Loss of Bifidobacteria in Lyme Disease: Cause or Effect

Introduction: Lyme disease is a poorly understood condition which starts with a rash but may continue with chronic fatigue and neurological symptoms. Approximately 1 in 5 early Lyme disease patients have GI symptoms, such as nausea, anorexia, abdominal pain, or diarrhea. Lyme disease is thought to be cased by microbes in the spirochetes phylum transmitted by black legged ticks. Lyme-related healthcare costs in America exceed 1.3 billion dollars annually. Bifidobacteria are known for their beneficial probiotic actions within the human gut microbiome. Their numbers are reduced in severe COVID-19, Clostridioides difficile infection and Inflammatory Bowel Disease. To our knowledge Bifidobacteria levels have not been studied in Lyme disease patients. Given the importance of Bifidobacterium abundance in other diseases, we focused on relative abundance of Bifidobacterium in fecal samples of patients with Lyme disease compared to controls. Method(s): Fecal samples were assessed for relative abundance of Bifidobacterium in Healthy Control subjects without Lyme disease (n=20) compared to patients with Lyme disease (n=39). The average symptom duration in patients with Lyme disease was 5 years and none were on antibiotics 2 weeks prior to sample collection (range of symptoms from 1 month to 20 years, all treated initially with antibiotics).Metagenomics Next Generation sequencing was performed on fecal samples, where DNA samples were extracted and normalized for library downstream analysis using Shotgun Methodology. Mann- Whitney Statistical test was used for comparison. This study was IRB approved. Result(s): Relative Abundance of bifidobacteria was significantly decreased (p< 0.0001) in patients with Lyme disease. Median and interquartile range (IQR) were: Control (Median:4.175%;IQR:1.72-10.27%) and Lyme disease (Median:0.0014%;IQR:0.00%-0.96%)(Figure). 30/39 Lyme disease patients (77%) were found to possess < 1% relative abundance of Bifidobacterium in their stool sample. Of interest only 1/39 samples showed presence of Spirochetes in stool samples. Conclusion(s): This is the first study that demonstrates low levels of Bifidobacteria in patients with chronic Lyme disease. These results raise three questions;whether the disease was caused by 1. the original microbe creating loss of Bifidobacterium 2. baseline low Bifidobacteria due likely to either diet or medications or 3. excessive treatment. Given Lyme disease comprises a gut dysbiosis issue, therapies should also aim at restoration of depleted Bifidobacteria. (Figure Presented).

Prospectively Assessed Long-Term Outcomes of Patients with E-Cigarette- or Vaping-associated Lung Injury.

Rationale: E-cigarette- or vaping-associated lung injury (EVALI) was first identified in 2019. The long-term respiratory, cognitive, mood disorder, and vaping behavior outcomes of patients with EVALI remain unknown. Objectives: To determine the long-term respiratory, cognitive, mood disorder, and vaping behavior outcomes of patients with EVALI. Methods: We prospectively enrolled patients with EVALI from two health systems. We assessed outcomes at 1 year after onset of EVALI using validated instruments measuring cognitive function, depression, anxiety, post-traumatic stress, respiratory disability, coronavirus disease (COVID-19) infection, pulmonary function, and vaping behaviors. We used multivariable regression to identify risk factors of post-EVALI vaping behaviors and to identify whether admission to the intensive care unit (ICU) was associated with cognitive, respiratory, or mood symptoms. Results: Seventy-three patients completed 12-month follow-up. Most patients were male (66.7%), young (mean age, 31 ± 11 yr), and White (85%) and did not need admission to the ICU (59%). At 12 months, 39% (25 of 64) had cognitive impairment, whereas 48% (30 of 62) reported respiratory limitations. Mood disorders were common, with 59% (38 of 64) reporting anxiety and/or depression and 62% (39 of 63) having post-traumatic stress. Four (6.4%) of 64 reported a history of COVID-19 infection. Despite the history of EVALI, many people continued to vape. Only 38% (24 of 64) reported quitting all vaping and smoking behaviors. Younger age was associated with reduced vaping behavior after EVALI (odds ratio, 0.93; P = 0.02). ICU admission was not associated with cognitive impairment, dyspnea, or mood symptoms. Conclusions: Patients with EVALI, despite their youth, commonly have significant long-term respiratory disability; cognitive impairment; symptoms of depression, anxiety, post-traumatic stress; and persistent vaping.

Challenges faced by teaching staff during virtual learning Coronavirus Disease 2019: A narrative review

The worldwide economy has been severely damaged by the coronavirus disease 2019 (COVID-19) outbreak. The education system is not shielded from the harmful impacts of lockdown, especially in South Asia. Schools and institutions have been forced to close permanently as a result, and traditional classroom instruction is being quickly replaced by online learning. This study is topical in that it explores teachers' perceptions of online instruction and the difficulties they face when doing so during the pandemic in light of recent developments. A search of electronic databases with a specific goal in mind to find literature;a quest for reliable summaries, various sources, including books, have detailed conceptual and theoretical studies, handbooks, and gray literature;we took a look at what social experts have been working to discover the parameters that allow challenges faced by teaching staff during virtual learning. A literature search was done systematically of various journal indexes such as PubMed, Embase, Google Scholar, and others. The study's findings demonstrate that, on average, teachers believe virtual education is a smart option for reducing the learning gap and shaping students' futures during the crisis, during COVID-19. Despite this, they ran into a number of roadblocks and other issues. The educational institution's management should provide sufficient training on learning software to teachers, allowing them to successfully instruct and lead students. © 2022 Journal of Datta Meghe Institute of Medical Sciences University ;Published by Wolters Kluwer-Medknow.

Role and importance of effective communication during the age of COVID-19

Currently, in the COVID-19 pandemic, few nations have effectively diminished their contamination rate early, while others have been overpowered. There are various reasons behind effective decrease in the rate of contamination in different nations but,the one that stands out is the distinguished rate which decides on how the information has been provided by the government and other networks and its effective adaptation and implementation by the public. This global disease has disturbed people psychologically;henceforth, effective communication, if overlooked, can be endangered for susceptible populations. Herein, this article gives an insight view of the basic structure for effective communication during the pandemic which should be understandable and practiced by the medical and dental experts and other health-care workers for developing a good rapport for treating COVID-19 patients. Effective communication aims at providing information to the public that may seem senseless at first instance, as well as aims at increasing their self reliance to react on the details they have that may also be beneficial. To develop a way for preventing and controlling future viral illnesses, especially those as dangerous as COVID-19, we need to move forward by building trust and developing multidisciplinary voices which help in utilizing effective communication for various objectives and audiences, so that clear, compassionate, and practical messages can be delivered. © 2022 Journal of Datta Meghe Institute of Medical Sciences University ;Published by Wolters Kluwer-Medknow.

Dyes and Pigments: Interventions and How Safe and Sustainable Are Colors of Life!!!

We are fond of varied colors and they are strongly bonded in our life. In most cases, even a child looks eagerly for colorful toys, bottles and with passage of time desire to have attractive textiles to psychological imprints for colorful life with individual perceptions. Thus, dyes and pigments are integral part of our civilization and documented since prehistoric days. They may be classified as natural and synthetic, application or solubility based with continual efforts to have best combinations. There is growing demand as well as concern over the adverse implication of synthetic colorants on both the consumer, environment, ecosystem and thus need for safe, nontoxic, sustainable coloring alternatives have increased multifold for varied applications in food additives, cosmetics, textiles, pharmaceuticals, packaging, automobiles, defense sectors, etc. They may be amine, nitro, Sulfur based azodyes, or others with established reports on usage at levels above than the permissible regulatory limits. The usage of bacterial and fungal biobased pigments is increasing gradually due to advantages over the synthetic pigments. They are preferred because of simple culturing, pigment extraction procedures, ease of scale-up, and economic viability in less time amidst few limitations. Liposome-dependent innovative pathways may be potential to meet the demand of next generations and developing cost-effective, environment-friendly biobased products with economical feasibility in a time bound manner. For effective decision-making in terms of market share, it is necessary to address market intelligence, consider Covid-19 or similar impacts for assessing the market trends, forecast, and human behavior for comprehensive scientific mapping. The strict implementations of updated holistic, industry-driven standards with compliances to international norms are vital from safety and quality perspective. We must strategically solve environmental issues faced by the current markets as a challenge and safeguard the environment for future generations. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Social Determinants of Health and Biochemical Alcohol Relapse in Alcohol-Associated Liver Disease

Purpose: Alcohol use after liver transplant is associated with higher rates of graft loss and increased mortality;however, there is limited data regarding the factors that influence biochemically confirmed relapse. We aimed to evaluate the association between social determinants of health (SDOH) and biochemical alcohol relapse in patients who have been transplanted for alcohol-associated liver disease (ALD). Method(s): This single-center, retrospective cohort study examined patients with ALD who were transplanted between 2018-2021. The primary outcome was biochemical alcohol relapse as measured by systematic phosphatidylethanol (PEth) testing. SDOH including race, ethnicity, income, employment, social support, education level, public vs private health insurance, mental health comorbidities, and comorbid illicit substance use were assessed for their association with the outcome using logistic regression analyses. Additionally, temporal trends in biochemical relapse related to the Covid-19 pandemic were evaluated using a cut point of April 2020 to differentiate between pre-pandemic and pandemic groups. Result(s): Seventy-five patients were transplanted for ALD over the study period, of whom 71 had biochemical PEth measurements (95%). Of these 71 patients, 21% were female with a mean (+/-SD) age of 52.9 (+/-10.4) years and 49% of the study population identified as Hispanic ethnicity. At the time of transplant listing, 73% were unemployed, 65% had public insurance, and 62% were married or had a stable co-companion. Over 64 person-years of follow up, 10 (15%) patients had biochemical relapse after transplant. Older age was protective OR=0.94 (95% CI 0.88-0.99;p=0.05), while non-Hispanic white race OR=6.29 (95% CI 1.22-32.51;p=0.03), and prior illicit substance use OR=4.2 (95% CI 1.05-16.90;p=0.04) were associated with an increased risk of relapse. Patients identifying as non-Hispanic white had non-significant trends toward lower household income, decreased social support, and higher rates of comorbid mental illness. Severe acute alcohol hepatitis, time from last drink to listing, SIPAT and AUDIT score were not associated with increased risk of relapse. The risk of relapse increased during the Covid-19 pandemic from 4.3% pre-Covid-19 to 18.8% during Covid-19 with a trend towards statistical significance OR=5.1 (95% CI 0.60-42.8;p=0.13). Conclusion(s): Non-Hispanic white race, younger age, and illicit substance use were associated with increased rates of biochemical alcohol relapse and may be explained by SDOH;however, conventional metrics including >6 months from last drink to listing and lower SIPAT score were not predictive of biochemical relapse.

Continuum of care through patient relationship management approach in Indian public healthcare system

Patient relationship management is a system-designed strategy for healthcare that has the potential to improve patient satisfaction while also lowering healthcare costs. The main goals of this concept are to create an effective referral model that provides a continuum of care while managing patient relationships with a cutting-edge digital healthcare system that manages a patient's healthcare data, to keep track of people's healthcare needs and develop a healthcare referral model, to provide effective and timely care by continuous follow-up, involving patient relationship management in the public healthcare system, and to develop a new healthcare delivery model. The application of digital solutions to health systems can help address constraints that have hindered the optimal delivery of equitable and high-quality care. © 2022 Elsevier Inc. All rights reserved.

Evaluating the Endothelial Impairments in COVID-19 Patients Using Near-Infrared Spectroscopy: the HEMOCOVID-19 trial

HEMOCOVID-19 is a multi-center trial aiming to assess the microvascular and endothelial health of severe COVID-19 patients in the intensive care using near-infrared spectroscopy. Here, we present the preliminary results, showing that peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome. © 2022 The Author(s).

PERSONAL AND PROFESSIONAL DEVELOPMENT DURING THE COVID-19 PANDEMIC: A QUALITATIVE EXPLORATION OF MEDICAL STUDENT EXPERIENCES

BACKGROUND: Understanding the impact of challenges and uncertainty due to the COVID-19 pandemic is critical to supporting US medical students' learning. The objective of this qualitative study was to gather perspectives from US medical students about stressors, tensions, and lessons learned during the pandemic. We were specifically interested in how these factors impacted personal and professional development. Additionally, we aimed to collect feedback about how undergraduate medical institutions can support their students. METHODS: Qualitative data was collected through semi-structured, one-onone telephone interviews. Interested students were recruited from 3,826 students who took a part in our previous online survey on burnout, stress, and loneliness during the early pandemic (May-July 2020). Interviews were conducted between February and June 2021. Open coding and thematic content analysis were performed using Atlas. TI software. RESULTS: Forty-four interviews were conducted with students from 22 US medical schools. Overall, 106/450 (24%) responded to the invitation to participate. 44 interviews were completed, ranging between 25-72 minutes in length, Most respondents were female (75%), white (77%), and third years (39%). Major themes centered around student responsibilities (e.g. personal, professional, societal), navigating tensions (e.g. personal risk vs. professional responsibilities, COVID-precaution conflicts), professional identity formation (e.g. commitment to medicine, caring for COVID patients) and stressors (e.g. academic, personal), emotional responses (e.g. mental health challenges) and lessons learned (e.g. examining priorities, adaptability). Student responsibilities included volunteering, patient-care, activism, public health education, and familial obligations. Tensions experienced centered around ethical concerns and prioritizing competing responsibilities. Additional findings centered on suggested resources to support student development, which included enhanced support mechanisms (e.g. structured reflection, mental health support) and recommendations for schools (e.g. clear communication, flexible policies). CONCLUSIONS: Undergraduate medical institutions should support their students through the COVID-19 pandemic and support positive personal and professional development. Medical students recommend that institutions prioritize transparent communication regarding ongoing changes in policies and curriculum. Participants also recommended giving students choices in caring for COVID patients and remaining in clinical roles. This fits into a general theme of the importance of giving students' flexibility to prioritize what is best for their own learning, safety, and wellbeing. Finally, students emphasized the importance of accessible mental health support that continues beyond the COVID-19 pandemic.

The Role of Oral Health in the Acquisition and Severity of SARS-CoV-2: A Retrospective Chart Review.

Objective: Studies have shown that gingival crevices may be a significant route for SARS-CoV-2 entry. However, the role of oral health in the acquisition and severity of COVID-19 is not known. Design: A retrospective analysis was performed using electronic health record data from a large urban academic medical center between 12/1/2019 and 8/24/2020. A total of 387 COVID-19 positive cases were identified and matched 1:1 by age, sex, and race to 387 controls without COVID-19 diagnoses. Demographics, number of missing teeth and alveolar crestal height were determined from radiographs and medical/dental charts. In a subgroup of 107 cases and controls, we also examined the rate of change in alveolar crestal height. A conditional logistic regression model was utilized to assess association between alveolar crestal height and missing teeth with COVID-19 status and with hospitalization status among COVID-19 cases. Results: Increased alveolar bone loss, OR = 4.302 (2.510 - 7.376), fewer missing teeth, OR = 0.897 (0.835-0.965) and lack of smoking history distinguished COVID-19 cases from controls. After adjusting for time between examinations, cases with COVID-19 had greater alveolar bone loss compared to controls (0.641 ± 0.613 mm vs 0.260 ± 0.631 mm, p < 0.01.) Among cases with COVID-19, increased number of missing teeth OR = 2.1871 (1.146- 4.174) was significantly associated with hospitalization. Conclusions: Alveolar bone loss and missing teeth are positively associated with the acquisition and severity of COVID-19 disease, respectively.

JLSC Board Editorial 2021

It hardly needs to be said that 2020 was a difficult year for the world. COVID-19 has infected over 120 million people and killed over 2 million as of March 2021 (Johns Hopkins). At the same time, police violence against people of color continues, even as communities engage in long-overdue reckoning initiatives. Across the globe, researchers, governments, and communities needed quick, open, up-to-date information on testing for, treating, and preventing COVID-19. Our increased dependence on technology during lockdowns provided some with safety and continuity, while others experienced the widening of the digital divide. There is no greater urgency than the work of identifying and addressing issues of inequality and lack of equity and inclusivity. Although the results remain to be seen, the field of scholarly communications experienced disruption in 2020. The editorials below discuss these recent changes and imagine what could come out of the pandemic. We hope that these reflections invite conversation and action.

HEMOCOVID-19 Study: An International Clinical Study to Evaluate Microvascular and Endothelial Impairments in Severe COVID-19 Patients Using Near-Infrared Spectroscopy

We present the HEMOCOVID-19 study spanning four countries and eight hospitals where near-infrared spectroscopy is utilized to evaluate microvascular and endothelial health of severe COVID-19 patients at the intensive care. © 2021 SPIE. All rights reserved.

RACIAL AND GENDER DISPARITIES EXIST IN INFLUENZA VACCINATION RATES AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE

INTRODUCTION Immunosuppressive therapies used to treat inflammatory bowel disease (IBD) are associated with an increased risk of infections, including vaccine-preventable diseases (VDP). Though patients with IBD have lower vaccination rates than the general population, no studies have assessed whether there are disparities in vaccination rates among patients with IBD. Determining if these disparities exist is of importance to assure high uptake of the a COVID-19 vaccine. The aim of this study was to determine if racial or ethnic disparities existed in immunization rates among patients with IBD at two tertiary referral medical centers. METHODS This was a retrospective case control study of patients with IBD at two tertiary referral IBD centers which included urban and rural patients. Patients who were 18 years or above and were seen in IBD clinic between 09/2019 and 02/2020 immunization rates. Each patient needed an active record in the Wisconsin Immunization Registry, which has very high rates of immunization documentation and is close to a comprehensive immunization record. For each patient, the WIR was accessed to obtain immunization data for pneumococcal 13 (PCV13), pneumococcal 23 (PPSV23) and influenza. Data analysis involved a Pearson’s chi-squared test for categorical variables. RESULTS In total 1968 patients with IBD were included in the study. Demographics are in Table 1. Average age was 46.8 years. 53% patients were female and 47% were male. 90.7% were White and 6.3% were Black. There was no significant difference between the number of female vs male patients. Black patients had significantly lower rate of influenza vaccination rates than white patients in for two influenza seasons (2019-2020, 2018-2019). (Table 2) There was no difference in pneumococcal immunization rates among the groups. Female patients had a significantly higher rate of influenza vaccination rates than male patients for each season. (Table 3) CONCLUSION This is the first study to demonstrate racial and gender disparities in influenza vaccination rates among patients with IBD. Future studies are needed to determine causes for and strategies to remediate racial and gender disparities in immunization rates. Identifying these barriers is imperative especially since certain ethnic and racial groups are at increased risk for a COVID illness and may display vaccine hesitancy. Efforts to ensure all patients with IBD have high uptake for COVID 19 vaccines is essential.(Table presented)

Preliminary findings on patient satisfaction with telepsychiatry-a systematic review

Introduction: During the COVID-19 pandemic, mental health services have been presented with the unique challenge of providing effective and safe patient care whilst maintaining safety regulations. Telepsychiatry has emerged as a potential solution to this and is now being used across the UK to diagnose and manage mental health conditions. Evidence has shown that its effectiveness is comparable to face to face consultations, however, is much less clear regarding patient satisfaction. We therefore initiated a systematic review to establish whether patients are satisfied with tele-delivery of psychiatric care, and to identify the predictors of a positive experience with telepsychiatry. Methods: A preliminary search was performed using five databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO), with a date restriction between 2010-2020 to reflect advances in technology over the past decade. Results: Preliminary data shows that patient views on telepsychiatric services are largely positive. Factors that arose in literature potentially affecting this include location, cost, privacy, digital literacy and technological issues including audio/video quality. Conclusion: Our study so far shows that patient views on telepsychiatry are generally positive. The review is still in process, however, we anticipate that it will only further support our preliminary findings. These findings will be used to improve patient-centred delivery and provision of telepsychiatric services. We intend to produce a checklist of factors affecting patient satisfaction and test this in a national multicentre study. We are hoping that the study results and the resulting checklist will encourage greater patient involvement in setting up and delivering telepsychiatric services.

Integrated analysis of plasma and single immune cells uncovers metabolic changes in individuals with COVID-19.

A better understanding of the metabolic alterations in immune cells during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may elucidate the wide diversity of clinical symptoms experienced by individuals with coronavirus disease 2019 (COVID-19). Here, we report the metabolic changes associated with the peripheral immune response of 198 individuals with COVID-19 through an integrated analysis of plasma metabolite and protein levels as well as single-cell multiomics analyses from serial blood draws collected during the first week after clinical diagnosis. We document the emergence of rare but metabolically dominant T cell subpopulations and find that increasing disease severity correlates with a bifurcation of monocytes into two metabolically distinct subsets. This integrated analysis reveals a robust interplay between plasma metabolites and cell-type-specific metabolic reprogramming networks that is associated with disease severity and could predict survival.