Successful ECMO course in an Acquired Immune Deficiency Syndrome (AIDS) patient with ARDS complicated by pneumocystis jirovecii pneumonia and COVID-19: A unique case

Objectives: Reviewing current literature and case reports of patients placed on Venous-Venous ECMO support for HIV and AIDS, with confection with Pneumocystis pneumonia and covid-19 pneumonia. The use of extracorporeal membrane oxygenation (ECMO) in patients who have acute respiratory distress syndrome has been shown to have very good outcomes. However, there is limited data to support the initiation of ECMO in patients who have human immunodeficiency virus infection with or without acquired immune deficiency syndrome. Method(s): We present a unique and challenging case of a 30 year old male, with no known past medical history, unvaccinated against covid-19, who presented with one week of progressive shortness of breath. On admission he was found with moderate bilateral infiltrates and was diagnosed with covid-19 pneumonia. Despite appropriate medical therapy, patient developed worsening hypoxic respiratory failure. Found to have elevated (1- 3)-7beta;-d-glucan and tested positive for HIV. CD4 count 11, HIV viral load 70,000. The patient remained severely hypoxemic despite mechanical ventilation, sedation, paralytics and proning. Venous venous extracorporeal membrane oxygenation was initiated. Considering his non improvement with variety of antivirals and antibiotics and with elevated (1-3)-7beta;-d-glucan in the setting of AIDS he was treated for presumed Pneumocystis pneumonia. The patient tolerated proning while on VV ECMO and his course was complicated with bilateral pneumothorax necessitating chest tube placement. Result(s): The patient successfully completed 64 days on VV ECMO, where he was treated for PCP pneumonia, covid pneumonia, CMV viremia and tolerated initiation of anti-retroviral therapy. Patient was successfully decannulated, and ultimately discharged from the hospital. Conclusion(s): VV-ECMO can be a beneficial intervention with successful outcomes in severely immunocomprimised patients with AIDS. This case highlights the importance of minimizing sedation and early mobilization on ECMO support. (Figure Presented).

Cystic fibrosis mental health research priorities: Qualitative content analysis of cystic fibrosis community and provider survey

Background: Mental health is among the top three research priorities of the CF community [1]. In 2020-21, the Cystic Fibrosis Foundation Mental Health Research Prioritization Working Group met to designate areas of focus for CF mental health research [2]. To elicit broad input to inform this work, a mixed-methods study was conducted. In June 2020, a 22-item survey was sent via email and social media to CF health care providers, people with CF, family caregivers, and other CF community members. We aimed to analyze qualitative content to add depth to quantitative findings. Method(s): Three hundred fifty-two providers and 693 community members completed the survey, which included three open-ended questions: Q1) When thinking about research topics specific to mental health, where are the current gaps in knowledge that should be prioritized for future research? Q2) Is there anything else regarding mental health and the needs of the community you would like to share? Q3) Considering the impacts of the COVID-19 pandemic, are there additional mental health topics that are (Figure Presented) Figure 1.: Cystic fibrosis (CF) mental health research priorities of all respondents according to frequency. Overarching top-line categories and general codes for open-ended survey responses of CF health care providers, people with CF, family caregivers, and other CF community members not covered by the survey questions? Reponses containing more than one main idea were subdivided into topic-specific codable items. For Q1 and Q2, a codebook guided hierarchical placement of each item into an overarching top-line category with corresponding general code and, if applicable, one or more specific codes and populations or settings. A simplified process designated only one major theme per item for Q3. Three teams of one CF researcher and two CF community members coded the first 20% of their assigned items by consensus and then worked in pairs to independently double code the remaining 80%. Two-sided t-tests were adjusted with the Bonferroni correction using a significance level of less than 0.1. Result(s): One thousand three hundred ninety-one provider items and 1638 community items were coded for Q1 and Q2, and 565 provider and 323 community items were coded for Q3. Strong inter-rater agreement was obtained across coding dyads (71-90%). For Q1 and Q2, the most common top-line priorities were mental health conditions;living with CF;screening, assessment, and intervention;systems-level barriers and facilitators;and effects of modulators (Figure 1). Strong agreement was found in the ranking of top priorities by community members and providers, although providers were significantly more likely to mention effects of modulators;screening, assessment, and intervention;and substance misuse, and community members were significantly more likely to mention stress and trauma. Respondents also noted concerns captured by a wide range of specific codes (e.g., access to mental health care, role and life changes, family relationships), populations (e.g., children), and settings (e.g., inpatient). For Q3, isolation and anxiety emerged as the top COVID-19 concerns, with isolation more salient forcommunity members and anxiety for providers. Conclusion(s): Qualitative analysis of a large survey of multiple stakeholders provided input on top research priorities for CF mental health. This information facilitated consideration of diverse perspectives to identify gaps and select areas of focus for future researchCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Collaboration-A Key to Success on a Challenging Pipeline Project

This paper discusses a 16,000-ft (4,877 m) reclaimed water transmission main project for JEA through a busy corridor in Jacksonville, FL. The pipeline route includes multiple trenchless crossings, two state highway crossings, navigation of easements, and open cut construction along a four-lane divided boulevard. Throughout the design and construction phases, numerous challenges arose. Those include a major crossing of a multilane state highway, an adjacent state department of transportation highway project, crossing a dual box culvert and creek, navigating a key corridor through a college campus area, accessing easements, and COVID-19 impacts. The evolution and resolution of each challenge presents an interesting case study. Throughout the course of the project, multiple stakeholders provided input and expectations that were incorporated, including federal, state, and local agencies, a university, and private landowners. Understanding and addressing multiple viewpoints was critical. Ultimately, continuous collaboration and coordination between the project team and the stakeholders were the key factors in the success of the project. The presentation provides a dynamic overview of the project through the design and construction phases, with a detailed account of the resolution of several challenges that arose, and the benefits of the project team's collaborative approach.

Endothelial Extracellular Vesicles: From Keepers of Health to Messengers of Disease

Endothelium has a rich vesicular network that allows the exchange of macromolecules between blood and parenchymal cells. This feature of endothelial cells, along with their polarized secretory machinery, makes them the second major contributor, after platelets, to the particulate secretome in circulation. Extracellular vesicles (EVs) produced by the endothelial cells mirror the remarkable molecular heterogeneity of their parent cells. Cargo molecules carried by EVs were shown to contribute to the physiological functions of endothelium and may support the plasticity and adaptation of endothelial cells in a paracrine manner. Endothelium-derived vesicles can also contribute to the pathogenesis of cardiovascular disease or can serve as prognostic or diagnostic biomarkers. Finally, endothelium-derived EVs can be used as therapeutic tools to target endothelium for drug delivery or target stromal cells via the endothelial cells. In this review we revisit the recent evidence on the heterogeneity and plasticity of endothelial cells and their EVs. We discuss the role of endothelial EVs in the maintenance of vascular homeostasis along with their contributions to endothelial adaptation and dysfunction. Finally, we evaluate the potential of endothelial EVs as disease biomarkers and their leverage as therapeutic tools.