Diagnosis and management of complicated urogenital schistosomiasis: a systematic review of the literature

Bladder cancer; Hydronephrosis; Neglected tropical diseasesCàncer de bufeta; Hidronefrosi; Malalties tropicals desatesesCáncer de vejiga; Hidronefrosis; Enfermedades tropicales desatendidasBackground Currently, there are no standardized guidelines for the diagnosis or management of the complications of urogenital schistosomiasis (UGS). This systematic review of the literature aims to investigate the state of the art in reference to diagnostic approaches and the clinical management of this condition. Methods A systematic review of literature published between January 1990 and January 2021 was conducted in the MEDLINE database, scoping for articles regarding diagnostic means or therapeutic options for the complications of UGS, namely obstructive uropathy, bladder cancer, abortion, ectopic pregnancy, infertility, kidney failure, urolithiasis and the need for invasive procedures. Relevant data were then extracted from the articles deemed eligible according to the inclusion criteria. Main results In total, 3052 articles were identified by the research query, of which 167 articles fulfilling inclusion criteria after title/abstract screening and full-text evaluation were included, 35% on both diagnostic and therapeutic aspects, and 51% on diagnosis and 14% on therapy. Ultrasound was the most frequently tool employed for the diagnosis of UGS complications showing a good performance. Concerning the management of hydronephrosis, the majority of available evidences came from community-based studies where universal treatment with praziquantel was used leading to decrease of prevalence of obstructive uropathy. Concerning studies on surgical procedures, laser endoureterotomy followed by stenting was mostly employed in adult patients leading to a crude cure rate of 60% (43 of 71 patients). In the case of severe hydronephrosis, surgery consisting of ureteral re-implantation showed excellent results with a crude cure rate of 98% (157 cured patients of 160 treated). Concerning bladder cancer, data on 93 patients with a clear diagnosis of UGS-related bladder were available reporting a variable and sometime combined approach based on disease stage. Available data on diagnosis and management of abortion, ectopic pregnancy, infertility, kidney failure, urolithiasis and the need for invasive procedures due to UGS are also presented. Conclusions The review produced a complete picture of the diagnostic and therapeutic options currently available for complicated UGS. These results can be useful both for guiding clinicians towards correct management and for tracing the direction of future research.Open access funding provided by Università degli Studi di Firenze within the CRUI-CARE Agreement. The authors did not receive support from any organization for the submitted work

A large case series of travel-related Mansonella perstans (vector-borne filarial nematode): a TropNet study in Europe

Mansonella perstans; Travel; TreatmentMansonella perstans; Viaje; TratamientoMansonella perstans; Viatge; TractamentBackground Infection with Mansonella perstans is a neglected filariasis, widely distributed in sub-Saharan Africa, characterized by an elusive clinical picture; treatment for mansonellosis is not standardized. This retrospective study aimed to describe the clinical features, treatment schemes and evolution, of a large cohort of imported cases of M. perstans infection seen in four European centres for tropical diseases. Methods Mansonella perstans infections, diagnosed by identification of blood microfilariae in migrants, expatriates and travellers, collected between 1994 and 2018, were retrospectively analysed. Data concerning demographics, clinical history and laboratory examinations at diagnosis and at follow-up time points were retrieved. Results A total of 392 patients were included in the study. Of the 281 patients for whom information on symptoms could be retrieved, 150 (53.4%) reported symptoms, abdominal pain and itching being the most frequent. Positive serology and eosinophilia were present in 84.4% and 66.1%, respectively, of those patients for whom these data were available. Concomitant parasitic infections were reported in 23.5% of patients. Treatment, administered to 325 patients (82.9%), was extremely heterogeneous between and within centres; the most commonly used regimen was mebendazole 100 mg twice a day for 1 month. A total of 256 (65.3%) patients attended a first follow-up, median 3 months (interquartile range 2–12) after the first visit; 83.1% of patients having received treatment based on mebendazole and/or doxycycline, targeting Wolbachia, became amicrofilaremic, 41.1–78.4% of whom within 12 months from single treatment. Conclusions Lack of specific symptoms, together with the inconstant positivity of parasitological and antibody-based assays in the infected population, makes the clinical suspicion and screening for mansonellosis particularly difficult. Prospective studies evaluating prevalence of infection in migrants from endemic areas, infection-specific morbidity, presence of Wolbachia endosymbionts in M. perstans populations from different geographical areas and efficacy of treatment regimens are absolutely needed to optimize the clinical management of infection.The publication of this study was funded by Italian Ministry of Health Fondi Ricerca Corrente–L2 to IRCCS Sacro Cuore Don Calabria Hospital

Chitosan feasibility to retain retinal stem cell phenotype and slow proliferation for retinal transplantation

Retinal stem cells (RSCs) are promising in cell replacement strategies for retinal diseases. RSCs can migrate, differentiate, and integrate into retina. However, RSCs transplantation needs an adequate support; chitosan membrane (ChM) could be one, which can carry RSCs with high feasibility to support their integration into retina. RSCs were isolated, evaluated for phenotype, and subsequently grown on sterilized ChM and polystyrene surface for 8 hours, 1, 4, and 11 days for analysing cell adhesion, proliferation, viability, and phenotype. Isolated RSCs expressed GFAP, PKC, isolectin, recoverin, RPE65, PAX-6, cytokeratin 8/18, and nestin proteins. They adhered (28 ± 16%, 8 hours) and proliferated (40 ± 20 cells/field, day 1 and 244 ± 100 cells/field, day 4) significantly low on ChM. However, they maintained similar viability (>95%) and phenotype (cytokeratin 8/18, PAX6, and nestin proteins expression, day 11) on both surfaces (ChM and polystyrene). RSCs did not express alpha-SMA protein on both surfaces. RSCs express proteins belonging to epithelial, glial, and neural cells, confirming that they need further stimulus to reach a final destination of differentiation that could be provided in in vivo condition. ChM does not alternate RSCs behaviour and therefore can be used as a cell carrier so that slow proliferating RSCs can migrate and integrate into retina

Consensus document for the management of schistosomiasis in Primary Care

Esquistosomiasis; Cribado; MigrantesSchistosomiasis; Screening; MigrantsEsquistosomiasi; Cribratge; MigrantsLa esquistosomiasis humana es la enfermedad parasitaria con mayor morbimortalidad a nivel mundial después de la malaria. Es endémica en más de 78 países tropicales y subtropicales, sobre todo de África Subsahariana, estimándose que 236 millones de personas están infectadas. Puede causar graves complicaciones de salud a nivel genitourinario y hepatoesplénico, llegando a ocasionar la muerte de 300.000 personas cada año. El número de casos importados en los países occidentales se ha ido incrementado en los últimos años debido a la llegada de un importante número de migrantes procedentes de regiones endémicas y de un creciente número de viajeros que han visitado las mismas. Por otro lado, recientemente se han comunicado brotes de transmisión autóctona en Córcega (Francia) y Almería (España). Por todos estos aspectos, las autoridades sanitarias europeas han recomendado el cribado serológico de la enfermedad en todas las personas migrantes procedentes de zonas endémicas y que lleven menos de 5 años en Europa. Dado que atención primaria es habitualmente el primer punto de contacto de estas personas con el sistema sanitario, los médicos deben conocer los principales aspectos de la enfermedad, y ser dotados de los medios necesarios para su diagnóstico y tratamiento. Este documento ha sido elaborado por profesionales pertenecientes a 5 sociedades científicas de atención primaria (SEMFyC, SEMG, SEMERGEN), Pediatría (SEIP) y Medicina Tropical y Salud Internacional (SEMTSI), con objeto de establecer unas recomendaciones claras para el diagnóstico y el manejo de la esquistosomiasis en atención primaria.Human schistosomiasis is the parasitic disease with the highest morbidity and mortality worldwide after malaria. It is endemic in more than 78 tropical and subtropical countries, especially in sub-Saharan Africa, and it is estimated that 236 million people are infected. It can cause serious health complications at the genitourinary and hepatosplenic level, leading to the death of 300,000 people each year. The number of imported cases in Western countries has increased in recent years due to the arrival of a significant number of migrants from endemic regions and a growing number of travelers who have visited them. On the other hand, outbreaks of autochthonous transmission have recently been reported in Corsica (France) and Almería (Spain). For all these reasons, the European health authorities have recommended serological screening for the disease in all migrants from endemic areas who have been living in Europe for less than 5 years. Since Primary Care is usually the first point of contact for these people with the Health System, doctors must know the main aspects of the disease, and be provided with the necessary means for its diagnosis and treatment. This document has been prepared by professionals belonging to five scientific societies of Primary Care (SEMFyC, SEMG, SEMERGEN), Pediatrics (SEIP) and Tropical Medicine and International Health (SEMTSI), in order to establish clear recommendations for the diagnosis and management of schistosomiasis in Primary Care.La publicación del manuscrito cuenta con la financiación de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI)

Metal-organic framework based mixed matrix membranes: a solution for highly efficient CO2 capture?

The field of metal-organic framework based mixed matrix membranes (M(4)s) is critically reviewed, with special emphasis on their application in CO2 capture during energy generation. After introducing the most relevant parameters affecting membrane performance, we define targets in terms of selectivity and productivity based on existing literature on process design for pre- and post-combustion CO2 capture. Subsequently, the state of the art in M(4)s is reviewed against these targets. Because final application of these membranes will only be possible if thin separation layers can be produced, the latest advances in the manufacture of M-4 hollow fibers are discussed. Finally, the recent efforts in understanding the separation performance of these complex composite materials and future research directions are outlined.European Commission FP7 608490 ERC 33574

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Sonocrystallization of zeolitic imidazolate frameworks (ZIF-7, ZIF-8, ZIF-11 and ZIF-20)

Zeolitic imidazolate frameworks ZIF-7, ZIF-8, ZIF-11 and ZIF-20 have been synthesized by sonocrystallization. In general, crystals obtained at lower temperatures and shorter times are smaller and have a narrower size distribution than those achieved by conventional solvothermal synthesis. Moreover, crystallization curves have been calculated from the XRD patterns and the Gualtieri?s model has been applied to simulate the extent of crystallization as a function of time. According to the parameters calculated, for ZIF-8 the nucleation rate controls the synthesis reaction, while for ZIF-11 and ZIF-20 both growth and nucleation rates are similar.Fil: Seoane, Beatriz. Universidad de Zaragoza. Instituto de Nanociencia de Aragón; EspañaFil: Zamaro, Juan Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Investigaciones en Catálisis y Petroquímica ; ArgentinaFil: Téllez, Carlos. Universidad de Zaragoza. Instituto de Nanociencia de Aragón; EspañaFil: Coronas, Joaquin. Universidad de Zaragoza. Instituto de Nanociencia de Aragón; Españ

Insight into the crystal synthesis, activation and application of ZIF-20

The crystallization of the zeolitic imidazolate framework ZIF-20 has been tuned from the point of view of crystal size and aggregation by using rotation and seeding with a previously prepared material. In addition, the activation of ZIF-20 by solvent extraction has been found to be in correlation with the relative permittivity of the solvent. High permittivity solvents (acetone and methanol) extract more guest dimethylformamide but amorphize the structure, while those with low permittivity (n-pentane and chloroform) preserve the crystallinity of ZIF-20. The dispersion in commercial polysulfone of the small synthesized ZIF-20 particles obtained with low aggregation results in an improved O2-selective mixed matrix membrane (O2 permeability and O2/N2 selectivity being 1.0 (±0.0) Barrer and 6.7 (±0.5), respectively).Fil: Seoane, Beatriz. Universidad de Zaragoza. Instituto de Nanociencia de Aragón; EspañaFil: Zamaro, Juan Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Investigaciones en Catálisis y Petroquímica ; ArgentinaFil: Téllez, Carlos. Universidad de Zaragoza. Instituto de Nanociencia de Aragón; EspañaFil: Coronas, Joaquin. Universidad de Zaragoza. Instituto de Nanociencia de Aragón; Españ