A study of knowledge, attitudes, and practices on ticks and tick-borne diseases of cattle among breeders of two bovine Portuguese autochthonous breeds

Beef cattle production in Portugal is an important sector of national agricultural production, with half of the herd being in the Alentejo region. Despite this, animal health is essential for its productivity, which may be compromised by ticks and tick-borne diseases. So far, no study has been conducted in Portugal to assess knowledge, attitudes, and practices (KAP) on ticks and tick-borne diseases in cattle, which the authors are aware of. This type of questionnaire is a very useful tool in the development and application of effective and sustainable prevention and control measures. Therefore, a KAP questionnaire was applied to 44 cattle breeders of autochthonous Portuguese breeds, namely 14 breeders of the Alentejana breed and 30 of the Mertolenga breed, between January 1 and May 9, 2023. Based on the analysis criteria of these surveys, 64% of the Alentejana breeders and 63% of the Mertolenga breeders have an average level of knowledge about ticks and tick-borne diseases, and 21% of the Alentejana breeders and 33% of the Mertolenga breeders have a high level of knowledge. Although only 21.4% of the Alentejana and 36.7% of the Mertolenga breeders consider tick infestation as a major animal health problem, 71.4% of the Alentejana and 63.3% of breeders of the Mertolenga state that one of the main reasons for veterinary consultations on their farm is deworming of animals, and 92.9% of breeders of the Alentejana and 96.7% of breeders of the Mertolenga refer the use of dewormers as a strategy to control tick infestation. The results of this study contribute to highlighting the importance of correcting some identified knowledge gaps and improving knowledge, especially on the life cycle of this parasite, its local distribution and seasonality, resistance to acaricides, and alternative control strategies.

A Genome-Wide Association Study for Resistance to Tropical Theileriosis in Two Bovine Portuguese Autochthonous Breeds

The control of Tropical Theileriosis, a tick-borne disease with a strong impact on cattle breeding, can be facilitated using marker-assisted selection in breeding programs. Genome-wide association studies (GWAS) using high-density arrays are extremely important for the ongoing process of identifying genomic variants associated with resistance to Theileria annulata infection. In this work, single-nucleotide polymorphisms (SNPs) were analyzed in the Portuguese autochthonous cattle breeds Alentejana and Mertolenga. In total, 24 SNPs suggestive of significance (p ≤ 10-4) were identified for Alentejana cattle and 20 SNPs were identified for Mertolenga cattle. The genomic regions around these SNPs were further investigated for annotated genes and quantitative trait loci (QTLs) previously described by other authors. Regarding the Alentejana breed, the MAP3K1, CMTM7, SSFA2, and ATG13 genes are located near suggestive SNPs and appear as candidate genes for resistance to Tropical Theileriosis, considering its action in the immune response and resistance to other diseases. On the other hand, in the Mertolenga breed, the UOX gene is also a candidate gene due to its apparent link to the pathogenesis of the disease. These results may represent a first step toward the possibility of including genetic markers for resistance to Tropical Theileriosis in current breed selection programs.

Detection and molecular characterization of Cryptosporidium spp. in dairy calves in Lisbon and Tagus Valley, Portugal

Cryptosporidium is a protozoan parasite with worldwide distribution, infecting a wide range of hosts with some zoonotic species. Calves have been identified as one of the most common reservoirs of this parasite. However, little is known about the genetics of Cryptosporidium in calves in Portugal. This study aimed to molecularly characterize infections of Cryptosporidium in pre-weaned calves from the Lisbon and Tagus Valley (LTV) in Portugal. Fifty-two samples were collected from calves from eight dairy and two beef farms in LTV, Portugal. Cryptosporidium oocysts were detected by Modified Ziehl-Neelsen staining (MZN) and direct immunofluorescent assay (DFA). MZN and DFA revealed the presence of Cryptosporidium oocysts in 40.4% (21/52) and 67.3% (35/52) samples, respectively. Positive samples were analyzed by PCR-RFLP of the 18 s rRNA gene for species identification. DNA amplification of the 18S rRNA gene was successful for 88.6% (31/35) of samples. Cryptosporidium parvum was identified in 96.8% (30/31) of the samples, and from one sample Cryptosporidium bovis was identified. Cryptosporidium parvum positive samples were subtyped by sequencing the PCR product of a partial fragment of the 60 kDa glycoprotein (gp60) gene. Subtype analysis of the C. parvum isolates revealed that all isolates belonged to subtype family IIa. Four subtypes were recognized within this subtype family, including the hyper-transmissible IIaA15G2R1 subtype that is the most frequently reported worldwide (27/30), IIaA14G2R1 (1/30), IIaA16G2R1 (1/30) and IIaA19G2R1 (1/30). To our knowledge, this is the first report of C. bovis, and C. parvum subtypes IIaA14G2R1 and IIaA19G2R1 in cattle in LTV, Portugal. The presence of the zoonotic C. parvum subtype in this study suggests that pre-weaned calves are likely to be a significant reservoir of zoonotic C. parvum, highlighting the importance of animal-to-human infection transmission risk. Further molecular studies are required to better understand the epidemiology of cryptosporidiosis in Portugal.

Polybrominated diphenyl ether (PBDE) exposure and adverse maternal and infant health outcomes: Systematic review

Polybrominated diphenyl ethers (PBDEs) are flame retardants found in ambient environment and are measured in humans. There are reports on general PBDE toxicity, including endocrine disrupting properties. Studies on adverse maternal and infant outcomes and underlying toxicity mechanisms needs to be understood. The objective of this study was to conduct a systematic review to examine the state of science on the relationship between PBDE and adverse maternal/infant health outcomes and related maternal biomarker changes. This literature review was conducted using PubMed, Scopus, Embase and Web of Science for published articles from January 2005-February 2022. Article quality was assessed using Newcastle-Ottawa Scale. Of the 1518 articles, only 54 human observational studies were screened in for this review. A second reviewer examined the validity of these articles. Reports on associations between PBDE and maternal health outcomes included gestational hypertension/preeclampsia (N = 2) and gestational diabetes mellitus/glycemic index (N = 6). Meanwhile, reports on PBDE and infant outcomes (N=32) included effects on infant birth weight, birth length and cephalic perimeter, preterm birth, fetal growth restriction and APGAR scores. Although findings on PBDE exposure and adverse infant outcomes showed inconsistencies across studies, in general, negative correlations between maternal PBDEs and infant birth weight, birth length and cephalic perimeter were seen, in few cases, after stratification by sex. Association between maternal PBDE and maternal biomarkers (N=18) suggested negative impact of PBDE exposure on markers relevant to neuro-endocrine system and inflammatory processes. The review findings identified potential associations between maternal PBDE and adverse maternal/infant health outcomes. Furthermore, PBDE-related biomarker changes suggest disturbances in maternal mechanisms relevant to endocrine disrupting properties of PBDEs. The observed study heterogeneity can be attributed to factors namely, sample size, study design and statistical analysis. Overall review findings imply the necessity for further research to validate PBDE exposure-related adverse maternal/infant health effects and to validate underlying toxicity mechanisms.

Can static hyperinflation predict exercise capacity in COPD?

INTRODUCTION

The diagnosis and severity assessment of COPD relies on spirometry, and in particular the FEV1. However, it has been proposed that hyperinflation and air-trapping are better predictors of exercise capacity and mortality than the FEV1.

RESEARCH

QUESTION: Does static hyperinflation predict exercise capacity?

METHODS

We conducted an observational prospective study. Patients with COPD referred to the lung function laboratory were consecutively recruited. Patients with hyperinflation (the experimental group) were compared to patients without hyperinflation (the control group). The sample sizes were determined assuming an effect size of 0.5 and a power of 0.80.

RESULTS

We recruited 124 participants, of whom 87% were male, the mean age was 66.1 ± 8.8 years. 67% were symptomatic (GOLD B or D). Airflow limitation was moderate to severe in the majority of patients (median FEV1 47%, IQR 38-65%) and 43% of patients had static hyperinflation. The median 6MWD was 479 meters (404-510) and peak workload in CPET was 64 watts (46-88) with peak VO2 1.12 L/min, 0.89-1.31 L/min. Patients with lower FEV1, DLCO and IC/TLC and higher RV/TLC had reduced exercise capacity in both 6MWT and CPET, measured as lower distance, greater desaturation and ∆Borg dyspnoea, and reduced workload, peak VO2 and peak VE and higher desaturation and ventilatory limitation (VE/MVV). An IC/TLC < 0.33 predicted reduced exercise performance (peak O2 <60%). Dyspnoea assessed by mMRC and QoL measured by CAT and CCQ were also worse in the hyperinflation in COPD patients.

CONCLUSION

In COPD patients, IC/TLC and RV/TLC are valuable predictors of exercise performance in both 6MWT and CPET and PRO.

Avian Malaria in wild birds from a wildlife rehabilitation center in Central Portugal

Avian haemosporidian (Haemoproteus, Leucocytozoon, Plasmodium) are vector-transmitted protozoan parasites highly prevalent in various bird species. Still, their importance for bird health, species decline, or impact on rehabilitation success is underestimated. This study aimed to determine the occurrence and diversity of haemosporidian parasites after necropsies of seventy wild birds from thirty-four species of twelve taxonomic orders. Detection of avian haemosporidian DNA was evaluated using PCR amplification of the cytochrome b gene. 48.6% of all sampled birds were positive, with 24.3% positive for Plasmodium spp./Haemoproteus spp. and 44.3% for Leucocytozoon spp. Mixed infections corresponded to 20% of all tested birds. Sequencing of several selected samples revealed the infection of Plasmodium matutinum, Plasmodium relictum and different lineages of Leucocytozoon spp. This study provides a baseline description of haemosporidian infections in wild birds from a rehabilitation center in central Portugal. The results show the necessity to test and monitor possible infections that undermine recovery processes for different birds. Further research into the occurrence of these haemosporidian species in birds kept in conservation centers is needed to understand the impact on bird health.

Prevalence and Risk Factors Associated with Theileria annulata Infection in Two Bovine Portuguese Autochthonous Breeds

Tropical Bovine Theileriosis is an important tick-borne disease. This study aims to assess the occurrence of Theileria annulata infection in two indigenous Portuguese cattle breeds. A total of 843 blood samples collected from animals of Alentejana (n = 420) and Mertolenga (n = 423) breeds were analyzed. The detection of Theileria annulata was determined by amplification of a fragment of the merozoite-pyroplasm surface antigen gene with 319 base pairs (bp). The prevalence found (10.8%) is lower than that reported in previous studies (21.3%). A statistically significant difference was found for positivity between breeds (p < 0.05). There is also a higher probability of older animals being positive compared to younger ones (p < 0.05). The region where Mertolenga animals are located is shown to have a significant impact on positivity (p < 0.05). Thus, the development of sustainable T. annulata control strategies and their implementation, adapted to the epidemiological conditions of higher risk, will be extremely important.

Genetic Resistance of Bovines to Theileriosis

Diseases caused by ticks have a high impact on the health, welfare, and productivity of livestock species. They are also an important cause of economic losses in farms worldwide. An example of such diseases is theileriosis, which can be controlled by drugs or vaccines, although these are not fully efficient. Therefore, there is a need to develop alternative and more sustainable and efficient complementary strategies. These may involve the identification and selection of animals more resistant to the disease. Several previous studies have identified significant differences in resistance between different breeds, with resistant breeds typically identified as those native to the region where they are being studied, and susceptible as those from exotic breeds. These studies have indicated that resistance traits are intrinsically related to the modulation of the immune response to infection. This review aims to systematize the general knowledge about theileriosis, emphasize resistance to this disease as a sustainable control strategy, and identify which traits of resistance to the disease are already known in cattle.

Knowledge, attitudes, and practices of municipal veterinary practitioners towards echinococcosis

Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are among the most relevant zoonoses in Europe. According to the European Food Safety Authority (EFSA), Echinococcus granulosus sensu lato causing CE is the most significant foodborne parasite in South-Western Europe, followed by Echinococcus multilocularis, the etiological agent of AE. Among the challenges and opportunities highlighted in the literature to combat these diseases are the need to evaluate and increase awareness of stakeholders. In Portugal, Municipal Veterinary Practitioners (MVP) are the animal health authority at the municipality level, playing a crucial role in diagnosis, prevention and control of infectious diseases in animals, helping to mitigate transmission to humans. However, their knowledge, attitudes, and practices (KAP) towards CE, as well as awareness of AE expansion across Europe, remain overlooked. In this work, a cross-sectional study was conducted for the first time in Portugal to bridge knowledge gaps concerning CE and AE, using an online self-administered questionnaire collecting information on the municipal kennel, KAP towards CE, and understanding of AE epidemiology. Eighty-three MVP from mainland and islands completed the questionnaire, with highest representability from the central-northern region. MVP had, on average, a medium to high level of knowledge of CE but acquaintance with AE was insufficient, although echinococcosis was frequently mentioned as target of health education sessions (77.0%). A high rate (60%) of reported entries into municipal kennels of stray dogs originating from countries with AE endemic areas was registered, suggesting that the presence of these potentially AE-infected stray dogs pose public health risks. Most kennels did not perform routine coprological analysis or faecal matter disinfection after dog internal deworming. The lack of proper training and well-conceived written plans of infection control and prevention were evidenced in several kennels. Altogether, our findings highlight the need to update knowledge and practice of MVP under the One Health approach, through reinforced education, training and communication involving all stakeholders.

Genetic and morphological identification of filarial worm from Iberian hare in Portugal

The Iberian hare (Lepus granatensis) is an endemic species of the Iberian Peninsula and the only hare species found in Portugal, although also being present in some areas of Spain. The reduction of wild hare populations due to several ecological and sanitary factors, has been raising growing concerns in the recent years. Despite different helminth species were already described in Iberian hares in Portugal, to this date, no filarial worms have been identified in this species. Furthermore, only a few studies on lagomorphs' onchocercid worms are available, referring to other hosts species of hares and/or rabbits. In this study, we describe the presence of filarial worms in the blood vessels of two adult Iberian hares collected in 2019 in continental Portugal. Morphology and sequencing data from the 12S rRNA, coxI, 18S rRNA, myoHC, hsp70 and rbp1 genes, showed that the filaroid species were genetically related with Micipsella numidica. However, the extension of the genetic differences found with M. numidica suggests that the filaroids specimens under study belong to a new species, that we provisionally named Micipsella iberica n. sp.. The body location of this putative new parasite species and its physiological implications indicate that it may constitute a potential menace to the already fragile Iberian hare justifying, therefore, further investigation regarding the morphological characterization, prevalence and real clinical impact of this new parasite in hares.

Dupilumab for atopic dermatitis: a real-world portuguese multicenter retrospective study

Introduction: Atopic dermatitis (AD) is a difficult-to-treat inflammatory skin disease with a high impact on patients' quality of life. Dupilumab, an IL-4 and IL-13 inhibitor, was the first monoclonal antibody approved for the treatment of moderate-to-severe AD and is currently approved in patients aged 6 or older.Methods: This is a nationwide, multicenter, retrospective, 48-week study designed by the Portuguese Group of AD to assess real-world efficacy and safety of dupilumab for the treatment of AD.Results: A total of 169 patients were enrolled, with a mean disease duration of 22.75 (±11.98) years. The percentage of patients achieving an improvement of at least 75% in Eczema Area and Severity Index (EASI) compared to baseline (EASI75 response) at weeks 12 and 48 was 67.6% and 74.1%, respectively. In the same timepoints, 25.0% and 44.1% achieved an EASI90 response. Patient-reported outcome measures also improved throughout the study period. Regarding safety, 32.0% of the patients developed adverse events, with conjunctivitis (26.6%), persistent facial erythema (4.7%), and arthritis/arthralgia (3.6%) as the more frequently reported.Conclusion: Data from real-world populations are crucial to guide clinicians in their daily decisions. This study provides data demonstrating that dupilumab is an effective and safe therapeutic option for AD.

Overview of Cattle Diseases Listed Under Category C, D or E in the Animal Health Law for Which Control Programmes Are in Place Within Europe

The COST action “Standardising output-based surveillance to control non-regulated diseases of cattle in the European Union (SOUND control),” aims to harmonise the results of surveillance and control programmes (CPs) for selected cattle diseases to facilitate safe trade and improve overall control of cattle infectious diseases. In this paper we aimed to provide an overview on the diversity of control for these diseases in Europe. A selected cattle disease was defined as an infectious disease of cattle with no or limited control at EU level, which is not included in the European Union Animal health law Categories A or B under Commission Implementing Regulation (EU) 2020/2002. A CP was defined as surveillance and/or intervention strategies designed to lower the incidence, prevalence, mortality or prove freedom from a specific disease in a region or country. Passive surveillance, and active surveillance of breeding bulls under Council Directive 88/407/EEC were not considered as CPs. A questionnaire was designed to obtain country-specific information about CPs for each disease. Animal health experts from 33 European countries completed the questionnaire. Overall, there are 23 diseases for which a CP exists in one or more of the countries studied. The diseases for which CPs exist in the highest number of countries are enzootic bovine leukosis, bluetongue, infectious bovine rhinotracheitis, bovine viral diarrhoea and anthrax (CPs reported by between 16 and 31 countries). Every participating country has on average, 6 CPs (min–max: 1–13) in place. Most programmes are implemented at a national level (86%) and are applied to both dairy and non-dairy cattle (75%). Approximately one-third of the CPs are voluntary, and the funding structure is divided between government and private resources. Countries that have eradicated diseases like enzootic bovine leukosis, bluetongue, infectious bovine rhinotracheitis and bovine viral diarrhoea have implemented CPs for other diseases to further improve the health status of cattle in their country. The control of the selected cattle diseases is very heterogenous in Europe. Therefore, the standardising of the outputs of these programmes to enable comparison represents a challenge.

Outcome of catheter ablation of arrhythmias in adult congenital heart disease with high density multi-electrode mapping with automatic annotation algorithm

Funding Acknowledgements

Type of funding sources: None.

Introduction

Arrhythmias are frequently encountered in adult congenital heart disease (ACHD) and respond poorly to pharmacological therapies. Catheter ablation is challenging due to anatomical variation and complexity of the arrhythmia substrate. High density multi electrode mapping (MEM) with automatic annotation of activation time may aid mapping of arrhythmia, decrease procedure time and improve the accuracy of targeting of ablation therapy.

Purpose

To compare the acute and long term outcomes and procedural characteristics of catheter ablation in ACHD patients with and without automatic annotation of activation with MEM.

Methods

Retrospective analysis of the acute and long term outcomes of ACHD patients in a single centre undergoing ablation procedures from 1 Jan 2014 to 18 August 2017 was undertaken. 2 groups were identified.

Group 1 included patients who had arrhythmia mapping performed with the CARTO 3D electroanatomic mapping system without the use of automatic signal annotation. Most patients in this group had sequential mapping performed with the ablation catheter (78%), the rest had multi-electrode mapping with the PentaRay 20 pole catheter.

Group 2 included patients who had arrhythmia mapping performed with the CARTO 3D electroanatomic mapping system using the automated CONFIDENSE mapping algorithm.

Results

Group 1: n = 27, mean age 44.6 +/-3 years. Male 46.6%. Group 2: n = 38, mean age 44.0 +/- 1.9 years. Male 56.7%. All patients had CHD of at least moderate complexity. 25% of patients in group 1 and 45% in group 2 were repeat ablations. 45 arrhythmias were induced in group 1 of which 29 were targeted and 74 arrhythmias were induced in group 2 of which 46 were targeted. Acute success rates (after attempts at reinduction) were 96.3% in group 1 and 94.7% in group 2. Recurrences of arrhythmia occurred significantly less in patients in group 2 compared to group 1  (44.7% and 70.4% respectively,  p &lt; 0.05) after a follow up duration of 17.3+/-0.43 months in group 2 and 45.3 +/-1.19 months in group 1. Fluoroscopy time, procedure time and ablation time were not significantly different between groups.

Conclusions

The use of multi-electrode mapping with an automatic annotation algorithm was associated with a significantly lower risk of recurrence during the follow up period of this study.

Molecular survey of vector-borne diseases in two groups of domestic dogs from Lisbon, Portugal

BACKGROUND

Canine vector-borne diseases (CVBDs) are caused by a wide range of pathogens transmitted by arthropods. They have been an issue of growing importance in recent years; however, there is limited information about the vector-borne pathogens circulating in Portugal. The aim of the present study was to detect canine vector-borne bacteria and protozoa of veterinary and zoonotic importance using molecular methods.

METHODS

One hundred and forty-two dogs from Lisbon, southern Portugal, were tested: 48 dogs from a veterinary hospital clinically suspected of vector-borne diseases and 94 apparently healthy dogs from shelters. Anaplasma spp./Ehrlichia spp., Babesia/Theileria spp., Hepatozoon spp., and Mycoplasma spp. infections were detected by PCR from blood samples and examined under light microscopy. Other information including clinical status and diagnostic test results were collected for each animal.

RESULTS

Infections were detected by PCR in 48 (33.80%) dogs. Single infections were found in 35 dogs (24.64%), and co-infections were found in 13 (9.15%) dogs. Twenty-nine (20.42%) dogs were positive for Hepatozoon spp., 15 (10.56%) for Mycoplasma spp., 11 (7.75%) for Anaplasma spp./Ehrlichia spp., and six (4.21%) for Babesia spp. DNA sequencing was used to identify Babesia vogeli (2.81%), Babesia canis (1.40%), Hepatozoon canis (20.42%), Mycoplasma haematoparvum (2.11%), Mycoplasma haemocanis (8.45%), Anaplasma platys (7.04%), and Ehrlichia canis (0.70%).

CONCLUSIONS

This is the first molecular identification of B. canis and M. haematoparvum in dogs from southern Portugal. This study highlights the importance of molecular methods to identify CVBD pathogens in endemic areas and helps to guide the clinical approach of veterinarians in practice.

Surveillance of foodborne parasitic diseases in Europe in a One Health approach

In 2012, WHO/FAO ranked 24 foodborne parasites (FBP) using multicriteria decision analysis (MCDA) to provide risk assessors with a basis for prioritising control of highly ranked FBP on the global level. One conclusion was that ranking may differ substantially per region. In Europe, the same methodology was used to rank FBP of relevance for Europe. Of the 24 FBP, the top-five prioritised FBP were identified for Europe as Echinococcus multilocularis, Toxoplasma gondii, Trichinella spiralis, E. granulosus, and Cryptosporidium spp., all of which are zoonotic. The objective of the present study was to provide an overview of surveillance and reporting systems in Europe for these top five prioritised FBP in the human and animal populations, to identify gaps, and give recommendations for improvement. Information on the surveillance systems was collected from 35 European countries and analysed according to the five different regions. For most FBP, human surveillance is passive in most countries and regions in Europe and notification differs between countries and regions. Adequate surveillance programmes for these FBP are lacking, except for T. spiralis, which is notifiable in 34 countries with active surveillance in susceptible animals under EU directive. Although human and animal surveillance data are available for the five prioritised FBP, we identified a lack of consistency in surveillance and reporting requirements between national experts and European bodies. Recommendations for improved surveillance systems are discussed.

A Mixed Methods Population Health Approach to Explore Radon-Induced Lung Cancer Risk Perception in Canada

BACKGROUND

Radon is a predominant indoor air pollutant and second leading cause of lung cancer in radon-prone areas. Despite the gravity of the health risk, residents in Canada have inadequate perception and taken minimal protective actions. Better perception of a risk motivates people to take preventive measures. Scholarship about radon health risk perception is lacking in Canada. We applied a mixed methods population health approach to explore the determinants shaping perception and actions of a resident population in Canada.

METHODS

We conducted mixed surveys (n = 557) and qualitative bilingual interviews (n = 35) with both homeowners and tenants of Ottawa-Gatineau areas. The study explored residents' risk perception and adaptations factors. Descriptive, correlational and regression analyses described and established associations between quantitative variables. Thematic, inductive analyses identified themes in the qualitative data. A mixed methods analysis triangulated both results to draw a holistic perception of the health risk.

RESULTS

Residents' quantitative perceptions of radon health risk, smoking at home, synergistic risk perception, social influence and care for family were associated significantly with their intention to test for radon levels in their home, actual testing and mitigation. These results were explained further with the qualitative findings. Residents who had dual cognitive and emotional awareness of the risk were motivated enough to take preventive actions. Caring for family, knowing others who contracted lung cancer and financial capability were enablers, whereas lack of awareness and homeownership, cost of mitigation and stigma were obstacles to preventive actions. We also explored the dual subjective and objective aspects of risk perception that are influenced by micro- and macro-level determinants.

CONCLUSIONS

Inducing protective action to reduce risk requires comprehensive population-level interventions considering dual perceptions of the risk that can modify the risk determinants. Future research can explore the dual aspects of risk perception and unequal distribution of the risk factors.

Deformable liposomes as enhancer of caffeine penetration through human skin in a Franz diffusion cell test

OBJECTIVE

The permeation of hydrophilic molecules through the skin is still a challenge due to the barrier posed by stratum corneum, the outermost layer of the skin. Liposomes have frequently been used as carriers for different types of drugs and may also function as permeation enhancers. Propylene glycol has also been used as an edge activator in liposomes to increase the permeation. The aim of this work was to prepare liposomes containing an edge activator and loaded with caffeine to evaluate the potential of caffeine reaching the deeper layers in the skin.

METHODS

The formulations were prepared by a top-down process using high-pressure homogenization at 200 00 psi for 10 min. They were characterized by size, polydispersity index (PI), zeta potential (ZP), pH, caffeine content and encapsulation efficiency (EE%) on preparation (time zero) and after 30 days. Cytotoxicity of blank and loaded liposomes was assessed by MTT proliferation assay with a normal keratinocyte cell line (HaCaT). In vitro permeation tests were performed with human skin in Franz cells over 24 h, and caffeine concentration was determined in the skin surface, stratum corneum, dermo-epidermal fraction and receptor medium by HPLC.

RESULTS

The caffeine liposomes with (DL-Caf) or without propylene glycol (CL-Caf) showed, respectively, mean size 94.5 and 95.4 nm, PI 0.48 and 0.42, ZP + 1.3 and + 18.1 mV and caffeine content of 78.57 and 80.13%. IC₅₀ values of caffeine in DL-Caf (3.59 v/v %) and CL-Caf (3.65 v/v %) were not significantly different from conventional blank liposome (3.27 v/v %). The DL-Caf formulation presented the best capability to enhance the caffeine permeation through the skin, resulting 1.94-folds higher than caffeine solution. Furthermore, the caffeine flux from DL-Caf was 1.56- and 3.05-folds higher than caffeine solution and CL-Caf, respectively. On the other hand, CL-Caf showed the lowest caffeine penetration revealing the importance of edge activator to aid hydrophilic drug penetration to all skin layers.

CONCLUSION

The DL-Caf formulation tested was able to improve the permeation of caffeine through the stratum corneum and dermo-epidermal layers, suggesting that this delivery system may be effective for deep skin delivery of hydrophilic drugs.

Burden of food insecurity in older adults from diverse global settings: policy recommendations

Food insecurity prevalence is highest in low and middle-income countries, yet there is a dearth of research on the burden in older adults in these settings. Food insecurity has long-term consequences for the health of older persons. We examined cross-sectional food security data from 1,482 participants in the 2016 wave of the longitudinal International Mobility in Aging Study (IMIAS) conducted in Canada, Albania, Colombia, and Brazil. These are community samples between 68 and 79 years. Food security was assessed with the Latin American and Caribbean Household Food Security Scale and recoded to yes/no. Covariates of interest included sex, site, income, living arrangement, and education. Descriptive statistics, with tests of statistical significance, were used. Responses to scale items varied from 10% of participants reporting worry about running out of food and being unable to eat healthy foods to 2% reporting not eating for a whole day or having to beg for food. Food insecurity in the sample was 17%. Few Canadian respondents (&lt;5%) were food insecure, compared to 30% in Tirana, 28% in Manizales, and 18% in Natal. Better educated and income sufficient respondents were significantly more food secure than lesser educated, lower income ones. Respondents living with spouses were significantly less likely to be food insecure than those living alone or in other arrangements (e.g. with children). The exception was Tirana; 25% of those in other arrangements were food insecure compared to 32% living with a spouse and 44% alone. Food insecurity did not differ significantly by age or sex. Site, income, living arrangement, and education were all associated with food insecurity status. Study findings contribute to a significant gap in literature about food security in older adults. Because food insecurity in older adults leads to negative health outcomes, results suggest specific interventions to improve health and reduce burden on healthcare systems is needed for elderly.

Key messages

Food insecurity has severe health consequences for elderly and location, income, education, and living arrangement contributes to health inequalities in this population across diverse settings. Little to no research has been done on food insecurity in elderly outside of North America and study findings contribute to significant gap in research in this population across global settings.

Older men from global settings more vulnerable to clinical changes associated with food insecurity

Background

Studies of the food security status of older adults are rare outside of the United States, especially in low- and middle-income settings. Food insecurity may contribute to disease and disability. Using a diverse sample of older adults, we examine the association of food insecurity with clinical and self-reported measures that are related to disease and impairment.

Methods

Cross sectional analysis of 1482 older adults from Kingston and St. Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). Outcome measures were Body Mass Index (BMI), waist circumference, and self-reported unintentional weight loss. Food insecurity was assessed with the 9-item Latin American and Caribbean Household Food Security Scale. Covariates were age, sex, study site, and education. Statistical analyses included Student's T-test, Chi-square test, and linear regression.

Results

83% of participants were food secure; 12% experienced mild food insecurity and 5%, moderate/severe food insecurity. Among men, BMI and waist circumference varied significantly by food security status (p &lt; 0.05). Mean BMI among men with moderate/severe food insecurity was 25.5 compared to 27.0 for mild and 27.5 for no food insecurity. The pattern for waist circumference was similar (93.9cm for moderate/severe, 96.7cm for mild, and 98.9cm for no food insecurity). More food insecure men reported unintentional weight loss (13%) than food secure men (10%). This pattern was not observed among women. Statistical adjustment for study site, education, and age did not change the findings.

Conclusions

Significant differences in clinical indicators of disease were observed by food security status in men. At the extreme, low BMI and waist circumference are linked to increased risk of malnutrition, compromised immune function, and respiratory and digestive diseases. Differences in these measures by food security status emphasize the need for gender and age specific food security interventions.

Key messages

Food insecure men experience clinical indicators of disease significantly more than food insecure women. Successful food security interventions may require sex specific focus across global settings. Little research has been done on food insecurity in elderly outside of North America and study findings contribute to significant gap in sex specific research in this population across global settings.

Canine parvovirus: a predicting canine model for sepsis

BACKGROUND

Sepsis is a severe condition associated with high prevalence and mortality rates. Parvovirus enteritis is a predisposing factor for sepsis, as it promotes intestinal bacterial translocation and severe immunosuppression. This makes dogs infected by parvovirus a suitable study population as far as sepsis is concerned. The main objective of the present study was to evaluate the differences between two sets of SIRS (Systemic Inflammatory Response Syndrome) criteria in outcome prediction: SIRS 1991 and SIRS 2001. The possibility of stratifying and classifying septic dogs was assessed using a proposed animal adapted PIRO (Predisposition, Infection, Response and Organ dysfunction) scoring system.

RESULTS

The 72 dogs enrolled in this study were scored for each of the PIRO elements, except for Infection, as all were considered to have the same infection score, and subjected to two sets of SIRS criteria, in order to measure their correlation with the outcome. Concerning SIRS criteria, it was found that the proposed alterations on SIRS 2001 (capillary refill time or mucous membrane colour alteration) were significantly associated with the outcome (OR = 4.09, p < 0.05), contrasting with the 1991 SIRS criteria (p = 0.352) that did not correlate with the outcome. No significant statistical association was found between Predisposition (p = 1), Response (p = 0.1135), Organ dysfunction (p = 0.1135), total PIRO score (p = 0.093) and outcome. To explore the possibility of using the SIRS criteria as a fast decision-making tool, a Fast-and-Frugal tree (FFT) was created with a sensitivity of 92% and a specificity of 29%.

CONCLUSION

These results suggest that increasing the SIRS criteria specificity may improve their prognostic value and their clinical usefulness. In order to improve the proposed PIRO scoring system outcome prediction ability, more specific criteria should be added, mainly inflammatory and organ dysfunction biomarkers.

Cross-cultural adaptation and validation of the VISA-P questionnaire for Portuguese-speaking (Portugal) patients with patellar tendinopathy

Introduction Patellar tendinopathy is a condition frequently verified in individuals who practice regular physical activity, therefore functional evaluation is crucial to monitor symptoms. The VISA-P was developed for English-speaking population to evaluate patients with this condition, and there is a need to adapt this tool to Portuguese (Portugal).

Objectives To cross-cultural adapt and validate the VISA-P questionnaire for Portuguese-speaking (Portugal) patellar tendinopathy patients

Methodology The VISA-P questionnaire was translated and cross-culturally adapted into Portuguese (VISA-P-Por) according to specific guidelines, using six steps: Translation, synthesis, back translation, expert committee review, pretesting (n = 10), and appraisal of the adaptation process. The resulting VISA-P-Por was then subjected to an analysis of the psychometric properties (construct validity, reproducibility [agreement and reliability], internal consistency and floor and ceiling effects) in 73 patellar tendinopathy patients and 73 asymptomatic people. Participants completed the questionnaire at baseline and after a minimum interval of 48 hours.

Results The Visa-P-Por questionnaire revealed a high level of agreement, presenting semantic and content validity. Construct validity showed differences between both groups (p &lt; 0,001) and the questionnaire exhibited very good internal consistency, with an excellent α Cronbach (0,91). Concerning reproducibility, agreement levels were considered optimal which can be proven by the Bland Altman graph, the standard error of measurement (5,74) and the minimally important change (15,91 points), as well as the excellent ICC value (0,92). There were no ceiling and floor effects detected.

Conclusion The VISA-P-Por questionnaire is a valid and reliable tool, with psychometric properties comparable with the original version. Thus, it can be recommended as a robust tool for measuring clinical severity and functional impact of patellar tendinopathy in Portuguese-speaking (Portugal) patients.

Serological survey of Neospora spp. and Besnoitia spp. in horses in Portugal

Equine neosporosis is regarded to be caused either by Neospora hughesi or Neospora caninum and equine besnoitiosis is caused by Besnoitia bennetti, both of which are apicomplexan parasites. N. caninum is the only known Neospora species in Europe, where equine N. caninum infections have been reported as being associated to abortion and reproductive failure. N. hughesi is prevalent in North America and was predominantly linked to neurological disorders. B. bennetti is considered an emergent disease in donkeys in North America and evidence for B. bennetti infection was recently reported in Europe. Though N. caninum and Besnoitia besnoiti are prevalent in cattle in Portugal, little is known about neosporosis in horses and, to the best of our knowledge, no information was hitherto available for Besnoitia spp. The aim of this study was thus to carry out a serological survey to determine the seroprevalence of these parasites in naturally exposed horses in Portugal. A total of 385 animals were screened by the Indirect Fluorescent Antibody Test at the cut-off value 1:50 and positive results were confirmed by Western blot. Exposure to Neospora spp. and Besnoitia spp. was confirmed in 9.1% (95% Confidence Interval [CI]: 6.6-12.4%) and 0.3% (95% CI: 0.0-1.5%) of horses, respectively. Considering the putative economic and animal health impact of neosporosis in horses and the consequences of a possible spread of equine besnoitiosis in Europe and elsewhere, more comprehensive studies are needed to characterize the species detected in serological surveys, evaluate the geographical distribution and assess possible risk factors that could favor transmission.

Aethalometer measurements in a road tunnel: A step forward in the characterization of black carbon emissions from traffic

A sampling campaign was conducted in the Liberdade Avenue tunnel (Braga, Portugal) during a week (with 56,000 vehicles) to monitor black carbon (eBC-equivalent black carbon) by means of an Aethalometer AE-31, and gaseous pollutants (CO₂, CO, NO_x). Inside the tunnel, the mean eBC mass concentration was 21 ± 10 μg m^-3, reaching a maximum hourly value of 49.0 μg m^-3. An hourly and weekday-weekend study was carried out. Regarding the Absorption Ångström exponent (AAE), a mean value of 0.97 ± 0.10 was obtained, for a source of practically pure traffic. There was a positive significant correlation between eBC and the number of light vehicles (r = 0.47; p < 0.001) and between eBC and the gaseous emissions: CO (r = 0.67; p < 0.001), CO₂ (r = 0.71; p < 0.001), NO (r = 0.63; p < 0.001) and NO₂ (r = 0.70; p < 0.001). The mean black carbon emission factors (EF_BC) inside the tunnel were 0.31 ± 0.08 g (kg fuel)^-1 and 0.11 ± 0.08 mg veh^-1 km^-1, similar to those found in other studies for gasoline and diesel vehicles in road tunnels.

Molecular detection and characterization of Leishmania infantum in free-ranging Egyptian mongoose (Herpestes ichneumon)

Wild mammals are susceptible to infection by Leishmania parasites. Although canine leishmaniasis is widely distributed in mainland Portugal, the sylvatic cycle of the parasite remains poorly understood. In this study, the occurrence of L. infantum in wild carnivores from Portugal was assessed by molecular screening of 132 hunted or accidentally road-killed animals. Spleen samples from Egyptian mongoose, red fox, stone marten, common genet and European badger were tested by amplification of Leishmania kinetoplastid DNA and ITS1. Five egyptian mongoose were confirmed Leishmania DNA-positive by kDNA-PCR. Phylogenetic analysis of a kDNA amplicon sequence clustered the strain with L. infantum sequences from Portugal. These results may suggest that L. infantum strains circulating in wild animals are genetically related with strains from more humanized settings. Exposure of wild carnivores to Leishmania infantum emphasizes the need of systematic studies to clarify the role of several taxa in the eco-epidemiology of leishmaniasis in Portugal, particularly in areas of carnivore species synanthropy and wherein disease control in the domestic population is inefficient or insufficient.

Maternal blood biomarkers and adverse pregnancy outcomes: a systematic review and meta-analysis

Background: Pregnancy is a vulnerable period for the mother and the infant and exposures to environmental chemicals in utero can influence neonatal morbidity and mortality. There is a momentum toward understanding and exploring the current maternal biological mechanisms specific to in utero effects, to improve birth outcomes. This study aims to examine the current understanding of the role of biomarkers that may be associated with term of pregnancy, infant birth weights and infant development in utero.Methods: Electronic searches were conducted in PubMed, Embase, OvidMD, and Scopus databases; and all relevant research articles in English were retrieved. Studies were selected if they evaluated maternal blood plasma/serum biomarkers proposed to influence adverse birth outcomes in the neonate. Data were extracted on characteristics, quality, and odds ratios from each study and meta-analysis was conducted.Results: A total of 54 studies (35 for meta-analysis), including 43,702 women, 50 plasma markers and six descriptors of birth outcomes were included in the present study. The random effect point estimates for risk of adverse birth outcomes were 1.61(95%CI: 1.39-1.85, p < 0.0001) for inflammation-related biomarkers and 1.65(95%CI: 1.22-2.25, p = 0.0013) for growth factor/hormone-related biomarkers. All subgroups of plasma markers showed significant associations with adverse birth outcomes with no apparent study bias.Conclusions: The two subsets of plasma markers identified in this study (inflammation-related and growth factor/hormone-related) may serve as potentially valuable tools in the investigation of maternal molecular mechanisms, especially select pathways underlying inflammatory and immunological mediation in terms of modulating adverse infant outcomes. Future large, prospective cohort studies are needed to validate the promising plasma biomarkers, and to examine other maternal biological matrices such as cervicovaginal fluid and urine.

Survey on the prevalence of Dermanyssus gallinae in commercial laying farms in Portugal

Dermanyssus gallinae, also known as the poultry red mite (PRM), is a blood-feeding ectoparasite of poultry and sylvatic birds. This mite is endemic in many parts of the globe and poses a threat to the egg industry, while compromising the health and welfare of hens, both directly and as a vector of diseases. In addition, people attacked by D. gallinae may develop gamasoidosis. Despite the high prevalence in several European countries, epidemiological information on D. gallinae in Portugal is scarce. This study aimed to assess the prevalence and infestation levels in laying farms in Portugal and evaluate the perception and attitudes of producers regarding D. gallinae. A survey was performed between August 2016 - November 2017, which included 24 farms in the NUTS2 regions Centro and Norte. Mites were sampled with corrugated cardboard traps and the perception and attitudes of farmers regarding the PRM were evaluated with the European COREMI questionnaire prepared by WG 1 of the COST action FA1404. D. gallinae was detected in 95.8% of farms (95% CI: 79.8-99.3%). The average number of trapped mites among farms was 5200 ± 16,522, with a median of 359 mites (interquartile range = 46-3135). Results from the questionnaire show that insufficient monitoring, under-detection and late and suboptimal treatment may contribute to the maintenance of significant infestation levels. The present data highlight the need for adequate monitoring of D. gallinae, timely action and effective treatment in order to improve poultry productivity and ensure human and animal health and welfare. RESEARCH HIGHLIGHTS A survey on the prevalence of D. gallinae in Portuguese layer farms is presented The perceived importance of D. gallinae was assessed with a questionnaire D. gallinae was detected in 95.8% of farms The results emphasize the need for adequate monitoring and treatment optimization.

Portuguese consensus document for the management of alpha-1-antitrypsin deficiency

Alpha-1-antitrypsin deficiency (AATD) is a genetic autosomal codominant disorder caused by mutations in SERPINA1 gene. It is one of the most prevalent genetic disorders, although it remains underdiagnosed. Whereas at international level there are several areas of consensus on this disorder, in Portugal, inter-hospital heterogeneity in clinical practice and resources available have been adding difficulties in reaching a diagnosis and in making therapeutic decisions in this group of patients. This raised a need to draft a document expressing a national consensus for AATD. To this end, a group of experts in this field was created within the Portuguese Pulmonology Society - Study group on AATD, in order to elaborate the current manuscript. The authors reviewed the existing literature and provide here general guidance and extensive recommendations for the diagnosis and management of AATD that can be adopted by Portuguese clinicians from different areas of Medicine. This article is part of a supplement entitled "Portuguese consensus document for the management of alpha-1-antitrypsin deficiency" which is sponsored by Sociedade Portuguesa de Pneumologia.

Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review

BACKGROUND

A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team.

METHODS

A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records.

RESULTS

There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of <2 units of red blood cells, occurred in two cases (12%). Common causes of non-compliance were: 24% (4/17) temperature monitoring, 18% (3/17) lactate measurement, 41% (7/17) arterial blood gas sampling, and 18% (3/17) hemoglobin maintenance within the target range of 55-95 g/L. Admission to intensive care and peripartum hysterectomy occurred in 12 and 5 cases (71% and 29%), respectively.

CONCLUSIONS

Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Epidemiology of taeniosis/cysticercosis in Europe, a systematic review: Western Europe

BACKGROUND

Taenia solium and Taenia saginata are zoonotic parasites of public health importance. Data on their occurrence in humans and animals in western Europe are incomplete and fragmented. In this study, we aimed to update the current knowledge on the epidemiology of these parasites in this region.

METHODS

We conducted a systematic review of scientific and grey literature published from 1990 to 2015 on the epidemiology of T. saginata and T. solium in humans and animals. Additionally, data about disease occurrence were actively sought by contacting local experts in the different countries.

RESULTS

Taeniosis cases were found in twelve out of eighteen countries in western Europe. No cases were identified in Iceland, Ireland, Luxembourg, Norway, Sweden and Switzerland. For Denmark, Netherlands, Portugal, Slovenia, Spain and the UK, annual taeniosis cases were reported and the number of detected cases per year ranged between 1 and 114. Detected prevalences ranged from 0.05 to 0.27%, whereas estimated prevalences ranged from 0.02 to 0.67%. Most taeniosis cases were reported as Taenia spp. or T. saginata, although T. solium was reported in Denmark, France, Italy, Spain, Slovenia, Portugal and the UK. Human cysticercosis cases were reported in all western European countries except for Iceland, with the highest number originating from Portugal and Spain. Most human cysticercosis cases were suspected to have acquired the infection outside western Europe. Cases of T. solium in pigs were found in Austria and Portugal, but only the two cases from Portugal were confirmed with molecular methods. Germany, Spain and Slovenia reported porcine cysticercosis, but made no Taenia species distinction. Bovine cysticercosis was detected in all countries except for Iceland, with a prevalence based on meat inspection of 0.0002-7.82%.

CONCLUSIONS

Detection and reporting of taeniosis in western Europe should be improved. The existence of T. solium tapeworm carriers, of suspected autochthonous cases of human cysticercosis and the lack of confirmation of porcine cysticercosis cases deserve further attention. Suspected cases of T. solium in pigs should be confirmed by molecular methods. Both taeniosis and human cysticercosis should be notifiable and surveillance in animals should be improved.

Guidelines for the Detection of Babesia and Theileria Parasites

The genera Babesia and Theileria (phylum Apicomplexa, order Piroplasmida) are mainly transmitted by Ixodid ticks in which the sexual part of their life cycle followed by sporogony takes place. They include protozoan parasites that infect erythrocytes of a variety of vertebrate hosts, including domestic and wild animals, with some Babesia spp. also infecting humans. Babesia sporozoites transmitted in the tick's saliva during the bloodmeal directly infect erythrocytes, where they asexually multiply to produce pear-shaped merozoites in the process of merogony; whereas a pre-erythrocytic schizogonic life stage in leukocytes is found in Theileria and precedes merogony in the erythrocytes. The wide spectrum of Babesia and Theileria species and their dissimilar characteristics with relation to disease severity, transmission, epidemiology, and drug susceptibility stress the importance of accurate detection of babesiosis and theileriosis and their causative agents. These guidelines review the main methods currently used for the detection of Babesia and Theileria spp. for diagnostic purposes as well as epidemiological studies involving their vertebrate hosts and arthropod vectors. Serological methods were not included once they did not indicate current infection but rather exposure.

Guidelines for the Direct Detection of Anaplasma spp. in Diagnosis and Epidemiological Studies

The genus Anaplasma (Rickettsiales: Anaplasmataceae) comprises obligate intracellular Gram-negative bacteria that are mainly transmitted by ticks, and currently includes six species: Anaplasma bovis, Anaplasma centrale, Anaplasma marginale, Anaplasma phagocytophilum, Anaplasma platys, and Anaplasma ovis. These have long been known as etiological agents of veterinary diseases that affect domestic and wild animals worldwide. A zoonotic role has been recognized for A. phagocytophilum, but other species can also be pathogenic for humans. Anaplasma infections are usually challenging to diagnose, clinically presenting with nonspecific symptoms that vary greatly depending on the agent involved, the affected host, and other factors such as immune status and coinfections. The substantial economic impact associated with livestock infection and the growing number of human cases along with the risk of transfusion-transmitted infections, determines the need for accurate laboratory tests. Because hosts are usually seronegative in the initial phase of infection and serological cross-reactions with several Anaplasma species are observed after seroconversion, direct tests are the best approach for both case definition and epidemiological studies. Blood samples are routinely used for Anaplasma spp. screening, but in persistently infected animals with intermittent or low-level bacteremia, other tissues might be useful. These guidelines have been developed as a direct outcome of the COST action TD1303 EURNEGVEC ("European Network of Neglected Vectors and Vector-Borne Diseases"). They review the direct laboratory tests (microscopy, nucleic acid-based detection and in vitro isolation) currently used for Anaplasma detection in ticks and vertebrates and their application.

Infant and mother related outcomes from exposure to metals with endocrine disrupting properties during pregnancy

BACKGROUND

Endocrine-related adverse health effects from exposure to heavy metals such as lead, arsenic, cadmium, and mercury are yet to be adequately described. The purpose of this review was to gain insight into maternal exposure to heavy metals, and to identify potential endocrine-related adverse health effects in the mother and the infant.

METHODS

Relevant databases were searched for original research reports and a total of 46 articles were retained for scrutiny. Required data was extracted from these studies and their methodology was assessed.

RESULTS

Impaired fetal growth was observed from exposure to all endocrine disrupting metals, while exposure to lead and arsenic were associated with spontaneous abortion, stillbirth and neonatal deaths. Maternal exposure to arsenic was associated with impaired glucose tolerance in these mothers.

CONCLUSION

Impaired fetal growth, fetal loss, and neonatal deaths were significantly associated with heavy metals exposure during pregnancy; however, hypertension and gestational diabetes require further investigation.