Evaluating the relationship between health-related social needs, patient demographics, and access to biologics in patients with moderate-to-severe asthma in Bronx, NY.

OBJECTIVES: This study assesses the relationship between patient age, gender, race, socioeconomic status, social determinants of health (SDoH), and access to biologics (products isolated from natural sources that target specific molecules, proteins, and cells) in patients with moderate-to-severe asthma in Bronx, NY. METHODS: Cohort of 289 patients with moderate-to-severe asthma treated at Montefiore Medical Center (MMC) from 2018 to 2020 was used. Patient demographics, self-reported social needs, and neighborhood socioeconomic characteristics were analyzed. Neighborhood socioeconomic status was estimated by determining median income in patients' residential zip codes using 2020 Census data and grouping patients based on whether neighborhood median income was above or below New York State (NYS) median ($71,117/year). Area Deprivation Index tool (ADI) was used as an additional measure of neighborhood socioeconomic status. RESULTS: Patients living in regions with incomes below NYS median found to have longer wait times between biologic approval to administration than patients living in regions above median income (p = 0.012). Mean time from insurance approval to biologic administration was significantly different between Black and Latinx patients (p = 0.009). No significant difference found for patient regional income status and time from biologic prescription to approval. No significant differences in access to biologics were found for age, gender, number of health-related social needs, or patient ADI quartile. CONCLUSIONS: Patients who live in areas of NYC where median income is below NYS median are more likely to experience delays in access to biologics, specifically due to time between approval and administration of medication.

The severely under-recognized public health risk of strongyloidiasis in North American cities-A One Health approach.

Strongyloides and other soil-transmitted helminths represent a severely under-recognized zoonotic public health risk, especially in North American cities. They are present throughout North America, including in urban areas, causing morbidity and mortality in human and non-human animals. Epidemiological "masking" of strongyloidiasis due to overlapping symptoms with other systemic diseases, including allergies, and diagnostic limitations complicate our understanding of the epidemiological extent of this disease, and auto-infection allows long-term persistence of individual infections. Zoonotic transmission and environmental transmission are critical components in the epidemiology of strongyloidiasis, and other diseases caused by soil-transmitted helminths. In this review, we bring together medical, veterinary and environmental expertise in a "One Health" context, to document and analyse this under-recognized risk. We also present implementable opportunities for action with respect to diagnostics, treatment, community engagement and land management to mitigate the impact and transmission of strongyloidiasis and other diseases caused by soil-transmitted helminths.

The role of vitamin D in the immunopathogenesis of allergic skin diseases.

Vitamin D plays key roles in innate and adaptive immunity through the stimulation of Toll-like receptors, increasing pro-inflammatory cytokine production, and possibly enhancing T helper type 2 responses. These mechanisms may explain the growing body of evidence connecting vitamin D to allergic diseases, including asthma, food allergies, and allergic rhinitis. The data relating vitamin D to allergic skin diseases are equivocal with studies linking both high and low vitamin D levels to an increased risk of developing atopic dermatitis. In this paper, we describe the role of vitamin D in the immunopathogenesis of atopic dermatitis and other allergic skin diseases.

The role of thymic stromal lymphopoietin in the immunopathogenesis of atopic dermatitis.

Atopic dermatitis (AD), a skin disease characterized by pruritus and chronic inflammation, results from a complex interplay between environmental and genetic factors. Thymic stromal lymphopoietin (TSLP), an IL-7-like cytokine, is believed to propagate AD lesions through T helper 2 (Th2) polarization. This paper describes the immunologic mechanisms involving TSLP in the generation of allergic disease. Specifically in AD, TSLP has been shown to be an inducer of myeloid dendritic cells, Th2 responses, mast cells, and natural killer T cells, thereby leading to cytokine secretion and the development of AD. We hope that further understanding of the TSLP pathway and its role in the pathogenesis of AD will lead to improved clinical management of AD in the future.

Single step self-enclosed fluidic channels via Two Photon Absorption (TPA) polymerization.

In this paper, we demonstrate a simple, fast and single-step method for fabricating self-enclosed fluidic channels via TPA. Pairs of parallel, polymerized ribs are linked by the subsequent polymerization with correctly predetermined offset between the ribs. The region, where the radicals are initiated but its concentration is below the threshold, we called it a sub-activated region. The subsequent polymerization is triggered by the overlap of the sub-activated regions of the two adjacent ribs. The dimensions of the self-enclosed channels depends on the offset between ribs, the scan speed as well as the laser parameters such as pulse energy, pulse width and repetition rate.

Maskless fabrication of nano-fluidic channels by two-photon absorption (TPA) polymerization of SU-8 on glass substrate.

We present a simple, fast, and repeatable method for fabricating nano-fluidic channels based on two-photon absorption (TPA) polymerization. Since our method does not require any mask, it is relatively cheaper and faster than other conventional lithography techniques. We illustrate that SU-8 has pronounced photoinitiation threshold behavior, which linearly decreases as the repetition rate increases. If the pulse energy and the repetition rate are controlled, channel width can be easily controlled. We report fluidic channels up to 110 nm in width, between polymerized parallel ribs, utilizing TPA and the photoinitiation threshold properties of SU-8. Finally, we also show that high repetition rate laser presents greater controllability in size of the polymerized region by varying fluence.

Functional antibody deficiency in a patient with type I Gaucher disease.

Gaucher disease (GD), the most common lysosomal storage disorder, demonstrates an autosomal recessive pattern of inheritance. The genetic defect in GD leads to decreased production of the lysosomal enzyme glucosylceramide hydrolase, thereby resulting in the deposition of glucosylceramide sphingolipids within multiple organ systems. Although the precise mechanisms remain unclear, GD is usually associated with chronic antigenic stimulation and hyperimmunoglobulinaemia. We report a novel case of type I GD coexisting with relatively low serum immunoglobulins, impaired antibody production, and recurrent bacterial infections in a 62-year-old male. The patient had been diagnosed with GD 30 years previously and had subsequently started enzyme replacement therapy. Since being diagnosed with GD, the patient had suffered from repeated episodes of acute bronchitis and a recent severe bout of community-acquired pneumonia that required a lengthy hospitalization. On our initial evaluation, the patient had laboratory testing that demonstrated: decreased serum IgG, IgG2, and IgA levels; reduced absolute CD3(+)/CD4(+), CD3(+)/CD8(+), and lymphocyte counts; low IgG titres to pneumococcal polysaccharide vaccine; and decreased anti-tetanus antibodies. Lymphocyte function analysis demonstrated a normal response to phytohaemagglutinin, and decreased responses to concanavalin A and pokeweed mitogen. Repeat testing after 6 months revealed normal serum immunoglobulin levels and mitogenic responses. Although the explanation for our observed transient hypogammaglobulinaemia remains unclear, this patient's clinical constellation (i.e. repeated infections, hypogammaglobulinaemia and lymphopenia, decreased post-vaccination titres, and impaired responses to some mitogens) shares overlapping features with common variable immunodeficiency (CVID).

Comparison of re-exposure rates of intraoral radiographs between dental students and trained dental assistants in an oral and maxillofacial radiology clinic.

OBJECTIVE: To compare the re-exposure rates of dental radiographs taken over a period of 1 year between dental students and trained dental assistants at a university-based oral and maxillofacial radiology clinic. METHODS: Detailed records of the number and type of intraoral radiographs taken by the students and staff members and the number of re-exposures that were required from July 2003 to July 2004 were used. Statistical analyses were performed on the data. RESULTS: A chi2 test showed that re-exposure rates of radiographic series between students and staff were statistically different. When comparing the students' re-exposure rates during each of the four quarters of their radiology rotation, one-way analysis of variance test showed that the results were not statistically significant for reduction in the number of re-exposures over the entire year. CONCLUSIONS: There were significant differences in the re-exposure rates between staff dental assistants and students. Film re-exposure rates for the students during the four quarters were expected to decrease with time. Instead, the consistency of the re-exposure rates of the students during the four quarters demonstrates the need to recognize why the students did not perform better as the year progressed. The percentage of films that needed to be re-exposed by either group (students or the staff dental assistants) was not extremely high.