DNA barcoding and new records of Ornithodoros yumatensis from Central Mexico.

Bats represent the second order of mammals with the highest number of species worldwide with over 1,616 species, and almost 10% of them are recorded in Mexico. These mammals have a great diversity of ectoparasites, in particular soft ticks of the genus Ornithodoros. Desmodus rotundus is one of the bat species that has scarcely been studied in terms of tick species richness in Mexico, with three tick species reported in five of the 32 Mexican states. For this reason, the aim of the present work was to identify ticks associated with D. rotundus from Central Mexico. Fieldwork was undertaken in the municipality El Marqués, Ejido Atongo A, Querétaro, Mexico. Bats were captured using mist nets and were visually inspected for tick presence. The ectoparasites were identified morphologically and molecularly with the use of mitochondrial markers 16SrDNA and cytochrome oxidase subunit I (COI). A total of 30 D. rotundus (1 female, 29 males) were captured, from which 20 larvae identified as Ornithodoros yumatensis were recovered. Molecular analysis confirmed the presence of this species with identity values of 99-100% with sequences of this species from the southwestern US, and the Yucatán Peninsula, Mexico. This is the first report of ticks associated with bats for the state of Querétaro, providing the first sequences of the COI gene from Mexican populations of O. yumatensis and shows an increase in the distribution of this soft tick across Central Mexico.

Early identification of axial psoriatic arthritis among patients with psoriasis: a prospective multicentre study.

OBJECTIVES: To evaluate a dermatologist-centred screening tool followed by a structured rheumatological examination including MRI of sacroiliac joints and spine for the recognition of psoriatic arthritis with axial involvement (axPsA). METHODS: This was a prospective multicentre study. Adult patients with a confirmed diagnosis of psoriasis who had chronic back pain (≥3 months), onset <45 years and had not been treated with any biologic or targeted synthetic disease-modifying antirheumatic drug in the 12 weeks before screening were referred to a specialised rheumatology clinic. A rheumatological investigation including clinical, laboratory and genetic assessments as well as imaging with conventional radiography and MRI of sacroiliac joints and spine was performed. The primary outcome of the study was the proportion of patients diagnosed with axPsA among all referred patients with PsO. RESULTS: Rheumatologists examined 100 patients of those who qualified for referral. 14 patients (including 3 with both axial and peripheral involvement) were diagnosed with axPsA and 5 were diagnosed with peripheral PsA solely. All patients diagnosed with axPsA had active inflammatory and/or structural (post)inflammatory changes in the sacroiliac joints and/or spine on imaging. In five patients, MRI changes indicative of axial involvement were found only in the spine. All but one patient with PsA (13/14 with axPsA and 5/5 with pPsA) fulfilled the Classification Criteria for Psoriatic Arthritis criteria for PsA. The Assessment of SpondyloArthritis International Society criteria for axSpA were fulfilled in 9 (64.3%) patients diagnosed with axPsA. CONCLUSIONS: Applying a dermatologist-centred screening tool may be useful for the early detection of axPsA in at-risk patients with psoriasis .

Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies.

Importance: Although highly effective disease-modifying therapies for multiple sclerosis (MS) have been associated with an increased risk of infections vs injectable therapies interferon beta and glatiramer acetate (GA), the magnitude of potential risk increase is not well established in real-world populations. Even less is known about infection risk associated with rituximab, which is extensively used off-label to treat MS in Sweden. Objective: To examine the risk of serious infections associated with disease-modifying treatments for MS. Design, Setting, and Participants: This nationwide register-based cohort study was conducted in Sweden from January 1, 2011, to December 31, 2017. National registers with prospective data collection from the public health care system were used. All Swedish patients with relapsing-remitting MS whose data were recorded in the Swedish MS register as initiating treatment with rituximab, natalizumab, fingolimod, or interferon beta and GA and an age-matched and sex-matched general population comparator cohort were included. Exposures: Treatment with rituximab, natalizumab, fingolimod, and interferon beta and GA. Main Outcomes and Measures: Serious infections were defined as all infections resulting in hospitalization. Additional outcomes included outpatient treatment with antibiotic or herpes antiviral medications. Adjusted hazard ratios (HRs) were estimated in Cox regressions. Results: A total of 6421 patients (3260 taking rituximab, 1588 taking natalizumab, 1535 taking fingolimod, and 2217 taking interferon beta/GA) were included, plus a comparator cohort of 42 645 individuals. Among 6421 patients with 8600 treatment episodes, the mean (SD) age at treatment start ranged from 35.0 (10.1) years to 40.4 (10.6) years; 6186 patients were female. The crude rate of infections was higher in patients with MS taking interferon beta and GA than the general population (incidence rate, 8.9 [95% CI, 6.4-12.1] vs 5.2 [95% CI, 4.8-5.5] per 1000 person-years), and higher still in patients taking fingolimod (incidence rate, 14.3 [95% CI, 10.8-18.5] per 1000 person-years), natalizumab (incidence rate, 11.4 [95% CI, 8.3-15.3] per 1000 person-years), and rituximab (incidence rate, 19.7 [95% CI, 16.4-23.5] per 1000 person-years). After confounder adjustment, the rate remained significantly higher for rituximab (HR, 1.70 [95% CI, 1.11-2.61]) but not fingolimod (HR, 1.30 [95% CI, 0.84-2.03]) or natalizumab (HR, 1.12 [95% CI, 0.71-1.77]) compared with interferon beta and GA. In contrast, use of herpes antiviral drugs during rituximab treatment was similar to that of interferon beta and GA and lower than that of natalizumab (HR, 1.82 [1.34-2.46]) and fingolimod (HR, 1.71 [95% CI, 1.27-2.32]). Conclusions and Relevance: Patients with MS are at a generally increased risk of infections, and this differs by treatment. The rate of infections was lowest with interferon beta and GA; among newer treatments, off-label use of rituximab was associated with the highest rate of serious infections. The different risk profiles should inform the risk-benefit assessments of these treatments.

Residual effects of benzodiazepine and non-benzodiazepine hypnotics on diurnal attention in a reaction time task / Efectos residuales de hipnóticos benzodiacepínicos y no-benzodiacepínicos sobre la tención diurna en una tarea de tiempo de reacción

The residual effects of benzodiazepines on attention and psychomotor performance have been extensively documented. However, there are very few studies comparing the action of benzodiazepines and non-benzodiazepine (imidazopiridines and cyclopirrolones) compounds on these parameters. The aim of this work was to assess the residual effects on diurnal wakefulness in healthy volunteers after nocturnal administration of a single dose of diazepam (10 mg), zolpidem (10 mg), zopiclone (7.5 mg), gamma-amino-ß-hydroxybutyrate (500 mg), or placebo. Drugs were given at 22 h (half-hour before bedtime), in a double-blind fashion according to an extended Youden Square design. Subjects slept for six consecutive nights in the sleep laboratory (habituation, baseline, drug 1, placebo, drug 2, placebo). The morning after nocturnal dosing, psychomotor performance was measured using a simple visuomotor reaction time (RT) task, with two stimulation patterns (isochronus and stochastic). The results indicated an absence of residual effects on attention after zopiclone and zolpidem intake. Likewise, administration of diazepam did not provoke a significant deterioration in the attention level. GABOB was the only drug which produced a marked decrease in the isochronus RT after 9 hours of its administration, in comparison to its baseline, not appreciating any significant modification in the stochastic RT. It is emphasized that residual impairment on RT following intake of hypnotics should be considered on the basis of the stimulation pattern used (stochastic vs isochronus) during vigilance assessment (AU)

Los efectos residuales de las benzodiacepinas sobre la atención y el rendimiento psicomotor han sido extensamente documentados. Sin embargo, existen muy pocos estudios que hayan comparado el efecto de compuestos benzodiacepínicos y no benzodiacepínicos (imidazopirinas y ciclopirrolonas) sobre dichos parámetros. El objetivo de este trabajo fue evaluar los efectos residuales sobre la atención diurna de una dosis aguda de diazepam (10 mg.), zolpidem (10 mg), zoplicona (7,5 mg), GABOB (500 mg) o placebo, administrada la noche anterior en sujetos voluntarios sanos. Los fármacos fueron administrados a las 22 h (media hora de acostarse), utilizando un diseño doble-ciego de cuadrado latino extendido. Los sujetos pasaron seis noches consecutivas en el laboratorio de sueño (habituación, línea-base, fármaco 1, lavado, fármaco 2, lavado). A la mañana siguiente, se examinó el rendimiento psicomotor utilizando una tarea de tiempo de reacción visomotor simple, con dos patrones de estimulación (isócrono y estocástico). Los resultados indicaron una ausencia de efectos residuales sobre la atención tras la administración de zoplicona y solpidem. Asimismo, la administración de diazepam no provocó un deterioro significativo en el nivel de atención. GABOB fue la única sustancia que produjo un marcado descenso en el tiempo de reacción isócrono, a las 9 horas de su administración, en comparación con la línea-base, no apreciándose ningúncambio significativo en el tiempo de reacción estocástico. Se subraya que los efectos residuales sobre el tiempo de reaación tras la ingesta de hispnótico deben ser considerados sobre la base del patrón de estimulación (estocástico vs isócrono) durante la evaluación de la vigilancia (AU)