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Waterborne pathogens and dental waterlines.

Humans, like every other living thing on Earth, have evolved in a world dominated by many billions of microscopic life forms. Most of the time, we live in a state of harmony (or even mutualism) with our invisible coinhabitants. When this balance becomes disturbed however, the consequences can be devastating. Infectious diseases including malaria, tuberculosis, and AIDS remain the world's greatest mass murderers. Dental workers strive to reduce infection risks for their patients through infection control measures that reduce or eliminate potentially pathogenic agents in the clinical environment. As increasing numbers of patients with varying degrees of immune suppression present for dental treatment, the need to ensure an aseptic treatment environment will become a higher priority for the dental profession. The possibility that exposure to aerosols contaminated with endotoxin might exacerbate asthma or cause chronic respiratory problems in dental health care workers should be investigated. Although direct evidence of widespread complications among patients or occupationally acquired illness among dental workers is presently lacking, reducing the numbers of microorganisms present in dental treatment water is consistent with other empiric measures that form the basis of infection-control practice.

Biofilms↗

Where do we go in protection against pathogens?

A few reflections are made on the future strategies and approaches for combating infectious diseases of livestock, keeping into consideration public concern on food quality and availability. The policy of eradication of pathogens/diseases instead of vaccination has rendered livestock naive to certain pathogens and as a consequence susceptible to epidemic outbreaks, even more so as we have to conclude that outside attack is quite often difficult to control. Therefore, immunoprophylactic measures in livestock remain top priority and will in the future focus more on the induction of mucosal immunity and the activation of innate immunity.

Animal Diseases↗

Histopathology of childhood pneumonia in developing countries.

Acute lower respiratory infection in children is a major cause of morbidity and mortality in developing countries. Viral and bacterial agents incite characteristic host responses at the level of the bronchi, bronchioles, alveolar walls, and air spaces that correlate with the clinical course. A systematic review of histopathologic features will enhance the understanding of the pathogenetic mechanisms and cofactors that influence the disease process, particularly how tissue injury may be influenced by nutritional status and access to antibiotics. Research priorities include immunologic assessment, micronutrient assays, and standardized autopsies in developing countries. DNA probes for organisms and immunocytochemical identification of cell markers in tissue promise a new era in microscopic visualization of pathogen-host interactions. International collaborative research between ministries of public health and medical universities must be encouraged as a means of providing technical assistance and of advancing new knowledge. Systematic standardized autopsy studies from multiple geographic areas may help define pathologic mechanisms, monitor the natural history of disease, and evaluate interventions in diverse populations.

Acute Disease↗

Public health and regulatory considerations of the Safe Drinking Water Act.

This paper provides an overview of the public health and economic issues associated with drinking water quality regulations in the United States. A historic perspective is provided by the use of filtration and chlorine disinfection, and of public health laws from the early 20th century up to passage of the Safe Drinking Water Act (SDWA), in 1974. The contaminants regulated under the Act, and the 1986 Amendments to the SDWA, are evaluated according to health endpoint, related issues in risk assessment, and the cost of complying with associated regulations. Risk-cost and benefit-cost analyses are offered for carcinogens, systemics, and pathogens. The paper describes the evolution of public health issues from the initial focus on waterborne infectious diseases to concerns over chemical contaminants, and the recent reemergence of microbials as the high-priority public health concern.

Cost-Benefit Analysis↗

Food safety: current situation, unaddressed issues and the emerging priorities.

This paper reviews the topic of food safety with reference to the Eastern Mediterranean Region. The differing views of food safety and the current situation with regard to ensuring food safety are presented. Also discussed are some of the unaddressed issues and challenges related to food safety. The new conditions that have arisen in the modern world which have facilitated the emergence of pathogens are presented, such as changes in animal husbandry, changes in international trade and travel, lifestyle and consumer changes. The urgent need for action in order to reduce the risk of microbiological and chemical foodborne diseases is emphasized. The food chain starts from farm and ends at fork; controlling this complex process requires an integrated approach and a responsible authority to oversee it in order to protect and promote food safety.

Animal Feed↗

Dysphagia and aspiration pneumonia in patients with Alzheimer's disease.

Dysphagia and aspiration pneumonia are the 2 most serious medical conditions seen in late-stage Alzheimer's disease (AD) patients. Pseudobulbar dysphagia is associated with weight loss, which is not always prevented by optimizing the management of the dysphagia. Failure of basic homeostatic mechanisms appears to play an important role in the nutritional status of these patients. Aspiration pneumonia is the most common cause of death in end-stage AD. The primary problems that predispose to aspiration pneumonia include a reduced level of consciousness, dysphagia, loss of the gag reflex, periodontal disease, and the mechanical effects of inserting various tubes into the respiratory and gastrointestinal tracts. The bacterial flora involved include the indigenous oral flora (among which aerobes predominate) and, in the hospital or nursing home setting, nosocomially acquired pathogens such as Staphylococcus aureus and various aerobic and facultative gram-negative bacilli that may colonize in patients. In addition to treatment with antibiotics, adequate symptomatic treatment of AD patients with pneumonia is a priority in order to relieve suffering.

Alzheimer Disease↗

Percutaneous blood exposure among Danish doctors: exposure mechanisms and strategies for prevention.

The objective of this study was to describe the mechanisms of percutaneous blood exposure (PCE) among doctors and discuss rational strategies for prevention. Data were obtained as part of a nation-wide questionnaire survey of occupational blood exposure among hospital employed doctors in Denmark. The doctors were asked to describe their most recent PCE, if any, within the previous 3 months. Detailed information on the instruments, procedures, circumstances and mechanisms that caused the PCE was obtained. Of 9375 doctors, 6256 (67%) responded, and 6005 questionnaires were eligible for analysis. Of 971 described PCE the majority were caused by suture needles (n = 483), i.v.-catheter-stylets (n = 94), injection needles (n = 75), phlebotomy needles (n = 53), scalpels (n = 45), arterial blood sample needles (n = 41) and bone fragments (n = 23). Inattentiveness was the most common cause, contributing to 30.5% of all PCE. Use of fingers rather than instruments was a major cause of injury in surgical specialities and was a contributing cause of 36.9% PCE on suture needles. Common contributing causes when fingers were used (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. It was often argued that instruments were not practical to use or might harm the tissue. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines like recapping only, but other mechanisms like sudden patient movements and 'acute situation' were common, especially in the case of PCE on i.v.-catheter-stylets. It is concluded that the exposure mechanisms of PCE reflect both unsafe routines, difficult working conditions and unsafe devices. Education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.

Blood-Borne Pathogens↗

Vaccination and mucosal responses to Helicobacter pylori infection.

H. pylori infection persists for life if not treated, and is responsible for major morbidity and mortality throughout the world. Preventative immunization, once thought to be impossible, is now considered by many to be the only practical approach to large-scale elimination of the bacterium from susceptible populations. High rates of protection have been achieved in the H. felis mouse model, utilizing antigens ranging from whole cells to purified recombinant proteins selected on the basis of their role in pathogenicity. Immunization has also been shown to cure established infection. H. pylori mouse models have been developed and may become the model of choice. Urease remains the favourite antigen but combinations will most likely be required. A priority is to define alternate muscosal adjuvants, as some used in the animal models may be too toxic for use in humans. Also, there is a need to understand the basis of immunization. Why does the natural immune response to H. pylori fail while the artificially stimulated response succeeds? The first important steps towards a vaccine have been made but, given safety issues and regulatory requirements, it may be 5-8 years before the final product becomes available. Over these years antimicrobial resistance is likely to be an increasing problem in the treatment of H. pylori infections. Thus, when the vaccine comes, the time will be ripe for the completely new approach of therapeutic immunization.

Animals↗

Intensive care unit design and environmental factors in the acquisition of infection.

The incidence of infection in the intensive care unit (ICU) is one of the highest in the hospital and yet facilities to prevent infection are often inadequate in this important clinical area. Many antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), Serratia marcescens and vancomycin-resistant enterococci (VRE), may survive and persist in the environment leading to recurrent outbreaks. A number of professional and scientific bodies in the UK, the USA and Europe have published guidelines on the design and layout of ICUs. All emphasize the importance of adequate isolation facilities (at least one cubicle for every six beds), sufficient space around each bed (20 m2), wash hand basins between every other bed, ventilation including positive and negative pressure ventilation for high risk patients and sufficient storage and utility space. Common sense and considerations of safety and comfort should guide decisions on floors, walls etc. Appropriate cleaning and disinfection programmes are essential to render the ICU relatively pathogen free and compliance with handwashing is imperative in minimizing infection in this high-risk area. Infection control teams should support ICU personnel in their efforts to upgrade facilities and help ensure that this is a priority when resources are limited.

Cross Infection↗

Inhibition of influenza virus infection by a novel antiviral peptide that targets viral attachment to cells.

Influenza A viruses continue to cause widespread morbidity and mortality. There is an added concern that the highly pathogenic H5N1 influenza A viruses, currently found throughout many parts of the world, represent a serious public health threat and may result in a pandemic. Intervention strategies to halt an influenza epidemic or pandemic are a high priority, with an emphasis on vaccines and antiviral drugs. In these studies, we demonstrate that a 20-amino-acid peptide (EB, for entry blocker) derived from the signal sequence of fibroblast growth factor 4 exhibits broad-spectrum antiviral activity against influenza viruses including the H5N1 subtype in vitro. The EB peptide was protective in vivo, even when administered postinfection. Mechanistically, the EB peptide inhibits the attachment to the cellular receptor, preventing infection. Further studies demonstrated that the EB peptide specifically binds to the viral hemagglutinin protein. This novel peptide has potential value as a reagent to study virus attachment and as a future therapeutic.

Amino Acid Sequence↗

The cost of hepatitis C and the cost-effectiveness of its prevention.

Hepatitis C infection is an emerging problem in public health and is now the most common blood-borne infection. The virus imposes a significant personal and social burden on those infected, as well as substantial costs to the health care system. In this paper we report an estimate of the costs of hepatitis C and consider the role such information might play in determining an appropriate preventive strategy. Preventing a single case of HCV would release resources valued Aus $6000 and Aus $19,000, depending on whether production loses were included. This information can be used to derive cost-effectiveness thresholds for any preventive activity, but is not in itself necessary in determining health priorities. Information on the marginal cost-effectiveness of preventive methods is both necessary and sufficient.

Australia↗

Neurological manifestations of human parvovirus B19 infection.

Since its discovery, human parvovirus B19 has been linked with a broad spectrum of clinical syndromes. An aetiological role for the virus has been confirmed in erythema infectiosum, transient aplastic crisis, persistent infection manifesting as pure red cell aplasia in immunocompromised persons, non-immune hydrops fetalis and arthritis. Less commonly recognised, but receiving increasing attention recently, are the neurological manifestations, a variety of which have been described in patients with either clinically diagnosed or laboratory confirmed B19 infection. The purpose of this review is to summarise present knowledge of B19, its known and potential pathogenic mechanisms and its association with human diseases, particularly those with neurological manifestations. The outcome of the review supports an aetiological role of the virus in neurological disease. However, the pathogenesis remains unknown and elucidating this is a priority.

Erythema Infectiosum↗

Disinfection by-products in small Alberta community drinking-water supplies.

Complacent attitudes toward drinking-water quality can lead to compromised disinfection practices, as noted in such episodes as Walkerton and North Battleford. The first priority for drinking-water providers must be to ensure microbial safety. However, it is recognized that effective disinfection may not be risk free. Consequently, drinking-water guidelines seek to balance the certain danger posed by microbial pathogens with the potential adverse health hazards that may arise from disinfection by-products (DBPs). Providers of drinking water in small communities often do not have the means to reduce concentrations of DBPs, compared to utilities in larger municipalities. A significant portion of Alberta's population receives drinking water from smaller scale treatment plants or from private wells. A survey of selected DBPs was conducted in 11 rural Alberta communities, with populations ranging from 60 to 2300. The objectives were to evaluate source water quality, as measured by total organic carbon, and to measure representative concentrations of trihalomethanes (THMs) and haloacetic acids (HAAs) at a point within each distribution system as well as within each water treatment plant. During the 5-wk study, our data show: (1) averages of THM3 (chloroform, bromodichloromethane, chloro dibromomethane) concentrations often exceed 100 microg/L (Health Canada's running annual average guideline for total THMs); (2) source waters with the highest TOC concentrations (15 mg/L) had the highest average THM3 concentrations (200 microg/L); and (3) poor source water quality may necessitate using alternative disinfection options to ensure compliance with microbial and chemical drinking-water guidelines.

Alberta↗

Adenovirus-mediated gene delivery to dendritic cells.

Dendritic cells (DCs) are "professional" antigen-presenting cells (APCs) that are uniquely capable of activating and instructing a naive immune system to mount a specific cellular and humoral response. Recognition of this crucial function makes the development of technologies for DC-based immuno-therapies a priority for the treatment of a wide variety of diseases. The most immediate impact of this emerging technology will be in the treatment of cancer and the development of third generation vaccines to protect against viral and intracellular pathogens. In addition to elicitation of immune responses, DCs also function to maintain tolerance to "self." Once the biological basis for this important function is understood, future applications of DC-based immuotherapies may be developed to ameliorate autoimmune diseases or enhance acceptance of transplanted organs. The feasibility of "engineering" the function of DCs has been realized by recent advances in ex vivo methodologies that allow selective DC propagation, antigen loading, and genetic modification in vitro for subsequent therapeutic transfer into the host. Ultimately, the ability to genetically modify these cells will allow us to design DC-mediated interventions that will direct predictable control of either immune activation or tolerance in vivo.

Adenoviridae↗

Problems in adult living donor liver transplantation using the right hepatic lobe.

BACKGROUND: Adult living donor liver transplantation (LDLT) is now widely applied to patients, children or adults, and the graft extends from the left hepatic lobe to the right hepatic lobe. Harvesting the right hepatic lobe would mean putting the donor at high risk. The congestion of a graft may cause small-for-size syndrome. The safety of the donor and its evaluation, which are related to the outcome for the recipient, play an important role in LDLT. How to decrease the congestion of the graft is another challenge to transplant experts. DATA SOURCES: A literature search from MEDLINE about adult LDLT in recent years was made to analyze the safety of the living donor and the innovation of surgical techniques for preventing small-for-size syndrome. RESULTS: The top priority for adult LDLT is donor safety. Preoperative donor evaluation consists of three stages: phase 1 for general evaluation, phase 2 for laboratory tests, and phase 3 for radiological evaluation of graft volume and vessel anatomy. The potential pathogenic mechanisms of small-for-size syndrome seem to be related to persistent portal hypertension and portal overperfusion. Improved surgical techniques for decreasing portal hypertension and preventing congestion of a graft may reduce the incidence of small-for-size syndrome. The improved techniques include reconstruction of the tributaries of the middle hepatic vein, end-to-side portocaval shunting, ligation of the splenic artery, dual-graft transplantation, and modified reconstruction of hepatic veins. CONCLUSION: With the careful preoperative assessment and the safety of the living donor, as well as improved surgical techniques, adult LDLT using the right lobe is safe.

Adult↗

Progress towards the treatment of Ebola haemorrhagic fever.

Being highly pathogenic for human and nonhuman primates and the subject of former weapon programmes makes Ebola virus one of the most feared pathogens worldwide today. Due to a lack of licensed pre- and postexposure intervention, the current response depends on rapid diagnostics, proper isolation procedures and supportive care of case patients. Consequently, the development of more specific countermeasures is of high priority for the preparedness of many nations. Over the past years, enhanced research efforts directed to better understand virus replication and pathogenesis have identified potential new targets for intervention strategies. The authors discuss the most promising therapeutic approaches for Ebola haemorrhagic fever as judged by their efficacy in animal models. The current development in this field encourages discussions on how to move some of the experimental approaches towards clinical application.

Animals↗

[Surveillance and control of ARI among urban nurseries in Beijing].

A study on acute respiratory infectious was carried out in four kindergartens in Beijing from September, 1984 to August, 1987. The results showed that ARI incidence rate in the children aged 0-7 years was 348.3%. Most of the cases were upper respiratory infectious. The incidence rate of pneumonia was 2.7%. The relationship between ARI incidence rate and age group showed that incidence of URI of 0-2 age group was 1.5 times higher than that of 5-7 age group, while the incidence of LRI of that 0-2 age group was 6.3 times higher than the later age group. The peak season of ARI was from October to January each year. The virus infections showed its priority in ARI. Duplicate samples of sera of 240 cases were tested. In which 122 cases were proved positive. Some strains of virus were isolated as well. It was showed that the influenza virus and adenovirus were the common pathogens of ARI. The effect of killed BCG(orally) on preventing ARI was observed. The preliminary date indicated the potential effect for the prevention of ARI by this measure.

BCG Vaccine↗

[Percutaneous blood exposure among Danish physicians. Mechanisms and prevention].

The study describes the mechanisms of percutaneous blood exposure (PCE) among Danish doctors and discusses rational strategies for prevention. Data were obtained as part of a nation-wide survey of occupational blood exposure. The most recent percutaneous or mucocutaneous exposure within the previous three months was described. Of 9375 doctors, 6005 (64%) participated. A total of 971 PCE were described. Inattentiveness contributed to 30.5%. Use of fingers rather than instruments was a contributing cause of 36.9% of 483 PCE on suture needles. Common concomitant causes in such cases (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines only. In conclusion, education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.

Accidents, Occupational↗