Hasil untuk "Specialties of internal medicine"

Yan Wang, Xiaohua Liu, Zhenwen Xiao

BackgroundDiabetic nephropathy (DN) represents one of the most prevalent microvascular complications of type 2 diabetes mellitus (T2DM). The pathogenesis of DN is significantly influenced by the inflammatory response. Thus, the current meta-analysis aimed to assess the diagnostic accuracy of neutrophil-to-lymphocyte ratio (NLR) in early DN and DN.MethodsCochrane, Pubmed, Embase, and Web of Science were retrieved from database establishment to August 31, 2024. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was utilized to assess the quality of included studies. This meta-analysis was carried out via Stata16.0 and Revman 5.3 software.ResultsFinally, this meta-analysis incorporated 18 studies, of which 5 were early DN studies, involving 232 patients with early DN, and 13 were DN studies, involving 4,818 patients with DN. The results indicated that the diagnostic sensitivity of NLR for early DN was 0.83 [95% CI: 0.60-0.94], the specificity was 0.76 [95% CI: 0.61-0.86], and the area under the receiver operating characteristic curve (AUROC) was 0.85 [95% CI: 0.81-0.88]. The diagnostic sensitivity of NLR for DN was 0.73 [95% CI: 0.67-0.79], the specificity was 0.70 [95% CI: 0.59-0.79], and the AUROC was 0.78 [95% CI: 0.74-0.81].ConclusionsNLR exhibited moderate performance in diagnosing both early DN and DN, and its diagnostic accuracy was higher in early DN than in DN. Due to the limitations of existing studies, further studies are required to verify the findings.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024591926.

Brusk Tariq Fars, Dana Ahmad Sharif

Background and Objectives: Diabetic Nephropathy is the leading cause of end-stage renal disease worldwide, placing enormous pressure on healthcare systems and creating a heavy socioeconomic burden. It is urgent to comprehensively study the epidemiological characteristics of Diabetic Nephropathy in diabetic patients and to analyze the related factors to its incidence in order to implement effective prevention and control measures. The objective of the study is to identify the percentage of diabetic patients who developed nephropathy. Methods: This cross-sectional study included 250 patients who visited Sulaymaniyah Endocrine and Diabetic Center from April 2023 to September 2023. The participants were sent for investigations, including urea, creatinine, urinary albumin-to-creatinine ratio, and Glycated hemoglobin. The estimated glomerular filtration rate was calculated by the Cockcroft­-Gault equation. Results: A total of 250 patients participated in the study; 147 were females and 103 were males. Additionally, 190 of the patients were from urban areas, and 60 from rural ones. The mean age of the participants was 59 ± 11.21 years old. Of the patients, 104 (41.60%) had only diabetes mellitus, while 146 (58.40%) had diabetes mellitus and another chronic illness.81 (32.4%) of patients had Diabetic nephropathy; of them, 28.4% had microalbuminuria and 4% had macroalbuminuria. The highest prevalence of nephropathy was found in those patients who were over 65 years old, and the lowest frequency was seen in those less than 45 years old. Conclusion: One-third of patients developed Diabetic nephropathy. Diabetic nephropathy was significantly affected by the duration of Diabetes Mellitus, older age, and other chronic illnesses; however, gender, residency, and Glycated hemoglobin level had no significant impact on the incidence of Diabetic nephropathy.

Kecheng Li, Kecheng Li, Xiaoli Zhou et al.

IntroductionBeta-amyloid accumulation in the brain appears to be a key initiating event in Alzheimer’s disease (AD), and factors associated with increased deposition of beta-amyloid are of great interest. Enhanced deposition of amyloid-β peptides is due to an imbalance between their production and elimination. Previous studies show that diminished levels of CSF amyloid beta 42 (Aβ42) is a biomarker in AD; however, the role of serum Aβ42 in AD is contradictory. BMI and obesity have been reported to be related to increased serum Aβ42 levels. Therefore, we aimed to investigate the relation between metabolic syndrome (MetS), its clinical measures (abdominal obesity, high glucose, high triglyceride, low high-density lipoprotein cholesterol level, and hypertension), and serum Aβ42 levels.MethodsA total of 1261 subjects, aged 18–89 years in Chengdu, China, were enrolled from January 2020 to January 2021 to explore the correlation of serum Aβ42 levels with body mass index (BMI), blood lipids, and blood pressure. Furthermore, as the risk of MetS is closely related to age, 1,212 participants (N = 49 with age ≥ 80 years old were excluded) were analyzed for the correlation of serum Aβ42 level and MetS clinical measures.ResultsThe results showed that log-transformed serum Aβ42 level was positively correlated with BMI (R = 0.29; p < 0.001), log-transformed triglyceride (R = 0.14; p < 0.001), and diastolic blood pressure (DBP) (R = 0.12; p < 0.001) and negatively correlated with high-density lipoprotein (HDL-c) (R = −0.18; p < 0.001). After adjusting for age, sex, and other covariates, elevated serum Aβ42 level was correlated with higher values of BMI (βmodel1 = 2.694, βmodel2 = 2.703) and DBP (βmodel1 = 0.541, βmodel2 = 0.546) but a lower level of HDL-c (βmodel2 = −1.741). Furthermore, serum Aβ42 level was positively correlated with MetS and its clinical measures, including BMI and DBP, and negatively correlated with HDL-c level in the Han Chinese population. However, the level of serum Aβ42 did not show a significant correlation with high glucose or high triglyceride.DiscussionThese observations indicate that MetS and its components are associated with higher levels of serum Aβ42 and hence limit the potential of serum Aβ42 as a suitable diagnostic biomarker for AD. As such, we recommend serum Aβ42 serve as a direct risk biomarker for MetS rather than for AD.

Carstens DD, Maselli DJ, Cook EE et al.

Donna D Carstens,1 Diego J Maselli,2 Erin E Cook,3 Fan Mu,3 Jingyi Chen,3 Danni Yang,3 Jessica Karacz DeMartino,1 Yen Chung1 1Respiratory & Immunology, AstraZeneca, Wilmington, DE, USA; 2Division of Pulmonary Diseases & Critical Care, University of Texas Health, San Antonio, TX, USA; 3Health Economic and Outcomes Research, Analysis Group, Boston, MA, USACorrespondence: Jessica Karacz DeMartino, AstraZeneca Pharmaceuticals, 1800 Concord Pike, Wilmington, DE, 19897, USA, Tel +1 302-897-0843, Email jessica.demartino@astrazeneca.com

Jisun Lee, Seung-Kee Min

Adventitial cystic disease (ACD), a rare vascular disease characterized by mucus accumulation in the adventitia of blood vessels, typically affects the popliteal artery. We present the case of a 61-year-old female diagnosed with ACD in 2018 who was initially treated with endovascular stenting and percutaneous aspiration of the cyst. The patient, who had been asymptomatic for 5 years, developed a stent fracture and pseudoaneurysm requiring surgical intervention. Despite initial successful treatment, complications such as stent fracture and recurrence can occur; therefore, surgical treatment is recommended to optimize outcomes in patients with ACD. Endovascular treatment and cyst aspiration should only be considered in cases with high surgical risk. After treatment, long-term follow-up and individualized management strategies are important to monitor ACD recurrence.

Takashi Nagase, MD, Shinichiro Oda, MD, PhD, Yoshinobu Maeda, MD et al.

The conventional Damus-Kaye-Stansel procedure may cause coronary artery compression when the coronary arteries are situated between the great arteries. We have performed a modified Damus-Kaye-Stansel procedure utilizing a “flap-bridging technique,” in which an inverted U-shaped flap incised from the aorta is bridged to the main pulmonary trunk, creating sufficient space between the great arteries, in an 8-month-old boy who was a Fontan candidate with congenitally corrected transposition of the great arteries. This modified approach yielded favorable outcomes without coronary events and can effectively prevent coronary obstruction in cases where the coronary arteries run between the great arteries.

Mai T. H. Nguyen, Yuki Sakamoto, Toshiki Maeda et al.

Background This review aimed to quantify the impact of socioeconomic status on functional outcomes from stroke and identify the socioeconomic status indicators that exhibit the highest magnitude of association. Methods and Results We performed a systematic literature search across Medline and Embase from inception to May 2022, to identify observational studies (n≥100, and in English). Risk of bias was assessed using the modified Newcastle Ottawa Scale. Random effects meta‐analysis was used to pool data. We included 19 studies (157 715 patients, 47.7% women) reporting functional outcomes measured with modified Rankin Scale or Barthel index, with 10 assessed as low risk of bias. Measures of socioeconomic status reported were education (11 studies), income (8), occupation (4), health insurance status (3), and neighborhood socioeconomic deprivation (3). Pooled data suggested that low socioeconomic status was significantly associated with poor functional outcomes, including incomplete education or below high school level versus high school attainment and above (odds ratio [OR], 1.66 [95% CI, 1.40–1.95]), lowest income versus highest income (OR, 1.36 [95% CI, 1.02–1.83]), a manual job/being unemployed versus a nonmanual job/working (OR, 1.62 [95% CI, 1.29–2.02]), and living in the most disadvantaged socioeconomic neighborhood versus the least disadvantaged (OR, 1.55 [95% CI, 1.25–1.92]). Low health insurance status was also associated with an increased risk of poor functional outcomes (OR, 1.32 [95% CI, 0.95–1.84]), although this was association was not statistically significant. Conclusions Despite great strides in stroke treatment in the past decades, social disadvantage remains a risk factor for poor functional outcome after an acute stroke. Further research is needed to better understand causal mechanisms and disparities.

Katarzyna Walicka-Serzysko, Magdalena Postek, Urszula Borawska-Kowalczyk et al.

Abstract Background The long-term consequences of prematurity are often not sufficiently recognized. To address this gap, a prospective cohort study, which is a continuation of the multicenter Polish study PREMATURITAS, was conducted, utilizing unique clinical data from 20 years ago. Objective The main goal was to evaluate lung function, detect any structural abnormalities using lung ultrasound, and assess psychological well-being in young adults born between 24 and 34 weeks of gestational age (GA). Additionally, the study aimed to investigate potential associations between perinatal risk factors and abnormalities observed in pulmonary function tests (PFTs) during adulthood. Methods The young survivors underwent a comprehensive set of PFTs, a lung ultrasound, along with the quality of life assessment. Information regarding the neonatal period and respiratory complications was obtained from the baseline data collected in the PREMATURITAS study. Results A total of 52 young adults, with a mean age of 21.6 years, underwent PFTs. They were divided into two groups based on GA: 24–28 weeks (n = 12) and 29–34 weeks (n = 40). The subgroup born more prematurely had significantly higher lung clearance index (LCI), compared to the other subgroup (p = 0.013). LCI ≥ 6.99 was more frequently observed in the more premature group (50% vs. 12.5%, p = 0.005), those who did not receive prenatal steroids (p = 0.020), with a diagnosis of Respiratory Distress Syndrome (p = 0.034), those who received surfactant (p = 0.026), and mechanically ventilated ≥ 7 days (p = 0.005). Additionally, elevated LCI was associated with the diagnosis of asthma (p = 0.010). Conclusions The findings suggest pulmonary effects due to prematurity persist into adulthood and their insult on small airway function. Regular follow-up evaluations of young survivors born preterm should include assessments of PFTs. Specifically, the use of LCI can provide valuable insights into long-term pulmonary impairment.

Vadym Sulimenko, Vladimíra Sládková, Tetyana Sulimenko et al.

Aggregation of high-affinity IgE receptors (FcϵRIs) on granulated mast cells triggers signaling pathways leading to a calcium response and release of inflammatory mediators from secretory granules. While microtubules play a role in the degranulation process, the complex molecular mechanisms regulating microtubule remodeling in activated mast cells are only partially understood. Here, we demonstrate that the activation of bone marrow mast cells induced by FcϵRI aggregation increases centrosomal microtubule nucleation, with G protein-coupled receptor kinase-interacting protein 2 (GIT2) playing a vital role in this process. Both endogenous and exogenous GIT2 were associated with centrosomes and γ-tubulin complex proteins. Depletion of GIT2 enhanced centrosomal microtubule nucleation, and phenotypic rescue experiments revealed that GIT2, unlike GIT1, acts as a negative regulator of microtubule nucleation in mast cells. GIT2 also participated in the regulation of antigen-induced degranulation and chemotaxis. Further experiments showed that phosphorylation affected the centrosomal localization of GIT2 and that during antigen-induced activation, GIT2 was phosphorylated by conventional protein kinase C, which promoted microtubule nucleation. We propose that GIT2 is a novel regulator of microtubule organization in activated mast cells by modulating centrosomal microtubule nucleation.

S. Roberts, Doug Leslie, Guodong Liu et al.

s from the 2020 Annual Meeting of the Society of General Internal Medicine "J OURNEY OF A THOUSAND MILES” CHALLENGES ENCOUNTERED BY INTERNATIONAL MEDICAL GRADUATES AND COMPARATIVE PROBLEMS FACED BY AMERICAN GRADUATES DURING INTERNAL MEDICINE RESIDENCY TRAINING AT A COMMUNITY HOSPITAL IN ILLINOIS. Gauri Pethe. Internal Medicine, Amita Saint Francis Hospital, Evanston, IL. (Control ID #3392714) BACKGROUND: International physicians make up 25% of the physician work force in the United States, a majority of international applicants pursue Internal Medicine. Based on their accents, religious symbolism or ethnicity, they are often perceived as being different. AmericanGraduates, although being in a familiar environment, face huddles such as student-loan debt and face challenges such as having to compete with International-Graduates who have more clinical experience. METHODS: A cross sectional study was done at Saint Francis Hospital. Questionnaires included a basic survey about questions including wellness, personal and work life balance, burnout, and discrimination at the workplace. International students had additional questions including ease of availability and access to basic necessities such as housing, cultural food, and community and learning curve. Questions also included communication barriers faced, and other perceived challenges. American Graduates were inquired about challenges and their perception regarding integration of international students. RESULTS: Total residents were 60; 39-IMGs-65%, 2-US-IMGs 3.33%, 19-AMG-31.66% with 22IMGs-56.4% and 10-AMGs-52.63% replied. Within IMGs: 12-females(54.54%) and 10-males(45.45%). AMGs: there were 5 females(50%) and 5 males(50%). 100%-IMGs applied for US residency match for: Better opportunities, 36.36%-Better pay, 90.9%Quality of life, 86.36%-Work hours. 95.45%-IMGs reported better work hours. 31.81%-IMGs stayed late for work vs 20%-AMGs. 22.73%-IMGs had difficulty finding apartment vs 0%-AMGs. 68.19%-IMGs reported difficulty in finding local food, 77.28%-reported difficulty finding home community. 90.9%-IMGs feel compensated enough for the work they do vs 60%-AMGs. 27.27%-IMGs face discrimination; 83.33%were discriminated based on race vs 30%-AMGs; 66.66% was racial and 33.33% sexual. 45.45%-IMGs reported depression vs 60% AMGs. 80% IMG and 83.33% AMGs are likely to seek help, mostly from family. Both IMGs and AMGs reported to feel burned out at least once a month, most during long-call days. 63.63%-IMGs reported ease in balancing work/personal life vs 80%AMGs. Most IMGs and AMGs interact with each other during work, and have no problems making friendsips, but rarely meet socially. 36.36%-IMGs think they are treated differently than AMGs. Biggest challenge for IMGs when adjusting to the US system was cultural change and getting used to EMRs. 81.81%IMGs and 90%AMGs stated that this is their intended specialty. Most IMGs are able to visit home 1-2 time/year, 4 cannot due to civil war. 100% IMGs do not regret their decision to pursue residency in USA. CONCLUSIONS: This study outlines different difficulties faced by IMGs and AMGs alike. IMGs reported more racial discrimination and the biggest challenge was to learn the Electronic-Medical-Records and culture. Despite these challenges, IMGs reported that 100% of them do not regret their decision to pursue residency in the United States. A MULTI-SITE FOCUS GROUP STUDY OF U.S. ADULT WOMEN’S BELIEFS AND ASSUMPTIONS ABOUT BLADDER HEALTH AND FUNCTION Beverly R. Williams; Missy D. Lavender; Kathryn L. Burgio; Yvette LaCoursiere; Diane K. Newman; Sonya S. Brady; Lisa K. Low; Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consoritum. Medicine, University of Alabama at Birmingham, Birmingham, AL; Medicine, Birmingham/Atlanta GRECC, Birmingham VA Medical Center, Birmingham, AL; Independent Researcher, Chicago, IL; Obstetrics, Gynecology, and Reproductive Health, UC San Diego Health La Jolla, La Jolla, CA; Medicine, University of Pennsylvania, Philadelphia, PA; School of Public Health, University of Minnesota, Minneapolis, MN; School of Nursing, University of Michigan, Ann Arbor, MI; NIH-NIDDK, District of Columbia, DC. (Control ID #3360438) BACKGROUND: The Study of Habits, Attitudes, Realities, and Experiences (SHARE), a qualitative study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, explored women’s knowledge experiences, perceptions, knowledge, and behaviors about bladder health/function. The purpose of this analysis was to characterize women's lay beliefs and assumptions about bladder health and function. METHODS: Forty-four focus groups were conducted across seven U.S. research centers with 360 women and adolescents, organized by six age categories. Focus groups were audio-recorded and transcribed. Following transcript and fieldnote coding, multi-level qualitative content analyses was used to classify emergent themes. A transdisciplinary lens and inductive approach guided data interpretation of the” bladder beliefs and assumptions code”. A team of investigators articulated interpretive insights, which were validated by a community engagement panel. RESULTS: Women exhibited limited understanding of bladder health and function, with assumptions and beliefs shaped by personal experience and hearsay. Except for the rare occasion when women had input from a medical professional, notions about bladder health and function were characterized by uncertainty, tentativeness, and unconfirmed impressions. Women speculated on (1)the function of the urinary tract system in cleansing or flushing the bodily system of impurities and toxins, (2) the functional relationship between and among the kidneys, bladder, urethra, vagina, pelvic floor and (3)the impact on bladder function of medications for chronic conditions. Women’s assumptions and beliefs about bladder healthwere framedwithin a “cause and effect” perspective, covering a wide array of habits/behaviors while conjecturing about the physiological mechanisms through such practices promote or deter bladder health. Finally, there was agreement on the importance of bladder friendly habits and the inadvisability of potentially harmful practices. This was acompanied by an assumption that bladder problems could be prevented by developing communitybased programs for educating women about bladder health and function, encouraging women to practice healthy bladder habits, eliminating taboos about discussing bladder health, and empowering women to speak out about their bladder-related experiences and concerns. S1 DOI: 10.1007/s11606-020-05890-3 © Society of General Internal Medicine 2020 J Gen Intern Med 35 :S1–S779 (Suppl 1) 8 Published online July 2 , 2020 CONCLUSIONS: Community-engaged public health messaging can inform women’s assumptions and beliefs about bladder health/function, educating women about the promotion of bladder health and the prevention of LUTS. BEHAVIORAL INCENTIVES TO IMPROVE MOBILITY AND DECREASE OPIOID USE IN VETERANS WITH CHRONIC PAIN Manik Chhabra; Krisda Chaiyachati; Peggy Compton. School of Nursing, University of Pennsylvania, Philadelphia, PA; Corporal Michael Crescenz VA Medical Center, Philadelphia, PA; University of Pennsylvania, Philadelphia, PA. (Control ID #3389698) BACKGROUND: An estimated 88.5 million adults suffer from daily pain, resulting in an estimated cost of $635 billion in lost productivity and $300 billion in health care expenditures. To manage their chronic pain, 5 to 8 million Americans take an opioid medication daily. However, the risks associated with ongoing opioid use (overdose, abuse, diversion) temper their analgesic effects. Appreciating the gains in health outcomes that behavioral incentives produce, we tested the hypothesis that loss-framed financial incentives combined with technology enabled care (TEC) can improve patient mobility, reduce pain, and decrease opioid use in patients with chronic pain. METHODS: We conducted a randomized controlled trial, allocating 40 patients 1:1 to a lottery-based behavioral incentive program combined with TEC vs. TEC alone (e.g., text-message communication and activity trackers). Patients were eligible if they received care from a VA pain-focused primary care program, on opioid therapy, and had a cell phone with text messaging capabilities. Patients were excluded if they had cancer-related pain, sensory impairments precluding the use of TEC, or had mobility limitations precluding them from walking. The primary outcome was the change in mobility (number of steps taken), and secondarily, pain severity, physical function, and opioid use using self-reported questionnaires over 12-weeks. Data were collected weekly using activity trackers, and text-messaged questionnaires. We measured baseline mobility using a two-week pre-study period observation before randomization. For the lottery + TEC arm, participants were eligible for a weekly regret lottery if their steps increased by 5% from the prior week. Once the subject reached 150% of baseline, they were always entered into the lottery. The eligible lottery participants could win either $30 or $100; those not meeting the walking goals were told what they would have won had they met their goal. RESULTS: Forty subjects have been enrolled and 38 have completed the study. The remaining two subjects will complete the trial by January 31, 2020. The results of the full sample will be available for presentation. Based on interim data analyses on the first 20 subjects, the lottery + TEC arm increased weekly average by 2004 steps, whereas the TEC only arm decreased by 1239 steps. For secondary outcomes, the lottery + TEC arm had improvements in pain severity and physical function but not chronic pain. CONCLUSIONS: Combining a regret lottery incentive with TEC improved mobility in patients with chronic pain, as well as increased participation in exercise and decreased pain severity and interference. While additional interventions o

Koji Kawakami, Masato Takeuchi, Nobuya Inagaki et al.

Neil S. Zhang, Sarah Blissett, D. Anderson et al.

Background While program director (PD) letters of recommendation (LOR) are subject to bias, especially against those underrepresented in medicine, these letters are one of the most important factors in fellowship selection. Bias manifests in LOR in a number of ways, including biased use of agentic and communal terms, doubt raising language, and description of career trajectory. To reduce bias, specialty organizations have recommended standardized PD LOR. Objective This study examined PD LOR for applicants to a cardiology fellowship program to determine the mechanism of how bias is expressed and whether the 2017 Alliance for Academic Internal Medicine (AAIM) guidelines reduce bias. Methods Fifty-six LOR from applicants selected to interview at a cardiology fellowship during the 2019 and 2020 application cycles were selected using convenience sampling. LOR for underrepresented (Black, Latinx, women) and non-underrepresented applicants were analyzed using directed qualitative content analysis. Two coders used an iteratively refined codebook to code the transcripts. Data were analyzed using outputs from these codes, analytical memos were maintained, and themes summarized. Results With AAIM guidelines, there appeared to be reduced use of communal language for underrepresented applicants, which may represent less bias. However, in both LOR adherent and not adherent to the guidelines, underrepresented applicants were still more likely to be described using communal language, doubt raising language, and career trajectory bias. Conclusions PDs used language in a biased way to describe underrepresented applicants in LOR. The AAIM guidelines reduced but did not eliminate this bias. We provide recommendations to PDs and the AAIM on how to continue to work to reduce this bias.

Charles M. LoPresti, T. Jensen, Renee K. Dversdal et al.

AAIM is the largest academically focused specialty organization representing departments of internal medicine at medical schools and teaching hospitals in the United States and Canada. As a consortium of five organizations, AAIM represents department chairs and chiefs; clerkship, residency, and fellowship program directors; division chiefs; and academic and business administrators as well as other faculty and staff in departments of internal medicine and their divisions.

Charles M. LoPresti, Daniel J. Schnobrich, William Novak et al.

AAIM is the largest academically focused specialty organization representing departments of internal medicine at medical schools and teaching hospitals in the United States and Canada. As a consortium of five organizations, AAIM represents department chairs and chiefs; clerkship, residency, and fellowship program directors; division chiefs; and academic and business administrators as well as other faculty and staff in departments of internal medicine and their divisions. s Current Point of Care Ultrasound Use and Training Among Internal Medicine Residency Programs from the 2020 APDIM Program Director’s Survey Charles M. LoPresti, MD, Daniel Schnobrich, MD, William Novak, MD, Emily Fondahn, MD, Rachel Bardowell, MD, Alec B. O’Connor, MD, MPH, Brian Uthlaut, MD, Jordan Ortiz, Nilam J. Soni, MD, MS Section of Acute Medicine, Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Ohio; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of General Internal Medicine, University of Minnesota School of Medicine, Minneapolis; Department of Medicine, University of Rochester School of Medicine and Dentistry, NY; Department of Medicine, Washington University School of Medicine, St. Louis, Mo; Department of Medicine, University of Virginia Health System, Charlottesville; Alliance for Academic Internal Medicine, Alexandria, Va; Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Tex.

R. Glassock, J. Benson, R. B. Copeland et al.

Muluken Genetu Chanie, Mequannent Sharew Melaku, Melaku Yalew et al.

Abstract Background Worldwide, pneumonia is the third leading cause of death in under 5 years children. Ethiopia is ranked 4th out of 15 countries having the highest burdens of the death rate among under-five children due to pneumonia. Regardless of this fact, efforts to identify determinants of pneumonia have been limited yet in Amhara region. This study was aimed to identify predictors of community-acquired childhood pneumonia among 2–59 months old children in the Amhara region, Ethiopia. Methods Facility-based case–control study was conducted in the Amhara region from June 4 to July 15, 2018, among 28 health centers distributed across the region. The total sample size used was 888 (296 cases and 592 controls) children whose age were 2–59 months. At first, multistage sampling technique was employed. Data were collected on a face-to-face interview. Epi data v. 4.6 for data entry and statistical packages for social sciences version 23 for data analysis were used. Multivariable logistic regression analyses were used to test the associations between the study variables at P-value < 0.05 with 95% CI. As a result, determinants were identified for CAP. Results Among 888 enrolled children (296 cases and 592 controls), who experienced a community-acquired pneumonia had an increased risk of maternal age of 18–24 years (AOR 0.03, at 95%CI (0.01, 0.14), Government employee (AOR 0.19, at 95% CI (0.07,0.54), lack of separate kitchen (AOR 5.37; at 95% CI (1.65, 17.43), history of diarrhea in the past two weeks (AOR 10.2; at 95% CI (5.13, 20.18), previous respiratory tract infections (AOR 8.3, at 95% CI (3.32, 20.55) and history of parental asthma (AOR 4.9, at 95% CI (2.42, 10.18). Conclusion Maternal age of 18–24 years and government employee, lack of separate kitchen, history of diarrhea in the past two weeks; previous respiratory tract infection and history of parental asthma were found statistically significant. Health personnel’s needs to focus on creating awareness to the community on the merit of the separate kitchen for reduction of Community-acquired childhood pneumonia, and focus on prevention and management of childhood diarrheal and acute respiratory tract infections.

Clement A. Meseda, Charles B. Stauft, Prabhuanand Selvaraj et al.

Abstract Numerous vaccine candidates against SARS-CoV-2, the causative agent of the COVID-19 pandemic, are under development. The majority of vaccine candidates to date are designed to induce immune responses against the viral spike (S) protein, although different forms of S antigen have been incorporated. To evaluate the yield and immunogenicity of different forms of S, we constructed modified vaccinia virus Ankara (MVA) vectors expressing full-length S (MVA-S), the RBD, and soluble S ectodomain and tested their immunogenicity in dose-ranging studies in mice. All three MVA vectors induced spike-specific immunoglobulin G after one subcutaneous immunization and serum titers were boosted following a second immunization. The MVA-S and MVA-ssM elicited the strongest neutralizing antibody responses. In assessing protective efficacy, MVA-S-immunized adult Syrian hamsters were challenged with SARS-CoV-2 (USA/WA1/2020). MVA-S-vaccinated hamsters exhibited less severe manifestations of atypical pneumocyte hyperplasia, hemorrhage, vasculitis, and especially consolidation, compared to control animals. They also displayed significant reductions in gross pathology scores and weight loss, and a moderate reduction in virus shedding was observed post challenge in nasal washes. There was evidence of reduced viral replication by in situ hybridization, although the reduction in viral RNA levels in lungs and nasal turbinates did not reach significance. Taken together, the data indicate that immunization with two doses of an MVA vector expressing SARS-CoV-2 S provides protection against a stringent SARS-CoV-2 challenge of adult Syrian hamsters, reaffirm the utility of this animal model for evaluating candidate SARS-CoV-2 vaccines, and demonstrate the value of an MVA platform in facilitating vaccine development against SARS-CoV-2.

E. Ricciardi, Giovanni La Malfa, G. Guglielmi et al.

Alec B. O’Connor, A. Halvorsen, John Cmar et al.

AAIM is the largest academically focused specialty organization representing departments of internal medicine at medical schools and teaching hospitals in the United States and Canada. As a consortium of five organizations, AAIM represents department chairs and chiefs; clerkship, residency, and fellowship program directors; division chiefs; and academic and business administrators as well as other faculty and staff in departments of internal medicine and their divisions.

N. Wenger, M. Man, J. Castioni et al.