Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Actividad molusquicida del Paraiso (Melia azedarach L.) (Meliaceae) sobre Lymnaea cubensis, molusco vector de Fasciolosis Molluscicidal activity of Paraiso (Melia azedarach L.) (Meliaceae) on Lymnaea cubensis, host snail of Fasciolosis

INTRODUCCIÓN: La Fasciolosis constituye en diversas regiones una fuente importante de pérdidas económicas y cuando se descuidan las medidas de control de sus hospedadores (moluscos), junto a condiciones ecológicas favorables, pueden ocurrir casos aislados de Fasciolosis humana. Dentro de los métodos alternativos para su control está el uso de extractos vegetales y se pretendió evaluar el probable empleo del jugo extraído del fruto y semillas del Paraiso (Melia azedarach L.) en el control de Lymnaea cubensis, principal vector de la Fasciolosis en Cuba. MATERIAL Y MÉTODO: Diferentes concentraciones del jugo extraído del fruto y semillas del Paraiso (Melia azedarach L.) fueron testados para determinar las dosis letales media (DL50) y máxima (DL90) usando un programa computarizado Probit-Log. Siete series experimentales fueron probadas usando 72 moluscos en cada una. Para determinar la influencia sobre la frecuencia cardíaca fueron testados tres grupos de 10 moluscos, dos fueron tratados con las DL50=0,88627 y DL90=1,7641, respectivamente, mientras que el tercero fue considerado como testigo. RESULTADOS Y CONCLUSIONES: Se observó una marcada influencia de ambas dosis sobre la frecuencia cardíaca del molusco estudiado. Estos resultados son alentadores, pues demuestran el potencial empleo de esta planta en el control de moluscos indeseables.<br>INTRODUÇÃO: A Fasciolosis constitui em diversas regiões fonte importante de perdas econômicas, e quando não se adotam medidas de controle de seus hospedeiros (moluscos), junto a condições ecológicas favoráveis, pode ocorrer o aparecimento de casos isolados de Fasciolosis humana. Dentro dos métodos alternativos para o seu controle está o uso de extratos vegetais e se tem pretendido avaliar o provável emprego do suco extraído do fruto e sementes do Paraíso (Melia azedarach L.), no controle de Lymnaea cubensis, principal vetor da Fasciolosis em Cuba. MATERIAL E MÉTODO: Diferentes concentrações do suco extraído do fruto e semente do Paraiso (Melia azedarach L.) foram testadas para determinar as doses médias letais (DL50) e máxima (DL90) usando um programa computadorizado PROBIT-LOG. Sete séries experimentais foram realizadas , usando 72 moluscos em cada uma. Para determinar a influência sobre a freqûência cardíaca foram testados três grupos de 10 moluscos, dois foram tratados com as CL50= 0,88627 e CL90= 1,7641, respectivamente, enquanto que o terceiro foi considerado como controle. RESULTADOS E CONCLUSÕES: Observou-se uma marcada influência de ambas as doses sobre a freqüência cardíaca do molusco estudado. Os resultados foram alentadores, pois demonstraram um potencial uso dessa planta no controle de moluscos não desejados.<br>INTRODUCTION: Fasciolosis is a source of serious economic loss in various regions of Brazil and when control measures of its host (molluscs) are not taken under favorable ecological conditions, isolated cases of human Fasciolosis may occur. Among the alternative measures for its control is the use of vegetable extracts and the purpose of this project is the assessment of the use of juice extracted from the fruit and seeds of the Paraiso plant (Melia azedarach L.) in the control of Lymnaea cubensis, the main vector of Fasciolosis in Cuba. MATERIAL AND METHOD: Various concentrations of the juice extracted from the Paraiso fruit (Melia azedarach L.) were tested to determine the average and maximum lethal doses (DL50 and DL90, respectively) used in a computerized PROBIT-LOG program. Seven experimental series were undertaken, 72 molluscs being used in each of them. Three groups of ten molluscs were tested to determine the effect on cardiac frequency, two of them being treated with CL50=0.88627 and CL90=1.7641, respectively, the third being used as control. RESULTS AND CONCLUSIONS: A considerable effect of both doses on the cardiac frequency of the mollusc studied was observed. The results were encouraging, for they demonstrated the potential use of this plant in the control of undesirable molluscs

A meta-analysis and real-world cohort study on the sex-related differences in efficacy and safety of immunotherapy for hepatocellular carcinoma

Background & Aims: Sex-related differences in the immune pathogenesis of hepatocellular carcinoma (HCC), particularly related to oestrogen-dependent secretion of pro-tumourigenic cytokines, are well-known. Whether sex influences the efficacy and safety of immunotherapy is not known. Methods: We performed a restricted maximum likelihood random effects meta-analysis of five phase III trials that evaluated immune checkpoint inhibitors (ICIs) in advanced HCC and reported overall survival (OS) hazard ratios (HRs) stratified by sex to evaluate sex-related differences in OS. In a real-world cohort of 840 patients with HCC from 22 centres included between 2018 and 2023, we directly compared the efficacy and safety of atezolizumab + bevacizumab (A+B) between sexes. Radiological response was reported according to RECIST v1.1. Uni- and multivariable Cox regression analyses were performed for OS and progression-free survival (PFS). Results: In the meta-analysis, immunotherapy was associated with a significant OS benefit only in male (pooled HR 0.79; 95% CI 0.73–0.86) but not in female (pooled HR 0.85; 95% CI 0.70–1.03) patients with HCC. When directly comparing model estimates, no differences in the treatment effect between sexes were observed. Among 840 patients, 677 (81%) were male (mean age 66 ± 11 years), and 163 (19%) were female (mean age 67 ± 12 years). Type and severity of adverse events were similar between the two groups. OS and PFS were comparable between males and females upon uni- and multivariable analyses (aHR for OS and PFS: 0.79, 95% CI 0.59–1.04; 1.02, 95% CI 0.80–1.30, respectively). Objective response rates (24%/22%) and disease control rates (59%/59%) were also similar between sexes. Conclusion: Female phase III trial participants experienced smaller OS benefit following ICI therapy for advanced HCC, while outcomes following A+B treatment were comparable between sexes in a large real-world database. Based on the ambiguous sex-related differences in survival observed here, further investigation of sex-specific clinical and biologic determinants of responsiveness and survival following ICIs are warranted. Impact and implications: While immune checkpoint inhibitors have emerged as standard of care for the treatment of hepatocellular carcinoma, there are conflicting reports on whether the efficacy of cancer immunotherapy differs between females and males. Our study suggests ambiguous sex-related differences in outcomes from immunotherapy in hepatocellular carcinoma. Further investigation of sex-specific clustering in clinicopathologic and immunologic determinants of responsiveness to immune checkpoint inhibitor therapy should be prioritised. Systematic review registration: PROSPERO CRD42023429625