The Impact of COVID-19 Pandemic on Neurogastroenterologists in Latin America: Results of an Online Survey

Q2Background: The COVID-19 pandemic has affected medical practice in fields not related to the infection. Neurogastroenterology is a subspecialty of gastroenterology focused on motility and functional gastrointestinal disorders, including consultations, and conducting procedures (eg, endoscopies, manometries/pH-monitoring). Aim: The aim of this study was to determine the impact of COVID-19 on Neurogastroenterology in Latin America. Methods: Members of the Latin American Society of Neurogastroenterology were invited by e-mail and social networks to participate in an online anonymous survey. It included 24 questions on demographics, clinical practice and procedure characteristics, impact of the pandemic, Telemedicine, and involvement in COVID-19 patient care. Results: Sixty-one members mainly from Colombia, Mexico, and Brazil answered the survey. All reported a negative impact on their practice (88.6%: a 61% to 100% decrease), mainly in office consultations and elective endoscopies. Interestingly, emergency endoscopies decreased by 33.3%, while only 4% stopped performing manometries/pH-monitoring. The main reasons were patients’ fear for consulting, country’s lockdown, and physician’s decision to prevent infection spread. Telemedicine was implemented by 83% but only 64.7% were being remunerated. Almost 46% had to reduce salaries and working hours of their personnel. Fifty-nine percent had colleagues diagnosed with COVID-19, 24.6% were involved in these patients’ care, and 11.5% were mobilized to COVID-19 wards. There were country differences: Colombia, lockdown (P=0.001); Mexico, COVID-19 patient-care (P=0.053); Mexico/Colombia, working in COVID-19 wards, (P= 0.012); Brazil, less common elective procedures’ ban (P=0.012) and Telemedicine/reimbursement (P=0.034). Conclusions: The COVID-19 pandemic has negatively impacted the practice and wellness of Neurogastroenterologists in Latin America. Guidelines to resume activities and policies for Telemedicine practice and reimbursement are warrantedhttps://orcid.org/0000-0002-9219-4548Revista Internacional - IndexadaS

Leishmania major-Infected Phlebotomus duboscqi Sand Fly Bites Enhance Mast Cell Degranulation

Leishmania parasites infect mammalian hosts through the bites of sand fly vectors. The response by mast cells (MC) to the parasite and vector-derived factors, delivered by sand fly bites, has not been characterized. We analyzed MC numbers and their mediators in BALB/c mice naturally infected in the ear with Leishmania major through the bite of the sand fly vector Phlebotomus duboscqi and compared them to non-infected sand fly bites. MC were found at the bite sites of infective and non-infected sand flies throughout 48 h, showing the release of granules with intense TNF-α, histamine, and tryptase staining. At 30 min and 48 h, the MC numbers were significantly higher (p < 0.001) in infected as compared to non-infected bites or controls. Neutrophil recruitment was intense during the first 6 h in the skin of infected and non-infected sand fly bites and decreased thereafter. An influx of neutrophils also occurred in lymph nodes, where a strong TNF-α stain was observed in mononuclear cells. Our data show that MC orchestrate an early inflammatory response after infected and non-infected sand fly bites, leading to neutrophilic recruitment, which potentially provides a safe passage for the parasite within the mammalian host

Differential expression of pathogenic genes of <i>Entamoeba histolytica</i> vs <i>E</i>. <i>dispar</i> in a model of infection using human liver tissue explants

<div><p>We sought to establish an <i>ex vivo</i> model for examining the interaction of <i>E</i>. <i>histolytica</i> with human tissue, using precision-cut liver slices (PCLS) from donated organs. <i>E</i>. <i>histolytica-</i> or <i>E</i>. <i>dispar</i>-infected PCLS were analyzed at different post-infection times (0, 1, 3, 24 and 48 h) to evaluate the relation between tissue damage and the expression of genes associated with three factors: a) parasite survival (peroxiredoxin, superoxide dismutase and 70 kDa heat shock protein), b) parasite virulence (<i>EhGal/GalNAc lectin</i>, amoebapore, cysteine proteases and calreticulin), and c) the host inflammatory response (various cytokines). Unlike <i>E</i>. <i>dispar</i> (non-pathogenic), <i>E</i>. <i>histolytica</i> produced some damage to the structure of hepatic parenchyma. Overall, greater expression of virulence genes existed in <i>E</i>. <i>histolytica</i>-infected versus <i>E</i>. <i>dispar</i>-infected tissue. Accordingly, there was an increased expression of <i>EhGal/GalNAc lectin</i>, <i>Ehap-a</i> and <i>Ehcp-5</i>, <i>Ehcp-2</i>, <i>ehcp-1</i> genes with <i>E</i>. <i>histolytica</i>, and a decreased or lack of expression of <i>Ehcp-2</i>, <i>and Ehap-a</i> genes with <i>E</i>. <i>dispar</i>. <i>E</i>. <i>histolytica</i>-infected tissue also exhibited an elevated expression of genes linked to survival, principally peroxiredoxin, superoxide dismutase and <i>Ehhsp-70</i>. Moreover, <i>E</i>. <i>histolytica</i>-infected tissue showed an overexpression of some genes encoding for pro-inflammatory interleukins (ILs), such as il-8, ifn-γ and tnf-α. Contrarily, <i>E</i>. <i>dispar</i>-infected tissue displayed higher levels of il-10, the gene for the corresponding anti-inflammatory cytokine. Additionally, other genes were investigated that are important in the host-parasite relationship, including those encoding for the 20 kDa heat shock protein (HSP-20), the AIG-1 protein, and immune dominant variable surface antigen, as well as for proteins apparently involved in mechanisms for the protection of the trophozoites in different environments (e.g., thioredoxin-reductase, oxido-reductase, and 9 hypothetical proteins). Some of the hypothetical proteins evidenced interesting overexpression rates, however we should wait to their characterization. This finding suggest that the present model could be advantageous for exploring the complex interaction between trophozoites and hepatocytes during the development of ALA, particularly in the initial stages of infection.</p></div

Summary of characteristics for donors of human livers.

<p>Summary of characteristics for donors of human livers.</p

Relative quantification of genes <i>E</i>. <i>histolytica</i> or <i>E</i>. <i>dispar</i> associated with pathogenicity and parasite survival.

<p>Relative quantification of genes <i>E</i>. <i>histolytica</i> or <i>E</i>. <i>dispar</i> associated with pathogenicity and parasite survival.</p

Primers and their sequences used in this study.

<p>Primers and their sequences used in this study.</p

Expression levels of genes linked to mechanisms of pathogenesis in the <i>ex vivo</i> infection model, selected by bibliographic revision.

<p>Expression levels of genes linked to mechanisms of pathogenesis in the <i>ex vivo</i> infection model, selected by bibliographic revision.</p