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Context Late intervention to open an occluded infarct-related artery (IRA) after initial acute myocardial infarction was postulated to lead to clinical benefit. Objective To conduct a meta-analysis of the randomized trials. Study Selection Eligibility criteria were: 1) randomized trials comparing percutaneous coronary intervention (PCI) in a totally occluded artery (TIMI flow 0-1) versus medical therapy, 2) in stable post myocardial infarction (MI) patients without spontaneous or low level exercise induced ischemia, 3) trials with a time from the onset of symptoms to randomization >24 hours, but

Among the established breeds of buffalo in Pakistan, the Nili-Ravi breed is dominant in the Punjab Province. The purpose of the study is to determine the chemical composition and fatty acid profile of buffalo milk. Milk is a complete food and contains all the nutritional components in balanced form. It helps to meet important nutritional needs of the human body. The buffaloes were divided into 3 groups on the basis of lactation period i.e. early, middle and late lactation. A total of 90 milk samples were obtained for analysis. Buffalo milk samples were analyzed for proximate analysis, parameters like fat, crude protein, lactose, ash, solids not fat (SNF), total solids (TS), pH and acidity were determined. Fatty acid profile of buffalo milk was determined by the method, Association of Office of Agricultural Chemists (AOAC, 2000). Milk fat content (%) was found to be significantly (p<0.05) lower in the early (6.52) and mid lactation (6.61) stages than the late lactation stage (6.85). The content of TS (%) was found to be significantly (p<0.05) higher in the late lactation (14.62 and 15.45) stage than the early (12.94 and 13.65)) and mid lactation (13.76 and 14.14) stages. In contrast, the content of total protein (4.31% to 4.78%), Solid not fat (8.40% to 8.70%), lactose (4.36% to 4.74%) and ash (0.18% to 0.19%) did not vary significantly among the different lactation stages. The values of Butyric acid, Caproic acid, Myristic acid, Stearic acid and Oleic acid showed significant increase towards end of lactation. These values of fatty acids also revealed that there is significant difference among the animals and lactation stages of Nili Ravi buffalo milk. Results showed that Capric acid, Lauric acid, Palmitic acid, Linoleic acid and Linolenic acid decreased in early to middle and increased towards end of lactation. [ABSTRACT FROM AUTHOR]

Abstract Background Heart failure patients with stable angina, acute coronary syndromes and valvular heart disease may benefit from revascularisation and/or valve surgery. However, the mortality rate is increased- 5-30%. Biventricular pacing using temporary epicardial wires after surgery is a potential mechanism to improve cardiac function and clinical endpoints. Method/design A multi-centred, prospective, randomised, single-blinded, intervention-control trial of temporary biventricular pacing versus standard pacing. Patients with ischaemic cardiomyopathy, valvular heart disease or both, an ejection fraction ≤ 35% and a conventional indication for cardiac surgery will be recruited from 2 cardiac centres. Baseline investigations will include: an electrocardiogram to confirm sinus rhythm and measure QRS duration; echocardiogram to evaluate left ventricular function and markers of mechanical dyssynchrony; dobutamine echocardiogram for viability and blood tests for renal function and biomarkers of myocardial injury- troponin T and brain naturetic peptide. Blood tests will be repeated at 18, 48 and 72 hours. The principal exclusions will be subjects with permanent atrial arrhythmias, permanent pacemakers, infective endocarditis or end-stage renal disease. After surgery, temporary pacing wires will be attached to the postero-lateral wall of the left ventricle, the right atrium and right ventricle and connected to a triple chamber temporary pacemaker. Subjects will be randomised to receive either temporary biventricular pacing or standard pacing (atrial inhibited pacing or atrial-synchronous right ventricular pacing) for 48 hours. The primary endpoint will be the duration of level 3 care. In brief, this is the requirement for invasive ventilation, multi-organ support or more than one inotrope/vasoconstrictor. Haemodynamic studies will be performed at baseline, 6, 18 and 24 hours after surgery using a pulmonary arterial catheter. Measurements will be taken in the following pacing modes: atrial inhibited; right ventricular only; atrial synchronous-right ventricular; atrial synchronous-left ventricular and biventricular pacing. Optimisation of the atrioventricular and interventricular delay will be performed in the biventricular pacing group at 18 hours. The effect of biventricular pacing on myocardial injury, post operative arrhythmias and renal function will also be quantified. Trial Registration ClinicalTrials.gov: NCT01027299

ABSTRACT: The goal of this study was to evaluate the Perception of dental undergraduates regarding need of psychological and psychosocial support throughout their undergraduate life. A total sample of 300 dental students participated from 3 private dental colleges of Lahore. A cross sectional study was done to evaluate their needs for psychological counseling. A questionnaire was made comprising of 15 questions regarding various aspects and perceptions of counseling to evaluate its need and outcomes. The data showed 62.2% of undergraduate dental students need counseling sessions and 84.4% believes that mentoring has high impact on dentist health and practice. Data showed 71.2% will attend if confidentiality is provided and 80.1% believes these sessions will be productive. Confidentiality in counseling sessions is the most important part as there is a reluctance seen for counseling because of lack of confidentiality. [ABSTRACT FROM AUTHOR]

Background: In 2012, it has been estimated that almost 527,600 new patients were diagnosed with cervical cancer causing over 265,000 deaths worldwide. Locally, the disease is affecting a substantial number of women in Qatar, placing it fifth in terms of the most common cancers among females in the country. Unfortunately, most cases are diagnosed at advanced stages, making the treatment more challenging. This is mainly due to the poor knowledge of the disease and the lack of awareness campaigns about cervical cancer. Aim: To raise the awareness about cervical cancer among women in Qatar to promote prevention and early detection. Methods: Qatar Cancer Society (QCS) launched a population-based campaign aimed at raising the public awareness about cervical cancer. In January 2018, health educators from QCS conducted 15 workshops in numerous public and private sectors across Qatar including companies, hotels, hospitals, and healthcare centers to educate the public about the signs and symptoms of the disease, its risk factors, as well as methods of prevention and early detection. In addition, the campaign was advertised in 10 local newspapers, 4 TV programs, 3 radio programs, social media, and 2 Web sites to deliver the educational material to a larger audience as possible. A hotline number was also reserved to answer women's questions and concerns about the disease. To promote the prevention and early detection of cervical cancer, women were encouraged to do Pap tests for free in Al-Ahli and Al-Emadi hospitals. Moreover, QCS organized a closing ceremony at the end of the campaign for all women who did the Pap test and a raffle draw was done to appreciate their participation. Results: A total of 635 women attended the various awareness workshops that were delivered over a month period. Interestingly, 100 women aged 21-65 years visited Al-Ahli and Al-Emadi hospitals to have Pap tests for cervical cancer screening. All of these women reported that they have never done the test before and they became aware of it from QCS campaign. Of note, participants indicated that it was the first time for them to learn about human papilloma virus (HPV) vaccine which prevents 70% of all cervical cancer cases. In addition, about 150 calls were received inquiring about different aspects of the disease. The closing ceremony came to reinforce the awareness messages delivered by QCS where an educational video about cervical cancer was presented, followed by a speech by a cervical cancer survivor who talked about her battle with the disease and her treatment journey. Conclusion: Despite the widespread of cervical cancer among women in Qatar, little was known about its signs and symptoms, prevention, and early detection methods. This population-based awareness campaign was very effective in raising the awareness about cervical cancer, which will help in detecting the disease at earlier stages, and will ultimately result in higher survival rates. [ABSTRACT FROM AUTHOR]

Our study compared the dissipation of antimicrobials and resistance genes (ARG) during composting of cattle manure fortified with antimicrobials versus manure from cattle administered the same antimicrobials in feed. Manure was collected from cattle fed diets containing (kg-1 dry feed): (1) 44 mg chlortetracycline (CTC), (2) a mixture of 44 mg each of chlortetracycline and sulfamethazine (CTCSMZ), (3) 11 mg tylosin (TYL) or (4) Control, no antimicrobials. Fortified treatments were generated by adding antimicrobials to control manure. All manures were composted for 30 d with a single mixing after 16 d. Quantitative PCR (qPCR) measured the concentration of 16S rDNA and genes associated with tetracycline (tet), erythromycin (erm), and sulfamethazine (sul) resistance. Over 95% of antimicrobials dissipated over 30 d of composting, but CTC and SMZ remained higher in fed than fortified treatments, with a reverse trend observed for tylosin. Copy numbers of 16S rDNA decreased (P < 0.05) over 30 d, but were not altered by the presence of antimcrobials. Levels of all ARG except tet(L) decreased by 0.1-1.6 log10 copies g dry matter-1 in the first compost cycle, but some genes [tet(B), tet(L), erm(F), and erm(X)] increased (P < 0.05) by 1.0-3.1 log10 copies g dry matter-1 in the second. This pattern aligned with the positive correlation of these ARG with residue concentrations in the first cycle and the negative correlation in the second. During 30 d of composting, levels of tet(M) and tet(W) in CTC, erm(A), erm(B) and erm(X) in TYL, and sul(1) in CTCSMZ remained higher (P < 0.05) in fed than fortified treatments. Our results suggest that dissipation of ARG during composting of manure fortified with antimicrobials differs from manure generated by cattle that are administered antimicrobials in feed and does not always align with the dissipation of antimicrobial residues. [ABSTRACT FROM AUTHOR]

OBJECTIVES Optimized temporary bi-ventricular (BiV) pacing may benefit heart failure patients after on-pump cardiac surgery compared with conventional dual-chamber right ventricular (RV) pacing. An improvement in haemodynamic function with BiV pacing may reduce the duration of ‘Level 3’ intensive care. METHODS Thirty-eight patients in sinus rhythm, ejection fraction ≤35%, undergoing on-pump surgical revascularization, valve surgery or both were enrolled in this study. Before closing the sternum, temporary epicardial pacing wires were attached to the right atrium, RV outflow tract and basal posterolateral wall of the left ventricle. Patients were randomly assigned to postoperative BiV pacing with the optimization of the atrio- (AV) and inter-ventricular (VV) pacing intervals (Group 1) or conventional dual-chamber right AV pacing (Group 2). The primary end-point was the duration of ‘Level 3’ intensive care. Secondary end-points included cardiac output which was measured by thermodiluation at admission to the intensive care unit and at 6 and 18 h later, in five different pacing modes. RESULTS The duration of ‘Level 3’ care was similar between groups (40 ± 35 vs 54 ± 63 h; Group 1 vs 2; P = 0.43). Cardiac output was similar in all pacing modes at baseline. At 18 h, cardiac output with BiV pacing (5.8 l/min) was 7% higher than atrial inhibited (5.4 l/min) and 9% higher than dual-chamber RV pacing (5.3 l/min; P = 0.02 and 0.001, respectively). Optimization of the VV interval produced a further 4% increase in cardiac output compared with baseline settings (P = 0.005). CONCLUSIONS Postoperative haemodynamic function may be enhanced by temporary BiV pacing of high-risk patients after on-pump cardiac surgery. [ABSTRACT FROM AUTHOR]

Abstract Background It is apparent that despite lack of family history, patients with the morphological characteristics of left ventricular non-compaction develop arrhythmias, thrombo-embolism and left ventricular dysfunction. Methods Forty two patients, aged 48.7 ± 2.3 yrs (mean ± SEM) underwent cardiovascular magnetic resonance (CMR) for the quantification of left ventricular volumes and extent of non-compacted (NC) myocardium. The latter was quantified using planimetry on the two-chamber long axis LV view (NC area). The patients included those referred specifically for CMR to investigate suspected cardiomyopathy, and as such is represents a selected group of patients. Results At presentation, 50% had dyspnoea, 19% chest pain, 14% palpitations and 5% stroke. Pulmonary embolism had occurred in 7% and brachial artery embolism in 2%. The ECG was abnormal in 81% and atrial fibrillation occurred in 29%. Transthoracic echocardiograms showed features of NC in only 10%. On CMR, patients who presented with dyspnoea had greater left ventricular volumes (both p < 0.0001) and a lower left ventricular ejection fraction (LVEF) (p < 0.0001) than age-matched, healthy controls. In patients without dyspnoea (n = 21), NC area correlated positively with end-diastolic volume (r = 0.52, p = 0.0184) and end-systolic volume (r = 0.56, p = 0.0095), and negatively with EF (r = -0.72, p = 0.0001). Conclusion Left ventricular non-compaction is associated with dysrrhythmias, thromboembolic events, chest pain and LV dysfunction. The inverse correlation between NC area and EF suggests that NC contributes to left ventricular dysfunction.

Several areas of the world suffer a notably high incidence of Shiga toxin-producing Escherichia coli . To assess the impact of persistent cross-species transmission systems on the epidemiology of E. coli O157:H7 in Alberta, Canada, we sequenced and assembled E. coli O157:H7 isolates originating from collocated cattle and human populations, 2007-2015. We constructed a timed phylogeny using BEAST2 using a structured coalescent model. We then extended the tree with human isolates through 2019 to assess the long-term disease impact of locally persistent lineages. During 2007-2015, we estimated that 88.5% of human lineages arose from cattle lineages. We identified 11 persistent lineages local to Alberta, which were associated with 38.0% (95% CI 29.3%, 47.3%) of human isolates. During the later period, six locally persistent lineages continued to be associated with human illness, including 74.7% (95% CI 68.3%, 80.3%) of reported cases in 2018 and 2019. Our study identified multiple locally evolving lineages transmitted between cattle and humans persistently associated with E. coli O157:H7 illnesses for up to 13 y. Locally persistent lineages may be a principal cause of the high incidence of E. coli O157:H7 in locations such as Alberta and provide opportunities for focused control efforts., Competing Interests: GT, LC, KS, EB, RZ, VL, SF, CL, TM No competing interests declared, (© 2024, Tarr et al.)

High-grain diets promote polymicrobial liver infections in cattle, commonly involving the bacterium Trueperella pyogenes . We have isolated T. pyogenes from the purulent material of abscesses and sequenced their genomes. These data enhance our understanding of the mechanisms underlying liver abscess development in cattle., Competing Interests: The authors declare no conflict of interest.

Background: Plasmids play a major role in the transfer of antimicrobial resistance (AMR) genes among bacteria via horizontal gene transfer. The identification of plasmids in short-read assemblies is a challenging problem and a very active research area. Plasmid binning aims at detecting, in a draft genome assembly, groups (bins) of contigs likely to originate from the same plasmid. Several methods for plasmid binning have been developed recently, such as PlasBin-flow, HyAsP, gplas, MOB-suite, and plasmidSPAdes. This motivates the problem of evaluating the performances of plasmid binning methods, either against a given ground truth or between them., Results: We describe PlasEval, a novel method aimed at comparing the results of plasmid binning tools. PlasEval computes a dissimilarity measure between two sets of plasmid bins, that can originate either from two plasmid binning tools, or from a plasmid binning tool and a ground truth set of plasmid bins. The PlasEval dissimilarity accounts for the contig content of plasmid bins, the length of contigs and is repeat-aware. Moreover, the dissimilarity score computed by PlasEval is broken down into several parts, that allows to understand qualitative differences between the compared sets of plasmid bins. We illustrate the use of PlasEval by benchmarking four recently developed plasmid binning tools-PlasBin-flow, HyAsP, gplas, and MOB-recon-on a data set of 53 E. coli bacterial genomes., Conclusion: Analysis of the results of plasmid binning methods using PlasEval shows that their behaviour varies significantly. PlasEval can be used to decide which specific plasmid binning method should be used for a specific dataset. The disagreement between different methods also suggests that the problem of plasmid binning on short-read contigs requires further research. We believe that PlasEval can prove to be an effective tool in this regard. PlasEval is publicly available at https://github.com/acme92/PlasEval., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Cephalometric analysis has been used as one of the main tools for orthodontic diagnosis and treatment planning. The analysis can be performed manually on acetate tracing sheets, digitally by manual selection of landmarks or by recently introduced Artificial Intelligence (AI)-driven tools or softwares that automatically detect landmarks and analyze them. The use of AI-driven tools is expected to avoid errors and make it less time consuming with effective evaluation and high reproducibility., Objective: To conduct intra- and inter-group comparisons of the accuracy and reliability of cephalometric tracing and evaluation done manually and with AI-driven tools that is WebCeph and CephX softwares., Methods: Digital and manual tracing of lateral cephalometric radiographs of 54 patients was done. 18 cephalometric parameters were assessed on each radiograph by 3 methods, manual method and by using semi (WebCeph) and fully automatic softwares (Ceph X). Each parameter was assessed by two investigators using these three methods. SPSS was then used to assess the differences in values of cephalometric variables between investigators, between softwares, between human investigator means and software means. ICC and paired T test were used for intra-group comparisons while ANOVA and post-hoc were used for inter-group comparisons., Results: Twelve out of eighteen variables had high intra-group correlation and significant ICC p-values, 5 variables had relatively lower values and only one variable (SNO) had significantly low ICC value. Fifteen out of eighteen variables had minimal detection error using fully-automatic method of cephalometric analysis. Only three variables had lowest detection error using semi-automatic method of cephalometric analysis. Inter-group comparison revealed significant difference between three methods for eight variables; Witts, NLA, SNGoGn, Y-Axis, Jaraback, SNO, MMA and McNamara to Point A., Conclusion: There is a lack of significant difference among manual, semiautomatic and fully automatic methods of cephalometric tracing and analysis in terms of the variables measured by these methods. The mean detection errors were the highest for manual analysis and lowest for fully automatic method. Hence the fully automatic AI software has the most reproducible and accurate results., (© 2024. The Author(s).)

Introduction: The oncological safety of a submental (SM) flap is thought to be controversial. The objective of our study was to validate our previous study regarding the oncological safety of SM flaps in oral cavity reconstruction., Materials and Methods: An electronic database was searched from 2015 to 2021 for all head-and-neck tumor patients, where reconstruction was performed using a SM flap., Results: Eighty-eight oral cavity squamous cell carcinoma patients, among whom 71 were males (81.8%), with a mean age of 55.3 years (range: 25-79 years), were retrieved from the database. The sites of involvement were 37 buccal mucosa, 27 lower alveolus, and 24 tongues. The mean follow-up was 33.5 months. The SM flap reconstruction was done for 88 patients; 3 had complete loss of flap, 17 had incomplete loss/partial necrosis, and 68 patients had uneventful recovery of the flap. We had 16 patients with local recurrence. Of these, 4 (4.5%) patients had clear margins and no lymphadenopathy at the level I at the final histopathology report., Conclusion: This study provides validation of the oncological safety of the SM flap and establishes that nodal positivity at level I alone does not contribute to recurrence at the primary site., (Copyright: © 2024 Qayyum MU, et al.)

An increase in chronic, non-responsive bovine respiratory disease (BRD) infections in North American feedlot cattle is observed each fall, a time when cattle are administered multiple antimicrobial treatments for BRD. A number of factors are responsible for BRD antimicrobial treatment failure, with formation of biofilms possibly being one. It is widely accepted that biofilms play a role in chronic infections in humans and it has been hypothesized that they are the default lifestyle of most bacteria. However, research on bacterial biofilms associated with livestock is scarce and significant knowledge gaps exist in our understanding of their role in AMR of the bacterial BRD complex. The four main bacterial species of the BRD complex, Mannheimia haemolytica , Pasteurella multocida , Histophilus somni , and Mycoplasma bovis are able to form biofilms in vitro and there is evidence that at least H. somni retains this ability in vivo . However, there is a need to elucidate whether their biofilm-forming ability contributes to pathogenicity and antimicrobial treatment failure of BRD. Overall, a better understanding of the possible role of BRD bacterial biofilms in clinical disease and AMR could assist in the prevention and management of respiratory infections in feedlot cattle. We review and discuss the current knowledge of BRD bacteria biofilm biology, study methodologies, and their possible relationship to AMR., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Andrés-Lasheras, Zaheer, Jelinski and McAllister.)

Background: The onset of the COVID-19 pandemic catalysed a monumental shift in the field of continuing professional development (CPD). Prior to this, the majority of CPD group-learning activities were offered in-person. However, the pandemic forced the field to quickly pivot towards more novel methods of learning and teaching in view of social distancing regulations. The purpose of this study was to obtain the perspectives of CPD leaders on the impact of the pandemic to elucidate trends, innovations, and potential future directions in the field., Methods: Semi-structured interviews were conducted between April-September 2022 with 23 CPD leaders from Canada and the USA. Interviews were audio-recorded, transcribed, and de-identified. A thematic analysis approach was used to analyse the data and generate themes., Results: Participants characterised COVID-19 as compelling widespread change in the field of CPD. From the interviews, researchers generated six themes pertaining to the impact of the pandemic on CPD: (1) necessity is the mother of innovation, (2) the paradox of flexibility and accessibility, (3) we're not going to unring the bell, (4) reimagining design and delivery, (5) creating an evaluative culture, and (6) a lifeline in times of turmoil., Conclusion: This qualitative study discusses the impact of the pandemic on the field of CPD and leaders' vision for the future. Despite innumerable challenges, the pandemic created opportunities to reform design and delivery. Our findings indicate a necessity to maintain an innovative culture to best support learners, to improve the healthcare system, and to prepare for future emergencies., (© 2024. The Author(s).)

Background: The Toronto Transit Commission (TTC) operates the public transit system in Toronto, Canada. From 1954 to 1980, there were 430 suicide deaths/attempts on the TTC subway system. In 2011, TTC implemented Crisis Link, a suicide helpline to connect subway passengers with counsellors. Upstream factors such as media reporting about suicide incidents may also influence suicidal behaviour. Our objectives were to investigate how Crisis Link and media reports about TTC suicide incidents influenced suicide rates., Methods: Suicide data were obtained from the TTC and Coroner, with Crisis Link data provided by Distress Centres of Greater Toronto (1998-2021). Media articles were identified through a database search of Toronto media publications. Interrupted time-series analysis investigated the association between Crisis Link calls, media articles, and quarterly suicide rates on the subway system., Findings: There were 302 suicides on TTC's subway system from 1998 to 2021. The introduction of Crisis Link was associated with a large but non-significant decrease in TTC-related suicide rate in the same quarter (IRR = 0.64, 95% CI = 0.36-1.12). Each subsequent post-Crisis-Link quarter experienced an average 2% increase in suicide rate (IRR = 1.02, 95% CI = 1.004-1.04). Furthermore, for each TTC-related media article in the previous quarter, the suicide rate on the TTC increased by 2% (IRR = 1.02, 95% CI = 1.004-1.04)., Interpretation: The Crisis Link helpline was associated with a large but non-significant short-term decrease in suicide rates. However, this outcome was not sustained; this may, in part, be attributable to media reporting which was associated with increased suicides. This should inform suicide prevention policies in Canada and worldwide., Funding: No funding., Competing Interests: CT is the Director of Safety, Health and Environment Policy and Strategy at the Toronto Transit Commission. ME works at the Distress Centres of Greater Toronto, the organization which oversees Crisis Link operations. MS has acted as an unpaid consultant to the TTC on some of its suicide prevention initiatives but has no relationship with Crisis Link., (© 2024 The Authors.)

Liver abscesses (LA) resulting from bacterial infection in cattle pose a significant global challenge to the beef and dairy industries. Economic losses from liver discounts at slaughter and reduced animal performance drive the need for effective mitigation strategies. Tylosin phosphate supplementation is widely used to reduce LA occurrence, but concerns over antimicrobial overuse emphasize the urgency to explore alternative approaches. Understanding the microbial ecology of LA is crucial to this, and we hypothesized that a reduced timeframe of tylosin delivery would alter LA microbiomes. We conducted 16S rRNA sequencing to assess severe liver abscess bacteriomes in beef cattle supplemented with in-feed tylosin. Our findings revealed that shortening tylosin supplementation did not notably alter microbial communities. Additionally, our findings highlighted the significance of sample processing methods, showing differing communities in bulk purulent material and the capsule-adhered material. Fusobacterium or Bacteroides ASVs dominated LA, alongside probable opportunistic gut pathogens and other microbes. Moreover, we suggest that liver abscess size correlates with microbial community composition. These insights contribute to our understanding of factors impacting liver abscess microbial ecology and will be valuable in identifying antibiotic alternatives. They underscore the importance of exploring varied approaches to address LA while reducing reliance on in-feed antibiotics., (© His Majesty the King in Right of Canada, as represented by the Minister of Agriculture and Agri-Food Canada, 2024.)

Cattle are the primary reservoir for STEC O157, with some shedding >10 4 CFU/g in feces, a phenomenon known as super-shedding (SS). The mechanism(s) responsible for SS are not understood but have been attributed to the environment, host, and pathogen. This study aimed to compare genetic characteristics of STEC O157 strains from cattle in the same commercial feedlot pens with SS or low-shedding (LS) status. Strains from SS (n = 35) and LS (n = 28) collected from 11 pens in three feedlots were analyzed for virulence genes, Shiga toxin-carrying bacteriophage insertion sites, and phylogenetic relationships. In silico analysis showed limited variation regarding virulence gene profiles. Stx -encoding prophage insertion sites mrlA and wrbA for stx1a and stx2a , respectively, were all occupied, but two isolates had fragments of the stx -carrying phage in mrlA and wrbA loci without stx1a and stx2a . All strains screened for lineage-specific polymorphism assay (LSPA-6) were 111111, lineage I. Of the isolates, 61 and 2 were clades 1 and 8, respectively. Phylogenetic analysis revealed that pens with more than one SS had multiple distantly related clusters of SS and LS isolates. Although virulence genes and lineage were largely similar within and across feedlots, multiple genetic origins of strains within a single feedlot pen illustrate challenges for on-farm control of STEC.

Objective: To determine the role of heated humidified high flow therapy (HHHFT) as primary respiratory support in spontaneously breathing moderate-late, very and extreme preterm neonates with respiratory distress syndrome (RDS) at a tertiary care hospital from a developing country., Design: Retrospective cohort study., Setting: Neonatal intensive care unit of Indus Hospital and Health Network, Karachi, Pakistan., Patients: All preterm neonates with RDS and who received HHHFT as primary respiratory support were included retrospectively, while neonates with orofacial anomalies, congenital heart and lung diseases other than RDS, abdominal wall defects, encephalopathy, congenital pneumonia and received continuous positive airway pressure or invasive ventilation were excluded., Interventions: HHHFT as primary respiratory support for RDS., Main Outcome Measures: Effectiveness, duration, failure rate and complications of HHHFT as a primary respiratory support in moderate-late, very and extremely preterm neonates were evaluated., Results: The cohort included 138 neonates during a period of 12 months. The median gestational age was 32 weeks, and the median birth weight was 1607 g. Grade 1-2 RDS was seen in 97%, surfactant instillation was done in 10.8% and HHHFT was provided in all the neonates as primary respiratory support. The total duration of HHHFT support was <1 week in 94% of neonates. Bronchopulmonary dysplasia and pneumothorax until discharge or death were observed in one neonate, haemodynamically significant Patent Ductus Artriosus (HsPDA) in two neonates and intraventricular haemorrhage Grade ≥2 in five neonates, while only one neonate died., Conclusion: This study appears to show that HHHFT is a simple, safe, efficient and cheap mode of primary respiratory support that can be given to spontaneously breathing moderate-late, very and extremely preterm neonates with RDS, especially in low- or middle-income countries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Antimicrobial use (AMU) in the livestock industry has been associated with increased levels of antimicrobial resistance. Recently, there has been an increase in the number of "natural" feedlots in the beef cattle sector that raise cattle without antibiotics. Shotgun metagenomics was employed to characterize the impact of AMU in feedlot cattle on the microbiome, resistome, and mobilome. Sequenced fecal samples identified a decline (q < 0.01) in the genera Methanobrevibacter and Treponema in the microbiome of naturally vs. conventionally raised feedlot cattle, but this difference was not (q > 0.05) observed in catch basin samples. No differences (q > 0.05) were found in the class-level resistome between feedlot practices. In fecal samples, decreases from conventional to natural (q < 0.05) were noted in reads for the antimicrobial-resistant genes (ARGs) mef A, tet 40, tet O, tet Q, and tet W. Plasmid-associated ARGs were more common in feces from conventional than natural feedlot cattle. Interestingly, more chromosomal- than plasmid-associated macrolide resistance genes were observed in both natural and conventional feedlots, suggesting that they were more stably conserved than the predominately plasmid-associated tetracycline resistance genes. This study suggests that generationally selected resistomes through decades of AMU persist even after AMU ceases in natural production systems.

Foodborne illness is exacerbated by novel and emerging pathotypes, persistent contamination, antimicrobial resistance, an ever-changing environment, and the complexity of food production systems. Sporadic and outbreak events of common foodborne pathogens like Shiga toxigenic E . coli (STEC), Salmonella , Campylobacter , and Listeria monocytogenes are increasingly identified. Methods of controlling human infections linked with food products are essential to improve food safety and public health and to avoid economic losses associated with contaminated food product recalls and litigations. Bacteriophages (phages) are an attractive additional weapon in the ongoing search for preventative measures to improve food safety and public health. However, like all other antimicrobial interventions that are being employed in food production systems, phages are not a panacea to all food safety challenges. Therefore, while phage-based biocontrol can be promising in combating foodborne pathogens, their antibacterial spectrum is generally narrower than most antibiotics. The emergence of phage-insensitive single-cell variants and the formulation of effective cocktails are some of the challenges faced by phage-based biocontrol methods. This review examines phage-based applications at critical control points in food production systems with an emphasis on when and where they can be successfully applied at production and processing levels. Shortcomings associated with phage-based control measures are outlined together with strategies that can be applied to improve phage utility for current and future applications in food safety.

Carbapenems are considered a last resort for the treatment of multi-drug-resistant bacterial infections in humans. In this study, we investigated the occurrence of carbapenem-resistant bacteria in feedlots in Alberta, Canada. The presumptive carbapenem-resistant isolates ( n = 116) recovered after ertapenem enrichment were subjected to antimicrobial susceptibility testing against 12 different antibiotics, including four carbapenems. Of these, 72% of the isolates ( n = 84) showed resistance to ertapenem, while 27% of the isolates ( n = 31) were resistant to at least one other carbapenem, with all except one isolate being resistant to at least two other drug classes. Of these 31 isolates, 90% were carbapenemase positive, while a subset of 36 ertapenem-only resistant isolates were carbapenemase negative. The positive isolates belonged to three genera; Pseudomonas , Acinetobacter , and Stenotrophomonas , with the majority being Pseudomonas aeruginosa ( n = 20) as identified by 16S rRNA gene sequencing. Whole genome sequencing identified intrinsic carbapenem resistance genes, including blaOXA-50 and its variants ( P. aeruginosa ), blaOXA-265 ( A. haemolyticus ), blaOXA-648 ( A. lwoffii ), blaOXA-278 ( A. junii ), and blaL1 and blaL2 ( S. maltophilia ). The acquired carbapenem resistance gene ( blaPST-2 ) was identified in P. saudiphocaensis and P. stutzeri . In a comparative genomic analysis, clinical P. aeruginosa clustered separately from those recovered from bovine feces. In conclusion, despite the use of selective enrichment methods, finding carbapenem-resistant bacteria within a feedlot environment was a rarity.

Objectives: In the process of scientific progress, prior evidence is both relied on and supplanted by new discoveries. We use the term 'knowledge half-life' to refer to the phenomenon in which older knowledge is discounted in favour of newer research. By quantifying the knowledge half-life, we sought to determine whether research published in more recent years is preferentially cited over older research in medical and scientific articles., Design: An observational study employing a directed, systematic search of current literature., Data Sources: BMJ , PNAS , JAMA , NEJM , The Annals of Internal Medicine , The Lancet , Science and Nature were searched., Eligibility Criteria for Selecting Studies: Eight high-impact medical and scientific journals were sampled examining original research articles from the first issue of every year over a 25-year span (1996-2020). The outcome of interest was the difference between the publication year of the article and references cited, termed 'citation lag'., Data Extraction and Synthesis: Analysis of variance was used to identify significant differences in citation lag., Results: A total of 726 articles and 17 895 references were included with a mean citation lag of 7.5±8.4 years. Across all journals, >70% of references had been published within 10 years of the citing article. Approximately 15%-20% of referenced articles were 10-19 years old, and articles more than 20 years old were cited infrequently. Medical journals articles had references with significantly shorter citation lags compared with general science journals (p≤0.01). Articles published before 2009 had references with significantly shorter citation lags compared with those published in 2010-2020 (p<0.001)., Conclusions: This study found evidence of a small increase in the citation of older research in medical and scientific literature over the past decade. This phenomenon deserves further characterisation and scrutiny to ensure that 'old knowledge' is not being lost., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background The current research compared the effectiveness of dexamethasone with ondansetron in terms of the frequency of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Methodology A comparative cross-sectional study was conducted in the Department of Surgery, Civil Hospital, Karachi, Pakistan, between June 2021 and March 2022. All patients aged between 18 and 70 years who were scheduled for elective laparoscopic cholecystectomy under general anesthesia were included in the study. All women who were on antiemetics or cortisone before surgery pregnant, and had hepatic, or renal malfunction were excluded. Group A included patients who were administered 8 mg of dexamethasone intravenously, and group B included patients who were prescribed 4 mg of ondansetron intravenously. Observation of patients was done for any symptoms such as vomiting, nausea, or the need for any antiemetic medication after the surgery. The number of episodes of vomiting and nausea was recorded in the proforma along with the duration of stay in the hospital. Results A total of 259 patients were examined during the study - 129 (49.8%) in the dexamethasone group (group A) and 130 (50.2%) in the ondansetron group (group B). The mean age of group A was 42.56 ± 11.9 years, with a mean weight of 61.4 ± 8.5 kg. The mean age of group B was 41.19 ± 10.8 years, with a mean weight of 62.56 ± 6.3 kg. Upon assessing the effectiveness of each drug in preventing nausea and vomiting, postoperatively, it was found that both drugs were equally effective in preventing nausea in the majority of the patients (73.85% vs. 65.89%; P  = 0.162). However, ondansetron was significantly more effective in preventing vomiting in patients than dexamethasone (91.54% vs. 79.07%; P  = 0.004). Conclusions This study concluded that the use of either dexamethasone or ondansetron effectively reduces the incidence of postoperative nausea and vomiting. However, ondansetron was significantly more effective in reducing the incidence of vomiting in patients after laparoscopic cholecystectomy than dexamethasone., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Qasemi et al.)

Enterococci are Gram-positive bacteria that can be isolated from a variety of environments including soil, water, plants, and the intestinal tract of humans and animals. Although they are considered commensals in humans, Enterococcus spp. are important opportunistic pathogens. Due to their presence and persistence in diverse environments, Enterococcus spp. are ideal for studying antimicrobial resistance (AMR) from the One Health perspective. We undertook a comparative genomic analysis of the virulome, resistome, mobilome, and the association between the resistome and mobilome of 246 E. faecium and 376 E. faecalis recovered from livestock (swine, beef cattle, poultry, dairy cattle), human clinical samples, municipal wastewater, and environmental sources. Comparative genomics of E. faecium and E. faecalis identified 31 and 34 different antimicrobial resistance genes (ARGs), with 62% and 68% of the isolates having plasmid-associated ARGs, respectively. Across the One Health continuum, tetracycline ( tetL and tetM ) and macrolide resistance ( ermB ) were commonly identified in E. faecium and E. faecalis . These ARGs were frequently associated with mobile genetic elements along with other ARGs conferring resistance against aminoglycosides [ ant(6)-la , aph(3')-IIIa ], lincosamides [ lnuG , lsaE ], and streptogramins ( sat4 ). Study of the core E. faecium genome identified two main clades, clade 'A' and 'B', with clade A isolates primarily originating from humans and municipal wastewater and carrying more virulence genes and ARGs related to category I antimicrobials. Overall, despite differences in antimicrobial usage across the continuum, tetracycline and macrolide resistance genes persisted in all sectors.

Objectives:  Due to the constant battle regarding the controversial topic of orthodontic extraction, this study aims to assess the changes in vertical dimensions of patients treated with premolar extractions compared with nonextraction orthodontic patients., Materials and Methods:  A sample of 60 borderline patients were recruited and divided into extraction and nonextraction groups. Eleven pretreatment cephalometric measurements were recorded using WebCeph and patients were followed-up until the completion of treatment., Statistical Analysis:  Intragroup and intergroup comparisons were made using paired t -test and two-sample independent t -test, respectively. The joint significance of differences was measured using F-tests., Results:  The intragroup comparison revealed that in the extraction group, the vertical dimension was significantly increased posttreatment for four cephalometric measurements, that is, mandibular plane angle ( p  < 0.05), palatal plane angle ( p  < 0.05), Frankfort mandibular plane angle ( p  < 0.05), and y-axis ( p  < 0.05). In the comparison of the posttreatment values of both groups, the mean differences of the posttreatment values for sella nasion (SN)-gonion (Go)-gnathion (Gn) angle ( p  = 0.008), the total anterior ( p  = 0.050), and lower anterior facial heights (AFH; p  = 0.011) were significantly higher. At the same time, the Jarabak ratio was significantly ( p  = 0.006) lower in the extraction group than in the nonextraction group., Conclusion:  The increase in vertical dimension is significantly higher in the extraction group than in the nonextraction group which indicates a significant impact of orthodontic extraction on the vertical dimensions., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Objective: To compare the mandibular ramal height differences between clinically symmetrical and asymmetrical face individuals., Methods: The comparative cross-sectional study was conducted from May 2020 to July 2021 at the Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, and comprised subjects regardless of age and gender who were divided into two equal groups. Those with a clinically symmetrical face were in Group-I, and those with a clinically asymmetrical face were in Group-II. Mandibular ramal height of both sides of all subjects was measured, and asymmetry index. Differences of both right and left ramal heights of each group were measured and compared. Data was analysed using SPSS 26., Results: Of the 78 subjects, 40(51%) were males and 38(49%) were females. The overall mean age was 18±5.78 years, with 44(56%) aged 16-25 years, 28(36%) <15 years and 6(8%) >26 years. There was high but non-significant correlation between the right and left sides of both the groups (p>0.05). Inter-group differences were significant with respect to ramal height (p=0.000), whereas difference in terms of asymmetry index was not significant (p>0.05)., Conclusions: There were significant differences in the mean ramal height between clinically symmetrical and asymmetrical face individuals.

Objective: The COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly., Method: As part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded., Results: We identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour., Conclusions: This review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.

Enterococcus faecium is a ubiquitous opportunistic pathogen that is exhibiting increasing levels of antimicrobial resistance (AMR). Many of the genes that confer resistance and pathogenic functions are localized on mobile genetic elements (MGEs), which facilitate their transfer between lineages. Here, features including resistance determinants, virulence factors and MGEs were profiled in a set of 1273 E. faecium genomes from two disparate geographic locations (in the UK and Canada) from a range of agricultural, clinical and associated habitats. Neither lineages of E. faecium , type A and B, nor MGEs are constrained by geographic proximity, but our results show evidence of a strong association of many profiled genes and MGEs with habitat. Many features were associated with a group of clinical and municipal wastewater genomes that are likely forming a new human-associated ecotype within type A. The evolutionary dynamics of E. faecium make it a highly versatile emerging pathogen, and its ability to acquire, transmit and lose features presents a high risk for the emergence of new pathogenic variants and novel resistance combinations. This study provides a workflow for MGE-centric surveillance of AMR in Enterococcus that can be adapted to other pathogens.

Shiga toxin ( stx ) is the principal virulence factor of the foodborne pathogen, Shiga toxin-producing Escherichia coli (STEC) O157:H7 and is associated with various lambdoid bacterio (phages). A comparative genomic analysis was performed on STEC O157 isolates from cattle ( n = 125) and clinical ( n = 127) samples to characterize virulence genes, stx -phage insertion sites and antimicrobial resistance genes that may segregate strains circulating in the same geographic region. In silico analyses revealed that O157 isolates harboured the toxin subtypes stx1a and stx2a. Most cattle (76.0%) and clinical (76.4%) isolates carried the virulence gene combination of stx1 , stx2 , eae and hlyA . Characterization of stx1 and stx2 -carrying phages in assembled contigs revealed that they were associated with mlrA and wrbA insertion sites, respectively. In cattle isolates, mlrA and wrbA insertion sites were occupied more often (77% and 79% isolates respectively) than in clinical isolates (38% and 1.6% isolates, respectively). Profiling of antimicrobial resistance genes (ARGs) in the assembled contigs revealed that 8.8% of cattle (11/125) and 8.7% of clinical (11/127) isolates harboured ARGs. Eight antimicrobial resistance genes cassettes (ARCs) were identified in 14 isolates (cattle, n = 8 and clinical, n = 6) with streptomycin ( aadA1 , aadA2 , ant(3'')-Ia and aph(3'') - Ib ) being the most prevalent gene in ARCs. The profound disparity between the cattle and clinical strains in occupancy of the wrbA locus suggests that this trait may serve to differentiate cattle from human clinical STEC O157:H7. These findings are important for stx screening and stx -phage insertion site genotyping as well as monitoring ARGs in isolates from cattle and clinical samples.

Objective:  This study aimed to compare dentoskeletal changes in skeletal class-II malocclusion with removable twin block appliance and fixed AdvanSync2 appliance., Materials and Methods:  A prospective randomized clinical trial was conducted over a span of 1 year at AFID at Rawalpindi. Thirty patients with skeletal class-II malocclusion, 16 males (53.3%) and 14 females (46.6%), were randomly selected and divided in two equal groups (15 each) to be treated with either fixed functional appliances (FFAs) or with removable functional appliances (RFAs). Out of 30 patients, 15 between cervical vertebral maturation (CVM) stages of 2 and 3 were treated with RFA (twin block appliances) and remaining 15 between CVM stages of 4 and 5 were treated with FFA (AdvanSync2 appliances). Pretreatment (T 1 ) and posttreatment (T 2 ), angular variable, and linear variable were measured to compare the dentoskeletal effects between the two groups., Statitical Analysis:  Paired sample t-test was used to assess significant difference between variables at T1 (Pre-treatment) and T2 (Post-treatment) stage for both RFA and FFA group. Comparison among the RFA and FFA group was made using non-parametric Mann-Whitney U Test. IBM SPSS version 25.0 was used for evaluation., Results:  No significant difference was found in angular variables between the RFA and FFA groups ( p  > 0.05) with the exception of linear variables. Sella-posterior nasal spine (S-PNS) length significantly increased and Jarabak's ratio significantly decreased for FFA group ( p  = 0.010 and 0.045, respectively), when compared with RFA group., Conclusion:  Both the appliances, twin block (RFA) and AdvanSync2 (FFA), are effective for correction of skeletal class-II malocclusion. Both the appliances produced similar effects in the sagittal plane but for better vertical control twin block should be the appliance of choice. AdvanSync2 appliance could be preferred over twin block appliance when dentoalveolar and slight retrusive effect on the maxilla is desired especially for individuals in postpubertal growth spurt., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Enterococci are commensal bacteria of the gastrointestinal tract of humans, animals, and insects. They are also found in soil, water, and plant ecosystems. The presence of enterococci in human, animal, and environmental settings makes these bacteria ideal candidates to study antimicrobial resistance in the One-Health continuum. This study focused on Enterococcus hirae isolates ( n = 4,601) predominantly isolated from beef production systems including bovine feces ( n = 4,117, 89.5%), catch-basin water ( n = 306, 66.5%), stockpiled bovine manure ( n = 24, 0.5%), and natural water sources near feedlots ( n = 145, 32%), and a few isolates from urban wastewater ( n = 9, 0.2%) denoted as human-associated environmental samples. Antimicrobial susceptibility profiling of a subset ( n = 1,319) of E. hirae isolates originating from beef production systems ( n = 1,308) showed high resistance to tetracycline (65%) and erythromycin (57%) with 50.4% isolates harboring multi-drug resistance, whereas urban wastewater isolates ( n = 9) were resistant to nitrofurantoin (44.5%) and tigecycline (44.5%) followed by linezolid (33.3%). Genes for tetracycline ( tetL, M, S/M, and O/32/O ) and macrolide resistance erm(B) were frequently found in beef production isolates. Antimicrobial resistance profiles of E. hirae isolates recovered from different environmental settings appeared to reflect the kind of antimicrobial usage in beef and human sectors. Comparative genomic analysis of E. hirae isolates showed an open pan-genome that consisted of 1,427 core genes, 358 soft core genes, 1701 shell genes, and 7,969 cloud genes. Across species comparative genomic analysis conducted on E. hirae , Enterococcus faecalis and Enterococcus faecium genomes revealed that E. hirae had unique genes associated with vitamin production, cellulose, and pectin degradation, traits which may support its adaptation to the bovine digestive tract. E. faecium and E. faecalis more frequently harbored virulence genes associated with biofilm formation, iron transport, and cell adhesion, suggesting niche specificity within these species., Competing Interests: CB is part owner and managing partner of Feedlot Health Management Services. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sherry J. Hannon, Calvin W. Booker, Deirdre Church, Gary Van Domselaar, Athanasios Zovoilis and Her Majesty the Queen in Right of Canada, as represented by the Minister of Agriculture and Agri-Food Canada for the contribution of Tim A. McAllister, Sani-e-Zehra Zaidi , Rahat Zaheer, Ruth Barbieri and Shaun R. Cook.)

Background: The resistome describes the array of antibiotic resistant genes (ARGs) present within a microbial community. Recent research has documented the resistome in the rumen of ruminants and revealed that the type and abundance of ARGs could be affected by diet and/or antibiotic treatment. However, most of these studies only assessed ARGs using metagenomics, and expression of the resistome and its biological function within the microbiome remains largely unexplored., Results: We characterized the pools of ARGs (resistome) and their activities in the rumen of 48 beef cattle belonging to three breeds (Angus, Charolais, Kinsella composite hybrid), using shotgun metagenomics and metatranscriptomics. Sixty (including 20 plasmid-associated) ARGs were expressed which accounted for about 30% of the total number of ARGs (187) identified in metagenomic datasets, with tetW and mefA exhibiting the highest level of expression. In addition, the bacterial hosts of 17 expressed ARGs were identified. The active resistome was less diverse in Kinsella composite hybrid than Angus, however, expression of ARGs did not differ among breeds. Although not associated with feed efficiency, the total abundance of expressed ARGs was positively correlated with metabolic pathways and 'attenuation values' (a measurement of stability) of the active rumen microbiome, suggesting that ARGs expression influences the stability and functionality of the rumen microbiome. Moreover, Ruminococcus spp., Prevotella ruminicola, Muribaculaceae spp. and Collinsella aerofaciens were all identified as hosts of expressed ARGs, possibly promoting the dominance of these carbohydrate degraders within the rumen microbiome., Conclusions: Findings from this study provide new insight into the active rumen resistome in vivo, which may inform strategies to limit the spread of ubiquitously found ARGs from the rumen to the broader environment without negatively impacting the key functional outcomes of the rumen microbiome., (© 2022. The Author(s).)

Numerous antimicrobial resistance (AMR) surveillance studies have been conducted in North American feedlot cattle to investigate the major bacterial pathogens of the bovine respiratory disease (BRD) complex, specifically: Mannheimia haemolytica , Pasteurella multocida , Histophilus somni , and Mycoplasma bovis . While most bacterial isolates recovered from healthy cattle are susceptible to a repertoire of antimicrobials, multidrug resistance is common in isolates recovered from cattle suffering from BRD. Integrative and conjugative elements (ICE) have gained increasing notoriety in BRD- Pasteurellaceae as they appear to play a key role in the concentration and dissemination of antimicrobial resistant genes. Likewise, low macrolide susceptibility has been described in feedlot isolates of M. bovis . Horizontal gene transfer has also been implicated in the spread of AMR within mycoplasmas, and in-vitro experiments have shown that exposure to antimicrobials can generate high levels of resistance in mycoplasmas via a single conjugative event. Consequently, antimicrobial use (AMU) could be accelerating AMR horizontal transfer within all members of the bacterial BRD complex. While metagenomics has been applied to the study of AMR in the microbiota of the respiratory tract, the potential role of the respiratory tract microbiome as an AMR reservoir remains uncertain. Current and prospective molecular tools to survey and characterize AMR need to be adapted as point-of-care technologies to enhance prudent AMU in the beef industry.

Primary myelofibrosis is a haematopoietic stem cell neoplasm resulting in ineffective haematopoiesis and bone marrow fibrosis. We present a case of a 67-year-old male patient who came to the oncology/haematology department of Dr. Ziauddin Hospital, Karachi, in February 2020 with complaints of weight loss, gastroesophageal reflux and loss of appetite. Examination revealed splenomegaly and initial workup demonstrated bicytopenia on complete blood picture. Bone marrow biopsy was consistent with pre-fibrotic myelofibrosis (Janus kinase 2 (JAK-2) positive). He was categorized as intermediate-2 risk according to Dynamic International Prognostic Scoring System (DIPPS) with score of 3 and was advised to start JAK-1/JAK-2 inhibitors. Prior to therapy, he underwent positron emission tomography-computed tomography (PET/CT) scan which showed increased fluorodeoxyglucose (FDG) uptake in the spleen and bone marrow. Monitoring by the scan after initiating treatment demonstrated decreased FDG uptake in bone marrow and spleen, demonstrating that PET/CT is a non-invasive way to assess and monitor treatment response in pre-fibrotic myelofibrosis.