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Abstract Background In March 2022, an outbreak investigation was initiated in Ireland after identifying a cluster of monophasic Salmonella Typhimurium cases, affecting primarily small children. Microbiological investigations revealed that the cluster was part of a wider international outbreak. Methods A total of 18 Irish outbreak cases were identified. We undertook a matched case–control study using the case–case method to determine if exposure to the implicated products was associated with illness. Results In univariable analysis, the highest odds of disease due to monophasic S. Typhimurium versus other gastrointestinal disease were obtained for a chocolate Product A of Brand A [matched odds ratio (mOR) = 7.77, 95% confidence intervals (CI): 0.89–67.20]. When grouping the implicated products in a composite variable, the odds of disease due to monophasic S. Typhimurium versus other gastrointestinal disease were 10.5 times higher with a consumption of at least one of the implicated products [mOR = 10.50, 95% CI: 1.24–88.60, p = 0.031]. Conclusion This analytical study supported the internationally generated hypothesis which led to the implementation of control measures. Owing to the high levels of chocolate purchasing with Easter approaching, early outbreak identification and involvement in the internationally coordinated investigation was essential to an efficient response and to minimise the risk of further harm to a particularly vulnerable population group.

Abstract Background and Objectives Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), besides causing human infection, has been shown to naturally infect several susceptible animal species including large cats (tigers, lions, pumas, spotted leopards), dogs, cats, ferrets, gorillas and minks. Cats and minks are continuing to be the most reported species with SARS‐CoV‐2 infections among animals but it needs to be investigated further. Methods and Results We report the detection of SARS‐CoV‐2 from a domestic cat that exhibited respiratory disease after being exposed to SARS‐CoV‐2 virus from humans in the same household. SARS‐CoV‐2 RNA was detected in two oropharyngeal swabs collected at two time points, 11 days apart; the first, when the cat was reported to be sick and the second, before euthanasia due to poor prognosis. The viral nucleic acid detected at two time points showed no genomic variation and resembled the clade GH circulating in humans in the United States. Clinical and pathological findings noted in this 16‐year‐old cat were consistent with respiratory and cardiac insufficiency. Conclusions SARS‐CoV‐2 viral infection was likely an incidental clinical finding, as the virus was not detected in fixed lungs, heart, or kidney tissues. Only fresh lung tissue collected at necropsy showed the presence of viral nucleic acid, albeit at a very low level. Further research is needed to clarify the clinical course of SARS‐CoV‐2 in companion animals of advanced age and underlying cardiac disease.

Abstract Cough and respiratory infections are common in pediatrics. Our case report illustrates the need for pediatricians to consider rare diagnoses such as genetic syndromes and primary gastrointestinal motility disorders in patients with unremitting respiratory and gastrointestinal symptoms. Early identification provides early intervention and reduces long‐term morbidity for pediatric patients.

Abstract Problem Smartphone applications are an increasingly useful part of patients' self‐management of chronic health conditions. Asthma is a common chronic health condition for which good self‐management by patients is very helpful in maintaining stability. User‐centered design and intelligent systems that learn are steps forward in building applications that are more effective in providing quality care that is scalable and tailored to each patient. Methods A literature and application store search to review historic and current asthma smart phone applications. User‐centered design is a methodology that involves all stakeholders of a proposed system from the beginning of the design phase to the end of installation. One aspect of this user‐centered approach involved conducting focus groups with patients and health care providers to determine what features they desire for use in applications and create a model to build smart infrastructure for a learning health care system. A simple prototype for an asthma smartphone application is designed and built with basic functionality. Outcomes Only one publication in the literature review of asthma smartphone applications describes both user‐centered design and intelligent learning systems. The authors have presented a set of user‐desired attributes for a smart health care application and a possible data flow diagram of information for a learning system. A prototype simple user‐centered designed asthma smartphone application that better assists patients in their care illustrates the value of the proposed architecture. Discussion Our user‐centered approach helped design and implement a learning prototype smart phone application to help patients better manage their asthma and provide information to clinical care providers. While popular in other industries, user‐centered design has had slow adoption in the health care area. However, the popularity of this approach is increasing and will hopefully result in mobile application that better meets the needs of both patients and their care providers.

Patients with human immunodeficiency virus (HIV) have an increased risk of inoculation with nontyphoid Salmonella compared to the general population. While nontyphoid Salmonella commonly manifests as gastroenteritis, Salmonella bacteremia can be seen in patients with HIV. We present a case of disseminated Salmonellosis in a patient with HIV complicated by bronchopleural fistula and secondary empyema. Case Presentation. A 40-year-old African American male with HIV noncompliant with HAART therapy presented with complaints of generalized weakness, weight loss, cough, night sweats, and nonbloody, watery diarrhea of four weeks’ duration. A computed tomography (CT) scan demonstrated a bilobed large, thick-walled cavitary lesion in the right upper lobe communicating with the pleural space to form a bronchopleural fistula. Thoracentesis yielded growth of nontyphi Salmonella species consistent with empyema; he was treated with intravenous Ceftriaxone and underwent placement of chest tube for drainage of empyema with instillation of alteplase/dornase twice daily for three days. Repeat CT chest showed a hydropneumothorax. The patient subsequently underwent video-assisted thoracoscopy with decortication. The patient continued to improve and follow-up CT chest demonstrated improved loculated right pneumothorax with resolution of the right bronchopleural fistula and resolution of the cavitary lesions. Discussion. We describe one of the few cases of development of bronchopulmonary fistula and the formation of empyema in the setting of disseminated Salmonella. Empyema complicated by bronchopulmonary fistula likely led to failure of intrapleural fibrinolytic therapy and the patient ultimately required decortication in addition to antibiotics. While Salmonella bacteremia can be seen in immunocompromised patients, extraintestinal manifestations of Salmonella infection such as empyema and bronchopleural fistulas are uncommon. Bronchopleural fistulas most commonly occur as a postoperative complication of pulmonary resection. Conclusions. This case highlights the unusual pulmonary manifestations that can occur due to disseminated Salmonella in an immunocompromised patient as well as complex management decisions related to these complications.

Background. The purpose of this study of preterm infants was to test the effect of four approaches to the time of transition from gavage to full oral feedings, time to discharge, and weight gain during the transition. Methods. A randomized experimental design was used with four intervention groups: early start (32 weeks’ postmenstrual age)/slow progressing experience (gradually increasing oral feedings offered per day); early start/maximum experience (oral feedings offered at every feeding opportunity); late start (34 weeks’ postmenstrual age)/slow progressing experience; and late start/maximum experience. Results. The analysis included 86 preterm infants. Once oral feedings were initiated, infants in the late start/maximum experience group achieved full oral feeding and were discharged to home significantly sooner than infants in either early start group. Although not significantly different, these infants also achieved these outcomes sooner than infants in the late start/slow progressing experience group. There were no differences in weight gain across groups. Conclusions. Results suggest starting oral feedings later in preterm infants may result in more rapid transition to full oral feedings and discharge although not at early postnatal ages. Provision of a more consistent approach to oral feeding may support infant neurodevelopment and reduce length of hospitalization.