Does Dexamethasone Reduce Hospital Readiness for Discharge, Pain, Nausea, and Early Patient Satisfaction in Hip and Knee Arthroplasty? A Randomized, Controlled Trial.

BACKGROUND: Reduction in postoperative pain, nausea, and vomiting in patients undergoing total joint arthroplasty may facilitate earlier discharge from hospital and reduce healthcare costs. This study was performed to primarily assess whether perioperative dexamethasone reduced hospital length of stay and to assess the effect on pain, nausea and vomiting, and patient satisfaction. METHODS: One hundred sixty-four patients undergoing total hip arthroplasty or total knee arthroplasty were randomized to receive either 8 mg intravenous dexamethasone (n = 86) or placebo (n = 78) at induction and at 24 hours postsurgery. The primary outcome was length of stay and secondary outcomes were pain and nausea visual analog scale scores, analgesic and antiemetic usage, blood glucose level, and patient satisfaction. RESULTS: Participants in the study group achieved earlier readiness for discharge. There was a 20% reduction in pain scores and morphine usage was 27% lower in the study group. Nausea scores were similar in the 2 groups but there was lower antiemetic usage in the study group. Satisfaction scores at 6 weeks postsurgery in the dexamethasone group were significantly higher than the placebo group. There was no difference in complication rates between the 2 groups. CONCLUSION: The administration of intravenous dexamethasone could lead to earlier readiness for discharge especially in patients undergoing elective total hip arthroplasty, primarily by a reduction in postoperative pain scores and/or morphine requirements.

Development and application of a vaccination planning tool for avian influenza.

The vaccination planning tool for avian influenza supports evidence-based planning and preparedness for vaccinating poultry at national and regional levels. This study describes the development, testing, and application of a vaccination planning tool for H5N1 highly pathogenic avian influenza (HPAI) used in two South Asian countries. The tool consists of eight planning clusters, 37 planning elements, and 303 referenced planning criteria. Both countries attained a score of 52% among planning clusters as a measure of preparedness. The highest and lowest planning cluster scores included vaccination strategies and financial readiness, respectively. The comprehensive vaccination program was identified as the most-useful planning cluster for assessing preparedness, and 86% of participants indicated that the objectives of the planning tool were achieved. Based on these results, the planning tool provides a structured approach for decision makers to develop their national vaccination program for HPAI as part of an overall strategy for the progressive reduction and control of endemic influenza viruses in poultry.

Anthropogenic and environmental factors associated with koala deaths due to dog attacks and vehicle collisions in South-East Queensland, Australia, 2009-2013.

Populations of the iconic Australian koala are under constant decline. Their deaths are associated with rapid and extensive urbanization and the fragmentation of habitat areas. Using citizen science data on reported koala mortalities, we quantified the association between anthropogenic and environmental factors and the two leading causes of koala deaths, dog attacks and vehicle collisions. We achieved this objective using a case-control study design to compare the odds of exposure to a given risk factor for cases (a given cause of death) with the odds of exposure to a given risk factor for controls (all other causes of death). Koala deaths due to dog attacks were positively associated with registered dog population density and negatively associated with lot density whereas koala deaths due to vehicle collisions were positively associated with road density (road length per square kilometer) and negatively associated with human population density and distance to primary and secondary roads. The results of this research can be used to develop strategies to mitigate the risk of deaths due to dog attacks, for example by conducting educational awareness programs, promoting registration of dogs and discouraging free roaming of dogs. In a similar manner, in high-risk areas for vehicle collisions, over- or underpasses can be built to facilitate safe movement of koalas for road crossings or speed limits could be introduced to reduce the likelihood of premature koala deaths due to vehicle collisions.

Development of core competencies for field veterinary epidemiology training programs.

A workforce with the adequate field epidemiology knowledge, skills and abilities is the foundation of a strong and effective animal health system. Field epidemiology training is conducted in several countries to meet the increased global demand for such a workforce. However, core competencies for field veterinary epidemiology have not been identified and agreed upon globally, leading to the development of different training curricula. Having a set of agreed core competencies can harmonize field veterinary epidemiology training. The Food and Agriculture Organization of the United Nations (FAO) initiated a collective, iterative, and participative process to achieve this and organized two expert consultative workshops in 2018 to develop core competencies for field veterinary epidemiology at the frontline and intermediate levels. Based on these expert discussions, 13 competencies were identified for the frontline and intermediate levels. These competencies were organized into three domains: epidemiological surveillance and studies; field investigation, preparedness and response; and One Health, communication, ethics and professionalism. These competencies can be used to facilitate the development of field epidemiology training curricula for veterinarians, adapted to country training needs, or customized for training other close disciplines. The competencies can also be useful for mentors and employers to monitor and evaluate the progress of their mentees, or to guide the selection process during the recruitment of new staff.

Estimating koala density from incidental koala sightings in South-East Queensland, Australia (1997-2013), using a self-exciting spatio-temporal point process model.

The koala, Phascolarctos cinereus, is an iconic Australian wildlife species facing a rapid decline in South-East Queensland (SEQLD). For conservation planning, the ability to estimate the size of koala populations is crucial. Systematic surveys are the most common approach to estimate koala populations but because of their cost they are often restricted to small geographic areas and are conducted infrequently. Public interest and participation in the collection of koala sighting data is increasing in popularity, but such data are generally not used for population estimation. We modeled monthly sightings of koalas reported by members of the public from 1997 to 2013 in SEQLD by developing a self-exciting spatio-temporal point process model. This allowed us to account for characteristics that are associated with koala presence (which vary over both space and time) while accounting for detection bias in the koala sighting process and addressing spatial clustering of observations. The density of koalas varied spatially due to the heterogeneous nature of koala habitat in SEQLD, with a mean density of 0.0019 koalas per km2 over the study period. The percentage of land areas with very low densities (0-0.0005 koalas per km2) remained similar throughout the study period representing, on average, 66% of the total study area. The approach described in this paper provides a useful starting point to allow greater use to be made of incidental koala sighting data. We propose that the model presented here could be used to combine systematic koala survey data (which is spatially restricted, but more precise) with koala sighting data (which is incidental and often biased by nature, but often collected over large geographical areas). Our approach could also be adopted for modeling the density of other wildlife species where data is collected in the same manner.

Phaeochromocytoma presenting as Takotsubo cardiomyopathy.

We report a case of a 72-year-old woman who presented with ST-elevation myocardial infarction (STEMI). However, coronary angiography showed unobstructed arteries while echocardiography (ECHO) showed severe left ventricular (LV) apical hypokinesia with ejection fraction (EF) of 25-30%. Seven months later she presented with a transient ischaemic attack and a repeat ECHO showed a normal EF.A few months later, she was diagnosed with breast cancer and as part of staging procedure, an incidental left adrenal mass was identified. This was biochemically confirmed as phaeochromocytoma (PY) and she underwent laparoscopic adrenalectomy.PY is a rare catecholamine secreting tumour arising from adrenomedullary chromaffin cells. Excessive catecholamine-induced stimulation can present as transient, reversible cardiomyopathy similar to Takotsubo cardiomyopathy and cerebrovascular events. The diagnosis of PY is often delayed but it is important to recognize PY as a cause of reversible cardiomyopathy. Early intervention is essential to improve mortality from cardiovascular and cerebrovascular complications.

The value of long-term citizen science data for monitoring koala populations.

The active collection of wildlife sighting data by trained observers is expensive, restricted to small geographical areas and conducted infrequently. Reporting of wildlife sightings by members of the public provides an opportunity to collect wildlife data continuously over wider geographical areas, at lower cost. We used individual koala sightings reported by members of the public between 1997 and 2013 in South-East Queensland, Australia (n = 14,076 koala sightings) to describe spatial and temporal trends in koala presence, to estimate koala sighting density and to identify biases associated with sightings. Temporal trends in sightings mirrored the breeding season of koalas. Sightings were high in residential areas (63%), followed by agricultural (15%), and parkland (12%). The study area was divided into 57,780 one-square kilometer grid cells and grid cells with no sightings of koalas decreased over time (from 35% to 21%) indicative of a greater level of spatial overlap of koala home ranges and human activity areas over time. The density of reported koala sightings decreased as distance from primary and secondary roads increased, indicative of a higher search effort near roads. Our results show that koala sighting data can be used to refine koala distribution and population estimates derived from active surveying, on the condition that appropriate bias correction techniques are applied. Collecting koala absence and search effort information and conducting repeated searches for koalas in the same areas are useful approaches to improve the quality of sighting data in citizen science programs.

Correction: Surveillance of Influenza A Virus and Its Subtypes in Migratory Wild Birds of Nepal.

[This corrects the article DOI: 10.1371/journal.pone.0133035.].

Traumatic Thumb Radial Sagittal Band Injury Mimicking EPL Rupture.

We present the case of a closed traumatic disruption of the thumb radial sagittal band (RSB) that sonographically mimicked rupture of the extensor pollicis longus (EPL) tendon. This injury was treated with primary repair of the RSB and lead to a good functional outcome for the patient. This case report highlights how early recognition and treatment can lead to a good functional outcome.

Perforating arteries of the thigh: An anatomical and radiological study.

INTRODUCTION: We aimed to advance the understanding of the anatomy of the perforating branches of the profunda femoris artery to facilitate the avoidance of iatrogenic injury in surgery around the thigh and ensure safe percutaneous embolisation. METHODS: Dissection was carried out on seven cadavers, examining the relationship of the point of origin of the perforating branches of profunda femoris, relative to lines connecting palpable bony landmarks (lines A and B). These were compared with 16 computed tomography angiograms (CTA). Left to right variation within subjects and variation between the dissection and imaged group was examined. The anatomy of the two groups was then compared with that described in anatomical textbooks. RESULTS: The side to side variation in number of perforators was not significant in the dissection (P = 0.20) nor the CT group (P = 0.70). Similarly, the point of origin of the perforating vessels along lines A and B did not demonstrate any significant difference except for the fourth perforator along line B (P = 0.03). There was no significant difference in points of origin along line B between the dissection and CT groups for the first four perforators on the left (P = 0.51, P = 0.80, P = 0.66, P = 0.09 respectively) and right (P = 0.79, P = 0.45, P = 0.56, P = 0.11 respectively). The number and distribution of perforators were then compared with commonly used anatomical texts. CONCLUSION: As in other parts of the body, textbook descriptions of anatomical structures may not be reflected consistently in vivo. However, the perforating branches of the profunda femoris demonstrate a predictable topographical relationship to palpable bony landmarks.

Risk factors and therapy for goat mastitis in a hospital-based case-control study in Bangladesh.

Bangladesh has a large population of goats, which contribute to the income, nutrition and welfare of the households of many families. Mastitis in goats has a low incidence, but is often very severe, making veterinary care necessary. The aim of this study was to identify seasonality and risk factors for goat mastitis in a hospital-based matched case-control study in a teaching veterinary hospital in Chittagong, Bangladesh and to describe the range of antimicrobial treatments applied in this situation. Cases of mastitis and controls were drawn from the hospital patient recording system, along with their risk factor status. Multiple imputation was applied to deal with the missing values in the data analysis. Mastitis occurred somewhat more in the rainy season, and comprised about 3% of all goats admitted to the hospital during January 2011-June 2014. Free-ranging farming system, poor body condition score and non-native goat breeds were significantly associated with case status. Treatment of clinical mastitis was variable and unsystematic, but the use of gentamicin was commonly recorded. The need for more prudent and evidence-based antimicrobial therapies is discussed.

Efficacy of platelet-rich plasma injections in pain associated with chronic tendinopathy: A systematic review.

BACKGROUND: Chronic tendinopathy has often been a management dilemma for general practitioners. With our understanding of the pathophysiology of tendinopathy evolving, so has our management, with the advent of newer strategies such as topical glycerol trinitrate, extracorporeal shock-wave therapy, as well as platelet-rich plasma (PRP). AIM: To systematically review the literature regarding PRP therapy in chronic tendinopathy. DESIGN AND SETTING: The databases used in our search include the Elton B. Stephens Co. (EBSCO) database, Medline, the Cochrane library, Ovid, and Embase (the Excerpta Medica database). A total of 389 articles were reviewed from Feb 2010 to April 2014, for possible inclusion. Of these articles, a total of 9 randomized controlled trials (RCTs) met our inclusion criteria. Only 1 RCT was excluded due to previous surgery in both the trial and control groups. METHODS: Each article was reviewed independently by 2 authors. Each article was analyzed using the Cochrane Criteria checklist. Where any discrepancy occurred in results, a third independent reviewer was consulted. RESULTS: Our review found that PRP was most effective in patellar and lateral epicondylar tendinopathy, with both RCTs in the patellar section of our study supporting the use of PRP in pain reduction at 3 and 12 months, whereas 2 of 4 studies in the lateral epicondylar section showed improvements in pain and disability at 6 and 12 months. There was a lack of evidence to support the use of PRP in Achilles and rotator cuff tendinopathy. CONCLUSIONS: Although the results of this review show promise for the use of PRP in chronic tendinopathy, the analysis highlighted the need for more controlled clinical trials comparing PRP with placebo.

Surveillance of Influenza A Virus and Its Subtypes in Migratory Wild Birds of Nepal.

Nepal boarders India and China and all three countries lie within the Central Asian Flyway for migratory birds. Novel influenza A H7N9 caused human fatalities in China in 2013. Subclinical infections of influenza A H7N9 in birds and the potential for virus dispersal by migratory birds prompted this study to assess avian H7N9 viral intrusion into Nepal. Surveillance of influenza A virus in migratory birds was implemented in early 2014 with assistance from the Food and Agricultural Organization (FAO). Of 1811 environmental fecal samples collected from seven wetland migratory bird roosting areas, influenza A H9N2 was found in one sample from a ruddy shelduck in Koshi Tappu Wildlife Reserve located in southern Nepal. Avian H7N9 and other highly pathogenic avian influenza viruses were not detected. This study provides baseline data on the status of avian influenza virus in migratory bird populations in Nepal.

Spatio-temporal epidemiology of highly pathogenic avian influenza (subtype H5N1) in poultry in eastern India.

In India, majority outbreaks of highly pathogenic avian influenza (HPAI) H5N1 have occurred in eastern states of West Bengal, Assam and Tripura. This study aimed to identify disease clusters and risk factors of HPAI H5N1 in these states, for targeted surveillance and disease control. A spatial scan statistic identified two significant disease clusters in West Bengal and Assam, occurring during January and November-December 2008, respectively. Key risk factors were identified at sub-district level using bootstrapped logistic regression and boosted regression trees model. With both methods, HPAI H5N1 outbreaks in backyard poultry were associated with accessibility in terms of time taken to access a city with >50,000 persons, human population density and duck density (P<0.005). In addition, areas at lower elevation were also identified as high risk by BRT model. It is recommended that risk-based surveillance should be implemented in high duck density areas and all live-bird markets in high-throughput locations.

A survey of gastro-intestinal parasitic infection in domestic and wild birds in Chittagong and Greater Sylhet, Bangladesh.

A survey of gastrointestinal parasitic infection as determined by faecal examination was conducted among domestic and wild birds in Bangladesh. Birds were sampled from households, wet markets and wetlands in Chittagong and Greater Sylhet districts during April 2012 to February 2013. Mist nets were used to catch resident wild and migratory birds. The overall prevalence of parasitic infection ranged among locations from 25 to 55% in indigenous domestic ducks (live bird samples=304), 20% in resident wild birds (environmental faecal samples=40) and 40% in migratory birds (live bird samples=35). The prevalence of parasitic infection was significantly higher in indigenous domestic ducks collected during summer (39%) than winter (22%) (p=0.04). In domestic indigenous ducks and Muscovy ducks, both single and multiple types of parasitic infections were found. However, other domestic birds and wild birds often had a single type of parasitic infection. Ascaridia spp. with an average egg load of 50-900, was commonly detected in faecal samples of domestic and wild birds in this study. Other identified parasites were Capillaria spp. and Heterakis spp. both in domestic and wild birds. Improvement of biosecurity measures for household duck farms through educating and motivating household farmers could help mitigate the effects of parasitic infection on production.