factors with a logistic regression model.     

Left ventricular hypertrophy was infrequent in patients starting dialysis after undergoing a strict blood pressure control in the pre-dialytic period

OBJECTIVE: We retrospectively investigated the factors influencing the left ventricular hypertrophy (LVH) occurrence in patients with chronic renal failure (CRF). METHODS AND PATIENTS: Blood pressure and echocardiographyically determined LVH were assessed in 110 patients on the basis of availability of monthly follow-up data obtained during the period of 2 years before the start of dialysis. When the patients showed the left ventricular mass index of not less than 125 g/m2, they were diagnosed as having LVH. Mean casual blood pressure distribution was classified into 5 groups: Group 1; <93 mmHg, Group 2; 93-100 mmHg, Group 3; 100-106 mmHg, Group 4; 106-114 mmHg and Group 5; >114 mmHg. RESULTS: LVH frequencies were 31.8, 72.7, 72.7, 81.8 and 95.5 (%) in Groups 1-5, respectively. Logistic regression showed that the factors influencing the progression of LVH were the duration of hypertension (per 1 year relative risk) (RR) 1.13, 95% confidential interval (CI) (1.01-1.26), treatment with angiotensin-converting enzyme inhibitors (ACE-1) (RR: 0.20, 95%CI: 0.04-0.99), pulse pressure (RR: 1.06, 95%CI: 1.00-1.11) and mean blood pressure (MBP). The RR of developing LVH increased progressively as MBP increased: Compared with LVH frequency in Group 1, RR of Group 2 was 4.38 (95%CI: 1.05-18.19), that of Group 3 was 5.50 (95%CI: 1.08-28.02), that of Group 4 was 5.66 (95%CI: 1.22-26.15), and that of Group 5 was 19.13 (95%CI: 1.75-209.4). CONCLUSION: Strict blood pressure control and ACE-I treatment could prevent LVH in patients with CRF.     

Prophylactic Effect of Somatostatin in Preventing Post-ERCP Pancreatitis: An Updated Meta-Analysis

Background/Aims:Somatostatin is regarded as a prophylactic agent on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), but studies are still controversial.Results:Eleven randomized controlled trials (RCTs), enrolling a total of 2869 patients, were included in the meta-analysis. After data were pooled from somatostatin trials, PEP occurred in 8.36% of controls versus 5.62% of the treated group, with a slight significance [relative risk (RR) =0.58, 95% confidence interval (CI) 0.35–0.98, P = 0.04]. The funnel plot showed no asymmetry with a negative slope (P = 0.108). The meta-analysis produced negative results for short-term infusion of somatostatin (RR = 1.40, 95% CI 0.93–2.12, P = 0.11), whereas a bolus or long-term injection of the drug proved effective (RR = 0.25, 95% CI 0.13–0.47, P < 0.0001; RR = 0.44, 95% CI 0.27–0.71, P = 0.0008). Postprocedure hyperamylasemia and pain was also observed in the meta-analysis, the pooled RR was significant for reduced risk of postprocedure hyperamylasemia (RR = 0.72, 95%CI 0.63 to 0.81, P < 0.00001), but not for the pain (RR = 0.67, 95% CI 0.42 to 1.08, P = 0.10).Conclusion:The current meta-analysis on the prophylactic use of somatostatin in patients undergoing ERCP documents a lack of benefit when given as short-term infusion, but showed an advantage of a single bolus or long-term injection. The beneficial effect of somatostatin, in reducing the incidence of postprocedural hyperamylasemia seems of marginal clinical significance. However, more new confirmatory data are needed to settle residual doubts.     

Enxerto de Bypass de Artéria Coronária Guiado por Angiografia ou Fisiologia: Uma Metanálise

Background:While invasive coronary angiography is considered the gold standard for the diagnosis of coronary artery disease (CAD) involving the epicardial coronary vessels, coronary physiology-guided revascularization represents a contemporary gold-standard practice for the invasive management of patients with intermediate CAD. Nevertheless, the long-term results of assessing the severity of stenosis through physiology compared to the angiogram as the guide to bypass surgery – coronary artery bypass grafting (CABG) are still uncertain. This meta-analysis aims to assess the clinical outcomes of a physiology guided CABG compared to the angiography-guided CABG.Objectives:We sought to determine if outcomes differ between a physiology guided CABG compared to an angiography-guided CABG.Methods:We searched Medline, EMBASE, and the Cochrane Library. The last date for this search was June 2020, and all of the previous studies were included. We conducted a pooled risk-ratio meta-analysis for four main outcomes: all-cause death, myocardial infarction (MI), target vessel revascularization (TVR) and major adverse cardiovascular events (MACE). P-value <0.05 was considered as statistically significant. Heterogeneity was assessed with Cochran''s Q test and quantified by the I² index.Results:We identified five studies that included a total of 1,114 patients. A pooled meta-analysis showed no significant difference between a physiology guided strategy and an angiography-guided strategy in MI (risk ratio [RR] = 0.72; 95%CI, 0.39–1.33; I2 = 0%; p = 0.65), TVR (RR = 1.25; 95%CI = 0.73–2.13; I2 = 0%; p = 0.52), or MACE (RR = 0.81; 95%CI = 0.62–1.07; I2 = 0%; p = 1). The physiology guided strategy has 0.63 times the risk of all-cause death compared to the angiography-guided strategy (RR = 0.63; 95%CI = 0.42–0.96; I2 = 0%; p = 0.55).Conclusion:This meta-analysis demonstrated a reduction in all-cause death when a physiology guided CABG strategy was used. Nevertheless, the short follow-up period, small sample size of the included studies and the non-discrimination of the causes of death can largely justify these conclusions. Studies with an extended follow-up period of observation are required to draw more robust and definitive conclusions.     

Human Astrovirus Outbreak in a Daycare Center and Propagation among Household Contacts

We investigated an outbreak of acute gastroenteritis due to human astrovirus in a daycare center, describing the transmission mechanism, the most affected age groups, conditioning factors and the extent of the outbreak among household contacts of the daycare center attenders. Data were collected from persons exposed at the daycare center and their home contacts. Fecal samples from affected and non-affected daycare center attenders were analyzed for viruses causing acute gastroenteritis by RT-PCR. The percentage of households affected and the attack rates (AR) were calculated. The attack rates were compared using the rate ratio (RR) with 95% confidence intervals. Information was obtained from 245 people (76 attenders and 169 contacts) of whom 49 were clinical cases. Five HAstV-4, two HAstV-8 and three non-typable HAstV cases were identified (six from clinical cases and four from asymptomatic infected people). The global AR was 20% (41.2% in children aged < 2 years). Data were obtained from 67 households: 20 households of affected attenders and 47 of non-affected attendees. Household contacts of affected attenders had a higher AR (74.3%) than that of non-affected attendees (2.4%). We found asymptomatic infections amongst daycare attendees. The transmission of HAstV during the outbreak was not limited to the daycare center but extended to household contacts of both affected and non-affected attenders.