ABSTRACT Game bird species were introduced to several insular systems during the 18th and 19th centuries. The Mascarenes are a relevant example of such introductions, including the grey francolin ( Francolinus pondicerianus ). In the case of Mauritius and Réunion Island, although this bird has been present for more than 300 years, limited information is available concerning its behavioural adaptations in insular systems, especially regarding its feeding behaviour. The first aim of this study was to describe the diet of the grey francolin, a well‐established game‐bird species in the Mascarenes. From this novel information, we also wish to discuss how the grey francolin can be positioned in insular food chains, and thus, its potential impact on the biodiversity of Mauritius and Réunion Island. We provide an analysis of 9115 food items, including both insects and seeds harvested from stomach contents of 13 grey francolin. The birds were harvested in Mauritius, from two distinct zones, and their stomach contents were sorted and identified using binocular magnifiers. The results revealed a total diversity of 20 seed species and 23 insect species, with a majority of exotic species. Solanum sp., Amaranthus sp. and Chamaesyce hirta were the dominant seeds, whereas insect food items were widely dominated by ant species ( Pheidole megacephala , Solenopsis geminata ). Important variability was observed in the composition of stomach contents, resulting in relevant amplitudes of species‐diversity indicators and the animal‐versus‐plant ratio, throughout the 13 birds. Furthermore, the amount of certain food items was particularly high for one stomach content, whereas their global occurrence among the 13 birds was rather low, suggesting that the grey francolin has a versatile and opportunistic diet. Despite the lack of monitoring of food availability or diversity, the variation in stomach contents suggests that the diets of these generalist birds are dependent on the availability of resources in the environment.
ABSTRACT Objective To determine the effect of cultural security training (CST) for health professionals and access to an Aboriginal Brain Injury Coordinator (ABIC) for Aboriginal Australians with stroke or traumatic brain injury (TBI). Design A stepped wedge cluster randomised controlled trial; the intervention package consisted of CST for hospital professionals and 6‐month access to ABICs providing education, support, liaison and advocacy; the commencement order of the intervention phase was randomised. Setting Four urban and four rural hospitals in Western Australia, 2018–2022. Participants Aboriginal adults ≥ 18 years hospitalised with stroke or TBI. Main Outcome Measures Primary outcome was quality of life (Euro QOL–5D‐3L Visual Analogue Scale (EQ‐VAS)) score at 26 weeks post‐injury. Secondary outcomes were modified Rankin Scale, Functional Independence Measure, Hospital Anxiety and Depression Scale, Modified Caregiver Strain Index at 12 and 26 weeks, rehabilitation occasions of service, hospital compliance with minimum processes of care (MPC), acceptability of interventions, feasibility of ABIC role and costs. Results In total, 108 participants recruited (target 312), 75% rural residents; 26‐week outcomes assessment completed for 78% of participants. The adjusted mean QoL showed no significant difference ( p = 0.83). The MPC outcome favored the intervention group, adjusted difference in means 6.8% at 26 weeks, 95% CI (0.40%, 13.26%). There were no significant differences between control and intervention groups for other secondary outcomes. Conclusions CST and implementation of an ABIC were feasible, acceptable and improved care processes for a predominantly rural population. Health outcomes did not differ. The effects of the COVID‐19 context are discussed. Trial Registration ACTRN12618000139279
ABSTRACT Background Food allergies are a major health concern with rising prevalence. Dietary habits are changing, and information about cashew‐induced anaphylaxis is limited. Methods Cases of tree nut‐induced anaphylaxis (TIA) registered from 2007 until April 2024 were extracted from the European Anaphylaxis Registry and analyzed. Results 1389 cases of TIA out of 5945 registered food‐induced reactions (23%) were identified. 1,083 cases with confirmed elicitor status, including 845 children (median age 4 years, 61% male) and 238 adults (38 years, 40% male), were selected for further analysis. The most frequent elicitors among children were cashew ( n = 334), hazelnut ( n = 211) and walnut ( n = 146). The proportion of cashew‐induced anaphylaxis increased from 2007 to 2024, and reactions were frequently caused by small amounts (< 1 teaspoon). Adults reacted frequently to hazelnut ( n = 105), walnut ( n = 47) but also almond ( n = 35) and to higher amounts. Potential cofactors were present in 50% of the adult patients and 17% of children. The reaction severity was age‐independent, and only a minority of patients was previously aware of their allergy (children 23%, adults 21%). The use of adrenaline was low in lay treatment (children 13%, adults 3%) and reached approximately 40% upon professional treatment. Conclusion Cashew is an increasing, relevant allergen leading to anaphylaxis and is now the most frequent cause of TIA among children. These findings highlight the need for effective prevention and treatment measures. Almond was a frequent elicitor among adults and should be further monitored. The acute management requires improvement to comply with current guidelines.
Abstract Background Severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019, affects multiple organs. The virus enters cells through angiotensin‐converting enzyme‐2 and host factors present in genital organs, leading to concern over virus shedding in semen and reproductive function. Objectives To investigate severe acute respiratory syndrome coronavirus 2 in semen from patients with a mild infection, identify the seminal infected cells, and explore the effect of the infection on sex hormones and semen parameters. Materials and methods Prospective study of 54 men with mild severe acute respiratory syndrome coronavirus 2 infection. Semen was collected at 7, 15, 30, 60, 90, 180, and 365 days after symptom onset, and severe acute respiratory syndrome coronavirus 2 RNA was measured in serum, saliva, urine, and semen. The presence of infectious severe acute respiratory syndrome coronavirus 2 in semen was assessed using Vero cell culture. Infected semen cells were identified using immunofluorescence against severe acute respiratory syndrome coronavirus 2 nucleoprotein antigen and cell markers. Semen characteristics as well as testosterone, inhibin B, luteinizing hormone, and follicle‐stimulating hormone levels were determined. Results 11% of patients had at least one severe acute respiratory syndrome coronavirus 2 RNA‐positive semen. One patient had viral semen shedding up to day 90 after infection onset, with replication‐competent virus isolated from semen and 40% cell fraction at day 7. After sperm preparation, 90% fraction was severe acute respiratory syndrome coronavirus 2 RNA‐positive at days 7 and 15. The swim‐up fraction was positive only on day 7. In semen, nucleoprotein antigen was detected mainly in exfoliated epithelial cells and less frequently in Sertoli cells. Sperm count and motile sperm count were lower at day 30 than at day 7. Round cells in semen were increased during the acute phase. At days 7 and 15, sperm count and motile sperm count were lower in severe acute respiratory syndrome coronavirus 2 RNA‐positive semen compared with negative semen, while semen volume and follicle‐stimulating hormone levels were increased. Long‐term follow‐up shows no evidence of a detrimental effect on hormonal or semen characteristics. Discussion and conclusion 11% of patients with mild coronavirus disease 2019 who were not hospitalized had severe acute respiratory syndrome coronavirus 2 excretions in semen, which persisted for up to 90 days in one patient. No germ cells appeared infected by the virus, but the detection of nucleoprotein antigen‐positive epithelial semen cells and Sertoli cells suggests genital tract infection. Albeit infrequent, semen may contain the replication‐competent virus during the acute phase with potential risk of severe acute respiratory syndrome coronavirus 2 transmissions during sexual contact and assisted reproduction procedures. The effect of mild coronavirus disease 2019 on spermatogenesis and reproductive hormones was moderate and reversible.
Abstract Background Current guidelines indicate that patients with extreme oligozoospermia or azoospermia should be tested for chromosomal imbalances, azoospermia factor (AZF) deletions and/or CFTR variants. For other sperm abnormalities, no genetic diagnostics are recommended. Objectives To determine whether exome sequencing (ES) with combined copy number variant (CNV) and single nucleotide variant (SNV) analysis is a reliable first‐tier method to replace current methods (validation study), and to evaluate the diagnostic yield after 10 months of implementation (evaluation study). Materials and Methods In the validation study, ES was performed on DNA of patients already diagnosed with AZF deletions ( n = 17), (non‐)mosaic sex chromosomal aneuploidies or structural chromosomal anomalies ( n = 37), CFTR variants ( n = 26), or variants in known infertility genes ( n = 4), and 90 controls. The data were analyzed using our standard diagnostic pipeline, with a bioinformatic filter for 130 male infertility genes. In the evaluation study, results of 292 clinical exomes were included. Results All previously reported variants in the validation cohort, including clinically relevant Y‐chromosomal microdeletions, were correctly identified and reliably detected. In the evaluation study, we identified one or more clinically relevant genetic anomalies in 67 of 292 of all cases (22.9%): these included aberrations that could have been detected with current methods in 30 of 67 patients (10.2% of total), (possible) (mono)genetic causes in the male infertility gene panel in 28 of 67 patients (9.6%), and carriership of cystic fibrosis in nine of 67 patients (3.1%). Conclusion ES is a reliable first‐tier method to detect the most common genetic causes of male infertility and, as additional genetic causes can be detected, in our evaluation cohort the diagnostic yield almost doubled (10.2%–19.8%, excluding CF carriers). A genetic diagnosis provides answers on the cause of infertility and helps the professionals in the counseling for treatment, possible co‐morbidities and risk for offspring and/or family members. Karyotyping will still remain necessary for detecting balanced translocations or low‐grade chromosomal mosaicism.
ABSTRACT Background Hepatitis delta virus (HDV) requires hepatitis B virus (HBV) surface antigen to enter hepatocytes. Although HBV/HDV coinfection is the most severe form of viral hepatitis, disease progression and liver‐related data are limited. Aims To evaluate the characteristics of studies reporting HDV outcomes and the incidence of liver‐related events among individuals with HDV. Methods We searched online databases from 1 January 2000 to 14 December 2022 and congress proceedings from 2021 to 2022. Randomised controlled trials (RCTs), non‐randomised interventional studies and observational studies reporting incidence of cirrhosis, hepatic decompensation, hepatocellular carcinoma (HCC), liver transplant (LT) and liver‐related death in ≥ 20 adults with active HDV infection were included. Study/participant characteristics, cumulative incidence and incidence rates were extracted. Results Data were extracted from 32 unique studies in 47 publications. While most ( n = 19; 59%) studies included < 100 individuals, five included ≥ 200. Most were retrospective cohort ( n = 19; 59%), and the remainder were prospective cohort ( n = 5), non‐randomised interventional ( n = 3), RCT ( n = 3) or registry/database studies ( n = 2). Outcomes reported by the largest numbers of studies were hepatic decompensation ( n = 21) and HCC ( n = 20); the least reported was cirrhosis ( n = 9). Heterogeneity existed in participant populations, with variability in baseline markers of liver disease severity. Consequently, a wide range of cumulative incidence values was observed (cirrhosis, 0%–63%; hepatic decompensation, 0%–52%; HCC, 0%–19%; LT, 2%–43%; liver‐related death, 0%–19%; composite endpoint, 3%–74%). Conclusions The number of studies describing the incidence of liver‐related outcomes among people with HDV remains limited. Quantifying incidence of liver‐related events can improve our understanding of disease progression and inform potential treatment strategies. Trial Registration PROSPERO registration ID: CRD42023386845
Aims Dostarlimab‐gxly is a humanized monoclonal antibody of the IgG4 isotype that binds to the programmed cell death protein‐1 (PD‐1) receptor and blocks its ligands. RUBY (NCT03981796) is a two‐part multicentre study in patients with recurrent or primary advanced endometrial cancer. The overall aims were to characterise the population pharmacokinetics (PopPK) from Part 1 of this study, identify relevant covariates of interest, and assess exposure–efficacy/safety (ER) relationships. Methods A PopPK model developed using GARNET (NCT02715284) study data for dostarlimab monotherapy was externally validated with RUBY Part 1 study data. Subsequently, the model was updated with data across the two studies. Exposure–safety analyses for adverse events related to dostarlimab alone or in combination with standard of care (SOC) were modelled using logistic regression. Exposure–efficacy analysis included Cox proportional hazards analysis of the primary efficacy endpoint of progression‐free survival (PFS). Results For the model update, 7957 pharmacokinetics observations from 868 patients pooled from both RUBY and GARNET studies were available. The model was consistent with the previous model. Dostarlimab clearance was estimated to be 7.79% lower when dostarlimab was given as SOC combination therapy. However, no significant covariates were clinically relevant. Hepatic or renal impairment did not affect pharmacokinetics. Among the safety endpoints, only rash showed a small yet statistically significant effect ( P < .05) in all subjects; however, this was not not deemed clinically relevant. There were no other clinically significant exposure–safety or exposure–PFS relationships. Conclusions The addition of chemotherapy to dostarlimab had limited effect on dostarlimab PopPK, with no clinically significant covariates or clinically relevant exposure–safety or exposure–PFS relationships.