SUMMARY: A latex cryptococcal antigen agglutination test (LCAT) was performed on sera obtained during the first 14 days of treatment from 58 animals (46 cats, 9 dogs, 2 koalas and 1 long billed corella) with cryptococcosis. The same commercial kit was used for all samples, and most serum samples were treated with pronase before testing. Sera from all 58 cases tested positive with the qualitative LCAT protocol (using undiluted sera), while sera from all 26 cats without cryptococcosis tested negative. Titres determined using the quantitative protocol ranged from 1 to 131 072 (median titre between 2048 and 4096), with 57 of 58 cases (including all 8 animals that presented for neurological signs) having titres 2 and thus considered positive according to the manufacturer's recommendations. The LCAT titre was positively correlated with disease severity (r = 0.4169; P = 0.0011), and patients with disseminated skin and/or lymph node involvement had significantly higher titres than those that did not (P = 0.0157). The presence of neurological signs, the species of the patient, concurrent viral disease (in cats) and the biotype of the isolate had no significant association with the LCAT titre. Cats that died of active cryptococcosis despite treatment did not have significantly higher titres (P = 0.3010) than those that responded to treatment. Sequential LCAT determinations obtained in 37 patients during treatment provided a useful quantitative indication of clinical progress, although the decline in titre lagged somewhat behind clinical improvement. Generally, the antigen titre declined by 2 to 4 fold per month during successful therapy. Although there are insufficent data to make unequivocal recommendations, we suggest that either antifungal therapy be continued until the LCAT titre declines to less than 1, or therapy be discontinued after a 32 fold or greater reduction in titre, with periodic monitoring of the serum antigen titre. Treatment of serum samples with pronase substantially increased the sensitivity of the LCAT.

Six cases (3 cats, 3 dogs) of cryptococcosis were cured using combination chemotherapy that included amphotericin B. We developed a simple, practical and inexpensive method of administering amphotericin B as a subcutaneous infusion during the treatment of these patients. For this, the calculated dose of amphotericin B (0.5 to 0.8 mg/kg) was added to 400 mL, for cats, or to 500 mL, for dogs, of 0.45% saline containing 2.5% dextrose. These amounts were given subcutaneously 2 or 3 times weekly over several months, to a total cumulative dose of 8 to 26 mg/kg body weight. Subcutaneous infusions were generally well tolerated by the animals, although concentrations of amphotericin B in excess of 20 mg/L resulted in local irritation. This protocol enabled the administration of larger, and thus more effective, quantities of amphotericin B without producing marked azotaemia.

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Background: Serious injuries and fatalities among vulnerable road users on two wheeled motorised vehicles have increased across Australia and internationally in the past decade, yet fallen for motor vehicle occupants. Almost half of all reported motorcycle injury crashes cause serious injury or death, nearly double that of motor vehicle police-reported crashes. This study explores associations with sociodemographic and pre-injury health characteristics and health outcomes after a road traffic injury; aiming to compare motorcyclists with other road users and inform recovery care. Methods: An inception cohort study recruited 1854 individuals aged >17 years, injured following land-transport crashes in New South Wales, Australia (July 2013-November 2016). Interviews conducted at baseline, 6-and 12-months post-injury elicited demographic, socioeconomic, and self-reported health conditions. Results: 628 (33.9%) motorcyclists, 299 (16.1%) bicyclists and 927 (50%) vehicle occupants were recruited at baseline. Injury patterns differed significantly between groups; motorcyclist injuries were more likely lower extremity, more severe (p<0.001) and result in longer hospital stays (p<0.001). Injured motorcyclists were predominantly male (88.1%, p<0.001), were younger on average (38 years) than bicyclists (41.5 years), had lower income and education levels, and poorer pre-injury physical health than other road user groups. Despite these differences, at 12 months post-injury motorcyclists had better physical health and reported less pain than vehicle occupants. Motorcyclists displayed less evidence of psychological distress than vehicle occupants, but more than bicyclists across several measures used. Conclusions: Road user types differ in important characteristics, including pre-injury health status and recovery after injury, which influences health and recovery outcomes after land-transport crashes. This information could aid post-crash care, such as targeting early intervention strategies not only to injury types, but also to the type of road user, to improve long-term recovery.

Introduction Poor sleep is common among people with spinal cord injury (SCI), yet little is known about its impact on employment and participation outcomes. This study aimed to describe the sleep quality of a large sample of Australians with SCI; examine associations between sleep quality and participant characteristics; and explore the relationship between sleep and outcomes. Methods Cross-sectional Australian survey, including 1579 community-dwelling people with SCI, aged 18 years and over. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Relationships between participant characteristics, sleep and other outcomes were examined with linear and logistic regression. Results The PSQI was completed by 1172 individuals; 68.4% reported poor sleep (PSQI&gt;5). Subjective sleep quality in people with SCI was poor (mean(SD) PSQI global score=8.5(4.5). Financial hardship and problems with other secondary health conditions were significantly associated with worse sleep quality (p&lt;0.05). Poor sleep quality was strongly associated with lower emotional wellbeing and energy, and greater problems with participation (p&lt;0.001). Individuals engaged in paid work reported better sleep quality than unemployed individuals (mean(SD) PSQI=8.1(4.3) vs 8.7(4.6), p&lt;0.05). Following adjustment for age, pre-injury employment, injury severity and years of education, better sleep quality remained strongly associated with being employed (OR=0.95, 95% CI=0.92-0.98), p=0.003). Conclusions This study has demonstrated pervasive and impactful relationships between sleep quality and important SCI outcomes. Poor sleep quality was strongly associated with worse emotional wellbeing and vitality, unemployment and lower participation. Determining whether treating sleep problems can improve outcomes for people living with SCI deserves more attention.