Coriolus versicolor, Asian centella, Azadirachta indica and Aloe vera on vaginal microbiota, cervical epithelization and vaginal health.To assess the effect of a 12-day treatment using a vaginal gel based on niosomes containing hyaluronic acid, ß-glucan, alpha-glucan oligosaccharide, Open-label, prospective pilot study conducted in asymptomatic women in daily practice. Cervical epithelization was evaluated by colposcopy using an ectopy epithelization score (from 5: no ectopy to 1: severe ectopy and bleeding), vaginal microbiota using the VaginaStatus-Diagnostic test  and further rated by the investigator using a 5-point Liker scale , and vaginal health using the Vaginal Health Index.P < 0.0001) (43% improvement). In 10 women, there was a trend of improving of vaginal microbiota status, with a mean score of 4.0 at the final visit vs. 3.3 at baseline (P = NS) (21.2% improvement). In 11 women, the Vaginal Health Index increased from 19.0 at baseline to 22.3 at the final visit (P = 0.007). The concentration of Lactobacillus spp. increased 54.5% of women and pH decreased from 4.32 to 4.09.In 21 women, a positive effect to improve epithelization of the cervical mucosa, with a mean score of 4.42 at the final visit as compared to 3.09 at baseline (These encouraging preliminary results provide the basis for designing a randomized controlled study, and for potential use in human papilloma virus infection.ISRCTN77955077. Registration date: February 15, 2017. Retrospectively registered Lactobacillus spp., a sufficient estrogen-dependent maturation of the vaginal epithelium and an intact local immunity [The human female genital tract which includes the vaginal fluids present in the cervico-vaginal mucosa contain all essential elements for a number of functions, such as response against genital pathogens, re-epithelization of lesions and maintenance of general vaginal health. The vaginal ecosystem plays an important role in preventing urogenital infections, and alterations of this dynamic environment causes vaginal dysbacteriosis , 2. A heimmunity . The vagimmunity . Preservimmunity , 6.Lactobacillus microbiota have been reported to be essential. It has been shown that topical combinations of lactobacilli and estrogens can be safely used in pre- and postmenopausal women for the restoration of the vaginal microbiota after anti-infective therapy, for treatment of symptomatic vaginal atrophy, and for abnormal vaginal flora therapy [To maintain a healthy vaginal ecosystem or to restore any disturbance, sufficient estrogen levels, an intact mature vaginal epithelium, and physiological  therapy , 8. Loca therapy , 10. Top therapy , 12.The concept of ‘vaginal health’ as the vaginal state in which the physiological conditions and the vaginal microenvironment and microbiota are not disrupted, has gained increasing interest in recent years and is also being extended to healthy women. Traditionally, natural products have been used for vaginal health, including probiotics, essential oils, propolis, lipid lubricans, pectins, medicinal plant extracts with phytoestroestrogenic activities and a variety of other extracts with primarily moisturizing effects –18.Coriolus versicolor, Asian centella, Azadirachta indica  and Aloe vera. Encapsulation in niosomes allows a more penetrating capability of the components, which have shown hydrating, repairing, anti-inflammatory and immunomodulatory effects as well as preserving the balance of vaginal microbiota [Recently, a non-hormonal gel that acts as a moisturizer and lubricant because of strong hydrating properties, also enhancing and accelerating repair of atrophic or injured cervicovaginal mucosa has been approved in Spain as a medical device. The product is based on niosomes containing hyaluronic acid, ß-glucan, alpha-glucan oligosaccharide, crobiota –24.Coriolus versicolor-based vaginal gel on epithelization of cervical lesions and to improve vaginal microbiota and vaginal health in asymptomatic healthy women.A pilot study was designed to assess the clinical benefits of this Coriolus versicolor-based vaginal gel on the following parameters: a) epithelization of cervical lesions , b) composition of vaginal microbiota, and c) vaginal health. The studies were performed in accordance with the principles of the Declaration of Helsinki for the protection of human subjects, and oral informed consent was obtained from all participants. According to Spain regulations, ethics approval is not required for studies with the following characteristics: real life, pilot study, with a medical device (not a drug) class I already marketed and used within approved indication, and sponsored by the principal investigator and not by a private pharmaceutical company.An open-label, non-comparative, prospective and pilot clinical study was conducted in two gynecology clinics from Madrid and Barcelona (Spain) in daily practice conditions. The objective of the study was to assess the effect of a Women aged between 18 and 45 years old attending a routine gynecological visit, without signs and symptoms of vaginal disease and a normal Papanicolaou smear were included in the study. An epithelization score between 4 and 1 was also an inclusion criterion. Exclusion criteria included vaginal infections, use of vaginal products other than the investigational compound and being pregnant or breastfeeding. Women with history or concomitant diseases who were deemed to be ineligible by the investigator were also excluded from the study.Coriolus versicolor as the main agent, the gel contains nisosomes of hyaluronic acid (a moisturing agent), nisosomes de beta-glucan (an anti-inflammatory agent), Bioecolia® (a prebiotic agent), Centella asiatica (fitosomes®) (a tissue regenerating agent), Azadirachta indica extract (Neem) (a re-epitelizing agent), and Aloe vera. It was recommended to use the medical device between periods, once a day and at bedtime for 12 consecutive days. There were no restrictions regarding sexual activity including the use of condoms. The use of douches or vaginal deodorants was not allowed. The vaginal gel was supplied to all women without cost for the total duration of treatment. Participants were visited at baseline  and after 12 days of treatment (visit 2). In both visits the degree of epithelization, composition of vaginal microbiota, Lactobacillus spp. concentration, vaginal pH, and the Vaginal Health Index were evaluated.Women who agreed and met the inclusion criteria were instructed on the correct use of the vaginal gel  according to the manufacturer’s information leaflet supplied with the gel. In addition to the extract from The degree of epithelization of the cervical mucosa was evaluated by standard colposcopy and rated by the investigator using an ectopy epithelization score, where 5 was no ectopy, 4: mild , 3: moderate , 2: severe  and 1: severe ectopy and bleeding.Candida spp. or Mycoplasma spp. or alterations in more than three species but not of all species); 3: moderate deterioration ; 4: mild deterioration ; and 5: normal. Lactobacillus spp. concentrations and pH were also measured.Vaginal microbiota was evaluated using the VaginaStatus-Diagnostic test   and furtThe Vaginal Health Index was also assessed . The VagBecause of the exploratory characteristics of the study, sample size calculation was not mandatory. Categorical variables are expressed as numbers and percentages, and quantitative variables as mean and standard deviation (SD). The Wilcoxon signed-rank test was used for the comparison of paired samples of continuous data. Data were analyzed with the Power Analysis and Sample Size software program, version 2011.Coriolus versicolor-based vaginal gel showed a positive effect to improve reepithelization of the cervical mucosa, with a mean score of 4.42 at the final visit as compared to 3.09 at baseline (P < 0.0001), and an overall improvement of 43%  participated in evaluation of epithelization of the ectocervix. Treatment with the Gardnerella vaginalis, E. coli, Streptococcus spp. etc.) despite of being clinically asymptomatic. There was trend of improving of vaginal microbiota status, with a mean score of 4.0 at the final visit vs. 3.3 at baseline (P = NS), and an improvement of 21.2%  were included in the assessment of vaginal microbiota (one exclusion due to sample manipulation error). At the baseline visit, 9 of 10 patients (90%) showed some alterations in the vaginal microbiota (P = 0.007)  and no changes were observed in 1. In the remaining 3 women, a decrease in Lactobacillus concentration was found. The mean vaginal pH showed a trend to decrease   were included in the assessment of vaginal health. There was a significant increase in the Vaginal Health Index from a mean of 19.0 at baseline to 22.3 at the final visit after 12 days of treatment  in the mucosal epithelium [The present findings showing a clear beneficial effect of the ithelium , 28 mighithelium –31.Coriolus versicolor, one of the components of the vaginal gel, have been shown to have antioxidant, immunomodulatory and anti-tumor properties [Coriolus versicolor appear to be a lymphocyte mitogen by differentially enhancing the production of Th1-related cytokines [In fact, the protection against viral aggression is based on three actions of the vaginal gel here described. Firstly, normalization of the vaginal microbiota. It is well known that bacterial vaginosis linked to an imbalance of vaginal ecosystem predisposes women to infection by HPV . Palomacoperties , 34. Morytokines . A Th1 rytokines . Thirdlyytokines .The present results should be interpreted taking into account the pilot nature of the study, the absence of a control group and the short-term use of the product. Also, a comparison with previous studies is not presented as we report preliminary results of a pilot study with a new vaginal gel. However, these encouraging preliminary findings provide the basis for designing a randomized controlled study, and subsequently in the presence of confirmatory data, for potential use in HPV taking the advantages of easy and comfortable administration of the product.Coriolus versicolor and other ingredients such as niosomes containing hyaluronic acid, ß-glucan, alpha-glucan oligosaccharide, Asian centella, Azadirachta indica and Aloe vera for 12 consecutive days showed positive effects toward improving vaginal microbiota, cervical epithelization and vaginal health. Further studies must be conducted to confirm these positive results, as well as to evaluate the potential use in human papilloma virus infection. Moreover, comparative studies with vaginal gels composed of estrogen and topical microbicides would be of interest.In a pilot study conducted among asymptomatic women, the use of a vaginal gel based on


The aim of this study was to investigate whether haemogram parameters are predictive factors for both the severity of the disease and a decision in favor of surgical treatment in patients with an established diagnosis of cubital tunnel syndrome (CuTS).The medical files of patients with a diagnosis of CuTS who were followed-up conservatively (n=92) or surgically treated (n=92) were retrospectively screened and the haemogram parameters were recorded.The receiver operating characteristic (ROC) curve analysis revealed an area of 0.665 under the curve, with 76.3% sensitivity and 84.8% specificity at the cut-off of a red cell distribution width (RDW) level grater than 15.45%. RDW levels higher than 15.5%, electromyography (EMG) severity, and a clinical score higher than three were found to be independently associated with surgeryLevel of Evidence III, Retrospective Study. An elevated RDW value was related to the severity of the electromyogram. RDW may, therefore, be a useful independent predictor for the decision to surgical treatment of CuTS.  Values are expressed as percentages, with a normal reference range of 11.5 to 14.5%. An elevated RDW indicates a greater variability in the size of the circulating RBCs (anisocytosis) and can occur in patients with nutritional deficiencies, haemoglobinopathies, and haemolysis.In the present study, EMG and clinical assessment have been considered the best surgical decision making parameters for CuTS patients. We hypothesized that RDW as inflammation marker may be used as a predictive marker for the decision to operate in CuTS patients related to the severity of the electromyogram. For that reason, we aimed to investigate whether haemogram parameters are indeed predictive factors for the severity of the disease and also make an alternative decision of surgical treatment in patients with an established diagnosis of CuTS.The medical files of patients with a diagnosis of CuTS who were either followed-up conservatively or who underwent surgery between July 2008 and April 2015 were screened retrospectively. The study was approved by the Local Hospital Management Committee. Additionally all patients approved the consent form. The diagnosis was based on the patient's history and a clinical examination; i.e. a positive Tinel's sign, sensory loss in the area innervated by the ulnar nerve, pain over the medial epicondyle, weakness of the muscles innervated by the ulnar nerve, and a positive elbow flexion test. Secondary conditions, which would lead to ulnar nerve involvement, were not detected in any participant. The presence of bone pathology (if any) was evaluated using anteroposterior and lateral elbow radiograms. Conservative methods  were tried preoperatively in all patients for at least 6 months. However, some patients were considered for surgery because of the presence of clinically progressive symptoms, sensorimotor deficits, lack of clinical and electroneurographic improvements and a worsening of the objective findings at follow-up controls performed several weeks after the initial visit. Besides, the patients were considered lack of motor function for surgical decision making process.Patients were excluded from the study if they had inflammatory disorders, an acute infection, had taken local or systemic steroids, had been morbidly obese, were diagnosed with any secondary CuTS pathology, had been diagnosed with cancer, were currently receiving radiotherapy or chemotherapy, had been diagnosed with a psychiatric disorder, had a neurological disease, or had been diagnosed with any cervical pathology.Patients were asked to complete the 'disability of arm shoulder and hand' (DASH) score. The electromyogram (EMG) measurements of all patients, which included sensory and motor nerve conduction velocity measurements, were evaluated retrospectively.Haemogram parameters, such as white blood cell count (WBC), haemoglobin (Hb), haematocrit (Htc), mean platelet volume (MPV), neutrophils (NEU), lymphocytes (LYM), platelets (PLT), NEU/LYM, PLT/LYM, and RDW values, which were measured simultaneously with the EMG examination, were recorded. Based on the results of previous studies, the patients' RDW values were divided into subgroups according to the RDW quartiles.p-value <0.05 was considered to indicate statistical significance.The data analysis was performed using the Statistical Package for the Social Sciences software, version 15 for Windows . The data are shown as means ± standard deviation for continuous variables, medians (minimum-maximum) for ordinal variables, and frequencies with a percentage for categorical variables. Comparisons between groups were performed using a one-way analysis of variance (ANOVA), with post hoc analysis by Tukey's honest significant difference (HSD) test, and a t-test plus the Kruskal-Wallis tests or a Mann-Whitney U test for the independent samples for normally and abnormally distributed data, respectively. The categorical variables were analyzed using a chi-squared test. Correlation was evaluated by the Spearman's correlation test. Receiver operator characteristic (ROC) curve analysis was performed to identify the optimal cut-off point of RDW  at which to predict the decision for surgery in CuTS patients. Areas under the curve (AUC) values were calculated as measures of the accuracy of the tests. We compared the AUCs using the Z test. We used univariate logistic regression analysis to quantify the association of variables with the decision to operate in CuTS. Variables that were found to be statistically significant in the univariate analysis and other potential confounders were used in a multiple logistic regression model with the forward stepwise method to identify independent prognostic factors of the decision to operate in CuTS. A In the present study, the medical files of 825 patients who underwent EMG examinations between July 2008 and April 2015 were evaluated retrospectively. The patients either underwent surgery (n=124) or were followed-up conservatively. The algorithm and planning criteria of the study are shown in p<0.001). In the conservative group, low , and moderate  EMG intensities were detected, while in the operative group, moderate , and severe  intensities were found, and a statistically significant intergroup difference was determined (p=0.00). In all patients a statistically significantly positive correlation was detected between the DASH score and the EMG intensity .  or operated on (n=92) were examined retrospectively. In those patients who were examined, a positive Tinel's sign, sensory loss in the area innervated by the ulnar nerve, pain over the medial epicondyle, weakness of the muscles innervated by the ulnar nerve, and a positive elbow flexion test were found to be more prevalent in the surgery group. In addition, a statistically significant difference was detected between the DASH scores of the groups (<0.001). p=0.026).  and 34.8% (n=32) when cut-off values of ≤15.5 and >15.5 were taken into consideration. However, in the surgery group the predictive values of RDW were found to be 48.9 % (n=45) and 51.1% (n=47) at cut-off values of ≤15.5 and 15.5, respectively, with a statistically significant intergroup difference (=0.026).  p=0.00) . Again, and only in the surgery group, a statistically significantly positive correlation was detected between the DASH score and RDW . ROC curve analysis revealed a 0.665  area under the curve, 76.3% sensitivity and 84.8% specificity at the cut-off of an RDW level >15.45%. .In both the univariate logistic regression analyses and the multivariate regression analysis, RDW levels >15.5%, EMG severity, and a clinical score >3 were determined to be independently associated with a decision for surgery (odds ratio [OR] 1.751; 95% CI 1.298-2.684; ,,-,,9 In the decision-making process for treatment alternatives in CuTS patients, the presence of a correlation has been reported between the clinical manifestations of the patient and the intensity of the EMG.,-,,,,,,Some physical examination findings-including a positive Tinel's sign, and some tests to measure sensory loss in the area innervated by the ulnar nerve, pain over the medial epicondyle, weakness of the muscles innervated by the ulnar nerve, and a positive elbow flexion test-were reported to be more severe in patients with a presumptive diagnosis of CuTS who were scheduled for surgery.,,-,-.....,A specific haemogram predictor marker for the diagnosis of CuTS has not yet been reported. However, some haemogram parameters are known to have predictive values for various diseases, including some involving the musculoskeletal system.There were some limitations to our study. The number of patients enrolled in the study was small; therefore, our findings should not be generalized. Instead, they should be supported by further studies using a sufficient number of patients. The retrospective nature and one-centre design of this study were other limitations. In addition, vitamin B12 levels of blood were not screened with haemogram parameters. Because differential central and peripheral neuropathy syndromes was seen in the vitamin B12 deficit, this correlated with vitamin B12 deficit and axonal processes were not reflected by the present study, and design of this study were other limitations. Prospective future studies conducted using a multicentre approach, vitamin B12 levels and haemogram parameters are needed for more accurate results.In conclusion, EMG and clinical assessment have been considered the best surgical decision making parameters for CuTS patients. However, RDW which is one of the haemogram parameters that can indicate the inflammatory process is an important parameter in inflammatory conditions that develop following chronic nerve compression. Therefore, an elevated RDW value is related to the severity of the chronic nerve compression. RDW may be a useful independent predictor for a decision to operate in patients with CuTS.


P < 0.001). Nine cohorts involving 155,435 patients reported data for COPD exacerbation with or without hospitalization, and they gave a HR of 0.58. Our systematic review of exclusively observational studies showed a clear benefit of statins for patients suffering from COPD.Recently, a number of observational studies have suggested that use of statins reduces mortality in patients suffering from chronic obstructive pulmonary disease (COPD). To obtain a more valid assessment, we update the meta-analysis of the effect of statins on COPD exacerbation and mortality. We searched for eligible articles using PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, Cochrane Databases and Web of Science between January 2006 and February 2017, with no restrictions. The hazard ratio (HR) with 95% confidence interval (CI) was estimated. Publication bias was evaluated by funnel plot and Begg's test. Sensitivity analyses were also conducted. Twenty studies with a total of 303,981 patients were included. Thirteen articles provided data on all-cause mortality , and the pooled hazard ratio of 0.65 (95% CI: 0.57–0.74,  Chronic obstructive pulmonary disease (COPD) is currently one of the leading causes of morbidity and mortality, the prevalence of this disease is rapidly increasing worldwide, and in 2020 it has been predicted that this disease will reach the third cause of mortality worldwide . Also, Cn = 165,221), 3 reported COPD mortality , 3 reported cardiovascular mortality  and 2 reported cancer-mortality . Also, there were 7 cohorts showed the effect of statins therapy on the risk of COPD exacerbation with or without hospitalization , 5 cohorts showed the effect of statins therapy on the risk of hospitalization  and 2 cohorts showed the effect of statins therapy on the risk of stroke .Overall our initial search found 1,003 articles that met the preliminary criteria. After removing duplicates, and screening titles and abstracts, 132 articles qualified for a full review. We finally found 20 eligible articles , 15–28 wI2 = 64%, P < 0.01). The analysis for three cohorts detected a protective effect of statin treatment on the risk of COPD mortality . Additionally, the analysis showed that statins use was associated with decrease COPD exacerbation requiring hospitalization . Sensitivity analyses confirmed that the association between statins on COPD and all outcomes did not change with the use of random effects models or fixed effects models for the meta-analysis. And when omitting one study at a time and recalculating the pooled HRs, we found the pooled result of all-cause mortality , and the pooled hazard ratio of 0.65 (95% CI: 0.57–0.74). Seven cohorts involving 128,046 patients reported data for COPD exacerbation, and they gave a HR of 0.58 (95%CI: 0.48–0.72). Statins use was associated with a 35% reduction in all-cause mortality (95% CI: 0.57–0.74) and a 59% reduction in COPD mortality (95% CI: 0.28–0.59). And the use of statins was associated with a significantly decrease risk of cardiovascular mortality . Additionally, the analysis showed that statins use was associated with a 42% lower risk of COPD exacerbation with or without hospitalization.Based on the findings of our study, we showed a clear benefit of statins for patients suffering from COPD. The protective effect of statins could be explained by their pleiotropic effects, including inhibit vascular endothelial inflammatory response, stabilize athermanous plaque, antithrombotic effects, and improve endothelial function . ChronicThe findings from observational studies showed that statins reduced mortality or exacerbations in patients with COPD were not consistent with a large multi-center randomized controlled trial study . The proP value from the Egger's test was 0.05, implying that a publication bias could exist in the 20 studies conducted in patients with COPD. Of course, there were some limitations of the present study. Firstly, we only include observational studies for system analysis due to the few randomized controlled study on statins for COPD. Observational studies have relative lower clinical evidence than randomized controlled studies. Secondly, the crude (unadjusted) odds ratio or HR for statins in COPD patients was reported, as different studies used different set(s) of confounders. Thirdly, many of the confounding factors were not controlled in some of the studies included, and the sample size of several subgroups was small. In the end, due to different study have different sample size, year of publication, use of different kinds of statins and different follow-up time, therefore there were significant heterogeneities among the studies. But the consistency between the results from HRs by fixed model and random-model makes the results reliable despite the heterogeneity.The present study has a number of advantages over the previous meta-analysis; on the one hand, all of the published observational studies, included both comparative cross-sectional and cross-sectional studies in this meta-analysis up to now. On the other hand, the HR for COPD mortality or exacerbation and hospitalization was pooled across a large number of studies. What is more, the In conclusion, our systematic review and meta-analyses showed that statins use was associated with a reduction in all-cause mortality and COPD exacerbation or hospitalization. Our systematic review showed a clear benefit of statins for patients suffering from COPD. Although this meta-analysis and previous original studies have common limitations in their observational research, these studies have presented meaningful results. Therefore, there is needed more and more randomized, well-designed, multi-center, double blind clinical studies to identify the long term effects of statins in COPD.Following recommendations of the Meta-analysis of Observational Studies in Epidemiology group,  we searcNo patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for design or implementation of the study. No patients were asked to advice on interpretation or writing up of results. There are no plans to disseminate the results of the research to study participants or the relevant patient community.Two investigators independently identified the titles and abstracts of potentially suitable studies, and the information included participant number, age, sex, follow-up duration, characteristics of the exposure and the reported outcomes. If a study reported hospitalities at different time, we included the first follow-up period for analysis. We used the 9-star Newcastle-Ottawa quality assessment scale for quality assessment of cohort studies . The scaP ≥ 0.10 was considered to indicate no significant heterogeneity. If no heterogeneity exits in the pooled result, results of random and fixed models are the same, and if significant heterogeneity is present, a random model is more conservative. And we used I2 test to assess the grade of heterogeneity. The grade divided into four levels, included low (0–25%), mild (25%–50%), moderate (50%–75%) and high (≥ 75%) [The data on the adjusted results were used for this meta-analysis. Heterogeneity among potentially studies was firstly assessed with the Q statistic, if  (≥ 75%) . We used (≥ 75%) . For sen


Mycoplasma pneumoniae (M. pneumoniae) and membrane-shed microparticles (MPs) in vulnerable atherosclerotic plaques. H&S Science and Biotechnology developed PTCTS, composed by natural particles from medicinal plants (PTC) combined with trans-Sialidase (TS), to combat MPs and Mycoplasma pneumoniae. Our aim was to determine the effects of the different components of PTCTS in a rabbit model of atherosclerosis. Rabbits were fed with high cholesterol diet for 12 weeks and treated during the last 6 weeks with either vehicle, PTC, TS, or PTCTS. Lipid profile and quantification of MPs positive for Mycoplasma pneumoniae and oxidized LDL antigens were carried out. Aortas and organs were then histologically analyzed. PTCTS reduced circulating MPs positive for Mycoplasma pneumoniae and oxidized LDL antigens, reduced the plaque area in the abdominal aorta, and caused positive remodeling of the ascendant aorta. PTC caused positive remodeling and reduced plaque area in the abdominal aorta; however, TS had a lipid lowering effect. PTCTS components combined were more effective against atherosclerosis than individual components. Our data reinforce the infectious theory of atherosclerosis and underscore the potential role of circulating MPs. Therefore, the removal of Mycoplasma-derived MPs could be a new therapeutic approach in the treatment of atherosclerosis.Previous studies showed the presence of Human atherosclerosis is a chronic systemic process, characterized by the presence of arterial wall thickening due to the accumulation of lipids, endothelial dysfunction, and inflammatory and fibroproliferative responses, resulting in the formation of atherosclerotic plaques, vascular proliferation, and extracellular matrix changes .When levels of LDL rise in systemic circulation, they bind to proteoglycans and increase their retention time in the arterial intima, settling on it, where they are oxidized by free radicals, triggering the inflammation that damages the endothelial barrier function, increasing thus vascular permeability . Mycoplasma pneumoniae (M. pneumoniae) was present within the atherosclerotic plaques, with greater quantities in vulnerable plaques, which broke and led to acute myocardial infarction, when associated with Chlamydophila pneumoniae  and triglycerides (TG). Similar procedure was performed immediately before the start of treatment with PCT, TS, or PTCTS and at the end of the experiment following the sacrifice of the animals. Samples obtained were named basal, pretreatment, and posttreatment, respectively.Biochemical analyses of total cholesterol and its fractions were performed at the Laboratory of Clinical Analysis, while histology and immunofluorescence analyses were performed at the Cardiac Pathology Laboratory, both at the Heart Institute of the Faculty of Medicine, University of São Paulo (InCor-HCFMUSP).The animals were sacrificed by first administering intramuscularly an anesthetic  in addition to barbiturate  to deepen the anesthetic action. Following this, animals were injected with 3 mL of potassium chloride by intracardiac route. Animals were immediately subjected to necropsy.Aorta was dissected from the monoblock of organs, sectioned at its root and iliac bifurcation. Cross sections along the aortic root containing approximately 0.5 cm extension from the ascending portion of the artery, 2 mm above the bronchial branches and 2 mm below the renal arteries, were made, and these fragments were then immediately embedded in paraffin for histological analysis.μm of thickness. Sections were then stained with hematoxylin and eosin (H&E) and scanned by ScanScope CS System®  with an objective Olympus UPlanSAPO 20x attached to the scanner that generated image files “.svs” that were then analyzed by Aperio ImageScope View software .Then, paraffin blocks were sectioned with a microtome into sections of 5 By means of the software aid, we measured at the ascending portion of aorta the external elastic lamina perimeter (PE); the internal elastic lamina perimeter (PI); the area of the middle layer (AM); potential lumen of the vessel (LP), vessel lumen without the plaque; the real lumen of the vessel (LR), vessel lumen with the plaque; the area of atheromatous plaque (AP); and the percentage of vessel obstruction (% Obs).In the thoracic and abdominal portions, we evaluated the total length of the fragment (Et), the length of the atheromatous plaque base (Ep), and its total area (AP).During the sacrifice, samples of liver, spleen, and kidneys were fixed in 10% buffered formalin, pH 7.4, for 24 hours, which were processed for embedding in paraffin. The paraffin blocks were serially 5 um sectioned, stained with H&E, scanned through ScanScope CS System , and finally analyzed qualitatively in Aperio ImageScope View software . The analysis of sections from these organs evaluated the integrity of tissues and cells, the presence of lesions, and cellular changes. M. pneumoniae and oxLDL antigens. This analysis was performed in the serum of animals from the different stages of the protocol .Immunofluorescence technique was used to quantify the numbers of MPs positive forTo separate MPs, total serum solution was mixed with H medium  and then centrifuged and thus separated into two phases: pellet and supernatant. Both fractions were analyzed fresh. Immunofluorescence analysis was performed on the supernatant where MPs are present. M. pneumoniae .The serum supernatant from animals in each group was incubated with primary antibody against oxLDL  or primary antibody against M. pneumoniae were incubated with donkey anti-mouse secondary antibody  .For detection, aliquots labeled with oxLDL antibody were incubated with donkey anti-mouse secondary antibody (Alexa Fluor 488 IgG H + L) , while aliquots labeled with antibody againstImages of immune-stained slides with their fluorophores were captured in fluorescent microscope EVOS FL Cell Imaging System (Advanced Microscopy Group (AMG), Thermo Fisher Scientific, Waltham, Massachusetts, USA) using an objective of magnification ×20 and saved in JPG format to be quantified with the IrfanView  software. The numbers of MPs were then quantified in two blind fields (4 pictures from each) from each sample, with magnification ×20.The quantitative variables obtained were expressed as mean ± SD. Statistical analysis was performed using SigmaStat for Windows, version 3.5.t-test. Paired t-test was applied to compare data obtained from animals of the same groups at different collection times (pretreatment versus posttreatment) in serum.The differences between CNeg × CPos were calculated using Student's T) using ANOVA test in order to verify if differences were induced by the treatment.For comparison of serum analysis between groups, we used the difference between the values of the pretreatment and posttreatment sampling  by Student's Later, PTCTS and CPOs data were compared to the other groups by ANOVA (CPos × PTCTS × other treatments). When ANOVA showed significant differences, the comparison between groups was performed using the post hoc Bonferroni test for data that passed the normality test and the Dunn test for analyses that did not pass the test, always setting the CPos as control.P < 0.05 as statistically significant.In all analyses, we considered As shown in P = 0.03), n-HDL cholesterol (P = 0.005), and triglycerides (P = 0.04). When compared to CNeg group, CPos increased significantly the TC (P = 0.009) and n-HDL cholesterol levels (P = 0.002); however, no differences were observed for the other variables  (CPos group showed a significant increase between pretreatment and posttreatment regarding TC ( = 0.09) .P = 0.02), n-HDL (P = 0.02), and triglycerides (P = 0.005) values and a modest decrease in the levels of HDL (P = 0.07) when we compared the pretreatment versus posttreatment samples. When comparing the ΔT difference between values of lipid profile with CPos, it was noted that they did not show any statistically significant differences .Biochemical analysis of serum from animals in the PTCTS group showed a significant increase in TC  or even when ΔT differences were compared to CPos and PTCTS groups .The PTC group showed no reducing effect over lipid profile when we have compared pretreatment versus posttreatment phases  and increased, although not significantly, n-HDL cholesterol (P = 0.08) between pretreatment and posttreatment stages, with no significant changes in the other variables . When comparing the ΔT differences to CPos and PTCTS groups, TS group showed a reduction in TC levels (P = 0.05) with no other differences .The TS group showed a lowering effect over HDL cholesterol ; however, they had larger plaque area (P = 0.003), increased % Obs of the vessel (P = 0.004), and decreased LR (P = 0.04), as shown in P = 0.73); however, CPos rabbits showed higher Ep (P = 0.004) and AP (P = 0.002). Similar results were observed in the abdominal aorta .The analysis of the ascending aortas of animals from CPos group showed no difference compared to CNeg group in relation to the size of the vessel , PI (P = 0.04), LP (P = 0.01), LR (P = 0.04), and AM (P = 0.01) when compared to CPos group, with no differences in the other variables . The thoracic aorta of animals from the PTCTS group showed no difference in the other variables compared to CPos . However, the abdominal aorta showed lower plaque length and plaque area in the group treated with PTCTS  although not significantly   .P = 0.03), PI (P = 0.03), and LR (P = 0.03) values compared to CPos and PTCTS groups . No histological differences were found in the thoracic  or in the abdominal portions of the aorta  in comparison to CPos and PTCTS groups , thoracic , or abdominal  portions of aorta when compared to CPos and PTCTS groups  to determine whether treatments influenced the number of these MPs , as shown in P = 0.57) , while there was no difference regarding MPs positive for oxLDL antigens (P = 0.37) as shown in Tables The analysis of samples from pretreatment and posttreatment stages revealed that the CPos group had significantly increased numbers of MPs positive for = 0.57) . CNeg gr = 0.57)  and 5. W M. pneumoniae antigens , while the evaluation of ΔT showed that the treatment had a clear effect in reducing such MPs compared to the CPos group .The treatment of animals with PTCTS reduced the number of MPs positive for oxLDL ands Tables  when theP = 0.28) and showed only a tendency to remove MPs positive for M. pneumoniae antigens (P = 0.06). The comparison of ΔT showed that the treatment of animals with PTC had no significant effect on both MPs positive for M. pneumoniae  and those positive for oxLDL (P = 0.11) antigens (Tables The PTC treatment was not able to reduce the number of MPs positive for oxLDL antigens (s Tables  and 5.P = 0.07) or M. pneumoniae (P = 0.13) antigens. When comparing the ΔT differences to CPos and PTCTS groups, TS group showed no differences in the count of both types of MPs  , and intense infiltration of lymphocytes, foam cells, and the presence of fat. The kidneys of animals from CPos group showed lymphocyte infiltration, the presence of fat, and typical cell change of fibrotic process, while the spleen contained xanthomatous macrophage and fat infiltration, besides presenting diffusion of red and white pulps.CPos group showed organs with altered aspects, with significantly increased size of the liver compared to CNeg group .Before the start of the treatments with the compounds, it was possible to note that, as expected, the hypercholesterolemic diet increased serum levels of total cholesterol and its fractions in animals that were exposed to the diet in comparison to baseline. M. pneumoniae and oxLDL antigens, even in CPos, which already had high baseline levels of MPs, indicating that Mycoplasmas and Mycoplasma-derived MPs may play a role in the development of atherosclerotic disease.In addition, we noted that there was an increase in serum MPs positive for M. pneumoniae antigens, although not significantly, when we compared between pretreatment and posttreatment stages. Furthermore, PTC did not affect the number of MPs positive for oxLDL in comparison to animals from CPos and PTCTS groups.The treatment of animals with PTC did not show any lipid lowering properties when pretreatment and posttreatment stages were compared or in comparison to CPos and PTCTS groups. However, PTC could reduce the number of MPs positive forIn addition, the PTC treatment did not show a significant antiatherosclerotic effect since it was not capable of reducing plaque area in the ascending aorta, location known to be more affected by atherosclerotic disease, together with the aortic arch, due to high pressure blood and therefore more likely to exhibit endothelial injury . HoweverImportantly, PTC treatment also showed important differences in the structure of the aorta with larger values of the external and internal perimeters compared to CPos, indicating that the vessel diameter in this group of the animals was greater. Such data associated with the potential and actual lumen values larger than the animals from CPos group, even with similar plaque area values, are indicative of positive remodeling, a phenomenon described by Glasgov et al. , in 1987The treatment of animals with TS significantly reduced serum HDL levels, although TG, n-HDL cholesterol, and total cholesterol levels remained high, which could be considered as a step towards an antilipidemic action. However, given alone, TS did not show any antiatherosclerotic effects in any of the analyzed portions of the aorta.−7 mg/mL, 100 μL/day], TS treatment was associated with a small antilipidemic effect and did not cause any further worsening of atherosclerosis in cholesterol-fed animals. Although an effect of the administered TS on circulating LDL particles cannot be completely ruled out, the daily dose of TS administered to rabbits in our study is very low compared to the concentration of TS which was shown to cause a modification of LDL particles [A negative correlation was previously observed between sialic acid levels of LDL and the capacity of these lipoprotein particles to cause intracellular accumulation of cholesterol . Comparearticles . Therefo M. pneumoniae or oxLDL antigens in circulating blood. This could be, partly, explained by the instability of TS in the acid pH of the stomach after oral administration.Furthermore, the administration of TS alone showed no ability to remove MPs positive for M. pneumoniae antigens in the serum of rabbits after treatment and in lowing lipid levels, two factors of paramount importance in the development of antiatherogenic and anti-inflammatory response.We found here, however, that the combination of PTC and TS, PTCTS, was effective at several levels in atherosclerotic rabbits such as in removing MPs positive for oxLDL andFurthermore, PTCTS demonstrated positive effects on the structure of the aorta by inducing changes in the vessel size as compared to negative and positive controls. These differences are again indicative of positive remodeling such as the one observed in the PTC group.Even with no effects over the composition of the plaque or its vulnerability, the treatment of rabbits with PTCTS could reduce, although not significantly, the amount of plaque present in the abdominal portion of the aorta, suggesting a more effective antiatherosclerotic effect compared to PTC alone. The effects of treatment of rabbits with TS were different from those of the treatment with PTC; however, the effects of PTCTS presented characteristics from both components, indicating that the combination of the two components together is complementary.The initiation of this study was based on previous work from our group, in which the PTCTS was administered intramuscularly to atherosclerotic rabbits and could remove almost completely plaque area in both the thoracic and abdominal portions or the aorta, as well as at the ascending aorta, while reducing the serum total cholesterol and its fractions and bringing them back to baseline levels . HoweverIt is known that oral administration of medications has many advantages, such as the fact that it is a safe and practical way that allows self-administration as well as being more economical; however, it also has some disadvantages that should be taken into consideration. For instance, the absorption can range from moderate to low as well as high likelihood of partial loss of the drug by inactivation of the active ingredients due to the action of gastric enzymes and acid pH, while intramuscular route of administration is rapid and has systemic absorption.The difference in the results with respect to antilipidemic and antiatherosclerotic actions of PTCTS may be due to either lesser plasma bioavailability with oral administration because of incomplete absorption or loss of some of the activity caused by the action of gastric enzymes.Therefore, it is warranted to devise future pharmacokinetic studies to adjust the dose, treatment time, and delivery vehicle such that the compound holds its integrity even in the low pH environment of the stomach. We are currently testing the application of the compound in a stabilizing gel, which may eventually be included in gelatin capsules, allowing for a higher concentration of the drug to reach the bloodstream and target organs. M. pneumoniae antigens.In conclusion, we have observed here that PTCTS components have different effects when administered alone. PTC treatment caused positive remodeling of the vessel, while the TS had lipid lowering effects with reduced TC in addition to the elimination of MPs positive forWhen combined, the PTC and TS complemented the action of each other, allowing PTCTS to achieve more comprehensive actions and leading to a better therapeutic result, by improving lipid and liver profiles, the elimination of MPs, and causing positive vascular remodeling.It is clearly warranted that, in order to achieve optimal results against atherosclerosis comparable to subcutaneously injected PTCTS, it is important to optimise the dosage, formulation, and the period of treatment for oral use of PTCTS.Altogether, the findings reported in the present study reinforce the infectious theory of the pathogenesis of atherosclerosis and underscore the potential key role of circulating MPs originating from such microorganisms in the development of the disease. Therefore, the removal of these MPs from blood could be a new therapeutic approach in the treatment of atherosclerosis.


We present three patients from Suriname who were diagnosed with Guillain–Barré syndrome (GBS) during the Zika virus (ZIKV) outbreak in this country. One patient had a positive ZIKV urine real-time RT-PCR (qRT-PCR) result. The other two patients had a negative ZIKV urine qRT-PCR but a positive virus neutralization test and presence of IgG antibodies against ZIKV in the serum. Considering the evidence of a past ZIKV infection and absence of evidence for recent infections with the most common preceding infections of GBS, it is very likely that these GBS cases were triggered by ZIKV. Since the Zika virus (ZIKV) outbreak in South America, an increased incidence of microcephaly and the Guillain–Barré syndrome (GBS) is reported in several affected countries in South America , 2.Campylobacter jejuni, Cytomegalovirus (CMV), Epstein–Barr virus (EBV), Mycoplasma pneumoniae, hepatitis E virus, and now ZIKV  in the CSF in absence of cells. Due to the typical presentation of symmetrical flaccid muscle weakness with decreased or absent deep tendon reflexes, an albuminocytologic dissociation in the CSF and absence of a sensory level, fever, encephalopathy, or other clinical signs of myelum involvement, the diagnosis of GBS was considered the most probable. ZIKV real-time RT-PCR (qRT-PCR) was performed locally on urine taken at day five after admission and was negative  score 4 , absent deep tendon reflexes in the legs and decreased deep tendon reflexes in the arms. During admission, the patient developed a unilateral peripheral facial nerve paralysis and areflexia in both legs and arms. A lumbar puncture was performed 3 days after hospital admission, and an elevated protein level was found . A urine sample, taken at day two after admission, was tested positive for ZIKV RNA with a Ct-value of 35.7 . Areflexia in both legs and arms was noted. The patient complained of paresthesias and pain in the legs but did not have a sensory level or other signs of myelum involvement. A lumbar puncture was performed 2 days after admission, and a high protein level was found in the CSF (4.4 g/L) while the cell count was slightly increased 32.7 × 106/L. A ur6/L) taken 5 days after admission. The progressive phase of the muscle weakness lasted for 6 days after which the patient started to recover. Motor NCS showed a decreased dCMAP and NCV and increased DML in predominantly the legs but also the arms. The tibial nerve was inexcitable in both legs . Features of demyelination were only found in one nerve, and as such the NCS results were classified as equivocal  and areflexia in all limbs. An elevated protein level with a mild increased cell count was found in the CSF , 5 and 7 (case 2), and 3 (case 3) after hospital admission.C. jejuni and showed an infection in the past with CMV (high avidity IgG anti CMV) and EBV. All serum samples tested negative for dengue virus (DENV) IgM antibodies and non-structural protein 1 (NS1) antigen and positive for DENV IgG antibodies. ELISA was used to detect the presence of IgM and IgG antibodies against GM1, GM2, GD1a, GD1b, GT1b, and GQ1b, and paired complexes of all these gangliosides in the acute phase serum of the patients  myelitis. None of the patients had a sensory level, increased or pathological reflexes, fever, encephalopathy, or other symptoms suggesting an acute myelitis, and there was no marked pleocytosis in the CSF. Only motor and no sensory NCS were performed in these patients. The results of the motor NCS were consistent with GBS in all three patients. Furthermore, all patients had progressive symmetrical muscle weakness with areflexia, a monophasic disease course, an albuminocytologic dissociation in the CSF, and absence of an identified alternative diagnosis for muscle weakness. All patients thus scored the highest level for diagnostic certainty for GBS (level I) according to the diagnostic criteria for GBS of the Brighton collaboration and were therefore diagnosed with GBS   . A recenFlavivirus exposures plays a role in the pathogenesis of ZIKV-associated GBS.The exact pathophysiological mechanism behind ZIKV-associated GBS remains to be elucidated, but antibody-dependent enhancement (ADE) of ZIKV infection might play a role. It has recently been described that DENV antibodies that are able to bind ZIKV, but cannot neutralize ZIKV, can promote ADE that can result in greater ZIKV replication . The thrTaken together, we can conclude that in the three presented cases, the relation between ZIKV infection and GBS was confirmed in one patient, and was plausible in the two others, given the increased GBS incidence during the ZIKV outbreak in Suriname, the ruling out of most prevalent preceding infections of GBS and the presence of ZIKV neutralizing antibodies in these patients. For definitive proof of this association, case–control studies are needed, using stringent and standardized diagnostic criteria, both for GBS and for the laboratory diagnosis.This study was approved by the Ministry of Health of Suriname. All participants signed informed consent prior to participation in this study.TL, BJ, CR, MK, EG, CG, and SV wrote the manuscript. MB, HY, and HA cared for the patients. TL, LD, TK, HY, and MB collected the data. JC, JR, and SP were responsible for the molecular diagnostic tests. EB, RM, CG, and CR were responsible for the serological tests. All authors reviewed and approved the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer VG and the handling Editor declared their shared affiliation, and the handling Editor states that the process nevertheless met the standards of a fair and objective review.


Objective: To assess the correlates of the high risk sexual behaviors of Polish migrants in the United Kingdom (UK) after 2004, and to compare such behaviors before/after immigration. Methods: In 2013, a cross-sectional study was conducted through the use of a Computer-assisted web interviewing surveying technique with the use of a self-administered questionnaire. Results: Among 408 respondents (56.9% women), with a median age of 32 years, significantly more admitted to having unprotected sexual contact with a casual partner while in the UK (p < 0.0001) than while in Poland; more were engaged in sex after the use of recreational drugs and alcohol (p < 0.0001 and p = 0.001 respectively). Being a male was associated with greater odds of unprotected sex, sex after the use of alcohol, and having multiple partners. Being single and having only been a resident for a short time in the UK, presenting a lower self-esteem, were predictors of unprotected sex. A total of 19.6% of the respondents admitted to having been tested while in Poland, a lower (p < 0.0001) frequency than while in the UK (49.5%); this referred to both genders; 1.2% (95% CI: 0.79–2.83%) reported that they were HIV positive. Conclusions: Migration can create a vulnerability to STIs, especially for single male migrants with low self-esteem, staying in the UK for less than two years. The results point to strengthening strategies which help reduce high risk sexual behavior among Polish migrants, and to introduce interventions to promote an awareness of HIV sero-status.  In May 2004, ten more nations, including Poland, became members of the European Union (EU). This gradually gave citizens of these countries the opportunity to seek work in other EU member states, particularly those countries granting full work rights. Of note, central and east European nationals were allowed to work in the UK, Sweden, and Ireland immediately after accession. If the average length of stay abroad is considered, the UK became the most important destination country for Polish migrants, post EU enlargement . Poland The relocation to a new country initiates various cultural and psychological changes that involve a number of forms of mutual accommodation, leading to longer-term psychological and socio-cultural adaptations . Such a While some recent research conducted in Europe ,8,9, as According to global literature, risky sexual behaviors among migrants are influenced by a wide range of personal, social, and cultural factors ,13,14. AAlthough according to a study among central and eastern European (CEE) migrants to London , reportsMore needs to be done to improve the understanding of the relationship between migration and sexual health, and to address migrant sexual health. Therefore, the objective of this study was to assess the correlates of high risk sexual behaviors of adult Polish migrants in the UK after 2004, and to compare such behaviors before and after immigration.www.ankietka.pl (the largest Polish system for comprehensive survey studies) utilized for the purpose of this survey. The following eligibility criteria needed to be met in order to participate in the study: self-identification as a recent post-accession Polish migrant in the UK, aged 18 years or over, and agreement to take part in the study. Recruited participants with whom contact had already been made could use social networks to refer the web site to other people who could potentially participate in the study . To preserve the anonymity of the respondents, a Computer-Assisted Web Interview method was used. This is an Internet surveying technique in which the interviewer fills in questions following a script provided on the website. The research questionnaires are made in a program for creating web interviews and are shown on the site in such a way as to be available online for respondents to fill out [The cross-sectional study was conducted between March and August 2013 among recent post-accession Polish migrants in the UK. As there is no adequate sampling frame for this new migrant population ,19 the ssocio-demographic: age; gender; education level ; marital status ; religion ; sexual orientation ” and “other sexual orientation”); professional situation ; length of stay in the UK ; and place of residence in Poland ;during the before-migration period and in the UK in the past 12 months .risky sexual behavior in Poland in the past 12 months determinants of risky sexual behaviors:personal: self-esteem measured by the Rosenberg self-esteem scale (RSES) .environmental/cultural: a. life satisfaction measured by the Berry’s MIRIPS Questionnaire , b. the HIV testing; participants were asked to answer the following question: Have you ever been tested for HIV: in Poland/in the UK? .A previously diagnosed HIV infection; participants were asked to answer the following question: Have you had an HIV infection diagnosed by a medical professional? .A self-administered questionnaire was designed with the use of a literature review ,9,12,13.Respondents were able to review and change their answers through a Back button. The survey tool was pilot-tested with 30 members of the immigrant community (results included). After reviewing the comments from the respondents included in the pilot study , a few amendments were made to improve the clarity of the questions for the study population. Informed consent was obtained from all participants through the dedicated web site. The study received approval from the Ethical Committee of London’s Polish University Abroad (reference number PUNO-EC/1/2013).unprotected sexual contact with a casual partner,sexual contact after the use of alcohol or recreational drugs,having multiple sexual partners.the pre- and post- migration comparison .variables influencing these outcomes while in the UK.in the context of:Data were validated using a customized program STATISTICA PL Version 12.5.  and R (R version 3.0.2) software . Our maip < 0.05) at the bivariate level were used to build a multivariable logistic regression model ; with the help of R software [A bivariate analysis assessed the demographic characteristics , together with the time spent in the UK and previous sexual education, associated with the outcome variables. The categorical variable groups were compared using the chi-square test with Yates correction and Fisher’s exact test; the Mann-Whitney test was used for the numerical variables. All of the variables significant  completed it.Among the 408 respondents (56.9% women), with a median age of 32 years, the vast majority (99.7%) were at least high school graduates, 74.5% came from Polish towns of between 50,000 and 500,000 inhabitants, most (89.2%) had regular employment in the UK, almost two thirds (63.9%) were married or living in an informal relationship (cohabiting), and 78.7% were religious (mostly Catholics). The vast majority of respondents (89.0%) were heterosexuals; there were 21 (5.1%) MSMs in the study. Almost half of the respondents (47.5%) came to the UK ≤2 years ago; More than one fourth of the respondents (29.0%) had a low self-esteem, measured with the use of RSES; 9.3%-average self-esteem and 61.5%-high self-esteem. A total of 18.4% of the participants had a low level of life satisfaction; 24.0%-an average and 57.6%-high. More than half of the respondents (53.2%) received regular sexual education at school. p < 0.0001) frequency than while in Poland (20.6%); more were engaged in sexual contact after the use of recreational drugs in the UK than in Poland , and also after alcohol intake ; p = 0.24). Regarding unprotected sexual contact with a casual partner, 38.7% of the respondents admitted to having unprotected sexual contact with a casual partner while in the UK, a greater , and less frequently reported having multiple partners (p = 0.008), while females were significantly more often engaged in sexual contact after the use of recreational drugs (p < 0.0001).Males were significantly more often engaged in unprotected sex and sexual contact after the use of recreational drugs/alcohol than while in Poland (p < 0.0001) frequency than while in the UK (49.5%); this referred to both genders (p = 0.02). Five participants (1.2% 95% CI: 0.79%–2.83%) reported that they were HIV positive. Regarding HIV testing, 19.6% of the respondents admitted to having been tested while in Poland, a lower , and difficulties in the acculturation process ,13. ImpaOf note, the use of illicit psychoactive substances is not a minority activity amongst young people in the UK . RelativThe aforementioned issues might explain the increase in the rates of risky sexual behaviors among Polish migrants in the UK when compared with rates before immigration. Furthermore, this new environment can give Polish migrants a sense of anonymity that facilitates risky behavior.Similar to the results presented in this study, a survey focusing on recent Latino immigrants in the U.S. noted that migrant men were also significantly more likely to engage in sex while under the influence of drugs or alcohol after migration; a decrease in condom use among males was observed after migration to the U.S. . We founThe results of this study show that numerous variables correlate with high risk sexual behaviors after migration to the UK. Du et al. reported that gender is a notable moderator of the relation between acculturation and sexual risk behavior . Gender Indeed, sexual risk behaviors among Polish migrants in the UK differed across genders. While in Poland, significantly more men reported condom use than women, which is in line with another Polish study . This caBeing single was associated with about a two times greater odds of unprotected sexual contact and of having multiple partners in this study. Considering the fact that one third of the respondents were living alone, which reflects the migrant population data ,7, this Experience of migration may negatively influence self-esteem ,32. AccoThe results of this study show that migrants with a higher educational status and those employed were much more likely to be engaged in this type of behavior. One motivation for trying recreational drugs is the desire for novel experiences ,42. AccoA short period of time spent in the UK was found to be significantly associated with high risk sexual behavior in this study, such as unprotected sexual contact with a casual partner and sexual contact under the influence of recreational drugs. However, according to a recent study on sexual and HIV risk behavior in CEE migrants in London (41% of them from Poland), which took place between 2008 and 2009, no associations between time in the UK and the high risk sexual behaviors were found . RegardiAccording to the study conducted by Evans et al. of CEE migrants in London, the reported HIV prevalence was similar (1.1%) to that observed by us (1.2%) ,19. Nevep < 0.0001) frequency than while in the UK; this referred to both genders. Potentially, migrants may be aware of their risky sexual behaviors in the UK, which are more frequent than while in Poland, and therefore utilize screening opportunities more often. Migrants form eight CEE countries  surveyed by Burns et al.  were mucNevertheless, the reported HIV prevalence among Polish migrants is worrisome, especially in light of the low estimated prevalence observed in the general Polish  and BritFirstly, the study design  limits the ability to draw causal inferences. Secondly, a random sampling method was not used to select the study population. Therefore a self-selection bias was possible. However, it was difficult to create a proper sampling frame due to the scant information available on some immigrant sub-groups, such as undocumented or recent migrants . CollectThese findings highlight the potential increasing risk for STIs of Polish immigrants in the UK who have frequent (more frequent than before immigration) unprotected sexual contact, sex under substance use, and sex with multiple sexual partners, but also if they acquire STIs, the increasing likelihood of transmitting such infections to their sexual partners. Furthermore, these results may explain, to some extent, how migration can create a vulnerability to STIs, especially for single male migrants with low self-esteem and a short duration of stay in the UK.Such findings have implications for the targeting of prevention and intervention efforts for migrants tailored to facilitate the access to specialists to promote and maintain psychological and sexual health. Difficulties related to discussing intimate relations in a foreign language can prevent the uptake of services . A lack


Toxoplasma gondii, and it has global distribution. The purposes of this systematic review and meta-analysis were to evaluate the seroprevalence of toxoplasmosis in Iranian pregnant women, and girls and women of childbearing age, and identify potentially preventable risk factors.Toxoplasmosis is caused by an intracellular obligatory parasite, T. gondii seroprevalence in Iranian women were searched. Our search resulted in 83 reports published from 1994 to 2017.Between November 2014 and February 2017, nine electronic databases that reported data on the T. gondii using a random-effect model was 43%  = 38–48%) in pregnant women and 33% (95% CI = 23–43%) in girls and the childbearing age groups. There was a significant association between the T. gondii seroprevalence with age and the gestational age of conception in pregnant women and those who had contact with cats in both groups.The results showed that the pooled estimation for the prevalence of T. gondii infection seroprevalence in Iranian women, which showed a high prevalence of Toxoplasma infection. Around 57% of pregnant women and 67% of girls and the childbearing age groups were seronegative and thus were susceptible to infection and should be monitored.This is the first comprehensive systematic review of The online version of this article (doi:10.1186/s41182-017-0048-7) contains supplementary material, which is available to authorized users. Toxoplasma gondii [T. gondii is spread worldwide, as at least one third of the world’s population is infected [T. gondii varies from 30 to 60% in both developing and developed countries [Toxoplasmosis, a cosmopolitan infection in humans and animals, is caused by an intracellular obligatory parasite, a gondii . T. gondinfected . The broinfected . The worountries . Infectiountries , 6.T. gondii remains dormant in healthy individuals, exposure to parasites during pregnancy can lead to vertical transmission to the embryo [T. gondii may develop congenital toxoplasmosis with microcephaly, hydrocephaly, blindness, spontaneous abortion, and stillbirth [Toxoplasma antibodies in pregnant women and also non-immune girls of childbearing age is the mainstay for controlling and preventing congenital infection [Toxoplasmosis can lead to life-threatening conditions in high-risk groups such as pregnant women, immunodeficient individuals  , 8. Althe embryo . The ince embryo . A newboillbirth . It may illbirth . It is iillbirth . Exceptiillbirth . Screeninfection , 11, 14.T. gondii is ubiquitous, seroepidemiologic studies help establish the health policies of each country. The purposes of this systematic review and meta-analysis were as follows: (1) to evaluate the seroprevalence of toxoplasmosis in Iranian pregnant women, (2) to estimate the prevalence of T. gondii in girls and women of childbearing age, (3) to identify the potentially preventable risk factors most likely to have the greatest impact on the incidence of Toxoplasma infection in pregnancy, and (4) to determine whether seronegative women are a high-risk group for toxoplasmosis that need specific control and prevention strategies to reduce the level of Toxoplasma infection.Because of its importance and the fact that The following four literature search strategies were used in this systematic review and meta-analysis: (1) computer search, (2) study selection, (3) data synthesis, and (4) data analysis and quality assessment.Toxoplasma gondii, toxoplasmosis, women, girl, pregnant women, childbearing age women, abortion, seroprevalence, seroepidemiology, Iran, and Islamic Republic of Iran. All citations were downloaded into EndNote.Six English language databases  and three Persian databases  were searched from 1994 to 2017. The search was restricted to English- and Persian language databases. Medical Subject Heading terms and keywords included Toxoplasma infection in pregnant women, women of childbearing age, women with an abortion, student girls from a university or high school, and girls referred to health centres for premarital laboratory tests or a medical laboratory for routine tests, except T. gondii, were selected for further use.Abstracts were reviewed independently by 4 authors, and cross-sectional studies that estimated the seroprevalence of The final decisions about the inclusion or exclusion of studies were made separately after inspection. Discrepancies were resolved by discussion and consensus. In addition, the collected bibliographic publications were screened carefully, and duplicate articles, studies based in Iran, animal-based studies, and those with a specific population  were also excluded.A protocol for data extraction was defined with groups. Data were extracted from selected publications using a data extraction sheet by authors, and then, the data were reviewed by a third author. The following data were extracted from the literature: first author, geographical region, the year of publication, diagnostic method with the cut-off value, total individuals, number of immunoglobulin (Ig)G-positive and IgG-negative cases, number of IgM-positive and IgM-negative cases, and number of both IgG- and IgM-positive cases among the study groups.All information included demographic factors such as contact with cats and other animals, the consumption of raw fruits and vegetables, washing methods, the consumption of undercooked meat and unpasteurized milk, age, occupational group, education level, place of residence, number of pregnancies and abortions, and gestation age of the total individuals and positive cases. Whether the subjects wore gloves when cutting meat and had contact with soil was also collected. Figure T. gondii in all groups or subgroups, included in this meta-analysis, was P = ∑ (pi) (1/vi)/∑ 1/vi. We used the metaprop command of STATA, version 12.1 , for pooling proportions. We estimated 95% confidence intervals (CIs) using the score statistic and the exact binomial method, and Freeman-Tukey double arcsine transformation of proportions via the ftt option. Forest plots were drawn to display the variation of the seroprevalence of the Toxoplasma infection test positivity rate among all studies together with the pooled measure and subgroup analysis. Heterogeneity of the prevalence estimates between studies was determined by the Q statistic and I2 index, assuming that I2 values of 25, 50, and 75% represented low, medium, and high heterogeneity, respectively. Therefore, we assess the quality of each study ) of = ∑ (pi) /vi/∑ 1/vToxoplasma infection among pregnant women. Approximately all the studies included in this meta-analysis had a cross-sectional design. Of 40,117 individuals, 16,698 cases had Ig against T. gondii and were included in the meta-analysis, followed by 39,837 individuals, with 15,822 positive cases for IgG, 16,590 with 652 positive cases for IgM, and 5447 with 224 cases positive for both IgG and IgM.Of 97,553 literature searches from nine databases, 83 records were eligible to include in this systematic review and meta-analysis. Thirty-eight articles reported results about the seroprevalence of toxoplasmosis in women and girls of childbearing age, 45 about the seroprevalence of Toxoplasma seropositivity in the girls group  based on the random-effect model was 33% (95% CI = 23–43%). Figure The prevalence of anti-95% CI = 3–43%. FiToxoplasma seropositivity and contact with cats (P = 0.04). Although the seroprevalence of Toxoplasma infection was higher among individuals who had direct contact with cats (30%); groups without contact with other animals (26%); individuals who consumed raw meat (34%), milk (45%), and fruits or vegetables (24%); individuals who washed vegetables or fruits with water (27%) and cut meat without wearing gloves (18%); individuals who had a low education level (63%); and those who were employed (53%) and were aged >20 years, there were no associations between these aforementioned factors and the rate of Toxoplasma infection. Table Data analysis showed that there was a significant relationship between  animals 6%; indivToxoplasma antibodies in pregnant women using the random-effect model was 43% (95% CI = 38–48%). Figure The pooled estimation for the prevalence of anti-P = 0.004), contact with cats (P = 0.005), gestation age of the pregnant women (P = 0.001), and the rate of infection. Data indicated that although the prevalence of T. gondii infection was higher among individuals who had direct contact with soil (42%); consumed raw meat (41%) and fruits or vegetables (39%); washed vegetables or fruits with water (39%); lived in rural areas (47%); had a senior-junior high school education level (39%); and were aged >30 years (53%), there were no associations between these aforementioned factors and T. gondii antibody positivity. Table In this group, there was a significant association among age groups P = 0.00, contactT. gondii has a wide range of distribution, and seroprevalence data indicate that toxoplasmosis is one of the most common human infections worldwide [Toxoplasma during pregnancy and its outcome for the foetus and newborn continue to occur in Iran and in other countries, despite the fact that it can be prevented. A large body of the research about the seroepidemiology of toxoplasmosis in women has been performed in Iran because of the great importance of T. gondii as a public health problem, but there is a lack of comprehensive systematic and documented data in this area.orldwide . Acute iT. gondii in groups of women were eligible to be included in this systematic review and meta-analysis. The present study showed that the seroprevalence of anti-T. gondii antibodies in Iranian pregnant women and women of childbearing age were 43 and 33%, respectively. A higher prevalence of anti-T. gondii antibodies was observed in previous studies conducted in Iran: 55% in patients who had received transplants, 50% in HIV-infected individuals, and 45% in patients with cancer [T. gondii in pregnant women in Europe varies from 9 to 67% [Toxoplasma infection in pregnant women (41.8–55.4%), conversely, Korea and Vietnam report a low seropositivity rate of T. gondii  [Toxoplasma antibody in pregnant women was found to be 33 and 19.25%, respectively [Toxoplasma infection in women of reproductive age was determined to be 58.3 and 1% for IgG and IgM, respectively [Among all nine databases searched from November 2014 to February 2017, 83 records involving 40,117 individuals and 16,698 cases containing immunoglobulin against ctively) –20. In oectively , 22. Howectively .Toxoplasma infection’s geographical distribution is related to several environmental factors  and sociodemographic factors  [Toxoplasma infection, but together, they can change the distribution pattern of the disease worldwide [sidence) . Any of orldwide .Toxoplasma infection. In the northern part of Iran (around the Caspian Sea), there is a high prevalence of T. gondii infection, whereas in cold mountainous and hot provinces, lower seropositivity rates are found. The right climate status in the northern part provides a suitable condition for oocyst sporulation and survival in the environment. In mild and wet climates, the maturation of oocysts and transmission to a new host happens [Toxoplasma antibodies in both girls and pregnant women in all parts of Iran.The geographical climate is one of the main factors of the disease. Our country has an arid climate, but the weather condition is variable. Some provinces such as Tehran, Fars, Kerman, and Khuzestan have various climates. Thus, an epidemiologic survey in this part of Iran is more difficult to administer. This variation of climatic conditions can introduce biases into the prevalence rate of  happens , 25. AddToxoplasma infection. Domestic cats are one of the main sources of infection. Our results showed that the anti-Toxoplasma antibody in cat and other pet owners was higher than that in individuals who did not own or have contact with domestic animals in both pregnant girls and those of childbearing age. Similar findings were reported by other studies [Toxoplasma infection, needs more consideration [The abundance of cats is another risk factor of  studies , 27. Catderation . PreviouT. gondii showed a higher antibody titre in individuals who consume undercooked meat, milk, vegetables, and fruits and washed them with water only instead of detergent in both aforementioned groups. Lopes et al. and Gelaye et al. showed the same results [T. gondii via contaminated meat with tissue cysts varies between cultural and eating habits in various communities. However, meat is one of the major sources of Iranian meals; thus, the consumption of undercooked meat can lead to the transmission of parasites. There is a risk of Toxoplasma infection by consuming dairy products. Tachyzoites are orally infectious because they can survive in pepsin and trypsin. The consumption of milk containing tachyzoites in girls and women of childbearing age with no prior contact to the organism can lead to horizontal transmission and clinical infection. In seronegative women during pregnancy, the consumption of undercooked meats such as kebab (a meat product like sausage), dairy products, raw vegetables, and fruits can lead to congenital toxoplasmosis, which is a serious problem [In our study,  results , 29. The problem .T. gondii infection among various occupations in both groups was different. In women of childbearing age and the girls group, the seroepidemiology of T. gondii in employees was a little higher than other jobs, but this difference was not significant. Our result was comparable to a study performed in Brazil, which showed a high prevalence of infection in this group [T. gondii oocysts have been isolated from soil samples [Our data showed that the seropositivity of is group . However samples .T. gondii seropositivity was observed. Evidence from a study by Hung et al. supported our finding [Toxoplasma biology and its prevention and control strategies. The lack of effective information about this disease such as the route of transmission during pregnancy and poor socioeconomic status can increase the risk of infection.Published studies have indicated that in women of childbearing age, by increasing the level of education, a rising trend in  finding . The autThe seroprevalence and serologically positive cases increased by age in pregnant groups. Nimiri et al. demonstrated that a higher seropositivity rate was seen in older age groups than in younger age groups . The reaT. gondii in pregnant women who lived in rural areas was higher than those in urban areas. In 2009, Lopes et al. found similar results with our findings [In the current study, the seroprevalence of findings . During findings , 33.T. gondii IgG and IgM detection are feasible [T. gondii infection, and the prevalence was proportionally increased with an increasing number of children. Null gravid women had a prevalence of 41%, whereas women with more than one child had a prevalence of 53%. Our results showed a trend towards an increasing risk of positive T. gondii antibodies with increasing parity. In our study, the rate of anti-Toxoplasma antibodies among women with spontaneous abortion was 44%. This finding is in agreement with reports from Taiwan and Ethiopia [In the present study, the seropositivity rate of infection in the first trimester of pregnancy was higher than that in the second and third trimesters. In all women during conception, ideally in the first trimester, a serological screening test for feasible . This kifeasible . In our Ethiopia , 31.T. gondii epidemiologic survey in both groups was ELISA. ELISA is a quantitative and inexpensive tool with a sensitivity and specificity of 100 and 98.4%, respectively [The most commonly used serological method of available data on ectively . The secToxoplasma infection rely on sufficient information about parasite epidemiology. The knowledge on T. gondii seroprevalence, risk factors, and prevention strategies can lead to efficient incidence reduction [The prevention and control of eduction . The genT. gondii to the foetus always happens during or before conception. In healthy women with previous infection, transmission to the foetus rarely occurs [T. gondii, and the risk of congenital toxoplasmosis is high. Thus, they require serial testing during gestation. Anti-Toxoplasma IgG-positive women should be tested for the IgM antibody, and in IgM-positive cases, confirmative tests are needed. In women with IgG-positive and IgM-negative antibodies, the gestation age is very important. In women at <18 weeks of gestation, it means past infection and the risk of congenital toxoplasmosis is zero. However, in women at >18 weeks of gestation, it is difficult to predict whether exposure happened in the past or during conception. In anti-Toxoplasma IgG-negative and IgM-positive cases, a serological test should be repeated after 3 weeks. In this group, two conditions can occur: the antibody titre persists (IgG− and IgM+) or the IgG antibody changes to positive (IgG+ and IgM+). Management of the first group is the same as that for IgG− and IgM− patients, and in the second group, seroconversion occurs. In this group, the risk of T. gondii transmission to the foetus is high, and treatment, amniotic fluid polymerase chain reaction, and ultrasound should be performed [Secondary prevention includes serological screening. The transmission of y occurs . In botherformed .The results show that there is heterogeneity across the studies as illustrated by the forest plot. The dissimilarity, sensitivity, and specificity of several methods used in various studies, differences in the sample size, nutritional habits, and environmental factors such as the geographical climate can result in this heterogeneity.Toxoplasma in women, which were not comprehensive [Toxoplasma infection in the population of Iranian women.There are many studies based on the seroepidemiologic survey on women with toxoplasmosis in Iran, but there has not been a comprehensive systematic and documented report on this topic, except two articles on the epidemiology of ehensive , 38. TheT. gondii in the overall population of women in our country. The data showed that 57% of Iranian pregnant women and 67% of girls and women of childbearing age were seronegative for Toxoplasma and susceptible to acute infection. Seronegative women are a high-risk group for congenital toxoplasmosis and should be monitored. We suggest that peer-led educational activities such as seminars and workshops are very effective, but they require great organizational efforts and lots of money and time. In Iran, there is no screening programme for women or seronegative pregnant women during gestation, but spouses are referred to health centres for premarital laboratory tests. It is necessary for the Ministry of Health to establish a screening programme and training course for couples who are referred to counselling departments for pre-marriage examinations. The risk factors for Toxoplasma should be documented in pamphlets and brochures with illustrations to make them easy to understand. However, didactic videos may serve as an effective teaching tool in these places. Importantly, health care organizations need to implement vast seroepidemiologic surveys on Toxoplasma infection in women and the disease risk factors using standardized methods, an identical sample size, and unique risk factors, to determine the true seropositivity rate in all provinces.This is the first comprehensive systematic review and meta-analysis of Additional file 1: Table S1.Girls group quality assessment table. (DOC 81 kb)Additional file 2: Table S2.Pregnant women group quality assessment table. (DOC 92 kb)Additional file 3: Figure S1.Toxoplasma total antibodies in both groups in different provinces of Iran. (JPG 380 kb)Prevalence rate of Additional file 4: Table S3.Girls and women of childbearing age group methods of included data. (DOCX 16 kb)Additional file 5: Table S4.Pregnant women group methods of included data. (DOCX 16 kb)