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Background: Rates of venous thromboembolism (VTE) recurrence and bleeding remain high in patients with cancer who are prescribed anticoagulants (ACs) such as low-molecular-weight heparin (LMWH) after an initial VTE event. Objectives: To identify patient characteristics associated with VTE recurrence and bleeding in patients receiving LMWH for cancer-associated VTE and to explore secondary AC management and clinical outcomes in these patients. Methods: An observational study was conducted using nationwide French data for adults with active cancer who were hospitalized with VTE in 2013-2018 and were reimbursed for LMWH ≤ 30 days after hospital discharge. The main outcomes were VTE recurrence and bleeding. For both outcomes, the proportions of patients who experienced the outcome were calculated for different patient characteristics. AC switching following VTE recurrence and bleeding was tracked using Anatomical Therapeutic Chemical codes. Results: A total of 31,771 patients received LMWH, of whom 1925 (6.1%) experienced VTE recurrence and 1804 (5.7%) bleeding. Most recurrent VTE and bleeding events occurred within 6 months after the initial VTE event. The proportion of patients with VTE recurrence and bleeding varied between cancer types. Most patients who experienced VTE recurrence or bleeding continued to receive LMWH. Eleven percent of patients with VTE recurrence experienced a further recurrent VTE event within 3 months. Conclusion: More than 10% of patients who received LMWH for cancer-associated VTE experienced VTE recurrence or bleeding. AC management options in this patient population should be prospectively assessed in clinical trials.

ABSTRACT: Rhipicephalus (Boophilus) microplus is a hard tick endemic in livestock-growing regions and causes economic losses in the largest beef-producing countries, including Brazil, Mexico, Argentina, Australia and Uruguay. The use of chemical acaricides is still the main strategy to control R. microplusinfestations. Nevertheless, immunological control of R. microplus with an anti-tick vaccine is a suitable alternative and has manifold advantages because it can avoid drug-resistance and the presence of acaricide residues in milk, beef and in the environment. Indeed, vaccines based on the Bm86 antigen have had relative commercial and technical success to control R. microplus in some regions. Although, the efficacy of such vaccines varies among tick populations and is insufficient to provide an acceptable level of protection. Therefore, the need to search for better antigens is impelling. This review focused on the restrictions imposed on the use of acaricides in Brazil and in the European Union, as well as on the impacts of Bm86-based vaccines on R. microplus control. The efficacy of experimental anti-tick vaccines (based on subolesin, glutathione S-transferase, ferritin 2; voltage-dependent anion channel; aquaporin, 60 S acidic ribosomal protein, metalloprotease and trypsin) that can elicit an immune response against the physiological functions of various ticks is discussed.

In the past decade, metagenomics studies exploring tick microbiota have revealed widespread interactions between bacteria and arthropods, including symbiotic interactions. Functional studies showed that obligate endosymbionts contribute to tick biology, affecting reproductive fitness and molting. Understanding the molecular basis of the interaction between ticks and their mutualist endosymbionts may help to develop control methods based on microbiome manipulation. Previously, we showed that Rhipicephalus microplus larvae with reduced levels of Coxiella endosymbiont of R. microplus (CERM) were arrested at the metanymph life stage (partially engorged nymph) and did not molt into adults. In this study, we performed a transcriptomic differential analysis of the R. microplus metanymph in the presence and absence of its mutualist endosymbiont. The lack of CERM resulted in an altered expression profile of transcripts from several functional categories. Gene products such as DA-P36, protease inhibitors, metalloproteases, and evasins, which are involved in blood feeding capacity, were underexpressed in CERM-free metanymphs. Disregulation in genes related to extracellular matrix remodeling was also observed in the absence of the symbiont. Taken together, the observed alterations in gene expression may explain the blockage of development at the metanymph stage and reveal a novel physiological aspect of the symbiont-tick-vertebrate host interaction.

AIMS: The aim of this study was to evaluate the frequencies of the HLA genotypes DQ2 and DQ8 and the alleles A1*05, A1*0201, B1*0201 and B1*0302 in individuals with celiac disease in Recife, northeastern Brazil. METHODS: HLA DQ2 and DQ8 genotyping was performed for 73 individuals with celiac disease and 126 first-degree relatives with negative transglutaminase serology. The alleles DQA1*05, DQA1*0201, DQB1*02 and DQB1*0302 were identified by sequencing using specific primers and the EU-DQ kit from the Eurospital Laboratory, Trieste, Italy and double-checked by the All Set SPP kit (Dynal). RESULTS: Among the 73 cases, 50 (68.5%) had the genotype DQ2, 13 (17.8%) had DQ8, 5 (6.8%) had DQ2 and DQ8, and 5 did not have any of these genotypes. Among the 5 negative individuals, four had the B1*02 allele and one did not have any of the alleles studied. B1*02 was the most frequent allele in both groups (94% in the patients and 89% in the control relatives). CONCLUSIONS: In this study, celiac disease was associated with the genotypes DQ2 and DQ8. DQ2 predominated, but the distribution of the frequencies was different from what has been found in European populations and was closer to what has been found in the Americas. The high frequencies of the HLA genotypes DQ2 and DQ8 that were found in first-degree relatives would make it difficult to use these HLA genotypes for routine diagnosis of celiac disease in this group.