Phylogenomics and Diversification of the Schistosomatidae Based on Targeted Sequence Capture of Ultra-Conserved Elements.

Schistosomatidae Stiles and Hassall 1898 is a medically significant family of digenetic trematodes (Trematoda: Digenea), members of which infect mammals or birds as definitive hosts and aquatic or amphibious gastropods as intermediate hosts. Currently, there are 17 named genera, for many of which evolutionary interrelationships remain unresolved. The lack of a resolved phylogeny has encumbered our understanding of schistosomatid evolution, specifically patterns of host-use and the role of host-switching in diversification. Here, we used targeted sequence capture of ultra-conserved elements (UCEs) from representatives of 13 of the 17 named genera and 11 undescribed lineages that are presumed to represent either novel genera or species to generate a phylogenomic dataset for the estimation of schistosomatid interrelationships. This study represents the largest phylogenetic effort within the Schistosomatidae in both the number of loci and breadth of taxon sampling. We present a near-comprehensive family-level phylogeny providing resolution to several clades of long-standing uncertainty within Schistosomatidae, including resolution for the placement of the North American mammalian schistosomes, implying a second separate capture of mammalian hosts. Additionally, we present evidence for the placement of Macrobilharzia at the base of the Schistosoma + Bivitellobilharzia radiation. Patterns of definitive and intermediate host use and a strong role for intermediate host-switching are discussed relative to schistosomatid diversification.

Outcome of misoprostol and oxytocin in induction of labour.

BACKGROUND: Induction of labour is the process of initiating the labour by artificial means from 24 weeks of gestation. The main aim of this study is to find out the maternal and foetal outcomes after induction of labour with misoprostol and oxytocin beyond 37 weeks of gestation. METHODS: This was a hospital-based observational study carried out at Paropakar Maternity and Women's Hospital, Nepal. Misoprostol of 25 µg was inserted in posterior fornix of vagina or oxytocin infusion was started from 2.5 units on whom induction was decided. Maternal and foetal/neonatal outcomes were observed. Collected data were analysed using SPSS and MS Excel. RESULTS: General induction rate was found to be 7.2%. In this study, post-term pregnancy was found to be the most common reason for induction of labour. Analysis of onset of labour led to the finding that mean onset of labour was much rapid in oxytocin (6.6 h) than misoprostol (13.6 h). However, there is similarity in induction-delivery interval in both groups. Overall, the rate of normal delivery and caesarean section was found to be 64.9% and 33.2%, respectively. Similarly, normal delivery within 12 h was seen in 18.4% of the patients given with misoprostol and 43.5% in oxytocin group. Foetal distress was found as the most common reason for caesarean section. The overall occurrence of maternal complication was found to be similar in misoprostol and oxytocin groups, nausea/vomiting being the most common (36.7%) complication followed by fever (24.1%). Besides this, the most common neonatal complication found in overall cases was meconium stained liquor (49.2%). CONCLUSION: It was found that misoprostol was used most frequently for induction of labour compared to oxytocin. The onset of labour was found to be rapid in oxytocin than misoprostol. However, the occurrence of side effects was found to be similar in both misoprostol and oxytocin groups.

Impacts of counseling on knowledge, attitude and practice of medication use during pregnancy.

BACKGROUND: Counseling has a significant role in improving knowledge, attitude and practice outcomes of pregnant women towards medication use. Proper counseling thus could be beneficial to prevent any medication related misadventure during pregnancy. The present study was aimed to assess the knowledge, attitude and practice (KAP) of pregnant women towards their medications, to provide counseling regarding their understanding of medication use during pregnancy and evaluate the impacts of such counseling. METHODS: Pre- post interventional (counseling) study was conducted at Manipal Teaching Hospital, Nepal among pregnant women who presented with complication and were prescribed at least one medication. A total of 275 pregnant women were included in the study. A structured questionnaire was used to assess the knowledge, attitude and practice of pregnant women before and after counseling. The impacts of counseling were then evaluated using suitable statistical methods. RESULTS: Of the total participants 229 completed the post counseling survey. Majority of the participants were in the age group 20-24 (43.2%), primigravida (59.4%) and in third trimester (58.6%). Housewives comprised 61.1% of participants and majority had received a University degree (33.2%). The mean and median scores assessed before counseling showed that there was no significant difference in the KAP scores with respect to age, trimester and gravidity whereas KAP scores with respect to occupation and level of education were statistically significant. There was an increase in mean and median KAP scores after counseling and the impacts of counseling was found to be statistically significant (p = <0.001). CONCLUSION: Counseling had a positive impact on knowledge, attitude and practice of pregnant women towards medication and thus it could be considered a suitable method to encourage safe medication during pregnancy.

Medication utilization pattern for management of pregnancy complications: a study in Western Nepal.

BACKGROUND: Drugs used during pregnancy can adversely affect the health and life of the mother and unborn child. However, the fact that drugs are needed to mitigate complications during pregnancy cannot be avoided. The present study was designed to identify the common complications during pregnancy and assess the medications that have been used to mitigate those complications in an attempt to improve drug prescribing during pregnancy. METHODS: A hospital based cross sectional study was conducted at Manipal Teaching Hospital, Nepal in 275 pregnant women presenting with at least one complication and the drugs prescribed for the management of those complications were analyzed. RESULTS: Majority of the patients in this study were in the age group 20-24 (44 %) and in the third trimester (53.8 %). Maximum patients complained pain (back, abdominal, lower abdominal, neck, pelvic) as primary complication (24.3 %) which was followed by nausea/vomiting, upper respiratory tract complications, acid reflux disease and others. Of the total prescriptions eighty six (86) did not have any medicines prescribed to the patients except multivitamins and nutritional supplements. The average drugs prescribed per patient was 2.78 in outpatient setting and 5.41 in in-patients. Ranitidine, hyoscine butylbromide, paracetamol were the most frequently prescribed medications. Antimicrobials comprised 12.8 % of total drugs prescribed and 18 % of total drugs were fixed dose combinations. Two hundred and thirty four (234) prescriptions out of 275 were prescribed by brand names. Most of the prescribed drugs were from FDA pregnancy category B and C. CONCLUSION: The present finding showed that pregnant patients were prescribed medications almost only when necessary and those considered safe during pregnancy were chosen to a large extent. However, few teratogenic drugs (2.49 % of total drugs prescribed) were also found to be prescribed which might need further assessments.

A genetically distinct Schistosoma from Radix luteola from Nepal related to Schistosoma turkestanicum: A phylogenetic study of schistosome and snail host.

During a survey of freshwater snails in the Terai region of southern Nepal, 16 of 2588 specimens of Radix luteola from 4 different habitats were found to be shedding schistosome cercariae. None of the 1411 specimens of Radix acuminata we collected were positive for schistosomes. Analysis of 28S, cox1, 16S and 12S sequences indicated that all the R. luteola-derived schistosomes were genetically very similar to one another and, although unambiguously grouping most closely to the widespread Asian species Schistosoma turkestanicum, were clearly genetically distinct from it. We lack information from other life cycle stages to verify the specific identity of these cercariae, but it is possible they are of Schistosoma bomfordi or Schistosoma dattai, both species previously known only from northern India, the latter species known to infect R. luteola. This study provides sequence evidence for a third genetically distinct lymnaeid-transmitted Schistosoma lineage in Asia (to go along with S. turkestanicum and S. incognitum). As a close relative of S. turkestanicum, it provides the first direct molecular evidence to accompany morphological results from earlier studies for the presence of a S. turkestanicum species group in Asia. It increases to five the number of known or suspected mammalian schistosome species to be present in the Terai region of Nepal. Radix luteola and R. acuminata were identified and differentiated using conchological features and by molecular phylogenetic analyses of cox1 and 16S genes.

The Schistosoma indicum species group in Nepal: presence of a new lineage of schistosome and use of the Indoplanorbis exustus species complex of snail hosts.

From 2007-2014, 19,360 freshwater snails from the Terai and Hilly regions of Nepal were screened for cercariae of mammalian schistosomes. Based on analysis of mitochondrial cytochrome oxidase I, 12S, 16S and 28S sequences (3,675bp) of the cercariae recovered, we provide, to our knowledge, the first report of the Schistosoma indicum species group in Nepal. Five samples of Schistosoma nasale, nine of Schistosoma spindale and 17 of Schistosoma sp. were recovered, all from the snail Indoplanorbis exustus. The last-mentioned lineage failed to group in any of our analyses with S. nasale, S. spindale or S. indicum. It diverged in cox1 sequence from them by 16%, 13% and 13%, respectively, levels of difference comparable to well-studied species pairs of Schistosoma. Analysis of cox1, 16S and internal transcribed spacer 1 sequences (1,874bp) for Nepalese specimens of I. exustus was also surprising in revealing the presence of four genetically distinct clades. They diverged from one another at levels comparable to those noted for species pairs in the sister genus Bulinus. There was no obvious pattern of use by Nepalese Schistosoma of the Indoplanorbis clades. We found high support for a close relationship between S. indicum and Schistosoma haematobium groups, but failed to retrieve support for a clean separation of the two, with a tendency for S. nasale to fall as the most basal representative. If this pattern holds, hypotheses for the origin of the Asian Indoplanorbis-transmitted S. indicum group from the Bulinus-transmitted S. haematobium group may require modification, including consideration of more contemporaneous origins of the two groups. The Indian subcontinent is under-studied with respect to schistosome diversity and our current knowledge of the S. indicum and I. exustus species groups is inadequate. Further study is warranted given the ability of indicum group species to cause veterinary problems and cercarial dermatitis, with a worrisome potential in the future to establish infections in humans.

Two avian schistosome cercariae from Nepal, including a Macrobilharzia-like species from Indoplanorbis exustus.

As part of a global survey of schistosomes, a total of 16,109 freshwater snails representing 14 species were collected from lakes, ponds, rivers, rice fields and swamps mostly in the Terai region of southern Nepal. Only two snails were found to harbor avian schistosome cercariae even though Nepal is well known for its rich avian diversity. One schistosome infection was from an individual of Radix luteola and on the basis of phylogenetic analyses using 28S rDNA and cox1 sequences, grouped as a distinctive and previously unknown lineage within Trichobilharzia. This genus is the most speciose within the family Schistosomatidae. It includes 40 described species worldwide, and its members mostly infect anseriform birds (ducks) and two families of freshwater snails (Lymnaeidae and Physidae). The second schistosome cercaria was recovered from an individual of Indoplanorbis exustus that was also actively emerging a Petasiger-like echinostome cercaria. Although I. exustus is commonly infected with mammalian schistosomes of the Schistosoma indicum species group on the Indian subcontinent, this is the first specifically documented avian schistosome reported in this snail. Both cercariae reported here are among the largest of all schistosome cercariae recovered to date. The I. exustus-derived schistosome clustered most closely with Macrobilharzia macrobilharzia, although it seems to represent a distinct lineage. Specimens of Macrobilharzia have thus far not been recovered from snails, being known only as adult worms from anhingas and cormorants. This study is the first to characterize by sequence data avian schistosomes recovered from Asian freshwater habitats. This approach can help unravel the complex of cryptic species causing cercarial dermatitis here and elsewhere in the world.

A molecular approach for identification of paramphistomes from Africa and Asia.

Paramphistomiasis is a disease of domestic and wild ruminants caused by some digenetic trematodes of the superfamily Paramphistomoidea. Human infections with certain species of paramphistomes have been reported. Given their ubiquity and their abundance within hosts, it seems likely that the importance of these worms is underestimated globally. Based on the reported difficulties of morphological identification of paramphistomes, the development of alternative approaches to better delineate species is needed. Paramphistome samples examined during this study were cercariae, rediae from snail hosts and adult flukes obtained from slaughterhouses from Kenya, Tanzania, Egypt and Nepal. The results confirm that ITS2 is a good molecular marker for paramphistome identification and can be used to determine the affiliation of samples among the different taxa of Paramphistomoidea. Our 22 samples include eight species of paramphistomes. Ten samples of paramphistome larvae (cercariae or rediae) yielded seven species and the 12 samples of adult flukes from bovines yielded four, only one of which was not also represented among the larvae. We found three cases in which the sequences for adult worms and larvae matched, thus revealing the hosts involved locally in those particular life cycles. We interpret our specimens to include five species from Kenya, two from Nepal, two from Tanzania and one from Egypt. Bulinus forskalii was found infected with three species of paramphistomes. The results of the present study will help construct a framework to facilitate identification and eventually control of this underestimated cosmopolitan group of digeneans.