Community outbreak of hepatitis A disproportionately affecting men who have sex with men in Toronto, Canada, January 2017-November 2018.

BACKGROUND: In late 2016 and early 2017, a number of countries began reporting hepatitis A virus (HAV) outbreaks involving person-to-person transmission among men who have sex with men (MSM), people using illicit drugs and homeless or underhoused persons. OBJECTIVE: To describe the epidemiology and public health response to an outbreak of HAV disproportionately affecting MSM in Toronto, Canada from January 2017 to November 2018. METHODS: Following an increase in the number of cases of HAV in MSM being reported in other countries, enhanced surveillance was performed for all non-travel-related cases of HAV reported from June 1, 2017 to November 1, 2018, including a retrospective analysis of cases reported from January 2017 to June 2017. Descriptive analysis and viral sequencing were performed to describe person-to-person transmission patterns and target interventions. Control strategies included interventions to promote the uptake of preexposure HAV vaccination, including social media campaigns geared to MSM, messaging to healthcare providers and vaccine clinics. RESULTS: Based on the outbreak case definitions, 52 confirmed and probable cases of HAV were identified. Over 80% of outbreak cases were male (n=43/52) and, among those for whom data were available, 64% (n=25/39) reported an MSM exposure. Data on hospitalization was available for 51 cases; 56% of confirmed cases (n=23/41) and 40% of probable cases (n=4/10) required hospitalization. Of the cases with serum samples that had HAV sequencing, 83% (n=30/36) had one of the three strains seen circulating in outbreaks among MSM internationally; 72% (n=26/36) were VRD_521_2016, which had been detected in recently reported European outbreaks among MSM. Targeted promotion of publicly-funded vaccination using social media platforms popular with MSM and targeted vaccine clinics were developed to promote HAV awareness and vaccine uptake among MSM. CONCLUSION: Outbreaks of HAV, attributed to person-to-person transmission of strains of HAV that disproportionately affected MSM and were likely to have been imported from international MSM outbreaks, have now occurred in Canada. Genetic sequencing of HAV, risk factor analysis of cases, monitoring trends of vaccine coverage in high-risk groups and initiation of vaccination campaigns that address barriers to HAV preexposure vaccine coverage in the MSM population may prevent future outbreaks.

Probiotic Pediococcus pentosaceus GS4 shields brush border membrane and alleviates liver toxicity imposed by chronic cadmium exposure in Swiss albino mice.

AIMS: To evaluate the protective efficacy of Pediococcus pentosaceus GS4 in cadmium (Cd)-induced toxicity in Swiss albino mice. METHODS AND RESULTS: The previously reported probiotic P. pentosaceus GS4 interaction with Cd was evaluated experimentally. Swiss albino mice were segregated randomly into three different groups containing nine animals each. The binding ability of P. pentosaceus GS4 and Cd was demonstrated by atomic absorption spectrometry, Fourier transform infrared spectroscopy and scanning electron microscopy analysis respectively. Cd challenge was attenuated by the P. pentosaceus GS4 treatment and was evaluated by estimating Cd level in liver and faeces, corresponding biomarkers for toxicity in liver and intestines and histopathological analysis with brush border membrane (BBM) integrity. Results showed that P. pentosaceus GS4 bound Cd effectively. Pediococcus pentosaceus GS4 intervention significantly enhanced faecal evacuation of Cd with an effect of reduced tissue deposition. Histologically, Cd-induced gut was found significantly replenished with lactobacilli in addition to reduced hyperplasia, lowered lymphocytes infiltration and enhancement of BBM-based disaccharidases, proving its role in protecting membrane integrity. CONCLUSIONS: Probiotic P. pentosaceus GS4 efficiently alleviated toxicity from vital organs such as liver and intestine caused by Cd exposure in a murine model. SIGNIFICANCE AND IMPACT OF THE STUDY: Intervention of P. pentosaceus GS4 alleviated Cd-induced toxicity, and thus it may be employed therapeutically to protect Cd toxicity.

Investigation and management of a large community mumps outbreak among young adults in Toronto, Canada, January 2017-February 2018.

BACKGROUND: In 2017, a mumps outbreak was identified in a cohort of 18-34 year olds in Toronto, Canada. OBJECTIVE: To describe a large community mumps outbreak in an urban centre from January 2017 to February 2018 among young adults. METHODS: A broad range of interventions were implemented in an attempt to reach the target audience; including case and contact management, vaccination clinics at schools and clinicians' offices, school exclusions, bar inspections, traditional communication strategies (including health care provider updates and posters) and newer communication strategies (including three sequential social media campaigns). RESULTS: A total of 143 cases of mumps were identified. Although cases' ages ranged from three to 72 years, most (76%) were 18-34 year olds, many of whom had frequented bars and local food establishments in downtown Toronto. 84% (n=120) of the cases were community-acquired. Only 16% (n=23) of the cases reported exposures in schools and post-secondary school institutions. Of those, 39% (n=56) of cases had an unknown vaccination history; 34% (n=49) were either not vaccinated or partially vaccinated with one dose of measles-mumps-rubella vaccine; and 27% (n=38) had received the recommended two doses of mumps vaccine. Determining vaccination status was a challenge, in part due to the lack of a registry. Vaccination was recommended when subjects were known to have had fewer than two doses of vaccine or had an unknown vaccination status. A social media campaign, emphasizing the risk of social activities if not protected from the mumps, yielded over 500,000 impressions from Facebook and Twitter messages and ads and an impressive engagement rate of between 1% and 10x%. CONCLUSION: This was the largest mumps outbreak in Toronto in over 20 years. Among young adults, ongoing social media and traditional communication campaigns can contribute to the control of community mumps outbreaks. Encouraging vaccine uptake is desirable, but without a vaccine registry it is difficult to assess vaccination coverage among adults. Susceptible cohorts of young adults who were not adequately vaccinated pose a risk for future outbreaks. Given that almost 30% of the mumps cases were fully vaccinated with two doses of mumps-containing vaccine, even two doses may not provide complete protection.

Updated NACI recommendations for measles post-exposure prophylaxis.

BACKGROUND: Human immune globulin (Ig) products are currently recommended as post-exposure prophylaxis (PEP) for measles in certain susceptible groups. However, successful measles vaccination programs in North America have led to low circulation of measles virus and most blood donors now have vaccine-derived immunity. Concurrently, the concentrations of anti-measles antibodies in human Ig products have shown trends of gradual decline and previously recommended doses and routes of administration may no longer be optimally protective. OBJECTIVES: To review the literature and update recommendations on post-exposure prophylaxis for measles, including dosing and route of administration, for measles Ig PEP in susceptible infants and in individuals who are immunocompromised or pregnant, in order to prevent severe disease. APPROACH: The National Advisory Committee on Immunization (NACI) Measles, Mumps, Rubella, Varicella Working Group reviewed key literature, international practices, and product information for current Ig products pertaining to the optimal dosage and routes of Ig administration for measles PEP. It then proposed evidence-based changes to the PEP recommendations that were considered and approved by NACI. RESULTS: NACI continues to recommend that susceptible immunocompetent individuals six months of age and older, who are exposed to measles and who have no contraindications be given measles-mumps-rubella (MMR) vaccine within 72 hours of the exposure. NACI recommends that for susceptible infants younger than six months of age, if injection volume is not a major concern, intramuscular immunoglobulin (IMIg) should be provided at a concentration of 0.5 mL/kg, to a maximum dose of 15 mL administered over multiple injection sites. Susceptible infants six to 12 months old who are identified after 72 hours and within six days of measles exposure should receive IMIg (0.5 mL/kg) if injection volume is not a major concern. For susceptible contacts who are pregnant or immunocompromised, if injection volume is not a concern, IMIg can be provided at a concentration of 0.5 mL/kg understanding that recipients 30 kg or more will not receive the measles antibody concentrations that are considered to be fully protective. Alternatively, in cases where injection volume is a major concern or for recipients 30 kg or more, intravenous immunoglobulin (IVIg) can be provided at a dose of 400 mg/kg.NACI does not recommend that susceptible immunocompetent individuals older than 12 months of age receive Ig PEP for measles exposure due to the low risk of disease complications and the practical challenges of administration for case and contact management. CONCLUSION: NACI has updated the recommendations for measles PEP to reflect current evidence and best practices in order to prevent severe disease in Canada. Consistent with recommendations in other countries, this includes consideration of off-label use of IVIg in some instances.

Infrared and visible emissions of rare-earth-doped CeO2 phosphor.

This paper reports the synthesis and characterization of Er(3+)-doped CeO2 phosphor with variable concentrations of erbium. The sample was synthesized using a solid-state reaction method, which is useful for the large-scale production of phosphors and is also eco-friendly. The prepared sample was characterized using an X-ray diffraction (XRD) technique. The XRD pattern confirmed that sample has the pure cubic fluorite crystal structure of CeO2. The crystallite size of the prepared phosphor was determined by Scherer's formula and the crystallite size giving an intense XRD peak is 40.06 nm. The surface morphology of the phosphor was determined by field emission gun scanning electron microscopy (FEGSEM). From the FEGSEM image, good surface morphology with some agglomerates was found. The functional group in the prepared sample was analysed by Fourier transform infrared (FTIR) spectroscopy. All samples prepared with variable concentrations of Er(3+) (0.1-2 mol%) were studied by photoluminescence analysis and it was found that the excitation spectra of the prepared phosphor shows broad excitation centred at 251 nm. Emission spectra at different concentrations of Er(3+) show strong peaks at 413 and 470 nm and a weaker peak at 594 nm. The dominant peaks at 413 and 470 nm are caused by the allowed electronic transition (4)S3/2 → (4)I15/2 and the weaker transition at 594 nm is due to the transition (4)F9/2 → (4)I15/2. Spectrophotometric determinations of peaks were evaluated using the Commission Internationale de I'Eclairage (CIE) technique. The emission spectra were also observed using an infrared (IR) laser 980 nm source, and three distinct peaks were found in the IR region at 848, 870 and 980 nm. The prepared phosphor has utility for application in display devices.

Pure primary signet ring cell carcinoma breast: A rare cytological diagnosis.

Signet ring cell carcinoma (SRCC) of the breast is a rare tumor and it is classified by World Health Organization in 2003 classification under 'mucin producing carcinomas'. Pure form of SRCC breast is an extremely rare entity and very few cases have been reported in literature so far. We present a case of pure primary SRCC of the breast in a 70-year-old female, which was diagnosed on fine needle aspiration cytology. Cytological features generally show cellular smears with tumor cells showing eccentrically placed large, irregular nuclei showing indentations at places with cytoplasmic vacuoles. This case is being presented in view of its characteristic cytological features and its rarity.

Study of an upper arm exoskeleton for gravity balancing and minimization of transmitted forces.

An upper-arm wearable exoskeleton has been designed for the assistance and functional training of humans. One of the goals of this design is to provide passive assistance to a user by gravity balancing, while keeping the transmitted forces to the shoulder joints at a minimum. Consistent with this goal, this paper discusses: analytical gravity balancing design conditions for the structure of the exoskeleton; a possible implementation of these conditions into practical designs; the minimization of transmitted joint forces to the shoulder while satisfying the gravity balancing conditions; the numerical optimization of the system for gravity balancing and minimization of transmitted forces; and the effect of parameter variation on joint moments and joint forces via numerical optimization. An implementation of the design was undertaken using zero-free-length springs. The design idea presented in this paper may be useful in relieving the actuators effort of exoskeletons to support the weight of the arm and therefore the possibility of using small actuators and making the system light and portable or even a stand-alone passive support device can be developed based on these gravity balancing conditions.

Antibiotic-induced Porphyromonas gingivalis LPS release and inhibition of LPS-stimulated cytokines by antimicrobial peptides.

Bacterial lipopolysaccharide (LPS) release during periodontal infection is a significant component of periodontal disease. We hypothesized that some bacterial LPS release results from bacterial exposure to antibiotics. Therefore, we examined the ability of various classes of antibiotics to induce LPS release from Porphyromonas gingivalis as well as the ability of antimicrobial peptides (AMPs) to inhibit purified LPS. All antibiotics tested against P. gingivalis were able to liberate 1.9-12.9 times more LPS as compared to untreated bacteria. Among the three AMPs tested, LL-37 was found to be the most potent inhibitor of cytokine (tumor necrosis factor-alpha, interleukin-1beta, interleukin-6) production and completely neutralized purified P. ginigivalis LPS activity in the chromogenic limulus amebocyte lysate (LAL) and whole blood cytokine stimulation assays. These observations suggest that therapeutic approaches utilizing AMPs as adjuncts to neutralize released LPS should be considered.

Biotransformation of geranyl acetate to geraniol during palmarosa (Cymbopogon martinii, Roxb. wats. var. motia) inflorescence development.

Only immature palmarosa (Cymbopogon martinii, Roxb. wats. var. motia) inflorescence with unopened spikelets accumulated essential oil substantially. Geraniol and geranyl acetate together constituted about 90% of the palmarosa oil. The proportion of geranyl acetate in the oil decreased significantly with a corresponding increase of geraniol, during inflorescence development. An esterase enzyme activity, involved in the transformation of geranyl acetate to geraniol, was detected from the immature inflorescence using a gas chromatographic procedure. The enzyme, termed as geranyl acetate cleaving esterase (GAE), was found to be active in the alkaline pH range with the optimum at pH 8.5. The catalysis of geranyl acetate was linear up to 6 h, and after 24 h of incubation, 75% of the geranyl acetate incubated was hydrolyzed. The GAE enzymic preparation, when stored at 4 degrees C for a week, was quite stable with only 40% loss of activity. The physiological role of GAE in the production of geraniol during palmarosa inflorescence development has been discussed.

The Mycobacterium tuberculosis pks2 gene encodes the synthase for the hepta- and octamethyl-branched fatty acids required for sulfolipid synthesis.

Multidrug-resistant tuberculosis is a major global health emergency. Cell wall lipids of Mycobacterium tuberculosis can play crucial roles in the pathogenesis. The enzymes involved in their synthesis can be ideal new drug targets against tuberculosis, because many such lipids are unique to this pathogen. A variety of multiple methyl-branched fatty acids are among such unique lipids. We have identified seven genes highly homologous to the mas gene, which is known to be involved in the production of one class of such multiple methyl-branched fatty acids. One of these mas-like genes, pks2, was disrupted using a phage-mediated delivery of the disruption construct. Gene disruption by homologous recombination was confirmed by polymerase chain reaction analysis of the flanking regions of the introduced disrupted gene and by Southern analysis. Thin-layer and radio gas-chromatographic analyses of lipids derived from [1-14C]propionic acid and gas chromatography/mass spectrometry analysis of the fatty acids and hydroxy fatty acids showed that the pks2 mutant was incapable of producing hepta- and octamethyl phthioceranic acids and hydroxyphthioceranic acids that are the major acyl constituents of sulfolipids. Consequently, pks2 mutant does not produce sulfolipids. Sulfolipid deficiency in pks2 mutant was confirmed by two-dimensional thin-layer chromatographic analysis of lipids derived from [1-14C]propionic acid and 35SO4(-2). With this sulfolipid-deficient mutant, it should be possible to test for the postulated important roles for sulfolipids in the pathogenesis of M. tuberculosis.

Pattern of cancer in Jammu region (hospital based study 1978-'87).

2681 histologically confirmed cases of cancer (1402 males and 1279 females) were seen during the ten year period 1978 to 1987 in Pathology Department, Government Medical College, Jammu. The relative frequencies of cancer at various primary sites have been determined with respect to age, sex and religion. The majority of cancers were seen between 31-60 years (67.7%) with a peak in 41-50 years age group. Out of the total cancer patients 2,437 were Hindus (90.8%) and 244 were Muslims (9.2%). The most common cancer sites among males were lung, skin, larynx, prostate and lymphnodes. Cancer cervix was the most common tumor in females, followed by cancer breast, gall bladder and uterus. Among Muslims, cancer cervix and penis were infrequent. Cancer lung and larynx were also relatively less frequent in Muslims.

Silicosis in slate pencil workers. A clinicoradiologic study.

We present a study of 151 persons working in slate-pencil manufacturing industries located in the Mandsaur district of Madhya Pradesh, India. Cough, dyspnea, and pain in the chest were the important symptoms. Cyanosis, rhonchi, and crepitations were found in varying numbers of cases. The chest x-ray films were abnormal in 85 cases.