The Ongoing Impact of COVID-19 on Testing for and Diagnoses of HIV and Bacterial Sexually Transmitted Infections in Oregon.

BACKGROUND: The COVID-19 pandemic has disrupted HIV and sexually transmitted infection (STI) testing accessibility. We sought to assess the longer-term impacts of COVID-19 on HIV and STI testing and diagnosis in Oregon. METHODS: First, we examined HIV, Neisseria gonorrhoeae / Chlamydia trachomatis (CT), and syphilis tests conducted at the Oregon State Public Health Laboratory (public sector) and a large commercial laboratory (private sector) and HIV, N. gonorrhoeae , CT, and primary and secondary (P&S) syphilis diagnoses in Oregon from January 1, 2019, to December 31, 2021. We compared monthly testing and diagnosis rates in 5 prespecified periods: pre-COVID-19 (January 2019-February 2020), stay-at-home order (March 2020-May 2020), reopening (June 2020-December 2020), vaccine availability (January 2021-June 2021), and Delta/early Omicron spread (July 2021-December 2021). Second, we calculated the number of HIV and STI diagnoses per test in the public and private sectors. Finally, we used seasonal autoregressive integrated moving average models to predict expected HIV and STI diagnoses for comparison to those observed. RESULTS: Both public and private sector HIV and bacterial STI testing fell to nadirs in April 2020 with incomplete recovery to 2019 levels by the close of 2021. Compared with pre-COVID-19, public sector and private sector testing was significantly lower in all subsequent periods. Compared with pre-COVID-19, P&S syphilis cases were 52%, 75%, and 124% greater in the reopening, vaccine availability, and Delta/early Omicron periods, respectively. From March 2020 to December 2021, we observed an excess of P&S syphilis cases (+37.1%; 95% confidence interval, 22.2% to 52.1%) and a deficit in CT cases (-10.7%; 95% confidence interval, -15.4% to -6.0%). CONCLUSIONS: By December 2021, HIV/STI testing had not recovered to pre-COVID-19 levels, and HIV/STI continues to be underdiagnosed. Despite decreased testing, P&S syphilis cases have increased substantially.

The Impact of the SARS-CoV-2 Pandemic on Human Immunodeficiency Virus and Bacterial Sexually Transmitted Infection Testing and Diagnosis in Oregon.

ABSTRACT: Human immunodeficiency virus, Neisseria gonorrhoeae/Chlamydia trachomatis, and syphilis testing decreased with the implementation of mitigation measures for SARS-CoV-2 and did not return to 2019 levels by September 2020. However, primary and secondary syphilis diagnoses increased during mitigation measures. Sexual health services are essential during the SARS-CoV-2 pandemic.

Cabergoline for postpartum lactation suppression: Effect on blood pressure and pulse.

OBJECTIVE: To evaluate the effect of cabergoline on maternal blood pressure and pulse immediately postpartum. METHODS: We conducted a retrospective cohort study of 224 post-partum women who delivered at the University of Washington and did not breastfeed. Women who received 1 mg cabergoline within 48 h post-partum were compared to unexposed non-breastfeeding women. Systolic and diastolic blood pressure and pulse were assessed at 4-h intervals up to 24 h after cabergoline administration, and compared to unexposed women using delivery as the reference time point. Mean systolic and diastolic blood pressure and pulse were compared using linear regression and 95% confidence intervals, adjusting for age, indication for lactation suppression and weeks' gestation at delivery. RESULTS: Cabergoline-exposed women had lower mean systolic blood pressure at all time intervals. The maximum systolic blood pressure decrease with cabergoline was -10.88 mmHg (95% confidence interval -18.15 to -3.61) at >20-24 h. Mean diastolic blood pressure among cabergoline-exposed women decreased by -8.15 mmHg (95% confidence interval -13.94 to -2.36) at >20-24 h only. We found no significant difference in maternal pulse. Cabergoline was well tolerated with no adverse effects observed. CONCLUSION: Cabergoline has minimal clinically-relevant hemodynamic effects and was well tolerated among normotensive postpartum women.

Concurrent Validity of the Zeno Walkway for Measuring Spatiotemporal Gait Parameters in Older Adults.

BACKGROUND AND PURPOSE: Previous studies have shown that older adults at high fall risk exhibit altered spatiotemporal gait parameters such as lesser gait speed, shorter step length, and greater step width compared with their healthy counterparts. Measurement of these gait parameters for older adults can play a pivotal role in clinical evaluation. While the GAITRite walkway has been previously validated and used extensively for research purposes, the Zeno walkway validity has not been established. Although both walkways use pressure sensor-based technology, comparison of the spatiotemporal gait measurements between the systems for older adults is unknown. Our purpose was to determine the concurrent validity of the Zeno walkway with the gold-standard GAITRite walkway among healthy older adults and those at high fall risk using a cross-sectional study design. METHODS: Thirty healthy older adults and 17 older adults at high fall risk performed 5 walking trials barefoot on a 16´ × 4´ Zeno walkway and a 14´ × 2´ GAITRite walkway in a quasi-randomized order. Testing on the Zeno walkway was performed in a continuous manner while testing on the GAITRite walkway was performed using 5 discrete trials. Walking trials were done at self-selected comfortable and fast pace conditions. Data from the Zeno walkway were processed using the PKMAS software. Data from the GAITRite were processed using the GAITRite software. For each group and condition, spatiotemporal gait parameters common to both walkways' footfall processing software were compared using a Wilcoxon signed rank test. Concurrent validity was estimated using intraclass correlation coefficient (ICC(2,5)) and Bland-Altman plots. RESULTS AND DISCUSSION: Both groups had significantly greater stride width on the GAITRite walkway during both conditions. During the fast pace condition, both groups walked with greater gait speed, cadence, and stride velocity, lesser step time, stance time, and double-support time, greater percentage of gait cycle spent in single-support phase, and lesser percentage of gait cycle spent in double-support phase on the GAITRite walkway. Differences observed could be attributed to surface textures, software used to process the footfalls, dimensions of the walkways, or the continuous versus discrete protocols used in the current study. The ranges of ICC(2,5) values for healthy older adults and adults at high fall risk walking at a comfortable pace were 0.449 to 0.918 and 0.854 to 0.969 and at a fast pace were 0.784 to 0.964 and 0.850 to 0.976, respectively. These values imply that the concurrent validity was moderate for most temporal parameters when healthy older adults walked at comfortable pace and excellent otherwise. Overall, the concurrent validity between both walkways was acceptable. CONCLUSION: Concurrent validity for spatiotemporal parameters between the GAITRite walkway and the Zeno walkway was moderate to excellent for older adults dependent on the specific parameter (spatial vs temporal), population (healthy or fall risk), and walking pace (comfortable or fast).

Magnesium physiology and clinical therapy in veterinary critical care.

OBJECTIVE: To review magnesium physiology including absorption, excretion, and function within the body, causes of magnesium abnormalities, and the current applications of magnesium monitoring and therapy in people and animals. ETIOLOGY: Magnesium plays a pivotal role in energy production and specific functions in every cell in the body. Disorders of magnesium can be correlated with severity of disease, length of hospital stay, and recovery of the septic patient. Hypermagnesemia is seen infrequently in people and animals with significant consequences reported. Hypomagnesemia is more common in critically ill people and animals, and can be associated with platelet, immune system, neurological, and cardiovascular dysfunction as well as alterations in insulin responsiveness and electrolyte imbalance. DIAGNOSIS: Measurement of serum ionized magnesium in critically or chronically ill veterinary patients is practical and provides information necessary for stabilization and treatment. Tissue magnesium concentrations may be assessed using nuclear magnetic resonance spectroscopy as well as through the application of fluorescent dye techniques. THERAPY: Magnesium infusions may play a therapeutic role in reperfusion injury, myocardial ischemia, cerebral infarcts, systemic inflammatory response syndromes, tetanus, digitalis toxicity, bronchospasms, hypercoagulable states, and as an adjunct to specific anesthetic or analgesic protocols. Further veterinary studies are needed to establish the frequency and importance of magnesium disorders in animals and the potential benefit of magnesium infusions as a therapeutic adjunct to specific diseases. PROGNOSIS: The prognosis for most patients with magnesium disorders is variable and largely dependent on the underlying cause of the disorder.

H1-receptor antagonist, tripelennamine, does not affect arterial hypoxemia in exercising Thoroughbreds.

It has been suggested that pulmonary injury and inflammation-induced histamine release from airway mast cells may contribute to exercise-induced arterial hypoxemia (EIAH). Because stress failure of pulmonary capillaries and EIAH are routinely observed in exercising horses, we examined whether preexercise administration of an H1-receptor antagonist may mitigate EIAH. Two sets of experiments, placebo (saline) and antihistaminic (tripelennamine HCl at 1.10 mg/kg iv, 15 min preexercise) studies, were carried out on seven healthy, exercise-trained Thoroughbred horses in random order 7 days apart. Arterial and mixed venous blood-gas and pH measurements were made at rest before and after saline or drug administration and during incremental exercise leading to maximal exertion at 14 m/s on 3.5% uphill grade for 120 s. Galloping at this workload elicited maximal heart rate and induced exercise-induced pulmonary hemorrhage in all horses in both treatments, thereby indicating that capillary stress failure-related pulmonary injury had occurred. In both treatments, EIAH, desaturation of hemoglobin, hypercapnia, and acidosis of a similar magnitude developed during maximal exertion, and statistically significant differences between the placebo and antihistaminic studies could not be demonstrated. The failure of the H1-receptor antagonist to modify EIAH significantly suggests that pulmonary injury-induced histamine release may not play a major role in bringing about EIAH in Thoroughbred horses.

Anti-inflammatory agent, dexamethasone, does not affect exercise-induced arterial hypoxemia in Thoroughbreds.

In view of the suggestion that pulmonary injury-induced release of histamine and/or other chemical mediators from airway inflammatory and mast cells contribute to the exercise-induced arterial hypoxemia (EIAH) in human athletes, we examined the effects of pretreatment with a potent anti-inflammatory agent, dexamethasone, on EIAH and desaturation of hemoglobin in horses. Seven healthy, sound, exercise-trained Thoroughbreds were studied in the control (no medications) experiments, followed in 7 days by intravenous dexamethasone (0.11 mg.kg(-1).day(-1) for 3 consecutive days) studies. Blood-gas measurements were made at rest and during incremental exercise leading to maximal exertion at 14 m/s on a 3.5% uphill grade. Galloping at this workload induced pulmonary hemorrhage in all horses in both treatments, thereby indicating that stress failure of pulmonary capillaries had occurred. In both treatments, significant EIAH, desaturation of hemoglobin, hypercapnia, acidosis, and hyperthermia developed during maximal exercise, but significant differences between the control and dexamethasone treatments were not discerned. The failure of pretreatment with dexamethasone to significantly affect EIAH suggests that pulmonary injury-evoked airway inflammatory response may not play a major role in EIAH in racehorses. However, our observations in both treatments that EIAH developed quickly (being evident at 30 s of exertion) and that its severity remained unaffected by increasing exercise duration (to 120 s) suggest that EIAH has a functional basis, probably related to significant shortening of the transit time for blood in the pulmonary capillaries as cardiac output increases dramatically.

Multiple mini-interviews: opinions of candidates and interviewers.

OBJECTIVES: To assess candidates' and interviewers' perceptions of the use of a multiple mini-interview (MMI) for selection of senior house officers (SHOs) to a UK regional paediatric training programme. METHODS: Both candidates and interviewers completed anonymous questionnaires (comprising 16 and 25 questions, respectively). Demographic data were recorded for both groups. Data were analysed by frequencies; using Mann-Whitney and Kruskall-Wallis tests for comparisons; and Cronbach's alpha for internal consistency within the data. RESULTS: Both candidates and interviewers were positive about the fairness of the MMI (mean scores of 4.0 and 4.4, respectively). The majority of candidates (83%) had not been to this type of interview before. Gender, age and previous experience of MMIs did not account for differences in candidate responses (P > 0.05). A total of 86% of candidates were international medical graduates who preferred the format more than UK graduates did (P = 0.01). Interviewers were mainly experienced consultants who agreed that the multi-station format was better than the traditional interview (mean score 4.8) and represented a reliable process (mean score 4.4). Interviewers were concerned about the range of competencies covered and the subsequent performance of candidates in post (mean scores 3.6 and 3.2, respectively). CONCLUSIONS: Both candidates and interviewers agreed that the MMI format was reliable, fair and asked appropriate, easy-to-understand questions. In high-stakes interviews such as for specialty training in Modernising Medical Careers programmes, it is vital that all concerned have confidence in the selection process.