Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal.

Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.

Gantry triggered x-ray verification during single-isocenter stereotactic radiosurgery: Increased certainty for a no-margin strategy.

BACKGROUND: Single-isocenter linac-based stereotactic radiosurgery (SRS) has emerged as a dedicated treatment option for multiple brain metastases. Consequently, image-guidance for patient positioning and motion management has become very important. The purpose of this study was to analyze intra-fraction errors measured with stereoscopic x-rays and their impact on the dose distribution. MATERIALS AND METHODS: Treatments were planned with non- coplanar dynamic conformal arcs for 33 patients corresponding to 127 brain lesions and 356 arcs. Intra-arc positioning errors were measuredusing stereoscopic x-rays (ExacTrac Dynamic, Brainlab), triggered during arc delivery. Couch corrections above 0.7 mm and 0.5° were always applied. Intra-arc positioning data was analyzed. The dose impact was evaluated by applying the measured errors to the dose given in each arc. RESULTS: Median residual errors were 0.10 mm, 0.13 mm and 0.08 mm for the lateral, longitudinal and vertical directions and 0.10°, 0.08° and 0.13° for the pitch, roll and yaw angles respectively. 90% of the treatment arcs showed shifts of less than 0.4 mm and 0.4°in all directions. Dosimetric impact of motion showed the largest losses in coverage on small targets. All targets achieved at least 95% of the prescription dose to 95% of their volume, even when planned without margins. CONCLUSIONS: Intra-fractional errors measured during beam delivery were found to be notably low with a dose impact that showed acceptable target coverage when applying these intra-arc errors to the dose distributions of the individual treatment arcs. Using an adequate immobilization and intra-fraction imaging prior to and during irradiation, no margins need to be added to compensate for intra-fraction motion.

Cellular environment of TTR deposits in an animal model of ATTR-Cardiomyopathy.

Introduction: Cardiac amyloidoses are the most fatal manifestation of systemic amyloidoses. It is believed the number of cases to be greatly underestimated mostly due to misdiagnosis. Particularly, the involvement of TTR V30M in the heart of ATTRV30M amyloidosis has not been completely understood specifically in terms of implicated cellular pathways, heart function and cardiac physiology. In the present work we proposed to characterize TTR V30M cardiac involvement particularly at the tissue cellular level in a mouse model. Methods: HSF ± hTTR V30M mice, a model that expresses human TTRV30M in a Ttr null background, widely used for the characterization and modulation of neurological features of ATTRV30M amyloidosis was used. SDS-PAGE of cardiac homogenates followed by Western blot was performed. Immunohistochemistry and double immunofluorescence analyses were carried out to determine TTR deposition pattern and sub-localization. Results: Western blots were able to detect TTR in its monomeric state at ∼14 kDa. Immunofluorescent images showed TTR was found mostly in the intercellular spaces. Blood contamination was excluded by CD31 staining. Tissues were Congo Red negative. Upon TTR and macrophages (CD68) staining in the cardiac tissue a clear tendency of macrophage convergence to the tissue regions where TTR was more abundant was observed. Moreover, in some instances it was possible to detect co-localization of both fluorophores. Cardiac fibroblasts were stained with PDGFr-alpha, and here the co-localization was not so evident although there was some degree of co-occurrence. The hearts of transgenic mice revealed higher content of Galectin-3. Conclusion: This animal model and associated features observed as result of cardiac TTR deposition provide a promising and invaluable research tool for a better understanding of the implicated pathways that lead to the lethality associated to TTR cardiac amyloidosis. New therapeutic strategies can be tested and ultimately this will lead to improved treatment alternatives capable of increasing patient's quality of life and life expectancy and, hopefully to eradicate a condition that is silently spreading worldwide.

Henoch-Schönlein purpura masquerading as Crohn's disease flare.

We describe the case of a 69-year-old male with Crohn's disease (CD), treated with infliximab and undergoing intestinal resection. The surgery and postoperative period were unremarkable, with no CD-related symptoms. Two months after surgery and two weeks after the introduction of infliximab, he was admitted due to acute onset diffuse abdominal pain, hematochezia and arthralgia. On physical observation on admission, he showed signs of arthritis of the left knee. Laboratory tests revealed renal failure with nephrotic proteinuria, slightly low complement (C3) and IgA elevation. Remaining autoimmunity and viral panel were negative. Abdominal examination showed duodenum and thickening of the proximal wall of the jejunum. Biopsies excluded active CD. Colon and ileum mucosa were normal. The patient met EULAR criteria for Henoch-Schönlein purpura and was started on prednisolone with response. Although no clear trigger was pointed out, we switched anti-TNF to ustekinumab. We present this case given its endoscopic exuberance, and because of the high index of suspicion to make the diagnosis in adult patients with previous inflammatory bowel disease. The distinction between this vasculitis and CD is of utmost importance, given the therapeutic implications.

Isolated Jejunal Crohn's Disease: a challenging diagnosis.

A 27-year-old Nepalese male presented with recurrent abdominal pain accompanied by a lower stool consistency over the past 2 years. These episodes occurred several times a year, lasting 1 to 2 weeks, and resolved spontaneously, after adjustment of diet and/or medication for symptomatic control (e.g., antispasmodics, probiotics). Over the last year, the patient had undergone an extensive diagnostic investigation, which revealed no alterations in the laboratory workup, abdominal scan, esophagogastroduodenoscopy, and colonoscopy, including biopsies of the duodenum, and colon, so the symptoms have been attributed to irritable bowel syndrome. However, the symptoms had become more frequent, so the patient was referred to our gastroenterology department. We repeated and extended the work-up. Laboratory investigations showed an elevated erythrocyte sedimentation rate and faecal calprotectin. The remaining laboratory as well an extensive stool workup for infection were unremarkable. Esophagogastroduodenoscopy and ileocolonoscopy were normal. Small bowel capsule endoscopy revealed jejunal mucosa with lymphangiectasias, pseudopolypoids formations and superficial longitudinal ulcers, these findings were corroborated by the double-balloon enteroscopy, and biopsies showed marked architectural distortion, chronic inflammatory infiltrate, and an epithelioid granuloma. The clinical, endoscopic, biochemical, and histological findings were consistent with isolated jejunal Crohn's disease. The patient started adalimumab with complete remission after one year. We present this case given its exuberant endoscopic findings and due to the difficulty in making the diagnosis due to its rarity, location, and unspecific presentation.

Time trends in episiotomy and severe perineal tears in Portugal: a nationwide register-based study.

INTRODUCTION: Rates of episiotomy and severe perineal tears (SPT) are indicators of the quality of obstetric care. Time-trends in the reported occurrence of episiotomy and SPT can contribute to understand both, changes in care and in the frequency of risk factors. Therefore, we aimed to estimate time trends in the frequency of SPT in Portugal and its relationship with episiotomy. METHODS: We conducted a nationwide register-based study using data from the national inpatient database of all Portuguese public hospitals between 2000 and 2015. Time-trend analysis using joinpoint regression models was performed to identify trends (joinpoints) and compare time changes in the prevalence of SPT and risk factors expressed as annual percentage changes (APC) with 95% Confidence Intervals (95% CI). Poisson regression models were fitted to estimate whether time-trends in SPT rates were explained by changes in risk factors and to assess the association between episiotomy and SPT. Adjusted relative risk (aRR) and their respective 95% CI were obtained. RESULTS: From 908,999 singleton vaginal deliveries, 20.6% were instrumental deliveries, 76.7% with episiotomy and 0.56% were complicated by SPT. Among women with non-instrumental deliveries and no episiotomy SPT decreased from 2009 onwards (1.3% to 0.7%), whereas SPT kept increasing in women with episiotomy for both non-instrumental (0.1% in 2000 to 0.4% in 2015) and instrumental deliveries (0.7% in 2005 to 2.3% in 2015). Time-trends in potential risk factors did not explain the observed increase in SPT. Episiotomy was associated with a decrease in SPT with adjusted RR varying between 2000 and 2015 from 0.18 (95%CI:0.13-0.25) to 0.59 (95%CI:0.44-0.79) for non-instrumental deliveries and from 0.45 (95%CI:0.25-0.81) to 0.50 (95%CI:0.40-0.72) for instrumental deliveries. CONCLUSIONS: Our findings suggest that episiotomy rate could safely further decrease as the main factor driving SPT rates seems to be an increase in awareness and reporting of SPT particularly among women who underwent an episiotomy.

Comportamentos aditivos com e sem substância em adolescentes: relação com a idade e o sexo / Additive behaviors with and without substance in adolescents: relation with age and sex

Resumo Contexto: O fenómeno da adição, com e sem substância, constitui um problema na adolescência pelo impacto negativo em diferentes domínios, nomeadamente na saúde mental. Assim, é fundamental que as equipas de saúde escolar conheçam a prevalência e características dos consumos aditivos dos adolescentes. Objetivo(s): Caracterizar o consumo aditivo com substância (tabaco, álcool e drogas) e sem substância (internet, jogos e redes sociais) em adolescentes, e relacionar os consumos entre si e com as variáveis idade e sexo. Métodos: Estudo transversal, descritivo-correlacional, com a aplicação de um questionário de autopreenchimento em contexto escolar, com uma amostra não probabilística constituída por 571 adolescentes. Resultados: O tabaco, o álcool, a internet e as redes sociais foram as adições mais prevalentes nos adolescentes. Foi encontrada associação entre o consumo de álcool e drogas ilícitas e as variáveis idade e sexo; e entre o consumo de álcool e o grupo etário. Existe correlação positiva e significativa entre o consumo de tabaco e o consumo de drogas; e correlação entre o consumo de álcool com os consumos de tabaco e drogas. Conclusões: Os adolescentes com consumo aditivo a uma substância apresentavam também outras adições, com ou sem substância. O presente estudo realça a necessidade de reforçar os programas de educação para a saúde na comunidade educativa com enfoque na prevenção de comportamentos aditivos com e sem substância nos adolescentes.

Abstract Background: The addiction behaviour is problematic due to its negative impact on adolescents' psychosocial well-being, including their mental health. Thus, it is essential that school health teams know the prevalence and the characteristics of adolescent addictive behaviours. Aim: To characterize addictive behaviour with substance (tobacco, alcohol, and drugs) and without substance (internet, games, and social media) in adolescents and to relate the additive behaviours with and without substance and with the variables age and sex. Methods: Cross-sectional, descriptive-correlational study with the application of a self-administered questionnaire, in a school context, to a non-probabilistic sample of 571 adolescents. Results: Tobacco, alcohol, the internet, and social media are the most prevalent adolescents' additions. Alcohol and illicit drugs consumption are associated with the variables age and sex, and alcohol consumption is associated with age. There is a positive and significant correlation between tobacco use and drug; and correlation between alcohol consumption and tobacco and drug consumption. Conclusions: Adolescents with addictive consumption on one substance have also other additions, with or without substance. The present study highlights the need to reinforce health education programs in the educational community with a focus on preventing addictive behaviors with and without substance in adolescents.

Bem-estar Psicológico e Utilização Problemática da Internet em Adolescentes / Psychological Well-Being and Problematic Use of the Internet in Adolescents

Resumo Contexto: A internet mudou os comportamentos dos adolescentes e trouxe novas formas de socialização e comunicação. Para além das suas vantagens, a utilização excessiva pode ter implicações no domínio pessoal, familiar, social e académico, com possíveis consequências nefastas para a saúde e bem-estar psicológico dos mais jovens. Objetivo(s): Caracterizar o bem-estar psicológico e a utilização da internet; relacionar o uso problemático da Internet com o bem-estar psicológico dos adolescentes; e relacionar o bem-estar psicológico dos adolescentes com as variáveis sociodemográficas, escolares e utilização da internet. Métodos: Estudo descritivo-correlacional e transversal com uma amostra de 478 adolescentes, com média de M=14,5 anos (DP=1,9), em contexto escolar. Aplicou-se um questionário que incluía a caracterização sociodemográfica e questões sobre a utilização da internet, o Questionário de Bem-estar Psicológico, versão reduzida (QBEP-R) e a Escala do Uso Generalizado e Problemático da Internet (GPIUS2). O tratamento estatístico foi efetuado com recurso à análise descritiva e inferencial. Resultados: Foram observados níveis satisfatórios e elevados de bem-estar psicológico nos adolescentes e utilização problemática da Internet em 13,4% da amostra. Verificou-se uma correlação negativa entre a utilização problemática da internet e o bem-estar psicológico. Constataram-se diferenças estatisticamente significativas no bem-estar psicológico em relação às variáveis: idade, sexo, nível de ensino, presença de hobby, utilização das redes sociais e jogos online. Conclusões: Os adolescentes com utilização problemática da internet apresentavam menor bem-estar psicológico, o que justifica a intervenção dos profissionais de saúde, na implementação de estratégias que promovam comportamentos saudáveis e consequentemente o bem-estar psicológico.

Abstract Background: The internet has changed the behavior of teenagers and brought new forms of socialization and communication. However, beyond its advantages there are also some risks. Excessive use can have consequences in the personal, family, social and academic domain, with possible harmful effects on the health and psychological well-being of youngsters. Aim: To characterize the psychological well-being and the use of the internet and to relate the problematic use of the Internet to the psychological well-being of adolescents. Methods: Descriptive-correlational, cross-sectional, and quantitative study, with a sample about 478 adolescents, with an average age of M=14,5 years old (SD =1,9), in a school context. A questionnaire was applied that included the sociodemographic characterization and use of the internet, the Psychological Well-being Questionnaire, short version (QBEP-R) and the Scale of Generalized and Problematic Use of the Internet (GPIUS2). The statistical treatment was performed using descriptive and inferential analysis. Results: Satisfactory and high levels of psychological well-being were observed in adolescents, and problematic use of the Internet was held by 13,4% of the sample. There was a negative correlation between problematic use of the Internet and psychological well-being. There were statistically significant differences in psychological well-being in relation to the variables: age, sex, level of education, presence of hobby, use of social networks and online games. Conclusions: Adolescents with problematic use of the internet have lower psychological well-being, which justifies the intervention of health professionals, namely nurses, in the implementation of strategies that promote healthy online behaviours and, consequently, psychological well-being.

Dynamic loading stimulates mandibular condyle remodeling.

BACKGROUND: We and others have reported that low-magnitude high-frequency dynamic loading has an osteogenic effect on alveolar bone. Since chondrocytes and osteoblasts originate from the same progenitor cells, we reasoned that dynamic loading may stimulate a similar response in chondrocytes. A stimulating effect could be beneficial for patients with damaged condylar cartilage or mandibular deficiency. METHODS: Studies were conducted on growing Sprague-Dawley rats divided into three groups: control, static load, and dynamic load. The dynamic load group received a dynamic load on the lower right molars 5 minutes per day with a 0.3 g acceleration and peak strain of 30 µÎµ registered by accelerometer and strain gauge. The static load group received an equivalent magnitude of static force (30 µÎµ). The control group did not receive any treatment. Samples were collected at days 0, 28, and 56 for reverse transcriptase polymerase chain reaction analysis, microcomputed tomography, and histology and fluorescent microscopy analysis. RESULTS: Our experiments showed that dynamic loading had a striking effect on condylar cartilage, increasing the proliferation and differentiation of mesenchymal cells into chondrocytes, and promoting chondrocyte maturation. This effect was accompanied by increased endochondral bone formation resulting in lengthening of the condylar process. CONCLUSIONS: Low-magnitude, high-frequency dynamic loading can have a positive effect on condylar cartilage and endochondral bone formation in vivo. This effect has the potential to be used as a treatment for regenerating condylar cartilage and to enhance the effect of orthopedic appliances on mandibular growth.

Histological Inflammation in the Endoscopically Uninflamed Mucosa is Associated With Worse Outcomes in Limited Ulcerative Colitis.

BACKGROUND: The Montreal classification categorizes patients with ulcerative colitis (UC) based on their macroscopic disease extent. Independent of endoscopic extent, biopsies through all colonic segments should be retrieved during index colonoscopy. However, the prognostic value of histological inflammation at diagnosis in the inflamed and uninflamed regions of the colon has never been assessed. METHODS: This was a multicenter retrospective cohort study of newly diagnosed patients with treatment-naïve proctitis and left-sided UC. Biopsies from at least 2 colonic segments (endoscopically inflamed and uninflamed mucosa) were retrieved and reviewed by 2 pathologists. Histological features in the endoscopically inflamed and uninflamed mucosa were scored using the Nancy score. The primary outcomes were disease complications (proximal disease extension, need for hospitalization or colectomy) and higher therapeutic requirements (need for steroids or for therapy escalation). RESULTS: Overall, 93 treatment-naïve patients were included, with a median follow-up of 44 months (range, 2-329). The prevalence of any histological inflammation above the endoscopic margin was 71%. Proximal disease extension was more frequent in patients with histological inflammation in the endoscopically uninflamed mucosa at diagnosis (21.5% vs 3.4%, P = 0.04). Histological involvement above the endoscopic margin was the only predictor associated with an earlier need for therapy escalation (adjusted hazard ratio, 3.69; 95% confidence interval, 1.05-13.0); P = 0.04) and disease complications (adjusted hazard ratio, 4.79; 95% confidence interval, 1.10-20.9; P = 0.04). CONCLUSIONS: The presence of histological inflammation in the endoscopically uninflamed mucosa at the time of diagnosis was associated with worse outcomes in limited UC.

Equitable migrant-friendly perinatal healthcare access and quality in public maternity units in Portugal.

BACKGROUND: Migrant women are at higher risk to face access barriers to perinatal care services and to experience worse pregnancy outcomes compared to native. Assessing the perception of migrant women and health providers discloses a multifaceted view on migrant-friendly care, a multidimensional concept in itself. This study aims to compare self-perceived assessments of migrant women and directors of obstetrics and gynaecology (GYN/OBS) departments on equitable migrant-friendly perinatal healthcare quality and access during the intrapartum and postpartum period at public maternities in Portugal. METHODS: In this cross-sectional study, two indicators on Healthcare access and Quality of care were developed to compare how adult migrant women who gave birth between April 2017 and March 2019 and GYN/OBS department directors assessed offered care. The one-sample Wilcoxon test was used to compare directors' with migrants' assessments and the Kruskal-Wallis one-way analysis of variance to test for country regional differences. A stratified analysis by sex, spoken language, and country of birth tested for potential effect modifiers. RESULTS: Migrants rated Healthcare access significantly better (P<0.05), but perceived Quality of care worse (P<0.01) than GYN/OBS department directors. Migrants' and directors' perceptions differed significantly according to directors' gender (P<0.05). Migrants' and directors' assessments on Healthcare access (P<0.05) and Quality (P<0.01) changed significantly across regions. CONCLUSIONS: Migrants' and directors' self-perceived appraisal of Healthcare access and Quality of care significantly varied. Identifying these discordances allows to deliver insights into existing barriers in access and provision of care and raises awareness to improve quality assurance, essential to inform practice and policies.

Novel xylan-degrading enzymes from polysaccharide utilizing loci of Prevotella copri DSM18205.

Prevotella copri is a bacterium that can be found in the human gastrointestinal tract (GIT). The role of P. copri in the GIT is unclear, and elevated numbers of the microbe have been reported both in dietary fiber-induced improvement in glucose metabolism but also in conjunction with certain inflammatory conditions. These findings raised our interest in investigating the possibility of P. copri to grow on xylan, and identify the enzyme systems playing a role in digestion of xylan-based dietary fibers. Two xylan degrading polysaccharide utilizing loci (PUL10 and 15) were found in the genome, with three and eight glycoside hydrolase (GH) -encoding genes, respectively. Three of them were successfully produced in Escherichia coli: One extracellular enzyme from GH43 (subfamily 12, in PUL10, 60 kDa) and two enzymes from PUL15, one extracellular GH10 (41 kDa), and one intracellular GH43 (subfamily 137 kDa). Based on our results, we propose that in PUL15, GH10 (1) is an extracellular endo-1,4-ß-xylanase, that hydrolazes mainly glucuronosylated xylan polymers to xylooligosaccharides (XOS); while, GH43_1 in the same PUL, is an intracellular ß-xylosidase, catalyzing complete hydrolysis of the XOS to xylose. In PUL10, the characterized GH43_12 is an arabinofuranosidase, with a role in degradation of arabinoxylan, catalyzing removal of arabinose-residues on xylan.

Monitoring severe acute maternal morbidity across Europe: A feasibility study.

BACKGROUND: Monitoring severe acute maternal morbidity (SAMM) appears essential for optimising care and informing health care policies, especially given changes in obstetric practices and mother profiles. International comparisons can identify areas where improvement is needed, but the comparability of indicators must be evaluated. OBJECTIVE: To assess the feasibility of monitoring SAMM using common definitions from hospital discharge databases across Europe. METHODS: We used hospital discharge data in eight countries (2 826 868 deliveries) to identify women with SAMM among all hospitalisations of women of reproductive age admitted for antenatal or delivery care. Five SAMM indicators were investigated: eclampsia, septicaemia, hysterectomy, hysterectomy associated with a diagnosis of obstetric haemorrhage, and red blood cell (RBC) transfusion associated with a diagnosis of obstetric haemorrhage. Between-country variation was described, by the ratio of the highest to lowest rates, while external validation was assessed by comparing with population-based studies on maternal morbidity. RESULTS: Ratios for hysterectomy and red blood cell (RBC) transfusion in the context of obstetric haemorrhage were 1:2.1 and 1:3.5, respectively. High values of hysterectomy and low values of transfusion were both consistent with high maternal mortality from haemorrhage (France, Italy, Portugal). Ratios across countries were relatively low for eclampsia (1:3.4) but very high for septicaemia (1:22.5). Compared to population-based morbidity estimates, eclampsia was over-reported in hospital databases whereas the two indicators of severe haemorrhage had good external validity. CONCLUSIONS: In association with diagnosis codes indicating obstetric haemorrhage, hysterectomy and RBC transfusion appear to be good candidates for surveillance of maternal morbidity in Europe.

Correction to: Evaluation of the efficacy of Lactobacillus plantarum HEAL9 and Lactobacillus paracasei 8700:2 on aspects of common cold infections in children attending day care: a randomised, double-blind, placebo-controlled clinical study.

The original version of this article unfortunately contained a mistake. A number in Table 6 has been corrected.

Evaluation of the efficacy of Lactobacillus plantarum HEAL9 and Lactobacillus paracasei 8700:2 on aspects of common cold infections in children attending day care: a randomised, double-blind, placebo-controlled clinical study.

BACKGROUND: The combination of Lactobacillus plantarum HEAL9 and Lactobacillus paracasei 8700:2 (commercially available as Probi Defendum®) has previously been reported to reduce the incidence, duration and severity of naturally acquired common colds in adults. The aim of the present study was to evaluate the impact of Probi Defendum® on aspects of common cold in healthy children 1-6 years of age attending day care. METHODS: A total of 131 children, out of the planned 320, were recruited into the study during 1 common cold season and randomised to consume once daily either 109 CFU (colony forming units) of the probiotic product or placebo. Due to unforeseen reasons, the recruitment of more children did not continue beyond the first cold season. RESULTS: There were 106 children that completed the study out of the 131 randomised. Daily consumption of the probiotic product for a period of 3 months significantly reduced the severity of the symptom "nasal congestion/runny nose" with a mean severity score for the whole study period of 7.5 ± 9.7 in the probiotic group and 13.9 ± 15.2 in the placebo (p < 0.05). Moreover, significantly less concomitant medication was used in the probiotic group. When the data were projected to a larger population corresponding to the originally estimated sample size, the results were in favour of the probiotic group regarding the reduced absence from day care (p < 0.05), reduced mean total severity per day in the reported episodes (p < 0.05) and reduced severity of the symptom "crying more than usual" (p < 0.05). CONCLUSION: Intake of Probi Defendum® once daily for a period of 3 months was beneficial to children and reduced the severity of common colds.

Ornithonyssus sylviarum (Acari: Macronyssidae) parasitism among poultry farm workers in Minas Gerais state, Brazil / Parasitismo de Ornithonyssus sylviarum (Acari: Macronyssidae) em trabalhadores de avicultura no Estado de Minas Gerais, Brasil

ABSTRACT: Ornithonyssus sylviarum is a hematophagous mite present in wild, domestic, and synanthropic birds. However, this mite can affect several vertebrate hosts, including humans, leading to dermatitis, pruritus, allergic reactions, and papular skin lesions. This study evaluated the epidemiological characteristics of O. sylviarum attacks on poultry workers, including data on laying hens, infrastructure and management of hen houses, and reports of attacks by hematophagous mites. In addition, a case of mite attack on a farm worker on a laying farm in the Midwest region in Minas Gerais is presented. It was found that 60.7% farm workers reported attacks by hematophagous mites. Correspondence analysis showed an association between reports of mite attacks in humans with (1) presence of O. sylviarum in the hen house, (2) manual removal of manure by employees, and (3) history of acaricide use. The specimens collected from the location were confirmatively identified as O. sylviarum. O. sylviarum attacks ave not been reported when manure was removed in a shorter time interval and did not use acaricide in the sheds when the removal was done by manure conveyor belt. Parasitism by O. sylviarum should be considered a relevant occupational hazard affecting employees working in direct contact with commercial egg-laying hens in Minas Gerais. We emphasized the need to monitor hen infestations by this mite to improve the development of mite control strategies.

RESUMO: Ornithonyssus sylviarum é um ácaro hematófago de aves silvestres, domésticas e sinantrópicas. No entanto, este ácaro pode afetar vários hospedeiros vertebrados, incluindo humanos, levando a dermatites, prurido, reações alérgicas e lesões cutâneas papulosas. O presente estudo avaliou os aspectos epidemiológicos do ataque de O. sylviarum em trabalhadores de granjas avícolas e descreveu um relato de caso em uma granja de postura. Este estudo utilizou um banco de dados secundário com informações sobre as poedeiras, infraestrutura e manejo dos galinheiros e relatos de ataques por ácaros hematófagos. Foi apresentado um caso de ataque de ácaro a um trabalhador rural no Centro-Oeste em Minas Gerais. Houve uma frequência de 60,7% de trabalhadores que relataram ter sido atacados por ácaros hematófagos em fazendas. A análise de correspondência mostrou uma associação entre relatos de ataques de ácaros em humanos com (1) presença de O. sylviarum na fazenda, (2) remoção manual de esterco por funcionários da fazenda e (3) histórico de uso de acaricidas. Os espécimes coletados do local foram identificados como O. sylviarum. Não há ataques de O. sylviarum, quando a remoçãodo esterco é feita em menor intervalo de tempo, e não se utiliza acaricida nos galpões quando a remoção é feita por esteira transportadora de esterco. Conclui-se que o parasitismo por O. Sylviarum deve ser considerado como um risco ocupacional relevante, que afeta trabalhadores que trabalham diretamente com poedeiras comerciais em Minas Gerais. Ressaltamos a necessidade de monitorar as infestações de aves por esse ácaro, a fim de melhorar o desenvolvimento de estratégias de controle.