Abstract.Hookworm infection affects 430 million people worldwide, causing iron deficiency, impaired cognitive development, and stunting in children. Because of the environmental conditions needed for the hookworm life-cycle, this parasite is endemic to resource-limited countries. Necator americanus was endemic in the southern United States before improvement of sewage disposal systems and eradication programs. With continued poverty, poor sanitation, and an environment suitable for the hookworm life-cycle in some regions of the southern United States, a current prevalence study using modern molecular diagnostics is warranted. Lowndes County, Alabama, was chosen as the study site given previous high hookworm burdens, degree of poverty, and use of open-sewage systems. Participants were interviewed, and stool, serum, and soil samples were tested for nine intestinal parasites using a multiparallel quantitative real-time PCR (qPCR) and enzyme-linked immunosorbent assays. We found that, among 24 households, 42.4% reported exposure to raw sewage within their home, and from 55 stool samples, 19 (34.5%) tested positive for N. americanus, four (7.3%) for Strongyloides stercoralis, and one (1.8%) for Entamoeba histolytica. Stool tested positive for N. americanus contained low levels of parasite DNA (geometric mean 0.0302 fg/μL). Soil studies detected one (2.9%) Cryptosporidium species, and Toxocara serology assay detected one (5.2%) positive in this population. Individuals living in this high-risk environment within the United States continue to have stool samples positive for N. americanus. Gastrointestinal parasites known to be endemic to developing countries are identifiable in American poverty regions, and areas with lower disease burden are more likely to be identified by using qPCR.
Given that the rise of electronic cigarettes (e-cigs) has become increasingly relevant to the younger generations of today’s society, this paper investigates the impact of e-cig components, specifically nicotine and various e-cig flavoring chemicals, to fetal exposure during pregnancy on offspring respiratory outcomes. Previous animal studies primarily document the fetal side effects attributed to nicotine, including impaired lung development, with a model of direct chemical exposure, but we have hypothesized that in e-cig users, such phenotypes could result from and be exacerbated by the additional amalgam of chemicals that are responsible for the flavoring of e-cigs. Therefore, we have examined the harmful effects of nicotine and flavoring chemicals used in e-cigs in defense of the hypothesis that perinatal inhaled nicotine and e-cig flavoring exposure in vivo results in an airway asthmatic phenotype in offspring, which is transmitted transgenerationally, is characterized by Th2 polarization, and is more severe with combined exposure than with either constituent alone. The findings of this review support the hypothesis of this paper in regard to the potential detrimental respiratory effects of combined constituent exposure and indicate the need for the testing of further experimental animal models to better understand the foreseeable health implications of a rising e-cig use.
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