Evaluation of analytical performance of the STANDARDTM M10 MPX/OPX assay for the simultaneous DNA detection and clade attribution of Monkeypox virus

Monkeypox virus (MPXV) infection confirmation needs reliable polymerase chain reaction (PCR) assays; in addition, viral clade attribution is a key factor in containment measures, considering a more severe syndrome in clade I and the possibility of simultaneous circulation. This study evaluates the performance of all-in-one STANDARD M10 MPX/OPX (SD BIOSENSOR, South Korea - M10). Frozen samples from 205 subjects were selected and stratified according to routine test results (RealStar® Orthopoxvirus PCR Kit 1.0, Altona DIAGNOTICS, Germany - RS; RS-1): in detail, 100 negative skin lesions (SL) and 200 positive samples at the variable stage of infection were analysed. Positive samples were retested with RS (RS-2). Positive and Negative Percent Agreements (PPA, NPA) were calculated. The median (IQR) Ct values of RS and M10 (OPXV target) assays were highly similar. The PPA of M10 compared to RS-1 was 89.5% considering system interpretation, and 96.0% when the operator classified results as positive if any target was detected; NPA was 100%. Comparing the RS-2 run and M10, an overall concordance of 95.3% between assays was found; however, considering operator interpretation, M10 returned more positive results than RS-2. The occurrence of False-Negative results was likely associated with the influence of thawing on low viral concentration; no False-Positive tests were observed. All samples collected at the time of Mpox diagnosis were positive and M10 correctly attributed the clade (West-Africa/II). The M10 MPX/OPX assay demonstrated high reliability in confirming MPXV infection and clade attribution.

First imported case of Candida auris infection in Milan, Italy: genomic characterisation

PURPOSE

Candida auris, an emerging multidrug-resistant yeast, has been reported worldwide. In Italy, the first case was reported in 2019. We describe the first case of C. auris, imported from Greece, in Milan, using whole genome sequencing to characterise mutations associated with antifungal resistance.

CASE PRESENTATION

On October 2022 an 80-year-old Italian man was hospitalised in Greece. In the absence of clinical improvement, the patient was transferred to our hospital, in Italy, where blood culture resulted positive for C. auris. Despite therapy, the patient died of septic shock. In a phylogenetic analysis the genome was assigned to Clade I with strains from Kenya, United Arab Emirates and India. D1/D2 region resulted identical to a Greek strain, as for many other strains from different World regions, highlighting the diffusion of this strain.

CONCLUSION

Importation of C. auris from abroad has been previously described. We report the first case of C. auris imported into Italy from Greece, according to phylogenetic analysis. This case reinforces the need for monitoring critically ill hospitalised patients also for fungi and addresses the need for the standardisation of susceptibility testing and strategies for diagnosis and therapy.

Detection and typization of HPV genotypes in subjects with oral and upper respiratory tract lesions, Milan, Italy

BACKGROUND

Oral human papillomavirus (HPV) is common among healthy individuals but causes and implications of persistent infections are under evaluation in the pathogenesis of head and neck neoplasms.

METHODS

This was a retrospective study evaluating the prevalence of high-risk (HR), probable HR and low-risk (LR) HPV types in patients reporting signs/symptoms of oral and upper respiratory tract lesions. Individuals attending between 2019 and 2022 a University Hospital in Milan, Italy, with risk factors for HPV (unprotected oral sex and/or previous documentation of HPV infection in oral and upper respiratory tract and/or another anatomical site) were included.

RESULTS

Fourteen out of 110 (12.7%) individuals tested positive for HPV DNA. The prevalence of HR-HPV and LR-HPV was 3.6% (4/110) and 9.1% (10/110), respectively. No probable/possible HR-HPV was detected. Specifically, 10/110 (9.1%) were diagnosed with 1 LR-HPV genotype, 3/110 (2.7%) were infected with 1 HR-HPV and 1/110 had 3 concomitant HR-HPV types. HPV 16 (2.7%, 3/110) and 6 (4.5%, 5/110) were the most common HR and LR types, respectively. One patient positive for HPV 16, 33 and 35 was diagnosed with cancer at the base of the tongue. Two individuals among those who tested positive for HPV DNA reported previous HPV vaccination.

CONCLUSIONS

Our data, in line with observations from previous prevalence studies, support the potential role of HPV in head and neck neoplasms. HPV DNA testing should be performed in patients presenting lesions in oral/respiratory tracts and risk factors for HPV. Improvement in HPV vaccination coverage is warranted.

Dynamics of viral DNA shedding and culture viral DNA positivity in different clinical samples collected during the 2022 mpox outbreak in Lombardy, Italy

BACKGROUND

Mpox virus (MPXV) has recently spread outside of sub-Saharan Africa. This large multicentre study was conducted in Lombardy, the most densely populated Italian region accounting for more than 40% of Italian cases. The present study aims to: i) evaluate the presence and the shedding duration of MPXV DNA in different body compartments correlating the MPXV viability with the time to onset of symptoms; ii) provide evidence of MPXV persistence in different body compartment as a source of infection and iii) characterize the MPXV evolution by whole genome sequencing (WGS) during the outbreak occurred in Italy.

MATERIAL AND METHODS

The study included 353 patients with a laboratory-confirmed diagnosis of MPXV infection screened in several clinical specimens in the period May 24th - September 1st, 2022. Viral isolation was attempted from different biological matrices and complete genome sequencing was performed for 61 MPXV strains.

RESULTS

MPXV DNA detection was more frequent in the skin (94.4%) with the longest median time of viral clearance (16 days). The actively-replicating virus in cell culture was obtained for 123/377 (32.6%) samples with a significant higher viral quantity on isolation positive samples (20 vs 31, p < 0.001). The phylogenetic analysis highlighted the high genetic identity of the MPXV strains collected, both globally and within the Lombardy region.

CONCLUSION

Skin lesion is gold standard material and the high viral load and the actively-replicating virus observed in genital sites confirms that sexual contact plays a key role in the viral transmission.

High prevalence of high-risk HPV genotypes in individuals attending an infectious diseases clinic from 2018 to 2022 in Milan, Italy

Human papillomavirus (HPV) is the most common sexually transmitted infection, linked to several types of lesions. HPV, specifically HPV 16, accounts for most of anal cancer cases. In this study, we evaluated the proportion of samples tested positive for HPV and characterized genotypes distribution in anal specimens collected from individuals at risk of anal HPV infection attending from 2018 to 2022 a large Infectious Diseases Department in Italy. The presence of HPV DNA was investigated through a commercial kit detecting 12 HR-HPV, 8 probable/possible HR-HPV, and 8 LR-HPV genotypes. Among 1514 samples, 84% (1266/1514) resulted positive for any type of HPV. The prevalence of high-risk HPV types remained high during all the years of the study period, from 2018 to 2022, ranging from 65% to 73%. Most of HR-HPV, LR-HPV and HPV 16 positive samples were collected from men >45 years. HPV 16 was also the most frequent type in men and women. We did not observe significant variations between years in detection of HR-HPV, instead of LR-HPV, that significantly decreased. In conclusion, the high prevalence of oncogenic HPV genotypes underlines the necessity of clear anal HPV screening guidelines and, along with frequent HR-HPV coinfections, reinforces the urge to intensify the anti-HPV vaccination campaign.

Gastrointestinal Parasite Infections and Environmental Sustainability of the Ovine Sector: Eimeria spp. Infections and Nitrogen and Phosphorus Excretions in Dairy Sheep in Italy

In sheep farming, gastrointestinal parasites can be responsible for significant reductions in animal health and production. Nitrogen (N) and phosphorus (P) fecal excretions are the main determining factors for N2O emissions from manure management and may pose other environmental problems, such as the acidification and eutrophication of natural habitats. By using the Mini-FLOTAC technique on fecal samples from sheep of different ages and physiological status from 19 dairy sheep farms in Tuscany (central Italy), gastrointestinal parasite infections were evaluated. The animal N and P fecal contents were also assessed, with the aim of evaluating possible relationships between the identified parasites and the environmental sustainability of the examined farms. The obtained results showed that Eimeria spp. (86.36%) and gastrointestinal strongyle (54.55%) infections are prevalent in the examined farms. Moreover, significantly higher (p ≤ 0.05) P and Eimeria oocyst/gram-of-feces (OPG) values were found in fecal samples from animals < 1 year of age, and a significant (p ≤ 0.05) positive correlation resulted between N content and Eimeria OPG in fecal samples from animals in the first month of lactation. The findings from this study suggest for the first time that Eimeria spp. infections may have an impact on the environmental sustainability of sheep farming.

Sterol, tocopherol, and bioactive fatty acid differences between conventional, high-quality, and organic cow milk

Milk contains several components that are important for human nutrition and health. To date, studies on organic and conventional milk have focused on their gross composition and fatty acid content, but little attention has been paid to the differences between other minor components, such as sterols and vitamins that may have functional actions. The aim of this study was to investigate the nutritional differences among 3 types of milk from a dairy plant: conventional, high-quality, and organic (in compliance with European regulations) milk, focusing on minor components such as sterols of animal and plant origin (phytosterols), tocopherols, and bioactive fatty acids. Cholesterol ranged from 271.37 mg/100 g of fat in conventional milk to 278.76 mg/100 g of fat in organic milk. Lanosterol was the main minor animal sterol in cow milk (ranging from 3.41 to 4.37 mg/100 g of fat), followed by desmosterol. The amount of total plant sterols in the analyzed milk ranged from 4.43 mg/100 g of fat in organic to 4.71 mg/100 g of fat in high-quality milk. Brassicasterol was the main sterol of plant origin which varied from 2.6 mg/100 g of fat in conventional and organic milk, to 2.93 mg/100 g of fat in high-quality milk. The second most present phytosterol was β-sitosterol, which ranged from 0.86 mg/100 g of fat in conventional to 0.97 mg/100 g of fat in high-quality, and organic milk. The results of the study showed no significant differences in gross and sterol composition between the 3 types of milk. However, the only significant difference found was in the fatty acid profile, with a higher n-3 content found in high-quality milk than in conventional and organic milk. These findings suggest that the investigated product categories and labels have minimal effect on the sterol and fatty acid profile of commercial cow milk.

Traditional Cultures versus Next Generation Sequencing for Suspected Orthopedic Infection: Experience Gained from a Reference Centre

(Background) The diagnosis and the antimicrobial treatment of orthopedic infection are challenging, especially in cases with culture-negative results. New molecular methods, such as next-generation sequencing (NGS), promise to overcome some limitations of the standard culture, such as the detection of difficult-to-grow bacteria. However, data are scarce regarding the impact of molecular techniques in real-life scenarios. (Methods) We included cases of suspected orthopedic infection treated with surgery from May 2021 to September 2023. We combined traditional cultures with NGS. For NGS, we performed a metagenomic analysis of ribosomal 16s, and we queried dedicated taxonomic libraries to identify the species. To avoid false positive results, we set a cut-off of 1000 counts of the percentage of frequency of reads. (Results) We included 49 patients in our study. Our results show the presence of bacteria in 36/49 (73%) and 29/49 (59%) cases studied with NGS and traditional cultures, respectively. The concordance rate was 61%. Among the 19/49 discordant cases, in 11/19 cases, cultures were negative and NGS positive; in 4/19, cultures were positive and NGS negative; and in the remaining 4/19, different species were detected by traditional cultures and NGS. (Conclusions) Difficult-to-grow microorganisms, such as slow-growing anaerobic bacteria, were better detected by NGS compared to traditional culture in our study. However, more data to distinguish between true pathogens and contaminants are needed. NGS can be an additional tool to be used for the diagnosis of orthopedic infections and the choice of appropriate antimicrobial therapy.

Amiata donkey body conformation, udder characteristics, and their relationship with milk yield and quality

To date, no selective actions have been taken to improve milk traits in dairy donkeys, and the characteristics of the udder are not well defined in relation to the productive characteristics. This study aimed at increasing knowledge on Amiata dairy donkey body conformation, udder traits, and their relationship with milk yield and quality. Morphological, udder, and teat measurements and milk evaluations of 45 pluriparous jennies were carried out. The average wither height of the jennies was 126 cm and the chest girth was 148 cm; a large standard deviation of some body measurements was found. Forty-nine percent of the animals showed a moderately developed udder, while most of the jennies had symmetrical half-udders (96%) and the intermammary cleft was clearly visible in 53% of subjects. Correlation analysis indicated that bigger animals tend to have bigger udders, higher teat diameter, and greater distance between teat tips. A positive correlation between the teat length and the milk fat was found ( p < 0.01), which suggests that jennies with longer teats have a better ability to release milk fat. The results of this paper may be useful to define the characteristics of the milking device and address selective choices of the animals.

Concomitant diagnosis of sexually transmitted infections and human monkeypox in patients attending a sexual health clinic in Milan, Italy

In 2022, many monkeypox (MPX) outbreaks have been documented in countries where MPX was not endemic. It spread all around the world, especially in European Union and United States. While MPX is classically considered to be transmitted through close contact with lesions, the hypothesis of sexual transmission has been proposed. This study considered a total of 49 patients suspected for MPX that were also tested for other sexually transmitted infections (STIs), including Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis. The data from coinfected patients suggested that MPXV and STIs might share the same route of inoculum, corroborating the hypothesis of possible sexual transmission for the emerging poxvirus. And like any other STI, MPX should be considered without stigmatization.

Isolation of viable monkeypox virus from anal and urethral swabs, Italy, May to July 2022

Anal and urethral samples from confirmed cases of monkeypox were screened for monkeypox virus (MPXV) by real-time PCR. Isolation of the virus was subsequently attempted in cell culture. Actively-replicating virus was demonstrated in 13 of 18 and 11 of 15 PCR-positive anal and urethral swabs, respectively, collected within 7 days from symptoms onset. Two asymptomatic secondary cases had detectable MPXV genetic material in urethral secretion and for one, MPXV was successfully isolated, supporting a potential MPXV sexual transmission hypothesis.

The ClassyFarm System in Tuscan Beef Cattle Farms and the Association between Animal Welfare Level and Productive Performance

Simple Summary

Interest in animal welfare has increased due to the growing ethical sensitivity of consumers and the awareness of its impact on food security and safety. In addition, respecting a high standard of animal welfare helps in the prevention of transmissible infectious diseases and the control of antimicrobial resistance. As a response to these needs, in 2018, the Italian Ministry of Health introduced the ClassyFarm system, which categorizes the level of risk arising from farm animal welfare and provides a specific checklist. This paper investigates the relationship between animal welfare and productive parameters on beef cattle farms. Animal welfare was assessed using the ClassyFarm system checklist for beef cattle. Our results demonstrated the influence of animal welfare on productive performance, suggesting that respecting high animal welfare levels helps to reach the full growth potential of beef cattle.

Abstract

In 2018, the Italian Ministry of Health introduced the ClassyFarm system in order to categorize the level of risk related to animal welfare. The ClassyFarm checklist for beef cattle is divided into four areas: Areas A “Farm management and personnel”; B “Structures and equipment”; C “Animal-based measures”; and “Emergency plan and alert system”. Answers contribute to the final Animal Welfare Score (AWS) and to the score of each area. The aim of this work was to assess the animal welfare level on 10 Tuscan beef cattle farms through the ClassyFarm checklist and to examine the relationship between the level of animal welfare on final weight (FW), carcass weight (CW), weight gain (WG), and average daily gain (ADG). The AWS was divided into four classes, and the scores for each area were divided into three classes. The analysis of variance was applied, and AWS class, sex, and breeding techniques (open and closed cycle) were included in the model. The AWS class and sex had a highly significant influence on all parameters, while the breeding technique did not significantly influence any parameter. Farms classified as excellent presented a higher FW (677.9 kg) than those classified as good and insufficient, and the same trend was found for the ADG. The classes obtained in Areas A and C had a highly significant influence on all the parameters investigated. The classes obtained in Area B significantly influenced FW and WG. In conclusion, the productive response of the animals seemed to benefit from the welfare conditions.

Differences of the Plasma Total Lipid Fraction from Pre-Foaling to Post-Foaling Period in Donkeys

Simple Summary

An association between increased metabolic demands and reduced dry matter intake is observed from late gestation to early lactation in donkeys. Furthermore, little is known about the nutritional and energy requirements of this period in animals. Changes in energy metabolism make donkeys more susceptible to metabolic diseases such as hyperlipemia, which is characterized by the mobilization of fatty acids from adipose tissue. A better knowledge of this period could improve animal husbandry, well-being, and health. The aim of this study was to analyze the plasma total lipid fraction, to highlight metabolic changes from the pre-foaling to post-foaling periods, using the gas chromatography technique. Our findings reveal a greater risk of metabolic disease in late gestation to early lactation in donkeys.

Abstract

The period from late gestation to early lactation is characterized by changes in energy metabolism. The aim of the current study was to analyze the plasma total lipid fraction using gas chromatography (GC) analysis, in order to highlight metabolic changes from the pre-foaling to post-foaling periods. Eleven pluriparous dairy jennies (mean age of 11.88 ± 3.79 years) belonging to the Amiata donkey breed were enrolled. Blood sampling was performed at 15 days before foaling (T0), and 15 (T1), 30 (T2), 60 (T3), and 90 (T4) days after foaling, for biochemical and GC analysis. A total of 37 fatty acids were identified in plasma samples: 4 medium chain (MCFA), 24 long chain (LCFA), and 9 very-long chain (VLCFA) fatty acids. Among them, 20 fatty acids changed significantly, and two fatty acid showed a trend toward significance. Furthermore, the LCFA, saturated, unsaturated, monounsaturated, and polyunsaturated ω-3 fatty acids changed significantly during the study period. The main alterations were between T0 and the other time points and appeared to be related to lipid metabolism, cellular structure and function, and inflammatory and immune responses. Our findings reveal greater energy requirements at the end of gestation compared to early lactation in donkeys.

Effects of the Physiological Status and Diet on Blood Metabolic Parameters in Amiata Dairy Donkeys

Simple Summary

This study investigated the physiological responses of donkeys feeding two different diets during maintenance, pregnancy and lactation. To investigate how the metabolic state influences dairy production, we also assessed the relationships between the blood metabolic profile and milk quality. We found that pregnancy and the first months of lactation led to lower feed intake and increases in blood non-esterified fatty acids (NEFAs), which was linked to the difficulty that the jennies have in meeting the higher energy needs. The intake of the concentrate in the diet was associated with the increase in blood glucose, both during maintenance and lactation. Higher NEFA were related to lower de novo synthesized milk fatty acids, whereas higher plasma B-HBA were related to higher somatic cell count. This paper contributes to the knowledge of physiological responses of jennies during milk production phases and provides information for donkey milk producers.

Abstract

Body weight changes and blood metabolic parameters in jennies feeding two different diets and in three physiological statuses were investigated (maintenance vs. pregnancy; maintenance vs. lactation). The relationships between blood metabolic profile and milk quality were also evaluated. Fourteen jennies were allocated to two groups (1: pregnant/lactating; 2: non-pregnant, non–lactating). Pregnant jennies and maintenance jennies (during the first 10-week measurement period) fed a diet consisted of ad libitum grass hay (diet 1); lactating jennies and maintenance jennies (during the last 10-week measurement period) fed ad libitum grass hay plus 2 kg/head/day of concentrate (diet 2). Blood sampling was performed on the jennies of both groups; individual milk samples were also collected during the first 70 days in milk. Higher blood NEFA (p < 0.05) were found in pregnant compared to maintenance jennies (diet 1) (68 vs. 37 μmol/L). Lactating jennies showed higher (p < 0.01) average blood NEFA (268 vs. 26 μmol/L) and glucose (66 vs. 55 mg/dL) compared to the maintenance (diet 2). Blood glucose was positively correlated to milk fat (p < 0.05), while negative significant correlations between de novo milk fatty acids and NEFAs were observed. Positive correlations between plasma B-HBA and somatic cell count (p < 0.01) were also found.

Characterization and Clonal Diffusion of Ceftaroline Non-Susceptible MRSA in Two Hospitals in Central Italy

Background: Ceftaroline represents a novel fifth-generation cephalosporin to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: Ceftaroline susceptibility of 239 MRSA isolates was assessed by disk diffusion and a MIC test strip following both EUCAST and CLSI guidelines. Non-susceptible isolates were epidemiologically characterized by pulsed-field gel electrophoresis, spa typing, and multilocus sequence typing, and further investigated by PCR and whole genome sequencing to detect penicillin-binding protein (PBP) mutations as well as antibiotic resistance and virulence genes. Results: Fourteen isolates out of two hundred and thirty-nine (5.8%) were non-susceptible to ceftaroline (MIC > 1 mg/L), with differences between the EUCAST and CLSI interpretations. The characterized isolates belonged to seven different pulsotypes and three different clones (ST228/CC5-t041-SCCmecI, ST22/CC22-t18014-SCCmecIV, and ST22/CC22-t022-SCCmecIV), confirming a clonal diffusion of ceftaroline non-susceptible strains. Mutations in PBPs involved PBP2a for ST228-t041-SCCmecI strains and all the other PBPs for ST22-t18014-SCCmecIV and ST22-t022-SCCmecIV clones. All isolates harbored antibiotic resistance and virulence genes with a clonal distribution. Conclusion: Our study demonstrated that ceftaroline non-susceptibile isolates belonged not only to ST228 strains (the most widespread clone in Italy) but also to ST22, confirming the increasing role of these clones in hospital infections.

Cyathostomin fecal egg count and milk quality in dairy donkeys

This study was performed to assess the possible relationship between gastrointestinal strongylid infections and milk quantity and quality in donkeys used for milk production. Individual fecal and milk samples were collected from 16 multiparous lactating jennies of Amiatina breed at their 6th month of lactation. Statistical analysis was carried out between strongylid eggs per gram of faeces (EPG) and milk parameters. All animals were found to shed cyathostomin eggs, with EPG ranging from 150 to 1900. A higher milk production was observed in animals showing an EPG< 250, but this result was statistically not significant. Conversely, significant higher concentrations of milk urea and pH values, and lower concentrations of milk lactose, were observed in jennies with an EPG >1000. In conclusion, results from this study suggest that cyathostomin EPG values > 1000 may affect milk quality in dairy donkeys. Considering the novelty of these findings, more data needs to be collected to determine EPG thresholds to be used as a good marker for parasite infections influencing milk performance and quality in donkeys.

Current Knowledge on Functionality and Potential Therapeutic Uses of Donkey Milk

Simple Summary

This paper examines scientific evidence on the positive effects of donkey milk consumption on human health and its possible therapeutic applications. The most investigated clinical use of donkey milk is in feeding infants with food allergies, in whom donkey milk is well tolerated in the 82.6–98.5% of cases. Donkey milk has shown several beneficial properties, including immunomodulatory activity, antioxidant and detoxifying effects, modulation of the intestinal microbiota, and lowering of blood sugar and triglycerides, which have been tested almost exclusively in experimental animals. Inhibitory actions on microorganisms have been also observed in vitro studies. This literature review highlights the need for new clinical trials to collect stronger evidence about the positive effects observed in experimental models which could lead to new therapeutic applications of donkey milk in humans.

Abstract

The increase of knowledge on the composition of donkey milk has revealed marked similarities to human milk, which led to a growing number of investigations focused on testing the potential effects of donkey milk in vitro and in vivo. This paper examines the scientific evidence regarding the beneficial effects of donkey milk on human health. Most clinical studies report a tolerability of donkey milk in 82.6–98.5% of infants with cow milk protein allergies. The average protein content of donkey milk is about 18 g/L. Caseins, which are main allergenic components of milk, are less represented compared to cow milk (56% of the total protein in donkey vs. 80% in cow milk). Donkey milk is well accepted by children due to its high concentration of lactose (about 60 g/L). Immunomodulatory properties have been reported in one study in humans and in several animal models. Donkey milk also seems to modulate the intestinal microbiota, enhance antioxidant defense mechanisms and detoxifying enzymes activities, reduce hyperglycemia and normalize dyslipidemia. Donkey milk has lower calorie and fat content compared with other milks used in human nutrition (fat ranges from 0.20% to 1.7%) and a more favourable fatty acid profile, being low in saturated fatty acids (3.02 g/L) and high in alpha-linolenic acid (about 7.25 g/100 g of fat). Until now, the beneficial properties of donkey milk have been mostly related to whey proteins, among which β-lactoglobulin is the most represented (6.06 g/L), followed by α-lactalbumin (about 2 g/L) and lysozyme (1.07 g/L). So far, the health functionality of donkey milk has been tested almost exclusively on animal models. Furthermore, in vitro studies have described inhibitory action against bacteria, viruses, and fungi. From the literature review emerges the need for new randomized clinical trials on humans to provide stronger evidence of the potential beneficial health effects of donkey milk, which could lead to new applications as an adjuvant in the treatment of cardiometabolic diseases, malnutrition, and aging.

A preliminary investigation into the unsaponifiable fraction of donkey milk: Sterols of animal origin, phytosterols, and tocopherols

We investigated the main sterols, phytosterols, and the α- and γ-tocopherol content in donkey milk during the first 2 mo of lactation. Cholesterol was the main sterol in milk (mean ± standard deviation = 0.97 ± 0.443 g/100 g of fat). Lanosterol was the main minor sterol of animal origin, followed by desmosterol (0.003 ± 0.001 and 0.001 ± 0.001 g/100 g of fat, respectively). Of the phytosterols, β-sitosterol was the main sterol of vegetal origin in donkey milk (0.005 ± 0.002 g/100 g of fat), but lower levels of campesterol, brassicasterol, and stigmasterol were also recorded. Mean levels of α- and γ-tocopherol were 0.01 ± 0.007 and 0.003 ± 0.001 g/100 g of fat, respectively. We observed no significant changes in sterol or tocopherol content during the first 2 mo of lactation. The presence of lanosterol in donkey milk is of particular interest, because lanosterol is a potential drug and has important physiological effects. The presence of phytosterols, which are considered nutraceutical molecules, enhances the nutritional quality of donkey milk fat for consumers.

Donkey Feeding During Maintenance, Pregnancy, and Lactation: Effects on Body Weight, Milk Production, and Foal Growth

We evaluated the daily intake in donkeys during maintenance, late pregnancy, and early lactation. The growth curves of the foals in the first eight weeks of life and the milk production in lactating jennies were also investigated. Donkeys were separated into two groups: seven pregnant jennies (group 1: pregnant/lactating) and seven nonpregnant, nonlactating jennies (group 2). The groups were fed two different diets each. The feeding period for group 1 covered eight weeks before parturition and eight weeks postpartum. Group 2 was managed during the same time period (16 weeks). Diet 1 consisted of ad libitum hay, which was fed to group 1 during late pregnancy and to group 2 from weeks 1-8. Diet 2 consisted of the same ad libitum hay supplemented with 2 kg/head/day of concentrate, which was fed to group 1 during lactation and to group 2 from weeks 9-16. The daily dry matter intake (diet 1) was 2.56 kg/100 kg of body weight (BW) for nonpregnant jennies and 31% lower in the pregnant donkeys. In the lactating jennies, the total dry matter intake was similar to the nonpregnant group fed diet 2. The nonpregnant jennies lost 1.9% of their initial BW when fed diet 1, whereas they gained 8.4% of their initial BW when fed with diet 2. A weight loss was also found in the lactating donkeys. The foals more than doubled in their birth weight within two months.

Can concurrent lower gastrointestinal manifestations help the timely diagnosis of small intestinal bacterial overgrowth in CVID patients?

Summary

Introduction and objective. Gastrointestinal complications are considered as one of the most common manifestations in patients with Common Variable Immunodeficiency (CVID). These complications can result from Small Intestinal Bacterial Overgrowth (SIBO). Hydrogen breath test is extensively used to diagnose SIBO. The objective of this study was to evaluate the prevalence of SIBO using the Hydrogen Breath Test (HBT) in patients with CVID. Materials and methods. Twenty-seven patients with CVID entered this cross-sectional study. Demographic and lower gastrointestinal symptoms were recorded in a check list. Hemoglobin level was measured in all patients. The concentration of IgA and IgG was assessed using nephelometry. Moreover, SIBO was detected by means of Glucose hydrogen breath test. Results. The mean (plus-minus SD) age of the patients was 35.25 (plus-minus 11.69) years. Twenty patients (74.1%) manifested at least one lower gastrointestinal symptom. The most frequent lower gastrointestinal manifestations were bloating (66.7%) and chronic diarrhea (40.7%), respectively. IgA level less than 10 mg/dl and IgG level less than 600 mg/dl were determined in 77.8% and 25.9% of patients, respectively. Positive HBT was detected in 40.7% (n = 11) of the patients. In the positive HBT group, bloating, chronic diarrhea and abdominal pain were the most common lower GI manifestations. There was no significant difference in terms of age, BMI, IgA level, and duration of CVID between the positive and negative HBT groups. The significant association of co-occurrence of anemia and abdominal pain with positive HBT (positive predictive value: 100%) might be considered as a clue to SIBO diagnosis. Conclusions. Regarding the high prevalence and non-specific manifestation of SIBO, it is suggested to consider concurrent symptoms in patients with CVID to manage the timely and precise diagnosis of SIBO.

Donkey's Milk in the Management of Children with Cow's Milk protein allergy: nutritional and hygienic aspects

Background

The therapeutic strategy for children with cow’s milk allergy (CMA) consists in the elimination of cow’s milk (CM) from their diet. Donkey’s milk (DM) has been reported to be an adequate alternative, mainly to his nutritional similarities with human milk (HM) and excellent palatability. The aim of present prospective study was to evaluate the nutritional impact of DM on the diet of children with CMA in term of children growth.

Methods

Before the nutritional trial on children and during the study the health and hygiene risks and nutritional and nutraceuticals parameters of DM were monitored. Children with CMA were identified by the execution of in vivo and in vitro tests for CM and subsequent assessment of tolerability of DM with oral food challenge (OFC). Finally, we prescribed DM to a selected group of patients for a period of 6 months during which we monitored the growth of children. A total of 81 children, 70 with IgE mediated cow’s milk protein allergy (IgE-CMPA) and 11 with Food Protein Induced Enterocolitis Syndrome to CM (CM-FPIES), were enrolled.

Results

Seventy-eight out of 81 patients underwent the OFC with DM and only one patient with IgE-CMPA (1.5 %) reacted. Twenty-two out of 81 patients took part of the nutritional trial. All the 22 patients took and tolerated the DM, moreover DM did not change the normal growth rate of infants.

Conclusions

In conclusion, DM resulted safe in term of health and hygiene risks and nutritionally adequate: no negative impact on the normal growth rate of children was assessed. Therefore, it may be a suitable alternative for the management of IgE mediated CMA and FPIES, also in the first 6 months of life, if adequately supplemented.

New simplified protocols for timed artificial insemination (TAI) in milk-producing donkeys

This study compared the outcome of two new timed artificial insemination (TAI) protocols in a milk-producing donkey farm. Ninety Amiata jennies were inseminated at the moment of ovulation induction with hCG, with fresh-transported semen that had been stored at room temperature from 3 up to 6 h, with an approximate average storage time of 4 h and a half. In both protocols, on Day 0 jennies were treated with alfaprostol (PGF2α), and on Day 7 they were checked by ultrasound (US) and, if in estrus, they were treated in order to induce ovulation and were then artificially inseminated. In the slow-short TAI protocol, jennies not already inseminated were treated again with PGF2α at Day 14. On day 21 US was repeated and estrus jennies were induced to ovulate and inseminated. In the fast-long TAI protocol, US was performed once a week in jennies not already inseminated and if found in estrus, they were induced to ovulate and inseminated, while those not in estrus were treated again with PGF2α. This protocol was repeated for up to nine weeks. The rates of inseminated/treated, pregnant/inseminated and pregnant/treated jennies were 76%, 56% and 43% for the slow-short TAI protocol and 94%, 47% and 44% for the fast-long TAI protocol. The age class and the lactation status of the jennies had no significant effect on synchronization success or final pregnancy rate. This study demonstrates that it is possible to achieve reasonable pregnancy rates through simplified TAI protocols in jennies, reducing animal handling to a minimum.

In Vitro Anthelmintic Activity of Saponins Derived from Medicago spp. Plants against Donkey Gastrointestinal Nematodes

With the aim to find new effective natural compounds for the control of nematodes, the in vitro anthelminthic properties of purified 1% saponins showing different chemical compositions and derived from Medicago sativa (MS), Medicago arborea (MA), Medicago polymorpha cultivar ‘Santiago’ (MPS), M. polymorpha cultivar ‘Anglona’ (MPA), and 1% prosapogenins from M. sativa (MSp), were evaluated and compared. As a source of nematode eggs, pooled fresh fecal samples taken from dairy donkeys naturally infected by gastrointestinal nematodes were used. From fecal samples, eggs were recovered, suspended in deionized water, and used immediately in the bioassay (egg hatch test). The activity of the tested compounds was compared to positive (0.1% thiabendazole) and negative (deionized water and 1% DMSO) controls. All experiments were repeated in triplicate and the obtained data were statistically analyzed. All the tested plant compounds caused a significant (p < 0.05) inhibition of nematode egg hatching (>80%). Moreover, all saponins and prosapogenins showed in vitro anthelmintic properties statistically comparable to that of the reference drug (p < 0.05), except for MPS extract. Obtained results showed that the different Medicago saponins evaluated in this study possess high anthelmintic properties against gastrointestinal nematodes of dairy donkeys, although to a different extent depending on their composition.

Short communication: Technological and seasonal variations of vitamin D and other nutritional components in donkey milk

Vitamin D is an essential nutrient that plays a crucial role in calcium homeostasis and bone metabolism and also acts as a hormone. Although several studies on the content of vitamin D in bovine milk have been conducted, little information is available regarding donkey milk. In the context of the nutritional assessment of donkey milk, the aim of this study was to assess the vitamin D content in donkey milk and its chemical profile, with particular reference to seasonal and technological modifications after pasteurization. The study was conducted on a dairy farm that produces donkey milk for human consumption located in central Italy. At sampling time, an aliquot of total bulk milk production was sampled before and after pasteurization (63°C for 30 min without homogenization) with a total of 20 raw and 20 pasteurized milk samples. The samples were collected for 10 mo, every 15 d, from May to February 2017. All the samples were analyzed for the chemical composition and vitamin D₂ and D₃ content by HPLC after saponification. The donkey milk analyzed showed a higher average vitamin D content (raw milk: vitamin D₂ = 1.68, vitamin D₃ = 0.60 μg/100 mL; pasteurized milk: vitamin D₂ = 1.38, vitamin D₃ = 0.30 μg/100 mL) than reported for bovine and human milk. The results of the effect of pasteurization on milk did not highlight significant differences in the total content of vitamin D. However, vitamin D₃ has a poor thermal stability, which led to a significant reduction in content in pasteurized milk compared with raw milk. The total vitamin D content of donkey milk did not show significant variations between seasons; however, a higher concentration of vitamin D₃ was found in spring and summer. In conclusion, raw and pasteurized donkey milk showed a high content of vitamin D, which could be useful in meeting the deficiencies of this vitamin in humans. Further investigations are needed to improve the vitamin D content in donkey milk by increasing its endogenous synthesis or its transfer in milk and to clarify other variability factors.

Patient satisfaction with occlusal scheme of conventional complete dentures: A randomised clinical trial (Part II)

The occlusion of choice is a controversial topic in conventional complete denture (CCD) treatment. This study aimed to compare patient satisfaction with CCD with partially group-function occlusion (PGFO), fully bilateral balanced occlusion (FBBO), buccalised occlusion (BO), lingualised occlusion (LO) and the entire balanced group. Participants received new CCDs with PGFO. All steps of patient enrolment, denture fabrication, assessments during the follow-up period and data collection were carried out exactly the same as part 1 of this research project. All patients were recalled at 1 and 3 months after delivery for data collection using the shortened version of oral health impact profile for edentulous patients (OHIP-EDENT) questionnaire and 7 visual analog scales (VASs) for the quality of CCD based on general patient satisfaction, masticatory function, ability to speak, comfort, stability, retention and aesthetics. Data were analysed using the Wilcoxon signed-rank test, the Kruskal-Wallis test and Mann-Whitney test via SPSS version 18.0 (α = 0.05). Thirty participants completed the follow-up period for PGFO group. The mean age ± standard deviation of the new participants was 57.97 ± 6.93 years. Participants reported significantly less satisfaction in terms of comfort, stability and retention of denture with PGFO compared to balanced groups. Also, using OHIP-EDENT questionnaire, significantly higher physical pain score was noted for PGFO group compared to BO and LO. Higher physical disability score was noted in PGFO compared to LO. Participants receiving CCDs with PGFO reported lower satisfaction in terms of comfort, stability and retention of denture and higher physical pain and physical disability than the balanced occlusal schemes.

Amiata Donkey Milk Chain: Animal Health Evaluation and Milk Quality

This study presents an investigation of Amiata donkey health and quality of milk for human consumption. Thirty-one lactating dairy jennies were examined. The following samples were collected: faecal samples from the rectum of animals for parasitological examination; cervical swabs for the detection of bacteria causing reproductive disorders; and blood samples for serological diagnosis of main zoonotic (Brucella spp., Leptospira spp.) and donkey abortion agents (Brucella spp., Leptospira spp., Salmonella abortus equi, Equine viral arterithis virus, Equine herpesvirus type 1). In addition, individual milk samples were collected and analysed for mastitis-causing pathogens and milk quality. Regarding animal health, we detected a high prevalence of strongyle parasites in donkeys. It is very important to tackle parasitic diseases correctly. Selective control programmes are preferable in order to reduce anthelmintic drug use. For dairy donkeys, withdrawal periods from anthelmintic drugs need to be carefully managed, in accordance with EU and national regulations. The isolation of Staphylococcus aureus in milk highlights the importance of preventing contamination during milking, by adopting appropriate hygiene and safety practices at a farm level. Lysozyme activity was high compared to cow’s milk, contributing to the inhibitory activity against certain bacteria. Donkey milk was characterised by high lactose content, low caseins, low fat, higher levels of unsaturated fatty acids compared to ruminant milks. Unsaturated fatty acids and omega 3 fatty acids in particular have become known for their beneficial health effect, which is favourable for human diet. These characteristics make it suitable for infants and children affected by food intolerance/allergies to bovine milk proteins and multiple food allergies as well as for adults with dyslipidemias. It is also recommended to prevent cardiovascular diseases.

Short communication: Monitoring nutritional quality of Amiata donkey milk: effects of lactation and productive season

Milk nutritional characteristics are especially interesting when donkey milk is aimed at consumption by children and the elderly. The aim of this study was to monitor the nutritional quality of Amiata donkey milk during lactation and productive season to provide information on the milk characteristics and to study action plans to improve milk yield and quality. Thirty-one pluriparous jennies belonging to the same farm were selected. Individual samples of milk from the morning milking were taken once per month starting from the d 30 of lactation until d 300. Milk yield and dry matter, fat, and ash content were constant throughout the experimental period. Milk total protein content showed a progressive decrease during the first 6 mo of lactation; after this period, the protein percentages remained constant (1.50%). Caseins and lactose were lower until d 60 of lactation and remained constant thereafter. During summer and autumn, milk yield and casein and lactose contents were higher, whereas during the spring season, higher protein and ash contents were found. The percentages of fat and dry matter were stable as were most of the minerals in the milk, except for calcium, which was higher in the spring. In conclusion, Amiata donkey milk was found to be relatively stable during lactation. This is an advantage in terms of the production and trade of a food product with consistent characteristics. The different milk yield and quality during the productive seasons were probably related to better adaptability of the animals to warm and temperate periods.

Detection and genotyping of Toxoplasma gondii DNA in the blood and milk of naturally infected donkeys (Equus asinus)

Background

Toxoplasma gondii is a worldwide zoonotic protozoan. Consumption of raw milk from infected animals is considered a risk factor for acquiring toxoplasmosis in humans. Recently, donkey milk has been indicated for therapeutic and nutritional purposes and T. gondii infection is common in donkeys. The purpose of the present paper was to detect the presence of parasite DNA in milk of T. gondii positive donkeys.

Findings

Antibodies to T. gondii were found in 11 out of 44 healthy lactating donkeys by IFAT. T. gondii DNA was detected by PCR in blood of 6 and milk of 3 seropositive jennies. Results of limited RFLP-PCR genotyping indicated the presence of T. gondii genotype II or III, commonly found in Europe.

Conclusions

The occurrence of T. gondii DNA in milk suggests that the consumption of raw milk from seropositive donkeys could be a potential source of human infection.