Sex-based differences and risk of recurrence in patients with atrial fibrillation undergoing pulmonary vein isolation.

INTRODUCTION: Studies suggest increased likelihood of atrial fibrillation (AF) recurrence after catheter ablation (CA) in women than in men, indicating that sex may be an independent risk factor for recurrence. Nevertheless, the influence of sex on AF recurrence and underlying mechanisms remains unclear. METHODS: Retrospective, single-centre study including patients undergoing AF CA between 2017 and 2021. Late recurrence (LR) was defined as AF recurrence ≥90 days after ablation, whereas early recurrence (ER) occurred within 90 days. RESULTS: 656 patients (32% women) were included, with a median follow-up period of 26 months. Compared to men, women undergoing CA were older, had higher body mass indexes, and had higher rates of hypertension, thyroid dysfunction, and valvular disease. Women also had increased LR risk after CA (HR 1.76, 95% CI [1.19, 2.59]). A time-split multivariable analysis at one year of follow-up showed no difference in LR risk during the first 12 months after CA (HR 1.19, 95% CI [0.73, 1.94]); however, LR risk increased in women (HR 2.90, 95% CI [1.68, 5.01]) after 12 months. In a sex-stratified analysis, coronary calcium score (CCS) >100 was associated with increased LR risk in men (HR 1.81, 95% CI [1.06, 3.08]), but not in women. Cardiac adipose tissue volume (CATV) was not associated with increased LR risk. CONCLUSIONS: Fewer women underwent CA than men and LR was more frequent in women, particularly one year after the procedure. CCS was associated with increased LR risk in men.

Detection of hepatitis E virus genotype 3 in an Algerian mouse (Mus spretus) in Portugal.

Virus monitoring in small mammals is central to the design of epidemiological control strategies for rodent-borne zoonotic viruses. Synanthropic small mammals are versatile and may be potential carriers of several microbial agents. In the present work, a total of 330 fecal samples of small mammals were collected at two sites in the North of Portugal and screened for zoonotic hepatitis E virus (HEV, species Paslahepevirus balayani). Synanthropic small mammal samples (n = 40) were collected in a city park of Porto and belonged to the species Algerian mouse (Mus spretus) (n = 26) and to the greater white-toothed shrew (Crocidura russula) (n = 14). Furthermore, additional samples were collected in the Northeast region of Portugal and included Algerian mouse (n = 48), greater white-toothed shrew (n = 47), wood mouse (Apodemus sylvaticus) (n = 43), southwestern water vole (Arvicola sapidus) (n = 52), Cabrera's vole (Microtus cabrerae) (n = 49) and Lusitanian pine vole (Microtus lusitanicus) (n = 51). A nested RT-PCR targeting a part of open reading frame (ORF) 2 region of the HEV genome was used followed by sequencing and phylogenetic analysis. HEV RNA was detected in one fecal sample (0.3%; 95% confidence interval, CI: 0.01-1.68) from a synanthropic Algerian mouse that was genotyped as HEV-3, subgenotype 3e. This is the first study reporting the detection of HEV-3 in a synanthropic rodent, the Algerian mouse. The identified HEV isolate is probably the outcome of either a spill-over infection from domestic pigs or wild boars, or the result of passive viral transit through the intestinal tract. This finding reinforces the importance in the surveillance of novel potential hosts for HEV with a particular emphasis on synanthropic animals.

Digital biomarkers of mobility and quality of life in Parkinson's disease based on a wearable motion analysis LAB.

BACKGROUND AND OBJECTIVE: Functional mobility, an indicator of the quality of life (QoL), requires fast and flexible changes during motion, which are limited in Parkinson's disease (PD). Recent body-worn sensors have emerged in the last decades as potential solutions to produce digital biomarkers able to quantify mobility outside routine consultations and during real-life scenarios for multiple days at a time. The proposed research aims to study the ability of a wearable motion analysis lab, developed by our team, to produce digital biomarkers of mobility and QoL levels in patients with PD. METHODS: A cross-sectional study was followed, including 40 patients stratified into three subgroups according to a clinic motor examination and a QoL questionnaire. RESULTS: The achieved outcomes demonstrate the ability of the proposed high-tech solution to measure prototypical gait impairments and discriminate motor condition (AUC=0,890) and patients' QoL levels (AUC=0,950). Also, from the measured multiple gait-associated parameters, we identified the variables with the most potential to be applied as digital biomarkers of mobility (67 % of the metrics) and QoL (72 % of the metrics) in PD. CONCLUSIONS: Overall, we confirmed our hypothesis of using our body-worn sensor-based solution for passive or active monitoring of mobility and QoL in PD to produce objective, feasible, and continuous digital biomarkers.

Rentabilização das competências dos enfermeiros especialistas em enfermagem de saúde materna e obstétrica na comunidade - obstáculos, forças e satisfação profissional / Making the most of maternal health and obstetric nurse specialists' skills in the community - obstacles, strengths and professional satisfaction

Este relatório integra a unidade curricular de estágio com relatório em enfermagem de saúde materna e obstétrica, inserida no curso de mestrado de enfermagem de saúde materna e obstétrica. É constituído por duas componentes: a componente clínica e componente de investigação em enfermagem. Na primeira aborda-se a caraterização dos contextos clínicos e reflete-se acerca do contributo das atividades desenvolvidas durante o estágio para o desenvolvimento das competências comuns do enfermeiro especialista e das competências específicas do enfermeiro especialista em enfermagem de saúde materna e obstétrica (EEESMO). Na segunda é apresentado um estudo, com o objetivo de desenvolver competências investigativas. O estudo desenvolvido surgiu das partilhas e reflexões realizadas durante os seminários ao longo dos estágios, onde verifiquei que as experiências das estudantes eram muito diversificadas nos diferentes contextos de estágio na comunidade. Ainda que sejam atribuídas muitas competências aos EEESMO na comunidade, constatei que estes enfrentam vários obstáculos para a sua concretização. Sabe-se que o investimento em profissionais dedicados à área de saúde materna e obstétrica melhora os resultados em saúde no mundo. Muitas das medidas para atingir os objetivos de desenvolvimento sustentável ocorrem ao nível da comunidade e os EEESMO tem aqui um papel importante na sua concretização. Apesar da existência de regulamentação específica para a prática clínica do EEESMO, há carência de estudos que mostrem a rentabilização das competências dos EEESMO em Portugal em contexto comunitário. Objetivos: identificar quais as áreas de competência rentabilizadas pelos EEESMO nos Agrupamentos de Centros de Saúde (ACES) Baixo Mondego e Pinhal Litoral; analisar os obstáculos à rentabilização das competências do EEESMO nos ACESs do Baixo Mondego e Pinhal Litoral e as forças que potenciam a sua utilização; e analisar o que motiva e/ou desmotiva o desenvolvimento profissional dos EEESMO nos ACESs do Baixo Mondego e Pinhal Litoral e qual a sua satisfação profissional. Metodologia: estudo exploratório qualitativo. Participaram seis EEESMO com vínculo profissional aos ACES referidos. A colheita de dados ocorreu através da realização de uma entrevista semiestruturada, de 13/02/2023 a 05/04/2023. Os dados foram analisados segundo a análise de conteúdo de Bardin (2009). Este estudo teve parecer positivo da comissão de ética da UICISA:E da Escola Superior de Enfermagem de Coimbra (Parecer nº P889_07_2022). Resultados: as competências rentabilizadas pelas EEESMO divergem consoante a unidade funcional em que estão inseridos. A falta de recursos físicos, materiais e humanos, o tipo de gestão de cuidados nas unidades de cuidados na comunidade e a organização dos cuidados de saúde, são obstáculos ao desenvolvimento das competências específicas do EEESMO. A valorização do seu trabalho, o trabalho de equipa, a autonomia e a resiliência são as forças ao desenvolvimento das suas competências. A satisfação profissional relaciona-se com os fatores que as motivam, que se relacionam com as forças ao desempenho das suas funções. Conclusão: a análise critica do estágio permitiu apresentar as atividades desenvolvidas e identificar as dificuldades e estratégias para o desenvolvimento de competências do EEESMO. Relativamente à componente de investigação verificamos que a maioria das competências especificas definidas pela Ordem dos Enfermeiros só são possíveis serem realizadas em contexto de comunidade, contudo ainda se verificam muitos obstáculos à sua rentabilização. Entendemos ser importante o investimento em EEESMO na comunidade de modo a garantir que todas as meninas e mulheres em idade fértil e no climatério tem acesso a cuidados especializados de proximidade. É fundamental mais investigação para construir evidencia científica que sustente a definição de políticas e a contratação de mais EEESMO para as unidades de saúde na comunidade, cumprindo-se as metas nacionais e internacionais definidas pela DGS, OMS e pela ONU.

Cardioneuroablation for severe neurocardiogenic syncope.

INTRODUCTION AND OBJECTIVES: Cardioneuroablation (CNA), a technique based on radiofrequency ablation of cardiac vagal ganglia, was developed to treat recurrent vasovagal syncope (VVS) with a predominant cardioinhibitory component, as an alternative to pacemaker implantation. The aim of our study was to evaluate the safety and success rate of CNA guided by extracardiac vagal stimulation in patients with highly symptomatic cardioinhibitory VVS. METHODS: Prospective study of patients who underwent anatomically guided CNA at two cardiology centers. All patients had a history of recurrent syncope with a predominant cardioinhibitory component and refractory to conventional measures. Acute success was determined by the absence or significant reduction of cardiac parasympathetic response to extracardiac vagal stimulation. The primary endpoint was the recurrence of syncope during follow-up. RESULTS: In total, 19 patients (13 males; mean age 37.8±12.9 years) were included. Ablation was acutely successful in all patients. One patient had a convulsive episode after the procedure, which was deemed unrelated to the ablation, requiring admission to intensive care but without sequelae. No other complications occurred. At a mean follow-up of 21.0±13.2 months (range 3-42 months), 17 patients remained free of syncope. The remaining two patients had recurrence of syncope and, despite undergoing a new ablation procedure, required pacemaker implantation during follow-up. CONCLUSION: Cardioneuroablation, confirmed by extracardiac vagal stimulation, appears to be an effective and safe treatment option for highly symptomatic patients with refractory VVS with a predominant cardioinhibitory component, providing a new potential approach as an alternative to pacemaker implantation.

Reactive oxygen species in biological media are they friend or foe? Major In vivo and In vitro sensing challenges.

The role of Reactive Oxygen Species (ROS) on biological media has been shifting over the years, as the knowledge on the complex mechanism that lies in underneath their production and overall results has been growing. It has been known for some time that these species are associated with a number of health conditions. However, they also participate in the immunoactivation cascade process, and can have an active role in theranostics. Macrophages, for example, react to the presence of pathogens through ROS production, potentially allowing the development of new therapeutic strategies. However, their short lifetime and limited spatial distribution of ROS have been limiting factors to the development and understanding of this phenomenon. Even though, ROS have shown successful theranostic applications, e.g., photodynamic therapy, their wide applicability has been hampered by the lack of effective tools for monitoring these processes in real time. Thus the development of innovative sensing strategies for in vivo monitoring of the balance between ROS concentration and the resultant immune response is of the utmost relevance. Such knowledge could lead to major breakthroughs towards the development of more effective treatments for neurodegenerative diseases. Within this review we will present the current understanding on the interaction mechanisms of ROS with biological systems and their overall effect. Additionally, the most promising sensing tools developed so far, for both in vivo and in vitro tracking will be presented along with their main limitations and advantages. This review focuses on the four main ROS that have been studied these are: singlet oxygen species, hydrogen peroxide, hydroxyl radical and superoxide anion.

A Systematic Review of Hepatitis E Virus Detection in Camels.

Hepatitis E virus (HEV) represents a major cause of acute hepatitis and is considered an emerging public health problem around the world. In the Middle East's and Africa's arid regions, where camels frequently interact with human populations and camel-derived food products are a component of the food chain, camel-borne zoonotic HEV infection is a potential threat. To date, no review paper has been published on HEV in camels. As such, the purpose of the current work is to provide a scientific review of the identification of HEV genotypes seven and eight in camels worldwide to have a better understanding of the current status of this topic and to identify gaps in the current knowledge. Searches were carried out in the electronic databases PubMed, Mendeley, Web of Science, and Scopus, including studies published until 31 December 2022 (n = 435). Once the databases were checked for duplicate papers (n = 307), the exclusion criteria were applied to remove any research that was not relevant (n = 118). As a result, only 10 papers were found to be eligible for the study. Additionally, in eight of the ten studies, the rates of HEV infection were found to be between 0.6% and 2.2% in both stool and serum samples. Furthermore, four studies detected HEV genotype seven in dromedary camels, and two studies have shown HEV genotype eight in Bactrian camels. Interestingly, these genotypes were recently reported in camels from the Middle East and China, where one human infection with HEV genotype seven has been associated with the consumption of contaminated camel meat and milk. In conclusion, more research will be needed to determine the prevalence of HEV infection in camels around the world as well as the risk of foodborne transmission of contaminated camel products. As camels are utility animals in several countries, HEV in these animals may pose a potential risk to public health.

A Systematic Review and Meta-Analysis on Hepatitis E Virus Detection in Farmed Ruminants.

Swine are widely recognized as the main reservoir of zoonotic HEV; however, a growing body of data on the HEV prevalence in farmed ruminants of different species also points to a potential route for HEV transmission through ruminants and ruminant products and by-products. Definite information on the zoonotic potential of ruminants is still absent or unclear, compelling the necessity for increasing knowledge on this. The aim of the current study was to analyze the state-of-the-art in this research topic and provide a summary of HEV detection and characterization in farmed ruminants. A total of 1567 papers were retrieved from four search databases that resulted in 35 eligible papers after application of exclusion/inclusion criteria. Studies on HEV in farmed ruminants were mainly based on the detection of HEV RNA and were reported in Africa (n = 1), America (n = 3), Asia (n = 18) and Europe (n = 13), and focused on a variety of ruminants species, namely cow, goat, sheep, deer, buffalo and yak. The overall pooled prevalence of HEV was 0.02% (0.01-0.03, 95% CI). The subgroup pooled prevalence of HEV RNA was 0.01% (0.00-0.02, 95% CI) in cow milk, stool, serum, liver, intestinal, bile, blood, spleen and rectal swab samples; 0.09% (0.02-0.18, 95% CI) in goat serum, bile, stool, milk, liver, rectal swab and blood samples; 0.01% (0.00-0.04, 95% CI) in sheep stool, serum, milk, blood and liver samples. Most of the HEV genotypes found in farmed ruminants belonged to the zoonotic HEV-3 (subtypes 3a, 3c) and HEV-4 (subtype 4d, 4h), with Rocahepevirus also found. The wide HEV circulation observed in different farmed ruminants raises concerns for the possibility of HEV transmission through products from infected ruminants and alerts for the potential zoonotic route for HEV in ruminant products, such as meat and dairy products. Also, contact exposure to infected farmed animals could be a risk factor. Further research should be conducted in order to understand the circulation of HEV in these animals and its zoonotic potential, as there is currently a lack of data on this topic.

Clinical outcome of a single procedure cryoballoon ablation for the treatment of atrial fibrillation: A real-world multicenter experience in Portugal.

BACKGROUND: Cryoballoon ablation (CBA) for pulmonary vein isolation (PVI) has been growing as an alternative technique, not only in patients with paroxysmal atrial fibrillation (PAF) but also in persistent atrial fibrillation (AF). Cryoballoon ablation has demonstrated encouraging acute and mid-term results. However, data on long-term follow-up of CB-based PVI are scarce. OBJECTIVE: We sought to examine efficacy, safety, and long-term outcomes of CBA in PAF and persistent AF in four Portuguese centers. METHODS: All patients that were treated with the cryoballoon catheter according to routine practices with a second-generation 28-mm CB in four centers were included. This was a retrospective, non-randomized analysis. Patients were followed-up for >12 months and freedom from atrial arrhythmias (AA) was evaluated at the end of follow-up. RESULTS: Four hundred and six patients (57.7±12.4 years, 66% men) participated. AF was paroxysmal in 326 patients (80.2%) and persistent in 80 (19.7%). The mean procedure time duration was 107.7±50.9 min, and the fluoroscopy time was 19.5±9.7 min. Procedural/periprocedural complications occurred in 30 cases (7.3%), being transient phrenic nerve palsy the most frequent incident (2 out of 3 complications). Anatomic variations of the PV were present in 16.1% of cases. At a mean follow-up of 22.0±15.0 months, 310 patients (76.3%) remained in stable sinus rhythm, with at least one AF episode recurrence documented in 98 cases (24.1%). The recurrence rate was 20.5% in the PAF group and 37.8% in the persistent AF group. CONCLUSION: In this multicenter experience, a single CBA procedure resulted in 75.9% freedom from AF at a 22-month follow-up. This technique was demonstrated to be a safe and effective option in experienced centers for the treatment of PAF and PersAF.

Are γ-terpinene, 1,8-cineole, p-coumaric acid, and quercetin active against wild-type and non-wild-type Sporothrix brasiliensis to itraconazole?

The emergence of itraconazole (ITZ)-resistant Sporothrix brasiliensis in feline and canine cases in southern Brazil has hampered the clinical cure of animal sporotrichosis, encouraging the search for therapeutic alternatives. The promising use of plants extracts from Lamiaceae family is known; however, there are no studies with its major compounds, as γ-terpinene (γTER), 1,8-cineole (1,8CIN), p-coumaric acid (pCOU), and quercetin (QUER). For the first time, we evaluated the antifungal, synergistic, cytotoxic activities and action mechanism of these compounds against S. brasiliensis. For this, 28 S. brasiliensis from cats (n = 24) and dogs (n = 4) and standard strains of S. brasiliensis and S. schenckii (n = 4) were tested by M38-A2 (CLSI), revealing non-wild-type (WT) isolates to ITZ on 54.2% (13/24) and 75% (03/04) of feline and canine isolates, respectively. Of the compounds, γTER stood out against all isolates (MIC/MFC 0.75 to > 3 mg/ml; MIC50 3 mg/ml). However, 1,8CIN, pCOU, and QUER showed little or no activity (MIC50 > 3 mg/ml). Thus, γTER was selected for checkerboard assay, whose combination with ITZ showed synergistic (WT isolates) and indifferent (non-WT isolates) interaction. For action mechanism (sorbitol protection and ergosterol effect), γTER acted in membrane by complexing with fungal ergosterol and at the cell wall level, showing two possible pathways as antifungal target. Finally, cytotoxicity (MTT assay) showed that γTER was the safest compound on MDBK cells, even at a concentration of 3 mg/ml (90.16%). Our findings support that γTER is a potent antifungal candidate for the control of sporotrichosis, including against non-WT S. brasiliensis.

Clinical relevance of the blanking period on late recurrence after catheter ablation of atrial fibrillation.

INTRODUCTION: Recurrence of atrial fibrillation (AF) within the blanking period after catheter ablation (CA) is traditionally classified as a transient and benign event. However, recent findings suggest that early recurrence (ER) is associated with late recurrence (LR), challenging the predefined "blanking period". We aimed to determine the clinical and procedural predictors of ER and LR after CA and establish the risk of LR in patients who experience ER. METHODS AND RESULTS: Retrospective single-centre study including all patients who underwent a first procedure of AF CA between 2017 and 2019. ER was defined as any recurrence of AF, atrial flutter or atrial tachycardia >30 s within 90 days after CA and LR as any recurrence after 90 days of CA. A total of 399 patients were included, 37% women, median age of 58 years [49-66] and 77% had paroxysmal AF. Median follow-up was 33 months (from 13 to 61). ER after CA was present in 14% of the patients, and LR was reported in 32%. Among patients who experienced ER, 84% also had LR (p < .001). Patients with ER had a higher prevalence of moderate/severe valvular heart disease, persistent AF, previous electrical cardioversion, a larger left atrium, higher coronary artery calcium score, and higher rates of intraprocedural electrical cardioversion and cardiac fibrosis on eletroanatomical mapping compared with patients without ER. After covariate adjustment, ER and female sex were defined as independent predictors of LR (hazard ratio [HR] 4.69; 95% confidence interval [CI], 2.99-7.35; p < .001 and HR 2.73; 95% CI, 1.47-5.10; p = .002, respectively). CONCLUSION: The risk of LR after an index procedure of CA was significantly higher in patients with ER (five-fold increased risk). These results support the imperative need to clarify the clinical role of the blanking period.

Higher coronary artery calcium score is associated with increased risk of atrial fibrillation recurrence after catheter ablation.

BACKGROUND: Coronary artery calcium score (CACS) is associated with an increased risk of atrial fibrillation (AF) development, but scarce data are available regarding the impact on AF recurrence. This study aims to assess the impact of CACS on AF recurrence following catheter ablation. METHODS: Retrospective study of patients with AF undergoing cardiac computed tomography (CCT) before ablation (2017-2019). Patients with coronary artery disease (CAD), significant valvular heart disease and previous catheter ablation were excluded. A cut-off of CACS ≥ 100 was used according to literature. RESULTS: A total of 311 patients were included (median age 57 [48, 64] years, 65% men and 21% with persistent AF). More than half of the patients had a CACS > 0 (52%) and 18% a CACS ≥ 100. Patients with CACS ≥ 100 were older (64 [59, 69] vs 55 [46, 63] years, p â€‹< â€‹0.001), had more frequently hypertension (68% vs 42%, p â€‹< â€‹0.001) and diabetes mellitus (21% vs 10%, p â€‹= â€‹0.020). During a median follow-up of 34 months (12-57 months), 98 patients (32%) had AF recurrence. CACS ≥ 100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 2.0; 95% confidence interval [CI], 1.3-3.1, p â€‹= â€‹0.002). After covariate adjustment, CACS ≥ 100 and persistent AF remained independent predictors of AF recurrence (HR, 1.7; 95% CI, 1.0-2.8, p â€‹= â€‹0.039 and HR, 2.0; 95% CI, 1.3-3.2, p â€‹= â€‹0.004, respectively). CONCLUSION: An opportunistic evaluation of CACS could be an important tool to improve clinical care considering that CACS ≥ 100 was independently associated with a 69% increase in the risk of AF recurrence after first catheter ablation.

Is amiodarone still a reasonable therapeutic option for rhythm control in atrial fibrillation?

Amiodarone is the most potent antiarrhythmic drug available and is commonly prescribed to treat and prevent not only life-threatening ventricular arrhythmias but also atrial fibrillation (AF). The latest European Society of Cardiology AF guidelines state that amiodarone is recommended for long-term rhythm control in all AF patients but that other antiarrhythmic drugs should be considered first whenever possible, due to its extracardiac toxicity. In patients without significant or with only minimal structural heart disease, amiodarone is not listed as a possibility in their therapeutic scheme. Still, amiodarone is widely and liberally used, and is the most prescribed antiarrhythmic drug for patients with AF despite its high toxicity profile. Non-cardiovascular death was more frequent with amiodarone treatment than with a rate control strategy in AFFIRM, while meta-analyses suggest an association between amiodarone use in patients without structural heart disease and increased non-cardiovascular mortality. Severe or even fatal outcomes due to amiodarone may occur years after treatment initiation and are often not acknowledged by the prescribing physician, who may no longer be following the patient. The lack of widely accepted diagnostic criteria and symptom definitions may lead to underestimation of the incidence of severe side effects and of its toxicity. Unlike the underestimated risk of toxicity with amiodarone, severe complications associated with catheter ablation are usually directly ascribed to the treatment even by non-medical personnel, possibly resulting in overestimation of risks. This brief review will address the issue of amiodarone overuse and the frequent underestimation of its toxicity, while suggesting scenarios in which its use is entirely reasonable, and compare it with catheter ablation.

The road to molecular identification and detection of fungal grapevine trunk diseases.

Grapevine is regarded as a highly profitable culture, being well spread worldwide and mostly directed to the wine-producing industry. Practices to maintain the vineyard in healthy conditions are tenuous and are exacerbated due to abiotic and biotic stresses, where fungal grapevine trunk diseases (GTDs) play a major role. The abolishment of chemical treatments and the intensification of several management practices led to an uprise in GTD outbreaks. Symptomatology of GTDs is very similar among diseases, leading to underdevelopment of the vines and death in extreme scenarios. Disease progression is widely affected by biotic and abiotic factors, and the prevalence of the pathogens varies with country and region. In this review, the state-of-the-art regarding identification and detection of GTDs is vastly analyzed. Methods and protocols used for the identification of GTDs, which are currently rather limited, are highlighted. The main conclusion is the utter need for the development of new technologies to easily and precisely detect the presence of the pathogens related to GTDs, allowing to readily take phytosanitary measures and/or proceed to plant removal in order to establish better vineyard management practices. Moreover, new practices and methods of detection, identification, and quantification of infectious material would allow imposing greater control on nurseries and plant exportation, limiting the movement of infected vines and thus avoiding the propagation of fungal inoculum throughout wine regions.

Detection of hepatitis E virus in milk: Current evidence for viral excretion in a wide range of mammalian hosts.

Infection with hepatitis E virus (HEV) is common in both developing and industrialized nations. Genotypes 3 and 4 are increasingly being reported, particularly in high-income countries where the precise extent of HEV transmission via food is currently unclear. Recently, HEV has been found to be excreted in milk; however, data on the potential milk-borne transmission is still lacking or conflicting and warrants further research on the topic. As such, the aim of the present study was to review the current scientific knowledge and to summarize the existing studies in which HEV has been detected in milk. Exhaustive searches were carried out in Mendeley, PubMed, Scopus and Web of Science. A total of 157 papers were retrieved from the four electronic databases. After removing duplicate articles from the databases (n = 30), exclusion criteria identified unrelated research (n = 115). This allowed the identification of 12 eligible papers. To date, studies on HEV detection in milk were mostly from China (n = 5), followed by Egypt (n = 2), Germany (n = 1), Belgium and Holland (n = 1), Turkey (n = 1), Czech Republic (n = 1) and Spain (n = 1) and were focused on a variety of animals (cow, goat, donkey, buffalo, sheep and camel) and humans. Four out of the 12 eligible studies did not find any evidence of HEV in milk. Moreover, 3 out of the 12 studies detected low rates of HEV (0.2-1.8%) and two were based on a low sample size (n = 1 and n = 4). Interestingly, one study showed very high detection rates and also detected HEV genotype 1 in an animal milk sample, an unusual finding since it only occurs in humans, deserving further studies for confirmation and characterization. Two studies detected high prevalence of HEV genotype 4 in bovine samples from China, with one showing indication of the presence of infectious HEV in milk. To date, there is still a small amount of available data on the HEV presence in milk, posing important questions regarding both animal and human health. Thus, further efforts on this potentially underestimated zoonotic route for HEV should be given, warranting further studies on the topic.

Carbon dots as Reactive Nitrogen Species nanosensors.

Three sets of Carbon Dots (Cdots) were produced through the carbohydrates acid thermal decomposition method. These nanoparticles were functionalized with a polymer, known for its biological compatibility: polyethylene glycol, PEG200, and folic acid, FA, a biomolecule associated with the reactive oxygen and nitrogen (ROS/RNS) savaging process, thus resulting CdotsPEG200, CdotsPEG200FA and CdotsFA. These nanoparticles were tested as nitric oxide radical (NO·) sensors and it was determined that CdotsPEG200FA and CdotsFA fluorescence intensity was quenched by the presence of this radical specie. Moreover, according to the Benesi-Hilderbrand plot, the nanoparticles have a high affinity towards the analyte and this interaction is consistent with a 1:1 stoichiometry, through an independent mechanism. The Stern-Volmer constant, obtained for both sensing systems, is compatible with the formation of stable complexes (static quenching) between the Folic Acid residues on the Cdots surface and NO·. The detection and quantification limits along with the sensitivity were calculated for both nanoparticles: DL (31.7 ± 0.02) x 10-9, QL (96.29 ± 0.01) x 10-9, Sensitivity (5.2 ± 0.5) x 109 M for CdotsFA and DL (83 ± 3) x 10-10, QL (251 ± 2) x 10-10, Sensitivity (8.4 ± 0.3) x 1010 M. These values are adequate for biological sensing and are quite competitive with other reported nanosensors for NO· detection and quantification.

Turn-on, photostable, nontoxic and specific, iron(II) sensor.

The pressing need to develop a specific analytical sensor that can identify and quantify Fe(II) without a cytotoxic response was the major motivation drive in this work. The turn-on fluorescent sensor here described can successfully detect Fe(II) and discriminate this ion from other analytes that commonly act as interferents in biological media. Moreover, this reduced fluoresceinamine-based sensor has a high photostability and high dissociation constant, which is an indication that the complex obtained between reduced fluoresceinamine (RFL) and Fe(II) is highly stable. This fluorescence-based sensor has a binding mechanism of 1:1 and a positive cooperativity was found between analyte and sensor. The detection, quantification and sensitivity parameters of the sensor were determined: 21.6 ± 0.1 µM; 65.6 ± 0.1 µM and 48 ± 3 (×107) µM, respectively. To evaluate a possible cytotoxicity effect an erythrocyte assay was performed and the obtained data were evaluated considering CdTe Quantum Dots (QDs) passivated with mercaptoacetic acid has experimental control. According to the resulting data RFL is not cytotoxic even when used in high concentrations, 660 mM. On the other hand QDs are quite different. Indeed it was proven that these heavy metal-based nanoparticles are responsible for 40% erytrocytes hemolysis in concentrations of 600 mM.

La pluripatologia en una Unidad de Insuficiencia Cardíaca: la perspectiva de un internista / Pluripathology in a Heart Failure Unit - a internist’ perspective

Objetivo: Determinar la frecuencia de pluripatología en una Unidad de Insuficiencia Cardíaca, definir las características de los pacientes pluripatológicos y su pronóstico vital según dos modelos: el índice PROFUND y el Seattle Heart Failure Model. Material y métodos: Se han analizado de forma consecutiva los pacientes observados en la consulta de insuficiencia cardíaca de un hospital de tercer nivel durante dos meses. Se han registrado comorbilidades, categorías de pluripatología y los índices de Charlson, Barthel, Seattle Heart Failure Model y PROFUND. Resultados: Se incluyeron 246 pacientes, de los que 118 (48%) fueron pluripatológicos, con índice de Charlson 7,9±3,8 y PROFUND 3,5±7,1.La categoría de pluripatología más prevalente fue la A, seguida de la B yC. Los pluripatológicos fueron mayores (77 vs. 73 años, p=0,001), más frágiles, con mayor limitación funcional (Barthel: 84,7 vs. 96,1, p<0,001),mayor prevalencia de factores de riesgo cardiovascular y enfermedades crónicas e ingresaron más (14,4 vs. 4,7, p=0,015). La etiología más frecuente fue la cardiopatía isquémica. Los pacientes pluripatológicos tenían clase funcional más avanzada NHYA III-IV (4,2 vs. 0,8, p<0,001), NT-proBNP más elevados (2985 pg/ml vs. 1780 pg/ml, p=0,013) y precisaron mayor dosis de diuréticos (60 vs 40, p<0,001). Se verificó una concordancia en la estimativa de mortalidad entre el PROFUND y el Seattle Heart Failure Model. Conclusiones: Este estudio demuestra la elevada frecuencia de pacientes pluripatológicos en una unidad de insuficiencia cardíaca, reflejando una mayor sobrecarga asistencial y necesidad de cuidados más complejos. Se trata de una población con gran fragilidad, dependencia funcional y comorbilidad, que obliga a plantear un abordaje multidisciplinar. (AU)

Objectives: to determine the frequency of pluripathology in a Heart Failure Unit, defining the characteristics of pluripathological patients and their vital prognosis according to two models: PROFUND score and Seattle Heart Failure Model. Methods: consecutive patients from a Heart Failure Unit of a third level hospital were analized during two months. Comorbidities, pluripathology categories and Charlson, Barthel, Seattle Heart Failure Model and PROFUND scores were registered. Results: 246 patients were included, of which 118 (48%) were pluripathological, with Charlson score 7.9 ± 3.8 and PROFUND 3.5 ± 7.1.The most prevalent category of pluripathology was A, followed by B and C. The pluripathological patients were older (77 vs. 73 years, p = 0.001),more fragile, with greater functional limitation (Barthel: 84.7 vs. 96, 1,p <0.001), higher prevalence of cardiovascular risk factors and chronic diseases and admitted more (14.4 vs. 4.7, p = 0.015). The most frequent etiology was ischemic heart disease. The pluripathological patients hadmore advanced functional class NHYA III-IV (4.2 vs. 0.8, p <0.001), higherNT-proBNP (2985 pg/ml vs. 1780 pg/ml, p = 0.013) and required higherdose of diuretics (60 vs 40, p <0.001). A concordance in the mortality estimate between the PROFUND and the Seattle Heart Failure Model wasverified. Conclusion: Our study demonstrates the high frequency of pluripathological patients in a heart failure unit, population with great fragility, due to functional dependence and the association of comorbidities, that requires a multidisciplinary approach. (AU)

Vibrotactile biofeedback devices in Parkinson's disease: a narrative review.

Parkinson's disease (PD) is often associated with a vast list of gait-associated disabilities, for which there is still a limited pharmacological/surgical treatment efficacy. Therefore, alternative approaches have emerged as vibrotactile biofeedback systems (VBS). This review aims to focus on the technologies supporting VBS and identify their effects on improving gait-associated disabilities by verifying how VBS were applied and validated with end-users. It is expected to furnish guidance to researchers looking to enhance the effectiveness of future vibrotactile cueing systems. The use of vibrotactile cues has proved to be relevant and attractive, as positive results have been obtained in patients' gait performance, suitability in any environment, and easy adherence. There seems to be a preference in developing VBS to mitigate freezing of gait, to improve balance, to overcome the risk of fall, and a prevalent use to apply miniaturized wearable actuators and sensors. Most studies implemented a biofeedback loop able to provide rescue strategies during or after the detection of a gait-associated disability. However, there is a need of more clinical evidence and inclusion of experimental sessions to evaluate if the biofeedback was effectively integrated into the patients' motor system.

Theta burst stimulation over the prefrontal cortex: Effects on cerebral oximetry and cardiovascular measures in healthy humans.

Theta Burst Stimulation (TBS) is a non-invasive neurophysiological technique, able to induce changes in synaptic activity. Research suggests that TBS may induce changes in cerebral oxygenation, cerebral blood flow, blood pressure and heart rate but there are conflicting results across studies. Thus, the objective of our sham-controlled study is to evaluate if TBS applied to the dorsolateral prefrontal cortex (DLPFC) of healthy volunteers produces changes in cerebral oximetry, heart rate and blood pressure. Forty-nine volunteers of both sexes were randomly allocated to one of five stimulation groups. Before and after real TBS or sham stimulation, blood pressure, heart rate, and cerebral oxygenation of the volunteers were measured. Cerebral oxygenation values were obtained with a near infra-red spectroscopy system. We found a significant reduction in left cortex oximetry after continuous TBS (cTBS) over the left DLPFC (p = 0.039) and a non-significant reduction in right cortex oximetry (p = 0.052). Right hemisphere inhibition (using cTBS) seemed to originate a significant reduction of 8 mmHg in systolic arterial pressure. No other changes were seen in oximetry, cardiac frequency and diastolic arterial pressure. In our group of normal subjects, cTBS applied to the left DLPFC was able to reduce oxygenation in the left cortex. Right hemisphere inhibition was associated with a significant reduction in systolic pressure.