Determination of bacterial quantity by sonication in vacum-assisted closure (VAC) foams used for treatment of chronic wounds

Background: Negative pressure wound treatment is increasingly used through a Vacuum-Assisted Closure (VAC) device in complex wound situations. For this purpose, sterile polyurethane (PU) and polyvinyl alcohol (PVA) foam dressings are fitted to the wound size and covered with an adhesive drape to create an airtight seal. Little information exists about the type and quantity of microorganisms within the foams. Therefore, we investigated VAC foams after removal from the wound using a validated method (sonication) to detect the bacterial bioburden in the foam consisting as microbial biofilms.Methods: We prospectively included VAC foams (PU and PVA, KCI, Rümlamg, Switzerland) without antibacterial additions (e.g. silver), which were removed from wounds in patients with chronic ulcers from January 2007 through December 2008. Excluded were patients with acute wound infection, necrotizing fasciitis, underlying osteomyelitis or implant. Removed foams from regular changes of dressing were aseptically placed in a container with 100 ml sterile Ringer's solution. Within 4 hours after removal, foams were sonicated for 5 min at 40 kHz (as described in NEJM 2007;357:654). The resulting sonication fluid was cultured at 37°C on aerobic blood agar plates for 5 days. Microbes were quantified as No. of colony-forming units (CFU)/ml sonication fluid and identified to the species level.Results: A total of 68 foams (38 PU and 30 PVA) from 55 patients were included in the study (median age 71 years; range 33-88 years, 57% were man). Foams were removed from the following anatomic sites: sacrum (n=29), ischium (n=18), heel (n=13), calves (n=6) and ankle (n=2). The median duration of being in place was 3 days (range, 1-8 days). In all 68 foams, bacteria were found in large quantities (median 105 CFU/ml, range 102-7 CFU/ml sonication fluid. No differences were found between PU and PVA foams. One type of organisms was found in 11 (16%), two in 17 (24%) and 3 or more in 40 (60%) foams. Gram-negative rods (Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa) were isolated in 70%, followed by Staphylococcus aureus (20%), koagulase-negative staphylococci, streptococci (8%), and enterococci (2%).Conclusion: With sonication, a high density of bacteria present in VAC foams was demonstrated after a median of 3 days. Future studies are needed to investigate whether antimicrobial-impregnated foams can reduce the bacterial load in foams and potentially improve wound healing.

Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline.

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.

Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial.

ABSTRACT: Iron deficiency without anemia (IDWA) is related to adverse symptoms that can be relieved by supplementation. Since a blood donation can induce such an iron deficiency, we investigated the clinical impact of an iron treatment after blood donation. METHODS: One week after donation, we randomly assigned 154 female donors with IDWA aged <50 years to a 4-week oral treatment of ferrous sulfate vs. placebo. The main outcome was the change in the level of fatigue before and after the intervention. Also evaluated were aerobic capacity, mood disorder, quality of life, compliance and adverse events. Biological markers were hemoglobin and ferritin. RESULTS: Treatment effect from baseline to 4 weeks for hemoglobin and ferritin were 5.2 g/L (p < 0.01) and 14.8 ng/mL (p < 0.01) respectively. No significant clinical effect was observed for fatigue (-0.15 points, 95% confidence interval -0.9 to 0.6, p = 0.697) or for other outcomes. Compliance and interruption for side effects was similar in both groups. Additionally, blood donation did not induce overt symptoms of fatigue in spite of the significant biological changes it produces. CONCLUSIONS: These data are valuable as they enable us to conclude that donors with IDWA after a blood donation would not clinically benefit from iron supplementation. Trial registration: NCT00689793.

Persistence and cell culturability of biocontrol strain Pseudomonas fluorescens CHA0 under plough pan conditions in soil and influence of the anaerobic regulator gene anr.

Certain fluorescent pseudomonads can protect plants from soil-borne pathogens, and it is important to understand how these biocontrol agents survive in soil. The persistence of the biocontrol strain Pseudomonas fluorescens CHA0-Rif under plough pan conditions was assessed in non-sterile soil microcosms by counting total cells (immunofluorescence microscopy), intact cells (BacLight membrane permeability test), viable cells (Kogure's substrate-responsiveness test) and culturable cells (colony counts on selective plates) of the inoculant. Viable but non-culturable cells of CHA0-Rif (106 cells g-1 soil) were found in flooded microcosms amended with fermentable organic matter, in which the soil redox potential was low (plough pan conditions), in agreement with previous observations of plough pan samples from a field inoculated with CHA0-Rif. However, viable but non-culturable cells were not found in unamended flooded, amended unflooded or unamended unflooded (i.e. control) microcosms, suggesting that such cells resulted from exposure of CHA0-Rif to a combination of low redox potential and oxygen limitation in soil. CHA0-Rif is strictly aerobic. Its anaerobic regulator ANR is activated by low oxygen concentrations and it controls production of the biocontrol metabolite hydrogen cyanide under microaerophilic conditions. Under plough pan conditions, an anr-deficient mutant of CHA0-Rif and its complemented derivative displayed the same persistence pattern as CHA0-Rif, indicating that anr was not implicated in the formation of viable but non-culturable cells of this strain at the plough pan.

Long maximal incremental tests accurately assess aerobic fitness in class II and III obese men.

This study aimed to compare two different maximal incremental tests with different time durations [a maximal incremental ramp test with a short time duration (8-12 min) (STest) and a maximal incremental test with a longer time duration (20-25 min) (LTest)] to investigate whether an LTest accurately assesses aerobic fitness in class II and III obese men. Twenty obese men (BMI≥35 kg.m-2) without secondary pathologies (mean±SE; 36.7±1.9 yr; 41.8±0.7 kg*m-2) completed an STest (warm-up: 40 W; increment: 20 W*min-1) and an LTest [warm-up: 20% of the peak power output (PPO) reached during the STest; increment: 10% PPO every 5 min until 70% PPO was reached or until the respiratory exchange ratio reached 1.0, followed by 15 W.min-1 until exhaustion] on a cycle-ergometer to assess the peak oxygen uptake [Formula: see text] and peak heart rate (HRpeak) of each test. There were no significant differences in [Formula: see text] (STest: 3.1±0.1 L*min-1; LTest: 3.0±0.1 L*min-1) and HRpeak (STest: 174±4 bpm; LTest: 173±4 bpm) between the two tests. Bland-Altman plot analyses showed good agreement and Pearson product-moment and intra-class correlation coefficients showed a strong correlation between [Formula: see text] (r=0.81 for both; p≤0.001) and HRpeak (r=0.95 for both; p≤0.001) during both tests. [Formula: see text] and HRpeak assessments were not compromised by test duration in class II and III obese men. Therefore, we suggest that the LTest is a feasible test that accurately assesses aerobic fitness and may allow for the exercise intensity prescription and individualization that will lead to improved therapeutic approaches in treating obesity and severe obesity.

Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome.

BACKGROUND: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. METHODS: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. RESULTS: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤ 2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. CONCLUSIONS: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.

Diabetes mellitus, periapical inflammation and endodontic treatment outcome

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol

Parhaat käyttökelpoiset tekniikat (BAT) perunankuorimoiden jätteiden käsittelyssä -käytäntöjä Euroopan maista

Yhä suurempi osa suurkeittiöistä ja ravintoloista käyttää ruuan valmistuksessa valmiiksi prosessoituja kasviksia, jotka hankitaan pääasiassa lähellä sijaitsevista tilakuorimoista. Kuorimoilla syntyy suuria määriä jätettä, enimmäkseen kuorijätteitä, multaa ja jätevettä. Tässä työssä tarkastellaan perunankuorimoiden kuorintamenetelmiä ja kuorintaprosessia, prosessissa syntyviä jätteitä ja niiden käsittelyä sekä ympäristöasioiden hallintamenetel-miä kuorimoilla Suomessa ja muissa EU-maissa. Työn tavoitteena oli selvittää, minkälainen on lainsäädäntö ja minkälaiset ovat kuorimotoimintaa koskevat lupakäytännöt Ruotsissa, Saksassa, Belgiassa ja Iso-Britanniassa. Lisäksi tavoitteena oli selvittää, onko näissä maissa määritelty, millainen on perunankuorimoille soveltuva paras käyttökelpoinen tekniikka (BAT) erityisesti jätteiden käsittelyssä. Euroopan yhteisön neuvoston direktiivi (96/61/EY) ympäristön pilaantumisen ehkäisemisen ja vähentämisen yhtenäistämiseksi edellyttää perunankuorimoilta toimintaansa ympäristöluvan. Laitosten koko, joilta ympäristölupa vaaditaan, vaihtelee suuresti eri maissa. Myös kuorimoiden jäteveden puhdistusvaatimukset vaihtelevat maittain. Belgi-assa ja Saksassa perunankuorimoilla syntyville jätevesille on asetettu päästöraja-arvot laissa. Kansallinen BAT-ohjeistus vihanneksia ja hedelmiä jatkojalostavalle teollisuudelleon tehty Belgiassa ja Iso-Britanniassa. Sen sijaan Saksassa ja Ruotsissa kansallista ohjeistusta ei ole tehty. Kansallisten BAT-ohjeistusten pohjalta Euroopan yhteisöjen komissio on julkaissut tammikuussa 2006 elintarviketeollisuudelle BAT-vertailuasiakirjan eli BREFin (BAT Referense Document), joissa kuvataan yleisellä tasolla BAT-tekniikoiksi sovitut tekniikat mm. perunan prosessoinnissa. Tässä työssä tuli ilmi, että kokoerot Suomen ja tässä työssä tarkasteltavien maiden kuo-rimoiden välillä ovat suuret. Voidaankin todeta, että tässä työssä tarkastelluissa BAT - ohjeistuksissa ja Euroopan komission BREF-dokumentissa esitetyt BAT-tekniikat etenkin jätevedenpuhdistuksessa eivät suoraan ole sovellettavissa Suomen olosuhteisiin kuorimoidemme pienestä koosta johtuen. Kiinteiden kuorintajätteiden käsittelyssä BAT-tekniikoiksi ulkomailla on määritelty lä-hinnä rehukäyttö, kompostointi ja peltoon levitys. Perunankuorimoiden jäteveden puhdistuksessa BAT-tekniikaksi Belgiassa on määritelty primääripuhdistus ja sekundääripuhdistus aerobisella menetelmällä. Iso-Britanniassapuolestaan BAT-tekniikkaa on primää-ripuhdistus, sekundääripuhdistus aerobisesti tai anaerobisesti ja tertiääripuhdistus, mikäli se on taloudellisesti mahdollista toteuttaa. Kuorijätteiden kompostointi on tällä hetkelläSuomessa melko harvinaista, sillä jätteiden suuri vesipitoisuus ja kylmä ilmastomme vaikeuttavat kompostointia. Kompostointimah-dollisuuksia ja kompostointiprosessin optimointia kuorintajätteille sopivaksi tulisikin tutkia tulevaisuudessa yhtenä jätteiden käsittelyvaihtoehtona. Kuorimoiden jätevesien puhdistuksessa tulevat Suomessa kysymykseen lähinnä yksinkertaiset kiinteistökohtaiset pienpuhdistamot, kuten panospuhdistamot. Pienpuhdistamolaitteistoihin liittyvää tutki-mus-ja kehitystyötä on viime vuosina tehty paljon ja sitä olisi tärkeää jatkaa edelleen, jotta löydettäisiin entistä kustannustehokkaampia ratkaisuja.

II Congreso español de gestión integral de deyecciones ganaderas : Barcelona, 9-10 de junio 2010. International workshop on anaerobic digestion of slaughterhouse waste : Barcelona, 11 junio 2010

La fuerte demanda de alimentos que ha tenido lugar a nivel mundial en los últimos años, ha provocadoun cambio en los sistemas de producción agraria y para el caso de la ganadera se ha pasado de lastípicas explotaciones extensivas ligadas al terreno a las granjas intensivas, en donde se ha incrementadola carga ganadera, bien aumentando el número de cabezas en pastoreo o mediante la construcción degranjas intensivas sin suelo

The Current Situation of Sewage Sludge and Manure Treatment in Livestock Enterprises in the Leningrad Region

The problem concerning livestock waste handling in the Leningrad region has been subjected to a number of research works. However, the requirements for use of manure and sewage sludge as well as for treatment processes are not certain. So, this problem remains relevant and, therefore, further investigation ought to be made. Currently a large amount of sewage sludge and manure is generated in the Leningrad region. These livestock wastes have to be obligatory treated. The most common methods for treatment in the region, such as anaerobic digestion, composting and aging as well as the most potential methods are described in the thesis. The most potential methods for the Leningrad region are anaerobic digestion, composting and combustion. Each method has strengths and weaknesses, which are also considered in the paper. Aging was not considered as potential treatment method because it does not meet the sanitary and epidemiological requirements. Furthermore, the work gives an overview and comparison of Finnish and Russian legislative and normative acts concerning livestock wastes handling. On the whole the requirements of the Russian Federation concerning sewage sludge and manure are not much different from the Finnish ones.

Caracterização de contaminantes presentes em sistemas de tratamento de esgotos, por cromatografia líquida acoplada à espectrometria de massas tandem em alta resolução

This work shows results on the characterization, by liquid chromatography coupled to high resolution tandem mass spectrometry (LC-IT-TOF-MS) with electrospray ionization, of organic compounds present in raw and treated effluents from a combined sewage treatment systems (upflow anaerobic sludge blanket-trickling filter). The sewage samples were prepared by C18 solid phase extraction and the spectra obtained from the various extracts were submitted to principal component analysis to evaluate their pattern and identify the major deprotonated species. Some target compounds were submitted to semiquantitative analysis, using phenolphtalein as internal standard. The results showed the anaerobic step had little impact on the removal of anionic surfactants (LAS), fatty acids, and some contaminantes such as bisphenol A and bezafibrate, whereas the aerobic post-treatment was very efficient in removing these organics.

The Methods of Possible Joint Treatment of Manure and Sewage Sludge in the Leningrad Region

The nutrient load to the Gulf of Finland has started to increase as a result of the strong economic recovery in agriculture and livestock farming in the Leningrad region. Also sludge produced from municipal wastewater treatment plant of the Leningrad region causes the great impact on the environment, but still the main options for its treatment is disposal on the sludge beds or Landfills. The aim of this study was to evaluate the implementation of possible joint treatment methods of manure form livestock and poultry enterprises and sewage sludge produced from municipal wastewater treatment plants in the Leningrad region. The study is based on published data. The most attention was put on the anaerobic digestion and incineration methods. The manure and sewage sludge generation for the whole Leningrad region and energy potential produced from their treatment were estimated. The calculations showed that total amount of sewage sludge generation is 1 348 000 t/a calculated on wet matter and manure generation is 3 445 000 t/a calculated on wet matter. The potential heat release from anaerobic digestion process and incineration process is 4 880 000 GJ/a and 5 950 000 GJ/a, respectively. Furthermore, the work gives the overview of the general Russian and Finnish legislation concerning manure and sewage sludge treatment. In the Gatchina district it was chosen the WWTP and livestock and poultry enterprises for evaluation of the centralized treatment plant implementation based on anaerobic digestion and incineration methods. The electricity and heat power of plant based on biogas combustion process is 4.3 MW and 7.8 MW, respectively. The electricity and heat power of plant based on manure and sewage sludge incineration process is 3.0 MW and 6.1 MW, respectively.

Kinetic behavior of nitrification in the post-treatment of poultry wastewater in a sequential batch reactor

A sequential batch reactor with suspended biomass and useful volume of 5 L was used in the removal of nutrients and organic matter in workbench scale under optimal conditions obtained by central composite rotational design (CCRD), with cycle time (CT) of 16 h (10.15 h, aerobic phase, and 4.35 h, anoxic phase) and carbon: nitrogen ratio (COD/NO2--N+NO3--N) equal to 6. Complete cycles (20), nitrification followed by denitrification, were evaluated to investigate the kinetic behavior of degradation of organic (COD) and nitrogenated (NH4+-N, NO2--N and NO3--N) matter present in the effluent from a bird slaughterhouse and industrial processing facility, as well as to evaluate the stability of the reactor using Shewhart control charts of individual measures. The results indicate means total inorganic nitrogen (NH4+-N+NO2- -N+NO3--N) removal of 84.32±1.59% and organic matter (COD) of 53.65±8.48% in the complete process (nitrification-denitrification) with the process under statistical control. The nitrifying activity during the aerobic phase estimated from the determination of the kinetic parameters had mean K1 and K2 values of 0.00381±0.00043 min-1 and 0.00381±0.00043 min-1, respectively. The evaluation of the kinetic behavior of the conversion of nitrogen indicated a possible reduction of CT in the anoxic phase, since removals of NO2--N and NO3--N higher than 90% were obtained with only 1 h of denitrification.

Establishment of anammox process in sludge samples collected from swine wastewater treatment system

The high load of nitrogen present in swine wastewater is one of the biggest management challenges of the activity. The Anammox process emerges as a good alternative for biological removal of nitrogen. This study aims to acclimate sludge collected from swine effluent treatment systems to establish the Anammox process. Two sludge samples were collected at Embrapa Swine and Poultry, Concordia - SC, Brazil, one from the bottom of an inactive anaerobic pond (inoculum A) and another from an aeration tank (inoculum B). Both were acclimated until the depletion of NO3-N, being subsequently inoculated in two reactors (Reactor A - Inoculum A and Reactor B - Inoculum B). The Reactor A showed activity after 110 days of operation, while the Reactor B needed 170 days. The difference in the start-up time could be explained by the different environmental conditions to which each sludge was submitted. FISH and PCR analyses confirmed the presence of microorganisms with Anammox activity, demonstrating that the sludge of swine wastewater treatment systems is a good source of inoculum for the development of the Anammox process.

Anaerobic co-digestion of crude glycerin and starch industry effluent

The Brazil's Biodiesel Production and Use Program introduces biodiesel in the Brazilian energy matrix, bringing along the perspective of a growth of the glycerin offer, co-product generated in the proportion of 10 kg for each 100 L of biodiesel. The aim of this study was to evaluate the addition of crude glycerin in the anaerobic digestion of cassava starch industry effluent (cassava wastewater), in a horizontal semi-continuous flow reactor of one phase in laboratory scale. It was used a reactor with a 8.77 L of useful volume, a medium support for corrugated conduit of polyvinyl chloride (PVC), temperature of 261 ºC, fed with cassava wastewater and glycerin, with hydraulic detention times of 4 and 5 days and increasing volumetric organic load of 3.05; 9.32; 14.83 and 13.59 g COD L-1 d-1, obtained with the addition of glycerin at 0; 2; 3 and 2% (v/v), respectively. The average removal efficiencies of TS and TVS were decreasing from the addition of glycerin to the cassava wastewater, averaging 81.19 to 55.58% for TS and 90.21 to 61.45% for TVS. The addition of glycerin at 2% increased the biogas production compared to the control treatment, reaching 1.979 L L-1 d-1. The biogas production as a function of the consumed COD was higher for the control treatment than for the treatments with addition of glycerin, which indicates lower conversion of organic matter into biogas.