Effectiveness and safety of secukinumab updosing in patients with moderate to severe plaque psoriasis: data from the PURE registry.

Secukinumab is a fully human IgG1 antibody that selectively binds to and neutralizes the proinflammatory cytokine interleukin-17A. Secukinumab is an effective and well-tolerated treatment for plaque psoriasis. There is a limited real-word evidence for dose optimisation of secukinumab based on clinical response. PURE is a multi-national, prospective, observational study in patients with moderate to severe chronic plaque psoriasis in Canada and Latin America, assessing the real-world safety and effectiveness of secukinumab and other indicated therapies. The aim of the current snapshot analysis was to evaluate the effectiveness and safety of on-label dose and updosed secukinumab in patients with plaque psoriasis enrolled in the PURE study. At the time of analysis, 676 patients received secukinumab, of which 84.6% (n = 572) remained on the on-label dose, while 15.4% (n = 104) were updosed. With on-label secukinumab, the absolute Psoriasis Area and Severity Index (PASI) score was reduced from 13.6 at baseline to 1.2 over 36 months, with treatment persistence of 73% at 40 months. At Month 36, 73.2% of the patients receiving on-label secukinumab achieved Investigator's Global Assessment (IGA) 0/1. With updosed secukinumab (300 mg every 2 weeks, 300 mg every 3 weeks, 450 mg every 4 weeks, or 450 mg every 3 weeks), 57.9% of the patients showed improvement in the absolute PASI score at the first visit after updosing, with treatment persistence of 50% at 12 months after updosing. At Month 15, 40% of patients receiving updosed secukinumab achieved IGA 0/1. Patients with previous biologic exposure (odds ratio [OR]: 3.25; 95% confidence interval [CI]: 2.03, 5.18, p < 0.0001) were more likely to be updosed while those with a body weight < 90 kg (OR: 0.49; 95% CI [0.31, 0.77], p = 0.0019) were less likely to be updosed. Previous biologic exposure (HR [hazard ratio]: 1.47; 95% CI [1.24, 1.75], p < 0.0001) and current biologic exposure (secukinumab vs. other indicated therapies: HR 0.57; 95% CI [0.43, 0.75], p = 0.0001) were significantly associated with time to secukinumab updosing. No new or unexpected safety signals were observed with updosed secukinumab. Secukinumab updosing was efficacious and well-tolerated in patients with psoriasis who failed to respond to the approved on-label regimen, suggesting that updosing may be a useful therapeutic option for approved dose non-responders.

Heterotopic ovarian allotransplantation in a caprine model: Effects of implant site on morphological parameters.

This study aimed to investigate a new implantation site (intra-auricular subcutaneous - IA) compared to intramuscular (IM) in the cervical portion (cervical splenius muscle) of the neck for ovarian transplantation in goats. Morphological aspects of the implant, follicular activation and morphology, and type I and III collagen deposits of the transplanted tissue were evaluated. Four fragments of the ovarian cortex were allotransplanted at the IA and IM sites in all goat recipients and recovered 7 (IA-7; IM-7) or 15 (IA-15; IM-15) days later and submitted to histological analysis. Two fragments/animal were separated for the fresh control (FC) group. There was a higher percentage of normal and developing primordial follicles at the IA-7 site (P < 0.05) compared to the other treatments, with similar values to the fresh control. Type I and III collagen fibers differed between the groups (P < 0.05), showing a considerable decrease in type I collagen fibers at the IA-7 site compared to the FC. However, the IM-7 and IA-15 sites showed higher values of type I collagen fibers, showing similarity to the FC. Therefore, we conclude that the IA site in goats is an effective site for ovarian tissue transplantation, as it is easily accessible, low invasive and has presented satisfactory rates of morphology and follicular activation.

Hybrid Dorsal Preservation Rhinoplasty: Reediting an Aesthetic Dorsum.

BACKGROUND: The prerequisite of a well-shaped dorsum with proper dorsal aesthetic lines that needs no modifications in its width and symmetry is key to letdown and push-down techniques as classically described. The common current concept is that total preservation of the middle vault is obligatory. This, however, obviously limits the indications, since nasal dorsum with natural aesthetic dorsal lines per se is relatively few. The recent, impressive, revival of letdown and push-down procedures has progressively generated numerous technical variations, but all those essentially still left the middle vault unmodified. The concept of splitting the middle vault and modifying its width and symmetry, while leaving the crucial dorsal (central) and lateral Keystone area intact, represents a new hybrid approach to the nasal dorsum. The structural benefits of classical component separation are combined with the major advantage of preserving the flexible chondro-osseous joint at the keystone junction. Osteotomies and/or osteoplasty can be done as necessary to modify the bony dorsum and at the same time any type of septal deformity can be addressed according to the time-tested L-strut principle, a Cottle septoplasty included. This hybrid approach expands indications beyond those of the conventional push-down/letdown technique, including moderate asymmetries of the bony and cartilaginous dorsum. Although splitting the middle vault along the septal T will also facilitate middle vault reshaping in cases where a full letdown procedure is indicated, this paper will clarity address only those instances where no circumferential osteotomy is done. METHODS AND MATERIALS: The dorsal bony nasal pyramid is always addressed first by rhinosculpture (osteoplasty) with piezoelectric inserts and/or burrs, in combination with different types of osteotomies as needed. This will allow narrowing of the bridge and correction of bony asymmetries. The osseous-cartilaginous connection of the central dorsal keystone area (DKA) is totally preserved. At this point, three main variations are possible: Type 1) preservation of the septal T and push-down by a high-middle septal strip resection, two different variations (1A and 1B) are possible here, Type 2) reduction in width of the septal T-segment and middle vault restoration by spreader flaps without any push-down of the septal T and Type 3) preservation of the septal T and letdown by low strip resection. CONCLUSION: Hybrid Dorsal Preservation involves concepts of Structure and Preservation Rhinoplasty. Dorsal and lateral keystone area are preserved, and the middle vault could be modified splitting the septal T in the anatomical plane, expanding patient indications and improve outcomes. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aortic Dissection With Cardiac Tamponade in Pregnancy: A Challenging Clinical Scenario.

Aortic dissection is the acute aortic syndrome with the highest mortality, and pregnancy and arterial hypertension are known risk factors. Its association with the perinatal period is a particularly unique and potentially devastating clinical catastrophe which is why the approach to a pregnant woman in cardiorespiratory arrest (CRA) should be multidisciplinary and early, with extraction of the fetus ideally within five minutes after the arrest. We present the case of a 39-year-old pregnant woman, who presented with a cardiorespiratory arrest in the context of an aortic dissection with cardiac tamponade and the need for an urgent perimortem cesarean section. Increasing knowledge and understanding among healthcare professionals has the potential to aid in the early detection and effective treatment of this challenging medical issue.

Sustained Effectiveness of Secukinumab Across Different Body Regions in Patients with Moderate-to-Severe Plaque Psoriasis from the PURE Registry.

INTRODUCTION: The association between physician-reported and patient-reported outcomes in patients with psoriasis is not adequately explored. Trends in PASI scores across body regions and the descriptive correspondence between physician-reported PASI components and patient-reported Psoriasis Symptom Diary are reported here. METHODS: PURE is a prospective observational study in adult patients from Canada and Latin America with moderate-to-severe chronic plaque psoriasis. The study enrolled 2362 adult patients treated with secukinumab versus other approved therapies (1:1 ratio). The PASI total score, PASI sub-scores for erythema, thickening, and scaling, and PASI scores for each body region were evaluated and further correlated with disease impact using the Psoriasis Symptom Diary. RESULTS: Secukinumab treatment showed early reduction in the PASI total score (mean ± SD) from 13.3 ± 9.02 at baseline to 2.3 ± 3.99 at 3 months; a similar trend was observed for PASI sub-scores for erythema (4.8 ± 3.21 to 0.9 ± 1.44), thickening (4.3 ± 3.00 to 0.7 ± 1.33) and scaling (4.2 ± 3.04 to 0.7 ± 1.30). The reduction in PASI total and sub-scores were sustained up to 36 months. Psoriasis Symptom Diary component scores related to redness, cracking, and scaling showed a similar reduction from baseline at 3 months that was also sustained up to 36 months. PASI regional scores for each body region showed reduction at 3 months with disease in the lower limbs being more treatment resistant. Safety profile of secukinumab was consistent with its established safety profile without any new or unexpected signals. CONCLUSIONS: Overall, an early and sustained resolution of erythema, thickening, and scaling was observed. Improvements were evident across all body regions, with the most persistent disease seen in the lower limbs. Trends in disease severity, as assessed by physicians using PASI, broadly reflected the trend in the comparable questions of the Psoriasis Symptom Diary assessed by patients.

Brewer's Spent Grain Enhanced the Recovery of Potential Probiotic Strains in Fermented Milk After Exposure to In Vitro-Simulated Gastrointestinal Conditions.

Brewer's spent grain (BSG) is a beer industry by-product with interesting functional properties by its high fiber content and bioactive compounds, which may be possibly employed as a prebiotic ingredient. The fermentability of BSG by ten probiotics and two starter cultures was evaluated, and the co-culture of Lacticaseibacillus paracasei subsp. paracasei F-19® (probiotic) and Streptococcus thermophilus TH-4® (starter) was selected to produce a potentially probiotic fermented milk (FM). Four formulations of FM were studied: FM1 (control), FM2 (probiotic - /BSG +), FM3 (probiotic + /BSG -), and FM4 (probiotic + /BSG +). The viability of the microorganisms in the FM was monitored throughout 28 days of storage. The resistance of the microorganisms in the FM to in vitro-simulated gastrointestinal tract (GIT) conditions was also evaluated. Even though the BSG did not influence the fermentation kinetics or increase the populations of both microorganisms in the FM, a significant improvement on the survival of TH-4® against in vitro-simulated GIT stress was observed in the formulations containing BSG alone or in combination with F-19®. All formulations showed potential as probiotic FM, since total probiotic populations were kept above 1010 CFU in a daily portion of 200 mL, and a minimum of 1010 and 108 CFU equivalent of, respectively, TH-4® and F-19® was recovered after the GIT stress. Therefore, TH-4® has potential as a probiotic strain in addition to its starter feature, while BSG may be employed as a possible prebiotic ingredient in a synbiotic approach. Nonetheless, further studies to evaluate possible health benefits are needed.

Anais da II Mostra Estadual de Educação Permanente em Saúde e I Mostra de Pesquisa Científica em Saúde: ciência e educação na saúde: transformando práticas / Proceedings of the 2nd State Exhibition of Permanent Education in Health and 1st Exhibition of Scientific Research in Health: science and education in health transforming practices

Anais da segunda Mostra Estadual de Educação Permanente em Saúde e da primeira Mostra de Pesquisa Científica em Saúde: Ciência e educação na saúde: transformando práticas realizadas em 7 e 8 de dezembro de 2022 em Palmas no Tocantins. Os temas abordados tratam de diferentes aspectos da área de saúde e suas práticas, com foco em melhorias nos processos de assistência, educação e gestão. São mencionados temas como primeiros socorros, humanização do atendimento hospitalar, segurança do paciente, planejamento estratégico, coleta de exames, regulamentação do trabalho na área da saúde, aleitamento materno, vigilância alimentar e nutricional, impactos da Covid-19, saúde mental, assistência odontológica, saúde do trabalhador, uso de tecnologia na capacitação em saúde, entre outros. As propostas e experiências relatadas buscam aprimorar a qualidade da assistência e dos serviços de saúde prestados à população, por meio da capacitação, atualização e aperfeiçoamento de profissionais, implementação de políticas públicas e melhoria dos processos de gestão e atendimento.

Proceedings of the Second State Exhibition on Permanent Education in Health and the First Scientific Research Exhibition in Health: Science and Education in Health: Transforming Practices held on December 7th and 8th, 2022, in Palmas, Tocantins. The topics covered deal with different aspects of the health field and its practices, focusing on improvements in the processes of assistance, education, and management. Topics such as first aid, humanization of hospital care, patient safety, strategic planning, examination collection, regulation of work in the health area, breastfeeding, food and nutritional surveillance, impacts of Covid-19, mental health, dental care, occupational health, use of technology in health training, among others, are mentioned. The proposals and experiences reported aim to improve the quality of assistance and health services provided to the population, through training, updating, and professional development, implementation of public policies, and improvement of management and care processes.

Actas de la Segunda Exhibición Estatal sobre Educación Permanente en Salud y la Primera Exhibición de Investigación Científica en Salud: Ciencia y Educación en Salud: Transformando Prácticas realizadas el 7 y 8 de diciembre de 2022 en Palmas, Tocantins. Los temas tratados abordan diferentes aspectos del campo de la salud y sus prácticas, enfocándose en mejoras en los procesos de asistencia, educación y gestión. Se mencionan temas como primeros auxilios, humanización de la atención hospitalaria, seguridad del paciente, planificación estratégica, recolección de exámenes, regulación del trabajo en el área de la salud, lactancia materna, vigilancia alimentaria y nutricional, impactos del Covid-19, salud mental, atención dental, salud ocupacional, uso de tecnología en la capacitación en salud, entre otros. Las propuestas y experiencias reportadas buscan mejorar la calidad de la asistencia y los servicios de salud proporcionados a la población, a través de la capacitación, actualización y desarrollo profesional, implementación de políticas públicas y mejora de los procesos de gestión y atención.

What Is Anthrax?

Anthrax has been feared for its high mortality in animals and humans for centuries. The etiologic agent is considered a potentially devastating bioweapon, and since 1876-when Robert Koch demonstrated that Bacillus anthracis caused anthrax-it has been considered the sole cause of the disease. Anthrax is, however, a toxin-mediated disease. The toxins edema toxin and lethal toxin are formed from protein components encoded for by the pXO1 virulence plasmid present in pathogenic B. anthracis strains. However, other members of the Bacillus cereus group, to which B. anthracis belongs, have recently been shown to harbor the pXO1 plasmid and produce anthrax toxins. Infection with these Bacillus cereus group organisms produces a disease clinically similar to anthrax. This suggests that anthrax should be defined by the exotoxins encoded for by the pXO1 plasmid rather than the bacterial species it has historically been associated with, and that the definition of anthrax should be expanded to include disease caused by any member of the B. cereus group containing the toxin-producing pXO1 plasmid or anthrax toxin genes specifically.

Modelling the ecological niche of naturally occurring anthrax at global and circumpolar extents using an ensemble modelling framework.

Bacillus anthracis, the causative agent of anthrax, is a spore-forming bacterium that primarily affects herbivorous livestock, wildlife and humans exposed to direct contact with infected animal carcasses or products. To date, there are a limited number of studies that have delineated the potential global distribution of anthrax, despite the importance of the disease from both an economic and public health standpoint. This study compiled occurrence data (n = 874) of confirmed human and animal cases from 1954 to 2021 in 94 countries. Using an ensemble ecological niche model framework, we developed updated maps of the global predicted ecological suitability of anthrax to measure relative risk at multiple scales of analysis, including a model for circumpolar regions. Additionally, we produced maps quantifying the disease transmission risk associated with anthrax to cattle, sheep and goat populations. Environmental suitability for B. anthracis globally is concentred throughout Eurasia, sub-Saharan Africa, the Americas, Southeast Asia, Australia and Oceania. Suitable environments for B. anthracis at the circumpolar scale extend above the Arctic Circle into portions of Russia, Canada, Alaska and northern Scandinavia. Environmental factors driving B. anthracis suitability globally include vegetation, land surface temperature, soil characteristics, primary climate conditions and topography. At the circumpolar scale, suitability is influenced by soil factors, topography and the derived climate characteristics. The greatest risk to livestock is concentrated within the Indian subcontinent, Australia, Anatolia, the Caucasus region, Central Asia, the European Union, Argentina, Uruguay, China, the United States, Canada and East Africa. This study expands on previous work by providing enhanced knowledge of the potential spatial distribution of anthrax in the Southern Hemisphere, sub-Saharan Africa, Asia and circumpolar regions of the Northern Hemisphere. We conclude that these updated maps will provide pertinent information to guide disease control programs, inform policymakers and raise awareness at the global level to lessen morbidity and mortality among animals and humans located in environmentally suitable areas.

A generalizable one health framework for the control of zoonotic diseases.

Effectively preventing and controlling zoonotic diseases requires a One Health approach that involves collaboration across sectors responsible for human health, animal health (both domestic and wildlife), and the environment, as well as other partners. Here we describe the Generalizable One Health Framework (GOHF), a five-step framework that provides structure for using a One Health approach in zoonotic disease programs being implemented at the local, sub-national, national, regional, or international level. Part of the framework is a toolkit that compiles existing resources and presents them following a stepwise schematic, allowing users to identify relevant resources as they are required. Coupled with recommendations for implementing a One Health approach for zoonotic disease prevention and control in technical domains including laboratory, surveillance, preparedness and response, this framework can mobilize One Health and thereby enhance and guide capacity building to combat zoonotic disease threats at the human-animal-environment interface.

West Nile Virus in the State of Ceará, Northeast Brazil.

In June 2019, a horse with neurological disorder was diagnosed with West Nile virus (WNV) in Boa Viagem, a municipality in the state of Ceará, northeast Brazil. A multi-institutional task force coordinated by the Brazilian Ministry of Health was deployed to the area for case investigation. A total of 513 biological samples from 78 humans, 157 domestic animals and 278 free-ranging wild birds, as well as 853 adult mosquitoes of 22 species were tested for WNV by highly specific serological and/or molecular tests. No active circulation of WNV was detected in vertebrates or mosquitoes by molecular methods. Previous exposure to WNV was confirmed by seroconversion in domestic birds and by the detection of specific neutralizing antibodies in 44% (11/25) of equids, 20.9% (14/67) of domestic birds, 4.7% (13/278) of free-ranging wild birds, 2.6% (2/78) of humans, and 1.5% (1/65) of small ruminants. Results indicate that not only equines but also humans and different species of domestic animals and wild birds were locally exposed to WNV. The detection of neutralizing antibodies for WNV in free-ranging individuals of abundant passerine species suggests that birds commonly found in the region may have been involved as amplifying hosts in local transmission cycles of WNV.

Root Resection in Molars: clinical Evaluation for 10 Years / Resección de la Raíz en Molares: evaluación Clínica Durante 10 años

Root resection (RR) is a therapeutic option for furcation lesions grade II and III, fracture of one of the roots and root caries. The aim of the study was to evaluate in each selected period (5, 8 and 10 years) the percentage of maintenance of molars that underwent RR therapy with furcation lesions grade II and III or with root fractures. Subjects received the therapy with RR in molars with periodontitis, with furcation lesion grades II or III, and with fractures, caries or endodontic reason, in one of the roots. The supportive periodontal therapy was made for at least one annual session during the assessed time. For the clinical therapy to be considered successful, the tooth is remaining in functional loading, without mobility above grade I, pocket depth ≥ 4 mm, absence of bleeding on probing or exudate, fractures and root caries. Were evaluated the files of 37 patients, 15 males and 22 females, with a mean age of 51.4 (SD = ± 12.46), with a total of 44 teeth with RR, 27 upper and 17 lower molars. The survival rates after the RR was 97.73 % for 05 years of evaluation (44 teeth), 95.35 % for the 08 years (43 teeth) and 97.57 % for the 10 years (41 teeth). 35 teeth were restored with total crows isolated or abutment of fixed prosthesis. The survival rates after 10-years was 90.91 %, and there was no statistical difference between the types of restorations performed and the tooth survival rate.

La resección de la raíz (RR) es una opción terapéutica para lesiones de furca de grado II y III, fractura de una de las raíces y caries de la raíz. El objetivo del estudio fue evaluar en cada período seleccionado (5, 8 y 10 años) el porcentaje de mantenimiento de los molares que se sometieron a terapia RR con lesiones de furca de grado II y III o con fracturas de raíz. Los sujetos recibieron la terapia con RR en molares con periodontitis, con lesión de furca de grado II o III, y con fracturas, caries o razón endodóntica, en una de las raíces. La terapia periodontal de apoyo se realizó durante al menos una sesión anual durante el tiem- po evaluado. Para que la terapia clínica se considere exitosa, el diente permanece en carga funcional, sin movilidad por encima del grado I, profundidad de bolsillo ≥ 4 mm, ausencia de sangrado al sondaje o exudado, fracturas y caries de raíz. Se evaluaron los archivos de 37 pacientes, 15 hombres y 22 mujeres, con una edad média de 51,4 (DE = ± 12,46), con un total de 44 dientes con RR, 27 molares superiores y 17 inferiores. Las tasas de supervivencia después del RR fueron del 97,73 % durante 5 años de evaluación (44 dientes), 95,35 % para los 8 años (43 dientes) y 97,57% para los 10 años (41 dientes). Se restauraron 35 dientes con cuervos totales aislados los pilares de prótesis fija. Las tasas de supervivencia después de 10 años fueron del 90,91 %, y no hubo diferencia estadística entre los tipos de restauraciones realizadas y la tasa de supervivencia dental.

Impact of a fermented soy beverage supplemented with acerola by-product on the gut microbiota from lean and obese subjects using an in vitro model of the human colon.

The aim of this study was to evaluate the effects of soy-based beverages manufactured with water-soluble soy extract, containing probiotic strains (Lactobacillus acidophilus LA-5 and Bifidobacterium longum BB-46) and/or acerola by-product (ABP) on pooled faecal microbiota obtained from lean and obese donors. Four fermented soy beverages (FSs) ("placebo" (FS-Pla), probiotic (FS-Pro), prebiotic (FS-Pre), and synbiotic (FS-Syn)) were subjected to in vitro digestion, followed by inoculation in the TIM-2 system, a dynamic in vitro model that mimics the conditions of the human colon. Short- and branched-chain fatty acids (SCFA and BCFA) and microbiota composition were determined. Upon colonic fermentation in the presence of the different FSs formulations, acetic and lactic acid production was higher than the control treatment for faecal microbiota from lean individuals (FMLI). Additionally, SCFA production by the FMLI was higher than for the faecal microbiota from obese individuals (FMOI). Bifidobacterium spp. and Lactobacillus spp. populations increased during simulated colonic fermentation in the presence of FS-Syn in the FMLI and FMOI. FS formulations also changed the composition of the FMOI, resulting in a profile more similar to the FMLI. The changes in the composition and the increase in SCFA production observed for the FMLI and FMOI during these in vitro fermentations suggest a potential modulation effect of these microbiotas by the consumption of functional FSs. KEY POINTS: • Soy beverages increased Bifidobacterium abundance in microbiota from obese individuals. • The synbiotic beverage increased Bifidobacterium abundance in microbiota from lean individuals. • The synbiotic beverage changed the microbiota from obese individuals, approaching the lean profiles.

Omalizumab Re-Treatment and Step-Up in Patients with Chronic Spontaneous Urticaria: OPTIMA Trial.

BACKGROUND: Omalizumab shows greater clinical benefit with 300 mg dose than with the 150 mg dose. OBJECTIVE: To determine outcomes postwithdrawal, relapse, and re-treatment in omalizumab responders, and from stepping up to 300 mg after insufficient symptom control with 150 mg. METHODS: This was a prospective, randomized (3:4), open-label, noncomparator study (clinicaltrials.gov: NCT02161562). A total of 314 adult patients with chronic spontaneous urticaria and symptomatic on H1-antihistamines were enrolled between August 1, 2014, and November 6, 2015. Patients received 150 mg/300 mg omalizumab, every 4 weeks for 24 weeks. Omalizumab 150 mg dose could be stepped up to 300 mg between week 8 and week 24, if the 7-day sum of the daily Urticaria Activity Score (UAS7) was more than 6. If patients relapsed after treatment withdrawal at week 24, they could be re-treated with the same dose on which omalizumab was started. Patients on 300 mg could extend treatment by 12 weeks if they did not achieve symptom control on 300 mg in the initial dosing phase. The primary end point was the proportion of well-controlled patients who relapsed postwithdrawal, and achieved symptom control at the end of re-treatment. Symptom control was assessed using UAS7 (UAS7 ≤ 6 = well controlled). RESULTS: Overall, 115 of 314 patients had adequate symptom control at week 24 (end of the initial dosing period) and 56 were re-treated after relapse postwithdrawal; 87.8% (95% CI, 78.6%-96.9%) regained symptomatic control (UAS7 ≤ 6). Most (141 of 178) patients initially treated with 150 mg required step-up to 300 mg, which resulted in a 9.5-point (95% CI, 7.6-11.3) improvement in UAS7 over the mean change observed initially on 150 mg. CONCLUSIONS: Step-up to 300 mg helps a greater proportion of patients achieve symptom control, and re-treatment with omalizumab is as effective as initial therapy.

Potential distributions of Bacillus anthracis and Bacillus cereus biovar anthracis causing anthrax in Africa.

BACKGROUND: Bacillus cereus biovar anthracis (Bcbva) is an emergent bacterium closely related to Bacillus anthracis, the etiological agent of anthrax. The latter has a worldwide distribution and usually causes infectious disease in mammals associated with savanna ecosystems. Bcbva was identified in humid tropical forests of Côte d'Ivoire in 2001. Here, we characterize the potential geographic distributions of Bcbva in West Africa and B. anthracis in sub-Saharan Africa using an ecological niche modeling approach. METHODOLOGY/PRINCIPAL FINDINGS: Georeferenced occurrence data for B. anthracis and Bcbva were obtained from public data repositories and the scientific literature. Combinations of temperature, humidity, vegetation greenness, and soils values served as environmental variables in model calibrations. To predict the potential distribution of suitable environments for each pathogen across the study region, parameter values derived from the median of 10 replicates of the best-performing model for each pathogen were used. We found suitable environments predicted for B. anthracis across areas of confirmed and suspected anthrax activity in sub-Saharan Africa, including an east-west corridor from Ethiopia to Sierra Leone in the Sahel region and multiple areas in eastern, central, and southern Africa. The study area for Bcbva was restricted to West and Central Africa to reflect areas that have likely been accessible to Bcbva by dispersal. Model predicted values indicated potential suitable environments within humid forested environments. Background similarity tests in geographic space indicated statistical support to reject the null hypothesis of similarity when comparing environments associated with B. anthracis to those of Bcbva and when comparing humidity values and soils values individually. We failed to reject the null hypothesis of similarity when comparing environments associated with Bcbva to those of B. anthracis, suggesting that additional investigation is needed to provide a more robust characterization of the Bcbva niche. CONCLUSIONS/SIGNIFICANCE: This study represents the first time that the environmental and geographic distribution of Bcbva has been mapped. We document likely differences in ecological niche-and consequently in geographic distribution-between Bcbva and typical B. anthracis, and areas of possible co-occurrence between the two. We provide information crucial to guiding and improving monitoring efforts focused on these pathogens.

Aqueous extracts of Agave sisalana boles have prebiotic potential.

This work aimed at evaluating the prebiotic potential of the aqueous extract and crude polysaccharides from Agave sisalana boles by an in vitro screening. Crude polysaccharides were obtained from the aqueous bole extract by precipitation with acetone and resuspension in water. The liquid extract and the polysaccharide solution were then spray dried and submitted to thermal analysis and quantification of metabolites. Prebiotic activity was checked on probiotic strains belonging to the Lactobacillus genus using inulin, fructo-oligosaccharides, fructose and glucose as positive controls. The powder of A. sisalana bole extract, which has recently been identified as a rich source of inulin, exhibited higher potential of fermentation compared with crude polysaccharides.

Salmonella Serotypes: A Novel Measure of Association with Foodborne Transmission.

Most nontyphoidal Salmonella (NTS) illnesses in the United States are thought to be foodborne. However, transmission routes likely vary among the different serotypes. We developed a relative ranking of NTS serotypes according to the strength of their association with foodborne transmission. We used Laboratory-based Enteric Disease Surveillance data to estimate the proportion of infections for each Salmonella serotype reported from 1998 to 2015 and Foodborne Disease Outbreak Surveillance System data to calculate the proportion of foodborne outbreak-associated Salmonella illnesses caused by each serotype. We calculated the ratios of these proportions to create a foodborne relatedness (FBR) measure for each serotype. Of the top 20 serotypes, Saintpaul (2.14), Heidelberg (1.61), and Berta (1.48) had the highest FBR measures; Mississippi (0.01), Bareilly (0.13), and Paratyphi B variant L(+) tartrate(+) (0.20) had the lowest. The FBRs for the three most prevalent serotypes were 1.22 for Enteritidis, 0.77 for Typhimurium, and 1.16 for Newport. This method provides a quantitative approach to estimating the relative differences in the likelihood that an illness caused by a particular serotype was transmitted by food, which may aid in tailoring strategies to prevent Salmonella illnesses and guide future research into serotype-specific source attribution.

Impact of Acerola (Malpighia emarginata DC) Byproduct and Probiotic Strains on Technological and Sensory Features of Fermented Soy Beverages.

Ten probiotic cultures were screened for the ability to hydrolyze soy proteins and bile salt deconjugation (BSD) to select one lactobacilli and one bifidobacteria strain to produce fermented soy beverages (FSBs) containing acerola byproduct (ABP). Next, the effect of the strains and the ABP on the technological and sensory characteristics of these beverages was evaluated during refrigerated storage for up to 28 days. None of the tested strains presented any proteolytic activity against soy proteins. Among the probiotic strains, the best BSD activities were observed for Lactobacillus acidophilus LA-5 and Bifidobacterium longum BB-46, which were further employed, individually or combined, to produce FSB supplemented or not with ABP, using Streptococcus thermophilus TH-4 as a starter, and the effect of these strains and ABP on the technological and sensory acceptability of FSB was evaluated. The probiotic strains did not influence FBS texture parameters, but ABP increased firmness in the ready product. BB-46 increased acidity, therefore decreasing acceptance, whereas the presence of LA-5 and/or ABP increased acceptance, even though the appearance was negatively affected by ABP after 21 days of storage. Thus, the presence of LA-5 and ABP contributed for the sensory acceptance of the FSBs without affecting their technological features. PRACTICAL APPLICATION: Lactobacillus acidophilus LA-5, Bifidobacterium longum BB-46, and/or acerola byproduct (ABP) were applied in the production of fermented soy beverages (FSBs). Principal components analysis was used to evaluate the formulations of the 23 factorial design and the sensory attributes and the effect of storage independently and covariance was the matrix type used for mapping purposes. LA-5 and ABP contributed for the sensory acceptance of FSB, without affecting their technological features, and could be used by food processing companies after scaling up, also reducing the environmental impact by decreasing discarding byproducts, which are sources of bioactive compounds.

Rationale, objectives and design of PURE, a prospective registry of patients with moderate to severe chronic plaque psoriasis in Canada and Latin America.

BACKGROUND: Treatment options for the management of moderate to severe plaque psoriasis include phototherapy, oral systemic agents, and biologic therapy. Secukinumab, a fully human monoclonal antibody that selectively targets IL-17A, is the first IL-17 antagonist approved for this patient population. Long-term observational data are required for establishing the true population-based benefit-risk ratio of approved treatments. PURE is a multinational registry that will assess the real-world safety and effectiveness of secukinumab and other approved therapies in the management of patients with moderate to severe psoriasis. METHODS: This is a multinational (Canadian and Latin American), prospective, observational study of adult patients with moderate to severe psoriasis that initiate treatment with secukinumab or other approved therapies as per local standard of care. A total of 2500 patients (1250 per cohort) will be recruited in the practices of hospital and community dermatologists. Decision regarding treatment must have been reached prior to and independent of patient enrollment in the study. The study includes a 5-year follow-up with recommended assessments at Baseline, 3 and 6 months post-Baseline, and every 6 months thereafter. The primary objective of the study is safety. Secondary outcome measures relate to effectiveness (Investigator's Global Assessment -IGA mod 2011-, Psoriasis Areas and Severity Index, Body Surface Area), patient reported outcomes (Dermatology Life Quality Index, Work Productivity and Activity Impairment Questionnaire, Hospital Anxiety and Depression Scale, Psoriasis Epidemiology Screening Tool, Psoriasis Symptom Diary, and Treatment Satisfaction Questionnaire), and healthcare resource utilization. DISCUSSION: This is the first observational study in Canada and Latin America assessing the real-world safety and effectiveness of secukinumab in the management of moderate to severe psoriasis. The extensive clinical, patient-reported and health economic outcomes collected will allow the comprehensive evaluation of this new treatment in comparison to other approved therapies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02786186 ; date of registration: May 30, 2016.

Anthrax Epizootic in Wildlife, Bwabwata National Park, Namibia, 2017.

In late September 2017, Bwabwata National Park in Namibia experienced a sudden die-off of hippopotamuses and Cape buffalo. A multiorganizational response was initiated, involving several ministries within Namibia and the US Centers for Disease Control and Prevention. Rapid interventions resulted in zero human or livestock cases associated with this epizootic.