PREVALENCIA Y FACTORES DE RIESGO ASOCIADOS CON LA INFECCIÓN DE TOXOCARA CANIS Y ANCYLOSTOMA CANINUM EN CANES DE COMPAÑÍA

El presente trabajo tuvo como objetivo determinar la prevalencia y factores de riesgo de infección de Toxocara canis y Ancylostoma caninum en canes de compañía en Santa Clara, Cuba. Se tomaron muestras de heces frescas de 108 canes de compañía y se encuestaron a sus dueños. La prevalencia de infestación por T. canis en los Consejos Populares urbano y rural, fueron del 9% y el 40% respectivamente, existiendo diferencias significativas entre ellos. La prevalencia de A. caninum en los consejos populares urbano y rural fueron 39% y 42%, respectivamente. No se encontró asociación entre la variable prevalencia de infestación de ambos nemátodos y los factores genéticos: edad, raza y sexo, así como con las condiciones de tenencias y nivel cultural del propietario, y región geográfica de los canes de compañía. Solamente una asociación significativa fue encontrada entre la prevalencia de infestación por T. canis y la región geográfica de los canes de compañía

COMPORTAMIENTO EPIDEMIOLÓGICO DE LA LEPTOSPIROSIS HUMANA Y ANIMAL EN LA PROVINCIA DE VILLA CLARA, CUBA

El presente trabajo tuvo como objetivo determinar el comportamiento epidemiológico de la Leptospirosis humana y animal en la provincia de Villa Clara, Cuba. Se tomaron datos retrospectivos mensuales de casos confirmados y muertes por leptospirosis humana y animal por un período de 11 años y 7 años, respectivamente. Se constató que la infección por Leptospira en la población humana y animal tiende a la disminución. Los brotes epidémicos de Leptospirosis humana y animal fueron más frecuentes en los meses lluviosos. El sexo masculino, el color de piel blanca y el residir en zonas rurales mostró un mayor riesgo de infección para la población humana con razones de prevalencias de 2,54 (IC [Intervalo de confianza]: 1,55-4,16), 4,75 (IC: 2,28 – 9,86) y 2,15 (IC: 1,19-3,91), respectivamente. El 99% (242/245) de los casos de Leptopirosis animal se presentó en la especie canina. La Leptospirosis humana y animal en la provincia de Villa Clara es endémica, tiende a la disminución y posee una presentación cíclica estacional con brotes epidémicos en los meses de verano y otoño, y períodos inter-epidémicos bianuales. Constituyen factores de riesgos asociados a la infección humana el sexo (masculino), el color de la piel (blanca) y la zona de residencia (rural). La Leptospirosis canina tiene características similares a Leptospirosis humana por lo que pudiera servir como un modelo de estudio

COMPORTAMIENTO EPIDEMIOLÓGICO DE LA FASCIOLOSIS EN LA PROVINCIA DE VILLA CLARA, CUBA

El presente trabajo tuvo como objetivo determinar el comportamiento epidemiológico de la fasciolosis humana y animal en la provincia de Villa Clara, Cuba. Se tomaron datos retrospectivos mensuales de casos confirmados y muertes por fasciolosis humana y animal por un período de 7 años. Se constató que solo se ha presentado un brote epidémico de fasciolosis humana de 2004 – 2008 en la provincia y fue debido al consumo de berro en el seno de una familia rural del municipio Santa Clara, Cuba. El sexo y la edad no estuvieron asociados a la presentación de fasciolosis humana con valores de riesgos relativos de 1,04 (IC: 0,26 – 4,14) y 1,08 (IC: 0,22 – 5,29), respectivamente. Como consecuencia de la fasciolosis animal mueren anualmente en la provincia más de 500 animales fundamentalmente bovinos y ovinos, se decomisan un promedio de 15 mil hígados en la especie bovina y se pierde económicamente 1.623.031 pesos por concepto de decomisos de hígados. La fasciolosis humana en Villa Clara se presenta en forma de brotes epidémicos esporádicos, y parece estar más vinculada a factores ecológicos que a la prevalencia de la enfermedad en la población animal y factores genéticos del huésped. La fasciolosis animal es hiperendémica, causa pérdidas económicas millonarias anualmente en la industria ganadera, y constituye una enfermedad olvidada

Seroepidemiology of Toxoplasma gondii in extensively raised Iberian pigs in Spain

Pigs reared under extensive farming conditions are currently in high commercial demand because they are associated with high-quality products. Nevertheless, the risk of contact with different pathogens of animal and public health concern is also higher in extensive production systems. Toxoplasma gondii is a widely prevalent zoonotic pathogen and transmission by contaminated pork is likely one of the main routes of human toxoplasmosis. The aim of this study was to determine the seroprevalence, risk factors and spatial distribution of T. gondii on extensive Iberian pig herds in Spain. Sera from 2245 Iberian pigs from 114 herds were collected between 2015 and 2017 and analyzed using a commercial ELISA. The apparent individual prevalence of antibodies against T. gondii was 24.1 % (542/2245) and the estimated true seroprevalence was 24.3 % (CI95 %: 22.5–26.1). Seropositivity was detected in 86.0 % (98/114; CI95 %: 77.4–91.1) of 114 herds analyzed. A multi-level logistic regression model showed that T. gondii infection was significantly more frequent in sows than in fattening pigs (OR: 2.6; CI95 %: 1.5–4.8) and in herds with more than three cats compared to no cats (OR: 2.9; CI95 %: 1.1–8.7). Our results indicate a widespread but heterogenous distribution of T. gondii in extensively reared Iberian pig herds, which may have important implications for public health through the consumption of undercooked or improperly cured pork products.The present work was partially funded by the Spanish Ministry of Economy and Competitiveness (MINECO) research grant Ref. AGL2013-49159-C2-2-R and by the Regional Ministry of Economy and Infrastructure of the Board of Extremadura research grant Ref. TB-PORCEX. We would like to thank the Asociación Universitaria Iberoamericana de Postgrado (AUIP, in Spanish) for helping fund the doctoral training of J.C. Castillo-Cuenca. S. Jiménez-Ruiz holds a PhD contract from the UCLM co-supported by the European Social Fund (2018/12504).Peer reviewe

Seroepidemiología de Toxoplasma gondii en cerdos ibéricos en España

Póster presentado virtualmente el 24 de noviembre de 2021 al Simposio Internacional sobre Desarrollo Agropecuario Sostenible Agrocentro.[ES]: Actualmente, los cerdos criados bajo prácticas ganaderas extensivas tienen una alta demanda comercial ya que están asociados a productos de alta calidad. Sin embargo, el riesgo de contacto con diferentes patógenos de preocupación para la salud pública y animal también es mayor en estos sistemas de producción extensivos. Toxoplasma gondii es un patógeno zoonótico ampliamente prevalente y la transmisión por cerdo contaminado es una de las principales fuentes de toxoplasmosis humana. El objetivo de este estudio fue determinar la seroprevalencia, factores de riesgo y distribución espacial de T. gondii en granjas extensivas de porcino ibérico en España. Se recogieron sueros de 2.245 cerdos ibéricos de 114 granjas entre 2015 y 2017. La prevalencia individual estimada de anticuerpos frente a T. gondii fue del 24,1% (542 / 2.245; IC95%: 22,4% -25,9%) utilizando un ELISA comercial. Se detectó seropositividad en el 86,0% (98/114; IC95%: 77,4-91,1) de las 114 granjas analizadas. Un modelo de ecuaciones de estimación generalizada mostró que la exposición a la infección por T.gondii fue significativamente mayor en granjas con más de 50 cerdas (OR = 2.7; IC95% = 1.3-5.8) y en granjas con más de tres gatos (OR = 2.5; IC95% = 1.0-6.0). El análisis espacial identificó dos grupos estadísticamente significativos de alta seroprevalencia. Nuestros resultados indican una distribución generalizada pero heterogénea de T. gondii en cerdos ibéricos de cría extensiva, lo que puede tener importantes implicaciones para la salud pública a través del consumo de productos derivados de esta especie mal cocidos o mal curados. Se deben implementar medidas de control para reducir la exposición de los cerdos ibéricos criados bajo sistemas de manejo extensivos en España.[EN]: Currently, pigs reared under extensive farming practices have a high commercial demand since they are associated with high quality products. However, the risk of contact with different pathogens of animal and public health concern is also higher in these extensive production systems. Toxoplasma gondii is a widely prevalent zoonotic pathogen and transmission by contaminated pork is among the main sources of human toxoplasmosis. The aim of this study was to determine the seroprevalence, risk factors and spatial distribution of T. gondii on extensive Iberian pig farms in Spain. Sera from 2,245 Iberian pigs from 114 farms were collected between 2015 and 2017. The estimated individual prevalence of antibodies against T. gondii was 24.1% (542/2,245; CI95%: 22.4%-25.9%) using a commercial ELISA. Seropositivity was detected in 86.0% (98/114; CI95%: 77.4-91.1) of the 114 farms analyzed. A generalized estimating equations model showed that exposure to T. gondii infection was significantly higher in farms with more than 50 sows (OR = 2.7; CI95% = 1.3-5.8) and in farms with more than three cats (OR = 2.5; CI95% = 1.0-6.0). The spatial analysis identified two statistically significant clusters of high seroprevalence. Our results indicate widespread but heterogenous distribution of T. gondii in extensively reared Iberian pigs, which may have important implications for public health through the consumption of undercook or not properly cured derived products of this species. Control measures should be implemented to reduce the exposure of Iberian pigs raised under extensive management systems in Spain.Peer reviewe

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used