Dermatologic Ultrasound in Primary Care: A New Modality of Teledermatology: A Prospective Multicenter Validation Study.

OBJECTIVES: This study aimed to validate dermatologic ultrasound as a complementary teledermatologic imaging modality in primary and tertiary care centers. METHODS: Six primary care centers and 1 tertiary care dermatology department collaborated in the program. Images were sent through the institutional teledermatologic platform to the tertiary care dermatology department. At the reference hospital, ultrasound images and clinical data were received and registered by a physician trained in dermatologic ultrasound. An in-person consultation was scheduled to confirm the teleultrasound diagnosis. The time of response by the tertiary center, quality and size of the teledermatologic image, and concordance with the in-person diagnosis were assessed for each dermatologic lesion. RESULTS: A total of 147 teleultrasound consultations with 143 patients (93 women and 50 men; mean age ± SD, 47 ± 23 years) were evaluated between June 2018 and January 2019. Nine teleultrasound consultations (6.1%) were not valid. Discordance between teleultrasound and the in-person diagnosis was evident in 6 of 138 cases (4.3%). Most cases corresponded to benign skin tumors (66.7%), followed by inflammatory skin lesions (15.9%), nonmelanoma skin lesions (13%), and other skin lesions (4.3%). All malignant tumors were detected (sensitivity, 100%), although 2 cases of benign lesions were telediagnosed as malignant (specificity, 97.8%). The positive and negative predictive values of a teleultrasound diagnosis of cutaneous malignancy were 90% and 100%, respectively. CONCLUSIONS: Asynchronous primary care teleultrasound combined with dermatologic ultrasound training at tertiary centers is an effective teledermatologic modality.

Molecular Pathways Leading to Induction of Cell Death and Anti-Proliferative Properties by Tacrolimus and mTOR Inhibitors in Liver Cancer Cells.

BACKGROUND/AIMS: Orthotopic liver transplantation (OLT) is the recommended treatment for patients at early stages of hepatocarcinoma (HCC) with portal hypertension and/or increased bilirubinemia, but without vascular-associated diseases. Tumor recurrence, which is the main drawback for the survival of patients submitted to OLT for HCC, has been related to tumor-related variables and the immunosuppressive therapies. We have previously shown that Tacrolimus (FK506) exerts a more potent pro-apoptotic and anti-proliferative effects than the mammalian target of rapamycin (mTOR) inhibitors (Sirolimus and Everolimus) in liver cancer cells. This study identified the role of the immunosuppressant partners such as FK506-binding proteins (FKBPs) in the induction of cell death and arrest of cell proliferation by immunosuppressants in two representative liver cancer cells. METHODS: The regulation of endoplasmic reticulum (ER) stress, apoptosis/autophagy, cell proliferation, and FKBPs expression was determined in Tacrolimus-, Sirolimus- and Everolimus-treated primary human hepatocytes, and hepatoma HepG2 and Huh7 cell lines. The functional repercussion of FKBPs on cell death and proliferation was also addressed using the siRNA technology. The assessed antitumoral properties of the immunosuppressants were associated to microRNAs (miRNAs) pattern. RESULTS: The enhanced pro-apoptotic and anti-proliferative properties of Tacrolimus versus mTOR inhibitors were associated with increased protein kinase RNA-like endoplasmic reticulum kinase (PERK)-related ER stress, Ser15P-p53/p53 ratio and p21 protein expression that may counterbalance the risk of proliferative upregulation caused by enhanced Thr172P-Cdk4/Cdk4 activation in liver cancer cells. The inhibition of the mTOR pathway by Sirolimus and Everolimus was related to an induction of autophagy; and at a high dose, these drugs impaired translation likely at a very early step of the elongation phase. Tacrolimus and mTOR inhibitors increased the protein expression of FKBP12 and FKBP51 that appeared to play pro-survival role. Interestingly, the administration of immunosuppressants yields a specific pattern of miRNAs. Tacrolimus and mTOR inhibitors decreased miR-92a-1-5p, miR-197-3p, miR-483-3p and miR-720, and increased miR-22-3p, miR-376a-3p, miR-663b, miR-886-5p, miR-1300 and miR-1303 expressions in HepG2 cells. CONCLUSION: The more potent pro-apoptotic and anti-proliferative properties of Tacrolimus versus mTOR inhibitors were associated with an increased activation of PERK and p53 signaling, and p21 protein expression. FKBP12 and FKBP51 appeared to be the most relevant partners of Tacrolimus and mTOR inhibitors exerting a pro-survival effect in HepG2 cells. The observed effects of immunosuppressants were related to a specific miRNA signature in liver cancer cells.

A case of inflammatory pseudotumour of the gallbladder presenting as a big mass of uncertain behavior.

BACKGROUND: Inflammatory pseudotumour has been used to describe an inflammatory or fibrosing tumoral process of an undetermined cause that may involve a variety of organ systems, including the lungs, spleen, liver, lymph nodes, pancreas and extrahepatic bile duct with potential for recurrence and persistent local growth. In this article, we report a patient with a big mass of uncertain nature and behavior. CASE PRESENTATION: A 60-year-old woman presented with a 1-week history of abdominal pain, fever and jaundice. Six months before she had had right upper quadrant pain that was interpreted as biliary colic. A contrast-enhanced CT scan showed a big mass of soft tissue with diffuse infiltration of the gallbladder, displacement of the transverse colon, hepatic flexure and duodenum. For diagnostic distinction between a chronic inflammatory disease or a neoplasm, exploratory laparotomy was required. Intraoperative exploration disclosed a big mass of hard texture involving the gallbladder, with multiple concrements, hepatoduodenal ligament, right and transverse mesocolon, stomach and duodenum. Cholecystectomy was performed, preserving adjacent organs with macroscopic desmoplastic reaction. Histopathologic examination of the gallbladder showed a spindle cell proliferation with diffuse chronic inflammatory infiltrate of lymphocytes, plasma cells and hyalinized fibrous stroma. No vascular invasion or cellular atypia were evident. CONCLUSION: Inflammatory pseudotumour is a rare condition and diagnostic distinction from a chronic inflammatory disease or other neoplasm is only possible by histopathologic examination. There is a limited number of case reports in the literature indicating tumor location in the gallbladder.

Early 3-month treatment with comprehensive physical therapy program restores continence in urinary incontinence patients after radical prostatectomy: A randomized controlled trial.

AIMS: The objective of this study is to ascertain whether an early three-month treatment with electrotherapy and biofeedback restores continence in urinary incontinence patients after radical prostatectomy (RP). METHODS: Design: The study performed a randomized, controlled trial of parallel and open groups. Configuration: Secondary care, urology department of a university hospital complex. PARTICIPANTS: Patients sent for RP due to prostate cancer (n = 60), 47 patients finally completed the study. INTERVENTIONS: The treatment group (TG) received physiotherapy consisting of electrotherapy and biofeedback, 3 days a week for 3 months, while the control group (CG) received no specific treatment. Both groups received a guide to perform pelvic floor exercises at home. The measurement instruments used were the 1- and 24-hour pad tests and the International Consultation on Incontinence Questionnaire Short-Form. The recording method used was a micturition (urinary) diary. RESULTS: The results of the 1-hour pad test (PT) show statistically significant differences between groups at 3 months (P = .001) and 6 months (P = .001), in favor of those in the TG. Sixty-four percent of patients in the TG recovered continence as against 9.1% in the CG after 3 months in the 1-hour PT, in line with the objective of this study. CONCLUSIONS: An early physiotherapy program helps RP patients with urinary incontinence recover continence after 3 months. Moreover, they lead a better quality life.

Epidemiology, use, and practice of the intraosseous route in an out-of-hospital emergency department: a retrospective cross-sectional study.

Introduction: The Spanish Emergency Medical Services, according to the model we know today, were formed during the 80s and 90s of the 20th century. The Health Emergency Service (EMS), 061 La Rioja, began to assist the population of La Rioja in November 1999. An essential part of the mission of the SES is the provision of care and the transfer of critical patients using advanced life support unit (ALSU) techniques. In daily practice, out-of-hospital emergency services are faced with situations in which they must deal with the care of serious or critically ill patients, in which the possibility of being able to channel peripheral vascular access as part of ALSU quickly may be difficult or impossible. In these cases, cannulation of intraosseous (IO) vascular access may be the key to early and adequate care. Aim: This study aimed to determine the incidence and epidemiology use of IO vascular access in SES 061 La Rioja during the year 2022. Matherial and methods: We performed observational retrospective cross-sectional studies conducted in 2022. It included a population of 4.364 possible patients as a total of interventions in the community of La Rioja in that year. Results: A total of 0.66% of patients showed a clinical situation that required the establishment of IO vascular access to enable out-of-hospital stabilization; this objective was achieved in 41.3%. A total of 26.1% of patients who presented with cardiorespiratory arrest (CA) were stabilized, while 100% presented with shock and severe trauma. Discussion: IO vascular access provides a suitable route for out-of-hospital stabilization of critically ill patients when peripheral vascular access is difficult or impossible.

Knowledge Level of ICU Nurses Regarding Nutritional Assessment of Critically Ill Patients: A Systematic Review.

BACKGROUND: Nutritional assessment on admission of critical patients is of vital importance to determine critical patients in whom there is a risk of malnutrition. Currently, it has been detected in most of the patients admitted to the Intensive Care Unit (ICU) that 60% of the daily calories are not achieved. Nurses play an essential role in the comprehensive assessment of the patient, including the nutritional area; however, significant deficits have been detected in some knowledge regarding Enteral Nutrition (EN). OBJECTIVE: We aim to determine the level of knowledge of nurses in the nutritional assessment of critically ill patients. METHODOLOGY: A systematic review of the scientific literature was conducted using the PRISMA statement. Between January 2017 and February 2023, articles were rescued from the electronic databases "Pubmed", "Scopus" and "The Cochrane Library", which analyzed the level of knowledge of ICU nurses regarding nutritional assessment. RESULTS: Most of the results found showed that nurses had deficient levels of knowledge in relation to nutritional assessment and practices. Interventions related to nutritional assessment were scarce, in contrast to those associated with the management of Nasogastric Tube (NGT) or patient positioning. CONCLUSIONS: The level of knowledge described was low or inadequate in relation to the care associated with the nutritional assessment of critically ill patients. The use of scales to assess the risk of malnutrition was not reported. This study was prospectively registered at PROSPERO on 25/10/2023 (insert date) with registration number CRD: 42023426924.

Hospital-based screening outperforms primary care screening as a means of achieving hepatitis C virus micro-elimination.

AIM: To assess the respective performances of a HCV screening program in a hospital setting and a HCV screening model applied concomitantly in a primary care centre. METHODS: Adult patients consecutively admitted to hospital for ambulatory surgery were screened for anti-HCV antibodies (hospital screening cohort, HPSC), as were patients receiving blood tests for medical reasons in a primary care centre (primary care screening cohort, PCSC). Serum anti-HCV and HCV RNA levels were tested by ELISA and real-time PCR, respectively. RESULTS: Seroprevalence of HCV infection was 2.2 % in the HPSC and 1.4 % in the PCSC (p = 0.044). All viraemic patients (0.2 % in HPSC and 0.1 % in PCSC) were treated with direct-acting antivirals and 85.7 % experienced a sustained virological response. CONCLUSIONS: Hospital-based HCV screening outperformed primary care-centered screening, significantly increasing HCV case findings.

Factors related with nursing students' health literacy: a cross sectional study.

Background: Nursing professionals have a crucial role in promoting health literacy in health services, so it is necessary to ensure health literacy skills in future health professionals. Objective: The objective of the study was to examine the health literacy of nursing students and its associated factors. Methods: A cross-sectional descriptive study was carried out on 460 nursing students. For data collection, a semi-structured questionnaire was obtained on sociodemographic characteristics, perception and health care, use of the health system and lifestyles. In addition, health literacy was assessed using the European Health Literacy Questionnaire. Results: 6.1% of the participants had an inadequate level of health literacy and 36.5% problematic. The probability of having sufficient health literacy is directly associated with age; and inversely with smoking, prolonged screen time and living alone (p < 0.05). Conclusion: A large percentage of nursing students need to improve their health literacy skills. It is necessary to integrate a greater number of contents in health literacy in the curriculum of nursing students.

Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study.

Introduction: Major trauma is one of the major health care problems facing modern society, trauma systems require careful planning to achieve an ideal level of coverage for the population. The Patient Blood Management Program is an integrated and global strategy to provide patient care that aims to assess and address, when possible, the etiology of blood abnormalities rather than transfuse without treating the underlying cause. We aimed to describe the factors that are associated with the clinical decision to transfuse polytraumatized patients admitted to the Intensive Care Unit (ICU). Method: We performed a cross sectional multicenter study of patients admitted to ICUs for trauma in 14 Spanish hospitals from September 2020 to December 2021. Results: A total of 69 patients were treated in the emergency room due to polytrauma, 46% of them were considered serious in the initial triage. Thirty were caused by a fall from considerable height (43.47%), followed by 39 patients admitted due to trac accidents (56.52%). The location of the trauma was mainly cranioencephalic, followed by thoracic trauma. Of the 69 patients, 25 received a blood transfusion during their ICU stay (36.23%). Discussion: No significant differences were observed between transfused and non-transfused patients, except for the severity scales, where transfused patients have a higher score on all the scales assessed in the ICU except for the Revised Trauma Score. As we can see, the incidence of kidney failure was also different between the groups analyzed, reaching 44.00% in transfused patients and 13.64% in the group of patients without blood transfusion, p = 0.005. In this sense, 92.00% of the transfusions performed were inadequate according to the criteria of Hb in blood prior to the decision to transfuse (Hb < 9). Our data support the need to consider clinical practice guidelines regarding blood transfusion and its practices.

Monitoring of Rabbit Hemorrhagic Disease Virus in European Wild Rabbit (Oryctolagus cuniculus) Populations by PCR Analysis of Rabbit Fecal Pellets.

European rabbits (Oryctolagus cuniculus) are affected by rabbit hemorrhagic disease (RHD), which is caused by a lagovirus responsible for significant mortality in European wild rabbit populations. Our study aimed to evaluate the potential for detecting viral RNA by duplex real-time PCR in rabbit fecal pellets collected in the field, as a noninvasive method to monitor RHD virus circulation in wild populations. To do this, monthly discoveries of rabbits that died from RHD and detection of viral RNA in fecal pellets were recorded in two enclosed populations of wild rabbits throughout a year. The results suggested a low performance of this procedure to monitor viral infection incidence and a weak concordance with monthly discoveries of rabbits that died from RHD. This poor association was probably due to the low amount of viral RNA in feces, the prolonged time of excretion after infection, and that the number of rabbits found dead from RHD does not necessarily correlate with RHD incidence. Nevertheless, this procedure may be a complementary noninvasive method to assist in determining the presence of RHD viruses in populations. Additional research is needed to determine the suitability of this methodology to perform epidemiologic surveys on wild populations of European rabbits and, especially, other European or North American lagomorph species affected by lagoviruses.

Changes in European wild rabbit population dynamics and the epidemiology of rabbit haemorrhagic disease in response to artificially increased viral transmission.

European wild rabbit (Oryctolagus cuniculus) populations are severely affected by rabbit haemorrhagic disease (RHD), currently aggravated by the spread of the new lagovirus serotype RHDV2 that replaced the classical RHDV strains (RHDV/RHDVa). This virus causes high mortality in both adult and young rabbits and to date, there is no management tool to effectively reduce its impact on wild rabbit populations. This hinders the success of common strategies, such as habitat management or restocking, in areas where rabbits are native. However, the present study, conducted on enclosed wild rabbit populations, showed that spreading RHDV2 on baits during breeding periods induced infection of young rabbits, reducing mortality rates, presumably due to maternal antibody protection. This reduced the young rabbit mortality hazard by a third, and more juvenile rabbits immune to RHDV2 were recruited into the adult breeding population. Young rabbits from populations in which the force of infection of RHDV2 was increased, however, exhibited considerably higher susceptibility to infection by RHDV than those from non-treated control populations. Since co-circulation of classical RHDVs was ruled out, differences in the type and degree of immunization, the level of cross-protection and/or other unknown factors, such as the circulation of undetected non-pathogenic lagoviruses, arose as possible explanations. This meant that although the present study demonstrated the possibility of successfully modulating the impact of RHD in wild populations, the epidemiological complexity of the situation where several lagoviruses circulate requires additional research to determine final applicability of the proposed method.

Assessment of listing and categorisation of animal diseases within the framework of the Animal Health Law (Regulation (EU) No 2016/429): infection with Equine Herpesvirus-1.

Equine Herpesvirus-1 infection has been assessed according to the criteria of the Animal Health Law (AHL), in particular criteria of: Article 7 on disease profile and impacts, Article 5 on the eligibility of the disease to be listed, Article 9 for the categorisation of the disease according to disease prevention and control measures as in Annex IV and Article 8 on the list of animal species related to Equine Herpesvirus-1 infection. The assessment has been performed following a methodology composed of information collection and compilation, and expert judgement on each criterion at individual and collective level. The outcome is the median of the probability ranges provided by the experts, which indicates whether the criterion is fulfilled (66-100%) or not (0-33%), or whether there is uncertainty about fulfilment (33-66%). For the questions where no consensus was reached, the different supporting views are reported. According to the assessment performed, Equine Herpesvirus-1 infection can be considered eligible to be listed for Union intervention according to Article 5 of the Animal Health Law with 33-90% certainty. According to the criteria as in Annex IV of the AHL related to Article 9 of the AHL for the categorisation of diseases according to the level of prevention and control, it was assessed with less than 1% certainty that EHV-1 fulfils the criteria as in Section 1 (category A), 1-5% for the criteria as in Section 2 (category B), 10-66% for the criteria as in Section 3 (category C), 66-90% for the criteria as in Section 4 (category D) and 33-90% for the criteria as in Section 5 (category E). The animal species to be listed for EHV-1 infection according to Article 8(3) criteria are the species belonging to the families of Equidae, Bovidae, Camelidae, Caviidae, Cervidae, Cricetidae, Felidae, Giraffidae, Leporidae, Muridae, Rhinocerontidae, Tapiridae and Ursidae.

Assessment of the control measures of the category A diseases of Animal Health Law: Rift Valley Fever.

EFSA received a mandate from the European Commission to assess the effectiveness of some of the control measures against diseases included in the Category A list according to Regulation (EU) 2016/429 on transmissible animal diseases ('Animal Health Law'). This opinion belongs to a series of opinions where these control measures were assessed for several diseases, with this opinion covering the assessment of control measures for Rift Valley Fever (RVF). In this opinion, EFSA and the AHAW Panel of experts review the effectiveness of: (i) clinical and laboratory sampling procedures, (ii) monitoring period and (iii) the minimum radius of the protection and surveillance zone and the minimum length of time the measures should be applied in these zones. The general methodology used for this series of opinions has been published elsewhere; nonetheless, the transmission kernels used for the assessment of the minimum radius of the protection and surveillance zones are shown. Several scenarios for which these control measures had to be assessed were designed and agreed prior to the start of the assessment. Different risk-based sampling procedures based on clinical visits and laboratory testing are assessed in case of outbreak suspicion, granting animal movements and for repopulation purposes. The length of monitoring period and minimum duration of measures to be implemented in the restricted zones as defined in the Delegated Regulation (30 days) are considered effective for the investigation and control of suspected and confirmed RVF outbreaks, as well as the size of protection and surveillance zone of 20 and 50 km, respectively, which are assessed as sufficient to contain disease transmission with at least 95% probability.

Assessment of the control measures of the Category A diseases of the Animal Health Law: prohibitions in restricted zones and risk-mitigating treatments for products of animal origin and other materials.

EFSA received a mandate from the European Commission to assess the effectiveness of prohibitions of certain activities in restricted zones, and of certain risk mitigation treatments for products of animal origin and other materials with respect to diseases included in the Category A list in the Animal Health Law (Regulation (EU) 2016/429). This opinion belongs to a series of opinions where other disease-specific control measures have been assessed. In this opinion, EFSA and the AHAW Panel of experts review the effectiveness of (i) prohibiting the movements of certain products, notably germinal products (semen, oocytes, embryos and hatching eggs), products of animal origin and animal by-products and feed of plant origin, hay and straw, and (ii) risk mitigation treatments for products of animal origin. In terms of semen, oocytes, embryos and hatching eggs, it was agreed that there was a lack of evidence particularly for embryos and oocytes reflected in a varying degree of uncertainty, whether these commodities could potentially contain the pathogen under consideration. The scenario assessed did not consider whether the presence of pathogen would lead to infection in the recipient animal. In terms of animal products, certain animal by-products and movement of feed of plant origin and straw, the assessment considered the ability of the commodity to transmit disease to another animal if exposed. For most pathogens, products were to some degree considered a risk, but lack of field evidence contributed to the uncertainty, particularly as potential exposure of ruminants to meat products is concerned. In terms of the risk mitigating treatments, recommendations have been made for several of these treatments, because the treatment description is not complete, the evidence is poor or inconclusive, or the evidence points to the treatment being ineffective.

[Prostate cancer, antiandrogen treatment and cardiovascular risk]. / Cáncer de próstata, terapia antiandrogénica y riesgo cardiovascular.

AIM: To assess if cardiovascular risk (CVR) charts are able to identify the increased risk caused by androgen deprivation therapy (ADT) in patients with prostate cancer (PCa). DESIGN: Retrospective cohort study. LOCATION: Urban and rural health centres in the province of Ourense. PARTICIPANTS: Patients diagnosed with PCa who had been prescribed treatment for ADT between 2007 and 2008. MAIN MEASURES: Age, residence (rural/urban), staging (Gleason), diagnostic procedure and, at the beginning and end of follow-up, lipid profile, blood pressure, diagnosis of diabetes mellitus, smoking, use of antihypertensive and lipid-lowering drugs, and Framingham calibrated and ATP III indexes, were determined. Cardiovascular events were recorded during the follow-up. Each patient was his own control. Increasing age was not used in the calculation of the scores at the end of the follow up period. The scores were compared using the t-test for paired samples (SPSS 15.0). RESULTS: A total of 209 cases were included. The mean (SD) age was 73.8 (8.0) years, with 64.6% of urban cases. The scores at baseline and at 12 months of follow-up were: Framingham 9.0 (4.6) and 9.2 (4.8) (P=0.5), ATP III 14.2 (1.7) and 14.2 (1.7) (P=0.9). CONCLUSION: CVR charts do not assess the increased risk associated with androgen deprivation therapy in prostate cancer.

Complications of polypropylene mesh for the treatment of female pelvic floor disorders.

OBJECTIVES: To assess the complications of polypropylene mesh in the treatment of female pelvic floor disorders. METHODS: Retrospective study of patients with pelvic floor pathology (SUI, cystocele, rectocele, enterocele) undergoing pelvic floor intervention with surgical meshes from March 2002 to October 2009. We evaluated complications, effectiveness of the technique and distribution of the impact of the results. For statistical analysis SPSS software was used and the curve of impact was estimated by Cox model. RESULTS: We analyzed 363 patients. Of these 363 patients, 290 (79.9%) suffered from Stress Urinary Incontinence 37 (10.2%)cystocele, 33 (9.4%) SUI and cystocele, 1 (0.3%) SUI and enterocele, 1 (0.3%) cystocele and enterocele and 1 (0.3%) cystocele, enterocele and rectocele. The interventions done were: 34 (9.4%) anterior and middle compartment meshes, 1 (0.3%) middle and posterior compartment meshes, 1 (0.3%) TOT and middle and posterior compartment mesh, 36 (9.9%) TVT and 3 (0.8%) TVT and anterior and middle compartment mesh. The median follow-up was 36 (3-90) months. 50 patients (13.8%) presented complications: 21 (42%) had lower urinary tract irritative symptoms, 10 (20%) externalization of the mesh, 3 (6%) necrotizing fascitis, 3 (6%)obturator fossa, thigh root or vaginal abscess, 5 (10%) chronic pelvic pain, thigh pain or dyspareunia, 2 (4%) bruising and bleeding, 3 (6%) urinary tract infections, 1 (2%)mesh entering bladder and 2 (4%) obstructive symptoms. The procedures were effective in 350 (96.4%)patients. The impact of complications was manifested in the first 10 months after surgery. CONCLUSIONS: Polypropylene meshes are very effective in the treatment of female pelvic floor disorders. Approximately 10% of the patients had complications that resolved spontaneously or with medical treatment in most cases. One third of the complications are subsidiaries of surgery, by removing the mesh totaly or partialy, without affecting the intervention results.

Interrelationship between reproductive hormones and acute phase proteins during estrous cycle and pregnancy in Spanish purebred broodmares.

In some species, female steroid hormones modify the profile of acute phase proteins (APPs) during the estrous cycle and pregnancy, according to the ovulation, embryonic implantation and placental development; however, nowadays there's no experimental evidence for equine species. Objectives of this study were: to compare the serum amyloid A (SAA), haptoglobin (Hp) and C-reactive protein (CRP) concentrations between cyclic and pregnant mares, and to analyze the influence of estradiol-17ß (E2) during estrous cycle or estrone sulfate (E1) during pregnancy, and progesterone (P4) on these proteins to assess their potential role to identify the cyclicity or pregnancy in Spanish mares. Blood samples were taken from 20 Purebred Spanish mares on the day of ovulation (day 0), on days +5 and +16 post-ovulation, and then, monthly during the whole pregnancy. SAA, Hp and CRP did not change between day 0, +5 and +16 post-ovulation days. P4 concentrations were significantly higher on day +16 than on days +5 and 0; and E2 concentrations were significantly higher on day 0 than day +5. On the other hand, pregnancy was characterized by a progressive increase in the Hp, variable modifications of E1 and P4 concentrations, without changes in SAA and CRP. The absence of significant differences in the APPs between days 0, +5 and +16, suggested that these proteins cannot be used as biomarkers of diagnosis of heat or pregnancy in Spanish mares, at least early, since the Hp later increases during the gestation. Nevertheless, it is possible to use them for comparative purposes with other equine breeds, as supervisor instrument of health status in breeding females as diagnostic tools to monitor pregnancy's development and/or subclinical reproductive inflammations, that could lead to the early embryonic death.

Scientific Opinion on the assessment of the control measures of the category A diseases of Animal Health Law: Highly Pathogenic Avian Influenza.

EFSA received a mandate from the European Commission to assess the effectiveness of some of the control measures against diseases included in the Category A list according to Regulation (EU) 2016/429 on transmissible animal diseases ('Animal Health Law'). This opinion belongs to a series of opinions where these control measures will be assessed, with this opinion covering the assessment of control measures for Highly Pathogenic Avian Influenza (HPAI). In this opinion, EFSA and the AHAW Panel of experts review the effectiveness of: (i) clinical and laboratory sampling procedures, (ii) monitoring period and (iii) the minimum radius of the protection and surveillance zone, and the minimum length of time the measures should be applied in these zones. The general methodology used for this series of opinions has been published elsewhere; nonetheless, specific details of the model used for the assessment of the laboratory sampling procedures for HPAI are presented here. Here, also, the transmission kernels used for the assessment of the minimum radius of the protection and surveillance zones are shown. Several scenarios for which these control measures had to be assessed were designed and agreed prior to the start of the assessment. In summary, sampling procedures as described in the diagnostic manual for HPAI were considered efficient for gallinaceous poultry, whereas additional sampling is advised for Anseriformes. The monitoring period was assessed as effective, and it was demonstrated that the surveillance zone comprises 95% of the infections from an affected establishment. Recommendations provided for each of the scenarios assessed aim to support the European Commission in the drafting of further pieces of legislation, as well as for plausible ad hoc requests in relation to HPAI.

Rift Valley Fever - epidemiological update and risk of introduction into Europe.

Rift Valley fever (RVF) is a vector-borne disease transmitted by a broad spectrum of mosquito species, especially Aedes and Culex genus, to animals (domestic and wild ruminants and camels) and humans. Rift Valley fever is endemic in sub-Saharan Africa and in the Arabian Peninsula, with periodic epidemics characterised by 5-15 years of inter-epizootic periods. In the last two decades, RVF was notified in new African regions (e.g. Sahel), RVF epidemics occurred more frequently and low-level enzootic virus circulation has been demonstrated in livestock in various areas. Recent outbreaks in a French overseas department and some seropositive cases detected in Turkey, Tunisia and Libya raised the attention of the EU for a possible incursion into neighbouring countries. The movement of live animals is the most important pathway for RVF spread from the African endemic areas to North Africa and the Middle East. The movement of infected animals and infected vectors when shipped by flights, containers or road transport is considered as other plausible pathways of introduction into Europe. The overall risk of introduction of RVF into EU through the movement of infected animals is very low in all the EU regions and in all MSs (less than one epidemic every 500 years), given the strict EU animal import policy. The same level of risk of introduction in all the EU regions was estimated also considering the movement of infected vectors, with the highest level for Belgium, Greece, Malta, the Netherlands (one epidemic every 228-700 years), mainly linked to the number of connections by air and sea transports with African RVF infected countries. Although the EU territory does not seem to be directly exposed to an imminent risk of RVFV introduction, the risk of further spread into countries neighbouring the EU and the risks of possible introduction of infected vectors, suggest that EU authorities need to strengthen their surveillance and response capacities, as well as the collaboration with North African and Middle Eastern countries.

Rift Valley Fever - assessment of effectiveness of surveillance and control measures in the EU.

Effectiveness of surveillance and control measures against Rift Valley Fever (RVF) in Mayotte (overseas France) and in continental EU were assessed using mathematical models. Surveillance for early detection of RVF virus circulation implies very low design prevalence values and thus sampling a high number of animals, so feasibility issues may rise. Passive surveillance based on notified abortions in ruminants is key for early warning and at present the only feasible surveillance option. The assessment of vaccination and culling against RVF in Mayotte suggests that vaccination is more effective when quickly implemented throughout the population, e.g. at a rate of 200 or 2,000 animals vaccinated per day. Test and cull is not an option for RVF control in Mayotte given the high number of animals that would need to be tested. If the risk of RVFV introduction into the continental EU increases, ruminant establishments close to possible points of disease incursion should be included in the surveillance. An enhanced surveillance on reproductive disorders should be applied during summer in risk areas. Serosurveillance targets of 0.3% animals should be at least considered. RVF control measures possibly applied in the continental EU have been assessed in the Netherlands, as an example. Culling animals on farms within a 20 km radius of detected farms appears as the most effective measure to control RVF spread, although too many animals should be culled. Alternative measures are vaccination in a 50 km radius around detection, ring vaccination between 20 and 50 km and culling of detected farms. The assessment of zoning showed that, following RVFV introduction and considering an R0 = 2, a mean vector dispersal of 10 km and 10 farms initially detected, RVFV would spread beyond a radius of up to 100 km or 50 km from the infected area with 10% or 55% probability, respectively.