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Background Schistosomiasis is a neglected tropical disease that mostly affects inhabitants of sub-Saharan Africa. With rising global migration, imported cases of schistosomiasis are increasingly being reported in non-endemic countries, where diagnosis is hindered by low parasite burdens and multiple Schistosoma species. Microscopy remains the gold standard, despite its limitations, whereas molecular techniques offer greater sensitivity. The aim of this study was to assess the performance of real-time polymerase chain reaction (PCR) protocols for the detection, at an international health centre in Barcelona, of imported cases of urogenital and intestinal schistosomiasis. Methods This cross-sectional study included 75 adults from sub-Saharan Africa attending the Drassanes-Vall d’Hebron International Health Unit, Barcelona, between May 2023 and February 2024. Paired urine and stool samples were collected. Microscopy was performed on all samples. Urine was analysed by real-time PCR using the Dra1 target sequence. Stool was tested by three protocols targeting, respectively, Dra1, Sm1-7, and 28S rRNA. Schistosoma infection was confirmed by microscopic identification of eggs and/or parasite DNA detection by real-time PCR. Results Schistosomiasis was confirmed in 12/75 patients (16%). Urogenital schistosomiasis was diagnosed in 3/75 cases; the performance values of real-time PCR in urine samples were not assessed. In stool, the pan- Schistosoma real-time PCR showed 55.6% sensitivity and 98.5% specificity, with a moderate agreement ( κ  = 0.631) with microscopy. The Sm1-7 assay fully matched microscopy for Schistosoma mansoni detection, and reached 100% sensitivity and specificity. A novel contribution of this study is the application of a real-time PCR assay targeting the Dra1 repetitive sequence in stool samples for the detection of Schistosoma intercalatum/Schistosoma guineensis . All of the microscopy-positive cases were real-time PCR positive, and one additional infection was detected by real-time PCR, which meant that 100% sensitivity and 98.6% specificity were achieved with this technique. Conclusions Our findings underscore the need for accurate diagnostic tools for cases of imported schistosomiasis in non-endemic settings. Microscopy remains the reference standard, while the pan- Schistosoma real-time PCR showed limited sensitivity for stool samples. In contrast, the Sm1-7 and Dra1 assays demonstrated higher sensitivity and strong concordance with microscopy, with Dra1 also proving useful for the detection of S. intercalatum / S. guineensis in stool. Graphical abstract

Background This study aimed to evaluate and compare the diagnostic performance of the Midi Parasep ® Solvent Free (SF) system and the Ritchie method for detecting helminths and protozoa in clinical stool samples. It also assessed the most suitable concentration technique for different laboratory contexts on the basis of parasitic burden and epidemiological factors. Methods A retrospective comparative study was performed with 100 helminth-positive samples from the Drassanes Vall d’Hebron Microbiology Laboratory (Barcelona, Spain). Samples were previously identified using the Ritchie technique and were reprocessed using the Midi Parasep ® SF system. All samples were examined by expert microscopists and in accordance with World Health Organization protocols and quality standards. Bivariate analysis was performed using the Z-test or Fisher’s exact test, as appropriate, and differences were considered statistically significant at P  < 0.05. Results The Ritchie method detected 139 parasitic aetiologies, whereas Midi Parasep ® SF identified 85, yielding an overall concordance of 61.15%. While protozoan detection showed 100% concordance between both methods, the correlation for helminths was significantly lower (54.6%; P  < 0.001). Midi Parasep ® SF exhibited reduced sensitivity, particularly for larger helminths (e.g., Strongyloides stercoralis, Schistosoma intercalatum ) and samples with low parasitic burden. In addition, the Alcorfix TM fixative agent caused morphological alterations in some helminth eggs and larvae. Midi Parasep ® SF offers operational advantages and hazard reduction; however, the Ritchie method is more sensitive for helminth detection. Conclusions The choice of concentration technique should be guided by the clinical context. Midi Parasep ® SF is efficient for protozoa and suitable for routine use in high-throughput settings. Conversely, the Ritchie method is preferable when helminth infection is highly suspected, particularly in migrant or travel medicine populations. Moreover, other diagnostic techniques, such as serological assays, could contribute to a more accurate diagnosis, thereby guiding the selection of the most appropriate concentration technique. Graphical Abstract Digital microscopy images of stool wet mount samples with altered helminth morphology after the Midi Parasep ® SF Alcorfix TM concentration procedure. All images were acquired at 400 × magnification (10 × ocular lens and 40 × objective lens). A Unfertilised Ascaris lumbricoides egg; the mammillated outer layer appears twisted or altered. B Hymenolepis nana egg; the outer membrane, shell, and hexacanth embryo are wrinkled. C Schistosoma intercalatum egg; the rigid shell is slightly altered, and the miracidium shows abnormalities in the anterior part. D and E Strongyloides stercoralis rhabditiform larvae; cuticle morphology is visibly affected. F Hookworm ( Ancylostoma duodenale) egg; the morula is slightly altered

The gold standard diagnosis for malaria is the microscopic visualization of blood smears to identify Plasmodium parasites, although it is an expert-dependent technique and could trigger diagnostic errors. Artificial intelligence (AI) tools based on digital image analysis were postulated as a suitable supportive alternative for automated malaria diagnosis. A diagnostic evaluation of the iMAGING AI-based system was conducted in the reference laboratory of the International Health Unit Drassanes-Vall d’Hebron in Barcelona, Spain. iMAGING is an automated device for the diagnosis of malaria by using artificial intelligence image analysis tools and a robotized microscope. A total of 54 Giemsa-stained thick blood smear samples from travelers and migrants coming from endemic areas were employed and analyzed to determine the presence/absence of Plasmodium parasites. AI diagnostic results were compared with expert light microscopy gold standard method results. The AI system shows 81.25% sensitivity and 92.11% specificity when compared with the conventional light microscopy gold standard method. Overall, 48/54 (88.89%) samples were correctly identified [13/16 (81.25%) as positives and 35/38 (92.11%) as negatives]. The mean time of the AI system to determine a positive malaria diagnosis was 3 min and 48 s, with an average of 7.38 FoV analyzed per sample. Statistical analyses showed the Kappa Index = 0.721, demonstrating a satisfactory correlation between the gold standard diagnostic method and iMAGING results. The AI system demonstrated reliable results for malaria diagnosis in a reference laboratory in Barcelona. Validation in malaria-endemic regions will be the next step to evaluate its potential in resource-poor settings.

Reciprocal interactions between endothelial cells (ECs) and adipocytes are fundamental to maintain white adipose tissue (WAT) homeostasis, as illustrated by the activation of angiogenesis upon WAT expansion, a process that is impaired in obesity. However, the molecular mechanisms underlying the crosstalk between ECs and adipocytes remain poorly understood. Here, we show that local production of polyamines in ECs stimulates adipocyte lipolysis and regulates WAT homeostasis in mice. We promote enhanced cell-autonomous angiogenesis by deleting Pten in the murine endothelium. Endothelial Pten loss leads to a WAT-selective phenotype, characterized by reduced body weight and adiposity in pathophysiological conditions. This phenotype stems from enhanced fatty acid β-oxidation in ECs concomitant with a paracrine lipolytic action on adipocytes, accounting for reduced adiposity. Combined analysis of murine models, isolated ECs and human specimens reveals that WAT lipolysis is mediated by mTORC1-dependent production of polyamines by ECs. Our results indicate that angiocrine metabolic signals are important for WAT homeostasis and organismal metabolism. Endothelial cells in white adipose tissue are shown to produce polyamines, which regulate adipocyte lipolysis, thus demonstrating how local angiocrine signals contribute to healthy adipose tissue homeostasis.