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Sample records for cholerae inguinal skin

  1. Cholera

    MedlinePlus

    ... cholerae. This same bacterium is also present in raw seafood, particularly shellfish. The best way to avoid ... contaminated with feces containing V. cholerae By eating raw shellfish contaminated with V. cholerae Who's At Risk ...

  2. Modified skin bridge technique for ilio-inguinal lymph node dissection: A forgotten technique revisited

    PubMed Central

    Ray, Mukur Dipi; Garg, Pankaj K; Jakhetiya, Ashish; Kumar, Sunil; Pandey, Durgatosh

    2016-01-01

    Ilio-inguinal lymph node dissection (IILD) is a commonly performed surgical procedure for a number of malignant conditions involving mainly the male and female genitalia, and the skin; however the postoperative morbidity of IILD, due to high frequency of flap necrosis, wound infection and seroma formation, has always been a major concern for the surgeons. The aim of the study is to highlight a modified skin bridge technique of IILD using two parallel curvilinear incisions to minimize postoperative skin flap necrosis. This technique was successfully employed in 38 IILD during May 2012 to November 2013. None of the patient had flap necrosis. Two patients developed seroma while another two patients had superficial surgical site infection; they were managed conservatively. Modified skin bridge technique for IILD is an effective method to minimize flap necrosis without compromising the oncological safety.

  3. Modified skin bridge technique for ilio-inguinal lymph node dissection: A forgotten technique revisited

    PubMed Central

    Ray, Mukur Dipi; Garg, Pankaj K; Jakhetiya, Ashish; Kumar, Sunil; Pandey, Durgatosh

    2016-01-01

    Ilio-inguinal lymph node dissection (IILD) is a commonly performed surgical procedure for a number of malignant conditions involving mainly the male and female genitalia, and the skin; however the postoperative morbidity of IILD, due to high frequency of flap necrosis, wound infection and seroma formation, has always been a major concern for the surgeons. The aim of the study is to highlight a modified skin bridge technique of IILD using two parallel curvilinear incisions to minimize postoperative skin flap necrosis. This technique was successfully employed in 38 IILD during May 2012 to November 2013. None of the patient had flap necrosis. Two patients developed seroma while another two patients had superficial surgical site infection; they were managed conservatively. Modified skin bridge technique for IILD is an effective method to minimize flap necrosis without compromising the oncological safety. PMID:27679781

  4. Modified skin bridge technique for ilio-inguinal lymph node dissection: A forgotten technique revisited.

    PubMed

    Ray, Mukur Dipi; Garg, Pankaj K; Jakhetiya, Ashish; Kumar, Sunil; Pandey, Durgatosh

    2016-09-26

    Ilio-inguinal lymph node dissection (IILD) is a commonly performed surgical procedure for a number of malignant conditions involving mainly the male and female genitalia, and the skin; however the postoperative morbidity of IILD, due to high frequency of flap necrosis, wound infection and seroma formation, has always been a major concern for the surgeons. The aim of the study is to highlight a modified skin bridge technique of IILD using two parallel curvilinear incisions to minimize postoperative skin flap necrosis. This technique was successfully employed in 38 IILD during May 2012 to November 2013. None of the patient had flap necrosis. Two patients developed seroma while another two patients had superficial surgical site infection; they were managed conservatively. Modified skin bridge technique for IILD is an effective method to minimize flap necrosis without compromising the oncological safety. PMID:27679781

  5. Cholera

    PubMed Central

    Harris, Jason B.; LaRocque, Regina C.; Qadri, Firdausi; Ryan, Edward T.; Calderwood, Stephen B.

    2013-01-01

    Summary Cholera is an acute, secretory diarrhea caused by infection with Vibrio cholerae of the O1 and O139 serogroups. Cholera is endemic in over 50 countries and also causes large epidemics. Since 1817, seven cholera pandemics have spread from Asia to much of the world. The 7th pandemic began in 1961 and affects 3–5 million people each year, killing 120,000. Although mild cholera may be indistinguishable from other diarrheal illnesses, the presentation of severe cholera is distinct, with dramatic diarrheal purging. Management of patients with cholera involves aggressive fluid replacement; effective therapy can decrease mortality from over 50% to less than 0.2%. Antibiotics decrease volume and duration of diarrhea by 50% and are recommended for patients with moderate to severe dehydration. Prevention of cholera depends on access to safe water and sanitation. Two oral cholera vaccines are available and the most effective use of these in integrated prevention programs is being actively evaluated. PMID:22748592

  6. Cholera.

    PubMed Central

    Kaper, J B; Morris, J G; Levine, M M

    1995-01-01

    Despite more than a century of study, cholera still presents challenges and surprises to us. Throughout most of the 20th century, cholera was caused by Vibrio cholerae of the O1 serogroup and the disease was largely confined to Asia and Africa. However, the last decade of the 20th century has witnessed two major developments in the history of this disease. In 1991, a massive outbreak of cholera started in South America, the one continent previously untouched by cholera in this century. In 1992, an apparently new pandemic caused by a previously unknown serogroup of V. cholerae (O139) began in India and Bangladesh. The O139 epidemic has been occurring in populations assumed to be largely immune to V. cholerae O1 and has rapidly spread to many countries including the United States. In this review, we discuss all aspects of cholera, including the clinical microbiology, epidemiology, pathogenesis, and clinical features of the disease. Special attention will be paid to the extraordinary advances that have been made in recent years in unravelling the molecular pathogenesis of this infection and in the development of new generations of vaccines to prevent it. PMID:7704895

  7. Cholera

    MedlinePlus

    ... universal access to safe drinking water and adequate sanitation, which is key in preventing both epidemic and endemic cholera. Actions targeting environmental conditions include: the development of piped water systems ...

  8. Cholera.

    PubMed

    Burnett, Mark W

    2014-01-01

    Vibrio cholerae is a comma-shaped, gram-negative rod that produces an enterotoxin, which causes an acute-onset diarrheal disease ranging in severity from mild to life threatening. Worldwide, there are an estimated 3?5 million cases per year, with more than 100,000 deaths. The disease remains a significant cause of death and illness in sub-Saharan Africa, southeast Asia (especially Bangladesh and India), and Haiti, and the infection should be recognized by the Special Operations Forces (SOF) medical provider. PMID:24952048

  9. Cholera toxin, a potent inducer of epidermal hyperplasia but with no tumor promoting activity in mouse skin carcinogenesis

    SciTech Connect

    Kuroki, T.; Chida, K.; Munakata, K.; Murakami, Y.

    1986-05-29

    Intracutaneous injection of cholera toxin into mice induced epidermal hyperplasia to a greater extent than 12-O-tetra-decanoylphorbol-13-acetate. It also induced adenylate cyclase and through weakly, ornithine decarboxylase of the epidermis. Cholera toxin, however, showed no tumor promoting activity in mouse skin carcinogenesis. In the single stage promotion, cholera toxin (50 ng) was injected once a week for 10 weeks into the skin of SENCAR mice initiated with 25 ..mu..g 7,12-dimethyl-benz(a)anthracene, but no tumors developed. In the two-stage promotion test, cholera toxin (10-100 ng) was injected for one or two weeks into the initiated skin and then mezerein (4 ..mu..g) was applied twice a week for 18 weeks, but the toxin did not increase incidence or numbers of papillomas.

  10. Tensor fasciae latae musculocutaneous flaps to reconstruct skin defects after radical inguinal lymphadenectomy.

    PubMed

    Gopinath, K S; Chandrashekhar, M; Kumar, M V; Srikant, K C

    1988-07-01

    Tensor fasciae latae flaps were used for primary reconstruction of large groin defects in 20 consecutive patients who had had radical block dissection of inguinal nodes as palliation for advanced nodal carcinoma. Excellent palliation was achieved, with lower than expected morbidity.

  11. Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors

    PubMed Central

    Stollwerck, Peter. L.; Schlarb, Dominik; Münstermann, Nicole; Stenske, Sebastian; Kruess, Christoph; Brodner, Gerhard; Krapohl, Björn Dirk; Krause-Bergmann, Albrecht F.

    2016-01-01

    Background: Inguinal lymph node dissection (ILND) is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu® Surgical Adhesive and ARTISS® fibrin sealant with a control population. Material and methods: We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany), from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures. Results: Complications occurred in 22/60 procedures in the TissuGlu group (TG), in 8/17 in the ARTISS group (AG), and in 29/65 in the control group (CG). Prolonged drainage and seroma were recorded in 16 (26.7%), four (23.5%), and 26 (40%) respectively (non-significant). TG showed less extended drainage vs. CG (p=0.082). Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001). The mean body mass index (BMI) was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000). Conclusion: The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND. (Level of evidence: level IV, retrospective case study) PMID

  12. Inguinal dermoid cyst presenting as an incarcerated inguinal hernia.

    PubMed

    Leeming, R; Olsen, M; Ponsky, J L

    1992-01-01

    A case of an inguinal dermoid cyst presenting as an incarcerated inguinal hernia in a 18-year-old boy is reported. A differential diagnosis of masses in the inguinal region is discussed and includes not only hernias but also gynecologic and vascular lesions. Dermoid cysts must be included in the differential diagnosis. Histologically, these cysts are characterized by an external lining composed of squamous epithelium with an underlying fibroconnective tissue containing hair follicles, sebaceous, eccrine, and apocrine glands. The presence of all the skin appendages in these cysts distinguishes them from epidermoid and sebaceous cysts. The lack of structures foreign to skin differentiates them from dermoids (benign cystic teratomas) in the ovarian, testicular, retroperitoneal, and sacrococcygeal region.

  13. Altered Cortical Responsiveness to Pain Stimuli after High Frequency Electrical Stimulation of the Skin in Patients with Persistent Pain after Inguinal Hernia Repair

    PubMed Central

    van den Broeke, Emanuel N.; Koeslag, Lonneke; Arendsen, Laura J.; Nienhuijs, Simon W.; Rosman, Camiel; van Rijn, Clementina M.; Wilder-Smith, Oliver H. G.; van Goor, Harry

    2013-01-01

    Background High Frequency electrical Stimulation (HFS) of the skin induces enhanced brain responsiveness expressed as enhanced Event-Related Potential (ERP) N1 amplitude to stimuli applied to the surrounding unconditioned skin in healthy volunteers. The aim of the present study was to investigate whether this enhanced ERP N1 amplitude could be a potential marker for altered cortical sensory processing in patients with persistent pain after surgery. Materials and Methods Nineteen male patients; 9 with and 10 without persistent pain after inguinal hernia repair received HFS. Before, directly after and thirty minutes after HFS evoked potentials and the subjective pain intensity were measured in response to electric pain stimuli applied to the surrounding unconditioned skin. Results The results show that, thirty minutes after HFS, the ERP N1 amplitude observed at the conditioned arm was statistically significantly larger than the amplitude at the control arm across all patients. No statistically significant differences were observed regarding ERP N1 amplitude between patients with and without persistent pain. However, thirty minutes after HFS we did observe statistically significant differences of P2 amplitude at the conditioned arm between the two groups. The P2 amplitude decreased in comparison to baseline in the group of patients with pain. Conclusion The ERP N1 effect, induced after HFS, was not different between patients with vs. without persistent pain. The decreasing P2 amplitude was not observed in the patients without pain and also not in the previous healthy volunteer study and thus might be a marker for altered cortical sensory processing in patients with persistent pain after surgery. PMID:24376568

  14. Robotic inguinal hernia repair.

    PubMed

    Escobar Dominguez, Jose E; Gonzalez, Anthony; Donkor, Charan

    2015-09-01

    Inguinal hernias have been described throughout the history of medicine with many efforts to achieve the cure. Currently, with the advantages of minimally invasive surgery, new questions arise: what is going to be the best approach for inguinal hernia repair? Is there a real benefit with the robotic approach? Should minimally invasive hernia surgery be the standard of care? In this report we address these questions by describing our experience with robotic inguinal hernia repair. PMID:26153353

  15. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1957-01-01

    Discussing the symptomatology of cholera, the author deals first with the incubation period, the clinical types, choleraic diarrhoea, and cholerine; he then considers in detail the various stages of cholera gravis and the relapses and complications that may be met. This is followed by sections on diagnosis and differential diagnosis, and on prognosis and the various factors influencing it. The author's highly detailed review of the treatment of cholera which concludes this study is divided into three parts, dealing with attempts at specific therapy, with infusion treatment, and with adjuvant treatment. PMID:13426761

  16. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1957-01-01

    The first section of this study deals with areas where cholera is endemic and with the conditions normally favouring endemicity. Turning next to epidemics, the author discusses their origin and types, climatic influences on them, their periodicity and the possibility of forecasting them, the role played in them by different serological races of V. cholerae, and the causes of their decline. In a section on the factors governing the local spread of cholera, he considers contact and water-borne infection; the role of contaminated food and drink, of fomites, of flies, and of carriers; and the incidence according to sex, age, race, and occupation. The last part deals with factors governing the spread of cholera over longer distances, and includes discussion of the effect of movements of individuals and groups and of assemblies of the population on pilgrimages or at religious festivals. PMID:13472431

  17. Cholera studies*

    PubMed Central

    Swaroop, S.; Pollitzer, R.

    1955-01-01

    In this study, figures relating to cholera deaths occurring in individual countries, from 1900 to 1952, are recorded as well as the incidence of the disease from 1923 up to the present time. The mode of spread of cholera from its endemic home in India to outside countries is described in relation to favourable seasons, main routes followed by the infection, and the role played by large religious gatherings. The incidence of the disease in the various seaports infected within recent years is discussed. PMID:14364186

  18. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1957-01-01

    After a general consideration of the loss of fluids and salts in evacuations from the gastro-intestinal tract, the author discusses in detail both the physical and the chemical changes in the blood of cholera patients. The author then deals exhaustively with the problems of circulatory and renal failure. PMID:13413649

  19. Video endoscopic inguinal lymphadenectomy for radical management of inguinal nodes in patients with penile squamous cell carcinoma

    PubMed Central

    Chaudhari, Rajeev; Khant, Shahil Rameshbhai; Patel, Dipen

    2016-01-01

    Background: Inguinal lymph node involvement is an important prognostic factor in penile cancer. Inguinal lymph node dissection allows staging and treatment of inguinal nodal disease. However, it causes morbidity and is associated with complications such as lymphocele, skin loss, and infection. Aims: To report our institutional experience with video endoscopic inguinal lymphadenectomy (VEIL) for radical management of inguinal nodes in patients with penile squamous cell carcinoma. Materials and Methods: It is a prospective analysis of data of patients that underwent VEIL, by a single surgeon, from 2008 to 2015. 14 patients of penile carcinoma were suitable for VEIL technique were included in this study and followed. Data analyzed included mean operative time, mean lymph node yield, intraoperative complications, cutaneous complication, lymph-related complications, and surgical emphysema. Results: The mean age of patients was 57.8 years (range: 45–70 years). Mean operative time for VEIL was 194.86 min (178–210 min). Mean lymph node yield was 7.68 (range: 5–11 nodes). No intraoperative complication was experienced during series. We noted no cutaneous complications, localized lymphocele were seen in total 6 units out of 22 units (27.2%). Surgical emphysema is seen in 3 limbs (13.63%). There was significantly decreased overall morbidity in our study. Follow-up of 10 out of 14 patients with median of 48 months shows no recurrence. Conclusions: In our early experience, VEIL is a safe and feasible technique in patients with penile carcinoma who require radical inguinal lymphadenectomy. It allows the removal of inguinal lymph nodes within the same limits as in conventional surgical dissection and reduces surgical morbidity substantially. PMID:27453648

  20. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1956-01-01

    The first portion of this study describes in detail the different aspects of stool examinations, including the collection, preservation, and pooling of specimens, macroscopic and bacterioscopic examination, enrichment methods, and cultivation on a variety of solid media. The author also deals with the examination of vomits and of water. The performance and value of different identification tests (agglutination, haemolysis, and bacteriophage) and confirmatory tests are then considered. An annex is included on bacteriological procedures in the laboratory diagnosis of cholera. PMID:13356145

  1. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1957-01-01

    In discussing prevention, the author deals first with the provision of permanently safe water, supplied from waterworks or wells, and with other improvements in environmental sanitation. Control of food and drinks, public health propaganda and education, and vaccination are also considered under this heading. The greater part of this study is devoted to suppressive measures, affecting the individual, the environment, and persons in the mass. Discussion of the isolation, detection and management of cholera patients, the management of contacts, and the management and treatment of carriers is followed by sections on, inter alia, disinfection, temporary improvements in water supplies, fly control, and personal prophylaxis. In dealing with mass prophylaxis, the author pays particular attention to vaccination. In the concluding sections he goes into the control of pilgrimages and local and international quarantine measures. PMID:13479774

  2. Cholera studies*†

    PubMed Central

    Pollitzer, R.; Burrows, W.

    1955-01-01

    Relevant information regarding the numerous problems encountered in cholera immunity is dealt with in great detail in this study. Toxin production, bacterial virulence, serological reactions, and the antigenic structure of V. cholerae are discussed. Natural, passive, and active cholera immunity receives special attention, the authors describing the various means of vaccination as well as the evaluation of the immunity induced. PMID:13240451

  3. Cholera studies*†

    PubMed Central

    Pollitzer, R.

    1955-01-01

    In this study, the author describes in detail experimental cholera infection of mammals (infection by the oral route, intragastric inoculation, and intestinal, gall-bladder, and parenteral infection). The pathogenicity for lower animals is examined, and certain observations on insects are included. The second part of the study is devoted to the pathology of human cholera (morbid anatomy distribution of the causative organisms in the dead bodies of cholera victims, and pathogenesis). PMID:13284569

  4. Cholera outbreaks in India.

    PubMed

    Ramamurthy, Thandavarayan; Sharma, Naresh C

    2014-01-01

    Cholera is a global health problem as several thousands of cases and deaths occur each year. The unique epidemiologic attribute of the disease is its propensity to occur as outbreaks that may flare-up into epidemics, if not controlled. The causative bacterial pathogen Vibrio cholerae prevails in the environment and infects humans whenever there is a breakdown in the public health component. The Indian subcontinent is vulnerable to this disease due its vast coastlines with areas of poor sanitation, unsafe drinking water, and overcrowding. Recently, it was shown that climatic conditions also play a major role in the persistence and spread of cholera. Constant change in the biotypes and serotypes of V. cholerae are also important aspects that changes virulence and survival of the pathogen. Such continuous changes increase the infection ability of the pathogen affecting the susceptible population including the children. The short-term carrier status of V. cholerae has been studied well at community level and this facet significantly contributes to the recurrence of cholera. Several molecular tools recognized altering clonality of V. cholerae in relation with the advent of a serogroup or serotype. Rapid identification systems were formulated for the timely detection of the pathogen so as to identify and control the outbreak and institute proper treatment of the patients. The antimicrobials used in the past are no longer useful in the treatment of cholera as V. cholerae has acquired several mechanisms for multiple antimicrobial resistance. This upsurge in antimicrobial resistance directly influences the management of the disease. This chapter provides an overview of cholera prevalence in India, possible sources of infection, and molecular epidemiology along with antimicrobial resistance of V. cholerae.

  5. Cholera studies*†

    PubMed Central

    Pollitzer, R.

    1955-01-01

    The morphological characteristics, biochemical properties, and cultural characteristics of V. cholerae are described in great detail in this study. The author also discusses the resistance of the organism to temperature, humidity, sunlight, and various chemicals, as well as the viability of V. cholerae outside the body (in faeces, contaminated material, food, beverages, water, etc.). PMID:14379012

  6. Minilaparoscopy For Inguinal Hernia Repair

    PubMed Central

    Malcher, Flavio; Cavazzola, Leandro Totti; Araujo, Guilherme D. E.; Silva, José Antônio Da Cunha E.; Rao, Prashanth; Iglesias, Antonio Carlos

    2016-01-01

    Background and Objectives: Inguinal hernia repair is among the most common procedures performed worldwide and the laparoscopic totally extraperitoneal (TEP) approach is a recognized and effective surgical technique. Although technically advantageous because of the option of no mesh fixation and no need for creation of a peritoneal flap resulting, in less postoperative pain and faster recovery, TEP has not achieved the popularity it deserves, mainly because of its complexity and steep learning curve. Minilaparoscopy was first described in the 1990s and has recently gained significantly from better instrumentation that may increase TEP's effectiveness and acceptance. We performed a prospective study, to analyze the outcomes of minilaparoscopy in pain and operative time when compared to the conventional laparoscopic technique in hernia repair. Methods: Fifty-eight laparoscopic inguinal hernia repairs were performed: 36 by traditional laparoscopic technique and 22 by minilaparoscopic instruments (mini). A study protocol was applied prospectively for data collection. Variables analyzed were early postoperative pain (at hour 6 after procedure), pain at discharge, use of on-demand analgesics, and operative time. Results: The mini group presented reduced early postoperative pain and operative time. The present study also suggests less postoperative pain at discharge with mini procedures, although this difference was not statistically significant. No difference between the groups regarding on-demand use of analgesics was found. Conclusions: This study corroborates findings in previously published papers that have shown the feasibility of minilaparoscopy in laparoscopic TEP hernia repair and its benefits regarding postoperative pain, operative time, and aesthetic outcomes. PMID:27777499

  7. Unusual Finding in the Inguinal Canal: Abdominal Tuberculosis Presenting as Inguinal Hernia.

    PubMed

    Dhandore, Priya; Hombalkar, Narendra Narayan; Ahmed, Mohd Hamid Shafique

    2016-04-01

    Abnormal findings in the inguinal canal during Herniotomy are not very rare for a paediatric surgeon. These abnormal findings may range from opposite gender sex organ (e.g. uterus and fallopian tube during orchidopexy) to unexpected malignancy (e.g. Rhabdomyosarcoma) to the abnormal embryological development (Splenogonadal fusion). Though abdominal tuberculosis is common, abdominal tuberculosis presenting as an inguinal hernia is exceedingly uncommon. We report an unusual case of abdominal tuberculosis presenting as inguinal hernia. PMID:27190886

  8. Unusual Finding in the Inguinal Canal: Abdominal Tuberculosis Presenting as Inguinal Hernia

    PubMed Central

    Dhandore, Priya; Hombalkar, Narendra Narayan

    2016-01-01

    Abnormal findings in the inguinal canal during Herniotomy are not very rare for a paediatric surgeon. These abnormal findings may range from opposite gender sex organ (e.g. uterus and fallopian tube during orchidopexy) to unexpected malignancy (e.g. Rhabdomyosarcoma) to the abnormal embryological development (Splenogonadal fusion). Though abdominal tuberculosis is common, abdominal tuberculosis presenting as an inguinal hernia is exceedingly uncommon. We report an unusual case of abdominal tuberculosis presenting as inguinal hernia. PMID:27190886

  9. Cholera in Haiti.

    PubMed

    Pfrimmer, Dale M

    2010-12-01

    Prior to the 7.1 magnitude earthquake that struck on January 12, 2010, conditions were dire in Haiti. Now, nearly a year later and with the emergency phase long since over, a cholera epidemic has hit Haiti.

  10. Cholera outbreaks in Africa.

    PubMed

    Mengel, Martin A; Delrieu, Isabelle; Heyerdahl, Leonard; Gessner, Bradford D

    2014-01-01

    During the current seventh cholera pandemic, Africa bore the major brunt of global disease burden. More than 40 years after its resurgence in Africa in 1970, cholera remains a grave public health problem, characterized by large disease burden, frequent outbreaks, persistent endemicity, and high CFRs, particularly in the region of the central African Great Lakes which might act as reservoirs for cholera. There, cases occur year round with a rise in incidence during the rainy season. Elsewhere in sub-Saharan Africa, cholera occurs mostly in outbreaks of varying size with a constant threat of widespread epidemics. Between 1970 and 2011, African countries reported 3,221,050 suspected cholera cases to the World Health Organization, representing 46 % of all cases reported globally. Excluding the Haitian epidemic, sub-Saharan Africa accounted for 86 % of reported cases and 99 % of deaths worldwide in 2011. The number of cholera cases is possibly much higher than what is reported to the WHO due to the variation in modalities, completeness, and case definition of national cholera data. One source on country specific incidence rates for Africa, adjusting for underreporting, estimates 1,341,080 cases and 160,930 deaths (52.6 % of 2,548,227 estimated cases and 79.6 % of 209,216 estimated deaths worldwide). Another estimates 1,411,453 cases and 53,632 deaths per year, respectively (50 % of 2,836,669 estimated cases and 58.6 % of 91,490 estimated deaths worldwide). Within Africa, half of all cases between 1970 and 2011 were notified from only seven countries: Angola, Democratic Republic of the Congo, Mozambique, Nigeria, Somalia, Tanzania, and South Africa. In contrast to a global trend of decreasing case fatality ratios (CFRs), CFRs have remained stable in Africa at approximately 2 %. Early propagation of cholera outbreaks depends largely on the extent of individual bacterial shedding, host and organism characteristics, the likelihood of people coming into contact with

  11. [Cholera in pediatrics].

    PubMed

    Lezama-Basulto, L A; Mota-Hernández, F

    1993-09-01

    Cholerae is a grave and acute bacterial intestine infection which is caused by a bacilo, V. cholerae 01, that produces toxic products. Its clinical symptoms range from abundant liquid diarrhoea combined with vomiting and rapid dehydration. It is highly lethal when right treatment is not applied. There are also cases of cholera where victims do not show any symptoms of it, that is asymptomatic carriers. Any clinical suspicion of cholerae has to be corroborated by epidemiological data and its diagnostic confirmation should be done by isolating the bacteria, V. cholerae. When beginning the treatment, it is not necessary to confirm the diagnostic and this is based on the restitution of the liquids lost through vomiting and facing using any methods that are recommended for any other type of diarrhoea. The antimicrobial treatment is used only for grave cases. This present revision includes recent knowledge about cholerae emphasising on the effective management of cases through an adequate use of right treatment methods and also using the principal prevention measures against dissemination of this disease.

  12. Rare inguinal hernia forms in children.

    PubMed

    Schier, F; Klizaite, J

    2004-10-01

    Rare inguinal hernia forms are encountered more frequently in the laparoscopic technique than in the open approach. The reasons are subject to speculation. The incidence of unusual inguinal hernia forms was studied in a series of inguinal hernias corrected laparoscopically in 452 children (334 boys and 118 girls aged 4 days--14 years, median age 1.6 years). The videos were retrospectively evaluated. Direct hernias were found in 10 children (2.2%), femoral hernias in five (1.1%), hernias en pantalon in three (0.7%), and a combination of indirect and femoral hernia and a combination of indirect, direct, and femoral hernia in one child each (0.2%). Routine videorecording during laparoscopy provides for the first time an objective and absolute picture of the true incidence of these unusual hernia forms. PMID:15503064

  13. Primary actinomycosis of vulva with inguinal lymphadenopathy

    PubMed Central

    Asia, Anand J; Tapre, Vaibhav N

    2016-01-01

    Actinomycosis is a chronic suppurative granulomatous infection of subcutaneous tissues caused by bacterium Actinomyces israelii. It is a normal commensal of the oral cavity, gastrointestinal tract, respiratory tract, and vagina. Infection is first established locally by breach of mucosal barrier during various procedures, aspiration, trauma, or human bite. Rarely, it may spread through hematogenous and lymphatic system. We present a case of actinomycosis involving the vulva, extending to the inguinal region along with inguinal lymphadenopathy. Involvement of vulva by actinomycosis is uncommon in literature. PMID:27730039

  14. Colocutaneous Fistula after Open Inguinal Hernia Repair

    PubMed Central

    Kallis, Panayiotis; Koronakis, Nikolaos; Hadjicostas, Panayiotis

    2016-01-01

    The plug-and-patch technique is frequently used for the open repair of inguinal hernias; however, serious complications may arise on rare occasions. We present the case of a 69-year-old patient who presented with a colocutaneous fistula with the sigmoid colon 9 years after the repair of a left sliding inguinal hernia with the plug-and-patch technique. The patient underwent sigmoidectomy and excision of the fistulous track. He was discharged on postoperative day 5 and had an uneventful recovery. Although such complications are reported rarely, the surgeon must be aware of them when deciding upon the method of hernia repair. PMID:27738544

  15. Cholera studies*†

    PubMed Central

    Pollitzer, R.

    1954-01-01

    In this, the first of a series of cholera studies, the history of the disease from its earliest recorded appearance up to 1923 is outlined, and its geographical distribution described. The origins and main routes of spread of the six great pandemics are indicated; possible causes of the variations in mortality which accompanied them are discussed. PMID:13160764

  16. Furazolidone in paediatric cholera*

    PubMed Central

    Karchmer, A. W.; Curlin, G. T.; Huq, M. I.; Hirschhorn, N.

    1970-01-01

    Tetracycline continues to be an effective antimicrobial agent in the clinical control of cholera but because of its high cost, relatively short shelf-life and recent reports of increased resistance of vibrios to tetracycline in vitro, alternative antimicrobial agents have been tested. Furazolidone, effective against cholera caused by the El Tor biotype in adults, was found to be as effective as tetracycline in reducing the volume and duration of diarrhoea in children with classical cholera and, given over a period of 7 days, only slightly less effective in reducing duration of vibrio excretion. Therapy with an antimicrobial agent over a period of 7 days was associated with a significantly smaller rise in vibriocidal antibody titre (of no clinical significance) in the youngest age-group studied; this was probably due to a diminished antigenic stimulus from the primary infection. Undernourished children showed a poorer response to anti-microbial therapy. The study indicated that furazolidone is a reasonable alternative to tetracycline in the treatment of cholera. PMID:5312991

  17. Inguinal hernia and a single strenuous event.

    PubMed Central

    Smith, G. D.; Crosby, D. L.; Lewis, P. A.

    1996-01-01

    A study of 129 consecutive patients, who had a total of 145 inguinal hernias, showed that in only 7% of the patients was the hernia subjectively attributable to a single muscular strain. Guidelines are suggested to assist in assessing 'cause' in claims for industrial injury in such patients. PMID:8712653

  18. Pediatric inguinal hernias, hydroceles, and undescended testicles.

    PubMed

    Lao, Oliver B; Fitzgibbons, Robert J; Cusick, Robert A

    2012-06-01

    Pediatric inguinal hernias are extremely common, and can usually be diagnosed by simple history taking and physical examination. Repair is elective, unless there is incarceration or strangulation. Hydroceles are also quite common, and in infancy many will resolve without operative intervention. Undescended testicles harbor an increased risk of infertility and malignancy, and require orchiopexy in early childhood.

  19. Endometriosis within a left-sided inguinal hernia sac

    PubMed Central

    Albutt, Katherine; Glass, Charity; Odom, Stephen; Gupta, Alok

    2014-01-01

    Endometriosis is a common gynecologic disorder wherein ectopic endometrial glands and stroma are found at extrauterine sites. Extrapelvic endometriosis is a well-documented, yet rare, disease entity that can affect almost any organ system. Inguinal endometriosis is an extremely rare disease entity characterized by tender inguinal swelling. Here we report a case of a sudden-onset and acutely painful left inguinal hernia with concordant endometriosis. A review of the literature is presented. The presence of isolated endometriosis contained within a left-sided inguinal hernia sac has, to our knowledge, never been reported. Often diagnosed incidentally or on histologic examination, general surgeons should consider inguinal endometriosis in the differential diagnosis of inguinal masses, even in the absence of catamenial symptoms. Surgical excision, with gynecologic follow-up, is locally curative and the treatment of choice for inguinal endometriosis. PMID:24876515

  20. Resveratrol--a potential inhibitor of biofilm formation in Vibrio cholerae.

    PubMed

    Augustine, Nimmy; Goel, A K; Sivakumar, K C; Kumar, R Ajay; Thomas, Sabu

    2014-02-15

    Resveratrol, a phytochemical commonly found in the skin of grapes and berries, was tested for its biofilm inhibitory activity against Vibrio cholerae. Biofilm inhibition was assessed using crystal violet assay. MTT assay was performed to check the viability of the treated bacterial cells and the biofilm architecture was analysed using confocal laser scanning microscopy. The possible target of the compound was determined by docking analysis. Results showed that subinhibitory concentrations of the compound could significantly inhibit biofilm formation in V. cholerae in a concentration-dependent manner. AphB was found to be the putative target of resveratrol using docking analysis. The results generated in this study proved that resveratrol is a potent biofilm inhibitor of V. cholerae and can be used as a novel therapeutic agent against cholera. To our knowledge, this is the first report of resveratrol showing antibiofilm activity against V. cholerae. PMID:24182988

  1. Vibrio cholerae O1 lineages driving cholera outbreaks during seventh cholera pandemic in Ghana.

    PubMed

    Thompson, Cristiane C; Freitas, Fernanda S; Marin, Michel A; Fonseca, Erica L; Okeke, Iruka N; Vicente, Ana Carolina P

    2011-12-01

    In recent years, the frequency of cholera epidemics across Africa has increased significantly with thousands of people dying each year. However, there still exists a lack of information concerning the Vibrio cholerae O1 lineages driving early and contemporary epidemics since the seventh cholera pandemic started in the continent. This compromises the understanding of the forces determining the epidemiology of cholera in Africa and its control. This study aimed to analyze a collection of V. cholerae O1 strains from the beginning of the seventh cholera pandemic in Ghana and to compare them with recent isolates to understand the evolution of the cholera epidemic in Ghana. V. cholerae O1 strains were characterized by means of Multilocus Sequence Analysis (MLSA), genes from the virulence core genome (VCG), and genes related to the choleragenic phenotype. Our results revealed two major clusters of Ghanaian V. cholerae O1 strains, El Tor and Amazonia/Ghana. Concerning the virulence genes, all strains harbored the set of VCG and most were positive for VSP-II genomic island. The ctxB gene of the contemporary strains was characterized as Altered El Tor. The strains from 1970 to 1980 were susceptible to all antibiotics tested, except for the Amazonia/Ghana cluster that was resistant to aminoglycosides and carried the class 2 integron with the sat2-aadA1 arrangement. This study showed that distinct V. cholerae O1 were the determinants of cholera outbreaks in Ghana. Thus, in endemic regions, such as Africa, cholera can be caused by various V. cholerae O1 genotypes. PMID:21896336

  2. Preoperative progressive pneumoperitoneum for giant inguinal hernias.

    PubMed

    Piskin, Turgut; Aydin, Cemalettin; Barut, Bora; Dirican, Abuzer; Kayaalp, Cuneyt

    2010-01-01

    Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient's tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients.

  3. Pain control following inguinal herniorrhaphy: current perspectives

    PubMed Central

    Bjurstrom, Martin F; Nicol, Andrea L; Amid, Parviz K; Chen, David C

    2014-01-01

    Inguinal hernia repair is one of the most common surgeries performed worldwide. With the success of modern hernia repair techniques, recurrence rates have significantly declined, with a lower incidence than the development of chronic postherniorrhaphy inguinal pain (CPIP). The avoidance of CPIP is arguably the most important clinical outcome and has the greatest impact on patient satisfaction, health care utilization, societal cost, and quality of life. The etiology of CPIP is multifactorial, with overlapping neuropathic and nociceptive components contributing to this complex syndrome. Treatment is often challenging, and no definitive treatment algorithm exists. Multidisciplinary management of this complex problem improves outcomes, as treatment must be individualized. Current medical, pharmacologic, interventional, and surgical management strategies are reviewed. PMID:24920934

  4. Chronic pain after open inguinal hernia repair.

    PubMed

    Nikkolo, Ceith; Lepner, Urmas

    2016-01-01

    Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient's quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged. PMID:26567717

  5. Chronic pain after open inguinal hernia repair.

    PubMed

    Nikkolo, Ceith; Lepner, Urmas

    2016-01-01

    Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient's quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged.

  6. Environmental Monitoring of Endemic Cholera

    NASA Astrophysics Data System (ADS)

    ElNemr, W.; Jutla, A. S.; Constantin de Magny, G.; Hasan, N. A.; Islam, M.; Sack, R.; Huq, A.; Hashem, F.; Colwell, R.

    2012-12-01

    Cholera remains a major public health threat. Since Vibrio cholerae, the causative agent of the disease, is autochthonous to riverine, estuarine, and coastal waters, it is unlikely the bacteria can be eradicated from its natural habitat. Prediction of disease, in conjunction with preventive vaccination can reduce the prevalence rate of a disease. Understanding the influence of environmental parameters on growth and proliferation of bacteria is an essential first step in developing prediction methods for outbreaks. Large scale geophysical variables, such as SST and coastal chlorophyll, are often associated with conditions favoring growth of V. cholerae. However, local environmental factors, meaning biological activity in ponds from where the bulk of populations in endemic regions derive water for daily usage, are either neglected or oversimplified. Using data collected from several sites in two geographically distinct locations in South Asia, we have identified critical local environmental factors associated with cholera outbreak. Of 18 environmental variables monitored for water sources in Mathbaria (a coastal site near the Bay of Bengal) and Bakergonj (an inland site) of Bangladesh, water depth and chlorophyll were found to be important factors associated with initiation of cholera outbreaks. Cholera in coastal regions appears to be related to intrusion. However, monsoonal flooding creates conditions for cholera epidemics in inland regions. This may be one of the first attempts to relate in-situ environmental observations with cholera. We anticipate that it will be useful for further development of prediction models in the resource constrained regions.

  7. Prophylactic Antibiotics for Mesh Inguinal Hernioplasty

    PubMed Central

    Sanabria, Alvaro; Domínguez, Luis Carlos; Valdivieso, Eduardo; Gómez, Gabriel

    2007-01-01

    Objective: To assess the effectiveness of antibiotic prophylaxis in mesh hernioplasty. Background: Antibiotic prophylaxis use in mesh inguinal hernioplasty is controversial. Available evidence is nonconclusive because of the low number of clinical trials assessing its effectiveness. Some trials have a small sample size that could overestimate or underestimate the real effectiveness of this intervention. Meta-analysis is a good method to improve these methodological flaws. Methods: Meta-analysis intended to measure the benefits of antibiotic prophylaxis on surgical site infection rate in adult patients scheduled for mesh inguinal hernioplasty. Six randomized clinical trials were found. Quality was assessed using Cochrane Collaboration criteria. Results: A total of 2507 patients were analyzed. Surgical site infection frequency was 1.38% in the antibiotic group versus 2.89% in the control group (odds ratio = 0.48; 95% confidence interval, 0.27–0.85). There was no statistical heterogeneity. Sensitivity analysis by quality did not show differences in overall results. Conclusion: Antibiotic prophylaxis use in patients submitted to mesh inguinal hernioplasty decreased the rate of surgical site infection by almost 50%. PMID:17435546

  8. Inguinal herniation with hydrometra/mucometra in a poodle bitch

    PubMed Central

    Sontas, B. Hasan; Toydemir, F.T. Seval; Erdogan, Özge; Şennazli, Gülbin; Ekici, Hayri

    2013-01-01

    A 5-year-old, sexually intact poodle bitch was presented with a 2-year history of inguinal mass. A tentative diagnosis of hydrometra/mucometra with inguinal herniation was made and ovariohysterectomy with hernia repair was performed. Both fluid-filled uterine horns, both broad ligaments, and the uterine body were observed to be herniated through the inguinal ring. On histopathology, marked edema and diffuse hemorrhage were diagnosed in the uterus. PMID:24155486

  9. Epidemic cholera spreads like wildfire

    NASA Astrophysics Data System (ADS)

    Roy, Manojit; Zinck, Richard D.; Bouma, Menno J.; Pascual, Mercedes

    2014-01-01

    Cholera is on the rise globally, especially epidemic cholera which is characterized by intermittent and unpredictable outbreaks that punctuate periods of regional disease fade-out. These epidemic dynamics remain however poorly understood. Here we examine records for epidemic cholera over both contemporary and historical timelines, from Africa (1990-2006) and former British India (1882-1939). We find that the frequency distribution of outbreak size is fat-tailed, scaling approximately as a power-law. This pattern which shows strong parallels with wildfires is incompatible with existing cholera models developed for endemic regions, as it implies a fundamental role for stochastic transmission and local depletion of susceptible hosts. Application of a recently developed forest-fire model indicates that epidemic cholera dynamics are located above a critical phase transition and propagate in similar ways to aggressive wildfires. These findings have implications for the effectiveness of control measures and the mechanisms that ultimately limit the size of outbreaks.

  10. Environmental factors influencing epidemic cholera.

    PubMed

    Jutla, Antarpreet; Whitcombe, Elizabeth; Hasan, Nur; Haley, Bradd; Akanda, Ali; Huq, Anwar; Alam, Munir; Sack, R Bradley; Colwell, Rita

    2013-09-01

    Cholera outbreak following the earthquake of 2010 in Haiti has reaffirmed that the disease is a major public health threat. Vibrio cholerae is autochthonous to aquatic environment, hence, it cannot be eradicated but hydroclimatology-based prediction and prevention is an achievable goal. Using data from the 1800s, we describe uniqueness in seasonality and mechanism of occurrence of cholera in the epidemic regions of Asia and Latin America. Epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. This causal mechanism is markedly different from endemic cholera where tidal intrusion of seawater carrying bacteria from estuary to inland regions, results in outbreaks.

  11. Environmental Factors Influencing Epidemic Cholera

    PubMed Central

    Jutla, Antarpreet; Whitcombe, Elizabeth; Hasan, Nur; Haley, Bradd; Akanda, Ali; Huq, Anwar; Alam, Munir; Sack, R. Bradley; Colwell, Rita

    2013-01-01

    Cholera outbreak following the earthquake of 2010 in Haiti has reaffirmed that the disease is a major public health threat. Vibrio cholerae is autochthonous to aquatic environment, hence, it cannot be eradicated but hydroclimatology-based prediction and prevention is an achievable goal. Using data from the 1800s, we describe uniqueness in seasonality and mechanism of occurrence of cholera in the epidemic regions of Asia and Latin America. Epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. This causal mechanism is markedly different from endemic cholera where tidal intrusion of seawater carrying bacteria from estuary to inland regions, results in outbreaks. PMID:23897993

  12. Cholera in 1994. Part I.

    PubMed

    1995-07-14

    In 1994, Vibrio cholerae O1 biotype El Tor, the agent responsible for the seventh cholera pandemic which began in 1961, continued to spread in all regions of the world (Map 1). In all, 384,403 cholera cases were officially reported to WHO in 1994 (a 2% increase over 1993), reversing the downward trend which started in 1992. A total of 10,692 deaths were reported in 1994, increasing the reported global case-fatality ratio (CFR) to 2.8% from 1.8% in 1993. Cholera cases were notified from 94 countries/areas, the highest number ever reporting in one year. (Table 1 and Fig. 1). The year was marked by the dramatic cholera outbreak that devastated the Rwandan refugee camps in Goma, Zaire in July. Major outbreaks also affected Afghanistan, Brazil, Guinea, Guinea-Bissau and Somalia. Africa reported a rise in the number of cholera cases, and was the continent accounting for the largest proportion of all reported cases. The incidence of cholera cases in the Americas continued to fall and reported CFR was the lowest recorded since the disease reached Latin America in 1991. Asia reported a 17% increase in cholera cases compared with 1993. Europe, which usually reports only imported cases, registered a significant increase in the number of indigenous cholera cases. Oceania reported 6 cases, 5 of which were imported, and no deaths (Figs. 2 and 3). The new V. cholerae strain O139 (Bengal) has affected 10 countries in Asia since it was first detected in India at PMID:7544150

  13. Anal Canal Cancer: Management of Inguinal Nodes and Benefit of Prophylactic Inguinal Irradiation (CORS-03 Study)

    SciTech Connect

    Ortholan, Cecile; Resbeut, Michel; Hannoun-Levi, Jean-Michel; Teissier, Eric; Gerard, Jean-Pierre; Ronchin, Philippe; Zaccariotto, Audrey; Minsat, Mathieu; Benezery, Karen; Francois, Eric; Salem, Naji; Ellis, Steve; Azria, David; Champetier, Cedric; Gross, Emmanuel; Cowen, Didier

    2012-04-01

    Purpose: To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC). Methods and Materials: This retrospective study analyzed the outcome of 208 patients presenting with ASCC treated between 2000 and 2004 in four cancer centers of the south of France. Results: The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45-50 Gy (PII group) and 106 did not receive PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age <68 years, p = 0.01) and had larger tumor (T3-4 = 46% vs. 27% p = 0.01). The other characteristics were well balanced between the two groups. Median follow-up was 61 months. Fourteen patients in the no PII group vs. 1 patient in the PII group developed inguinal recurrence. The 5-year cumulative rate of inguinal recurrence (CRIR) was 2% and 16% in PII and no PII group respectively (p = 0.006). In the no PII group, the 5-year CRIR was 12% and 30% for T1-T2 and T3-T4 respectively (p = 0.02). Overall survival, disease-specific survival, and disease-free survival were similar between the two groups. In the PII group, no Grade >2 toxicity of the lower extremity was observed. Conclusion: PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%).

  14. The Role of Vibrio cholerae Haemagglutinin Protease (HAP) in Extra-Intestinal Infection

    PubMed Central

    Koley, Hemanta; Pal, Amit

    2016-01-01

    Introduction Based on the diversity of surface O antigen Vibrio cholerae can be classified into 206 serogroups. Vibrio cholerae is the causative agent of cholera and extra intestinal infections like, septicemia, wound infection and haemorrhagic reactions. Pathogenic factors of V. cholerae extra-intestinal infection are yet to be explored. Aim To identify the pathogenic factor associated with V. cholerae extra-intestinal infection. Materials and Methods This study was carried out between April, 2007 to October 2007 in National Institute of Cholera and Enteric Diseases (NICED). Haemagglutinin Protease (HAP), a major secreted proteolytic enzyme, was purified from the culture supernatant of Vibrio cholerae O1 strain C6709 after removal of outer membrane vesicles using a single step ion-exchange chromatography. Function of HAP was characterized by animal model, like, subcutaneous mouse assay, basement membrane component’s degradation assays and tissue culture assays. Result When suckling mouse was subcutaneously injected with culture supernatant of C6709 strain or purified HAP in both cases, distinct in vivo haemorrhagic response along with histopathological changes like necrosis of the capillaries and muscle layer, acute myofibre degeneration as well as moderate number of erythrocyte scattered through the skin, capillary necrosis, acute myofiber degeneration and necrosis of muscle layer were found. When Tryptic Soy Broth (TSB) media was used, the haemorrhagic effects in suckling mouse were not detectable. The major protein components, laminin and collagen, of basement membrane comprising of vascular endothelial cells, were degraded by HAP. Purified HAP showed cell rounding effects on Int 407 cells. Conclusion Result indicates that HAP may be a causative agent of Vibrio cholerae mediated extra-intestinal infection. This study confirms that Vibrio cholera as a sole pathogen can cause the extra-intestinal infection. This information is important for public health

  15. Endoscopic inguinal lymphadenectomy in penile cancer: case report and literature review

    PubMed Central

    Astigueta Pérez, Juan Carlos; Abad-Licham, Milagros; Silva, Eloy; Yan, Edgar; Álvarez, Hugo; Agreda, Folker; Pow-Sang, Mariela

    2015-01-01

    Objectives The objective was to submit our first experience in endoscopic inguinal lymphadenectomy (EIL), evaluate the feasibility of the procedure and carry out a review of the literature. Material and methods A 41-year-old patient was diagnosed with penile cancer with squamous cell carcinoma pT2G1 pathology, with no palpable inguinal lymph nodes. A bilateral inguinal lymphadenectomy was performed with preservation of the saphenous vein, conventional left and endoscopic right procedures. The perioperative data is presented and that obtained is discussed in the literature. Results The total time was 270 minutes, 180 for endoscopic and 90 for conventional procedures. Blood loss was minimal in both cases. Fifteen lymph nodes were dissected on the endoscopic side, and 17 in the conventional side, the latter with more pain and devitalised skin flap. Conclusions EIL for penile cancer is feasible and there is less morbidity with an early recovery. The literature is not conclusive on the indication of EIL. PMID:26557874

  16. Cholera: foodborne transmission and its prevention.

    PubMed

    Estrada-García, T; Mintz, E D

    1996-10-01

    The last several years have witnessed a tremendous increase in reported cholera cases across the globe. The explosive arrival of the seventh cholera pandemic in Latin American in 1991, dramatic epidemics of cholera on the Indian subcontinent and in Southeast Asia due to the newly recognized Vibrio cholerae O139 strain, and the often deadly presence of cholera among populations affected by political and social upheaval in Africa and Eastern Europe are evidence that many countries have failed to adopt effective measures for cholera prevention and control. Foodborne transmission of cholera has been well documented by epidemiologic investigations in nearly every continent, and its interruption is a critical component to any integrated programme for cholera prevention and control. We emphasize clear and effective guidelines for the prevention of foodborne cholera transmission that are drawn from a comprehensive review of relevant epidemiologic and laboratory data. PMID:8905306

  17. Iatrogenic inguinal chyle fistula: a rare case report.

    PubMed

    Zubaidah, N H; Jasmi, A Y; Hanafiah, H; Shaker, A H; Asri, C M; Emad, A R; Das, S

    2012-01-01

    Chyle fistula may be common in the neck and thorax region but it is a rare entity in the inguinal region. The rarity of the incidence of chyle fistula and the tremendous response to conservative management are the important aspects to be remembered. We hereby report a case of iatrogenic inguinal chyle fistula complicating a femoral vein cannulation.

  18. One surgeon experiences in childhood inguinal hernias

    PubMed Central

    2011-01-01

    Purpose In this manuscript we report one pediatric surgeon's experience in childhood inguinal hernia repair. Methods From 2005 to 2008, 402 children with inguinal hernias were operated on by one surgeon. A retrospective survey of their charts was carried out to evaluate the demographics and clinical aspects of these patients. Results The ages ranged from 20 days to 16 years with a male-to-female ratio of 2.5:1. 64.9% right, 27.1% left, and 7.9% bilateral hernias. Hydroceles were present in 6.2% assosiated hernias. Incarceration occurred in 8.7% of children. An opposite-side hernia developed in 5.7%. 5.3 percent of patients with a hernia repair on the right side later developed a hernia on the left side, and 8.2% of patients with a hernia repair on the left side later developed one on the right side. 4.5 percent of all male patients in this series and 8.6% of female patients developed an opposite-side hernia. While overall recurrence rate was 1.2%, our recurrence rate was 0.25%. There was a 0.24% wound infection rate, and 1 (0.24%) testicle was atrophic at follow-up. Conclusion In this study, in the recurrence of childhood hernia, the general surgeon's intervention was the prominent cause. It is suggested by the study that inguinal hernias on the contralateral side becomes symptomatic within the first six months following initial operation.Therefor, close observation is needed in that time. PMID:22066100

  19. [Loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling in a 28-year-old man].

    PubMed

    Wahl, U; Stranzenbach, R; Tischoff, I; Tannapfel, A; Stadler, R; Ernst, F

    2014-03-01

    A 28-year-old man presented with loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling. The tentative diagnosis of malignant lymphoma was made. To confirm the diagnosis, extirpation of a lymph node and a skin biopsy were performed. Systemic treatment with methylprednisolone resulted in an improvement of eczema and lymph node swelling. Because of the histological findings and clinical course, we diagnosed dermatopathic lymphadenopathy, also known as Pautrier-Woringer syndrome.

  20. Inguinal Lymph Node Anthracosis: A Case Report.

    PubMed

    Biguria, Rafael; Soto, Carlos Alberto

    2016-07-01

    Anthracosis is defined as black, dense pigments in tissues, usually carbon deposits. We, as surgeons, have to make decisions during surgery to the best of our knowledge and based on what the literature provides us. We present the case of a 30-year-old female patient who underwent abdominoplasty. During surgery, bilateral inguinal pigmented and enlarged lymph nodes were seen. Biopsy of the nodes was done to rule out any malignancy. The results showed tattoo pigments on all lymph nodes. We present this case as tattoo pigment migration, which has been rarely described. PMID:27536493

  1. Inguinal Lymph Node Anthracosis: A Case Report

    PubMed Central

    Soto, Carlos Alberto

    2016-01-01

    Summary: Anthracosis is defined as black, dense pigments in tissues, usually carbon deposits. We, as surgeons, have to make decisions during surgery to the best of our knowledge and based on what the literature provides us. We present the case of a 30-year-old female patient who underwent abdominoplasty. During surgery, bilateral inguinal pigmented and enlarged lymph nodes were seen. Biopsy of the nodes was done to rule out any malignancy. The results showed tattoo pigments on all lymph nodes. We present this case as tattoo pigment migration, which has been rarely described. PMID:27536493

  2. Ultrasound Prenatal Diagnosis of Inguinal Scrotal Hernia and Contralateral Hydrocele

    PubMed Central

    Massaro, G.; Sglavo, G.; Cavallaro, A.; Pastore, G.; Nappi, C.; Di Carlo, C.

    2013-01-01

    Fetal inguinal scrotal hernia is a rare condition resulting in an abnormal embryonic process of the tunica vaginalis. We report a case of ultrasound prenatal diagnosis of inguinal scrotal hernia associated with contralateral hydrocele in a woman at 37 weeks of gestation, referred to our clinic for a scrotal mass. Differential diagnosis includes hydrocele, teratoma, hemangiomas, solid tumours of testis, bowel herniation, and testicular torsion. Bowel peristalsis is an important ultrasound sign and it allowed us to make diagnosis of inguinal scrotal hernia. Diagnosis was confirmed at birth and a laparoscopic hernia repair was performed without complications on day 10. During surgery, a bilateral defect of canal inguinal was seen and considered as the cause of scrotal inguinal hernia and contralateral hydrocele observed in utero. PMID:24455356

  3. Cholera and the Scientific Method.

    ERIC Educational Resources Information Center

    Cronin, Jim

    1993-01-01

    Describes an approach to teaching the scientific method where an outbreak of cholera within the school is simulated. Students act like epidemiologists in an attempt to track down the source of the contamination. (PR)

  4. Coleridge's choleras: cholera morbus, Asiatic cholera, and dysentery in early nineteenth-century England.

    PubMed

    Rousseau, George S; Haycock, David Boyd

    2003-01-01

    Samuel Taylor Coleridge suffered from a variety of bowel disorders throughout his life; though a large part of his ailment was caused by his famous opium habit, he continuously sought an organic origin, and on at least two separate occasions, in 1804 and 1831-32, he ascribed his disorders to attacks of "cholera." With Asiatic cholera apparently first reaching England in late 1831, there was considerable argument among both physicians and the general public as to whether it was a distinctly new disease, or merely a severer variation of traditional English cholera, known as "cholera morbus." Coleridge took a particular interest in these discussions. In this paper, we attempt to establish the exact nature of his attacks of illness, and point to the complexities of describing and framing new diseases and bowel disorders in the early nineteenth century.

  5. [The determination of the optimal conditions for the production of a number of pathogenicity factors in Vibrio cholerae].

    PubMed

    Mazrukho, A B; Mikas', N K; Monakhova, E V; Rozhkov, K K

    2000-01-01

    Conditions for the cultivation of V. cholerae of different sero- and biovars on tryptone medium, ensuring the maximum production of cholera toxin (CT), dermonecrotic factor (DNF), hemorrhagic factor (HF) and new cholera toxin (NCT) have been determined. The lack of coincidence in the optimum conditions ensuring the maximum production of CT, DNF and HF has been established, which may be indicative of different nature of these toxic substances. NCT, produced by vct- strains, is similar to CN in biological activity as determined in the skin permeability test and in the conditions of accumulation in tryptone medium.

  6. Characterization of Vibrio cholerae Strains Isolated from the Nigerian Cholera Outbreak in 2010.

    PubMed

    Dupke, Susann; Akinsinde, Kehinde A; Grunow, Roland; Iwalokun, Bamidele A; Olukoya, Daniel K; Oluwadun, Afolabi; Velavan, Thirumalaisamy P; Jacob, Daniela

    2016-10-01

    We examined clinical samples from Nigerian patients with acute watery diarrhea for Vibrio cholerae during the 2010 cholera outbreak. A total of 109 suspected isolates were characterized, but only 57 V. cholerae strains could be confirmed using multiplex real-time PCR as well as rpoB sequencing and typed as V. cholerae O:1 Ogawa biotype El Tor. This finding highlighted the need for accurate diagnosis of cholera in epidemic countries to implement life-saving interventions. PMID:27487957

  7. [Management of chronic pain after inguinal hernioplasty].

    PubMed

    Minossi, José Guilherme; Minossi, Vinícius Vendites; Silva, Alcino Lázaro da

    2011-01-01

    Chronic groin pain after herniorrhaphy is a concern, as approximately 10% of patients undergoing inguinal hernia repair have symptoms, which often limit physical ability. The etiopathogenesis is related to periostitis pubis (somatic pain) and more often to nerve injury (neuropathic pain). It is clinically important to distinguish between these two types of pain because treatment can be different. The physician should establish a routine diagnosis and treatment, and most patients will need surgical approach. Prevention of this condition is of great importance and can lead to a lower incidence of the syndrome. Some measures are key, such as how to avoid application of stitches or clips to the pubis periosteum, using the prosthesis carefully and identifying the nerves in the groin. This last measure is certainly the most important in the prevention of chronic pain and involves thorough knowledge of anatomy and the use of refined technique.

  8. Inguinal hernia repair: toward Asian guidelines.

    PubMed

    Lomanto, Davide; Cheah, Wei-Keat; Faylona, Jose Macario; Huang, Ching Shui; Lohsiriwat, Darin; Maleachi, Andy; Yang, George Pei Cheung; Li, Michael Ka-Wai; Tumtavitikul, Sathien; Sharma, Anil; Hartung, Rolf Ulrich; Choi, Young Bai; Sutedja, Barlian

    2015-02-01

    Groin hernias are very common, and surgical treatment is usually recommended. In fact, hernia repair is the most common surgical procedure performed worldwide. In countries such as the USA, China, and India, there may easily be over 1 million repairs every year. The need for this surgery has become an important socioeconomic problem and may affect health-care providers, especially in aging societies. Surgical repair using mesh is recommended and widely employed in Western countries, but in many developing countries, tissue-to-tissue repair is still the preferred surgical procedure due to economic constraints. For these reason, the development and implementation of guidelines, consensus, or recommendations may aim to clarify issues related to best practices in inguinal hernia repair in Asia. A group of Asian experts in hernia repair gathered together to debate inguinal hernia treatments in Asia in an attempt to reach some consensus or develop recommendations on best practices in the region. The need for recommendations or guidelines was unanimously confirmed to help overcome the discrepancy in clinical practice between countries; the experts decided to focus mainly on the technical aspects of open repair, which is the most common surgery for hernia in our region. After the identification of 12 main topics for discussion (indication, age, and sex; symptomatic and asymptomatic hernia: type of hernia; type of treatment; hospital admission; preoperative care; anesthesia; surgical technique; perioperative care; postoperative care; early complications; and long-term complications), a search of the literature was carried out according to the five levels of the Oxford Classification of Evidence and the four grades of recommendation.

  9. Widespread epidemic cholera caused by a restricted subset of Vibrio cholerae clones.

    PubMed

    Moore, S; Thomson, N; Mutreja, A; Piarroux, R

    2014-05-01

    Since 1817, seven cholera pandemics have plagued humankind. As the causative agent, Vibrio cholerae, is autochthonous in the aquatic ecosystem and some studies have revealed links between outbreaks and fluctuations in climatic and aquatic conditions, it has been widely assumed that cholera epidemics are triggered by environmental factors that promote the growth of local bacterial reservoirs. However, mounting epidemiological findings and genome sequence analysis of clinical isolates have indicated that epidemics are largely unassociated with most of the V. cholerae strains in aquatic ecosystems. Instead, only a specific subset of V. cholerae El Tor 'types' appears to be responsible for current epidemics. A recent report examining the evolution of a variety of V. cholerae strains indicates that the current pandemic is monophyletic and originated from a single ancestral clone that has spread globally in successive waves. In this review, we examine the clonal nature of the disease, with the example of the recent history of cholera in the Americas. Epidemiological data and genome sequence-based analysis of V. cholerae isolates demonstrate that the cholera epidemics of the 1990s in South America were triggered by the importation of a pathogenic V. cholerae strain that gradually spread throughout the region until local outbreaks ceased in 2001. Latin America remained almost unaffected by the disease until a new toxigenic V. cholerae clone was imported into Haiti in 2010. Overall, cholera appears to be largely caused by a subset of specific V. cholerae clones rather than by the vast diversity of V. cholerae strains in the environment.

  10. [Complications associated with inguinal orchiectomy and scrotal orchiectomy].

    PubMed

    Anheuser, P; Kranz, J; Will, J; Dieckmann, K P

    2014-05-01

    Inguinal excision of testis is technically an elementary surgical procedure. According to the indication (e.g., malignant tumors, infarction, inflammation), an inguinal or alternatively a transcrotal approach is possible. Despite its straightforwardness, surgery of the scrotum includes remarkable risks and complications such as postoperative hemorrhage, hematoma formation, infections, and disturbances of wound healing followed by insufficient unfavorable cosmetic results. Nerve injury may be accompanied by temporary or persistent paresthesias which have been documented in our patients undergoing orchiectomy. PMID:24744108

  11. Videoscopic Versus Open Inguinal Lymphadenectomy for Cancer

    ClinicalTrials.gov

    2015-05-04

    Melanoma; Merkel Cell Carcinoma; Squamous Cell Carcinoma; Penile Carcinoma; Urethral Carcinoma; Extramammary Paget's Disease; Scrotal Carcinoma; Anal Cancer; Vulvar Cancer; Skin Cancer; Lymphadenopathy

  12. Inguinal or inguino-iliac/obturator lymph node dissection after positive inguinal sentinel lymph node in patients with cutaneous melanoma

    PubMed Central

    Glumac, Nebojsa; Hocevar, Marko; Zadnik, Vesna; Snoj, Marko

    2012-01-01

    Background The aim of the study was to determine whether the presence of inguinal sentinel lymph node (SLN) metastases smaller than 2 mm (micrometastases) subdivided according to the number of micrometastases predicts additional, non-sentinel inguinal, iliac or obturator lymph node involvement in completion lymph node dissection (CLND). Patients and methods. Positive inguinal SLN was detected in 58 patients (32 female, 26 male, median age 55 years) from 743 consecutive and prospectively enrolled patients with primary cutaneous melanoma stage I and II who were treated with SLN biopsy between 2001 and 2007. Results Micrometastases in inguinal SLN were detected in 32 patients, 14 were single, 2 were double, and 16 were multiple. Twenty-six patients had macrometastases. Conclusions No patient with any micrometastases or a single SLN macrometastasis in the inguinal region had any iliac/obturator non-sentinel metastases after CLND in our series. Furthermore, no patient with single SLN micrometastasis in the inguinal region had any non-sentinel metastases at all after CLND in our series. In these cases respective CLND might be omitted. PMID:23077465

  13. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

    PubMed Central

    Tatar, Cihad; Tüzün, İshak Sefa; Karşıdağ, Tamer; Kızılkaya, Mehmet Celal; Yılmaz, Erdem

    2016-01-01

    Background: Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of non-complicated cases. However, due to the risk of prosthetic material-related infections, the use of mesh in the repair of strangulated or incarcerated hernia has often been subject to debate. Recent studies have demonstrated that biomaterials represent suitable materials for performing urgent hernia repair. Certain studies recommend mesh repair only for cases where no bowel resection is required; other studies, however, recommend mesh repair for patients requiring bowel resection as well. Aim: The aim of this study was to compare the outcomes of different surgical techniques performed for strangulated hernia, and to evaluate the effect of mesh use on postoperative complications. Study Design: Retrospective cross-sectional study. Methods: This retrospective study was performed with 151 patients who had been admitted to our hospital’s emergency department to undergo surgery for a diagnosis of incarcerated inguinal hernia. The patients were divided into two groups based on the applied surgical technique. Group 1 consisted of 112 patients treated with mesh-based repair techniques, while Group 2 consisted of 39 patients treated with tissue repair techniques. Patients in Group 1 were further divided into two sub-groups: one consisting of patients undergoing bowel resection (Group 3), and the other consisting of patients not undergoing bowel resection (Group 4). Results: In Group 1, it was observed that eight (7.14%) of the patients had wound infections, while two (1.78%) had hematomas, four (3.57%) had seromas, and one (0.89%) had relapse. In Group 2, one (2.56%) of the patients had a wound infection, while three (7.69%) had hematomas, one (2.56%) had seroma, and none had relapses. There were no statistically significant differences between the two groups with respect to wound infection, seroma

  14. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

    PubMed Central

    Tatar, Cihad; Tüzün, İshak Sefa; Karşıdağ, Tamer; Kızılkaya, Mehmet Celal; Yılmaz, Erdem

    2016-01-01

    Background: Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of non-complicated cases. However, due to the risk of prosthetic material-related infections, the use of mesh in the repair of strangulated or incarcerated hernia has often been subject to debate. Recent studies have demonstrated that biomaterials represent suitable materials for performing urgent hernia repair. Certain studies recommend mesh repair only for cases where no bowel resection is required; other studies, however, recommend mesh repair for patients requiring bowel resection as well. Aim: The aim of this study was to compare the outcomes of different surgical techniques performed for strangulated hernia, and to evaluate the effect of mesh use on postoperative complications. Study Design: Retrospective cross-sectional study. Methods: This retrospective study was performed with 151 patients who had been admitted to our hospital’s emergency department to undergo surgery for a diagnosis of incarcerated inguinal hernia. The patients were divided into two groups based on the applied surgical technique. Group 1 consisted of 112 patients treated with mesh-based repair techniques, while Group 2 consisted of 39 patients treated with tissue repair techniques. Patients in Group 1 were further divided into two sub-groups: one consisting of patients undergoing bowel resection (Group 3), and the other consisting of patients not undergoing bowel resection (Group 4). Results: In Group 1, it was observed that eight (7.14%) of the patients had wound infections, while two (1.78%) had hematomas, four (3.57%) had seromas, and one (0.89%) had relapse. In Group 2, one (2.56%) of the patients had a wound infection, while three (7.69%) had hematomas, one (2.56%) had seroma, and none had relapses. There were no statistically significant differences between the two groups with respect to wound infection, seroma

  15. Open inguinal herniotomy: Analysis of variations

    PubMed Central

    Ibrahim, Musa; Ladan, Mu’azu Adamu; Abdussalam, Umar Sharif; Getso, Kabiru Ibrahim; Mohammad, Mohammad Aminu; Chukwuemeka, Anyanwu Lofty-John; Owolabi, Femi Luqman; Akhparov, Nurlan Nurkenovich; Aipov, Rassulbek Rakhmanberdievich

    2015-01-01

    Background: Repair of congenital groin hernia/hydrocele is the most common surgical procedure performed by paediatric surgeons. There is dearth of literature comparing the outcomes of open herniotomy in children using various surgical approaches. This study was aimed at evaluating the efficacy of open herniotomy by comparing external ring incision, hernial sac twisting and whether or not double ligation has benefit over a single suture application. Materials and Methods: A multi-centre prospective randomised clinical trial was conducted with a total of 428 patients having congenital inguinal hernia and/or hydrocele. Patients were randomly assigned into four groups: RO (had external ring opened, hernial sac twisted and doubly ligated), ST (had hernial sac twisted and doubly ligated without opening the ring), DL (had double ligation of hernial sac without ring opening nor twisted) while SL (had single ligation of hernial sac with neither ring opening nor sac twisting). Results: A total of 458 repairs were done. Patients’ age ranged from 0.25 years (3 months) to 21 years in group RO with mean of 4.87 ± 4.07 (median, 4), 0.069 years (24 days) to 17 years in group ST with mean of 4.23 ± 4.03 (median, 3), 0.5 years (6 months) to 16 years in group DL with mean of 4.59 ± 3.87 (median, 4) and 1 year to 19 years in group SL with mean of 5.00 ± 4.19 (median, 4). Operation time per repair was 26.50 ± 5.46 min, range 16-40 min (median, 27 min) in group RO, 22.18 ± 5.34 min, range 12-39 min (median, 21 min) in group ST while 17.98 ± 3.40 min with range of 12-39 min (median, 17 min) in group DL and 15.27 ± 4.18 min, range 7-40 min (median, 15 min) in group SL P < 0.0001. The mean paracetamol dose/patient was 3.96 ± 1.43, 2.94 ± 0.81, 2.18 ± 0.69, 1.87 ± 0.78 in group RO, ST, DL and SL, respectively, P < 0.0001. Conclusion: Congenital inguinal hernia repair with opening of the external ring, hernia sac twisting and double ligation of the processus vaginalis confers

  16. How Will Climate Change Impact Cholera Outbreaks?

    NASA Astrophysics Data System (ADS)

    Nasr Azadani, F.; Jutla, A.; Rahimikolu, J.; Akanda, A. S.; Huq, A.; Colwell, R. R.

    2014-12-01

    Environmental parameters associated with cholera are well documented. However, cholera continues to be a global public health threat. Uncertainty in defining environmental processes affecting growth and multiplication of the cholera bacteria can be affected significantly by changing climate at different temporal and spatial scales, either through amplification of the hydroclimatic cycle or by enhanced variability of large scale geophysical processes. Endemic cholera in the Bengal Delta region of South Asia has a unique pattern of two seasonal peaks and there are associated with asymmetric and episodic variability in river discharge. The first cholera outbreak in spring is related with intrusion of bacteria laden coastal seawater during low river discharge. Cholera occurring during the fall season is hypothesized to be associated with high river discharge related to a cross-contamination of water resources and, therefore, a second wave of disease, a phenomenon characteristic primarily in the inland regions. Because of difficulties in establishing linkage between coarse resolutions of the Global Climate Model (GCM) output and localized disease outbreaks, the impact of climate change on diarrheal disease has not been explored. Here using the downscaling method of Support Vector Machines from HADCM3 and ECHAM models, we show how cholera outbreak patterns are changing in the Bengal Delta. Our preliminary results indicate statistically significant changes in both seasonality and magnitude in the occurrence of cholera over the next century. Endemic cholera is likely to transform into epidemic forms and new geographical areas will be at risk for cholera outbreaks.

  17. Dynamics in genome evolution of Vibrio cholerae.

    PubMed

    Banerjee, Rachana; Das, Bhabatosh; Balakrish Nair, G; Basak, Surajit

    2014-04-01

    Vibrio cholerae, the etiological agent of the acute secretary diarrheal disease cholera, is still a major public health concern in developing countries. In former centuries cholera was a permanent threat even to the highly developed populations of Europe, North America, and the northern part of Asia. Extensive studies on the cholera bug over more than a century have made significant advances in our understanding of the disease and ways of treating patients. V. cholerae has more than 200 serogroups, but only few serogroups have caused disease on a worldwide scale. Until the present, the evolutionary relationship of these pandemic causing serogroups was not clear. In the last decades, we have witnessed a shift involving genetically and phenotypically varied pandemic clones of V. cholerae in Asia and Africa. The exponential knowledge on the genome of several representatives V. cholerae strains has been used to identify and analyze the key determinants for rapid evolution of cholera pathogen. Recent comparative genomic studies have identified the presence of various integrative mobile genetic elements (IMGEs) in V. cholerae genome, which can be used as a marker of differentiation of all seventh pandemic clones with very similar core genome. This review attempts to bring together some of the important researches in recent times that have contributed towards understanding the genetics, epidemiology and evolution of toxigenic V. cholerae strains.

  18. Proficiency of Surgeons in Inguinal Hernia Repair

    PubMed Central

    Neumayer, Leigh A.; Gawande, Atul A.; Wang, Jia; Giobbie-Hurder, Anita; Itani, Kamal M. F.; Fitzgibbons, Robert J.; Reda, Domenic; Jonasson, Olga

    2005-01-01

    Objectives: We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair. Summary Background Data: In a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies, conducted in Veterans Administration hospitals (CSP 456), we reported significant differences in recurrence rates (RR) for the laparoscopic procedure as a result of surgeons’ experience. We have also reported significant differences in RR for the open procedure related to resident postgraduate year (PGY) level. Methods: We analyzed data from unilateral laparoscopic and open herniorrhaphies from CSP 456 (n = 1629). Surgeon's experience (experienced ≥250 procedures; inexperienced <250), surgeon's age, median PGY level of the participating resident, operation time, and hospital observed-to-expected (O/E) ratios for mortality were potential independent predictors of RR. Results: Age was dichotomized into older (≥45 years) and younger (<45 years). Surgeon's inexperience and older age were significant predictors of recurrence in laparoscopic herniorrhaphy. The odds of recurrence for an inexperienced surgeon aged 45 years or older was 1.72 times that of a younger inexperienced surgeon. For open repairs, although surgeon's age and operation time appeared to be related to recurrence, only median PGY level of <3 was a significant independent predictor. Conclusion: This analysis demonstrates that surgeon's age of 45 years and older, when combined with inexperience in laparoscopic inguinal herniorrhaphies, increases risk of recurrence. For open repairs, only a median PGY level of <3 was a significant risk factor. PMID:16135920

  19. Antimicrobial drugs for treating cholera

    PubMed Central

    Leibovici-Weissman, Ya'ara; Neuberger, Ami; Bitterman, Roni; Sinclair, David; Salam, Mohammed Abdus; Paul, Mical

    2014-01-01

    Background Cholera is an acute watery diarrhoea caused by infection with the bacterium Vibrio cholerae, which if severe can cause rapid dehydration and death. Effective management requires early diagnosis and rehydration using oral rehydration salts or intravenous fluids. In this review, we evaluate the additional benefits of treating cholera with antimicrobial drugs. Objectives To quantify the benefit of antimicrobial treatment for patients with cholera, and determine whether there are differences between classes of antimicrobials or dosing schedules. Search methods We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; African Index Medicus; LILACS; Science Citation Index; metaRegister of Controlled Trials; WHO International Clinical Trials Registry Platform; conference proceedings; and reference lists to March 2014. Selection criteria Randomized and quasi-randomized controlled clinical trials in adults and children with cholera that compared: 1) any antimicrobial treatment with placebo or no treatment; 2) different antimicrobials head-to-head; or 3) different dosing schedules or different durations of treatment with the same antimicrobial. Data collection and analysis Two reviewers independently applied inclusion and exclusion criteria, and extracted data from included trials. Diarrhoea duration and stool volume were defined as primary outcomes. We calculated mean difference (MD) or ratio of means (ROM) for continuous outcomes, with 95% confidence intervals (CI), and pooled data using a random-effects meta-analysis. The quality of evidence was assessed using the GRADE approach. Main results Thirty-nine trials were included in this review with 4623 participants. Antimicrobials versus placebo or no treatment Overall, antimicrobial therapy shortened the mean duration of diarrhoea by about a day and a half compared to placebo or no treatment (MD -36.77 hours, 95% CI -43

  20. Repeated in vivo inguinal measurements to estimate a single optimal mesh size for inguinal herniorrhaphy

    PubMed Central

    2012-01-01

    Background Inguinal hernia is a common condition and its repair (herniorrhaphy) is one of the most commonly performed procedures in general surgery. The Lichtenstein herniorrhaphy technique is a widely used and effective surgery that uses mesh to reinforce the area of weakness. Although a wide range of mesh sizes are available for use in hernia repair, in low-resource health care settings the provision of multiple products may not be supportable and it may be necessary for the provision and use of a single mesh size. This study aimed to determine whether the recommended 7.0 cm x 15.0 cm size is an appropriate single mesh size. Methods In order to determine the optimal mesh size according to recommended surgical practices, in vivo measurements of key dimensions of the inguinal floor were taken in patients undergoing herniorrhaphy. Results Measurements were taken in 43 patients: 40 men and 3 women, mean age 43 years (SD 13.6); 39 with indirect hernias, 4 with direct. Allowing for recommended mesh overlaps, the optimal mesh size for provision to be appropriate for the majority of patients was determined to be 8.5 cm x 14.0 cm, 21% wider than the mesh size currently recommended for use in Lichtenstein herniorrhaphy. Conclusions An appropriate size for routine provision in low-resource settings, or other settings where the provision of several mesh sizes is not supportable, may be 8.5 cm x 14.0 cm. PMID:23031606

  1. Actions of cholera toxin and the prevention and treatment of cholera

    NASA Astrophysics Data System (ADS)

    Holmgren, Jan

    1981-07-01

    The drastic intestinal secretion of fluid and electrolytes that is characteristic of cholera is the result of reasonably well understood cellular and biochemical actions of the toxin secreted by Vibrio cholerae. Based on this understanding it is possible to devise new techniques for the treatment and prophylaxis of cholera to complement those based on fluid replacement therapy and sanitation.

  2. Unusual Initial Presentation of Herpes Simplex Virus as Inguinal Lymphadenopathy

    PubMed Central

    Fleming, Sarah A.; Strickler, John G.

    2015-01-01

    Genital herpes simplex virus (HSV) infections are a common cause of inguinal lymphadenopathy. However, surgical excision of enlarged inguinal nodes is almost never performed to initially diagnose genital herpes simplex virus, due to the distinct external presentation of genital herpetic vesicles that usually occur with the first symptoms of infection. Therefore, the histologic and immunophenotypic features of HSV-associated inguinal lymphadenopathy are unfamiliar to most pathologists. The current report describes the lymph node pathology of two immunocompetent patients, whose initial HSV diagnosis was established through surgical excision of enlarged inguinal lymph nodes. Histologic examination showed features consistent with viral lymphadenopathy, including florid follicular hyperplasia, monocytoid B-cell hyperplasia, and paracortical hyperplasia without extensive necrosis. Immunohistochemical stains for HSV antigens, using polyclonal anti-HSV I and II antibodies, demonstrate strong immunoreactivity for HSV in a small number of cells in the subcapsular sinuses, especially in areas with monocytoid B-cell hyperplasia. Rare scattered HSV-positive cells also are identified in paracortical areas and germinal centers. We conclude that an initial diagnosis of genital HSV infection may be established by inguinal lymph node biopsy. PMID:25815228

  3. Unusual initial presentation of herpes simplex virus as inguinal lymphadenopathy.

    PubMed

    Fleming, Sarah A; Strickler, John G

    2015-01-01

    Genital herpes simplex virus (HSV) infections are a common cause of inguinal lymphadenopathy. However, surgical excision of enlarged inguinal nodes is almost never performed to initially diagnose genital herpes simplex virus, due to the distinct external presentation of genital herpetic vesicles that usually occur with the first symptoms of infection. Therefore, the histologic and immunophenotypic features of HSV-associated inguinal lymphadenopathy are unfamiliar to most pathologists. The current report describes the lymph node pathology of two immunocompetent patients, whose initial HSV diagnosis was established through surgical excision of enlarged inguinal lymph nodes. Histologic examination showed features consistent with viral lymphadenopathy, including florid follicular hyperplasia, monocytoid B-cell hyperplasia, and paracortical hyperplasia without extensive necrosis. Immunohistochemical stains for HSV antigens, using polyclonal anti-HSV I and II antibodies, demonstrate strong immunoreactivity for HSV in a small number of cells in the subcapsular sinuses, especially in areas with monocytoid B-cell hyperplasia. Rare scattered HSV-positive cells also are identified in paracortical areas and germinal centers. We conclude that an initial diagnosis of genital HSV infection may be established by inguinal lymph node biopsy.

  4. Pyometra in an inguinal hernia in a bitch.

    PubMed

    Gogny, A; Bruyas, J-F; Fiéni, F

    2010-12-01

    Pyometra in an inguinal hernia was diagnosed in a 10-year-old intact cross-bred bitch which had had dysorexia, depression and inguinal distension. The hernia contained caudal portions of the two uterine horns, uterine cervix and cranial part of the vagina. As the organs were enlarged and full of pus, manual attempt to push back the uterine horns and the vagina in the abdominal cavity through the inguinal canal was unsuccessful. Herniated uterine horns were ligated and cut in their median portion, so it became possible to remove the cervix and the caudal portion of the horns through the hernial orifice, and the ovaries and the cranial part of the horns through a peritoneal midline incision. This bitch was not intended for breeding purposes and, given the presence of a huge pyometra associated with an inguinal hernia, an ovario-hysterectomy was recommended. Uterine herniation should be considered as a differential diagnosis of a caudal lateral inguinal mass. When pushing the uterus back in the abdominal cavity is impossible, a surgical procedure should be performed to detect ischemia–reperfusion injury and/or a septic risk. PMID:20088851

  5. Controlling Endemic Cholera with Oral Vaccines

    PubMed Central

    Longini, Ira M; Nizam, Azhar; Ali, Mohammad; Yunus, Mohammad; Shenvi, Neeta; Clemens, John D

    2007-01-01

    Background Although advances in rehydration therapy have made cholera a treatable disease with low case-fatality in settings with appropriate medical care, cholera continues to impose considerable mortality in the world's most impoverished populations. Internationally licensed, killed whole-cell based oral cholera vaccines (OCVs) have been available for over a decade, but have not been used for the control of cholera. Recently, these vaccines were shown to confer significant levels of herd protection, suggesting that the protective potential of these vaccines has been underestimated and that these vaccines may be highly effective in cholera control when deployed in mass immunization programs. We used a large-scale stochastic simulation model to investigate the possibility of controlling endemic cholera with OCVs. Methods and Findings We construct a large-scale, stochastic cholera transmission model of Matlab, Bangladesh. We find that cholera transmission could be controlled in endemic areas with 50% coverage with OCVs. At this level of coverage, the model predicts that there would be an 89% (95% confidence interval [CI] 72%–98%) reduction in cholera cases among the unvaccinated, and a 93% (95% CI 82%–99%) reduction overall in the entire population. Even a more modest coverage of 30% would result in a 76% (95% CI 44%–95%) reduction in cholera incidence for the population area covered. For populations that have less natural immunity than the population of Matlab, 70% coverage would probably be necessary for cholera control, i.e., an annual incidence rate of ≤ 1 case per 1,000 people in the population. Conclusions Endemic cholera could be reduced to an annual incidence rate of ≤ 1 case per 1,000 people in endemic areas with biennial vaccination with OCVs if coverage could reach 50%–70% depending on the level of prior immunity in the population. These vaccination efforts could be targeted with careful use of ecological data. PMID:18044983

  6. Of cabbages and chlorine: cholera in Peru.

    PubMed

    1992-07-01

    The low case fatality rates (1%) from the 1991 cholera epidemic in Peru was more a result of including diarrheas of a less virulent etiology than that of cholera. In fact, a study during the early phases of the cholera epidemic in Trujillo, Peru revealed that only 79% of suspected cholera cases were infected with vibrio cholera 01. Further other people contended that the government of Peru did not chlorinate many water supplies because studies by the US Environmental Protection Agency suggested that chlorine increases the cancer risk. It reacts with organic matter to make trihalomethanes. 1 study noted that this risk may explain as many as 700 cases of cancer/year in the US, yet cholera was responsible for nearly 40009 deaths in Latin America the 1st year. Besides in Trujillo, Peru the reason for not chlorinating the water supply was not due to a conscious decision to not do so on the part of the government, but because no funds had been made available to purchase chlorinators and chlorine. This is typical of many towns in developing countries. Further raw fish also played a role in transmitting cholera in Peru. Moreover the study in Trujillo indicated that water stored in containers in the home, and not the water supply, was the most important vehicle of transmission. Nevertheless chlorination of both the water supply and stored water would have prevented cholera transmission. In addition, cabbage irrigated with raw wastewater contributed to cholera transmission in Trujillo. But a concern arises if developing countries follow the advice of WHO of 1st treating wastewater in stabilization ponds. Aquatic blue green algae, other zooplankton, and phytoplankton from a microhabitat suitable for V. cholera. In fact, a study in Peru identified a seasonal pattern of the cholera epidemic with the seasonality of V. cholera non-01 from sewage lagoons in Lima. PMID:1351603

  7. Cholera: pathophysiology and emerging therapeutic targets.

    PubMed

    Muanprasat, Chatchai; Chatsudthipong, Varanuj

    2013-05-01

    Cholera is a diarrheal disease that remains an important global health problem with several hundreds of thousands of reported cases each year. This disease is caused by intestinal infection with Vibrio cholerae, which is a highly motile gram-negative bacterium with a single-sheathed flagellum. In the course of cholera pathogenesis, V. cholerae expresses a transcriptional activator ToxT, which subsequently transactivates expressions of two crucial virulence factors: toxin-coregulated pilus and cholera toxin (CT). These factors are responsible for intestinal colonization of V. cholerae and induction of fluid secretion, respectively. In intestinal epithelial cells, CT binds to GM1 ganglioside receptors on the apical membrane and undergoes retrograde vesicular trafficking to endoplasmic reticulum, where it exploits endoplasmic reticulum-associated protein degradation systems to release a catalytic A1 subunit of CT (CT A1) into cytoplasm. CT A1, in turn, catalyzes ADP ribosylation of α subunits of stimulatory G proteins, leading to a persistent activation of adenylate cyclase and an elevation of intracellular cAMP. Increased intracellular cAMP in human intestinal epithelial cells accounts for pathogenesis of profuse diarrhea and severe fluid loss in cholera. This review provides an overview of the pathophysiology of cholera diarrhea and discusses emerging drug targets for cholera, which include V. cholerae virulence factors, V. cholerae motility, CT binding to GM1 receptor, CT internalization and intoxication, as well as cAMP metabolism and transport proteins involved in cAMP-activated Cl(-) secretion. Future directions and perspectives of research on drug discovery and development for cholera are discussed. PMID:23651092

  8. Detection of Vibrio cholerae and Acanthamoeba species from same natural water samples collected from different cholera endemic areas in Sudan

    PubMed Central

    2011-01-01

    Background Vibrio cholerae O1 and V. cholerae O139 infect humans, causing the diarrheal and waterborne disease cholera, which is a worldwide health problem. V. cholerae and the free-living amoebae Acanthamoeba species are present in aquatic environments, including drinking water and it has shown that Acanthamoebae support bacterial growth and survival. Recently it has shown that Acanthamoeba species enhanced growth and survival of V. cholerae O1 and O139. Water samples from different cholera endemic areas in Sudan were collected with the aim to detect both V. cholerae and Acanthamoeba species from same natural water samples by polymerase chain reaction (PCR). Findings For the first time both V. cholerae and Acanthamoeba species were detected in same natural water samples collected from different cholera endemic areas in Sudan. 89% of detected V. cholerae was found with Acanthamoeba in same water samples. Conclusions The current findings disclose Acanthamoedae as a biological factor enhancing survival of V. cholerae in nature. PMID:21470437

  9. Iron acquisition in Vibrio cholerae.

    PubMed

    Wyckoff, Elizabeth E; Mey, Alexandra R; Payne, Shelley M

    2007-06-01

    Vibrio cholerae, the causative agent of cholera, has an absolute requirement for iron and must obtain this element in the human host as well as in its varied environmental niches. It has multiple systems for iron acquisition, including the TonB-dependent transport of heme, the endogenous siderophore vibriobactin and several siderophores that are produced by other microorganisms. There is also a Feo system for the transport of ferrous iron and an ABC transporter, Fbp, which transports ferric iron. There appears to be at least one additional high affinity iron transport system that has not yet been identified. In iron replete conditions, iron acquisition genes are repressed by Fur. Fur also represses the synthesis of a small, regulatory RNA, RyhB, which negatively regulates genes for iron-containing proteins involved in the tricarboxylic acid cycle and respiration as well as genes for motility and chemotaxis. The redundancy in iron transport systems has made it more difficult to determine the role of individual systems in vivo and in vitro, but it may reflect the overall importance of iron in the growth and survival of V. cholerae.

  10. Vibrio cholerae-induced inflammation in the neonatal mouse cholera model.

    PubMed

    Bishop, Anne L; Patimalla, Bharathi; Camilli, Andrew

    2014-06-01

    Vibrio cholerae is the causative agent of the acute diarrheal disease of cholera. Innate immune responses to V. cholerae are not a major cause of cholera pathology, which is characterized by severe, watery diarrhea induced by the action of cholera toxin. Innate responses may, however, contribute to resolution of infection and must be required to initiate adaptive responses after natural infection and oral vaccination. Here we investigated whether a well-established infant mouse model of cholera can be used to observe an innate immune response. We also used a vaccination model in which immunized dams protect their pups from infection through breast milk antibodies to investigate innate immune responses after V. cholerae infection for pups suckled by an immune dam. At the peak of infection, we observed neutrophil recruitment accompanied by induction of KC, macrophage inflammatory protein 2 (MIP-2), NOS-2, interleukin-6 (IL-6), and IL-17a. Pups suckled by an immunized dam did not mount this response. Accessory toxins RtxA and HlyA played no discernible role in neutrophil recruitment in a wild-type background. The innate response to V. cholerae deleted for cholera toxin-encoding phage (CTX) and part of rtxA was significantly reduced, suggesting a role for CTX-carried genes or for RtxA in the absence of cholera toxin (CTX). Two extracellular V. cholerae DNases were not required for neutrophil recruitment, but DNase-deficient V. cholerae caused more clouds of DNA in the intestinal lumen, which appeared to be neutrophil extracellular traps (NETs), suggesting that V. cholerae DNases combat NETs. Thus, the infant mouse model has hitherto unrecognized utility for interrogating innate responses to V. cholerae infection.

  11. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  12. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  13. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  14. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  15. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  16. [Various aspects of the seventh cholera pandemic].

    PubMed

    Ladnyĭ, I D

    1976-07-01

    Problems on epidemiological surveillance over cholera are elucidated; recommendations elaborated at the meeting in Madrid in 1975 are given. Data on cholera morbidity on different continent in 1961-1975, with indication of the number of countries which sent their reports to the WHO, are presented. PMID:1007738

  17. Crystallization of isoelectrically homogeneous cholera toxin

    SciTech Connect

    Spangler, B.D.; Westbrook, E.M. )

    1989-02-07

    Past difficulty in growing good crystals of cholera toxin has prevented the study of the crystal structure of this important protein. The authors have determined that failure of cholera toxin to crystallize well has been due to its heterogeneity. They have now succeeded in overcoming the problem by isolating a single isoelectric variant of this oligomeric protein (one A subunit and five B subunits). Cholera toxin purified by their procedure readily forms large single crystals. The crystal form has been described previously. They have recorded data from native crystals of cholera toxin to 3.0-{angstrom} resolution with our electronic area detectors. With these data, they have found the orientation of a 5-fold symmetry axis within these crystals, perpendicular to the screw dyad of the crystal. They are now determining the crystal structure of cholera toxin by a combination of multiple heavy-atom isomorphous replacement and density modification techniques, making use of rotational 5-fold averaging of the B subunits.

  18. Nepalese origin of cholera epidemic in Haiti.

    PubMed

    Frerichs, R R; Keim, P S; Barrais, R; Piarroux, R

    2012-06-01

    Cholera appeared in Haiti in October 2010 for the first time in recorded history. The causative agent was quickly identified by the Haitian National Public Health Laboratory and the United States Centers for Disease Control and Prevention as Vibrio cholerae serogroup O1, serotype Ogawa, biotype El Tor. Since then, >500 000 government-acknowledged cholera cases and >7000 deaths have occurred, the largest cholera epidemic in the world, with the real death toll probably much higher. Questions of origin have been widely debated with some attributing the onset of the epidemic to climatic factors and others to human transmission. None of the evidence on origin supports climatic factors. Instead, recent epidemiological and molecular-genetic evidence point to the United Nations peacekeeping troops from Nepal as the source of cholera to Haiti, following their troop rotation in early October 2010. Such findings have important policy implications for shaping future international relief efforts. PMID:22510219

  19. Sampson's Artery Hemorrhage after Inguinal Hernia Repair: Second Case Reported

    PubMed Central

    Adjei Boachie, Joseph

    2016-01-01

    Sampson artery is normally obliterated in postembryonic development. In rare cases it can remain patent and complicate a routine outpatient herniorrhaphy when severed. This is the second reported case in the available English literature of hemoperitoneum due to bleeding from a patent Sampson's artery following an open inguinal hernia repair. PMID:27247822

  20. Sampson's Artery Hemorrhage after Inguinal Hernia Repair: Second Case Reported.

    PubMed

    Adjei Boachie, Joseph; Smith-Singares, Eduardo

    2016-01-01

    Sampson artery is normally obliterated in postembryonic development. In rare cases it can remain patent and complicate a routine outpatient herniorrhaphy when severed. This is the second reported case in the available English literature of hemoperitoneum due to bleeding from a patent Sampson's artery following an open inguinal hernia repair. PMID:27247822

  1. Single-site video endoscopic inguinal lymphadenectomy: initial report.

    PubMed

    Tobias-Machado, Marcos; Correa, Walter F; Reis, Leonardo Oliveira; Starling, Eduardo S; de Castro Neves, Oseas; Juliano, Roberto V; Pompeo, Antonio C L

    2011-04-01

    Techniques that attempt to further reduce the morbidity and improve cosmesis of laparoscopic surgery have particularly generated interest. Since its initial urologic description in 2007, there has been a surge of interest in laparoendoscopic single-site surgery, which is now an emerging technique within the field of minimally invasive urologic surgery. This report describes a preliminary experience with single-site video endoscopic inguinal lymphadenectomy (SSVEIL) compared with conventional video endoscopic inguinal lymphadenectomy (VEIL) on inguinal nodes management in a 45-year-old man with pT(2) grade 2 squamous cell penile carcinoma and impalpable inguinal nodes. VEIL with saphenous vein preservation in the left leg and SSVEIL on the other side presented no difference concerning operative time (100 vs 120 min), blood loss (50 mL), drainage volume, number of nodes retrieved (8), pain, and oncologic outcome. The patient had an uneventful postoperative course, was discharged 12 hours after the procedure, and preferred the aesthetic result of SSVEIL. Further refinements in technology will likely alleviate many of the persistent technical problems. Additional rigorous comparison studies are needed to evaluate the true benefits of the technique and the extent of its clinical application, mainly oncologic results, before the widespread adoption of SSVEIL. Ultimately, advance breakthroughs in fields of in-vivo instrumentation, robotics, and purpose-built robotic platforms will bring its potential to full clinical realization. PMID:21226622

  2. Inguinal Lymph Nodes in Carcinoma Penis-Observation or Surgery?

    PubMed Central

    Althaf, Syed; Gangaiah, Dinesh M.; Dev, Kapil; Kurpad, Vishnu P.; Gurawalia, Jaiprakash

    2016-01-01

    Introduction In Indian sub-continent the presentation of carcinoma penis is variable. Mostly presents with palpable inguinal lymph nodes but not confirm of metastases. Aim To evaluate whether all clinically positive nodes are metastatic and decide when to address inguinal lymph node. Materials and Methods A retrospective observational study on carcinoma penis from a regional cancer centre of south India over a period from 2001 to 2012. All the clinical, investigational, operative, pathology details and follow-up data were collected from patient records. Results Two hundred and thirty cases of carcinoma penis have been identified and 112 cases had clinically positive nodes. In 74 cases fine needle cytology was positive for malignancy and they have been addressed with block dissection with surgery of primary lesion. At two years follow up, 70 patients were identified with inguinal lymph node metastasis and block dissection was performed and all was were positive for malignancy on histology. The rate of recurrence is related to the T stage of the primary tumour. Conclusion It can be concluded that elective surgery is appropriate for palpable inguinal lymph nodes and prophylactic nodal dissection in high risk cases of carcinoma penis. PMID:26894163

  3. Two Ports Laparoscopic Inguinal Hernia Repair in Children

    PubMed Central

    Ibrahim, Medhat M.

    2015-01-01

    Introduction. Several laparoscopic treatment techniques were designed for improving the outcome over the last decade. The various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, and mode of dissection of the hernia sac. Patients and Surgical Technique. 90 children were subjected to surgery and they undergone two-port laparoscopic repair of inguinal hernia in children. Technique feasibility in relation to other modalities of repair was the aim of this work. 90 children including 75 males and 15 females underwent surgery. Hernia in 55 cases was right-sided and in 15 left-sided. Two patients had recurrent hernia following open hernia repair. 70 (77.7%) cases were suffering unilateral hernia and 20 (22.2%) patients had bilateral hernia. Out of the 20 cases 5 cases were diagnosed by laparoscope (25%). The patients' median age was 18 months. The mean operative time for unilateral repairs was 15 to 20 minutes and bilateral was 21 to 30 minutes. There was no conversion. The complications were as follows: one case was recurrent right inguinal hernia and the second was stitch sinus. Discussion. The results confirm the safety and efficacy of two ports laparoscopic hernia repair in congenital inguinal hernia in relation to other modalities of treatment. PMID:25785196

  4. Management of inguinal hernia in premature infants: 10-year experience

    PubMed Central

    Crankson, Stanley John; Al Tawil, Khalil; Al Namshan, Mohammad; Al Jadaan, Saud; Baylon, Beverly Jane; Gieballa, Mutaz; Ahmed, Ibrahim Hakim

    2015-01-01

    Aim: Debatable issues in the management of inguinal hernia in premature infants remain unresolved. This study reviews our experience in the management of inguinal hernia in premature infants. Materials and Methods: Retrospective chart review of premature infants with inguinal hernia from 1999 to 2009. Infants were grouped into 2: Group 1 had repair (HR) just before discharge from the neonatal intensive care unit (NICU) and Group 2 after discharge. Results: Eighty four premature infants were identified. None of 23 infants in Group 1 developed incarcerated hernia while waiting for repair. Of the 61 infants in Group 2, 47 (77%) underwent day surgery repair and 14 were admitted for repair. At repair mean postconceptional age (PCA) in Group1 was 39.5 ± 3.05 weeks. Mean PCA in Group 2 was 66.5 ± 42.73 weeks for day surgery infants and 47.03 ± 8.87 weeks for admitted infants. None of the 84 infants had an episode of postoperative apnea. Five (5.9%) infants presented subsequently with metachronous contralateral hernia and the same number of infants had hernia recurrence. Conclusions: Delaying HR in premature infants until ready for discharge from the NICU allows for repair closer to term without increasing the risk of incarceration. Because of low occurrence of metachronous hernia contralateral inguinal exploration is not justified. Day surgery HR can be performed in former premature infant if PCA is >47 weeks without increasing postoperative complications. PMID:25552826

  5. Inguinal Hernia and Airport Scanners: An Emerging Indication for Repair?

    PubMed Central

    Cawich, Shamir O.; Maharaj, Ravi; Dan, Dilip

    2013-01-01

    The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency. PMID:24368923

  6. Inguinal bladder hernia associated with vesico-ureteric reflux.

    PubMed

    Noble, J G; Christmas, T J; Chapple, C R; Rickards, D

    1992-04-01

    The urinary bladder is frequently found as a component of inguinal herniae. This report describes a case of 'bladder hernia' associated with vesico-ureteric reflux. The current methods of investigation and subsequent treatment for this condition are reviewed along with the possible underlying cause of vesico-ureteric reflux in this case.

  7. A Rare Emergency: Testicular Torsion in the Inguinal Canal

    PubMed Central

    Şener, Nevzat Can; Bas, Okan; Yesil, Suleyman; Zengin, Kursad; Imamoglu, Abdurrahim

    2015-01-01

    Objectives. To report our experience and present the largest series of testicular torsion cases in the inguinal canal. Material and Methods. The clinical data of 13 patients with testicular torsion in the inguinal canal treated between 2005 and 2013 were reviewed. Recorded patient age, whether the testes were palpable or not, side of the affected testes, the presence of hernia, ischemia time, and operation outcomes were assessed. Results. Patient age ranged from 8 to 70 months (29.15 ± 20.22). Mean ischemia time was 16.5 ± 21.3 hours. Accompanying inguinal hernia was present in 92% of the cases (12/13). Four of the thirteen patients (30.8%) were treated by orchiectomy because the necrosis was present after prolonged ischemia time. Nine patients (69.2%) were treated by single session orchidopexy. Conclusion. Torsion of testes in the inguinal canal is a rare disease, but with rapid diagnosis, affected testes can be salvaged, but the key factor is to keep this condition in mind. PMID:25654093

  8. A rare emergency: testicular torsion in the inguinal canal.

    PubMed

    Şener, Nevzat Can; Bas, Okan; Karakoyunlu, Nihat; Ercil, Hakan; Yesil, Suleyman; Zengin, Kursad; Imamoglu, Abdurrahim

    2015-01-01

    Objectives. To report our experience and present the largest series of testicular torsion cases in the inguinal canal. Material and Methods. The clinical data of 13 patients with testicular torsion in the inguinal canal treated between 2005 and 2013 were reviewed. Recorded patient age, whether the testes were palpable or not, side of the affected testes, the presence of hernia, ischemia time, and operation outcomes were assessed. Results. Patient age ranged from 8 to 70 months (29.15 ± 20.22). Mean ischemia time was 16.5 ± 21.3 hours. Accompanying inguinal hernia was present in 92% of the cases (12/13). Four of the thirteen patients (30.8%) were treated by orchiectomy because the necrosis was present after prolonged ischemia time. Nine patients (69.2%) were treated by single session orchidopexy. Conclusion. Torsion of testes in the inguinal canal is a rare disease, but with rapid diagnosis, affected testes can be salvaged, but the key factor is to keep this condition in mind.

  9. Antimicrobial drugs for treating cholera

    PubMed Central

    Leibovici-Weissman, Ya'ara; Neuberger, Ami; Bitterman, Roni; Sinclair, David; Salam, Mohammed Abdus; Paul, Mical

    2014-01-01

    Background Cholera is an acute watery diarrhoea caused by infection with the bacterium Vibrio cholerae, which if severe can cause rapid dehydration and death. Effective management requires early diagnosis and rehydration using oral rehydration salts or intravenous fluids. In this review, we evaluate the additional benefits of treating cholera with antimicrobial drugs. Objectives To quantify the benefit of antimicrobial treatment for patients with cholera, and determine whether there are differences between classes of antimicrobials or dosing schedules. Search methods We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; African Index Medicus; LILACS; Science Citation Index; metaRegister of Controlled Trials; WHO International Clinical Trials Registry Platform; conference proceedings; and reference lists to March 2014. Selection criteria Randomized and quasi-randomized controlled clinical trials in adults and children with cholera that compared: 1) any antimicrobial treatment with placebo or no treatment; 2) different antimicrobials head-to-head; or 3) different dosing schedules or different durations of treatment with the same antimicrobial. Data collection and analysis Two reviewers independently applied inclusion and exclusion criteria, and extracted data from included trials. Diarrhoea duration and stool volume were defined as primary outcomes. We calculated mean difference (MD) or ratio of means (ROM) for continuous outcomes, with 95% confidence intervals (CI), and pooled data using a random-effects meta-analysis. The quality of evidence was assessed using the GRADE approach. Main results Thirty-nine trials were included in this review with 4623 participants. Antimicrobials versus placebo or no treatment Overall, antimicrobial therapy shortened the mean duration of diarrhoea by about a day and a half compared to placebo or no treatment (MD -36.77 hours, 95% CI -43

  10. Antimicrobials & cholera: are we stranded?

    PubMed

    Ghosh, Amit; Ramamurthy, T

    2011-02-01

    Antimicrobial resistance poses a major threat in the treatment of infectious diseases. Though significant progress in the management of diarrhoeal diseases has been achieved by improved hygiene, development of new antimicrobials and vaccines, the burden remains the same, especially in children below 5 yr of age. In the case of cholera, though oral rehydration treatment is the mainstay, antimicrobial therapy is mandatory at times to reduce the volume of stool and shorten the duration of the disease. Though for many pathogens, antimicrobial resistance emerged soon after the introduction of antibiotics, Vibrio cholerae remained sensitive to most of the antibiotics for quite a long period. However, the scenario changed over the years and today, V. cholerae strains isolated world over are resistant to multiple antibiotics. A myriad number of mechanisms underlie this phenomenon. These include production of extended-spectrum beta-lactamases, enhanced multi-drug efflux pump activity, plasmid-mediated quinolone and fluoroquinolone resistance, and chromosomal mutations. Horizontal transfer of resistance determinants with mobile genetic elements like integrons and the integrating conjugative elements (ICEs), SXTs help in the dissemination of drug resistance. Though all strains isolated are not resistant to all antibiotics and we are not as yet "stranded", expanding spectrum of drug resistance is a definite cause for concern. Pipelines of discovery of new antibiotics are drying up as major pharmaceutical companies are losing interest in investing money in this endeavour, mainly due to the short shelf-life of the antibiotics and also due to the fast emergence of drug resistance. To address this issue, attempts are now being made to discover drugs which are pathogen specific and target their "virulence mechanisms". It is expected that development of resistance against such antibiotics would take much longer. This review briefly focuses on all these issues.

  11. Lactoferrin binding properties of Vibrio cholerae.

    PubMed

    Ascencio, F; Ljungh, A; Wadström, T

    1992-01-01

    The lactoferrin binding properties of Vibrio cholerae, a non-invasive pathogen were investigated. Screening of fifty V. cholerae strains of different serogroups and serotypes, showed that 10% of the V. cholerae strains bound to 125I-labelled lactoferrin, and 40% of the 125I-labelled lactoferrin bound to V. cholerae strain 623 could be displaced by unlabelled lactoferrin. Other iron-binding glycoproteins and ferroproteins like ferritin, transferrin, haemoglobin, and myoglobin inhibited the binding of 125I-lactoferrin to a lesser degree. Monosaccharides (GalNac, Man, Gal, and Fuc), and other glycoproteins such as fetuin and orosomucoid also inhibited the binding to a lesser extent. V. cholerae 623 showed a cell surface associated-proteolytic activity which cleaved off the cell-bound 125I-labelled lactoferrin. The generation of cryptotopes on the V. cholerae cell surface by proteolytic digestion favoured the binding of ferritin, transferrin, haemoglobin, and haemin, as well as Congo red, to cells of V. cholerae 623.

  12. Update: outbreak of cholera ---Haiti, 2010.

    PubMed

    2010-12-10

    The first cholera outbreak in Haiti in at least a century was confirmed by the Haitian National Public Health Laboratory on October 21, 2010. Surveillance data through December 3, provided by the Haitian Ministry of Public Health and Population (MSPP), indicated that the outbreak had spread nationwide and that cases of cholera and cholera-associated hospitalizations and deaths had climbed rapidly in November. As of December 3, MSPP reported 91,770 cases of cholera from all 10 departments and the capital city of Port-au-Prince; 43,243 (47.1%) patients had been hospitalized, and 2,071 (2.3%) had died. A rapid mortality assessment in Artibonite Department found that deaths occurred as rapidly as 2 hours after symptom onset and identified important gaps in access to life-saving treatments, including oral rehydration solution (ORS). Urgent activities are under way, and additional efforts are imperative to reduce cholera mortality by expanding access to cholera treatment and to reduce cholera transmission by improving access to safe water and adequate sanitation. PMID:21150867

  13. Cholera Epidemiology in Nigeria: an overview

    PubMed Central

    Adagbada, Ajoke Olutola; Adesida, Solayide Abosede; Nwaokorie, Francisca Obiageri; Niemogha, Mary-Theresa; Coker, Akitoye Olusegun

    2012-01-01

    Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium, Vibrio cholera. Choleragenic V. cholera O1 and O139 are the only causative agents of the disease. The two most distinguishing epidemiologic features of the disease are its tendency to appear in explosive outbreaks and its predisposition to causing pandemics that may progressively affect many countries and spread into continents. Despite efforts to control cholera, the disease continues to occur as a major public health problem in many developing countries. Numerous studies over more than a century have made advances in the understanding of the disease and ways of treating patients, but the mechanism of emergence of new epidemic strains, and the ecosystem supporting regular epidemics, remain challenging to epidemiologists. In Nigeria, since the first appearance of epidemic cholera in 1972, intermittent outbreaks have been occurring. The later part of 2010 was marked with severe outbreak which started from the northern part of Nigeria, spreading to the other parts and involving approximately 3,000 cases and 781 deaths. Sporadic cases have also been reported. Although epidemiologic surveillance constitutes an important component of the public health response, publicly available surveillance data from Nigeria have been relatively limited to date. Based on existing relevant scientific literature on features of cholera, this paper presents a synopsis of cholera epidemiology emphasising the situation in Nigeria. PMID:22937199

  14. A De in the life of cholera

    PubMed Central

    Hall, Robert H.

    2011-01-01

    The 50-year commemoration of S.N. De’s seminal 1959 publication in Nature provides an opportunity to reflect on scientific discovery, recognition, and public health. De’s paper marked the first major conceptual advance in cholera research since 1884, when Robert Koch definitively identified Der Kommabazillus as the aetiological agent of cholera. Unfortunately, Koch reported that systemic toxinosis and multi-organ failure led to severe dehydrating diarrhoea, thereby mistaking cause for effect. As a consequence, while work on other microbial pathogens advanced into the development of vaccines and therapeutics, cholera research languished as scientists injected animals parenterally in decades of futile effort to develop an animal model of diarrhoea. This fundamental misconception in cholera pathogenesis was swept away when S.N. De used ligated loops of rabbit ileum to demonstrate lumenal fluid accumulation in the presence of Vibrio cholerae culture filtrates. After some delay, De’s observation of a diarrhoeagenic exotoxin became the founding principle of modern cholera research, vaccination, and treatment; and a burst of discovery saw V. cholerae transformed into the enteric pathogen best understood at the molecular level. The scientific basis for orally administering vaccines to induce mucosal immunity was established, and the success of oral rehydration, what has been described as one of the 20th century’s most important medical advances, was explained. Nobel laureate Joshua Lederberg wrote of De’s iconoclastic creativity, experimental skill, and observational mastery, and many other leaders in the field concurred. De was nominated for the Nobel Prize in Physiology or Medicine more than once. But despite the passage of half a century from De’s work, cholera remains a frustrating problem: we are clearly missing something. In reviewing the scientific and programmatic impact of S.N. De on cholera, it is clear that a defining victory against the disease is

  15. A De in the life of cholera.

    PubMed

    Hall, Robert H

    2011-02-01

    The 50-year commemoration of S.N. De's seminal 1959 publication in Nature provides an opportunity to reflect on scientific discovery, recognition, and public health. De's paper marked the first major conceptual advance in cholera research since 1884, when Robert Koch definitively identified Der Kommabazillus as the aetiological agent of cholera. Unfortunately, Koch reported that systemic toxinosis and multi-organ failure led to severe dehydrating diarrhoea, thereby mistaking cause for effect. As a consequence, while work on other microbial pathogens advanced into the development of vaccines and therapeutics, cholera research languished as scientists injected animals parenterally in decades of futile effort to develop an animal model of diarrhoea. This fundamental misconception in cholera pathogenesis was swept away when S.N. De used ligated loops of rabbit ileum to demonstrate lumenal fluid accumulation in the presence of Vibrio cholerae culture filtrates. After some delay, De's observation of a diarrhoeagenic exotoxin became the founding principle of modern cholera research, vaccination, and treatment; and a burst of discovery saw V. cholerae transformed into the enteric pathogen best understood at the molecular level. The scientific basis for orally administering vaccines to induce mucosal immunity was established, and the success of oral rehydration, what has been described as one of the 20 th century's most important medical advances, was explained. Nobel laureate Joshua Lederberg wrote of De's iconoclastic creativity, experimental skill, and observational mastery, and many other leaders in the field concurred. De was nominated for the Nobel Prize in Physiology or Medicine more than once. But despite the passage of half a century from De's work, cholera remains a frustrating problem: we are clearly missing something. In reviewing the scientific and programmatic impact of S.N. De on cholera, it is clear that a defining victory against the disease is achievable

  16. Mesenteric Panniculitis Associated With Vibrio cholerae Infection

    PubMed Central

    Roginsky, Grigory; Mazulis, Andrew; Ecanow, Jacob S.

    2015-01-01

    We report the first case of acute Vibrio cholerae infection with computed tomography (CT) changes consistent with mesenteric panniculitis (MP). A 78-year-old Indian man returned from overseas travel with progressively severe nausea, vomiting, abdominal pain, and watery diarrhea. His stool tested positive twice for Vibrio cholerae. CT revealed prominent lymph nodes and a hazy mesentery consistent with MP. Antibiotic treatment resulted in complete resolution of MP on follow-up CT 8 months later. In the setting of Vibrio cholerae infection, the CT finding of MP appears to be the result of a immunologically mediated reactive inflammatory disorder of the mesentery. PMID:26504876

  17. Inguinal hernia repair: anaesthesia, pain and convalescence.

    PubMed

    Callesen, Torben

    2003-08-01

    Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (< 1%), although intraoperative pain is quite common. The generally low rate of serious complications does not allow firm conclusions, but the rate of less serious complications is lower by local anaesthesia, compared to other anaesthetic techniques. Of special interest is, that the rate of urinary retention can be eliminated by the use of local anaesthesia. Local anaesthesia results, in comparative studies, in a higher degree of patient satisfaction than other anaesthetic techniques. Local anaesthesia also facilitates faster mobilisation and earlier discharge/fulfilment of discharge criteria from post anaesthetic care units than other anaesthetic techniques. Pain after hernia repair is more pronounced at mobilisation or coughing than during rest, and younger patients seem to have more pain than older patients. The pain ceases over time, and it is most pronounced the day after surgery, where two thirds have moderate or severe pain during activity, while one third still have moderate or severe pain after one week, and approximately 10% after 4 weeks. Pain after laparoscopic surgery is less pronounced than after open surgery, while different open repair techniques do not exhibit significant differences. Postoperative

  18. Acquired Incarcerated Inguinal Hernia: A Review of 13 Horses

    PubMed Central

    Weaver, A. David

    1987-01-01

    The case records of 13 horses with acquired incarcerated inguinal hernia in January-August 1983, were reviewed. Nine cases were in stallions. The remaining four involved eventration 5-48 hours following castration. Ages ranged from 1-17 years. Horses showed a variable degree of colic. Bowel was felt to pass through the internal inguinal ring on rectal examination in most cases. The physical features of the scrotum varied considerably. Resection of ischemic jejunum and/or ileum was necessary in three horses. Two horses were euthanized at surgery (one with bilateral ischemic jejunum, one with bowel perforation), and a further horse on day 16 postsurgery following development of multiple adhesions. All stallions were castrated. Follow-up for 6-24 months (mean 12.7) disclosed that all ten discharged horses were alive and healthy (recovery rate 77%). PMID:17422760

  19. Transmission of Infectious Vibrio cholerae through Drinking Water among the Household Contacts of Cholera Patients (CHoBI7 Trial)

    PubMed Central

    Rafique, Raisa; Rashid, Mahamud-ur; Monira, Shirajum; Rahman, Zillur; Mahmud, Md. Toslim; Mustafiz, Munshi; Saif-Ur-Rahman, K. M.; Johura, Fatema-Tuz; Islam, Saiful; Parvin, Tahmina; Bhuyian, Md. Sazzadul I.; Sharif, Mohsena B.; Rahman, Sabita R.; Sack, David A.; Sack, R. Bradley; George, Christine M.; Alam, Munirul

    2016-01-01

    Recurrent cholera causes significant morbidity and mortality among the growing population of Dhaka, the capital city of Bangladesh. Previous studies have demonstrated that household contacts of cholera patients are at >100 times higher risk of cholera during the week after the presentation of the index patient. Our prospective study investigated the mode of transmission of Vibrio cholerae, the cause of cholera, in the households of cholera patients in Dhaka city. Out of the total 420 rectal swab samples analyzed from 84 household contacts and 330 water samples collected from 33 households, V. cholerae was isolated from 20%(17/84) of household contacts, 18%(6/33) of stored drinking water, and 27%(9/33) of source water samples. Phenotypic and molecular analyses results confirmed the V. cholerae isolates to be toxigenic and belonging to serogroup O1 biotype El Tor (ET) possessing cholera toxin of classical biotype (altered ET). Phylogenetic analysis by pulsed-field gel electrophoresis (PFGE) showed the V. cholerae isolates to be clonally linked, as >95% similarity was confirmed by sub-clustering patterns in the PFGE (NotI)-based dendrogram. Mapping results showed cholera patients to be widely distributed across 25 police stations. The data suggesting the transmission of infectious V. cholerae within the household contacts of cholera patients through drinking water underscores the need for safe water to prevent spread of cholera and related deaths in Dhaka city. PMID:27803695

  20. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era.

    PubMed

    Esposito, Ciro; Escolino, Maria; Turrà, Francesco; Roberti, Agnese; Cerulo, Mariapina; Farina, Alessandra; Caiazzo, Simona; Cortese, Giuseppe; Servillo, Giuseppe; Settimi, Alessandro

    2016-08-01

    The surgical repair of inguinal hernia and hydrocele is one of the most common operations performed in pediatric surgery practice. This article reviews current concepts in the management of inguinal hernia and hydrocele based on the recent literature and the authors׳ experience. We describe the principles of clinical assessment and anesthetic management of children undergoing repair of inguinal hernia, underlining the differences between an inguinal approach and minimally invasive surgery (MIS). Other points discussed include the current management of particular aspects of these pathologies such as bilateral hernias; contralateral patency of the peritoneal processus vaginalis; hernias in premature infants; direct, femoral, and other rare hernias; and the management of incarcerated or recurrent hernias. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and hydrocele, emphasizing that the current use of MIS in pediatric patients has completely changed the management of pediatric inguinal hernias. PMID:27521714

  1. Immunizing Canada geese against avian cholera

    USGS Publications Warehouse

    Price, J.I.

    1985-01-01

    A small flock of captive giant Canada geese were vaccinated with the experimental bac- terin in Nebraska to test its efficacy under field conditions. Only 2 of 157 vaccinates died from avian cholera during an annual spring die-off.

  2. Are wetlands the reservoir for avian cholera?

    USGS Publications Warehouse

    Samuel, M.D.; Shadduck, D.J.; Goldberg, D.R.

    2004-01-01

    Wetlands have long been suspected to be an important reservoir for Pasteurella multocida and therefore the likely source of avian cholera outbreaks. During the fall of 1995a??98 we collected sediment and water samples from 44 wetlands where avian cholera epizootics occurred the previous winter or spring. We attempted to isolate P. multocida in sediment and surface water samples from 10 locations distributed throughout each wetland. We were not able to isolate P. multocida from any of the 440 water and 440 sediment samples collected from these wetlands. In contrast, during other investigations of avian cholera we isolated P. multocida from 20 of 44 wetlands, including 7% of the water and 4.5% of the sediment samples collected during or shortly following epizootic events. Our results indicate that wetlands are an unlikely reservoir for the bacteria that causes avian cholera.

  3. Influence of human behavior on cholera dynamics.

    PubMed

    Wang, Xueying; Gao, Daozhou; Wang, Jin

    2015-09-01

    This paper is devoted to studying the impact of human behavior on cholera infection. We start with a cholera ordinary differential equation (ODE) model that incorporates human behavior via modeling disease prevalence dependent contact rates for direct and indirect transmissions and infectious host shedding. Local and global dynamics of the model are analyzed with respect to the basic reproduction number. We then extend the ODE model to a reaction-convection-diffusion partial differential equation (PDE) model that accounts for the movement of both human hosts and bacteria. Particularly, we investigate the cholera spreading speed by analyzing the traveling wave solutions of the PDE model, and disease threshold dynamics by numerically evaluating the basic reproduction number of the PDE model. Our results show that human behavior can reduce (a) the endemic and epidemic levels, (b) cholera spreading speeds and (c) the risk of infection (characterized by the basic reproduction number).

  4. Pursuing Justice in Haiti's Cholera Epidemic.

    PubMed

    Weinmeyer, Richard

    2016-01-01

    In 2010, the nation of Haiti was leveled by a shattering earthquake that killed thousands and devastated its already fragile infrastructure. During relief efforts to aid Haiti's suffering population, the United Nations sent troops to Haiti to assist the rebuilding of country's most basic services. But those troops unknowingly carried with them the bacteria that cause cholera, and through the UN's negligent actions, it triggered a horrifying cholera epidemic that continues to harm the Haitian people. Those injured by the cholera epidemic have sought relief in the US federal court system to obtain justice for those killed or sickened by the cholera outbreak. The UN has declared legal immunity for causing the epidemic, yet the litigation on this matter is ongoing.

  5. Influence of human behavior on cholera dynamics

    PubMed Central

    Wang, Xueying; Gao, Daozhou; Wang, Jin

    2015-01-01

    This paper is devoted to studying the impact of human behavior on cholera infection. We start with a cholera ordinary differential equation (ODE) model that incorporates human behavior via modeling disease prevalence dependent contact rates for direct and indirect transmissions and infectious host shedding. Local and global dynamics of the model are analyzed with respect to the basic reproduction number. We then extend the ODE model to a reaction-convection-diffusion partial differential equation (PDE) model that accounts for the movement of both human hosts and bacteria. Particularly, we investigate the cholera spreading speed by analyzing the traveling wave solutions of the PDE model, and disease threshold dynamics by numerically evaluating the basic reproduction number of the PDE model. Our results show that human behavior can reduce (a) the endemic and epidemic levels, (b) cholera spreading speeds and (c) the risk of infection (characterized by the basic reproduction number). PMID:26119824

  6. Pursuing Justice in Haiti's Cholera Epidemic.

    PubMed

    Weinmeyer, Richard

    2016-01-01

    In 2010, the nation of Haiti was leveled by a shattering earthquake that killed thousands and devastated its already fragile infrastructure. During relief efforts to aid Haiti's suffering population, the United Nations sent troops to Haiti to assist the rebuilding of country's most basic services. But those troops unknowingly carried with them the bacteria that cause cholera, and through the UN's negligent actions, it triggered a horrifying cholera epidemic that continues to harm the Haitian people. Those injured by the cholera epidemic have sought relief in the US federal court system to obtain justice for those killed or sickened by the cholera outbreak. The UN has declared legal immunity for causing the epidemic, yet the litigation on this matter is ongoing. PMID:27437822

  7. Intestinal Colonization Dynamics of Vibrio cholerae

    PubMed Central

    Almagro-Moreno, Salvador; Pruss, Kali; Taylor, Ronald K.

    2015-01-01

    To cause the diarrheal disease cholera, Vibrio cholerae must effectively colonize the small intestine. In order to do so, the bacterium needs to successfully travel through the stomach and withstand the presence of agents such as bile and antimicrobial peptides in the intestinal lumen and mucus. The bacterial cells penetrate the viscous mucus layer covering the epithelium and attach and proliferate on its surface. In this review, we discuss recent developments and known aspects of the early stages of V. cholerae intestinal colonization and highlight areas that remain to be fully understood. We propose mechanisms and postulate a model that covers some of the steps that are required in order for the bacterium to efficiently colonize the human host. A deeper understanding of the colonization dynamics of V. cholerae and other intestinal pathogens will provide us with a variety of novel targets and strategies to avoid the diseases caused by these organisms. PMID:25996593

  8. Vibrio cholerae: lessons for mucosal vaccine design

    PubMed Central

    Bishop, Anne L; Camilli, Andrew

    2011-01-01

    The ability of Vibrio cholerae to persist in bodies of water will continue to confound our ability to eradicate cholera through improvements to infrastructure, and thus cholera vaccines are needed. We aim for an inexpensive vaccine that can provide long-lasting protection from all epidemic cholera infections, currently caused by O1 or O139 serogroups. Recent insights into correlates of protection, epidemiology and pathogenesis may help us design improved vaccines. This notwithstanding, we have come to appreciate that even marginally protective vaccines, such as oral whole-cell killed vaccines, if widely distributed, can provide significant protection, owing to herd immunity. Further efforts are still required to provide more effective protection of young children. PMID:21162623

  9. Association Between Thoracic Aortic Disease and Inguinal Hernia

    PubMed Central

    Olsson, Christian; Eriksson, Per; Franco‐Cereceda, Anders

    2014-01-01

    Background The study hypothesis was that thoracic aortic disease (TAD) is associated with a higher‐than‐expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population‐based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance. Methods and Results The prevalence of inguinal hernia in subjects with TAD was determined from nation‐wide register data and compared to a non‐TAD group (patients with isolated aortic stenosis). Groups were balanced using propensity score matching. Multivariable statistical analysis (logistic regression) was performed to identify variables independently associated with hernia. Hernia prevalence was 110 of 750 (15%) in subjects with TAD versus 29 of 301 (9.6%) in non‐TAD, P=0.03. This statistically significant difference remained after propensity score matching: 21 of 159 (13%) in TAD versus 14 of 159 (8.9%) in non‐TAD, P<0.001. Variables independently associated with hernia in multivariable analysis were male sex (odds ratio [OR] with 95% confidence interval [95% CI]) 3.4 (2.1 to 5.4), P<0.001; increased age, OR 1.02/year (1.004 to 1.04), P=0.014; and TAD, OR 1.8 (1.1 to 2.8), P=0.015. Conclusions The prevalence of inguinal hernia (15%) in TAD is higher than expected in a general population and higher in TAD, compared to non‐TAD. TAD is independently associated with hernia in multivariable analysis. Presence or history of hernia may be of importance in detecting TAD, and the association warrants further study. PMID:25146705

  10. [Laparoscopic repair of inguinal hernia--experience in 54 consecutive cases].

    PubMed

    Kyzer, S; Kristalni, I; Alis, M; Charuzi, I

    1999-02-15

    We describe our experience in 54 consecutive patients who underwent laparoscopic repair of 86 inguinal hernias. Laparoscopic repair of inguinal hernia is technically feasible, does not prolong the length of the procedure nor of hospitalization and is not accompanied by increased morbidity. Although there is not yet general agreement, in our experience and that of others, it appears that laparoscopic repair will be the preferred approach to the treatment of inguinal hernia. PMID:10914213

  11. PREDICTIVE MODELING OF CHOLERA OUTBREAKS IN BANGLADESH

    PubMed Central

    Koepke, Amanda A.; Longini, Ira M.; Halloran, M. Elizabeth; Wakefield, Jon; Minin, Vladimir N.

    2016-01-01

    Despite seasonal cholera outbreaks in Bangladesh, little is known about the relationship between environmental conditions and cholera cases. We seek to develop a predictive model for cholera outbreaks in Bangladesh based on environmental predictors. To do this, we estimate the contribution of environmental variables, such as water depth and water temperature, to cholera outbreaks in the context of a disease transmission model. We implement a method which simultaneously accounts for disease dynamics and environmental variables in a Susceptible-Infected-Recovered-Susceptible (SIRS) model. The entire system is treated as a continuous-time hidden Markov model, where the hidden Markov states are the numbers of people who are susceptible, infected, or recovered at each time point, and the observed states are the numbers of cholera cases reported. We use a Bayesian framework to fit this hidden SIRS model, implementing particle Markov chain Monte Carlo methods to sample from the posterior distribution of the environmental and transmission parameters given the observed data. We test this method using both simulation and data from Mathbaria, Bangladesh. Parameter estimates are used to make short-term predictions that capture the formation and decline of epidemic peaks. We demonstrate that our model can successfully predict an increase in the number of infected individuals in the population weeks before the observed number of cholera cases increases, which could allow for early notification of an epidemic and timely allocation of resources. PMID:27746850

  12. Cholera on a Gulf Coast oil rig.

    PubMed

    Johnston, J M; Martin, D L; Perdue, J; McFarland, L M; Caraway, C T; Lippy, E C; Blake, P A

    1983-09-01

    A single case of severe diarrhea on a floating Texas oil rig was followed two days later by what proved to be the largest outbreak of cholera in the United States in over a century. After isolation of toxigenic Vibrio cholerae El Tor Inaba of the typical United States phage type from the index patient's stool, the ensuing investigation detected 14 additional cases of cholera and one asymptomatic infection serologically. Infection was associated with eating rice on the oil rig on a particular day (P = 0.03) when an open valve permitted the rig's drinking-water system to be contaminated by canal water containing sewage (including that from the index patient) discharged from the rig. The rice had been rinsed in the contaminated water after cooking, and before being served it had been maintained at a temperature that allows V. cholerae 01 to multiply. Toxigenic V. cholerae 01 is persisting in the United States, and large common-source outbreaks of cholera can occur if proper sanitation is not maintained.

  13. The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans.

    PubMed

    Deen, Jacqueline; von Seidlein, Lorenz; Luquero, Francisco J; Troeger, Christopher; Reyburn, Rita; Lopez, Anna Lena; Debes, Amanda; Sack, David A

    2016-01-01

    Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists. The supply of licensed, WHO-prequalified cholera vaccines is not sufficient to meet endemic and epidemic needs worldwide and so prioritisation is needed. We have developed a scenario approach to systematically classify situations in which oral cholera vaccination might be useful. Our scenario approach distinguishes between five types of cholera epidemiology based on experiences from around the world and provides evidence that we hope will spur the development of detailed guidelines on how and where oral cholera vaccines could, and should, be most rationally deployed.

  14. Retroperitoneal dissection of a pancreatic pseudocyst to the left inguinal region.

    PubMed

    Lombrozo, R; Wolloch, Y; Dintsman, M

    1977-03-01

    We describe a patient in whom retroperitoneal dissection of an infected pseudocyst of the pancreas into the left inguinal region imitated an incarcerated hernia. The high level of diastase (32,000 units/ml) in the fluid from the inguinal region and the roentgenologically demonstrated communication between the pancreas and the left inguinal region proved that the source of the fluid was the pancreas. The appearance of a mass in the inguinal region in an alcoholic patient who has recently had pancreatitis should arouse suspicion of an origin in a dissecting pseudocyst of the pancreas.

  15. Cholera: ancient scourge on the rise. WHO announces global plan for cholera control. (25 April 1991).

    PubMed

    1991-04-01

    Vibrio cholerae spreads quickly via contaminated water and food, especially in areas with a poor health and sanitation infrastructure. Its enterotoxin induces vomiting and huge amounts of watery diarrhea leading to severe dehydration. 80-90% of cholera victims during an epidemic can use oral rehydration salts. A cholera epidemic is now spreading through Latin America threatening 90-120 million people (started in January 1991), particularly those in urban slums and rural/mountainous areas. As of mid April 1991, there were more than 177,000 new reported cases in 12 countries and 78% of these cases and more than 1200 deaths were limited to 5 countries: Brazil, Chile, Colombia, Ecuador, and Peru, WHO's Global Cholera Control Task Force coordinates global cholera control efforts to prevent deaths in the short term and to support infrastructure development in the long term. Its members are specialists in disease surveillance, case management, water and sanitation, food safety, emergency intervention, and information and education. WHO's Director General is asking for the support of the international community in cholera control activities. These activities' costs are considerable. For example, Peru needs about US$ 60 million in 1992 to fulfill only the most immediate demands of rehabilitation and reconstruction of the infrastructure. Costs of infrastructure capital throughout Latin America is almost US$ 5 thousand million/year over the next 10 years. It is indeed an effective infrastructure which ultimately prevents cholera. Cholera is evidence of inadequate development, so to fight it, we must also fight underdevelopment and poverty.

  16. Household Transmission of Vibrio cholerae in Bangladesh

    PubMed Central

    Sugimoto, Jonathan D.; Koepke, Amanda A.; Kenah, Eben E.; Halloran, M. Elizabeth; Chowdhury, Fahima; Khan, Ashraful I.; LaRocque, Regina C.; Yang, Yang; Ryan, Edward T.; Qadri, Firdausi; Calderwood, Stephen B.; Harris, Jason B.; Longini, Ira M.

    2014-01-01

    Background Vibrio cholerae infections cluster in households. This study's objective was to quantify the relative contribution of direct, within-household exposure (for example, via contamination of household food, water, or surfaces) to endemic cholera transmission. Quantifying the relative contribution of direct exposure is important for planning effective prevention and control measures. Methodology/Principal Findings Symptom histories and multiple blood and fecal specimens were prospectively collected from household members of hospital-ascertained cholera cases in Bangladesh from 2001–2006. We estimated the probabilities of cholera transmission through 1) direct exposure within the household and 2) contact with community-based sources of infection. The natural history of cholera infection and covariate effects on transmission were considered. Significant direct transmission (p-value<0.0001) occurred among 1414 members of 364 households. Fecal shedding of O1 El Tor Ogawa was associated with a 4.9% (95% confidence interval: 0.9%–22.8%) risk of infection among household contacts through direct exposure during an 11-day infectious period (mean length). The estimated 11-day risk of O1 El Tor Ogawa infection through exposure to community-based sources was 2.5% (0.8%–8.0%). The corresponding estimated risks for O1 El Tor Inaba and O139 infection were 3.7% (0.7%–16.6%) and 8.2% (2.1%–27.1%) through direct exposure, and 3.4% (1.7%–6.7%) and 2.0% (0.5%–7.3%) through community-based exposure. Children under 5 years-old were at elevated risk of infection. Limitations of the study may have led to an underestimation of the true risk of cholera infection. For instance, available covariate data may have incompletely characterized levels of pre-existing immunity to cholera infection. Transmission via direct exposure occurring outside of the household was not considered. Conclusions Direct exposure contributes substantially to endemic transmission of symptomatic

  17. Spatial dependency of cholera prevalence on potential cholera reservoirs in an urban area, Kumasi, Ghana

    NASA Astrophysics Data System (ADS)

    Osei, Frank B.; Duker, Alfred A.; Augustijn, Ellen-Wien; Stein, Alfred

    2010-10-01

    Cholera has been a public health burden in Ghana since the early 1970s. Between 1999 and 2005, a total of 25,636 cases and 620 deaths were officially reported to the WHO. In one of the worst affected urban cities, fecal contamination of surface water is extremely high, and the disease is reported to be prevalent among inhabitants living in close proximity to surface water bodies. Surface runoff from dump sites is a major source of fecal and bacterial contamination of rivers and streams in the study area. This study aims to determine (a) the impacts of surface water contamination on cholera infection and (b) detect and map arbitrary shaped clusters of cholera. A Geographic Information System (GIS) based spatial analysis is used to delineate potential reservoirs of the cholera vibrios; possibly contaminated by surface runoff from open space refuse dumps. Statistical modeling using OLS model reveals a significant negative association between (a) cholera prevalence and proximity to all the potential cholera reservoirs ( R2 = 0.18, p < 0.001) and (b) cholera prevalence and proximity to upstream potential cholera reservoirs ( R2 = 0.25, p < 0.001). The inclusion of spatial autoregressive coefficients in the OLS model reveals the dependency of the spatial distribution of cholera prevalence on the spatial neighbors of the communities. A flexible scan statistic identifies a most likely cluster with a higher relative risk (RR = 2.04, p < 0.01) compared with the cluster detected by circular scan statistic (RR = 1.60, p < 0.01). We conclude that surface water pollution through runoff from waste dump sites play a significant role in cholera infection.

  18. Cholera

    MedlinePlus

    ... the time you feel ill. The World Health Organization (WHO) has developed packets of salts that are ... Saunders; 2015:chap 140. United Nations World Health Organization. WHO position paper on oral rehydration salts to ...

  19. Cholera

    MedlinePlus

    ... While You Travel Dengue Fever Malaria Typhoid Fever Ebola First Aid: Diarrhea Stool Test: Bacteria Culture Do ... Food Poisoning Why Is Hand Washing So Important? Ebola Why Do I Need to Wash My Hands? ...

  20. Cholera

    MedlinePlus

    ... Health Issues Conditions Abdominal ADHD Allergies & Asthma Autism Cancer Chest & Lungs Chronic Conditions Cleft & Craniofacial Developmental Disabilities Ear Nose & Throat Emotional Problems Eyes Fever From Insects or Animals Genitals and Urinary Tract Glands & Growth ...

  1. Avian cholera in Nebraska's Rainwater Basin

    USGS Publications Warehouse

    Windingstad, R.M.; Hurt, J.J.; Trout, A.K.; Cary, J.

    1984-01-01

    The first report of avian cholera in North America occurred in northwestern Texas in winter 1944 (Quortrup et al. 1946). In 1975, mortality from avian cholera occurred for the first time in waterfowl in the Rainwater Basin of Nebraska when an estimated 25,000 birds died (Zinkl et al. 1977). Avian cholera has continued to cause mortality in wild birds in specific areas of the Basin each spring since. Losses of waterfowl from avian cholera continue to be much greater in some of the wetlands in the western part of the Basin than in the east. Several wetlands in the west have consistently higher mortality and are most often the wetlands where initial mortality is noticed each spring (Figure 1). The establishment of this disease in Nebraska is of considerable concern because of the importance of the Rainwater Basin as a spring staging area for waterfowl migrating to their breeding grounds. The wetlands in this area are on a major migration route used by an estimated 5 to 9 million ducks and several hundred thousand geese. A large portion of the western mid-continental greater white-fronted goose (Anser albifrons) population stage in the Basin each spring. Occasionally, whooping cranes (Grus americana) use these wetlands during migration, and lesser sandhill cranes (Grus canadensis) staging on the nearby Platte River sometimes use wetlands where avian cholera occurs (Anonymous 1981). Our objectives were to determine whether certain water quality variables in the Rainwater Basin differed between areas of high and low avian cholera incidence. These results would then be used for laboratory studies involving the survivability of Pasteurella multocida, the causative bacterium of avian cholera. Those studies will be reported elsewhere.

  2. Skin Dictionary

    MedlinePlus

    ... your skin, hair, and nails Skin dictionary Camp Discovery Good Skin Knowledge lesson plans and activities Video library Find a ... your skin, hair, and nails Skin dictionary Camp Discovery Good Skin Knowledge lesson plans and activities Video library Find a ...

  3. Surgical physiology of inguinal hernia repair - a study of 200 cases

    PubMed Central

    Desarda, Mohan P

    2003-01-01

    Background Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations are due to lack of consideration of physiological aspects. Many patients with inguinal hernia are cured as a result of current techniques of operation, though factors that are said to prevent hernia formation are not restored. Therefore, the surgical physiology of inguinal canal needs to be reconsidered. Methods A retrospective study is describer of 200 patients operated on for inguinal hernia under local anaesthesia by the author's technique of inguinal hernia repair. Results The posterior wall of the inguinal canal was weak and without dynamic movement in all patients. Strong aponeurotic extensions were absent in the posterior wall. The muscle arch movement was lost or diminished in all patients. The movement of the muscle arch improved after it was sutured to the upper border of a strip of the external oblique aponeurosis (EOA). The newly formed posterior wall was kept physiologically dynamic by the additional muscle strength provided by external oblique muscle to the weakened muscles of the muscle arch. Conclusions A physiologically dynamic and strong posterior inguinal wall, and the shielding and compression action of the muscles and aponeuroses around the inguinal canal are important factors that prevent hernia formation or hernia recurrence after repair. In addition, the squeezing and plugging action of the cremasteric muscle and binding effect of the strong cremasteric fascia, also play an important role in the prevention of hernia. PMID:12697071

  4. Pubic inguinal pain syndrome: the so-called sports hernia.

    PubMed

    Cavalli, Marta; Bombini, Grazia; Campanelli, Giampiero

    2014-03-01

    The "sportsman's hernia" commonly presents as a painful groin in those sports that involve kicking and twisting movements while running, particularly in rugby, football, soccer, and ice hockey players. Moreover, sportsman's hernia can be encountered even in normally physically active people. The pain experienced is recognized at the common point of origin of the rectus abdominis muscle and the adductor longus tendon on the pubic bone and the insertion of the inguinal ligament on the pubic bone. It is accepted that this chronic pain caused by abdominal wall weakness or injury occurs without a palpable hernia. We proposed the new name "pubic inguinal pain syndrome." In the period between January 2006 and November 2013 all patients afferent in our ambulatory clinic for chronic groin pain without a clinically evident hernia were assessed with medical history, physical examination, dynamic ultrasound, and pelvic and lumbar MRI. All patients were proposed for a conservative treatment and then, if it was not effective, for a surgical treatment. Our etiopathogenetic theory is based on three factors: (1) the compression of the three nerves of the inguinal region, (2) the imbalance in strength of adductor and abdominal wall muscles caused by the hypertrophy and stiffness of the insertion of rectus muscle and adductor longus muscle, and (3) the partial weakness of the posterior wall. Our surgical procedure includes the release of all three nerves of the region, the correction of the imbalance in strength with the partial tenotomy of the rectus and adductor longus muscles, and the repair of the partial weakness of the posterior wall with a lightweight mesh. This treatment reported excellent results with complete relief of symptoms after resumption of physical activity in all cases. PMID:24526429

  5. Open tension free repair of inguinal hernias; the Lichtenstein technique

    PubMed Central

    Sakorafas, George H; Halikias, Ioannis; Nissotakis, Christos; Kotsifopoulos, Nikolaos; Stavrou, Alexios; Antonopoulos, Constantinos; Kassaras, George A

    2001-01-01

    Background Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. Their use has been associated with several advantages, such as less postoperative pain, rapid recovery, low recurrence rates. Methods In this retrospective study, 540 tension-free inguinal hernia repairs were performed between August 1994 and December 1999 in 510 patients, using a polypropylene mesh (Lichtenstein technique). The main outcome measure was early and late morbidity and especially recurrence. Results Inguinal hernia was indirect in 55 % of cases (297 patients), direct in 30 % (162 patients) and of the pantaloon (mixed) type in 15 % (81 patients). Mean patient age was 53.7 years (range, 18 – 85). Follow-up was completed in 407 patients (80 %) by clinical examination or phone call. The median follow-up period was 3.8 years (range, 1 – 6 years). Seroma and hematoma formation requiring drainage was observed in 6 and 2 patients, respectively, while transient testicular swelling occurred in 5 patients. We have not observed acute infection or abscess formation related to the presence of the foreign body (mesh). In two patients, however, a delayed rejection of the mesh occurred 10 months and 4 years following surgery. There was one recurrence of the hernia (in one of these patients with late mesh rejection) (recurrence rate = 0.2 %). Postoperative neuralgia was observed in 5 patients (1 %). Conclusion Lichtenstein tension-free mesh inguinal hernia repair is a simple, safe, comfortable, effective method, with extremely low early and late morbidity and remarkably low recurrence rate and therefore it is our preferred method for hernia repair since 1994. PMID:11696246

  6. Knowledge, Attitudes, and Practices regarding Diarrhea and Cholera following an Oral Cholera Vaccination Campaign in the Solomon Islands

    PubMed Central

    Burnett, Eleanor; Dalipanda, Tenneth; Ogaoga, Divi; Gaiofa, Jenny; Jilini, Gregory; Halpin, Alison; Dietz, Vance; Date, Kashmira; Mintz, Eric; Hyde, Terri; Wannemuehler, Kathleen; Yen, Catherine

    2016-01-01

    Background In response to a 2011 cholera outbreak in Papua New Guinea, the Government of the Solomon Islands initiated a cholera prevention program which included cholera disease prevention and treatment messaging, community meetings, and a pre-emptive cholera vaccination campaign targeting 11,000 children aged 1–15 years in selected communities in Choiseul and Western Provinces. Methodology and Principal Findings We conducted a post-vaccination campaign, household-level survey about knowledge, attitudes, and practices regarding diarrhea and cholera in areas targeted and not targeted for cholera vaccination. Respondents in vaccinated areas were more likely to have received cholera education in the previous 6 months (33% v. 9%; p = 0.04), to know signs and symptoms (64% vs. 22%; p = 0.02) and treatment (96% vs. 50%; p = 0.02) of cholera, and to be aware of cholera vaccine (48% vs. 14%; p = 0.02). There were no differences in water, sanitation, and hygiene practices. Conclusions This pre-emptive OCV campaign in a cholera-naïve community provided a unique opportunity to assess household-level knowledge, attitudes, and practices regarding diarrhea, cholera, and water, sanitation, and hygiene (WASH). Our findings suggest that education provided during the vaccination campaign may have reinforced earlier mass messaging about cholera and diarrheal disease in vaccinated communities. PMID:27548678

  7. Subcostal Skin Graft Donor Site for Autologous Ear Construction.

    PubMed

    Hassanein, Aladdin H; Greene, Arin K

    2015-06-01

    Autologous ear construction for microtia creates an auricle using a costal cartilage framework. To separate the construct from the mastoid, a skin graft is required to form a retroauricular sulcus. Skin graft donor sites that have been described include the inguinal area (split or full-thickness) or scalp (split-thickness). The purpose of this study is to report a novel skin graft donor site for ear construction. We harvest a full-thickness graft from the subcostal area based on the previous scar from the cartilage harvest. Unlike the inguinal donor site, this method does not place an additional scar on the child. In contrast to the scalp donor site, the technique is simpler and a full-thickness graft minimizes contraction of the retroauricular sulcus. PMID:26080199

  8. Phylogenetic Diversity of Vibrio cholerae Associated with Endemic Cholera in Mexico from 1991 to 2008

    PubMed Central

    Choi, Seon Young; Rashed, Shah M.; Hasan, Nur A.; Alam, Munirul; Islam, Tarequl; Sadique, Abdus; Johura, Fatema-Tuz; Eppinger, Mark; Huq, Anwar; Cravioto, Alejandro

    2016-01-01

    ABSTRACT An outbreak of cholera occurred in 1991 in Mexico, where it had not been reported for more than a century and is now endemic. Vibrio cholerae O1 prototype El Tor and classical strains coexist with altered El Tor strains (1991 to 1997). Nontoxigenic (CTX−) V. cholerae El Tor dominated toxigenic (CTX+) strains (2001 to 2003), but V. cholerae CTX+ variant El Tor was isolated during 2004 to 2008, outcompeting CTX− V. cholerae. Genomes of six Mexican V. cholerae O1 strains isolated during 1991 to 2008 were sequenced and compared with both contemporary and archived strains of V. cholerae. Three were CTX+ El Tor, two were CTX− El Tor, and the remaining strain was a CTX+ classical isolate. Whole-genome sequence analysis showed the six isolates belonged to five distinct phylogenetic clades. One CTX− isolate is ancestral to the 6th and 7th pandemic CTX+ V. cholerae isolates. The other CTX− isolate joined with CTX− non-O1/O139 isolates from Haiti and seroconverted O1 isolates from Brazil and Amazonia. One CTX+ isolate was phylogenetically placed with the sixth pandemic classical clade and the V. cholerae O395 classical reference strain. Two CTX+ El Tor isolates possessing intact Vibrio seventh pandemic island II (VSP-II) are related to hybrid El Tor isolates from Mozambique and Bangladesh. The third CTX+ El Tor isolate contained West African-South American (WASA) recombination in VSP-II and showed relatedness to isolates from Peru and Brazil. Except for one isolate, all Mexican isolates lack SXT/R391 integrative conjugative elements (ICEs) and sensitivity to selected antibiotics, with one isolate resistant to streptomycin. No isolates were related to contemporary isolates from Asia, Africa, or Haiti, indicating phylogenetic diversity. PMID:26980836

  9. Single benign metastasising leiomyoma of an inguinal lymph node.

    PubMed

    Laban, Kamil G; Tobon-Morales, Roberto E; Hodge, Janice A L; Schreuder, Henk W R

    2016-01-01

    Benign metastasising leiomyoma (BML) is a rare benign disease associated with uterine leiomyoma and history of uterine surgery. It most frequently occurs in premenopausal woman, with a pulmonary localisation, and consisting of multiple nodules. We present an uncommon case of a 69-year-old woman with a single BML of an inguinal lymph node. CT scans of thorax and abdomen excluded other metastasis localisation. The patient was cured with surgical excision of the mass. Lymph node involvement has been reported incidentally in BML literature. Lymphangitic spread can be considered a possible mechanism of BML metastasis. PMID:27511755

  10. Phylogeny of Vibrio cholerae Based on recA Sequence

    PubMed Central

    Stine, O. Colin; Sozhamannan, Shanmuga; Gou, Qing; Zheng, Siqen; Morris, J. Glenn; Johnson, Judith A.

    2000-01-01

    We sequenced a 705-bp fragment of the recA gene from 113 Vibrio cholerae strains and closely related species. One hundred eighty-seven nucleotides were phylogenetically informative, 55 were phylogenetically uninformative, and 463 were invariant. Not unexpectedly, Vibrio parahaemolyticus and Vibrio vulnificus strains formed out-groups; we also identified isolates which resembled V. cholerae biochemically but which did not cluster with V. cholerae. In many instances, V. cholerae serogroup designations did not correlate with phylogeny, as reflected by recA sequence divergence. This observation is consistent with the idea that there is horizontal transfer of O-antigen biosynthesis genes among V. cholerae strains. PMID:11083852

  11. Cholera nomenclature and nosology: a historical note

    PubMed Central

    Howard-Jones, Norman

    1974-01-01

    The term “cholera” appears several times in the Hippocratic writings, and for more than 2 000 years designated ill-defined sporadic gastrointestinal derangements of diverse etiology. When the first pandemic of Asiatic cholera started in 1817, the superficial resemblance of its symptoms to those of “cholera” led to its being given the same name, although there were many objections to this nomenclature and numerous other diagnostic terms were proposed. Some thought that Asiatic cholera was an entirely new disease, while others believed that the old “cholera” had newly become “epidemic”. This terminological confusion befogged ideas on the nature and epidemiology of Asiatic cholera for many years, and especially after 1830, when the disease began to spread widely over Europe. PMID:4618514

  12. Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique – own experience

    PubMed Central

    Patkowski, Dariusz

    2014-01-01

    Introduction Percutaneous internal ring suturing (PIRS) is a method of laparoscopic herniorrhaphy, i.e. percutaneous closure of the internal inguinal ring under the control of a telescope placed in the umbilicus. Aim To evaluate the usefulness of the PIRS technique. Material and methods Fifty-five children (39 girls and 16 boys) underwent surgery using this method in our institution between 2008 and 2010. Results In 10 cases the presence of an open inguinal canal on the opposite side was also noted during surgery, and umbilical hernia was recognized in 2 patients. In 5 cases it was necessary to convert to the open surgery because of the inability to continue the laparoscopic procedure. In 1 case, male pseudohermaphroditism was diagnosed during surgery. Recurrent inguinal hernia required a conventional method of surgery in 1 child. Other children did not exhibit the characteristics of hernia recurrence. The inguinal canals were followed up with postoperative ultrasound examination in 29 children. In 23 children, the ultrasound examination showed no dilatation of the inguinal canal. In the other 6 children dilatation of the inguinal canal or the presence of fluid within the inguinal canal was observed during ultrasound. In 6 children symptoms such as swelling and soreness around the inguinal canal developed within 3 to 6 months after surgery. Conclusions Inguinal hernia surgery using the PIRS procedure is an alternative, effective, minimally invasive method of surgery. Visualization of the peritoneal cavity allows for detection of other abnormalities, as well as for performing other procedures during the same session (such as closing the contralateral inguinal canal or umbilical hernia surgery). PMID:24729810

  13. Cholera: possible infection from aircraft effluent.

    PubMed

    Rondle, C J; Ramesh, B; Krahn, J B; Sherriff, R

    1978-12-01

    This paper presents the hypothesis that some cases of cholera might be due to effluent discharge from aircraft. The theoretical case is borne out by inspection of data on the physical conditions pertaining between high altitudes and ground level. A study of the distribution of isolated outbreaks and single cases of disease and their relation to major airline routes showed a reasonable correspondence. Sporadic outbreaks of cholera in Europe between 1970 and 1975 were found to lie within the flight paths of regular airline services from Calcutta, where cholera is endemic, to the Northern Hemisphere. Laboratory studies on the stability of Vibrio cholerae to conditions likely to be encountered in droplets falling from high altitude to the ground suggested that significant numbers of organisms might survive. It should be noted that in this study no account was taken of the effect of ultra-violet light on viability and it is known that at high altitides the ultraviolet light component of solar radiation is much higher than at ground level. Results of experiments where small numbers of organisms were inoculated into relatively poor media showed that rapid growth ensued and that sufficient organisms were produced to give an infective dose of Vibrio cholerae in 1-10 ml/fluid. It could be concluded that human infection could easily occur by ingestion of fluids such as milk or soup which had some time earlier received a fortuitous but slight contamination from the air. Investigation of one disinfectant (chloramine T) showed that it reacted rapidly and in a complex manner with peptone. One effect of this reaction was the elimination of bactericidal activity and it seems likely that, as at present employed, chloramine T is of doubtful value in aeroplane hygiene. One important conclusion that arises from this work is that if cholera can be spread, even only occasionally, by effluent from aircraft then close investigation should be made of the possibility of other bacteria and

  14. Epidemiology, Genetics, and Ecology of Toxigenic Vibrio cholerae

    PubMed Central

    Faruque, Shah M.; Albert, M. John; Mekalanos, John J.

    1998-01-01

    Cholera caused by toxigenic Vibrio cholerae is a major public health problem confronting developing countries, where outbreaks occur in a regular seasonal pattern and are particularly associated with poverty and poor sanitation. The disease is characterized by a devastating watery diarrhea which leads to rapid dehydration, and death occurs in 50 to 70% of untreated patients. Cholera is a waterborne disease, and the importance of water ecology is suggested by the close association of V. cholerae with surface water and the population interacting with the water. Cholera toxin (CT), which is responsible for the profuse diarrhea, is encoded by a lysogenic bacteriophage designated CTXΦ. Although the mechanism by which CT causes diarrhea is known, it is not clear why V. cholerae should infect and elaborate the lethal toxin in the host. Molecular epidemiological surveillance has revealed clonal diversity among toxigenic V. cholerae strains and a continual emergence of new epidemic clones. In view of lysogenic conversion by CTXΦ as a possible mechanism of origination of new toxigenic clones of V. cholerae, it appears that the continual emergence of new toxigenic strains and their selective enrichment during cholera outbreaks constitute an essential component of the natural ecosystem for the evolution of epidemic V. cholerae strains and genetic elements that mediate the transfer of virulence genes. The ecosystem comprising V. cholerae, CTXΦ, the aquatic environment, and the mammalian host offers an understanding of the complex relationship between pathogenesis and the natural selection of a pathogen. PMID:9841673

  15. Impact of Drainage Networks on Cholera Outbreaks in Lusaka, Zambia

    PubMed Central

    Suzuki, Hiroshi; Fujino, Yasuyuki; Kimura, Yoshinari; Cheelo, Meetwell

    2009-01-01

    Objectives. We investigated the association between precipitation patterns and cholera outbreaks and the preventative roles of drainage networks against outbreaks in Lusaka, Zambia. Methods. We collected data on 6542 registered cholera patients in the 2003–2004 outbreak season and on 6045 cholera patients in the 2005–2006 season. Correlations between monthly cholera incidences and amount of precipitation were examined. The distribution pattern of the disease was analyzed by a kriging spatial analysis method. We analyzed cholera case distribution and spatiotemporal cluster by using 2590 cholera cases traced with a global positioning system in the 2005–2006 season. The association between drainage networks and cholera cases was analyzed with regression analysis. Results. Increased precipitation was associated with the occurrence of cholera outbreaks, and insufficient drainage networks were statistically associated with cholera incidences. Conclusions. Insufficient coverage of drainage networks elevated the risk of cholera outbreaks. Integrated development is required to upgrade high-risk areas with sufficient infrastructure for a long-term cholera prevention strategy. PMID:19762668

  16. The value of and challenges for cholera vaccines in Africa.

    PubMed

    von Seidlein, Lorenz; Jiddawi, Mohammad; Grais, Rebecca F; Luquero, Francisco; Lucas, Marcelino; Deen, Jacqueline

    2013-11-01

    The 21st century saw a shift in the cholera burden from Asia to Africa. The risk factors for cholera outbreaks in Africa are incompletely understood, and the traditional emphasis on providing safe drinking water and improving sanitation and hygiene has proven remarkably insufficient to contain outbreaks. Current killed whole-cell oral cholera vaccines (OCVs) are safe and guarantee a high level of protection for several years. OCVs have been licensed for >20 years, but their potential for preventing and control cholera outbreaks in Africa has not been realized. Although each item in the long list of technical reasons why cholera vaccination campaigns have been deferred is plausible, we believe that the biggest barrier is that populations affected by cholera outbreaks are underprivileged and lack a strong political voice. The evaluation and use of OCVs as a tool for cholera control will require a new, more compassionate, less risk-averse generation of decision makers.

  17. Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014

    PubMed Central

    Rumunu, John; Abubakar, Abdinasir; West, Haley; Ciglenecki, Iza; Helderman, Trina; Wamala, Joseph Francis; Vázquez, Olimpia de la Rosa; Perea, William; Sack, David A.; Legros, Dominique; Martin, Stephen; Lessler, Justin; Luquero, Francisco J.

    2016-01-01

    Following mass population displacements in South Sudan, preventive cholera vaccination campaigns were conducted in displaced persons camps before a 2014 cholera outbreak. We compare cholera transmission in vaccinated and unvaccinated areas and show vaccination likely halted transmission within vaccinated areas, illustrating the potential for oral cholera vaccine to stop cholera transmission in vulnerable populations. PMID:27192187

  18. Sagging Skin

    MedlinePlus

    ... Non-ablative Laser Rejuvenation Non-invasive Body Contouring Treatments Skin Cancer Skin Cancer Information Free Skin Cancer Screenings Skin ... Non-ablative Laser Rejuvenation Non-invasive Body Contouring Treatments Skin Cancer Skin Cancer Information Free Skin Cancer Screenings Skin ...

  19. Influence of preoperative showers on staphylococcal skin colonization: a comparative trial of antiseptic skin cleansers.

    PubMed

    Kaiser, A B; Kernodle, D S; Barg, N L; Petracek, M R

    1988-01-01

    We undertook a prospective randomized observer-blinded study comparing the ability of preoperative showers with chlorhexidine gluconate (Hibiclens), povidone-iodine (Betadine), and a lotion soap (Safe 'N Sure) to diminish the staphylococcal skin flora of patients. By block randomization, patients scheduled for an elective cardiac operation or coronary artery angioplasty were assigned to shower with one of the study skin cleansers either once (evening only) or twice (both evening and morning) before the procedure. Semiquantitative samples for culture were obtained from the subclavian and inguinal sites on the evening before the procedure (baseline culture) and again the next morning before the operation. The chlorhexidine skin cleanser consistently reduced staphylococcal colony counts at both the subclavian and inguinal sites before the procedure. This reduction was significant for patients showering both evening and morning (p less than 0.05). The use of the povidone-iodine skin cleanser inconsistently affected skin flora. Patients using lotion soap either experienced no change or had an increase in colony counts. Chlorhexidine is more effective than povidone-iodine in diminishing skin colonization with staphylococci in patients before operation. Repeated applications of chlorhexidine are superior to a single shower with this agent.

  20. Skin Diseases: Skin Health and Skin Diseases

    MedlinePlus

    Skip Navigation Bar Home Current Issue Past Issues Skin Diseases Skin Health and Skin Diseases Past Issues / Fall 2008 Table of Contents ... acne to wrinkles Did you know that your skin is the largest organ of your body? It ...

  1. Non-toxigenic environmental Vibrio cholerae O1 strain from Haiti provides evidence of pre-pandemic cholera in Hispaniola

    PubMed Central

    Azarian, Taj; Ali, Afsar; Johnson, Judith A.; Jubair, Mohammad; Cella, Eleonora; Ciccozzi, Massimo; Nolan, David J.; Farmerie, William; Rashid, Mohammad H.; Sinha-Ray, Shrestha; Alam, Meer T.; Morris, J. Glenn; Salemi, Marco

    2016-01-01

    Vibrio cholerae is ubiquitous in aquatic environments, with environmental toxigenic V. cholerae O1 strains serving as a source for recurrent cholera epidemics and pandemic disease. However, a number of questions remain about long-term survival and evolution of V. cholerae strains within these aquatic environmental reservoirs. Through monitoring of the Haitian aquatic environment following the 2010 cholera epidemic, we isolated two novel non-toxigenic (ctxA/B-negative) Vibrio cholerae O1. These two isolates underwent whole-genome sequencing and were investigated through comparative genomics and Bayesian coalescent analysis. These isolates cluster in the evolutionary tree with strains responsible for clinical cholera, possessing genomic components of 6th and 7th pandemic lineages, and diverge from “modern” cholera strains around 1548 C.E. [95% HPD: 1532–1555]. Vibrio Pathogenicity Island (VPI)-1 was present; however, SXT/R391-family ICE and VPI-2 were absent. Rugose phenotype conversion and vibriophage resistance evidenced adaption for persistence in aquatic environments. The identification of V. cholerae O1 strains in the Haitian environment, which predate the first reported cholera pandemic in 1817, broadens our understanding of the history of pandemics. It also raises the possibility that these and similar environmental strains could acquire virulence genes from the 2010 Haitian epidemic clone, including the cholera toxin producing CTXϕ. PMID:27786291

  2. Role of Zooplankton Diversity in Vibrio cholerae Population Dynamics and in the Incidence of Cholera in the Bangladesh Sundarbans ▿

    PubMed Central

    de Magny, Guillaume Constantin; Mozumder, Pronob K.; Grim, Christopher J.; Hasan, Nur A.; Naser, M. Niamul; Alam, Munirul; Sack, R. Bradley; Huq, Anwar; Colwell, Rita R.

    2011-01-01

    Vibrio cholerae, a bacterium autochthonous to the aquatic environment, is the causative agent of cholera, a severe watery, life-threatening diarrheal disease occurring predominantly in developing countries. V. cholerae, including both serogroups O1 and O139, is found in association with crustacean zooplankton, mainly copepods, and notably in ponds, rivers, and estuarine systems globally. The incidence of cholera and occurrence of pathogenic V. cholerae strains with zooplankton were studied in two areas of Bangladesh: Bakerganj and Mathbaria. Chitinous zooplankton communities of several bodies of water were analyzed in order to understand the interaction of the zooplankton population composition with the population dynamics of pathogenic V. cholerae and incidence of cholera. Two dominant zooplankton groups were found to be consistently associated with detection of V. cholerae and/or occurrence of cholera cases, namely, rotifers and cladocerans, in addition to copepods. Local differences indicate there are subtle ecological factors that can influence interactions between V. cholerae, its plankton hosts, and the incidence of cholera. PMID:21764957

  3. Vibrio cholerae Serogroup O139: Isolation from Cholera Patients and Asymptomatic Household Family Members in Bangladesh between 2013 and 2014

    PubMed Central

    Chowdhury, Fahima; Mather, Alison E.; Begum, Yasmin Ara; Asaduzzaman, Muhammad; Baby, Nabilah; Sharmin, Salma; Biswas, Rajib; Ikhtear Uddin, Muhammad; LaRocque, Regina C.; Harris, Jason B.; Calderwood, Stephen B.; Ryan, Edward T.; Clemens, John D.; Thomson, Nicholas R.; Qadri, Firdausi

    2015-01-01

    Background Cholera is endemic in Bangladesh, with outbreaks reported annually. Currently, the majority of epidemic cholera reported globally is El Tor biotype Vibrio cholerae isolates of the serogroup O1. However, in Bangladesh, outbreaks attributed to V. cholerae serogroup O139 isolates, which fall within the same phylogenetic lineage as the O1 serogroup isolates, were seen between 1992 and 1993 and in 2002 to 2005. Since then, V. cholerae serogroup O139 has only been sporadically isolated in Bangladesh and is now rarely isolated elsewhere. Methods Here, we present case histories of four cholera patients infected with V. cholerae serogroup O139 in 2013 and 2014 in Bangladesh. We comprehensively typed these isolates using conventional approaches, as well as by whole genome sequencing. Phenotypic typing and PCR confirmed all four isolates belonging to the O139 serogroup. Findings Whole genome sequencing revealed that three of the isolates were phylogenetically closely related to previously sequenced El Tor biotype, pandemic 7, toxigenic V. cholerae O139 isolates originating from Bangladesh and elsewhere. The fourth isolate was a non-toxigenic V. cholerae that, by conventional approaches, typed as O139 serogroup but was genetically divergent from previously sequenced pandemic 7 V. cholerae lineages belonging to the O139 or O1 serogroups. Conclusion These results suggest that previously observed lineages of V. cholerae O139 persist in Bangladesh and can cause clinical disease and that a novel disease-causing non-toxigenic O139 isolate also occurs. PMID:26562418

  4. Alternative mechanism of cholera toxin acquisition by Vibrio cholerae: generalized transduction of CTXPhi by bacteriophage CP-T1.

    PubMed

    Boyd, E F; Waldor, M K

    1999-11-01

    Horizontal transfer of genes encoding virulence factors has played a central role in the evolution of many pathogenic bacteria. The unexpected discovery that the genes encoding cholera toxin (ctxAB), the main cause of the profuse secretory diarrhea characteristic of cholera, are encoded on a novel filamentous phage named CTXPhi, has resulted in a renewed interest in the potential mechanisms of transfer of virulence genes among Vibrio cholerae. We describe here an alternative mechanism of cholera toxin gene transfer into nontoxigenic V. cholerae isolates, including strains that lack both the CTXPhi receptor, the toxin coregulated pilus (TCP), and attRS, the chromosomal attachment site for CTXPhi integration. A temperature-sensitive mutant of the V. cholerae generalized transducing bacteriophage CP-T1 (CP-T1ts) was used to transfer a genetically marked derivative of the CTX prophage into four nontoxigenic V. cholerae strains, including two V. cholerae vaccine strains. We demonstrate that CTXPhi transduced by CP-T1ts can replicate and integrate into these nontoxigenic V. cholerae strains with high efficiency. In fact, CP-T1ts transduces the CTX prophage preferentially when compared with other chromosomal markers. These results reveal a potential mechanism by which CTXPhi(+) V. cholerae strains that lack the TCP receptor may have arisen. Finally, these findings indicate an additional pathway for reversion of live-attenuated V. cholerae vaccine strains.

  5. Relationship between Distinct African Cholera Epidemics Revealed via MLVA Haplotyping of 337 Vibrio cholerae Isolates

    PubMed Central

    Moore, Sandra; Miwanda, Berthe; Sadji, Adodo Yao; Thefenne, Hélène; Jeddi, Fakhri; Rebaudet, Stanislas; de Boeck, Hilde; Bidjada, Bawimodom; Depina, Jean-Jacques; Bompangue, Didier; Abedi, Aaron Aruna; Koivogui, Lamine; Keita, Sakoba; Garnotel, Eric; Plisnier, Pierre-Denis; Ruimy, Raymond; Thomson, Nicholas; Muyembe, Jean-Jacques; Piarroux, Renaud

    2015-01-01

    Background Since cholera appeared in Africa during the 1970s, cases have been reported on the continent every year. In Sub-Saharan Africa, cholera outbreaks primarily cluster at certain hotspots including the African Great Lakes Region and West Africa. Methodology/Principal Findings In this study, we applied MLVA (Multi-Locus Variable Number Tandem Repeat Analysis) typing of 337 Vibrio cholerae isolates from recent cholera epidemics in the Democratic Republic of the Congo (DRC), Zambia, Guinea and Togo. We aimed to assess the relationship between outbreaks. Applying this method, we identified 89 unique MLVA haplotypes across our isolate collection. MLVA typing revealed the short-term divergence and microevolution of these Vibrio cholerae populations to provide insight into the dynamics of cholera outbreaks in each country. Our analyses also revealed strong geographical clustering. Isolates from the African Great Lakes Region (DRC and Zambia) formed a closely related group, while West African isolates (Togo and Guinea) constituted a separate cluster. At a country-level scale our analyses revealed several distinct MLVA groups, most notably DRC 2011/2012, DRC 2009, Zambia 2012 and Guinea 2012. We also found that certain MLVA types collected in the DRC persisted in the country for several years, occasionally giving rise to expansive epidemics. Finally, we found that the six environmental isolates in our panel were unrelated to the epidemic isolates. Conclusions/Significance To effectively combat the disease, it is critical to understand the mechanisms of cholera emergence and diffusion in a region-specific manner. Overall, these findings demonstrate the relationship between distinct epidemics in West Africa and the African Great Lakes Region. This study also highlights the importance of monitoring and analyzing Vibrio cholerae isolates. PMID:26110870

  6. Cost-effectiveness of oral cholera vaccine in a stable refugee population at risk for epidemic cholera and in a population with endemic cholera.

    PubMed

    Murray, J; McFarland, D A; Waldman, R J

    1998-01-01

    Recent large epidemics of cholera with high incidence and associated mortality among refugees have raised the question of whether oral cholera vaccines should be considered as an additional preventive measure in high-risk populations. The potential impact of oral cholera vaccines on populations prone to seasonal endemic cholera has also been questioned. This article reviews the potential cost-effectiveness of B-subunit, killed whole-cell (BS-WC) oral cholera vaccine in a stable refugee population and in a population with endemic cholera. In the population at risk for endemic cholera, mass vaccination with BS-WC vaccine is the least cost-effective intervention compared with the provision of safe drinking-water and sanitation or with treatment of the disease. In a refugee population at risk for epidemic disease, the cost-effectiveness of vaccination is similar to that of providing safe drinking-water and sanitation alone, though less cost-effective than treatment alone or treatment combined with the provision of water and sanitation. The implications of these data for public health decision-makers and programme managers are discussed. There is a need for better information on the feasibility and costs of administering oral cholera vaccine in refugee populations and populations with endemic cholera.

  7. Cholera Toxin Production Induced upon Anaerobic Respiration is Suppressed by Glucose Fermentation in Vibrio cholerae.

    PubMed

    Oh, Young Taek; Lee, Kang-Mu; Bari, Wasimul; Kim, Hwa Young; Kim, Hye Jin; Yoon, Sang Sun

    2016-03-01

    The causative agent of pandemic cholera, Vibrio cholerae, infects the anaerobic environment of the human intestine. Production of cholera toxin (CT), a major virulence factor of V. cholerae, is highly induced during anaerobic respiration with trimethylamine N-oxide (TMAO) as an alternative electron acceptor. However, the molecular mechanism of TMAO-stimulated CT production is not fully understood. Herein, we reveal that CT production during anaerobic TMAO respiration is affected by glucose fermentation. When the seventh pandemic V. cholerae O1 strain N16961 was grown with TMAO and additional glucose, CT production was markedly reduced. Furthermore, an N16961 Δcrp mutant, devoid of cyclic AMP receptor protein (CRP), was defective in CT production during growth by anaerobic TMAO respiration, further suggesting a role of glucose metabolism in regulating TMAO-mediated CT production. TMAO reductase activity was noticeably decreased when grown together with glucose or by mutation of the crp gene. A CRP binding region was identified in the promoter region of the torD gene, which encodes a structural subunit of the TMAO reductase. Gel shift assays further confirmed the binding of purified CRP to the torD promoter sequence. Together, our results suggest that the bacterial ability to respire using TMAO is controlled by CRP, whose activity is dependent on glucose availability. Our results reveal a novel mechanism for the regulation of major virulence factor production by V. cholerae under anaerobic growth conditions.

  8. Cholera Toxin Production Induced upon Anaerobic Respiration is Suppressed by Glucose Fermentation in Vibrio cholerae.

    PubMed

    Oh, Young Taek; Lee, Kang-Mu; Bari, Wasimul; Kim, Hwa Young; Kim, Hye Jin; Yoon, Sang Sun

    2016-03-01

    The causative agent of pandemic cholera, Vibrio cholerae, infects the anaerobic environment of the human intestine. Production of cholera toxin (CT), a major virulence factor of V. cholerae, is highly induced during anaerobic respiration with trimethylamine N-oxide (TMAO) as an alternative electron acceptor. However, the molecular mechanism of TMAO-stimulated CT production is not fully understood. Herein, we reveal that CT production during anaerobic TMAO respiration is affected by glucose fermentation. When the seventh pandemic V. cholerae O1 strain N16961 was grown with TMAO and additional glucose, CT production was markedly reduced. Furthermore, an N16961 Δcrp mutant, devoid of cyclic AMP receptor protein (CRP), was defective in CT production during growth by anaerobic TMAO respiration, further suggesting a role of glucose metabolism in regulating TMAO-mediated CT production. TMAO reductase activity was noticeably decreased when grown together with glucose or by mutation of the crp gene. A CRP binding region was identified in the promoter region of the torD gene, which encodes a structural subunit of the TMAO reductase. Gel shift assays further confirmed the binding of purified CRP to the torD promoter sequence. Together, our results suggest that the bacterial ability to respire using TMAO is controlled by CRP, whose activity is dependent on glucose availability. Our results reveal a novel mechanism for the regulation of major virulence factor production by V. cholerae under anaerobic growth conditions. PMID:26718467

  9. Swedish isolates of Vibrio cholerae enhance their survival when interacted intracellularly with Acanthamoeba castellanii.

    PubMed

    Shanan, Salah; Bayoumi, Magdi; Saeed, Amir; Sandström, Gunnar; Abd, Hadi

    2016-01-01

    Vibrio cholerae is a Gram-negative bacterium that occurs naturally in aquatic environment. Only V. cholerae O1 and V. cholerae O139 produce cholera toxin and cause cholera, other serogroups can cause gastroenteritis, open wounds infection, and septicaemia. V. cholerae O1 and V. cholerae O139 grow and survive inside Acanthamoeba castellanii. The aim of this study is to investigate the interactions of the Swedish clinical isolates V. cholerae O3, V. cholerae O4, V. cholerae O5, V. cholerae O11, and V. cholerae O160 with A. castellanii. The interaction between A. castellanii and V. cholerae strains was studied by means of amoeba cell counts, viable counts of the bacteria in the absence or presence of amoebae, and of the intracellularly growing bacteria, visualised by electron microscopy. These results show that all V. cholerae can grow and survive outside and inside the amoebae, disclosing that V. cholerae O3, V. cholerae O4, V. cholerae O5, V. cholerae O11, and V. cholerae O160 all can be considered as facultative intracellular bacteria. PMID:27118300

  10. Swedish isolates of Vibrio cholerae enhance their survival when interacted intracellularly with Acanthamoeba castellanii

    PubMed Central

    Shanan, Salah; Bayoumi, Magdi; Saeed, Amir; Sandström, Gunnar; Abd, Hadi

    2016-01-01

    Vibrio cholerae is a Gram-negative bacterium that occurs naturally in aquatic environment. Only V. cholerae O1 and V. cholerae O139 produce cholera toxin and cause cholera, other serogroups can cause gastroenteritis, open wounds infection, and septicaemia. V. cholerae O1 and V. cholerae O139 grow and survive inside Acanthamoeba castellanii. The aim of this study is to investigate the interactions of the Swedish clinical isolates V. cholerae O3, V. cholerae O4, V. cholerae O5, V. cholerae O11, and V. cholerae O160 with A. castellanii. The interaction between A. castellanii and V. cholerae strains was studied by means of amoeba cell counts, viable counts of the bacteria in the absence or presence of amoebae, and of the intracellularly growing bacteria, visualised by electron microscopy. These results show that all V. cholerae can grow and survive outside and inside the amoebae, disclosing that V. cholerae O3, V. cholerae O4, V. cholerae O5, V. cholerae O11, and V. cholerae O160 all can be considered as facultative intracellular bacteria. PMID:27118300

  11. EFFECT OF AGGREGATION ON VIBRIO CHOLERAE INACTIVATION

    EPA Science Inventory

    Extensive research has shown that microorganisms exhibit increased resistance due to clumping, aggregation, particle association, or modification of antecedent growth conditions. During the course of investigating a major water-borne Vibrio cholerae outbreak in Peru, U.S. EPA inv...

  12. Surface-attachment sequence in Vibrio Cholerae

    NASA Astrophysics Data System (ADS)

    Utada, Andrew; Gibiansky, Maxsim; Wong, Gerard

    2013-03-01

    Vibrio cholerae is a gram-negative bacterium that causes the human disease cholera. It is found natively in brackish costal waters in temperate climates, where it attaches to the surfaces of a variety of different aquatic life. V. cholerae has a single polar flagellum making it highly motile, as well as a number of different pili types, enabling it to attach to both biotic and abiotic surfaces. Using in-house built tracking software we track all surface-attaching bacteria from high-speed movies to examine the early-time attachment profile of v. cholerae onto a smooth glass surface. Similar to previous work, we observe right-handed circular swimming trajectories near surfaces; however, in addition we see a host of distinct motility mechanisms that enable rapid exploration of the surface before forming a more permanent attachment. Using isogenic mutants we show that the motility mechanisms observed are due to a complex combination of hydrodynamics and pili-surface interactions. Lauga, E., DiLuzio, W. R., Whitesides, G. M., Stone, H. A. Biophys. J. 90, 400 (2006).

  13. Preventing Maritime Transfer of Toxigenic Vibrio cholerae

    PubMed Central

    Slaten, Douglas D.; Marano, Nina; Tappero, Jordan W.; Wellman, Michael; Albert, Ryan J.; Hill, Vincent R.; Espey, David; Handzel, Thomas; Henry, Ariel; Tauxe, Robert V.

    2012-01-01

    Organisms, including Vibrio cholerae, can be transferred between harbors in the ballast water of ships. Zones in the Caribbean region where distance from shore and water depth meet International Maritime Organization guidelines for ballast water exchange are extremely limited. Use of ballast water treatment systems could mitigate the risk for organism transfer. PMID:23017338

  14. Plasma Leptin Levels in Children Hospitalized with Cholera in Bangladesh.

    PubMed

    Falkard, Brie; Uddin, Taher; Rahman, M Arifur; Franke, Molly F; Aktar, Amena; Uddin, Muhammad Ikhtear; Bhuiyan, Taufiqur Rahman; Leung, Daniel T; Charles, Richelle C; Larocque, Regina C; Harris, Jason B; Calderwood, Stephen B; Qadri, Firdausi; Ryan, Edward T

    2015-08-01

    Vibrio cholerae, the cause of cholera, induces both innate and adaptive immune responses in infected humans. Leptin is a hormone that plays a role in both metabolism and mediating immune responses. We characterized leptin levels in 11 children with cholera in Bangladesh, assessing leptin levels on days 2, 7, 30, and 180 following cholera. We found that patients at the acute stage of cholera had significantly lower plasma leptin levels than matched controls, and compared with levels in late convalescence. We then assessed immune responses to V. cholerae antigens in 74 children with cholera, correlating these responses to plasma leptin levels on day 2 of illness. In multivariate analysis, we found an association between day 2 leptin levels and development of later anti-cholera toxin B subunit (CtxB) responses. This finding appeared to be limited to children with better nutritional status. Interestingly, we found no association between leptin levels and antibody responses to V. cholerae lipopolysaccharide, a T cell-independent antigen. Our results suggest that leptin levels may be associated with cholera, including the development of immune responses to T cell-dependent antigens.

  15. Cholera: Environmental Reservoirs and Impact on Disease Transmission

    PubMed Central

    ALMAGRO-MORENO, SALVADOR; TAYLOR, RONALD K.

    2015-01-01

    Vibrio cholerae is widely known to be the etiological agent of the life-threatening diarrheal disease cholera. Cholera remains a major scourge in many developing countries, infecting hundreds of thousands every year. Remarkably, V. cholerae is a natural inhabitant of brackish riverine, estuarine, and coastal waters, and only a subset of strains are known to be pathogenic to humans. Recent studies have begun to uncover a very complex network of relationships between V. cholerae and other sea dwellers, and the mechanisms associated with the occurrence of seasonal epidemics in regions where cholera is endemic are beginning to be elucidated. Many of the factors required for the organism’s survival and persistence in its natural environment have been revealed, as well as the ubiquitous presence of horizontal gene transfer in the emergence of pathogenic strains of V. cholerae. In this article, we will focus on the environmental stage of pathogenic V. cholerae and the interactions of the microorganism with other inhabitants of aquatic environments. We will discuss the impact that its environmental reservoirs have on disease transmission and the distinction between reservoirs of V. cholerae and the vectors that establish cholera as a zoonosis. PMID:25674360

  16. Genome assortment, not serogroup, defines Vibrio cholerae pandemic strains

    SciTech Connect

    Brettin, Thomas S; Bruce, David C; Challacombe, Jean F; Detter, John C; Han, Cliff S; Munik, A C; Chertkov, Olga; Meincke, Linda; Saunders, Elizabeth; Choi, Seon Y; Haley, Bradd J; Taviani, Elisa; Jeon, Yoon - Seong; Kim, Dong Wook; Lee, Jae - Hak; Walters, Ronald A; Hug, Anwar; Colwell, Rita R

    2009-01-01

    Vibrio cholerae, the causative agent of cholera, is a bacterium autochthonous to the aquatic environment, and a serious public health threat. V. cholerae serogroup O1 is responsible for the previous two cholera pandemics, in which classical and El Tor biotypes were dominant in the 6th and the current 7th pandemics, respectively. Cholera researchers continually face newly emerging and re-emerging pathogenic clones carrying combinations of new serogroups as well as of phenotypic and genotypic properties. These genotype and phenotype changes have hampered control of the disease. Here we compare the complete genome sequences of 23 strains of V. cholerae isolated from a variety of sources and geographical locations over the past 98 years in an effort to elucidate the evolutionary mechanisms governing genetic diversity and genesis of new pathogenic clones. The genome-based phylogeny revealed 12 distinct V. cholerae phyletic lineages, of which one, designated the V. cholerae core genome (CG), comprises both O1 classical and EI Tor biotypes. All 7th pandemic clones share nearly identical gene content, i.e., the same genome backbone. The transition from 6th to 7th pandemic strains is defined here as a 'shift' between pathogenic clones belonging to the same O1 serogroup, but from significantly different phyletic lineages within the CG clade. In contrast, transition among clones during the present 7th pandemic period can be characterized as a 'drift' between clones, differentiated mainly by varying composition of laterally transferred genomic islands, resulting in emergence of variants, exemplified by V.cholerae serogroup O139 and V.cholerae O1 El Tor hybrid clones that produce cholera toxin of classical biotype. Based on the comprehensive comparative genomics presented in this study it is concluded that V. cholerae undergoes extensive genetic recombination via lateral gene transfer, and, therefore, genome assortment, not serogroup, should be used to define pathogenic V

  17. Round Ligament Leiomyoma Presenting as an Incarcerated Inguinal Hernia: Case Report and Review of the Literature

    PubMed Central

    Mandel, Marc

    2016-01-01

    Leiomyomas are common benign gynecologic tumors occurring in up to 30% of women. Round ligament leiomyomas however are very rare and, if symptomatic, can present as an inguinal hernia. We report the case of a 47-year-old woman who presented with an irreducible inguinal mass consistent with an incarcerated hernia. Intraoperatively, the mass was found to be a round ligament leiomyoma, a diagnosis that was confirmed by histopathology following excision of the mass. Although rare, round ligament leiomyomas should be part of the differential diagnosis of an inguinal hernia in females. PMID:27144048

  18. The Inguinal Herniation of the Ovary in the Newborn: Ultrasound and Color Doppler Ultrasound Findings

    PubMed Central

    Kaya, Omer; Esen, Kaan; Gulek, Bozkurt; Yilmaz, Cengiz; Soker, Gokhan; Onem, Onder

    2014-01-01

    Inguinal hernias in the newborn age group are seldom encountered. In the affected female patient, the ovaries, fallopian tubes, and the intestines may settle in the hernia sac. The early diagnosis of torsion in cases in which the ovary is herniated into the inguinal canal is of utmost importance in order to give surgery the chance of reduction and correction. In this paper, a case of an ovarian herniation into the inguinal canal without the presence of torsion is being presented, and the place of US and CDUS in the differential diagnosis of the situation is being discussed. PMID:24795829

  19. Sanitation in the time of cholera.

    PubMed

    Misch, A

    1991-01-01

    Cholera, identified by violent diarrhea, cramps, vomiting, and dehydration, is spreading through Peru into Colombia, Ecuador, Child, and Brazil. Water contaminated with Vibrio cholerae is used for washing food and/or drinking thereby transmitting the disease. PAHO estimates 6 million people in South America may get cholera within the next 3 years. This cholera epidemic is the result of unsanitary conditions in which the urban poor in South America live. In fact, in Lima, Peru, 40% of the people do not have potable, piped water available. These individuals fetch their water from far away taps and private vendors both of which are not necessarily safe. In addition, 40% do not have access to a sewage system. Further, 80% of sick people in developing countries have a water related illness, be it transmitted by contaminated water or by insects and snails that reproduce in the water. Diarrhea is the most deadly of these conditions. Indeed every year 10-20 million children die from the effects of diarrhea which include malnutrition, dehydration, and shock. Yet 940 million people in developing countries have no access to safe water and 1.7 billion do not have a sanitary means of disposing of human wastes, despite the fact that the UN decreed the 1980s the International Drinking Water Supply and Sanitation Decade. Nevertheless UNICEF efforts did bring communal taps, odorless latrines, and/or pour flush toilets to 1.2 billion people. These types of sanitation costs $20-25/person whereas conventional sewers cost $350/person. Low technology supplied water averages $30/person compared to $200/person for piped water. Peru has spent $43 million on emergency medical care for cholera victims which could have provided low cost clean water and sanitation for almost 800,000 poor.

  20. [The role of food in cholera transmission].

    PubMed

    Dobosch, D; Gomez Zavaglia, A; Kuljich, A

    1995-01-01

    The spreading of cholera, from Peru to other Latinoamerican countries in 1991, raised questions regarding food safety, food transportation and handling. Control, prevention and risks implied in food import-export were also matters of concern. We deemed it interesting to determine the viability of Vibrio cholerae in wide consumption food locally. Selected food had different intrinsic characteristics such as: acidity (pH), water activity (aw), chemical composition, indigenous flora and other biologic and physic parameters. Twenty food products were contaminated with V. cholerae O1, Ogawa, toxigenic and not toxigenic strains: yoghurt, cream cheese, apricot marmelade, hip rose marmelade, mayonnaise, italian pasta for "empanadas", "dulce de leche", meat sausage, meat and spinach ravioli, margarine, milk dessert (made with cocoa, milk confiture, starch and additives), lettuce, tuna fish, ricotta and sterilized milk. Table I shows the viability of V. cholerae in tested foods, its pH and the reasons why the experiments were ended: 75% of the products studied could tolerate the development of the microorganism for a period ranging from one day (pasta for "empanadas") to ninety days (sterilized milk). Foods with acredity higher than pH 5.5 did not favor the growth of Vibrio. When pH was neutral or slightly acid, viability persisted independently from aw, microbial antagonisms and other physic, chemical or biologic parameters. Nevertheless, other factors such as: surface adherence, amino acids, magnesium and environmental influences not yet well determined, could eventually modify the persistence of V. cholerae in food. According to this study, most food products could tolerate growth and persistence of the infectant agent, up for three months in some cases.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7565031

  1. Sudden unexpected death due to strangulated inguinal hernia.

    PubMed

    Menezes, Ritesh G; Padubidri, Jagadish Rao; Raghavendra Babu, Y P; Naik, Ramadas; Kanchan, Tanuj; Senthilkumaran, Subramanian; Chawla, Khushboo

    2016-06-01

    Sudden unwitnessed, unexpected deaths when the bodies are found in public places require a complete and meticulous medicolegal autopsy to ascertain the cause and manner of death to avoid further unnecessary investigations by the legal authorities. Such deaths attributed to gastrointestinal causes at autopsy are relatively uncommon. We report a case of sudden unexpected death due to strangulated inguinal hernia in a 60-year-old man. The body was discovered in a public area near a place of worship. The present case illustrates a potentially preventable sudden unexpected death due to a surgically correctable gastrointestinal condition. In the present case, the individual feared being hospitalised for treatment of his scrotal swelling with potential surgery and the eventual loss of daily income. In our opinion, such apprehensions may have delayed the potentially life-saving hospital surgical intervention in the individual. PMID:26837567

  2. Tourniquet Master Training for Junctional and Inguinal Hemorrhage Control (TMT).

    PubMed

    Weyhrauch, Peter W; Niehaus, James; Metzger, Max; Laufer, Shlomi; Kwan, Calvin; Pugh, Carla

    2014-01-01

    Junctional and inguinal bleeding is a significant and challenging problem on the battlefield. Inventors have developed new types of tourniquets, including the Abdominal Aortic Tourniquet™ (AAT) and the Combat Ready Clamp™ (CRoC) to address these abdominal and pelvic injuries. While these hemorrhage control technologies have been developed, validated, and approved for use, training systems that teach and refresh skills related to these technologies have not been developed. These training systems are vital because these skills can be difficult to train and are infrequently used. To address these needs, a sensor-enabled manikin was designed. Using the sensor data, the different phases of applying the tourniquet were captured and key performance was measured.

  3. [A giant myxoid leiomyoma mimicking an inguinal hernia].

    PubMed

    Huszár, Orsolya; Zaránd, Attila; Szántó, Gyöngyi; Juhász, Viktória; Székely, Eszter; Novák, András; Molnár, Béla Ákos; Harsányi, László

    2016-03-01

    Leiomyoma is a rare, smooth muscle tumour that can occur everywhere in the human body. The authors present the history of a 60-year-old female, who had a giant, Mullerian type myxoid leiomyoma in the inguinal region mimicking acute abdominal symptoms. After examination the authors removed the soft tissue mass in the right femoral region reaching down in supine position to the middle third of the leg measuring 335 × 495 × 437 mm in greatest diameters in weight 33 kg. Reconstruction of the tissue defect was performed using oncoplastic guidelines. During the follow-up time no tumour recurrence was detected and the quality of life of the patient improved significantly. PMID:26920330

  4. A trial of suction drainage in inguinal hernia repair.

    PubMed

    Beacon, J; Hoile, R W; Ellis, H

    1980-08-01

    A prospective randomized trial was conducted on 301 adult males undergoing inguinal herniorrhaphy to assess the value of postoperative suction drainage. Hernias were classified into 'complicated' and 'simple'. In the 'complicated' group suction drainage for 24 h significantly reduced the incidence of wound haematoma, seroma or infection from 48.7 per cent to 17.6 per cent (P < 0.01); there was also a noticeable effect on the postoperative morbidity in the 'simple' hernias, although this just failed to achieve significance (4.5 per cent in the suction group compared with 9.8 per cent in the controls). It is concluded that suction drainage should be employed postoperatively following repair of hernias where dissection may be difficult or where other complicating factors are present.

  5. [Inguinal hernia in Africa and laparoscopy: utopia or realism?].

    PubMed

    Pallas, G; Simon, F; Sockeel, P; Chapuis, O; Jancovici, R

    2000-01-01

    Inguinal hernia is a common indication for surgery in Africa. Most cases involve men and are treated in advanced stages often with complications. Until now the benchmark technique for surgical management has been the well-defined herniorrhaphy technique. Use of prosthetic implants has been rare because of high cost. Recently there has been a growing interest in video-assisted surgery throughout developing countries. However this enthusiasm should not obscure the fact that the technique is still in the developing stage and thus is more costly for the local economy. Indications for video-assisted surgery should be carefully selected in function of local conditions as well as problems specific to developing countries.

  6. Outer Membrane Vesicles Mediate Transport of Biologically Active Vibrio cholerae Cytolysin (VCC) from V. cholerae Strains

    PubMed Central

    Elluri, Sridhar; Enow, Constance; Vdovikova, Svitlana; Rompikuntal, Pramod K.; Dongre, Mitesh; Carlsson, Sven; Pal, Amit; Uhlin, Bernt Eric; Wai, Sun Nyunt

    2014-01-01

    Background Outer membrane vesicles (OMVs) released from Gram-negative bacteria can serve as vehicles for the translocation of virulence factors. Vibrio cholerae produce OMVs but their putative role in translocation of effectors involved in pathogenesis has not been well elucidated. The V. cholerae cytolysin (VCC), is a pore-forming toxin that lyses target eukaryotic cells by forming transmembrane oligomeric β-barrel channels. It is considered a potent toxin that contributes to V. cholerae pathogenesis. The mechanisms involved in the secretion and delivery of the VCC have not been extensively studied. Methodology/Principal Findings OMVs from V. cholerae strains were isolated and purified using a differential centrifugation procedure and Optiprep centrifugation. The ultrastructure and the contents of OMVs were examined under the electron microscope and by immunoblot analyses respectively. We demonstrated that VCC from V. cholerae strain V:5/04 was secreted in association with OMVs and the release of VCC via OMVs is a common feature among V. cholerae strains. The biological activity of OMV-associated VCC was investigated using contact hemolytic assay and epithelial cell cytotoxicity test. It showed toxic activity on both red blood cells and epithelial cells. Our results indicate that the OMVs architecture might play a role in stability of VCC and thereby can enhance its biological activities in comparison with the free secreted VCC. Furthermore, we tested the role of OMV-associated VCC in host cell autophagy signalling using confocal microscopy and immunoblot analysis. We observed that OMV-associated VCC triggered an autophagy response in the target cell and our findings demonstrated for the first time that autophagy may operate as a cellular defence mechanism against an OMV-associated bacterial virulence factor. Conclusion/Significance Biological assays of OMVs from the V. cholerae strain V:5/04 demonstrated that OMV-associated VCC is indeed biologically active and

  7. Quadrapod mesh for posterior wall reconstruction in adult inguinal hernias.

    PubMed

    Wu, Shih-Chung; Wang, Chih-Chi; Yong, Chee-Cheng

    2008-03-01

    Inguinal hernia repairs are the most frequently carried out operations worldwide, and open-mesh herniorrhaphies have gained wide acceptance for advantages of little tension, less pain and lower recurrence rates. Even so, potential drawbacks of original open-mesh repairs exist, and we accordingly make some modifications, suggesting a new 'quadrapod' marlex mesh as an alternative. From July 2002 to March 2004, we carried out 288 consecutive inguinal hernia repairs using quadrapod mesh in 273 patients, all of them were male and aged older than 35 years. Patient demographics, operative parameters, morbidity and outcomes were collected in detail. After surgery, patients were followed up every 6 months at one surgeon's clinic and any major abnormality was recorded. Mean age of the 273 patients was 58.7 years. Twenty-eight patients had recurrent hernias and 15 bilateral hernias. Mean surgical duration was 50.7 min. One patient suffered from major wound infection and needed prolonged hospitalization for parenteral antibiotics. Owing to old age and benign prostatic hyperplasia, 11 patients receiving spinal anaesthesia had temporary postoperative urine retention and needed short-term urinary catheter insertion. Most patients were discharged 1 day following surgery. Acute wound pain generally improved within days, and no patients complained of chronic pain or debility necessitating special interventions. With a mean follow up of 40.7 months, no case of recurrent herniation was detected to date. Open-mesh herniorrhaphy using quadrapod mesh provides a cheap, feasible and effective alternative choice in centres with limited resources. Preliminary results are encouraging, and a formal prospective study may be warranted.

  8. [Reconstrudive significance of stretch mark tears of the skin].

    PubMed

    Schmidt, U; Bohnert, M; Pollak, S

    2000-01-01

    Stretchmark-like tears of the inguinal region are commonly referred to as typical lesions in pedestrian accidents when the victim is run over by a motorcar. These lesions can also be observed when a pedestrian is hit by a vehicle while being in an upright position. Stretchmark-like tears are due to hyperextension or excessive abduction of the hip joint. Characteristic morphological features are variable numbers of equally superficial and parallel tears of the skin following the skin's cleavage lines. Drivers of two-wheeled vehicles may exhibit inguinal stretchmark-like tears when they hit an obstacle with their bent knee, suffering excessive abduction of the hip joint. Finally, stretchmark-like tears are described in victims of collisions with railed vehicles, of aircraft crashes and--very rarely--in severely injured car passengers.

  9. Chemoproteomic profiling of host and pathogen enzymes active in cholera

    PubMed Central

    Hatzios, Stavroula K.; Hubbard, Troy; Sasabe, Jumpei; Munera, Diana; Clark, Lars; Bachovchin, Daniel A.; Qadri, Firdausi; Ryan, Edward T.; Davis, Brigid M.; Weerapana, Eranthie; Waldor, Matthew K.

    2016-01-01

    Activity-based protein profiling (ABPP) is a chemoproteomic tool for detecting active enzymes in complex biological systems. We used ABPP to identify secreted bacterial and host serine hydrolases that are active in animals infected with the cholera pathogen Vibrio cholerae. Four V. cholerae proteases were consistently active in infected rabbits, and one, VC0157 (renamed IvaP), was also active in human cholera stool. Inactivation of IvaP influenced the activity of other secreted V. cholerae and rabbit enzymes in vivo, while genetic disruption of all four proteases increased the abundance and binding of an intestinal lectin—intelectin—to V. cholerae in infected rabbits. Intelectin also bound to other enteric bacterial pathogens, suggesting it may constitute a previously unrecognized mechanism of bacterial surveillance in the intestine that is inhibited by pathogen-secreted proteases. Our work demonstrates the power of activity-based proteomics to reveal host-pathogen enzymatic dialogue in an animal model of infection. PMID:26900865

  10. The role of Vibrio cholerae genotyping in Africa.

    PubMed

    De, Rituparna; Ghosh, Jayeeta Banerjee; Sen Gupta, Sourav; Takeda, Yoshifumi; Nair, G Balakrish

    2013-11-01

    Toxigenic Vibrio cholerae, the causative agent of the disease cholera, is prevalent in the African continent from the 1970s when the seventh pandemic spread from Asia to Africa. In the past decade, cholera has caused devastating outbreaks in much of Africa, illustrated by the recent cholera epidemics in Zimbabwe and regions of central Africa. Given the extent of cholera in Africa, a robust and efficient surveillance system should be in place to prevent and control the disease in this continent. Such a surveillance system would be greatly bolstered by use of molecular typing techniques to identify genetic subtypes. In this review, we highlight the role that modern molecular typing techniques can play in tracking and aborting the spread of cholera. PMID:24101642

  11. Perforated carcinoma of the sigmoid colon in an incarcerated inguinal hernia: report of a case.

    PubMed

    Kouraklis, Gregory; Kouskos, Efstratios; Glinavou, Andromachi; Raftopoulos, John; Karatzas, Gabriel

    2003-01-01

    Perforation of the large bowel due to benign or malignant disease in an inguinal hernia is very rare, but should be considered as a potential cause of strangulated hernias. A 79-year-old man with a 2-day history of scrotal swelling and pain in the left side associated with fever and chills was brought to our Emergency Department, where he was classified as American Society of Anesthesiologists IVE. A large left incarcerated scrotal hernia was diagnosed and surgical exploration was performed using local infiltration anesthesia. A standard oblique inguinal incision was made, revealing perforation of the sigmoid colon due to cancer. A 40-cm segmental resection of the sigmoid colon was done, and a double-barrel colostomy was made through the inguinal incision. This surgical strategy involving construction of a double-barrel colostomy through the inguinal hernia incision could be an alternative method of managing such critically ill patients.

  12. Inguinal hernia containing a kidney with a duplicated system: an exceptionally rare case.

    PubMed

    Farrell, Michael Ryan; Coogan, Christopher; Hibbeln, John; Millikan, Keith; Benson, Jonas

    2014-03-01

    An inguinal hernia is a commonly encountered surgical case, with multiple unusual contents being reported. We present an exceptionally rare case of an inguinal hernia. Computed tomography imaging of the 62-year-old male patient showed a large left inguinal hernia extending into the left scrotum that contained a duplicated left kidney. There was an associated large left hydrocele and incidental non-obstructive nephrolithiasis. Left nephropexy, left orchiectomy, and repair of the incarcerated left inguinal hernia with mesh placement via a preperitoneal (retroperitoneal) approach were performed. The patient was discharged to home on post-operative day 5 and the post-operative course was uneventful. We discuss a possible mechanism for this rare event.

  13. A Rare Case Report of Inguinal Hernia with Persistent Mullerian Duct and Klinefelter Syndrome

    PubMed Central

    Om, Prabha; Shridatt, Sharma Ankit; Patni, Ankur; Verma, Naveen

    2016-01-01

    Inguinal hernia in male is a common problem but having female reproductive organs in hernial sac is rare. It occur because of failure of mullerian duct to regress in a male fetus during embryonic development, result in a syndrome known as Persistent Mullerian Duct Syndrome (PMDS), which is a rare entity of male pseudohermaphroditism. We hereby present a case of 21-year-old male patient reported with complains of cryptorchidism and inguinal hernia. Generally diagnosis of PMDS was established during investigation like ultrasonography, MRI for localization of undescended testis and during surgical exploration for inguinal hernia or cryptorchidism. Our patient was operated by bilateral inguinal incision; hernial sac contained adult size uterus fallopian tube and upper 2/3rd of vagina. On karyotyping it was found that he was a case of klinefelter syndrome also. Association of PMDS with klinefelter syndrome is very rare. PMID:27504355

  14. A Rare Case Report of Inguinal Hernia with Persistent Mullerian Duct and Klinefelter Syndrome.

    PubMed

    Dadheech, Darpan; Om, Prabha; Shridatt, Sharma Ankit; Patni, Ankur; Verma, Naveen

    2016-06-01

    Inguinal hernia in male is a common problem but having female reproductive organs in hernial sac is rare. It occur because of failure of mullerian duct to regress in a male fetus during embryonic development, result in a syndrome known as Persistent Mullerian Duct Syndrome (PMDS), which is a rare entity of male pseudohermaphroditism. We hereby present a case of 21-year-old male patient reported with complains of cryptorchidism and inguinal hernia. Generally diagnosis of PMDS was established during investigation like ultrasonography, MRI for localization of undescended testis and during surgical exploration for inguinal hernia or cryptorchidism. Our patient was operated by bilateral inguinal incision; hernial sac contained adult size uterus fallopian tube and upper 2/3(rd) of vagina. On karyotyping it was found that he was a case of klinefelter syndrome also. Association of PMDS with klinefelter syndrome is very rare. PMID:27504355

  15. Depilatory laser: a potential causative factor for inguinal hyperhidrosis: report of three cases.

    PubMed

    Obeid, Grace; Helou, Josiane; Maatouk, Ismael; Moutran, Roy; Tomb, Roland

    2013-10-01

    Hyperhidrosis has recently been described as a novel adverse effect of laser-assisted hair removal in the axillary area. Inguinal Hyperhidrosis (IH) is a localized and, typically, a primary form of hyperhidrosis affecting the groin area in individuals before age 25. IH has been reported in the literature after traumas and as a dysfunction of the central sympathetic nervous system. To the best of our knowledge, IH has never been reported as secondary to laser-assisted hair removal. Herein, we report three cases of IH following depilatory laser of the inguinal zone. Three female patients with no relevant medical history presented with the complaint of excessive sweating in the inguinal area after undergoing full bikini depilatory laser sessions. Although never described before, depilatory laser seems to trigger the occurrence of hyperhidrosis in the inguinal zone. PMID:23465053

  16. A large inguinal hernia with undescended testes and micropenis in Robinow syndrome.

    PubMed

    Türken, A; Balci, S; Senocak, M E; Hiçsönmez, A

    1996-04-01

    We present a 1 month-old infant with Robinow syndrome and large inguinal hernia, undescended testes and micropenis mimicking penile agenesis. Genital anomalies are common in Robinow syndrome. The ambiguous genitalia appearance may lead to confusion in gender assignment.

  17. Depilatory laser: a potential causative factor for inguinal hyperhidrosis: report of three cases.

    PubMed

    Obeid, Grace; Helou, Josiane; Maatouk, Ismael; Moutran, Roy; Tomb, Roland

    2013-10-01

    Hyperhidrosis has recently been described as a novel adverse effect of laser-assisted hair removal in the axillary area. Inguinal Hyperhidrosis (IH) is a localized and, typically, a primary form of hyperhidrosis affecting the groin area in individuals before age 25. IH has been reported in the literature after traumas and as a dysfunction of the central sympathetic nervous system. To the best of our knowledge, IH has never been reported as secondary to laser-assisted hair removal. Herein, we report three cases of IH following depilatory laser of the inguinal zone. Three female patients with no relevant medical history presented with the complaint of excessive sweating in the inguinal area after undergoing full bikini depilatory laser sessions. Although never described before, depilatory laser seems to trigger the occurrence of hyperhidrosis in the inguinal zone.

  18. Updated Global Burden of Cholera in Endemic Countries

    PubMed Central

    Ali, Mohammad; Nelson, Allyson R.; Lopez, Anna Lena; Sack, David A.

    2015-01-01

    Background The global burden of cholera is largely unknown because the majority of cases are not reported. The low reporting can be attributed to limited capacity of epidemiological surveillance and laboratories, as well as social, political, and economic disincentives for reporting. We previously estimated 2.8 million cases and 91,000 deaths annually due to cholera in 51 endemic countries. A major limitation in our previous estimate was that the endemic and non-endemic countries were defined based on the countries’ reported cholera cases. We overcame the limitation with the use of a spatial modelling technique in defining endemic countries, and accordingly updated the estimates of the global burden of cholera. Methods/Principal Findings Countries were classified as cholera endemic, cholera non-endemic, or cholera-free based on whether a spatial regression model predicted an incidence rate over a certain threshold in at least three of five years (2008-2012). The at-risk populations were calculated for each country based on the percent of the country without sustainable access to improved sanitation facilities. Incidence rates from population-based published studies were used to calculate the estimated annual number of cases in endemic countries. The number of annual cholera deaths was calculated using inverse variance-weighted average case-fatality rate (CFRs) from literature-based CFR estimates. We found that approximately 1.3 billion people are at risk for cholera in endemic countries. An estimated 2.86 million cholera cases (uncertainty range: 1.3m-4.0m) occur annually in endemic countries. Among these cases, there are an estimated 95,000 deaths (uncertainty range: 21,000-143,000). Conclusion/Significance The global burden of cholera remains high. Sub-Saharan Africa accounts for the majority of this burden. Our findings can inform programmatic decision-making for cholera control. PMID:26043000

  19. When, how, and where can oral cholera vaccines be used to interrupt cholera outbreaks?

    PubMed

    Clemens, John; Holmgren, Jan

    2014-01-01

    Cholera continues to be a major global health problem, at times causing major and prolonged outbreaks in both endemic and nonendemic settings in developing countries. While improved water quality, sanitation, and hygiene (WASH) will provide the ultimate solution to prevention of this disease burden, this is a far-off goal for most developing countries. Oral cholera vaccines cholera vaccines (OCVs) have been demonstrated to be effective in the control of cholera outbreaks, and constitute useful tools to be used in conjunction with efforts to improve WASH. Two killed OCVs are prequalified by WHO for purchase by UN agencies for international use. Recently, WHO has launched a global stockpile stockpile of killed OCVs for use to control outbreaks. Rational deployment of OCV from this stockpile will require consideration of costs, feasibility, disease epidemiology epidemiology , and the protective characteristics of the vaccine deployed, as well as effective and rapid coordination of processes and logistics logistics used to make decisions on deployment and delivery of the vaccine to the population in need. Despite not having data on all the questions of relevance as to how to use OCVs to control cholera outbreaks in different settings, there is clearly more than enough evidence to initiate their use, as answers to remaining questions and refinement of policies will mainly come with experience.

  20. Occult distal urethral carcinoma presenting as metastatic carcinoma in the inguinal lymph nodes.

    PubMed

    Hammer-Hansen, Niels; Høyer, Søren; Jensen, Jørgen Bjerggaard

    2015-02-01

    A 65-year-old man presented with metastatic squamous cell carcinoma in the inguinal lymph nodes from an unknown primary tumour. The initial work-up lacked clinical examination of the glans penis, in part due to the patient having phimosis. More than a year after presentation, a primary tumour, located distally on the penis, was diagnosed. A discussion of urethral carcinoma as well as inguinal lymph-node metastasis of unknown primary tumour is presented. PMID:25313619

  1. Cholera in Portugal, 1974. II. Transmission by bottled mineral water.

    PubMed

    Blake, P A; Rosenberg, M L; Florencia, J; Costa, J B; do Prado Quintino, L; Gangarosa, E J

    1977-04-01

    During a cholera epidemic, Vibrio cholerae was isolated from two springs which supplied mineral water to a spa and to a commercial water bottling plant. Epidemiologic investigation found that cholera attack rates were 10-fold greater among visitors to the spa than among non-visitors. A subsequent matched-pair case-control study which excluded persons who had visted the spa showed that a history of consumption of the bottled non-carbonated water was significantly more common among bacteriologically confirmed cholera cases than among paired controls.

  2. Modern cholera in the Americas: an opportunistic societal infection.

    PubMed

    Cerda, Rodrigo; Lee, Patrick T

    2013-11-01

    In the Americas, the only two cholera epidemics of the past century have occurred in the past 25 years. Lessons from the 1991 Peruvian cholera epidemic can help to focus and refine the response to the current Haitian epidemic. After three years of acute epidemic response, we have an opportunity to refocus on the chronic conditions that make societies vulnerable to cholera. More importantly, even as international attention wanes in the aftermath of the earthquake and acute epidemic, we are faced with a need for continued and coordinated investment in improving Haiti's structural defenses against cholera, in particular access to improved water and sanitation.

  3. Recombination shapes the structure of an environmental Vibrio cholerae population.

    PubMed

    Keymer, Daniel P; Boehm, Alexandria B

    2011-01-01

    Vibrio cholerae consists of pathogenic strains that cause sporadic gastrointestinal illness or epidemic cholera disease and nonpathogenic strains that grow and persist in coastal aquatic ecosystems. Previous studies of disease-causing strains have shown V. cholerae to be a primarily clonal bacterial species, but isolates analyzed have been strongly biased toward pathogenic genotypes, while representing only a small sample of the vast diversity in environmental strains. In this study, we characterized homologous recombination and structure among 152 environmental V. cholerae isolates and 13 other putative Vibrio isolates from coastal waters and sediments in central California, as well as four clinical V. cholerae isolates, using multilocus sequence analysis of seven housekeeping genes. Recombinant regions were identified by at least three detection methods in 72% of our V. cholerae isolates. Despite frequent recombination, significant linkage disequilibrium was still detected among the V. cholerae sequence types. Incongruent but nonrandom associations were observed for maximum likelihood topologies from the individual loci. Overall, our estimated recombination rate in V. cholerae of 6.5 times the mutation rate is similar to those of other sexual bacteria and appears frequently enough to restrict selection from purging much of the neutral intraspecies diversity. These data suggest that frequent recombination among V. cholerae may hinder the identification of ecotypes in this bacterioplankton population. PMID:21075874

  4. Modern cholera in the Americas: an opportunistic societal infection.

    PubMed

    Cerda, Rodrigo; Lee, Patrick T

    2013-11-01

    In the Americas, the only two cholera epidemics of the past century have occurred in the past 25 years. Lessons from the 1991 Peruvian cholera epidemic can help to focus and refine the response to the current Haitian epidemic. After three years of acute epidemic response, we have an opportunity to refocus on the chronic conditions that make societies vulnerable to cholera. More importantly, even as international attention wanes in the aftermath of the earthquake and acute epidemic, we are faced with a need for continued and coordinated investment in improving Haiti's structural defenses against cholera, in particular access to improved water and sanitation. PMID:24028256

  5. Modern Cholera in the Americas: An Opportunistic Societal Infection

    PubMed Central

    Lee, Patrick T.

    2013-01-01

    In the Americas, the only two cholera epidemics of the past century have occurred in the past 25 years. Lessons from the 1991 Peruvian cholera epidemic can help to focus and refine the response to the current Haitian epidemic. After three years of acute epidemic response, we have an opportunity to refocus on the chronic conditions that make societies vulnerable to cholera. More importantly, even as international attention wanes in the aftermath of the earthquake and acute epidemic, we are faced with a need for continued and coordinated investment in improving Haiti’s structural defenses against cholera, in particular access to improved water and sanitation. PMID:24028256

  6. The eltor cholera epidemic in Dhaka in 1974 and 1975*

    PubMed Central

    Khan, Moslem Uddin; Shahidullah, Mohammad; Ahmed, Waseque Uddin; Purification, Dominica; Khan, Maksud Ali

    1983-01-01

    Surveillance of hospitalized cholera cases from 1970 to 1977 in Dhaka, a matched control study in 1974, and a neighbourhood control study in 1975 were carried out and show a change from classical cholera to the eltor biotype during this period. Of all the hospitalized cholera cases, 9.1% in 1972 and 99.9% in 1973 were due to the eltor biotype. In 1974 and 1975 the distribution of eltor cholera cases in the city was uniform, except for areas with modern sanitation whose residents were spared. The incidence rates of cholera per 1000 infants (under the age of 1 year) were 1.16 and 0.93 for 1974 and 1975, respectively. On the whole, children below 10 years and females between 15 and 44 years of age were the ones most affected with eltor cholera. Higher rates of diarrhoea and hospitalization were noted among the contacts with cholera cases, compared with non-cholera controls. Contracting cholera was significantly associated with eating in places away from home, especially at charitable feeding centres. PMID:6605213

  7. National surveillance data on the epidemiology of cholera in Cameroon.

    PubMed

    Djomassi, L Dempouo; Gessner, Bradford D; Andze, G Ondobo; Mballa, G A Etoundi

    2013-11-01

    Background. The cholera burden in Cameroon has increased during the past 2 decades. During 2010 and 2011, the largest number of cholera cases in Cameroon since February 1971 were reported. This article describes cholera outbreaks during 2010-2011. Methods. Data received from the national surveillance system from 2010 and 2011 were compiled and analyzed. Results. The first suspected cholera cases were reported in the Far North region on 6 May 2010. In 2010, 10 759 cholera cases were reported by 8 of the 10 regions in the country, with 657 deaths (case-fatality ratio [CFR], 6.1%). In 2011, through September 22, 17 121 suspected cholera cases, including 636 deaths (CFR, 3.7%), were reported all over the country. During 2010, the Far North region accounted for 87.6% of cases (9421/10 759) and 91.6% of deaths (602/657) recorded. By contrast, during 2011, 5 regions (Far North, North, Center, Southwest, and Littoral) accounted for 90.6% of cases (15 511/17 121) and 84.0% of deaths recorded. Vibrio cholerae was identified in 525 stool specimens, and all organisms were serogroup O1. Conclusions. The ongoing cholera outbreak in Cameroon increased in intensity and geographic spread from 2010 to 2011. Nevertheless, the overall CFR decreased during this period. Strengthening the early warning system and enhancing water, sanitation, and hygiene interventions and sensitization should be considered in addressing cholera outbreaks.

  8. Lower incidence of inguinal hernia after radical prostatectomy using open gasless endoscopic single-site surgery.

    PubMed

    Fukuhara, H; Nishimatsu, H; Suzuki, M; Fujimura, T; Enomoto, Y; Ishikawa, A; Kume, H; Homma, Y

    2011-06-01

    Inguinal hernia is one of the long-term complications requiring surgical interventions after retropubic radical prostatectomy (RRP), and its incidence has been reported to range from 12 to 21%. The number of open gasless laparoendoscopic single-site surgery, especially minimum incision endoscopic radical prostatectomy (MIES-RRP) is increasing in Japan. The incidence of post-operative inguinal hernia was compared between conventional RRP and MIES-RRP. The medical records of 333 patients who underwent conventional RRP (n=214) or MIES-RRP (n=119) with pelvic lymphadenectomy at our hospital were retrospectively evaluated. There were no significant differences between the two groups in age, pre-operative PSA levels, or previous major abdominal surgery (cholecystectomy, gastrectomy and colectomy), appendectomy or inguinal hernia repair. MIES-RRP was carried out with a 5-8-cm lower abdominal midline incision. Inguinal hernia developed postoperatively in 41 (19%) of the 214 men undergoing conventional RRP during mean follow-up of 58 months (range: 7-60 months). In contrast, 7 (5.9%) of the 119 men receiving MIES-RRP, developed inguinal hernia during mean follow-up of 21 months (range: 13-31 months). The hernia-free survival was significantly higher after MIES-RRP than after conventional RRP (P=0.037). Our results suggest that MIES-RRP is less associated with post-operative inguinal hernia than conventional RRP.

  9. Active surveillance for Vibrio cholerae O1 and vibriophages in sewage water as a potential tool to predict cholera outbreaks.

    PubMed Central

    Madico, G; Checkley, W; Gilman, R H; Bravo, N; Cabrera, L; Calderon, M; Ceballos, A

    1996-01-01

    The 1991 Peruvian cholera epidemic has thus far been responsible for 600,000 cholera cases in Peru. In an attempt to design a cholera surveillance program in the capital city of Lima, weekly sewage samples were collected between August 1993 and May 1996 and examined for the presence of Vibrio cholerae O1 bacteria and V. cholerae O1 bacteriophages (i.e., vibriophages). During the 144 weeks of surveillance, 6,323 cases of clinically defined cholera were recorded in Lima. We arbitrarily defined an outbreak as five or more reported cases of cholera in a week. The odds of having an outbreak were 7.6 times greater when V. cholerae O1 was present in sewage water during the four previous weeks compared with when it was not (P < 0.001). Furthermore, the odds of having an outbreak increased as the number of V. cholerae O1 isolations during the previous 4 weeks increased (P < 0.001). The odds of having an outbreak were 2.4 times greater when vibriophages were present in sewage water during the four previous weeks compared with when they were not, but this increase was not statistically significant (P = 0.15). The odds of having an outbreak increased as the number of vibriophage isolations during the previous 4 weeks increased (P < 0.05). The signaling of a potential cholera outbreak 1 month in advance may be a valuable tool for implementation of preventive measures. In Peru, active surveillance for V. cholerae O1 and possibly vibriophages in sewage water appears to be a feasible and effective means of predicting and outbreak of cholera. PMID:8940432

  10. Use of Dipsticks for Rapid Diagnosis of Cholera Caused by Vibrio cholerae O1 and O139 from Rectal Swabs

    PubMed Central

    Bhuiyan, N. A.; Qadri, Firdausi; Faruque, A. S. G.; Malek, M. A; Salam, M. A.; Nato, Farida; Fournier, J. M.; Chanteau, S.; Sack, David A.; Balakrish Nair, G.

    2003-01-01

    We evaluated the recently developed dipsticks for the rapid detection of Vibrio cholerae serotypes O1 and O139 from rectal swabs of hospitalized diarrheal patients after enrichment for 4 h in alkaline peptone water. The sensitivity and specificity of the dipsticks were above 92 and 91%, respectively. The dipsticks represent the first rapid test which has been successfully used to diagnose cholera from rectal swabs, and this would immensely improve surveillance for cholera, especially in remote settings. PMID:12904424

  11. Comparative microscopy study of Vibrio cholerae flagella

    NASA Astrophysics Data System (ADS)

    Konnov, Nikolai P.; Baiburin, Vil B.; Zadnova, Svetlana P.; Volkov, Uryi P.

    1999-06-01

    A fine structure of bacteria flagella is an important problem of molecular cell biology. Bacteria flagella are the self-assembled structures that allow to use the flagellum protein in a number of biotechnological applications. However, at present, there is a little information about high resolution scanning probe microscopy study of flagellum structure, in particular, about investigation of Vibrio cholerae flagella. In our lab have been carried out the high resolution comparative investigation of V. cholerae flagella by means of various microscopes: tunneling (STM), scanning force (SFM) and electron transmission. As a scanning probe microscope is used designed in our lab versatile SPM with replaceable measuring heads. Bacteria were grown, fixed and treated according to the conventional techniques. For STM investigations samples were covered with Pt/Ir thin films by rotated vacuum evaporation, in SFM investigations were used uncovered samples. Electron microscopy of the negatively stained bacteria was used as a test procedure.

  12. Cholera outbreaks (2012) in three districts of Nepal reveal clonal transmission of multi-drug resistant Vibrio cholerae O1

    PubMed Central

    2014-01-01

    Background Although endemic cholera causes significant morbidity and mortality each year in Nepal, lack of information about the causal bacterium often hinders cholera intervention and prevention. In 2012, diarrheal outbreaks affected three districts of Nepal with confirmed cases of mortality. This study was designed to understand the drug response patterns, source, and transmission of Vibrio cholerae associated with 2012 cholera outbreaks in Nepal. Methods V. cholerae (n = 28) isolated from 2012 diarrhea outbreaks {n = 22; Kathmandu (n = 12), Doti (n = 9), Bajhang (n = 1)}, and surface water (n = 6; Kathmandu) were tested for antimicrobial response. Virulence properties and DNA fingerprinting of the strains were determined by multi-locus genetic screening employing polymerase chain reaction, DNA sequencing, and pulsed-field gel electrophoresis (PFGE). Results All V. cholerae strains isolated from patients and surface water were confirmed to be toxigenic, belonging to serogroup O1, Ogawa serotype, biotype El Tor, and possessed classical biotype cholera toxin (CTX). Double-mismatch amplification mutation assay (DMAMA)-PCR revealed the V. cholerae strains to possess the B-7 allele of ctx subunit B. DNA sequencing of tcpA revealed a point mutation at amino acid position 64 (N → S) while the ctxAB promoter revealed four copies of the tandem heptamer repeat sequence 5'-TTTTGAT-3'. V. cholerae possessed all the ORFs of the Vibrio seventh pandemic island (VSP)-I but lacked the ORFs 498–511 of VSP-II. All strains were multidrug resistant with resistance to trimethoprim-sulfamethoxazole (SXT), nalidixic acid (NA), and streptomycin (S); all carried the SXT genetic element. DNA sequencing and deduced amino acid sequence of gyrA and parC of the NAR strains (n = 4) revealed point mutations at amino acid positions 83 (S → I), and 85 (S → L), respectively. Similar PFGE (NotI) pattern revealed the Nepalese V. cholerae to be clonal

  13. The relationship of vibriocidal antibody titre to susceptibility to cholera in family contacts of cholera patients*

    PubMed Central

    Mosley, W. H.; Ahmad, Shamsa; Benenson, A. S.; Ahmed, Ansaruddin

    1968-01-01

    A bacteriological and serological study of family contacts of 81 cholera patients was carried out in Dacca, East Pakistan. In the 10-day follow-up, 78 (16.7%) of 466 contacts were found to be infected with Vibrio cholerae; half of them were symptomatic and 29 had to be admitted to hospital. A study of serum pairs revealed a 4-fold, or greater, rise in titre in 86% of those infected in whom diarrhoea was present, and in 77% of individuals with inapparent infections. The infection rate fell markedly with age. Serological tests for vibriocidal antibody on blood specimens collected at the initiation of the follow-up revealed higher titres with increasing age. Vibrio cholerae infection, whether symptomatic or asymptomatic, predominantly occurred in individuals with low titres. PMID:5303331

  14. Activation of cholera toxin production by anaerobic respiration of trimethylamine N-oxide in Vibrio cholerae.

    PubMed

    Lee, Kang-Mu; Park, Yongjin; Bari, Wasimul; Yoon, Mi Young; Go, Junhyeok; Kim, Sang Cheol; Lee, Hyung-Il; Yoon, Sang Sun

    2012-11-16

    Vibrio cholerae is a gram-negative bacterium that causes cholera. Although the pathogenesis caused by this deadly pathogen takes place in the intestine, commonly thought to be anaerobic, anaerobiosis-induced virulence regulations are not fully elucidated. Anerobic growth of the V. cholerae strain, N16961, was promoted when trimethylamine N-oxide (TMAO) was used as an alternative electron acceptor. Strikingly, cholera toxin (CT) production was markedly induced during anaerobic TMAO respiration. N16961 mutants unable to metabolize TMAO were incapable of producing CT, suggesting a mechanistic link between anaerobic TMAO respiration and CT production. TMAO reductase is transported to the periplasm via the twin arginine transport (TAT) system. A similar defect in both anaerobic TMAO respiration and CT production was also observed in a N16961 TAT mutant. In contrast, the abilities to grow on TMAO and to produce CT were not affected in a mutant of the general secretion pathway. This suggests that V. cholerae may utilize the TAT system to secrete CT during TMAO respiration. During anaerobic growth with TMAO, N16961 cells exhibit green fluorescence when stained with 2',7'-dichlorofluorescein diacetate, a specific dye for reactive oxygen species (ROS). Furthermore, CT production was decreased in the presence of an ROS scavenger suggesting a positive role of ROS in regulating CT production. When TMAO was co-administered to infant mice infected with N16961, the mice exhibited more severe pathogenic symptoms. Together, our results reveal a novel anaerobic growth condition that stimulates V. cholerae to produce its major virulence factor.

  15. Spatially explicit modelling of cholera epidemics

    NASA Astrophysics Data System (ADS)

    Finger, F.; Bertuzzo, E.; Mari, L.; Knox, A. C.; Gatto, M.; Rinaldo, A.

    2013-12-01

    Epidemiological models can provide crucial understanding about the dynamics of infectious diseases. Possible applications range from real-time forecasting and allocation of health care resources to testing alternative intervention mechanisms such as vaccines, antibiotics or the improvement of sanitary conditions. We apply a spatially explicit model to the cholera epidemic that struck Haiti in October 2010 and is still ongoing. The dynamics of susceptibles as well as symptomatic and asymptomatic infectives are modelled at the scale of local human communities. Dissemination of Vibrio cholerae through hydrological transport and human mobility along the road network is explicitly taken into account, as well as the effect of rainfall as a driver of increasing disease incidence. The model is calibrated using a dataset of reported cholera cases. We further model the long term impact of several types of interventions on the disease dynamics by varying parameters appropriately. Key epidemiological mechanisms and parameters which affect the efficiency of treatments such as antibiotics are identified. Our results lead to conclusions about the influence of different intervention strategies on the overall epidemiological dynamics.

  16. Tetra- versus Pentavalent Inhibitors of Cholera Toxin**

    PubMed Central

    Fu, Ou; Pukin, Aliaksei V; van Ufford, H C Quarles; Branson, Thomas R; Thies-Weesie, Dominique M E; Turnbull, W Bruce; Visser, Gerben M; Pieters, Roland J

    2015-01-01

    The five B-subunits (CTB5) of the Vibrio cholerae (cholera) toxin can bind to the intestinal cell surface so the entire AB5 toxin can enter the cell. Simultaneous binding can occur on more than one of the monosialotetrahexosylganglioside (GM1) units present on the cell surface. Such simultaneous binding arising from the toxins multivalency is believed to enhance its affinity. Thus, blocking the initial attachment of the toxin to the cell surface using inhibitors with GM1 subunits has the potential to stop the disease. Previously we showed that tetravalent GM1 molecules were sub-nanomolar inhibitors of CTB5. In this study, we synthesized a pentavalent version and compared the binding and potency of penta- and tetravalent cholera toxin inhibitors, based on the same scaffold, for the first time. The pentavalent geometry did not yield major benefits over the tetravalent species, but it was still a strong inhibitor, and no major steric clashes occurred when binding the toxin. Thus, systems which can adopt more geometries, such as those described here, can be equally potent, and this may possibly be due to their ability to form higher-order structures or simply due to more statistical options for binding. PMID:26478842

  17. The Vaccine Candidate Vibrio cholerae 638 Is Protective against Cholera in Healthy Volunteers

    PubMed Central

    García, Luis; Jidy, Manuel Díaz; García, Hilda; Rodríguez, Boris L.; Fernández, Roberto; Año, Gemma; Cedré, Bárbara; Valmaseda, Tania; Suzarte, Edith; Ramírez, Margarita; Pino, Yadira; Campos, Javier; Menéndez, Jorge; Valera, Rodrigo; González, Daniel; González, Irma; Pérez, Oliver; Serrano, Teresita; Lastre, Miriam; Miralles, Fernando; del Campo, Judith; Maestre, Jorge Luis; Pérez, José Luis; Talavera, Arturo; Pérez, Antonio; Marrero, Karen; Ledón, Talena; Fando, Rafael

    2005-01-01

    Vibrio cholerae 638 is a living candidate cholera vaccine strain attenuated by deletion of the CTXΦ prophage from C7258 (O1, El Tor Ogawa) and by insertion of the Clostridium thermocellum endoglucanase A gene into the hemagglutinin/protease coding sequence. This vaccine candidate was previously found to be well tolerated and immunogenic in volunteers. This article reports a randomized, double-blind, placebo-controlled trial conducted to test short-term protection conferred by 638 against subsequent V. cholerae infection and disease in volunteers in Cuba. A total of 45 subjects were enrolled and assigned to receive vaccine or placebo. The vaccine contained 109 CFU of freshly harvested 638 buffered with 1.3% NaHCO3, while the placebo was buffer alone. After vaccine but not after placebo intake, 96% of volunteers had at least a fourfold increase in vibriocidal antibody titers, and 50% showed a doubling of at least the lipopolysaccharide-specific immunoglobulin A titers in serum. At 1 month after vaccination, five volunteers from the vaccine group and five from the placebo group underwent an exploratory challenge study with 109 CFU of ΔCTXΦ attenuated mutant strain V. cholerae 81. Only two volunteers from the vaccine group shed strain 81 in their feces, but none of them experienced diarrhea; in the placebo group, all volunteers excreted the challenge strain, and three had reactogenic diarrhea. An additional 12 vaccinees and 9 placebo recipients underwent challenge with 7 × 105 CFU of virulent strain V. cholerae 3008 freshly harvested from a brain heart infusion agar plate and buffered with 1.3% NaHCO3. Three volunteers (25%) from the vaccine group and all from the placebo group shed the challenge agent in their feces. None of the 12 vaccinees but 7 volunteers from the placebo group had diarrhea, and 2 of the latter exhibited severe cholera (>5,000 g of diarrheal stool). These results indicate that at 1 month after ingestion of a single oral dose (109 CFU) of strain

  18. Multidrug-Resistant Vibrio cholerae O1 was Responsible for a Cholera Outbreak in 2013 in Bagalkot, North Karnataka.

    PubMed

    Bhattacharya, Debdutta; Dey, Shuchismita; Roy, Subarna; Parande, Mahantesh V; Telsang, M; Seema, M H; Parande, Aisha V; Mantur, Basappa G

    2015-01-01

    Cholera is a major cause of illness in the developing world. During the monsoon season, small sporadic clusters of cholera cases are reported on an annual basis in Karnataka, India. During the monsoons of 2013, there was a cholera outbreak in Badami, a remote area of Bagalkot district in Karnataka. The multi-drug-resistant Vibrio cholerae O1 serotype Ogawa was found to be responsible for this outbreak. On 5 August 2013, a 30-year-old woman presented with severe dehydration and watery diarrhea at the Aganwadi Health Centre in Badami. A total of 49 suspected cholera cases were reported, with an attack rate of 3.5%. The V. cholerae isolates exhibited resistance to a wide range of drugs, including ampicillin, co-trimoxazole, nitrofurantoin, carbenicillin, and third generation cephalosporins, and showed reduced susceptibility to third generation fluoroquinolones. All of the cephalosporin-resistant V. cholerae strains produced extended-spectrum beta-lactamase. All V. cholerae O1 isolates harbored virulent genes (ctxA, ctxB, tcpA El Tor, Tox S, VPI, ToxT, ToxR, ToxRS, ace, zot, and tcpP) and were found to be genetically similar as determined by randomly amplified polymorphic DNA fingerprinting assay. To the best of our knowledge, this is the first report of a cholera outbreak in the district of Bagalkot. The resistance of V. cholerae to commonly used antimicrobial drugs is becoming a major public health concern in the region as clinicians are left with a limited choice of antibiotics for the treatment of cholera.

  19. Phenotypic and Genetic Heterogeneity in Vibrio cholerae O139 Isolated from Cholera Cases in Delhi, India during 2001–2006

    PubMed Central

    Ghosh, Raikamal; Sharma, Naresh C.; Halder, Kalpataru; Bhadra, Rupak K.; Chowdhury, Goutam; Pazhani, Gururaja P.; Shinoda, Sumio; Mukhopadhyay, Asish K.; Nair, G. Balakrish; Ramamurthy, Thadavarayan

    2016-01-01

    Incidence of epidemic Vibrio cholerae serogroup O139 has declined in cholera endemic countries. However, sporadic cholera caused by V. cholerae O139 with notable genetic changes is still reported from many regions. In the present study, 42 V. cholerae O139 strains isolated from 2001 to 2006 in Delhi, India, were retrospectively analyzed to understand their phenotype and molecular characteristics. The majority of isolates were resistant to ampicillin, furazolidone and nalidixic acid. Though the integrative conjugative element was detected in all the O139 isolates, the 2004–2006 isolates remained susceptible to co-trimoxazole, chloramphenicol, and streptomycin. Cholera toxin genotype 1 was present in the majority of the O139 isolates while few had type 3 or a novel type 4. In the cholera toxin encoding gene (ctx) restriction fragment length polymorphism, the majority of the isolates harbored three copies of CTX element, of which one was truncated. In this study, the ctx was detected for the first time in the small chromosome of V. cholerae O139 and one isolate harbored 5 copies of CTX element, of which 3 were truncated. The ribotype BII pattern was found in most of the O139 isolates. Three V. cholerae O139 isolated in 2001 had a new ribotype BVIII. Pulsed-field gel electrophoresis analysis revealed clonal variation in 2001 isolates compared to the 2004–2006 isolates. Molecular changes in V. cholerae O139 have to be closely monitored as this information may help in understanding the changing genetic features of this pathogen in relation to the epidemiology of cholera. PMID:27555841

  20. Synthesis of protein in intestinal cells exposed to cholera toxin

    SciTech Connect

    Peterson, J.W.; Berg, W.D. Jr.; Coppenhaver, D.H.

    1987-11-01

    The mechanism by which cyclic adenosine monophosphate (AMP), formed by intestinal epithelial cells in response to cholera toxin, ultimately results in alterations in water and electrolyte transport is poorly understood. Several studies have indicated that inhibitors of transcription or translation block much of the transport of ions and water in the intestine and edema formation in tissue elicited by cholera toxin. Data presented in this study confirmed the inhibitory effects of cycloheximide on cholera toxin-induced fluid accumulation in the rabbit intestinal loop model. Neither cycloheximide nor actinomycin D altered the amount of cyclic AMP that accumulated in intestinal cells and Chinese hamster ovary cells exposed to cholera toxin. An increase in (/sup 3/H) leucine incorporation was readily demonstrable in intestinal epithelial cells from rabbits challenged with Vibrio cholerae. Similarly, intestinal epithelial cells incubated with cholera toxin for 4 hr synthesized substantially more protein than controls as determined by relative incorporation of (/sup 35/S) methionine. Most of the new protein synthesized in response to cholera toxin was membrane associated and of high molecular weight. The possible significance of the toxin-induced protein relative to cholera pathogenesis was discussed.

  1. Avian cholera and organochlorine residues in an American oystercatcher

    USGS Publications Warehouse

    Blus, L.J.; Locke, L.N.; Cromartie, E.

    1978-01-01

    Pasteurella multocida, the causative bacterium of avian cholera, was isolated from cultures of the liver and heart blood of a female, adult American oystercatcher (Haematopus palliatus) found dead on the Cape Romain National Wildlife Refuge, South Carolina, in May 1973. This is apparently the first record of avian cholera in the oystercatcher. Low levels of DDE were identified in tissues of the oystercatcher.

  2. Cholera toxin stimulation of human mammary epithelial cells in culture

    SciTech Connect

    Stampfer, M.R.

    1982-06-01

    Addition of cholera toxin to human mammary epithelial cultures derived from reduction mammoplasties and primary carcinomas greatly stimulated cell growth and increased the number of times the cells could be successfully subcultured. Other agents known to increase intracellular cAMP levels were also growth stimulatory. The increased growth potential conferred by cholera toxin enhances the usefulness of this cell culture system.

  3. Satellite Water Impurity Marker (SWIM) for predicting seasonal cholera outbreaks

    NASA Astrophysics Data System (ADS)

    Jutla, A. S.; Akanda, A. S.; Islam, S.

    2011-12-01

    Prediction of outbreaks of cholera, a deadly water related disease, remains elusive. Since coastal brackish water provides a natural ecological niche for cholera bacteria and because a powerful evidence of new biotypes is emerging, it is highly unlikely that cholera will be fully eradicated. Therefore, it is necessary to develop cholera prediction model with several months' of lead time. Satellite based estimates of chlorophyll, a surrogate for phytoplankton abundance, has been associated with proliferation of cholera bacteria. However, survival of cholera bacteria in a variety of coastal ecological environment put constraints on predictive abilities of chlorophyll algorithm since it only measures greenness in coastal waters. Here, we propose a new remote sensing reflectance based statistical index: Satellite Water Impurity Marker, or SWIM. This statistical index estimates impurity levels in the coastal waters and is based on the variability observed in the difference between the blue (412nm) and green (555nm) wavelengths in coastal waters. The developed index is bounded between clear and impure water and shows the ability to predict cholera outbreaks in the Bengal Delta with a predicted r2 of 78% with two months lead time. We anticipate that a predictive system based on SWIM will provide essential lead time allowing effective intervention and mitigation strategies to be developed for other cholera endemic regions of the world.

  4. Multinational cholera outbreak after wedding in the Dominican Republic.

    PubMed

    Jiménez, Mercedes Laura; Apostolou, Andria; Suarez, Alba Jazmin Palmera; Meyer, Luis; Hiciano, Salvador; Newton, Anna; Morgan, Oliver; Then, Cecilia; Pimentel, Raquel

    2011-11-01

    We conducted a case–control study of a cholera outbreak after a wedding in the Dominican Republic, January 22, 2011. Ill persons were more likely to report having consumed shrimp on ice (odds ratio 8.50) and ice cubes in beverages (odds ratio 3.62). Travelers to cholera affected areas should avoid consuming uncooked seafood and untreated water. PMID:22204039

  5. Malonate inhibits virulence gene expression in Vibrio cholerae.

    PubMed

    Minato, Yusuke; Fassio, Sara R; Häse, Claudia C

    2013-01-01

    We previously found that inhibition of the TCA cycle, either through mutations or chemical inhibition, increased toxT transcription in Vibrio cholerae. In this study, we found that the addition of malonate, an inhibitor of succinate dehydrogenase (SDH), decreased toxT transcription in V. cholerae, an observation inconsistent with the previous pattern observed. Unlike another SDH inhibitor, 2-thenoyltrifluoroacetone (TTFA), which increased toxT transcription and slightly inhibited V. cholerae growth, malonate inhibited toxT transcription in both the wild-type strain and TCA cycle mutants, suggesting malonate-mediated inhibition of virulence gene expression is independent to TCA cycle activity. Addition of malonate also inhibited ctxB and tcpA expressions but did not affect aphA, aphB, tcpP and toxR expressions. Malonate inhibited cholera toxin (CT) production in both V. cholerae classical biotype strains O395N1 and CA401, and El Tor biotype strain, N16961. Consistent with previous reports, we confirmed that these strains of V. cholerae did not utilize malonate as a primary carbon source. However, we found that the addition of malonate to the growth medium stimulated V. cholerae growth. All together, these results suggest that metabolizing malonate as a nutrient source negatively affects virulence gene expression in V. cholerae.

  6. Understanding the Hydrology of Cholera in South Asia

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A. S.; Islam, S.

    2007-12-01

    Cholera is an acute waterborne illness caused by the bacterium Vibrio cholerae. The disease remains a major public health issue in several regions of the developing world, mainly in coastal areas around the tropics. Cholera incidences have been historically linked to climate variables and more recently with El Nino-Southern Oscillation. The occurrence of cholera shows bi-annual seasonal peaks and strong inter-annual variability in the Ganges basin region of South Asia. However, the role of hydrologic variables in the seasonal patterns of cholera epidemics is less understood. Preliminary results suggest that a unique combination of increasing water temperature and higher salinity in the coastal zone during the low flow season provide the situation amenable to the first outbreak of cholera in the spring season. Other major factors contributing to the subsequent spread of the disease are sea surface height, monsoon precipitation, and coastal phytoplankton concentration. We will further examine the lag periods between the dominant environmental variables and cholera incidences to understand the seasonal dynamics of cholera in South Asia.

  7. Risk Factors for Sustained Cholera Transmission, Juba County, South Sudan, 2014.

    PubMed

    Ujjiga, Thomas T A; Wamala, Joseph F; Mogga, Juma J H; Othwonh, Thabo O; Mutonga, David; Kone-Coulibaly, Asta; Shaikh, Masood Ali; Mpairwe, Allan M; Abdinasir, Abubaker; Abdi, Mohamed A; Yoti, Zabulon; Olushayo, Olu; Nyimol, Pinyi; Lul, Riek; Lako, Richard L; Rumunu, John

    2015-10-01

    We conducted a case-control study to identify risk factors for the 2014 cholera outbreak in Juba County, South Sudan. Illness was associated with traveling or eating away from home; treating drinking water and receiving oral cholera vaccination were protective. Oral cholera vaccination should be used to complement cholera prevention efforts.

  8. Cholera with severe renal failure in an Italian tourist returning from Cuba, July 2013.

    PubMed

    Mascarello, M; Deiana, M L; Maurel, C; Lucarelli, C; Luzzi, I; Luzzati, R

    2013-08-29

    In July 2013, an Italian tourist returning from Cuba was hospitalised in Trieste, Italy, for cholera caused by Vibrio cholerae O1 serotype Ogawa with severe renal failure. An outbreak of cholera was reported in Cuba in January 2013. Physicians should consider the diagnosis of cholera in travellers returning from Cuba presenting with acute watery diarrhoea.

  9. Effectiveness of Lichtenstein repairs in planned treatment of giant inguinal hernia – own experience

    PubMed Central

    Kosim, Anna; Kołodziejczak, Małgorzata; Zmora, Jan; Kultys, Ewa

    2012-01-01

    Introduction Occurrence of giant inguinal hernias is not frequent because of growing medical awareness in the community as well as progress in surgical treatment in this field. Aim To evaluate the effectiveness of repairs using the Lichtenstein technique in scheduled treatment of giant inguinal hernias. Material and methods Between 2006 and 2010 in the Department of Surgery with the Subdepartment of Proctology, Hospital at Solec in Warsaw, 909 repairs of inguinal hernia were performed, including 15 patients (1.65%) with the diagnosis of giant hernia. In 3 cases it was direct inguinal hernia and in 12 cases indirect inguinal hernia. All giant hernias occurred in male patients between 33 and 87 years of age (mean age 65 years old) and developed for many years, median of 14.2 years. All patients underwent scheduled repairs using the tension-free Lichtenstein technique. A non-absorbable polypropylene mesh was used for hernioplasty. Exact Fisher's test (p < 0.01) was used for statistical analysis. Results In all cases contents of the hernial sac consisted of loops of small intestine, colon and omentum. Early complications occurred in 11 patients (73%) in the group of patients with giant hernias, whereas in the remaining group of patients early complications occurred in 53 patients (5.9%). The difference was statistically significant. In the group of patients with giant hernias no recurrence was observed over the observation period ranging from 6 months to 4.5 years. In the remaining group of patients recurrences occurred in 23 patients (2.6%). Conclusions The Lichtenstein technique of repair is effective in management of giant inguinal hernias. A statistically significantly higher percentage of complications was observed in the group of patients with giant hernias as compared to the remaining group of patients with inguinal hernias. Patients with giant hernias require proper preparation for surgery, especially in relation to their respiratory efficiency. PMID:23630552

  10. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study

    PubMed Central

    de Araújo, Felipe Brandão Corrêa; Starling, Eduardo Simão; Maricevich, Marco; Tobias-Machado, Marcos

    2014-01-01

    OBJECTIVE: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. BACKGROUND: TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. PATIENTS AND METHODS: Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. RESULTS: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. CONCLUSION: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven. PMID:25336820

  11. Early clinical outcomes following laparoscopic inguinal hernia repair.

    PubMed

    Tolver, Mette Astrup

    2013-07-01

    Laparoscopic inguinal hernia repair (TAPP) has gained increasing popularity because of less post-operative pain and a shorter duration of convalescence compared with open hernia repair technique (Lichtenstein). However, investigation of duration of convalescence with non-restrictive recommendations, and a procedure-specific characterization of the early clinical outcomes after TAPP was lacking. Furthermore, optimization of the post-operative period with fibrin sealant versus tacks for fixation of mesh, and the glucocorticoid dexamethasone versus placebo needed to be investigated in randomized clinical trials. The objective of this PhD thesis was to characterize the early clinical outcomes after TAPP and optimize the post-operative period. The four studies included in this thesis have investigated duration of convalescence and procedure-specific post-operative pain and other early clinical outcomes after TAPP. Furthermore, it has been shown that fibrin sealant can improve the early post-operative period compared with tacks, while dexamethasone showed no advantages apart from reduced use of antiemetics compared with placebo. Based on these findings, and the existing knowledge, 3-5 days of convalescence should be expected when 1 day of convalescence is recommended and future studies should focus on reducing intraabdominal pain after TAPP. Fibrin sealant can optimize the early clinical outcomes but the risk of hernia recurrence and chronic pain needs to be evaluated. Dexamethasone should be investigated in higher doses. PMID:23809977

  12. Estimating effects of improved drinking water and sanitation on cholera.

    PubMed

    Leidner, Andrew J; Adusumilli, Naveen C

    2013-12-01

    Demand for adequate provision of drinking-water and sanitation facilities to promote public health and economic growth is increasing in the rapidly urbanizing countries of the developing world. With a panel of data on Asia and Africa from 1990 to 2008, associations are estimated between the occurrence of cholera outbreaks, the case rates in given outbreaks, the mortality rates associated with cholera and two disease control mechanisms, drinking-water and sanitation services. A statistically significant and negative effect is found between drinking-water services and both cholera case rates as well as cholera-related mortality rates. A relatively weak statistical relationship is found between the occurrence of cholera outbreaks and sanitation services.

  13. Zebrafish as a Natural Host Model for Vibrio cholerae Colonization and Transmission

    PubMed Central

    Runft, Donna L.; Mitchell, Kristie C.; Abuaita, Basel H.; Allen, Jonathan P.; Bajer, Sarah; Ginsburg, Kevin; Neely, Melody N.

    2014-01-01

    The human diarrheal disease cholera is caused by the aquatic bacterium Vibrio cholerae. V. cholerae in the environment is associated with several varieties of aquatic life, including insect egg masses, shellfish, and vertebrate fish. Here we describe a novel animal model for V. cholerae, the zebrafish. Pandemic V. cholerae strains specifically colonize the zebrafish intestinal tract after exposure in water with no manipulation of the animal required. Colonization occurs in close contact with the intestinal epithelium and mimics colonization observed in mammals. Zebrafish that are colonized by V. cholerae transmit the bacteria to naive fish, which then become colonized. Striking differences in colonization between V. cholerae classical and El Tor biotypes were apparent. The zebrafish natural habitat in Asia heavily overlaps areas where cholera is endemic, suggesting that zebrafish and V. cholerae evolved in close contact with each other. Thus, the zebrafish provides a natural host model for the study of V. cholerae colonization, transmission, and environmental survival. PMID:24375135

  14. Spread of Cholera with Newer Clones of Vibrio cholerae O1 El Tor, Serotype Inaba, in India

    PubMed Central

    Dutta, B.; Ghosh, R.; Sharma, N. C.; Pazhani, G. P.; Taneja, N.; Raychowdhuri, A.; Sarkar, B. L.; Mondal, S. K.; Mukhopadhyay, A. K.; Nandy, R. K.; Bhattacharya, M. K.; Bhattacharya, S. K.; Ramamurthy, T.

    2006-01-01

    During 2004 and 2005, cholera was recorded in 15 states of India, with 7 outbreaks. The newly emerged Vibrio cholerae O1 Inaba had a different antibiogram and ribotype, different pulsotypes, and different mutations in the wbeT gene. Due to the absence of serogroup O139, the Inaba serotype may have acquired the potential to affect the population at large. PMID:16954282

  15. Killed oral cholera vaccines: history, development and implementation challenges.

    PubMed

    Lopez, Anna Lena; Gonzales, Maria Liza Antoinette; Aldaba, Josephine G; Nair, G Balakrish

    2014-09-01

    Cholera is still a major global health problem, affecting mainly people living in unsanitary conditions and who are at risk for outbreaks of cholera. During the past decade, outbreaks are increasingly reported from more countries. From the early killed oral cholera vaccine, rapid improvements in vaccine development occurred as a result of a better understanding of the epidemiology of the disease, pathogenesis of cholera infection and immunity. The newer-generation oral killed cholera vaccines have been shown to be safe and effective in field trials conducted in cholera endemic areas. Likewise, they have been shown to be protective when used during outbreak settings. Aside from providing direct protection to vaccinated individuals, recent studies have demonstrated that these killed oral vaccines also confer indirect protection through herd immunity. Although new-generation oral cholera vaccines should not be considered in isolation from other preventive approaches in countries where they are most needed, especially improved water quality and sanitation, these vaccines serve as immediately available public health tools for preventing further morbidity and mortality from cholera. However, despite its availability for more than two decades, use of these vaccines has not been optimized. Although there are limitations of the currently available oral cholera vaccines, recent data show that the vaccines are safe, feasible to use even in difficult circumstances and able to provide protection in various settings. Clear identification of the areas and target population groups who will benefit from the use of the cholera vaccines will be required and strategies to facilitate accessibility and usage of these vaccines in these areas and population groups will need to be developed.

  16. The Role of Fibrin Glue Polypropylene Mesh Fixation in Open Inguinal Hernia Repair

    PubMed Central

    Odobasic, Amer; Krdzalic, Goran; Hodzic, Mirsad; Hasukic, Sefik; Sehanovic, Aida; Odobasic, Ademir

    2014-01-01

    ABSTRACT The aim: of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. Material and Methods: The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients – Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery–the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient’s ability to return to regular activities were followed for 3 months. Results and discussion: Statistically significant difference in the duration of surgery, pain intensity and complications (p<0.05) were verified between method A, the group of patients whose inguinal hernia was repaired using polypropylene mesh–fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. Conclusions: The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance. PMID:24937929

  17. Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Using Memory-Ring Mesh: A Pilot Study

    PubMed Central

    Nomura, Tsutomu; Matsuda, Akihisa; Takao, Yoshimune

    2016-01-01

    Purpose. To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™ mesh). Patients and Methods. Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias. The 76 hernias included 37 indirect inguinal hernias, 29 direct hernias, 1 femoral hernia, 1 pantaloon hernia (combined direct/indirect inguinal hernia), and 8 recurrent hernias after open anterior hernia repair. The immediate postoperative outcomes as well as the short-term outcomes (mainly recurrence and incidence of chronic pain) were studied. Results. There was no conversion from TAPP repair to anterior open repair. The mean operation time was 109 minutes (range, 40–132) for unilateral hernia repair. Scrotal seroma was diagnosed at the operation site in 5 patients. No patient had operation-related orchitis, testicle edema, trocar site infection, or chronic pain during follow-up. Conclusions. The use of Polysoft mesh for TAPP inguinal hernia repair does not seem to adversely affect the quality of repair. The use of this mesh is therefore feasible and safe and may reduce postoperative pain. PMID:27635414

  18. Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Using Memory-Ring Mesh: A Pilot Study

    PubMed Central

    Nomura, Tsutomu; Matsuda, Akihisa; Takao, Yoshimune

    2016-01-01

    Purpose. To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™ mesh). Patients and Methods. Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias. The 76 hernias included 37 indirect inguinal hernias, 29 direct hernias, 1 femoral hernia, 1 pantaloon hernia (combined direct/indirect inguinal hernia), and 8 recurrent hernias after open anterior hernia repair. The immediate postoperative outcomes as well as the short-term outcomes (mainly recurrence and incidence of chronic pain) were studied. Results. There was no conversion from TAPP repair to anterior open repair. The mean operation time was 109 minutes (range, 40–132) for unilateral hernia repair. Scrotal seroma was diagnosed at the operation site in 5 patients. No patient had operation-related orchitis, testicle edema, trocar site infection, or chronic pain during follow-up. Conclusions. The use of Polysoft mesh for TAPP inguinal hernia repair does not seem to adversely affect the quality of repair. The use of this mesh is therefore feasible and safe and may reduce postoperative pain.

  19. Anatomic Aspects of Inguinal Lymph Nodes Applied to Lymphadenectomy in Penile Cancer

    PubMed Central

    de Carvalho, João Paulo Martins; Patrício, Bruno F.; Medeiros, Jorge; Sampaio, Francisco J. B.; Favorito, Luciano A.

    2011-01-01

    Objectives. To provide a better understanding of the distribution of inguinal nodes in order to prevent the complications of unnecessary and extended dissections in penile cancer. Methods. The bilateral inguinal regions of 19 male cadavers were dissected. Nodal distribution was noted and quantified based on anatomical location. The superficial nodes were subdivided into quarters as follows: superomedial, superolateral, inferomedial, and inferolateral. Statistical analysis was performed comparing node distribution between quarters using one-way analysis of variance (ANOVA), and the unpaired T-test was used between superficial and deep nodes. Results. Superficial nodes were found in all inguinal regions studied (mean = 13.60), and their distribution was more prominent in the superomedial quarter (mean = 3.94) and less in the inferolateral quarter (mean = 2.73). There was statistical significance between quarters when comparing the upper group with the lower one (P = 0.02). Nodes were widely distributed in the superficial region compared with deep lymph nodes (mean = 13.60 versus 1.71, P < 0.001). Conclusions. A great number of inguinal lymph nodes are distributed near the classical anatomical landmarks for inguinal lymphadenectomy, more prominent in upper quadrants. PMID:22110493

  20. Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Using Memory-Ring Mesh: A Pilot Study.

    PubMed

    Matsutani, Takeshi; Nomura, Tsutomu; Hagiwara, Nobutoshi; Matsuda, Akihisa; Takao, Yoshimune; Uchida, Eiji

    2016-01-01

    Purpose. To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™ mesh). Patients and Methods. Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias. The 76 hernias included 37 indirect inguinal hernias, 29 direct hernias, 1 femoral hernia, 1 pantaloon hernia (combined direct/indirect inguinal hernia), and 8 recurrent hernias after open anterior hernia repair. The immediate postoperative outcomes as well as the short-term outcomes (mainly recurrence and incidence of chronic pain) were studied. Results. There was no conversion from TAPP repair to anterior open repair. The mean operation time was 109 minutes (range, 40-132) for unilateral hernia repair. Scrotal seroma was diagnosed at the operation site in 5 patients. No patient had operation-related orchitis, testicle edema, trocar site infection, or chronic pain during follow-up. Conclusions. The use of Polysoft mesh for TAPP inguinal hernia repair does not seem to adversely affect the quality of repair. The use of this mesh is therefore feasible and safe and may reduce postoperative pain. PMID:27635414

  1. Skin Cancer

    MedlinePlus

    ... are specialized skin cells that produce pigment called melanin. The melanin pigment produced by melanocytes gives skin its color. ... absorbing and scattering the energy. People with more melanin have darker skin and better protection from UV ...

  2. Skin Conditions

    MedlinePlus

    Your skin is your body's largest organ. It covers and protects your body. Your skin Holds body fluids in, preventing dehydration Keeps harmful ... it Anything that irritates, clogs, or inflames your skin can cause symptoms such as redness, swelling, burning, ...

  3. Genetic characteristics of drug-resistant Vibrio cholerae O1 causing endemic cholera in Dhaka, 2006-2011.

    PubMed

    Rashed, Shah M; Mannan, Shahnewaj B; Johura, Fatema-Tuz; Islam, M Tarequl; Sadique, Abdus; Watanabe, Haruo; Sack, R Bradley; Huq, Anwar; Colwell, Rita R; Cravioto, Alejandro; Alam, Munirul

    2012-12-01

    Vibrio cholerae O1 biotype El Tor (ET), causing the seventh cholera pandemic, was recently replaced in Bangladesh by an altered ET possessing ctxB of the Classical (CL) biotype, which caused the first six cholera pandemics. In the present study, V. cholerae O1 strains associated with endemic cholera in Dhaka between 2006 and 2011 were analysed for major phenotypic and genetic characteristics. Of 54 representative V. cholerae isolates tested, all were phenotypically ET and showed uniform resistance to trimethoprim/sulfamethoxazole (SXT) and furazolidone (FR). Resistance to tetracycline (TE) and erythromycin (E) showed temporal fluctuation, varying from year to year, while all isolates were susceptible to gentamicin (CN) and ciprofloxacin (CIP). Year-wise data revealed erythromycin resistance to be 33.3 % in 2006 and 11 % in 2011, while tetracycline resistance accounted for 33, 78, 0, 100 and 27 % in 2006, 2007, 2008, 2009 and 2010, respectively; interestingly, all isolates tested were sensitive to TE in 2011, as observed in 2008. All V. cholerae isolates tested possessed genetic elements such as SXT, ctxAB, tcpA(ET), rstR(ET) and rtxC; none had IntlI (Integron I). Double mismatch amplification mutation assay (DMAMA)-PCR followed by DNA sequencing and analysis of the ctxB gene revealed a point mutation at position 58 (C→A), which has resulted in an amino acid substitution from histidine (H) to asparagine (N) at position 20 (genotype 7) since 2008. Although the multi-resistant strains having tetracycline resistance showed minor genetic divergence, V. cholerae strains were clonal, as determined by a PFGE (NotI)-based dendrogram. This study shows 2008-2010 to be the time of transition from ctxB genotype 1 to genotype 7 in V. cholerae ET causing endemic cholera in Dhaka, Bangladesh.

  4. Hydroclimatological And Anthropogenic Drivers For Cholera Spreading

    NASA Astrophysics Data System (ADS)

    Righetto, Lorenzo; Bertuzzo, Enrico; Mari, Lorenzo; Casagrandi, Renato; Gatto, Marino; Rinaldo, Andrea

    2010-05-01

    The nature of waterborne diseases, among which cholera has a prominent importance, calls for a better understanding of the link between epidemic spreading, water and climate. To this end, we have developed a framework which involves a network-based description of a river system, connected with local communities which act as nodes of the network. This has allowed us to produce consistent simulations of real case studies. More recent investigations comprise the evaluation of the spreading velocity of an epidemic wave by means of a reaction-diffusion modeling approach. In particular, we have found that both transport processes and epidemiological quantities, such as the basic reproduction number, have a crucial effect in controlling the spreading of the epidemics. We first developed a description of bacterial movement along the network driven by advection and diffusion; afterward, we have included the movement of human populations. This latter model allowed us to establish the conditions that can trigger epidemic waves that start from the coastal region, where bacteria are autochthonous, and travel inland. In particular, our findings suggest that even relatively low values of human diffusion can have the epidemic propagate upstream. The interaction between climate, hydrology and epidemic events is still much debated, since no clear correlation between climatologic and epidemiological phenomena has emerged so far. However, a spatial assessment of hydrological and epidemiological mechanisms could be crucial to understand the evolution of cholera outbreaks. In particular, a hotly debated topic is the understanding of the mechanisms that can generate patterns of cholera incidence that exhibit an intra-annual double peak, as frequently observed in endemic region such as Bangladesh. One of the possible explanations proposed in the literature is that spring droughts cause bacteria concentration in water to rise dramatically, triggering the first peak. On the other hand

  5. A Low-Cost Teaching Model of Inguinal Canal: A Useful Method to Teach Surgical Concepts in Hernia Repair

    ERIC Educational Resources Information Center

    Ansaloni, Luca; Catena, Fausto; Coccolini, Frederico; Ceresoli, Marco; Pinna, Antonio Daniele

    2014-01-01

    Objectives: Inguinal canal anatomy and hernia repair is difficult for medical students and surgical residents to comprehend. Methods: Using low-cost material, a 3-dimensional inexpensive model of the inguinal canal was created to allow students to learn anatomical details and landmarks and to perform their own simulated hernia repair. In order to…

  6. Molecular tools in understanding the evolution of Vibrio cholerae.

    PubMed

    Rahaman, Md Habibur; Islam, Tarequl; Colwell, Rita R; Alam, Munirul

    2015-01-01

    Vibrio cholerae, the etiological agent of cholera, has been a scourge for centuries. Cholera remains a serious health threat for developing countries and has been responsible for millions of deaths globally over the past 200 years. Identification of V. cholerae has been accomplished using a variety of methods, ranging from phenotypic strategies to DNA based molecular typing and currently whole genomic approaches. This array of methods has been adopted in epidemiological investigations, either singly or in the aggregate, and more recently for evolutionary analyses of V. cholerae. Because the new technologies have been developed at an ever increasing pace, this review of the range of fingerprinting strategies, their relative advantages and limitations, and cholera case studies was undertaken. The task was challenging, considering the vast amount of the information available. To assist the study, key references representative of several areas of research are provided with the intent to provide readers with a comprehensive view of recent advances in the molecular epidemiology of V. cholerae. Suggestions for ways to obviate many of the current limitations of typing techniques are also provided. In summary, a comparative report has been prepared that includes the range from traditional typing to whole genomic strategies.

  7. [Cholera epidemics on Reunion Island during the 19th century].

    PubMed

    Gaüzère, B-A; Aubry, P

    2012-01-01

    The first cholera outbreak on Bourbon Island (now Reunion Island) was recorded in January 1820. The disease was imported from Mauritius Island aboard the steamer Pivert. The epidemic began on Mauritius in November 1819 after the English frigate, La Topaze, called from Calcutta, India. Dr. François Vinson demonstrated the transmissibility of cholera during this epidemic. Drastic sanitary measures spared Reunion from the two epidemics on Mauritius Island, in 1854 and 1856. The second outbreak of cholera on Reunion Island was recorded on March 6, 1859. The disease was introduced from East Africa by the steamer Mascareignes, which carried indentured servants. The captain (d'Agnel) et the supercargo (Menon) of the steamer claimed to the doctor who boarded the ship before landing that no passengers or crew had had cholera, in flagrant contradiction to the autopsy report issued by Navy surgeon Alfred Vaillant, who had concluded that cholera was present when the vessel left the African coast. This report was withheld from the boarding physician. Cholera spread quickly on the island and affected the poorest people, especially freed slaves, most severely. Dr. Petit, the chief Navy Physician and Director of the Health Department, obtained a confession by Menon about the fraudulent statements. On January 24, 1860, a trial for public health endangerment began on Reunion Island; it ended on February 1 with a not-guilty verdict, based largely on the testimony of several island doctors that cholera was not contagious. PMID:22992340

  8. Molecular tools in understanding the evolution of Vibrio cholerae

    PubMed Central

    Rahaman, Md. Habibur; Islam, Tarequl; Colwell, Rita R.; Alam, Munirul

    2015-01-01

    Vibrio cholerae, the etiological agent of cholera, has been a scourge for centuries. Cholera remains a serious health threat for developing countries and has been responsible for millions of deaths globally over the past 200 years. Identification of V. cholerae has been accomplished using a variety of methods, ranging from phenotypic strategies to DNA based molecular typing and currently whole genomic approaches. This array of methods has been adopted in epidemiological investigations, either singly or in the aggregate, and more recently for evolutionary analyses of V. cholerae. Because the new technologies have been developed at an ever increasing pace, this review of the range of fingerprinting strategies, their relative advantages and limitations, and cholera case studies was undertaken. The task was challenging, considering the vast amount of the information available. To assist the study, key references representative of several areas of research are provided with the intent to provide readers with a comprehensive view of recent advances in the molecular epidemiology of V. cholerae. Suggestions for ways to obviate many of the current limitations of typing techniques are also provided. In summary, a comparative report has been prepared that includes the range from traditional typing to whole genomic strategies. PMID:26500613

  9. Lipopolysaccharides of Vibrio cholerae. I. Physical and chemical characterization.

    PubMed

    Chatterjee, S N; Chaudhuri, Keya

    2003-10-15

    Vibrio cholerae is the causative organism of the disease cholera. The lipopolysaccharide (LPS) of V. cholerae plays an important role in eliciting the antibacterial immune response of the host and in classifying the vibrios into some 200 or more serogroups. This review presents an account of our up-to-date knowledge of the physical and chemical characteristics of the three constituents, lipid-A, core-polysaccharide (core-PS) and O-antigen polysaccharide (O-PS), of the LPS of V. cholerae of different serogroups including the disease-causing ones, O1 and O139. The structure and occurrence of the capsular polysaccharide (CPS) on V. cholerae O139 have been discussed as a relevant topic. Similarity and dissimilarity between the structures of LPS of different serogroups, and particularly between O22 and O139, have been analysed with a view to learning their role in the causation of the epidemic form of the disease by avoiding the host defence mechanism and in the evolution of the newer pathogenic strains in future. An idea of the emerging trends of research involving the use of immunogens prepared from synthetic oligosaccharides that mimic terminal epitopes of the O-PS of V. cholerae O1 in the development of a conjugate anti cholera vaccine is also discussed.

  10. How community ecology can improve our understanding of cholera dynamics

    PubMed Central

    Constantin de Magny, Guillaume; Hasan, Nur A.; Roche, Benjamin

    2013-01-01

    Understanding the seasonal emergence and reemergence of cholera is challenging due to the complex dynamics of different protagonists. The abundance of Vibrio cholerae, the causative agent of cholera and a natural inhabitant of aquatic environments, fluctuates according to abiotic, and biotic factors. Among the biotic factors, the zooplankton community dynamics has been suggested to play a pivotal role in the survival, persistence, and natural competence of V. cholerae. However, factors regulating V. cholerae population structure and seasonal dynamics are still not fully understood. Investigation of the temporal shifts and variability in aquatic community composition in relation to the occurrence or abundance of V. cholerae appears very promising yet remained underexplored. Recent advances in metagenomics, facilitated by high-throughput ultra deep sequencing, have greatly improved our ability for a broader and deeper exploration of microbial communities including an understanding of community structure, function, as well as inter- and intra-specific competitions. Here, we discuss possible areas of research focusing how combination of community ecology and metagenomic approaches could be applied to study the cholera system. PMID:24765090

  11. Vibrio cholerae Hemagglutinin/Protease Degrades Chironomid Egg Masses

    PubMed Central

    Halpern, Malka; Gancz, Hanan; Broza, Meir; Kashi, Yechezkel

    2003-01-01

    Cholera is a severe diarrheal disease caused by specific serogroups of Vibrio cholerae that are pathogenic to humans. The disease does not persist in a chronic state in humans or animals. The pathogen is naturally present as a free-living organism in the environment. Recently, it was suggested that egg masses of the nonbiting midge Chironomus sp. (Diptera) harbor and serve as a nutritive source for V. cholerae, thereby providing a natural reservoir for the organism. Here we report that V. cholerae O9, O1, and O139 supernatants lysed the gelatinous matrix of the chironomid egg mass and inhibited eggs from hatching. The extracellular factor responsible for the degradation of chironomid egg masses (egg mass degrading factor) was purified from V. cholerae O9 and O139 and was identified as the major secreted hemagglutinin/protease (HA/P) of V. cholerae. The substrate in the egg mass was characterized as a glycoprotein. These findings show that HA/P plays an important role in the interaction of V. cholerae and chironomid egg masses. PMID:12839800

  12. Sliding inguinal hernia with incarceration of urinary bladder diverticulum in a child.

    PubMed

    Ko, Po-Jui; Lin, How-Yu; Lin, Wen-Hsi; Lai, Hong-Shiee

    2010-01-01

    Although inguinal herniorrhaphy is generally safe, certain complications can occur even with an experienced pediatric surgeon. We present a case of sliding right inguinal hernia with incarceration of urinary bladder diverticulum in a 2-year-old boy. A small perforation at the anterior wall of the urinary bladder, peritonitis, and kinking of the sigmoid colon occurred after the herniorrhaphy. He received exploratory laparotomy for repairing the urinary bladder perforation hole and drainage of the ascites. An anal tube was inserted to keep the sigmoid colon patent. The patient recovered from this insult gradually with an uneventful postoperative course 10 months after the operation, until the writing of this study. Surgeons should be aware of the possibility of urinary bladder diverticulum incarceration at the inguinal canal and should perform the operation meticulously. PMID:21309417

  13. Inguinal endometriosis in a patient without a previous history of gynecologic surgery

    PubMed Central

    Kim, Da Hee; Kim, Min Jung; Park, Jong Taek; Lee, Ji Hyun

    2014-01-01

    Endometriosis, defined as growth of endometrial stroma and glands outside the uterine cavity, is a chronic and recurrent disease that affects patients' quality of life. Ectopic endometrial tissue can proliferate at any location in the body, but the pelvic organs and peritoneum are the most frequent implantation sites. Among extrapelvic endometriosis, inguinal endometriosis is a very rare gynecologic condition usually associated with previous pelvic surgery. Endometriosis should be preoperatively distinguished from other inguinal masses using computed tomography, magnetic resonance imaging, or ultrasonography. Here, we report a case of right inguinal endometriosis in a patient with no previous history of gynecologic surgery; in addition, we have provided a brief review of relevant literature. PMID:24678494

  14. Inguinal Hernia Containing Uterus, Fallopian Tube, and Ovary in a Premature Newborn

    PubMed Central

    Karadeniz Cerit, Kıvılcım; Ergelen, Rabia; Colak, Emel; Dagli, Tolga E.

    2015-01-01

    A female infant weighing 2,200 g was delivered at 34 weeks of gestation by vaginal delivery. She presented with an irreducible mass in the left inguinal region at 32 days of age. An ultrasonography (US) was performed and an incarcerated hernia containing uterus, fallopian tube, and ovary was diagnosed preoperatively. Surgery was performed through an inguinal approach; the uterus, fallopian tube, and ovary were found in the hernia sac. High ligation and an additional repair of the internal inguinal ring were performed. Patent processus vaginalis was found during contralateral exploration and also closed. The postoperative course was uneventful. After one year of follow-up, there have been no signs of recurrence. PMID:26351609

  15. Multisystem Langerhans Cell Histiocytosis in Adults Revealed by Skin Lesions.

    PubMed

    Atarguine, Hanane; Hocar, Ouafa; Oussmane, Samia; Mouafik, Sara Batoul; Hamdaoui, Abderrachid; Hafiane, Hanan; Belbaraka, Rhizlane; Akhdari, Nadia; Amal, Said

    2016-01-01

    A 37-year-old woman with no remarkable medical or family history presented with papules and vesicles on an erythematous background involving the neck, sacrum, and folds (postauricular, axillary, inguinal, and under the breasts) (Figure 1). During the previous year, she was treated with local and systemic antifungals without improvement. Her history included a secondary amenorrhea, polydipsia, and polyuria (6 L/d) that started 2 years prior. Physical examination revealed chronic bilateral purulent otorrhea with thick eardrums. Histologic examination of skin biopsy revealed a highly suggestive appearance of multisystem Langerhans cell histiocytosis (LCH) with immunohistochemistry (anti-PS100 and anti-CD1a), which were positive (Figure 2A and 2B). Pituitary magnetic resonance imaging showed a thickening of the pituitary stalk in relation to a location histiocytic (Figure 3). Bone gaps were objectified on two radiographic tibial diaphyseal. Results from computed tomography (CT) scan showed a magma coelio mesenteric, axillary, and inguinal lymph nodes. PMID:27319965

  16. Predictive modeling of cholera using GRACE and TRMM satellite data

    NASA Astrophysics Data System (ADS)

    Jutla, A.; Akanda, A. S. S.; Colwell, R. R.

    2015-12-01

    Cholera outbreaks can be classified in three forms- epidemic (sudden or seasonal outbreaks), endemic (recurrence and persistence of the disease for several consecutive years) and mixed-mode endemic (combination of certain epidemic and endemic conditions) with significant spatial and temporal heterogeneity. Endemic cholera is related to floods and droughts in regions where water and sanitation infrastructure are inadequate or insufficient. With more than a decade of terrestrial water storage (TWS) data obtained from Gravity Recovery and Climate Experiment (GRACE), understanding dynamics of river discharge is now feasible. We explored lead-lag relationships between TWS in the Ganges-Brahmaputra-Meghna (GBM) basin and endemic cholera in Bangladesh. Since bimodal seasonal peaks in cholera in Bangladesh occur during the spring and autumn season, two separate models, between TWS and disease time series (2002 to 2010) were developed. TWS, hence water availability, showed an asymmetrical, strong association with spring (τ=-0.53; p<0.001) and autumn (τ=0.45; p<0.001) cholera prevalence up to five to six months in advance. One unit (cm of water) decrease in water availability in the basin increased odds of above normal cholera by 24% [confidence interval (CI) 20-31%; p<0.05] in the spring season, while an increase in regional water by one unit, through floods, increased odds of above average cholera in the autumn by 29% [CI:22-33%; p<0.05]. Epidemic cholera is related with warm temperatures and heavy rainfall. Using TRMM data for several locations in Asia and Africa, probability of cholera increases 18% [CI:15-23%; p<0.05] after heavy precipitation resulted in a societal conditions where access to safe water and sanitation was disrupted. Results from mechanistic modeling framework using systems approach that include satellite based hydroclimatic information with tradition disease transmission models will also be presented.

  17. Survival of Vibrio cholerae O1 on fomites.

    PubMed

    Farhana, Israt; Hossain, Zenat Zebin; Tulsiani, Suhella Mohan; Jensen, Peter Kjær Mackie; Begum, Anowara

    2016-09-01

    It is well established that the contamination sources of cholera causing bacteria, Vibrio cholerae, are water and food, but little is known about the transmission role of the fomites (surfaces that can carry pathogens) commonly used in households. In the absence of appropriate nutrients or growth conditions on fomites, bacteria have been known to assume a viable but non-culturable (VBNC) state after a given period of time. To investigate whether and when V. cholerae O1 assumes such a state, this study investigated the survival and viable quantification on a range of fomites such as paper, wood, glass, plastic, cloth and several types of metals under laboratory conditions. The fomites were inoculated with an outbreak strain of V. cholerae and its culturability was examined by drop plate count method at 30 min intervals for up to 6 h. For molecular detection, the viable/dead stain ethidium monoazide (EMA) which inhibits amplification of DNA from dead cells was used in combination with real-time polymerase chain reaction (EMA-qPCR) for direct quantitative analyses of viable V. cholerae at 2, 4, 6, 24 h and 7 day time intervals. Results showed that V. cholerae on glass and aluminum surfaces lost culturability within one hour after inoculation but remained culturable on cloth and wood for up to four hours. VBNC V. cholerae on dry fomite surfaces was detected and quantified by EMA-qPCR even 7 days after inoculation. In conclusion, the prolonged survival of V. cholerae on various household fomites may play vital role in cholera transmission and needs to be further investigated.

  18. Survival of Vibrio cholerae O1 on fomites.

    PubMed

    Farhana, Israt; Hossain, Zenat Zebin; Tulsiani, Suhella Mohan; Jensen, Peter Kjær Mackie; Begum, Anowara

    2016-09-01

    It is well established that the contamination sources of cholera causing bacteria, Vibrio cholerae, are water and food, but little is known about the transmission role of the fomites (surfaces that can carry pathogens) commonly used in households. In the absence of appropriate nutrients or growth conditions on fomites, bacteria have been known to assume a viable but non-culturable (VBNC) state after a given period of time. To investigate whether and when V. cholerae O1 assumes such a state, this study investigated the survival and viable quantification on a range of fomites such as paper, wood, glass, plastic, cloth and several types of metals under laboratory conditions. The fomites were inoculated with an outbreak strain of V. cholerae and its culturability was examined by drop plate count method at 30 min intervals for up to 6 h. For molecular detection, the viable/dead stain ethidium monoazide (EMA) which inhibits amplification of DNA from dead cells was used in combination with real-time polymerase chain reaction (EMA-qPCR) for direct quantitative analyses of viable V. cholerae at 2, 4, 6, 24 h and 7 day time intervals. Results showed that V. cholerae on glass and aluminum surfaces lost culturability within one hour after inoculation but remained culturable on cloth and wood for up to four hours. VBNC V. cholerae on dry fomite surfaces was detected and quantified by EMA-qPCR even 7 days after inoculation. In conclusion, the prolonged survival of V. cholerae on various household fomites may play vital role in cholera transmission and needs to be further investigated. PMID:27430513

  19. Wind Direction and Its Linkage with Vibrio cholerae Dissemination

    PubMed Central

    Paz, Shlomit; Broza, Meir

    2007-01-01

    Background The relevance of climatic events as causative factors for cholera epidemics is well known. However, examinations of the involvement of climatic factors in intracontinental disease distribution are still absent. Objectives The spreading of cholera epidemics may be related to the dominant wind direction over land. Methods We examined the geographic diffusion of three cholera outbreaks through their linkage with the wind direction: a) the progress of Vibrio cholerae O1 biotype El Tor in Africa during 1970–1971 and b) again in 2005–2006; and c) the rapid spread of Vibrio cholerae O139 over India during 1992–1993. We also discuss the possible influence of the wind direction on windborn dissemination by flying insects, which may serve as vectors. Results Analysis of air pressure data at sea level and at several altitudes over Africa, India, and Bangladesh show a correspondence between the dominant wind direction and the intracontinental spread of cholera. Conclusions We explored the hypothesis that winds have assisted the progress of cholera Vibrios throughout continents. The current analysis supports the hypothesis that aeroplankton (the tiny life forms that float in the air and that may be caught and carried upward by the wind, landing far from their origin) carry the cholera bacteria from one body of water to an adjacent one. This finding may improve our understanding of how climatic factors are involved in the rapid distribution of new strains throughout a vast continental area. Awareness of the aerial transfer of Vibrio cholerae may assist health authorities by improving the prediction of the disease’s geographic dissemination. PMID:17384764

  20. Cholera Outbreak in Senegal in 2005: Was Climate a Factor?

    PubMed Central

    Constantin de Magny, Guillaume; Thiaw, Wassila; Kumar, Vadlamani; Manga, Noël M.; Diop, Bernard M.; Gueye, Lamine; Kamara, Mamina; Roche, Benjamin; Murtugudde, Raghu; Colwell, Rita R.

    2012-01-01

    Cholera is an acute diarrheal illness caused by Vibrio cholerae and occurs as widespread epidemics in Africa. In 2005, there were 31,719 cholera cases, with 458 deaths in the Republic of Senegal. We retrospectively investigated the climate origin of the devastating floods in mid-August 2005, in the Dakar Region of Senegal and the subsequent outbreak of cholera along with the pattern of cholera outbreaks in three other regions of that country. We compared rainfall patterns between 2002 and 2005 and the relationship between the sea surface temperature (SST) gradient in the tropical Atlantic Ocean and precipitation over Senegal for 2005. Results showed a specific pattern of rainfall throughout the Dakar region during August, 2005, and the associated rainfall anomaly coincided with an exacerbation of the cholera epidemic. Comparison of rainfall and epidemiological patterns revealed that the temporal dynamics of precipitation, which was abrupt and heavy, was presumably the determining factor. Analysis of the SST gradient showed that the Atlantic Ocean SST variability in 2005 differed from that of 2002 to 2004, a result of a prominent Atlantic meridional mode. The influence of this intense precipitation on cholera transmission over a densely populated and crowded region was detectable for both Dakar and Thiès, Senegal. Thus, high resolution rainfall forecasts at subseasonal time scales should provide a way forward for an early warning system in Africa for cholera and, thereby, trigger epidemic preparedness. Clearly, attention must be paid to both natural and human induced environmental factors to devise appropriate action to prevent cholera and other waterborne disease epidemics in the region. PMID:22952995

  1. Anatomical examination of the great inguinal blood vessels in preterm and term neonates.

    PubMed

    Eifinger, Frank; Lazaridis, Elpida Chochliourou; Roth, Bernhard; Koebke, Jürgen

    2014-04-01

    It is generally accepted that vessel cannulation is technically more difficult and results in more complications in neonates. A sound anatomical knowledge of the inguinal area is therefore important in the selection of appropriately sized central line catheters as well as the approach to central vessel access. Eleven stillborns were investigated. Birth weight (mean: 2,414 g, 900-4,100 g) and gestational age (mean 34 1/7 weeks', 27 6/7-42 1/7) varied within normal range. The outer diameters of the femoral artery (FA), femoral vein (FV), and great saphenous vein (GSV) were determined. The distance between the anterior superior iliac spine and the pubic tubercle was set as 100% and the vessel intersection points were calculated as percentage values of the inguinal ligament length, starting at the iliac spine. The FA has a diameter of 1.9 ± 0.5 mm without correlation to gestational age. The FA crosses the inguinal ligament centrally. The FV has a diameter of 3.1 ± 1.0 mm and does have correlation to gestational age. The FV crosses the inguinal ligament at 63-64%. The GSV has a diameter of 1.4 ± 0.7 mm. Its point of intersection at the level of the inguinal ligament is 68-70%. We conclude that cannulation of the femoral artery or vein should not be performed too far (<1 cm) from the inguinal ligament. The course of the GSV is not suitable for catheter insertion.

  2. Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia

    PubMed Central

    Nazem, Masoud; Dastgerdi, Mohamad Masoud Heydari; Sirousfard, Motaherh

    2015-01-01

    Background: Considering that complications and outcome of each method of pediatric inguinal hernia repair are one of the determinants for pediatric surgeons for selection of the appropriate surgical technique, we compared the early and late complications of two inguinal repair techniques, with and without opening the external oblique muscle fascia. Materials and Methods: In this double-blind clinical trial study, boy children aged 1-month to 6 years with diagnosed inguinal hernia were included and randomly allocated into two groups for undergoing two types of hernia repair techniques, with and without opening the external oblique muscle fascia. Surgical complications such as fever, scrotal edema and hematoma, and wound infections classified as early complication and recurrence, testis atrophy and sensory impairment of inguinal area classified as late complications. The rates of mentioned early and late complications were compared in the two interventional groups. Results: In this study, 66 patients were selected and allocated to the two interventional groups. The prevalence of early and late complications in two studied groups were not different significantly in two interventional groups (P > 0.05). Operation time was significantly shorter in inguinal repair techniques without opening the external oblique muscle fascia than the other studied technique (P = 0.001). Conclusion: The findings of our study indicated that though early and late complications of the two repair methods were similar, but the time of procedure was shorter in herniotomy without opening the external oblique muscle, which considered the superiority of this method than inguinal hernia repair with opening the external oblique muscle. PMID:26958052

  3. Outcomes after concurrent inguinal hernia repair and robotic-assisted radical prostatectomy.

    PubMed

    Kyle, Christopher C; Hong, Matthew K H; Challacombe, Benjamin J; Costello, Anthony J

    2010-12-01

    Inguinal hernias occur more frequently following radical prostatectomy. Simultaneous inguinal hernia repair during open and laparoscopic radical prostatectomy for prostate cancer has been described previously. The emergence of robotic-assisted radical prostatectomy (RALP) has necessitated the evaluation of concomitant herniorrhaphy in this new setting. We report the outcomes of this operation in our series of patients. Retrospective review was performed on 700 patients with localised prostate cancer who underwent RALP performed by a single surgeon from 2004 to 2009. Details of cases where concurrent inguinal hernia repair was performed were recorded and compared with the remainder of the cohort. Hernia repair was performed using a monofilament knitted polypropylene cone mesh plug and fascial defect closure with Hem-o-Lok clips. A total of 38 inguinal herniorraphies were performed in 37 patients as a simultaneous procedure during transperitoneal RALP. The hernia repair on average added 5-10 min to the total procedure time. One patient underwent a bilateral repair. Across this group, mean age was 62.9 years, average body mass index was 27.1, and median follow-up was 29 months. There were no complications at the time of mesh placement. There were no cases complicated by wound infection, fluid collection, or chronic pain. Recurrence of an inguinal hernia occurred in one patient due to migration of the mesh. We conclude that concomitant inguinal hernia repair during RALP is safe, feasible, and effective. The herniorrhaphy can be performed quickly, adds little to the overall procedure time and avoids a further operative procedure for the patient. PMID:27627948

  4. A successful laparoscopic neovaginoplasty using peritoneum in Müllerian agenesis with inguinal ovaries accompanied by primary ovarian insufficiency

    PubMed Central

    Gweon, Seonghye; Lee, Jisun; Hwang, Suna; Hwang, Kyoung Joo

    2016-01-01

    The combination of Müllerian agenesis with inguinal ovaries accompanied by primary ovarian insufficiency is extremely rare. A 21-year-old Korean woman was referred to our center with primary amenorrhea. The patient was diagnosed with Müllerian agenesis with inguinal ovaries. Her hormonal profile showed hypergonadotrophic hypogonadism suggesting primary ovarian insufficiency. We performed laparoscopic neovaginoplasty using modified Davydov's procedure and reposition inguinal ovaries in the pelvic cavity. Oral estrogen replacement was applied for the treatment of primary ovarian insufficiency. This is a rare case report on Mayer-Rokitansky-Kuster-Hauser syndrome accompanied not only by inguinal ovaries but also with primary ovarian insufficiency. We present our first experience on the laparoscopic neovaginoplasty performed on the patient with müllerian agenesis accompanied by inguinal ovaries and primary ovarian insufficiency. PMID:27462606

  5. Radiotherapy of stage I and II Hodgkin disease with inguinal presentation

    SciTech Connect

    Lanzillo, J.H.; Moylan, D.J.; Mohiuddin, M.; Kramer, S.

    1985-01-01

    Seventeen patients who presented with inguinal adenopathy were found to have stage I or II infradiaphragmatic Hodgkin disease. Two patients with stage IIB disease also received MOPP chemotherapy. Fifteen patients currently have no evidence of recurrence; one died of acute myelogenous leukemia 6 years after total nodal irradiation, while another died of cardiopulmonary disease but had no evidence of Hodgkin disease at autopsy. In one patient, progressive peripheral atherosclerosis developed in an irradiated inguinal area, requiring angioplasty. Patient characteristics and results of treatment are analyzed and implications for management presented.

  6. An Uncommon Case of Adolescent Ovarian Teratoma Incarcerated in Inguinal Hernia

    PubMed Central

    Girgenti, Vincenza; Cimador, Marcello; Li Voti, Giuseppe

    2016-01-01

    Mature cystic teratoma is the most frequent benign ovarian neoplastic lesion in adolescents and is generally composed of fully differentiated tissue arising from multipotential three germinal layers. It accounts for approximately 50% of benign ovarian tumors in childhood. Rarely, a bilateral, synchronous, or metachronous presentation can be observed, supporting a conservative approach as the first surgical approach. We report a case of an ovarian mature cystic incarcerated in indirect inguinal hernia in a 15-year-old girl undergoing ovary-sparing surgery. To our knowledge this is the first case of such lesion incarcerated in an inguinal hernia reported in literature. PMID:27525145

  7. Unusual cause of pneumomediastinum in a laparoscopic extraperitoneal inguinal hernia repair

    PubMed Central

    Teng, Tze Yeong; Lau, Cheryl Chien-Li

    2014-01-01

    Pneumomediastinum is an extremely rare complication after laparoscopic inguinal hernia repair. Very few cases have been reported in the surgical literature to date and most reports indicate pneumoperitoneum from the transabdominal preperitoneal approach as a causative factor. This case report describes a patient in whom an elective total extraperitoneal inguinal hernia repair was complicated by a pneumomediastinum without concomitant pneumoperitoneum, and identifies the tracking of air along the anterior extraperitoneal space and endothoracic fascia as a cause. Previous case reports were reviewed and possible etiologies are discussed. PMID:25348336

  8. Scrotal distension after endoscopic harvesting of the saphenous vein in patients with inguinal hernia.

    PubMed

    Najam, Osman; Krishnamoorthy, Bhuvana; Kadir, Isaac; Karagounis, Apostolos Paul; Waterworth, Paul; Fildes, James E; Yonan, Nizar

    2011-08-01

    The great saphenous vein remains the most commonly used conduit for coronary artery bypass grafting. The endoscopic vein harvesting technique is widely used due to reduced postoperative complications. We present the case of 5 patients with a history of inguinal hernia undergoing coronary artery bypass grafting, which resulted in CO2 infiltration through the deep inguinal ring and into the scrotum leading to acute scrotal enlargement. Due to the risk of impediment of vascular blood supply and necrosis, endoscopic vein harvesting was withdrawn, and the vein was harvested by using the bridging technique. Postoperatively, severe contusion, inflammation, and erythematous vesicular eruption resulted in a lengthened hospital stay.

  9. Indirect Inguinal Hernia Containing a Fallopian Tube and Ovary in a Reproductive Aged Woman

    PubMed Central

    Graul, Ashley; Ko, Emily

    2014-01-01

    An indirect inguinal hernia containing an incarcerated fallopian tube and ovary is extremely rare in adult females. The current report describes a woman of reproductive years presenting with an irreducible indirect hernia which required the surgical intervention of a general surgeon as well as counseling regarding future fertility by a gynecologist. The diagnosis was made by physical and sonographic examination and was confirmed by CT scan and surgical intervention. We suggest a multimodel and multidisciplinary approach in order to safely and efficiently preserve ovarian and fertility function in young women who present with an inguinal hernia containing reproductive organs. PMID:25028618

  10. New developments in the understanding of cholera.

    PubMed

    Butler, T

    2001-08-01

    Recent advances in prevention and treatment of cholera have occurred in the areas of vaccine testing, modifications of oral-rehydration solutions (ORS), and antimicrobial treatment. Oral vaccines consisting of killed whole bacterial cells (WC) with and without the B-subunit of cholera toxin (BS) were shown to be effective in large trials in Bangladesh, Peru, and Vietnam. However, the trials did not resolve whether two or three doses of vaccine are required and whether BS adds significantly to the immune protection of WC. Live, attenuated bacterial vaccines that are immunogenic and have been shown protective in human volunteer studies are candidates for future field trials. Rehydration of patients is a life- saving effort. The best ORS contains rice powder in place of glucose, and solutions with reduced osmolarity (245 mOsm/L, sodium 75 mEq/L) are as effective as standard ORS. Ciprofloxacin in a single dose is effective in adults, and erythromycin or ampicillin in multiple doses is effective in children. PMID:11470000

  11. Cholera toxin interactions with lipid bilayers.

    PubMed

    Tosteson, M T; Tosteson, D C; Rubnitz, J

    1980-01-01

    The purpose of the experiments described in this paper was to assess the binding of cholera toxin to bilayers containing its receptor, the monosialoganglioside, GMl. The assay was based on the fact that GMl confers on the bilayer a negative surface charge. The magnitude of this surface charge was estimated by measuring the electrical conductance (G) of the bilayers exposed to nonactin-K+ under conditions where G is directly proportional to the potassium concentration in the aqueous solutions immediatey adjacent to the membrane surface. When bilayers were formed from mixtures of GMl and glycerolmonooleate (GMO), it was found that the molar ratio of the lipids in the bilayer was the same as that in the membrane forming solution. It was further found that cholera toxin or the binding subunit of the toxin (choleragenoid) bind to GMO bilayers containing GMl (but not to GMO bilayers containing phosphatidyl serine or disialoganglioside GDla). The value of the apparent dissociation constant for the binding of choleragen to its receptor was found to be 10(-11) M, comparable to values found in intact cells.

  12. In Vitro Inhibition of Cholera Toxin Production in Vibrio cholerae by Methanol Extract of Sweet Fennel Seeds and Its Components.

    PubMed

    Chatterjee, Shruti; Zahid, M Shamim Hasan; Awasthi, Sharda Prasad; Chowdhury, Nityananda; Asakura, Masahiro; Hinenoya, Atsushi; Ramamurthy, T; Iwaoka, Emiko; Aoki, Shunji; Yamasaki, Shinji

    2016-09-21

    A newly emerged Vibrio cholerae O1 El Tor variant strain with multidrug resistance is considered a threat to public health. Recent strategies to suppress virulence factors production instead of bacterial growth may lead to less selective pressure for the emergence of resistant strains. The use of spices and their active constituents as the inhibitory agents against cholera toxin (CT) production in V. cholerae may be an alternative approach to treat cholera. In this study, we examined the potential of sweet fennel seed (Foeniculum vulgare Miller var. dulce) methanol extract to inhibit CT production in V. cholerae without affecting viability. The methanol extract of sweet fennel seeds significantly inhibited CT production in various V. cholerae strains, regardless of serogroup or biotype. Interestingly, trans-anethole and 4-allylanisole, essential oil components of sweet fennel seeds, also demonstrated similar effects. Here, we report that sub-bactericidal concentrations of sweet fennel seed methanol extract and its major components can drastically inhibit CT production in various V. cholerae strains.

  13. In Vitro Inhibition of Cholera Toxin Production in Vibrio cholerae by Methanol Extract of Sweet Fennel Seeds and Its Components.

    PubMed

    Chatterjee, Shruti; Zahid, M Shamim Hasan; Awasthi, Sharda Prasad; Chowdhury, Nityananda; Asakura, Masahiro; Hinenoya, Atsushi; Ramamurthy, T; Iwaoka, Emiko; Aoki, Shunji; Yamasaki, Shinji

    2016-09-21

    A newly emerged Vibrio cholerae O1 El Tor variant strain with multidrug resistance is considered a threat to public health. Recent strategies to suppress virulence factors production instead of bacterial growth may lead to less selective pressure for the emergence of resistant strains. The use of spices and their active constituents as the inhibitory agents against cholera toxin (CT) production in V. cholerae may be an alternative approach to treat cholera. In this study, we examined the potential of sweet fennel seed (Foeniculum vulgare Miller var. dulce) methanol extract to inhibit CT production in V. cholerae without affecting viability. The methanol extract of sweet fennel seeds significantly inhibited CT production in various V. cholerae strains, regardless of serogroup or biotype. Interestingly, trans-anethole and 4-allylanisole, essential oil components of sweet fennel seeds, also demonstrated similar effects. Here, we report that sub-bactericidal concentrations of sweet fennel seed methanol extract and its major components can drastically inhibit CT production in various V. cholerae strains. PMID:26902215

  14. Methods to Assess the Impact of Mass Oral Cholera Vaccination Campaigns under Real Field Conditions

    PubMed Central

    Deen, Jacqueline; Ali, Mohammad; Sack, David

    2014-01-01

    There is increasing interest to use oral cholera vaccination as an additional strategy to water and sanitation interventions against endemic and epidemic cholera. There are two internationally-available and WHO-prequalified oral cholera vaccines: an inactivated vaccine containing killed whole-cells of V. cholerae O1 with recombinant cholera toxin B-subunit (WC/rBS) and a bivalent inactivated vaccine containing killed whole cells of V. cholerae O1 and V. cholerae O139 (BivWC). The efficacy, effectiveness, direct and indirect (herd) protection conferred by WC/rBS and BivWC are well established. Yet governments may need local evidence of vaccine impact to justify and scale-up mass oral cholera vaccination campaigns. We discuss various approaches to assess oral cholera vaccine protection, which may be useful to policymakers and public health workers considering deployment and evaluation of the vaccine. PMID:24516595

  15. Construction and Evaluation of V. cholerae O139 Mutant, VCUSM21P, as a Safe Live Attenuated Cholera Vaccine

    PubMed Central

    Murugaiah, Chandrika; Nik Mohd Noor, Nik Zuraina; Mustafa, Shyamoli; Manickam, Ravichandran; Pattabhiraman, Lalitha

    2014-01-01

    Cholera is a major infectious disease, affecting millions of lives annually. In endemic areas, implementation of vaccination strategy against cholera is vital. As the use of safer live vaccine that can induce protective immunity against Vibrio cholerae O139 infection is a promising approach for immunization, we have designed VCUSM21P, an oral cholera vaccine candidate, which has ctxA that encodes A subunit of ctx and mutated rtxA/C, ace and zot mutations. VCUSM21P was found not to disassemble the actin of HEp2 cells. It colonized the mice intestine approximately 1 log lower than that of the Wild Type (WT) strain obtained from Hospital Universiti Sains Malaysia. In the ileal loop assay, unlike WT challenge, 1×106 and 1×108 colony forming unit (CFU) of VCUSM21P was not reactogenic in non-immunized rabbits. Whereas, the reactogenicity caused by the WT in rabbits immunized with 1×1010 CFU of VCUSM21P was found to be reduced as evidenced by absence of fluid in loops administered with 1×102–1×107 CFU of WT. Oral immunization using 1×1010 CFU of VCUSM21P induced both IgA and IgG against Cholera Toxin (CT) and O139 lipopolysaccharides (LPS). The serum vibriocidal antibody titer had a peak rise of 2560 fold on week 4. Following Removable Intestinal Tie Adult Rabbit Diarrhoea (RITARD) experiment, the non-immunized rabbits were found not to be protected against lethal challenge with 1×109 CFU WT, but 100% of immunized rabbits survived the challenge. In the past eleven years, V. cholerae O139 induced cholera has not been observed. However, attenuated VCUSM21P vaccine could be used for vaccination program against potentially fatal endemic or emerging cholera caused by V. cholerae O139. PMID:24505241

  16. Skin Biomes.

    PubMed

    Fyhrquist, N; Salava, A; Auvinen, P; Lauerma, A

    2016-05-01

    The cutaneous microbiome has been investigated broadly in recent years and some traditional perspectives are beginning to change. A diverse microbiome exists on human skin and has a potential to influence pathogenic microbes and modulate the course of skin disorders, e.g. atopic dermatitis. In addition to the known dysfunctions in barrier function of the skin and immunologic disturbances, evidence is rising that frequent skin disorders, e.g. atopic dermatitis, might be connected to a dysbiosis of the microbial community and changes in the skin microbiome. As a future perspective, examining the skin microbiome could be seen as a potential new diagnostic and therapeutic target in inflammatory skin disorders.

  17. Bovine lactogenic immunity against cholera toxin-related enterotoxins and Vibrio cholerae outer membranes.

    PubMed Central

    Boesman-Finkelstein, M; Walton, N E; Finkelstein, R A

    1989-01-01

    The newly parturient cow secretes large quantities of immunoglobulin G1, a relatively protease- and heat-resistant immunoglobulin, in its colostrum and milk. This study establishes the feasibility of producing protective colostral immunoglobulins by immunizing pregnant cows with cholera toxin (CT), a CT-related enterotoxin from Escherichia coli, and Vibrio cholerae outer membranes (OMs). The OMs were prepared from bacteria grown under iron-replete or iron-deficient (to simulate the in vivo environment) conditions. Immunoglobulins were purified from the colostrum of newly parturient control and immunized cows. The bovine anti-CT and anti-H-LT (CT-related heat-labile enterotoxin produced by diarrheogenic E. coli strains of human origin) antibodies were quantitated by enzyme-linked immunosorbent assays and by neutralization of toxin activity in both Y-1 adrenal cell and infant rabbit assays. The bovine anti-OM antibodies from both high-iron-grown and low-iron-grown vibrios were assessed by bacterial agglutination and by Western blot (immunoblot) analysis of polyacrylamide gel electrophoresis of high-iron-grown and low-iron-grown OMs. To test their protective effect, immunoglobulin preparations were administered orally in infant feeding formula to 6-day-old rabbits. Anti-CT and anti-OM immunoglobulins elicited statistically significant protection against diarrhea in infant rabbits challenged intraintestinally with virulent cholera vibrios. Images PMID:2925248

  18. Cellulose acetate phthalate microparticles containing Vibrio cholerae: steps toward an oral cholera vaccine.

    PubMed

    Pastor, Marta; Esquisabel, Amaia; Marquínez, Iratxe; Talavera, Arturo; Pedraz, José Luis

    2014-07-01

    Oral cholera vaccine (OCV) has been recommended in some endemic areas and epidemic situations since 1999. Although safe and effective vaccines are currently on the market, the burden of transport and storage remains an issue. Herein, we report an approach to develop an alternative OCV in the form of a gastro-resistant powder. Heat-killed Vibrio cholerae (VC) was encapsulated with a spray-drying technique at different temperatures. Cellulose acetate phthalate (Aquacoat® CPD) was chosen as the core polymer and the addition of alginate was studied. The microparticles (MPs) produced were characterized by surface morphology, particle size, drug loading, antigenicity and gastro resistance. The MPs obtained were 6 µm in size and had appropriate drug content, ranging from 8.16 to 8.64%. Furthermore, antigenicity was maintained, never dropping below 85%, and enteric properties were achieved for all the formulations. Next, an in vivo study was carried out with Aquacoat® CPD MP prepared at 80 °C with and without alginate. Two different doses were assayed, 30 and 60 mg, and compared to the VC suspension. The evoked immune responses showed that alginate containing MPs, especially at the 30 mg dose, displayed values that were very similar to those of VC. In conclusion, spray-dried alginate VC MPs seem to be a promising step toward a powder-form cholera vaccination.

  19. Chemical ions affect survival of avian cholera organisms in pondwater

    USGS Publications Warehouse

    Price, J.I.; Yandell, B.S.; Porter, W.P.

    1992-01-01

    Avian cholera (Pasteurella multocida) is a major disease of wild waterfowl, but its epizootiology remains little understood. Consequently, we examined whether chemical ions affected survival of avian cholera organisms in water collected from the Nebraska Rainwater Basin where avian cholera is enzootic. We tested the response of P. multocida to ammonium (NH4), calcium (Ca), magnesium (Mg), nitrate (NO3), and ortho-phosphate (PO4) ions individually and in combination using a fractional factorial design divided into 4 blocks. High concentrations of Ca and Mg, singly or in combination, increased survival of P. multocida organisms (P < 0.001). We developed a survival index to predict whether or not specific ponds could be "problem" or "nonproblem" avian cholera sites based on concentrations of these ions in the water.

  20. Cholera Toxin B: One Subunit with Many Pharmaceutical Applications

    PubMed Central

    Baldauf, Keegan J.; Royal, Joshua M.; Hamorsky, Krystal Teasley; Matoba, Nobuyuki

    2015-01-01

    Cholera, a waterborne acute diarrheal disease caused by Vibrio cholerae, remains prevalent in underdeveloped countries and is a serious health threat to those living in unsanitary conditions. The major virulence factor is cholera toxin (CT), which consists of two subunits: the A subunit (CTA) and the B subunit (CTB). CTB is a 55 kD homopentameric, non-toxic protein binding to the GM1 ganglioside on mammalian cells with high affinity. Currently, recombinantly produced CTB is used as a component of an internationally licensed oral cholera vaccine, as the protein induces potent humoral immunity that can neutralize CT in the gut. Additionally, recent studies have revealed that CTB administration leads to the induction of anti-inflammatory mechanisms in vivo. This review will cover the potential of CTB as an immunomodulatory and anti-inflammatory agent. We will also summarize various recombinant expression systems available for recombinant CTB bioproduction. PMID:25802972

  1. Cholera in Haiti and Other Caribbean Regions, 19th Century

    PubMed Central

    Szabo, Victoria

    2011-01-01

    Medical journals and other sources do not show evidence that cholera occurred in Haiti before 2010, despite the devastating effect of this disease in the Caribbean region in the 19th century. Cholera occurred in Cuba in 1833–1834; in Jamaica, Cuba, Puerto Rico, St. Thomas, St. Lucia, St. Kitts, Nevis, Trinidad, the Bahamas, St. Vincent, Granada, Anguilla, St. John, Tortola, the Turks and Caicos, the Grenadines (Carriacou and Petite Martinique), and possibly Antigua in 1850–1856; and in Guadeloupe, Cuba, St. Thomas, the Dominican Republic, Dominica, Martinique, and Marie Galante in 1865–1872. Conditions associated with slavery and colonial military control were absent in independent Haiti. Clustered populations, regular influx of new persons, and close quarters of barracks living contributed to spread of cholera in other Caribbean locations. We provide historical accounts of the presence and spread of cholera epidemics in Caribbean islands. PMID:22099117

  2. Environmental reservoirs and mechanisms of persistence of Vibrio cholerae

    PubMed Central

    Lutz, Carla; Erken, Martina; Noorian, Parisa; Sun, Shuyang; McDougald, Diane

    2013-01-01

    It is now well accepted that Vibrio cholerae, the causative agent of the water-borne disease cholera, is acquired from environmental sources where it persists between outbreaks of the disease. Recent advances in molecular technology have demonstrated that this bacterium can be detected in areas where it has not previously been isolated, indicating a much broader, global distribution of this bacterium outside of endemic regions. The environmental persistence of V. cholerae in the aquatic environment can be attributed to multiple intra- and interspecific strategies such as responsive gene regulation and biofilm formation on biotic and abiotic surfaces, as well as interactions with a multitude of other organisms. This review will discuss some of the mechanisms that enable the persistence of this bacterium in the environment. In particular, we will discuss how V. cholerae can survive stressors such as starvation, temperature, and salinity fluctuations as well as how the organism persists under constant predation by heterotrophic protists. PMID:24379807

  3. Cholera associated with imported frozen coconut milk--Maryland, 1991.

    PubMed

    1991-12-13

    During August 1991, three cases of cholera in Maryland were associated with the consumption of frozen coconut milk imported from Asia. Following an investigation, the product was recalled, and no other cases have been reported. PMID:1961175

  4. Chitin and Products of Its Hydrolysis in Vibrio cholerae Ecology.

    PubMed

    Markov, E Yu; Kulikalova, E S; Urbanovich, L Ya; Vishnyakov, V S; Balakhonov, S V

    2015-09-01

    The role of chitin and its hydrolysis products generated by Vibrio cholerae chitinases in mechanisms of its adaptation in water environments, metabolism, preservation, acquisition of pathogenic potential, and its epidemiological value are reviewed. Chitin utilization by V. cholerae as a source of energy, carbon, and nitrogen is described. Chitin association promotes biofilm formation on natural chitinous surfaces, increasing V. cholerae resistance to adverse factors in ecological niches: the human body and water environments with its inhabitants. Hydrolytic enzymes regulated by the corresponding genes result in complete chitin biodegradation by a chitinolytic catabolic cascade. Consequences of V. cholerae cell and chitin interaction at different hierarchical levels include metabolic and physiological cell reactions such as chemotaxis, cell division, biofilm formation, induction of genetic competence, and commensalic and symbiotic mutual relations with higher organisms, nutrient cycle, pathogenicity for humans, and water organisms that is an example of successful interrelation of bacteria and substratum in the ecology of the microorganism.

  5. Environmental reservoirs and mechanisms of persistence of Vibrio cholerae.

    PubMed

    Lutz, Carla; Erken, Martina; Noorian, Parisa; Sun, Shuyang; McDougald, Diane

    2013-01-01

    It is now well accepted that Vibrio cholerae, the causative agent of the water-borne disease cholera, is acquired from environmental sources where it persists between outbreaks of the disease. Recent advances in molecular technology have demonstrated that this bacterium can be detected in areas where it has not previously been isolated, indicating a much broader, global distribution of this bacterium outside of endemic regions. The environmental persistence of V. cholerae in the aquatic environment can be attributed to multiple intra- and interspecific strategies such as responsive gene regulation and biofilm formation on biotic and abiotic surfaces, as well as interactions with a multitude of other organisms. This review will discuss some of the mechanisms that enable the persistence of this bacterium in the environment. In particular, we will discuss how V. cholerae can survive stressors such as starvation, temperature, and salinity fluctuations as well as how the organism persists under constant predation by heterotrophic protists.

  6. Cholera in Haiti: Reproductive numbers and vaccination coverage estimates

    NASA Astrophysics Data System (ADS)

    Mukandavire, Zindoga; Smith, David L.; Morris, J. Glenn, Jr.

    2013-01-01

    Cholera reappeared in Haiti in October, 2010 after decades of absence. Cases were first detected in Artibonite region and in the ensuing months the disease spread to every department in the country. The rate of increase in the number of cases at the start of epidemics provides valuable information about the basic reproductive number (). Quantitative analysis of such data gives useful information for planning and evaluating disease control interventions, including vaccination. Using a mathematical model, we fitted data on the cumulative number of reported hospitalized cholera cases in Haiti. varied by department, ranging from 1.06 to 2.63. At a national level, 46% vaccination coverage would result in an () <1, which would suppress transmission. In the current debate on the use of cholera vaccines in endemic and non-endemic regions, our results suggest that moderate cholera vaccine coverage would be an important element of disease control in Haiti.

  7. Cholera Outbreak in Grande Comore: 1998–1999

    PubMed Central

    Troeger, Christopher; Gaudart, Jean; Truillet, Romain; Sallah, Kankoe; Chao, Dennis L.; Piarroux, Renaud

    2016-01-01

    In 1998, a cholera epidemic in east Africa reached the Comoros Islands, an archipelago in the Mozambique Channel that had not reported a cholera case for more than 20 years. In just a little over 1 year (between January 1998 and March 1999), Grande Comore, the largest island in the Union of the Comoros, reported 7,851 cases of cholera, about 3% of the population. Using case reports and field observations during the medical response, we describe the epidemiology of the 1998–1999 cholera epidemic in Grande Comore. Outbreaks of infectious diseases on islands provide a unique opportunity to study transmission dynamics in a nearly closed population, and they may serve as stepping-stones for human pathogens to cross unpopulated expanses of ocean. PMID:26572869

  8. Antibody response in the intestinal secretions of volunteers immunized with various cholera vaccines*

    PubMed Central

    Ganguly, R.; Clem, L. W.; Benčić, Z.; Sinha, R.; Sakazaki, R.; Waldman, R. H.

    1975-01-01

    The efficacy of various cholera vaccines in eliciting an intestinal antibody response was assessed in human volunteers who received oral live, oral killed, or parenteral cholera vaccines, or placebo. The intestinal immune response in terms of antibacterial and antitoxin antibodies was determined 2 and 4 weeks after immunization. By means of the mouse peritoneum opsonization assay and the infant mouse protection test, antibacterial activity could be detected in the intestinal secretions of volunteers who had been immunized either orally or by the parenteral route. Significant protective activity and duration of immunity were observed with the oral killed vaccine. The bacteriological data indicated the absence of significant intestinal colonization of the live attenuated strain after oral administration, and probably explains the observed lack of effectiveness of the oral vaccine compared with that of the killed vaccine. The predominant immunoglobulin class of intestinal antibody was found to be IgA. None of the vaccines used in the study elicited significant antitoxin activity in the intestinal secretions, as determined by the skin permeability neutralization test. PMID:779998

  9. Hydroclimatic Extremes and Cholera Dynamics in the 21st Century

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A. S.; Islam, S.

    2012-12-01

    Cholera, an acute water-borne diarrheal illness, has reemerged as a significant health threat across much of the developing world. Despite major advances in the ecological and the microbiological understanding of the causative agent, V. cholerae, the role of the underlying climatic and environmental processes in propagating transmission is not adequately understood. Recent findings suggest a more prominent role of hydroclimatic extremes - droughts and floods - on the unique dual cholera peaks in the Bengal Delta region of South Asia, the native homeland of cholera. Increasing water scarcity and abundance, and coastal sea-level rise, influenced by changing climate patterns and large-scale climatic phenomena, is likely to adversely impact cholera transmission in South Asia. We focus on understanding how associated changes in macro-scale conditions in this region will impact micro-scale processes related to cholera in coming decades. We use the PRECIS Regional Climate Model over the Ganges-Brahmaputra-Meghna (GBM) basin region to simulate detailed high resolution projections of climate patterns for the 21st century. Precipitation outputs are analyzed for the 1980-2040 period to identify the trends and changes in hydroclimatic extremes and potential impacts on cholera dynamics over the next three decades (2010-2040), in relation to the cholera surveillance operations over the past three decades (1980-2010). We find that an increased number of extreme precipitation events with prolonged dry periods in the Ganges basin region will likely adversely affect dry season cholera outbreaks. Increased monsoon precipitation volumes in the Brahmaputra basin catchments are likely to cause record floods and subsequently trigger large epidemics in downstream areas. Our results provide new insight by identifying the changes in the two distinctly different, pre and post monsoon, cholera transmission mechanisms related to large-scale climatic controls that prevail in the region. A

  10. Cholera vaccine: new preventive tool for endemic countries.

    PubMed

    Verma, Ramesh; Khanna, Pardeep; Chawla, Suraj

    2012-05-01

    Cholera is a major global public health problem and remains an important threat in almost every developing country, especially in areas where population overcrowding and poor sanitation are common, such as slums and refugee camps. Cholera is one of the most dreaded diseases in the world, in some cases leading to death within 24 h if left untreated. Without treatment, severe infection has a mortality rate of 30-50%. In 2007, WHO recorded 177,963 cholera cases and 4,031 deaths worldwide. However, the estimated actual burden of cholera is in the vicinity of 3 to 5 million cases and 100,000 to 130,000 deaths per year. The disease is endemic to parts of Africa, Asia, the Middle East and South America. Large outbreaks are common after natural disasters or in populations displaced by war, where there is inadequate sewage disposal and contaminated water. In India, during the 10-y period (1997-2006) studied, the states having the highest number of reported outbreaks were West Bengal, Orissa, Maharashtra and Kerala, which together accounted for 60% of all reported outbreaks. A review of cholera cases in India reported to WHO from 2003-2007 showed that the numbers were in the few thousands with a case fatality rate of < 1%. However, it is believed that the number of cholera cases and deaths occurring annually in India is much greater than the number reported. A literature review covering a four-year period from 2003 to 2006 found reported cholera outbreaks in 18 of the 35 States and Union Territories of India. Of these, 11 had cholera outbreaks reported for multiple years. Vietnam has produced a cheaper variant of killed whole-cell vaccine devoid of the B subunit. This vaccine contains both Vibrio cholerae O1 and O139, and provides 50 per cent protection for at least three years after vaccination. For endemic cholera, population-level immunity is relatively high, making control possible with relatively low vaccine coverage levels. This vaccine should be used in areas where

  11. Community health facility preparedness for a cholera surge in Haiti.

    PubMed

    Mobula, Linda Meta; Jacquet, Gabrielle A; Weinhauer, Kristin; Alcidas, Gladys; Thomas, Hans-Muller; Burnham, Gilbert

    2013-01-01

    With increasing population displacement and worsening water insecurity after the 2010 earthquake, Haiti experienced a large cholera outbreak. Our goal was to evaluate the strengths and weaknesses of seven community health facilities' ability to respond to a surge in cholera cases. Since 2010, Catholic Relief Services (CRS) with a number of public and private donors has been working with seven health facilities in an effort to reduce morbidity and mortality from cholera infection. In November 2012, CRS through the Centers for Disease Control and Prevention (CDC)'s support, asked the Johns Hopkins Center for Refugee and Disaster Response to conduct a cholera surge simulation tabletop exercise at these health facilities to improve each facility's response in the event of a cholera surge. Using simulation development guidelines from the Pan American Health Organization and others, a simulation scenario script was produced that included situations of differing severity, supply chain, as well as a surge of patients. A total of 119 hospital staff from seven sites participated in the simulation exercise including community health workers, clinicians, managers, pharmacists, cleaners, and security guards. Clinics that had challenges during the simulated clinical care of patients were those that did not appropriately treat all cholera patients according to protocol, particularly those that were vulnerable, those that would need additional staff to properly treat patients during a surge of cholera, and those that required a better inventory of supplies. Simulation-based activities have the potential to identify healthcare delivery system vulnerabilities that are amenable to intervention prior to a cholera surge.

  12. Transcript changes in Vibrio cholerae in response to salt stress.

    PubMed

    Fu, Xiuping; Liang, Weili; Du, Pengcheng; Yan, Meiying; Kan, Biao

    2014-01-01

    Vibrio cholerae, which is a serious human intestinal pathogen, often resides and thrives in estuaries but requires major self-regulation to overcome intestinal hyperosmotic stress or high salt stress in water and food. In the present study, we selected multiple O1 and O139 group V. cholerae strains that were isolated from different regions and during different years to study their salt tolerance. Based on the mechanisms that other bacteria use to respond to high salt stress, we selected salt stress-response related genes to study the mechanisms which V. cholerae responds to high salt stress. V. cholerae strains showed salt-resistance characteristics that varied in salt concentrations from 4% to 6%. However, group O1 and group O139 showed no significant difference in the degree of salt tolerance. The primary responses of bacteria to salt stress, including Na(+) exclusion, K(+) uptake and glutamate biosynthesis, were observed in V. cholerae strains. In addition, some sigma factors were up-regulated in V. cholerae strains, suggesting that V. cholerae may recruit common sigma factors to achieve an active salt stress response. However, some changes in gene transcript levels in response to salt stress in V. cholerae were strain-specific. In particular, hierarchical clustering of differentially expressed genes indicated that transcript levels of these genes were correlated with the degree of salt tolerance. Therefore, elevated transcript levels of some genes, including sigma factors and genes involved in peptidoglycan biosynthesis, may be due to the salt tolerance of strains. In addition, high salt-tolerant strains may recruit common as well as additional sigma factors to activate the salt stress response. PMID:25589902

  13. The Role of Cyanobacteria Blooms in Cholera Epidemic in Bangladesh

    NASA Astrophysics Data System (ADS)

    Sagir Ahmed, Md.; Raknuzzaman, Md.; Akther, Hafeza; Ahmed, Sumaiya

    A study was conducted on association of Vibrio cholerae with plankton specially emphasis on cyanobacteria in relation to some physico-chemical parameters in the River Buriganga, Dhaka, from January to December 2002. Monthly abundance of phytoplankton and zooplankton varied from 457 to 14166 and from 169 to 1055 individual L-1, respectively. Monthly average of faecal coliform in water, zooplankton and phytoplankton samples were 3.99x109, 4.54x103 and 4.28x102 (CFU L-1), respectively. During epidemics, toxigenic V. cholerae 01 and 0139 were isolated from the patients as well as from the surface water. V. cholerae 01 and 0139 were also isolated from plankton samples. More over, it was observed that ctx (cholera toxic) positive in water and phytoplankton samples of the river. A bloom of Oscillatoria sp. (1.6x104 individual L-1) occurred in the upper reaches of the River Buriganga in May 2002. Methanol-water extract of bloom sample was analyzed by high performance liquid chromatography with UV detection and Mass Spectrum (MS) detected microcystin-RR. Cyanobacteria are abundant in the aquatic environment of Bangladesh and it was established that V. cholerae maintain a symbiotic relationship with these algae particularly mucilaginous cyanobacteria. During epidemics, patients symptoms included diarrhea, vomiting and hemorrhagic enteritis and in severe cases hemorrhagic diarrhea. So, question has arisen that which is responsible, microcystins or cholera for death of cholera/diarrhea patients in Bangladesh. Future research should be directed to isolate microcystins and cholera toxins from the epidemic areas to clarify the fact.

  14. Third-generation cephalosporin-resistant Vibrio cholerae, India.

    PubMed

    Mandal, Jharna; Sangeetha, Vilwanathan; Ganesan, Vithiya; Parveen, Mohamudha; Preethi, Venkatesan; Harish, Belgode Narasimha; Srinivasan, Sampath; Parija, Subhash Chandra

    2012-08-01

    Vibrio cholerae resistance to third-generation cephalosporins is rarely reported. We detected a strain that was negative for extended-spectrum β-lactamase and positive for the AmpC disk test, modified Hodge test, and EDTA disk synergy test and harbored the blaDHA-1 and blaNDM-1 genes. The antimicrobial drug susceptibility profile of V. cholerae should be monitored. PMID:22840562

  15. Community health facility preparedness for a cholera surge in Haiti.

    PubMed

    Mobula, Linda Meta; Jacquet, Gabrielle A; Weinhauer, Kristin; Alcidas, Gladys; Thomas, Hans-Muller; Burnham, Gilbert

    2013-01-01

    With increasing population displacement and worsening water insecurity after the 2010 earthquake, Haiti experienced a large cholera outbreak. Our goal was to evaluate the strengths and weaknesses of seven community health facilities' ability to respond to a surge in cholera cases. Since 2010, Catholic Relief Services (CRS) with a number of public and private donors has been working with seven health facilities in an effort to reduce morbidity and mortality from cholera infection. In November 2012, CRS through the Centers for Disease Control and Prevention (CDC)'s support, asked the Johns Hopkins Center for Refugee and Disaster Response to conduct a cholera surge simulation tabletop exercise at these health facilities to improve each facility's response in the event of a cholera surge. Using simulation development guidelines from the Pan American Health Organization and others, a simulation scenario script was produced that included situations of differing severity, supply chain, as well as a surge of patients. A total of 119 hospital staff from seven sites participated in the simulation exercise including community health workers, clinicians, managers, pharmacists, cleaners, and security guards. Clinics that had challenges during the simulated clinical care of patients were those that did not appropriately treat all cholera patients according to protocol, particularly those that were vulnerable, those that would need additional staff to properly treat patients during a surge of cholera, and those that required a better inventory of supplies. Simulation-based activities have the potential to identify healthcare delivery system vulnerabilities that are amenable to intervention prior to a cholera surge. PMID:24481887

  16. Lymphoedema of the penis and scrotum as a sequela of chronic skin infection

    PubMed Central

    Nishimoto, Soh; Kinoshita, Masato; Miyazaki, Yuko; Kawai, Kenichiro; Kakibuchi, Masao

    2016-01-01

    A Japanese male patient presented with an enormously disfigured penis and scrotum. The penis was swollen and distorted rightward, and the skin was hard and lumpy. The patient had had a subdermal abscess for 6 years. The current condition was considered secondary lymphoedema of the penis and scrotum resulting from chronic skin infection. Wide excision of the affected area with bilateral inguinal lymph node dissection were performed. The degloved penile shaft and scrotum were covered with skin grafts, and a satisfactory result was obtained. PMID:27432903

  17. Haitian variant ctxB producing Vibrio cholerae O1 with reduced susceptibility to ciprofloxacin is persistent in Yavatmal, Maharashtra, India, after causing a cholera outbreak.

    PubMed

    Kumar, P; Mishra, D K; Deshmukh, D G; Jain, M; Zade, A M; Ingole, K V; Yadava, P K

    2014-05-01

    Vibrio cholerae O1 biotype El Tor producing Haitian variant Cholera Toxin (HCT) and showing reduced susceptibility to ciprofloxacin caused a cholera outbreak associated with a high case fatality rate (4.5) in India. HCT-secreting strains responsible for severe cholera epidemics in Orissa (India), Western Africa and Haiti were associated with increased mortality. There is a pressing need for an integrated multidisciplinary approach to combat further spread of newly emerging variant strains. The therapeutic effect of ciprofloxacin was diminished whereas use of doxycycline in moderate to severe cholera patients was found to be effective in outbreak management.

  18. Flexible transinguinal laparoscopy to assess the contralateral ring in pediatric inguinal hernias.

    PubMed

    Pavlovich, C P; Gmyrek, G A; Gardner, T A; Poppas, D P; Mininberg, D T

    1998-09-01

    The incidence of contralateral patent processus vaginalis (CPPV) is >50% in infants with clinical unilateral inguinal hernia (CUIH) and decreases only slowly with advancing age. Laparoscopy through the hernia sac (transinguinal laparoscopy) to detect suspected CPPV is a safe and efficient way to minimize routine contralateral inguinal exploration, but can be technically difficult. We used flexible urologic instruments and/or angled cystoscopic lenses to make transinguinal laparoscopy easier. Over a 3-year period, 37 patients (34 boys and 3 girls) ranging in age from 4 months to 12 years (mean age 59 months) with CUIH underwent ipsilateral groin exploration and diagnostic transinguinal laparoscopy. Laparoscopy was performed with flexible 17F cystoscopes (26 cases), flexible 9F ureteroscopes (2 cases), and rigid 70 degrees cystoscope lenses (9 cases). We detected eight CPPV (22%) in our series of 20 right and 17 left inguinal hernias, in a mean transinguinal laparoscopy time of 4.5 minutes. At 26-month mean follow-up, no patient whose contralateral inguinal ring was deemed closed had developed a hernia. Flexible fiberoptic urologic scopes and/or angled cystoscope lenses make transinguinal laparoscopy easy and efficacious in the pediatric population. Our series represents the longest longitudinal study of transinguinal laparoscopy for the diagnosis of CPPV. PMID:9800892

  19. Vasal Injury During Inguinal Herniorrhaphy: A Case Report and Review of the Literature

    PubMed Central

    Flechner, Lawrence; Smith, James; Treseler, Patrick; Maa, John

    2014-01-01

    An injury to the vas deferens during inguinal herniorrhaphy from possible tethering of the vas has not, to our knowledge, previously been described in the surgical literature. We report a case of iatrogenic injury of the vas deferens that occurred during elective hernia repair in a 28-year-old man who had previously sustained blunt trauma to the abdomen and pelvis. PMID:25662530

  20. Sutures for inguinal herniorrhaphy--a comparison of monofilaments with PTFE.

    PubMed Central

    Cahill, J.; Northeast, A. D.; Jarret, P. E.; Leach, R. D.

    1989-01-01

    Polybutester (Novafil, Davis & Geck) and expanded polytetrafluoroethylene PTFE (Gore-tex, W L Gore) were compared with nylon (Ethilon, Ethicon UK) for elective inguinal herniorrhaphy. PTFE had the best handling characteristics, but is expensive, and increased wound sepsis attended its use. Polybutester had significantly better handling characteristics, and is an attractive alternative to nylon for hernia repair. PMID:2705719

  1. A genome-wide association study identifies four novel susceptibility loci underlying inguinal hernia

    PubMed Central

    Jorgenson, Eric; Makki, Nadja; Shen, Ling; Chen, David C.; Tian, Chao; Eckalbar, Walter L.; Hinds, David; Ahituv, Nadav; Avins, Andrew

    2015-01-01

    Inguinal hernia repair is one of the most commonly performed operations in the world, yet little is known about the genetic mechanisms that predispose individuals to develop inguinal hernias. We perform a genome-wide association analysis of surgically confirmed inguinal hernias in 72,805 subjects (5,295 cases and 67,510 controls) and confirm top associations in an independent cohort of 92,444 subjects with self-reported hernia repair surgeries (9,701 cases and 82,743 controls). We identify four novel inguinal hernia susceptibility loci in the regions of EFEMP1, WT1, EBF2 and ADAMTS6. Moreover, we observe expression of all four genes in mouse connective tissue and network analyses show an important role for two of these genes (EFEMP1 and WT1) in connective tissue maintenance/homoeostasis. Our findings provide insight into the aetiology of hernia development and highlight genetic pathways for studies of hernia development and its treatment. PMID:26686553

  2. Medial Versus Traditional Approach to US-guided TAP Blocks for Open Inguinal Hernia Repair

    ClinicalTrials.gov

    2012-04-30

    Abdominal Muscles/Ultrasonography; Adult; Ambulatory Surgical Procedures; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Hernia, Inguinal/Surgery; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional

  3. Cystic lymphangioma of the inguinal and scrotal regions in childhood - report of three cases

    PubMed Central

    Patoulias, I; Prodromou, K; Feidantsis, Th; Kallergis, I; Koutsoumis, G

    2014-01-01

    Backround: Cystic lymphangiomas are congenital lymphatic malformations that most commonly develop in the neck, axilla, mediastinum and retroperitoneum. Inguinal and scrotal lymphangiomas are extremely rare. Cases report: We present the cases of three children with cystic lymphangiomas that were treated in our department during a two year period. The patients were all boys, aged 3.5, 9 and 13 years, and the location of the cystic lymphangioma was the scrotum, the inguinal region and the epididymis respectively. Clinical examination and ultrasonography described the lesions as cystic. Surgical excision of the lesions with a testis-sparing approach was performed in all three cases and histopathology set the diagnosis of cystic lymphangiomas. Complementary imaging of the regions adjacent to the excised lesions, excluded any extension or co-existing lesions. Post-operative period was uneventful and during a follow-up period of six months all patients were well with no signs of recurrence. Conclusions: Scrotal and inguinal cystic lymphangiomas are treated with surgical excision with care to preserve the intra-scrotal structures and the structures of the inguinal canal. Complete excision is necessary to prevent recurrence. Complementary imaging of the adjacent regions is necessary to identify any possible extension or co-existing lesions. PMID:25125963

  4. [Acute unilateral deafness and contralateral hearing loss following inguinal hernia repair under controlled anesthesia].

    PubMed

    Constantinidis, J; Mertzlufft, F; Steinhart, H

    1999-10-01

    Acute hearing loss following non-otologic surgery and general anesthesia is a rare occurrence. Deafness following anesthesia has more commonly been associated with spinal anesthesia or cardiopulmonary bypass surgical procedures. We present a case with unilateral cochlear dysfunction and sensorineural hearing loss after inguinal hernia operation. The literature is reviewed and the mechanisms causing hearing loss during anesthesia are discussed.

  5. A genome-wide association study identifies four novel susceptibility loci underlying inguinal hernia.

    PubMed

    Jorgenson, Eric; Makki, Nadja; Shen, Ling; Chen, David C; Tian, Chao; Eckalbar, Walter L; Hinds, David; Ahituv, Nadav; Avins, Andrew

    2015-01-01

    Inguinal hernia repair is one of the most commonly performed operations in the world, yet little is known about the genetic mechanisms that predispose individuals to develop inguinal hernias. We perform a genome-wide association analysis of surgically confirmed inguinal hernias in 72,805 subjects (5,295 cases and 67,510 controls) and confirm top associations in an independent cohort of 92,444 subjects with self-reported hernia repair surgeries (9,701 cases and 82,743 controls). We identify four novel inguinal hernia susceptibility loci in the regions of EFEMP1, WT1, EBF2 and ADAMTS6. Moreover, we observe expression of all four genes in mouse connective tissue and network analyses show an important role for two of these genes (EFEMP1 and WT1) in connective tissue maintenance/homoeostasis. Our findings provide insight into the aetiology of hernia development and highlight genetic pathways for studies of hernia development and its treatment. PMID:26686553

  6. Epidermoid cyst at a rare location, as a content of inguinal hernia: A case report with a review of the literature

    PubMed Central

    Meher, Sadananda; Baijal, Manish; Soni, Vandana; Sharma, Anil; Khullar, Rajesh; Chowbey, Pradeep

    2016-01-01

    Epidermoid cysts can occur in a variety of locations including the face, trunk, neck, extremities, and scalp. No case of epidermoid cyst as content of inguinal hernia has been reported so far; however, cases with dermoid, teratoma, lipoma, lymphangioma and leiomyoma as content of inguinal canal have been reported. A 29-year-old female presented with a lump in the left inguinal region that was clinically diagnosed as left inguinal hernia. The patient was planned for laparoscopic inguinal hernia repair after routine investigation. Intraoperatively, a cystic mass was found to be attached to the left round ligament that was excised completely. Histopathological report was consistent with epidermal inclusion cyst. Inguinal epidermoid cyst mimicking inguinal hernia is a rare entity. If such a cyst is encountered during operation, it should be completely excised. PMID:27279405

  7. Considerations around the introduction of a cholera vaccine in Bangladesh.

    PubMed

    Nelson, Christopher B; Mogasale, Vittal; Bari, Tajul Islam A; Clemens, John D

    2014-12-12

    Cholera is an endemic and epidemic disease in Bangladesh. On 3 March 2013, a meeting on cholera and cholera vaccination in Bangladesh was convened by the Foundation Mérieux jointly with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B). The purpose of the meeting was to discuss the investment case for cholera vaccination as a complimentary control and prevention strategy. The performance of a new low cost oral cholera vaccine, Shanchol™, used in recent trials in Bangladesh, was also reviewed in the context of a potential large-scale public-sector vaccination program. Findings showed the oral vaccine to be highly cost-effective when targeting ages 1-14 y, and cost-effective when targeting ages 1+y, in high-burden/high-risk districts. Other vaccination strategies targeting urban slums and rural areas without improved water were found to be cost-effective. Regardless of cost-effectiveness (value), the budget impact (affordability) will be an important determinant of which target population and vaccination strategy is selected. Most importantly, adequate vaccine supply for the proposed vaccination programs must be addressed in the context of global efforts to establish a cholera vaccine stockpile and supply other control and prevention efforts.

  8. Algal blooms in the spread and persistence of cholera.

    PubMed

    Epstein, P R

    1993-01-01

    Cholera has been long associated with the seasonality of coastal algal blooms off Bangladesh. Using fluorescent antibody (FA) techniques, microbiologists have now identified a viable, non-cultivable form of Vibrio cholerae in a wide range of marine life, including cyanobacteria (Anabaena variabilis), diatoms (Skeletonema costatum), phaeophytes (Ascophyllum nodosum), in copepod molts, and in freshwater vascular aquatic plants (water hyacinths and duckweed). In unfavourable conditions V. cholerae assumes spore-like forms; with proper nutrients, pH and temperature, it reverts to a readily transmissible and infectious state. Nitrates and phosphates in sewage and fertilizers cause eutrophication, and scientists report an increase in intensity, duration and shifts in the biodiversity of algal blooms in many coastal, brackish and fresh waters worldwide. V. cholerae has been isolated from phyto- and zooplankton in marine and fresh waters near Lima, Peru. V. cholera 01, biotype El Tor, serotype Inaba, may have arrived in the Americas in the bilge of a Chinese freighter. There, in the abundant coastal sea life along the Latin American Pacific coast, nourished by the Humboldt current and eutrophication, it found a reservoir for surviving unfavourable conditions. It is hypothesized that the algae and Vibrio populations grew exponentially; consumed by fish, mollusks and crustacea, a heavy 'inoculum' of carriers infected with V. cholerae was generated and transported into multiple coastal communities. PMID:8155853

  9. [Cholera in Europe and Denmark in the 19th century].

    PubMed

    Bonderup, G

    1996-01-01

    There are several reasons for dealing with cholera in the 19th century: it acted as a spotlight throwing into sharp relief the darkest corners of society that are seldom mentioned in the sources. We learn about everyday life in large parts of the population, especially the poor. The fight against the disease also reveals how a society worked socially and politically. When cholera arrived in Europe -- the first time was in the 1830's and several times after that--the population reacted very violently, often by lynching doctors, while the authorities more or less let matters take their course. That is why international researchers have come to see cholera as a catalyst for the constantly latent social unrest following in the train of wars and revolutions. During my research on cholera in Denmark it became clear to me that matters were different here. There were no riots, nor any signs of social unrest--neither before nor after the outbreak of cholera. On the contrary, the authorities and the population joined forces against the epidemic. There was an atmosphere of mutual trust, and almost everybody turned out to be worthy of such trust. That points to a balanced society based on consensus, so cholera also functions as a detector of the fundamental structure of a society. PMID:11625139

  10. The repertoire of glycosphingolipids recognized by Vibrio cholerae.

    PubMed

    Benktander, John; Ångström, Jonas; Karlsson, Hasse; Teymournejad, Omid; Lindén, Sara; Lebens, Michael; Teneberg, Susann

    2013-01-01

    The binding of cholera toxin to the ganglioside GM1 as the initial step in the process leading to diarrhea is nowadays textbook knowledge. In contrast, the knowledge about the mechanisms for attachment of Vibrio cholerae bacterial cells to the intestinal epithelium is limited. In order to clarify this issue, a large number of glycosphingolipid mixtures were screened for binding of El Tor V. cholerae. Several specific interactions with minor complex non-acid glycosphingolipids were thereby detected. After isolation of binding-active glycosphingolipids, characterization by mass spectrometry and proton NMR, and comparative binding studies, three distinct glycosphingolipid binding patterns were defined. Firstly, V. cholerae bound to complex lacto/neolacto glycosphingolipids with the GlcNAcβ3Galβ4GlcNAc sequence as the minimal binding epitope. Secondly, glycosphingolipids with a terminal Galα3Galα3Gal moiety were recognized, and the third specificity was the binding to lactosylceramide and related compounds. V. cholerae binding to lacto/neolacto glycosphingolipids, and to the other classes of binding-active compounds, remained after deletion of the chitin binding protein GbpA. Thus, the binding of V. cholerae to chitin and to lacto/neolacto containing glycosphingolipids represents two separate binding specificities. PMID:23349777

  11. Maximizing protection from use of oral cholera vaccines in developing country settings: an immunological review of oral cholera vaccines.

    PubMed

    Desai, Sachin N; Cravioto, Alejandro; Sur, Dipika; Kanungo, Suman

    2014-01-01

    When oral vaccines are administered to children in lower- and middle-income countries, they do not induce the same immune responses as they do in developed countries. Although not completely understood, reasons for this finding include maternal antibody interference, mucosal pathology secondary to infection, malnutrition, enteropathy, and previous exposure to the organism (or related organisms). Young children experience a high burden of cholera infection, which can lead to severe acute dehydrating diarrhea and substantial mortality and morbidity. Oral cholera vaccines show variations in their duration of protection and efficacy between children and adults. Evaluating innate and memory immune response is necessary to understand V. cholerae immunity and to improve current cholera vaccine candidates, especially in young children. Further research on the benefits of supplementary interventions and delivery schedules may also improve immunization strategies.

  12. Cholera at the Crossroads: The Association Between Endemic Cholera and National Access to Improved Water Sources and Sanitation

    PubMed Central

    Nygren, Benjamin L.; Blackstock, Anna J.; Mintz, Eric D.

    2014-01-01

    We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and different definitions of endemicity. Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the tradeoff between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation. PMID:25200265

  13. Epidemiology, determinants and dynamics of cholera in Pakistan: gaps and prospects for future research.

    PubMed

    Naseer, Maliha; Jamali, Tanzil

    2014-11-01

    Cholera is one of the notifiable endemic diseases in Pakistan, but the reporting of cholera cases is still unsatisfactory. Most of the diagnosed cases are never reported to the relevant authorities. In the year 1993 - 2005, the country did not report any single case of cholera to the WHO. The objectives of this review were to understand the epidemiology and to identify the possible determinants of cholera infection in Pakistan. Medscape, Medline, PakMedinet and PubMed, was searched, using key words, epidemiology and determinants of cholera infection in Pakistan during 1995 - 2010. Morbidity and mortality due to cholera infection during 1995 - 2010, without any language restriction. Out of 27 articles published between 1995 - 2010, 17 articles were included in the review. Vibrio cholerae O139 identified as a major cause of infection in older age group, while O1 biotype of cholera as a predominant cause of cholera among young individuals. Mainly reported determinants of cholera in Pakistan include poor sanitation and hygiene practices, increased population density in urban areas, leading to rapid and unplanned urbanization of the major cities and climate change due to increased environmental pollution in Pakistan are plausible factors for endemicity of cholera in Pakistan. Cholera reporting as a notifiable disease to the relevant departments and timely action can prevent the risk of outbreaks. There is a need to identify specific behavioral and environmental determinants responsible for outbreaks and epidemics of cholera in Pakistan which can help to design appropriate preventive and control interventions.

  14. Binding of cholera toxin by various tissues.

    PubMed

    Gascoyne, N; Van Heyningen, W E

    1975-09-01

    Under certain conditions, it is possible to confirm the observation by Peterson (1974) that the cholera toxin-binding capacities of tissues from brain and colon mucosa, and from liver and small intestine mucosa, are comparable. Binding of toxin by all tissues except brain is very variable, but is roughtly proportional to their content of the toxin-binding ganglioside galactosyl-N-acetylgalactosaminyl (sialosyl) lactosyl ceramide. It appears that some toxin-binding sites of the mucosa of the small intestin and colon may be masked. It has also been confirmed that there may be some solubilization of toxin-binding material from brain on standing a few days at 4 C, but this is comparatively slight. Some disadvantages of measuring toxin binding by adding small amounts of radioactive toxin to compartively large amounts of tissue are discussed.

  15. Hybrid microarray based on double biomolecular markers of DNA and carbohydrate for simultaneous genotypic and phenotypic detection of cholera toxin-producing Vibrio cholerae.

    PubMed

    Shin, Hwa Hui; Seo, Jeong Hyun; Kim, Chang Sup; Hwang, Byeong Hee; Cha, Hyung Joon

    2016-05-15

    Life-threatening diarrheal cholera is usually caused by water or food contaminated with cholera toxin-producing Vibrio cholerae. For the prevention and surveillance of cholera, it is crucial to rapidly and precisely detect and identify the etiological causes, such as V. cholerae and/or its toxin. In the present work, we propose the use of a hybrid double biomolecular marker (DBM) microarray containing 16S rRNA-based DNA capture probe to genotypically identify V. cholerae and GM1 pentasaccharide capture probe to phenotypically detect cholera toxin. We employed a simple sample preparation method to directly obtain genomic DNA and secreted cholera toxin as target materials from bacterial cells. By utilizing the constructed DBM microarray and prepared samples, V. cholerae and cholera toxin were detected successfully, selectively, and simultaneously; the DBM microarray was able to analyze the pathogenicity of the identified V. cholerae regardless of whether the bacteria produces toxin. Therefore, our proposed DBM microarray is a new effective platform for identifying bacteria and analyzing bacterial pathogenicity simultaneously.

  16. Memory B cell responses to Vibrio cholerae O1 lipopolysaccharide are associated with protection against infection from household contacts of patients with cholera in Bangladesh.

    PubMed

    Patel, Sweta M; Rahman, Mohammad Arif; Mohasin, M; Riyadh, M Asrafuzzaman; Leung, Daniel T; Alam, Mohammad Murshid; Chowdhury, Fahima; Khan, Ashraful I; Weil, Ana A; Aktar, Amena; Nazim, Mohammad; LaRocque, Regina C; Ryan, Edward T; Calderwood, Stephen B; Qadri, Firdausi; Harris, Jason B

    2012-06-01

    Vibrio cholerae O1 causes cholera, a dehydrating diarrheal disease. We have previously shown that V. cholerae-specific memory B cell responses develop after cholera infection, and we hypothesize that these mediate long-term protective immunity against cholera. We prospectively followed household contacts of cholera patients to determine whether the presence of circulating V. cholerae O1 antigen-specific memory B cells on enrollment was associated with protection against V. cholerae infection over a 30-day period. Two hundred thirty-six household contacts of 122 index patients with cholera were enrolled. The presence of lipopolysaccharide (LPS)-specific IgG memory B cells in peripheral blood on study entry was associated with a 68% decrease in the risk of infection in household contacts (P = 0.032). No protection was associated with cholera toxin B subunit (CtxB)-specific memory B cells or IgA memory B cells specific to LPS. These results suggest that LPS-specific IgG memory B cells may be important in protection against infection with V. cholerae O1.

  17. First Case Report of Acute Renal Failure After Mesh-Plug Inguinal Hernia Repair in a Kidney Transplant Recipient

    PubMed Central

    Veroux, Massimiliano; Ardita, Vincenzo; Zerbo, Domenico; Caglià, Pietro; Palmucci, Stefano; Sinagra, Nunziata; Giaquinta, Alessia; Veroux, Pierfrancesco

    2016-01-01

    Abstract Acute renal failure due to ureter compression after a mesh-plug inguinal repair in a kidney transplant recipient has not been previously reported to our knowledge. A 62-year-old man, who successfully underwent kidney transplantation from a deceased donor 6 years earlier, was admitted for elective repair of a direct inguinal hernia. The patient underwent an open mesh-plug repair of the inguinal hernia with placement of a plug in the preperitoneal space. We did not observe the transplanted ureter and bladder during dissection of the inguinal canal. Immediately after surgery, the patient became anuric, and a graft sonography demonstrated massive hydronephrosis. The serum creatinine level increased rapidly, and the patient underwent an emergency reoperation 8 hours later. During surgery, we did not identify the ureter but, immediately after plug removal, urine output increased progressively. We completed the hernia repair using the standard technique, without plug interposition, and the postoperative course was uneventful with complete resolution of graft dysfunction 3 days later. Furthermore, we reviewed the clinical features of complications related to inguinal hernia surgery. An increased risk of urological complications was reported recently in patients with a previous prosthetic hernia repair undergoing kidney transplantation, mainly due to the mesh adhesion to surrounding structures, making the extraperitoneal dissection during the transplant surgery very challenging. Moreover, older male kidney transplant recipients undergoing an inguinal hernia repair may be at higher risk of graft dysfunction due to inguinal herniation of a transplanted ureter. Mesh-plug inguinal hernia repair is a safe surgical technique, but this unique case suggests that kidney transplant recipients with inguinal hernia may be at higher risk of serious urological complications. Surgeons must be aware of the graft and ureter position before proceeding with hernia repair. A prompt

  18. First Case Report of Acute Renal Failure After Mesh-Plug Inguinal Hernia Repair in a Kidney Transplant Recipient.

    PubMed

    Veroux, Massimiliano; Ardita, Vincenzo; Zerbo, Domenico; Caglià, Pietro; Palmucci, Stefano; Sinagra, Nunziata; Giaquinta, Alessia; Veroux, Pierfrancesco

    2016-03-01

    Acute renal failure due to ureter compression after a mesh-plug inguinal repair in a kidney transplant recipient has not been previously reported to our knowledge. A 62-year-old man, who successfully underwent kidney transplantation from a deceased donor 6 years earlier, was admitted for elective repair of a direct inguinal hernia. The patient underwent an open mesh-plug repair of the inguinal hernia with placement of a plug in the preperitoneal space. We did not observe the transplanted ureter and bladder during dissection of the inguinal canal. Immediately after surgery, the patient became anuric, and a graft sonography demonstrated massive hydronephrosis. The serum creatinine level increased rapidly, and the patient underwent an emergency reoperation 8 hours later. During surgery, we did not identify the ureter but, immediately after plug removal, urine output increased progressively. We completed the hernia repair using the standard technique, without plug interposition, and the postoperative course was uneventful with complete resolution of graft dysfunction 3 days later. Furthermore, we reviewed the clinical features of complications related to inguinal hernia surgery. An increased risk of urological complications was reported recently in patients with a previous prosthetic hernia repair undergoing kidney transplantation, mainly due to the mesh adhesion to surrounding structures, making the extraperitoneal dissection during the transplant surgery very challenging. Moreover, older male kidney transplant recipients undergoing an inguinal hernia repair may be at higher risk of graft dysfunction due to inguinal herniation of a transplanted ureter. Mesh-plug inguinal hernia repair is a safe surgical technique, but this unique case suggests that kidney transplant recipients with inguinal hernia may be at higher risk of serious urological complications. Surgeons must be aware of the graft and ureter position before proceeding with hernia repair. A prompt diagnosis

  19. Molecular Epidemiology and Antibiotic Susceptibility of Vibrio cholerae Associated with a Large Cholera Outbreak in Ghana in 2014

    PubMed Central

    Eibach, Daniel; Herrera-León, Silvia; Gil, Horacio; Hogan, Benedikt; Ehlkes, Lutz; Adjabeng, Michael; Kreuels, Benno; Nagel, Michael; Opare, David; Fobil, Julius N; May, Jürgen

    2016-01-01

    Background Ghana is affected by regular cholera epidemics and an annual average of 3,066 cases since 2000. In 2014, Ghana experienced one of its largest cholera outbreaks within a decade with more than 20,000 notified infections. In order to attribute this rise in cases to a newly emerging strain or to multiple simultaneous outbreaks involving multi-clonal strains, outbreak isolates were characterized, subtyped and compared to previous epidemics in 2011 and 2012. Methodology/Principal Findings Serotypes, biotypes, antibiotic susceptibilities were determined for 92 Vibrio cholerae isolates collected in 2011, 2012 and 2014 from Southern Ghana. For a subgroup of 45 isolates pulsed-field gel electrophoresis, multilocus sequence typing and multilocus-variable tandem repeat analysis (MLVA) were performed. Eighty-nine isolates (97%) were identified as ctxB (classical type) positive V. cholerae O1 biotype El Tor and three (3%) isolates were cholera toxin negative non-O1/non-O139 V. cholerae. Among the selected isolates only sulfamethoxazole/trimethoprim resistance was detectable in 2011, while 95% of all 2014 isolates showed resistance towards sulfamethoxazole/trimethoprim, ampicillin and reduced susceptibility to ciprofloxacin. MLVA achieved the highest subtype discrimination, revealing 22 genotypes with one major outbreak cluster in each of the three outbreak years. Apart from those clusters genetically distant genotypes circulate during each annual epidemic. Conclusions/Significance This analysis suggests different endemic reservoirs of V. cholerae in Ghana with distinct annual outbreak clusters accompanied by the occurrence of genetically distant genotypes. Preventive measures for cholera transmission should focus on aquatic reservoirs. Rapidly emerging multidrug resistance must be monitored closely. PMID:27232338

  20. Incidence and molecular analysis of Vibrio cholerae associated with cholera outbreak subsequent to the super cyclone in Orissa, India.

    PubMed Central

    Chhotray, G. P.; Pal, B. B.; Khuntia, H. K.; Chowdhury, N. R.; Chakraborty, S.; Yamasaki, S.; Ramamurthy, T.; Takeda, Y.; Bhattacharya, S. K.; Nair, G. Balakrish

    2002-01-01

    An epidemiological study was carried out to find out the aetiological agent for diarrhoeal disorders in the cyclone and flood affected areas of Orissa, India. Rectal swabs collected from 107 hospitalized diarrhoea patients were bacteriologically analysed to isolate and identify the various enteropathogens. Detection of toxic genes among E. coli and V. cholerae was carried out by polymerase chain reaction (PCR) assay. Of the 107 rectal swabs analysed, 72.3% were positive for V. cholerae O1 Ogawa, 7.2% for V. cholerae O139, 1.2% for E. coli (EAggEC) and 1.2% for Shigella flexneri type 6. Using multiplex PCR assay it was found that all V. cholerae isolates were ctxA positive and El Tor biotype. Strains of V. cholerae O1 were observed to be resistant to nalidixic acid, furazolidone, streptomycin, co-trimoxazole and ampicillin. Except for nalidixic acid, the resistance pattern for O139 was identical to that of O1 strains. Representative strains of V. cholerae were further characterized by randomly amplified polymorphic DNA (RAPD) analysis and ribotyping. Both O1 and O139 V. cholerae strains exhibited the R3 pattern of ribotype and belonged to a similar pattern of RAPD compared with that of Calcutta strains. Early bacteriological and epidemiological investigations have revealed the dominance of V. cholerae O1 among the hospitalized patients in cyclone affected areas of Orissa. Drinking water scarcity and poor sanitation were thought to be responsible for these diarrhoeal outbreaks. Timely reporting and implementation of appropriate control measures could contain a vital epidemic in this area. PMID:12002529

  1. Characterization of tryptophanase from Vibrio cholerae.

    PubMed

    Nuidate, Taiyeebah; Tansila, Natta; Chomchuen, Piraporn; Phattaranit, Phattiphong; Eangchuan, Supachok; Vuddhakul, Varaporn

    2015-01-01

    Tryptophanase (Trpase) is a pyridoxal phosphate (PLP)-dependent enzyme responsible for the production of indole, an important intra- and interspecies signaling molecule in bacteria. In this study, the tnaA gene of Vibrio cholerae coding for VcTrpase was cloned into the pET-20b(+) vector and expressed in Escherichia coli BL21(DE3) tn5:tnaA. Using Ni(2+)-nitrilotriacetic acid (NTA) chromatography, VcTrpase was purified, and it possessed a molecular mass of ∼49 kDa with specific absorption peaks at 330 and 435 nm and a specific activity of 3 U/mg protein. The VcTrpase had an 80 % homology to the Trpase of Haemophilus influenzae and E. coli, but only around 50 % identity to the Trpase of Proteus vulgaris and Porphyromonas gingivalis. The optimum conditions for the enzyme were at pH 9.0 and 45 °C. Recombinant VcTrpase exhibited analogous kinetic reactivity to the EcTrpase with K m and k cat values of 0.612 × 10(-3) M and 5.252 s(-1), respectively. The enzyme catalyzed S-methyl-L-cysteine and S-benzyl-L-cysteine degradation, but not L-phenylalanine and L-serine. Using a site-directed mutagenesis technique, eight residues (Thr52, Tyr74, Arg103, Asp137, Arg230, Lys269, Lys270, and His463) were conserved for maintaining enzyme catalysis. All amino acid substitutions at these sites either eliminated or remarkably diminished Trpase activity. These sites are thus potential targets for the design of drugs to control the V. cholerae Trpase and to further investigate its functions.

  2. On spatially explicit models of cholera epidemics.

    PubMed

    Bertuzzo, E; Casagrandi, R; Gatto, M; Rodriguez-Iturbe, I; Rinaldo, A

    2010-02-01

    We generalize a recently proposed model for cholera epidemics that accounts for local communities of susceptibles and infectives in a spatially explicit arrangement of nodes linked by networks having different topologies. The vehicle of infection (Vibrio cholerae) is transported through the network links that are thought of as hydrological connections among susceptible communities. The mathematical tools used are borrowed from general schemes of reactive transport on river networks acting as the environmental matrix for the circulation and mixing of waterborne pathogens. Using the diffusion approximation, we analytically derive the speed of propagation for travelling fronts of epidemics on regular lattices (either one-dimensional or two-dimensional) endowed with uniform population density. Power laws are found that relate the propagation speed to the diffusion coefficient and the basic reproduction number. We numerically obtain the related, slower speed of epidemic spreading for more complex, yet realistic river structures such as Peano networks and optimal channel networks. The analysis of the limit case of uniformly distributed population sizes proves instrumental in establishing the overall conditions for the relevance of spatially explicit models. To that extent, the ratio between spreading and disease outbreak time scales proves the crucial parameter. The relevance of our results lies in the major differences potentially arising between the predictions of spatially explicit models and traditional compartmental models of the susceptible-infected-recovered (SIR)-like type. Our results suggest that in many cases of real-life epidemiological interest, time scales of disease dynamics may trigger outbreaks that significantly depart from the predictions of compartmental models.

  3. Cholera Outbreaks in Urban Bangladesh In 2011

    PubMed Central

    Haque, Farhana; Hossain, M. Jahangir; Kundu, Subodh Kumar; Naser, Abu Mohd.; Rahman, Mahmudur; Luby, Stephen P.

    2015-01-01

    Background In 2011, a multidisciplinary team investigated two diarrhoea outbreaks affecting urban Bangladeshi communities from the districts of Bogra and Kishorganj to identify etiology, pathways of transmission, and factors contributing to these outbreaks. Methods We defined case-patients with severe diarrhoea as residents from affected communities admitted with ≥3 loose stools per day. We listed case-patients, interviewed and examined them, and collected rectal swabs. We visited the affected communities to explore the water and sanitation infrastructure. We tested the microbial load of water samples from selected case household taps, tube wells, and pump stations. We conducted anthropological investigations to understand community perceptions regarding the outbreaks. Results We identified 21 case-patients from Bogra and 84 from Kishorganj. The median age in Bogra was 23 years, and 21 years in Kishorganj. There were no reported deaths. We isolated Vibrio in 29% (5/17) of rectal swabs from Bogra and in 40% (8/20) from Kishorganj. We found Vibrio in 1/8 tap water samples from Bogra and in both of the samples from Kishorganj. We did not find Vibrio in water samples from pumps or tube wells in either outbreak. Ground water extracted through deep tube wells was supplied intermittently through interconnected pipes without treatment in both areas. We found leakages in the water pipes in Bogra, and in Kishorganj water pipes passed through open sewers. Conclusion The rapid onset of severe diarrhoea predominantly affecting adults and the isolation of cholera in rectal swabs confirmed that these outbreaks were caused by Vibrio cholerae. The detection of Vibrio in water samples organisms from taps but not from pumps or tube wells, suggested contamination within the pipes. Safe water provision is difficult in municipalities where supply is intermittent, and where pipes commonly leak. Research to develop and evaluate water purification strategies could identify appropriate

  4. Sustained Local Diversity of Vibrio cholerae O1 Biotypes in a Previously Cholera-Free Country

    PubMed Central

    2016-01-01

    ABSTRACT Although the current cholera pandemic can trace its origin to a specific time and place, many variants of Vibrio cholerae have caused this disease over the last 50 years. The relative clinical importance and geographical distribution of these variants have changed with time, but most remain in circulation. Some countries, such as Mexico and Haiti, had escaped the current pandemic, until large epidemics struck them in 1991 and 2010, respectively. Cholera has been endemic in these countries ever since. A recent retrospective study in mBio presents the results of more than 3 decades of V. cholerae monitoring from environmental and clinical sources in Mexico (S. Y. Choi et al., mBio 7:e02160-15, 2016, http://dx.doi.org/10.1128/mBio.02160-15). It reveals that multiple V. cholerae variants, including classical strains from the previous pandemic, as well as completely novel biotypes, have been circulating in Mexico. This discovery has important implications for the epidemiology and evolution of V. cholerae. PMID:27143391

  5. Sustained Local Diversity of Vibrio cholerae O1 Biotypes in a Previously Cholera-Free Country.

    PubMed

    Boucher, Yan

    2016-01-01

    Although the current cholera pandemic can trace its origin to a specific time and place, many variants of Vibrio cholerae have caused this disease over the last 50 years. The relative clinical importance and geographical distribution of these variants have changed with time, but most remain in circulation. Some countries, such as Mexico and Haiti, had escaped the current pandemic, until large epidemics struck them in 1991 and 2010, respectively. Cholera has been endemic in these countries ever since. A recent retrospective study in mBio presents the results of more than 3 decades of V. cholerae monitoring from environmental and clinical sources in Mexico (S. Y. Choi et al., mBio 7:e02160-15, 2016, http://dx.doi.org/10.1128/mBio.02160-15). It reveals that multiple V. cholerae variants, including classical strains from the previous pandemic, as well as completely novel biotypes, have been circulating in Mexico. This discovery has important implications for the epidemiology and evolution of V. cholerae. PMID:27143391

  6. Skin Complications

    MedlinePlus

    ... drugs that can help clear up this condition. Day-to-Day Skin Care See our tips for daily skin ... Risk? Diagnosis Lower Your Risk Risk Test Alert Day Prediabetes My Health Advisor Tools to Know Your ...

  7. Skin Aging

    MedlinePlus

    ... too. Sunlight is a major cause of skin aging. You can protect yourself by staying out of ... person has smoked. Many products claim to revitalize aging skin or reduce wrinkles, but the Food and ...

  8. Skin tears.

    PubMed

    Baranoski, S

    2001-08-01

    Skin tears are a serious, painful problem for older patients. Find out how your staff can recognize patients at risk, what they can do to prevent skin tears, and how to manage them effectively if they occur.

  9. Skin Pigment

    MedlinePlus

    ... Professional Version Pigment Disorders Overview of Skin Pigment Albinism Vitiligo Hyperpigmentation Melasma Melanin is the brown pigment ... dark-skinned people produce the most. People with albinism have little or no melanin and thus their ...

  10. Comparing sociocultural features of cholera in three endemic African settings

    PubMed Central

    2013-01-01

    Background Cholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration of community-based priorities. The present work compares local sociocultural features of endemic cholera in urban and rural sites from three field studies in southeastern Democratic Republic of Congo (SE-DRC), western Kenya and Zanzibar. Methods A vignette-based semistructured interview was used in 2008 in Zanzibar to study sociocultural features of cholera-related illness among 356 men and women from urban and rural communities. Similar cross-sectional surveys were performed in western Kenya (n = 379) and in SE-DRC (n = 360) in 2010. Systematic comparison across all settings considered the following domains: illness identification; perceived seriousness, potential fatality and past household episodes; illness-related experience; meaning; knowledge of prevention; help-seeking behavior; and perceived vulnerability. Results Cholera is well known in all three settings and is understood to have a significant impact on people’s lives. Its social impact was mainly characterized by financial concerns. Problems with unsafe water, sanitation and dirty environments were the most common perceived causes across settings; nonetheless, non-biomedical explanations were widespread in rural areas of SE-DRC and Zanzibar. Safe food and water and vaccines were prioritized for prevention in SE-DRC. Safe water was prioritized in western Kenya along with sanitation and health education. The latter two were also prioritized in Zanzibar. Use of oral rehydration solutions and rehydration was a top priority everywhere; healthcare facilities were universally reported as a primary source of help. Respondents in SE-DRC and Zanzibar reported cholera as affecting almost everybody without differentiating much for gender, age

  11. Monitoring water sources for environmental reservoirs of toxigenic Vibrio cholerae O1, Haiti.

    PubMed

    Alam, Meer T; Weppelmann, Thomas A; Weber, Chad D; Johnson, Judith A; Rashid, Mohammad H; Birch, Catherine S; Brumback, Babette A; Beau de Rochars, Valery E Madsen; Morris, J Glenn; Ali, Afsar

    2014-03-01

    An epidemic of cholera infections was documented in Haiti for the first time in more than 100 years during October 2010. Cases have continued to occur, raising the question of whether the microorganism has established environmental reservoirs in Haiti. We monitored 14 environmental sites near the towns of Gressier and Leogane during April 2012-March 2013. Toxigenic Vibrio cholerae O1 El Tor biotype strains were isolated from 3 (1.7%) of 179 water samples; nontoxigenic O1 V. cholerae was isolated from an additional 3 samples. All samples containing V. cholerae O1 also contained non-O1 V. cholerae. V. cholerae O1 was isolated only when water temperatures were ≥31°C. Our data substantiate the presence of toxigenic V. cholerae O1 in the aquatic environment in Haiti. These isolations may reflect establishment of long-term environmental reservoirs in Haiti, which may complicate eradication of cholera from this coastal country.

  12. Efficiency of Local Antiseptic Alkosol (Ethanol, Isopropanol-30g and Ortophenilphenol) and Povidone Iodide on the Incidence Of Surgical Site Infection After Inguinal Hernioplasty

    PubMed Central

    Djozic, Harun; Pandza, Haris; Hasukic, Sefik; Custovic, Samir; Pandza, Berina; Krupalija, Amina; Beciragic, Edin

    2016-01-01

    Background: The risk of wound infection after elective inguinal hernia repair depends on several factors. One of the most important factors is the preoperative skin preparation. The use of antisepsis is performed to reduce the risk of surgical site infections (SSIs) and to remove causing organisms. This work compares two different agent forms for preoperative skin preparation to prevent SSIs. Objectives: The objective of the study is comparing the effects of two different agents used for preoperative skin preparation and prevention of SSIs. Material and methods: 100 adult patients were divided and randomized into two groups, each containing 50 patients. Both groups included patients that are scheduled for elective Lichtenstein inguinal hernia repair. The first group includes patients whose skin preparations were done with povidone iodine (PI) only. The second group included patients that are treated with two antiseptics; Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide. Alkosol is applied before the induction of anesthesia. The povidone iodide is applied after Alkosol has evaporated. The presence of bacterial growth in the wound was determined 24 and 48 hours after operation. Swabs were used to take samples, which were then cultivated to check for bacterial growth. The presence of infection was also determined by the following criteria: pain or tenderness, induration, erythema, local warmth of the wound etc. Results: The surgeon or clinician declared that after 24 hours the wound was infected in 20 patients in the control group and in 22 patients after 48 hours. In the Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide group infection was declared in only 3 patients after 24 hours. Discussion: Compared to the use of providone only, the use of Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide has many advantages and was associated with lower rates of SSIs

  13. Time series analysis of cholera in Matlab, Bangladesh, during 1988-2001.

    PubMed

    Ali, Mohammad; Kim, Deok Ryun; Yunus, Mohammad; Emch, Michael

    2013-03-01

    The study examined the impact of in-situ climatic and marine environmental variability on cholera incidence in an endemic area of Bangladesh and developed a forecasting model for understanding the magnitude of incidence. Diarrhoea surveillance data collected between 1988 and 2001 were obtained from a field research site in Matlab, Bangladesh. Cholera cases were defined as Vibrio cholerae O1 isolated from faecal specimens of patients who sought care at treatment centres serving the Matlab population. Cholera incidence for 168 months was correlated with remotely-sensed sea-surface temperature (SST) and in-situ environmental data, including rainfall and ambient temperature. A seasonal autoregressive integrated moving average (SARIMA) model was used for determining the impact of climatic and environmental variability on cholera incidence and evaluating the ability of the model to forecast the magnitude of cholera. There were 4,157 cholera cases during the study period, with an average of 1.4 cases per 1,000 people. Since monthly cholera cases varied significantly by month, it was necessary to stabilize the variance of cholera incidence by computing the natural logarithm to conduct the analysis. The SARIMA model shows temporal clustering of cholera at one- and 12-month lags. There was a 6% increase in cholera incidence with a minimum temperature increase of one degree celsius in the current month. For increase of SST by one degree celsius, there was a 25% increase in the cholera incidence at currrent month and 18% increase in the cholera incidence at two months. Rainfall did not influenc to cause variation in cholera incidence during the study period. The model forecast the fluctuation of cholera incidence in Matlab reasonably well (Root mean square error, RMSE: 0.108). Thus, the ambient and sea-surface temperature-based model could be used in forecasting cholera outbreaks in Matlab.

  14. Identification of Hog Cholera Viral Antigen by Immunofluorescence. Application as a Diagnostic and Assay Method.

    PubMed

    Mengeling, W L; Pirtle, E C; Torrey, J P

    1963-10-01

    In the absence of detectable cytologic changes in hog cholera virus-infected tissue culture cells, hog cholera viral antigen was readily detected by immunofluorescence. The ability to detect hog cholera viral antigen by this method allowed for determination of infectivity titers and also for titration of homologous antibody. Immunofluorescence made possible the identification, in tissue culture, of hog cholera virus from blood, serum, and spleen extracts of experimentally infected swine. Further applications of this method and its limitations are being investigated.

  15. Efficacy of Ciprofloxacin for Treatment of Cholera Associated with Diminished Susceptibility to Ciprofloxacin to Vibrio cholerae O1

    PubMed Central

    Khan, Wasif Ali; Saha, Debasish; Ahmed, Sabeena; Salam, Mohammed Abdus; Bennish, Michael Louis

    2015-01-01

    Objective We identified a poor clinical response to treatment of cholera with a single 1 g dose of ciprofloxacin, a standard treatment for cholera. Methods To determine reasons for the poor response and better therapeutic approaches we examined the minimal inhibitor concentration (MIC, n = 275) and disc-diffusion zone sizes (n = 205) for ciprofloxacin and nalidixic acid of V. cholerae O1 strains isolated in Bangladesh from 1994 to 2012, and reexamined data from 161patients infected with Vibrio cholerae O1 recruited in four clinical trials who received single- or multiple-dose ciprofloxacin for treatment of cholera and compared their clinical response to the V. cholerae O1 susceptibility. Results Although all 275 isolates of V. cholerae O1 remained susceptible to ciprofloxacin using standard MIC and disc-diffusion thresholds, the MIC90 to ciprofloxacin increased from 0.010 in 1994 to 0.475 μgm/ml in 2012. Isolates became frankly resistant to nalidixic with the MIC90 increasing from 21 μgm/ml in 1994 to >256 μgm/ml and 166 of 205 isolates from 1994 to 2005 being frankly resistant using disc-diffusion testing. Isolates resistant to nalidixic acid by disc-diffusion testing had a median ciprofloxacin MIC of 0.190 μgm/ml (10th-90th centiles 0.022 to 0.380); nalidixic acid-susceptible isolates had a median ciprofloxacin MIC of 0.002 (0.002 to 0.012).The rate of clinical success with single-dose ciprofloxacin treatment for nalidixic acid-susceptible strains was 94% (61 of 65 patients) and bacteriologic success 97% (63/65) compared to 18% (12/67) and 8% (5/67) respectively with nalidixic acid-resistant strains (P<0.001 for both comparisons). Multiple-dose treatment with ciprofloxacin had 86% and 100% clinical and bacteriologic success rates respectively in patients infected with nalidixic acid-susceptible strains of V. cholerae O1 compared to clinical success 67% and bacteriologic success 60% with nalidixic acid-resistant strains. Conclusions Single-dose ciprofloxacin

  16. Cholera in coastal Africa: a systematic review of its heterogeneous environmental determinants.

    PubMed

    Rebaudet, Stanislas; Sudre, Bertrand; Faucher, Benoît; Piarroux, Renaud

    2013-11-01

    According to the "cholera paradigm," epidemiology of this prototypical waterborne disease is considered to be driven directly by climate-induced variations in coastal aquatic reservoirs of Vibrio cholerae. This systematic review on environmental determinants of cholera in coastal Africa shows that instead coastal epidemics constitute a minor part of the continental cholera burden. Most of coastal cholera foci are located near estuaries, lagoons, mangrove forests, and on islands. Yet outbreaks often originate in coastal cities, where cholera is more likely to be imported from distant areas. Cholera outbreaks also may intensify in densely populated slum quarters before spreading to adjacent regions. Frequent seasonality of cholera incidence appears driven by the rainfall-induced contamination of unprotected water sources through latrine overflow and sewage, as well as by the periodicity of human activities like fishing or traveling. Lulls in transmission periods of several years are repeatedly recorded even in high-risk coastal areas. To date, environmental studies have failed to demonstrate a perennial aquatic reservoir of toxigenic V. cholerae around the continent. Finally, applicability of the cholera paradigm therefore appears questionable in Africa, although available data remain limited. Thorough surveys with microbiological analyses of water samples and prospective genotyping of environmental and clinical strains of V. cholerae are needed to understand determinants of cholera in coastal Africa and better target prevention and control measures.

  17. 9 CFR 309.5 - Swine; disposal because of hog cholera.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Swine; disposal because of hog cholera... INSPECTION AND CERTIFICATION ANTE-MORTEM INSPECTION § 309.5 Swine; disposal because of hog cholera. (a) All swine found by an inspector to be affected with hog cholera shall be identified as U.S. Condemned...

  18. 9 CFR 309.5 - Swine; disposal because of hog cholera.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Swine; disposal because of hog cholera... INSPECTION AND CERTIFICATION ANTE-MORTEM INSPECTION § 309.5 Swine; disposal because of hog cholera. (a) All swine found by an inspector to be affected with hog cholera shall be identified as U.S. Condemned...

  19. 9 CFR 309.5 - Swine; disposal because of hog cholera.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Swine; disposal because of hog cholera... INSPECTION AND CERTIFICATION ANTE-MORTEM INSPECTION § 309.5 Swine; disposal because of hog cholera. (a) All swine found by an inspector to be affected with hog cholera shall be identified as U.S. Condemned...

  20. 9 CFR 309.5 - Swine; disposal because of hog cholera.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Swine; disposal because of hog cholera... INSPECTION AND CERTIFICATION ANTE-MORTEM INSPECTION § 309.5 Swine; disposal because of hog cholera. (a) All swine found by an inspector to be affected with hog cholera shall be identified as U.S. Condemned...

  1. A model to predict when a cholera outbreak might hit the Congo

    NASA Astrophysics Data System (ADS)

    Schultz, Colin

    2014-09-01

    In 2011, as many as 600,000 people in 58 countries contracted cholera, with thousands succumbing to the disease. In most countries, cholera is rare. In others, like the Democratic Republic of the Congo, cholera is an endemic threat, always lurking in the background waiting for the right set of conditions to spark an outbreak.

  2. 9 CFR 309.5 - Swine; disposal because of hog cholera.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Swine; disposal because of hog cholera... INSPECTION AND CERTIFICATION ANTE-MORTEM INSPECTION § 309.5 Swine; disposal because of hog cholera. (a) All swine found by an inspector to be affected with hog cholera shall be identified as U.S. Condemned...

  3. Outbreak-associated Vibrio cholerae genotypes with identical pulsotypes, Malaysia, 2009.

    PubMed

    Teh, Cindy Shuan Ju; Suhaili, Zarizal; Lim, King Ting; Khamaruddin, Muhamad Afif; Yahya, Fariha; Sajili, Mohd Hailmi; Yeo, Chew Chieng; Thong, Kwai Lin

    2012-07-01

    A cholera outbreak in Terengganu, Malaysia, in November 2009 was caused by 2 El Tor Vibrio cholerae variants resistant to typical antimicrobial drugs. Evidence of replacement of treatable V. cholerae infection in the region with antimicrobial-resistant strains calls for increased surveillance and prevention measures.

  4. Sensitive skin.

    PubMed

    Misery, L; Loser, K; Ständer, S

    2016-02-01

    Sensitive skin is a clinical condition defined by the self-reported facial presence of different sensory perceptions, including tightness, stinging, burning, tingling, pain and pruritus. Sensitive skin may occur in individuals with normal skin, with skin barrier disturbance, or as a part of the symptoms associated with facial dermatoses such as rosacea, atopic dermatitis and psoriasis. Although experimental studies are still pending, the symptoms of sensitive skin suggest the involvement of cutaneous nerve fibres and neuronal, as well as epidermal, thermochannels. Many individuals with sensitive skin report worsening symptoms due to environmental factors. It is thought that this might be attributed to the thermochannel TRPV1, as it typically responds to exogenous, endogenous, physical and chemical stimuli. Barrier disruptions and immune mechanisms may also be involved. This review summarizes current knowledge on the epidemiology, potential mechanisms, clinics and therapy of sensitive skin. PMID:26805416

  5. Simulation and study of the behaviour of the transversalis fascia in protecting against the genesis of inguinal hernias.

    PubMed

    Fortuny, G; Rodríguez-Navarro, J; Susín, A; López-Cano, M

    2009-10-16

    Simulating the muscular system has many applications in biomechanics, biomedicine and the study of movement in general. We are interested in studying the genesis of a very common pathology: human inguinal hernia. We study the effects that some biomechanical parameters have on the dynamic simulation of the region, and their involvement in the genesis of inguinal hernias. We use the finite element method (FEM) and current models for the muscular contraction to determine the deformed fascia transversalis for the estimation of the maximum strain. We analysed the effect of muscular tissue density, Young's modulus, Poisson's coefficient and calcium concentration in the genesis of human inguinal hernia. The results are the estimated maximum strain in our simulations, has a close correlation with experimental data and the accepted commonly models by the medical community. Our model is the first study of the effect of various biological parameters with repercussions on the genesis of the inguinal hernias.

  6. A Capsaicin (8%) Patch in the Treatment of Severe Persistent Inguinal Postherniorrhaphy Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

    PubMed Central

    Bischoff, Joakim M.; Ringsted, Thomas K.; Petersen, Marian; Sommer, Claudia; Üçeyler, Nurcan; Werner, Mads U.

    2014-01-01

    Background Persistent pain after inguinal herniorrhaphy is a disabling condition with a lack of evidence-based pharmacological treatment options. This randomized placebo-controlled trial investigated the efficacy of a capsaicin 8% cutaneous patch in the treatment of severe persistent inguinal postherniorrhaphy pain. Methods Forty-six patients with persistent inguinal postherniorrhaphy pain were randomized to receive either a capsaicin 8% patch or a placebo patch. Pain intensity (Numerical Rating Scale [NRS 0–10]) was evaluated under standardized conditions (at rest, during movement, and during pressure) at baseline and at 1, 2 and 3 months after patch application. Skin punch biopsies for intraepidermal nerve fiber density (IENFD) measurements were taken at baseline and 1 month after patch application. Quantitative sensory testing was performed at baseline and at 1, 2, and 3 months after patch application. The primary outcome was comparisons of summed pain intensity differences (SPIDs) between capsaicin and placebo treatments at 1, 2 and 3 months after patch application (significance level P<0.01). Results The maximum difference in SPID, between capsaicin and placebo treatments, was observed at 1 month after patch application, but the pain reduction was not significant (NRS, mean difference [95% CI]: 5.0 [0.09 to 9.9]; P = 0.046). No differences in SPID between treatments were observed at 2 and 3 months after patch application. Changes in IENFD on the pain side, from baseline to 1 month after patch application, did not differ between capsaicin and placebo treatment: 1.9 [−0.1 to 3.9] and 0.6 [−1.2 to 2.5] fibers/mm, respectively (P = 0.32). No significant changes in sensory function, sleep quality or psychological factors were associated with capsaicin patch treatment. Conclusions The study did not demonstrate significant differences in pain relief between capsaicin and placebo treatment, although a trend toward pain improvement in capsaicin treated

  7. Chemoproteomic profiling of host and pathogen enzymes active in cholera.

    PubMed

    Hatzios, Stavroula K; Abel, Sören; Martell, Julianne; Hubbard, Troy; Sasabe, Jumpei; Munera, Diana; Clark, Lars; Bachovchin, Daniel A; Qadri, Firdausi; Ryan, Edward T; Davis, Brigid M; Weerapana, Eranthie; Waldor, Matthew K

    2016-04-01

    Activity-based protein profiling (ABPP) is a chemoproteomic tool for detecting active enzymes in complex biological systems. We used ABPP to identify secreted bacterial and host serine hydrolases that are active in animals infected with the cholera pathogen Vibrio cholerae. Four V. cholerae proteases were consistently active in infected rabbits, and one, VC0157 (renamed IvaP), was also active in human choleric stool. Inactivation of IvaP influenced the activity of other secreted V. cholerae and rabbit enzymes in vivo, and genetic disruption of all four proteases increased the abundance of intelectin, an intestinal lectin, and its binding to V. cholerae in infected rabbits. Intelectin also bound to other enteric bacterial pathogens, suggesting that it may constitute a previously unrecognized mechanism of bacterial surveillance in the intestine that is inhibited by pathogen-secreted proteases. Our work demonstrates the power of activity-based proteomics to reveal host-pathogen enzymatic dialog in an animal model of infection. PMID:26900865

  8. Cyclo(valine-valine) inhibits Vibrio cholerae virulence gene expression.

    PubMed

    Vikram, Amit; Ante, Vanessa M; Bina, X Renee; Zhu, Qin; Liu, Xinyu; Bina, James E

    2014-06-01

    Vibrio cholerae has been shown to produce a cyclic dipeptide, cyclo(phenylalanine-proline) (cFP), that functions to repress virulence factor production. The objective of this study was to determine if heterologous cyclic dipeptides could repress V. cholerae virulence factor production. To that end, three synthetic cyclic dipeptides that differed in their side chains from cFP were assayed for virulence inhibitory activity in V. cholerae. The results revealed that cyclo(valine-valine) (cVV) inhibited virulence factor production by a ToxR-dependent process that resulted in the repression of the virulence regulator aphA. cVV-dependent repression of aphA was found to be independent of known aphA regulatory genes. The results demonstrated that V. cholerae was able to respond to exogenous cyclic dipeptides and implicated the hydrophobic amino acid side chains on both arms of the cyclo dipeptide scaffold as structural requirements for inhibitory activity. The results further suggest that cyclic dipeptides have potential as therapeutics for cholera treatment.

  9. Isolation of isoelectrically pure cholera toxin for crystallization

    SciTech Connect

    Spangler, B.D.; Westbrook, E.M.

    1989-01-01

    We have determined that the failure of cholera toxin to crystallize well results from its isoelectric heterogeneity, which is probably due to a post-translational process such as deamidation of its B subunit. Every sample of cholera toxin we have examined from commercial or academic suppliers has been heterogeneous; heterogeneous cholera toxin does not crystallize satisfactorily. We have overcome this problem by using ion-exchange fast protein liquid chromatography (FPLC) to obtain an isoelectrically homogeneous species of cholera toxin. Homogeneous cholera toxin crystallizes readily, forming single, nonmosaic crystals suitable for x-ray diffraction studies. For this process, protein was applied to a MonoQ ion-exchange column, then eluted with an isocratic low salt buffer followed by a linear salt gradient (0-100 mM NaCl). Column fractions were analyzed on isoelectric focusing gels, and those fractions containing the desired homogeneous species were pooled and concentrated. Crystals formed within 24 to 48 hours in a MOPS/PEG buffer, which made use of slow isoelectric precipitation to induce crystallization. 23 refs., 6 figs.

  10. Cholera in disasters: do vaccines prompt new hopes?

    PubMed

    Chaignat, Claire-Lise; Monti, Victoria; Soepardi, Jane; Petersen, Georg; Sorensen, Eigil; Narain, Jai; Kieny, Marie Paule

    2008-05-01

    Humanitarian aid workers regularly encounter the challenge of setting up functioning surveillance systems immediately after a disaster. Detecting potential outbreaks of diseases, such as cholera, that might arise from disturbed living conditions, displacement and lack of clean water and sanitation is, therefore, extremely difficult. Fears of cholera outbreaks are often rife in such conditions and the pertinence of using cholera vaccines, now available on the market, merit attention. The case of Aceh province, Indonesia, following the 2004 tsunami is examined here: the government of Indonesia decided to carry out a mass vaccination campaign using oral cholera vaccines, a two-dose product that has not been used widely in the particular circumstances of complex emergencies. The preparation and implementation of this campaign faced many hindrances that unfavorably impacted on the time taken to vaccinate the target population and the costs involved. An estimated 69.3% of the target population received immunization. Evidence gathered during the Aceh campaign could be compared with those of a campaign held in another emergency context--Darfur (Sudan). In spite of many dissimilarities, both experiences illustrate the fact that the question of feasibility and relevance of interventions, as well as prioritization of health needs in complex emergencies, remain crucial to alleviate the affected population's suffering in the most efficient way. Following these two campaigns, WHO recommendations on the use of oral cholera vaccines in complex emergencies were issued in 2006. PMID:18444890

  11. Nonredundant Roles of Iron Acquisition Systems in Vibrio cholerae.

    PubMed

    Peng, Eric D; Wyckoff, Elizabeth E; Mey, Alexandra R; Fisher, Carolyn R; Payne, Shelley M

    2015-12-07

    Vibrio cholerae, the causative agent of the severe diarrheal disease cholera, thrives in both marine environments and the human host. To do so, it must encode the tools necessary to acquire essential nutrients, including iron, under these vastly different conditions. A number of V. cholerae iron acquisition systems have been identified; however, the precise role of each system is not fully understood. To test the roles of individual systems, we generated a series of mutants in which only one of the four systems that support iron acquisition on unsupplemented LB agar, Feo, Fbp, Vct, and Vib, remains functional. Analysis of these mutants under different growth conditions showed that these systems are not redundant. The strain carrying only the ferrous iron transporter Feo grew well at acidic, but not alkaline, pH, whereas the ferric iron transporter Fbp promoted better growth at alkaline than at acidic pH. A strain defective in all four systems (null mutant) had a severe growth defect under aerobic conditions but accumulated iron and grew as well as the wild type in the absence of oxygen, suggesting the presence of an additional, unidentified iron transporter in V. cholerae. In support of this, the null mutant was only moderately attenuated in an infant mouse model of infection. While the null mutant used heme as an iron source in vitro, we demonstrate that heme is not available to V. cholerae in the infant mouse intestine.

  12. Nonredundant Roles of Iron Acquisition Systems in Vibrio cholerae

    PubMed Central

    Peng, Eric D.; Wyckoff, Elizabeth E.; Mey, Alexandra R.; Fisher, Carolyn R.

    2015-01-01

    Vibrio cholerae, the causative agent of the severe diarrheal disease cholera, thrives in both marine environments and the human host. To do so, it must encode the tools necessary to acquire essential nutrients, including iron, under these vastly different conditions. A number of V. cholerae iron acquisition systems have been identified; however, the precise role of each system is not fully understood. To test the roles of individual systems, we generated a series of mutants in which only one of the four systems that support iron acquisition on unsupplemented LB agar, Feo, Fbp, Vct, and Vib, remains functional. Analysis of these mutants under different growth conditions showed that these systems are not redundant. The strain carrying only the ferrous iron transporter Feo grew well at acidic, but not alkaline, pH, whereas the ferric iron transporter Fbp promoted better growth at alkaline than at acidic pH. A strain defective in all four systems (null mutant) had a severe growth defect under aerobic conditions but accumulated iron and grew as well as the wild type in the absence of oxygen, suggesting the presence of an additional, unidentified iron transporter in V. cholerae. In support of this, the null mutant was only moderately attenuated in an infant mouse model of infection. While the null mutant used heme as an iron source in vitro, we demonstrate that heme is not available to V. cholerae in the infant mouse intestine. PMID:26644383

  13. Case studies in cholera: lessons in medical history and science.

    PubMed

    Kavic, S M; Frehm, E J; Segal, A S

    1999-01-01

    Cholera, a prototypical secretory diarrheal disease, is an ancient scourge that has both wrought great suffering and taught many valuable lessons, from basic sanitation to molecular signal transduction. Victims experience the voluminous loss of bicarbonate-rich isotonic saline at a rate that may lead to hypovolemic shock, metabolic acidosis, and death within afew hours. Intravenous solution therapy as we know it was first developed in an attempt to provide life-saving volume replacement for cholera patients. Breakthroughs in epithelial membrane transport physiology, such as the discovery of sugar and salt cotransport, have paved the way for oral replacement therapy in areas of the world where intravenous replacement is not readily available. In addition, the discovery of the cholera toxin has yielded vital information about toxigenic infectious diseases, providing a framework in which to study fundamental elements of intracellular signal transduction pathways, such as G-proteins. Cholera may even shed light on the evolution and pathophysiology of cystic fibrosis, the most commonly inherited disease among Caucasians. The goal of this paper is to review, using case studies, some of the lessons learned from cholera throughout the ages, acknowledging those pioneers whose seminal work led to our understanding of many basic concepts in medical epidemiology, microbiology, physiology, and therapeutics.

  14. Isolation of isoelectrically pure cholera toxin for crystallization

    NASA Astrophysics Data System (ADS)

    Spangler, Brenda D.; Westbrook, Edwin M.

    1991-03-01

    We have determined that the failure of cholera toxin to crystallize well results from its isoelectric heterogeneity, which is probably due to a post-translational process such as deamidation of its B subunit. Every sample of cholera toxin we have examined from commercial or academic suppliers has been heterogeneous; heterogeneous cholera toxin does not crystallize satisfactorily. We have overcome this problem by using ion-exchange fast protein liquid chromatography (FPLC) to obtain an isoelectrically homogeneous species of cholera toxin. Homogeneous cholera toxin crystallizes readily, forming single, nonmosaic crystals suitable for X-ray diffraction studies. For this process, protein was applied to a MonoQ ion-exchange column, then eluted with an isocratic low salt buffer followed by a linear salt gradient (0-100 mM NaCl). Column fractions were analyzed on isoelectric focusing gels, and those fractions containing the desired homogeneous species were pooled and concentrated. Crystals formed within 24 to 48 h in a MOPS/PEG buffer, which made use of slow isoelectric precipitation to induce crystallization.

  15. On the probability of extinction of the Haiti cholera epidemic

    NASA Astrophysics Data System (ADS)

    Bertuzzo, Enrico; Finger, Flavio; Mari, Lorenzo; Gatto, Marino; Rinaldo, Andrea

    2014-05-01

    Nearly 3 years after its appearance in Haiti, cholera has already exacted more than 8,200 deaths and 670,000 reported cases and it is feared to become endemic. However, no clear evidence of a stable environmental reservoir of pathogenic Vibrio cholerae, the infective agent of the disease, has emerged so far, suggesting that the transmission cycle of the disease is being maintained by bacteria freshly shed by infected individuals. Thus in principle cholera could possibly be eradicated from Haiti. Here, we develop a framework for the estimation of the probability of extinction of the epidemic based on current epidemiological dynamics and health-care practice. Cholera spreading is modelled by an individual-based spatially-explicit stochastic model that accounts for the dynamics of susceptible, infected and recovered individuals hosted in different local communities connected through hydrologic and human mobility networks. Our results indicate that the probability that the epidemic goes extinct before the end of 2016 is of the order of 1%. This low probability of extinction highlights the need for more targeted and effective interventions to possibly stop cholera in Haiti.

  16. Robotic bilateral inguinal lymphadenectomy in penile cancer, development of a technique without robot repositioning: a case report

    PubMed Central

    Sotelo, Rene; Cabrera, Marino; Carmona, Oswaldo; de Andrade, Robert; Martin, Oscar; Fernandez, Golena

    2013-01-01

    Introduction Inguinal lymphadenectomy is the treatment of choice for patients with penile cancer and inguinal lymph node metastases. We describe the performance of the robotic bilateral inguinal lymphadenectomy technique without repositioning the robot in a patient with penile carcinoma and high risk for nodal metastases and no palpable lymph nodes. Materials and methods A 64-year-old male patient was diagnosed with penile cancer (TNM: T3 N 0 M 0) and underwent a total penectomy with perineal urethrostomy. We performed a robotic bilateral inguinal lymphadenectomy four weeks after the penectomy. Results The entire procedure was performed with the robot-assisted technique. The operative time, median estimated blood loss, and hospital stay was 360 min, 100 ml (50 ml in the right side and 150 ml in the left side), and three days, respectively. Metastatic nodes were present in both inguinal regions, with a yield of 19 lymph nodes on the right and 14 on the left. The patient presented with a left-side lymphocele that was drained at follow-up. No other complications were reported. Conclusion Robotic bilateral inguinal lymphadenectomy secondary to penile cancer is feasible, safe, and provides a good performance. Prospective studies are required to include a larger number of patients and long-term monitoring to assess the results of this procedure in comparison with open and laparoscopic techniques. PMID:24101945

  17. Rare variant of inguinal hernia, interparietal hernia and ipsilateral abdominal ectopic testis, mimicking a spiegelian hernia. Case report.

    PubMed

    Hirabayashi, Takeshi; Ueno, Shigeru

    2013-07-20

    We report a case in which the combination of an interparietal inguinal hernia and ipsilateral ectopic testicle mimicked a spigelian hernia. The patient was a 22-day-old boy who presented with a reducible mass that extended from the right lumbar region to the iliac fossa region. The right testis was palpable in the right lumbar region. Ultrasonography and magnetic resonance imaging revealed that a small bowel had herniated through the inguinal region below the external oblique aponeurosis. Surgery was performed when the patient was 23 months old. Laparoscopic examination to identify the hernia orifice revealed that it was the deep inguinal ring, and the testicular vessels and the vas deferens passed beneath the hernia sac. An inguinal incision was made, and a hernia sac was observed passing through the deep inguinal ring and extending superiorly below the aponeurosis. The testis was found in the hernia sac. Traditional inguinal herniorrhaphy and traditional orchidopexy were performed, and the postoperative course was uneventful. It is difficult to understand the surgical anatomy of interparietal hernias, but once the surgical anatomy is understood, surgical repair is simple. We report the case with a review of the literature and also emphasize that laparoscopic exploration is helpful during surgery.

  18. Cholera in Pregnancy: Outcomes from a Specialized Cholera Treatment Unit for Pregnant Women in Léogâne, Haiti

    PubMed Central

    Ciglenecki, Iza; Bichet, Mathieu; Tena, Javier; Mondesir, Erneau; Bastard, Mathieu; Tran, Nguyen-Toan; Antierens, Annick; Staderini, Nelly

    2013-01-01

    Background The association between cholera in pregnancy and negative fetal outcome has been described since the 19th century. However, there is limited published literature on the subject. We describe pregnancy outcomes from a specialized multidisciplinary hospital unit at the onset of a large cholera outbreak in Haiti in 2010 and 2011. Methods Pregnant women with cholera were hospitalized in a specialized unit within the MSF hospital compound in Léogâne and treated using standard cholera treatment guidelines but with earlier, more intense fluid replacement. All women had intravenous access established at admission regardless of their hydration status, and all received antibiotic treatment. Data were collected on patient demographics, pregnancy and cholera status, and pregnancy outcome. In this analysis we calculated risk ratios for fetal death and performed logistic regression analysis to control for confounding factors. Results 263 pregnant women with cholera were hospitalized between December 2010 and July 2011. None died during hospitalization, 226 (86%) were discharged with a preserved pregnancy and 16 (6%) had live fullterm singleton births, of whom 2 died within the first 5 days postpartum. The remaining 21 pregnancies (8%) resulted in intrauterine fetal death. The risk of fetal death was associated with factors reflecting severity of the cholera episode: after adjusting for confounding factors, the strongest risk factor for fetal death was severe maternal dehydration (adjusted risk ratio for severe vs. mild dehydration was 9.4, 95% CI 2.5–35.3, p = 0.005), followed by severe vomiting (adjusted risk ratio 5.1, 95% 1.1–23.8, p = 0.041). Conclusion This is the largest cohort of pregnant women with cholera described to date. The main risk factor identified for fetal death was severity of dehydration. Our experience suggests that establishing specialized multidisciplinary units which facilitate close follow-up of both pregnancy and dehydration

  19. Treatment of a giant inguinal hernia using transabdominal pre-peritoneal repair.

    PubMed

    Momiyama, Masato; Mizutani, Fumitoshi; Yamamoto, Tatsuyoshi; Aoyama, Yoshinori; Hasegawa, Hiroshi; Yamamoto, Hideo

    2016-01-01

    We present the case of a male Japanese patient with a giant inguinal hernia that extended to his knees while standing. A transabdominal pre-peritoneal (TAPP) repair was performed under general anesthesia. Complete reduction of the contents of the hernia was achieved within 2 h 50 min. A blood loss of approximately 700 ml was noted. The patient was discharged from the hospital on post-operative Day 12, with no recurrence of the hernia 6 months post-surgery. Factors contributing to the successful outcomes included preparation of several reduction methods before surgery, use of a large size mesh and implementation of pre-operative measures to prevent abdominal compartment syndrome. Further studies are required to evaluate the feasibility of laparoscopic repair in the management of giant inguinal hernia. PMID:27672103

  20. Treatment of a giant inguinal hernia using transabdominal pre-peritoneal repair

    PubMed Central

    Momiyama, Masato; Mizutani, Fumitoshi; Yamamoto, Tatsuyoshi; Aoyama, Yoshinori; Hasegawa, Hiroshi; Yamamoto, Hideo

    2016-01-01

    We present the case of a male Japanese patient with a giant inguinal hernia that extended to his knees while standing. A transabdominal pre-peritoneal (TAPP) repair was performed under general anesthesia. Complete reduction of the contents of the hernia was achieved within 2 h 50 min. A blood loss of approximately 700 ml was noted. The patient was discharged from the hospital on post-operative Day 12, with no recurrence of the hernia 6 months post-surgery. Factors contributing to the successful outcomes included preparation of several reduction methods before surgery, use of a large size mesh and implementation of pre-operative measures to prevent abdominal compartment syndrome. Further studies are required to evaluate the feasibility of laparoscopic repair in the management of giant inguinal hernia.

  1. An extraneural primary anaplastic ependymoma at the subcutaneous inguinal region: Report of a rare case.

    PubMed

    Sayar, Hamide; Ersen, Ayca; Kurtul, Neslihan; Yazar, Mehmet Fatih; Balakan, Ozan

    2015-01-01

    Ependymomas commonly arise in the central nervous system. Extraneural presentation is quite rare. Herein, we describe a primary extraneural ependymoma in a young female. The mass was located in the right inguinal area. The cut surface of the 7.5 mm × 6.5 mm × 4.5 mm sized tumor was brownish-yellow in color. Histologically, it was hypercellular exhibiting pseudorosette or rosette formations and some papillary structures. Mitosis was counted as high as 10 per 10 high power fields. Neither necrosis nor vascular endothelial proliferation within the tumor was observed. Tumor cells showed strong glial fibrillary acidic protein immunoreactivity. On epithelial membrane antigen, intracytoplasmic dot-like immunostaining was observed. This is the first report presenting a primary extraneural anaplastic ependymoma arising in the inguinal subcutaneous region. PMID:26549094

  2. Treatment of a giant inguinal hernia using transabdominal pre-peritoneal repair

    PubMed Central

    Momiyama, Masato; Mizutani, Fumitoshi; Yamamoto, Tatsuyoshi; Aoyama, Yoshinori; Hasegawa, Hiroshi; Yamamoto, Hideo

    2016-01-01

    We present the case of a male Japanese patient with a giant inguinal hernia that extended to his knees while standing. A transabdominal pre-peritoneal (TAPP) repair was performed under general anesthesia. Complete reduction of the contents of the hernia was achieved within 2 h 50 min. A blood loss of approximately 700 ml was noted. The patient was discharged from the hospital on post-operative Day 12, with no recurrence of the hernia 6 months post-surgery. Factors contributing to the successful outcomes included preparation of several reduction methods before surgery, use of a large size mesh and implementation of pre-operative measures to prevent abdominal compartment syndrome. Further studies are required to evaluate the feasibility of laparoscopic repair in the management of giant inguinal hernia. PMID:27672103

  3. Scrotal Apocrine Adenocarcinoma with Pagetoid Phenomenon and Inguinal Lymph Node Metastases

    PubMed Central

    Fyllos, Apostolos Haralampos; Havaki, Sophia; Sotiriou, Sotirios; Kotakidis, Georgios; Arvanitis, Dimitrios Leonidas

    2016-01-01

    We report a case of scrotal apocrine adenocarcinoma in a 72-year-old Caucasian male which was initially presented as a reddish superficial lesion which in time became an ulcerated nodule. The initial pathological examination showed an apocrine adenocarcinoma with pagetoid phenomenon. The tumor recurred after four months and then excision biopsy showed tumor with pagetoid phenomenon which reached all the surgical margins. Three months later an ulcerated nodule in the scrotum and greatly enlarged ipsilateral inguinal lymph nodes were noticed. The final pathological examination showed multiple separated malignant foci, some with overlying pagetoid phenomenon and inguinal lymph node metastases. Immunohistochemistry showed positivity for Gross Cystic Disease Fluid Protein-15 (GCDFP-15), androgen receptors, and score 3+ for the Human Epidermal growth factor Receptor-2 (HER2). The aggressive behavior of the present tumor goes along with previous reports showing that HER2 high score cases exhibit a worse prognosis.

  4. Small Bowel Melanoma Metastasing to Inguinal Lymph Node - a Rare Case.

    PubMed

    Chisthi M, Meer; M, Rahul; A, Sreekumar

    2015-06-01

    Malignant Melanoma is one of the commonest cutaneous malignancies affecting human beings. The gastrointestinal tract is a common site for melanoma, both as primary and metastases. However it is rare for gastrointestinal melanoma to metastase oustide of the abdominal cavity. In the literature, there is no evidence about inguinal lymph node metastases from small bowel melanoma. Here we present a case report of an old lady who underwent laparoscopic resection of small bowel for melanoma and presented 4 years later with metastatic lymph node in inguinal lymph node. Though it could not be verified, we hypothesise that the tumour disseminated to the lymph node through a port-site metastases. Literature review shows several mechanisms which were put forward to explain the mechanism of port-site metastases.

  5. Case 230: Congenital Inguinal Herniation of the Left Ureter (Extraperitoneal Form).

    PubMed

    Di Nicolò, Pierpaolo; Aleo, Daniele; Riccioli, Emilio; Granata, Antonio

    2016-06-01

    History A 52-year-old man with a history of urinary tract infections and a previous clinical diagnosis of left inguinal hernia presented to the nephrologist with recent onset of dysuria and increasing swelling in the left inguinoscrotal region in the absence of fever or scrotal trauma. There was no relevant surgical or family history. The general physical examination findings were unremarkable, with a normal abdomen at both visual inspection and palpation; urogenital examination revealed a small left-sided palpable mass of the testis, compatible with an inguinal hernia or hydrocele. At first, gray-scale and color Doppler ultrasonographic (US) images of the testes and the inguinoscrotal region were obtained. Contrast material-enhanced computed tomographic (CT) images of the lower abdomen and pelvis were then obtained to further evaluate the urinary tract. PMID:27183410

  6. Vibrio cholerae O139 in Calcutta, 1992-1998: incidence, antibiograms, and genotypes.

    PubMed Central

    Basu, A.; Garg, P.; Datta, S.; Chakraborty, S.; Bhattacharya, T.; Khan, A.; Ramamurthy, S.; Bhattacharya, S. K.; Yamasaki, S.; Takeda, Y.; Nair, G. B.

    2000-01-01

    We report results of surveillance for cholera caused by Vibrio cholerae O139 from September 1992, when it was first identified, to December 1998. V. cholerae O139 dominated as the causative agent of cholera in Calcutta during 1992-93 and 1996- 97, while the O1 strains dominated during the rest of the period. Dramatic shifts in patterns of resistance to cotrimoxazole, neomycin, and streptomycin were observed. Molecular epidemiologic studies showed clonal diversity among the O139 strains and continuous emergence of new epidemic clones, reflected by changes in the structure, organization, and location of the CTX prophages in the V. cholerae O139 PMID:10756147

  7. Conjugated Linoleic Acid Reduces Cholera Toxin Production In Vitro and In Vivo by Inhibiting Vibrio cholerae ToxT Activity.

    PubMed

    Withey, Jeffrey H; Nag, Drubhajyoti; Plecha, Sarah C; Sinha, Ritam; Koley, Hemanta

    2015-12-01

    The severe diarrheal disease cholera is endemic in over 50 countries. Current therapies for cholera patients involve oral and/or intravenous rehydration, often combined with the use of antibiotics to shorten the duration and intensity of the disease. However, as antibiotic resistance increases, treatment options will become limited. Linoleic acid has been shown to be a potent negative effector of V. cholerae virulence that acts on the major virulence transcription regulator protein, ToxT, to inhibit virulence gene expression. ToxT activates transcription of the two major virulence factors required for disease, cholera toxin (CT) and toxin-coregulated pilus (TCP). A conjugated form of linoleic acid (CLA) is currently sold over the counter as a dietary supplement and is generally recognized as safe by the U.S. Food and Drug Administration. This study examined whether CLA could be used as a new therapy to reduce CT production, which, in turn, would decrease disease duration and intensity in cholera patients. CLA could be used in place of traditional antibiotics and would be very unlikely to generate resistance, as it affects only virulence factor production and not bacterial growth or survival.

  8. Genome-Wide Study of the Defective Sucrose Fermenter Strain of Vibrio cholerae from the Latin American Cholera Epidemic

    PubMed Central

    Garza, Daniel Rios; Thompson, Cristiane C.; Loureiro, Edvaldo Carlos Brito; Dutilh, Bas E.; Inada, Davi Toshio; Junior, Edivaldo Costa Sousa; Cardoso, Jedson Ferreira; Nunes, Márcio Roberto T.; de Lima, Clayton Pereira Silva; Silvestre, Rodrigo Vellasco Duarte; Nunes, Keley Nascimento Barbosa; Santos, Elisabeth C. O.; Edwards, Robert A.; Vicente, Ana Carolina P.; de Sá Morais, Lena Lillian Canto

    2012-01-01

    The 7th cholera pandemic reached Latin America in 1991, spreading from Peru to virtually all Latin American countries. During the late epidemic period, a strain that failed to ferment sucrose dominated cholera outbreaks in the Northern Brazilian Amazon region. In order to understand the genomic characteristics and the determinants of this altered sucrose fermenting phenotype, the genome of the strain IEC224 was sequenced. This paper reports a broad genomic study of this strain, showing its correlation with the major epidemic lineage. The potentially mobile genomic regions are shown to possess GC content deviation, and harbor the main V. cholera virulence genes. A novel bioinformatic approach was applied in order to identify the putative functions of hypothetical proteins, and was compared with the automatic annotation by RAST. The genome of a large bacteriophage was found to be integrated to the IEC224's alanine aminopeptidase gene. The presence of this phage is shown to be a common characteristic of the El Tor strains from the Latin American epidemic, as well as its putative ancestor from Angola. The defective sucrose fermenting phenotype is shown to be due to a single nucleotide insertion in the V. cholerae sucrose-specific transportation gene. This frame-shift mutation truncated a membrane protein, altering its structural pore-like conformation. Further, the identification of a common bacteriophage reinforces both the monophyletic and African-Origin hypotheses for the main causative agent of the 1991 Latin America cholera epidemics. PMID:22662140

  9. Characterization of Undermethylated Sites in Vibrio cholerae

    PubMed Central

    Dalia, Ankur B.; Lazinski, David W.

    2013-01-01

    The activities of DNA methyltransferases are important for a variety of cellular functions in bacteria. In this study, we developed a modified high-throughput technique called methyl homopolymer tail mediated sequencing (methyl HTM-seq) to identify the undermethylated sites in the Vibrio cholerae genome for the two DNA methyltransferases, Dam, an adenine methyltransferase, and VchM, a cytosine methyltransferase, during growth in rich medium in vitro. Many of the undermethylated sites occurred in intergenic regions, and for most of these sites, we identified the transcription factors responsible for undermethylation. This confirmed the presence of previously hypothesized DNA-protein interactions for these transcription factors and provided insight into the biological state of these cells during growth in vitro. DNA adenine methylation has previously been shown to mediate heritable epigenetic switches in gene regulation. However, none of the undermethylated Dam sites tested showed evidence of regulation by this mechanism. This study is the first to identify undermethylated adenines and cytosines genomewide in a bacterium using second-generation sequencing technology. PMID:23504020

  10. [The ultrasound semiotics of uncomplicated wound healing after inguinal mesh plastics].

    PubMed

    Kharitonov, S V; Ziniakova, M V

    2012-01-01

    Dynamic ultrasound (US) investigation was performed in 89 patients operated on inguinal hernia with the use of meshes of various type. The US scanning proved to be a highly informative means of visualization, allowing the objective postoperative assessment of muscular and aponeurotic structures as well as the implant form and position. The study showed, that the mesh implantation was always accompanied by the exudative tissue reaction, which was determined by the physico-chemical characteristics of the implant.

  11. Surgery Duration Predicts Urinary Retention after Inguinal Herniorraphy: A Single Institution Review

    PubMed Central

    Hudak, Kevin E.; Frelich, Matthew J.; Rettenmaier, Chris R.; Xiang, Qun; Wallace, James R.; Kastenmeier, Andrew S.; Gould, Jon C.; Goldblatt, Matthew I.

    2016-01-01

    Background Inguinal hernia repair, laparoscopic or open, is one of the most frequently performed operations in general surgery. Postoperative urinary retention (POUR) can occur in 0.2–35% of patients after inguinal hernia repair. The primary objective of this study was to determine the incidence of POUR after inguinal hernia repair. As a secondary goal, we sought to determine if perioperative and patient factors predicted urinary retention. Methods This study is a retrospective review of patients who underwent inguinal hernia repair with synthetic mesh at the Medical College of Wisconsin from January 2007 to June 2012. Procedures were performed by four surgeons. Clinical information and perioperative outcomes were collected up to hospital discharge. Urinary retention was defined as need for urinary catheterization post-operatively. Results A total of 192 patients were included in the study (88 bilateral, 46%) and (104 unilateral, 54%). The majority of subjects (76%) underwent laparoscopic repair. The overall POUR rate was 13%, with 25 of 192 patients requiring a Foley catheter prior to discharge POUR was significantly associated with bilateral hernia repairs (p=0.04), BMI≥35kg/m2 (p=0.05) and longer operative times (p=0.03). Based on odds ratio estimates, for every 10-minute increase in operative time, an 11% increase in the odds of urinary retention is expected (OR 1.11, CI 1.004 – 1.223; p=0.04). For every 10-minute increase in operative time, an 11% increase in POUR is expected. Conclusions Bilateral hernia repairs, BMI ≥ 35kg/m2, and operative time are significant predictors of POUR. These factors are important to determine potential risk to patients and interventions such as strict fluid administration, use of catheters, and potential premedication. PMID:25612548

  12. Clinical Outcome Following Infra-Inguinal Percutaneous Transluminal Angioplasy for Critical Limb Ischemia

    SciTech Connect

    Matsagas, Miltiadis I.; Rivera, Marco A.; Tran, Tan; Mitchell, Adam; Robless, Peter; Davies, Alun H.; Geroulakos, George

    2003-06-15

    Objective: The aim of this study was to assess the efficacy and durability of infra-inguinal PTA in patients with CLI, in terms of clinical outcome. Design:Retrospective study of 50 consecutive patients with CLI that were exclusively treated by infra-inguinal PTA. Methods: The indications for intervention were rest pain in seven (14%) patients,non-healing ulcers in 27 (54%), and gangrenous lesions in 16 (32%).Thirty-three (66%) of these patients presented with a single arterial lesion, and the remaining 17 (34%) with multilevel arterial lesions.Kaplan-Meier analysis was used to assess survival, patency,limb-salvage rates, and amputation-free survival. Results: A total of 67 endovascular procedures were performed and 59 (88.1%) of them were considered to be technically successful. The median follow-up period was 12 months (interquartilerange: 17 months). The 30-day mortality was 4%, while the cumulative survival rates at 12, 24, and 36 months were 73%, 67%, and 59%,respectively. The cumulative primary patency rates at 12 and 24 months were 63% and 52%, respectively, and remained unchanged thereafter.The estimated secondary patency rate was 72% at 36 months. There was only one below-knee amputation in the patients that were treated exclusively with infra-inguinal PTA. The cumulative amputation-free survival at the same period was estimated at 60%. Conclusions: Infra-inguinal PTA had a good early and late outcome in this series of patients with a limited life expectancy.These results are comparable to historical results of surgical revascularization in the treatment of CLI. There is need for a randomized study to determine the primary optimal interventional approach for patients with CLI.

  13. Small Bowel Neuroendocrine Tumors with Inguinal Metastases: A Diagnostic and Therapeutic Dilemma.

    PubMed

    Inayat, Faisal; Daly, Kevin P; Askarian, Farhad; Saif, Muhammad W

    2016-01-01

    Small bowel neuroendocrine tumors (NETs) are frequently characterized by a strong propensity to metastasize to the liver, mesentery, and peritoneum. However, only a few extra-abdominal metastatic sites have been reported in the published literature. The present paper implicates that primary small bowel NETs may unusually metastasize to the inguinal lymph nodes. Furthermore, we discuss the formidable diagnostic and therapeutic challenges associated with the metastatic NETs. PMID:27555990

  14. Small Bowel Neuroendocrine Tumors with Inguinal Metastases: A Diagnostic and Therapeutic Dilemma

    PubMed Central

    Daly, Kevin P; Askarian, Farhad; Saif, Muhammad W

    2016-01-01

    Small bowel neuroendocrine tumors (NETs) are frequently characterized by a strong propensity to metastasize to the liver, mesentery, and peritoneum. However, only a few extra-abdominal metastatic sites have been reported in the published literature. The present paper implicates that primary small bowel NETs may unusually metastasize to the inguinal lymph nodes. Furthermore, we discuss the formidable diagnostic and therapeutic challenges associated with the metastatic NETs. PMID:27555990

  15. Vitello-intestinal duct injury after transabdominal preperitoneal inguinal hernia repair.

    PubMed

    Albeyatti, Amina; Hussain, Abdulzahra; El-Hasani, Shamsi

    2013-02-01

    A 71-year-old patient underwent a transabdominal preperitoneal right inguinal hernia repair and presented to the emergency department 48 hours postoperatively with nonspecific abdominal and chest pain and was diagnosed an abdominal abscess at the umbilicus by computed tomography. Laparotomy showed a vitello-intestinal duct injury caused by the umbilical trocar at his previous laparoscopic surgery. We will discuss this rare complication and how to avoid it in future practice. PMID:23386168

  16. Umbilical hernia, inguinal hernias, and hydroceles in children: diagnostic clues for optimal patient management.

    PubMed

    Gill, F T

    1998-01-01

    The assessment of pediatric patients with a possible umbilical hernia, inguinal hernias, or hydroceles can often be problematic for the pediatric nurse practitioner. Understanding the embryologic processes related to these conditions may increase the diagnostic capabilities of the practitioner. Clues to assist in the differential diagnosis and current treatment modalities will be offered. Tips for parental guidance related to these conditions will enhance the team approach to effective referrals and optimal treatment of the children in this clinical population.

  17. Warming Oceans, Phytoplankton, and River Discharge: Implications for Cholera Outbreaks

    PubMed Central

    Jutla, Antarpreet S.; Akanda, Ali S.; Griffiths, Jeffrey K.; Colwell, Rita; Islam, Shafiqul

    2011-01-01

    Phytoplankton abundance is inversely related to sea surface temperature (SST). However, a positive relationship is observed between SST and phytoplankton abundance in coastal waters of Bay of Bengal. This has led to an assertion that in a warming climate, rise in SST may increase phytoplankton blooms and, therefore, cholera outbreaks. Here, we explain why a positive SST-phytoplankton relationship exists in the Bay of Bengal and the implications of such a relationship on cholera dynamics. We found clear evidence of two independent physical drivers for phytoplankton abundance. The first one is the widely accepted phytoplankton blooming produced by the upwelling of cold, nutrient-rich deep ocean waters. The second, which explains the Bay of Bengal findings, is coastal phytoplankton blooming during high river discharges with terrestrial nutrients. Causal mechanisms should be understood when associating SST with phytoplankton and subsequent cholera outbreaks in regions where freshwater discharge are a predominant mechanism for phytoplankton production. PMID:21813852

  18. Mortality Rates during Cholera Epidemic, Haiti, 2010-2011.

    PubMed

    Luquero, Francisco J; Rondy, Marc; Boncy, Jacques; Munger, André; Mekaoui, Helmi; Rymshaw, Ellen; Page, Anne-Laure; Toure, Brahima; Degail, Marie Amelie; Nicolas, Sarala; Grandesso, Francesco; Ginsbourger, Maud; Polonsky, Jonathan; Alberti, Kathryn P; Terzian, Mego; Olson, David; Porten, Klaudia; Ciglenecki, Iza

    2016-03-01

    The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded. To estimate the magnitude of the death toll during the first wave of the epidemic, we retrospectively conducted surveys at 4 sites in the northern part of Haiti. Overall, 70,903 participants were included; at all sites, the crude mortality rates (19.1-35.4 deaths/1,000 person-years) were higher than the expected baseline mortality rate for Haiti (9 deaths/1,000 person-years). This finding represents an excess of 3,406 deaths (2.9-fold increase) for the 4.4% of the Haiti population covered by these surveys, suggesting a substantially higher cholera mortality rate than previously reported.

  19. Cholera toxin can catalyze ADP-ribosylation of cytoskeletal proteins

    SciTech Connect

    Kaslow, H.R.; Groppi, V.E.; Abood, M.E.; Bourne, H.R.

    1981-11-01

    Cholera toxin catalyzes transfer of radiolabel from (/sup 32/P)NAD/sup +/ to several peptides in particulate preparations of human foreskin fibroblasts. Resolution of these peptides by two-dimensional gel electrophoresis allowed identification of two peptides of M/sub r/ = 42,000 and 52,000 as peptide subunits of a regulatory component of adenylate cyclase. The radiolabeling of another group of peptides (M/sub r/ = 50,000 to 65,000) suggested that cholera toxin could catalyze ADP-ribosylation of cytoskeletal proteins. This suggestion was confirmed by showing that incubation with cholera toxin and (/sup 32/P)NAD/sup +/ caused radiolabeling of purified microtubule and intermediate filament proteins.

  20. Review of recent trends in cholera research and control

    PubMed Central

    Felsenfeld, O.

    1966-01-01

    Since 1961 cholera El Tor has been sweeping through the Far East, and this dissemination of the disease has stimulated research not only in the countries afflicted but also in Europe and the Americas. New laboratories and workers have entered the field and many fresh ideas and concepts have emerged. The time seemed ripe, therefore, to survey the most important papers published since 1959, when the literature on cholera was thoroughly reviewed by Pollitzer, for the benefit both of those engaged in research and of those concerned with public health practice. This review covers history and incidence, causative agents (including the ”classical”, ”El Tor” and ”incomplete” forms), pathophysiology, diagnosis, treatment, mode of spreading and control measures (with particular reference to public health education and the International Sanitary Regulations). An annex, intended for laboratory use, contains selected procedures for the isolation and identification of cholera vibrios. PMID:5328492

  1. Flow cytofluorometric monitoring of leukocyte apoptosis in experimental cholera

    NASA Astrophysics Data System (ADS)

    Lotsmanova, Ekaterina Y.; Kravtsov, Alexander L.; Livanova, Ludmila F.; Kobkova, Irina M.; Kuznetsov, Oleg S.; Shchukovskaya, Tatyana N.; Smirnova, Nina I.; Kutyrev, Vladimir V.

    2003-10-01

    Flow cytofluorometric DNA analysis was applied to determine of the relative contents of proliferative (more then 2C DNA per cell) and apoptotic (less then 2C DNA per cell) leukocytes in blood of adult rabbits, challenged with 10,000 times the 50 % effective dose of Vibrio cholerae virulent strain by the RITARD technique. It has been shown that irreversible increase the percentage of cells carrying DNA in the degradation stage brings to disbalance between the genetically controlled cell proliferation and apoptosis that leads to animal death from the cholera infection. Such fatal changes were not observed in challenging of immunized animals that were not died. Thus received data show that the flow cytofluorometric measurements may be used for detection of transgressions in homeostasis during acute infection diseases, for outlet prognosis of the cholera infection.

  2. [Cholera in children. A report of 8 cases].

    PubMed

    Lezama-Basulto, L A; Mota-Hernández, F; Bravo-Barrios, E

    1993-11-01

    Cholera is an acute intestinal infection caused by Vibrio cholerae 01. When an infected person presents severe dehydration and is not adequately treated, he or she will develop hypovolemic shock and eventually could died. There is scarce information concerning this disease in the Pediatric group. Herein we report on eight cases of Pediatric cholera, in children 17 month to four years of age. Seven patients out of eight were admitted presenting dehydration. Four presenting mild or moderate dehydration and three presenting hypovolemic shock. These three patients were rehydrated by intravenous route and thereafter the hydration was maintained by oral therapy. The outcome was uneventful in six patients. One patient developed abdominal distention probably due to hypopotassemia, and another patient presented hyponatremia and seizures. All the patients recovered within five days after admission.

  3. [The first case of Vibrio cholerae 0139 in Denmark].

    PubMed

    Dalsgaard, A; Nielsen, G L; Echeverria, P; Larsen, J L; Schønheyder, H C

    1996-09-01

    We report the first case of V. cholerae O139 in Denmark. In 1994, a 61-year-old Vietnamese woman was admitted to Aalborg Hospital, Denmark due to severe diarrhoea. The diagnosis was confirmed by biochemical characterization and agglutination in O139 antiserum of a strain isolated from a stool specimen. The woman had stayed in Denmark after family reunion for nine months and had not travelled outside the country. She had not eaten any foods imported from Southeast Asia. The V. cholerae O139 isolate had similar antibiotic susceptibility pattern and contained genes encoding a virulence gene cassette previously identified in O139 isolates from Southeast Asia. Ribotyping showed a banding pattern similar to patterns exhibited by O139 isolates from Bangladesh, India and Thailand. However, the exact mode of transmission of this first Danish case of V. cholerae O139 infection was not determined.

  4. Mortality Rates during Cholera Epidemic, Haiti, 2010–2011

    PubMed Central

    Rondy, Marc; Boncy, Jacques; Munger, André; Mekaoui, Helmi; Rymshaw, Ellen; Page, Anne-Laure; Toure, Brahima; Degail, Marie Amelie; Nicolas, Sarala; Grandesso, Francesco; Ginsbourger, Maud; Polonsky, Jonathan; Alberti, Kathryn P.; Terzian, Mego; Olson, David; Porten, Klaudia; Ciglenecki, Iza

    2016-01-01

    The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded. To estimate the magnitude of the death toll during the first wave of the epidemic, we retrospectively conducted surveys at 4 sites in the northern part of Haiti. Overall, 70,903 participants were included; at all sites, the crude mortality rates (19.1–35.4 deaths/1,000 person-years) were higher than the expected baseline mortality rate for Haiti (9 deaths/1,000 person-years). This finding represents an excess of 3,406 deaths (2.9-fold increase) for the 4.4% of the Haiti population covered by these surveys, suggesting a substantially higher cholera mortality rate than previously reported. PMID:26886511

  5. [Histological alterations of the muscle cremaster in certain inguinal-scrotal anomalies].

    PubMed

    Esteban, R M Paredes; Cueva, C; Sánchez, B Velasco; Mariscal, M González; Vargas, J Rodríguez; García, A Lorite; Ruiz, M García

    2007-01-01

    The alteration in the cremaster muscle has been involved in the pathogeny of certain inguinal-scrotal anomalies, even though there are no conclusive studies up to date. The target of our paper is to determine the eventual existence of alterations in the cremaster muscle (CM) that helps to explain the etiopathogeny of different anomalies such as inguinal hernia, hydrocele or undescended testicle. We carried out a study on 42 patients with: inguinal hernia (n = 14), cryptorchidism (n = 14) and hydrocele (n = 14). Samples of the cremaster muscle were taken during the surgical intervention. Surgical samples were introduced or into formol and glutaraldehyde or into physiological serum and freezing for histological study. They were dyed with hematoxilin-eosin, PAS and phosphotungstic acid haematoxilin. In the histochemical study NADH, phosphoric hydrolases and Engel's trichromic were used. Parameters indicative of myopathic changes were evaluated. All CM samples from all three groups showed myopathic changes of primary type in different levels: first, second and third stages. This changes that produce alterations in the muscle's contractility, changes might make us think in a primary myopathy even though there are data pointing to a neurological influence on it.

  6. The morphometric histopathology of undescended testes and testes associated with incarcerated inguinal hernia: a comparative study.

    PubMed

    Hadziselimović, F; Herzog, B; Huff, D S; Menardi, G

    1991-08-01

    The underlying injury to undescended testes may be hormonal, a transient perinatal form fruste of hypogonadotropic hypogonadism characterized by blunting of the surge in gonadotropins normally seen at age 60 to 90 days. Ischemia is the underlying injury to testes associated with incarcerated inguinal hernias. To determine if the histopathology of these 2 injuries is different histomorphometric analyses were performed on semithin microscopic sections of biopsies of 21 control testes, 17 undescended testes and 13 intrascrotal testes associated with incarcerated inguinal hernias. The infants in all groups were 30 to 120 days old. The results showed that, as in previous studies, undescended testes at this age are characterized by hypoplasia of Leydig cells, normal germ cell counts and defective maturation of gonocytes into adult dark spermatogonia. In contrast, testes associated with incarcerated inguinal hernias were characterized by hyperplasia of Leydig cells, reduced germ cell counts and normal maturation of gonocytes into adult dark spermatogonia. One might conclude that the underlying injury of undescended testes, presumably the blunted surge of gonadotropins, causes a primary hypoplasia and hypofunction of Leydig cells, which in turn causes a secondary defect in transformation of gonocytes into spermatogonia. In contrast, ischemia may primarily cause a tubular epithelial lesion leaving the hypothalamic-pituitary-gonadal axis intact and allowing normal transformation of gonocytes into spermatogonia. Reduced gonadotropins and ischemia appear to produce distinctly different primary and secondary pathophysiological effects on the testes.

  7. Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers

    PubMed Central

    Orchard, J. W.; Read, J. W.; Neophyton, J.; Garlick, D.

    1998-01-01

    OBJECTIVES: To investigate the prevalence of inguinal canal posterior wall deficiency (sports hernia) in professional Australian Rules footballers using an ultrasound technique and correlate the results with the clinical symptom of groin pain. METHODS: Thirty five professional Australian footballers with and without groin pain were investigated blind with a dynamic high resolution ultrasound technique for presence of posterior wall deficiency. RESULTS: Fourteen players had a history of significant recent groin pain and ten of these were found to have bilateral inguinal canal posterior wall deficiency (p < 0.01). The relative risk for a history of groin pain with bilateral deficiency was 8.0 (95% confidence interval 1.73 to 37.1). Groin pain was also found to be associated with increasing age (p < 0.01) which was an independent risk factor. Surgical, clinical, and ultrasound follow up for players who underwent hernia repair confirmed the validity of ultrasound as a diagnostic tool. CONCLUSIONS: Dynamic ultrasound examination is able to detect inguinal canal posterior wall deficiency in young males with no clinical signs of hernia. This condition is very prevalent in professional Australian Rules footballers, including some who are asymptomatic. There was a correlation between bilateral deficiency and groin pain, although the temporal relationship between the clinical and ultrasound findings is not established by the current study. Ultrasound shows promise as a diagnostic tool in athletes with chronic groin pain who are considered possible candidates for hernia repair. 


 PMID:9631220

  8. Clinical Curative Effect of Mesalt Combined with Mepilex Dressing in Postoperative Infection of Inguinal Hernia

    PubMed Central

    Liu, Zhenjun; Xiong, Zhonghua; Wu, Jiayu; Wang, Fang

    2015-01-01

    Background Inguinal hernia is a common surgical disease. Tension-free hernioplasty is currently commonly used for its treatment, with multiple advantages such as simple surgical method, low recurrence rate, and ability to be performed in primary care hospitals, but the risk of incision infection still exists. Mild infection can be cured by local washing, dressing, and systemic antibiotics. If the infection is severe, the wound may not heal after removing the patch, and secondary suturing is needed. Material/Methods A total of 60 patients with postoperative infection after tension-free repair of inguinal hernia were randomly divided into control (n=30) and treatment (n=30) groups. Patients in the treatment group received Mesalt combined with Mepilex for dressing while the patients in the control group received conventional gauze for dressing. Pain degree, wound healing time, and dressing times were observed. Results The clinical therapeutic effect in the treatment group was significantly better than in the control group. The treatment group exhibited significantly less pain when patients receive dressing, shorter wounds healing time (15±3.5 vs. 30±5.0), and less dressing frequency (10±2.1 vs. 20±2.4). Conclusions Mesalt combined with Mepilex can effectively improve postoperative infection after inguinal hernia treatment, obviously reducing pain, shorting wound healing time, and decreasing dressing frequency. It can be widely used in clinical practice. PMID:25854191

  9. Spatial and environmental connectivity analysis in a cholera vaccine trial.

    PubMed

    Emch, Michael; Ali, Mohammad; Root, Elisabeth D; Yunus, Mohammad

    2009-02-01

    This paper develops theory and methods for vaccine trials that utilize spatial and environmental information. Satellite imagery is used to identify whether households are connected to one another via water bodies in a study area in rural Bangladesh. Then relationships between neighborhood-level cholera vaccine coverage and placebo incidence and neighborhood-level spatial variables are measured. The study hypothesis is that unvaccinated people who are environmentally connected to people who have been vaccinated will be at lower risk compared to unvaccinated people who are environmentally connected to people who have not been vaccinated. We use four datasets including: a cholera vaccine trial database, a longitudinal demographic database of the rural population from which the vaccine trial participants were selected, a household-level geographic information system (GIS) database of the same study area, and high resolution Quickbird satellite imagery. An environmental connectivity metric was constructed by integrating the satellite imagery with the vaccine and demographic databases linked with GIS. The results show that there is a relationship between neighborhood rates of cholera vaccination and placebo incidence. Thus, people are indirectly protected when more people in their environmentally connected neighborhood are vaccinated. This result is similar to our previous work that used a simpler Euclidean distance neighborhood to measure neighborhood vaccine coverage [Ali, M., Emch, M., von Seidlein, L., Yunus, M., Sack, D. A., Holmgren, J., et al. (2005). Herd immunity conferred by killed oral cholera vaccines in Bangladesh. Lancet, 366(9479), 44-49]. Our new method of measuring environmental connectivity is more precise since it takes into account the transmission mode of cholera and therefore this study validates our assertion that the oral cholera vaccine provides indirect protection in addition to direct protection.

  10. Vaccination Strategies to Combat an Infectious Globe: Oral Cholera Vaccines

    PubMed Central

    López-Gigosos, Rosa M; Plaza, Elena; Díez-Díaz, Rosa M; Calvo, Maria J

    2011-01-01

    Cholera is a substantial health burden in many countries in Africa and Asia, where it is endemic. It is as well responsible for ongoing epidemics in sub-Saharan Africa which are becoming greater in terms of frequency, extension, and duration. Given the availability of two oral cholera vaccines and the new data on their efficacy, field effectiveness, feasibility, and acceptance in cholera-affected populations and in travelers, these vaccines should be used in endemic areas, in travelers for these areas and should be considered in areas at risk for outbreaks. The two vaccines currently available in worldwide are: (1) The killed oral vaccine (Dukoral, licensed by SBL–Sweden to Crucell–Holland) is recommended since 1999 by WHO and consists of a mixture of four preparations of heat or formalin killed whole cell Vibrio cholera O1 (Inaba and Ogaba serotypes, and classical and El Tor biotypes) that are then added with purified recombinant cholera toxin (CT) B subunit. Because CT cross-reacts with Escherichia coli LT the vaccine also provides short-term protection against ETEC (enterotoxigenic E. coli) which is of added benefit for travelers. It is available in more than 60 countries. (2) A bivalent O1 and O139 whole cell oral vaccine without CT B subunit (Shanchol) has been lately developed in Vietnam (licensed by VaBiotech–Viet Nam to Shantha Biotechnics–India. It is available in India and Indonesia. A structured search of papers in PubMed and reports on cholera vaccines by WHO and CDC, as well as critical reading and synthesis of the information was accomplished. Inclusion criteria were defined according to reports quality and relevance. PMID:21572610

  11. Vaccination strategies to combat an infectious globe: oral cholera vaccines.

    PubMed

    López-Gigosos, Rosa M; Plaza, Elena; Díez-Díaz, Rosa M; Calvo, Maria J

    2011-01-01

    Cholera is a substantial health burden in many countries in Africa and Asia, where it is endemic. It is as well responsible for ongoing epidemics in sub-Saharan Africa which are becoming greater in terms of frequency, extension, and duration. Given the availability of two oral cholera vaccines and the new data on their efficacy, field effectiveness, feasibility, and acceptance in cholera-affected populations and in travelers, these vaccines should be used in endemic areas, in travelers for these areas and should be considered in areas at risk for outbreaks. The two vaccines currently available in worldwide are: (1) The killed oral vaccine (Dukoral, licensed by SBL-Sweden to Crucell-Holland) is recommended since 1999 by WHO and consists of a mixture of four preparations of heat or formalin killed whole cell Vibrio cholera O1 (Inaba and Ogaba serotypes, and classical and El Tor biotypes) that are then added with purified recombinant cholera toxin (CT) B subunit. Because CT cross-reacts with Escherichia coli LT the vaccine also provides short-term protection against ETEC (enterotoxigenic E. coli) which is of added benefit for travelers. It is available in more than 60 countries. (2) A bivalent O1 and O139 whole cell oral vaccine without CT B subunit (Shanchol) has been lately developed in Vietnam (licensed by VaBiotech-Viet Nam to Shantha Biotechnics-India. It is available in India and Indonesia. A structured search of papers in PubMed and reports on cholera vaccines by WHO and CDC, as well as critical reading and synthesis of the information was accomplished. Inclusion criteria were defined according to reports quality and relevance.

  12. Unique Clones of Vibrio cholerae O1 El Tor with Haitian Type ctxB Allele Implicated in the Recent Cholera Epidemics from Nigeria, Africa

    PubMed Central

    Pazhani, Gururaja Perumal; Abiodun, Iwalokun Bamidele; Afolabi, Oluwadun; Kolawole, Olukoya Daniel; Mukhopadhyay, Asish K.; Ramamurthy, Thanadarayan

    2016-01-01

    Background and Objectives The antimicrobial susceptibility patterns and genetic characteristics of Vibrio cholerae O1, which is responsible for several cholera epidemics in Nigeria, are not reported in detail since 2007. In this study, we screened V. cholerae O1 El Tor biotype isolates from cholera cases and water samples from different states to investigate their phenotypic and genetic attributes with special reference to their clonality. Results All the V. cholerae O1 biotype El Tor isolates isolated during 2007–2013 were susceptible to fluoroquinolones and tetracycline, the drugs currently used in the treatment of cholera cases in Nigeria. Emergence of CT genotype 7 (Haitian type of ctxB allele) was predominantly seen among Ogawa serotype and the CT genotype 1 (classical ctxB allele) was mostly found in Inaba serotype. Overall, V. cholerae O1 from clinical and water samples were found to be closely related as determined by the pulsed-field gel electrophoresis. V. cholerae isolates from Abia, Kano and Bauchi were found to be genetically distinct from the other states of Nigeria. Conclusion Fecal contamination of the water sources may be the possible source of the cholera infection. Combined prevalence of Haitian and classical ctxB alleles were detected in Ogawa and Inaba serotypes, respectively. This study further demonstrated that V. cholerae O1 with the ctxB has been emerged similar to the isolates reported in Haiti. Our findings suggest that the use of fluoroquinolones or tetracycline/doxycycline may help in the effective management of acute cholera in the affected Nigerian states. In addition, strengthening the existing surveillance in the hospitals of all the states and supply of clean drinking water may control cholera outbreaks in the future. PMID:27479360

  13. [Epidemiological Surveillance of Cholera in Russia During the Period of the Seventh Pandemic].

    PubMed

    Onishhenko, G G; Moskvitina, E A; Kruglikov, V D; Titova, S V; Adamenko, O L; Vodop'ianov, A S; Vodop'ianov, S O

    2015-01-01

    In this work basic stages of formation of the epidemiological surveillance of cholera in Russia are described. In 1990-s for the first time zoning by epidemic manifestations of cholera was carried out at the level of subjects forming parts of Russia and other Republics of the Soviet Union with the introduction of differential tactics of epidemiological surveillance. Improvement of epidemiological surveillance of cholera was aimed at harmonization with the IHR (2005), integration of epidemiological surveillance of cholera and social-hygienic monitoring of water objects of I and II categories. Characterization of isolated Vibrio cholerae strains (1990-2014) on the genomic basis determined the emergence of new VNTR-genotypes of V. cholerae O1 ctxAB+ tcpA+, responsible for outbreaks, simultaneously with isolation of V. cholerae 01 ctxAB-tcpA-strains during monitoring of environmental objectsfor cholera. A viewpoint is considered of the beginning of the eighth cholera pandemic in the context of emergence of V. cholerae El Tor strains with CTXφ prophage carrying ctxB gene of cholera toxin of classical biovar. Main directions offurther enhancement ofepidemiological surveillance include the study of basic data structures used in the epidemiological surveillance system, the use of zoning of municipal units offederal subjects with corresponding surveillance tactics and expected economic effect.

  14. A global map of suitability for coastal Vibrio cholerae under current and future climate conditions.

    PubMed

    Escobar, Luis E; Ryan, Sadie J; Stewart-Ibarra, Anna M; Finkelstein, Julia L; King, Christine A; Qiao, Huijie; Polhemus, Mark E

    2015-09-01

    Vibrio cholerae is a globally distributed water-borne pathogen that causes severe diarrheal disease and mortality, with current outbreaks as part of the seventh pandemic. Further understanding of the role of environmental factors in potential pathogen distribution and corresponding V. cholerae disease transmission over time and space is urgently needed to target surveillance of cholera and other climate and water-sensitive diseases. We used an ecological niche model (ENM) to identify environmental variables associated with V. cholerae presence in marine environments, to project a global model of V. cholerae distribution in ocean waters under current and future climate scenarios. We generated an ENM using published reports of V. cholerae in seawater and freely available remotely sensed imagery. Models indicated that factors associated with V. cholerae presence included chlorophyll-a, pH, and sea surface temperature (SST), with chlorophyll-a demonstrating the greatest explanatory power from variables selected for model calibration. We identified specific geographic areas for potential V. cholerae distribution. Coastal Bangladesh, where cholera is endemic, was found to be environmentally similar to coastal areas in Latin America. In a conservative climate change scenario, we observed a predicted increase in areas with environmental conditions suitable for V. cholerae. Findings highlight the potential for vulnerability maps to inform cholera surveillance, early warning systems, and disease prevention and control.

  15. A global map of suitability for coastal Vibrio cholerae under current and future climate conditions.

    PubMed

    Escobar, Luis E; Ryan, Sadie J; Stewart-Ibarra, Anna M; Finkelstein, Julia L; King, Christine A; Qiao, Huijie; Polhemus, Mark E

    2015-09-01

    Vibrio cholerae is a globally distributed water-borne pathogen that causes severe diarrheal disease and mortality, with current outbreaks as part of the seventh pandemic. Further understanding of the role of environmental factors in potential pathogen distribution and corresponding V. cholerae disease transmission over time and space is urgently needed to target surveillance of cholera and other climate and water-sensitive diseases. We used an ecological niche model (ENM) to identify environmental variables associated with V. cholerae presence in marine environments, to project a global model of V. cholerae distribution in ocean waters under current and future climate scenarios. We generated an ENM using published reports of V. cholerae in seawater and freely available remotely sensed imagery. Models indicated that factors associated with V. cholerae presence included chlorophyll-a, pH, and sea surface temperature (SST), with chlorophyll-a demonstrating the greatest explanatory power from variables selected for model calibration. We identified specific geographic areas for potential V. cholerae distribution. Coastal Bangladesh, where cholera is endemic, was found to be environmentally similar to coastal areas in Latin America. In a conservative climate change scenario, we observed a predicted increase in areas with environmental conditions suitable for V. cholerae. Findings highlight the potential for vulnerability maps to inform cholera surveillance, early warning systems, and disease prevention and control. PMID:26048558

  16. Influence of climate factors on Vibrio cholerae dynamics in the Pearl River estuary, South China.

    PubMed

    Yue, Yujuan; Gong, Jianhua; Wang, Duochun; Kan, Biao; Li, Baisheng; Ke, Changwen

    2014-06-01

    Current research has seldom focused on the quantitative relationships between Vibrio cholerae (V. cholerae) and climate factors owing to the complexities and high cost of field observation in the aquatic environment. This study has focused on the relationships between V. cholerae and climate factors based on linear regression method and data partition method. Data gathered from 2008 to 2009 in the Pearl River estuary, South China, were adopted. Positive rate of V. cholerae was correlated closely with monthly climate factors of water temperature and air temperature, respectively in 2009. Quarterly data analysis from 2008 to 2009 showed that there existed seasonal characteristic for V. cholerae. Positive rate of V. cholerae was correlated positively with quarterly climate factors of land surface temperature, pH, water temperature, air temperature and rainfall, respectively and negatively with quarterly air pressure. Partition data analysis in 2009 showed that there existed geography region characteristic for V. cholerae. V. cholerae dynamics was closely correlated to climate factors in the downstream area. However, it was more greatly affected by human geography factors in the urban area. Positive annual rate of V. cholerae was higher in the downstream area than in the urban area both in 2008 and 2009. At last, a cellular automaton model was used to simulate V. cholerae diffusion downstream, and the distribution of V. cholerae obtained from this model was similar to that obtained from the field observations.

  17. [Epidemiological Surveillance of Cholera in Russia During the Period of the Seventh Pandemic].

    PubMed

    Onishhenko, G G; Moskvitina, E A; Kruglikov, V D; Titova, S V; Adamenko, O L; Vodop'ianov, A S; Vodop'ianov, S O

    2015-01-01

    In this work basic stages of formation of the epidemiological surveillance of cholera in Russia are described. In 1990-s for the first time zoning by epidemic manifestations of cholera was carried out at the level of subjects forming parts of Russia and other Republics of the Soviet Union with the introduction of differential tactics of epidemiological surveillance. Improvement of epidemiological surveillance of cholera was aimed at harmonization with the IHR (2005), integration of epidemiological surveillance of cholera and social-hygienic monitoring of water objects of I and II categories. Characterization of isolated Vibrio cholerae strains (1990-2014) on the genomic basis determined the emergence of new VNTR-genotypes of V. cholerae O1 ctxAB+ tcpA+, responsible for outbreaks, simultaneously with isolation of V. cholerae 01 ctxAB-tcpA-strains during monitoring of environmental objectsfor cholera. A viewpoint is considered of the beginning of the eighth cholera pandemic in the context of emergence of V. cholerae El Tor strains with CTXφ prophage carrying ctxB gene of cholera toxin of classical biovar. Main directions offurther enhancement ofepidemiological surveillance include the study of basic data structures used in the epidemiological surveillance system, the use of zoning of municipal units offederal subjects with corresponding surveillance tactics and expected economic effect. PMID:26234099

  18. An intracellular replication niche for Vibrio cholerae in the amoeba Acanthamoeba castellanii.

    PubMed

    Van der Henst, Charles; Scrignari, Tiziana; Maclachlan, Catherine; Blokesch, Melanie

    2016-04-01

    Vibrio cholerae is a human pathogen and the causative agent of cholera. The persistence of this bacterium in aquatic environments is a key epidemiological concern, as cholera is transmitted through contaminated water. Predatory protists, such as amoebae, are major regulators of bacterial populations in such environments. Therefore, we investigated the interaction between V. cholerae and the amoeba Acanthamoeba castellanii at the single-cell level. We observed that V. cholerae can resist intracellular killing. The non-digested bacteria were either released or, alternatively, established a replication niche within the contractile vacuole of A. castellanii. V. cholerae was maintained within this compartment even upon encystment. The pathogen ultimately returned to its aquatic habitat through lysis of A. castellanii, a process that was dependent on the production of extracellular polysaccharide by the pathogen. This study reinforces the concept that V. cholerae is a facultative intracellular bacterium and describes a new host-pathogen interaction.

  19. Environmental surveillance for toxigenic Vibrio cholerae in surface waters of Haiti.

    PubMed

    Kahler, Amy M; Haley, Bradd J; Chen, Arlene; Mull, Bonnie J; Tarr, Cheryl L; Turnsek, Maryann; Katz, Lee S; Humphrys, Michael S; Derado, Gordana; Freeman, Nicole; Boncy, Jacques; Colwell, Rita R; Huq, Anwar; Hill, Vincent R

    2015-01-01

    Epidemic cholera was reported in Haiti in 2010, with no information available on the occurrence or geographic distribution of toxigenic Vibrio cholerae in Haitian waters. In a series of field visits conducted in Haiti between 2011 and 2013, water and plankton samples were collected at 19 sites. Vibrio cholerae was detected using culture, polymerase chain reaction, and direct viable count methods (DFA-DVC). Cholera toxin genes were detected by polymerase chain reaction in broth enrichments of samples collected in all visits except March 2012. Toxigenic V. cholerae was isolated from river water in 2011 and 2013. Whole genome sequencing revealed that these isolates were a match to the outbreak strain. The DFA-DVC tests were positive for V. cholerae O1 in plankton samples collected from multiple sites. Results of this survey show that toxigenic V. cholerae could be recovered from surface waters in Haiti more than 2 years after the onset of the epidemic.

  20. An intracellular replication niche for Vibrio cholerae in the amoeba Acanthamoeba castellanii

    PubMed Central

    Van der Henst, Charles; Scrignari, Tiziana; Maclachlan, Catherine; Blokesch, Melanie

    2016-01-01

    Vibrio cholerae is a human pathogen and the causative agent of cholera. The persistence of this bacterium in aquatic environments is a key epidemiological concern, as cholera is transmitted through contaminated water. Predatory protists, such as amoebae, are major regulators of bacterial populations in such environments. Therefore, we investigated the interaction between V. cholerae and the amoeba Acanthamoeba castellanii at the single-cell level. We observed that V. cholerae can resist intracellular killing. The non-digested bacteria were either released or, alternatively, established a replication niche within the contractile vacuole of A. castellanii. V. cholerae was maintained within this compartment even upon encystment. The pathogen ultimately returned to its aquatic habitat through lysis of A. castellanii, a process that was dependent on the production of extracellular polysaccharide by the pathogen. This study reinforces the concept that V. cholerae is a facultative intracellular bacterium and describes a new host–pathogen interaction. PMID:26394005

  1. [Djibouti, history of 2 epidemics of cholera: 1993-1994].

    PubMed

    Morillon, M; De Pina, J J; Husser, J A; Baudet, J M; Bertherat, E; Martet, G

    1998-01-01

    When two cholera epidemics broke out in Djibouti, respectively in 1993 and 1994, Bioforce was obliged to intervene. The first time, three goals were pursued: setting up a rehydration centre in a tent, organizing epidemiological surveillance and training local personnel in treatment and diagnosis techniques. The next year, the epidemic followed serious flooding. The epidemiological analysis showed that cholera had become endemic in the poor neighbourhoods of the town and that epidemic break-outs were favoured by contaminated surface water and disturbances in the distribution of drinking water. The epidemic of 1997, likewise following flooding, only confirmed this point of view. PMID:10078376

  2. Field evaluation of environmental sanitation measures against cholera*

    PubMed Central

    Azurin, J. C.; Alvero, M.

    1974-01-01

    Data obtained in a controlled field study over 5 years in 4 communities showed that the provision of sanitary facilities for human waste disposal can reduce the incidence of cholera by as much as 68%, while the provision of a safe water supply can decrease it by 73%. Where both toilets and water supplies are provided, the incidence can be reduced by as much as 76%. There was evidence that cholera infection gaining access to communities with these facilities tends to spread less and produce fewer secondary cases than in a community where such facilities are not provided. PMID:4549038

  3. Field evaluation of environmental sanitation measures against cholera.

    PubMed

    Azurin, J C; Alvero, M

    1974-01-01

    Data obtained in a controlled field study over 5 years in 4 communities showed that the provision of sanitary facilities for human waste disposal can reduce the incidence of cholera by as much as 68%, while the provision of a safe water supply can decrease it by 73%. Where both toilets and water supplies are provided, the incidence can be reduced by as much as 76%. There was evidence that cholera infection gaining access to communities with these facilities tends to spread less and produce fewer secondary cases than in a community where such facilities are not provided. PMID:4549038

  4. Avian cholera in Southern Great Petrel (Macronectes giganteus) from Antarctica

    USGS Publications Warehouse

    Leotta, G.A.; Rivas, M.; Chinen, I.; Vigo, G.B.; Moredo, F.A.; Coria, N.; Wolcott, M.J.

    2003-01-01

    A southern giant petrel (Macronectes giganteus) was found dead at Potter Peninsula, King George Island, South Shetland, Antarctica. The adult male was discovered approximately 48 hr after death. Macroscopic and microscopic lesions were compatible with avian cholera and the bacterium Pasteurella multocida subsp. gallicida, serotype A1 was isolated from lung, heart, liver, pericardial sac, and air sacs. In addition, Escherichia coli was isolated from pericardial sac and air sacs. This is the first known report of avian cholera in a southern giant petrel in Antarctica.

  5. Avian cholera in waterfowl in Saskatchewan, spring 1977.

    PubMed

    Wobeser, G; Hunter, D B; Wright, B; Nieman, D J; Isbister, R

    1979-01-01

    Avian cholera was diagnosed in lesser snow geese (Anser c. caerulescens), Ross' geese (Anser rossii) and individuals of several other waterfowl species in a small area of south-western Saskatchewan over a 1 month period during the 1977 spring migration. Approximately 250 dead birds were found. This is apparently the first time avian cholera has been reported in migrating waterfowl in Canada. The site of the mortality was midway between the wintering and nesting areas of the two principal species, and the significance of the occurrence of the disease this far north is discussed. PMID:459043

  6. Skin findings in newborns

    MedlinePlus

    Newborn skin characteristics; Infant skin characteristics; Neonatal care - skin ... the first few weeks of the baby's life. Newborn skin will vary, depending on the length of the pregnancy. Premature infants have thin, transparent skin. The skin of a ...

  7. Oily skin

    MedlinePlus

    ... keep your skin clean using warm water and soap, or a soapless cleanser. Clean your face with astringent pads if frequent face washing causes irritation. Use only water-based or oil-free cosmetics if you have oily skin. Your ...

  8. Cholera in Bahrain: epidemiological characteristics of an outbreak*

    PubMed Central

    Gunn, Robert A.; Kimball, Ann M.; Mathew, P. P.; Dutta, S. R.; Rifaat, A. H. M.

    1981-01-01

    In the period 10 August 1978-23 January 1979, 913 culture-confirmed cases of cholera caused by Vibrio cholerae, biotype El Tor, serotype Ogawa, occurred in Bahrain. After discovery of the initial cases, others occurred sporadically, and the incidence reached a peak of 25-35 cases per day during the seventh week of the outbreak (16-22 September). The overall attack rate (27 per 10 000) was low and the outbreak subsided without mass immunization campaigns or rigorous border control of persons and imports. Investigation of 746 culture-confirmed cases that occurred in the period 10 August—13 October 1978, showed that cases occurred throughout most areas of the country and mainly affected infants, young children, and adult working-age males. Symptoms were very mild; fewer than 20% of patients required specific rehydration therapy. The highest attack rate (84 per 10 000) occurred in infants less than 1 year of age. No common vehicle or mode of transmission was identified. A matched-pair study of 35 cases and controls showed that adult cases were more likely than controls to have consumed food or beverage outside of the home before becoming ill. V. cholerae was isolated from stored drinking water in the houses of 8 cases but not from numerous samples of food and tap-water. It was presumed that cholera transmission occurred through a complex interaction of mild and asymptomatically infected persons with food, water, and the environment. PMID:6973417

  9. Assessing effects of cholera vaccination in the presence of interference.

    PubMed

    Perez-Heydrich, Carolina; Hudgens, Michael G; Halloran, M Elizabeth; Clemens, John D; Ali, Mohammad; Emch, Michael E

    2014-09-01

    Interference occurs when the treatment of one person affects the outcome of another. For example, in infectious diseases, whether one individual is vaccinated may affect whether another individual becomes infected or develops disease. Quantifying such indirect (or spillover) effects of vaccination could have important public health or policy implications. In this article we use recently developed inverse-probability weighted (IPW) estimators of treatment effects in the presence of interference to analyze an individually-randomized, placebo-controlled trial of cholera vaccination that targeted 121,982 individuals in Matlab, Bangladesh. Because these IPW estimators have not been employed previously, a simulation study was also conducted to assess the empirical behavior of the estimators in settings similar to the cholera vaccine trial. Simulation study results demonstrate the IPW estimators can yield unbiased estimates of the direct, indirect, total, and overall effects of vaccination when there is interference provided the untestable no unmeasured confounders assumption holds and the group-level propensity score model is correctly specified. Application of the IPW estimators to the cholera vaccine trial indicates the presence of interference. For example, the IPW estimates suggest on average 5.29 fewer cases of cholera per 1000 person-years (95% confidence interval 2.61, 7.96) will occur among unvaccinated individuals within neighborhoods with 60% vaccine coverage compared to neighborhoods with 32% coverage. Our analysis also demonstrates how not accounting for interference can render misleading conclusions about the public health utility of vaccination.

  10. Hydroclimatic mechanisms of cholera transmission in the Bengal Delta

    NASA Astrophysics Data System (ADS)

    Tretkoff, Ernie

    2011-07-01

    Cholera, a deadly waterborne disease, remains a major threat in many areas of the world, including the Bengal Delta region. In this region, cholera outbreaks have two annual peaks; the first occurs during the dry season in the spring, and the second occurs in the fall following the wet season. However, the large-scale hydroclimatic processes underlying the propagation of the disease have not been well understood. Akanda et al. show that cholera outbreaks in the Bengal Delta region propagate from the coast to inland and from spring to fall following two distinct transmission cycles. The first outbreak begins in the spring near the coast when northward movement of plankton-rich seawater and increasing salinity promote the growth of cholera-causing bacteria in rivers, which are used for irrigation, sanitation, and consumption. The second outbreak begins in the fall, after summer floods and monsoons affect sanitation conditions that aid in bacterial transmission by contaminating waters over much of Bangladesh. (Water Resources Research, doi:10.1029/ 2010WR009914, 2011)

  11. Persistence of Pasteurella multocida in wetlands following avian cholera outbreaks

    USGS Publications Warehouse

    Blanchong, Julie A.; Samuel, M.D.; Goldberg, D.R.; Shadduck, D.J.; Lehr, M.A.

    2006-01-01

    Avian cholera, caused by Pasteurella multocida, affects waterbirds across North America and occurs worldwide among various avian species. Once an epizootic begins, contamination of the wetland environment likely facilitates the transmission of P. multocida to susceptible birds. To evaluate the ability of P. multocida serotype-1, the most common serotype associated with avian cholera in waterfowl in western and central North America, to persist in wetlands and to identify environmental factors associated with its persistence, we collected water and sediment samples from 23 wetlands during winters and springs of 1996a??99. These samples were collected during avian cholera outbreaks and for up to 13 wk following initial sampling. We recovered P. multocida from six wetlands that were sampled following the initial outbreaks, but no P. multocida was isolated later than 7 wk after the initial outbreak sampling. We found no significant relationship between the probability of recovery of P. multocida during resampling and the abundance of the bacterium recovered during initial sampling, the substrate from which isolates were collected, isolate virulence, or water quality conditions previously suggested to be related to the abundance or survival of P. multocida. Our results indicate that wetlands are unlikely to serve as a long-term reservoir for P. multocida because the bacterium does not persist in wetlands for long time periods following avian cholera outbreaks.

  12. [Endemic cholera in Chad: a real public health problem].

    PubMed

    Richard, V; Tosi, C; Arzel, B; Kana, N

    1999-01-01

    At the present time, cholera epidemics have become annual, even seasonal, events in Chad. This review of data obtained from a Division of the Sanitation Information System in Chad was carried out to determine the epidemiological profile and natural course of cholera in Chad and to propose preventive measures within the country's means. The main findings were that cholera epidemics start at the junction between the dry and rainy season (March to June), that they last for six months, and that peak incidence occurs 4 to 6 weeks after the first reported cases. The mortality rate is approximately 5 p. 100 depending on time and place. Two foci were located: one at Logone-Gana (Chari-Baguiri) and the other at Fianga (Mayo-Kebbi). These findings show that cholera is now endemic in Chad. A major implication of this study is that decentralized epidemiological surveillance should be set up with monitoring units located around endemic sites. Mortality could probably be lowered by better patient care at the beginning of the epidemic. Improvements in public hygiene, waste disposal, and water purification are needed.

  13. Cholera Toxin and Cell Growth: Role of Membrane Gangliosides

    PubMed Central

    Hollenberg, Morley D.; Fishman, Peter H.; Bennett, Vann; Cuatrecasas, Pedro

    1974-01-01

    The binding of cholera toxin to three transformed mouse cell lines derived from the same parent strain, and the effects of the toxin on DNA synthesis and adenylate cyclase activity, vary in parallel with the ganglioside composition of the cells. TAL/N cells of early passage, which contain large quantities of gangliosides GM3, GM2, GM1, and GDla, as well as the glycosyltransferases necessary for the synthesis of these gangliosides, bind the most cholera toxin and are the most sensitive to its action. TAL/N cells of later passage, which lack chemically detectable GM1 and GDla and which have no UDP-Gal:GM2 galactosyltransferase activity, are intermediate in binding and response to the toxin. SVS AL/N cells, which lack GM2 in addition to GM1 and GDla and which have little detectable UDP-GalNAc:GM3N-acetylgalactosaminyltransferase activity, bind the least amount of toxin. The SVS AL/N cells are the least responsive to inhibition of DNA synthesis and stimulation of adenylate cyclase activity by cholera toxin. Gangliosides (especially GM1), which appear to be the natural membrane receptors for cholera toxin, may normally have important roles in the regulation of cell growth and cAMP-mediated responses. PMID:4530298

  14. Extraction from prawn shells of substances cryoprotective for Vibrio cholerae.

    PubMed Central

    Shimodori, S; Moriya, T; Kohashi, O; Faming, D; Amako, K

    1989-01-01

    Substances cryoprotective for Vibrio cholerae were detected from prawn shells immersed in phosphate-buffered saline. This cryoprotective activity was heat resistant and sensitive to treatment with trypsin. For the exhibition of its full activity, the presence of Mg ion was indispensable. The cryoprotective activity of this substance was more active than that of other known cryoprotectants, like glycerol or serum. PMID:2604409

  15. Invariant recognition of polychromatic images of Vibrio cholerae 01

    NASA Astrophysics Data System (ADS)

    Alvarez-Borrego, Josue; Mourino-Perez, Rosa R.; Cristobal, Gabriel; Pech-Pacheco, Jose L.

    2002-04-01

    Cholera is an acute intestinal infectious disease. It has claimed many lives throughout history, and it continues to be a global health threat. Cholera is considered one of the most important emergence diseases due its relation with global climate changes. Automated methods such as optical systems represent a new trend to make more accurate measurements of the presence and quantity of this microorganism in its natural environment. Automatic systems eliminate observer bias and reduce the analysis time. We evaluate the utility of coherent optical systems with invariant correlation for the recognition of Vibrio cholerae O1. Images of scenes are recorded with a CCD camera and decomposed in three RGB channels. A numeric simulation is developed to identify the bacteria in the different samples through an invariant correlation technique. There is no variation when we repeat the correlation and the variation between images correlation is minimum. The position-, scale-, and rotation-invariant recognition is made with a scale transform through the Mellin transform. The algorithm to recognize Vibrio cholerae O1 is the presence of correlation peaks in the green channel output and their absence in red and blue channels. The discrimination criterion is the presence of correlation peaks in red, green, and blue channels.

  16. Biofilm recruitment of Vibrio cholerae by matrix proteolysis.

    PubMed

    Duperthuy, Marylise; Uhlin, Bernt Eric; Wai, Sun Nyunt

    2015-11-01

    The appearance of bacterial biofilms involves secretion of polysaccharides and proteins that form an extracellular matrix embedding the bacteria. Proteases have also been observed, but their role has remained unclear. Smith and co-workers have now found that proteolysis can contribute to further recruitment of bacteria to Vibrio cholerae biofilms.

  17. [The in vitro action of plants on Vibrio cholerae].

    PubMed

    Guevara, J M; Chumpitaz, J; Valencia, E

    1994-01-01

    Natural products of several plants, according to the geographic location, are used by Peruvian people in the popular treatment of diarrhea, with good success. When cholerae cases appeared in Peru, we were interested to know the "in vitro" effect against Vibrio cholerae 01, of these useful plants to treat diarrhea. The following plants were tested: Cichorium intybus, Althaea officinalis, Psorela glandulosa, Geranium maculatum, Punica granatum, Malus sativa, Cydonia oblonga, Chenopodium ambrosoides, Krameria triandria, Tea chinensis, Daucus carota, Persea gratissima, Psidium guayaba and Lippia dulcis. Decoction or infusion of the plants were used in the "in vitro" experiments. The following plants showed no "in vitro" effect against V. cholerae: Cichorium intybus, Althaea officinalis, Psorela glandulosa, Geranium maculatum, Chenopodium ambrosoides, Krameria triandria, Psidium guayaba, Lippia dulcis and Daucus carota. Decoction of Malus sativa and Cydenia oblonga showed bactericidal effect for their acidity and stone avocado (Persea gratissima) a late bactericidal effect. Tea infusión and the decoction of Punica granatum peel, showed the best bactericidal effect and we suggest to use them as to stop cholera spreading.

  18. Cholera transmission dynamic models for public health practitioners

    PubMed Central

    2014-01-01

    Great progress has been made in mathematical models of cholera transmission dynamics in recent years. However, little impact, if any, has been made by models upon public health decision-making and day-to-day routine of epidemiologists. This paper provides a brief introduction to the basics of ordinary differential equation models of cholera transmission dynamics. We discuss a basic model adapted from Codeço (2001), and how it can be modified to incorporate different hypotheses, including the importance of asymptomatic or inapparent infections, and hyperinfectious V. cholerae and human-to-human transmission. We highlight three important challenges of cholera models: (1) model misspecification and parameter uncertainty, (2) modeling the impact of water, sanitation and hygiene interventions and (3) model structure. We use published models, especially those related to the 2010 Haitian outbreak as examples. We emphasize that the choice of models should be dictated by the research questions in mind. More collaboration is needed between policy-makers, epidemiologists and modelers in public health. PMID:24520853

  19. Genetic components of stringent response in Vibrio cholerae

    PubMed Central

    Pal, Ritesh Ranjan; Das, Bhabatosh; Dasgupta, Shreya; Bhadra, Rupak K.

    2011-01-01

    Nutritional stress elicits stringent response in bacteria involving modulation of expression of several genes. This is mainly triggered by the intracellular accumulation of two small molecules, namely, guanosine 3’-diphosphate 5’-triphosphate and guanosine 3’,5’-bis(diphosphate), collectively called (p)ppGpp. Like in other Gram-negative bacteria, the cellular level of (p)ppGpp is maintained in Vibrio cholerae, the causative bacterial pathogen of the disease cholera, by the products of two genes relA and spoT. However, apart from relA and spoT, a novel gene relV has recently been identified in V. cholerae, the product of which has been shown to be involved in (p)ppGpp synthesis under glucose or fatty acid starvation in a ΔrelA ΔspoT mutant background. Furthermore, the GTP binding essential protein CgtA and a non-DNA binding transcription factor DksA also seem to play several important roles in modulating stringent response and regulation of other genes in this pathogen. The present review briefly discusses about the role of all these genes mainly in the management of stringent response in V. cholerae. PMID:21415497

  20. Antagonistic interactions among marine bacteria impede the proliferation of Vibrio cholerae.

    PubMed

    Long, Richard A; Rowley, David C; Zamora, Eric; Liu, Jiayuan; Bartlett, Douglas H; Azam, Farooq

    2005-12-01

    Changes in global climate have raised concerns about the emergence and resurgence of infectious diseases. Vibrio cholerae is a reemerging pathogen that proliferates and is transported on marine particles. Patterns of cholera outbreaks correlate with sea surface temperature increases, but the underlying mechanisms for rapid proliferation of V. cholerae during ocean warming events have yet to be fully elucidated. In this study, we tested the hypothesis that autochthonous marine bacteria impede the spread of V. cholerae in the marine environment. It was found that some marine bacteria are capable of inhibiting the growth of V. cholerae on surfaces and that bacterial isolates derived from pelagic particles show a greater frequency of V. cholerae inhibition than free-living bacteria. Vibrio cholerae was less susceptible to antagonism at higher temperatures, such as those measured during El Niño-Southern Oscilliation and monsoonal events. Using a model system employing green fluorescent protein-labeled bacteria, we found that marine bacteria can directly inhibit V. cholerae colonization of particles. The mechanism of inhibition in our model system was linked to the biosynthesis of andrimid, an antibacterial agent. Antibiotic production by the model antagonistic strain decreased at higher temperatures, thereby explaining the increased competitiveness of V. cholerae under warmer conditions. These findings suggest that bacterium-bacterium antagonism is a contributing mechanism in regulating the proliferation of V. cholerae on marine particles.

  1. The discovery of cholera - like enterotoxins produced by Escherichia coli causing secretory diarrhoea in humans

    PubMed Central

    Sack, R. Bradley

    2011-01-01

    Non-vibrio cholera has been recognized as a clinical entity for as long as cholera was known to be caused by Vibrio cholerae. Until 1968, the aetiologic agent of this syndrome was not known. Following a series of studies in patients with non-vibrio cholera it was found that these patients had large concentrations of Escherichia coli in the small bowel and stools which produced cholera toxin-like enterotoxins, and had fluid and electrolyte transport abnormalities in the small bowel similar to patients with documented cholera. Furthermore, these patients developed antibodies to the cholera-like enterotoxin. Later studies showed that these strains, when fed to volunteers produced a cholera-like disease and that two enterotoxins were found to be produced by these organisms: a heat-labile enterotoxin (LT) which is nearly identical to cholera toxin, and a heat-stable enterotoxin (ST), a small molecular weight polypeptide. E. coli that produced one or both of these enterotoxins were designated enterotoxigenic E. coli (ETEC). ETEC are now known not only to cause a severe cholera-like illness, but to be the most common bacterial cause of acute diarrhoea in children in the developing world, and to be the most common cause of travellers’ diarrhoea in persons who visit the developing world. PMID:21415491

  2. Social and cultural determinants of oral cholera vaccine uptake in Zanzibar.

    PubMed

    Schaetti, Christian; Ali, Said M; Hutubessy, Raymond; Khatib, Ahmed M; Chaignat, Claire-Lise; Weiss, Mitchell G

    2012-09-01

    Effectiveness of mass cholera vaccination campaigns requires not only technical and financial capacity but also consideration of social and cultural factors affecting vaccine acceptance. This study examined the influence of local community views of cholera on oral cholera vaccine (OCV) uptake in a mass vaccination campaign in 2009 in peri-urban and rural areas of Zanzibar. It used data from interviews conducted before the campaign and followed previous research assessing determinants of anticipated OCV acceptance. OCV uptake was lower than the reported anticipated acceptance. Less than half of the 356 adult respondents (49.7%) drank the required two doses of OCV. Variables referring to socio-cultural features of diarrheal illness that respondents identified with a cholera case vignette explained uptake better than analysis only of socio-demographic characteristics. Somatic features of illness not specific for cholera were negative determinants. Recognition of unconsciousness as a serious sign of dehydration and concern that cholera outbreaks would overwhelm the local healthcare system in the rural area were positive determinants of acceptance. Female gender, rural residence and older age were also positive determinants of OCV uptake. For further vaccine action with OCVs, cholera as a cause of severe dehydration should be distinguished from other causes of diarrhea. Planning should acknowledge rural concern about the relationship of limited capacity of the healthcare system to cope with cholera outbreaks and the priority of a cholera vaccine. Findings recommend particular efforts to increase cholera immunization coverage among young adults, in peri-urban areas and for men. PMID:22894965

  3. Low detection of Vibrio cholerae carriage in healthcare workers returning to 12 Latin American countries from Haiti.

    PubMed

    Llanes, R; Somarriba, L; Hernández, G; Bardaji, Y; Aguila, A; Mazumder, R N

    2015-04-01

    SUMMARY This investigation was undertaken to characterize the prevalence of intestinal Vibrio cholerae in healthcare workers (HCWs) returning from Haiti due to the ongoing cholera epidemic. Eight hundred and fifty asymptomatic HCWs of the Cuban Medical Brigade, who planned to leave Haiti, were studied by laboratory screening of stool culture for V. cholerae. A very low percentage (0.23%) of toxigenic V. cholerae serogroup O1, serotype Ogawa was found. To the best of our knowledge, this study represents the largest reported screening study for V. cholerae infection in asymptomatic HCWs returning from a cholera-affected country. Cholera transmission to health personnel highlights a possible risk of transmitting cholera during mobilization of the population for emergency response. Aid workers are encouraged to take precautions to reduce their risk for acquiring cholera and special care should be taken by consuming safe water and food and practising regular hand washing.

  4. An Optimal Cost Effectiveness Study on Zimbabwe Cholera Seasonal Data from 2008–2011

    PubMed Central

    Sardar, Tridip; Mukhopadhyay, Soumalya; Bhowmick, Amiya Ranjan; Chattopadhyay, Joydev

    2013-01-01

    Incidence of cholera outbreak is a serious issue in underdeveloped and developing countries. In Zimbabwe, after the massive outbreak in 2008–09, cholera cases and deaths are reported every year from some provinces. Substantial number of reported cholera cases in some provinces during and after the epidemic in 2008–09 indicates a plausible presence of seasonality in cholera incidence in those regions. We formulate a compartmental mathematical model with periodic slow-fast transmission rate to study such recurrent occurrences and fitted the model to cumulative cholera cases and deaths for different provinces of Zimbabwe from the beginning of cholera outbreak in 2008–09 to June 2011. Daily and weekly reported cholera incidence data were collected from Zimbabwe epidemiological bulletin, Zimbabwe Daily cholera updates and Office for the Coordination of Humanitarian Affairs Zimbabwe (OCHA, Zimbabwe). For each province, the basic reproduction number () in periodic environment is estimated. To the best of our knowledge, this is probably a pioneering attempt to estimate in periodic environment using real-life data set of cholera epidemic for Zimbabwe. Our estimates of agree with the previous estimate for some provinces but differ significantly for Bulawayo, Mashonaland West, Manicaland, Matabeleland South and Matabeleland North. Seasonal trend in cholera incidence is observed in Harare, Mashonaland West, Mashonaland East, Manicaland and Matabeleland South. Our result suggests that, slow transmission is a dominating factor for cholera transmission in most of these provinces. Our model projects cholera cases and cholera deaths during the end of the epidemic in 2008–09 to January 1, 2012. We also determine an optimal cost-effective control strategy among the four government undertaken interventions namely promoting hand-hygiene & clean water distribution, vaccination, treatment and sanitation for each province. PMID:24312540

  5. Connecting Environmental Observations with Cholera Outbreaks in Bangladesh

    NASA Astrophysics Data System (ADS)

    Stack, D.; Sandborn, A.; Widmeyer, P. A.; Escobar, V. M.

    2011-12-01

    Research has demonstrated that cholera epidemics in Bangladesh occur seasonally. This bimodal outbreak pattern closely follows times when large monsoon events are most frequent (spring and fall). While these patterns are presented in regional data, this knowledge alone cannot forecast the severity and location of cholera outbreaks until a monsoon event occurs, or an outbreak is reported. Therefore, there can only be reactive responses to cholera outbreaks. A heightened understanding of the link between environmental factors and outbreak occurrence will greatly enhance disease management capabilities. A predictive tool capable of giving an advanced warning of the environmental hazards that lead to location specific outbreaks allows for proactive and preventative responses, minimizing negative effects. A specific goal of this research was to relate latitude-longitude data with existing points associated with V. cholerae human case data collected from four cities in Bangladesh. Remotely sensed products were used to better understand the correlation between human outbreak occurrences, chlorophyll-a estimates, sea surface temperature (SST), and rainfall. Using MODIS, SeaWiFS, and TRMM satellite data, a gridded regional image was developed. Correlation analyses of the data were studied within the context of geographically diverse locations for the four cities of interest. Seasonal relationships were found between the cholera case data and all three of the chosen remotely sensed parameters. The strongest correlation found was between chlorophyll-a concentrations and reported human cases. The primary deliverable of this project was the production of an interactive Google Earth base map for use in a pilot design study that will lead to the development of applications to connect earth science products with water and health studies. The base map, with its inherent value of merging remotely sensed data with in situ observation points, can be used as a basis for constructing

  6. Antimicrobial Susceptibility of Autochthonous Aquatic Vibrio cholerae in Haiti

    PubMed Central

    Baron, Sandrine; Lesne, Jean; Jouy, Eric; Larvor, Emeline; Kempf, Isabelle; Boncy, Jacques; Rebaudet, Stanilas; Piarroux, Renaud

    2016-01-01

    We investigated the antimicrobial susceptibility of 50 environmental isolates of Vibrio cholerae non-O1/non-O139 collected in surface waters in Haiti in July 2012, during an active cholera outbreak. A panel of 16 antibiotics was tested on the isolates using the disk diffusion method and PCR detection of seven resistance-associated genes (strA/B, sul1/2, ermA/B, and mefA). All isolates were susceptible to amoxicillin-clavulanic acid, cefotaxime, imipenem, ciprofloxacin, norfloxacin, amikacin, and gentamicin. Nearly a quarter (22.0%) of the isolates were susceptible to all 16 antimicrobials tested and only 8.0% of the isolates (n = 4) were multidrug-resistant. The highest proportions of resistant isolates were observed for sulfonamide (70.0%), amoxicillin (12.0%), and trimethoprim-sulfamethoxazole (10.0%). One strain was resistant to erythromycin and one to doxycycline, two antibiotics used to treat cholera in Haiti. Among the 50 isolates, 78% possessed at least two resistance-associated genes, and the genes sul1, ermA, and strB were detected in all four multidrug-resistant isolates. Our results clearly indicate that the autochthonous population of V. cholerae non-O1/non-O139 found in surface waters in Haiti shows antimicrobial patterns different from that of the outbreak strain. The presence in the Haitian aquatic environment of V. cholerae non-O1/non-O139 with reduced susceptibility or resistance to antibiotics used in human medicine may constitute a mild public health threat.

  7. Cholera in the time of civil war. Liberia.

    PubMed

    Barth, J

    1991-01-01

    170 years of strife in Liberia between freed slaves from the Americas (Americo-Liberians) and indigenous tribes erupted in 1980 when a member of the indigenous ethnic group the Khran overthrew and killed the president. Contrary to what he promised, an equitable distribution of goods and services did not occur, human rights abuses continued, and civil service jobs went to Khran members. Many Americo-Liberians left. The US government recognized his government in 1986. US government and corporate interest in Liberia included a Voice of American transmitter, a navigation station, and rubber plantations. A civil war followed. An African American teacher ran a cholera ward during the war at Island Hospital where staff was not used to treating the lower class. She also started an orphanage next to the hospital, initially, for the well children from the ward. She operated the ward because the physician had left and cholera treatment included double-dosing patients with chloramphenicol and tetracycline. Moreover, patients also received an anti-parasitic. Further, kwashiorkor was common in Liberia. Only soldiers received intravenous therapy, so cholera patients were not rehydrated. The teacher and 3 student nurses began administering oral rehydration fluids orally every 5 minutes and saved lives. Despite evidence that the patients indeed had cholera, the US embassy physician refused to admit it for a long time. Eventually, the embassy sent medicine stored for weeks to the ward. A long time after widespread diarrhea started, the British Broadcasting Corporation began a radio program about oral rehydration. Yet many people did not understand its message without seeing a demonstration of mixing oral rehydration salts. Moreover, many people treated diarrhea with a diuretic medication which only complicated it. Nevertheless, the teacher and her efforts stopped cholera. She also helped a woman set up a home for handicapped children who survived the war. PMID:12159259

  8. Skin graft

    MedlinePlus

    ... caused a large amount of skin loss Burns Cosmetic reasons or reconstructive surgeries where there has been ... Smoking increases your chance of problems such as slow healing. Ask your doctor or nurse for help ...

  9. Your Skin

    MedlinePlus

    ... Butterflies? Read This Chloe & Nurb Meet The Brain (Movie) Quiz: Do You Need a Flu Shot? Got ... For Kids For Parents MORE ON THIS TOPIC Movie: Skin Acne Myths Blisters, Calluses, and Corns Fungal ...

  10. Skin Infections

    MedlinePlus

    ... nearby What to Do Teach kids not to pop, pick at, or scratch pimples, pus-filled infections, ... Your Skin Abscess Impetigo Ringworm Cellulitis Should I Pop My Pimple? Tips for Taking Care of Your ...

  11. Skin Cancer

    MedlinePlus

    ... States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, ... If not treated, some types of skin cancer cells can spread to other tissues and organs. Treatments ...

  12. Skin Cancer

    MedlinePlus

    ... exposure to ultraviolet light, which is found in sunlight and in lights used in tanning salons. What ... the safe-sun guidelines. 1. Avoid the sun. Sunlight damages your skin. The sun is strongest during ...

  13. Skin Cancer

    MedlinePlus

    ... Review. 17 Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, ... MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin ...

  14. Hyperelastic skin

    MedlinePlus

    ... is most often seen in people who have Ehlers-Danlos syndrome. People with this disorder have very elastic skin. ... any member of your family been diagnosed with Ehlers-Danlos syndrome? What other symptoms are present? Alternative Names India ...

  15. Skin - clammy

    MedlinePlus

    ... of clammy skin include: Anxiety attack Heart attack Heat exhaustion Internal bleeding Low blood oxygen levels Sepsis (body-wide infection) Severe allergic reaction (anaphylaxis) Severe pain Shock (low blood pressure)

  16. Protection against mortality due to Vibrio cholerae infection in infant rabbits caused by immunization of mothers with cholera protective antigen.

    PubMed

    Sciortino, C V

    1996-03-01

    Vaccination of female rabbits with cholera protective antigen (CPA) protected their F1 progeny from lethal challenge with Vibrio cholerae. Protection was determined by the choleragenic score and survival rates. Serum and milk IgG, IgM, IgA titres to CPA, cholera toxin, and LPS were determined. At 8 and 20 weeks post-immunization, mothers' milk, sera, and infants' sera showed elevated CPA-specific IgG and IgA, and infants were protected. Mothers' serum and milk antibody remained elevated for 36 weeks. At 26 weeks, mothers were re-bred, but their progeny were swapped and cross-fed. Infants born to the placebo-vaccinated mothers and nursed by CPA-immune nannies were partially protected from challenge. Infants born to CPA-immune mothers and cross-fed by the placebo-vaccinated nannies were less protected. CPA stimulated both transplacental and milk antibody, but passive immunity was primarily milk-derived. A 36-week booster vaccine stimulated an anamnestic serological response that did not provide protection equivalent to the original vaccine. CPA provided partial protective immunity to the milk-fed infant rabbits that suggests that CPA may be important in the development of a cholera vaccine.

  17. Epidemic cholera in rural El Salvador: risk factors in a region covered by a cholera prevention campaign.

    PubMed

    Quick, R E; Thompson, B L; Zuniga, A; Dominguez, G; De Brizuela, E L; De Palma, O; Almeida, S; Valencia, A; Ries, A A; Bean, N H

    1995-04-01

    In response to the Latin American cholera epidemic, El Salvador began a prevention programme in April 1991. The first case was confirmed in August, and 700 cases were reported within 3 months. A matched case-control study was conducted in rural La Libertad Department in November 1991. Illness was associated with eating cold cooked or raw seafood (odds ratio [OR] = 7.0; 95% confidence limits [CL] = 1.4, 35.0) and with drinking water outside the home (OR = 8.8; 95% CL = 1.7, 44.6). Assertion of knowledge about how to prevent cholera (OR = 0.2; 95% CL = 0.1, 0.8) and eating rice (OR = 0.2; 95% CL = 0.1, 0.8) were protective. More controls than patients regularly used soap (OR = 0.3; 95% CL = 0.1, 1.0). This study demonstrated three important points for cholera prevention: (1) seafood should be eaten cooked and hot; (2) populations at risk should be taught to treat household drinking water and to avoid drinking water outside the home unless it is known to be treated; and (3) education about hygiene can be an important tool in preventing cholera.

  18. Senescent Skin

    PubMed Central

    Kushniruk, William

    1974-01-01

    The cutaneous surface is continually influenced by aging and environmental factors. A longer life span is accompanied by an increase in the frequency of problems associated with aging skin. Although most of these changes and lesions are not life threatening, the premalignant lesions must be recognized and treated. The common aging and actinic skin changes are discussed and appropriate management is described. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:20469067

  19. Neuromodulators for Aging Skin

    MedlinePlus

    ... Non-ablative Laser Rejuvenation Non-invasive Body Contouring Treatments Skin Cancer Skin Cancer Information Free Skin Cancer Screenings Skin ... Non-ablative Laser Rejuvenation Non-invasive Body Contouring Treatments Skin Cancer Skin Cancer Information Free Skin Cancer Screenings Skin ...

  20. Cholera toxin production during anaerobic trimethylamine N-oxide respiration is mediated by stringent response in Vibrio cholerae.

    PubMed

    Oh, Young Taek; Park, Yongjin; Yoon, Mi Young; Bari, Wasimul; Go, Junhyeok; Min, Kyung Bae; Raskin, David M; Lee, Kang-Mu; Yoon, Sang Sun

    2014-05-01

    As a facultative anaerobe, Vibrio cholerae can grow by anaerobic respiration. Production of cholera toxin (CT), a major virulence factor of V. cholerae, is highly promoted during anaerobic growth using trimethylamine N-oxide (TMAO) as an alternative electron acceptor. Here, we investigated the molecular mechanisms of TMAO-stimulated CT production and uncovered the crucial involvement of stringent response in this process. V. cholerae 7th pandemic strain N16961 produced a significantly elevated level of ppGpp, the bacterial stringent response alarmone, during anaerobic TMAO respiration. Bacterial viability was impaired, and DNA replication was also affected under the same growth condition, further suggesting that stringent response is induced. A ΔrelA ΔspoT ppGpp overproducer strain produced an enhanced level of CT, whereas anaerobic growth via TMAO respiration was severely inhibited. In contrast, a ppGpp-null strain (ΔrelA ΔspoT ΔrelV) grew substantially better, but produced no CT, suggesting that CT production and bacterial growth are inversely regulated in response to ppGpp accumulation. Bacterial capability to produce CT was completely lost when the dksA gene, which encodes a protein that works cooperatively with ppGpp, was deleted. In the ΔdksA mutant, stringent response growth inhibition was alleviated, further supporting the inverse regulation of CT production and anaerobic growth. In vivo virulence of ΔrelA ΔspoT ΔrelV or ΔdksA mutants was significantly attenuated. The ΔrelA ΔspoT mutant maintained virulence when infected with exogenous TMAO despite its defective growth. Together, our results reveal that stringent response is activated under TMAO-stimulated anaerobic growth, and it regulates CT production in a growth-dependent manner in V. cholerae.

  1. Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial

    PubMed Central

    Saber, Aly; Hokkam, Emad N.; Ellabban, Goda M.

    2015-01-01

    INTRODUCTION: The repair of the recurrent hernia is a daunting task because of already weakened tissues and distorted anatomy. Open posterior preperitoneal approach gives results far superior to those of the anterior approach. Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with advantages of a minimally invasive approach. The present work aimed at comparing these three approaches for repair of recurrent inguinal hernia regarding complications and early recurrence. MATERIALS AND METHODS: A total of 180 patients were divided randomly into three equal groups: A, B, and C. Group A patients were subjected to open posterior preperitoneal approach , those of group B were subjected to transinguinal anterior tension-free repair and group C patients were subjected to TAPP. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling, and wound infections. RESULTS: The mean hospital stay, the mean time to return to work and the mean time off from work were less in group C then A and B. Chronic postoperative pain was observed in eight patients in group A (13.33%), in 18 patients in group B (30%) and six patients in group C (10%). The overall complication rate was 19.7% in both groups A and C and 34.36% in group B. CONCLUSION: In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair is inexpensive, has a low recurrence rate. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence. Trial

  2. Influence of statins on postoperative wound complications after inguinal or ventral herniorrhaphy.

    PubMed

    Hauer-Jensen, M; Fort, C; Mehta, J L; Fink, L M

    2006-03-01

    The lipid-lowering agents, statins, are the most commonly prescribed class of drugs in the western world. Because of their widespread use, many patients undergo surgical procedures while on statins. Statins, in addition to cholesterol-lowering effects, also have anticoagulant, immunosuppressive, and antiproliferative properties that may affect the risk of local wound complications. This study investigated the relationship between statins and postoperative wound complications in a large cohort of patients undergoing inguinal or ventral hernia repair. Data mining was performed in the Veterans Integrated Service Network (VISN)16 Data Warehouse. This database contains clinical and demographic information about all veterans cared for at the ten VA Medical Centers that comprise the South Central VA Healthcare Network in the mid-south region of the US. Aggregate data (age, body mass index, smoking history, gender, race, history of diabetes, statin use, and postoperative wound complications) were obtained for all patients who underwent inguinal or ventral hernia repair during the period October 1, 1996-November 30, 2004. During the period of the query, 10,782 patients (10,676 male, 106 female), 1,242 (11.5%) of whom received statins, underwent herniorrhaphy. Statin use did not affect the risk of wound infection or delayed wound healing. Statin use was, however, associated with an increased rate of local postoperative bleeding complications (P=0.01). When the type of hernia, age, smoking, diabetes, and body mass index were included in a multivariate analysis, statins remained borderline significant as an independent predictor of wound hematoma/postoperative bleeding (P=0.04), odds ratio 1.6 (95% CI 1.03-2.44). Patients who undergo inguinal herniorrhaphy while on statins have an increased risk of postoperative wound hematoma/hemorrhage. Focus on additional factors that may affect the propensity to postoperative bleeding and on meticulous intraoperative hemostasis are

  3. Preperitoneal Surgery Using a Self-Adhesive Mesh for Inguinal Hernia Repair

    PubMed Central

    Oguntodu, Olakunle F.; Rodriguez, Francisco; Rassadi, Roozbeh; Haley, Michael; Shively, Cynthia J.; Dzandu, James K.

    2014-01-01

    Background and Objectives: Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh. Methods: This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from April 4, 2010, through July 22, 2014. Data assessed were age, sex, body mass index (BMI), hernia repair indications, hernia type, pain, paresthesia, occurrence (bilateral or unilateral), recurrence, and patient satisfaction. Descriptive and regression analyses were performed. Results: Six hundred forty patients underwent laparoscopic preperitoneal hernia surgery with self-adhesive mesh. The average age was 56 years, nearly all were men (95.8%), and the mean BMI was 26.2 kg/m2. Cases involved primary hernia more frequently than recurrent hernia (94% vs 6%; P < .05). After surgery, 92% of the patients reported no more than minimal pain, <1% reported paresthesia, and 0.2% had early recurrence. There were 7 conversions to an open procedure. The patients had no adverse reactions to anesthesia and no bladder injury. Postoperative acute pain or recurrence was not explained by demographics, BMI, or preoperative pain. There were significant associations of hernia side, recurrence, occurrence, and sex with composite end points. Nearly all patients (98%) were satisfied with the outcome. Conclusion: The use of self-adhesive, Velcro-type mesh in laparoscopic TEP inguinal hernia repair is associated with reduced pain; low rates of early recurrence, infection, and hematoma; and improved patient satisfaction. PMID:25587212

  4. Local anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a randomized trial.

    PubMed

    Sanchez, Barry; Waxman, Kenneth; Tatevossian, Raymond; Gamberdella, Marla; Read, Bruce

    2004-11-01

    Pain after an open inguinal hernia repair may be significant. In fact, some surgeons feel that the pain after open repair justifies a laparoscopic approach. The purpose of this study was to determine if the use of local anesthetic infusion pumps would reduce postoperative pain after open inguinal hernia repair. We performed a prospective, double-blind randomized study of 45 open plug and patch inguinal hernia repairs. Patients were randomized to receive either 0.25 per cent bupivicaine or saline solution via an elastomeric infusion pump (ON-Q) for 48 hours, at 2 cc/h. The catheters were placed in the subcutaneous tissue and removed on postoperative day 3. Both groups were prescribed hydrocodone to use in the postoperative period at the prescribed dosage as needed for pain. Interviews were conducted on postoperative days 3 and 7, and patient's questionnaires, including pain scores, amount of pain medicine used, and any complications, were collected accordingly. During the first 5 postoperative days, postoperative pain was assessed using a visual analog scale. Twenty-three repairs were randomized to the bupivicaine group and 22 repairs randomized to the placebo group. In the bupivicaine group, there was a significant decrease in postoperative pain on postoperative days 2 through 5 with P values <0.05. This significant difference continued through postoperative day 5, 2 days after the infusion pumps were removed. Patients who had bupivicaine instilled in their infusion pump had statistically significant lower subjective pain scores on postoperative days 2 through 5. This significant difference continued even after the infusion pumps were removed. Local anesthetic infusion pumps significantly decreased the amount of early postoperative pain. Pain relief persisted for 2 days after catheter and pump removal. PMID:15586515

  5. Encysted Spermatic Cord Hydrocele in a 60-year-old, Mimicking Incarcerated Inguinal Hernia: A Case Report

    PubMed Central

    D, Manimaran; M, Karthikeyan T; Khan, Dost Mohamed

    2014-01-01

    Hydrocele of spermatic cord is caused by defect in closure of the processus vaginalis, as the testicles descend into the scrotum during foetal development. It usually occurs in infancy and childhood. There are two types of hydrocele of spermatic cord. Encysted type is caused by defective closure at both proximal and distal ends of processus vaginalis and it does not communicate with the peritoneal cavity. Funicular type is caused by defective closure of only distal end of tunica vaginalis and it communicates with the peritoneal cavity. The encysted type can be confused clinically with incarcerated inguinal hernia, inguinal lymphadenopathy, undescended testis and primary tumours of cord like lipoma. We are presenting a case of encysted hydrocele of spermatic cord in a 60-year-old male, which clinically mimicked incarcerated inguinal hernia. PMID:24701514

  6. Considerations for oral cholera vaccine use during outbreak after earthquake in Haiti, 2010-2011.

    PubMed

    Date, Kashmira A; Vicari, Andrea; Hyde, Terri B; Mintz, Eric; Danovaro-Holliday, M Carolina; Henry, Ariel; Tappero, Jordan W; Roels, Thierry H; Abrams, Joseph; Burkholder, Brenton T; Ruiz-Matus, Cuauhtémoc; Andrus, Jon; Dietz, Vance

    2011-11-01

    Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed.

  7. Genomic Epidemiology of Vibrio cholerae O1 Associated with Floods, Pakistan, 2010

    PubMed Central

    Shah, Muhammad Ali; Mutreja, Ankur; Thomson, Nicholas; Baker, Stephen; Parkhill, Julian; Dougan, Gordon; Bokhari, Habib

    2014-01-01

    In August 2010, Pakistan experienced major floods and a subsequent cholera epidemic. To clarify the population dynamics and transmission of Vibrio cholerae in Pakistan, we sequenced the genomes of all V. cholerae O1 El Tor isolates and compared the sequences to a global collection of 146 V. cholerae strains. Within the global phylogeny, all isolates from Pakistan formed 2 new subclades (PSC-1 and PSC-2), lying in the third transmission wave of the seventh-pandemic lineage that could be distinguished by signature deletions and their antimicrobial susceptibilities. Geographically, PSC-1 isolates originated from the coast, whereas PSC-2 isolates originated from inland areas flooded by the Indus River. Single-nucleotide polymorphism accumulation analysis correlated river flow direction with the spread of PSC-2. We found at least 2 sources of cholera in Pakistan during the 2010 epidemic and illustrate the value of a global genomic data bank in contextualizing cholera outbreaks. PMID:24378019

  8. The Vibrio cholerae type VI secretion system employs diverse effector modules for intraspecific competition.

    PubMed

    Unterweger, Daniel; Miyata, Sarah T; Bachmann, Verena; Brooks, Teresa M; Mullins, Travis; Kostiuk, Benjamin; Provenzano, Daniele; Pukatzki, Stefan

    2014-04-01

    Vibrio cholerae is a Gram-negative bacterial pathogen that consists of over 200 serogroups with differing pathogenic potential. Only strains that express the virulence factors cholera toxin (CT) and toxin-coregulated pilus (TCP) are capable of pandemic spread of cholera diarrhoea. Regardless, all V. cholerae strains sequenced to date harbour genes for the type VI secretion system (T6SS) that translocates effectors into neighbouring eukaryotic and prokaryotic cells. Here we report that the effectors encoded within these conserved gene clusters differ widely among V. cholerae strains, and that immunity proteins encoded immediately downstream from the effector genes protect their host from neighbouring bacteria producing corresponding effectors. As a consequence, strains with matching effector-immunity gene sets can coexist, while strains with different sets compete against each other. Thus, the V. cholerae T6SS contributes to the competitive behaviour of this species.

  9. In situ survival of Vibrio cholerae and Escherichia coli in a tropical rain forest watershed.

    PubMed

    Pérez-Rosas, N; Hazen, T C

    1989-02-01

    For 12 months, Vibrio cholerae and fecal coliform densities were monitored along with nine other water quality parameters at 12 sites in a rain forest watershed in Puerto Rico. Densities of V. cholerae and fecal coliforms were not significantly correlated, even though the highest densities of both bacteria were found at a sewage outfall. High densities of V. cholerae were also found at pristine sites at the highest point in the watershed. The density of Escherichia coli and V. cholerae in membrane diffusion chambers did not change significantly during the course of two such studies. Physiological activity, as measured by electron transport system activity and relative nucleic acid composition, indicated that both E. coli and V. cholerae remained active. This study suggests that V. cholerae is indigenous to tropical fresh waters and that assays other than those that detect fecal coliforms or E. coli must be used for assessing public health risk in tropical waters.

  10. Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011

    PubMed Central

    Vicari, Andrea; Hyde, Terri B.; Mintz, Eric; Danovaro-Holliday, M. Carolina; Henry, Ariel; Tappero, Jordan W.; Roels, Thierry H.; Abrams, Joseph; Burkholder, Brenton T.; Ruiz-Matus, Cuauhtémoc; Andrus, Jon; Dietz, Vance

    2011-01-01

    Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed. PMID:22099114

  11. Cholera gravis associated with acute renal failure in a traveler from Haiti to the United States.

    PubMed

    Reyes-Corcho, Andrés; Pinsker, Richard W; Sarkar, Samir; Bagheri, Farshad; Patel, Mahendra C; Lam, Pablo; González, Argentina

    2012-09-01

    Cholera is a gastroenteric disease caused by epidemic or pandemic Vibrio cholerae which still is responsible for over 100,000 annual deaths worldwide. Since October 2010, Haiti experienced a cholera outbreak affecting more than 300,000 persons. Few imported cases related to the Haitian epidemic have been reported so far in the United States and Canada. We presented a patient who developed cholera gravis soon after arrival at New York City from Haiti. The patient needed admission to an Intensive Care Unit, for vigorous intravenous hydration, antibiotic therapy, and hemodialysis due to refractory oliguric renal failure. The patient was discharged the day 6 after admission and V. cholerae O1 was isolated from the stool culture. Cholera can be a life-threatening disease; early recognition based on travel history and clinical features is the corner stone for successful management. PMID:23137437

  12. In situ survival of Vibrio cholerae and Escherichia coli in a tropical rain forest watershed.

    PubMed Central

    Pérez-Rosas, N; Hazen, T C

    1989-01-01

    For 12 months, Vibrio cholerae and fecal coliform densities were monitored along with nine other water quality parameters at 12 sites in a rain forest watershed in Puerto Rico. Densities of V. cholerae and fecal coliforms were not significantly correlated, even though the highest densities of both bacteria were found at a sewage outfall. High densities of V. cholerae were also found at pristine sites at the highest point in the watershed. The density of Escherichia coli and V. cholerae in membrane diffusion chambers did not change significantly during the course of two such studies. Physiological activity, as measured by electron transport system activity and relative nucleic acid composition, indicated that both E. coli and V. cholerae remained active. This study suggests that V. cholerae is indigenous to tropical fresh waters and that assays other than those that detect fecal coliforms or E. coli must be used for assessing public health risk in tropical waters. PMID:2655536

  13. Dynamics of Cholera Outbreaks in Great Lakes Region of Africa, 1978–2008

    PubMed Central

    Nkoko, Didier Bompangue; Giraudoux, Patrick; Plisnier, Pierre-Denis; Tinda, Annie Mutombo; Piarroux, Martine; Sudre, Bertrand; Horion, Stephanie; Tamfum, Jean-Jacques Muyembe; Ilunga, Benoît Kebela

    2011-01-01

    Cholera outbreaks have occurred in Burundi, Rwanda, Democratic Republic of Congo, Tanzania, Uganda, and Kenya almost every year since 1977–1978, when the disease emerged in these countries. We used a multiscale, geographic information system–based approach to assess the link between cholera outbreaks, climate, and environmental variables. We performed time-series analyses and field investigations in the main affected areas. Results showed that cholera greatly increased during El Niño warm events (abnormally warm El Niños) but decreased or remained stable between these events. Most epidemics occurred in a few hotspots in lakeside areas, where the weekly incidence of cholera varied by season, rainfall, fluctuations of plankton, and fishing activities. During lull periods, persistence of cholera was explained by outbreak dynamics, which suggested a metapopulation pattern, and by endemic foci around the lakes. These links between cholera outbreaks, climate, and lake environments need additional, multidisciplinary study. PMID:22099090

  14. Strategy, demand, management, and costs of an international cholera vaccine stockpile.

    PubMed

    Maskery, Brian; DeRoeck, Denise; Levin, Ann; Kim, Young Eun; Wierzba, Thomas F; Clemens, John D

    2013-11-01

    In this article, we review the feasibility of mass vaccination against cholera and estimate the global population at risk for epidemic cholera. We then examine the cost of establishing and managing a cholera vaccine stockpile and summarize published mathematical models of the estimated impact of reactive vaccination campaigns developed for the current Haitian outbreak and a recent outbreak in Zimbabwe. On the basis of these evaluations, we recommend a stockpile that starts at 2 million doses, with an estimated annual cost of $5.5-$13.9 million in 2013, and grows to 10 million doses per year by 2017, with an annual cost of $27-$51 million. We believe that the stockpile can enhance efforts to mitigate future cholera outbreaks by guaranteeing the availability of cholera vaccines and, through use of the stockpile, by revealing knowledge about the efficient use of cholera vaccines during and after crises.

  15. Physiological repair of inguinal hernia: a new technique (study of 860 patients).

    PubMed

    Desarda, M P

    2006-04-01

    The author has developed a new operation technique based on the physiological principle that provides dynamic posterior wall for inguinal hernia repair. Results of the first series of 400 patients were published in 2001 (ANZ J Surg 71:241-244, 2001). Now the author has described the results of the second series of 860 patients having 920 hernias with follow-up for more than 7 years. An undetached strip of the external oblique aponeurosis (EOA) is sutured to the inguinal ligament below and the muscle arch above, behind the cord, to form a new posterior wall. External oblique muscle gives additional strength to the weakened muscle arch to keep this strip physiologically dynamic. In this prospective study, 920 inguinal hernia repairs were performed between August 1990 and December 2003 in 860 patients. Follow-up was done for 7 years. The main outcome measure was early and late morbidities and especially recurrence in a long-term follow-up. Mean patient age was 50.5 years (range 18-90). A total of 851 (98.95%) patients were operated under local or regional anesthesia; 838 (97.4%) patients were ambulatory with limited movements in 6 h and free movements in 18-24 h; 792 (92%) patients had a hospital stay of one night and 840 (97.6%) patients returned to normal activities within 1-2 weeks. Hematoma formation requiring drainage was observed in one patient, while seven patients had wound edema during the postoperative period which subsided on its own. Follow-up was completed in 623 patients (72.5 %) by clinical examination or questionnaire. The median follow-up period was 7.8 years (range 1-12 years). There was no recurrence of hernia or postoperative neuralgia. This operation is simple to perform, does not require foreign body like a mesh or complicated dissection of the inguinal floor as in Bassini/Shouldice. It has shown excellent results with virtually zero recurrence rates.

  16. A novel animal model for skin flap prelamination with biomaterials

    PubMed Central

    Zhou, Xianyu; Luo, Xusong; Liu, Fei; Gu, Chuan; Wang, Xi; Yang, Qun; Qian, Yunliang; Yang, Jun

    2016-01-01

    Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible. PMID:27659066

  17. Investigating the role of water in the Diffusion of Cholera using Agent-Based simulation

    NASA Astrophysics Data System (ADS)

    Augustijn, Ellen-Wien; Doldersum, Tom; Augustijn, Denie

    2014-05-01

    Traditionally, cholera was considered to be a waterborne disease. Currently we know that many other factors can contribute to the spread of this disease including human mobility and human behavior. However, the hydrological component in cholera diffusion is significant. The interplay between cholera and water includes bacteria (V. cholera) that survive in the aquatic environment, the possibility that run-off water from dumpsites carries the bacteria to surface water (rivers and lakes), and when the bacteria reach streams they can be carried downstream to infect new locations. Modelling is a very important tool to build theory on the interplay between different types of transmission mechanisms that together are responsible for the spread of Cholera. Agent-based simulation models are very suitable to incorporate behavior at individual level and to reproduce emergence. However, it is more difficult to incorporate the hydrological components in this type of model. In this research we present the hydrological component of an Agent-Based Cholera model developed to study a Cholera epidemic in Kumasi (Ghana) in 2005. The model was calibrated on the relative contribution of each community to the distributed pattern of cholera rather than the absolute number of incidences. Analysis of the results shows that water plays an important role in the diffusion of cholera: 75% of the cholera cases were infected via river water that was contaminated by runoff from the dumpsites. To initiate infections upstream, the probability of environment-to-human transmission seemed to be overestimated compared to what may be expected from literature. Scenario analyses show that there is a strong relation between the epidemic curve and the rainfall. Removing dumpsites that are situated close to the river resulted in a strong decrease in the number of cholera cases. Results are sensitive to the scheduling of the daily activities and the survival time of the cholera bacteria.

  18. Culturable and VBNC Vibrio cholerae: interactions with chironomid egg masses and their bacterial population.

    PubMed

    Halpern, Malka; Landsberg, Ori; Raats, Dina; Rosenberg, Eugene

    2007-02-01

    Vibrio cholerae, the etiologic agent of cholera, is autochthonous to various aquatic environments. Recently, it was found that chironomid (nonbiting midges) egg masses serve as a reservoir for the cholera bacterium and that flying chironomid adults are possible windborne carriers of V. cholerae non-O1 non-O139. Chironomids are the most widely distributed insect in freshwater. Females deposit egg masses at the water's edge, and each egg mass contains eggs embedded in a gelatinous matrix. Hemagglutinin/protease, an extracellular enzyme of V. cholerae, was found to degrade chironomid egg masses and to prevent them from hatching. In a yearly survey, chironomid populations and the V. cholerae in their egg masses followed phenological succession and interaction of host-pathogen population dynamics. In this report, it is shown via FISH technique that most of the V. cholerae inhabiting the egg mass are in the viable but nonculturable (VBNC) state. The diversity of culturable bacteria from chironomid egg masses collected from two freshwater habitats was determined. In addition to V. cholerae, representatives of the following genera were isolated: Acinetobacter, Aeromonas, Klebsiella, Shewanella, Pseudomonas, Paracoccus, Exiguobacterium, and unidentified bacteria. Three important human pathogens, Aeromonas veronii, A. caviae, and A. hydrophila, were isolated from chironomid egg masses, indicating that chironomid egg masses may be a natural reservoir for pathogenic Aeromonas species in addition to V. cholerae. All isolates of V. cholerae were capable of degrading chironomid egg masses. This may help explain their host-pathogen relationship with chironomids. In contrast, almost none of the other bacteria that were isolated from the egg masses possessed this ability. Studying the interaction between chironomid egg masses, the bacteria inhabiting them, and V. cholerae could contribute to our understanding of the nature of the V. cholerae-egg mass interactions. PMID:17186156

  19. Detection of Antibodies to Toxin-Coregulated Pili in Sera from Cholera Patients

    PubMed Central

    Attridge, Stephen R.; Wallerström, Gun; Qadri, Firdausi; Svennerholm, Ann-Mari

    2004-01-01

    Monoclonal antibodies (MAbs) were prepared against toxin-coregulated pili (TCP) isolated from Vibrio cholerae O1 El Tor. Despite their limited bactericidal potential, two MAbs were able to mediate biotype-specific protection against experimental cholera in infant mice. These MAbs were used in immunoblotting studies to assess seroconversion to El Tor TCP following cholera. Clear anti-pilus responses were observed in five of nine patients. PMID:14977996

  20. SXT-Related Integrating Conjugative Element in New World Vibrio cholerae

    PubMed Central

    Burrus, Vincent; Quezada-Calvillo, Roberto; Marrero, Joeli; Waldor, Matthew K.

    2006-01-01

    SXT-related integrating conjugative elements (ICEs) became prevalent in Asian Vibrio cholerae populations after V. cholerae O139 emerged. Here, we describe an SXT-related ICE, ICEVchMex1, in a Mexican environmental V. cholerae isolate. Identification of ICEVchMex1 represents the first description of an SXT-related ICE in the Western Hemisphere. The significant differences between the SXT and ICEVchMex1 genomes suggest that these ICEs have evolved independently. PMID:16598018

  1. Detection of ctx gene positive non-O1/non-O139 V. cholerae in shrimp aquaculture environments.

    PubMed

    Madhusudana, Rao B; Surendran, P K

    2013-06-01

    Water and post-larvae samples from black tiger (Penaeus monodon) shrimp hatcheries; pond water, pond sediment and shrimp from aquaculture farms were screened for the presence of V. cholerae. A V. cholerae-duplex PCR method was developed by utilizing V. cholerae species specific sodB primers and ctxAB genes specific primers. Incidence of V. cholerae was not observed in shrimp hatchery samples but was noticed in aquaculture samples. The incidence of V. cholerae was higher in pond water (7.6%) than in pond sediment (5.2%). Shrimp head (3.6%) portion had relatively higher incidence than shrimp muscle (1.6%). All the V. cholerae isolates (n = 42) belonged to non-O1/non-O139 serogroup, of which 7% of the V. cholerae isolates were potentially cholera-toxigenic (ctx positive). All the ctx positive V. cholerae (n = 3) were isolated from the pond water. Since, cholera toxin (CT) is the major contributing factor for cholera gravis, it is proposed that the mere presence of non-O1/non-O139 V. cholerae need not be the biohazard criterion in cultured black tiger shrimp but only the presence of ctx carrying non-O1/non-O139 V. cholerae may be considered as potential public health risk. PMID:24425944

  2. Rainfall mediations in the spreading of epidemic cholera

    NASA Astrophysics Data System (ADS)

    Righetto, L.; Bertuzzo, E.; Mari, L.; Schild, E.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2013-10-01

    Following the empirical evidence of a clear correlation between rainfall events and cholera resurgence that was observed in particular during the recent outbreak in Haiti, a spatially explicit model of epidemic cholera is re-examined. Specifically, we test a multivariate Poisson rainfall generator, with parameters varying in space and time, as a driver of enhanced disease transmission. The relevance of the issue relates to the key insight that predictive mathematical models may provide into the course of an ongoing cholera epidemic aiding emergency management (say, in allocating life-saving supplies or health care staff) or in evaluating alternative management strategies. Our model consists of a set of dynamical equations (SIRB-like i.e. subdivided into the compartments of Susceptible, Infected and Recovered individuals, and including a balance of Bacterial concentrations in the water reservoir) describing a connected network of human communities where the infection results from the exposure to excess concentrations of pathogens in the water. These, in turn, are driven by rainfall washout of open-air defecation sites or cesspool overflows, hydrologic transport through waterways and by mobility of susceptible and infected individuals. We perform an a posteriori analysis (from the beginning of the epidemic in October 2010 until December 2011) to test the model reliability in predicting cholera cases and in testing control measures, involving vaccination and sanitation campaigns, for the ongoing epidemic. Even though predicting reliably the timing of the epidemic resurgence proves difficult due to rainfall inter-annual variability, we find that the model can reasonably quantify the total number of reported infection cases in the selected time-span. We then run a multi-seasonal prediction of the course of the epidemic until December 2015, to investigate conditions for further resurgences and endemicity of cholera in the region with a view to policies which may bring to

  3. Analysis of the roles of antilipopolysaccharide and anti-cholera toxin immunoglobulin A (IgA) antibodies in protection against Vibrio cholerae and cholera toxin by use of monoclonal IgA antibodies in vivo.

    PubMed Central

    Apter, F M; Michetti, P; Winner, L S; Mack, J A; Mekalanos, J J; Neutra, M R

    1993-01-01

    Secretory immunoglobulin A (IgA) antibodies (sIgA) directed against cholera toxin (CT) and surface components of Vibrio cholerae are associated with protection against cholera, but the relative importance of specific sIgAs in protection is unknown. A monoclonal IgA directed against the V. cholerae lipopolysaccharide (LPS), secreted into the intestines of neonatal mice bearing hybridoma tumors, was previously shown to provide protection against a lethal oral dose of 10(7) V. cholerae cells. We show here that a single oral dose of 5 to 50 micrograms of the monoclonal anti-LPS IgA, given within 2 h before V. cholerae challenge, protected neonatal mice against challenge. In contrast, an oral dose of 80 micrograms of monoclonal IgA directed against CT B subunit (CTB) failed to protect against V. cholerae challenge. A total of 80 micrograms of monoclonal anti-CTB IgA given orally protected neonatal mice from a lethal (5-micrograms) oral dose of CT. Secretion of the same anti-CTB IgA antibodies into the intestines of mice bearing IgA hybridoma backpack tumors, however, failed to protect against lethal oral doses of either CT (5 micrograms) or V. cholerae (10(7) cells). Furthermore, monoclonal anti-CTB IgA, either delivered orally or secreted onto mucosal surfaces in mice bearing hybridoma tumors, did not significantly enhance protection over that provided by oral anti-LPS IgA alone. These results demonstrate that anti-LPS sIgA is much more effective than anti-CT IgA in prevention of V. cholerae-induced diarrheal disease. Images PMID:8225601

  4. Endoscopic totally extraperitoneal (TEP) hernia repair for inguinal disruption (Sportsman's hernia): rationale and design of a prospective observational cohort study (TEP-ID-study)

    PubMed Central

    Voorbrood, C E H; Goedhart, E; Verleisdonk, E J M M; Sanders, F; Naafs, D; Burgmans, J P J

    2016-01-01

    Introduction Chronic inguinal pain is a frequently occurring problem in athletes. A diagnosis of inguinal disruption is performed by exclusion of other conditions causing groin pain. Up to now, conservative medical management is considered to be the primary treatment for this condition. Relevant large and prospective clinical studies regarding the treatment of inguinal disruption are limited; however, recent studies have shown the benefits of the totally extraperitoneal patch (TEP) technique. This study provides a complete assessment of the inguinal area in athletes with chronic inguinal pain before and after treatment with the TEP hernia repair technique. Methods and analysis We describe the rationale and design of an observational cohort study for surgical treatment with the endoscopic TEP hernia repair technique in athletes with a painful groin (inguinal disruption). The study is being conducted in a high-volume, single centre hospital with specialty in TEP hernia repair. Patients over 18 years, suffering from inguinal pain for at least 3 months during or after playing sports, and whom have not undergone previous inguinal surgery and have received no benefit from physiotherapy are eligible for inclusion. Patients with any another cause of inguinal pain, proven by physical examination, inguinal ultrasound, X-pelvis/hip or MRI are excluded. Primary outcome is reduction in pain after 3 months. Secondary outcomes are pain reduction, physical functioning, and resumption of sport (in frequency and intensity). Ethics and dissemination An unrestricted research grant for general study purposes was assigned to the Hernia Centre. This study itself is not directly subject to the above mentioned research grant or any other financial sponsorship. We intend to publish the outcome of the study, regardless of the findings. All authors will give final approval of the manuscript version to be published. PMID:26739740

  5. [Design and implementation of Geographical Information System on prevention and control of cholera].

    PubMed

    Li, Xiu-jun; Fang, Li-qun; Wang, Duo-chun; Wang, Lu-xi; Li, Ya-pin; Li, Yan-li; Yang, Hong; Kan, Biao; Cao, Wu-chun

    2012-04-01

    To build the Geographical Information System (GIS) database for prevention and control of cholera programs as well as using management analysis and function demonstration to show the spatial attribute of cholera. Data from case reporting system regarding diarrhoea, vibrio cholerae, serotypes of vibrio cholerae at the surveillance spots and seafoods, as well as surveillance data on ambient environment and climate were collected. All the data were imported to system database to show the incidence of vibrio cholerae in different provinces, regions and counties to support the spatial analysis through the spatial analysis of GIS. The epidemic trends of cholera, seasonal characteristics of the cholera and the variation of the vibrio cholerae with times were better understood. Information on hotspots, regions and time of epidemics was collected, and helpful in providing risk prediction on the incidence of vibrio cholerae. The exploitation of the software can predict and simulate the spatio-temporal risks, so as to provide guidance for the prevention and control of the disease.

  6. Worldwide occurrence of integrative conjugative element encoding multidrug resistance determinants in epidemic Vibrio cholerae O1.

    PubMed

    Marin, Michel A; Fonseca, Erica L; Andrade, Bruno N; Cabral, Adriana C; Vicente, Ana Carolina P

    2014-01-01

    In the last decades, there has been an increase of cholera epidemics caused by multidrug resistant strains. Particularly, the integrative and conjugative element (ICE) seems to play a major role in the emergence of multidrug resistant Vibrio cholerae. This study fully characterized, by whole genome sequencing, new ICEs carried by multidrug resistant V. cholerae O1 strains from Nigeria (2010) (ICEVchNig1) and Nepal (1994) (ICEVchNep1). The gene content and gene order of these two ICEs are the same, and identical to ICEVchInd5, ICEVchBan5 and ICEVchHai1 previously identified in multidrug resistant V. cholerae O1. This ICE is characterized by dfrA1, sul2, strAB and floR antimicrobial resistance genes, and by unique gene content in HS4 and HS5 ICE regions. Screening for ICEs, in publicly available V. cholerae genomes, revealed the occurrence and widespread distribution of this ICE among V. cholerae O1. Metagenomic analysis found segments of this ICE in marine environments far from the direct influence of the cholera epidemic. Therefore, this study revealed the epidemiology of a spatio-temporal prevalent ICE in V. cholerae O1. Its occurrence and dispersion in V. cholerae O1 strains from different continents throughout more than two decades can be indicative of its role in the fitness of the current pandemic lineage.

  7. Survival and proliferation of the lysogenic bacteriophage CTXΦ in Vibrio cholerae.

    PubMed

    Fan, Fenxia; Kan, Biao

    2015-02-01

    The lysogenic phage CTXΦ of Vibrio cholerae can transfer the cholera toxin gene both horizontally (inter-strain) and vertically (cell proliferation). Due to its diversity in form and species, the complexity of regulatory mechanisms, and the important role of the infection mechanism in the production of new virulent strains of V. cholerae, the study of the lysogenic phage CTXΦ has attracted much attention. Based on the progress of current research, the genomic features and their arrangement, the host-dependent regulatory mechanisms of CTXΦ phage survival, proliferation and propagation were reviewed to further understand the phage's role in the evolutionary and epidemiological mechanisms of V. cholerae. PMID:25613689

  8. Detection of Vibrio cholerae in environmental waters including drinking water reservoirs of Azerbaijan.

    PubMed

    Rashid, Ahmadov; Haley, Bradd J; Rajabov, Mukhtar; Ahmadova, Sevinj; Gurbanov, Shair; Colwell, Rita R; Huq, Anwar

    2013-02-01

    Cholera, a globally prevalent gastrointestinal disease, remains a persistent problem in many countries including the former Soviet republics of the Caucasus region where sporadic outbreaks occurred recently. Historically, this region has experienced cholera during every pandemic since 1816; however, no known comprehensive evaluation of the presence of Vibrio cholerae in surface waters using molecular methods has been done. Here we present the first report of the presence of V. cholerae in surface waters of Azerbaijan and its seasonality, using a combination of bacteriological and molecular methods. Findings from the present study indicate a peak in the presence of V. cholerae in warmer summer months relative to colder winter months. In the Caspian Sea, water temperature when optimal for growth of V. cholerae was significantly associated with detection of V. cholerae. Vibrio cholerae was simultaneously detected at freshwater sites including two water reservoirs. Most importantly, detection of V. cholerae in these water reservoirs, the source of municipal drinking water, poses a potential health risk to the population due to the limited and insufficient treatment of water in Azerbaijan. Routine monitoring of environmental waters used for recreational purposes, and especially drinking water reservoirs, is highly recommended as a measure for public health safety.

  9. Survivability and molecular variation in Vibrio cholerae from epidemic sites in China.

    PubMed

    Li, X Q; Wang, M; Deng, Z A; Shen, J C; Zhang, X Q; Liu, Y F; Cai, Y S; Wu, X W; DI, B

    2015-01-01

    The survival behaviour of Vibrio cholerae in cholera epidemics, together with its attributes of virulence-associated genes and molecular fingerprints, are significant for managing cholera epidemics. Here, we selected five strains representative of V. cholerae O1 and O139 involved in cholera events, examined their survival capacity in large volumes of water sampled from epidemic sites of a 2005 cholera outbreak, and determined virulence-associated genes and molecular subtype changes of the surviving isolates recovered. The five strains exhibited different survival capacities varying from 17 to 38 days. The virulence-associated genes of the surviving isolates remained unchanged, while their pulsotypes underwent slight variation. In particular, one waterway-isolated strain maintained virulence-associated genes and evolved to share the same pulsotype as patient strains, highlighting its role in the cholera outbreak. The strong survival capacity and molecular attributes of V. cholerae might account for its persistence in environmental waters and the long duration of the cholera outbreak, allowing effective control measures.

  10. Hurricanes, climate change and the cholera epidemic in Puerto Rico of 1855-1856.

    PubMed

    Christenson, Bernard

    2008-01-01

    Hurricanes and global climate changes may affect the environmental factors of cholera dynamics in warm coastal areas, vulnerable to seasonal or sporadic outbreaks. The cholera epidemic of Puerto Rico in 1855-1856 had a profound effect on the Puerto Rican society; but it was not influenced by any climatic events, such as preceding hurricanes or storms based on past documentary sources. Particularly, the environmental non-toxigenic strains of Vibrio Cholerae in Puerto Rican water sources can maintain their pathogenic potential for sporadic or erratic toxigenic cholera outbreaks--if a "perfect storm" ever occurs.

  11. Linking Satellite Derived Land Surface Temperature with Cholera: A Case Study for South Sudan

    NASA Astrophysics Data System (ADS)

    Aldaach, H. S. V.; Jutla, A.; Akanda, A. S.; Colwell, R. R.

    2014-12-01

    A sudden onset of cholera in South Sudan, in April 2014 in Northern Bari in Juba town resulted in more than 400 cholera cases after four weeks of initial outbreak with a case of fatality rate of CFR 5.4%. The total number of reported cholera cases for the period of April to July, 2014 were 5,141 including 114 deaths. With the limited efficacy of cholera vaccines, it is necessary to develop mechanisms to predict cholera occurrence and thereafter devise intervention strategies for mitigating impacts of the disease. Hydroclimatic processes, primarily precipitation and air temperature are related to epidemic and episodic outbreak of cholera. However, due to coarse resolution of both datasets, it is not possible to precisely locate the geographical location of disease. Here, using Land Surface Temperature (LST) from MODIS sensors, we have developed an algorithm to identify regions susceptible for cholera. Conditions for occurrence of cholera were detectable at least one month in advance in South Sudan and were statistically sensitive to hydroclimatic anomalies of land surface and air temperature, and precipitation. Our results indicate significant spatial and temporal averaging required to infer usable information from LST over South Sudan. Preliminary results that geographically location of cholera outbreak was identifiable within 1km resolution of the LST data.

  12. Previous appendicitis may affect peritoneal overlap of the mesh in laparoscopic inguinal hernia repair.

    PubMed

    Vecchio, R; Di Martino, M; Lipari, G; Sambataro, L

    2002-02-01

    Laparoscopic inguinal hernia repair is now increasingly performed in bilateral and recurrent groin hernias. The avoidance of direct exposure of the commonly used meshes to the abdominal viscera is considered essential to reduce the risk of bowel adhesions. We report a case of bilateral inguinal hernia repair in a patients who had had an appendectomy performed 8 years earlier for a perforated appendicitis. Probably as a result of previous inflammation, any attempt to dissect the preperitoneal layer in the right side resulted in peritoneal lacerations. Since the peritoneum could not be used to cover the mesh, we decided to position an expanded polytetrafluoroethylene (e-PTFE) mesh to avoid postoperative adhesions. The mesh was fixed with tacks to the symphysis pubis, Cooper's ligament, the ilio-pubic tract, and the transversalis fascia 2 cm above the hernia defect. This case suggests that in patient with previous appendicitis, a difficult preperitoneal dissection can be expected. In such cases, especially in young patients for whom future surgical operations cannot be excluded, any attempt to reduce adhesions is justified. At the present time, the use of e-PTFE meshes, which induce no tissue reaction, is a good option in this situation. PMID:11967702

  13. Metastatic malignant melanoma of the inguinal lymph node with unknown primary lesion.

    PubMed

    Eltawansy, Sherif Ali; Panasiti, Ryane; Hasanien, Samaa; Lourdusamy, Dennis; Sharon, David

    2015-01-01

    Background. Malignant melanoma could present with metastasis with unknown primary (MUP) and this happens in 2-3% according to the studies. Around 90% of melanomas have cutaneous origin, but still there are melanomas that could be found in visceral organs or lymph nodes with unknown primary site. Spontaneous regression of the primary site could be an explanation. Case Report. We report a 58-year-old Caucasian male who presented with a right sided swelling in the inguinal region. Surgery was performed and biopsy showed metastatic malignant melanoma. No cutaneous lesions were identified by history or physical examination. Work up could not detect the primary lesion and patient was started on radiotherapy and immunotherapy. Conclusion. We present a case of malignant melanoma of unknown primary presenting in an unusual place which is the inguinal lymph node. Theories try to explain the pathway of development of such tumors and one of the theories mentions that it could be a spontaneous regression of the primary cutaneous lesion. Another theory is that it could be from transformation of aberrant melanocyte within the lymph node. Prognosis is postulated to be better in this case than in melanoma with a known primary. PMID:25705230

  14. Simple prophylactic procedure of inguinal hernia after radical retropubic prostatectomy: isolation of the spermatic cord.

    PubMed

    Sakai, Yasuyuki; Okuno, Tetsuo; Kijima, Toshiki; Iwai, Aki; Matsuoka, Yoh; Kawakami, Satoru; Kihara, Kazunori

    2009-10-01

    To reduce the incidence of inguinal hernia (IH) after radical retropubic prostatectomy (RRP), a simple prophylactic procedure was carried out during RRP. A consecutive 82 patients who had undergone RRP for clinically localized prostate cancer between July 2002 and October 2006 at Toride Kyodo General Hospital were enrolled. From July 2002 to November 2003, 20 patients underwent conventional RRP. Thereafter, 62 patients underwent conventional RRP with blunt dissection of the peritoneum at the internal inguinal ring and isolation of the spermatic cord from the peritoneum as a prophylactic procedure for IH. There was no significant difference in patient characteristics between the two groups. In the conventional RRP group, IH occurred in 10 patients during a median range follow-up period of 41 (1 to 73) months. In contrast, in the RRP plus prophylactic procedure group, IH occurred in one patient (1.6%) during a median range follow-up period of 41 (25 to 59) months. The incidence of IH after RRP plus the prophylactic procedure was significantly lower than that after conventional RRP, indicating the efficacy of the presented procedure.

  15. Genetic and functional analysis of the TBX3 gene promoter in indirect inguinal hernia.

    PubMed

    Zhao, Zhongqing; Tian, Wenjun; Wang, Lin; Wang, Haihua; Qin, Xianyun; Xing, Qining; Pang, Shuchao; Yan, Bo

    2015-01-01

    Inguinal hernia is a common developmental disease in children and most cases are indirect inguinal hernia (IIH). Genetic factors have been suggested to play important roles in IIH. Although IIH has been observed in several human syndromes, genetic causes and molecular mechanisms for IIH remain unknown. TBX3 is a member of the T-box family of transcription factors that are essential to the embryonic development. Human studies and animal experiments have demonstrated that TBX3 is required for the development of the heart, limbs, mammary glands and other tissues and organs. TBX3 gene expression has been detected in human fibroblast and tissues of abdominal wall. We speculated that TBX3 may be involved in the IIH formation. Since TBX3 activity is highly dosage-sensitive, a TBX3 gene promoter was genetically and functionally analyzed in IIH patients and ethnic-matched controls in this study. One heterozygous deletion variant (g.4820_4821del) was identified in one IIH patient, but in none of controls. The variant significantly decreased TBX3 gene promoter activities, likely by creating a binding site for sex-determining region Y (SRY), mobility group transcription factor. One heterozygous insertion variant (g.3913_3914ins) was only found in one control, which did not affect TBX3 gene promoter activities. Taken together, TBX3 gene variants may contribute to IIH as a rare risk factor by reducing TBX3 levels. PMID:25455105

  16. Inguinal Mesh Hernioplasties: A Rural Private Clinic Experience in South Eastern Nigeria

    PubMed Central

    Enyinnah, Michael; Dienye, Paul Owajionyi; Njoku, Patrick

    2013-01-01

    Objective: The objective of this paper is to review hernioplasties done for inguinal hernias in a rural private hospital, bringing out the socio-demographic and clinical pattern and to sensitize surgeons and family physicians in our environment about the possibility of making hernioplasty a standard of care for inguinal hernias. Method: The records of seventy seven patients operated in a rural private hospital were reviewed. Socio-demographic data, operative techniques and post-operative outcomes were documented. The results were compared with relevant findings in the literature. Results: Eighty one Lichtenstein procedures were done, of which four were bilateral. Polypropylene mesh was used in all cases. A total of three patients (3.9%) had early post-operative complications. The complications were scrotal haematoma, haematoma complicated by wound sepsis and wound sepsis only. All the complications were successfully managed. There was no case of mesh removal or mortality. Conclusion: Early post-operative results suggest that mesh hernioplasty is possible in rural communities of West Africa, given the availability of mesh, basic medical infrastructure and relevant skilled manpower. PMID:23777733

  17. Comparative genomics of Vibrio cholerae from Haiti, Asia, and Africa.

    PubMed

    Reimer, Aleisha R; Van Domselaar, Gary; Stroika, Steven; Walker, Matthew; Kent, Heather; Tarr, Cheryl; Talkington, Deborah; Rowe, Lori; Olsen-Rasmussen, Melissa; Frace, Michael; Sammons, Scott; Dahourou, Georges Anicet; Boncy, Jacques; Smith, Anthony M; Mabon, Philip; Petkau, Aaron; Graham, Morag; Gilmour, Matthew W; Gerner-Smidt, Peter

    2011-11-01

    Cholera was absent from the island of Hispaniola at least a century before an outbreak that began in Haiti in the fall of 2010. Pulsed-field gel electrophoresis (PFGE) analysis of clinical isolates from the Haiti outbreak and recent global travelers returning to the United States showed indistinguishable PFGE fingerprints. To better explore the genetic ancestry of the Haiti outbreak strain, we acquired 23 whole-genome Vibrio cholerae sequences: 9 isolates obtained in Haiti or the Dominican Republic, 12 PFGE pattern-matched isolates linked to Asia or Africa, and 2 nonmatched outliers from the Western Hemisphere. Phylogenies for whole-genome sequences and core genome single-nucleotide polymorphisms showed that the Haiti outbreak strain is genetically related to strains originating in India and Cameroon. However, because no identical genetic match was found among sequenced contemporary isolates, a definitive genetic origin for the outbreak in Haiti remains speculative.

  18. Genomics of immune response to typhoid and cholera vaccines

    PubMed Central

    Majumder, Partha P.

    2015-01-01

    Considerable variation in antibody response (AR) was observed among recipients of an injectable typhoid vaccine and an oral cholera vaccine. We sought to find whether polymorphisms in genes of the immune system, both innate and adaptive, were associated with the observed variation in response. For both vaccines, we were able to discover and validate several polymorphisms that were significantly associated with immune response. For the typhoid vaccines, these polymorphisms were on genes that belonged to pathways of polysaccharide recognition, signal transduction, inhibition of T-cell proliferation, pro-inflammatory signalling and eventual production of antimicrobial peptides. For the cholera vaccine, the pathways included epithelial barrier integrity, intestinal homeostasis and leucocyte recruitment. Even though traditional wisdom indicates that both vaccines should act as T-cell-independent antigens, our findings reveal that the vaccines induce AR using different pathways. PMID:25964454

  19. Genomics of immune response to typhoid and cholera vaccines.

    PubMed

    Majumder, Partha P

    2015-06-19

    Considerable variation in antibody response (AR) was observed among recipients of an injectable typhoid vaccine and an oral cholera vaccine. We sought to find whether polymorphisms in genes of the immune system, both innate and adaptive, were associated with the observed variation in response. For both vaccines, we were able to discover and validate several polymorphisms that were significantly associated with immune response. For the typhoid vaccines, these polymorphisms were on genes that belonged to pathways of polysaccharide recognition, signal transduction, inhibition of T-cell proliferation, pro-inflammatory signalling and eventual production of antimicrobial peptides. For the cholera vaccine, the pathways included epithelial barrier integrity, intestinal homeostasis and leucocyte recruitment. Even though traditional wisdom indicates that both vaccines should act as T-cell-independent antigens, our findings reveal that the vaccines induce AR using different pathways.

  20. Epidemic cholera in Latin America: spread and routes of transmission.

    PubMed

    Guthmann, J P

    1995-12-01

    In the most recent epidemic of cholera in Latin America, nearly a million cases were reported and almost 9000 people died between January 1991 and December 1993. The epidemic spread rapidly from country to country, affecting in three years all the countries of Latin America except Uruguay and the Caribbean. Case-control studies carried out in Peru showed a significant association between drinking water and risk of disease. Cholera was associated with the consumption of unwashed fruit and vegetables, with eating food from street vendors and with contaminated crabmeat transported in travellers' luggage. This article documents the spread of the epidemic and its routes of transmission and discusses whether the introduction of the epidemic to Peru and its subsequent spread throughout the continent could have been prevented.

  1. Mathematical analysis of a cholera model with public health interventions.

    PubMed

    Mwasa, A; Tchuenche, J M

    2011-09-01

    Cholera, an acute gastro-intestinal infection and a waterborne disease continues to emerge in developing countries and remains an important global health challenge. We formulate a mathematical model that captures some essential dynamics of cholera transmission to study the impact of public health educational campaigns, vaccination and treatment as control strategies in curtailing the disease. The education-induced, vaccination-induced and treatment-induced reproductive numbers R(E), R(V), R(T) respectively and the combined reproductive number R(C) are compared with the basic reproduction number R(0) to assess the possible community benefits of these control measures. A Lyapunov functional approach is also used to analyse the stability of the equilibrium points. We perform sensitivity analysis on the key parameters that drive the disease dynamics in order to determine their relative importance to disease transmission and prevalence. Graphical representations are provided to qualitatively support the analytical results.

  2. Construction of a Vibrio cholerae prototype vaccine strain O395-N1-E1 which accumulates cell-associated cholera toxin B subunit.

    PubMed

    Rhie, Gi-eun; Jung, Hae-Mi; Kim, Bong Su; Mekalanos, John J

    2008-10-01

    Because of its production and use in Vietnam, the most widely used oral cholera vaccine consists of heat- or formalin-killed Vibrio cholerae whole cells (WC). An earlier version of this type of vaccine called whole cell-recombinant B subunit vaccine (BS-WC) produced in Sweden also contained the B subunit of cholera toxin (CTB). Both WC and BS-WC vaccines produced moderate levels of protection in field trials designed to evaluate their cholera efficacy. V. cholerae cells in these vaccines induce antibacterial immunity, and CTB contributes to the vaccine's efficacy presumably by stimulating production of anti-toxin neutralizing antibody. Although more effective than the WC vaccine, the BS-WC vaccine has not been adopted for manufacture by developing world countries primarily because the CTB component is difficult to manufacture and include in the vaccine in the doses needed to induce significant immune responses. We reasoned this was a technical problem that might be solved by engineering strains of V. cholerae that express cell-associated CTB that would co-purify with the bacterial cell fraction during the manufacture of WC vaccine. Here we report that construction of a V. cholerae O1 classical strain, O395-N1-E1, that has been engineered to accumulate CTB in the periplasmic fraction by disrupting the epsE gene of type II secretion pathway. O395-N1-E1 induces anti-CTB IgG and vibriocidal antibodies in mice immunized with two doses of formalin killed whole cells. Intraperitoneal immunization of mice with O395-N1-E1 induced a significantly higher anti-CTB antibody response compared to that of the parental strain, O395-N1. Our results suggest that this prototype cholera vaccine candidate strain may assist in preparing improved and inexpensive oral BS-WC cholera vaccine without the need to purify CTB separately. PMID:18582519

  3. Vibrio cholerae O139 conjugate vaccines: synthesis and immunogenicity of V. cholerae O139 capsular polysaccharide conjugates with recombinant diphtheria toxin mutant in mice.

    PubMed

    Kossaczka, Z; Shiloach, J; Johnson, V; Taylor, D N; Finkelstein, R A; Robbins, J B; Szu, S C

    2000-09-01

    Epidemiologic and experimental data provide evidence that a critical level of serum immunoglobulin G (IgG) antibodies to the surface polysaccharide of Vibrio cholerae O1 (lipopolysaccharide) and of Vibrio cholerae O139 (capsular polysaccharide [CPS]) is associated with immunity to the homologous pathogen. The immunogenicity of polysaccharides, especially in infants, may be enhanced by their covalent attachment to proteins (conjugates). Two synthetic schemes, involving 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) and 1-cyano-4-dimethylaminopyridinium tetrafluoroborate (CDAP) as activating agents, were adapted to prepare four conjugates of V. cholerae O139 CPS with the recombinant diphtheria toxin mutant, CRMH21G. Adipic acid dihydrazide was used as a linker. When injected subcutaneously into young outbred mice by a clinically relevant dose and schedule, these conjugates elicited serum CPS antibodies of the IgG and IgM classes with vibriocidal activity to strains of capsulated V. cholerae O139. Treatment of these sera with 2-mercaptoethanol (2-ME) reduced, but did not eliminate, their vibriocidal activity. These results indicate that the conjugates elicited IgG with vibriocidal activity. Conjugates also elicited high levels of serum diphtheria toxin IgG. Convalescent sera from 20 cholera patients infected with V. cholerae O139 had vibriocidal titers ranging from 100 to 3,200: absorption with the CPS reduced the vibriocidal titer of all sera to < or =50. Treatment with 2-ME reduced the titers of 17 of 20 patients to < or =50. These data show that, like infection with V. cholerae O1, infection with V. cholerae O139 induces vibriocidal antibodies specific to the surface polysaccharide of this bacterium (CPS) that are mostly of IgM class. Based on these data, clinical trials with the V. cholerae O139 CPS conjugates with recombinant diphtheria toxin are planned. PMID:10948122

  4. Biocompatible capped iron oxide nanoparticles for Vibrio cholerae detection

    NASA Astrophysics Data System (ADS)

    Sharma, Anshu; Baral, Dinesh; Rawat, Kamla; Solanki, Pratima R.; Bohidar, H. B.

    2015-05-01

    We report the studies relating to fabrication of an efficient immunosensor for Vibrio cholerae detection. Magnetite (iron oxide (Fe3O4)) nanoparticles (NPs) have been synthesized by the co-precipitation method and capped by citric acid (CA). These NPs were electrophoretically deposited onto indium-tin-oxide (ITO)-coated glass substrate and used for immobilization of monoclonal antibodies against Vibrio cholerae (Ab) and bovine serum albumin (BSA) for Vibrio cholerae detection using an electrochemical technique. The structural and morphological studies of Fe3O4 and CA-Fe3O4/ITO were characterized by x-ray diffraction (XRD), transmission electron microscopy (TEM), Fourier transform infrared (FTIR) spectroscopy, and dynamic light scattering (DLS) techniques. The average crystalline size of Fe3O4, CA-Fe3O4 nanoparticles obtained were about 29 ± 1 nm and 37 ± 1 nm, respectively. The hydrodynamic radius of the nanoparticles was found to be 77.35 nm (Fe3O4) and 189.51 nm (CA-Fe3O4) by DLS measurement. The results of electrochemical response studies of the fabricated BSA/Ab/CA-Fe2O3/ITO immunosensor exhibits a good detection range of 12.5-500 ng mL-1 with a low detection limit of 0.32 ng mL-1, sensitivity 0.03 Ω/ng ml-1 cm-2, and reproducibility more than 11 times.

  5. Biocompatible capped iron oxide nanoparticles for Vibrio cholerae detection.

    PubMed

    Sharma, Anshu; Baral, Dinesh; Rawat, Kamla; Solanki, Pratima R; Bohidar, H B

    2015-05-01

    We report the studies relating to fabrication of an efficient immunosensor for Vibrio cholerae detection. Magnetite (iron oxide (Fe(3)O(4))) nanoparticles (NPs) have been synthesized by the co-precipitation method and capped by citric acid (CA). These NPs were electrophoretically deposited onto indium-tin-oxide (ITO)-coated glass substrate and used for immobilization of monoclonal antibodies against Vibrio cholerae (Ab) and bovine serum albumin (BSA) for Vibrio cholerae detection using an electrochemical technique. The structural and morphological studies of Fe(3)O(4) and CA-Fe(3)O(4)/ITO were characterized by x-ray diffraction (XRD), transmission electron microscopy (TEM), Fourier transform infrared (FTIR) spectroscopy, and dynamic light scattering (DLS) techniques. The average crystalline size of Fe(3)O(4), CA-Fe(3)O(4) nanoparticles obtained were about 29 ± 1 nm and 37 ± 1 nm, respectively. The hydrodynamic radius of the nanoparticles was found to be 77.35 nm (Fe(3)O(4)) and 189.51 nm (CA-Fe(3)O(4)) by DLS measurement. The results of electrochemical response studies of the fabricated BSA/Ab/CA-Fe(2)O(3)/ITO immunosensor exhibits a good detection range of 12.5-500 ng mL(-1) with a low detection limit of 0.32 ng mL(-1), sensitivity 0.03 Ω/ng ml(-1) cm(-2), and reproducibility more than 11 times.

  6. An assistant ship surgeon's account of cholera at sea.

    PubMed

    Goodyer, Bronwen E J

    2008-09-01

    The diary of Thomas Graham, a naval ship surgeon, brings the voyage of HMS troopship Apollo in 1849 to life. A year after England's second great cholera outbreak, the pervasive fear of the disease became a reality onboard when cholera broke out. The intended voyage from England to China was diverted to South America where the ship was put into quarantine. So bad were the conditions onboard that the Times correspondent wrote: 'I have never seen a convict-ship in which the convicts were not more comfortably lodged'. Graham's writing provides an insightful record of life at sea in the mid-nineteenth century and the circumstances that led to this cholera outbreak, namely the overcrowding and poor hygiene. He wrote about the current beliefs and assumptions surrounding the disease; that the foul air was to blame. He also noted the varied methods taken to confine patients and treat the disease. The diary is supported by evidence from naval records and newspaper articles. Graham's writing gives us a glimpse into the life of a man who saw the world from a perspective inaccessible to us and the experience of observing newly discovered continents, cultures and wildlife, which he meticulously recorded. This was Graham's last piece of writing as he died unexpectedly of malaria shortly after the journey's end. The diary encapsulates the struggle to overcome disease and the tragic plight a humble ship surgeon shared with the crew.

  7. Differential thiol-based switches jumpstart Vibrio cholerae pathogenesis

    PubMed Central

    Liu, Zhi; Wang, Hui; Zhou, Zhigang; Naseer, Nawar; Xiang, Fu; Kan, Biao; Goulian, Mark; Zhu, Jun

    2015-01-01

    Bacterial pathogens utilize gene expression versatility to adapt to environmental changes. Vibrio cholerae, the causative agent of cholera, encounters redox potential changes when it transitions from oxygen-rich aquatic reservoirs to the oxygen-limiting human gastrointestinal tract. We previously showed that the virulence regulator AphB uses thiol-based switches to sense the anoxic host environment and transcriptionally activate the key virulence activator tcpP. Here, by performing a high-throughput transposon sequencing screen in vivo, we identified OhrR as another regulator that enables V. cholerae rapid anoxic adaptation. Like AphB, reduced OhrR binds to and regulates the tcpP promoter. OhrR and AphB displayed differential dynamics in response to redox potential changes: OhrR is reduced more rapidly than AphB. Furthermore, OhrR thiol modification is required for rapid activation of virulence and successful colonization. This reveals a mechanism whereby bacterial pathogens employ posttranslational modifications of multiple transcription factors to sense and adapt to dynamic environmental changes. PMID:26748713

  8. Comparative Effectiveness of Different Strategies of Oral Cholera Vaccination in Bangladesh: A Modeling Study

    PubMed Central

    Dimitrov, Dobromir T.; Troeger, Christopher; Halloran, M. Elizabeth; Longini, Ira M.; Chao, Dennis L.

    2014-01-01

    Background Killed, oral cholera vaccines have proven safe and effective, and several large-scale mass cholera vaccination efforts have demonstrated the feasibility of widespread deployment. This study uses a mathematical model of cholera transmission in Bangladesh to examine the effectiveness of potential vaccination strategies. Methods & Findings We developed an age-structured mathematical model of cholera transmission and calibrated it to reproduce the dynamics of cholera in Matlab, Bangladesh. We used the model to predict the effectiveness of different cholera vaccination strategies over a period of 20 years. We explored vaccination programs that targeted one of three increasingly focused age groups (the entire vaccine-eligible population of age one year and older, children of ages 1 to 14 years, or preschoolers of ages 1 to 4 years) and that could occur either as campaigns recurring every five years or as continuous ongoing vaccination efforts. Our modeling results suggest that vaccinating 70% of the population would avert 90% of cholera cases in the first year but that campaign and continuous vaccination strategies differ in effectiveness over 20 years. Maintaining 70% coverage of the population would be sufficient to prevent sustained transmission of endemic cholera in Matlab, while vaccinating periodically every five years is less effective. Selectively vaccinating children 1–14 years old would prevent the most cholera cases per vaccine administered in both campaign and continuous strategies. Conclusions We conclude that continuous mass vaccination would be more effective against endemic cholera than periodic campaigns. Vaccinating children averts more cases per dose than vaccinating all age groups, although vaccinating only children is unlikely to control endemic cholera in Bangladesh. Careful consideration must be made before generalizing these results to other regions. PMID:25473851

  9. Comparative phenotypic characterization of Vibrio cholerae isolates collected from aquatic environments of Georgia.

    PubMed

    Kokashvili, T; Elbakidze, T; Jaiani, E; Janelidze, N; Kamkamidze, G; Whitehouse, C; Huq, A; Tediashvili, M

    2013-11-01

    Vibrio cholerae is ubiquitous in aquatic environment inhabiting marine, fresh and brackish waters. V. cholerae serotypes O1 and O139 cause the devastating diarrheal disease cholera, which is often fatal without proper treatment. Little is known regarding the abundance and diversity of clinically important nonhalophilic vibrios in the South Caucasus region, particularly in Georgia. Here we provide the data on the Georgian environmental strains of V. cholerae isolated in 2006-2009 years from the coastal waters of the Black Sea and inland water reservoirs near Tbilisi. In total, 846 V. cholerae strains were collected from the water samples, most of them (705 strains) obtained from fresh water lakes. Isolation pattern of V. cholerae showed obvious seasonality with the highest isolation rates in late summer - early autumn. Twenty-nine isolates of V. cholerae were attributed to the O1 serotype based on serological studies and PCR identification and were further grouped by biochemical properties into classical and El Tor biotypes as well as hybrids. The study of antibiotic susceptibility profiles for V. cholerae isolates showed that 95% were sensitive to tetracycline, 91% to doxycycline, and 91% to ciprofloxacin. Interestingly, the freshwater isolates appeared to be more resistant to antibiotics than the Black Sea isolates. Among Black Sea isolates of V. cholerae toxigenic strains of O1 serotype revealed higher antibiotic resistance compared to non- O1/non-O139 isolates. In addition, V. cholerae O1 and non- O1/non-O139 isolates differed by phage susceptibility profiles, with higher diversity within the population of environmental non-O1/non-O139 V. cholerae isolates.

  10. Cholera Outbreaks in Nigeria Are Associated with Multidrug Resistant Atypical El Tor and Non-O1/Non-O139 Vibrio cholerae

    PubMed Central

    Marin, Michel A.; Thompson, Cristiane C.; Freitas, Fernanda S.; Fonseca, Erica L.; Aboderin, A. Oladipo; Zailani, Sambo B.; Quartey, Naa Kwarley E.; Okeke, Iruka N.; Vicente, Ana Carolina P.

    2013-01-01

    Background The current millennium has seen a steep rise in the number, size and case-fatalities of cholera outbreaks in many African countries. Over 40,000 cases of cholera were reported from Nigeria in 2010. Variants of Vibrio cholerae O1 El Tor biotype have emerged but very little is known about strains causing cholera outbreaks in West Africa, which is crucial for the implementation of interventions to control epidemic cholera. Methodology/Principal Findings V. cholerae isolates from outbreaks of acute watery diarrhea in Nigeria from December, 2009 to October, 2010 were identified by standard culture methods. Fifteen O1 and five non-O1/non-O139 strains were analyzed; PCR and sequencing targeted regions associated with virulence, resistance and biotype were performed. We also studied genetic interrelatedness among the strains by multilocus sequence analysis and pulsed-field gel electrophoresis. The antibiotic susceptibility was tested by the disk diffusion method and E-test. We found that multidrug resistant atypical El Tor strains, with reduced susceptibility to ciprofloxacin and chloramphenicol, characterized by the presence of the SXT element, and gyrASer83Ile/parCSer85Leu alleles as well CTX phage and TCP cluster characterized by rstRElTor, ctxB-7 and tcpACIRS alleles, respectively, were largely responsible for cholera outbreaks in 2009 and 2010. We also identified and characterized a V. cholerae non-O1/non-O139 lineage from cholera-like diarrhea cases in Nigeria. Conclusions/Significance The recent Nigeria outbreaks have been determined by multidrug resistant atypical El Tor and non-O1/non-O139 V. cholerae strains, and it seems that the typical El Tor, from the beginning of seventh cholera pandemic, is no longer epidemic/endemic in this country. This scenario is similar to the East Africa, Asia and Caribbean countries. The detection of a highly virulent, antimicrobial resistant lineage in Nigeria is worrisome and points to a need for vaccine-based control of

  11. Incidence of pain after inguinal hernia repair in the elderly. A retrospective historical cohort evaluation of 18-years’ experience with a mesh & plug inguinal hernia repair method on about 3000 patients

    PubMed Central

    2013-01-01

    Background Chronic pain after prosthetic inguinal hernioplasty is one of the most important current issues in the current literature debate. Mechanisms related to pain development are only partially known. Influence of age as well as other factors is still unclear. The aim of this work was to evaluate whether development of chronic pain after open prosthetic plug and mesh inguinal hernioplasty is influenced by age. Methods Analysis was retrospectively conducted, dividing our cohort of patients (2,902) who had undergone prosthetic open plug&mesh inguinal hernioplasty from Jannuary 1994 to May 2012, following only the age criterion (cut-off 65 yrs.), into two groups (Gr.A<65 yrs, Gr.B>65 yrs.). All patients were routinely submitted to a postoperative questionnaire. Complications such as analgesic assumption were registered in both groups. Pain intensity was classified following the Visual Analogic Scale (VAS). Incidence of chronic pain, discomfort, and numbness, was assessed in both groups. Statistical significance was assessed by X2-test. Results Only 0.2% of patients suffered from a recurrence in our cohort. Postoperative chronic pain was observed in Gr. A in 0.12% of patients vs Gr.B 0.09% (p>0.05). Incidence of other postoperative symptoms such as discomfort or numbness were slightly prevalent on young patients (respectively p = 0.0286 and p = 0.01), while for hyperesthesia and sensation of foreign body no statistically significant difference of incidence between groups was observed. Conclusions Real chronic pain after inguinal hernioplasty is a rare clinical entity. Other causes of chronic pain should be accurately researched and excluded. In young patients psychological factors seem to show a slight influence. There was no influence of age on chronic postoperative pain incidence after inguinal hernioplasty. PMID:24268023

  12. Complicated acute appendicitis within a right inguinal hernia sac (Amyand’s hernia): report of a case

    PubMed Central

    Kouskos, E; Komaitis, S; Kouskou, M; Despotellis, M; Sanidas, G

    2014-01-01

    Background: The term Amyand’s hernia refers to a rare clinical situation characterized by the presence of a normal or inflammed appendix within the sac of an inguinal hernia. The situation may be asymptomatic or may present as an incarcerated hernia in case of strangulation or acute appendicitis occurring inside the hernia sac. Description of the case: We present the case of a right Amyand’s hernia on a 88-years-old male that presented to our emergency department with a severely tender and swollen inguinal mass that was diagnosed as a strangulated inguinal hernia – inguinal abcess and underwent emergency operation. The intraoperative findings included a severely inflamed and perforated appendix along with healthy part of the caecum inside the sac. Appendectomy with subsequent primary hernia repair without mesh was performed with excellent outcome. Conclusion: Because of the fact that most of such rare cases are managed by urgent surgery with no preoperative diagnosis, every surgeon should be prepared for the possibility of coping with such an unexpected situation. PMID:25125958

  13. Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing

    PubMed Central

    Jiang, H.; Ma, R.; Zhang, X.

    2016-01-01

    The aim of this study was to explore the clinical efficacy of a novel retrograde puncture approach to establish a preperitoneal space for laparoscopic direct inguinal hernia repair with inguinal ring suturing. Forty-two patients who underwent laparoscopic inguinal hernia repair with retrograde puncture for preperitoneal space establishment as well as inguinal ring suturing between August 2013 and March 2014 at our hospital were enrolled. Preperitoneal space was successfully established in all patients, with a mean establishment time of 6 min. Laparoscopic repairs were successful in all patients, with a mean surgical time of 26±15.1 min. Mean postoperative hospitalization duration was 3.0±0.7 days. Two patients suffered from postoperative local hematomas, which were relieved after puncturing and drainage. Four patients had short-term local pain. There were no cases of chronic pain. Patients were followed up for 6 months to 1 year, and no recurrence was observed. Our results demonstrate that preperitoneal space established by the retrograde puncture technique can be successfully used in adult laparoscopic hernioplasty to avoid intraoperative mesh fixation, and thus reduce medical costs. PMID:27191609

  14. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair

    PubMed Central

    Venkatraman, Rajagopalan; Abhinaya, Ranganathan Jothi; Sakthivel, Ayyanar; Sivarajan, Govindarajan

    2016-01-01

    Background and aim Transversus abdominis plane block (TAP block) is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. Materials and methods Sixty patients scheduled for elective inguinal hernia repair were selected for the study. At the end of the surgical procedure, they were randomly divided into two groups. Ultrasound-guided TAP block was performed with 20 mL of ropivacaine 0.2% (group A) or normal saline (group B). Visual analog scale (VAS) scores were used to assess pain. Paracetamol was given if VAS > 3 and tramadol was used when VAS > 6. Patients were monitored for VAS scores and total analgesic consumption for the 24-hour period. Results The TAP block with ropivacaine (group A) reduced VAS scores at 4, 6, and 12 hours. There was no distinction in VAS scores at 0, 2, and 24 hours between the two groups. The duration of analgesia for TAP block with ropivacaine lasted for 390 minutes. Total analgesics consumption was also significantly reduced in group A than group B. No complication was reported to TAP block in both the groups. Conclusion The ultrasound-guided TAP block provides good postoperative analgesia, reduces analgesic requirements, and provides good VAS scores with fewer complications following inguinal hernia surgery. PMID:26848274

  15. Immunization of Mice With Vibrio cholerae Outer-Membrane Vesicles Protects Against Hyperinfectious Challenge and Blocks Transmission

    PubMed Central

    Bishop, Anne L.; Tarique, Abdullah A.; Patimalla, Bharathi; Calderwood, Stephen B.; Qadri, Firdausi

    2012-01-01

    Background. Vibrio cholerae excreted by cholera patients is “hyperinfectious” (HI), which can be modeled by passage through infant mice. Immunization of adult female mice with V. cholerae outer-membrane vesicles (OMVs) passively protects suckling mice from challenge. Although V. cholerae is unable to colonize protected pups, the bacteria survive passage and have the potential to be transmitted to susceptible individuals. Here, we investigated the impact of OMV immunization and the HI state on V. cholerae transmission. Methods. Neonatal mice suckled by OMV- or sham-immunized dams were challenged with HI V. cholerae. The infectivity of spatially and temporally separate V. cholerae populations obtained from infected naive or protected pups was tested. Recombination-based in vivo expression technology was used to assess virulence gene expression within these populations. Results. OMV immunization significantly reduced colonization of neonates challenged with HI V. cholerae. Vibrio cholerae that had colonized the naive host was HI, whereas V. cholerae excreted by neonates born to OMV-immunized dams, although viable, was hypoinfectious and failed to fully induce virulence gene expression. Conclusions. OMV immunization can significantly reduce the V. cholerae burden upon challenge with HI V. cholerae and can also block transmission from immune mice by reducing the infectivity of shed bacteria. PMID:22147790

  16. Comparison of Positron Emission Tomography Scanning and Sentinel Node Biopsy in the Detection of Inguinal Node Metastases in Patients With Anal Cancer

    SciTech Connect

    Mistrangelo, Massimiliano; Pelosi, Ettore; Bello, Marilena; Castellano, Isabella; Cassoni, Paola; Ricardi, Umberto; Munoz, Fernando; Racca, Patrizia; Contu, Viviana; Beltramo, Giancarlo; Morino, Mario; Mussa, Antonio

    2010-05-01

    Background: Inguinal lymph node metastases in patients with anal cancer are an independent prognostic factor for local failure and overall mortality. Inguinal lymph node status can be adequately assessed with sentinel node biopsy, and the radiotherapy strategy can subsequently be changed. We compared this technique vs. dedicated 18F-fluorodeoxyglucose positron emission tomography (PET) to determine which was the better tool for staging inguinal lymph nodes. Methods and Materials: In our department, 27 patients (9 men and 18 women) underwent both inguinal sentinel node biopsy and PET-CT. PET-CT was performed before treatment and then at 1 and 3 months after treatment. Results: PET-CT scans detected no inguinal metastases in 20 of 27 patients and metastases in the remaining 7. Histologic analysis of the sentinel lymph node detected metastases in only three patients (four PET-CT false positives). HIV status was not found to influence the results. None of the patients negative at sentinel node biopsy developed metastases during the follow-up period. PET-CT had a sensitivity of 100%, with a negative predictive value of 100%. Owing to the high number of false positives, PET-CT specificity was 83%, and positive predictive value was 43%. Conclusions: In this series of patients with anal cancer, inguinal sentinel node biopsy was superior to PET-CT for staging inguinal lymph nodes.

  17. Fowl cholera immunization in turkeys. 3. Significance of market quality in the evaluation of fowl cholera vaccines.

    PubMed

    Davis, R B; Brown, J; Dawe, D L; Foster, J W; Srivastava, K K

    1970-05-01

    Turkeys vaccinated with various experimental vaccines and a commerical bacterin for fowl cholera and surviving an artificially induced epornitic were killed, and their carcasses were examined for wholesomeness. It was evident that, if the "fitness for human consumption" judgement was considered in addition to mortality, efficacy ratings of the various vaccines changed. This suggests that the "fitness for human consumption" factor be considered in future evaluation of biologicals for use in meat-producing birds.

  18. How to Check Your Skin for Skin Cancer

    MedlinePlus

    ... Home Cancer Types Skin Cancer Skin Cancer Patient Skin Cancer Treatment Melanoma Treatment Merkel Cell Carcinoma Treatment Skin Cancer Prevention Skin Cancer Screening Health Professional Skin Cancer Treatment Melanoma Treatment Merkel Cell Carcinoma Treatment Skin Cancer ...

  19. Collagen hydrogels strengthened by biodegradable meshes are a basis for dermo-epidermal skin grafts intended to reconstitute human skin in a one-step surgical intervention.

    PubMed

    Hartmann-Fritsch, Fabienne; Biedermann, Thomas; Braziulis, Erik; Luginbühl, Joachim; Pontiggia, Luca; Böttcher-Haberzeth, Sophie; van Kuppevelt, Toin H; Faraj, Kaeuis A; Schiestl, Clemens; Meuli, Martin; Reichmann, Ernst

    2016-01-01

    Extensive full-thickness skin loss, associated with deep burns or other traumata, represents a major clinical problem that is far from being solved. A promising approach to treat large skin defects is the use of tissue-engineered full-thickness skin analogues with nearly normal anatomy and function. In addition to excellent biological properties, such skin substitutes should exhibit optimal structural and mechanical features. This study aimed to test novel dermo-epidermal skin substitutes based on collagen type I hydrogels, physically strengthened by two types of polymeric net-like meshes. One mesh has already been used in clinical trials for treating inguinal hernia; the second one is new but consists of a FDA-approved polymer. Both meshes were integrated into collagen type I hydrogels and dermo-epidermal skin substitutes were generated. Skin substitutes were transplanted onto immuno-incompetent rats and analyzed after distinct time periods. The skin substitutes homogeneously developed into a well-stratified epidermis over the entire surface of the grafts. The epidermis deposited a continuous basement membrane and dermo-epidermal junction, displayed a well-defined basal cell layer, about 10 suprabasal strata and a stratum corneum. Additionally, the dermal component of the grafts was well vascularized.

  20. Isolation of Vibrio cholerae from nightsoil during epidemics of classical and El Tor cholera in East Pakistan*

    PubMed Central

    Bart, Kenneth J.; Khan, Moslemuddin; Mosley, Wiley H.

    1970-01-01

    A clear difference has been observed between the classical Inaba V. cholerae and the El Tor Ogawa V. cholerae in relation to the ability to isolate the organism from the environment. An early attempt to utilize nightsoil sampling as a tool to measure the extent of infection in the community during an epidemic of classical Inaba cholera in Dacca, East Pakistan, in the spring and fall of 1968 proved unsuccessful. During an epidemic caused by both the classical Inaba and the El Tor Ogawa vibrios in Chittagong between July 1968 and March 1969 the reasons for this failure became apparent. In Dacca, only 2 isolations of classical Inaba were made from 9906 individual latrine and pooled communal nightsoil samples, whereas in Chittagong, from 62 588 similar samples in which 2 classical Inaba isolations were also made, there were 52 El Tor Ogawa isolations. In areas where cases due to both biotypes were occurring simultaneously, El Tor Ogawa vibrios were isolated 10 times more frequently than the classical Inaba. It remains unclear whether the differences observed between El Tor Ogawa and classical Inaba are related to the biotype or to the serotype of the organism, or to both. An extrapolation of nightsoil sampling, therefore, to the incidence and prevalence of infection in a community must consider both the biotype and the serotype. PMID:5312997