Seasonal challenges of tropical bats (Rousettus aegyptiacus) in temperate zones

Egyptian fruit bats (Rousettus aegyptiacus) manage to survive and flourish in a large geographic range despite the variability of natural and anthropogenic conditions in this range. To examine the challenges faced by free-ranging R. aegyptiacus living at the northern edge of their distribution, we performed a retrospective analysis of ~1500 clinical cases reported by a bat rescue NGO over 25 months, from all over Israel. All cases of injured or stranded bats were evaluated and categorized according to date, place, sex, age, and etiology of the morbidity. The analysis of the data showed an increase in all types of morbidity during the wintertime, with more than twice the number of cases in comparison with the summertime, over two consecutive years. Moreover, we found that the number of abandoned pups peaks during spring till autumn when adult morbidity is minimal. We characterize two prominent types of previously undescribed morbidity in R. aegyptiacus, one in the form of bacterial illness, and the other associated with feet deformation which affects bats in addition to major anthropogenic-related threats related to synanthropic predators. We analyze the reasons driving winter morbidity and conclude that winter weather and specifically low temperature best explains this morbidity. We hypothesize that R. aegyptiacus, a fruit-bat of tropical origin is facing major seasonal difficulties near the northern edge of its distribution, probably limiting its further spread northward.

Prevalence of Growth Restriction at Birth for Newborns With Congenital Heart Defects: A Population-Based Prospective Cohort Study EPICARD

Background and Objectives: Congenital heart defects (CHD) and growth restriction at birth are two major causes of childhood and adult morbidity and mortality. The aim of this study was to assess the overall risk of growth restriction at birth, as measured by its imperfect proxy small (< 10th percentile) for gestational age (SGA), for newborns with CHD.Methods: Using data from a population-based cohort of children born with CHD, we assessed the risk of growth restriction at birth using SGA and severe SGA (3rd percentile). To compare the odds of SGA and severe SGA across five specific major CHD, we used ordinal logistic regression using isolated, minor (non-operated) ventricular septal defect (VSD) as the control group.Results: The overall proportion of SGA for “isolated” CHD (i.e., those not associated with other anomalies) was 13% (95% CI, 12–15%), which is 30% higher than what would be expected in the general population (i.e., 10%). The risk of severe SGA was 5% (95% CI, 4–6%) as compared with the expected 3% in the general population. There were substantial differences in the risk of overall SGA and more so severe SGA across the different CHD. The highest risk of SGA occurred for Tetralogy of Fallot (adjusted OR 2.7, 95% CI, 1.3–5.8) and operated VSD (adjusted OR 2.1, 95% CI, 1.1–3.8) as compared with the control group of minor (non-operated) VSD.Conclusion: The overall risks of both SGA and severe SGA were higher in isolated CHD than what would be expected in the general population with substantial differences across the subtypes of CHD. These results may provide a clue for understanding the underlying mechanisms of the relation between alterations in fetal circulation associated with different types of CHD and their effects on fetal growth.

Do Social Support and Strain Mediate the Relationship Between Childhood Exposures and Frailty in Later Life?

Previous studies have identified the early origins of physical frailty, notably poor childhood health and socioeconomic status, but relatively few studies examine whether social support in later life mitigates the influence of early noxious exposures on frailty. Given the established relationship between health and social relationships in older adults, this research uses data from the Health and Retirement study (2004-2016) to examine whether social support and strain mediate the effect of childhood exposures on frailty in later life. A series of linear regression and pathway models were estimated to test whether childhood exposures, including socioeconomic status, infectious and chronic diseases, impairments, and risky adolescent parental behaviors, were associated with phenotypic frailty (Fried et al. 2001). After adjusting for demographic and adult factors, accumulated childhood misfortune was directly (b=0.015, p<.01) and indirectly (b=0.007, p<.001) associated with more frailty. Average social support, but not strain, from one’s spouse, children, family and friends significantly mediated the relationship between accumulated misfortune and frailty (b= -.002, p<.01). Path analysis revealed that social support reduces later life frailty directly (b=-0.106 ,p<.001) and indirectly through a reduction in adult morbidity (b=-0.031, p<.001). However, counterintuitively we found that accumulated misfortune was associated with more social support. Supplemental analyses reveal that one or more infectious diseases in childhood were responsible for the positive relationship (b= 0.393, p<.001). These results have implications for how we may reduce the burden of frailty on those who have experienced misfortune early in life.

Selection of PPI in a comorbid patient with NSAIDgastroesophagopathy: case study

Over the past decades, there have been significant changes in the structure of adult morbidity. Clinicians are increasingly faced with the problems of combined pathology and development of comorbidity, as well as to solve the issues of rational tactics of management of such patients. Polypragmasia due to comorbidity leads to a sharp increase in the probability of developing systemic and undesirable effects of drugs, while prolonged use of several drugs can lead to the development of complications that develop into independent nosological forms, which is especially important in older age groups. The most common forms of comorbidity in the elderly are in one or another combination of the following diseases: hypertension, coronary heart disease, diabetes, diseases of the musculoskeletal system. It is known that the leading place in the relief of pain in the latter is occupied by non-steroidal antiinflammatory drugs (NSAIDs), the use of which can be prolonged and induce the development of serious gastrotoxic reactions. Well studied and described NSAIDs-induced gastropathy, which, in most cases, is asymptomatic even in the presence of erosive and ulcerative changes. However, NSAIDs may be associated with the emergence of various dyspeptic complaints and lesions of the esophagus, which can be viewed in the framework of NSAID-associated esophageal, especially relevant in older patients. The article deals with the problem of comorbidity, polypragmasia, therapeutic tactics in the management of comorbid patients with NSAIDsesophagogastropathy and the possibility of prescribing for the prevention and treatment of not only effective, but also safe means of correction of these clinical and endoscopic manifestations.

Extensive hepatitis A outbreak in an urban childcare facility in Ireland, associated with considerable adult morbidity

Hepatitis A infection results in a spectrum of illness from asymptomatic disease to severe fulminant hepatitis. Since 2000, <50 cases have been reported annually in Ireland. We report on an outbreak of hepatitis A associated with a childcare facility(CCF) in 2015 in Ireland. Between January and July 2015, 12 outbreak-associated symptomatic hepatitis A cases were identified, including one delayed, retrospective diagnosis. Seven (58%) cases were adults, eight (67%) were male, six of the adults required hospitalisation. All 12 cases were confirmed on serology and the four cases that were genotyped were identical on phylogenetic analysis. Potential environmental exposures and hygiene practices at the CCF were investigated. Outbreak control measures included the provision of: hepatitis A information, infection prevention advice, hepatitis A vaccination to 554 CCF contacts, and voluntary closure of the CCF for deep-cleaning and staff education. From a healthcare perspective1, outbreak control costs were in excess of €45 000. This outbreak illustrates the considerable adult morbidity that can occur in hepatitis A outbreaks, highlights the challenges in controlling a large CCF-associated outbreak and the importance of early recognition by clinicians of hepatitis A.

Evaluating Stress during Pregnancy: Do We Have the Right Conceptions and the Correct Tools to Assess It?

Gestational stress is believed to increase the risk of pregnancy failure and perinatal and adult morbidity and mortality in both the mother and her child or children. However, some contradictions might arise from methodological issues or even from differences in the philosophical grounds that guide the studies on gestational stress. Biased perspectives could lead us to use and/or design inadequate/incomplete panels of biochemical determinations and/or psychological instruments to diagnose it accurately during pregnancy, a psychoneuroimmune-endocrine state in which allostatic loads may be significant. Here, we review these notions and propose a model to evaluate and diagnose stress during pregnancy.