The commitment of health workers the effect of transformational leadership charismatic leadership during the Covid-19 pandemic

The purpose of this study was to determine and analyze the effect of transformational leadership and charismatic leadership on the commitment to health workers during the Covid-19 pandemic. The approach used in this research was quantitative. The population in this study were health workers who served in hospitals (private and government hospitals) in several cities in Indonesia, with as many as 367 health workers. The data collection technique was the survey method. The analysis used the multilinear regression assumption test by using SPSS. The study results found that transformational leadership had a direct positive effect of 4.4% on the commitment of health workers during the Covid-19 pandemic. Charismatic leadership directly had a positive effect of 5.7% on the commitment of health workers during the Covid-19 pandemic. Simultaneously transformational leadership and charismatic leadership influenced 18% of the commitment of health workers during the Covid-19 pandemic. © 2023 Author(s).

The effects of charismatic leadership and transformational leadership on job performance among health workers during the Covid-19 pandemic with the commitment as the mediator

This research aimed to understand the impacts of charismatic leadership on job performance moderated by a commitment among the health workers during the pandemic period. There were 367 health workers of private and state hospitals from several cities in Indonesia. This research used the convenience sampling data collection technique and was analyzed using three methods, namely the four-step model from Baron & Kenny, package MEDIAN, and package PROCESS-R. The result shows that (1) there is a positive significant influence between charismatic leadership and job performance, (2) there is a positive but not significant influence between job performance and commitment, (3) there is a positive significant influence between charismatic leadership and commitment, and (4) there is a positive significant influence between charismatics leadership and job performance mediated by a commitment among health workers during the Covid-19 pandemic. © 2023 Author(s).

The Effect of Weekly 50,000 IU Vitamin D3 Supplements on the Serum Levels of Selected Cytokines Involved in Cytokine Storm: A Randomized Clinical Trial in Adults with Vitamin D Deficiency.

This research aimed to evaluate the effects of high-dose cholecalciferol (VD3) supplements (50,000 IU/week) on selected circulating cytokines associated with cytokine storms in adults with vitamin D deficiency. This clinical trial, based in Jordan, included 50 participants receiving vitamin D3 supplements (50,000 IU/week) for 8 weeks; the exact number was assigned to the control group. Interleukin-6 (IL-6), interleukin-1ß (IL-1ß), interleukin-10 (IL-10), tumor necrotic factor-α (TNF-α), and leptin were measured in serum at baseline and 10 weeks (wash out: 2 weeks). Our results revealed that vitamin D3 supplementation significantly increased the serum levels of 25OHD, IL-6, IL-10, IL-1ß, and leptin compared with baseline. In contrast, the serum level of TNF-α insignificantly increased in the group receiving vitamin D3 supplementation. Although the observations of this trial may refer to a potential negative effect of VD3 supplementation during cytokine storms, further trials are required to clarify the potential benefits of VD3 supplement during cytokine storms.

COVID-19 and tinnitus-a tertiary care Centre experience

Background: COVID-19 outbreak was declared a global pandemic in March 2020 by WHO. Due to person-to-person transmission of this infection, majority of countries of world introduced lockdown to ensure people stay at home. A complex bidirectional interaction exists between tinnitus and emotional distress, as they can exacerbate one another. Also, COVID-19 infection can cause damage to outer hair cells. The aim of this study is to find out relationship between COVID-19 and initiation or exacerbation of tinnitus. Method(s): The present retrospective study, after approval by Institutional Ethics Committee, was conducted in Department of ENT, GMC Jammu, from June 2020 to March 2021 on 90 patients with primary complaint of tinnitus. All 90 patients were asked to complete the Tinnitus Handicap Inventory. Also, all patients were asked COVID-19-related questions (history of contracting virus/history of grief/anxiety/depression/stress/nervousness/financial status/ physical exercise/sleep routine/ social interactions). Result(s): Out of 90 patients, 72 patients (80%) had chronic longstanding tinnitus and 18 patients (20%) experienced tinnitus during pandemic. Out of 72 patients who gave history of longstanding tinnitus, 41 patients (56.9%) reported tinnitus to be stable during COVID-19 pandemic, 26 patients (36.1%) reported it to become more bothersome and 5 patients (6.9%) reported that tinnitus was improved. Out of 90 patients, 21 patients (23.3%) were diagnosed as COVID-19 positive. Of these 21 patients experiencing COVID-19 symptoms, 16 patients (76.2%) gave history of exacerbation of tinnitus, 4 patients (19%) gave history of tinnitus remaining stable and 1 patient (4.7%) said that tinnitus was improved. Out of 90 patients, history of negative psychological impact due to COVID-19 restrictions was seen in 65 patients (72.2%). Conclusion(s): With our study, we concluded that ENT specialists should be fully aware that not only pre-existing tinnitus may be exaggerated due to COVID-19 infection, but also, there can be development of new-onset tinnitus due to COVID-19 infection and the negative psychological impact due to COVID-19 pandemic.Copyright © 2022, The Author(s).

Retrospective Analysis of Neutralizing Antibody Cocktail (Casirivimab and Imdevimab): A Game Changer in Treating Mild COVID-19 Patients

Our retrospective study aimed to evaluate the effectiveness of monoclonal antibodies (casirivimab and imdevimab) on mild cases of coronavirus disease 2019 patients admitted to the tertiary care center. A total of 161 patients were evaluated of which the test group consisted of 79 and the control group of 82. In the test group the patients had been administered with diluted 250 ml of 0.9 % sodium chloride along with co-formulated casirivimab (600 mg) and imdevimab (600 mg) solution intravenously and in the control group the patients were administered standard coronavirus disease 2019 treatment protocol. The monitoring of patients in both groups was done at least 1 h after drug infusion in the designated room. Post-treatment designed interviews were taken to evaluate the effectiveness of treatment. This retrospective analysis discovered a significant association of symptoms with the group at 48 h for injected and non-injected patients and 1 mo from the chi-square test after injecting monoclonal antibodies. There is no significant association of symptoms with the groups at 3 mo. A significant difference in the symptom distribution through different time points in the injected group and not injected group was observed. From the pairwise McNemar's test, a significant difference in the symptoms between each time in 48 h, the difference was p=0.0075 and after 1 mo, p<0.001 points in both groups. The combination of casirivimab and imdevimab could be considered a treatment of choice for vaccinated, non-vaccinated and mild to highrisk coronavirus disease 2019 patients.

Co-infection of COVID-19 patients with atypical bacteria: A study based in Jordan.

Objective: The aim of this work was to know the prevalence of Chlamydophila pneumoniae and Mycoplasma pneumoniae in coronavirus disease 2019 (COVID-19) patients in Jordan. Also, to assess a TaqMan real-time polymerase chain reaction (PCR) assay in detecting these two bacteria. Methods: This is a retrospective study performed over the last five months of the 2021. All nasopharyngeal specimens from COVID-19 patients were tested for C. pneumonia, and M. pneumoniae. The C. pneumoniae Pst-1 gene and M. pneumoniae P1 cytadhesin protein gene were the targets. Results: In this study, 14 out of 175 individuals with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (8.0%) were co-infected with C. pneumoniae or M. pneumoniae. Co-infection with SARS-CoV-2 and C. pneumoniae was reported in 5 (2.9%) patients, while 9 (5.1%) patients had M. pneumoniae and SARS-CoV-2 co-infection. The mean (± std) of the correlation coefficient of the calibration curve for real-time PCR analysis was -0.993 (± 0.001) for C. pneumoniae and -0.994 (± 0.003) for M. pneumoniae. The mean amplification efficiencies of C. pneumoniae and M. Pneumoniae were 187.62% and 136.86%, respectively. Conclusion: In this first study based in Jordan, patients infected with COVID-19 have a low rate of atypical bacterial co-infection. However, clinicians should suspect co-infections with both common and uncommon bacteria in COVID-19 patients. Large prospective investigations are needed to give additional insight on the true prevalence of these co-infections and their impact on the clinical course of COVID-19 patients.

Perception and attitudes toward COVID- 19 vaccines in Jordan: lessons for future pandemics.

Objective: This study aimed to assess Jordanians' perception and attitudes toward COVID-19 vaccines authorized for use in Jordan. Another objective was to evaluate the population's confidence in vaccine efficacy, their fears of the vaccines, and their perceptions and attitudes after vaccination. Methods: This cross-sectional study was conducted over four months (August 2021- December 2021) and included the general Jordanian population above 18 years old. Results: A total of 398 participants were included in the study, with the majority (around 81.0%) received at least one dose of any of COVID-19 vaccines approved for use in Jordan. Most non-vaccinated participants (67.4%) were either unwilling to receive the COVID-19 vaccine or unsure. The main reasons for receiving the vaccine were: family protection, self-protection, global efforts to fight the virus and local restrictions, with some variability between vaccinated and non-vaccinated. The major reasons for fear of COVID-19 vaccines were limited research, vaccine effectiveness, and vaccine side effects. Pfizer-BioNTech vaccine was the most trusted vaccine by vaccinated and non-vaccinated participants (47.8% and 57.9%, respectively), and Oxford-AstraZeneca was the most feared by them (42.2% and 57.9%, respectively). Internet websites (>85.0%), social media platforms (>70.0%), relatives and friends (>69.0%), and news applications (>60.0%) were the major sources of information about the COVID-19 vaccines among participants. Conclusion: Our results revealed that hesitation in receiving the vaccine remains a challenge in Jordan, as in other countries. The findings also show that participants, regardless of their vaccination status, had many concerns about the four types of vaccines approved for use in Jordan during the study conduction period. Moreover, the participants' perceptions and attitudes towards the vaccines were variable between vaccinated and non-vaccinated participants and were variable for the four types of vaccines.

The effect of omega-3 supplements on the serum levels of ACE/ACE2 ratio as a potential key in cardiovascular disease: A randomized clinical trial in participants with vitamin D deficiency.

Objective: The aim of this randomized controlled clinical trial was to determine the effect of the omega-3 fatty acid supplementations 300 mg per day for 8 weeks on the serum levels of ACE/ACE2 ratio in Jordanian participants with vitamin D deficiency (VDD). Methods: The physical and clinical characteristic of individuals in both intervention and control randomized controlled clinical trial were measured and analyzed. The comparisons between the two groups and the changes in each group before and after taking omega-3 doses were studied through independent t test and paired t test, respectively. Possible factors that have a role in the changes were determined by multivariate stepwise regression. Follow-up period lasted 10 weeks. Results: The sample consisted of 82 participants with VDD and a mean age of 37.85 ± 9.85 years. Omega-3 Supplements resulted in a significant decrease in serum ACE levels, ACE/ACE2 ratio and serum 25-hydroxy vitamin D (25OHD). While the change in serum ACE2 levels and serum triglycerides levels were insignificant. Also, a significant increase in serum LDL levels were observed. Conclusion: It is possible that taking high doses of omega-3 fatty acid supplementations have positive effects on the heart and circulatory system and could protect from COVID-19 or decrease disease severity, in connection with a decrease in the ACE/ACE 2 ratio. On the other hand, omega-3 supplement may have negative effect on cardiovascular system due to the significant increase in serum LDL levels.

Tourism supply chains: Issues and resilience strategies during the global pandemic

Covid-19 related border restrictions and national lockdowns have challenged the overall resilience of hotel supply chains in New Zealand due to the industry's over-reliance on international tourists. Using case study research methodology, this study interviewed 13 hotel managers in Akaroa, a famous tourist destination located near Banks Peninsula in the South Island of New Zealand. This study has revealed that the major objectives for these supply chains were related to surviving and maintaining breakeven during the lockdown periods (March 2020 and August 2021). Significantly, during these restrictions, most of the interviewed hotels streamlined their internal operations and focused on building better relationships with their network partners. Having an extensive network structure, and the help of key government organisations like Tourism NZ (who shared information and created targeted marketing campaigns focused on attracting domestic tourists), enabled these supply chains to bounce back relatively quickly. While managers faced many challenges but the key challenge was demand management as the relationship with online suppliers (booking.com) was deteriorating. Suppliers and other service providers for these hotels also found themselves in a difficult position (due to Covid-19 related restrictions) that further worsened the situation. By modifying their products and services, adjusting their prices, utilising local suppliers, diversifying their customer bases, and coordinating with tour operators in the region, these hotel supply chains were able to quickly recover and today, show further signs of improvement. © The Author(s) 2022.

The Impact of COVID-19 on Cancer Recurrence: A Narrative Review.

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) continues to be a worldwide healthcare problem. While our knowledge of the interaction of cancer and its management with COVID-19 mortality is gradually evolving, there are still many unanswered questions regarding the impact of COVID-19 on cancer and its prognosis. Several factors activated during COVID-19 have been implicated in tumorigenesis and the development of metastasis. Inflammation, hypoxia, reduced levels of angiotensin converting enzyme 2, elevated levels of Interleukin 6 and some other cytokines that are hallmarks of COVID-19 are capable of inducing tumor relapse and metastasis. On the other hand, there are reports that COVID-19 has been associated with cancer cure. Understanding the interaction between COVID-19 and tumor cells is essential for evaluating the potential long-term risks of COVID-19 in cancer patients, and for scheduling necessary preventive and therapeutic interventions. In this review, we briefly overview the potential impacts that COVID-19 might have on tumorigenesis and cancer relapse, as well as the role that COVID-19 might play in cancer remission and cure.

Modeling social interaction and metapopulation mobility of the COVID-19 pandemic in main cities of highly populated Java Island, Indonesia: An agent-based modeling approach

IntroductionCoronavirus transmission is strongly influenced by human mobilities and interactions within and between different geographical regions. Human mobility within and between cities is motivated by several factors, including employment, cultural-driven, holidays, and daily routines. MethodWe developed a sustained metapopulation (SAMPAN) model, an agent-based model (ABM) for simulating the effect of individual mobility and interaction behavior on the spreading of COVID-19 viruses across main cities on Java Island, Indonesia. The model considers social classes and social mixing affecting the mobility and interaction behavior within a sub-population of a city in the early pandemic. Travelers' behavior represents the mobility among cities from central cities to other cities and commuting behavior from the surrounding area of each city. ResultsLocal sensitivity analysis using one factor at a time was performed to test the SAMPAN model, and we have identified critical parameters for the model. While validation was carried out for the Jakarta area, we are confident in implementing the model for a larger area with the concept of metapopulation dynamics. We included the area of Bogor, Depok, Bekasi, Bandung, Semarang, Surakarta, Yogyakarta, Surabaya, and Malang cities which have important roles in the COVID-19 pandemic spreading on this island. DiscussionOur SAMPAN model can simulate various waves during the first year of the pandemic caused by various phenomena of large social mobilities and interactions, particularly during religious occasions and long holidays.

Pediatric ovarian torsion: A diagnostic challenge in covid-19 times

Ovarian torsion is a rare gynecological emergency in children and an early surgical intervention is needed to salvage the ovary. Herein, we present a case of eight year old girl who presented with complaints of lower abdominal pain during ongoing COVID-19 pandemic. She was diagnosed as a case of ovarian torsion on right side. She underwent exploratory laparotomy and ovarian cystectomy was performed. Delay in diagnosis and treatment of ovarian torsion may have grave consequences, resulting in functional loss of the ovary. Copyright © 2020, Kathmandu University. All rights reserved.

Perceptions and engagement of Klang Valley urbanites on COVID-19 PSAs during the pandemic

Since the start of the COVID-19 pandemic, rampant misinformation about the virus has created large-scale panic and uneasiness among the Malaysian public. In response to this threat, the Malaysian government launched public service announcements (PSAs) on COVID-19 in various media to increase public awareness and knowledge, specifically on recommended solutions. The messages in the PSAs were tailored to underscore the various phases of the pandemic to persuade public belief as well as nurture positive attitude and behavioural changes. The objectives of this study are: (1) to investigate the public's information-seeking behaviours, (2) to investigate user perceptions and indicators of PSAs, and (3) to determine the effectiveness of PSAs as a communication platform to convey important information about the pandemic throughout the different Movement Control Order (MCO) phases. Through focus group discussions with eight urban Klang Valley informants, findings highlight the crucial elements in identifying motivation and factors of media preferences which affect how various media platforms benefit the Malaysian public. The findings also illustrate the need for the government to ensure that the content and context of the PSAs meet the audiences' demographics in ensuring effective dissemination of information and awareness during a pandemic. © SEARCH Journal 2022.

Is Virtual Learning Here to Stay? A Multispecialty Survey of Residents, Fellows, and Faculty.

The transition to virtual learning during the coronavirus disease 2019 pandemic marks a paradigm shift in graduate medical education (GME). From June to September 2021, we conducted a dual-center, multispecialty survey of residents, fellows, and faculty members to determine overall perceptions about virtual learning and assess its benefits, drawbacks, and future role in GME. We discovered a mainly positive view of virtual education among trainees (138/207, 0.67, 95% CI 0.59-0.73) and faculty (180/278, 0.65, 0.59-0.70). Large group sessions, such as didactic lectures, grand rounds, and national conferences, were ranked best-suited for the virtual environment, whereas small groups and procedural training were the lowest ranked. Major benefits and drawbacks to virtual learning was identified. A hybrid approach, combining in-person and virtual sessions, was the preferred format among trainees (167/207, 0.81, 0.75-0.86) and faculty (229/278, 0.82, 0.77-0.87). Virtual learning offers a valuable educational experience that should be retained in postpandemic GME curriculums.

Detecting Students' Behavior on the E-Learning System Using SVM Kernels - Based Ensemble Learning Algorithm

The corona pandemic has changed learning methods from face-to-face to online. However, the application of online learning creates difficulties for teachers in monitoring student behavior because of the reduced direct interaction. This problem causes the learning process to be less optimal. Moreover, students may fail to achieve learning objectives. This research addresses this problem by building a model to detect student behavior in this online learning. It focuses on finding an optimal model by exploring the ensemble learning-stacking method based on a combination of SVM kernels (Linear, Polynomial, RBF, Sigmoid). After the model was built, it was evaluated using two performance measurement techniques, namely: cross-validation and percentage split, and several performance measures, namely: AUC, Accuracy, F1, Precision, and Recall. The evaluation results show the superiority of the models applying ensemble learning over those without it. In terms of accuracy, the highest result in the cross-validation technique is 98.4%, achieved by three models employing stacking. Those three are with base learners combination of linear-polynomial-sigmoid kernel (LinPolSig_Stack), a combination of linear-RBF-sigmoid kernel (LinRBFSig_Stack), and a combination of all kernels-linear, polynomial, RBF, sigmoid (AllKernels_Stack). In the percentage split technique, the highest performance is 97.4%, achieved by two models implementing ensemble learning-stacking with base-learners combination of RBF-sigmoid kernel (RBFSig_Stack) and combination of linearpolynomial-sigmoid kernel (LinPolSig_Stack). Finally, the highest performance of these models is equivalent to the minimum error in detecting student behavior. Detection errors were only three students in the three models in the cross-validation technique and only six in the two models in the percentage split technique. © 2023, International Journal of Intelligent Engineering and Systems. All Rights Reserved.

Impact of deepfake technology on FinTech applications

The distribution of fabricated disinformation through deliberate manipulation of audio/video content by imposters with the intent to affect organization is deepfake. The "infodemic" that spread alongside the COVID-19 pandemic also increased cyber risk in financial technology (FinTech) applications. The continuous evolution of cybercrime has culminated with deepfakes which severely magnify the threats of traditional frauds. Recent evidence indicates that deepfake videos are mainly created with the help of artificial intelligence (AI) or machine learning (ML) techniques. This results in creation of fake videos by merging, superimposing, and replacing actual video clips and images with other videos. There are a lot of people who accept deepfake videos as actual videos without any doubt. The use of AL and ML techniques have made video/image forgery difficult to identify with the help of existing deepfake detection techniques. Deepfake technology is becoming more and more sophisticated, and detection of fake videos is relatively challenged for quite some time. © 2023, IGI Global.

COVID-19 effect on patients with noncommunicable diseases: A narrative review.

Background and Aims: On March 11, 2020, the WHO has declared COVID-19 a global pandemic, affecting our day-to-day lives. Physical distancing and lockdown made significant obstacles to populations, particularly healthcare systems. Most healthcare workers were reallocated to COVID-19 facilities. Noncommunicable disease patients were given low priority and are at a higher risk of severe COVID-19 infection, which disrupted the treatment and disease management of these patients. This review aimed to assess the effect of COVID-19 on different types of noncommunicable diseases and the severity it may cause to patients. Methods: We have conducted a review of the literature on COVID-19 and noncommunicable diseases from December 2019 until January 2022. The search was done in PubMed and Cochrane for relevant articles using variety of searching terms. Data for study variables were extracted. At the end of the selection process, 46 papers were selected for inclusion in the literature review. Result: The result from this review found that the COVID-19 pandemic has affected the efficiency of the patient's treatment indirectly by either delaying or canceling sessions, which solidified the need to rely more on telemedicine, virtual visits, and in-home visits to improve patient education and minimize the risk of exposure to the patients. The major and most common types of noncommunicable diseases are known to be related to the severe outcomes of COVID-19 infection. It is strongly recommended to prioritize these patients for vaccinations against COVID-19 to provide them with the protection that will neutralize the risk imposed by their comorbidities. Conclusion: We recommend conducting more studies with larger population samples to further understand the role of noncommunicable diseases (NCDs) in this pandemic. However, this pandemic has also affected the efficiency of NCDs treatment indirectly by delaying or canceling sessions and others.

Evaluation of the prevalence of illness anxiety disorder following the COVID‐19 pandemic in Iran and its related factors: a cross‐sectional study

Background and Aims COVID‐19 pandemic has generated a rise in psychological distress, such as illness anxiety disorder, apart from its negative physical effects. This study intends to the evaluation of illness anxiety disorder rate following the prevalence of COVID‐19 in Iran and its associated factors. Methods In this study, 634 people were studied. The data collection method was performed via the virtual networks using a questionnaire, with the sampling method being convenient and nonprobable with the method of snowball. Evans illness anxiety disorder questionnaire was utilized in this investigation. The logistic regression model and the χ2 were used to evaluate the data. Results The prevalence of illness anxiety disorder was 12.1%. The chance to have an illness anxiety disorder in the people whose relatives had a history of COVID‐19 was 5.32 times, and in those who had a relative with a history of COVID‐19 had higher (odds ratio = 1.27). But, this connection in people who worked or studied in nonmedical fields, is several times more than those who are busy in the medical fields. In individuals of 30 years and older, the chance of patients in single people compared to married people was 5.20 times higher, but under the age of 30 years, the chance of illness anxiety disorder in single people was 0.91. Conclusion COVID‐19 pandemic, also to the physical effects, may have psychological implications for people. Therefore, reducing the individual and social activities in terms of this disease, along with measures related to physical problems, diagnosis, timely treatment and proper psychological consequences, including illness anxiety disorder can be very fruitful.

Information and Communications Technology (ICT) as a Teaching and Learning Tool: A Study of Students' Readiness and Satisfaction

Students and academics in higher education institutions (HEIs) were perilously hit by the unparalleled changes due to the COVID-19 pandemic. Within a span of less than a month, teaching and learning activities were shifted online to warrant continuity. This study intends to probe the online learning readiness and satisfaction among university students within the scope of students' prior ICT knowledge and the university's ICT infrastructure. This study employs a quantitative approach with a questionnaire as the research instrument. A sample size of 1,692 Sunway University students in the Ministry of Education (MOE) General Studies subjects were chosen. The data were analysed descriptively, and the results revealed that students are generally ready for online learning, and they are satisfied with the ICT amenities provided. As a result, both students and Sunway University are wellprepared, with the major implication that student preparation and satisfaction, as well as infrastructures, are critical to scaffold the accelerated transition in the use of online learning. ©Authors.

A comprehensive clinical guide for Pneumocystis jirovecii pneumonia: a missing therapeutic target in HIV-uninfected patients.

INTRODUCTION: Pneumocystis jirovecii is an opportunistic, human-specific fungus that causes Pneumocystis pneumonia (PCP). PCP symptoms are non-specific. A patient with P. jirovecii and another lung infection faces a diagnostic challenge. It may be difficult to determine which of these agents is responsible for the clinical symptoms, preventing effective treatment. Diagnostic and treatment efforts have been made more difficult by the rising frequency with which coronavirus 2019 (COVID-19) and PCP co-occur. AREAS COVERED: Herein, we provide a comprehensive review of clinical and pharmacological recommendations along with a literature review of PCP in immunocompromised patients focusing on HIV-uninfected patients. EXPERT OPINION: PCP may be masked by identifying co-existing pathogens that are not necessarily responsible for the observed infection. Patients with severe form COVID-19 should be examined for underlying immunodeficiency, and co-infections must be considered as co-infection with P. jirovecii may worsen COVID-19's severity and fatality. PCP should be investigated in patients with PCP risk factors who come with pneumonia and suggestive radiographic symptoms but have not previously received PCP prophylaxis. PCP prophylaxis should be explored in individuals with various conditions that impair the immune system, depending on their PCP risk.