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Background: Hepatozoonosis has been reported in many species around the world. Few incidences have been reported in various species of wild felids. Tigers are endangered large cats and are protected under the Wildlife Protection Act, 1972 under Schedule I. The study was carried out to estimate the positivity rate of hepatozoonosis in tigers of the Vidarbha region of Maharashtra, India. Methods: Blood (n = 21) or tissue samples (n = 5) were collected from 26 wild captured / zoo-born or dead tigers during the quarantine period/post-mortem examination. Blood smear examination along with Polymerase Chain Reaction (PCR) studies were conducted for the detection of hepatozoonosis. All the amplicons from the positive samples were purified and sequenced, and the sequences were subjected to nBLAST analysis to detect the species of Hepatozoon. The sequences were deposited into public domain database of National Center for Biotechnology Information (NCBI) and accession numbers were allotted. A phylogenetic study was undertaken to understand the evolutionary lineage of the pathogen. Tissue distribution studies were carried out on tissue samples received during post mortem. A clinical case in a tiger cub was managed and sub-clinical cases were monitored for relapse. Age-wise, sex-wise, region-wise and captive time-wise positivity rate was estimated. The data was analyzed using statistical tools. Results: A total of 12 tigers were found positive for H. felis during the screening. A clinical case was diagnosed and successfully treated. The age group of 0–3 years reported a positivity rate of 66.66%, and all the cases found positive were reported between the age group of 0–7 years. Males reported a positivity rate of 58.33 per cent, while females reported 35.71%. Taboba and Andhari Tiger Reserve of the state had a positivity rate of 52.94 per cent. However, the statistical analysis for blood parameters and positivity rate by 't' test and Chi-squared test were found to be non-significant. Conclusions: An overall positivity rate of 46.15% indicates the wide distribution of hepatozoonosis among wild tigers of the Vidarbha region of Maharashtra, India, which is strategically important considering the gene flow and migration of tigers. Hepatozoonosis can progress to clinical outcomes in young animals and require veterinary intervention. Molecular tools and phylogenetic studies can supplement important data on circulating species of Hepatozoon in the field. Further studies on the clinical management and epidemiology of the infection in wild felids will comprehend the cause of wildlife conservation. [ABSTRACT FROM AUTHOR]

Background: Tigers are protected under schedule I of the Wildlife Protection Act, 1972. The current report highlights the detection of Hepatoozoon felis in a tiger cub. The infection is transmitted by ingestion of infected tick, infected prey and carrion. It is subclinical in adults; however, the cubs and immunocompromised adults may show clinical symptoms. Concurrent infection with bacterial or viral infections may be fatal to the infected animal. Methods: Hepatozoonosis was detected by blood smear examination using Giemsa staining. A PCR targeting the 18S ribosomal RNA was used to confirm the infection. The amplicon was purified and sequenced using a sanger sequencer. The 18S ribosomal RNA fragment sequence was compared to the available sequences in NCBI database using the nucleotide BLAST Tool. Neighbour joining phylogenetic trees using the bootstrap method were constructed using MEGA X software. Result: The presence of an intermediate gamont stage in neutrophils was seen under high resolution. The 660 bp amplicon was purified, sequenced and analysed for identity using the nucleotide BLAST tool of NCBI. The sequence was found to be 99.32%, similar to Hepatozoon felis. The phylogenetic analysis by neighbour joining phylogenetic tree using the bootstrap method indicated similarity with other reported sequences of H. felis isolated from Asian Lions. The sequence, however, was very dissimilar to the previously reported H. felis isolated from Royal Bengal Tiger. Considering the potential threat Hepatozoonosis can have in the wild, the prevalence must be estimated in prey base, sympatric cat species and arthropod vectors. [ABSTRACT FROM AUTHOR]

In this article the study of strongly r-precious ring is initiated. An element r ∈ R is strongly r-precious if r is the sum of an idempotent element, a regular element, a nilpotent element and these elements are commute with each other. A ring R is considered to be a strongly r-precious ring if all of its elements are strongly r-precious. In this article, we discuss some of the fundamental properties of strongly r-precious rings and discuss the behaviour of strongly r-precious rings under finite direct product, homomorphic images, matrix ring and group rings. [ABSTRACT FROM AUTHOR]

Conflict leopards are often critically wounded and need care and rehabilitation under captivity. These incapacitated leopards need special health care and management including changes in diet to suit their physiological needs. In most zoos, a monotonous diet protocol of carabeef / beef is followed. It is essential to make changes to diet to suit the incapacity and provide wise supplementation where needed. In our study, five incapacitated or geriatric leopards were selected, their diet was modified considering their incapacity and their health was monitored by daily health monitoring, body score indexing, faecal scores, blood and biochemical monitoring etc. It was observed that making changes in regular diet to suit incapacitated and geriatric leopards was instrumental in the health and well being of incapacitated leopards in captivity. Similarly, geriatric leopards need special care to avert health complications and lead a healthy life. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to assessment of meteorological drought in Maharashtra, India. It mentions that standardized precipitation index (SPI), decile drought index (DI) and effective drought index (EDI) are widely used meteorological drought indices for drought quantification. It also mentions that SPI and EDI detect the onset of drought, its spatial and temporal variation consistently.

Present study was taken up to develop a topical formulation that releases the drug in controlled manner, reduce the side effects associated with topical drug delivery and improve product efficacy with aid of microsponges. Microsponges loaded with sertaconazole nitrate were prepared by using quasi emulsion solvent diffusion with five different proportions of the polymer (Eudragit RS 100). The developed microsponges were analyzed for particle size, production yield, entrapment efficiency and drug content. Scanning electron microscopic images of microsponges revealed that they are spherical in shape and contain pores. Pore structure analysis was done by using mercury intrusion porosimetry technique, which confirmed the porous nature of microsponges. Microsponges were then incorporated in to a 1% corbopol gel and evaluated for pH, drug content, texture profile analysis and in vitro drug release. The batch F IV was found to be optimal as it shown 69.38% controlled drug release in 8 h that followed Higuchi model. [ABSTRACT FROM AUTHOR]

Eleven dogs were diagnosed with corneal opacity based on clinical and opthalmic examination. Antibiotic and corticosteriod therapy initially for seven days followed by cyclosporine after confirmation of epithelization. Negative fluorescin dye test was confirmation for effective therapy. [ABSTRACT FROM AUTHOR]

A total of 12 female dogs presented at TVCC, NVC, Nagpur were included in this study and were divided into 2 different groups of 6 dogs each. The dogs were subjected to laparoscopic ovariectomy and laparoscopic ovariohysterectomy in group I and II, respectively. The surgical parameters like surgical operating time, time to resect left and right organs and length of incision were studied. The mean surgical time of 71.16 ± 3.08 minutes was recorded in group I than that of 60.66 ± 5.60 minutes in group II. The time for resection of left ovary was longer in laparoscopic ovariectomy (26.66 ± 2.53 minutes) than by laparoscopic ovariohysterectomy (20.66 ± 3.02 mins). The time for resection of right ovary was longer in laparoscopic ovariectomy (18.83 ± 2.42 minutes) followed by laparoscopic ovariohysterectomy (14.33 ± 2.71 mins). Ovarian pedicle bleeding and splenic puncture in one dog were the intraoperative complications recorded in the study. It could be concluded that both the techniques were found equally feasible and safe for patients and further that surgical time can be reduced with experienced and skilled surgeons. [ABSTRACT FROM AUTHOR]

A new minimal invasive technique using stainless steel stapling in six dogs was compared with practiced surgical technique. After draining, the haematoma and removal of complete blood and fibrin clots through the incision, haematoma cavity was flushed with Povidine iodine and stainless steel stapling was applied into the ear in six (6) dogs and practiced surgical method in another six (6) dogs. The stapling technique required less surgical time for obliteration of dead space and less time required for complete healing as compared to surgical technique. [ABSTRACT FROM AUTHOR]

Two bullocks with history of fracture of horn, foul smelling, head shaking, mucopurulent discharge from the corresponding nostrils, dull, depressed, partially closed eyes and head pressing were presented. Both animals were suspected for sinusitis and in second case tumor mass (squamous cell carcinoma) at the tip was observed. The affected horns were surgically removed and no recurrence was observed. Animals recovered uneventfully. [ABSTRACT FROM AUTHOR]

A nine year old pomeranian female dog was reported with inappetance, reduced water intake, occasional vomiting, and large growth since last two months. Clinical examination revealed fever, dysponea, auscultation of chest revealed lung consolidation and large tumor in left caudal abdominal gland. Surgical intervention under dissociative anaesthesia, removal of tumorous mass and post-operative care was undertaken. The histopathological examination revealed proliferation of mesenchymal cells along with tubular epithelial type representing fibrosarcoma of mammary gland. Uneventful recovery marked the successful surgical intervention. [ABSTRACT FROM AUTHOR]

The fourth Society for Academic Emergency Medicine (SAEM) Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4) is on the topic of the emergency department (ED) management of nonopioid use disorders and focuses on alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS). The SAEM GRACE-4 Writing Team, composed of emergency physicians and experts in addiction medicine and patients with lived experience, applied the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding six priority questions for adult ED patients with AWS, AUD, and CHS. The SAEM GRACE-4 Writing Team reached the following recommendations: (1) in adult ED patients (over the age of 18) with moderate to severe AWS who are being admitted to hospital, we suggest using phenobarbital in addition to benzodiazepines compared to using benzodiazepines alone [low to very low certainty of evidence]; (2) in adult ED patients (over the age of 18) with AUD who desire alcohol cessation, we suggest a prescription for one anticraving medication [very low certainty of evidence]; (2a) in adult ED patients (over the age of 18) with AUD, we suggest naltrexone (compared to no prescription) to prevent return to heavy drinking [low certainty of evidence]; (2b) in adult ED patients (over the age of 18) with AUD and contraindications to naltrexone, we suggest acamprosate (compared to no prescription) to prevent return to heavy drinking and/or to reduce heavy drinking [low certainty of evidence]; (2c) in adult ED patients (over the age of 18) with AUD, we suggest gabapentin (compared to no prescription) for the management of AUD to reduce heavy drinking days and improve alcohol withdrawal symptoms [very low certainty of evidence]; (3a) in adult ED patients (over the age of 18) presenting to the ED with CHS we suggest the use of haloperidol or droperidol (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence]; and (3b) in adult ED patients (over the age of 18) presenting to the ED with CHS, we also suggest offering the use of topical capsaicin (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence]., (© 2024 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

Introduction: We conducted this systematic review to identify emergency department (ED) relevant recommendations in current guidelines for care of transgender and gender-diverse (TGD) people internationally., Methods: Using PRISMA criteria, we did a systematic search of Ovid Medline, EMBASE, and CINAHL and a hand search of gray literature for clinical practice guidelines (CPG) or best practice statements (BPS) published until June 31, 2021. Articles were included if they were in English, included medical or paramedical care of TGD populations of any age, in any setting, region or nation, and were national or international in scope. Exclusion criteria included primary research studies, review articles, narrative reviews or otherwise non-CPG or BPS, editorials, or letters to the editor, articles of regional or individual hospital scope, non-medical articles, articles not in English, or if a more recent version of the guideline existed. Recommendations relevant to ED care were identified, recorded, and assessed for quality using the AGREE-II and AGREE-REX criteria. We performed interclass correlation coefficient for interrater reliability. Recommendations were coded for the relevant point of care while in the ED (triage, registration, rooming, investigations, etc.)., Results: We screened 1,658 unique articles, and 1,555 were excluded. Of the remaining 103 articles included, seven had recommendations relevant to care in the ED, comprising a total of 10 recommendations. Four guidelines and eight recommendations were of high quality. They included recommendations for testing, prevention, referral, and provision of post-exposure prophylaxis for HIV, and culturally competent care of TGD people., Conclusions: This is the most comprehensive review to date of guidelines and best practices statements offering recommendations for care of ED TGD patients, and several are immediately actionable. There are also many opportunities to build community-led research programs to synthesize and inform a comprehensive dedicated guideline for care of TGD people in emergency settings., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Background: Pediatric patients with pain of various causes present to the emergency department. Appropriate assessment and management of pain are important aspects of emergency department treatment. However, only a few studies have identified the predictors of both outcomes. This study aimed to evaluate the rate of pain assessment at triage and subsequent management and to identify the predictors of each outcome., Methods: This was a multi-center retrospective study based at five community emergency departments. Pediatric patients (< 18 years) with pain or injury who presented to the emergency department between February 2018 and May 2018 were included. In addition to patient demographics, the initial pain assessment at triage, reason for visit, and time to analgesia were determined. Further, the type and route of analgesia were identified in patients who received analgesia. Univariate and multivariable regression models were used to identify predictors of pain assessment and management., Results: There were 4,128 patients with an average age of 9.6 years, and 49.1% of them were female. Only 74.2% of the patients underwent assessment for pain at triage, and 18.3% received analgesia. The median time to analgesia was 95 (IQR: 49-154) min. Most patients presented with head/neck (36.1%), upper limb (21.6%), and lower limb (19.9%) pain. The oral route was the most common analgesia delivery method (67.4%), and ibuprofen and acetaminophen were the primary agents used. Younger age, higher acuity, and presenting with head or neck pain were independent predictors of pain assessment at triage, while children 3-5 years and those with lower extremity pain were more likely to receive analgesia., Conclusion: Although pain assessment at triage has improved in pediatric patients, there is still a major deficiency in adequate pain management. Our study highlights predictors of pain assessment and management that can be considered for improved pediatric care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Valani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Opioids are often prescribed for acute pain to patients discharged from the emergency department (ED), but there is a paucity of data on their short-term use. The purpose of this study was to synthesize the evidence regarding the efficacy of prescribed opioids compared to nonopioid analgesics for acute pain relief in ED-discharged patients., Methods: MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and gray literature databases were searched from inception to January 2023. Two independent reviewers selected randomized controlled trials investigating the efficacy of prescribed opioids for ED-discharged patients, extracted data, and assessed risk of bias. Authors were contacted for missing data and to identify additional studies. The primary outcome was the difference in pain intensity scores or pain relief. All meta-analyses used a random-effect model and a sensitivity analysis compared patients treated with codeine versus those treated with other opioids., Results: From 5419 initially screened citations, 46 full texts were evaluated and six studies enrolling 1161 patients were included. Risk of bias was low for five studies. There was no statistically significant difference in pain intensity scores or pain relief between opioids versus nonopioid analgesics (standardized mean difference [SMD] 0.12; 95% confidence interval [CI] -0.10 to 0.34). Contrary to children, adult patients treated with opioid had better pain relief (SMD 0.28, 95% CI 0.13-0.42) compared to nonopioids. In another sensitivity analysis excluding studies using codeine, opioids were more effective than nonopioids (SMD 0.30, 95% CI 0.15-0.45). However, there were more adverse events associated with opioids (odds ratio 2.64, 95% CI 2.04-3.42)., Conclusions: For ED-discharged patients with acute musculoskeletal pain, opioids do not seem to be more effective than nonopioid analgesics. However, this absence of efficacy seems to be driven by codeine, as opioids other than codeine are more effective than nonopioids (mostly NSAIDs). Further prospective studies on the efficacy of short-term opioid use after ED discharge (excluding codeine), measuring patient-centered outcomes, adverse events, and potential misuse, are needed., (© 2023 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada.