The aim of the present study is to assess the efficacy of the methods used in a HACCP system by measuring the Total Viable Count (TVC) and Coliforms, after cleaning and disinfecting the surfaces used and also by monitoring TVC and enterobacteriaceae of hot and cold meals. In order to evaluate the appropriateness of the surfaces used, samples were obtained from kitchens of 37 Greek hotels/resorts, all of which operated a documented HACCP safety management scheme, while the samples of hot and cold meals were selected from the menu of a catering unit and collected from the actual point of hot and cold dishes banquette at the start time (time 0) and after 4 hours. The developed colonies were counted. The results showed that only 13.5% of the hotels presented surfaces without any TVC or coliforms and 86.5% of the hotels had surfaces with TVC or coliforms or both above the limits. However, 75.8% of the total surfaces examined were acceptable for TVC and 81.9% of the surfaces examined were coliforms. Our microbiological monitoring of food showed that the TVC content of hot meal samples after 4 hours of display (above 60℃) was not significantly different from the TVC content of the aforementioned samples at time 0, while in cold meals TVC and enterobacteriaceae content had significantly risen after 4 hours of display (below 5℃).Conclusively, insufficient application of disinfection and ineffective surface and equipment cleaning programs were found. Additionally, cold meals are more vulnerable than hot meals in developing TVC and enterobacteriaceae
The evaluation and treatment of the posterior malleolus fracture in unstable ankle injuries remain a topic of controversy. The main objective of this systematic review was to examine the available literature and identify the variables that affect the management of posterior malleolar fractures and how these are related to the outcomes. To that end, a systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of MEDLINE, Embase, and Cochrane Library was conducted. The search terms used were as follows: "posterior malleolar", "ankle fractures", "trimalleolar fractures", "ORIF", "surgery", "operative", and "conservative". The available studies were screened against the inclusion and exclusion criteria.Based on the review of the available literature, we have concluded that the size of the posterior malleolar fragment is not an accurate indicator, and clinicians should consider other factors such as fracture configuration and articular surface congruity. Also, the risk for the development of post-traumatic arthritis increases when the joint surface is not restored regardless of the surgical intervention and fragment size.The complications of posterior malleolus fractures necessitate evidence-based management. The assessment and the final treatment of these injuries in unstable ankle fractures should not be based on the traditional fragment-size parameters. Clinicians should assess the fracture configuration through imaging modalities and try to preserve the articular surface congruity so as to achieve optimal outcomes. Finally, more studies with high-level evidence are required in order to determine the most appropriate management pathway for these patients.
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