Potential presence of microsporidia in clinical faecal specimens from the Isle of Man.

Human-related microsporidia Enterocytozoon bieneusi and Encephalitozoon spp. have emerged as opportunistic infectious agents affecting both immunocompromised and immunocompetent individuals. A pilot study to determine the potential presence of microsporidia in the general population that have attended Nobles’ Hospital in Isle of Man (UK) since January 2018 was performed. Thirty eight faecal samples submitted to the Nobles’ Hospital microbiology lab for routine testing were analysed via microscopy using the Modified Trichrome stain. Encephalitozoon spp. spores were observed in 4 samples, specifically 3 female from a range of ages (24 yr, 65yr and 89 yr old) and one male (69 yr old). These four patients were presented with diarrhoea in a semi-liquid/liquid form. Other symptoms included vomiting (89 yr old female), abdominal pain (24 yr old female), right flank pain (68 yr old male), dehydration (89 yr old female) and acute kidney injury (89 yr old female). Campylobacter spp. growth was also detected in one sample (65 yr old female). Although preliminary, our results indicate Encephalitozoon spp. were observed in faecal samples from patients in the Isle of Man presenting with diarrhoea, for which further studies will be required to determine the species and the pathogenic involvement of these pathogens in these patients. To our knowledge, this is the first study of the presence of microsporidia in human faecal samples in Isle of Man. A more comprehensive study is needed to determine the occurrence of microsporidia in patients attending with a diarrheic picture to focus attention on the need to include microsporidial diagnosis in their management

Azelastine potentiates antiasthmatic dexamethasone effect on a murine asthma model

Glucocorticoids are among the most effective drugs to treat asthma. However, thesevere adverse effects associated generate the need for its therapeutic optimization. Conversely, though histamine is undoubtedly related to asthma development, there is a lack of efficacy of antihistamines in controlling its symptoms, which prevents their clinical application. We have reported that antihistamines potentiate glucocorticoids? responses in vitro and recent observations have indicated that the coadministration of an antihistamine and a synthetic glucocorticoid has synergistic effects on a murine model of allergic rhinitis. Here, the aim of this work is to establish if this therapeutic combination could be beneficial in a murine model of asthma. We used an allergen‐induced model of asthma (employing ovalbumin) to evaluate the effectsof the synthetic glucocorticoid dexamethasone combined with the antihistamineazelastine. Our results indicate that the cotreatment with azelastine and a suboptimal dose of dexamethasone can improve allergic lung inflammation as shown by a decrease in eosinophils in bronchoalveolar lavage, fewer peribronchial and perivascular infiltrates, and mucin‐producing cells. In addition, serum levels of allergen‐specific IgE and IgG1 were also reduced, as well as the expression of lung inflammatory‐related genes IL‐4, IL‐5, Muc5AC, and Arginase I. The potentiation of dexamethasone effects by azelastine could allow to reduce the effective glucocorticoid dose needed to achieve a therapeutic effect. These findings provide first new insights into the potential benefits of glucocorticoids and antihistamines combination for the treatment of asthma and grants further research to evaluate this approach in other related inflammatory conditions.Fil: Zappia, Carlos Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Soto, Ariadna Soledad. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología. Centro de Estudios en Salud y Medio Ambiente; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Granja Galeano, Gina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Fenoy, Ignacio Martín. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología. Centro de Estudios en Salud y Medio Ambiente; ArgentinaFil: Fernandez, Natalia Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Davio, Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; ArgentinaFil: Shayo, Carina Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Fitzsimons, Carlos P.. University of Amsterdam; Países BajosFil: Goldman, Alejandra. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología. Centro de Estudios en Salud y Medio Ambiente; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Monczor, Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; Argentin

Applicability of monthly CDC case studies to improve reflection in biomedical science students.

Background Academics from De Montfort University (DMU, UK) in collaboration with other EU universities, virologists and first responders are developing training for health science students to deal with biological incidents. Initially the training is being tested with final year students enrolled on the BSc Biomedical Science (Hons) and in the BMedSci Medical Science (Hons) degree programmes in 2016/17 at DMU. To improve the limited clinical skills of these students, a series of parasitology case studies have been introduced, where students will need to reflect on their knowledge and search for information from different sources to propose possible diagnoses. Reflection is an essential learning tool for developing aspects such autonomous working, critical and analytical thinking and integration of theory with practice (Quintanilla et al., 2016). Methods A series of teaching sessions (theoretical and practical) has been created related to emergency preparedness and response (Peña-Fernández et al., 2016). Students are provided with different scenarios to develop an intervention programme to protect human health in the aftermath of a biological incident involving different biological agents including emerging parasites. During the theoretical component of the training students are provided with different slides collected from the Laboratory Identification of Parasitic Diseases of Public Health Concern (DPDx) (CDC, 2016). Students, by peer group interaction, provide a possible “diagnosis” for each clinical case based on the clinical features presented and microscopic slides provided. Critical thinking is encouraged. Results Although our results are preliminary and we need to evaluate the students’ feedback, the introduction of clinical case-studies has shown to facilitate the acquisition of some clinical skills, particularly in the biomedical science cohort. This is informed by the high level of students’ interaction during these sessions and the formulation of appropriate questions. Students have also shown some gradual improvement in the resolution of clinical case studies throughout the course. Conclusions Despite the fact that student feedback will not be collected until the end of the course, students have display strong engagement and interest in these workshops through interim module level feedback. A priori, these case-studies have been shown to be effective in facilitating the acquisition of different transversal competences including critical thinking, clinical skills, communication and team work

Exploring the presence of human pathogenic free-living amoebas in different water ecosystems in Leicester, UK.

Background: The presence and distribution of Acanthamoeba spp., Balamuthia mandrillaris and Naegleria fowleri (human pathogenic free-living amoebas, FLA) in different environmental compartments and geographical locations in Europe remains unknown. These FLA can be a public health threat as their cysts are highly resistant to harsh environmental conditions. The aim of this pilot study was to determine the presence of FLA in different water ecosystems close or in Leicester city (Leicestershire, UK) as information on the presence these emerging parasites in the UK is limited in the literature. Materials/methods: A total of 30 water samples were collected from different open water environments in Leicester during winter 2016/17 including: the River Soar and the Grand Union Canal (a canalised section of the River Soar), different lakes highly frequented for fishing or leisure (e.g. John Merricks' Lake, Kings Lears Lake; Bennion Pools Fishing Lake), and a marina near River Soar. The River Soar is rich in wildlife including water birds, fish and plant populations attracting large numbers of users. Water samples were obtained following protocol 1623 described by US EPA and concentrated using IDEXX® Filta Max system following manufacturer's instructions. DNA extraction from concentrated water was performed from each water sample with Fast DNA® Kit. A triplex real-time TaqMan PCR assay was performed to detect FLA; positive controls for the three amoebae were used. Results: All 30 samples assessed for FLA were negative. However these results should be considered as inconclusive as, although rare, several studies have reported the presence of Acanthamoeba spp. in the UK domestic water supplies which may indicate the presence of these human pathogens in other water systems including the environment. Moreover, the incidence of Acanthamoeba keratitis has increased in recent years in England. Conclusions: Further studies will be needed to determine the presence and distribution of FLA in the open water systems monitored to protect the public as recent evidence indicates an increase in infections due to these emerging human pathogens globally. This information is crucial to develop novel strategies to protect humans and increase the awareness of these protozoan parasites in aquatic environments in the UK

Building on-line materials for teaching parasitology to health sciences’ students: initial impressions.

Background: It is widely recognised that the use of web-based teaching resources is an increasingly important method for delivering education, and it will be particularly important in the near future due to the progressively increasing number of health science students and the current number of academics in the “European Higher Education Area”. The study of parasitology and infectious diseases is essential to build professionals in the health sector with the key knowledge and skills to face global public health threats such as food-, water- or vector-borne infectious diseases outbreaks. However, the current time dedicated to the teaching of this discipline in all health sciences degrees at De Montfort University (DMU, Leicester, UK) is very little or non-existent depending on the degree/master. Methods: An innovative teaching group at DMU is trying to fill this gap in the currently available teaching offer in line with new trends in global health education, the large number of students enrolled in any health degree and the increasing number of students that would like to study this discipline (but due to different commitments do not have enough time or resources to study on a full time basis). Thus, an innovative teaching group from different EU Universities (DMU and the Spanish universities: University of San Pablo CEU, University of Alcalá, and University Miguel Hernández de Elche) and clinicians (University Hospitals of Leicester, UK) have started to design, create and develop a complete on-line package in Parasitology for undergraduate and postgraduate students that study health sciences. Results: The e-Parasitology package will be accessible through the DMU website (http://parasitology.dmu.ac.uk) in 2017 and will be focused on infection, prevention and treatment of major and emerging parasitological diseases. Conclusions: This teaching resource will aid our undergraduate and postgraduate students to gain a significant knowledge in parasitology by promoting self-learning and internationalization. This poster will explore one of the first mini-modules developed so far related with Toxocara, a helminthiasis with prevalence rates that can reach as high as 40% or more in parts of the world, and the challenges for its development

Developing a novel resource for teaching and learning parasitology: DMU e-Parasitology.

Background: The study of parasitology has become essential to develop future health care professionals with skills to respond to public health threats such as the recent outbreak of Cryptosporidium in the UK. To facilitate the teaching of parasitology, which is negligible across the different undergraduate and taught masters degrees at De Montfort University (DMU, UK), a group from different EU Universities [DMU and the Spanish universities: University of San Pablo CEU (USP-CEU) and University Miguel Hernández] and clinicians are developing an on-line package for teaching and learning parasitology named DMU e-Parasitology. The development of this teaching resource will cover a gap in the traditional teaching and learning methods that are currently used and provided in the participating universities. Materials/methods: The DMU e-Parasitology resource is being created for undergraduate and postgraduate human health science students, with corresponding degrees of difficulty on the DMU website (http://parasitology.dmu.ac.uk/). To develop the theoretical section, a preliminary unit about the helminth Toxocara was initially developed to be used as a model for this section: http://parasitology.dmu.ac.uk/learn/modules/toxocara/story.html. Volunteers that studied Parasitology during the first term in 2016/17 [n=27; 6 European Credit Transfer and Accumulation System credits (ECTS); 3rd year module] from the bilingual Pharmacy and Biotechnology degree at USP-CEU provided comprehensive feedback for this preliminary unit at the beginning of the second term. The module was tested with these students because of their knowledge of parasitology. Results: Students described the initial unit as interactive and presenting the appropriate content and resources to study the parasitic disease addressed (toxocariasis). Limitations were the poor navigability in the formative exercise section and the excessive information provided in some slides that could hinder their understanding. Conclusions: The team has addressed these limitations and is using this unit as a model to build the DMU e-Parasitology, which will be accessible through the website (http://parasitology.dmu.ac.uk) in 2018. We consider that this teaching and learning resource will overcome barriers of time, space, equipment and resource. Finally, this resource could facilitate the introduction of parasitology in any health science programme with limited time for teaching this subject in their curriculums

Creating a model module for the novel resource DMU e-Parasitology.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI linkThe study of parasitology has become essential to build future health care professionals with skills to respond to public health threats such as the recent outbreaks due to Cryptosporidium spp. or Giardia in the United Kingdom (UK). To facilitate the teaching of parasitology, which negligible across the different undergraduate and taught masters degrees at De Montfort University (DMU, Leicester, UK), a group from different EU Universities [DMU and the Spanish universities: University of San Pablo CEU (USP-CEU) and University Miguel Hernández], clinicians and practising Biomedical Scientists from the UK National Health Service are developing an on-line package for teaching and learning parasitology named DMU e-Parasitology. This package will have three sections or modules: a theoretical module with mini e-learning units to study major human parasites such as Leishmania spp. or malaria; a virtual laboratory module with units to enhance the learning and study of parasitic diseases such as culture of parasites, staining and use of light microscope to identify these organisms or molecular techniques for the identification of parasites to species level; and a virtual microscope with a real slide collection of clinical samples of parasites. The e-Parasitology resource is being created for undergraduate/postgraduate human health science students, with corresponding degrees of difficulty. Units will include a tool to assess the learning process of the students, in form of a quiz, activity and/or exam, and several formative activities throughout each mini-module. The development of this teaching resource will cover a gap in the traditional teaching and learning methods that are currently used and provided in the participating Universities. The DMU e-Parasitology will aid to our undergraduate students to gain a significant knowledge in parasitology by promoting self-learning. A unit related with Toxocara, a helmintiasis with prevalence rates that can reach as high as 40% or more in different parts of the world, was firstly developed to use as a model for the development of the DMU e-Parasitology. Three undergraduate students that studied parasitology during the first term in 2016/17 [n=27; 6 European Credit Transfer and Accumulation System credits (ECTS); 3rd year module] from the bilingual Pharmacy and Biotechnology degree at USP-CEU were voluntarily recruited to provide comprehensive feedback for this model unit at the beginning of the second term. This unit was tested with these students because of their comprehensive knowledge of parasitology. Students described it as interactive and presenting the appropriate content and resources to study the parasitic disease addressed (toxocariasis). Limitations were the poor navigability in the formative exercise section and the excessive information provided in some slides that could hinder their understanding. The team has addressed these limitations and is using this unit as a model to build the DMU e-Parasitology, which will be accessible through the DMU website (http://parasitology.dmu.ac.uk) in 2018. We consider that this teaching and learning resource will overcome barriers of time, space, equipment and resources; and may help students and scientists around the world in the diagnostic of different parasitic diseases that impact human health

Development of a virtual environment for teaching and learning biomedical techniques and equipment for the study of human pathogens.

An international innovative teaching group from different EU Universities (De Montfort University, Leicester, UK; University of San Pablo CEU, Madrid, Spain; University of Miguel Hernandez, Elche, Spain) and biomedical scientists registered by the Health and Care Professions Council (HCPC, UK) are developing a complete e-learning package in medical parasitology for undergraduate and postgraduate students that study Health Sciences. This package, named DMU e-Parasitology, is accessible through the DMU website (http://parasitology.dmu.ac.uk) and will present different modules including a virtual laboratory module for the study of traditional and novel biomedical laboratory techniques and equipment for detecting, identifying and studying human pathogens, specifically parasites. These techniques could also be potentially used to study other pathogens such as bacteria or viruses. The virtual biomedical laboratory is under development, but is available in the DMU website here: http://parasitology.dmu.ac.uk/learn/laboratory.htm. To develop this new module of the DMU e-Parasitology, we are using Storyline 360 software and the scaffolding and methods used to build the theoretical module (Peña-Fernández et al., 2017) [1]. To facilitate the navigation, study and comprehension of the final user, we have divided the virtual laboratory into a series of sub-sections that include different units; the sub-sections so far are: microscopes (with units such as the electron microscope); molecular biology (e.g. polymerase chain reaction and gel electrophoresis); biological safety cabinets and cell/parasite culture; biochemical and immunological techniques (e.g. magnetic immunoseparation); histology (e.g. microtome) and staining techniques (e.g. Kinyoun staining). The virtual laboratory units are highly interactive and present short videos of academics and/or technicians working in real conditions with the different laboratory equipment such as a thermocycler, a microtome, or a biological safety cabinet, as well as performing a specific technique such as a staining to determine pathogens. Therefore, the user of this virtual environment will receive a complete and “real” experience of the work in a biomedical laboratory. The DMU e-Parasitology package, and specifically its virtual laboratory environment, could help technicians and students across the world to learn how to work in a biomedical laboratory as well as to perform techniques to identify and diagnose human pathogens such as microsporidia or Plasmodium spp. Thus, the virtual resource is supported by a virtual library that includes a real collection of clinical slides that will provide the user with the functionality of a light and/or an immunofluorescence microscope. In conclusion, the virtual laboratory may serve as a high quality and reliable on-line environment for the learning of techniques and equipment. These resources can be used to improve the learning of undergraduate and postgraduate students of human health sciences as well as to develop CPD training. Moreover, the virtual laboratory module may impact in the teaching of laboratory techniques and skills in developing countries due to their limited resources. This communication will explore the design and development of the virtual laboratory environment that will be publicly accessible by the end of 2018

Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index

Background: Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days. Methods: The sample comprised cases from a national registry of pulmonary thromboembolism in patients with cancer (1075 patients from 14 Spanish centres). Diagnosis was incidental in 53.5% of the events in this registry. The Exhaustive CHAID analysis was applied with 10-fold crossvalidation to predict development of serious complications following PE diagnosis. Results: About 208 patients (19.3%, 95% confidence interval (CI), 17.1-21.8%) developed a serious complication after PE diagnosis. The 15-day mortality rate was 10.1%, (95% CI, 8.4-12.1%). The decision tree detected six explanatory covariates: Hestia-like clinical decision rule (any risk criterion present vs none), Eastern Cooperative Group performance scale (ECOG-PS; = 2), O-2 saturation (= 90%), presence of PE-specific symptoms, tumour response (progression, unknown, or not evaluated vs others), and primary tumour resection. Three risk classes were created (low, intermediate, and high risk). The risk of serious complications within 15 days increases according to the group: 1.6, 9.4, 30.6%; P<0.0001. Fifteen-day mortality rates also rise progressively in low-, intermediate-, and high-risk patients: 0.3, 6.1, and 17.1%; P<0.0001. The cross-validated risk estimate is 0.191 (s.e. = 0.012). The optimism-corrected area under the receiver operating characteristic curve is 0.779 (95% CI, 0.717-0.840). Conclusions: We have developed and internally validated a prognostic index to predict serious complications with the potential to impact decision-making in patients with cancer and PE