Characterisation and comparative genomics of three new Varanus-associated Borrelia spp. from Indonesia and Australia

BACKGROUND

Borrelia are important disease-causing tick- and louse-borne spirochaetes than can infect a wide variety of vertebrates, including humans and reptiles. Reptile-associated (REP) Borrelia, once considered a peculiarity, are now recognised as a distinct and important evolutionary lineage, and are increasingly being discovered worldwide in association with novel hosts. Numerous novel Borrelia spp. associated with monitor lizards (Varanus spp.) have been recently identified throughout the Indo-Pacific region; however, there is a lack of genomic data on these Borrelia.

METHODS

We used metagenomic techniques to sequence almost complete genomes of novel Borrelia spp. from Varanus varius and Varanus giganteus from Australia, and used long- and short-read technologies to sequence the complete genomes of two strains of a novel Borrelia sp. previously isolated from ticks infesting Varanus salvator from Indonesia. We investigated intra- and interspecies genomic diversity, including plasmid diversity and relatedness, among Varanus-associated Borrelia and other available REP Borrelia and, based on 712 whole genome orthologues, produced the most complete phylogenetic analysis, to the best of our knowledge, of REP Borrelia to date.

RESULTS

The genomic architecture of Varanus-associated Borrelia spp. is similar to that of Borrelia spp. that cause relapsing fever (RF), and includes a highly conserved megaplasmid and numerous smaller linear and circular plasmids that lack structural consistency between species. Analysis of PF32 and PF57/62 plasmid partitioning genes indicated that REP Borrelia plasmids fall into at least six distinct plasmid families, some of which are related to previously defined Borrelia plasmid families, whereas the others appear to be unique. REP Borrelia contain immunogenic variable major proteins that are homologous to those found in Borrelia spp. that cause RF, although they are limited in copy number and variability and have low sequence identities to RF variable major proteins. Phylogenetic analyses based on single marker genes and 712 single copy orthologs also definitively demonstrated the monophyly of REP Borrelia as a unique lineage.

CONCLUSIONS

In this work we present four new genomes from three novel Borrelia, and thus double the number of REP Borrelia genomes publicly available. The genomic characterisation of these Borrelia clearly demonstrates their distinctiveness as species, and we propose the names Borrelia salvatorii, 'Candidatus Borrelia undatumii', and 'Candidatus Borrelia rubricentralis' for them.

The koala gut microbiome is largely unaffected by host translocation but rather influences host diet

Introduction

Translocation is a valuable and increasingly used strategy for the management of both threatened and overabundant wildlife populations. However, in some instances the translocated animals fail to thrive. Differences in diet between the source and destination areas may contribute to poor translocation outcomes, which could conceivably be exacerbated if the animals' microbiomes are unsuited to the new diet and cannot adapt.

Methods

In this study we tracked how the faecal microbiome of a specialist Eucalyptus folivore, the koala (Phascolarctos cinereus), changed over the course of a year after translocation. We assessed microbiome composition by 16S rRNA amplicon sequencing of faecal pellets.

Results

We found no significant overall changes in the faecal microbiomes of koalas post-translocation (n = 17) in terms of microbial richness, diversity or composition when compared to the faecal microbiomes of koalas from an untranslocated control group (n = 12). This was despite the translocated koalas feeding on a greater variety of Eucalyptus species after translocation. Furthermore, while differences between koalas accounted for half of the microbiome variation, estimated diets at the time of sampling only accounted for 5% of the variation in the koala microbiomes between sampling periods. By contrast, we observed that the composition of koala faecal microbiomes at the time of translocation accounted for 37% of between koala variation in post-translocation diet. We also observed that translocated koalas lost body condition during the first month post-translocation and that the composition of the koalas' initial microbiomes were associated with the magnitude of that change.

Discussion

These findings suggest that the koala gut microbiome was largely unaffected by dietary change and support previous findings suggesting that the koala gut microbiome influences the tree species chosen for feeding. They further indicate that future research is needed to establish whether the koalas' gut microbiomes are directly influencing their health and condition or whether aspects of the koala gut microbiomes are an indicator of underlying physiological differences or pathologies. Our study provides insights into how animal microbiomes may not always be affected by the extreme upheaval of translocation and highlights that responses may be host species-specific. We also provide recommendations to improve the success of koala translocations in the future.

851 SMILE: Sustaining Medical Education in A Lockdown Environment. Student Perceptions of a Free Online Access Medical Education Platform as An Adjunct to The Traditional Undergraduate Curriculum During Lockdown

Introduction

The coronavirus outbreak has had significant impact on medical students worldwide. SMILE is a free online access medical education (FOAMEd) platform. SMILE delivered 200 lectures during lockdown with up to 1400 students per session from UK medical schools and 33 abroad. Here we discuss student perceptions to SMILE during lockdown

Method

A survey was used to collect information from students who had utilised the platform during lockdown. This examined access to learning, impact on mental health during lockdown and the differences between FOAMed and more traditional based campus lecture-based learning.

Results

1306 students responded to the survey. The majority of students were concerned regarding their training during lockdown, with 71% reporting an impact on their stress levels and 44% reporting a negative impact on mental health.

On average students attended 4.3hours of teaching put on by their university per week, vs 7.9hours by SMILE.

Positives included anonymity, making 80% more likely to both ask and answer questions, the informal approach, ease of access and enthusiastic teachers. Negatives included time differences and technical issues.

Conclusions

Lockdown provided challenges in medical education, which platforms like SMILE addressed. Our experiences highlighted many positive outcomes of online medical education that may be applicable to other educators.

Effect of the UK postcode lottery on survival of patients with metastatic renal cancer: an audit of outcomes in patients with metastatic renal cancer suitable for treatment with tyrosine kinase inhibitors

AIMS

To determine whether primary care trusts' agreement or refusal to fund sorafenib or sunitinib affects outcomes for patients with metastatic renal cell carcinoma.

MATERIALS AND METHODS

This retrospective audit was conducted in a tertiary referral centre for urological cancer. Requests to prescribe drugs not approved by the National Institute for Health and Clinical Excellence are recorded on a trust database. We obtained details of all requests made for sunitinib and sorafenib for patients with renal cell carcinoma since licence in 2006. Outcome measures analysed were overall survival measured from the date of request for funding and hospital resource use as measured from Payment by Results data. Known prognostic factors and the patient's Index of Multiple Deprivation score were assessed at baseline as potential confounders of survival difference.

RESULTS

Seventy-nine patients were identified. The groups were similar with respect to prognostic factors and Index of Multiple Deprivation scores. Thirty-seven and eight patients had funding approved for sunitinib and sorafenib, respectively; 21 and 13 were turned down. Seven patients who were denied funding received one or other of these drugs by self-funding treatment. Survival was longer for patients who received treatment with a drug for which they had applied for funding than for those who did not (hazards ratio 0.46; 95% confidence interval 0.21-1.01; chi(2)=3.80; 1 d.f.; P=0.05); the advantage was similar for patients receiving sunitinib (hazards ratio=0.49; 95% confidence interval 0.18-1.36; chi(2)=1.86; 1 d.f.; P=0.17) and sorafenib (hazard ratio=0.44; 95% confidence interval 0.11-1.69; chi(2)=1.58; 1 d.f.; P=0.21). Overall National Health Service resource use apart from funding for the renal cancer drugs was similar for both groups.

CONCLUSIONS

Compared with patients receiving treatment, patients denied access to sunitinib and sorafenib had substantially worse survival outcomes, despite receiving treatment from the same clinical team. Access to the new drugs did not have an effect on overall use of National Health Service resources by funded patients. Modern treatments for advanced renal cancer should be available to all National Health Service patients with the disease.

Recommendations to institutions

Results from the Interdisciplinary Generalist Curriculum (IGC) Project support current ideas of management within a chaotic environment. Important aspects of building support for educational innovation included the following. The trend toward primary care and request for proposal process were important catalysts for change. Buy-in from the dean and key opinion leaders was essential. Early identification of champions for the proposal and ability to achieve broad consensus helped shape coherent projects. Being able to read the culture of the institution and accede to pragmatic changes were important for bridging the initial implementation and maintenance of the change. IGC Project leaders were quick to identify key leverage points, both internal and external. The recommendations of key school committees and licensing bodies were used to foster ongoing change. A respected home for the project on neutral ground was sought. Dedicated coordinators helped sustain daily details, while developing rewards and recognition for collaboration supported faculty involvement. New relationships fostered new systems, which the projects used to continue after funding lapsed and to successfully apply for other grants and contracts.

Physician gender and psychosocial care for children: attitudes, practice characteristics, identification, and treatment

OBJECTIVE

To examine differences by physician gender in the identification and treatment of childhood psychosocial problems.

DESIGN

Survey of patients (n = 19,963) and physicians (n = 366) in primary care offices in 2 large, practice-based research networks. Multivariate regressions were used to control for patient, physician, and visit characteristics, with a correction for the clustered sample.

SUBJECTS

Children ages 4 to 15 years seen consecutively for nonemergent care.

MEASURES

Physician report of attitudes, training, practice factors, and identification and treatment of psychosocial problems. Parental report of demographics and behavioral symptoms.

RESULTS

Compared with male physicians, female physicians were less likely to view care for psychosocial problems as burdensome. They were more likely to see children who were female, younger, black or Hispanic, in single-parent households, enrolled in public or managed health plans, and with physical health limitations. Children seen by male physicians had higher symptom counts. Male physicians were more likely to report having primary care responsibility for their patient and that parents agree with their care plan. Female physicians spent more time with patients. After controlling for these differences, female physicians did not differ from male physicians in identification or treatment of childhood psychosocial problems.

CONCLUSIONS

Male and female physicians see different kinds of children for different visit purposes and have different kinds of relationships with their patients. After controlling for these factors, management of childhood psychosocial problems does not differ by physician gender. Improving management of psychosocial conditions depends on identifying modifiable factors that affect diagnosis and treatment; our work suggests that characteristics of the practice environment, physician-patient relationship, and patient self-selection deserve more research.

The quality of mothers' solutions to child-rearing problems: what difference does setting internal or external to the family make?

In this study we examined the difference the setting of a child-rearing problem, either internal or external to the family, made for mothers' generation of solutions likely to assist a child's development of problem-solving competencies. In addition, the direct effect of a mother's personal resources (age, education, number of children parented, and verbal ability) and the direct and mediating effect of the extent to which a mother took the child's perspective on her generation of assistive solutions were explored. Adult mothers (n = 128) of children ranging in age from 1 month to 18 years were interviewed by telephone concerning eight hypothetical child-rearing problems. Mothers generated a greater proportion of assistive solutions and took the child's perspective more often for external problems than for internal problems. For internal problems, a mother's verbal ability made a significant contribution to the proportion of assistive solutions generated. For external problems, number of children made a significant negative contribution. For external problems, perspective taking had a mediating effect on the relationship of number of children with the proportion of assistive solutions generated. The nature of a mother's perspective taking and the function that it has in solution generation for child-rearing problems merit exploration.

Differential effects of three radiographic contrast media on platelet aggregation and degranulation: implications for clinical practice?

We have determined the effects of three radiographic contrast media on platelet aggregation and degranulation in vitro. Aggregation was measured as loss of single platelets, and degranulation was measured as P-selectin expression using flow cytometry. Iopamidol added to hirudinized blood induced aggregation directly and also potentiated that induced by weak platelet agonists such as adenosine diphosphate (ADP). Iodixanol also potentiated platelet aggregation, but ioxaglate inhibited it. Iopamidol also caused marked platelet degranulation. The pro-aggregatory effect of iopamidol was evident in non-anticoagulated blood as well as in hirudinized blood, but not in citrated blood. In platelet-rich plasma (PRP) prepared from hirudinized blood neither iopamidol nor iodixanol directly induced platelet aggregation, but they rendered platelets hypersensitive to ADP. ADP antagonists inhibited the platelet aggregation and degranulation induced by iopamidol in whole blood, whereas aspirin, an inhibitor of thromborane A2 synthesis, did not. These data are consistent with clinical reports of increased thromboembolic risk with non-ionic low-osmolar media, and raise concerns about the routine use of these contrast media during diagnostic and interventional arteriographic procedures. Routine use of citrate in previous experiments may have masked a pro-aggregatory effect of some contrast media.

Transendoscopic chemical ablation of progressive ethmoidal hematomas in standing horses

OBJECTIVE

To examine the response of horses with progressive ethmoidal hematoma (PEH) to intralesional injection of 4% formaldehyde solution.

STUDY DESIGN

Nasal passages of horses affected with PEH were examined endoscopically at different intervals to determine the effects of intralesional injection of formaldehyde solution.

ANIMALS

21 horses with PEH.

METHODS

PEHs were injected transendoscopically with 4% formaldehyde solution. Horses were examined endoscopically and retreated at different intervals until the PEH was eliminated or was so small that reinjection was not possible.

RESULTS

Lesions diminished significantly in size or were eliminated after 1 to 18 injections (median, 5; mean, 7.0 +/- 5.62). Seventeen lesions (60.7%) resolved completely after 1 to 18 injections (median, 5; mean, 7.2 +/- 5.71). Five lesions decreased markedly in size but did not resolve after receiving 1 to 18 injections (median, 5; mean, 7.6 +/- 6.66). Injection of these lesions was discontinued 4.0 to 25.1 months (median, 9.5; mean, 11.02 +/- 8.446) after the first injection. The PEH of one horse was removed surgically after one injection. Three horses, one with bilateral PEH, were lost to follow-up. One horse developed signs of laminitis. No other complications were observed.

CONCLUSIONS

Horses with a PEH can be treated effectively by transendoscopic, intralesional injection of 4% formaldehyde solution.

CLINICAL RELEVANCE

Ablation of PEH using formaldehyde solution avoids general anesthesia and problems associated with ablation by conventional surgery or laser.

Multi-adjustable chairs for children with disabilities

There is a growing demand that severely disabled children should be offered a normal-looking, comfortable alternative to highly supportive wheelchair seating to facilitate relaxation and social integration. An evaluation of five chairs, funded by Medical Devices Agency, an executive agency of the Department of Health, was undertaken with potential and actual users of these chairs to investigate the chairs' function with respect to the child's posture, and what features were effective. Twenty-nine children tried five chairs for up to 30 min in each; and a postal survey received 100 responses. The chairs seem to meet many users' postural needs (78% of postal survey; 31-72% of short-term evaluation depending on chair); the chairs' adjustability and availability of special features are important in meeting the needs of this user group; evidence of poor design and its implications are discussed.

Choosing a commode for the ward environment

The choice of appropriate equipment to promote patient independence and enhance nursing care is of major concern to the nurse in the ward environment. This article reports on a recent evaluation of specialist commodes, (Ballinger et al, 1994), with reference to the programme funded by the Medical Devices Agency, Department of Health, under whose auspices the project was carried out. The results of user evaluations and technical tests of six mobile commodes are presented, the preferred model being the Mayfair commode supplied by Carters (J&A) Ltd. The article concludes by identifying a number of important considerations to bear in mind when selecting a commode.

Registration of myometrial activity using multiple site electromyography in cyclic mares

A method for interpreting and analysing electromyographic (EMG) data of myometrial electrical activity was established. This method was used to study EMG activity in the uterus during the various stages of the oestrus cycle in mares. Recordings were analysed from four pairs of electrodes that were surgically implanted in the myometrium of four reproductively sound mares. The electrodes were placed at the tip, middle and base of the left horn and in the uterine body. Electrical activity was monitored by a polygraph. Data were transformed to a digitized form and statistically analysed. Myometrial electrical activity during oestrus and dioestrus was analysed for frequency (number of activity bursts per hour), duration (time elapsed from the start to the end of a burst) and intensity (peaks per minute). In addition, the degrees of synchronous activity among all of the monitored sites of the uterus were compared. The minimal amount of time of EMG recordings that allowed meaningful statistical analyses was determined to be 3.5 h during oestrus and 7 h during dioestrus. Variations in intensity of electrical activity were seen between the sites of implanted electrodes (P < 0.001). Electrical activity was highest in the middle of the horn and lowest in the uterine body. The frequency of activity bursts was the same during oestrus and dioestrus (4.35 +/- 0.22 and 4.44 +/- 0.20, respectively). The duration and intensity of uterine electrical activity depended on the stage of the oestrous cycle. The mean duration of uterine activity burst during dioestrus was significantly (P < 0.005) shorter during oestrus (3.32 +/- 0.18 min) than during dioestrus (5.7 +/- 0.39 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Multiple site electromyography recordings of uterine activity following an intrauterine bacterial challenge in mares susceptible and resistant to chronic uterine infection

The electrical myometrial activity of three mares with a documented increased susceptibility to chronic uterine infection (CUI) and three mares considered to be resistant to CUI was investigated. Electrodes were surgically implanted in the myometrium of the mares and electrical activity was monitored by a Grass polygraph. Oestrus was determined by transrectal ultrasonography of the reproductive tract and teasing of the mares with a stallion. Findings were confirmed by blood progesterone concentrations < 0.1 ng ml-1. At the third day of oestrus or when a follicle > 35 mm was detected, the uterus was infused with a genital strain of 5 x 10(6) Streptococcus zooepidemicus. Myometrial electrical activity was monitored for 1-4 h before the bacterial infusion and continued until a visual stabilization of the activity occurred. No statistically significant differences in electrical myometrial activity were detected between susceptible and resistant mares before the infusion of bacteria into the uterus. A visible increase in myometrial electrical activity was seen in all mares following the bacterial infusion. However, the myometrial response of susceptible and resistant mares was different. Resistant mares demonstrated a greater myometrial activity (P < 0.001) than did susceptible mares. These differences were observed in frequency (P < 0.005) as well as duration (P < 0.001) and intensity (P < 0.001) of the uterine activity. Differences were most marked between 10 and 20 h after the intrauterine inoculation of bacteria. It was concluded from this study that myometrial activity is an important part of the uterine defence mechanism in mares.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodialysis for treatment of oxytetracycline-induced acute renal failure in a neonatal foal

Acute renal failure in a 4-day-old foal secondary to oxytetracycline toxicosis was treated by hemodialysis. Oxytetracycline had been administrered as treatment for forelimb flexor tendon contracture. Conservtive treatment with fluids, furosemide, and dopamine partially alleviated serum electrolyte concentration imbalances, but was ineffective in promoting diuresis or decreasing azotemia. Three hemodialysis treatments over 4 days were administered, after which the clinical appearance of the foal improved, and biochemical and electrolyte values returned to within reference ranges. The nephrotoxic potential of oxytetracycline should be considered prior to its administration. Hemodialysis may be a treatment option in management of acute renal failure in foals that are nonresponsive to conservative medical treatment.

Enalapril maleate and atenolol combined with hydrochlorothiazide in moderate to severe essential hypertension

This open randomised parallel trial compared the antihypertensive efficacy of enalapril and atenolol given alone once a day or with hydrochlorothiazide in 20 patients with moderate to severe hypertension. Active treatment was over a 26 week period, consisting of an initial titration phase followed by a fixed dose phase. Both treatment regimes effectively lowered systolic and diastolic blood pressures. All patients on enalapril reached normotension (supine diastolic blood pressure less than or equal to 90 mmHg) compared with 78% on atenolol. Pulse rate was not appreciably changed by enalapril, but was significantly reduced by atenolol. No serious adverse reactions or significant changes in laboratory values were noted in either group. The commonest adverse reaction with enalapril was dizziness which occurred in two cases and resolved on dosage reduction. Enalapril with hydrochlorothiazide given once daily may provide a useful combination in the treatment of moderate to severe hypertension.

150 bicycle injuries in children: a comparison with accidents due to other causes

One hundred and fifty bicycle accidents seen at the Children's Hospital Sheffield over a 6-month period from mid-August 1979 were analysed and 9.3 per cent of the cases were admitted. Twenty-two per cent had fractures, 20 per cent had soft tissue injuries of face or scalp, 8 children having damaged their teeth. Of the accidents 17.3 per cent were due to hitting an obstruction, 30.7 per cent were due to loss of control on a hill or corner and 8 per cent were of mechanical origin. Eighty-eight per cent had cycling experience of a year or more, and 32.7 per cent had had previous cycling accidents. Comparison with other types of accidents previously studied at the hospital, involving skateboards, playground equipment or road traffic accidents affecting child pedestrians, showed that by far the most serious were those involving child pedestrians. The injuries from bicycle accidents were similar in severity to those involving skateboards.