Impact of Lung Disease on COVID-19 Health Outcomes in People Living With HIV.

Introduction COVID-19 most commonly causes pulmonary/lung infection, and these pulmonary diseases can complicate HIV infection. Underlying pulmonary diseases in people living with HIV (PLWH) could affect health outcomes if infected with COVID-19. Therefore, this study was designed to determine the impact of pulmonary diseases on the health outcomes of PLWH that were infected with COVID-19. Materials and methods We conducted a retrospective study to assess the impact of superimposed COVID-19 infection on pre-existing lung pathologies in patients living with human immunodeficiency virus (HIV) infection using data from the Minnesota Fairview network from January 1, 2020 to December 31, 2022. Ordinal logistic regressions were used to determine the effect of lung comorbidities on COVID-19 severity, COVID-19-specific mortality, and all-cause mortality, adjusting for patient age and gender.  Results Two hundred sixteen PLWH tested positive for COVID-19. 24.54% of these patients had one or more pulmonary diseases, including asthma, chronic obstructive pulmonary disease (COPD), and other lung diseases (interstitial lung diseases and pulmonary hypertension). The severity of COVID-19 outcomes was evaluated by the ranking of patients' medical records of testing positive, admitted to the hospital, being admitted to the ICU, and death. COVID-19-specific and all-cause mortality were evaluated separately. PLWH with underlying asthma or COPD was not associated with increased all-cause or COVID-19-specific mortality. Interstitial lung disease or pulmonary hypertension was significantly associated with poor health outcomes for COVID-19-specific mortality and all-cause mortality (Fisher's Exact p-value <0.001), with ICU admissions accounting for the most impact. Using the multivariate models, interstitial lung disease and pulmonary hypertension was significantly associated with an increased risk of more severe COVID-19 outcomes and COVID-19-specific mortality (OR=6.6153, CI=2.5944, 17.0795, p-value < 0.001). Interstitial lung disease and pulmonary hypertension were also significantly associated with an increased risk of more severe COVID-19 outcomes and all-cause mortality (OR=​​5.0885, CI=2.0590, 12.5542, p-value < 0.001). Conclusions To mitigate the poor outcomes associated with interstitial lung diseases and pulmonary hypertension in PLWH due to COVID-19, healthcare providers must educate their patients about safety measures against the COVID-19 vaccine. They can also encourage the COVID-19 vaccine uptake among their eligible patients.

The Trend of Cefepime-Induced Neurotoxicity: A Systematic Review.

There has been increased use of cefepime due to concerns about the nephrotoxic effects of the combined use of vancomycin and Zosyn. However, cefepime is associated with neurotoxicity. We conducted a systematic review using online data to explore the trend of cefepime-induced neurotoxicity over the last 10 years. Forty-six articles met our inclusion criteria, including 73 cases of cefepime-induced neurotoxicity. We noticed a steady increase in the reports of cefepime-induced neurotoxicity, from one case in 2013 to 11 cases in 2022. Individuals aged 65 and older accounted for most cefepime-induced neurotoxicity cases (52%). The top three indications for cefepime administration included bone and joint infections (25%), urinary tract infections (22.7%), and pneumonia (22.7%). Most patients with renal impairment have never had a renal adjustment of their cefepime dosage (either 2 g 12 hours a day or 2 g eight hours a day). Most cases of cefepime-induced neurotoxicity occurred between days two and five (n=29, 71%), while most resolution occurred between days one and five (n=29, 85%). While cefepime continues to be a popularly used and effective antibiotic against gram-negative bacteria like Pseudomonas aeruginosa, its dosage needs to be adjusted in patients with renal impairment to avoid neurotoxicity.

Infective Endocarditis-Induced Lung Injury Mimicking Acute Vanishing Lung Syndrome.

Infective endocarditis is the infection of the endocardial surface of the heart valve. The right-sided endocarditis can be complicated by pulmonary injury. The pulmonary complications of infective endocarditis include pulmonary embolism, empyema, pleural effusion, lung abscess, and, in rare cases, pneumothorax. We present a case of bilateral pneumatoceles mimicking vanishing lung syndrome, a very rare pulmonary complication of right-sided infective endocarditis.

Awareness of the Malaria Vaccine in India.

BACKGROUND: Malaria remains a serious public health problem in India. According to the World Health Organization (WHO), as per the 2021 report, India accounts for 83% of malaria cases in Southeast Asia. Various interventions have been implemented to control malaria's burden in India. In October 2021, the WHO approved the RTS,S/AS01 (RTS,S) malaria vaccine for administration in four scheduled doses in children five months of age to reduce the burden and severity of malaria. The objectives of this study were to assess public awareness about the vaccine among residents of India and determine any associations with demographic characteristics. METHODS: The study was a web-based, cross-sectional survey. The survey questionnaire was sent out electronically using Qualtrics® (Provo, UT) and remained active for 12 weeks (December 2021 to March 2022). The questionnaire was self-administered anonymously, using a link that was shared with people across India through social media platforms. A total of 2,371 respondents above 18 years of age and current residents of India participated in the study. The chi-square test was used to examine the association between awareness about the vaccine and demographic characteristics. A p-value of <0.05 was used to describe a statistically significant association. RESULTS: Most participants (71.95%) had heard about the malaria vaccine, and 68.75% favored making it a required childhood vaccine. Similarly, 67.27% indicated that they would encourage caregivers to get their children/wards vaccinated. Age, gender, educational status, residence, and caregiver status were associated with the awareness regarding the malaria vaccine (p < 0.05). Males, participants between 18 and 24 years old, and caregivers of children aged five years or less were more likely to be aware of the vaccine. Participants with higher education and residing in urban localities had more awareness of the vaccine. CONCLUSION: The malaria vaccine has the potential to eradicate malaria in India, especially if included in the immunization schedule for children. However, it is critical that health policymakers target populations that are less aware of information on any intended rollout of the malaria vaccine to ensure rapid uptake toward the goal of eliminating malaria from India.

An Unusual Presentation of Clostridioides Difficile Colitis in a Patient on Opioids.

Clostridioides difficile colitis is an inflammation of the colon due to toxins produced by a gram-positive bacterium called Clostridioides difficile (also known as Clostridium difficile). Clostridioides difficile colitis is associated with an increased risk of morbidity and mortality in elderly patients. The infection develops because of the disruption of the microbiome that usually suppresses the overgrowth of Clostridioides difficile. Testing for Clostridium difficile infection is routinely recommended in patients with at least three loose bowel movements in a day. We present an unusual case of a 74-year-old woman on chronic opioids who presented with a three-day history of lower abdominal pain, constipation, hematochezia, with no diarrhea. Radiologic imaging showed evidence of colitis, and the patient was found to have Clostridium difficile colitis.

Availability Bias and the COVID-19 Pandemic: A Case Study of Legionella Pneumonia.

Cognitive biases, such as the availability heuristic or availability bias, can inadvertently affect patient outcomes. These biases may be magnified during times of heightened awareness of a particular disease. Failure to identify cognitive biases when managing patients during the coronavirus disease 2019 (COVID-19) pandemic can delay the institution of the right treatment option and result in poor health outcomes. We present a case of delayed diagnosis of Legionella pneumonia due to COVID-19-related availability bias. We discuss some methods to mitigate the effects of this bias and the importance of challenging trainees to recognize these pitfalls in medical training.

A Randomized Trial of Nicotine versus No-nicotine E-cigarettes Among African American Smokers: Changes in Smoking and Tobacco Biomarkers.

INTRODUCTION: The objective of this clinical trial was to compare the effects of e-cigarettes with and without nicotine on patterns of combustible cigarette use and biomarkers of exposure to tobacco toxicants among African American smokers. METHODS: African American smokers (n = 234) were enrolled in a 12-week, single blind, randomized controlled trial and assigned to ad lib use of nicotine e-cigarettes with or without menthol (2.4% nicotine [equivalent to combustible cigarettes], n = 118), or no-nicotine e-cigarettes (n = 116) for 6 weeks. Surveys were administered at baseline, 2, 6, and 12 weeks, and urinary biomarkers 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and total nicotine equivalents (TNE) were assessed at baseline and 6 weeks. RESULTS: Participants smoked an average of 11.4 cigarettes per day (CPD) and 88% used menthol cigarettes at baseline. At Week 6, the nicotine group reported using e-cigarettes 9.1 times per day compared to 11.4 times in the no-nicotine group (p = 0.42). Combustible cigarette smoking decreased 3.0 CPD in the nicotine group compared to 2.7 CPD in the no-nicotine group (p = 0.74). Neither TNE nor NNAL changed significantly between baseline and Week 6. There were no differences in nicotine withdrawal symptoms between treatment groups. Smoking reduction persisted in both groups at Week 12. CONCLUSIONS: Contrary to our hypotheses, nicotine e-cigarettes did not significantly reduce the use of combustible cigarettes compared to no-nicotine e-cigarettes in this cohort of African American smokers. Findings suggest e-cigarettes are modestly associated with the decreased use of combustible cigarettes among non-treatment seeking smokers, regardless of nicotine content, but without a reduction in tobacco toxicants. IMPLICATIONS: Although e-cigarettes have the potential to reduce harm if substituted for combusted cigarettes (or if they promoted cessation) because of lower levels of tobacco toxicants, this study suggests ad lib use of e-cigarettes among African American smokers, with or without nicotine, results in modest smoking reduction but does not change toxicant exposure in a cohort where smoking cessation or reduction is not the goal. These data suggest that testing future harm reduction interventions using e-cigarettes should include more specific behavioral change coaching, including substituting for or completely stopping combusted cigarettes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov - NCT03084315.

Identifying metrics of success for transitional care practices in childhood cancer survivorship: A qualitative interview study of parents.

BACKGROUND: Survivor-focused care for adolescent and young adult (AYA) childhood cancer survivors (CCS) often involves their parents. Recognizing the importance of parents in the ongoing care of CCS, our study sought to identify key aspects of a successful transition for CCS from pediatric- to adult-centered care from the parent perspective. METHODS: We conducted qualitative interviews with 26 parents of CCS who were receiving care in the long-term follow-up (LTFU) clinic at a single institution. We used a semi-structured interview protocol with the parents and conducted a thematic content analysis. RESULTS: Using a constant comparison approach, data revealed three primary themes regarding parents' perspectives toward ensuring a seamless transition from pediatric- to adult-centered follow-up care: (1) the transition needs to include seamless communication between all involved parties, (2) survivors need to demonstrate sufficient health care self-efficacy in order to achieve a successful transition, and (3) the survivor-focused care should include support for survivors' overall well-being, including financial and health insurance literacy. CONCLUSIONS: For parents of AYA CCS, the optimal pediatric to adult care transition model should include mechanisms that facilitate communication between parents, CCS, and survivor-focused providers while also supporting self-efficacy and financial literacy as it relates to health insurance.