Unveiling genotypic diversity of Theileria orientalis in lethal outbreaks among bovines in Karnataka, India.

Theileria orientalis, the causal agent of oriental theileriosis, is known to cause mild disease in cattle and buffalo across the world. Recently, different genotypes of T. orientalis have emerged as pathogenic, causing high reported morbidity in cattle. This study focuses on investigating three suspected outbreaks of oriental theileriosis that resulted in fatalities among crossbred and indigenous bulls in Karnataka, India. Examination of blood smears revealed the presence of T. orientalis piroplasms within erythrocytes. The genetic characterization of T. orientalis was conducted by targeting specific markers, including the mpsp gene, p23 gene, and ribosomal DNA markers (18S rRNA gene, ITS-1, and ITS-2). Analysis based on the 18S rRNA gene unveiled the presence of both Type A and Type E genotypes of T. orientalis in the outbreaks. The mpsp gene-based analysis identified genotype 7 of T. orientalis in crossbred cows, whereas genotype 1 (Chitose B) was found to be present in indigenous bulls. Haplotype network analysis based on the mpsp gene revealed the presence of 39 distinct haplotypes within the 12 defined genotypes of T. orientalis with a high haplotype diversity of 0.9545 ± 0.017. Hematological and biochemical analysis revealed a decrease in calcium, hemoglobin levels, red blood cell counts, and phosphorus. This study constitutes the initial documentation of a clinical outbreak of oriental theileriosis in indigenous bulls with genotype 1 (Chitose 1B). Substantial epidemiological investigations are imperative to gain a comprehensive understanding of the geographical distribution of distinct genotypes and the diverse clinical manifestations of the disease across various hosts.

Clinical decision support to Optimize Care of patients with Atrial Fibrillation or flutter in the Emergency department: protocol of a stepped-wedge cluster randomized pragmatic trial (O'CAFÉ trial).

BACKGROUND: Management of adults with atrial fibrillation (AF) or atrial flutter in the emergency department (ED) includes rate reduction, cardioversion, and stroke prevention. Different approaches to these components of care may lead to variation in frequency of hospitalization and stroke prevention actions, with significant implications for patient experience, cost of care, and risk of complications. Standardization using evidence-based recommendations could reduce variation in management, preventable hospitalizations, and stroke risk. METHODS: We describe the rationale for our ED-based AF treatment recommendations. We also describe the development of an electronic clinical decision support system (CDSS) to deliver these recommendations to emergency physicians at the point of care. We implemented the CDSS at three pilot sites to assess feasibility and solicit user feedback. We will evaluate the impact of the CDSS on hospitalization and stroke prevention actions using a stepped-wedge cluster randomized pragmatic clinical trial across 13 community EDs in Northern California. DISCUSSION: We hypothesize that the CDSS intervention will reduce hospitalization of adults with isolated AF or atrial flutter presenting to the ED and increase anticoagulation prescription in eligible patients at the time of ED discharge and within 30 days. If our hypotheses are confirmed, the treatment protocol and CDSS could be recommended to other EDs to improve management of adults with AF or atrial flutter. TRIAL REGISTRATION: ClinicalTrials.gov NCT05009225 .  Registered on 17 August 2021.

Bovine babesiosis in India: Estimation of prevalence by systematic review and meta analysis.

Bovine babesiosis is a serious threat to the livestock sector especially in tropical countries like India. Understanding the epidemiology of the disease in the country is essentially important in strategizing the available methods to effectively control the disease. Keeping this as the background, the present study was undertaken to estimate the pooled prevalence of bovine babesiosis in India. The relevant literature pertaining to bovine babesiosis was identified and a total of 49 studies published between 1983 and 2018 were included in the final systematic review and meta-analysis. Meta-analysis was conducted using meta-package of R software and prevalence estimates were calculated. Bovine babesiosis was reported from 21 states of India with pooled prevalence estimate of 6% (95% CI = 4%-9%) using random effect model. Zone wise analysis revealed highest pooled prevalence in the west zone and north zone (8%) followed by east zone (7%), central zone (6%), south zone (4%) and northeast zone (4%). The results of meta-analysis indicated high variability between studies. In addition, the pooled seroprevalence was high (29%) compared to prevalence of active infection (5%) of bovine babesiosis in India. Further, the pooled prevalence estimate of B. bigemina infection in India was more (7%) compared to B. bovis infection (1%). The estimation of prevalence of active infection and seroprevalence separately will helps to understand the actual disease prevalence in the country. The study indicated the wide prevalence of bovine babesiosis in India which urges for immediate mitigation strategies.

New-onset Adult-onset Still's disease-like syndrome after ChAdOx1 nCoV-19 vaccination-a case series with review of literature.

We report a series of 3 Adult-onset Still's disease (AOSD)-like presentations in previously healthy females following vaccination with the ChAdOx1 nCoV-19 vaccine, and also compare them with similar cases reported in literature through a PubMed database search. Our first patient had a high spiking bi-quotidian type of fever with myalgia, sore throat, and arthritis with onset 10-day post-vaccination, with laboratory features of hyper inflammation responding to only naproxen. She was off treatment after 2 months. The second patient, with onset 3-week post-vaccination, had a more severe illness, requiring high dose immunosuppression. In our third case, the onset of illness was slightly delayed i.e., 3-month post-vaccination, but she had the most severe disease with macrophage activation syndrome at presentation requiring immunosuppression and biologicals. The underlying mechanism may be linked to the activation of Toll-like receptors (TLR)-TLR-7 and TLR-9-leading to a robust immune response. These 3 cases highlight the immunogenicity of COVID-19 vaccines, with the possibility of occurrence of new-onset systemic hyper-inflammation illness which can happen a few days following the vaccination, sometimes even delayed to months, and can range in severity from mild to even life-threatening. More cases need to be studied to understand the profile and prognosis of these syndromes in the long run.

Mining the pervasiveness of surra in different animal species of Northeastern states of India: Assam, Mizoram and Tripura.

Trypanosoma evansi is a flagellated, extracellular haemoprotozoan parasite infecting a wide range of mammalian hosts including dromedaries, cattle, equines and dogs cause disease surra. Carrier animals with sub-clinical infection cause significant monetary losses to livestock holders and therefore detection of infection status using molecular diagnostic techniques becomes important in order to control the disease. In the current study cattle, buffalo, goat, pig and dog samples from three northeastern states of India-Assam, Mizoram and Tripura were screened to determine the prevalence of surra. A total of 1702 samples including 795 from Assam, 678 from Mizoram and 229 from Tripura were screened by CATT/T. evansi test out of which 16.8%, 27.1% and 22.3% samples in respective states were found to have antibodies against T. evansi. DNA detection of T. evansi by PCR amplification targeting VSG gene revealed the molecular prevalence of surra in Assam, Mizoram and Tripura as 8.5%, 7.5% and 4.4% respectively. The analysis of amplified partial VSG sequences showed 99% similarity within an animal species whereas 86-94% similarity was observed among different species of animals revealing the homogeneity. The study established the prevalence of surra in different species of animals in the three northeastern states of India-Assam, Mizoram and Tripura and this study is the first report of T. evansi infection in pig and goat from India. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12639-021-01392-z.

Seroprevalence of Trypanosoma evansi in cattle and analysis of associated climatic risk factors in Mizoram, India.

Surra, a haemoprotozoan parasitic disease even in subclinical form poses a challenge in terms of diagnosis and management to animal health practitioners and policy makers as well; eventually imparting financial loss to the livestock holders. A systematic study was designed to assess the seroprevalence of surra in cattle and associated climatic risk factors, by collecting 480 serum samples across the eight districts of Mizoram during 2017-2019. The apparent and true seroprevalence detected by card agglutination test was 37.08% (CI at 95%: 32.88-41.49) and 36.59% (CI at 95%: 32.4-40.99) whereas by recombinant Variable Surface Glycoprotein based indirect ELISA was 41.88% (CI at 95%: 37.5-46.3) and 40.35% (CI at 95%: 36.02-44.76) respectively. Climate parameters which influence vector population were extracted from their respective database and were correlated with seroprevalence data. Linear discriminant analysis revealed that air temperature, relative humidity and diurnal temperature range, leaf area index and soil moisture as significant risk factors discriminating seropositive and seronegative data sets classified by indirect ELISA. This study is the first report on seroprevalence of surra in cattle of Mizoram and the situation demands deployment of intervention strategies in order to assess the endemicity of the disease and thereby preventing the economic losses.

In-vitro evaluation of antimicrobial and insect repellent potential of supercritical-carbon dioxide (SCF-CO2) extracts of selected botanicals against stored product pests and foodborne pathogens.

In the present study, the antimicrobial and the insect repellent activity of 16 botanical extracts obtained by supercritical CO2 (SCF) extraction were evaluated. The present investigation was conducted as there is a necessity for exploration of natural botanical extracts that target both stored product insects and microbes. The antimicrobial activity was studied by disc diffusion and broth microdilution methods against ten microbial species, including Gram-positive bacteria (Staphylococcus aureus, Bacillus subtilis and Listeria monocytogenes), Gram-negative bacteria (Escherichia coli and Salmonella enterica), and fungi (Aspergillus flavus, Aspergillus paraciticus, Aspergillus ochraceous, Aspergillus niger and Penicillium verrucosum). Repellency assay was carried out by area preference method against three coleopteran insects (Tribolium castaneum, Rhyzopertha dominica and Sitophilus oryzae). Among all the extracts, thyme and ajwain were effective against all the tested bacteria with a minimum inhibition concentration (MIC) of 256-1024 µg/mL. Hop extract resulted in better antibacterial activity against all the tested Gram-positive bacteria with a MIC of 32-64 µg/mL. Oregano, thyme and ajwain extracts showed broad-spectrum antifungal activity against all the tested fungi with MIC of 128-1024 µg/mL. Most of the extracts exhibited class V (80.1-100%) repellency against T. castaneum. Extracts of hop, ajwain and thyme were found to have strong repellency against T. castaneum and R. dominica. Therefore, SCF extracts of ajwain and thyme can be explored further for the application of bio-extracts as a growth limiting factors in a microcosm where such consortia thrive.

Complications of augmentation procedures for dental implants in private practice, Victoria, Australia.

PURPOSE: This study audited complications associated with augmentation for dental implants, retrospectively over a 5-year period in a variety of private dental practices in Victoria (Australia). METHODS: Complications were categorized as surgical or biological and compared to a group not requiring augmentation. Implant factors underwent univariate and multivariate analysis. RESULTS: The study assessed 8486 implants with 26.9% undergoing augmentation. Augmentation had no effect on implant survival, however, a significant increase in complications for those implants requiring augmentation was found (P = <0.001). The hard tissue augmented group had significantly more cases of insufficient bone/dehiscences at implant placement (P < 0.001), and post-placement bone loss (P = 0.0014). These implants were grafted simultaneously (P < 0.05) with particulate autogenous bone and/or Bio-Oss (P < 0.05) with resorbable xenograft membrane (P < 0.001). There was significantly more bone loss in open sinus lifted cases than implants placed in native bone (1.90% v 0.30%; P = 0.009). CONCLUSIONS: The study demonstrated no increase in graft complications that could be related to any specific augmentation technique, suggesting that routine grafting procedures used in private practice were safe and appropriate. Previously augmented sites were found to be more likely to require further augmentation at implant placement.

Potential of pyrethroid-synergised pyrethrum on stored product insects and implications for use as prophylactic sprays.

The study was conducted to evaluate the synergistic effects of 2% pyrethrum extract with synthetic pyrethroids on the mortality of stored product insects. Contact toxicity was performed at variable concentrations observing mortality at 12, 24 and 48 h durations. The results of the present study indicated that, pyrethrum + deltamethrin combination (25:1 ratio) was effective on the adults of Rhyzopertha dominica (F.) and Tribolium castaneum (Herbst). On the other hand, pyrethrum + cypermethrin combination proved effective against Sitophilus oryzae (L.). The efficacy of the tested combination showed reasonable increase in mortality response in treated insects over increasing exposures. At 48 h, 450 ppm pyrethrum + deltamethrin combination induced 25, 90 and 97% mortalities in S. oryzae, T. castaneum and R. dominica adults; while, pyrethrum-cypermethrin combination recorded 75, 45 and 75% mortalities respectively. On the other hand, it was observed that, among the pyrethrum alone treatments i.e. at 300, 450 and 600 ppm concentrations, maximum mortality (62.5%) was observed in S. oryzae exposed to 600 ppm pyrethrum for 48 h. The effective LC50 concentrations for pyrethrum (600 ppm) + deltamethrin combination was estimated to be as 0.1987 and 0.7039 µl/cm2 for R. dominica and T. castaneum adults respectively. Contrastingly, for treatments with S. oryzae, a LC50 value of 0.8673 µl/cm2 was recorded for pyrethrum (600 ppm) + cypermethrin mixture. This investigation strengthens the fact that pyrethrum along with pyrethroids is effective against storage insect pests which can be promisingly a safer insecticidal combination.

Alcohol-involved maxillofacial fractures.

BACKGROUND: Alcohol-related facial trauma is an increasingly prominent social problem and health hazard. Interpersonal violence (IPV) is often implicated in these trauma presentations and the facial skeleton frequently targeted. This paper examines the characteristics of admitted patients with alcohol-related facial fractures. METHODS: Electronic data of patients assessed or treated for facial fractures from January 2012 to December 2014 at Western Health was obtained through the Clinical Record Department. Variables analysed include patient age and gender, fracture site(s), alcohol involvement, country of birth, injury mechanism and surgical intervention. RESULTS: Of 659 patient records analysed, 18% presentations had alcohol involvement. In the alcohol group, 88% were male, 44% in the 20-34 year age group, 41% suffered nasal fractures, 65% presented following IPV and 60% required surgery. Thirty-seven per cent of patients were non-Australians. Alcohol involvement was significantly correlated with gender, age group and fracture sites but not with surgical intervention or ethnic origin. CONCLUSIONS: A binge drinking culture has contributed to prevalence of alcohol-related trauma. This study reports alcohol involvement in facial fractures to have high predilection for gender, age group of patients and fracture location. Facial trauma frequently necessitates surgical intervention. Educational programmes should be implemented to raise awareness of this potentially preventable health burden among health providers.

Ameloblastoma: demographic data and treatment outcomes from Melbourne, Australia.

BACKGROUND: There is a lack of published data on the demographics and treatment outcomes of ameloblastomas treated in Australia. Our objective was to collect this data and compare the findings to other international studies. METHODS: A retrospective study of 42 patients with ameloblastoma was conducted at The Royal Melbourne Hospital, Australia. Data on the demographic features, management techniques (ablative and reconstructive), and outcomes were collected and analysed. RESULTS: The majority of tumours were solid/multicystic (81%) and occurred most commonly in the mandible (80.5%). Unicystic ameloblastomas affected a younger age group, with Type 3 being the most common subtype. Overall, the recurrence rate for solid/multicystic ameloblastomas was 14.7%; however, radical surgery was found to have a significantly lower recurrence rate when compared to conservative management (p=0.015), with a mean of 51 months follow-up. Results indicated that vascularized free-flaps had fewer postoperative complications than non-vascularized bone grafts; however, the differences did not reach statistical significance. CONCLUSIONS: This is the largest clinicopathological study regarding ameloblastoma management from Australia, and our results support the current literature in recommending radical surgery for the treatment of solid/multicystic and Type 3 unicystic tumours.

Analysis of commonly reported medical conditions amongst patients receiving dental implant therapy in private practice.

BACKGROUND: The population seeking implants in private practice is a demographically and medically unique group. Understanding their medical needs can improve treatment planning and service delivery specifically for this population. METHODS: Privately practising dental clinicians from Victoria, Australia, participated in a five-year retrospective study. Data were collected from the medical histories of 4116 patients who met the inclusion criterion of at least one implant placed within the study period of 1 January 2005 to 31 December 2009. Descriptive statistics were used to describe patient demographics and commonly reported medical conditions. RESULTS: The most common age group to receive implant therapy was between 51 and 60 years (30.4% of patients). The patient population reported a broad range of co-morbidities including psychiatric disorders (83 patients), cardiovascular disorders (253 patients), gastrointestinal disorders (224 patients) and respiratory disorders (502 patients). Smoking was less prevalent amongst the study population compared to the general population. CONCLUSIONS: The population assessed in this study was a medically diverse group. Clinicians must be familiar with their target demographic and understand how the common co-morbidities amongst this patient group can influence clinical decision making and outcomes.

Non-small cell lung cancer metastasis to the oral cavity: a case report.

Lung cancer, including non-small cell lung cancer, remains prevalent in Australia and has a very poor survival rate. Metastases to the oral cavity are a rare occurrence that can arise from lung cancers. This case report describes the presentation of a metastatic lesion from a poorly differentiated lung adenocarcinoma on the mandibular buccal alveolar attached gingivae. The inpatient had terminal disease with known pleural, brain and liver metastases and was receiving palliative care at the time of diagnosis of the oral lesion.

Influence of the site of origin on the outcome of squamous cell carcinoma of the maxilla-oral versus sinus.

The maxilla may be affected by squamous cell carcinoma (SCC) from both oral and sinus sites. We sought to determine whether the site of origin of the maxillary tumour, oral as compared to sinus, influences survival. Univariate Kaplan-Meier and multivariate Cox proportional hazard models analysis of 58 patients with SCC involving the maxilla, treated with curative intent, was conducted. The overall 5-year disease-free survival for the group was 41.7%. Five-year disease-free survival for oral subsite SCC was 56.8%, while for sinus subsite was only 21.6%. Univariate analysis found SCC of sinus origin to be associated with a poorer prognosis, however this was not confirmed on multivariate analysis. T-stage and positive margins were found to be the only independent risk factors. For SCC of the maxilla, sinus origin of the tumour per se does not confer a poorer prognosis; however, as a result of the complex anatomy of the midface, these tumours can present at an advanced stage, while surgical control of the disease can be more difficult, especially posteriorly. Tumour size and positive margins were the determinants of a poor prognosis in this group of patients with maxillary SCC.

Assessment of bone grafts placed within an oral and maxillofacial training programme for implant rehabilitation.

BACKGROUND: This study aimed to review the survival of bone grafting procedures, performed by surgical trainees and assess factors affecting survival of these bone grafts as an adjunct to implant rehabilitation. METHODS: Data were collected from patients between 2003 and 2009 receiving bone grafting. Graft failure was defined as any complete or partial graft loss, graft which had to be removed or regrafted, or was unable to have an implant placed. Implant survival rates were not assessed in this study. RESULTS: Seventy-five patients received 86 bone grafts over a period of 7 years. Overall graft survival was 87.3% with 7 complete graft failures (8.1%) and 3 partial graft failures (4.6%). All failed grafts were of the block graft type, predominately in the anterior maxilla. The main reason for failure was secondary infection. Other complications occurred in about 27% of patients. Factors significantly increasing the risk of graft failure included use of bone block augmentation (p = 0.001), mixed autogenous/bone substitute grafts (p = 0.007) and diabetes mellitus (p = 0.006). Smoking was not found to affect graft survival. CONCLUSIONS: Good results were found in a series of patients treated in an oral and maxillofacial training programme. Care should be taken in regards to planning block grafts in diabetic patients.

A five-year assessment of clinical incidents requiring transfer in a dental hospital day surgery unit.

BACKGROUND: Previous studies regarding general anaesthesia related morbidity and mortality rates for dental surgery have taken the form of a retrospective survey. The Australian and New Zealand College of Anaesthetists also do not record morbidity and mortality for dental/oral and maxillofacial procedures. The aim of this study was to document the clinical incidents requiring transfer to another hospital and mortality. METHODS: Records from patients transferred to another hospital after having treatment under general anaesthesia performed at the Royal Dental Hospital of Melbourne between 1 January 2005 and 31 December 2009 were prospectively reviewed. RESULTS: There were 17,557 general anaesthesia procedures performed during the review period, including paediatric, special needs and minor oral and maxillofacial surgery procedures. The incidence of morbidity requiring transfer to a hospital with overnight stay facilities was 0.13%. There were no cases of mortality recorded. The most common complication was low oxygen saturation. CONCLUSIONS: The low incidence of morbidity seen is most likely attributed to the safety of modern anaesthesia and appropriate patient selection. Dentists and dental specialists performing general anaesthesia procedures should be aware of the complications that arise so that informed consent can be obtained. This study also provides a benchmark for general anaesthesia morbidity/mortality for dental procedures.

Outcomes of patients with adenoid cystic carcinoma of the minor salivary glands.

Adenoid cystic carcinoma is a tumour of glandular cells responsible for 10% of salivary gland neoplasms. It has a high rate of perineural spread but limited involvement of regional lymphatics even in late stage disease. Early survival is typically good (60-90%) although long term survival is poor with spread to distant sites in 40-60% of cases. The authors performed a retrospective review of clinical and pathological records for 24 patients managed by their institution over a 22-year period. The overall 5, 10 and 20-year survival rates in this study were 92%, 72% and 54%, respectively. Perineural invasion was seen in 63% and close or positive margins seen in 64% of all primary resection specimens although survival was not associated with any clinical factor other than the initial size of lesion. Most patients presented complaining of a lump, whilst a burning neuralgia-type pain was the second most common symptom. The study confirms the conclusion of previous studies that tumour size at diagnosis is the most important predictor of outcome.

Dental implant tourism.

Access and affordability of dental care can be problematic for some in the Australian community. Therefore, dental tourism is increasingly becoming more attractive to some patients due to decreased expense, increased convenience and immediacy of treatment. However, there are significant issues for both clinician and patient in regards to dental tourism. Lack of accountability and regulation are the main issues and this is particularly evident when complications occur. This paper presents five cases where complications have arisen in the setting of dental tourism.

Outcomes of dental implants placed in a surgical training programme.

BACKGROUND: This study evaluates surgical outcomes and survival rates of implants placed in a multidisciplinary implant teaching programme. METHODS: A retrospective review of all implant surgery performed over a 6-year period by accredited oral and maxillofacial surgery trainees at the Royal Dental Hospital of Melbourne was undertaken. Patients were reviewed for a minimum of 6 months post-implant placement. Implant survival was defined as those implants which were not removed, were clinically integrated as assessed by torque testing and in an appropriate position to receive a subsequent prosthesis. Kaplan-Meier analysis was used to assess overall survival and univariate factors affecting survival. Multivariate analysis used Cox proportional hazards models. RESULTS: Over 6 years, 127 patients were treated. Follow-up data were present for 105 patients with 236 implants placed. Survival of implants at 1 and 5 years was 94 per cent and 92.8 per cent, respectively. The only univariate and multivariate factor which affected implant survival was perioperative bone grafting. All failed implants were single stage. Other factors such as patient age, smoking status, implant site, anaesthetic type, immediate or delayed placement, implant length and diameter, and medical comorbidities did not significantly affect implant survival. CONCLUSIONS: A satisfactory implant survival rate was found in a tertiary teaching centre. Perioperative bone grafting significantly increased the risk of implant failure.

An unusual fracture of the mandible 20 months after a split sagittal osteotomy.

An unusual fracture of the mandible is reported that occurred 20 months after a bilateral split sagittal osteotomy.