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Metastrongyloidea includes nematodes that parasitize mammals, mainly infecting their respiratory and cardiovascular systems, and are responsible for emerging zoonosis in the world. Terrestrial mollusks are their main intermediate hosts, with few exceptions. Here we present the results of a malacological survey to know the distribution of Angiostrongylus cantonensis in Macapá, Amapá, in the Brazilian Amazon region, after the report of a case of eosinophilic meningitis in 2018. Mollusks were collected in 45 neighborhoods between March 2019 and February 2020. They were identified, parasitologically analyzed, and their nematodes parasites were identified based on the morphology and MT-CO1 sequencing. Infections of An. cantonensis were observed in Achatina fulica, Sarasinula linguaeformis and Subulina octona. These are the first records of the natural infection of the last two species by An. cantonensis in the Brazilian Amazon region. The angiostrongylid Aelurostrongylus abstrusus, which parasitizes cats, was also detected parasitizing A. fulica and Diplosolenodes occidentalis. This is also the first record of the slug D. occidentalis infected by Ae. abstrusus. The highest infection rates were recorded in neighborhoods where the environment conditions favor the proliferation of both mollusks and rodents. The results demonstrate the ample distribution of An. cantonensis in Macapá and the need for surveillance and mollusk vector control in Brazil and other countries.

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The World Health Organization (WHO) recognizes schistosomiasis as one of the Neglected Tropical Diseases targeted for global elimination in the 2030 Agenda of the Sustainable Development Goals. In Brazil, schistosomiasis mansoni is considered a public health problem, particularly prevalent among vulnerable populations living in areas with poor environmental and sanitary conditions. In 2022, the WHO published a Guideline encompassing recommendations to assist national programs in endemic countries in achieving morbidity control, eliminating schistosomiasis as a public health problem, and advancing towards interrupting transmission. The perspectives presented here, collectively prepared by members of the Oswaldo Cruz Foundation's (Fiocruz) Schistosomiasis Translational Program (FioSchisto), along with invited experts, examine the feasibility of the WHO recommendations for the Brazilian settings, providing appropriate recommendations for public health policies applicable to the epidemiological reality of Brazil, and suggests future research to address relevant issues. In Brazil, the provision of safe water and sanitation should be the key action to achieve schistosomiasis elimination goals. The agencies involved in measures implementation should act together with the Primary Care teams for planning, executing, monitoring, and evaluating actions in priority municipalities based on their epidemiological indicators. Host snails control should prioritize judicious ecological interventions at breeding sites. The Information, Education, and Communication (IEC) strategy should be associated with water and sanitation and other control actions, actively involving school community. To identify infected carriers, FioSchisto recommends a two-stage approach of immunological and molecular tests to verify transmission interruption during the intervention and beyond. Praziquantel administration should be done under medical supervision at the Primary Care level. MDA should be considered in exceptional settings, as a measure of initial attack strategy in locations presenting high endemicity, always integrated with water and sanitation, IEC, and snail control. To assist decision-making, as well as the monitoring and evaluation of strategic actions, there is a need for an Information System. FioSchisto considers this systematization essential to make investments in strategic research to support the improvement of schistosomiasis control actions. Efforts toward schistosomiasis elimination in Brazil will succeed with a paradigm shift from the vertical prescriptive framework to a community-centered approach involving intersectoral and interdisciplinary collaboration.

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Breast cancer is the most incidental and deadly neoplasm worldwide; in Mexico, very few epidemiologic reports have analyzed the pathological features and its impact on their clinical outcome. Here, we studied the relation between pathological features and the clinical presentation at diagnosis and their impact on the overall and progression-free survival of patients with breast cancer. For this purpose, we collected 199 clinical records of female patients, aged at least 18 years old (y/o), with breast cancer diagnosis confirmed by biopsy. We excluded patients with incomplete or conflicting clinical records. Afterward, we performed an analysis of overall and progression-free survival and associated risks. Our results showed an average age at diagnosis of 52 y/o (24-85), the most common features were: upper outer quadrant tumor (32%), invasive ductal carcinoma (76.8%), moderately differentiated (44.3%), early clinical stages (40.8%), asymptomatic patients (47.8%), luminal A subtype (47.8%). Median overall survival was not reached, but median progression-free survival was 32.2 months (29.75-34.64, CI 95%) associated risk were: clinical stage (p < 0.0001) symptomatic presentation (p = 0.009) and histologic grade (p = 0.02). Therefore, we concluded that symptom presence at diagnosis impacts progression-free survival, and palpable symptoms are related to an increased risk for mortality.

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BACKGROUND: Schistosomiasis is a neglected tropical disease that occurs in locations with inadequate sanitation conditions. The geographic distribution of Schistosoma mansoni trematode depends directly on the presence of its intermediate host, Biomphalaria mollusks. Studies involving recently isolated and laboratory strains are not common due to the difficulty in cycle maintenance. This study evaluated the susceptibility and infectivity responses in intermediate and definitive hosts with strains of S. mansoni, one isolated and kept in laboratory environment for 34 years (BE) and the other recently collected (BE-I) METHODS: For experimental infection, a total of 400 B. glabrata mollusks were divided in four infection groups. Thirty mice were divided in two groups for infection with the two strains. RESULTS: It was possible to notice differences about S. mansoni infection in both strains. The laboratory strain was more harmful to freshly collected mollusks. Differences in the patterns of infection in mice could be observed. CONCLUSION: Particularities occurred in each group of infection by S. mansoni strains, despite having the same geographic origin. Effects from the parasite-host interaction are visible in terms of infection in definitive and intermediate hosts.

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The Helminthological Collection of the Oswaldo Cruz Institute is the biggest in Latin America and it is among the largest collections at worldwide reference level, with around 40,000 sets of specimens and approximately one million individual specimens. It contains helminths parasites of vertebrate and invertebrate animals that form part of the fauna of Brazil and other countries. The samples comprise holotypes, paratypes and representative specimens of Platyhelminthes, Acanthocephala, Nematoda and other non-helminth phyla, such as Annelida and Arthropoda. Some of the samples preserved in liquid media were found to have dried out. This made it impossible to analyze these samples morphologically for taxonomic purposes. The aim of this study was to test techniques used for rehydration of the tegument of specimens that had been found to have dried out and present protocols for such techniques. A total of 528 specimens that either no longer were immersed in preservatives or had already dried out were analyzed: 96 digenetic trematodes, 45 cestodes, 22 acanthocephalans, 357 nematodes, four hirudineans and four pentastomid crustaceans. The technique of rehydration using only distilled water on the specimens proved to be efficient for recovering tegument malleability, for all samples analyzed in this present study.

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The Helminthological Collection of the Oswaldo Cruz Institute is the biggest in Latin America and it is among the largest collections at worldwide reference level, with around 40,000 sets of specimens and approximately one million individual specimens. It contains helminths parasites of vertebrate and invertebrate animals that form part of the fauna of Brazil and other countries. The samples comprise holotypes, paratypes and representative specimens of Platyhelminthes, Acanthocephala, Nematoda and other non-helminth phyla, such as Annelida and Arthropoda. Some of the samples preserved in liquid media were found to have dried out. This made it impossible to analyze these samples morphologically for taxonomic purposes. The aim of this study was to test techniques used for rehydration of the tegument of specimens that had been found to have dried out and present protocols for such techniques. A total of 528 specimens that either no longer were immersed in preservatives or had already dried out were analyzed: 96 digenetic trematodes, 45 cestodes, 22 acanthocephalans, 357 nematodes, four hirudineans and four pentastomid crustaceans. The technique of rehydration using only distilled water on the specimens proved to be efficient for recovering tegument malleability, for all samples analyzed in this present study.(AU)

A Coleção Helmintológica do Instituto Oswaldo Cruz é a maior da América Latina e está entre as maiores coleções de referência mundial, com cerca de 40.000 lotes e, aproximadamente, um milhão de espécimes. Seu acervo reúne helmintos parasitos de animais vertebrados e invertebrados da fauna brasileira e de outros países. Seus exemplares são holótipos, parátipos e espécimes representativos de parasitos, pertencentes aos filos Platyhelminthes, Acanthocephala, Nematoda e, ainda alguns espécimes não-helmintos, pertencentes aos filos Annelida e Arthropoda. Parte das amostras preservadas como material líquido foram encontradas dessecadas. Esta condição torna as amostras inviáveis para análise morfológica para propósitos taxonômicos. Portanto, o objetivo deste trabalho foi testar técnicas usadas na reidratação do tegumento dos espécimes que se encontram dessecados e apresentar seus protocolos. Foram analisados 528 lotes, cujos espécimes encontravam-se sem conservantes ou já dessecados: 96 trematodeos digenéticos, 45 cestoides, 22 acantocéfalos, 357 nematoides, quatro hirudíneos e quatro crustáceos pentastomídeos. A técnica de reidratação dos espécimes, utilizando-se apenas água destilada, mostrou-se eficiente na recuperação da maleabilidade tegumentar de todas as amostras trabalhadas no presente estudo.(AU)

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An ample variety of parasitic associations are found between mollusks and nematodes, in which the mollusks may act as intermediate, paratenic or definitive hosts. Some free-living nematodes, in particular those of the order Rhabditida, are also found frequently in terrestrial mollusks. The present study reviews the results of the parasitological testing on samples of terrestrial mollusks conducted at the Brazilian National Reference Laboratory for Schistosomiasis and Malacology between 2008 and 2021. The samples were supplied primarily by the public health authorities from the different regions of Brazil, but also by research institutions and general population. The mollusks were processed individually and the obtained larvae were identified from their morphology and, whenever necessary, by molecular analysis. A total of 1,919 service orders were registered during the period, including 19,758 mollusk specimens collected from 23 of the 26 Brazilian states, as well as the Federal District, totalizing 145 municipalities. There was a marked predominance of the synanthropic species that are widely distributed in Brazil-Achatina fulica (87.08%), Bulimulus tenuissimus (4.18%), Bradybaena similaris (2.06%), and Sarasinula linguaeformis (1.50%). Of the 16,750 terrestrial mollusks examined, nematodes were recorded in 1,308 service orders, with the predominance of the superfamily Metastrongyloidea, in 616 service orders. They included Angiostrongylus cantonensis, rat lungworm, which was found in 252 samples, and Aelurostrongylus abstrusus in 145 samples. Free-living nematodes were found in 952 samples, Ancylostoma caninum and Cruzia tentaculata (previously identified as Strongyluris sp.) in one and 275 samples, respectively, and other parasites in 210 samples (not identified). The results highlight the diversity of the associations between nematodes and terrestrial mollusks in Brazil, in particular invasive and synanthropic species, with emphasis on the giant African land snail, Achatina fulica. They demonstrate the prominent role of this species of mollusk in the transmission of medically-important nematodes, which affect the health of both humans and animals, in particular eosinophilic meningitis, which is caused by Angiostrongylus cantonensis. This reinforces the need for more studies, and justify the growing demand for information as well as parasitological diagnosis of this mollusk, given its wide distribution in Brazil and its impact as an urban pest.

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PURPOSE: The identification of subpopulations harboring druggable targets has become a major step forward in the subclassification of solid tumors into small groups suitable for specific therapies. BRAF fusions represent a paradigm of uncommon and targetable oncogenic events and have been widely correlated to the development of specific malignancies. However, they are only present in a limited frequency across most common tumor types. At this regard, we performed a genomic screening aimed to identifying rare variants associated to advanced prostate cancer development. METHODS: Tumoral tissue genomic screening of 41 patients developing advanced prostate cancer was performed at our center as part of the GETHI XX study. The project, sponsored by the Spanish Collaborative Group in Rare Cancers (GETHI), aims to analyze the molecular background of rare tumors and to discover unfrequent molecular variants in common tumors. RESULTS: Here we present the clinical outcome and an in-deep molecular analysis performed in a case harboring a SND1-BRAF fusion gene. The identification of such rearrangement in a patient refractory to standard therapies led to the administration of trametinib (MEK inhibitor). Despite unsensitive to standard therapies, the patient achieved a dramatic response to trametinib. A comprehensive study of the tumor demonstrated this event to be a trunk alteration with higher expression of MEK in areas of tumor invasion. CONCLUSIONS: Our study describes the patient-driven discovery of the first BRAF fusion-driven prostate cancer effectively treated with trametinib. Consequently, MAPK pathway activation could define a new subtype of prostate cancer susceptible to a tailored management.

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Familial hyperchylomicronemia syndrome is a monogenic autosomal recessive disorder that causes severe and refractory hypertriglyceridemia. This uncommon condition is challenging to diagnose and treat and can lead to comorbidities such as acute pancreatitis. Although treatment options are limited in the pediatric population, strict diets and treatments approved for other dyslipidemias may be implemented in familial hyperchylomicronemia syndrome, given the lack of pharmacological interventions available. We report a 14-year-old female presented to the emergency room with abdominal pain suggestive of acute pancreatitis. Biochemical analysis revealed a triglyceride value of 4260 mg/dL. Treatment for triglyceride reduction with a strict CHILD-2 triglyceride-lowering diet, insulin infusion, fibrates, and multiple plasmapheresis were initially insufficient. Primary hypertriglyceridemia was suspected, and genetic testing identified a homozygous pathogenic variant in the lipoprotein lipase gene, diagnosing familial hyperchylomicronemia syndrome. She was discharged with a maximum dose of fibrate, statin, omega-3 fatty acids, and a restrictive diet. At her 1-month and 9-month follow-ups, her triglyceride values were 756 and 495 mg/dL, respectively, without incident complications. Familial hyperchylomicronemia syndrome is an uncommon condition with limited available literature and treatment options, especially in the pediatric population. Acute pancreatitis secondary to severe hypertriglyceridemia is a condition with a high risk of mortality which requires prompt clinical suspicion and treatment.

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Aelurostrongylus abstrusus is a metastrongilid nematode that causes feline aelurostrongylosis. The adult life stage parasitizes the lungs of wild and domestic felids. Terrestrial mollusks act as its intermediate host, and birds, amphibians, and small mammals act as paratenic hosts. Aelurostrongylus abstrusus presents a worldwide distribution, and in Brazil it has been recorded in most states. The present study investigates the occurrence of Aelurostrongylus abstrusus in terrestrial mollusks from urban areas of two out of the six Mesoregions of Rio de Janeiro state: Metropolitana and Centro Fluminense (46 municipalities). Larvae were recovered from the tissue of the mollusks collected during the surveys and identified based on morphology and sequences of the Internal Transcribed Spacer 2 (ITS2). In all, 2791 mollusks, belonging to 14 different species, were collected. Larvae of A. abstrusus were recovered from two species: Achatina fulica in 22 out of 46 municipalities, and from the slug Latipes erinaceus in 1 out of 46 municipalities. Aelurostrongylus abstrusus was recorded in half (50%) of the municipalities of the Metropolitana Mesoregion and in 44% of those of the Centro Fluminense Mesoregion. Results indicate a strong association between A. abstrusus and A. fulica, since 99% of the mollusks infected with A. abstrusus were A. fulica. This study recorded A. abstrusus in the Centro Fluminense Mesoregion and naturally parasitizing L. erinaceus for the first time. Despite the high number of mollusks infected with A. abstrusus and their wide distribution in Rio de Janeiro State, there are still few reports of infection in Brazilian felids, probably given that this is an under-diagnosed parasitosis in this country. Further studies in other regions of the Rio de Janeiro State, and other Brazilian States, focusing on intermediate and definitive hosts, particularly in the urban environments where they coexist, are needed. These studies will enable further understanding of the epidemiology and prevention of aelurostrongylosis.

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