Discordant phylogeographic patterns between the tortoise tick Hyalomma aegyptium and their Testudo graeca hosts.

Tortoise ticks, Hyalomma aegyptium, are considered so strongly associated with their hosts that they are even used as indirect indicators for them. In such a case, a robust pattern of congruence between host and parasite could be expected, with phylogeographic breaks within the host being reflected in their parasites. We sequenced two mitochondrial partial gene regions (12S rRNA and Cytochrome Oxidase 1) from ticks across northern Africa and Anatolia, and compared patterns of variation with those identified in its main host, Testudo graeca. Two distinct haplogroups were identified, both of which were found distributed across much of northern Africa. This pattern does not reflect the known variation within the host, which has multiple, geographically disjunct subspecies in this region, but rather the major climatic zones. This relationship can be explained by adaptive processes to environmental conditions influenced by the climate, as well as by the spatial structure of the communities of tick potential hosts in larval and nymphal stages. Extensive anthropogenic movement of tortoises may also obscure congruence patterns between H. aegyptium ticks and their hosts.

Diversity of microorganisms in Hyalomma aegyptium collected from spur-thighed tortoise (Testudo graeca) in North Africa and Anatolia.

Ticks carry a diverse community of microorganisms including non-pathogenic symbionts, commensals, and pathogens, such as viruses, bacteria, protozoans, and fungi. The assessment of tick-borne microorganisms (TBM) in tortoises and their ticks is essential to understand their eco-epidemiology, and to map and monitor potential pathogens to humans and other animals. The aim of this study was to characterize the diversity of microorganisms found in ticks collected from the spur-thighed tortoise (Testudo graeca) in North Africa and Anatolia. Ticks feeding on wild T. graeca were collected, and pathogens were screened by polymerase chain reaction using group-specific primers. In total, 131 adult Hyalomma aegyptium ticks were collected from 92 T. graeca in Morocco (n = 48), Tunisia (n = 2), Algeria (n = 70), and Turkey (n = 11). Bacteria and protozoa detected included Hemolivia mauritanica (22.9%), Midichloria mitochondrii (11.4%), relapsing-fever borreliae (8.4%), Ehrlichia spp. (7.6%), Rickettsia spp. (3.4%), Borrelia burgdorferi s.l. (0.9%), Francisella spp. (0.9%), and Wolbachia spp. (0.8%). The characterization of Rickettsia included R. sibirica mongolitimonae (Algeria), R. aeschlimannii (Turkey), and R.africae (Morocco). Hemolivia mauritanica and Ehrlichia spp. prevalence varied significantly with the sampling region/country. We did not detect significant associations in microorganism presence within ticks, nor between microorganism presence and tick mitochondrial DNA haplogroups. This is the first report of Francisella persica-like, relapsing fever borreliae, M. mitochondrii, and Wolbachia spp. in H. aegyptium ticks collected from wild hosts from the South and Eastern Mediterranean region, and of R. sibirica mongolitimonae and R. africae in H. aegyptium from Algeria and Morocco, respectively. Given that T. graeca is a common species in commercial and non-commercial pet trade, the evaluation of the role of this species and its ticks as hosts for TBM is particularly relevant for public health.

Overview of evidence on emergency carotid stenting in patients with acute ischemic stroke due to tandem occlusions: a systematic review and meta-analysis.

INTRODUCTION: Endovascular intracranial thrombectomy (IT) has established itself as the standard of care in treating large-vessel anterior circulation acute ischemic stroke (AIS). However, internal carotid artery (ICA) stenosis/occlusion hampers distal access and controversy about simultaneous emergency ICA stenting ensues. The purpose of this review was to evaluate the safety of emergency ICA stenting in combination with IT for AIS with tandem occlusions. To our knowledge this is the first meta-analysis to evaluate emergency ICA stenting in tandem occlusions, combining results from studies with a control group. EVIDENCE ACQUISITION: A meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. EVIDENCE SYNTHESIS: A total of 649 potentially relevant articles were initially selected. After reviewing at title or abstract level, 87 articles were read in full and 23 were included. These studies recruited 1000 patients, 220 submitted to IT with no emergency ICA stenting and 780 to IT and emergency ICA stenting. Successful revascularization (Thrombolysis in cerebral infarction scale [TICI] ≥2b) was achieved in 48.6-100%. Good outcome (modified Rankin scale [mRS] ≤2) ranged from 18.2-100%. Symptomatic intracranial hemorrhage (sICH) ranged from 0-45.7% (overall N.=168; 17.2%). Mortality at 90 days ranged from 0-45.4% (overall N.=114; 11.7%). Time to recanalization was significantly longer in the stenting group with an overall mean difference of 1.76 (95% CI: 1.59-1.93). CONCLUSIONS: In this meta-analysis time to recanalization was significantly longer in the emergency ICA stenting group. There was no benefit from emergency stenting in parameters such as successful revascularization (TICI≥2b), clinical outcome (mRS≤2) or 90-day mortality. Data on sICH were scarce. Emergency ICA stenting appears to increase time to revascularization and increase the risk of complications with no demonstrated clinical benefit. Furthermore, no prospective, randomized controlled trials demonstrating relative efficacy and safety of concomitant ICA stenting have been published to date. Additional studies must be undertaken to define the role of angioplasty and stenting of the extracranial carotid arteries in the early management of acute stroke in tandem occlusions. Until then, we recommend that ICA stenting concomitant to thrombectomy in acute stroke patients should be avoided.

Outcomes of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians.

OBJECTIVE: We set out to present the late 3-year performance of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians by the chimney/snorkel technique. METHODS: At one center, between January 2009 and December 2014, chimney/snorkel technique-endovascular aortic aneurysm repair was performed in 35 high-risk unfit-for-open-repair octogenarian patients with juxtarenal aortic aneurysms. Twenty-five patients were asymptomatic (71.4%), and 10 patients were treated in an urgent care setting. The median follow-up was 36 months (range, 1-69). The primary endpoint was the survival rate. RESULTS: Technical success was 100%. A single chimney-graft placement was performed in 22 patients (62.9%), double chimneys in 10 patients (28.6%), and triple chimneys were performed in 3 (8.5%) patients. Overall, 51 renovisceral vessels (22 right renal arteries, 23 left renal arteries, and 6 superior mesenteric arteries) were involved. The thirty-day mortality rate was 2.9% (n = 1). Early morbidity was 14.3%, predominantly due to access-related complications. Major adverse events were observed in 5.7% (n = 2) of the present cohort. No early reinterventions for endoleaks were registered. The midterm reintervention rate was 12.1% due to type Ib endoleak (n = 1), type II endoleak (n = 1), and high-grade chimney-graft stenosis (n = 2). Estimated survival was 91.9% at 1 year and 72.8% at 3 years. Freedom from reintervention at 1 and 3 years was 94% and 91%, respectively. CONCLUSIONS: Juxtarenal aortic aneurysm treatment with chimney/snorkel technique-endovascular aortic aneurysm repair in octogenarians is associated with low perioperative mortality and morbidity as well as acceptable midterm survival and secondary procedures.

Os desafios enfrentados pela equipe de enfermagem da comissão intra-hospitalar de doação de órgãos e tecidos para transplantes ­ CIHDOTT / The challenges faced by the commission of nursing team intra-hospital of donation organ and tissue for transplants

Objetivo: identificar os desafios enfrentados pela equipe de enfermagem da comissão intra-hospitalar de doação de órgãos e tecidos para transplantes em um hospital da região do extremo sul catarinense. Métodos: Trata-se de estudo caracterizado por uma pesquisa de abordagem qualitativa, descritiva, exploratória. Resultados: Atualmente a equipe estudada esta composta por cinco profissionais graduados em enfermagem, sendo todas do sexo feminino com faixa etária entre 26 e 41 anos, média de 31,40 anos. Sobre as dificuldades e desafios enfrentados pela equipe de enfermagem do CIHDOTT no processo de doação e captação de órgãos, 80% dos profissionais responderam que a falta de treinamento é a principal dificuldade e desafio enfrentado. Conclusão: O resultado evidência a necessidade em aplicar educação continuada aos profissionais de enfermagem pertencentes ao setor, bem como, buscar a disseminação da informação á sociedade.

Objective: To identify the challenges faced by the nursing team of in-hospital committee of organ donation and tissues for transplantation in a hospital in the southern end of Santa Catarina region. Methods: This study is characterized by a qualitative research, descriptive and exploratory. Results: Currently the team studied is composed of five graduates in nursing, all female aged between 26 and 41 years, mean 31.40 years. About the difficulties and challenges faced by CIHDOTT the nursing staff in the donation process and organ harvest, 80% of professionals said that lack of training is the main difficulty and challenge faced. Conclusion: The results highlighted the need to implement continuing education for nursing professionals belonging to the sector as well as to seek the dissemination of information to society.