Differences in the acquired resistance of dogs, hamsters, and guinea pigs to repeated infestations with adult ticks Rhipicephalus sanguineus (Acari: Ixodidae)

Grupos experimentais de cães, hamsters e cobaias sem contato anterior com carrapatos, sofreram três infestações consecutivas por carrapatos Rhipicephalus sanguineus adultos e a resistência adquirida comparada com base na variação de alguns dos parâmetros biológicos da fêmea do carrapato. Os resultados mostraram que hamsters e cobaias principalmente, desenvolvem uma reação imune muito eficiente a esta espécie de carrapato como demonstrado por uma queda altamente significativa na taxa de eficiência da fêmea em converter sua reserva alimentar em ovos e larvas da primeira para as segunda e terceira infestações. Já cães foram incapazes de desenvolver tal resistência. Neste hospedeiro a performance das fêmeas dos carrapatos foi similar durante todas as infestações, havendo até uma tendência de melhora com a sucessão das infestações. Estes resultados reforçam a necessidade de estudos comparativos sobre a resistência adquirida a carrapatos, envolvendo hospedeiros naturais e não naturais, como forma de colocar em evidência mecanismos de defesa que possam estar alterados ou ocultos em relações parasita-hospedeiro naturais.Tick-bite naive experimental groups of dogs, hamsters and guinea pigs were infested three times with adult ticks Rhipicephalus sanguineus and the acquired resistance, based on the variation of some biological parameters of the female tick was compared. The results showed that hamsters and mainly guinea pigs develop a very efficient immunity to this tick species as demonstrated by a very significant drop in the efficiency rate of female ticks in converting their food reservoir to eggs and larvae from the first to the second and third infestations. At the same time, dogs were unable to display such a resistance. Female tick performance was similar throughout the infestations in this host; there was even a tendency of improvement of the performance with the succession of infestations. These results underline the need of comparative studies on the acquired resistance to ticks involving natural and unnatural hosts as a way of putting in evidence defence mechanisms which might be altered or hidden in natural host - parasite relationships

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

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