Sandfly surveillance and investigation of Leishmania spp. DNA in sandflies in Kosovo.

In the past decade, leishmaniasis seems to be re-emerging in Balkan countries. There are serious implications that Kosovo is a visceral leishmaniasis endemic region with autochthonous transmission; nevertheless, surveillance of vectors, reservoirs or the disease is not yet established. Gaining knowledge about sandfly vector species is a prerequisite for the development of a monitoring and control plan in the future. After a long gap in research of over 70 years, sandfly studies in Kosovo were resumed in 2014. During this presence/absence study, nine sandfly species were detected: Phlebotomus papatasi, Ph. perfiliewi, Ph. tobbi, Ph. neglectus, Ph. simici, Ph. balcanicus, Ph. alexandri, Ph. mascittii and Sergentomyia minuta. Three species are new with regard to the fauna of Kosovo - Ph. alexandri, Ph. balcanicus and Ph. mascittii. Besides increased diversity, changes in the number of collected specimens and distribution range of species were recorded, with Ph. neglectus being the most dominant species with the widest distribution. Testing of randomly chosen females for Leishmania spp. DNA resulted the in detection of L. tropica in a specimen of Ph. neglectus. The presence of numerous vector species in the sandfly fauna of Kosovo pose a threat for the re-emergence of vector-borne diseases. Therefore, continuous surveillance is recommended with regular updates on vector distribution and abundance.

Sampling strategies for phlebotomine sand flies (Diptera: Psychodidae) in Europe.

The distribution of phlebotomine sand flies is widely reported to be changing in Europe. This can be attributed to either the discovery of sand flies in areas where they were previously overlooked (generally following an outbreak of leishmaniasis or other sand fly-related disease) or to true expansion of their range as a result of climatic or environmental changes. Routine surveillance for phlebotomines in Europe is localized, and often one of the challenges for entomologists working in non-leishmaniasis endemic countries is the lack of knowledge on how to conduct, plan and execute sampling for phlebotomines, or how to adapt on-going sampling strategies for other haematophagous diptera. This review brings together published and unpublished expert knowledge on sampling strategies for European phlebotomines of public health concern in order to provide practical advice on: how to conduct surveys; the collection and interpretation of field data; suitable techniques for the preservation of specimens obtained by different sampling methods; molecular techniques used for species identification; and the pathogens associated with sand flies and their detection methods.

A novel phlebovirus in Albanian sandflies.

Sandflies were collected in two districts of Albania and tested for a probable phlebovirus infection. A novel phlebovirus, provisionally named Adria virus, was detected in 2/12 pools, both trapped in a region close to the Adriatic Sea. The new virus is genetically closer (similarity 77.1% at nucleotide level) to Arbia virus, which belongs to the Salehabad serocomplex. Its distribution and probable pathogenicity to humans remain to be elucidated.

Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis: results of an open randomised clinical trial.

OBJECTIVE: The aim of the study was to compare sequential versus combined diuretic therapy in patients with cirrhosis, moderate ascites and without renal failure. DESIGN: One hundred patients were randomly assigned to the two diuretic treatments. The sequential treatment provided potassium canrenoate at the initial dose of 200 mg/day, then increased to 400 mg/day. Non-responders were treated with 400 mg/day of potassium canrenoate and furosemide at an initial dose of 50 mg/day, then increased to 150 mg/day. The combined treatment provided the initial dose of 200 mg/day of potassium canrenoate and 50 mg/day of furosemide, then increased to 400 mg/day and 150 mg/day, respectively. RESULTS: Most patients who received sequential treatment responded to potassium canrenoate alone (19% to 200 mg/day and 52.63% to 400 mg/day, respectively). Most patients who received the combined treatment responded to the first two steps (40% to the first step and 50% to the second, ie, 400 mg/day of potassium canrenoate plus 100 mg/day of furosemide). Adverse effects (38% vs 20%, p<0.05), in particular, hyperkalaemia (18% vs 4%, p<0.05), were more frequent in patients who received sequential therapy. As a consequence, the per cent of patients who resolved ascites without changing the effective diuretic step was higher in those who received the combined treatment (56% vs 76%, p<0.05). CONCLUSIONS: The combined diuretic treatment is preferable to the sequential one in the treatment of moderate ascites in patients with cirrhosis and without renal failure. NCT00741663. This work is an open randomised clinical trial.

Técnicas de enfermería aplicadas al paciente en situación terminal: comparación entre cáncer y no cáncer / No disponible

Objetivo: conocer y comparar el uso de técnicas de enfermería utilizadas en el paciente en situación de enfermedad terminal (SET) oncológica y no oncológica. Material y métodos: estudio descriptivo, longitudinal y prospectivo en el que se incluyeron los pacientes SET oncológicos y no oncológicos ingresados en la Unidad de Cuidados Paliativos (UCP) desde el 1 de junio al 30 de diciembre del 2002. Variables estudiadas: curas, sonda nasogástrica (SNG), gastrostomía endoscópica percutánea (PEG), sonda urinaria (SU), traqueostomía, ostomías y derivaciones de eliminación (colostomías, ileostomías, nefrostomías, ureterostomías y urostomías), aspiración de secreciones, oxigenoterapia, dispositivos de ventilación mecánica no invasiva: presión de aire positiva bifásica (BIPAP) y presión de aire positiva continua (CPAP), vía subcutánea (VSC), vía endovenosa (VE) y vía intramuscular(VIM). Estas variables han sido registradas al ingreso y al alta o éxitus del paciente en la UCP. Resultados: al ingreso, pacientes oncológicos-no oncológicos: curas30-25,8%, SNG 13,3-32,3%, PEG 2,2-0%, SU 18,9-51,6%, traqueostomía 8,9-9,7%, ostomías 8,9-0%, aspiración 3,3-9,7%, oxigenoterapia18,9-45,2%, CPAP/BIPAP 0-0%, VSC 25,6-12,9%, VE 73,3-77,4%, VIM0-0%. Al alta, pacientes oncológicos-no oncológicos: curas 32,20-25,8%,SNG 11,1-29%, PEG 2,2-0%, SU 23,3-38,7%, traqueostomía 10-6,5%, ostomías 8,9-0%, aspiración 4,4-6,5%, oxigenoterapia 22,2-45,2%,CPAC/BIPAP 0-0%, VSC 40-12,9%, VE 52,2-54,8%, VIM 0-0%. Conclusiones: Al ingreso la frecuencia de SU, oxigenoterapia y SNG es significativamente superior en los pacientes no oncológicos (p < 0,05). Al alta o éxitus la frecuencia de la VSC es significativamente superior en los oncológicos (p < 0,05). La frecuencia de oxigenoterapia y SNG es significativamente superior en los no oncológicos (p < 0,05) (AU)

Objective: to find out and compare the various nursing techniques used with terminally ill patients, both oncological and non-oncological. Material and methods: a longitudinal, descriptive, prospective study of all terminally ill patiens –both oncological and non-oncological– admitted to the palliative care ward from June 1st to December 30th, 2002. Variables considered included: dressings, nasogastric tubes, percutaneous endoscopic gastrostomy (PEG), urethral catheters, tracheostomies, ostomies and elimination diversions (colostomy, ileostomy, nephrostomy, ureterostomy, urostomy), secretion aspirations, oxygen therapy, devices for mechanical noninvasive ventilation such as biphasic positive airway pressure (BIPAP)and continuous positive airway pressure (CPAP), subcutaneous routes (SCR),intravenous routes (IVR), intramuscular routes (IMR). These variables have been considered on admission and on discharge. Discharges included home, death, and transfers to other healthcare centers. Results: on admission, both oncological and non-oncological patients: dressings 30-25.8%, nasogastric tubes 13.3-32.3%, PEGs 2.2-0%, urethral catheters 18.9-51.6%, tracheostomies 8.9-9.7%, ostomies 8.9-0%, aspirations 3.3-9.7%, oxygen therapy 18.9-45.2%, CPAC/BIPAP 0-0%, SCRs 25.6-12.9%, IVRs 73.3-77.4%, IMRs 0-0%.On discharge, both oncological and non-oncological patients: dresings 32.20-25.8%, nasogastric tubes 11.1-29%, PEG 2.2-0%, urethral catheters 23.3-38.7%, tracheostomies 10-6.5%, ostomies 8.9-0%, aspirations 4.4-6.5%, oxygen therapy 18.9-45.2%, CPAP/BIPAP 0-0%, SCRs 40-12.9%, IVRs 52.2-54.8%, IMRs 0-0%. Conclusions: on admission, the frequency of urethral catheter, oxygen therapy, and nasogastric tube use is significantly higher in non-oncological patients (p < 0.05). On discharge, the frequency of SCR use is significantly higher in oncological patients (p < 0.05). The frequency of oxygen therapy, and nasogastric tube use is significantly higher in non-oncological patients (p < 0.05) (AU)

Entomological and parasitological study on phlebotomine sandflies in central and northern Albania.

An entomological survey was carried out in two districts of central (Kruje) and northern (Lezhe) Albania. Six collecting sites, showing a variety of diurnal resting sites, were monitored for adult sandflies from June through October 2002. Flies were collected with CDC miniature light traps, sticky traps and mechanical or hand aspirators in peridomestic sites, in bedrooms and inside cow barns, chicken coops and pigpens. All collecting sites monitored were found positive for sandflies. A total of 849 specimens were caught (29.2% males) belonging to five Phlebotomus species. Phlebotomus neglectus (75.6%) was the most abundant species followed by P. perfiliewi (14.4%), P. papatasi (4.6%), P. tobbi (3.6%) and P. similis (1.8%). The first adult of P. neglectus appeared on June 11 and the last one was collected on October 16. The highest density for this species was observed at the end of July. A total of 111 blood-fed females were caught from the two areas studied. P. neglectus was the only species found blood fed in Lezhe and the same species was prevalent (56.1%) in Kruje followed by P. perfiliewi (30.3%), P. tobbi (10.6%); P. papatasi was represented by only two specimens. Blood meal origin was determined in 45/66 (68.2%) of the females tested from Kruie district. P. neglectus was found fed on four hosts, showing the following feeding patterns: cow (71.4%), dog (117.1%), chicken (5.7%) and human (5.7%); P. perfiliewi was found fed on cow (80.0%) and chicken (20.0%), P. tobbi on cow (50.0%), chicken (25.0%) and dog (25.0%). One specimen of P. papatasi was found fed on cow. When such prevalences were analysed by the available biomass for each host present at the collecting site, P. neglectus resulted to be an opportunistic feeder rather than exhibiting preferences for any specific animal. PCR analysis of 39 P. neglectus from the Lezhe district gave negative results for the presence of Leishmania DNA.

Identification of Borrelia burgdorferi sensu lato, Anaplasma and Ehrlichia species, and spotted fever group Rickettsiae in ticks from Southeastern Europe.

Prevalence data for tick-borne pathogens are used to assess the risk for human health. In this study the presence and identity of Borrelia burgdorferi sensu lato, Ehrlichia, Anaplasma, and Rickettsia species in Bulgarian Ixodes ricinus ticks and in non- Ixodes ticks from Turkey and Albania was determined by polymerase chain reaction (PCR) and reverse line blot hybridization. In the adult Bulgarian ticks, the prevalence of Borrelia burgdorferi sensu lato infection was approximately 40%, while Borrelia afzelii was the predominant species, representing more than half of all Borrelia-positive ticks. Ehrlichia and Anaplasma species were detected in 35% of the adult Ixodes ricinus ticks and in 10% of the nymphs. Sequence analysis of PCR products reacting with the Anaplasma phagocytophila probe revealed a 16S rRNA gene identical to that of the Anaplasma phagocytophila prototype strain. Ehrlichia and Anaplasma species were found in approximately 7% of the non- Ixodes ticks. Sequence analysis of some of these samples revealed the presence of Anaplasma ovis, Ehrlichia canis, and a species closely resembling Ehrlichia chaffeensis. About half of all adult ticks examined and approximately 20% of all nymphs were infected with Rickettsia species. In Ixodes ricinus ticks, Rickettsia helvetica and a Rickettsia species designated as IRS3 were found in high prevalence. Rickettsia conorii was found in virtually all non- Ixodes tick species from Albania and Turkey. The results of this study show that many tick-borne diseases are most probably endemic in the Balkan area. Furthermore, the results suggest that there is a considerable chance for simultaneous transmission of tick-borne pathogens to human beings.

[Validation of the translation to Catalan and Spanish of cognitive evoked potential N400]. / Validación de la traducción a los idiomas catalán y castellano del potencial evocado cognitivo N400.

INTRODUCTION: The cognitive evoked potential N400 permits an objective assessment of the verbal semantic processing. It has been suspected to be clinically useful in cognitive abnormalities and a correlation with attentional and memory functions has been found. The present study tries to validate the translation and adaptation of the English paradigm to the Catalan and Spanish languages. METHOD: The study was performed on 16 healthy volunteers with Catalan native language and 16 volunteers with Spanish native language. Three blocks of 50 sentences (4-9 words) were administered using headphones. The last word of 50 % of the sentences was incongruent. The beginning of this word was the trigger for the EEG average. EEG leads used were: Fz, Cz, Pz, C3, C4, T3, T4 with biauricular reference. The measures were amplitude and latency of the potential obtained after the subtraction of the EEG average of congruent and incongruent sentences. A t-test for one sample (the original potential) was applied. RESULTS: Amplitude and latency of the potential obtained by the Catalan and Spanish languages were not result statistically different from the original potential. The major amplitude was obtained in Cz. Mean amplitudes: Catalan language: 5.3 2.3 V (95 % CI for the difference: 0.39 2.12 V); Spanish language: 5.2 2.3 V (95 % CI for the difference: 0.43 2.32 V). CONCLUSIONS: The Catalan and Spanish version of the N400 evoked potential offer the possibility to use an objective instrument for the study of language in neuroscience.

Validación de la traducción a los idiomas catalán y castellano del potencial evocado cognitivo N400 / Validation of the translation to Catalan and Spanish of cognitive evoked potential N400

Introducción: El potencial evocado cognitivo N400 permite una valoración objetiva del procesamiento verbal semántico. Se ha postulado su utilidad en el estudio del deterioro cognitivo, habiéndose correlacionado con funciones atencionales, mnésicas y de dominancia hemisférica. El presente estudio intenta validar la traducción y adaptación a los idiomas catalán y castellano del paradigma original en inglés.Método: Participaron en el estudio 16 voluntarios sanos de sexo masculino con idioma materno catalán y 16 voluntarios con idioma materno castellano. Se administraron mediante auriculares 3 bloques de 50 frases (4-9 palabras). El 50 por ciento de las frases contenían la última palabra incongruente.El inicio de esta palabra era el marcador del promediado del electroencefalograma (EEG). Derivaciones EEG: Fz, Cz, Pz, C3, C4, T3, T4 con referencia biauricular. Se valoró la amplitud y latencia del potencial obtenido después de la sustracción del promediado EEG de las frases congruentes e incongruentes.Se aplicó un test de la t de Student para una sola muestra respecto al potencial original.Resultados: La amplitud y latencia del potencial obtenido para los idiomas catalán y castellano no resultaron significativamente diferentes respecto al potencial original. El potencial de mayor amplitud se obtuvo en Cz. Amplitud media: idioma catalán, 5,3 ñ 2,3 µV (intervalo de confianza [IC] 95 por ciento para la diferencia: -0,39 ñ2,12 µV); idioma castellano, 5,2 ñ 2,3 µV (IC 95 por ciento para la diferencia: -0,43 ñ2,32 µV).Conclusión: Las versiones catalana y castellana del potencial N400 ofrecen la posibilidad de usar un instrumento objetivo para el estudio del lenguaje en el campo de las neurociencias (AU)

Recrudescence of visceral leishmaniasis in Albania: retrospective analysis of cases during 1997 to 2001 and results of an entomological survey carried out during 2001 in some districts.

The epidemiological status of zoonotic visceral leishmaniasis (VL) in Albania is almost unknown to international health organizations and to the scientific community. Results from a retrospective analysis of recent VL cases, and from an entomological survey carried out in summer 2001 are reported here. From January 1997 to December 2001, 867 parasitologically confirmed VL cases were recorded in 35 of 36 Albanian districts with an average of 173 cases/year and a cumulative morbidity of 2.8/10000 population. The temporal distribution of cases showed an increasing trend (from 144 to 209), indicating that cases have almost doubled during the past 10 years. A high proportion of the patients (67.6%) was children aged < 5 years. The entomological survey confirmed Phlebotomus neglectus as the probable vector, being the most abundant and widespread species. The increase in VL morbidity, 20-40-fold higher than in other southern European countries, could be attributed to increased susceptibility of infants to clinical disease or to variations in Leishmania infection associated with changes in canine reservoir and/or vector populations.

Crimean-Congo hemorrhagic fever in Albania, 2001.

During the spring and summer of 2001, an outbreak of eight cases of Crimean-Congo hemorrhagic fever (CCHF) occurred in Albania. The epidemiological investigation, the clinical presentation of the cases, and the course of the disease are described. Seven of the cases were laboratory confirmed. A nosocomial infection and a cluster of cases within a family were observed. Genetic analysis of the CCHF virus strain that caused the outbreak showed that it was clustered together with other European CCHF virus strains except the Greek one (strain AP92). The Greek strain, which forms an independent clade, differed from the causative strain by 25.3% at the nucleotide level.