Evidence of a Rapid Shift in Outpatient Practice During the COVID-19 Pandemic Using Telemedicine.

Introduction: During the current pandemic, measures for preventing SARS-CoV-2 virus exposure has severely impacted the delivery of outpatient clinical care to patients with a chronic neurological condition. Telemedicine has emerged as an obvious choice to counter these impediments. However, its potential for maintaining outpatient care at pre-pandemic levels during these rapidly changing times is untested. Therefore, we analyzed our experience in a tertiary care epilepsy center. Methods: We divided the study period from March 1, 2020 to April 15, 2020 into a baseline, transition (to telemedicine), and current phase. We divided outpatient encounters into clinic, virtual (using Cleveland Clinic Express Care Online platform), and telephone (including commercial video conferencing platforms). Results: Completed outpatient visits during baseline and current period were 595 and 590, respectively. Nearly 1 out of 4 patients missed outpatient visits during the transition period. The virtual visits accounted for 19.7% of completed visits during baseline and increased to 66.8% during the current period. There were no telephone visits during the baseline phase but accounted for 26.1% of completed visits during the current phase. Less than 1 percent of completed visits in the current phase were in the clinic. Conclusion: We provide evidence that telemedicine's robust and rapid scalability can help maintain a seamless transition of outpatient care during the pandemic.

Antimicrobial prophylaxis does not improve post-surgical outcomes in SIV/SHIV-uninfected or SIV/SHIV-infected macaques (Macaca mulatta and Macaca fascicularis) based on a retrospective analysis.

Surgical antimicrobial prophylaxis is indicated when performing contaminated surgeries, when specific surgical implants are placed, and for prolonged surgical procedures. Unnecessary prophylactic antibiotics are often utilized for macaque surgeries, despite medical and veterinary guidelines. In this study we compared complication rates in macaques receiving peripheral lymph node (PLN) and laparoscopic biopsies, with and without antimicrobial prophylaxis. A majority of animals were SIV or SHIV infected at the time of surgery, so we also compared post-operative complication rates based on infection status. We found no significant difference in PLN biopsy complication rates for animals that received antimicrobial prophylaxis versus those that did not. Animals who underwent laparoscopic procedures and received prophylactic antibiotics had a higher complication rate than those who did not receive them. Complication rates did not differ significantly for SIV/SHIV infected versus uninfected animals for both laparoscopic biopsy procedures and PLN biopsy procedures. SIV/SHIV infected animals that underwent PLN biopsies had no significant difference in complication rates with and without antimicrobial prophylaxis, and SIV/SHIV infected animals receiving prophylactic antibiotics for laparoscopic biopsies had a higher complication rate than those that did not. This study suggests that perioperative prophylactic antibiotics have no role in the management of SIV/SHIV-infected and uninfected macaques undergoing clean, minimally invasive surgeries. Additionally, we recommend eliminating unnecessary antibiotic use in study animals due to their potential confounding impacts on research models and their potential to promote antimicrobial resistance.

Prevalence of Fascioliasis and Associated Economic Losses in Cattle Slaughtered at Lira Municipality Abattoir in Northern Uganda.

Fascioliasis (liver fluke infestation) is one of the most important parasitic diseases affecting cattle, other ruminant animals and humans. Fascioliasis causes large, but usually neglected, economic losses to cattle farmers and traders. The objectives of this study were to assess the prevalence and associated risks for fascioliasis in slaughter cattle and estimate the financial losses due to liver condemnation at the Lira Municipal abattoir in Uganda. A total of 216 cattle were sampled during the study period. Animal breed and sex were determined by observing the phenotypic characteristics of the animals. Age was determined by assessing the eruption and wearing of permanent teeth. After slaughter, the liver was examined for presence of Fasciola spp. (liver flukes) by visual inspection, palpation, and incisions. The bile ducts and gall bladder were similarly examined for presence of mature Fasciola spp. The gross weight and amount of liver trimmed-off due to fluke infestation were determined. Of the 216 liver examined, 65.7% (n = 142) were infested with Fasciola spp. Cattle that were aged 4-5 years old at the time of slaughter had significantly greater odds (OR = 5.84; CI [2.79-12.22]) of being infested with Fasciola spp. compared to those that were younger than 3.5 years old. In contrast, cattle that had a body condition score of 3.5 or 4 had lower odds (OR= 0.42; CI [0.21-0.88] and OR = 0.22; CI [0.04-1.10]) of fascioliasis than those with a BCS of 3. Other tested variables including animal origin, breed, sex, and gross weight of the liver had no significant effect on the prevalence of fascioliasis. This study also revealed that the abattoir loses an estimated 38 million UGX annually due to condemnation of Fasciola-infested liver (one UGX= 0.00027 USD; July 2016). Our study showed that the prevalence of fascioliasis was high in Lira District, Uganda, which results in a large amount of liver being condemned and destroyed, leading to financial losses for affected farmers in the area. Therefore, there is a need to take the necessary preventive measures to control the disease and increase awareness among farmers and medical personnel in the area due to the zoonotic nature of fascioliasis.