Complete mitochondrial genome of the introduced Indian walking stick Carausius morosus (Lonchodidae, Insecta) from California.

We present the complete mitochondrial genome of Carausius morosus from Salinas, CA. The mitochondrial genome of C. morosus is circular, AT rich (78.1%), and 16,671 bp in length. It consists of 13 protein-coding, 22 transfer RNA, and 2 ribosomal RNA genes and is identical in gene content to Carausius sp.

Malaria seroepidemiology in very low transmission settings in the Peruvian Amazon.

Despite progress towards malaria reduction in Peru, measuring exposure in low transmission areas is crucial for achieving elimination. This study focuses on two very low transmission areas in Loreto (Peruvian Amazon) and aims to determine the relationship between malaria exposure and proximity to health facilities. Individual data was collected from 38 villages in Indiana and Belen, including geo-referenced households and blood samples for microscopy, PCR and serological analysis. A segmented linear regression model identified significant changes in seropositivity trends among different age groups. Local Getis-Ord Gi* statistic revealed clusters of households with high (hotspots) or low (coldspots) seropositivity rates. Findings from 4000 individuals showed a seropositivity level of 2.5% (95%CI: 2.0%-3.0%) for P. falciparum and 7.8% (95%CI: 7.0%-8.7%) for P. vivax, indicating recent or historical exposure. The segmented regression showed exposure reductions in the 40-50 age group (ß1 = 0.043, p = 0.003) for P. vivax and the 50-60 age group (ß1 = 0.005, p = 0.010) for P. falciparum. Long and extreme distance villages from Regional Hospital of Loreto exhibited higher malaria exposure compared to proximate and medium distance villages (p < 0.001). This study showed the seropositivity of malaria in two very low transmission areas and confirmed the spatial pattern of hotspots as villages become more distant.

Quantifying the effect of human population mobility on malaria risk in the Peruvian Amazon.

The impact of human population movement (HPM) on the epidemiology of vector-borne diseases, such as malaria, has been described. However, there are limited data on the use of new technologies for the study of HPM in endemic areas with difficult access such as the Amazon. In this study conducted in rural Peruvian Amazon, we used self-reported travel surveys and GPS trackers coupled with a Bayesian spatial model to quantify the role of HPM on malaria risk. By using a densely sampled population cohort, this study highlighted the elevated malaria transmission in a riverine community of the Peruvian Amazon. We also found that the high connectivity between Amazon communities for reasons such as work, trading or family plausibly sustains such transmission levels. Finally, by using multiple human mobility metrics including GPS trackers, and adapted causal inference methods we identified for the first time the effect of human mobility patterns on malaria risk in rural Peruvian Amazon. This study provides evidence of the causal effect of HPM on malaria that may help to adapt current malaria control programmes in the Amazon.

Integrating Parasitological and Entomological Observations to Understand Malaria Transmission in Riverine Villages in the Peruvian Amazon.

BACKGROUND: Remote rural riverine villages account for most of the reported malaria cases in the Peruvian Amazon. As transmission decreases due to intensive standard control efforts, malaria strategies in these villages will need to be more focused and adapted to local epidemiology. METHODS: By integrating parasitological, entomological, and environmental observations between January 2016 and June 2017, we provided an in-depth characterization of malaria transmission dynamics in 4 riverine villages of the Mazan district, Loreto department. RESULTS: Despite variation across villages, malaria prevalence by polymerase chain reaction in March 2016 was high (>25% in 3 villages), caused by Plasmodium vivax mainly and composed of mostly submicroscopic infections. Housing without complete walls was the main malaria risk factor, while households close to forest edges were more commonly identified as spatial clusters of malaria prevalence. Villages in the basin of the Mazan River had a higher density of adult Anopheles darlingi mosquitoes, and retained higher prevalence and incidence rates compared to villages in the basin of the Napo River despite test-and-treat interventions. CONCLUSIONS: High heterogeneity in malaria transmission was found across and within riverine villages, resulting from interactions between the microgeographic landscape driving diverse conditions for vector development, housing structure, and human behavior.

Open-Source 3D Printable GPS Tracker to Characterize the Role of Human Population Movement on Malaria Epidemiology in River Networks: A Proof-of-Concept Study in the Peruvian Amazon.

Human movement affects malaria epidemiology at multiple geographical levels; however, few studies measure the role of human movement in the Amazon Region due to the challenging conditions and cost of movement tracking technologies. We developed an open-source low-cost 3D printable GPS-tracker and used this technology in a cohort study to characterize the role of human population movement in malaria epidemiology in a rural riverine village in the Peruvian Amazon. In this pilot study of 20 participants (mean age = 40 years old), 45,980 GPS coordinates were recorded over 1 month. Characteristic movement patterns were observed relative to the infection status and occupation of the participants. Applying two analytical animal movement ecology methods, utilization distributions (UDs) and integrated step selection functions (iSSF), we showed contrasting environmental selection and space use patterns according to infection status. These data suggested an important role of human movement in the epidemiology of malaria in the Peruvian Amazon due to high connectivity between villages of the same riverine network, suggesting limitations of current community-based control strategies. We additionally demonstrate the utility of this low-cost technology with movement ecology analysis to characterize human movement in resource-poor environments.

Economic costs analysis of uncomplicated malaria case management in the Peruvian Amazon.

BACKGROUND: Case management is one of the principal strategies for malaria control. This study aimed to estimate the economic costs of uncomplicated malaria case management and explore the influence of health-seeking behaviours on those costs. METHODS: A knowledge, attitudes and practices (KAP) survey was applied to 680 households of fifteen communities in Mazan-Loreto in March 2017, then a socio-economic survey was conducted in September 2017 among 161 individuals with confirmed uncomplicated malaria in the past 3 months. Total costs per episode were estimated from both provider (Ministry of Health, MoH) and patient perspectives. Direct costs were estimated using a standard costing estimation procedure, while the indirect costs considered the loss of incomes among patients, substitute labourers and companions due to illness in terms of the monthly minimum wage. Sensitivity analysis evaluated the uncertainty of the average cost per episode. RESULTS: The KAP survey showed that most individuals (79.3%) that had malaria went to a health facility for a diagnosis and treatment, 2.7% received those services from community health workers, and 8% went to a drugstore or were self-treated at home. The average total cost per episode in the Mazan district was US$ 161. The cost from the provider's perspective was US$ 30.85 per episode while from the patient's perspective the estimated cost was US$ 131 per episode. The average costs per Plasmodium falciparum episode (US$ 180) were higher than those per Plasmodium vivax episode (US$ 156) due to longer time lost from work by patients with P. falciparum infections (22.2 days) than by patients with P. vivax infections (17.0 days). The delayed malaria diagnosis (after 48 h of the onset of symptoms) was associated with the time lost from work due to illness (adjusted mean ratio 1.8; 95% CI 1.3, 2.6). The average cost per malaria episode was most sensitive to the uncertainty around the lost productivity cost due to malaria. CONCLUSIONS: Despite the provision of free malaria case management by MoH, there is delay in seeking care and the costs of uncomplicated malaria are mainly borne by the families. These costs are not well perceived by the society and the substantial financial impact of the disease can be frequently undervalued in public policy planning.

Utilization of Acid Suppression Medication in an Underserved Population.

OBJECTIVES: Acid suppression therapy (AST), composed of proton pump inhibitors (PPIs), histamine-2 receptor blockers, and antacids, is one of the most common medication groups used in the United States. Long-term AST is concerning, however, because it is linked with an increased risk of community-acquired pneumonia, Clostridium difficile infections, bone fractures, and nutritional deficiencies. The potentially harmful biological and economic consequences associated with the improper use of acid suppression medications presents a great deal of risk to those in underserved communities. We sought to determine the prevalence of AST in an underserved population and the common diagnoses and symptoms associated with therapy. In addition, we studied the frequency of suboptimal usage of PPIs in an indigent care population and the potential factors related to high-risk behaviors. METHODS: The study was a cross-sectional study using a survey that was distributed to participants during their regularly scheduled visits to a public sector provider of health care for low-income patients. RESULTS: Of the 176 participants surveyed, 70 (40%) were using AST. Esophagitis and gastroesophageal reflux disease were the most prevalent in our sample population. PPIs were the most common acid suppression medication used in our population. Of those using PPIs, 85% were never instructed to cease use. Of the 27 patients with PPI prescriptions, 26 used it in a suboptimal manner, and of those without prescriptions, 7 used it in a suboptimal manner. CONCLUSIONS: ASTs are prevalent in low-income populations, and patients are not being managed appropriately to minimize their risk for complications of AST.

Use of open mobile mapping tool to assess human mobility traceability in rural offline populations with contrasting malaria dynamics.

Infectious disease dynamics are affected by human mobility more powerfully than previously thought, and thus reliable traceability data are essential. In rural riverine settings, lack of infrastructure and dense tree coverage deter the implementation of cutting-edge technology to collect human mobility data. To overcome this challenge, this study proposed the use of a novel open mobile mapping tool, GeoODK. This study consists of a purposive sampling of 33 participants in six villages with contrasting patterns of malaria transmission that demonstrates a feasible approach to map human mobility. The self-reported traceability data allowed the construction of the first human mobility framework in rural riverine villages in the Peruvian Amazon. The mobility spectrum in these areas resulted in travel profiles ranging from 2 hours to 19 days; and distances between 10 to 167 km. Most Importantly, occupational-related mobility profiles with the highest displacements (in terms of time and distance) were observed in commercial, logging, and hunting activities. These data are consistent with malaria transmission studies in the area that show villages in watersheds with higher human movement are concurrently those with greater malaria risk. The approach we describe represents a potential tool to gather critical information that can facilitate malaria control activities.

Effectiveness of a Malaria Surveillance Strategy Based on Active Case Detection during High Transmission Season in the Peruvian Amazon.

Background: Faced with the resurgence of malaria, malaria surveillance in the Peruvian Amazon incorporated consecutive active case detection (ACD) interventions using light microscopy (LM) as reactive measure in communities with an unusual high number of cases during high transmission season (HTS). We assessed the effectiveness in malaria detection of this local ACD-based strategy. Methods: A cohort study was conducted in June⁻July 2015 in Mazan, Loreto. Four consecutive ACD interventions at intervals of 10 days were conducted in four riverine communities (Gamitanacocha, Primero de Enero, Libertad and Urco Miraño). In each intervention, all inhabitants were visited at home, and finger-prick blood samples collected for immediate diagnosis by LM and on filter paper for later analysis by quantitative real-time polymerase chain reaction (qPCR). Effectiveness was calculated by dividing the number of malaria infections detected using LM by the number of malaria infections detected by delayed qPCR. Results: Most community inhabitants (88.1%, 822/933) were present in at least one of the four ACD interventions. A total of 451 infections were detected by qPCR in 446 participants (54.3% of total participants); five individuals had two infections. Plasmodium vivax was the predominant species (79.8%), followed by P. falciparum (15.3%) and P. vivax-P. falciparum co-infections (4.9%). Most qPCR-positive infections were asymptomatic (255/448, 56.9%). The ACD-strategy using LM had an effectiveness of 22.8% (detection of 103 of the total qPCR-positive infections). Children aged 5⁻14 years, and farming as main economic activity were associated with P. vivax infections. Conclusions: Although the ACD-strategy using LM increased the opportunity of detecting and treating malaria infections during HTS, the number of detected infections was considerably lower than the real burden of infections (those detected by qPCR).

Pharmaceutical strategies for smoking cessation during pregnancy.

Introduction: Tobacco use is the most preventable cause of death worldwide, with over 7 million deaths per year. Smoking during pregnancy causes harm to the mother, fetus, and can result in problems for the infant from childhood into adulthood. Practitioners should ask all expectant mothers about tobacco use. For expectant mothers who smoke or recently quit, practitioners should advice to quit and provide psychosocial interventions. Rates of smoking during pregnancy differ between geographical locations, with estimates of 10.8% in the UK and 7.2% in the US. Practitioners should provide expectant mothers unable to quit smoking with information about the risks and benefits of pharmacotherapy and use a patient-centered approach to determine the use. Although there is no definitive evidence on birth outcomes, nicotine replacement therapy and bupropion are adequate pharmacotherapies to help those unable to quit. Areas covered: Herein, this author looks at the various pharmaceutical strategies to help patients cease smoking and provides expert perspectives on the subject. Expert opinion: Additional research on pharmacotherapy is warranted, especially with varenicline. Practitioners working with pregnant patients should be familiar with the evidence for pharmacotherapy in smoking cessation during pregnancy. This evidence can be difficult to navigate due to conflicting results and limitations with the trials.

Apparently high Leptospira antibody seropositivity in donkeys for slaughter in three municipalities in Durango, Mexico.

We determined the seropositive percentage and the determinants of Leptospira exposure in domestic donkeys presented for slaughter in the State of Durango, Mexico. We examined 194 donkeys in 4 gathering premises. Sera of donkeys were analyzed for anti- Leptospira IgG antibodies using a microscopic agglutination assay with a panel of 7 Leptospira antigens. The association between Leptospira seropositivity and general characteristics of donkeys was assessed by bivariate and multivariate analyses. Antibodies against Leptospira (for at least 1 of the 7 Leptospira serovars examined) were found in 151 of 194 (77.8%) donkeys. Seropositive donkeys were found in all regions, municipalities, and premises examined. The predominant serovar was L. interrogans Icterohaemorrhagiae ( n = 117; 60.3%), followed by L. interrogans Sejroe ( n = 96; 49.5%), L. interrogans Canicola ( n = 10; 5.2%), L. kirschneri Grippotyphosa ( n = 6; 3.1%), L. borgpetersenii Ballum ( n = 5; 2.6 %), L. biflexa Semaranga ( n = 3; 1.5%), and L. noguchii Panama ( n = 2; 1%). Leptospira seropositivity was associated with gathering premises (OR = 2.64; 95% CI: 1.27-5.46; p = 0.009) and municipalities (OR = 0.11; 95% CI: 0.01-0.78; p = 0.02). Our results demonstrate an apparently high seropositive percentage of Leptospira infection in the donkeys studied in Mexico.

Linfoma intestinal complicado con obstrucción intestinal: Reporte de caso y revisión de la literatura / Intestinal lymphoma complicated with intestinal obstruction: Case report and literature review

Introducción: Los tumores de Intestino Delgado son muy infrecuentes, suponen menos del 2% de todas las neoplasias gastrointestinales, con una prevalencia en la población de sólo del 0,6%. Reporte de caso: se reporta el caso de paciente varón, de 71 años, con diagnóstico de Linfoma de células T primario de Duodeno, quien estando recibiendo quimioterapia desarrolló Obstrucción intestinal. Conclusión: Se presenta el caso, el manejo del cuadro agregado y se hace revisión de la literatura médica sobre esta patología y su complicación de rara presentación.

Prevalencia del consumo de sustancias psicoactivas y la aparición de la enfermedad mental en adolescentes / Prevalence of psychoactive substance use and mental illness in adolescents / Prevalência de uso de substâncias psicoativas e doenças mentais em adolescentes

Resumen El objetivo de este trabajo es presentar los resultados de una investigación secundaria acerca de la prevalencia del consumo de sustancias psicoactivas (SPA) en la población adolescente con enfermedad mental en comparación con los adolescentes que no padecen enfermedad mental. Se formuló una pregunta según el acrónimo"PICO" (pacientes, intervención, comparación, resultados); posteriormente, se buscó información en distintas bases de datos sugeridas en el curso de Práctica Clínica Basada en la Evidencia, impartido por el Programa de Colaboración para la Investigación de Enfermería Basada en la Evidencia de Costa Rica (CIEBE-CR). Para la búsqueda de información se efectuó una revisión de artículos científicos en Medline Plus, PudMed y EBSCO Host, con el fin de recuperar la mayor cantidad de información. Después de establecer los criterios de inclusión y exclusión y realizar un análisis crítico, se seleccionó cuatro documentos que dieron respuesta a la pregunta planteada. Se detectó 58 documentos relacionados con el tema de los cuales solo cuatro cumplían criterios de calidad que establece el Critical Appraisal Skills Programme español (CASPe) para responder a la pregunta clínica. Se evidencia cómo en la niñez la psicopatología se reconoce cada vez más como un factor de riesgo en cuanto al uso de sustancias psicoactivas. Se concluye que los adolescentes con patología mental tienen una mayor prevalencia al uso de sustancias psicoactivas en comparación con los adolescentes que no padecen enfermedad mental.

Abstract The objective of this paper is to present the results of secondary research on the prevalence of psychoactive substance use (PSA) in the adolescent population with mental illness compared to adolescents who do not suffer from mental illness. A question was formulated according to the acronym "PICO" (patients, intervention, comparison, results); Subsequently, information was sought in different databases suggested in the Clinical Practice Based on Evidence course, taught by the Collaboration Program for Nursing Research Based on the Evidence of Costa Rica (CIEBE-CR). For the search of information, a review of scientific articles was carried out in Medline Plus, PudMed and EBSCO Host, in order to recover the greatest amount of information. After establishing the inclusion and exclusion criteria and performing a critical analysis, four documents that answered the question posed were selected. It was detected 58 documents related to the topic of which only four met quality criteria established by the Spanish Critical Appraisal Skills Program (CASPe) to answer the clinical question. It is evidenced how, in childhood, psychopathology is increasingly recognized as a risk factor in the use of psychoactive substances. It is concluded that adolescents with mental pathology have a higher prevalence of the use of psychoactive substances in comparison with adolescents who do not suffer from mental illness.

Resumo O objetivo deste trabalho é apresentar os resultados da pesquisa secundária sobre a prevalência do uso de substâncias psicoativas (PSA) na população adolescente com doença mental em comparação com adolescentes que não sofrem de doença mental. Uma pergunta foi formulada de acordo com a sigla "PICO" (pacientes, intervenção, comparação, resultados); Posteriormente, a informação foi buscada em diferentes bancos de dados sugeridos no curso de Prática Clínica Baseada na Evidência, ministrado pelo Programa de Colaboração para Pesquisa de Enfermagem com base na Evidência da Costa Rica (CIEBE-CR). Para a busca de informações, foi realizada uma revisão de artigos científicos no Medline Plus, PudMed e EBSCO Host, a fim de recuperar a maior quantidade de informações. Depois de estabelecer os critérios de inclusão e exclusão e realizar uma análise crítica, foram selecionados quatro documentos que responderam à pergunta colocada. Foram detectados 58 documentos relacionados ao tema, dos quais apenas quatro critérios de qualidade estabelecidos pelo Programa Espanhol de Competências de Avaliação Crítica (CASPe) para responder à questão clínica. É evidenciado como, na infância, a psicopatologia é cada vez mais reconhecida como fator de risco no uso de substâncias psicoativas. Conclui-se que os adolescentes com patologia mental têm maior prevalência do uso de substâncias psicoativas em comparação com adolescentes que não sofrem de doença mental.

Seroepidemiology of Sarcocystis neurona and Neospora hughesi infections in domestic donkeys (Equus asinus) in Durango, Mexico.

There is currently no information regarding Sarcocystis neurona and Neospora hughesi infections in donkeys in Mexico. Here, we determined the presence of antibodies against S. neurona and N. hughesi in donkeys in the northern Mexican state of Durango. Serum samples of 239 domestic donkeys (Equus asinus) were assayed for S. neurona and N. hughesi antibodies using home-made enzyme-linked immunoassays; six (2.5%) of the 239 donkeys tested seropositive for S. neurona. The seroprevalence of S. neurona infection was comparable among donkeys regardless of their origin, health status, or sex. Multivariate analysis showed that seropositivity to S. neurona was associated with increased age (OR = 2.95; 95% CI: 1.11-7.82; p = 0.02). Antibodies to N. hughesi were found in two (0.8%) of the 239 donkeys. Both exposed donkeys were healthy, 3- and 6-year-old females. This is the first evidence of S. neurona and N. hughesi infections in donkeys in Mexico.

Pólipo fibrovascular gigante y ulcerado de esófago ­ reporte de caso y revisión de la literatura / Giant and ulcered fibrovascular polyp of the esophagus - case report and literature review

Introducción: Los pólipos fibrovasculares son neoplasias benignas muy raras del esófago, originadas generalmente por debajo del cricoides; son poco sintomáticos por largo tiempo, pudiendo debutar el paciente con regurgitación del pólipo y asfixia, o más frecuentemente con disfagia. Reporte de caso: paciente varón, 43 años, con historia de 3 meses de disfagia progresiva, baja ponderal y sensación de cuerpo extraño en esófago; al realizarle exámenes se diagnostica pólipo fibrovascular benigno gigante ulcerado en esófago que requirió remoción quirúrgica por esofagotomia cervical, con evolución post operatoria favorable y diagnóstico patológico final de Pólipo fibrovascular benigno gigante, ulcerado, de esófago. Interpretación: El pronóstico de estos pólipos una vez resecados es excelente, siendo la recurrencia muy rara. Los casos reportados de recidivas, mayoritariamente al ser reevaluados, son considerados como secundarios a remoción incompleta del pólipo en la primera intervención quirúrgica.

Introduction. Fibrovascular polyps are very rare benign neoplasms of the esophagus, usually originating below the cricoid; Are not very symptomatic for a long time, being able to debut the patient with regurgitation of the polyp and asphyxia, or more frequently with dysphagia. Case report: male patient, 43 years old, with a history of 3 months of progressive dysphagia, low weight and sensation of foreign body in the esophagus; The diagnosis of benign fibrotic polyp ulcerated ulcerated in the esophagus that required surgical removal by cervical esophagotomy, with favorable post-operative evolution and final pathological diagnosis of benign, ulcerated benign fibrotic polyp of the esophagus was diagnosed. Interpretation: The prognosis of these polyps once resected is excellent, with recurrence very rare. The reported cases of relapses, mostly when reevaluated, are considered secondary to incomplete removal of the polyp in the first surgical procedure.

An update on the pharmacotherapeutic interventions for smoking cessation.

INTRODUCTION: Cigarette smoking can damage every organ in the body and is the leading known preventable cause of death globally. It is estimated that 70% of patients want to quit, and about 50% report a quit attempt in the past year, yet only 4-7% are successful. These low quit rates represent the importance of appropriate treatment for smoking cessation through behavioral and pharmacotherapeutic means. AREAS COVERED: Pharmacotherapy approximately doubles patients' chances of quitting, and the first-line approved pharmacotherapetuic options include nicotine gum, lozenge, patch, nasal spray, and inhaler, sustained-release bupropion, and varenicline. Second-line therapies include nortriptyline and clonidine. Recent evidence suggests a potential role for cytisine and naltrexone. Healthcare providers play an important role in helping patients quit smoking; therefore, a clear understanding of appropriate dosing, regimen, technique, disadvantages, advantages, warnings/precautions, and contraindications for available pharmacotherapeutic options is essential. EXPERT OPINION: To improve chances of success, providers should consider patient preferences and prior experiences with quitting, provide medication-specific counseling for the selected therapy, and encourage adherence with the behavioral and pharmacotherapeutic treatment regimen.

Evidence for Aedes aegypti (Diptera: Culicidae) Oviposition on Boats in the Peruvian Amazon.

Dengue vector Aedes aegypti L. is invading peri-urban and rural areas throughout Latin America. Our previous research in the Peruvian Amazon has shown that river boats are heavily infested with immature and adult Ae. aegypti mosquitoes, likely playing a major role in their long-distance dispersal and successful invasion. However, the presence of immature mosquitoes provides no information about the timing of oviposition, and whether it took place in the boats. Here, we used baited ovitraps deployed on river boats to test the hypothesis that Ae. aegypti oviposition occurs during boat travel. We deployed 360 ovitraps on 60 different barges during August and October of 2013, and February 2014 (with 20 barges sampled during each month). We found that Ae. aegypti mosquitoes in 22 individual ovitraps from 15 of the 60 barges (premise index 25%) across all sampling dates. Further, the distribution of Ae. aegypti egg abundance was highly aggregated: 2.6% of traps (N=7) were responsible for 71.8% of eggs found, and 1.5% of traps (N=4) were responsible for all (100%) of the larvae found. Similarly, 5% of boats were responsible for the 71.47% of eggs. Our results provide strong evidence that Ae. aegypti oviposition commonly occurs during boat travel. Baited ovitraps could represent a cost-effective means of monitoring and controlling mosquito populations on boats.

The treatment of gastroparesis, constipation and small intestinal bacterial overgrowth syndrome in patients with Parkinson's disease.

INTRODUCTION: Parkinson's disease (PD) affects the nerves of the entire gastrointestinal (GI) tract and may result in profound gastrointestinal (GI) dysfunction leading to poor patient outcomes. Common GI disturbances in patients with PD include gastroparesis (GP), constipation and small intestinal bacterial overgrowth syndrome (SIBO). In particular, GP is difficult to treat due to the limited options available and precautions, contraindications and adverse effects associated with the approved treatments. Moreover, some commonly used medications can worsen pre-existing PD. AREAS COVERED: Our review will focus on treatment options for GP and SIBO with motilin agonists, dopamine receptor antagonists, Ghrelin agonists muscarinic agonists, 5-HT4 receptor agonists, antibiotics, probiotics and herbal formulation such as iberogast. Constipation occurs in the majority of patients with PD and fortunately many treatments are now available. Our review is based on original papers or reviews selected from PUBMED search and Cochrane reviews. EXPERT OPINION: Motility disorders of the GI tract are found frequently in patients with PD and treating the underlying GI disorders caused by PD with various prokinetics and laxatives is paramount in achieving improvements in patient's motor function. Various prokinetics and laxatives are now available to provide some relief of the GI morbidity caused by PD leading even to better absorption of even the PD treatments.

River boats contribute to the regional spread of the dengue vector Aedes aegypti in the Peruvian Amazon.

BACKGROUND AND OBJECTIVES: The dramatic range expansion of the dengue vector Aedes aegypti is associated with various anthropogenic transport activities, but little is known about the underlying mechanisms driving this geographic expansion. We longitudinally characterized infestation of different vehicle types (cars, boats, etc.) to estimate the frequency and intensity of mosquito introductions into novel locations (propagule pressure). METHODS: Exhaustive adult and immature Ae. aegypti collections were performed on six different vehicle types at five ports and two bus/ taxi departure points in the Amazonian city of Iquitos, Peru during 2013. Aquatic vehicles included 32 large and 33 medium-sized barges, 53 water taxis, and 41 speed boats. Terrestrial vehicles sampled included 40 buses and 30 taxis traveling on the only highway in the region. Ae. aegypti adult infestation rates and immature indices were analyzed by vehicle type, location within vehicles, and sampling date. RESULTS: Large barges (71.9% infested) and medium barges (39.4% infested) accounted for most of the infestations. Notably, buses had an overall infestation rate of 12.5%. On large barges, the greatest number of Ae. aegypti adults were found in October, whereas most immatures were found in February followed by October. The vast majority of larvae (85.9%) and pupae (76.7%) collected in large barges were produced in puddles formed in cargo holds. CONCLUSIONS: Because larges barges provide suitable mosquito habitats (due to dark, damp cargo storage spaces and ample oviposition sites), we conclude that they likely serve as significant contributors to mosquitoes' propagule pressure across long distances throughout the Peruvian Amazon. This information can help anticipate vector population mixing and future range expansions of dengue and other viruses transmitted by Ae. aegypti.

Detection and measurement of the intracellular calcium variation in follicular cells.

This work presents a new method for measuring the variation of intracellular calcium in follicular cells. The proposal consists in two stages: (i) the detection of the cell's nuclei and (ii) the analysis of the fluorescence variations. The first stage is performed via watershed modified transformation, where the process of labeling is controlled. The detection process uses the contours of the cells as descriptors, where they are enhanced with a morphological filter that homogenizes the luminance variation of the image. In the second stage, the fluorescence variations are modeled as an exponential decreasing function, where the fluorescence variations are highly correlated with the changes of intracellular free Ca(2+). Additionally, it is introduced a new morphological called medium reconstruction process, which helps to enhance the data for the modeling process. This filter exploits the undermodeling and overmodeling properties of reconstruction operators, such that it preserves the structure of the original signal. Finally, an experimental process shows evidence of the capabilities of the proposal.