Locally acquired lymphocytic choriomeningitis virus infections in South-East Queensland: an outbreak of a pathogen rarely described in Australia.

Lymphocytic choriomeningitis virus (LCMV) is a zoonotic virus that can cause clinically significant illnesses in humans. Although cases of LCMV infection are well described globally, and there is evidence that the virus is present in Australian rodent populations, there has been only one case of domestically acquired LCMV infection published previously. Here, we describe a cluster of LCMV infections in South-East Queensland identified in early 2021, and the diagnostic testing processes implemented. This identifies LCMV as an under-recognised human pathogen in Australia.

Passive management of labour may predispose to anal sphincter injury.

INTRODUCTION AND HYPOTHESIS: To compare anal sphincter damage in two groups of primigravid women in Sydney: one passively managed in public hospitals, the other more actively managed in adjacent private hospitals. Data from actively managed labours at the National Women's Hospital, Dublin, served as an independent control. METHODS: We carried out a comparative study of third and fourth degree anal sphincter tears in all primiparas delivering at term in the years 2010-2015 in six Sydney public teaching hospitals with data from patients delivered in six adjacent Sydney private hospitals. A second comparator was published data from the National Women's Hospital, Dublin, where active management is still performed under the direction of midwives. All data was publicly available from www.health.nsw.gov.au/hsnsw . The difference between the two groups: public hospitals were under MANDATORY (NSW DG's upper case emphasis) direction from the Director General of NSW Health (PD 2010-045 File no 09/638-3) for labour to proceed without any augmentation. RESULTS: The study comprised 130,000 women. The mean third and fourth degree anal sphincter tear rate was 8.17% for the public hospitals and 1.52% for the private hospitals in the same period (p < 0.0003). Dublin's rate was 2.6%. There was no significant difference in the emergency Caesarean section rate 2010-2015 (13.7% private vs 12.7% public, 7.9% in National Women's Hospital Dublin) as well as an increase in epidurals, forceps/ventouse and lower Apgar scores. CONCLUSION: Passive management of labour instituted in Sydney public hospitals by government directive seems to be associated with a higher rate of obstetric anal sphincter injuries than was observed with active management. In addition, there were more epidurals, forceps/ventouse, and lower Apgar scores. Our hypothesis of deflexion of the head causing deficient powers is logically appealing, but needs further proof.

The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study.

BACKGROUND: Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand. METHODS: LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification. FINDINGS: Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases. INTERPRETATION: The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world. FUNDING: Health Research Council of New Zealand.

Psychotropic drug-induced weight gain alleviated with orlistat: a case series.

Weight gain is a common side effect associated with antidepressant, anxiolytic, and antipsychotic drug use. Obesity is a risk factor for several other disorders, including hypertension, diabetes, and coronary artery disease. To date, there have been few safe, well-tolerated, and effective pharmacological agents available to alleviate weight gain in general, and virtually no studies specific to psychiatric drug-induced weight gain. This case series looks at the use of orlistat, a reversible inhibitor of lipases approved by the US Food and Drug Administration for obesity management, naturalistically in 13 patients with weight gain secondary to psychotropic drug use. The results showed that orlistat, administered in 3 daily doses with meals, was safe, well-tolerated, and effective, resulting in an average weight loss of 35% during an acute treatment period of about 3 months.

Excessive yawning and SSRI therapy.

As we become more experienced with the long-term use of selective serotonin reuptake inhibitors (SSRIs), more subtle side-effects may become evident. Clinicians may be aware of yawning as a side-effect of antidepressant therapy, however sparse literature exists on the topic. We present two cases in which excessive daytime yawning was associated with SSRI treatment.