Emergency Department Management of the Covid-19 Pandemic.

BACKGROUND: Emergency departments (EDs) need to be prepared to manage crises and disasters in both the short term and the long term. The coronavirus disease 2019 (COVID-19) pandemic has necessitated a rapid overhaul of several aspects of ED operations in preparation for a sustained response. OBJECTIVE: We present the management of the COVID-19 crisis in 3 EDs (1 large academic site and 2 community sites) within the same health care system. DISCUSSION: Aspects of ED throughput, including patient screening, patient room placement, and disposition are reviewed, along with departmental communication procedures and staffing models. Visitor policies are also discussed. Special considerations are given to airway management and the care of psychiatric patients. Brief guidance around the use of personal protective equipment is also included. CONCLUSIONS: A crisis like the COVID-19 pandemic requires careful planning to facilitate urgent restructuring of many aspects of an ED. By sharing our departments' responses to the COVID-19 pandemic, we hope other departments can better prepare for this crisis and the next.

One world of veterinary medicine.

The veterinary profession finds itself in the midst of a new world order. Today veterinarians are part of a world that is exquisitely interconnected culturally, economically, socially, and professionally. As a consequence, societal needs and expectations of the profession are more demanding, critical and far-reaching. Veterinarians must play important roles in five intersecting domains of work: public health, bio-medical research, global food safety and security, ecosystem health and the more traditional role of caring for animals. To be successful in this broad and complex range of services and activities, veterinarians must possess an expanded knowledge base, acquire new skills, and develop a new mindset that will ensure their success and excellence in all these domains. The veterinary profession is becoming more fragmented and specialised, and it needs to be brought back together by a single sphere of knowledge or discipline that can serve as an intellectual foundation. The concept of One World of Veterinary Medicine can do just that. With this mindset veterinarians will become better connected to the world around and gain new public recognition and esteem. To achieve this, a special commitment by academic veterinary medicine is, of course, essential. Veterinary schools must lead an educational transformation that reaffirms the social contract of veterinarians and works to align diverse sectors, build a global community, find a common purpose and expand the 21st Century veterinary portfolio of services, activities, and new possibilities.

Magnetic resonance imaging of bone bruising in the acutely injured knee--short-term outcome.

AIM: To investigate the short-term outcome and associated injuries of bone bruising in the acutely injured knee. METHOD AND MATERIALS: Thirty patients (age range 17-39 years, mean 28 years) with bone bruising identified on magnetic resonance imaging (MRI) after an acute knee injury were rescanned 12-14 weeks post-injury. The volume of bone bruising was measured on coronal STIR (short TI inversion recovery) images and correlation made with the presence and type of ligamentous and osteochondral injuries. RESULTS: All bone bruises were present on repeat MRI. Twenty of the 30 patients (67%) had associated anterior cruciate ligament (ACL) injuries, seven of the 30 (23%) had collateral ligament injuries and three of the 30 (10%) had no associated ligamentous injuries. Greater than 50% reduction in bone bruise volume was demonstrated at repeat scanning in 24 of the 30 patients (80%) and less than 50% in five of the 30 patients (17%). One patient showed an increase in volume of bone bruising at follow-up. There was no correlation between initial size or size reduction of bone bruising and the presence/absence or type of associated injuries. In 21 patients the bone bruises resolved from the periphery, whilst eight patients showed bone bruises that resolved towards the joint margin, all of whom had associated osteochondral injuries. Of the 30 patients, 17 showed bone bruising that extended to the joint margin, 10 of whom had associated osteochondral injuries on MRI. On clinical review some degree of knee pain was still present in all but one of the patients reviewed. The single patient who reported complete resolution of symptoms was one of the three patients with isolated bone bruising. CONCLUSION: Bone bruises persist for at least 12-14 weeks, which is longer than previously quoted. Two discrete patterns of bone bruise resolution have been demonstrated. The size and persistence of bone bruising is not related to the presence or absence or type of associated ligamentous injuries.

New partnerships between animal health services and public health agencies.

As Veterinary Services and animal health organisations attempt to respond to a new era of emerging and re-emerging zoonotic diseases, their ability and skill in forming new strategic partnerships will be paramount. While these new partnerships are likely to include many relationships outside traditional Veterinary Services and animal agriculture, none will become more important than the formation of new animal health and public health partnerships. Episodes of emerging zoonoses are being increasingly recognised around the world and the confluence of people, animals and animal products today is unprecedented. Concurrently, a wide array of complex factors are also converging that will not only ensure the continuous emergence of zoonoses, but are also likely to drive the further increase and expansion of these diseases. This article discusses the need for the creation of more effective and co-operative partnerships in the face of new microbial threats, the complexity of both the formation and expansion of zoonoses, and the collective abilities of both human and animal health services to respond to them. Lessons learned from recent zoonotic epidemics supportthe need for co-ordinated research, interdisciplinary centres, integrated surveillance systems, response systems and infrastructures, and workforce development strategies. While there are some excellent examples of collaborative animal and public health relationships, there is no question that more and stronger partnerships among national and international organisations, both academic and private, will be necessary to meet the future challenges of emerging zoonoses and to manage their profound implications.

Bioavailability of dietary doses of 3H-labelled tea antioxidants (+)-catechin and (-)-epicatechin in rat.

1. The bioavailability and pharmacokinetic characteristics of the tea antioxidants (+)-catechin and (-)-epicatechin were investigated in the rat following intake of dietary doses. 2. To achieve this objective, tritiated derivatives (tritium was incorporated at the 3-position of the heterocyclic ring) of these compounds were administered to rats orally and intravenously at dose levels equivalent to human dietary levels of intake. 3. Following intravenous administration of both compounds, about one-third of the dose was excreted in the urine and two-thirds in the faeces, indicating extensive biliary excretion. When the same doses were administered orally, only about 5% of the dose of each compound was recovered in the urine. 4. Comparison of the areas under the curve following oral and intravenous administration revealed that the bioavailability of both compounds was less than 5%. 5. Exchange of tritium with water in the blood occurred 3 h after oral, but not after intravenous, administration of the flavanols to rat. This is believed to represent microbial degradation of the compounds by the gut flora. 6. It was established that the bioavailability of the tea antioxidants (+)-catechin and (-)-epicatechin in the rat following intake of dietary doses was poor.

Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse.

BACKGROUND: The late onset of pelvic visceral prolapse and incontinence after childbirth injury could be explained by menopause-associated connective tissue weakening. Uterosacral ligament resilience (UsR) was assessed to determine whether it influenced uterine or pelvic floor mobility, or varied with age, vaginal delivery, menopause or histological variations in the ligament. METHODS: UsR was measured by tensiometry in ligaments from 85 hysterectomy specimens, and was correlated with the presence of symptomatic uterocervical prolapse, prehysterectomy uterine and anorectal mobility, patient age, history of vaginal delivery and menopause. Forty-five of these ligaments were examined for ligament thickness, muscle to collagen ratio, and oestrogen and progesterone receptor density. The results were correlated with UsR. RESULTS: UsR was significantly reduced (P = 0.02) in symptomatic uterovaginal prolapse, but there was no correlation with either uterocervical or anorectal descent in women without symptomatic prolapse. There was a significant decrease in UsR with vaginal delivery (P = 0.003), menopause (P = 0.009) and older age (P = 0.005). The uterosacral ligament was significantly thinner and contained fewer oestrogen and progesterone receptors after menopause, but this did not affect UsR. CONCLUSION: Where pelvic floor muscles are weakened, decreases in pelvic connective tissue resilience related to the menopause may facilitate progression to symptomatic pelvic visceral prolapse.

Socio-cultural deterrents to family planning practices among Swazi women.

To investigate deterrents to family planning practices among Swazi women, 205 structured interviews were conducted with conveniently selected women in the four geographical regions of Swaziland. The Statistical Package for Social Sciences (SPSS) was used to analyse data. These results revealed that cultural practices, religious beliefs, gender issues and health care practices were the main barriers to the use of contraceptives among Swazi women. Recommendations were suggested regarding the education of men, women, adolescents and the entire society about contraceptive practices.

MnDPDP enhanced magnetic resonance imaging of focal liver lesions.

Mangafodipir trisodium (MnDPDP) is a contrast agent for use in magnetic resonance imaging (MRI) of the liver. The agent is taken up by normal hepatocytes resulting in increased signal on T1-weighted imaging, and is excreted in the biliary system. Hepatocyte-containing liver neoplasms such as hepatomas or focal nodular hyperplasia (FNH), take up MnDPDP and demonstrate varying degrees of enhancement. Metastatic liver deposits and primary liver tumours of non-hepatocyte origin do not typically enhance with MnDPDP thus increasing their conspicuity compared with pre-contrast T1-weighted images. Metastases may demonstrate rim enhancement particularly on delayed imaging at 24 h, which can increase their conspicuity, thus allowing better visualization of small lesions. Functional biliary obstruction due to liver metastases can also result in wedge shaped areas of parenchymal enhancement. The MRI features of various focal liver after continuance with lesions following MnDPDP are discussed and illustrated including primary lesions such as hepatoma and secondary metastases.

Constraints on cosmological parameters from the analysis of the cosmic lens all sky survey radio-selected gravitational lens statistics.

We derive constraints on cosmological parameters and the properties of the lensing galaxies from gravitational lens statistics based on the final Cosmic Lens All Sky Survey data. For a flat universe with a classical cosmological constant, we find that the present matter fraction of the critical density is Omega(m)=0.31(+0.27)(-0.14) (68%)+0.12-0.10 (syst). For a flat universe with a constant equation of state for dark energy w=p(x)(pressure)/rho(x)(energy density), we find w<-0.55(+0.18)(-0.11) (68%).

Comparative metabolism of genistin by human and rat gut microflora: detection and identification of the end-products of metabolism.

1. Biotransformations by gut microflora play a pivotal role in determining the biological activity of isoflavones that occur in soya-based foods predominantly as betaglycosyl conjugates. Microflora prepared from rat caecae and human faeces were used to investigate the metabolic fate of genistein beta-glycosides extracted from soya flour. The end-products of such metabolism were determined by parallel incubations of microflora with [2',3,5',6'-3H] and [4-14C]-labelled genistein. 2. Quantitative analysis by LC-MS/IS indicated very rapid and complete degradation of genistin, which was associated with a transient increase in genistein. Qualitative studies indicated that the malonyl and acetyl glycosides of genistein were also degraded by the microflora. 3. Incubation of caecal and faecal microflora with [3H] and [14C]genistein yielded similar radiolabelled metabolites, which were identified by radio-LC-MS(n) as the intermediates dihydrogenistein and 6'-hydroxy-O-desmethylangolensin and end-product 4-hydroxyphenyl-2-propionic acid. This profile of genistein metabolites indicated selective hydrolysis of 6'-hydroxy-O-desmethylangolensin between carbon atoms 1' and 1 to yield the end-products 4-hydroxyphenyl-2-propionic acid and 1,3,5-trihydroxybenzene. 4. The biological significance of the products of genistein metabolism warrant further investigation since they may play an important role in mediating the beneficial antioxidant health effects associated with the consumption of isoflavones in food.

Fate of the mushroom hydrazine agaritine in the rat and mouse.

The fate of the mushroom hydrazine [14C]agaritine was investigated in the mouse and rat strains previously employed in carcinogenicity studies with the edible mushroom Agaricus bisporus. Agaritine was rapidly absorbed in both species, achieving higher blood levels in the mouse, but with similar area under the curve. Covalent binding of agaritine material to proteins was detected only in the liver and kidney, but the extent of binding was the same in the rat and mouse. Most of the radioactivity was excreted during the first 24 hours in both animal species: in the rat it was distributed equally between urine and feces, whereas in the mouse more of the radioactivity was excreted in the urine. No qualitative differences in the metabolic profile were evident, but quantitative differences were observed. Treatment of the urine with deconjugating enzymes did not reveal the presence of any conjugates. Agaritine, N'-acetyl-4-(hydroxymethyl)phenylhydrazine, and 4-(hydroxymethyl)benzene diazonium ion were not detected in the urine or in the plasma of either species. No mutagens or promutagens were detected by the Ames mutagenicity assay in the urine of either species after exposure to agaritine. Repeated administration of agaritine to rats and mice did not alter the urinary metabolic profile and excretion of radioactivity. Similarly, feeding mice a raw mushroom diet, according to the protocol employed in the carcinogenicity studies, did not modulate the excretion of radioactivity or the urinary metabolic pattern. No major species differences in the fate of agaritine in rat and mouse were noted that could provide a rationale for the carcinogenicity of A. bisporus in the mouse, but not in the rat.

Hepatobiliary and pancreatic manifestations of cystic fibrosis: MR imaging appearances.

Magnetic resonance (MR) imaging and MR cholangiopancreatography are useful, noninvasive techniques for the assessment of pancreatic and hepatobiliary complications in cystic fibrosis. Abnormalities of the pancreas in cystic fibrosis are typically characterized by fat deposition, which has increased signal intensity on T1-weighted MR images, and pancreatic fibrosis, which has low signal intensity on both T1- and T2-weighted images. Pancreatic cysts are a relatively common finding; these cysts are typically quite small but are well demonstrated at MR imaging and MR cholangiopancreatography. Pancreatic duct abnormalities are also occasionally seen. Hepatic manifestations range from hepatomegaly and diffuse fatty infiltration to severe cirrhosis with fibrotic change, regenerative nodules, and portal hypertension. Splenomegaly is often characterized by siderotic nodules that manifest as multiple focal areas of abnormal low signal intensity within the spleen. Biliary manifestations include cholelithiasis, stricturization, and narrowing or dilatation of intra- and extrahepatic bile ducts. Gallbladder abnormalities including microgallbladder are also readily demonstrated. MR cholangiopancreatography can be used to help determine the presence and severity of biliary complications without resorting to more invasive procedures and, in conjunction with MR imaging, may prove useful in the assessment of patients with cystic fibrosis who present with abdominal symptoms that suggest hepatobiliary involvement.

Structural improvement of higher education in environmental toxicology in Latin America and Europe.

Industrial development has resulted in an increased release of chemicals and other agents into the environment, resulting in damage to the environment as well as increasing the risk of adverse effects on human health. Environmental toxicology (ET) is the discipline responsible for assessing the risks to human health and the environment from the effects of new chemicals and those already present in the environment. The development of human resources in toxicology is therefore a priority in both Latin America (LA) and the European Union (EU), although LA professionals are more involved in risk evaluation than in risk assessment compared to their EU colleagues. A solid background in general toxicology will enable those interested in environmental issues to tackle local problems. Moreover, the increasing globalization of markets and, therefore, of the necessary regulations, requires harmonisation of postgraduate programmes to ensure that risk assessment and management related to the environment are dealt with uniformly and by highly qualified scientists. The Inaugural Meeting of the ALFA-OMET Toxicology', a 2-year programme supported by the European Commission, offered the opportunity to discuss a number of these issues. The present status of existing ET courses in the EU and LA and the corresponding professional profiles in the two regions were examined, and a harmonized academic curriculum for a postgraduate professional profiles in the two regions were examined, and a harmonized academic curriculum for a postgraduate course in environmental toxicology was developed. Finally, a course programme for toxicology and a specialization in environmental toxicology designed by a panel of experts was discussed, and its relevance as a model for other specialisation programmes was analysed. Exercises such as those performed by ALFA-OMET may be useful not only in promoting discussion for the implementation of national and international professional registers in LA, but also in encouraging the same, ongoing process in the EU.

Pulmonary MALT lymphoma: imaging findings in 24 cases.

The aim of this study was to describe the imaging features of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. The chest radiographs (n = 18) and CT scans (n = 17) of 24 patients (18 men and 6 women) aged 27-78 years (mean = 56 years), with a known diagnosis of pulmonary MALT lymphoma, were retrospectively reviewed by two radiologists and the imaging findings are described. Six of the 24 patients had a history of an autoimmune disorder and 1 patient had acquired immune deficiency syndrome. Multiple pulmonary lesions were identified in 19 of 24 patients (79%) and solitary lesions in 4 of 24 patients (17%). Diffuse pulmonary infiltration was present in 1 patient. Lesions included masses or mass-like areas of consolidation (n = 21) and pulmonary nodules (n = 18). Associated findings were air bronchograms, airway dilatation, a positive angiogram sign and a halo of ground-glass shadowing at lesion margins. Peribronchovascular thickening was also observed, as were hilar or mediastinal lymph node enlargement and pleural effusions or thickening. Although rare, the diagnosis of pulmonary MALT lymphoma should be considered in patients with the imaging features described, particularly when in association with an indolent clinical course or a history of autoimmune disease.

The best possible means of benefiting the incurable: Walter Bruetsch and the malaria treatment of paresis.

The first effective treatment for a specific psychiatric disorder was not developed until the early 20th century. The promise of discovery of causes of and cures for specific diseases had come with the development of laboratory science, especially the study of infectious diseases, in the last half of the 19th century. The introduction of malaria treatment of paresis in the 1920s was a landmark in psychiatry and was possible because, in this particular disorder, the knowledge gained from the study of infectious disease could be applied to the treatment of a psychiatric disease that had resulted from an earlier infection.

A brief history of psychiatry: millennia past and present. Part IV.

Biological scientists have been trying to look inside the black box of the brain since the middle of the nineteenth century. Techniques in many disciplines were being developed in the last century that would lead beyond philosophical speculation about the mind/body relation and the meaning of insanity. Only in the last several years have molecular biology and the beginnings of understanding of its relation to mind, body, behavior, and the human environment made it possible to start to find solutions to some of the problems. Neurobiology, psychology, and sociology now seem much more closely related, albeit in enormously complex ways.

Imaging of the rotator cuff and biceps tendon.

Several different imaging techniques are available for evaluating the rotator cuff and biceps tendon. The common disorders of impingement, rotator cuff tears and biceps tendonitis are discussed along with the role which the various imaging modalities can play in establishing their diagnosis. Plain radiographs can be helpful particularly with a history of trauma but give limited information on the soft tissues. Ultrasound is a useful and inexpensive means of assessing the rotator cuff and biceps tendon but has a number of limitations and varying reports on its accuracy. Computed tomography (CT) is most helpful in the evaluation of shoulder trauma but gives limited information on the soft tissues. Magnetic resonance imaging (MRI) is an accurate imaging modality for evaluating the rotator cuff and biceps tendon, allowing visualisation of the soft tissues and the adjacent bony structures.