First report of Culex flavivirus infection from Culex coronator (Diptera: Culicidae), Colombia

BACKGROUND

Flaviviruses are important pathogens for humans and animals (Dengue viruses, Yellow fever virus, Zika virus and West Nile virus). Culex flavivirus (CxFV) is an insect-specific virus of the genus Flavivirus, detected in a wide variety of mosquito species.

OBJECTIVE

To detect Flavivirus in mosquitoes of a tropical region of the Colombian Caribbean.

METHODS

In 2014, an entomological surveillance of arboviruses was conducted in the department of Cordoba area of the Caribbean, Colombia. A total of 8270 mosquitoes were captured as follow: Mansonia (n = 3271/39.5%), Culex (n = 2668/32.26%), Anopheles (n = 840/10.15%), Aedeomyia (n = 411/4.9%), Psorophora (n = 397/4.8%), Coquilletidia (n = 369/4.46%), Uranotaenia (n = 261/3.15%) and Aedes (n = 53/0.6%). All mosquito species were collected in dry tropical forest of the Caribbean area. Universal primers for NS5 gene (958 pb), RT-PCR for flavivirus and sequencing were used for molecular identification of viruses detected.

RESULTS

Two pools belonging to Culex coronator were positive for flavivirus RNA sequence by RT-PCR. The sequences of the PCR amplicons, matched that of the Culex flaviviruses, CxFv COL PM_149 (GenBank: KR014201) and CxFv COL PM_212 (GenBank: KT307717). Phylogenetic analysis of the NS5 protein sequences of the Culex flaviviruses sequences with those of reference sequences available in GenBank indicated viruses of Genotype II, closely related to the Brazilian strain, BR_SJRP_01_ (GenBank: KT726939), from Culex sp. The alignment of Culex flavivirus sequences CxFv COL_ PM 212 and CxFv COL_ PM 149 with sequences of strains detected in different geographical regions grouped the strains in a Latin American clade reported in Brazil, Argentina and Mexico.

CONCLUSIONS

The present work illustrated that CxFV was circulating among vectors of human pathogenic arboviruses in Colombia, but the impact of CxFV on other flaviviruses which are endemic in the study area still remains to be explored.

A morphological and phylogenetic analysis of Ornithodoros marinkellei (Acari: Argasidae), with additional notes on habitat and host usage

Ornithodoros marinkellei was described from larvae collected on Pteronotus spp. bats in Colombia and Panama. More recently, this tick was reported in the Brazilian Amazon. Because some morphometric differences were observed between O. marinkellei larvae from Colombia and Brazil, it was proposed that further investigations were needed to assess whether the differences could be attributed to intra- or inter-specific polymorphism. Herein, we collected O. marinkellei specimens in the type locality of Colombia, in Brazil, and in a new locality in Nicaragua, expanding the distribution of the species to Nicaragua. Morphometric analysis of larvae and adults, corroborated by a principal component analysis (PCA), indicated that the Brazilian specimens were larger than specimens from Colombia and Nicaragua. Phylogenetic analysis inferred from the mitochondrial 16S rRNA gene showed ticks from Colombia and Nicaragua more genetically related than any of them with ticks from Brazil, although ticks from the three countries grouped in a clade sister to a major clade containing sequences of various Neotropical Ornithodoros species. We concluded that ticks identified as O. marinkellei from Colombia, Nicaragua, and Brazil represent the same taxon, and that the genetic and morphological differences between them are likely to have a geographical bias. We redescribed the nymph of O. marinkellei, which has a vestigial hypostome, probably incompatible with blood feeding. We also report human infestation by O. marinkellei adults. As all reports of O. marinkellei adults have been from hot caves (temperature > 35 °C), this abiotic condition could be a limiting factor for the occurrence of this tick species.

Human Factors for Capacity Building. Lessons learned from the OpenMRS Implementers Network

Objectives: Theoverallobjectiveofthisprojectwastoinvestigateways to strengthen the OpenMRS community by (i) developing capacity and implementing a network focusing specifically on the needs of OpenMRS implementers,(ii) strengthening community-driven aspects of OpenMRS and providing a dedicated forum for implementation-specific issues, and; (iii) providing regional support for OpenMRS implementations as well as mentorship and training.

Methods: Themethodsusedincluded(i)face-to-facenetworkingusing meetings and workshops; (ii) online collaboration tools, peer support and mentorship programmes; (iii) capacity and community development programmes, and; (iv) community outreach programmes.

Results: Thecommunity-driven approach,combined withafewsimple interventions,has been a key factor in the growth and success of the OpenMRS ImplementersNetwork.Ithascontributed toimplementations in at least twenty-three different countries using basic online tools; and provided mentorship and peer support through an annual meeting, workshops and an internshipprogram. The OpenMRS Implementers Network has formed collaborations with several other open source networks and is evolving regional OpenMRS Centres of Excellence to provide localized support for OpenMRS development and implementation. These initiativesare increasingthe range of functionalityand sustainability of open source software in the health domain, resulting in improvedadoption and enterprise-readiness.

Conclusions: Socialorganizationandcapacitydevelopmentactivities are important in growing a successful community-driven open source softwaremodel.

The Benefit of Mirtazapine in the Treatment of Progressive Multifocal Leukoencephalopathy in a Young HIV-positive Patient: A Case Report

Highly active antiretroviral therapy is well-established in the treatment of human immunodeficiency virus (HIV)-positive patients. Nonadherence with therapy regimens often leads to the occurrence of opportunistic infections that further complicate treatment and challenge the treating physician. We report a young HIV-positive patient who suffered from progressive multifocal leukoencephalopathy caused by the human John Cunningham virus and showed objective clinical improvement after adding mirtazapine to the treatment regimen, an observation that is supported by the emerging literature.

Management of patients with hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a high prevalence in the population. Treatment options are both medical and surgical. Medical treatment is based on the use of antibiotics, retinoids, and anti-inflammatory drugs, in which anti-TNFα agents (infliximab y adalimumab) play a central role in the treatment of moderate-to-severe HS and enjoy the highest level of scientific support. Currently, adalimumab is the only drug approved in the summary of product characteristics for the treatment of this disease. Due to the scarcity of clinical trials in HS, there is still no therapeutic guideline backed by solid evidence and the evidence for most drugs is low. However, early treatment in patients with HS would probably reduce the complications of this disease. This review analyses the distinct treatments used in this dermatological disease and provides a therapeutic algorithm with different treatment options.

Prediction of fetal growth restriction using estimated fetal weight vs a combined screening model in the third trimester

OBJECTIVES

To compare the performance of third-trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, fetoplacental ultrasound and maternal biochemical markers, for the prediction of small-for-gestational-age (SGA) neonates and late-onset fetal growth restriction (FGR).

METHODS

This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester (32 + 0 to 36 + 6 weeks' gestation) evaluation. Maternal baseline characteristics, mean arterial pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently delivered a SGA neonate (n = 175), defined as birth weight < 10^th centile according to customized standards, and in a control group (n = 875). Among SGA cases, those with birth weight < 3^rd centile and/or abnormal uterine artery pulsatility index (UtA-PI) and/or abnormal cerebroplacental ratio (CPR) were classified as FGR. Logistic regression predictive models were developed for SGA and FGR, and their performance was compared with that obtained using EFWc alone.

RESULTS

In SGA cases, EFWc, CPR Z-score and maternal serum concentrations of unconjugated estriol and PlGF were significantly lower, while mean UtA-PI Z-score and lipocalin-2 and inhibin A concentrations were significantly higher, compared with controls. Using EFWc alone, 52% (area under receiver-operating characteristics curve (AUC), 0.82 (95% CI, 0.77-0.85)) of SGA and 64% (AUC, 0.86 (95% CI, 0.81-0.91)) of FGR cases were predicted at a 10% false-positive rate. A combined screening model including a-priori risk (maternal characteristics), EFWc, UtA-PI, PlGF and estriol (with lipocalin-2 for SGA) achieved a detection rate of 61% (AUC, 0.86 (95% CI, 0.83-0.89)) for SGA cases and 77% (AUC, 0.92 (95% CI, 0.88-0.95)) for FGR. The combined model for the prediction of SGA and FGR performed significantly better than did using EFWc alone (P < 0.001 and P = 0.002, respectively).

CONCLUSIONS

A multivariable integrative model of maternal characteristics, fetoplacental ultrasound and maternal biochemical markers modestly improved the detection of SGA and FGR cases at 32-36 weeks' gestation when compared with screening based on EFWc alone. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Performance of third-trimester combined screening model for prediction of adverse perinatal outcome

OBJECTIVE

To explore the potential value of third-trimester combined screening for the prediction of adverse perinatal outcome (APO) in the general population and among small-for-gestational-age (SGA) fetuses.

METHODS

This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester evaluation (32 + 0 to 36 + 6 weeks' gestation). Maternal baseline characteristics, mean arterial blood pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently had an APO (n = 148) and in a control group without perinatal complications (n = 902). APO was defined as the occurrence of stillbirth, umbilical artery cord blood pH < 7.15, 5-min Apgar score < 7 or emergency operative delivery for fetal distress. Logistic regression models were developed for the prediction of APO in the general population and among SGA cases (defined as customized birth weight < 10^th centile).

RESULTS

The prevalence of APO was 9.3% in the general population and 27.4% among SGA cases. In the general population, a combined screening model including a-priori risk (maternal characteristics), estimated fetal weight (EFW) centile, umbilical artery pulsatility index (UA-PI), estriol and PlGF achieved a detection rate for APO of 26% (area under receiver-operating characteristics curve (AUC), 0.59 (95% CI, 0.54-0.65)), at a 10% false-positive rate (FPR). Among SGA cases, a model including a-priori risk, EFW centile, UA-PI, cerebroplacental ratio, estriol and PlGF predicted 62% of APO (AUC, 0.86 (95% CI, 0.80-0.92)) at a FPR of 10%.

CONCLUSIONS

The use of fetal ultrasound and maternal biochemical markers at 32-36 weeks provides a poor prediction of APO in the general population. Although it remains limited, the performance of the screening model is improved when applied to fetuses with suboptimal fetal growth. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Coffee is protective against oral and pharyngeal cancer: A systematic review and meta-analysis

OBJECTIVES

Coffee is one of the most popular and consumable drinks worldwide. However, there are conflicting results on the influence of this drink in oral and pharyngeal cancer risk. To clarify this, we aimed to systemically review and carry out a meta-analysis of the relevant literature on the association between coffee and oral and pharyngeal cancer.

STUDY DESIGN

We carried out an electronic search of publications up to August 2016 from PubMed, National Library of Medicines Medline, Embase, Science Direct and the Cochrane Central Register. The Newcastle-Ottawa scale was used to address the quality of the studies a meta-analysis was carried out using random-effects models.

RESULTS

From the 22,515 entries identified in the search, 13 case-control and 4 cohort studies were selected. With regards to quality on the Newcastle-Ottawa scale, an overall value of 6.06 was obtained. The analysis for oral and pharyngeal cancer grouped together indicated a pooled OR of .69 (95% CI of .57-.84; p<.001) for high versus low coffee consumption with a moderate heterogeneity (I2: 50.3%; p=.009). Regarding studies on oral cavity cancers we observed a pooled OR of 0.82; 95% CI =.58-1.16; p=.257) and for pharyngeal cancers a pooled OR of .72 (95% CI of 0.54-.95; p=.019). There was no significant publication bias.

CONCLUSION

The results show an inverse association between high coffee consumption and the risk of oral and pharyngeal cancers, which indicates that coffee may have a protective role against these cancers. Further larger prospective observational cohort studies are needed to address any effect of other possible co-factors.

Endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in non-small cell lung carcinoma

INTRODUCTION

Lung cancer staging has recently evolved to include endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for nodal assessment.

AIM

Evaluate the performance and safety of EBUS-TBNA as a key component of a staging algorithm for non-small cell lung carcinoma (NSCLC) and as a single investigation technique for diagnosis and staging of NSCLC.

METHODS

Patients undergoing EBUS-TBNA for NSCLC staging at our institution between April 1, 2010 and December 31, 2014 were consecutively included with prospective data collection. EBUS-TBNA was performed under general anesthesia through a rigid scope.

RESULTS

A total of 122 patients, 84.4% males, mean age 64.2 years. Histological type: 78 (63.9%) adenocarcinoma, 33 (27.0%) squamous cell carcinoma, 11 (8.9%) undifferentiated/other NSCLC. A total of 435 lymph node stations were punctured. Median number of nodes per patient was 4. EBUS-TBNA nodal staging: 63 (51.6%) N0; 8 (6.5%) N1; 34 (27.9%) N2, and 17 (13.9%) N3. EBUS-TBNA was the primary diagnostic procedure in 27 (22.1%) patients. EBUS-TBNA NSCLC staging had a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy rate of 83.3, 100, 100, 86.1, and 91.8%, respectively. No complications were attributable to the procedure.

CONCLUSION

A comprehensive lung cancer staging strategy that includes EBUS-TBNA seems to be safe and effective. Our EBUS-TBNA performance and safety in this particular setting was in line with previously published reports. Additionally, our study showed that, in selected patients, lung cancer diagnosis and staging are achievable with a single endoscopic technique.

Probable case of spotted fever group rickettsial infection in a new suspected endemic area, Colombia

Spoted fever group (SFG) rickettsioses are actually considered as emerging and re-emerging zoonotic diseases, caused by pathogenic bacteria of the spotted fever group rickettsiae (SFGR). Recently, serologic studies in human and animals conducted in Colombian Orinoquia, showed a high seroprevalence against SFGR. In June 2015, a 50-year-old male was admitted to a hospital in Bogotá, Colombia, with two days of malaise and temperature of 39°C, associated to generalized rash 24h after the onset of fever. He referred a work visit and outdoor activities in rural area of the Department of Meta 15days prior the onset of symptoms. The patient was transferred to the intensive care unit with supplementary oxygen, inotropic support and was assessed by the infectious diseases department, indicating the addition of Doxycycline. After seven days of antibiotic treatment the patient was discharged with no evidence of new symptoms or sequels. Retrospectively, two serum samples collected during the acute and convalescent phase were evaluated; there was four fold rise in titer against SFGR. With the foregoing, associated with the recent serological evidence that suggests the circulation of SFGR species in the Colombian Orinoquia, we consider to recognize this region as a new endemic area for SFG Rickettsioses.

Brain microbleeds: Epidemiology and clinical implications

INTRODUCTION

Brain microbleeds (BMB) are haemosiderin deposits contained within macrophages, which are displayed as hypointense images in some T2-weighted magnetic resonance imaging sequences. There are still many questions to be answered about the pathophysiology and clinical relevance of BMB.

DEVELOPMENT

We conducted a literature review of the main epidemiological, clinical, and anatomical pathology studies of BMB performed in the general population, in patients at risk of or already suffering from a vascular disease, and in patients with cognitive impairment. We analysed the prevalence of BMB, risk factors, and potential pathophysiological mechanisms and clinical implications.

CONCLUSIONS

The prevalence of BMB is highly variable (3%-27% in the general population, 6%-80% in patients with vascular risk factors or vascular disease, and 16%-45% in patients with cognitive impairment). BMB are associated with ageing, Alzheimer disease (AD), and in particular haemorrhagic or ischaemic cerebrovascular disease. The pathological substrate of BMB is either lipohyalinosis (subcortical BMB) or cerebral amyloid angiopathy (lobar BMB). BMB exacerbate cognitive impairment, possibly through cortical-subcortical and intracortical disconnection, and increase the risk of death, mostly due to vascular causes. BMB also increase the risk of cerebral haemorrhage, particularly in patients with multiple lobar BMB (probable erebral amyloid angiopathy). Therefore, anticoagulant treatment may be contraindicated in these patients. In patients with lower risk of bleeding, the new oral anticoagulants and the combination of clinical and magnetic resonance imaging follow-up could be helpful in the decision-making process.

MicroRNAs involved in the browning process of adipocytes

The present review focuses on the role of miRNAs in the control of white adipose tissue browning, a process which describes the recruitment of adipocytes showing features of brown adipocytes in white adipose tissue. MicroRNAs (miRNAs) are a class of short non-coding RNAs (19-22 nucleotides) involved in gene regulation. Although the main effect of miRNAs is the inhibition of the translational machinery, thereby preventing the production of the protein product, the activation of protein translation has also been described in the literature. In addition to modifying translation, miRNAs binding to its target mRNAs also trigger the recruitment and association of mRNA decay factors, leading to mRNA destabilization, degradation, and thus to the decrease in expression levels. Although a great number of miRNAs have been reported to potentially regulate genes that play important roles in the browning process, only a reduced number of studies have demonstrated experimentally an effect on this process associated to changes in miRNA expressions, so far. These studies have shown, by using either primary adipocyte cultures or experimental models of mice (KO mice, mice overexpressing a specific miRNA), that miR-196a, miR-26, and miR-30 are needed for browning process development. By contrast, miR-155, miR-133, miR-27b, and miR-34 act as negative regulators of this process [corrected]. Further studies are needed to fully describe the miRNA network-involved white adipose tissue browning regulation.

Molecular detection of Anaplasma sp. and Ehrlichia sp. in ticks collected in domestical animals, Colombia

Anaplasma and Ehrlichia species are important tick-borne pathogens that cause disease in cattle, dogs, horses and humans; with little information available about these agents in Colombia. The aim of this study was to provide molecular evidence for the presence of Anaplasma sp. and Ehrlichia sp. species in ticks collected from horses, dogs and cattle in Cordoba, Colombia. In this study, 1.105 ticks were removed from 226 zebu cattle (Bos indicus), 87 dogs (Canis lupus familiaris) and 19 horses (Equus caballus), from different localities of Cordoba. Ticks were identified taxonomically and PCR assays were used for the amplification of Anaplasma sp. and Ehrlichia sp. DNA. The amplification products were sequenced and analyzed. From the 1,105 ticks examined, 679 (61.5%) were Rhipicephalus microplus, collected from cattle, 353 (32%) were Rhipicephalus sanguineus from dogs and 73 (6,6%) Dermacentor nitens collected on horses; 332 pools were formed to develop the PCR assay. Anaplasma sp. and Ehrlichia sp. DNA was detected in 5.7% (19/332 pools). Direct sequencing of amplicons showed that seven sequences had similarities between 99-100% with Anaplasma marginale, one sequence showed 100% identical with Anaplasma phagocytophilum, seven sequences showed 100% identity with Ehrlichia ewingii, one sequence had 100% identity with E. chaffensis and three sequences showed similarities of 99% and 95% with Ehrlichia mineirensis and Ehrlichia canis respectively. In conclusion, several tick-borne pathogens identified in this survey suggests that there is a risk for the emergence of tick-borne diseases in domestic animals and humans in Colombia. Our data provides evidence of Ehrlichia and Anaplasma species circulating in ticks from Cordoba.

Surgical treatment of bronchiectasis: A review of 20 years of experience

BACKGROUND

Bronchiectasis is defined as an abnormal and irreversible dilation and distortion of the bronchi, which has numerous causes. Surgical treatment of this disease is usually reserved for focal disease and when the medical treatment is no longer effective. We report our center experience and outcomes in bronchiectasis surgery during the last 20 years.

METHODS

Between 1994 and 2014, sixty-nine patients underwent surgical resection for bronchiectasis. Patient demographics, presenting symptoms, indications for surgical treatment, type of lung resection, morbidity and mortality, as well as clinical follow-up and outcomes were analyzed.

RESULTS

From the 69 patients included, 31 (44.9%) were male and 38 (55.1%) were female. Surgery was indicated because of unsuccessful medical therapy in 33 patients (47.8%), haemoptysis in 22 patients (31.9%), nondiagnostic lung mass in 9 patients (13.0%) and lung abscess in 5 patients (7.3%). The surgical procedures were lobectomy in 45 (65.2%) patients, pneumonectomy in 10 (14.5%) patients, bilobectomy in 8 (11.6%) patients, lobectomy plus segmentectomy in 3 (4.3%) patients and only segmentectomy in 3 (4.3%) patients. Morbidity rate was 14.5% and there was no perioperative mortality. The follow-up was possible in 60 patients, with an outcome reported as excellent in 44 (73.3%) patients, as improved in 11 (18.3%) and as unchanged in 5 (8.3%).

CONCLUSION

Although the number of patients with bronchiectasis referred for surgical treatment has decreased, pulmonary resection still plays a significant role. Surgical resection of localized bronchiectasis is a safe procedure with proven improvement of quality of life for the majority of patients.

Outbreak of Chikungunya virus in the north Caribbean area of Colombia: clinical presentation and phylogenetic analysis

INTRODUCTION

The Caribbean area of Colombia has been severely affected by a Chikungunya virus (CHIKV) outbreak since 2014.

METHODOLOGY

The study was carried out on 100 patients during a fever outbreak from August to September 2014 in two small rural villages in the northern Caribbean area of Colombia. The molecular assays performed by reverse transcription polymerase chain reaction (RT-PCR) on acute patient sera were collected within one to five days of the appearance of symptoms. Sequence analyses were carried out based on phylogenetic analyses of genes NS1 and E2. For serological assays, 49 (49%) patients at ≥ 6 days of disease onset were tested with NovaLisa Chikungunya IgG/IgM µ-capture enzyme-linked immunosorbent assay (ELISA).

RESULTS

The main signs or symptoms associated with Chikungunya infection were arthralgia of the lower limbs (96%), fever (91%), arthralgia of the upper limbs (85%), rash (64%), and headache (57%). Ninety-four percent (46/49) of patients were positive for either IgM or IgG; the remaining three (6%) patients were seronegative. Viral loads were detected in 25 patients. Based on phylogenetic analysis of NS1 and E2, the characterization of the Colombian CHIKV indicated that it was a strain closely related to the British Virgin Islands strain and to the Asian genotype.

CONCLUSIONS

This study shows the phylogenetic and clinical description of CHIKV in Colombia. The main symptoms shown were: arthralgia, fever, and rash. CHIKV sequences detected in Colombian patients were within the Asian genotype and closely related to the British Virgin Islands strain.

An Evaluation of Commercial Pedometers for Monitoring Slow Walking Speed Populations

BACKGROUND

Pedometers are considered desirable devices for monitoring physical activity. Two population groups of interest include patients having undergone surgery in the lower extremities or who are otherwise weakened through disease, medical treatment, or surgery procedures, as well as the slow walking senior population. For these population groups, pedometers must be able to perform reliably and accurately at slow walking speeds. The objectives of this study were to evaluate the step count accuracy of three commercially available pedometers, the Yamax (Tokyo, Japan) Digi-Walker(®) SW-200 (YM), the Omron (Kyoto, Japan) HJ-720 (OM), and the Fitbit (San Francisco, CA) Zip (FB), at slow walking speeds, specifically at 1, 2, and 3 km/h, and to raise awareness of the necessity of focusing research on step-counting devices and algorithms for slow walking populations.

MATERIALS AND METHODS

Fourteen participants 29.93 ±4.93 years of age were requested to walk on a treadmill at the three specified speeds, in four trials of 100 steps each. The devices were worn by the participants on the waist belt. The pedometer counts were recorded, and the error percentage was calculated.

RESULTS

The error rate of all three evaluated pedometers decreased with the increase of speed: at 1 km/h the error rates varied from 87.11% (YM) to 95.98% (FB), at 2 km/h the error rates varied from 17.27% (FB) to 46.46% (YM), and at 3 km/h the error rates varied from 22.46% (YM) to a slight overcount of 0.70% (FB).

CONCLUSIONS

It was observed that all the evaluated devices have high error rates at 1 km/h and mixed error rates at 2 km/h, and at 3 km/h the error rates are the smallest of the three assessed speeds, with the OM and the FB having a slight overcount. These results show that research on pedometers' software and hardware should focus more on accurate step detection at slow walking speeds.

First molecular evidence of Coxiella burnetii infecting ticks in Cuba

Coxiella burnetii is the causative agent of Q fever. In order to explore the occurrence of C. burnetii in ticks, samples were collected from horses, dogs and humans living in a Cuban occidental community. The species most commonly recovered were Amblyomma mixtum (67%), Rhipicephalus sanguineus s.l. (27%) and Dermacentor nitens (6%). Specific IS1111 PCR and amplicon sequencing allowed the identification of C. burnetii DNA in A. mixtum collected from a domestic horse. These findings, for first time in Cuba, indicate the need for an in-depth assessment of the C. burnetii occurrence in hosts and humans at risk of infection.

Potential application of non-flavonoid phenolics in diabetes: antiinflammatory effects

Polyphenols are members of a very large family of plant-derived compounds that may have beneficial effects on human health, and thus their study has become an increasingly important area of human nutrition research. Considering that it is increasingly accepted that chronic sub-acute inflammation plays an important role in the development of insulin resistance and of diabetes in animals and in humans, the aim of the present review is to compile information concerning the anti-inflammatory effects of non-flavonoid polyphenols on diabetes prevention and/or treatment. Most of these studies have been carried out with different cultured cells and using animal models displaying different types of diabetes, such as diabetes induced by streptozotocin or streptozotocin-nicotinamide, genetic diabetes or diabetes induced by high-fat feeding. In general terms, non-flavonoid polyphenols reduce the production of inflammatory mediators, such as IL-1β, IL-8, MCP-1, COX-2 or iNOS in these animal models of diabetes. This effect is accompanied in the vast majority of these studies by improved insulin action. In addition, some of the non-flavonoid polyphenols are also able to ameliorate or prevent several pathological alterations associated with the development of diabetes, such as nephropathy, cardiopathy or retinopathy. Very little information has been reported with regard to human studies to date. Thus, new studies are needed to confirm if the beneficial effects observed in preclinical studies can apply to human beings.

Nucleus accumbens medium spiny neuron subtypes mediate depression-related outcomes to social defeat stress

BACKGROUND

The nucleus accumbens is a critical mediator of depression-related outcomes to social defeat stress. Previous studies demonstrate distinct neuroplasticity adaptations in the two medium spiny neuron (MSN) subtypes, those enriched in dopamine receptor D1 versus dopamine receptor D2, in reward and reinforcement leading to opposing roles for these MSNs in these behaviors. However, the distinct roles of nucleus accumbens MSN subtypes, in depression, remain poorly understood.

METHODS

Using whole-cell patch clamp electrophysiology, we examined excitatory input to MSN subtypes and intrinsic excitability measures in D1-green fluorescent protein and D2-green fluorescent protein bacterial artificial chromosome transgenic mice that underwent chronic social defeat stress (CSDS). Optogenetic and pharmacogenetic approaches were used to bidirectionally alter firing of D1-MSNs or D2-MSNs after CSDS or before a subthreshold social defeat stress in D1-Cre or D2-Cre bacterial artificial chromosome transgenic mice.

RESULTS

We demonstrate that the frequency of excitatory synaptic input is decreased in D1-MSNs and increased in D2-MSNs in mice displaying depression-like behaviors after CSDS. Enhancing activity in D1-MSNs results in resilient behavioral outcomes, while inhibition of these MSNs induces depression-like outcomes after CSDS. Bidirectional modulation of D2-MSNs does not alter behavioral responses to CSDS; however, repeated activation of D2-MSNs in stress naïve mice induces social avoidance following subthreshold social defeat stress.

CONCLUSIONS

Our studies uncover novel functions of MSN subtypes in depression-like outcomes. Notably, bidirectional alteration of D1-MSN activity promotes opposite behavioral outcomes to chronic social stress. Therefore, targeting D1-MSN activity may provide novel treatment strategies for depression or other affective disorders.

Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten

The gluten-free (GF) products market represents one of the most prosperous markets in the field of food and beverages in the immediate future. Historically, counselling for celiac disease has focused on the absence of gluten in foods, however the nutritional quality of GF foodstuffs is an important aspect to consider. The aim of the present work was to compare the nutritional composition of the 206 GF rendered products most consumed in Spain, against the composition of 289 equivalent foods with gluten, and to make a comparison between the diet including GF products and the same diet with equivalent products with gluten in a 58 adult celiac population. The results of the present collaborative study pointed out differences in calorie, macronutrient, fiber, sodium, salt and cholesterol content between GF rendered and gluten-containing foodstuffs. Thus, calorie and nutrient intake in a GF diet is different when compared to its equivalent diet with gluten. Following a diet based on GF products could suppose a nutritional imbalance for celiac patients as well as for non-celiacs who follow a diet that includes many GF rendered foodstuffs.

Influence of multiple initiatives in Sweden to enhance ARB prescribing efficiency following generic losartan; findings and implications for other countries

BACKGROUND

Encouraging the prescribing of ACEIs first line vs. angiotensin receptor blockers (ARBs) has been a health authority focus with generic ACEIs as ACEIs and ARBs have similar effectiveness and there is limited coughing with ACEIs. This includes Sweden with its multiple initiatives keeping expenditure on renin-angiotensin inhibitor drugs similar between 2001 and 2007 despite appreciably increased volumes. Generic losartan became available and was reimbursed in March 2010 providing further opportunities for the authorities in Sweden to save costs with all ARBs seen as similar in managing hypertension and CHF at appropriate doses.

AIMS

The main aim of this study was to assess changes in the utilisation of losartan vs. other single ARBs after generic losartan alongside accompanying demand-side measures. Additional aims were to (i) assess changes in the price of generic losartan and single ARB expenditure over time; (ii) suggest additional programmes, if needed; and (iii) analyse utilisation of ARB FDCs and compare with ACEI FDCs.

METHODS

Retrospective observational study using an interrupted time series design.

RESULTS

Multiple demand-side measures introduced among the 21 Counties in Sweden significantly enhanced the utilisation of generic losartan, growing from 26% to 27% of total ARBs (DDD basis) before generic losartan to 40% by August 2011. Losartan was principally generics (97% by August 2011). Expenditure/DDD for generic losartan was 10% of the pre-patent loss price in August 2011. This reduced total single ARB expenditure by 26% by the study end despite a 16% increase in utilisation. Greater utilisation of ARB FDCs than seen with ACEI FDCs. This may be due to similarities in prices between single and FDC ARBs.

DISCUSSION

Multiple demand-side measures appreciably enhanced ARB prescribing efficiency, mirroring other studies. No significant increase in losartan utilisation following generics was seen in European countries where no specific measures were instigated. Losartan price reduction was in line with expectations.

CONCLUSION

Multiple and intensive demand-side measures are needed to change physician prescribing habits. Authorities cannot rely on physicians transferring their activities from one class to another without interventions.