Exhaled Breath Condensate Surveillance for Aspergillus in Acute Leukemia-a Pilot Trial.

Invasive fungal infections in patients with leukemia carry a high mortality rate, but early diagnosis has the potential to modify this natural history. A novel screening method using Aspergillus droplet-digital polymerase chain reaction in exhaled breath condensate may have a similar performance to serum galactomannan screening. Larger studies, including other molds, are necessary.

An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada.

BACKGROUND: The fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity. METHODS: An audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt. RESULTS: Fidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly. CONCLUSIONS: We describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

Evaluation of Food Safety Knowledge and Attitudes Among Adults in the United Arab Emirates.

Background Food is handled by many individuals in large food setups, therefore increasing the chance of contamination that leads to foodborne diseases (FBDs). This study was purposed to evaluate adults' understanding of food safety, FBDs, and hygiene practices across various demographic groups in the United Arab Emirates (UAE) and to explore the link between their knowledge of food safety and their corresponding attitudes. Methods A cross-sectional study was conducted with 402 adults using a validated, self-administered questionnaire available in both printed and online formats. The study was carried out at Gulf Medical University and Thumbay hospitals and clinics over six months, beginning in December 2022 to June 2023. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was employed to examine the association between variables, and significant associations were further analyzed through logistic regression. Results Out of the 402 participants, the population was predominantly female 275 (67.9%), and from Southeast Asia 222 (55.4%), with students comprising the largest occupational group 186 (47%). Only 106 (26.36%) had received food safety training, and a mere 187 (46.51%) demonstrated adequate knowledge. Awareness levels varied, with the highest for raw food safety (64.02%) and the lowest for canned foods (40.79%). Demographic analysis revealed significant associations: males exhibited more inadequate knowledge 79 (62.2%) than females 136 (49.4%), and students showed higher inadequacy 104 (55.9%) compared to healthcare workers 31 (35.6%). Positive attitudes towards food safety were prevalent 226 (56.2%), and positive attitudes were found in women 157 (57.1%), individuals above 30 years of age 110 (50.5%), individuals working in healthcare 140 (62%), and married individuals 117 (60.9%). With a strong correlation (p<0.001), women were 1.68 times more likely to possess adequate knowledge than men (95% CI: 1.09, 2.59), and healthcare workers were 2.33 times more likely than students (95% CI: 1.37, 3.95). Conclusion The study reveals a low level of knowledge about food safety among adults in the UAE. Therefore, emphasis should be placed on increasing awareness of these concepts to reduce the burden of FBDs on the healthcare system.

Cases from a Community Hospital JCHIMP Series #2: 66-Year-old Man with Recurrent Painful Rashes and Oral Ulcerations.

This is part of a series of case reports detailing scenarios from our community hospital. The cases are selected to feature clinical dilemmas, provide a review on what is currently known about the topic with expert perspective. A 66-year-old black man presented to the primary care clinic with his fourth episode of generalized painful rash and oral ulcerations without a diagnosis despite two emergency room (ED) visits alongside doxycycline treatment. Symptoms interfered with daily activities with skin exam notable for widespread erythematous patches and plaques. In office biopsies were obtained with final diagnosis of erythema multiforme. Etiologic workup revealed positive HSV 1 IgG and active untreated hepatitis C infection. He was treated with prednisone, and acyclovir with resolution of lesions and no further recurrences over a nine-month follow up period. This case depicts an unusual presentation of a common skin disorder. It highlights the challenge of recognizing atypical target lesions in skin of color and the important role of primary care in bridging access to dermatological care.

Path tracking control of a steerable catheter in transcatheter cardiology interventions.

PURPOSE: Intracardiac transcatheter interventions allow for reducing trauma and hospitalization stays as compared to standard surgery. In the treatment of mitral regurgitation, the most widely adopted transcatheter approach consists in deploying a clip on the mitral valve leaflets by means of a catheter that is run through veins from a peripheral access to the left atrium. However, precise manipulation of the catheter from outside the body while copying with the path constraints imposed by the vessels remains challenging. METHODS: We proposed a path tracking control framework that provides adequate motion commands to the robotic steerable catheter for autonomous navigation through vascular lumens. The proposed work implements a catheter kinematic model featuring nonholonomic constraints. Relying on the real-time measurements from an electromagnetic sensor and a fiber Bragg grating sensor, a two-level feedback controller was designed to control the catheter. RESULTS: The proposed method was tested in a patient-specific vessel phantom. A median position error between the center line of the vessel and the catheter tip trajectory was found to be below 2 mm, with a maximum error below 3 mm. Statistical testing confirmed that the performance of the proposed method exhibited no significant difference in both free space and the contact region. CONCLUSION: The preliminary in vitro studies presented in this paper showed promising accuracy in navigating the catheter within the vessel. The proposed approach enables autonomous control of a steerable catheter for transcatheter cardiology interventions without the request of calibrating the intuitive parameters or acquiring a training dataset.

Management of Adverse Reactions for BCMA-Directed Therapy in Relapsed Multiple Myeloma: A Focused Review.

Anti-B-cell maturation antigen therapies consisting of bispecific antibodies, antibody-drug conjugates, and chimeric antigen receptor T cells have shown promising results in relapsed refractory multiple myeloma (RRMM). However, the severe side effects include cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, cytopenia(s), infections, hemophagocytic lymphohistiocytosis, and organ toxicity, which could sometimes be life-threatening. This review focuses on these most common complications post-BCMA therapy. We discussed the risk factors, pathogenesis, clinical features associated with these complications, and how to prevent and treat them. We included four original studies for this focused review. All four agents (idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, belantamab mafodotin) have received FDA approval for adult RRMM patients. We went through the FDA access data packages of the approved agents to outline stepwise management of the complications for better patient outcomes.

A Challenging Case of Kaposi Sarcoma Inflammatory Cytokine Syndrome.

Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS) is a serious, uncommon disease that occurs in patients who are positive for HIV and human herpesvirus-8 (HHV-8). It is characterized by a constellation of clinical findings, including fever, weight loss, and fluid retention, as well as a lack of multicentric Castleman disease (MCD) features on histopathology and an elevated serum HHV-8 viral load. Diagnosis is often delayed, and treatment options are limited, culminating in high mortality rates. We hereby present a 32-year-old male patient with HIV who was untreated for a few years and came with fever, night sweats, pancytopenia, and widespread adenopathy. A thorough evaluation of opportunistic infections was unremarkable. Clinically MCD was suspected, but lymph node biopsy only showed Kaposi sarcoma (KS) with no characteristic features of MCD. However, with clinical deterioration, KICS was strongly suspected. Kaposi sarcoma immune reconstitution syndrome (KS-IRIS) was also a possibility as the patient was restarted on antiretroviral therapy. Rituximab was commenced, but the patient suffered a cardiac arrest and could not be revived. Alternative diagnosis must be explored in patients with HIV presenting with constitutional symptoms, cytopenia, and adenopathy after opportunistic infections and malignancies are ruled out. If they have KS with HHV-8 positivity and there is a lack of characteristic features of MCD in lymph node biopsy, prompt suspicion of KICS should be made, and treatment with rituximab and/or chemotherapy should be instituted rapidly. KS-IRIS is also possible if patients have recently received antiretroviral therapy and have a rapid decline in viral load and increase in CD4 counts (immunological recovery). HHV8 viral load levels may help to distinguish between these two inflammatory conditions.

Investigation of resource curse hypothesis: the role of renewable energy and urbanization in realizing environmental sustainability in China.

This research investigates the resource curse hypothesis and environmental sustainability by integrating China's natural resources, renewable energy, and urbanization. However, the EKC N shape describes the complete picture of the EKC hypothesis for the growth-pollution relationship. The findings of FMOLS and DOLS show that economic expansion positively drives carbon dioxide emissions in the beginning, then negatively so after the target level of growth is reached. Continuing economic expansion in China does not maintain the intended level and again has a beneficial impact on the country's carbon dioxide emissions. However, the EKC U, inverted U, and N shapes persist in the growth-pollution connection over the long term. Although adopting renewable energy and urbanization help reduce carbon dioxide emissions, the formation of fixed capital worsens environmental conditions. Natural resource rents are a major cause of environmental degradation and the resource curse that has plagued China. Economic growth, as well as its square and cube, has a causal effect on CO2 emissions, as shown by the frequency domain causation. Carbon dioxide emissions at frequencies of 0.05, 1.50, and 2.50 are momentarily predicted by the use of renewable energy and urbanization. The investigation recommends switching to renewable energy sources owing to low cost and the potential to limit the overuse of non-renewables. To balance the overdo of natural resources and ensure continued long-term growth-environment sustainability, technological advancement is recommended as a countermeasure as a mitigating mechanism.

Identification of time-varying wetlands neglected in Pakistan through remote sensing techniques.

Aside from Ramsar Convention awareness programs, the concept of wetlands is mostly ignored in developing countries. Wetland ecosystems are essential to hydrological cycles, ecosystem diversity, climatic change, and economic activity. Under the Ramsar Convention, there are 2414 wetlands that are internationally recognized, and Pakistan is home to 19 of them. The major goal of this study is to use the satellite image technology to locate Pakistan's underutilized wetlands (Borith, Phander, Upper Kachura, Satpara, and Rama Lakes). The other goals are to understand how these wetlands are affected by climate change, ecosystem change, and water quality. We used analytical techniques including supervised classification and Tasseled Cap Wetness to identify the wetlands. To find changes caused by climate change, Quick Bird high-resolution images was used to create the change detection index. Tasseled Cap Greenness and the Normalized Difference Turbidity Index were also used to assess the water quality and changes in the ecology in these wetlands. Sentinel-2 was used to analyze data from 2010 and 2020. ASTER DEM was also used to do a watershed analysis. The land surface temperature (°C) of a few selected wetlands was calculated using Modis data. Rainfall (mm) data was taken from PERSIANN (precipitation estimation from remotely sensed information using artificial neural networks) databases. Results indicated that in 2010, the water content of Borith, Phander, Upper Kachura, Satpara, and Rama Lakes was 22.83%, 20.82%, 22.26%, 24.40%, and 22.91%. While in 2020, these lakes' water ratios are 21.33%, 20.65%, 21.76%, 23.85%, and 22.59%, respectively. Therefore, the competent authorities must take precautions to ensure that these wetlands are preserved in the future in order to improve the dynamics of the ecosystem.

Assessment of risk factors associated with outbreak of hepatitis A in Shakrial, Rawalpindi, Pakistan.

INTRODUCTION: Two patients with jaundice reported to the National Institute of Health (NIH), Islamabad from Shakrial, Rawalpindi in April 2017. An outbreak investigation team was formulated to assess the disease magnitude, risk factors and control measures. METHODOLOGY: A case-control study was conducted in 360 houses in May 2017. The case definition was: onset of acute jaundice with any symptom including fever, right upper-quadrant pain, loss of appetite, dark urine, nausea and vomiting among Shakrial residents from March 10 - May 19, 2017. Four age and gender matched controls were selected for each case. Blood samples were sent to the NIH for laboratory confirmation. Frequencies, attack rates (AR), odd ratios, and logistic regression were computed at 95% confidence interval and p < 0.05. RESULTS: A total of 25 cases (23 new) were identified with mean age 8 years and male to female ratio 1.5:1. Overall AR was 1.39% and the most severely affected age-group was 5-10 years (AR of 3.92%). Multivariate analysis revealed that raw vegetable consumption, lack of awareness and poor handwashing practices had significant association with disease spread. All blood samples were positive for hepatitis A, and no resident was previously vaccinated. Lack of awareness of disease spread among the community was the most probable reason for the outbreak. There were no new cases during follow up until May 30, 2017. CONCLUSIONS: Healthcare departments should implement public policies towards the management of hepatitis A in Pakistan. Health awareness sessions and vaccination for children ≤ 16 years age is recommended.

ICT, renewable energy, financial development, and CO2 emissions in developing countries of East and South Asia.

This study aims to analyze the impact of ICT, renewable energy consumption, and financial development on CO2 emissions in selected developing countries of East and South Asia. Using panel data spanning 1985-2020, Pooled Mean Group (PMG) estimator is used to analyze the short-run and long-run effects. Results suggest that ICT and financial development positively contribute to the degradation of the environment in the long run, while their impact on CO2 emissions is insignificant in the short run. On the other hand, renewable energy consumption affects environmental quality positively in both the long run and short run. It is also examined that economic growth affects CO2 emissions positively but the squared economic growth reduces CO2 emissions which validates inverted U-shaped EKC hypothesis. The empirical findings of the Granger Causality test suggest unidirectional causality from ICT and financial development to CO2 emissions, while a bi-directional relationship is found among renewable energy and CO2 emissions. Results imply that governments in these countries need to invest in renewable energy to control environmental degradation.

Full-Time Cardiac Intensive Care Unit Staffing by Heart Failure Specialists and its Association with Mortality Rates.

BACKGROUND: Cardiac intensive care units (CICUs) serve medically complex patients with multiorgan dysfunction. Whether a CICU that is staffed full time by heart failure (HF) specialists is associated with decreased mortality is unclear. METHODS AND RESULTS: A retrospective review of consecutive CICU admissions from January 1, 2012, to December 31, 2016, was performed. In January 2014, the CICU changed from an open unit staffed by any cardiologist to a closed unit managed by HF specialists. Patients' baseline characteristics were determined, and a multivariate regression analysis was performed to ascertain mortality rates in the CICU. Baseline severity of illness was higher in the closed/HF specialist CICU model (P< 0.001). Death occurred in 101 of 1185 patients admitted to the CICU (8.5%) in the open-unit model and in 139 of 2163 patients (6.4%) admitted to the closed/HF specialist model (absolute risk reduction 2.1%, 95% confidence interval [CI] 0.1-4.0%; P = 0.01). The transition from an open to a closed/HF specialist model was associated with a lower overall CICU mortality rate (odds ratio [OR] 0.63; 95% CI 0.43-0.93). Prespecified interaction with a mechanical circulatory support device and unit model showed that treatment with such a device was associated with lower mortality rates in the closed/HF specialist model of a CICU (OR 0.6; 95% CI 0.18-0.78; P for interaction <0.01). CONCLUSION: Transition to a closed unit model staffed by a dedicated HF specialist is associated with lower CICU mortality rates.

A History of Heart Failure Is an Independent Risk Factor for Death in Patients Admitted with Coronavirus 19 Disease.

AIMS: The association between cardiovascular diseases, such as coronary artery disease and hypertension, and worse outcomes in COVID-19 patients has been previously demonstrated. However, the effect of a prior diagnosis of heart failure (HF) with reduced or preserved left ventricular ejection fraction on COVID-19 outcomes has not yet been established. METHODS AND RESULTS: We retrospectively studied all adult patients with COVID-19 admitted to our institution from March 1st to 2nd May 2020. Patients were grouped based on the presence or absence of HF. We used competing events survival models to examine the association between HF and death, need for intubation, or need for dialysis during hospitalization. Of 4043 patients admitted with COVID-19, 335 patients (8.3%) had a prior diagnosis of HF. Patients with HF were older, had lower body mass index, and a significantly higher burden of co-morbidities compared to patients without HF, yet the two groups presented to the hospital with similar clinical severity and similar markers of systemic inflammation. Patients with HF had a higher cumulative in-hospital mortality compared to patients without HF (49.0% vs. 27.2%, p < 0.001) that remained statistically significant (HR = 1.383, p = 0.001) after adjustment for age, body mass index, and comorbidities, as well as after propensity score matching (HR = 1.528, p = 0.001). Notably, no differences in mortality, need for mechanical ventilation, or renal replacement therapy were observed among HF patients with preserved or reduced ejection fraction. CONCLUSIONS: The presence of HF is a risk factor of death, substantially increasing in-hospital mortality in patients admitted with COVID-19.

Psychosocial stress, bicultural identity integration, and bicultural self-efficacy among Hispanic emerging adults.

Most studies on psychosocial stress among Hispanics have focused on risk factors. To better understand psychosocial stress among this population, this study aimed to examine components of bicultural identity integration and bicultural self-efficacy, that may be associated with lower psychosocial stress among Hispanic emerging adults (ages 18-25). This aim was tested on a cross-sectional sample of Hispanic emerging adults (Mage = 21.30, SD = 2.09) that included 200 participants (Arizona n = 99, Florida n = 101). The sample included men (n = 98) and women (n = 102). Most participants were US-born (70%), college students (69.5%), and of Mexican heritage (44%). Standardized coefficients from a hierarchical multiple regression model indicate that higher levels of the bicultural harmony component of bicultural identity integration (ß = -0.26, p < 0.001) and the social groundedness component of bicultural self-efficacy (ß = -0.23, p < 0.01) were associated with lower levels of psychosocial stress. To our knowledge, this is the first study to examine components of bicultural identity integration and bicultural self-efficacy and their respective associations with psychosocial stress among any racial/ethnic group. Thus, more studies are needed to replicate our findings to determine if bicultural identity integration and bicultural self-efficacy should be considered in psychosocial stress interventions for Hispanics.