Papel del farmacéutico comunitario costarricense en quimioterapia preventiva de parasitosis intestinal. Estudio exploratorio / Role of the Costa Rican community pharmacist in preventive chemotherapy of intestinal parasitosis. Exploratory study

Objetivo: Identificar intervenciones farmacéuticas, en quimioterapia preventiva de parasitosis intestinal, que promuevan la prevención de esta enferme-dad y el uso efectivo y seguro de los antiparasitarios. Método: Estudio de opinión exploratorio, descriptivo transversal y multicéntrico donde se entrevistó, de forma presencial mediante un instrumento diseñado para tal fin, a 49 farmacéuticos comunitarios. Resultado: De la totalidad de los farmacéuticos comunitarios entrevistados, un 89.80% (n=44) comentó ofertar el servicio de indicación farmacéutica en caso de quimioterapia preventiva de parasitosis intestinal. Como parte de las intervenciones realizadas destacaron: derivación al médico u otro profesional de salud según criterios específicos (100.00%), dispensación de un medicamento antiparasitario (93.18%) y brindar recomendaciones higiénicas y dietéticas (79.55%). El albendazol y la nitazoxanida fueron los principales medicamentos indicados y dispensados. Conclusión: Se evidencia la importancia del papel del farmacéutico comunitario costarricense, en quimioterapia preventiva de parasitosis intestinal, para la muestra estudiada, cuyas acciones favorecen el uso racional de antiparasitarios y la prevención de las parasitosis. (AU)

Objective: To identify pharmacist interventions, in preventive chemotherapy for intestinal parasitosis that promote the prevention of intestinal parasito-sis and the effective and safe use of antiparasitic drugs. Method: It was carried out an exploratory, descripti-ve, cross-sectional and multicentre opinion study in which 49 community pharmacists were interviewed in person, using an instrument designed for this purpose. Result: Overall, 89.80% (n=44) of the community pharmacists interviewed reported offering the mi-nor ailments service in the case of preventive che-motherapy for intestinal parasitosis. Interventions included: referral to a physician or other health care provider according to criteria (100.00%), dispensing of an antiparasitic agent (93.18%) and hygiene and dietary recommendations (79.55%). Albenda-zole and nitazoxanide were the main medications dispensed. Conclusion: The importance of the role of the Costa Rican community pharmacist in preventive chemotherapy of intestinal parasitosis is evident according to the sample analyzed because his/her actions promote rational use of antiparasitic agents and the prevention of parasitosis.(AU)

Human intestinal parasitic infection: a narrative review on global prevalence and epidemiological insights on preventive, therapeutic and diagnostic strategies for future perspectives.

INTRODUCTION: Intestinal parasitic infection (IPI) is a global health concern among socioeconomically deprived communities in many developing countries. Many preventative strategies have been deployed to control IPI, however, there is a lack in standards on the techniques used to diagnose and monitor the prevalence of IPI. AREAS COVERED: The present article will review the diseases associated with IPI and discuss the current IPI control strategies such as the water, sanitation, and hygiene (WASH) interventions, community-led total sanitation (CLTS) approach, and regular anthelminthic treatments. For the first time, this review will also evaluate all currently practised diagnostic techniques for the detection of intestinal parasites and provide insights on future IPI control strategies. EXPERT OPINION: Advanced and improved diagnostic methods such as qPCR coupled with a high-resolution melting curve, aptamers, biosensors, and detection of extracellular vesicles can be used for detection of IPI. Vaccination against intestinal parasites can be made available to increase antibodies to interfere with the blood-feeding process by the parasites, which subsequently reduces the reproductive rates of the parasites. These methods collectively can serve as future management strategies for intestinal parasitic infections.

No siempre es una enfermedad de Crohn: amebiasis como diagnóstico diferencial de la enfermedad inflamatoria intestinal / It is not always Crohn's disease: Amebiasis as a differential diagnosis of inflammatory bowel disease

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Evaluation of Parasitological Homeopathic Complex in the Control of Gastrointestinal Nematodes in Peripartum Sheep.

BACKGROUND: The appearance of anthelmintic resistance has made it difficult to control verminosis in sheep, leading to increased research to find alternative nematode control. The use of homeopathy in veterinary medicine has been studied as an alternative for the treatment and control of some diseases. In this study, ewes received an anti-parasitic homeopathic complex medicine during the critical peripartum period of increased susceptibility to nematodes. METHODS: Three randomized groups containing 16 animals each were assigned as follows: 'H10' received 10 g homeopathic complex added to concentrated food per day; 'H20' received 20 g homeopathic complex added to concentrated food per day; 'C' (control group) did not receive a homeopathic complex. Animals were tested to evaluate the effect of homeopathy on several health parameters during a period of 110 days. RESULTS: The parasite that prevailed in the copro-cultures of both treatments throughout the experiment was Haemonchus contortus (78.26%). Packed cell volume averages did not present statistically significant differences between the treatments (24.5, 24.4 and 23.9% to C, H10 and H20, respectively; p < 0.05). For total white cell count, lower mean values ( ± standard error of mean) were observed for the H20 treatment (5,490.9 ± 0.02/µL; p < 0.05), whereas the H10 (5,919.4 ± 0.02/µL) and control (6,098.5 ± 0.02/µL) presented higher and similar averages (p > 0.05). The values for erythrocytes, monocytes, and lymphocytes did not show differences between treatments (p > 0.05). Body weight was greater in the H10-treated animals compared with control. For the fecal egg count (FEC) of Trichostrongylidae and Strongyloides spp., respectively, the averages of the H20 treatment (1,523.0 and 30.6) were not different from control (1,616.0 and 31.6) and H10 (1,038.0 and 27.6); for Trichostrongylidae, however, H10 presented a lower FEC than the control (p = 0.02). For Cooperia, H10- and H20-treated animals showed FEC reductions of 97% and 98%, respectively. CONCLUSIONS: H20 treatment in peripartum sheep resulted in greater body weight and lower leukocyte count. H10 was associated with lower FEC for Trichostrongylidae. Both H10 and H20 justify a label of 'effective anthelmintic' for Cooperia.

Prevalence and clinical outcomes of Plasmodium falciparum and intestinal parasitic infections among children in Kiryandongo refugee camp, mid-Western Uganda: a cross sectional study.

BACKGROUND: The prevalence of Plasmodium falciparum and Intestinal Parasitic Infections (IPIs) - with the corresponding pathogenesis among children remain uncertain. This study aimed at determining the prevalence and the outcomes (including anaemia) of the respective infections and co-infections. Anaemia is a condition in which the number of red blood cells transporting oxygen to the various body parts is not sufficient to meet the needs of the body. METHODS: This was a cross sectional study conducted among 476-refugee camp school children. Kato-Katz technique was used to screen stool samples for intestinal parasites. Microscopy was used for malaria testing while the portable Haemoglobin (Hb) calorimeter was used to measure haemoglobin concentration. RESULTS: The overall prevalence of the mixed infections was 63.03%. Plasmodium falciparum was most prevalent of the single infections 262(55.04%) followed by Taenia spp. 14 (2.9%), Schistosoma mansoni 12(2.5%), Giardia lamblia 7 (2.9%), Trichuris trichiura 2(0.4%), Hookworm 2(0.4%) and Strongyloides stercoralis 1(0.2%). The odds of developing simple or uncomplicated malaria infection or anaemia was 14 times higher in individuals with dual co-infection with Plasmodium falciparum + Taenia sp. compared to single parasitic infection (Odds = 14.13, P = 0.019). Co-infection with Plasmodium falciparum + Taenia spp, was a strong predictor of Malaria and anaemia. CONCLUSION: This study shows that Plasmodium falciparum and Taenia spp. co-infections is a stronger predictor of malaria and anaemia. The prevalence of malaria and anaemia remains higher than the other regions in Uganda outside restricted settlements. The findings of this study underline the need for pragmatic intervention programmes to reduce burden of the co-infections in the study area and similar settlements.

An Alternative Treatment Against Acanthocephala ( Prosthenorchis elegans) in Captive Squirrel Monkeys ( Saimiri sciureus) in Mexico.

We provide the first report of Acanthocephala ( Prosthenorchis elegans) in Mexican non-human primates. There has been no known treatment against this parasite except for surgical removal, and this has been relatively ineffective because of the small juveniles. We report the presence of P. elegans in a captive breeding colony of squirrel monkeys ( Saimiri sciureus) in Mexico, and we describe a successful treatment protocol. Treatment involved 2 steps: oral administration of the drugs loperamide chlorhydrate (0.5 mg/0.9 kg/3 days) and niclosamide (0.2 mg/0.9 kg/3 days) followed by surgical removal of adult worms from the intestine. Fecal examination during treatment revealed live adults but no living juveniles and no eggs. Surgery after 1 wk of treatment revealed the presence of adults and an absence of juvenile parasites. All adults were physically extracted during the surgery. All subjects recovered from surgery within 1 wk.

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d'Ivoire.

BACKGROUND: Preventive chemotherapy with donated anthelminthic drugs is the cornerstone for the control of helminthiases. However, reinfection can occur rapidly in the absence of clean water and sanitation coupled with unhygienic behaviour. The purpose of this study was to assess the effect of an integrated package of interventions, consisting of preventive chemotherapy, community-led total sanitation (CLTS) and health education, on the prevalence of helminth and intestinal protozoa infections and on participants' knowledge, attitude, practice and beliefs (KAPB) towards these diseases including water, sanitation and hygiene (WASH). METHODS: A cross-sectional survey was carried out in nine communities of south-central Côte d'Ivoire to assess people's infection with helminths and intestinal protozoa and KAPB. Subsequently, interventions were targeted to five communities, while the remaining communities served as control. The intervention encouraged latrine construction and an evaluation was done 6-7 months later to determine open defecation status of the respective communities. Anthelminthic treatment was provided to all community members. A follow-up cross-sectional survey was conducted approximately one year later, using the same procedures. RESULTS: Overall, 810 people had complete baseline and follow-up data and were given anthelminthic treatment. The baseline prevalence of hookworm, Schistosoma haematobium, Trichuris trichiura, Schistosoma mansoni and Ascaris lumbricoides was 31.1%, 7.0%, 2.0%, 1.0% and 0.3%, respectively. Four of the five intervention communities were classified open-defecation free. For hookworm infection, we observed higher negative changes in terms of proportion of decrease (-0.10; 95% confidence interval (CI): - 0.16, -0.04) and higher egg reduction rate (64.9 vs 15.2%) when comparing intervention with control communities. For intestinal protozoa, prevalence reduction was higher in intervention compared to control communities (8.2 vs 2.6%) and WASH indicators and intervention outcomes associated with lower odds for infection at follow-up. The intervention significantly impacted on reported latrine use (before: 15.5%, after: 94.6%), open defecation in the community surroundings (before: 75.0%, after: 16.7%) and awareness for environmental contamination through open defecation (before: 20.4%, after: 52.2%). CONCLUSIONS: An integrated package of interventions consisting of preventive chemotherapy, health education and CLTS reduces the prevalence of helminth and intestinal protozoa infection. Additional studies in other social-ecological settings are warranted to confirm our findings.

The Brazilian Family Health Strategy and the management of intestinal parasitic infections.

AimThis study analyzed the management of intestinal parasitic infections in the Family Health Strategy covering Brazilian urban slums. BACKGROUND: The Family Health Strategy is the preferred strategy for providing public, community-based primary health care in the Brazilian Unified Health System (SUS). Through this strategy, Family Health teams are responsible for the health of residents of a defined territory, including health promotion, health education and control of neglected tropical diseases such as intestinal parasitic infections. METHODS: Knowledge, attitudes and practices surveys were applied with Family Health team members (n=58) and patients (n=571) of an agglomeration of Brazilian urban slums in Rio de Janeiro.FindingsThe management of intestinal parasitic infections and health promotion were limited. Health education was not considered an essential aspect of team members' work and did not include environmental or social determinants of health. Community health workers and urban slum residents presented similar knowledge, attitudes and practices regarding intestinal parasitic infections. CONCLUSIONS: Multiple, competing demands promote prioritization of the aspects of care where curative, biomedical activities predominate over prevention and an integral approach to health. However, the complex processes involving the cycle of poverty and disease go beyond the biomedical, limiting the potential for health in urban slums. Implications include a need to better prepare health professionals for primary health care services through reflection on local concerns and the social determinants of health, highlighting the importance of territorialized care and permanent education.

Economic evaluation and efficacy of strategic-selective treatment of gastrointestinal parasites in dairy calves.

In the Experimental Farm of the Universidade Federal de Lavras (EF-UFLA), state of Minas Gerais, Brazil, on their day of birth, female Holstein calves were randomly selected and placed into two groups containing fifteen animals each: Strategic-Selective Treatment (S-ST) or Conventional Treatment (CT). In the S-ST, calves were treated after coproparasitological examinations according to criteria established previously by the researchers. Calves in the CT were treated according to the opinion of the veterinarian of EF-UFLA. For statistical analysis, the frequency (%) of fecal samples with count of eggs per gram of feces (EPG) ≥300, count of oocysts per gram of feces (OoPG) ≥500 and fecal samples with count of cysts of Giardia spp. ≥1 were conducted. The overall average frequency of fecal samples with EPG ≥300, OoPG ≥500 and Giardia spp. cysts ≥1, respectively, was similar (p >0.05) between S-ST (20.3%; 17.3%; and 31.5%) and CT (26.4%; 23.9%; and 37.3%). The effective operational cost, per animal, in 12 months, was of R$ 784.58 (US$ 241.41) and R$ 83.90 (US$ 25.81) in S-ST and CT, respectively. The S-ST requires adjustments to be used as a technically efficient and economically viable alternative for the control of gastrointestinal parasitosis in female Holstein calves.

Economic evaluation and efficacy of strategic-selective treatment of gastrointestinal parasites in dairy calves / Avaliação econômica e eficácia do tratamento estratégico-seletivo de parasitos gastrointestinais em bezerras leiteiras

Abstract In the Experimental Farm of the Universidade Federal de Lavras (EF-UFLA), state of Minas Gerais, Brazil, on their day of birth, female Holstein calves were randomly selected and placed into two groups containing fifteen animals each: Strategic-Selective Treatment (S-ST) or Conventional Treatment (CT). In the S-ST, calves were treated after coproparasitological examinations according to criteria established previously by the researchers. Calves in the CT were treated according to the opinion of the veterinarian of EF-UFLA. For statistical analysis, the frequency (%) of fecal samples with count of eggs per gram of feces (EPG) ≥300, count of oocysts per gram of feces (OoPG) ≥500 and fecal samples with count of cysts of Giardia spp. ≥1 were conducted. The overall average frequency of fecal samples with EPG ≥300, OoPG ≥500 and Giardia spp. cysts ≥1, respectively, was similar (p >0.05) between S-ST (20.3%; 17.3%; and 31.5%) and CT (26.4%; 23.9%; and 37.3%). The effective operational cost, per animal, in 12 months, was of R$ 784.58 (US$ 241.41) and R$ 83.90 (US$ 25.81) in S-ST and CT, respectively. The S-ST requires adjustments to be used as a technically efficient and economically viable alternative for the control of gastrointestinal parasitosis in female Holstein calves.

Resumo Na Fazenda Experimental da Universidade Federal de Lavras (FE-UFLA), Minas Gerais, Brasil, no dia do nascimento, bezerras da raça holandesa foram sorteadas de forma aleatória para compor um dos dois grupos, formados por 15 animais cada: Tratamento Estratégico-Seletivo (TE-S) ou Tratamento Convencional (TC). No TE-S, as bezerras foram tratadas após exames coproparasitológicos de acordo com critérios previamente estabelecidos pelos pesquisadores. No TC, as bezerras foram tratadas conforme orientação do veterinário da FE-UFLA. Em ambos grupos, as bezerras foram monitoradas a cada 14 dias, do nascimento até os 12 meses de idade, por meio de exames coproparasitológicos. Para análise estatística, considerou-se a frequência (%) de amostras fecais com contagem de ovos por grama de fezes (OPG) ≥300, contagem de oocistos por grama de fezes (OoPG) ≥500, e amostras fecais com contagem de cistos de Giardia spp. ≥1. A frequência média global de amostras fecais com contagem de OPG ≥300, OoPG ≥500 e cistos de Giardia spp. ≥1, respectivamente, foi similar (p >0,05) entre TE-S (20,3%; 17,3%; e 31,5%) e TC (26,4%; 23,9%; e 37,3%). O custo operacional efetivo, por animal, em 12 meses, foi R$ 784,58 (US$ 241.40) e R$ 83,90 (US$ 25.81) para TE-S e TC, respectivamente. O TE-S necessita de ajustes para que possa ser indicado como uma alternativa, tecnicamente eficiente e economicamente viável, no controle das parasitoses gastrointestinais em bezerras leiteiras.

Effects of dietary intake of garlic on intestinal trematodes.

The current strategy for the control of helminth infections relies on chemotherapy. However, resistance appearance is promoting the necessity of developing new drugs against trematodes. Herein, potential trematocidal effects of garlic (Allium sativum) are investigated in the context of intestinal foodborne trematodes, employing the Echinostoma caproni-mouse model. Daily administration of dietary doses of garlic was conducted in three groups of mice: (i) before infection (prophylaxis), (ii) after infection (therapeutic) and (iii) both, before and after infection (continuous). A fourth group of mice, not exposed to garlic, was used as control. No differences in worm recovery, fecundity and local cytokine expression profiles were found with respect to control infections. However, considerable alterations in tegument structure, including swelling, furrowing, vacuolization and changes in secretory bodies were detected in garlic-exposed parasites using scanning and transmission electron microscopy. Protein secretion was markedly reduced in response to garlic, whereas up-regulation of several proteins, such as major vault protein and tER-ATPase, was observed in treated worms. The results presented herein provide new insights in the anthelminthic activity of bioactive garlic compounds and the manner that parasites respond to toxins.

Esquistosomiasis mansónica / Schistosomiasis masoni

Se presenta el caso clínico de un paciente de 10 años de edad, quien asistió al puesto médico de Santa Johana, municipio de Itamarandiba, estado brasileño de Minas Gerais, acompañado de su madre, por presentar dolor abdominal de tipo cólico, con deposiciones diarreicas mezcladas con sangre y falta de apetito, además ligera palidez cutaneomucosa, lo cual se correspondían con una esquistosomiasis mansónica. Se le realizaron los exámenes pertinentes y se le indicó el tratamiento oportuno, de manera que el niño evolucionó favorablemente

The case report of a 10 years patient is presented who attended Santa Johana doctor´s office, Itamarandiba municipality, Minas Gerais Brazilian state, accompanied by his mother, due to abdominal pain of colic type, with diarrhea mixed with blood and loss of appetite, also a light mucouscutaneous paleness, which corresponded to a schistosomiasis mansoni. The pertinent exams were carried out and the appropriate treatment was indicated, so that the boy had a favorable clinical course

Which is the best phenotypic trait for use in a targeted selective treatment strategy for growing lambs in temperate climates?

Targeted selective treatment (TST) requires the ability to identify the animals for which anthelmintic treatment will result in the greatest benefit to the entire flock. Various phenotypic traits have previously been suggested as determinant criteria for TST; however, the weight gain benefit and impact on anthelmintic efficacy for each determinant criterion is expected to be dependent upon the level of nematode challenge and the timing of anthelmintic treatment. A mathematical model was used to simulate a population of 10,000 parasitologically naïve Scottish Blackface lambs (with heritable variation in host-parasite interactions) grazing on medium-quality pasture (grazing density=30 lambs/ha, crude protein=140g/kg DM, metabolisable energy=10MJ/kg DM) with an initial larval contamination of 1000, 3000 or 5000 Teladorsagia circumcincta L3/kg DM. Anthelmintic drenches were administered to 0, 50 or 100% of the population on a single occasion. The day of anthelmintic treatment was independently modelled for every day within the 121day simulation. Where TST scenarios were simulated (50% treated), lambs were either chosen by random selection or according to highest faecal egg count (FEC, eggs/g DM faeces), lowest live weight (LW, kg) or lowest growth rate (kg/day). Average lamb empty body weight (kg) and the resistance (R) allele frequency amongst the parasite population on pasture were recorded at slaughter (day 121) for each scenario. Average weight gain benefit and increase in R allele frequency for each determinant criterion, level of initial larval contamination and day of anthelmintic treatment were calculated by comparison to a non-treated population. Determinant criteria were evaluated according to average weight gain benefit divided by increase in R allele frequency to determine the benefit per R. Whilst positive phenotypic correlations were predicted between worm burden and FEC; using LW as the determinant criterion provided the greatest benefit per R for all levels of initial larval contamination and day of anthelmintic treatment. Hence, LW was identified as the best determinant criterion for use in a TST regime. This study supports the use of TST strategies as benefit per R predictions for all determinant criteria were greater than those predicted for the 100% treatment group, representing an increased long-term productive benefit resulting from the maintenance of anthelmintic efficacy. Whilst not included in this study, the model could be extended to consider other parasite species and host breed parameters, variation in climatic influences on larval availability and grass growth, repeated anthelmintic treatments and variable proportional flock treatments.

Anthelmintic effects of forage chicory (Cichorium intybus) against gastrointestinal nematode parasites in experimentally infected cattle.

Two experiments studied the effects of dietary chicory against gastrointestinal nematodes in cattle. In Experiment (Exp.) 1, stabled calves were fed chicory silage (CHI1; n = 9) or ryegrass/clover hay (CTL1; n = 6) with balanced protein/energy intakes between groups. After 16 days, all calves received 10 000 Ostertagia ostertagi and 66 000 Cooperia oncophora third-stage larvae (L3) [day (D) 0 post-infection (p.i.)]. In Exp. 2, calves were assigned to pure chicory (CHI2; n=10) or ryegrass/clover (CTL2; n = 10) pastures. After 7 days, animals received 20 000 O. ostertagi L3/calf (D0 p.i.) and were moved regularly preventing pasture-borne infections. Due to poor regrowth of the chicory pasture, CHI2 was supplemented with chicory silage. At D40 p.i. (Exp. 1) and D35 p.i. (Exp. 2) calves were slaughtered for worm recovery. In Exp.1, fecal egg counts (FEC) were similar between groups. However, O. ostertagi counts were significantly reduced in CHI1 by 60% (geometric mean; P < 0·01), whereas C. oncophora burdens were unaffected (P = 0·12). In Exp. 2, FEC were markedly lowered in CHI2 from D22 p.i onwards (P < 0·01). Ostertagia ostertagi adult burdens were significantly reduced in CHI2 by 66% (P < 0·001). Sesquiterpene lactones were identified only in chicory (fresh/silage). Chicory shows promise as an anti-Ostertagia feed for cattle and further studies should investigate its on-farm use.

Review of the causes and management of chronic gastrointestinal symptoms in returned travellers referred to an Australian infectious diseases service.

BACKGROUND: Thirty to seventy per cent of overseas travellers experience traveller's diarrhoea (TD), a potential cause of serious gastrointestinal (GI) sequelae. However, there is limited evidence on the optimal management of TD. OBJECTIVE: The objectives of this article are to characterise the aetiologies and management of returned travellers with ongoing GI symptoms referred to a specialist infectious diseases service. METHODS: We conducted a retrospective medical record review of patients referred to the Victorian Infectious Disease Service (VIDS) in 2013-15 with a history of overseas travel and GI symptoms present for longer than two weeks. For each diagnostic group, we compared demographic and travel characteristics, illness course, investigation results, and number of and response to treatments. RESULTS: The most common diagnosis was parasitic infection (31 out of 65 patients). Referral was made for infection with a controversial or uncommon organism; negative microbiological findings +/- failed metronidazole treatment; or severe or prolonged infections. DISCUSSION: Our results highlight the utility of ordering more than one faecal specimen for oocytes, cysts and parasites (O/C/P) examination, potential benefits of tinidazole use, and role of specialist services for uncertain diagnoses and complex and/or unusual organ-isms.

Familiarity with and uptake of alternative methods to control sheep gastro-intestinal parasites on farms in England.

A questionnaire was distributed electronically amongst sheep farmers in England; it aimed to provide a quantification of current anthelmintic practices, farmer awareness of the issue of anthelmintic resistance (AR) and the uptake, awareness and opinions surrounding conventional and alternative methods of nematode control. The majority of farmers relied on several anthelmintics and used faecal egg counts to identify worm problems. Although farmers were aware of the issue of AR amongst helminth parasites in the UK, there was a disconnection between such awareness and on farm problems and practice of nematode control. Grazing management was used by 52% of responders, while breeding for resistance and bioactive forages by 22 and 18% respectively. Farms with more than 500 ewes, and farmers who felt nematodes were a problem, had a higher probability of using selective breeding. Farmers who considered their wormer effective, had a qualification in agriculture and whose staff did not include any family members, were more likely to use bioactive forages; the opposite was the case if farmers dosed their lambs frequently. Amongst the alternatives, highest preference was for selective breeding and vaccination, if the latter was to become commercially available, with more respondents having a preference for breeding than actually using it. Several barriers to the uptake of an alternative were identified, the most influential factor being the cost to set it up and the length of time for which it would remain effective. The disconnection between awareness of AR and practice of nematode control on farm reinforces the need for emphasising the links between the causes of AR and the consequences of strategies to address its challenge.

Efectividad del Oleozon® por vía oral en pacientes con giardiasis / Effectiveness of the oral Oleozon® in patients with giardiasis

Se realizó una intervención terapéutica en 108 adultos con giardiasis, atendidos en el Servicio de Medicina Natural y Tradicional del Centro Médico Psicopedagógico América Labadí Arce de Santiago de Cuba, desde julio del 2013 hasta igual periodo del 2014, con vistas a determinar la efectividad del Oleozon® por vía oral en los afectados. Se conformaron 2 grupos de 54 integrantes cada uno; el de estudio, recibió Oleozon®, y el de control, fue tratado con medicamentos convencionales. Se empleó la prueba de Ji al cuadrado, con una significación estadística de p < 0,05. Predominaron el sexo masculino (59,2 por ciento en el grupo de estudio y 55,5 por ciento en el de control), el grupo etario de 30-39 años (38,9 por ciento en el primero y 51,8 por ciento en el segundo). La rápida evolución de los pacientes tratados con Oleozon® demostró su efectividad; por tanto, se recomendó su utilización como enfoque terapéutico de elección(AU)

A therapeutical intervention in 108 adults with giardiasis, assisted in the Natural and Traditional Medicine Service of America Labadí Arce Psychopedagogical Medical Center in Santiago de Cuba was carried out from July, 2013 to the same period of 2014, aimed at determining the effectiveness of the oral Oleozon® in those patients affected. Two groups of 54 members each were formed; the study group received Oleozon®, and the control group was treated with conventional drugs. The Chi square test was used, with a statistical significance of p 0,05. The male sex (59.2 percent in the study group and 55.5 percent in the control group), the age group 30-39 years (38.9 percent in the first one and 51.8 percent in the second one). The fast clinical course of the patients treated with Oleozon® demonstrated its effectiveness; therefore, its use was recommended as an alternative therapeutic approach(AU)

Recomendações da Sociedade Brasileira de Reumatologia sobre diagnóstico e tratamento das parasitoses intestinais em pacientes com doenças reumáticas autoimunes / Recommendations from the Brazilian Society of Rheumatology on the diagnosis and treatment of intestinal parasitic infections in patients with autoimmune rheumatic disorders

RESUMOAs parasitoses intestinais – helmintíases e protozooses – são doenças cosmopolitas com maior prevalência em regiões tropicais. Pacientes com diagnóstico de doenças reumáticas autoimunes apresentam, em função da própria doença de base ou de seu tratamento, um maior risco de ocorrência de manifestações graves das parasitoses intestinais. Embora a prevalência dessas parasitoses seja bastante elevada em nosso meio, nem sempre o reumatologista está atento à necessidade de investigação e tratamento das helmintíases e protozooses antes do uso de terapias imunomoduladoras, imunossupressoras e dos medicamentos biológicos modificadores do curso da doença. Neste documento, a Sociedade Brasileira de Reumatologia estabelece recomendações gerais sobre o diagnóstico e tratamento das parasitoses intestinais no Brasil em pacientes com doenças reumáticas autoimunes, com destaque para a artrite reumatoide, o lúpus eritematoso sistêmico e as espondiloartrites.

ABSTRACTIntestinal parasites – helminths and protozoa – are cosmopolitan diseases which are most prevalent in tropical regions. Patients with diagnoses of autoimmune rheumatic diseases have, due to the underlying disease or its treatment, an increased risk of occurrence of severe manifestations of intestinal parasites. Although the prevalence of these parasitic infections is very high in our environment, not always is the rheumatologist attentive to the need for investigation and treatment of helminthiasis and protozooses before the use of immunomodulatory, immunosuppressive therapies, and of biological drugs that are modifiers of the course of the disease. In this document, the Brazilian Society of Rheumatology establishes general recommendations on the diagnosis and treatment of intestinal parasitic infections in Brazil in patients with autoimmune rheumatic diseases, highlighting rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritis.

Duddingtonia flagrans in the control of gastrointestinal nematodes of horses.

Horses can harbor a large amount of parasites that may cause serious clinical signs even death. The aim of this study was to evaluate the predatory activity of the fungus Duddingtonia flagrans against infective larvae (L3) of gastrointestinal nematodes of horses in fecal culture. The experimental design was completely randomized with three treated groups (G1, G2 and G3) and one control (CG), using eight animals/group. The treated animals received G1: 1.5 × 10(5); G2: 3 × 10(5) and G3: 6 × 10(5) chlamydospores of D. flagrans/kg body weight during 21 days. The fungi preparation was given at every other three-day interval. Faecal samples were collected during 30 days, on the same interval, to perform the fecal egg counts (EPG) and fecal culture for each horse. All groups demonstrated similar results for the EPG (P > 0.05) counts. D. flagrans significantly reduced (P < 0.05) the number of infective larvae after 72 h-interval between treatments. The G2 and G3 promoted higher results (P < 0.05) of L3 reduction compared to the CG. The biological control with the predacious fungi D. flagrans is still a promising free-living parasite regulator alternative to be use in livestock.