Epidemiological and genomic investigation of chikungunya virus in Rio de Janeiro state, Brazil, between 2015 and 2018

Since 2014, Brazil has experienced an unprecedented epidemic caused by chikungunya virus (CHIKV), with several waves of East-Central-South-African (ECSA) lineage transmission reported across the country. In 2018, Rio de Janeiro state, the third most populous state in Brazil, reported 41% of all chikungunya cases in the country. Here we use evolutionary and epidemiological analysis to estimate the timescale of CHIKV-ECSA-American lineage and its epidemiological patterns in Rio de Janeiro. We show that the CHIKV-ECSA outbreak in Rio de Janeiro derived from two distinct clades introduced from the Northeast region in mid-2015 (clade RJ1, n = 63/67 genomes from Rio de Janeiro) and mid-2017 (clade RJ2, n = 4/67). We detected evidence for positive selection in non-structural proteins linked with viral replication in the RJ1 clade (clade-defining: nsP4-A481D) and the RJ2 clade (nsP1-D531G). Finally, we estimate the CHIKV-ECSA's basic reproduction number (R0) to be between 1.2 to 1.6 and show that its instantaneous reproduction number (Rt) displays a strong seasonal pattern with peaks in transmission coinciding with periods of high Aedes aegypti transmission potential. Our results highlight the need for continued genomic and epidemiological surveillance of CHIKV in Brazil, particularly during periods of high ecological suitability, and show that selective pressures underline the emergence and evolution of the large urban CHIKV-ECSA outbreak in Rio de Janeiro

Will a preoperative theatre visit reduce anxiety? A randomised controlled trial

To assess the effect of preoperative theatre visit in reducing anxiety and its associated adverse outcomes, a single centre randomised controlled trial was conducted at the Professorial Gynaecology Unit, Colombo South Teaching Hospital, Sri Lanka. 64 patients were randomised. The intervention group had a pre-operative theatre visit with an informative session regarding the surgery. Patients’ anxiety before, at the time and after the surgery was assessed using APAIS score. Pre-induction parameters and pain score were also assessed. APAIS anxiety difference before the surgery and on the day of the surgery was −1.937 (±4.641) and −1.781 (±2.586) for the intervention and the control groups respectively (p = 0.643). There was no significant difference in pre-induction parameters between the groups. Pain score at 6 hours after surgery was 5.04 (±2.510) for the intervention group and 6.08 (±2.888) for the control (p = 0.189). Preoperative theatre visit prior to surgery made no significant difference in the patient’s anxiety, though a trend in reduction of anxiety and pain was noted.Impact statement What is already known on this subject? Patients experience significant anxiety before surgical procedures and high levels of anxiety can lead to adverse outcomes needing high induction doses of aneasthesia, delayed recovery and more postoperative pain. Different methods for preoperative anxiety reduction such as provision of systematic preoperative instructions, cognitive-behavioural interventions had been successful. What do the results of this study add? There are only a limited number of studies conducted assessing the methods of informational interventions to reduce anxiety. Preoperative theatre visit is a simple intervention that can be carried out without any additional preparation. What are the implications of these findings for clinical practice and/or further research? Our study could not show that preoperative theatre visit as an effective intervention in reducing anxiety in patients undergoing elective gynaecological surgery. However, there was a trend towards reduction in anxiety and postoperative pain with the intervention. Future research on providing additional information at the preoperative visit, timing of the visit and larger sample sizes may reveal better outcomes

Transmission and predictors of burden of lungworms of the striped dolphin (Stenella coeruleoalba) in the western mediterranean

Pseudaliid lungworms infect the lungs and sinuses of cetaceans. Information on the life cycle and epidemiology of pseudaliids is very scarce and mostly concerns species that infect coastal or inshore cetaceans. Available evidence indicates that some pseudaliids are vertically transmitted to the host, whereas others are acquired via infected prey. We documented pseudaliid infections in an oceanic cetacean, the striped dolphin (Stenella coeruleoalba) in the western Mediterranean, and investigated the possibilities of vertical vs. horizontal transmission and the potential influence of host body size, sex, and season on infection levels. We found two species of lungworm in 87 dolphins that stranded along the Spanish Mediterranean coast between 1987 and 2018. One or two larvae of Stenurus ovatus were found in three adult dolphins. Larger numbers of larvae and adults of Skrjabinalius guevarai were collected in 51 dolphins, including unweaned calves. These observations suggested that Skrjabinalius guevarai could be vertically transmitted. The abundance of Skrjabinalius guevarai increased significantly with host size, which suggested that it could be trophically transmitted, as well, with larger hosts consuming more infected prey. Infection levels peaked in spring, outside of the calving season, which is likely a reflection of a seasonal shift in dolphin diet. In summary, results indicate that Skrjabinalius guevarai was capable of both vertical and horizontal transmission, but future research should be directed at clarifying the potential mechanics behind transmission and intermediate hosts. © Wildlife Disease Association 2020