COVID-19 in Australia: our national response to the first cases of SARS-CoV-2 infection during the early biocontainment phase.

BACKGROUND: On 31 December 2019, the World Health Organization recognised clusters of pneumonia-like cases due to a novel coronavirus disease (COVID-19). COVID-19 became a pandemic 71 days later. AIM: To report the clinical and epidemiological features, laboratory data and outcomes of the first group of 11 returned travellers with COVID-19 in Australia. METHODS: This is a retrospective, multi-centre case series. All patients with confirmed COVID-19 infection were admitted to tertiary referral hospitals in New South Wales, Queensland, Victoria and South Australia. RESULTS: The median age of the patient cohort was 42 years (interquartile range (IQR), 24-53 years) with six men and five women. Eight (72.7%) patients had returned from Wuhan, one from Shenzhen, one from Japan and one from Europe. Possible human-to-human transmission from close family contacts in gatherings overseas occurred in two cases. Symptoms on admission were fever, cough and sore throat (n = 9, 81.8%). Co-morbidities included hypertension (n = 3, 27.3%) and hypercholesterolaemia (n = 2, 18.2%). No patients developed severe acute respiratory distress nor required intensive care unit admission or mechanical ventilation. After a median hospital stay of 14.5 days (IQR, 6.75-21), all patients were discharged. CONCLUSIONS: This is a historical record of the first COVID-19 cases in Australia during the early biocontainment phase of the national response. These findings were invaluable for establishing early inpatient and outpatient COVID-19 models of care and informing the management of COVID-19 over time as the outbreak evolved. Future research should extend this Australian case series to examine global epidemiological variation of this novel infection.

Isolation and rapid sharing of the 2019 novel coronavirus (SARS-CoV-2) from the first patient diagnosed with COVID-19 in Australia.

OBJECTIVES: To describe the first isolation and sequencing of SARS-CoV-2 in Australia and rapid sharing of the isolate. SETTING: SARS-CoV-2 was isolated from a 58-year-old man from Wuhan, China who arrived in Melbourne on 19 January 2020 and was admitted to the Monash Medical Centre, Melbourne from the emergency department on 24 January 2020 with fever, cough, and progressive dyspnoea. MAJOR OUTCOMES: Clinical course and laboratory features of the first reported case of COVID-19 (the illness caused by SARS-CoV-2) in Australia; isolation, whole genome sequencing, imaging, and rapid sharing of virus from the patient. RESULTS: A nasopharyngeal swab and sputum collected when the patient presented to hospital were each positive for SARS-CoV-2 (reverse transcription polymerase chain reaction). Inoculation of Vero/hSLAM cells with material from the nasopharyngeal swab led to the isolation of SARS-CoV-2 virus in culture. Electron microscopy of the supernatant confirmed the presence of virus particles with morphology characteristic of viruses of the family Coronaviridae. Whole genome sequencing of the viral isolate and phylogenetic analysis indicated the isolate exhibited greater than 99.99% sequence identity with other publicly available SARS-CoV-2 genomes. Within 24 hours of isolation, the first Australian SARS-CoV-2 isolate was shared with local and overseas reference laboratories and major North American and European culture collections. CONCLUSIONS: The ability to rapidly identify, propagate, and internationally share our SARS-CoV-2 isolate is an important step in collaborative scientific efforts to deal effectively with this international public health emergency by developing better diagnostic procedures, vaccine candidates, and antiviral agents.

Refractory hypercalcaemia associated with disseminated Cryptococcus neoformans infection.

SUMMARY: Hypercalcaemia is a very common endocrine condition, yet severe hypercalcaemia as a result of fungal infection is rarely described. There are have only been two reported cases in the literature of hypercalcaemia associated with Cryptococcus infection. Although the mechanism of hypercalcaemia in these infections is not clear, it has been suggested that it could be driven by the extra-renal production of 1-alpha-hydroxylase by macrophages in granulomas. We describe the case of a 55-year-old woman with a 1,25-OH D-mediated refractory hypercalcaemia in the context of a Cryptococcus neoformans infection. She required treatment with antifungals, pamidronate, calcitonin, denosumab and high-dose glucocorticoids. A disseminated fungal infection should be suspected in immunosuppressed individuals presenting with hypercalcaemia. LEARNING POINT: In immunocompromised patients with unexplained hypercalcaemia, fungal infections should be considered as the differential diagnoses; Glucocorticoids may be considered to treat 1,25-OH D-driven hypercalcaemia; however, the benefits of lowering the calcium need to be balanced against the risk of exacerbating an underlying infection; Fluconazole might be an effective therapy for both treatment of the hypercalcaemia by lowering 1,25-OH D levels as well as of the fungal infection.

Bond strength of composite to dentin and enamel using self-etching adhesive systems.

To determine the shear bond strength of 10 self-etching adhesive systems to dentin and enamel, flat bonding sites were prepared on 216 extracted human molar teeth, using 600-grit silicon carbide paper to expose dentin or enamel. Following the application of each adhesive system, bonded assemblies of Spectrum TPH were prepared using a gelatin capsule matrix (n = 24). After 24 hours of storage in water at 37 degrees C, 12 specimens from each enamel and dentin group were debonded. This was followed by thermocycling for 6,000 cycles between water baths at 5 degrees C and 55 degrees C, with a dwell time of 20 seconds in each bath. Specimens were loaded to failure in a testing machine with a crosshead speed of 5 mm/minute. Statistical analysis included a one-way ANOVA and least square difference post hoc test. There were significant differences in shear bond strength for both enamel and dentin among the materials tested (p < 0.05).

Bonding and curing considerations for incipient and hidden caries.

Contemporary adhesive systems and restorative composite materials can successfully seal and restore teeth and can facilitate the use of a minimally invasive cavity preparation technique. These systems give the operator the potential to reinforce damaged teeth and preserve healthy tooth structure. The adhesion principles rely on strict adherence to excellence in clinical technique. Differences in clinical results may depend may more on the operator's adherence to good clinical technique than the specific material selected.

Supported employment for people with co-occurring disorders.

Research shows that people with dual disorders (i.e., a co-occurring mental illness and substance use disorder) are successful in supported employment programs and that employment can be a crucial step in their recovery. Based on experience observing supported employment services for 15 years, we propose practice guidelines for people with dual disorders. Successful programs share several approaches: 1) encourage employment, 2) understand substance abuse as part of the vocational profile, 3) find a job that supports recovery, 4) help with money management, and 5) use a team approach to integrate mental health, substance abuse, and vocational services.

Bond strength of composite to dentin using self-etching adhesive systems.

PURPOSE: To determine the shear bond strength to dentin of five newer-generation self-etching adhesive systems. METHOD AND MATERIALS: Flat bonding sites were prepared on 100 extracted human molar teeth with 600-grit silicon carbide paper, which exposed the dentin. The systems tested were: Clearfil SE Bond; Optibond Solo Plus Self-Etch; Xeno CF III; Tyrian SPE; and Adper Prompt L-Pop. Following application of each adhesive system, bonded assemblies of Z-100 were prepared using a gelatin capsule matrix (n = 20). Ten specimens in each group were debonded after water storage for 24 hours at 37 degrees C, and 10 were stored for at least 30 days, followed by thermocycling for 850 cycles between water baths at 5 degrees C and 55 degrees C, with a dwell time of 1 minute in each bath. Specimens were loaded to failure in an Instron Model 1123 testing machine with a crosshead speed of 5 mm/min. Statistical analysis included a two-way analysis of variance (adhesive and time) and Tukey's post hoc test. RESULTS: Mean shear bond strengths (MPa) at 24 hours were: Clearfil, 26.4+/-4.2; Optibond, 23.5+/-4.4; Xeno, 19.5+/-4.2; Tyrian, 16.5+/-3.7; and Adper, 15.3+/-3.3. Mean shear bond strengths (MPa) after storage and thermocycling were: Optibond, 27.5+/-5.7; Clearfil, 25.5+/-4.9; Adper, 21.5+/-3.3; Xeno, 20.4+/-2.2; and Tyrian, 19.2+/-6.4. Both adhesive system and storage time were significant factors affecting shear bond strength (P < .05). CONCLUSION: There are significant differences in the in vitro dentin shear bond strength among the self-etching adhesive materials tested. Water storage and thermocycling did not significantly degrade the shear bond strength of the materials in this study.