Epidemiology, clinical presentations and outcome of patients presenting to the emergency department after a COVID-19 vaccination: An observational study.

OBJECTIVE: The World Health Organization declared the COVID-19 pandemic on 11 March 2020. In 2021, several vaccines were provisionally approved to reduce the risk of transmission and hospitalisation of COVID-19 infection. A surge in COVID-19 vaccination was seen between August and October 2021 in Victoria, Australia. We hypothesised this led to an increase in ED presentations. METHODS: Patients in the present study were adults who presented to the ED within 21 days of receiving a dose of a COVID-19 vaccine between 11 August 2021 and 14 November 2021. All cases underwent chart reviews to extract epidemiological features, clinical presentations, ED assessments, investigations and disposition. RESULTS: Notably, 968 patients were included in the study, comprising 6.1% of all ED presentations during the study period. The median age was 31 years. 82.9% of patients were younger than 45 years. 20.1% of patients arrived by ambulance. Chest pain was the most common presenting complaint (43.6%), followed by headache (10.3%) and palpitations (8.2%). The most common investigations were a full blood examination (73.5%), an ECG (63.8%) and serum troponin (49.1%). 64.8% of patients were directly discharged home and 22.1% were sent home after a short stay admission. Only 2.2% of patients were admitted to the hospital. CONCLUSION: A majority of patients who presented to the ED after their COVID vaccinations were young and discharged home after the initial assessment. These presentations have significantly increased the workload in prehospital settings and EDs, contributing to increased investigation usage, ED treatment space occupancy, and increased costs to the health system.

Global correlates of terrestrial and marine coverage by protected areas on islands.

Many islands are biodiversity hotspots but also extinction epicenters. In addition to strong cultural connections to nature, islanders derive a significant part of their economy and broader wellbeing from this biodiversity. Islands are thus considered as the socio-ecosystems most vulnerable to species and habitat loss. Yet, the extent and key correlates of protected area coverage on islands is still unknown. Here we assess the relative influence of climate, geography, habitat diversity, culture, resource capacity, and human footprint on terrestrial and marine protected area coverage across 2323 inhabited islands globally. We show that, on average, 22% of terrestrial and 13% of marine island areas are under protection status, but that half of all islands have no protected areas. Climate, diversity of languages, human population density and development are strongly associated with differences observed in protected area coverage among islands. Our study suggests that economic development and population growth may critically limit the amount of protection on islands.

Movement Patterns, Home Range Size and Habitat Selection of an Endangered Resource Tracking Species, the Black-Throated Finch (Poephila cincta cincta).

Understanding movement patterns and home range of species is paramount in ecology; it is particularly important for threatened taxa as it can provide valuable information for conservation management. To address this knowledge gap for a range-restricted endangered bird, we estimated home range size, daily movement patterns and habitat use of a granivorous subspecies in northeast Australia, the black-throated finch (Poephila cincta cincta; BTF) using radio-tracking and re-sighting of colour banded birds. Little is known about basic aspects of its ecology including movement patterns and home range sizes. From 2011-2014 we colour-banded 102 BTF and radio-tracked 15 birds. We generated home ranges (calculated using kernel and Minimum Convex Polygons techniques of the 15 tracked BTF). More than 50% of the re-sightings occurred within 200 m of the banding site (n = 51 out of 93 events) and within 100 days of capture. Mean home-range estimates with kernel (50%, 95% probability) and Minimum Convex Polygons were 10.59 ha, 50.79 ha and 46.27 ha, respectively. Home range size differed between two capture sites but no seasonal differences were observed. BTF home ranges overlapped four habitat types among eight available. Habitat selection was different from random at Site 1 (χ2 = 373.41, df = 42, p<0.001) and Site 2 (χ2 = 1896.1, df = 45, p<0.001); however, the preferred habitats differed between the two sites. BTF moved further than expected on the basis of current knowledge, with three individuals being resighted over 15 km from the banding location. However, BTF maintain small home ranges over short time-frames. Occasional long-distance movements may be related to resource bottleneck periods. Daily movement patterns differed between sites, which is likely linked to the fact that the sites differ in the spatial distribution of resources. The work provides information about home range sizes and local movement of BTF that will be valuable for targeting effective management and conservation strategies for this endangered granivore.

Sympathy for the Devil: Detailing the Effects of Planning-Unit Size, Thematic Resolution of Reef Classes, and Socioeconomic Costs on Spatial Priorities for Marine Conservation.

Spatial data characteristics have the potential to influence various aspects of prioritising biodiversity areas for systematic conservation planning. There has been some exploration of the combined effects of size of planning units and level of classification of physical environments on the pattern and extent of priority areas. However, these data characteristics have yet to be explicitly investigated in terms of their interaction with different socioeconomic cost data during the spatial prioritisation process. We quantify the individual and interacting effects of three factors-planning-unit size, thematic resolution of reef classes, and spatial variability of socioeconomic costs-on spatial priorities for marine conservation, in typical marine planning exercises that use reef classification maps as a proxy for biodiversity. We assess these factors by creating 20 unique prioritisation scenarios involving combinations of different levels of each factor. Because output data from these scenarios are analogous to ecological data, we applied ecological statistics to determine spatial similarities between reserve designs. All three factors influenced prioritisations to different extents, with cost variability having the largest influence, followed by planning-unit size and thematic resolution of reef classes. The effect of thematic resolution on spatial design depended on the variability of cost data used. In terms of incidental representation of conservation objectives derived from finer-resolution data, scenarios prioritised with uniform cost outperformed those prioritised with variable cost. Following our analyses, we make recommendations to help maximise the spatial and cost efficiency and potential effectiveness of future marine conservation plans in similar planning scenarios. We recommend that planners: employ the smallest planning-unit size practical; invest in data at the highest possible resolution; and, when planning across regional extents with the intention of incidentally representing fine-resolution features, prioritise the whole region with uniform costs rather than using coarse-resolution data on variable costs.

A rare case of paratesticular leiomyosarcoma.

Soft-tissue sarcomas of the genitourinary tract account for only 1-2% of urological malignancies and 2.1% of soft-tissue sarcomas in general. A 69-year-old male complained of a 4 month history of a painless right groin swelling during routine urological review for prostate cancer follow-up. Clinical examination revealed a non-tender, firm right inguinoscrotal mass. There was no discernible cough impulse. Computed tomography of abdomen and pelvis showed a non-obstructed right inguinal hernia. During elective hernia repair a solid mass involving the spermatic cord and extending into the proximal scrotum was seen. The mass was widely resected and a right orchidectomy was performed. Pathology revealed a paratesticular sarcoma. He proceeded to receive adjuvant radiotherapy. Only around 110 cases of leiomyosarcoma of the spermatic cord have been described in the literature. They commonly present as painless swellings in the groin. The majority of diagnoses are made on histology.

First evidence of spatial clustering of lymphatic filariasis in an Aedes polynesiensis endemic area.

Successful elimination of lymphatic filariasis (LF) requires accurate identification of residual foci of transmission and stringent surveillance strategies to combat potential resurgence. This is challenging in areas where the day-biting Aedes polynesiensis is endemic, such as Samoa, since in previous studies no geographical clustering of infection has been demonstrated. Another challenge for this low prevalence phase is the choice of diagnostic assay as testing for circulating filarial antigen (CFA) or microfilariae (Mf) alone may not have adequate sensitivity. This could be solved by using the commercially available filariasis Cellabs enzyme linked immunosorbent assay (CELISA) to measure antibody. In the current study five Samoan villages were chosen based on previous epidemiological assessments to represent a range of infection prevalences. CFA, Mf, and antibody levels in children ≤ 10 years had been recorded and results linked to household of residence and/or primary school of attendance. To ascertain the location of exposure, two scenarios based on potential foci of transmission around communities and schools were explored. Both scenarios revealed significant spatial clusters of households with infected individuals and a relationship to antibody positive children when they were included in the spatial analysis. Fasitoo-Tai had the highest LF prevalence and largest geographical spatial clusters for both scenarios. In Falefa, spatial clusters were detected only for the primary school scenario. In Tafua, which spanned an area of 19.5 km(2), no spatial clusters were detected. Lastly, in Siufaga, the village with the lowest LF prevalence, significant clustering of infected individuals was observed and, for the primary school scenario, this was geographically related to exposure. These promising findings are the first published evidence of spatial clustering of LF in a day-biting Ae. polynesiensis endemic area.

Giant adrenal pseudocyst harbouring adrenocortical cancer.

The authors report a very rare case of adreno-cortical carcinoma arising in a giant adrenal pseudocyst. A 64-year-old woman presented to the emergency department with a 6 week history of progressively worsening severe left abdominal pain, anorexia, anergia and constipation. On examination, she was cachectic with tenderness over the left abdomen and flank. Medical history was significant for gastritis and anaemia. During her investigation, a well-defined para-renal 12×6 centimetre multi-loculated cyst, of uncertain origin was identified on CT. Ultrasound-guided biopsy was not diagnostic. MRI showed the cyst to be likely adrenal in origin. Serum and urinary catecholamines were unremarkable. At laparotomy an unresectable large, tense, fixed, cystic mass was seen to occupy the left side of the abdomen. The cyst was de-roofed. Pathology showed a high-grade poorly differentiated adreno-cortical carcinoma with a pseudo-capsule. She died 2 months postoperatively.