Comparative Genomics of 42 Arcanobacterium phocae Strains

For the last 13 years, the fur industry in Europe has suffered from epidemic spouts of a severe necrotizing pyoderma. It affects all species currently farmed for fur and causes animal welfare problems and significant losses to the farmers. The causative agent of this disease was identified as Arcanobacterium phocae. Previously, this bacterium has been isolated from seals and other marine mammals, apparently causing wound and lung infections. Attempts at antibiotic treatment have been unsuccessful and the current advice on preventing the disease is to cull all animals with clinical signs. This poses an urgent question regarding possible vaccine development, as well as the need for further understanding of the pathogenicity of this organism. This study compared the whole genomes of 42 A. phocae strains isolated from seals, blue foxes, finnraccoons, mink and otter. The sequences were created using the Illumina technology and annotations were done using the RAST pipeline. A phylogenetic analysis identified a clear separation between the seal strains and the fur-animal-derived isolates, but also indicated that the bacterium readily adapts to new environments and host species with reasonable diversity. A pan- and core-genome was created and analyzed for proteins. A further analysis identified several virulence factors as well as multiple putative and secreted proteins of special interest for vaccine development.

Predicting the effect of decompression sickness on survival following submarine tower escape

Purpose The purpose of the present study was the development of a methodology for translating predicted rates of decompression sickness (DCS), following tower escape from a sunken submarine, into predicted probability of survival, a more useful statistic for making operational decisions. Design/methodology/approach Predictions were made, using existing models, for the probabilities of a range of DCS symptoms following submarine tower escape. Subject matter expert estimates of the effect of these symptoms on a submariner’s ability to survive in benign weather conditions on the sea surface until rescued were combined with the likelihoods of the different symptoms occurring using standard probability theory. Plots were generated showing the dependence of predicted probability of survival following escape on the escape depth and the pressure within the stricken submarine. Findings Current advice on whether to attempt tower escape is based on avoiding rates of DCS above approximately 5%–10%. Consideration of predicted survival rates, based on subject matter expert opinion, suggests that the current advice might be considered as conservative in the distressed submarine scenario, as DCS rates of 10% are not anticipated to markedly affect survival rates. Originality/value According to the authors’ knowledge, this study represents the first attempt to quantify the effect of different DCS symptoms on the probability of survival in submarine tower escape.

New method for quantification of severity of isolated scaphocephaly linked to intracranial volume

Purpose The aim is to implement Utrecht Cranial Shape Quantificator (UCSQ) for quantification of severity of scaphocephaly and compare UCSQ with the most used quantification method, cranial index (CI). Additionally, severity is linked to intracranial volume (ICV). Methods Sinusoid curves of 21 pre-operative children (age < 2 years) with isolated scaphocephaly were created. Variables of UCSQ (width of skull and maximum occiput and forehead) were combined to determine severity. CI was calculated. Three raters performed visual scoring for clinical severity (rating of 6 items; total score of 12 represents most severe form). Pearson’s correlation test was used for correlation between UCSQ and visual score and between both CIs. ICV was calculated using OsiriX. ICV was compared to normative values and correlated to severity. Results Mean UCSQ was 22.00 (2.00–42.00). Mean traditional CI was 66.01 (57.36–78.58), and mean visual score was 9.1 (7–12). Correlations between both traditional CI and CI of UCSQ and overall visual scores were moderate and high (r = − 0.59; p = 0.005 vs. r = − 0.81; p < 0.000). Mean ICV was 910 mL (671–1303), and ICV varied from decreased to increased compared to normative values. Negligible correlation was found between ICV and UCSQ (r = 0.26; p > 0.05) and between ICV and CI and visual score (r = − 0.30; p > 0.05 and r = 0.17; p > 0.05, respectively). Conclusion Our current advice is to use traditional CI in clinical practice; it is easy to use and minimally invasive. However, UCSQ is more precise and objective and captures whole skull shape. Therefore, UCSQ is preferable for research. Additionally, more severe scaphocephaly does not result in more deviant skull volumes.

Analysis of reports of unintended pregnancies associated with the combined use of non-enzyme-inducing antibiotics and hormonal contraceptives

BackgroundEnzyme-inducing antibacterial drugs can impair the efficacy of hormonal contraceptives. Suspicion that other antibiotics might do likewise led to advice that extra contraceptive precautions should be taken during a course of antibiotics. However, current advice is that the purported interaction does not occur, based on small studies observing few pregnancies, assuming that all women are susceptible, and without measuring unbound hormone concentrations.ObjectiveTo test the null hypothesis that antibiotics do not impair the effectiveness of oral contraceptives.DesignA database review of Yellow Card reports to the UK’s Medicines and Healthcare products Regulatory Agency.DataSpontaneous reports of suspected adverse drug reactions in people taking antibacterial drugs (n=74 623), enzyme-inducing medicines (n=32 872), or control medicines (n=65 578).Main outcome measuresReports of the primary outcome—unintended pregnancies; reports of cardiac arrhythmias and headaches (control events); reports of congenital abnormalities (positive control events); and reports of diarrhoea (a possible confounding factor).ResultsCompared with control medicines, unintended pregnancies were seven times more commonly reported with antibiotics and 13 times more commonly reported with enzyme inducers (the positive controls). Congenital abnormalities were reported seven times more often with enzyme inducers but were not more common with antibiotics. Diarrhoea was not a confounding factor.ConclusionThis study provides a signal that antibacterial drugs may reduce the efficacy of hormonal contraceptives. Women taking hormonal contraceptives should be warned that antibiotics may impair their effectiveness. Extra precautions can be taken during a course of antibiotics; an unintended pregnancy is a life-changing event.

MS, pregnancy and COVID-19

Concerns regarding infection with the novel coronavirus SARS-CoV-2 leading to COVID-19 are particularly marked for pregnant women with autoimmune diseases such as multiple sclerosis (MS). There is currently a relative paucity of information to guide advice given to and the clinical management of these individuals. Much of the limited available data around COVID-19 and pregnancy derives from the obstetric literature, and as such, neurologists may not be familiar with the general principles underlying current advice. In this article, we discuss the impact of potential infection on the pregnant woman, the impact on her baby, the impact of the current pandemic on antenatal care, and the interaction between COVID-19, MS and pregnancy. This review provides a framework for neurologists to use to guide the individualised advice given to both pregnant women with MS, and those women with MS who are considering pregnancy. This includes evidence derived from previous novel coronavirus infections, and emerging evidence from the current pandemic.

Healthy rabbits and communicating with owners

Rabbits need species-specific care, in order to meet their health, welfare and behavioural needs. Preventative health care is imperative to help keep rabbits healthy. Advice needs to be given to owners on their rabbit's dietary requirements, and why hay and grass is imperative as the bulk of their diet. Vaccinations to help prevent myxomatosis and rabbit viral haemorrhagic disease (RVHD1 and RVHD2) should be advised for all rabbits, including house rabbits. Rabbits require adequate space and the companionship of another rabbit to live a good quality life. They should have access to an exercise area, and have the choice of where to spend their time, without the need to be picked up and moved from a hutch to a run. Many owners will look to veterinary nurses for current advice, and it is important that nurses feel confident in offering the most up-to-date information. At times, it may be that owners need to make changes to the way they care for their rabbits, and being confident in explaining why these need to be implemented, and the positive effects these will have on the rabbit's life, is vital.

Is withdrawing treatment really more problematic than withholding treatment?

There is a concern that as a result of COVID-19 there will be a shortage of ventilators for patients requiring respiratory support. This concern has resulted in significant debate about whether it is appropriate to withdraw ventilation from one patient in order to provide it to another patient who may benefit more. The current advice available to doctors appears to be inconsistent, with some suggesting withdrawal of treatment is more serious than withholding, while others suggest that this distinction should not be made. We argue that there is no ethically relevant difference between withdrawing and withholding treatment and that suggesting otherwise may have problematic consequences. If doctors are discouraged from withdrawing treatment, concern about a future shortage may make them reluctant to provide ventilation to patients who are unlikely to have a successful outcome. This may result in underutilisation of available resources. A national policy is urgently required to provide doctors with guidance about how patients should be prioritised to ensure the maximum benefit is derived from limited resources.

Ensuring remote consultations are undertaken safely

When it comes to remote consultations, the situation is fast changing. Rob Hendry has some advice for practice managers to keep abreast of current advice from the appropriate regulatory authorities