A rare cause of hypoglycaemia

This paper describes a case study concerning a young man on treatment for psychiatric illness who developed severe episodes of hypoglycaemia. After several investigations, lithium therapy was implicated. Stopping this treatment resulted in the patient being relieved of these episodes.peer-reviewe

Association of coeliac disease and thyroid disorders

A case study is presented. This involves a woman who presented with features of hyperthyroidism, which were refractory to conventional therapy. She was eventually diagnosed to have co-existing coeliac disease and eventually improved on a diet excluding gluten. A discussion exploring the association between gluten-enetropathy and thyroid dysfunction follows.peer-reviewe

The use of K39 test in the diagnosis of visceral leishmaniasis

From time to time patients admitted with fever of unknown origin prove to be a diagnostic dilemma. While textbooks describe typical symptoms and signs, and also diagnostic tests, these are not always helpful. The following are two case reports of patients who were eventually diagnosed to be suffering from visceral leishmaniasis. It is apparent that the usual diagnostic tools at our disposal were not enough to identify the disease and new tests were needed. The case reports have some similarities; both patients are male, diabetic, resident in Gozo but not of Gozitan stock. These factors could have reduced their immunity to visceral leishmaniasis, making them more susceptible to the disease.peer-reviewe

Failure of anaesthetic machine automated self-check to detect massive leak in ventilator bellows

Anaesthetic machines are designed to provide for a safe, non-hypoxic gas mixture delivered to the patient. For this reason, anaesthetic machines provide a number of features to ensure such safety. Still, a number of anaesthetic societies, including the Association of Anaesthetists of Great Britain and Ireland [1], the American Society of Anaesthesiologists [2] and the Canadian Society of Anaesthesiologists [3] recommend that anaesthetic machines should be checked prior to each list, and prior to each case.peer-reviewe

Selection of indicators for assessing and managing the impacts of bottom trawling on seabed habitats

Bottom trawl fisheries are the most widespread\ua0source of anthropogenic physical disturbance to seabed habitats. Development of fisheries-, conservation- and ecosystem-based management strategies requires the selection of indicators of the impact of bottom trawling on the state of benthic biota. Many indicators have been proposed, but no rigorous test of a range of candidate indicators against nine commonly agreed criteria (concreteness, theoretical basis, public awareness, cost, measurement, historical data, sensitivity, responsiveness, specificity) has been performed. Here, we collated data from 41 studies that compared the benthic biota in trawled areas with those in control locations (that were either not trawled or trawled infrequently), examining seven potential indicators (numbers and biomass for individual taxa and whole communities, evenness, Shannon–Wiener diversity and species richness) to assess their performance against the set of nine criteria. The effects of trawling were stronger on whole-community numbers and biomass than for individual taxa. Species richness was also negatively affected by trawling but other measures of diversity were not. Community numbers and biomass met all criteria, taxa numbers and biomass and species richness satisfied most criteria, but evenness and Shannon–Wiener diversity did not respond to trawling and only met few criteria, and hence are not suitable state indicators of the effect of bottom trawling. Synthesis and applications. An evaluation of each candidate indicator against a commonly agreed suite of desirable properties coupled with the outputs of our meta-analysis showed that whole-community numbers of individuals and biomass are the most suitable indicators of bottom trawling impacts as they performed well on all criteria. Strengths of these indicators are that they respond strongly to trawling, relate directly to ecosystem functioning and are straightforward to measure. Evenness and Shannon–Wiener diversity are not responsive to trawling and unsuitable for the monitoring and assessment of bottom trawl impacts

Trawl impacts on the relative status of biotic communities of seabed sedimentary habitats in 24 regions worldwide

Bottom trawling is widespread globally and impacts seabed habitats. However, risks from trawling remain unquantified at large scales in most regions. We address these issues by synthesizing evidence on the impacts of different trawl-gear types, seabed recovery rates, and spatial distributions of trawling intensity in a quantitative indicator of biotic status (relative amount of pretrawling biota) for sedimentary habitats, where most bottom-trawling occurs, in 24 regions worldwide. Regional average status relative to an untrawled state (=1) was high (>0.9) in 15 regions, but 0.8. These assessments are first order, based on parameters estimated with uncertainty from meta-analyses; we recommend regional analyses to refine parameters for local specificity. Nevertheless, our results are sufficiently robust to highlight regions needing more effective management to reduce exploitation and improve stock sustainability and seabed environmental status—while also showing seabed status was high (>0.95) in regions where catches of trawled fish stocks meet accepted benchmarks for sustainable exploitation, demonstrating that environmental benefits accrue from effective fisheries management. Furthermore, regional seabed status was related to the proportional area swept by trawling, enabling preliminary predictions of regional status when only the total amount of trawling is known. This research advances seascape-scale understanding of trawl impacts in regions around the world, enables quantitative assessment of sustainability risks, and facilitates implementation of an ecosystem approach to trawl fisheries management globally

Study Protocol for the COVID-19 Pandemic Adjustment Survey (CPAS): A Longitudinal Study of Australian Parents of a Child 0–18 Years

Background: The COVID-19 pandemic presents significant risks to the mental health and wellbeing of Australian families. Employment and economic uncertainty, chronic stress, anxiety, and social isolation are likely to have negative impacts on parent mental health, couple and family relationships, as well as child health and development. Objective: This study aims to: (1) provide timely information on the mental health impacts of the emerging COVID-19 crisis in a close to representative sample of Australian parents and children (0–18 years), (2) identify adults and families most at risk of poor mental health outcomes, and (3) identify factors to target through clinical and public health intervention to reduce risk. Specifically, this study will investigate the extent to which the COVID-19 pandemic is associated with increased risk for parents’ mental health, lower well-being, loneliness, and alcohol use; parent-parent and parent-child relationships (both verbal and physical); and child and adolescent mental health problems. Methods: The study aims to recruit a close to representative sample of at least 2,000 adults aged 18 years and over living in Australia who are parents of a child 0–4 years (early childhood, N = 400), 5–12 years (primary school N = 800), and 13–18 years (secondary school, N = 800). The design will be a longitudinal cohort study using an online recruitment methodology. Participants will be invited to complete an online baseline self-report survey (20 min) followed by a series of shorter online surveys (10 min) scheduled every 2 weeks for the duration of the COVID-19 pandemic (i.e., estimated to be 14 surveys over 6 months). Results: The study will employ post stratification weights to address differences between the final sample and the national population in geographic communities across Australia. Associations will be analyzed using multilevel modeling with time-variant and time-invariant predictors of change in trajectory over the testing period. Conclusions: This study will provide timely information on the mental health impacts of the COVID-19 crisis on parents and children in Australia; identify communities, parents, families, and children most at risk of poor outcomes; and identify potential factors to address in clinical and public health interventions to reduce risk

Global analysis of depletion and recovery of seabed biota after bottom trawling disturbance

Bottom trawling is the most widespread human activity affecting seabed habitats. Here, we collate all available data for experimental and comparative studies of trawling impacts on whole communities of seabed macroinvertebrates on sedimentary habitats and develop widely applicable methods to estimate depletion and recovery rates of biota after trawling. Depletion of biota and trawl penetration into the seabed are highly correlated. Otter trawls caused the least depletion, removing 6% of biota per pass and penetrating the seabed on average down to 2.4 cm, whereas hydraulic dredges caused the most depletion, removing 41% of biota and penetrating the seabed on average 16.1 cm. Median recovery times posttrawling (from 50 to 95% of unimpacted biomass) ranged between 1.9 and 6.4 y. By accounting for the effects of penetration depth, environmental variation, and uncertainty, the models explained much of the variability of depletion and recovery estimates from single studies. Coupled with large-scale, high-resolution maps of trawling frequency and habitat, our estimates of depletion and recovery rates enable the assessment of trawling impacts on unprecedented spatial scales

Trawl fishing impacts on the status of seabed fauna in diverse regions of the globe

Bottom trawl fishing is a controversial activity. It yields about a quarter of the world's wild seafood, but also has impacts on the marine environment. Recent advances have quantified and improved understanding of large-scale impacts of trawling on the seabed. However, such information needs to be coupled with distributions of benthic invertebrates (benthos) to assess whether these populations are being sustained under current trawling regimes. This study collated data from 13 diverse regions of the globe spanning four continents. Within each region, we combined trawl intensity distributions and predicted abundance distributions of benthos groups with impact and recovery parameters for taxonomic classes in a risk assessment model to estimate benthos status. The exposure of 220 predicted benthos-group distributions to trawling intensity (as swept area ratio) ranged between 0% and 210% (mean = 37%) of abundance. However, benthos status, an indicator of the depleted abundance under chronic trawling pressure as a proportion of untrawled state, ranged between 0.86 and 1 (mean = 0.99), with 78% of benthos groups > 0.95. Mean benthos status was lowest in regions of Europe and Africa, and for taxonomic classes Bivalvia and Gastropoda. Our results demonstrate that while spatial overlap studies can help infer general patterns of potential risk, actual risks cannot be evaluated without using an assessment model that incorporates trawl impact and recovery metrics. These quantitative outputs are essential for sustainability assessments, and together with reference points and thresholds, can help managers ensure use of the marine environment is sustainable under the ecosystem approach to management