A study of prevalence of tobacco use and related factors among medical students as per the Global Health Professions Student Survey protocol

Background: Physicians who smoke are less likely to ask patients about their smoking and initiate cessation interventions. Hence it is important to study the prevalence of tobacco use, attitude and training of health professional students. Objectives were to study prevalence and attitudes towards tobacco use and training related to tobacco cessation.Methods: Armed Forces Medical college-based cross-sectional survey by anonymous, self-administered questionnaire as per Global Health Professions Student Survey (GHPSS) was conducted. Data was compiled and analyzed for various variables as per the GHPSS questionnaire.Results: Forty-two percent of the students had ever smoked cigarettes and 24% were current smokers. Nearly one in five had tried their first cigarette before 20 years of age. Male gender was associated with smoking. There is a significant association between not smoking and support for smoking ban in public places. Almost all the respondents (98.1%) thought smoking should be banned in all enclosed public places. In light of 20.6% of all respondents who smoked in college buildings during past this year indicated a gap between their knowledge, attitude and behavior. There was a strong desire to quit smoking but only 42% reported receiving help/ advice to stop smoking. Only one in ten reported receiving formal training in smoking cessation techniques.Conclusions: The fight against tobacco can get a boost through interventions aimed at health care professional students. Active Interventions should be made to address smoking issues among medical students. Skill based medical school curriculum should incorporate and emphasize on acquiring effective smoking cessation skills

NSAID-Associated Perforation of a Meckel’s Diverticulum: A Case Report

Meckel’s diverticulum is the most frequent congenital malformation of the gastrointestinal tract. The most common ectopic tissue within a Meckel’s is heterotopic gastric mucosa, with bleeding being the most common presentation. However, perforation of a Meckel’s diverticulum is a rare presentation. NSAID-associated Meckel’s perforation has been suggested, however has not been documented in the literature. We present a case of a 17-year-old female with acute abdominal pain and tenderness following a 24-hour history of excessive ingestion of NSAIDS for pain related to tooth extraction. Chest radiograph demonstrated free intra-abdominal air and she was subsequently taken for exploratory laparotomy. A perforated Meckel’s diverticulum was isolated and resected. Though NSAID-associated bleeding of heterotopic gastric mucosa has been described, and perforation of the Meckel’s diverticulum has been suggested, no clear association between heterotopic gastric mucosa and perforation exists. On the other hand, the relationship between NSAIDS and gastric ulcer perforation is well documented. A similar mechanism may also play a role in NSAID-associated Meckel’s perforation. With how common NSAID use is, we believe it is important to document NSAID-associated perforation of a Meckel’s diverticulum

Mitotic Recombination and Rapid Genome Evolution in the Invasive Forest Pathogen Phytophthora ramorum

Invasive alien species often have reduced genetic diversity and must adapt to new environments. Given the success of many invasions, this is sometimes called the genetic paradox of invasion. Phytophthora ramorum is invasive, limited to asexual reproduction within four lineages, and presumed clonal. It is responsible for sudden oak death in the United States, sudden larch death in Europe, and ramorum blight in North America and Europe. We sequenced the genomes of 107 isolates to determine how this pathogen can overcome the invasion paradox. Mitotic recombination (MR) associated with transposons and low gene density has generated runs of homozygosity (ROH) affecting 2,698 genes, resulting in novel genotypic diversity within the lineages. One ROH enriched in effectors was fixed in the NA1 lineage. An independent ROH affected the same scaffold in the EU1 lineage, suggesting an MR hot spot and a selection target. Differences in host infection between EU1 isolates with and without the ROH suggest that they may differ in aggressiveness. Non-core regions (not shared by all lineages) had signatures of accelerated evolution and were enriched in putative pathogenicity genes and transposons. There was a striking pattern of gene loss, including all effectors, in the non-core EU2 genome. Positive selection was observed in 8.0% of RxLR and 18.8% of Crinkler effector genes compared with 0.9% of the core eukaryotic gene set. We conclude that the P. ramorum lineages are diverging via a rapidly evolving non-core genome and that the invasive asexual lineages are not clonal, but display genotypic diversity caused by MR

Emergent Laparoscopic Repair of a Spigelian Hernia: Case Report and Review of the Literature

A spigelian hernia is a protrusion through an anterior abdominal wall defect along the linea semilunaris. The traditional method of repair consists of an open surgical technique requiring a lengthy abdominal incision to allow visualization of the defect. However, with the emergence and availability of laparoscopic techniques, a minimally invasive approach is feasible. Only eight prior case reports have documented emergent laparoscopic repair of a spigelian hernia. We describe the first successful laparoscopic repair of a spigelian hernia in an emergent setting at our institution.Peer Reviewe

Emergent Laparoscopic Repair of a Spigelian Hernia: Case Report and Review of the Literature

A spigelian hernia is a protrusion through an anterior abdominal wall defect along the linea semilunaris. The traditional method of repair consists of an open surgical technique requiring a lengthy abdominal incision to allow visualization of the defect. However, with the emergence and availability of laparoscopic techniques, a minimally invasive approach is feasible. Only eight prior case reports have documented emergent laparoscopic repair of a spigelian hernia. We describe the first successful laparoscopic repair of a spigelian hernia in an emergent setting at our institution

SODplex, a Series of Hierarchical Multiplexed Real-Time PCR Assays for the Detection and Lineage Identification of Phytophthora ramorum, the Causal Agent of Sudden Oak Death and Sudden Larch Death

Since its emergence in the 1990s, the invasive pathogen Phytophthora ramorum has spread in Europe and the west coast of North America, causing sudden oak death in the United States and sudden larch death in the United Kingdom, resulting in the mortality or destruction of millions of trees. Due to its invasive nature, its damage potential, its wide host range, and its ability to disseminate via the plant trade, P. ramorum has been placed on quarantine lists worldwide. Rapid and reliable detection of the pathogen and identification of its lineages are crucial to limit spread and inform mitigation and eradication efforts. SODplex, a suite of new multiplex real-time PCR tools, was developed to streamline the detection and identification of P. ramorum. It offers four multiplexed assays covering different use cases. SODplex-base combines primers and probes for the sensitive and accurate detection of Phytophthora spp. and P. ramorum. SODplex-ITS and SODplex-mito offer a single-step identification of P. ramorum and the EU1, NA1, and NA2 lineages present in the United States and Canada. SODplex-lin targets each of the four P. ramorum lineages present in Europe and North America in a single reaction. The assays have high levels of accuracy and are robust to the use of different instruments, different operators, and different temperatures. The redundancy within the assays reduces the likelihood of false negatives and false positives. The SODplex assays presented here improve the toolbox available for the detection of P. ramorum and its lineages. [Graphic: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license

Mitotic Recombination and Rapid Genome Evolution in the Invasive Forest Pathogen Phytophthora ramorum

Alien species are often successful invaders in new environments, despite the introduction of a few isolates with a reduced genetic pool. This is called the genetic paradox of invasion. We found two mechanisms by which the invasive forest pathogen causing sudden oak and sudden larch death can evolve. Extensive mitotic recombination producing runs of homozygosity generates genotypic diversity even in the absence of sexual reproduction, and rapid turnover of genes in the non-core, or nonessential portion of genome not shared by all isolates, allows pathogenicity genes to evolve rapidly or be eliminated while retaining essential genes. Mitotic recombination events occur in genomic hot spots, resulting in similar ROH patterns in different isolates or groups; one ROH, independently generated in two different groups, was enriched in pathogenicity genes and may be a target for selection. This provides important insights into the evolution of invasive alien pathogens and their potential for adaptation and future persistence.Invasive alien species often have reduced genetic diversity and must adapt to new environments. Given the success of many invasions, this is sometimes called the genetic paradox of invasion. Phytophthora ramorum is invasive, limited to asexual reproduction within four lineages, and presumed clonal. It is responsible for sudden oak death in the United States, sudden larch death in Europe, and ramorum blight in North America and Europe. We sequenced the genomes of 107 isolates to determine how this pathogen can overcome the invasion paradox. Mitotic recombination (MR) associated with transposons and low gene density has generated runs of homozygosity (ROH) affecting 2,698 genes, resulting in novel genotypic diversity within the lineages. One ROH enriched in effectors was fixed in the NA1 lineage. An independent ROH affected the same scaffold in the EU1 lineage, suggesting an MR hot spot and a selection target. Differences in host infection between EU1 isolates with and without the ROH suggest that they may differ in aggressiveness. Non-core regions (not shared by all lineages) had signatures of accelerated evolution and were enriched in putative pathogenicity genes and transposons. There was a striking pattern of gene loss, including all effectors, in the non-core EU2 genome. Positive selection was observed in 8.0% of RxLR and 18.8% of Crinkler effector genes compared with 0.9% of the core eukaryotic gene set. We conclude that the P. ramorum lineages are diverging via a rapidly evolving non-core genome and that the invasive asexual lineages are not clonal, but display genotypic diversity caused by MR

Dryad_S2

Quality control of Illumina sequencing and SNP filtering of Phytophthora ramorum

Dryad_S4

Nucleotide and gene content of the de novo assemblies obtained for the four Phytophthora ramorum lineage