Previous Meal Research Articles

Investigation of a Norovirus GII.4Sydney[P16] outbreak in a care facility in Portugal, 2022

Abstract Background On the 29th of April 2022 the local Public Health unit was notified of 12 cases of acute gastroenteritis in residents of a long-term care facility (LTCF). A joint epidemiological investigation team was established and initiated an outbreak investigation to characterize the outbreak and implement infection control measures. Methods Epidemiological questionnaires were administered to staff (n = 44) and residents (n = 60). Case definition was LTCF residents or staff members with at least one of the following symptoms: diarrhoea, vomiting, nausea, between April 25th and May 14th, 2022. Stool or vomit samples were collected for 11 individuals. To assess environmental contamination fifteen food samples from previous meals and six surface samples from toilet faucets, wash tubs, and cutting boards were collected. Spatial distribution of cases within the LTCF was performed to guide infection control implementation. Results A total of 43 people met the case definition. Attack rates in residents and staff were 37% (23/63) and 42% (20/48), respectively. Of the total tested specimens, six (6/8) from residents and two (2/3) from staff were positive for the Norovirus (NoV) GII.4 Sydney [P16] variant by genotyping. Two (2/6) samples from surface swabs from the toilet faucet in the resident’s living room were also positive for NoV GII. Food samples were negative for major bacterial agents implicated in gastrointestinal outbreaks. Cases were distributed throughout the LTCF wards with no clear clustering. Four residents required hospital admission. Conclusions Results suggest person-to-person as well as environmental transmission of NoV. Identification of behavioural and spatial patterns of residents and staff and subsequent enactment of infection control strategies mitigated the outbreak. These findings reinforce the need for public health to maintain continuous technical support to LTCF on the implementation of infection control best practices. Key messages • Outbreak investigation in LTCF confirms Norovirus transmission, emphasizing the importance of infection control measures in long-term care facilities. • Study reveals Norovirus outbreak in LTCF, underscores the role of person-to-person and environmental transmission, highlighting the need for robust infection control protocols.

Complementary feeding and food handling practices among caregivers in a semi-urban setting in Northern Uganda

Background: Complementary feeding practices influence the nutritional status and health of children, especially in developing countries where sub-optimal infant feeding practices are the major cause of childhood undernutrition, morbidity, and mortality. This study sought to characterize the adequacy of complimentary feeding and food handling practices among caregivers of children aged 6-23 months in a semi-urban setting. Methods: Exploratory cross-sectional study was conducted in Adyel division, Lira district in Northern Uganda among 127 child-caregiver pairs randomly selected from three villages. Caregivers were interviewed about their child-feeding practices, complementary foods used, and common practices in handling and preparation of foods used as complementary feeds. Results: Overall, children’s feeding patterns met the recommended dietary intake when assessed using the child feeding index (CFI) whereby children aged 6-8, 9-11, and 12-23 months scored 8.03, 9.17, and 7.59, respectively. However, most children were complemented with foods from the household meals and dietary diversity was limited by frequent use of food leftover from the previous meals. Conclusions: Inappropriate meal patterns and food handling practices identified are likely to compromise child nutrition and health. Nutrition education is needed to improve the caregivers’ child-feeding and food handling practices within their socio-economic and cultural context. Keywords: Complementary feeding practices; food handling; diet quality; food safety; children; Uganda.

A Review to Illustrate the Concept of Krimi in Ayurveda

Background: Knowledge of Krimi and its description in Vedas and Ayurvedic Samhitas is very unique and different from the concept of worm in modern medical science. Krimi is a broad terminology in ancient Indian science which encompasses various types of helminths, microorganisms such as bacteria, viruses, fungi, and protozoa causing a large variety of diseases. Materials and Methods: A narrative review was conducted and result was presented under the result. Result and Discussion: Krimi Roga is one among the various diseases which must be paid prime attention in terms of Ayurveda management. Drugs and formulations from herbal sources play key role in management of these helminthic and parasitic infections. A majority of patients being from pediatric age segment, the knowledge of Krimi Roga management may bring a boon to pediatric ailments. Conclusion: Ayurveda believes in Prakriti (specific body constitution of the individual), if we can change the internal environment of the intestine (Kostha) through Apkarshana, Prakriti Vighata and Nidana parivarjana using appropriate drugs as well as enhancing the strength of Agni; then, affinity towards production and multiplication of Krimi may be arrested and hence, the ailments can be treated. Krimi is a condition, affecting all age groups, but children have always been at risk due to their playful activities and lack of maintenance of adequate personal hygiene. Once infected, the entire family may eventually get affected from the infected children.[1] If we consider Drishya Krimi as worm infestation, In India, more than 200 million children are infected on an average with roundworm, hookworm, etc. In Ayurveda, several causes (nidanas) have been mentioned for development of Krimi (microbes/worms) in human body like Ajirna (indigestion in GIT), Adhyashana (eating even when the previous meal has not been digested), Asatmyaahara, Virudhasana, Malinasana (incompatible foods or unhygienic meal habit), Avyayam (sedentary lifestyle), Diwaswapna (sleeping during the daytime), Guru (heavy), Atisnigdha (excessively fatty diet), Atisheet Ahara-Vihara (cold

IMPACT OF DIET AND LIFESTYLE ON AGE OF MENARCHE

Menarche is a medical term that describes a woman's first menstrual period, marking the onset of menstruation and reproductive maturity. Menarche typically occurs during adolescence, usually between the age of 10 to 16 years. Various factors, including genetics, nutrition, body weight, and overall health, influence the onset of menarche. The impact of diet and lifestyle on the age of menarche in adolescent subjects was studied. A cross-sectional survey design was employed, involving a minimum of 203 subjects in and around Vijayanagar, Bangalore. Subjects were categorized into three groups based on the age at which they attained menarche: Group 1 (before 12 years), Group 2 (between 12-14 years), and Group 3 (above 14 years). Results of this survey showed a varied distribution of age of menarche: 8.0 % below 12 years of age group, 80 % between the age group 12-14, and 12 % above 14 years of age group. The dietary habits and consumption of ksheera (milk), ghrita (ghee), junk foods, caffeine, iron-rich foods, and water intake were examined, and other factors such as menarcheal age and status of agni ( digestive fire), samashana (eating wholesome an unwholesome food together), ajeernashana (eating without the previous meal getting digested), adhyasana (eating excess), guru ahara (heavy food), sheeta ahara ( cold food), virudda aahara (food having opposite potentials), exercise, emotional resilience, co-curricular activities, use of antibiotics, stress relation, exposure to sunlight of the subjects were also evaluated. The survey findings highlight diverse menarcheal ages, suggesting potential links with diet and lifestyle.

Ageing of Plasmodium falciparum malaria sporozoites alters their motility, infectivity and reduces immune activation in vitro

BackgroundSporozoites (SPZ), the infective form of Plasmodium falciparum malaria, can be inoculated into the human host skin by Anopheline mosquitoes. These SPZ migrate at approximately 1 µm/s to find a blood vessel and travel to the liver where they infect hepatocytes and multiply. In the skin they are still low in number (50–100 SPZ) and vulnerable to immune attack by antibodies and skin macrophages. This is why whole SPZ and SPZ proteins are used as the basis for most malaria vaccines currently deployed and undergoing late clinical testing. Mosquitoes typically inoculate SPZ into a human host between 14 and 25 days after their previous infective blood meal. However, it is unknown whether residing time within the mosquito affects SPZ condition, infectivity or immunogenicity. This study aimed to unravel how the age of P. falciparum SPZ in salivary glands (14, 17, or 20 days post blood meal) affects their infectivity and the ensuing immune responses.MethodsSPZ numbers, viability by live/dead staining, motility using dedicated sporozoite motility orienting and organizing tool software (SMOOT), and infectivity of HC-04.j7 liver cells at 14, 17 and 20 days after mosquito feeding have been investigated. In vitro co-culture assays with SPZ stimulated monocyte-derived macrophages (MoMɸ) and CD8+ T-cells, analysed by flow cytometry, were used to investigate immune responses.ResultsSPZ age did not result in different SPZ numbers or viability. However, a markedly different motility pattern, whereby motility decreased from 89% at day 14 to 80% at day 17 and 71% at day 20 was observed (p ≤ 0.0001). Similarly, infectivity of day 20 SPZ dropped to ~ 50% compared with day 14 SPZ (p = 0.004). MoMɸ were better able to take up day 14 SPZ than day 20 SPZ (from 7.6% to 4.1%, p = 0.03) and displayed an increased expression of pro-inflammatory CD80, IL-6 (p = 0.005), regulatory markers PDL1 (p = 0.02), IL-10 (p = 0.009) and cytokines upon phagocytosis of younger SPZ. Interestingly, co-culture of these cells with CD8+ T-cells revealed a decreased expression of activation marker CD137 and cytokine IFNγ compared to their day 20 counterparts. These findings suggest that older (day 17–20) P. falciparum SPZ are less infectious and have decreased immune regulatory potential.ConclusionOverall, this data is a first step in enhancing the understanding of how mosquito residing time affects P. falciparum SPZ and could impact the understanding of the P. falciparum infectious reservoir and the potency of whole SPZ vaccines.

After-meal blood glucose level prediction for type-2 diabetic patients

Type 2 Diabetes, a metabolic disorder disease, is becoming a fast growing health crisis worldwide. It reduces the quality of life, and increases mortality and health care costs unless managed well. After-meal blood glucose level measure is considered as one of the most fundamental and well-recognized steps in managing Type 2 diabetes as it guides a user to make better plans of their diet and thus control the diabetes well. In this paper, we propose a data-driven approach to predict the 2 h after meal blood glucose level from the previous discrete blood glucose readings, meal, exercise, medication, & profile information of Type 2 diabetes patients. To the best of our knowledge, this is the first attempt to use discrete blood glucose readings for 2 h after meal blood glucose level prediction using data-driven models. In this study, we have collected data from five prediabetic and diabetic patients in free living conditions for six months. We have presented comparative experimental study using different popular machine learning models including support vector regression, random forest, and extreme gradient boosting, and two deep layer techniques: multilayer perceptron, and convolutional neural network. We present also the impact of different features in blood glucose level prediction, where we observe that meal has some modest and medication has a good influence on blood glucose level.

Calorie Compensation Patterns Observed in App-Based Food Diaries.

Self-regulation of food intake is necessary for maintaining a healthy body weight. One of the characteristics of self-regulation is calorie compensation. Calorie compensation refers to adjusting the current meal's energy content based on the energy content of the previous meal(s). Preload test studies measure a single instance of compensation in a controlled setting. The measurement of calorie compensation in free-living conditions has largely remained unexplored. This paper proposes a methodology that leverages extensive app-based observational food diary data to measure an individual's calorie compensation profile in free-living conditions. Instead of a single compensation index followed in preload-test studies, we present the compensation profile as a distribution of days a user exhibits under-compensation, overcompensation, non-compensation, and precise compensation. We applied our methodology to the public food diary data of 1622 MyFitnessPal users. We empirically established that four weeks of food diaries were sufficient to characterize a user's compensation profile accurately. We observed that meal compensation was more likely than day compensation. Dinner compensation had a higher likelihood than lunch compensation. Precise compensation was the least likely. Users were more likely to overcompensate for missing calories than for additional calories. The consequences of poor compensatory behavior were reflected in their adherence to their daily calorie goal. Our methodology could be applied to food diaries to discover behavioral phenotypes of poor compensatory behavior toward forming an early behavioral marker for weight gain.

Food Recommendation System using One-Stage Algorithm

Abstract: There are a number of reasons why it's helpful when people suggest their favourite foods. There has been a rise in the use of automated systems that provide recommendations for various forms of food, including recipes, restaurants, and grocery stores. Scientists have been looking at these sorts of systems for a long time, and their findings show they may help individuals not just identify food they would want to eat, but also fuel themselves more properly. This article summarises the current status of so-called food recommender systems, focusing on both foundational and cutting-edge approaches to the issue, as well as essential specialisations such food recommendation systems for groups of users or systems that encourage healthy eating. Assisting consumers in finding their ideal meal is a crucial function of food recommender systems. Choosing what to eat is a complicated and multi-faceted process that is impacted by many things, including the ingredients, the look of the dish, the user's own preference on food, and many situations, such as what had been eaten at the previous meal. This paper formalises the meal suggestion issue as forecasting user preference on recipes using three essential factors: the user's (and other users') history, the recipe's components, and the recipe's descriptive picture. In order to solve this difficult issue, we design a special neural network. The recommender creates a model of eating habits based on responses to previous surveys. The model is then used to prompt respondents, based on the meals they have previously picked, to submit any linked items they may have forgotten to mention. Model-generated cues were evaluated against those that were manually programmed by dietitians.

Human glucose rhythms and subjective hunger anticipate meal timing

Circadian rhythms, metabolism, and nutrition are closely linked.1 Timing of a three-meal daily feeding pattern synchronizes some human circadian rhythms.2 Despite animal data showing anticipation of food availability, linked to a food-entrainable oscillator,3 it is unknown whether human physiology predicts mealtimes and restricted food availability. In a controlled laboratory protocol, we tested the hypothesis that the human circadian system anticipates large meals. Twenty-four male participants undertook an 8-day laboratory study, with strict sleep-wake schedules, light-dark schedules, and food intake. For 6days, participants consumed either hourly small meals throughout the waking period or two large daily meals (7.5 and 14.5h after wake-up). All participants then undertook a 37-h constant routine. Interstitial glucose was measured every 15min throughout the protocol. Hunger was assessed hourly during waking periods. Saliva melatonin was measured in the constant routine. During the 6-day feeding pattern, both groups exhibited increasing glucose concentration early each morning. In the small meal group, glucose concentrations continued to increase across the day. However, in the large meal group, glucose concentrations decreased from 2h after waking until the first meal. Average 24-h glucose concentration did not differ between groups. In the constant routine, there was no difference in melatonin onset between groups, but antiphasic glucose rhythms were observed, with low glucose at the time of previous meals in the large meal group. Moreover, in the large meal group, constant routine hunger scores increased before the predicted meal times. These data support the existence of human food anticipation.

Statistical modelling of voluntary feed intake in individual Atlantic salmon (Salmo salar L.)

Precision feeding aims to provide the correct amount of feed to farmed animals for optimal growth and performance and to avoid feed waste. However, knowledge underlying the meal-to-meal variability in voluntary feed intake of farmed species is still limited. This study examined the relationship between meals, feed deprivation time and the feed (pellets) consumed by Atlantic salmon post smolts. The data was collected from individual fish handfed to satiety without social interaction in three independent short-term (6-12 days) experiments. The fixed variables of our model (feed deprivation time (i.e., time between meals), number of pellets provided, day, previous meal size, and fish growth) explained most of the feed intake (number of pellets ingested) (R2 0.68). Results show that fish ingested more pellets over the course of the trials as they grew, resulting in a positive correlation between feed intake and fish growth (final minus initial fish weight). The time between meals and prior meal size (the number of pellets ingested in the previous meal) significantly affected feed intake in the following meal. Our results suggest that it is possible to optimise meal size by considering the size of the previous meal and the time since it was given.

Voles, shrews and red squirrels as sources of tick blood meals and tick-borne pathogens on an island in southwestern Finland

Molecular identification of the previous blood meal source of a questing tick (Acari: Ixodidae) from blood meal fragments was proposed a few decades ago. Following this, several blood meal assays have been developed and published, but none of them have been taken into widespread use. Recently, novel retrotransposon-based qPCR assays designed for detecting blood meal fragments of North American host species were published. We wanted to assess their function with host species present in Finland.Questing ticks were collected by cloth dragging in August-September 2021 from an island in southwestern Finland. DNA was extracted from Ixodes ricinus nymphs (n=438) and qPCR assays applied to identify larval blood meal sources (voles, shrews and red squirrels) and screen for several tick-borne human pathogens and other microbes with pathogenic potential [Borrelia spp. (including specific assays for Borrelia afzelii, Borrelia garinii, Borrelia valaisiana), Anaplasma phagocytophilum, Babesia spp., Rickettsia spp., and Neoehrlichia mikurensis].The probability of a nymph having fed as larva on either a vole, shrew or red squirrel was 0.34 (0.30 – 0.38; 95% confidence interval). Bacteria of the genus Borrelia were the most common pathogens detected, with host-specific probabilities of carrying Borrelia of 0.30 (0.18 – 0.44) for nymphs that had fed on voles, 0.23 (0.14 – 0.35) for nymphs that had fed on shrews, and 0.42 (0.28 – 0.58) for nymphs that had fed on red squirrels. Other microbes were rarely acquired from these hosts, apart from N. mikurensis from voles.This study highlights that shrews and red squirrels may equal voles as blood meal sources for I. ricinus larvae. Overall, variation in proportions of blood meals provided by these animals may be high across even proximate study areas. All studied host species appeared to be important sources for particularly Borrelia afzelii, and voles also for N. mikurensis.

Litchi consumption and missed meals continue to be associated with acute encephalopathy syndrome among children: an investigation of the 2019 outbreak in Muzaffarpur district, Bihar, India.

Muzaffarpur district in Bihar State of India recorded a resurgence of acute encephalopathy syndrome (AES) cases in the summer of 2019 after no reported outbreak in 3 y. Earlier studies generated evidence that litchi consumption and missing the previous evening's meal were associated with AES. We investigated the recent outbreak to understand the risk factors associated with AES. We conducted a matched case-control study by comparing AES cases with healthy controls from case-households and the neighborhood community for risk factors like missing evening meal and litchi consumption before onset of AES. We recruited 61 cases and 239 controls. Compared with the community controls, case-patients were five times more likely to have reported eating litchi in the 7 d preceding the onset of illness (adjusted OR [AOR]=5.1; 95% CI 1.3 to 19) and skipping the previous evening's meal (AOR=5.2; 95% CI 1.4 to 20). Compared with household controls, case-patients were five times more likely to be children aged <5 y (AOR=5.3; 95% CI 1.3 to 22) and seven times more likely to have skipped the previous evening's meal (AOR=7.4; 95% CI 1.7 to 34). Skipping the previous evening's meal and litchi consumption were significantly associated with AES among children in Muzaffarpur and adjoining districts of Bihar.

Social Hierarchy within Communal Foraging Flocks of Great Cormorants Phalacrocorax carbo as Reflected by Differences in Prey Composition and Food Intake at the Roost

Day-fresh Great Cormorant pellets were collected at a huge single winter roost at Kreupel island in Lake IJsselmeer, The Netherlands. The roost is situated on a sandy island, 3 m above the water level and is regularly used by 1000–8000+ Cormorants. By examining pellets and thus reconstructing the previous day's meal of Cormorants gathering at the roost, we explored spatio-temporal differences in the diet of individual birds. We found that structural differences in pellets (size, colour and structure) are related to their content (fish species and fresh mass of a daily meal). Structurally larger and lighter coloured pellets contained larger and coarser fish and represented a higher total fish mass. Pellets of different size and structure were non-randomly distributed at the roost. Birds positioned centrally in the roost produced on average larger pellets than birds at the edges. Cormorants having few or no food remains in their pellets were more frequently recorded on the edge of the roost than in the centre and in particular, they were more likely to be located to the rear of the roost. The same was true for pellets showing a bloody signature which may be linked to either injury by sharp fin rays or to a parasite induced effect. Pellet data were corroborated by observations of differential distribution of faecal splashes of Cormorants, showing that individuals in the centre of the roost produced most guano. Clear diet differences existed within the roost between birds in the centre and elsewhere in the roost, whereas smaller differences existed between the front, edge and rear of the roost. Our data suggest a social hierarchy based on higher foraging success of birds returning earlier to the roost and settling in the centre, hereby forcing later arriving and less successful Cormorants towards the edge, rear and front position. We conclude that position at the roost is a reflection of previous foraging success, possibly caused by differences in dominance between Cormorants during the period of communal foraging. From a methodological point of view, our study demonstrates that, because of structural differences in pellets and spatial differences in occurrence, it is important to collect pellets randomly if one is to describe a proper diet sample by using pellets at any given site. Especially in marshlands and under trees and bush growth with a lot of litter, the likely collection of larger, more conspicuous pellets will cause a bias towards the larger fish species and sizes. Also sampling only at edge locations or specifically at the centre of a roost may give biased results, as this may result in an under- or overestimation in reconstructed fish uptake (e.g. fish size, mass, species) from the waterbody under study.

Model-based identification of eating behavioral patterns in populations with type 1 diabetes

In the paper, a probabilistic model of the eating behavior of subjects with type 1 diabetes is proposed and validated against two extensive datasets collected during experiments in free-living conditions in Padova and Amsterdam clinical centers. Meals are modeled as a discrete-time marked point process. The random meal events are associated to a Markov Chain whose state is the fasting period and the transition probabilities depend on variables such as daytime and carbohydrate intake of the previous meal. The random marks associated to each meal represent the carbohydrate intake and their distribution possibly depends on daytime, fasting period and carbohydrate intake of the previous meal. Logistic and Gaussian Mixture models are used to identify two models from the Padova and Amsterdam datasets, respectively. In order to validate it, the proposed model is used to simulate synthetic datasets, whose statistical properties appear to be in good agreement with those of the experimental datasets. The availability of a probabilistic model of eating behavior is expected to be valuable for several purposes ranging from the optimization and customization of automatic insulin dosing systems to decision supporting tools for insulin dosing and the alert management for missing meal announcements.

Impact of Sequential Lipid Meals on Lymphatic Lipid Absorption and Transport in Rats.

The sequential meal pattern has recently received more attention because it reflects a phycological diet style for human beings. The present study investigated the effects of the second lipid meal on lymphatic lipid absorption and transport in adult rats following a previous lipid meal. Using the well-established lymph fistula model, we found that the second lipid meal significantly increased the lymphatic output of triglycerides, cholesterol, phospholipids, and non-esterified fatty acids compared with a single lipid meal. Besides that, the time reaching the peak of each lipid output was significantly faster compared with the first lipid meal. Additionally, the second lipid meal significantly increased the lymphatic output of apolipoprotein A-IV (ApoA-IV), but not apolipoprotein B-48 (ApoB-48) or apolipoprotein A-I (ApoA-I). Interestingly, the triglyceride/apoB-48 ratio was significantly increased after the second lipid meal, indicating the increased chylomicron size in the lymph. Finally, the second lipid meal increased the lymphatic output of rat mucosal mast cell protease II (RMCPII). No change was found in the expression of genes related to the permeability of lymphatic lacteals, including vascular endothelial growth factor-A (Vegfa), vascular endothelial growth factor receptor 1 (Flt1), and Neuropilin1 (Nrp1). Collectively, the second lipid meal led to the rapid appearance of bigger-sized chylomicrons in the lymph. It also increased the lymphatic output of various lipids and apoA-IV, and mucosal mast cell activity in the intestine.

Breath Stable Isotope Analysis Serves as a Non-invasive Analytical Tool to Demonstrate Dietary Changes in Adolescent Students Over Time.

Concern about adolescent diets, obesity, and the associated health risks have been growing in the United States. This inspired former First Lady Michelle Obama to spearhead the Healthy Hunger-Free Kids Act (HHFKA), which made changes to the national school lunch program by increasing servings of whole grains, fruits, and vegetables. Our study examined the variability of student carbohydrate sources throughout the day and before and after the implementation of HHFKA using a stable isotope dietary biomarker. This method uses carbon stable isotope values of exhaled CO2 breath (δ13Cbreath) and provides a quantitative, non-invasive measure. δ13Cbreath samples were collected throughout the day from students (n = 31) that attended a public high school in Salt Lake City, UT. δ13Cbreath measurements reflected the short-term carbohydrate inputs from the previous meal. Carbohydrate sources were not consistent throughout the day; most students had their lowest inputs of corn/sugar-based carbohydrates after lunch. We compared our results with an earlier study that had been conducted pre-HHFKA. After-lunch δ13Cbreath values decreased significantly between the two time points, suggesting an increase in whole grain, fruit, and vegetable carbohydrates in the lunch program. Our results demonstrated that δ13Cbreath measurements provide a valuable tool to examine carbohydrate sources in an individual's diet throughout the day. We believe that this tool could be beneficial to studies examining the relationship between sugar sweetened beverages, added sugars, and refined carbohydrates and health outcomes like diabetes and obesity in both adolescent and adult populations.

Cardiac Heart Rate Dependence on Mitochondrial Deuterium 2H Content

Mitochondrial cardiac ATP production efficiency in beef hearts has been known to decrease with increasing systemic deuterium 2H levels since the 1980’s. Recently ketogenic diets which are known to decrease deuterium levels in humans were found to decrease both the resting and exercise heart rates in a volunteer. Furthermore, resting heart rates were found to systematically vary with the deuterium content from the previous meal consumed by six volunteers. A cardiac model is proposed showing extreme sensitivity of heart rate on the deuterium loading of the ATP synthase nanomotors. A predicted increase in heart rate by 28% is expected with a 5% decrease in ATP production. This finding strongly suggests that high deuterium levels in the fatty acids contribute to the diastolic dysfunction in heart failure not already attributed to direct structural damage, i.e., heart failure with preserved ejection fraction.

The transmission-blocking effects of antimalarial drugs revisited: fitness costs and sporontocidal effects of artesunate and sulfadoxine-pyrimethamine

Assays used to evaluate the transmission-blocking activity of antimalarial drugs are largely focused on their potential to inhibit or reduce the infectivity of gametocytes, the blood stages of the parasite that are responsible for the onward transmission to the mosquito vector. For this purpose, the drug is administered concomitantly with gametocyte-infected blood, and the results are evaluated as the percentage of reduction in the number of oocysts in the mosquito midgut. We report the results of a series of experiments that explore the transmission-blocking potential of two key antimalarial drugs, artesunate and sulfadoxine-pyrimethamine, when administered to mosquitoes already infected from a previous blood meal. For this purpose, uninfected mosquitoes and mosquitoes carrying a 6 day old Plasmodium relictum infection (early oocyst stages) were allowed to feed either on a drug-treated or an untreated host in a fully factorial experiment. This protocol allowed us to bypass the gametocyte stages and establish whether the drugs have a sporontocidal effect, i.e. whether they are able to arrest the ongoing development of oocysts and sporozoites, as would be the case when a mosquito takes a post-infection treated blood meal. In a separate experiment, we also explored whether a drug-treated blood meal impacted key life history traits of the mosquito relevant for transmission, and if this depended on their infection status. Our results showed that feeding on an artesunate- or sulfadoxine-pyrimethamine-treated hosts has no epidemiologically relevant effects on the fitness of infected or uninfected mosquitoes. In contrast, when infected mosquitoes fed on an sulfadoxine-pyrimethamine-treated host, we observed both a significant increase in the number of oocysts in the midgut, and a drastic decrease in both sporozoite prevalence (−30%) and burden (−80%) compared with the untreated controls. We discuss the potential mechanisms underlying these seemingly contradictory results and contend that, provided the results are translatable to human malaria, the potential epidemiological and evolutionary consequences of the current preventive use of sulfadoxine-pyrimethamine in malaria-endemic countries could be substantial.

T2-Weighted High-Resolution Isotropic Magnetic Resonance Lymphangiography of the Thoracic and Abdominal Lymphatic Vessels with and without Previous High-Fat Meal

The aim of this study was to assess the potential benefit of a high-fat meal for preparation of patients before lymphangiography of the thoracic and abdominal lymphatic vessels by a heavily T2-weighted 3D magnetic resonance sequence at 3T. A heavily T2-weighted 3D Fast-Spin-Echo sequence was applied twice for lymphangiography in 15 healthy volunteers. One examination was performed following overnight fasting and the second examination was conducted 3 hours after a drinking of 200 ml of cream and a solid meal. The effect of a high-fat meal on the visualization of different segments of the thoracic and abdominal lymphatic vessels was analyzed by scoring of the image quality. Evaluation of the summarized score of all four segments of the thoracic duct showed significantly improved general visualization of the lymphatic system in the postprandial examination when compared to the results obtained after overnight fasting (mean ± SD: 4.5 ± 1.7 vs. 5.9 ± 1.8, p = 0.007*). Regarding different segments of the lymphatic system significant differences between pre and post cream lymphangiographies were found in the cervical segment (p = 0.012*), the inferior thoracic segment (p = 0.003*) and the abdominal segment (p = 0.035*). In contrast, the visualization of the superior thoracic segment was not significantly improved by high fat meal preparation of the subjects (p = 0.388). A high-fat meal 3 hours prior to T2-weighted MR-lymphangiography improves the visualization of the main lymphatic thoracic and abdominal vessels, particularly the abdominal and cervical part as well as the inferior segment of the thoracic duct.

S3011 Recurring Gastrointestinal Symptoms as a Novel Presentation of Alpha-Gal Allergy

INTRODUCTION: Galactose-alpha-1,3-galactose (alpha-gal) allergy is a delayed allergy after ingestion of mammalian meat such as beef, pork, or lamb. In the literature, symptoms range from urticaria to anaphylaxis with concomitant gastrointestinal manifestations. There are no case reports of adults with abdominal pain as the sole symptom of this allergy. This case delineates a novel presentation of the alpha-gal allergy with a patient with only gastrointestinal symptoms. CASE DESCRIPTION/METHODS: A 46 year old male with a past medical history of hypothyroidism, gastroesophageal reflux disease, hypertriglyceridemia, seasonal allergies and asthma presented with abdominal pain. His first episode occurred two years ago after the ingestion of prime rib, at which time he developed abdominal pain, nausea, and vomiting. Subsequently, he noticed abdominal pain after eating any red meat. Each abdominal pain episode was stabbing in quality and generally lasted two hours. Additional history revealed tick-exposure prior to the first episode of symptoms. Workup confirmed an allergy to beef with an elevated beef alpha-gal IgE of 0.71 kU/L (reference range, <0.35 kU/L). IgE levels were within normal range for pork and lamb. After eliminating all mammalian meat from the diet, the patient’s symptoms resolved. DISCUSSION: The first alpha-gal allergy to mammalian meat was documented in 2006 and it is still not fully understood. It is proposed that remnant alpha-gal from previous mammalian blood meals are transmitted to humans through the saliva of Amblyomma americanum (lone star tick), which is endemic to the southwest region of the United States. After ingestion of mammalian meat containing alpha-gal, the alpha-gal, found in glycolipids, is packaged into chylomicrons. It is released into the thoracic duct and IgE is deployed. It is suspected that this prolonged pathway is why symptoms do not manifest until 3 to 8 hours after ingestion. It is crucial to obtain a good clinical history and recognize that recurrent abdominal pain, nausea or vomiting may be the only presentation especially given that the current mean time to diagnosis is 7.1 years. Diagnosis is made with blood work assessing IgE levels to beef, pork, and lamb. Elevation of IgE titers to only one mammalian meat is required for diagnosis. Given the risk of anaphylaxis, prescription of an epinephrine pen and elimination of mammalian meat is the only treatment.