Showing posts with label related. Show all posts
Showing posts with label related. Show all posts
Friday, November 11, 2016
Age Related Macular Degeneration Awareness in Massachusetts
Age Related Macular Degeneration Awareness in Massachusetts
“Age Related Macular Degeneration (AMD) is the leading cause of visual impairment and blindness in Americans older than 50, affecting more than two million people. Although AMD is incurable, there are new treatments that can, at a minimum, prevent further vision loss from the disease and in many cases actually help recover lost vision,” commented Massachusetts Ophthalmologist Francis A. D’Ambrosio, Jr., M.D., Medical Director of D’Ambrosio Eye Care.
AMD causes central vision to blur, but leaves peripheral vision intact. It is progressive and painless. There are two types of ARMD: Dry and Wet. Approximately 90 percent of people with AMD have the dry form which results in gradual vision loss. Although only 10 percent of people with ARMD have the wet form, it generally progresses much quicker than the dry form. Wet AMD is characterized by the growth of abnormal retinal blood vessels that leak blood or fluid, causing rapid and severe central vision loss.
Patients can often reduce the risk of developing ARMD by not smoking as well as working to eat a heart-healthy diet rich in fish, fruit and green leafy vegetables, avoiding foods with trans fats, exercising and controlling blood pressure and weight. “We are fortunate to be able to offer Anti-Vascular Endothelial Growth Factor (VEGF) drugs that inhibit the development of unwanted blood vessels that cause wet ARMD as these agents are effective in helping to prevent further visual loss and even improve vision,” said Dr. D’Ambrosio, Jr.
Patients older than 50 years of age are encouraged to have a comprehensive, dilated eye examination every one to two years to ensure that ARMD is detected and treated early. The key to successful treatment is early detection and intervention.
If you or someone you know is at risk for AMD please call D’Ambrosio Eye Care at 800-325-3937 to schedule and eye exam. You may also request an appointment at facebook.com/dambrosioeyecare.
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Thursday, October 27, 2016
Two Related Occupational Cases of Legionella longbeachae Infection Quebec Canada Volume 22 Number 7—July 2016 Emerging Infectious Disease journal CDC
Two Related Occupational Cases of Legionella longbeachae Infection Quebec Canada Volume 22 Number 7—July 2016 Emerging Infectious Disease journal CDC
Two Related Occupational Cases of Legionella longbeachae Infection, Quebec, Canada - Volume 22, Number 7—July 2016 - Emerging Infectious Disease journal - CDC
Volume 22, Number 7—July 2016
Dispatch
Two Related Occupational Cases of Legionella longbeachae Infection, Quebec, Canada
On This Page
- The Study
- Conclusions
- Suggested Citation
Marianne Picard-Masson
, Élisabeth Lajoie1, Judith Lord1, Cindy Lalancette, Geneviève Marchand, Éric Levac, Marc-André Lemieux, Patricia Hudson, and Louise Lajoie
, Élisabeth Lajoie1, Judith Lord1, Cindy Lalancette, Geneviève Marchand, Éric Levac, Marc-André Lemieux, Patricia Hudson, and Louise LajoieSuggested citation for this article
Abstract
Two patients with no exposure to gardening compost had related Legionella longbeachae infections in Quebec, Canada. Epidemiologic investigation and laboratory results from patient and soil samples identified the patients’ workplace, a metal recycling plant, as the likely source of infection, indicating a need to suspect occupational exposure for L. longbeachae infections.
Several Legionella species can cause legionellosis, which results in influenza-like illness (Pontiac fever) or pneumonia (Legionnaires’ disease) (1,2). L. pneumophila, which is mainly transmitted from aerosolized water, has been the principal Legionella species reported from Canada (3). Unlike L. pneumophila, L. longbeachae is highly adapted to the soil environment and primarily transmitted from potting soils and compost (2).
During summer 2015, a regional public health authority in Quebec, Canada, received reports of 2 cases of pneumonia attributable to L. longbeachaeinfection. These cases occurred 1 month apart in persons who shared the same workplace. We conducted epidemiologic and environmental investigations to identify the source of infection and propose appropriate control measures.
The Study
On July 3, 2015, the provincial public health laboratory (Laboratoire de santé publique du Québec [LSPQ], Sainte-Anne-de-Bellevue, Quebec, Canada), informed the regional public health authority (Centre intégré de santé et de services sociaux de la Montérégie-Centre, Longueuil, Quebec) about a case ofL. longbeachae serogroup 1 infection. The investigation team included members with expertise in infectious diseases and in occupational and environmental health. Public health experts from the Institut national de santé publique du Québec (Quebec City, Quebec), the Institut de recherche Robert-Sauvé en Santé et en sécurité du travail (Montreal, Quebec), and the LSPQ joined the investigation team of the regional public health authority. The investigators questioned the patient by using a standardized epidemiologic questionnaire and explored potential relationships between the patient’s illness (i.e., clinical manifestations, laboratory results, and diagnosis) and personal factors (i.e., demographic, behavioral, and medical risk factors) and possible exposure sources. During the investigation, another worker from the same workplace was hospitalized with severe pneumonia, and the public health team recommended testing for L. longbeachae. On July 20, 2015, the LSPQ confirmed L. longbeachae serogroup 1 infection for the second patient, and the investigation team questioned this patient by using the same standardized epidemiologic questionnaire answered by the first patient. No other causal organism was identified for either patient.
A lag of 1 month separated onset of symptoms in the 2 patients. Both had severe pneumonia that required admission to intensive care. They recovered and returned to work a few months later. Both had personal risk factors for Legionnaires’ diseases. However, neither had a history of travel, gardening, visits to gardening centers, or exposure to hanging plant pots or compost. Both worked at the same metal recycling plant for many years and shared no nonprofessional activities. One was a shredder operator at a fixed work station; the other was responsible for machinery maintenance throughout the plant (3,750 m2 in size); the only shared spaces were the locker and lunch rooms. Their work shifts overlapped for a few hours. The company, which employed ?25 workers, has been in operation for >40 years and had no prior case of legionellosis.
On July 8, 2015, the regional public health authority investigated the workplace and assessed the industrial processes. Trucks containing cars and other bulk metal materials unload at the site. An industrial grapple clamps the materials and feeds them to a shredder. Any overload is stacked until it can be processed. Diverse metals are then sorted out and sold. The business operates during April–December.
The investigation identified different sources of soil exposure. First, most of the site lies on bare ground. A tanker truck regularly sprinkles water to control dust. Second, a conveyor belt with foam residue and other debris generates aerosols that contain soil particles. However, employees are not allowed near the conveyor belt when it is operating. Third, some cars are reportedly filled with soil by suppliers to increase weight and raise selling value.
On July 31, 2015, multiple soil samples were taken from a workplace area where the soil could have been at higher risk for L. longbeachae contamination (i.e., because of greater-than-usual humidity, less exposure to wind, and less ultraviolet exposure from the sun). A control sample was taken from an area of undisturbed soil in this workplace. Proper sterilization of equipment was ensured between collections of samples. Sixteen randomly located sites (each 4 m2) were sampled, including the control site.
The Institut de recherche Robert-Sauvé en santé et en sécurité du travail obtained an isolate from 1 soil sample and used PCR for identification. The LSPQ obtained isolates from bronchoalveolar lavages and, in collaboration with Canada’s National Microbiology Laboratory, confirmed their identity by using the 16S sequencing method. Pulsed-field gel electrophoresis was used to investigate concordance of the outbreak strains and to compare the isolates’ patterns with those obtained from previous L. longbeachae isolates from Quebec. An adaptation of the full pulsed-field gel electrophoresis SfiI protocol developed for L. pneumophila (4) was also conducted by using AscI for L. longbeachae isolates.
Figure. Patterns of pulsed-field gel electrophoresis (PFGE) using AscI and SfiI enzymes for specimens from 2 occupational cases of Legionella longbeachae infection, a positive soil sample, and various other L. longbeachaestrains...
All soil samples were positive for Legionella spp., an expected outcome because these bacteria are ubiquitous in the environment. PCR and cultures conducted on the soil sample taken near the truck-unloading station were positive for L. longbeachae. By using the 2 enzymes (AscI and SfiI) protocol, laboratory findings showed that the strains from the 2 patients and from the positive soil sample were concordant (Figure), except for 1 difference, and were closely related, according to Tenover’s criteria (5).
Conclusions
L. longbeachae infections are rarely reported in Quebec. During 2003–2014, the LSPQ identified only 7 sporadic cases and no geographic clustering. In 2015, 2 severe L. longbeachae pneumonia cases occurred 1 month apart. The determination that the only common temporospatial exposure for the 2 patients was the workplace constitutes a strong epidemiologic link. Furthermore, L. longbeachae of the same genotype was isolated in the workplace soil samples. Although the diversity and distribution of L. longbeachae strains in Quebec soils are unknown, finding the same L. longbeachae genotype in the workplace soil suggests a causal link between the 2 case-patients and their workplace.
Unlike clusters of L. longbeachae described in the literature (6,7), these 2 patients did not come into contact with potting soils or compost during the exposure period. However, several sources of soil were found in their work environment. Although L. longbeachae usually is found in highly organic soil (2), the positive soil sample in this investigation came from poor soil. Until now, no Legionnaires’ disease case has been linked to L. longbeachae in this type of soil. Possibly, L. longbeachae traveled from the environment surrounding the plant or from soil trapped in trunks of wrecked cars. Also, soil analysis results might not reflect the conditions that prevailed during the exposure period.
This outbreak resolved spontaneously. The regional public health authority recommended preventive measures, such as handwashing, reinforced personal hygiene, avoidance of soil dumping from car trunks, and dust control.
The small number of cases in this outbreak and a general paucity of knowledge about L. longbeachae limited this investigation. The precise mechanism leading to infection has not yet been identified. Whereas hand-to-mouth contamination followed by microaspiration (8) seems the most probable route of exposure, dust inhalation cannot be ruled out. Early mobilization of experts and good collaboration with the implicated company facilitated the outbreak investigation.
These cases highlight the need to search for L. longbeachae in cases of severe pneumonia by performing appropriate cultures and to consider the risk for occupational exposure when soil is present. Environmental investigation appears useful to understand L. longbeachae transmission and ecology in Canada’s soils. Additional research is needed to improve understanding of sources of exposure, the pathogenesis of this species, and appropriate control measures.
Dr. Picard-Masson is a public health and preventive medicine specialist working with the environmental health team of the Montérégie Public Health Department in Quebec, Canada. Her research interests include occupational and environmental health.
Acknowledgment
We thank Pierre Chevalier, Benoit Lévesque, Denis Gauvin, and Jean Longtin from the Institut National de Santé Publique du Québec for their help in this investigation.
References
- Steinert M, Hentschel U, Hacker J. Legionella pneumophila: an aquatic microbe goes astray. FEMS Microbiol Rev. 2002;26:149–62. DOIPubMed
- Whiley H, Bentham R. Legionella longbeachae and legionellosis. Emerg Infect Dis. 2011;17:579–83. DOIPubMed
- Agence de la santé publique du Canada. Legionella pneumophila [in French]. Modified 2011 Apr 19 [cited 2015 Dec 1]. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/legionella-fra.php
- Lévesque S, Plante PL, Mendis N, Cantin P, Marchand G, Charest H, Genomic characterization of a large outbreak of Legionella pneumophilaserogroup 1 strains in Quebec City, 2012. PLoS One. 2014;9:e103852. DOIPubMed
- Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233–9.PubMed
- Potts A, Donaghy M, Marley M, Othieno R, Stevenson J, Hyland J, Cluster of Legionnaires disease cases caused by Legionella longbeachae serogroup 1, Scotland, August to September 2013. Euro Surveill. 2013;18:20656.DOIPubMed
- Pravinkumar SJ, Edwards G, Lindsay D, Redmond S, Stirling J, House R, A cluster of Legionnaires’ disease caused by Legionella longbeachae linked to potting compost in Scotland, 2008–2009. Euro Surveill. 2010;15:19496.PubMed
- Steele TW. The ecology of Legionella longbeachae in Australia. Med J Aust. 1996;164:703–4.PubMed
Figure
Suggested citation for this article: Picard-Masson M, Lajoie É, Lord J, Lalancette C, Marchand G, Levac É, et al. Two related occupational cases of Legionella longbeachae infection, Quebec, Canada. Emerg Infect Dis. 2016 Jul [date cited]. http://dx.doi.org/10.3201/eid2207.161084.
1These authors were co–principal investigators.
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Friday, August 12, 2016
Stuff Related to Turning 35
Stuff Related to Turning 35
Turning 35 brought a couple fun things my way.
Heres my birthday cake which I forgot to put in my previous birthday post. Its a Little Debbie "St Patricks Day Fancy Cake." I am obsessed with the Fancy Cakes snack cakes. Easter Cakes. Christmas Tree Cakes. Fall Cakes. Regular old Fancy Cakes. I could easily eat like 8 of them in one sitting. Ive not had one since I started Weight Watchers almost two years ago so thats why I decided to have ONE for my birthday cake. 4 points for ONE. And that would be why I havent had one in so long. It was just as delicious as I remembered. Stupid Fancy Cakes.
When you turn 35 you have to get a new drivers license. I had the option to just renew online and I promptly rejected that option in favor of heading to the license branch.
Do you blame me?
Look at that full, round face! I look like a completely different person. As much as Ive traveled lately, I seriously CANNOT believe that the TSA NEVER stopped me. Plus, 190 pounds? Yeah right. I was definitely in the 220s in that photo.
Check this out yall! A license that isnt a big fat lie!
My doctor suggested that I go ahead and get my baseline mammogram at 35. Shes never been too fond of my lumpy boobs (I didnt know they were lumpy as I dont have much experience with any other boobs - but apparently, they are - sorry, TMI??). So, Im guessing she decided to use this age milestone as an excuse to get them smashed and x-rayed. I was dreading the whole ordeal because you hear so many horror stories about how awful and painful it is. Well Im here to tell you, it was no. big. deal. At all. I was in and out of the office in less than 20 minutes and that includes the paperwork I had to fill out, disrobing, the "smashing," re-robing and out the door. It was not painful. It was only mildly uncomfortable, but it was over so fast that I hardly had time to even think about it.
And my results came back. Lumpy or not, they looked good to the x-ray machine! Take that, 35! Mammogram CONQUERED!
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