Spanish Consensus on the Management of Chronic Rhinosinusitis With Nasal Polyps (POLIposis NAsal/POLINA 2.0)

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly prevalent and burdensome disease for both individuals and health systems. Its management involves many specialties, including otorhinolaryngology, allergology, pulmonology, primary care, pharmacy, and pediatrics. A multidisciplinary approach and the participation of the patient in decision-making are essential, both for diagnosis and for therapy. The authors of the consensus aim to translate current knowledge into an easy-to-read practical guide and emphasize those aspects requiring further discussion or with unmet needs owing to the lack of appropriate scientific evidence. An iterative approach for the development of an evidence-based systematic review with recommendations was followed using a standard quality assessment approach (Scottish Intercollegiate Guidelines Network [SIGN] and National Institute for Health and Care Excellence [NICE]). The guideline was critically evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) and Recommendation Excellence (AGREE REX) instruments. Consequently, POLINA has been considered a high-quality guideline by an independent agency. The POLINA consensus provides new definitions of control, therapeutic management (including surgery and evaluation of severity), indications for use of biologics, and response. Finally, this guideline focuses on unmet research needs in CRSwNP.

Periodization of altitude training: A collective case study of high-level swimmers

The objective was to quantify parallel changes in performance and physiological measures in relation to periodization of sequential altitude training over a season in elite swimmers. The altitude training of four female and two male international swimmers in selected seasons was examined using a collective case study approach. All swimmers were a medalist in World (WC) and/or European Championships (EC) 2013, 2014, 2016 and 2018 in short or long course competition. A traditional periodization model was employed using three macrocycles with 3-4 altitude camps (duration 21-24 days each) scheduled over the season, following a polarized training intensity distribution (TID) with a volume ranged between 729 km and 862 km. The timing of return from altitude prior to competition was between 20-32 days, with 28 days the most common period. Competition performance was assessed with major (international) and minor (regional or national) competitions. Hemoglobin concentration, hematocrit, anthropometric characteristics, were measured before and after each camp. Competition performance following the altitude training camps improved by 0.6% ± 0.8% (personal best time; mean ± SD) (95% confidence limits (CL) 0.1%-1.1%), 1.6% ± 0.7% (95% CL 1.2% to 2.0%) (season best time) and 1.6% ± 0.5% (95% CL 1.3%-1.9%) (previous season time). Hemoglobin concentration increased 4.9% from pre-to post-altitude training camps, while hematocrit increased by 4.5%. The sum of six skinfolds reduced by 14.4% (95% CL 18.8%-9.9%) and 4.2% (95% CL 2.4%-9.2%) for the two males (EC), and by 15.8% (95% CL 19.5%-12.0%) for two females (WC). Three to four altitude training camps in a competitive season, around 21-24 days of duration, scheduling the last return between 20-32 days before the main competition, integrated in a traditional periodized sequence, can induce worthwhile improvements in international swimming performance, hematological parameters, and anthropometric characteristics.

No detection of Besnoitia besnoiti DNA in the semen of chronically infected bulls

Bovine besnoitiosis is a chronic and debilitating disease observed in many European countries that may cause important economic losses in cattle. The recent widespread of the parasite in Europe had led the European Food Safety Authority to declare bovine besnoitiosis as a re-emerging disease in Europe. Many aspects of the epidemiology of bovine besnoitiosis such as the main routes of transmission are still unclear and need to be further studied. Among the different hypotheses, a sexual transmission has not yet been investigated. Therefore, the aim of this study was to evaluate the presence of Besnoitia besnoiti DNA in the semen of naturally infected bulls by using a highly sensitive method (real-time qPCR). Both pre-sperm and sperm fractions of 40 bulls, including seronegative (n = 11), seropositive subclinically (n = 17), and seropositive clinically (n = 12) infected animals, were collected by electroejaculation and analyzed by real-time qPCR. No B. besnoiti DNA was detected in 27 pre-sperm and 28 sperm fractions of the 40 examined bulls, suggesting that the transmission of B. besnoiti infection by the semen of chronically infected bulls is very unlikely.

Survey of flea infestation in cats in Spain

Fleas are a common cause of feline skin disorders as well as vectors of zoonotic diseases. This study evaluated the flea species infesting domestic cats in Spain and assessed factors influencing their distribution. Fleas from 217 cats from 57 localities in Spain were identified and associations between abundance, and host-dependent, host habitat and environmental factors were examined. Variations in infracommunity and component community structure were also explored. Three species were present, of which Ctenocephalides felis (Bouché) (Siphonaptera: Pulicidae) was the most abundant (98.4%), followed by Ctenocephalides canis (Curtis) (1.1%) and Pulex irritans (L.) (Siphonaptera: Pulicidae) (0.5%). Overall abundance and abundances of both C. felis and C. canis were higher on farms than in apartments, but overall flea abundance and abundances of both C. felis and C. canis were lower in rural than urban environments. Overall abundance and C. felis abundance were lower during the warmest months, and mean annual rainfall was positively correlated with overall, C. felis and C. canis abundances. No relationship between the number of species per cat and any host, habitat or physiographical variable was found. Species richness was not correlated with mean annual temperature or rainfall. Flea abundance was mainly associated with host habitat and environmental factors.

Chronic bovine besnoitiosis: intra-organ parasite distribution, parasite loads and parasite-associated lesions in subclinical cases

Bovine besnoitiosis caused by Besnoitia besnoiti is a chronic and debilitating disease. The most characteristic clinical signs of chronic besnoitiosis are visible tissue cysts in the scleral conjunctiva and the vagina, thickened skin and a generally poor body condition. However, many seropositive animals remain subclinically infected, and the role that these animals may play in spreading the disease is not known. The aim of the present study was to assess the intra-organ parasite distribution, the parasite load and the parasite-associated lesions in seropositive but subclinically infected animals. These animals were seropositive at the time of several consecutive samplings, had visible tissue cysts in the past and, at time of slaughter, had detectable specific anti-Besnoitia spp. antibody levels, but they did not show evident clinical signs at culling. Thus, histopathological, immunohistochemical and molecular analyses of several samples from the respiratory tract, reproductive tract, other internal organs and skin from six cows were performed. The tissue cysts were located primarily in the upper respiratory tract, i.e., in the rhinarium and larynx/pharynx (four cows), followed by the distal genital tract (vulva/vagina) and the skin of the neck (three and two cows, respectively, out of the four cows with cysts in the respiratory tract). We were unable to detect any parasites in the two remaining cows. Cysts were associated with a significant non-purulent inflammatory infiltrate consisting predominantly of T lymphocytes and activated monocytes/macrophages in two cows. The parasite burden, estimated by quantitative real-time PCR, was very low. It is noteworthy that the only animal that showed a recent increase in the antibody titre had the highest parasite burden and the most conspicuous inflammatory reaction against the cysts. In conclusion, although these cows no longer displayed any visible signs of besnoitiosis, they remained infected. Therefore, cows without visible signs of disease may still be able to transmit the parasite.

Development and use of an indirect ELISA in an outbreak of bovine besnoitiosis in Spain

An indirect ELISA based on a soluble extract of Besnoitia besnoiti tachyzoites was developed and standardised. A set of positive and negative reference bovine sera were characterised using an immunofluorescence antibody test and Western blot. A cut-off with a relative index per cent of 8.1 was determined for equal sensitivity and specificity (100 per cent) by two-graph receiver operating characteristic analysis. Cross-reactions with other closely related Apicomplexan parasites were discarded. The standardised ELISA was then used during an outbreak of bovine besnoitiosis in a mountainous area of central Spain. The outbreak occurred in nine herds, and 358 animals that shared grazing lands during the summer season were affected. Clinical examination and blood sampling were carried out for all animals, and skin biopsies were obtained from animals with skin lesions. The confirmatory diagnosis was carried out by means of the indirect ELISA, together with the identification of tissue cysts by microscopy. Most of the animals were seropositive (90.5 per cent), but only 43 per cent of seropositive cattle developed clinical signs compatible with besnoitiosis. Additionally, a significant increase in seroprevalence and clinical signs was found to be associated with the increasing age of the animals, suggesting rapid horizontal transmission of the disease.

Retrograde atrial kick in acute aortic regurgitation. Study of mitral and pulmonary venous flow velocities by transthoracic and transesophageal echocardiography

BACKGROUND AND HYPOTHESIS

The purpose of this study was the comprehensive evaluation of the changes in pulmonary venous and mitral flow velocities of patients with acute and chronic severe aortic regurgitation. Transmitral flow velocities obtained with pulsed-wave Doppler echocardiography have been used to provide information on left ventricular (LV) filling and diastolic function. Pulmonary venous flow tracings are an important adjunct to LV inflow pattern in assessing LV diastolic function.

METHODS

Fourteen patients with severe aortic regurgitation (8 chronic and 6 acute) and in sinus rhythm were examined by transthoracic and transesophageal pulsed Doppler echocardiography. Mitral and pulmonary flow velocities were recorded and compared. All patients had ejection fractions > 40%.

RESULTS

Early mitral flow peak velocity was higher in patients with acute regurgitation (p < 0.001). The mitral A wave was absent in five patients with acute regurgitation. In contrast, a prominent reverse atrial pulmonary systolic wave AR was demonstrated in these patients. Peak diastolic velocity of the pulmonary venous flow was greater in patients with acute aortic regurgitation (0.76 +/- 0.13) than in patients with chronic aortic regurgitation (0.40 +/- 0.09) (p < 0.001). Peak systolic velocity did not differ significantly between the two groups. The systolic fraction of pulmonary venous flow in patients with acute aortic regurgitation was lower (0.43 +/- 0.05) than that of patients with chronic regurgitation (0.63 +/- 0.1) (p < 0.01). All patients with acute aortic regurgitation had an S/D ratio < 1, while those with chronic regurgitation had an S/D > 1 (p < 0.001) and an E/A < 1.

CONCLUSION

Patients with severe acute aortic regurgitation showed a retrograde atrial kick (absence of transmitral A wave with prominent pulmonary AR wave). These patients had an S/D ratio < 1 (restrictive Doppler pattern). Patients with chronic aortic regurgitation exhibited a Doppler pattern of abnormal LV relaxation (E/A < 1, S/D > 1).

Heterologous prime-boost vaccination with a non-replicative vaccinia recombinant vector expressing LACK confers protection against canine visceral leishmaniasis with a predominant Th1-specific immune response

Leishmaniasis caused by Leishmania infantum is a severe endemic disease in the Mediterranean basin, being domestic dogs the main reservoir of the disease that plays a key role in the transmission to humans. Studies on vaccines against canine leishmaniasis, aimed to modify the T cell repertoire, have advanced in recent years. LACK vaccination assays, using protein or DNA vectors, show protection against cutaneous L. major infections by redirecting the early IL-4 responses to a protective Th1 response. The aim of this study was to define the effectiveness and type of immune response in a canine visceral leishmaniasis model of two poxvirus vectors (Western reserve strain, WR and modified vaccinia virus Ankara, MVA) expressing the LACK protein of L. infantum in prime/boost vaccination protocols. The results obtained showed that dog vaccination priming with DNA-LACK followed by a booster with MVA-LACK or rVV-LACK triggered a Th1 type of immune response, leading to protection against canine visceral leishmaniasis. This protection correlated with absence of visceral leishmaniasis symptoms, lower Leishmania-specific antibodies, higher degree of T cell activation in Leishmania-target organs and higher synthesis of Th1 cytokines. In addition, we found that dogs boosted with the non-replicative virus show less VL symptoms and higher degree of T cell activation, providing evidences for a clear advantage of MVA-LACK as a vaccination vector against canine visceral leishmaniasis.

Use of domperidone in the treatment of canine visceral leishmaniasis: a clinical trial

The aim of this study was to evaluate the effects of domperidone, a dopamine D2 receptor antagonist, in dogs naturally infected by Leishmania infantum. Ninety-eight dogs were treated with single-agent domperidone at 1mg/kg twice a day orally for 1 month. Clinical, serological, biochemical and immunological examinations were conducted for the following 12 months. Domperidone was effective in controlling and reducing clinical signs and antibody titre. Significant decreases in reciprocal serum antibodies were seen in 74.3% of the dogs with mild clinical signs and 40% of the dogs became seronegative. In dogs with several clinical signs and high antibody titres, clinical improvement occurred in 86% of animals and the reciprocal serum antibody titres decreased in 38% of these dogs. A significant increase was noted in the immune cellular status, as measured by the leishmanin skin test and a lymphocyte proliferation assay.

Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: the ESPRINT questionnaire

OBJECTIVES

To develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations.

METHODS

An initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test-retest (2-4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).

RESULTS

The new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score.

CONCLUSIONS

This new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.

Fleas parasitizing domestic dogs in Spain

In addition to their importance to veterinary clinical practice as ectoparasites, fleas of domestic dogs are of special concern because they can be vectors of disease, including zoonoses. Flea assemblages parasitizing domestic dogs usually comprise several flea species whose distribution is determined by factors acting at several scales. Knowledge of these factors will aid in assessment of the distribution patterns of flea parasitism, and is an important tool in developing control strategies and in evaluation of flea-borne disease risk in dogs and humans. In this survey we used data from 744 domestic dogs from 79 localities in Spain to explore the associations between the abundance of flea species, host-dependent factors (sex and age), and host habitat factors including abode (farm, house with garden, apartment), location (urban or rural), the presence of other pets, and dog activity (measured as the frequency with which dogs left their abode). We also considered environmental factors including the time of year and mean annual temperature and rainfall. Variations in flea community structure at infracommunity and component community levels were also explored. Four flea species were found parasitizing dogs. Ctenocephalides felis was the most abundant (88.02% of fleas identified), followed by Ctenocephalides canis (10.38%), Pulex irritans (1.47%) and Echidnophaga gallinacea (0.13%). Overall flea abundance was higher on dogs living on farms than in apartments, as was the abundance of Ct. felis, Ct. canis and P. irritans. Ct. felis was more abundant on dogs living in houses than in apartments, but the reverse was found for P. irritans. Overall flea abundance and Ct. canis abundance were highest in rural areas, whereas the presence of other pets sharing the abode was associated with higher overall flea abundance and Ct. felis abundance. Only P. irritans abundance was positively related to the activity of dogs. Ct. canis and P. irritans abundances were higher during the warm period of the year. Mean annual temperature was negatively correlated with overall, Ct. canis and P. irritans abundances, but positively related to Ct. felis abundance. Annual rainfall was negatively correlated with Ct. canis and P. irritans abundances. Variations in the number of flea species found on a dog reflected the abundance distribution patterns for each species and their associations with host habitat and environmental factors. At the component community level, flea species richness was inversely related to annual mean temperature. The structure of flea assemblages on dogs was mainly associated with host habitat and environmental variables, and not with host-dependent variables. However, a large amount of variation in flea abundance remained unexplained, suggesting the effect of other non-controlled factors.

Isolation and development of haematopoietic progenitor cells from peripheral blood of adult and newborn pigs

Pluripotent stem cells (PSCs), already described in human beings, are fibroblast-like cells that exhibit a CD34 marker specific for haematopoietic stem cells. In this work we have demonstrated the presence of PSCs in the peripheral blood of pigs, a species frequently used in transplantation studies as an animal model for human diseases. Differentiation into haematopoietic colonies (granulomacrophagic colonies, erythroid colonies and mixed colonies) has been carried out with the peripheral blood of adult and newborn pigs, using solely human commercial media. Peripheral blood mononuclear cells (PBMNCs) were cultured in semisolid methylcellulose based media enriched with recombinant human cytokines, achieving granulomacrophagic-colony forming unit (GM-CFU) and mixed-colony forming unit (Mix-CFU) growth with erythroblastic lineage proliferation in the presence of erythropoietin (Epo). In all the samples CFU growth was associated with the presence of recombinant human cytokine. No evidence of proliferation in control plates without cytokines was found. From liquid medium culture, a population of macrophages and CD34+ fibroblast like cells were retrieved 21 days after sowing. These findings allow us to think about the direct application of this simple and standardised method in several work fields such as the study of pharmacological effects of many drugs over the haematopoietic line and in the study of new strategies in cellular therapy for some human diseases.

Kinetics ofOestrus ovisinfection and activity of adult flies

Oestrus Ovis is a common sheep parasite in the Mediterranean region. This study was carried out in the Ebro River Valley near Zaragoza (northeast Spain) using tracer animals to describe the seasons when infestation is more likely. Based on that information and an analysis of the evolution of the parasite within the host, we suggest the most appropriate time for treatment. Adult instars appeared in May until November and there was a diapause beginning in October-November and as least until February, so it is suggested than sheep be treated with larvicide in December.

Rupatadine 10 mg and ebastine 10 mg in seasonal allergic rhinitis: a comparison study

BACKGROUND

The aim of this study is to establish the efficacy and safety of rupatadine vs ebastine and placebo in the treatment of seasonal allergic rhinitis (SAR). Rupatadine is a new second generation H(1)-antihistamine with once-daily dosing that may provide better control of symptoms than the currently used H(1)-receptor blockers because of its dual pharmacological profile (anti-PAF and anti-H(1)).

METHODS

In a multicentre study, 250 patients with SAR were included in a double-blind, randomized, parallel-group and placebo-controlled study. Patients received either rupatadine 10 mg, ebastine 10 mg or placebo once daily for 2 weeks. The main efficacy outcome was based on the patient's record of severity of nasal symptoms (sneezing, nasal itching, runny nose and nasal obstruction) and nonnasal symptoms (conjunctival itching, tearing and pharyngeal itching). The daily total symptom score (DTSS) was the mean of the DSS recorded for each of the seven symptoms assessed, and the mean DTSS (mDTSS) was the mean of the DTSS values for each study day.

RESULTS

Significant differences in mDTSS were detected between rupatadine and placebo (33% lower for rupatadine group; P = 0.005) after 2 weeks of treatment. The TSS for rupatadine were 22% lower than for ebastine, although the differences were not statistically significant. No serious adverse events were reported during the study period.

CONCLUSIONS

Rupatadine 10 mg once daily was clearly superior to placebo in alleviating the symptoms of SAR over a 2-week period. In comparison with ebastine, rupatadine shows a trend towards a better profile as regard several secondary efficacy variables.

Ten-year viability study on natural populations of Drosophila sibling species from Laguna Verde, Veracruz, México

The generation of electricity in nuclear power plants produces an increase in background radiation that could possibly have some impact on the organisms that live in that area. In order to identify and quantify any such possible effect, the natural populations of two sibling species, D. melanogaster and D. simulans, that live in the immediate vicinity of the first Mexican Nuclear Power Plant were analyzed for a period of 10 years. Collections of flies were made at two sites, one close to and one farther from the power plant, during the pre and operational stages of the reactor, and their egg-to-adult viability was analyzed. The data obtained indicate that in both sites, the egg-to-adult viability was generally higher in D. melanogaster than in D. simulans. Further, a relationship was found between egg-to-adult viability and the season of the year (warm-wet or cool-dry season). Some differences were found between the two sites. It may be concluded that there is no negative impact on the Drosophila populations studied.

Modified direct agglutination test for simplified serologic diagnosis of leishmaniasis

Human leishmaniasis is a severe health problem in many countries around the world. Hence, a cheap, reliable, and accurate diagnostic test is required to fight this disease. Perhaps the direct agglutination test (DAT) meets these criteria, but antigen elaboration involves many difficulties. We have developed a new antigen elaboration method, the EasyDAT method, that avoids the problems associated with the DAT. In this study, we compared the traditional DAT antigen method with our EasyDAT antigen method by using canine sera. The sensitivities (100%) and specificities (98.7%) were the same for both methods; we therefore concluded that the EasyDAT Leishmania antigen method simplifies serologic diagnosis, making this method easier and cheaper to use.

Lactating females Syrian hamster (Mesocricetus auratus) show protection against experimental Leishmania infantum infection

The Syrian hamster (Mesocricetus auratus) is the best animal model for human leishmaniosis, an emergent disease that causes 400,000 new cases every year. The main objective of this assay was to prove the relationship between female lactation, which implies hyperprolactinaemia (IFN-gamma, IL-12, IL-2 and TNF-alpha elevated), and leishmaniosis (IFN-gamma, IL-12, IL-2 and TNF-alpha diminished). The results demonstrate the clear implication of lactation in immune response. The infected lactating females did not show any symptoms of sickness, a 24 g mean increase was noticed, throughout the assay they were negative in the indirect diagnosis test (Direct Agglutination Test (DAT)), and in the direct diagnosis tests (N-N-N isolation, tissue impressions).

Histochemical differentiation of Dirofilaria immitis, Dirofilaria repens and Acanthocheilonema dracunculoides microfilariae by staining with a commercial kit, Leucognost-SP

The diagnosis of canine heartworm infection is based upon the presence of circulating Dirofilaria immitis microfilariae or on techniques for the detection of serum antibodies or antigens. In the first of these, discrimination between D. immitis, D. repens and Acanthocheilonema dracunculoides microfilariae is based upon the acid phosphatase histochemical stain. In this paper, we propose an alternative technique for histochemical staining using a commercial kit test of naphthol-AS-OL (Leucognost-SP). This offers the advantages of speed and simplicity as compared to the standard Barka procedure.

[Diagnosis of apical hypertrophic cardiomyopathy using contrast echocardiography]

Apical hypertrophic cardiomyopathy is a disease with clear electrocardiographic and echocardiographic characteristics. However, poor visualization of apical endocardial border is a limiting factor to diagnose apical hypertrophic cardiomyopathy by echocardiography. We present a case report of a patient with a characteristic electrocardiogram but poor apical endocardial border delineation. A contrast-enhanced echocardiography was performed to confirm the diagnosis of apical hypertrophic cardiomyopathy. We discuss the role of echocardiographic image enhancement with contrast to diagnose apical hypertrophic cardiomyopathy.

Structure, organization and characterization of the gene cluster involved in the production of microcin E492, a channel-forming bacteriocin

Microcin E492 is a low-molecular-weight, channel-forming bacteriocin produced and excreted by Klebsiella pneumoniae RYC492. A 13 kb chromosomal DNA fragment from K. pneumoniae RYC492 was sequenced, and it was demonstrated by random Tn5 mutagenesis that most of this segment, which has at least 10 cistrons, is needed for the production of active microcin and its immunity protein. Genes mceG and mceH correspond to an ABC exporter and its accessory protein, respectively, and they are closely related to the colicin V ABC export system. The microcin E492 system also requires the product of gene mceF as an additional factor for export. Despite the fact that this bacteriocin lacks post-translational modifications, genes mceC, mceI and mceJ are needed for the production of active microcin. Genes mceC and mceI are homologous to a glycosyl transferase and acyltransferase, respectively, whereas mceJ has no known homologue. Mutants in these three genes secrete an inactive form of microcin, able to form ion channels in a phospholipidic bilayer, indicating that the mutation of these microcin genes does not alter the process of membrane insertion. On the other hand, microcin isolated from mutants in genes mceC and mceJ has a lethal effect when incubated with spheroplasts of sensitive cells, indicating that the microcin defects in these mutants are likely to alter receptor recognition at the outer membrane. A model for synthesis and export is proposed as well as a novel maturation pathway that would involve conformational changes to explain the production of active microcin E492.