Long-COVID improves in 50% of patients after a year in a Midwestern cohort.

Background: Many of those infected with COVID-19 experience long-term disability due to persistent symptoms known as Long-COVID, which include ongoing respiratory issues, loss of taste and smell, and impaired daily functioning. Research Question: This study aims to better understand the chronology of long-COVID symptoms. Study Design and Methods: We prospectively enrolled 403 adults from the University of Iowa long-COVID clinic (June 2020 to February 2022). Participants provided symptom data during acute illness, symptom progression, and other clinical characteristics. Patients in this registry received a survey containing questions including current symptoms and status since long-COVID diagnosis (sliding status scale, PHQ2, GAD2, MMRC). Those >12 months since acute-COVID diagnosis had chart review done to track their symptomology. Results: Of 403 participants contacted, 129 (32%) responded. The mean age (in years) was 50.17 +/-14.28, with 31.8% male and 68.2% female. Severity of acute covid treatment was stratified by treatment in the outpatient (70.5%), inpatient (16.3%), or ICU (13.2%) settings. 51.2% reported subjective improvement (sliding scale scores of 67-100) since long-COVID onset. Ages 18-29 reported significantly higher subjective status scores. Subjective status scores were unaffected by severity. 102 respondents were >12 months from their initial COVID-19 diagnosis and were tracked for longitudinal symptom persistence. All symptoms tracked had variance (mean fraction 0.58, range 0.34-0.75) in the reported symptoms at the time of long-COVID presentation when compared with patient survey report. 48 reported persistent dyspnea, 23 (48%) had resolved it at time of survey. For fatigue, 44 had persistence, 12 (27%) resolved. Interpretation: Overall, 51.2% respondents improved since their long-COVID began. Pulmonary symptoms were more persistent than neuromuscular symptoms (anosmia, dysgeusia, myalgias). Gender, time since acute COVID infection, and its severity didn't affect subjective status or symptoms. This study highlights recall bias that may be prevalent in other long-COVID research reliant on participant memory.

A Case of Metastatic Choriocarcinoma-Related Paraneoplastic Thyroid Storm.

Thyroid storm due to gestational trophoblastic disease (GTD) with metastatic choriocarcinoma is a rare but potentially life-threatening endocrine emergency. We report on a woman with molar pregnancy and metastatic choriocarcinoma who presented with thyroid storm (Burch-Wartofsky point scale of 45) a few weeks after the evacuation of GTD. She was initially managed with intravenous hydrocortisone, oral propylthiouracil (PTU), and esmolol infusion. After stabilization in the intensive care unit, 10 cycles of chemotherapy with etoposide, methotrexate, leucovorin, dactinomycin, and cyclophosphamide (EMA-CO) were initiated for stage 4 choriocarcinoma with brain and lung metastases. She underwent a hysterectomy soon after completing chemotherapy and received an additional 3 cycles of chemotherapy after the hysterectomy. As human chorionic gonadotropin (hCG) levels normalized, thyroid function reverted to normal as well. At the last follow-up, the patient was asymptomatic, euthyroid (without antithyroid medication), had a normal hCG titer of 1.7 mIU/mL (normal nonpregnant reference is < 5 mIU/mL), and the lung and brain lesions had resolved entirely. Management of thyroid storm in the presence of untreated metastatic choriocarcinoma requires a high index of suspicion and a multidisciplinary team approach to prevent complications and improve survival.

Unique Usages of Dehydrated Human Amnion Chorion Membrane Allografts in Dermatology.

Dehydrated human amnion chorion membrane (dHACM) allografts are synthetic skin substitutes derived from placental tissue. dHACM allografts are used for replacing lost or damaged dermal tissue, as they contain many of the components found within the extracellular matrix that are beneficial in wound healing. Common uses of dHACM allografts include the healing of diabetic and non-diabetic foot and leg ulcers, decubitus ulcers, and wounds following debridement. While these grafts have been proven to be beneficial in other disciplines of medicine, their potential for use in the field of dermatology is emerging. Current clinical cases and research have shown dHACM allografts to be beneficial in repairing damaged tissue due to dermatologic conditions. They could play a role in the treatment of conditions causing chronic wounds, including dermal scarring or loss, and the repair of fragile skin. Examples of dHACM allograft use in dermatology include cases of pyoderma gangrenosum, Netherton syndrome, and wound healing with Mohs micrographic surgery. This literature review explores the efficacy of using dHACM allografts for the treatment of healing wounds within the field of dermatology. J Drugs Dermatol. 2023;22(12):1228-1231. doi:10.36849/JDD.7115.

Perinatal Homicide in the United States: A Systematic Literature Review.

This review focused on literature from the United States evaluating homicide during the perinatal period. It was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies met the criteria for inclusion, including: describing prevalence and risk factors related to homicide deaths of pregnant or postpartum birthing individuals; being conducted in the United States; and being published in English 2007 or later. This review found that homicide is an important contributor to maternal mortality and is a leading cause of death during pregnancy and the postpartum period, especially if an individual is Black and under the age of 30. Future efforts must be made to standardize data collection efforts and resolve nuanced terminology that results in interpretation challenges. The United States should examine maternal deaths through the entirety of the perinatal period and fully invest in violence prevention efforts.

Novel pain management therapies for patients with pemphigus.

Pemphigus is a class of rare autoimmune diseases that causes incredibly painful blistering of the skin and significantly impacts patients' day-to-day lives and well-being. Many strides have been made in treating pemphigus; however, no comprehensive literature exists on how to treat the pain that accompanies the disease. It is important to remember that treating pemphigus involves a two-fold treatment plan assessing both the underlying autoimmune disease and the pain involved with the lesions. This literature review explores novel therapies that have been shown to be effective in treating pain in pemphigus.

Individual Differences in Reward-Based Learning Predict Fluid Reasoning Abilities.

The ability to reason and problem-solve in novel situations, as measured by the Raven's Advanced Progressive Matrices (RAPM), is highly predictive of both cognitive task performance and real-world outcomes. Here we provide evidence that RAPM performance depends on the ability to reallocate attention in response to self-generated feedback about progress. We propose that such an ability is underpinned by the basal ganglia nuclei, which are critically tied to both reward processing and cognitive control. This hypothesis was implemented in a neurocomputational model of the RAPM task, which was used to derive novel predictions at the behavioral and neural levels. These predictions were then verified in one neuroimaging and two behavioral experiments. Furthermore, an effective connectivity analysis of the neuroimaging data confirmed a role for the basal ganglia in modulating attention. Taken together, these results suggest that individual differences in a neural circuit related to reward processing underpin human fluid reasoning abilities.

Use of Backward Walking Speed to Screen Dynamic Balance and Mobility Deficits in Older Adults Living Independently in the Community.

BACKGROUND AND PURPOSE: Older adults who live independently in the community are higher functioning and routinely ambulate in the community. Unrestricted community ambulation increases the likelihood of encountering precarious situations challenging balance. Sufficient dynamic balance is necessary to avoid falls. Currently used balance and mobility assessments may not sufficiently challenge dynamic balance to uncover mobility deficits in independent community-dwelling older adults. The purpose of this study was to investigate whether backward walking speed (BWS) can serve as an outcome measure to screen dynamic balance and mobility deficits in independent community-dwelling older adults. METHODS: A convenience sample of 30 older adults (73.68 ± 6.54 years) participated in this cross-sectional study. Participants walked backward on an instrumented walkway to record BWS. Other outcomes included forward walking speed (FWS), Community Balance and Mobility (CB&M) Scale, Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG) test, and 7-day average step count (ASC). A multivariate analysis of variance investigated the overall group differences between older adults at fall risk and those not at risk and was followed up by univariate tests. Pearson and spearman coefficients investigated associations between study outcomes. Youden's index assessed diagnostic accuracy. RESULTS AND DISCUSSION: Backward walking speed, CB&M, FES-I, ASC discriminated older adults at fall risk from those not at risk (P < .01) whereas FWS and TUG did not. Backward walking speed strongly correlated with challenging assessments of balance and mobility (CB&M, FES-I, and ASC) but only moderately correlated with the TUG. The CB&M Scale independently explained 53% variance in the BWS performance (P < .01). Youden's index was highest (Y = 0.6, sensitivity = 93%, and specificity = 67%) for BWS (0.73 m/s) compared with other study outcomes. CONCLUSIONS: Preliminary results suggest that BWS can screen for dynamic balance and mobility deficits in independent community-dwelling older adults. Accurate screening is the first step to capture early decline in function for independent community-dwelling older adults. Longitudinal follow-up studies are warranted to validate BWS as a screening tool.

Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem.

Despite the fact that universal inclusion is a basic principle of the Sustainable Development Goals, the inclusion of persons with disabilities in humanitarian interventions and development policies remains elusive. Persons with disabilities face high risks of poverty, poor nutrition, limited inclusion in labor markets and poor mental health as a result. Stigma is likely to play a negative role in this regard and yet, no study has investigated the impact of stigma on depression and self-esteem of persons with disabilities. To address this gap in the literature, we conducted in June 2017 a random sample disability case control household study in Soweto, a township in Johannesburg, South Africa. Using propensity score analysis and structural equation modeling, we investigated the relationship between disability, stigma, depression and self-esteem controlling for socioeconomic covariates. Our main empirical results showed that stigma significantly mediates the association between disability and higher depression on the one hand and between disability and lower self-esteem on the other. This mediating effect exists even after controlling for age, gender, marital status, education, employment and wealth. We also found strong direct associations between disability and depressive mood, somatic indicators and negative feelings such as unhappiness and low self-esteem. Unemployment aggravates depression and low self-esteem while low education worsens self-esteem only. In addition, depression exacerbates low self-esteem. Both unemployment and low education are more common among persons with disabilities aggravating the disability, depression, poor self-esteem nexus. Similarly, persons with disabilities who are more likely to be depressed are also at higher risk of low self-esteem. These results point to a vicious reinforcing circle of exclusion from society, despair and self-deprecation, which could prove difficult to break. Substantial psycho-social support and anti-stigma policies anchored in local cultural values, engaging persons with disabilities and their communities, are required to break this vicious circle.

Evidence of non-economic indicators as markers of success for youth in youth employability programs: Insights from a South African study.

Evaluation studies of youth employment programs prioritize employment and earnings outcomes and use these indicators to determine what labor market interventions are most successful. Evidence from pre and post data of a cluster randomized controlled longitudinal study, consisting of 1 892 youth between 18 and 25 years who participated in Youth Employability Programs (YEPs) in South Africa, confirms the importance of the inclusion of non-economic indicators to measure success for youth. This study provides evidence that non-economic markers of success such as job-search resilience, self-esteem, self-efficacy and future orientation are potentially important in the transition to employment in the longer term and points to the need for more evaluations that use these markers to predict youth's success in employment. The findings further suggest that these non-economic outcomes, which were conceptualized as intermediary outcomes, can influence how young people manage the increasingly protracted and difficult transition to work. The study enlarges our understanding of the non-linear and protracted pathways of youth transitions to work in a development context, and how to best support youth in this transition period. These findings have implications for rethinking YEP evaluation outcomes that could lead to adaptive programming and management of interventions.

Food insecurity, sexual risk taking, and sexual victimization in Ghanaian adolescents and young South African adults.

OBJECTIVES: The objectives of this study were to examine whether food insecurity is associated with sexual risk taking and victimization in young people (aged 16-24); and to investigate whether the relationship of food insecurity with sexual risk taking and victimization is moderated by gender. METHODS: Cross-sectional data were obtained in 2014 from a sample of Ghanaian adolescents (n = 773) and in 2015 from young South African adults (n = 823). We used multilevel logistic regression given the study's binary outcome and clustered data. We tested a moderation effect of gender by including an interaction between gender and food insecurity. RESULTS: Food insecurity was highly prevalent (72% in Ghana and 83% in South Africa). Food insecurity was significantly associated with unwanted sexual contact among Ghanaian adolescents (OR 1.05, 95% CI 1.02, 1.08) and age-disparate sex among young South African adults (OR 1.03, 95% CI 1.00, 1.06). Results indicated no moderating effect of gender. CONCLUSIONS: Our findings underscore the importance of food access on young people's sexual health, regardless of gender. Prevention efforts may be more relevant when integrated with food security interventions that target vulnerable adolescents and young adults, irrespective of gender.

A20 suppresses canonical Smad-dependent fibroblast activation: novel function for an endogenous inflammatory modulator.

BACKGROUND: The ubiquitin-editing cytosolic enzyme A20, the major negative regulator of toll-like receptor (TLR)-mediated cellular inflammatory responses, has tight genetic linkage with systemic sclerosis (SSc). Because recent studies implicate endogenous ligand-driven TLR signaling in SSc pathogenesis, we sought to investigate the regulation, role and mechanism of action of A20 in skin fibroblasts. METHOD: A20 expression and the effects of forced A20 expression or siRNA-mediated A20 knockdown on fibrotic responses induced by transforming growth factor-ß (TGF-ß) were evaluated was evaluated in explanted human skin fibroblasts. Additionally, A20 regulation by TGF-ß, and by adiponectin, a pleiotropic adipokine with anti-fibrotic activity, was evaluated. RESULTS: In normal fibroblasts, TGF-ß induced sustained downregulation of A20, and abrogated its TLR4-dependent induction. Forced expression of A20 aborted the stimulation of collagen gene expression and myofibroblast transformation induced by TGF-ß, and disrupted canonical Smad signaling and Smad-dependent transcriptional responses. Conversely, siRNA-mediated knockdown of A20 enhanced the amplitude of fibrotic responses elicited by TGF-ß. Adiponectin, previously shown to block TLR-dependent fibrotic responses, elicited rapid and sustained increase in A20 accumulation in fibroblasts. CONCLUSION: These results identify the ubiquitin-editing enzyme A20 as a novel endogenous mechanism for negative regulation of fibrotic response intensity. Systemic sclerosis-associated genetic variants of A20 that cause impaired A20 expression or function, combined with direct suppression of A20 by TGF-ß within the fibrotic milieu, might play a significant functional role in persistence of fibrotic responses, while pharmacological augmentation of A20 inhibitory pathway activity might represent a novel therapeutic strategy.

Peptide-based systems analysis of inflammation induced myeloid-derived suppressor cells reveals diverse signaling pathways.

A better understanding of molecular signaling between myeloid-derived suppressor cells (MDSC), tumor cells, T-cells, and inflammatory mediators is expected to contribute to more effective cancer immunotherapies. We focus on plasma membrane associated proteins, which are critical in signaling and intercellular communication, and investigate changes in their abundance in MDSC of tumor-bearing mice subject to heightened versus basal inflammatory conditions. Using spectral counting, we observed statistically significant differential abundances for 35 proteins associated with the plasma membrane, most notably the pro-inflammatory proteins S100A8 and S100A9 which induce MDSC and promote their migration. We also tested whether the peptides associated with canonical pathways showed a statistically significant increase or decrease subject to heightened versus basal inflammatory conditions. Collectively, these studies used bottom-up proteomic analysis to identify plasma membrane associated pro-inflammatory molecules and pathways that drive MDSC accumulation, migration, and suppressive potency.

'I am a mother': young women's negotiation of femininity and risk in the transition to adulthood.

In studies of sexual risk behaviour among youth, the role of dominant conceptions of masculinity and femininity has received increasing attention. However, where research has sought to explore femininity, it has predominantly focused on adolescent girls. This paper departs from previous research by offering insights into how young women negotiate their femininity as they transition from adolescence to adulthood and encounter changing social contexts. Drawing on data from ethnographic enquiry, it argues that as young women transition out of school and into emerging adulthood, their options for negotiating different types of femininity become constrained, with consequences for engagement in sexual risk behaviours. This may to some extent explain why in some South African contexts older young women are more vulnerable to HIV infection than adolescent girls. The paper offer insights into future prospects for youth development programming seeking to reduce young women's vulnerability to risk.

Anodization control for barrier-oxide thinning and 3D interconnected pores and direct electrodeposition of nanowire networks on native aluminium substrates.

Here we report a strategy for combining techniques for pore branching and barrier layer thinning to produce 3D porous anodized aluminum oxide films with direct ohmic contact to the native aluminum. This method provides an example of a rationally designed template which need not be removed from the aluminum, but which is also not constrained to traditional 2D pore geometry. We first demonstrate the barrier layer removal and pore branching techniques independently, and then combine them to produce free standing arrays of interconnected Ni nanostructures. Nickel nanostructures are deposited directly onto the aluminum to demonstrate the success of the structural modification, and showcase the potential for these films to be used as templates. This approach is the first to demonstrate the design and execution of multiple pore modification techniques in the same membrane, and demonstrates the first directly deposited 3D structures on aluminum substrates.