Unique aspects of IFN-γ/STAT1 signaling in neurons.

The IFN-γ/STAT1 immune signaling pathway impacts many homeostatic and pathological aspects of neurons, beyond its canonical role in controlling intracellular pathogens. Well known for its potent pro-inflammatory and anti-viral functions in the periphery, the IFN-γ/STAT1 pathway is rapidly activated then deactivated to prevent excessive inflammation; however, neurons utilize unique IFN-γ/STAT1 activation patterns, which may contribute to the non-canonical neuron-specific downstream effects. Though it is now well-established that the immune system interacts and supports the CNS in health and disease, many aspects regarding IFN-γ production in the CNS and how neurons respond to IFN-γ are unclear. Additionally, it is not well understood how the diversity of the IFN-γ/STAT1 pathway is regulated in neurons to control homeostatic functions, support immune surveillance, and prevent pathologies. In this review, we discuss the neuron-specific mechanisms and kinetics of IFN-γ/STAT1 activation, the potential sources and entry sites of IFN-γ in the CNS, and the diverse set of homeostatic and pathological effects IFN-γ/STAT1 signaling in neurons has on CNS health and disease. We will also highlight the different contexts and conditions under which IFN-γ-induced STAT1 activation has been studied in neurons, and how various factors might contribute to the vast array of downstream effects observed.

Validation of Lung Ultrasound for COVID-19 Prognostication in an International Multicenter Cohort Study.

BACKGROUND: Despite many studies evaluating lung ultrasound (LUS) for COVID-19 prognostication, the generalizability and utility across clinical settings is uncertain. METHODS: Adults (≥18 years of age) with COVID-19 were enrolled at two military hospitals, an emergency department, home visits, and a homeless shelter in the United States, and in a referral hospital in Uganda. Participants had a 12-zone LUS scan performed at time of enrollment and clips were read off-site. The primary outcome was progression to higher level of care after the ultrasound scan. We calculated the cross-validated area under the curve for the validation cohort for individual LUS features. RESULTS: We enrolled 191 participants with COVID-19 were enrolled (57.9% female, median age 45.0 years, interquartile range [IQR]: 31.5, 58.0). Nine participants clinically deteriorated. The top predictors of worsening disease in the validation cohort measured by cross-validated area under the curve (cvAUC) were B-lines (0.88, 95% confidence interval [CI]: 0.87, 0.90), discrete B-lines (0.87, 95% CI: 0.85, 0.88), oxygen saturation (0.82, 95%: CI:0.81, 0.84), and A-lines (0.80, 95% CI: 0.78, 0.81). CONCLUSIONS: In an international multisite POCUS cohort, LUS parameters had high discriminative accuracy. Ultrasound can be applied towards triage across a wide breadth of care settings during a pandemic.

Retrospective Analysis of Blood Biomarkers of Neurological Injury in Human Cases of Viral Infection and Bacterial Sepsis.

BACKGROUND: Blood biomarkers of neurological injury could provide a rapid diagnosis of central nervous system (CNS) injury caused by infections. An FDA-approved assay for mild traumatic brain injury (TBI) measures glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), which signal astrocyte and neuronal injury, respectively. Here, we assessed the applicability of this biomarker assay for determining infection-induced brain injury. METHODS: We measured serum levels of GFAP and UCH-L1 retrospectively in serum samples from three study populations: 1) human cases infected with Venezuelan equine encephalitis virus (VEEV) and Madariaga virus (MADV) (n = 73), 2) human sepsis patients who were severely ill or diagnosed with encephalitis (n = 66), and 3) sepsis cases that were subsequently evaluated for cognitive impairment (n = 64). RESULTS: In the virus infection group, we found elevated GFAP for VEEV (p = 0.014) and MADV (p = 0.011) infections, which correlated with seizures (p = 0.006). In the bacterial sepsis group, GFAP was elevated in cases diagnosed with encephalitis (p = 0.0007) and correlated with headaches (p = 0.0002). In the bacterial sepsis cases with a later cognitive assessment, elevated GFAP (p = 0.0057) at study enrollment was associated with cognitive impairment six months later with a positive prognostic capacity of 79% (CI: 66-95%; p = 0.0068). CONCLUSIONS: GFAP and UCH-L1 levels measured using an FDA-approved assay for TBI may indicate brain injury resulting from viral or bacterial infections and could predict the development of neurological sequelae.

Evidence of Orientia spp. Endemicity among Severe Infectious Disease Cohorts, Uganda.

At 3 severe infection cohort sites in Uganda, Orientia seropositivity was common. We identified 4 seroconversion cases and 1 PCR-positive case. These results provide serologic and molecular support for Orientia spp. circulating in sub-Saharan Africa, possibly expanding its endemic range. Orientia infections could cause severe illness and hospitalizations in this region.

Perspectives of Sexual and Gender Minority Youth on Anti-Vaping Messages in Social Media.

INTRODUCTION: Sexual and gender minority (SGM) youth have higher rates of nicotine vaping than other youth in the United States. While social media can be effective in reaching youth and discouraging vaping, informed cultural tailoring is necessary to ensure effective messaging to SGM youth. This study aimed to understand SGM youth perspectives on anti-vaping social media messages and tailoring approaches. METHODS: In-depth, qualitative videoconference interviews were conducted from February to July 2022 with 34 SGM youth recruited in the United States via social media ads. The interview guide addressed participants' beliefs about vaping, the context of vaping, perspectives on tailoring messages, and responses to examples of social media anti-vaping messages. Coding and thematic analysis followed a team-based approach. RESULTS: SGM youth perspectives fell into four categories - representation and diversity, facts and evidence, empowering messages, and source credibility. Participants stressed the importance of accurate, genuine representation of SGM youth in messages, but also noted that more overt representation may be seen as tokenizing. Participants recommended partnering with known LGBTQ+ influencers who can promote or share anti-vaping messages on social media platforms. They also recommended using culturally tailored language, including statistics specific to SGM youth, and invoking themes of empowerment to improve the relevance, reach, and effectiveness of anti-vaping campaigns. CONCLUSIONS: Findings can inform future efforts to develop anti-vaping messages for SGM youth with effective reach through social media. Nuanced perspectives on SGM representation in messages suggest a careful approach to tailoring. Concerns around inauthenticity may be minimized by ensuring SGM youth are included in message development and dissemination. IMPLICATIONS: This study describes the importance of being attentive to the tailoring preferences among the current generation of sexual and gender minority youth. Findings will inform social media-based messaging strategies that discourage nicotine vaping tailored for SGM youth in health campaign material design and evaluation, ensuring that tailored messages are designed in ways that avoid unintended consequences. The study also describes methods for effectively engaging SGM youth in research to improve the relevance of health education materials for this population and increase reach, which in turn can lead to reduction in vaping practices among SGM youth.

Should Communication Campaigns Promoting Vaccination Address Misinformation Beliefs? Implications from a Nationally Representative Longitudinal Survey Study among U.S. Adults.

Public health communication campaign planners must carefully consider whether misinformation beliefs are important to target and, ideally, correct. Guided by the reasoned action approach, we hypothesized that behavior-specific beliefs regarding COVID-19 vaccination would account for any observed relationship between general coronavirus misinformation beliefs (misinformation beliefs that are not specific to the anticipated consequences of COVID-19 vaccination) and subsequent vaccine uptake. To test our hypothesis, we used panel data from a two-wave nationally representative sample of U.S. adults pre- and post-vaccine availability (T1: July 2020, T2: April/June 2021, analytic sample: n = 665). Contrary to our hypothesis, we find a residual observed relationship between general coronavirus misinformation beliefs and subsequent vaccine uptake (AOR = 0.40, SE = 0.10). Intriguingly, our post-hoc analyses do show that after also adjusting for T2 behavioral beliefs, this association was no longer significant. With this and other justifications, we recommend that messages promoting vaccination prioritize targeting relevant behavioral beliefs.

On the Environmental Presence of Burkholderia pseudomallei in South-Central Ghana.

Burkholderia pseudomallei is a Gram-negative soil saprophyte with the potential to cause melioidosis, an opportunistic disease with a high mortality potential. Periodic case reports of melioidosis in or imported from Africa occur in the literature dating back decades. Furthermore, statistical models suggest Western sub-Saharan Africa as a high-risk zone for the presence of B. pseudomallei. A recent case report from the United Kingdom of a returning traveler from Ghana highlights the need for environmental studies in Ghana. We examined 100 soil samples from a rice farm in south-central Ghana. Soil was subjected to selective enrichment culture for B. pseudomallei using threonine-basal salt solution with colistin (TBSS-C50) and erythritol medium, as described in the literature. Bacterial cultures were identified with standard biochemical tests, a rapid antigen detection assay, and real-time PCR specific for B. pseudomallei. Of the 100 soil samples, 55% yielded cultures consistent with B. pseudomallei on Ashdown's agar as well as by capsular polysaccharide antigen production. This is the first confirmatory report of culture-confirmed B. pseudomallei in the environment of Ghana. Our study emphasizes the need for further exploration of the burden of human melioidosis in Ghana. We recommend that local clinicians familiarize themselves with the diagnosis and clinical management of melioidosis, while laboratories develop capacity for the safe isolation and identification of B. pseudomallei. IMPORTANCE We present the first confirmation of the presence of B. pseudomallei in the environment of Ghana. This study will bring attention to a disease with the potential to cause significant morbidity and mortality in Ghana, but which has gone completely unrecognized until this point. Furthermore, this work would encourage local clinicians to familiarize themselves with the diagnosis and clinical management of melioidosis and laboratories to develop capacity for the safe isolation and identification of B. pseudomallei.

Missed Opportunities to Promptly Diagnose and Treat Adrenal Tumors.

INTRODUCTION: Adrenal mass management guidelines are insufficiently applied, and timeliness of treatment is unknown. We evaluated missed opportunities to promptly diagnose and treat adrenal tumors that ultimately required adrenalectomy. METHODS: From the Veterans Affairs Corporate Data Warehouse, we identified patients who underwent adrenalectomy (2010-2016) in the South-Central Veterans Affairs HealthCare Network and reviewed their records. Diagnostic timeliness was assessed by the interval between initial (index) imaging with adrenal abnormality and the next diagnostic step. Workup was defined as early (interval ≤6 mo) or late (>6 mo). Adrenalectomy was considered prompt when the interval between index imaging and adrenalectomy was ≤12 mo and delayed when this was >12 mo. We quantified diagnostic and treatment delays and assessed factors associated with delayed adrenalectomy. RESULTS: During the study period, 84 patients underwent adrenalectomy: male (86.9%), White (57.1%), with a mean age of 58.7 y (±8.8). Of those, 25 (29.8%) had late workup, and 36 (42.9%) had delayed surgery (median interval: 44 mo, range 14-282). Late hormonal workup occurred in 24 of 36 (66.7%) patients with delayed surgery, compared with one of 48 (2.1%, P < 0.001) with prompt surgery. CONCLUSIONS: Missed opportunities in prompt diagnosis and treatment were common in patients with adrenal masses ultimately requiring adrenalectomy. Late hormonal workup is associated with delayed adrenalectomy. Interventions are needed to aid clinicians to recognize the presence, promptly evaluate, and make guideline-informed decisions on the management of an adrenal mass.

Improving Gene Editing Outcomes in Human Hematopoietic Stem and Progenitor Cells by Temporal Control of DNA Repair.

Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR-associated system (Cas9)-mediated gene editing of human hematopoietic stem cells (hHSCs) is a promising strategy for the treatment of genetic blood diseases through site-specific correction of identified causal mutations. However, clinical translation is hindered by low ratio of precise gene modification using the corrective donor template (homology-directed repair, HDR) to gene disruption (nonhomologous end joining, NHEJ) in hHSCs. By using a modified version of Cas9 with reduced nuclease activity in G1 phase of cell cycle when HDR cannot occur, and transiently increasing the proportion of cells in HDR-preferred phases (S/G2), we achieved a four-fold improvement in HDR/NHEJ ratio over the control condition in vitro, and a significant improvement after xenotransplantation of edited hHSCs into immunodeficient mice. This strategy for improving gene editing outcomes in hHSCs has important implications for the field of gene therapy, and can be applied to diseases where increased HDR/NHEJ ratio is critical for therapeutic success. Stem Cells 2019;37:284-294.

Editing the Sickle Cell Disease Mutation in Human Hematopoietic Stem Cells: Comparison of Endonucleases and Homologous Donor Templates.

Site-specific correction of a point mutation causing a monogenic disease in autologous hematopoietic stem and progenitor cells (HSPCs) can be used as a treatment of inherited disorders of the blood cells. Sickle cell disease (SCD) is an ideal model to investigate the potential use of gene editing to transvert a single point mutation at the ß-globin locus (HBB). We compared the activity of zinc-finger nucleases (ZFNs) and CRISPR/Cas9 for editing, and homologous donor templates delivered as single-stranded oligodeoxynucleotides (ssODNs), adeno-associated virus serotype 6 (AAV6), integrase-deficient lentiviral vectors (IDLVs), and adenovirus 5/35 serotype (Ad5/35) to transvert the base pair responsible for SCD in HBB in primary human CD34+ HSPCs. We found that the ZFNs and Cas9 directed similar frequencies of nuclease activity. In vitro, AAV6 led to the highest frequencies of homology-directed repair (HDR), but levels of base pair transversions were significantly reduced when analyzing cells in vivo in immunodeficient mouse xenografts, with similar frequencies achieved with either AAV6 or ssODNs. AAV6 also caused significant impairment of colony-forming progenitors and human cell engraftment. Gene correction in engrafting hematopoietic stem cells may be limited by the capacity of the cells to mediate HDR, suggesting additional manipulations may be needed for high-efficiency gene correction in HSPCs.

Next-generation Diagnostics for Melioidosis: Evaluation of a Prototype i-STAT Cartridge to Detect Burkholderia pseudomallei Biomarkers.

BACKGROUND: Infection with the gram-negative bacterium Burkholderia pseudomallei can result in melioidosis, a life-threatening disease that can be difficult to diagnose. Culture remains the gold standard for diagnosis but requires laboratory resources not available in many endemic regions. A lateral flow immunoassay has shown promise for POC diagnostics but suffers from low sensitivity when used on blood samples. PCR also has low sensitivity on blood, attributed to the low bacterial numbers in blood observed in melioidosis patients, even when bacteraemic. METHODS: A prototype i-STAT cartridge was developed to utilize the monoclonal antibody specific for the capsule of pathogenic Burkholderia species employed on the LFI. The resulting POC assay was evaluated on 414 clinical specimens from Darwin, Australia and Cambodia. RESULTS: The i-STAT assay accurately distinguished Australian blood culture positive melioidosis patients from Australian patients hospitalized with other infections (AUC = 0.91, 95% CI 0.817 - 1.0). We derived an assay cutoff with 76% sensitivity and 94% specificity that correctly classified 88% (n = 74) of the Australian patients. Interestingly, only 46% (6/13) of the culture-positive melioidosis patients in Cambodia were classified correctly. Of great importance however, the assay detected capsule from blood samples for 32% of blood culture negative melioidosis patients in both cohorts and previously undiagnosed melioidosis patients in Cambodia. In addition the assay showed high sensitivity and specificity for urine, pus and sputum. CONCLUSIONS: Diagnostic tools that are not dependent upon the growth kinetics or the levels of bacteremia of B. pseudomallei represent the next-generation of diagnostics and must be pursued further.

Direct-from-blood RNA sequencing identifies the cause of post-bronchoscopy fever.

BACKGROUND: Antibiotic resistance is rising at disturbing rates and contributes to the deaths of millions of people yearly. Antibiotic resistant infections disproportionately affect those with immunocompromising conditions, chronic colonization, and frequent antibiotic use such as transplant patients or those with cystic fibrosis. However, clinicians lack the diagnostic tools to confidently diagnose and treat infections, leading to widespread use of empiric broad spectrum antimicrobials, often for prolonged duration. CASE PRESENTATION: A 22 year-old Caucasian female with cystic fibrosis received a bilateral orthotopic lung transplantation 5 months prior to the index hospitalization. She underwent routine surveillance bronchoscopy and was admitted for post-procedure fever. A clear cause of infection was not identified by routine methods. Imaging and bronchoscopic lung biopsy did not identify an infectious agent or rejection. She was treated with a prolonged course of antimicrobials targeting known colonizing organisms from prior bronchoalveolar lavage cultures (Pseudomonas, Staphylococcus aureus, and Aspergillus). However, we identified Stenotrophomonas maltophilia in two independent whole blood samples using direct-pathogen sequencing, which was not identified by other methods. CONCLUSIONS: This case represents a common clinical conundrum: identification of infection in a high-risk, complex patient. Here, direct-pathogen sequencing identified a pathogen that would not otherwise have been identified by common techniques. Had results been clinically available, treatment could have been customized, avoiding a prolonged course of broad spectrum antimicrobials that would only exacerbate resistance. Direct-pathogen sequencing is poised to fill a diagnostic gap for pathogen identification, allowing early identification and customization of treatment in a culture-independent, pathogen-agnostic manner.

Confusion and nutritional backlash from news media exposure to contradictory information about carbohydrates and dietary fats.

OBJECTIVE: To test the effect of news media exposure to contradictory information about carbohydrates and dietary fats on levels of confusion, nutritional backlash and dietary intentions. DESIGN: We conducted an online survey experiment between 11 and 28 February 2018, randomizing participants to one of six experimental conditions. Two 'contradictory information' conditions asked participants to read one news article on the risks of a low-carbohydrate diet and one article on the risks of a low-fat diet. Two 'convergent information' conditions asked participants to read two articles with similar information on the risks of one of these two diets. A fifth 'established health recommendations' control condition asked participants to read two articles on the harms of smoking and sun exposure. A sixth 'no information' condition served as a second control group. We used general linear models to test hypotheses on the effects of exposure on confusion, nutritional backlash and dietary intentions. SETTING: USA. PARTICIPANTS: Adults (n 901) registered with Amazon's Mechanical Turk (M-Turk). RESULTS: Exposure to contradictory information about carbohydrates and dietary fats increased confusion and nutritional backlash compared with exposure to established health recommendations for non-dietary behaviours and a no-exposure control. Exposure to contradictory information also increased confusion compared with exposure to consistent nutrition information regarding carbohydrates and dietary fats. CONCLUSIONS: Contradictory nutrition information in the news media can negatively affect consumers' attitudes, beliefs and behavioural intentions. Dietary debates that play out in the media may adversely influence both short-term dietary decisions and future efforts to communicate about unrelated nutrition issues.

In the dental implant era, why do we still bother saving teeth?

Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long-term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri-implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow-up protocols are implemented and that treatment planning is ethically responsible and evidence based.

Loricrin downregulation and epithelial-related disorders: a systematic review.

Loricrin downregulation has been associated with age-related changes as well as inherited and inflammatory skin diseases. We hypothesize that changes in loricrin could be more related to altered barrier function and consequently disorders that affect epithelial cells, such as psoriasis, atopic dermatitis (AD), erythrokeratoderma, loricrin keratoderma (LK) and periodontitis. The aim of this review is to summarize what is known about the association between loricrin downregulation and epithelial-related disorders (ERDs). A search was performed on the following databases: Medline, Cochrane Library, PubMed, EMBASE, Lilacs, Scopus and Google Scholar, resulting in 16 included articles. Loricrin keratoderma was the ERD most frequently associated with loricrin mutations (730insG, 709insC and 578insG; 5/7 cases - 71.44 %). Atopic dermatitis was the ERD most frequently associated with loricrin downregulation (2/7 cases - 28.6 %). Mutilating palmoplantar keratoderma, progressive symmetrical erythrokeratoderma and a new type of erythrokeratoderma were not associated with any mutations. At the gene level, periodontitis patients showed the highest decrease (-6.89x), followed by AD (-6.5x) and psoriasis patients (-0.5x). In summary, loricrin mutation and downregulation were associated with several ERDs. The diversity in disease presentation is likely related to whether there is a total loss of loricrin, mislocalization and/or if the mutant form of loricrin causes dysfunction of other proteins and/or changes in cornification.

Prognosis and complications of immature teeth following lateral luxation: A systematic review.

BACKGROUND/AIMS: Lateral luxation injuries are a type of traumatic dental injury in which the tooth becomes displaced in the palatal/lingual or labial direction. This injury is common among children and can result in pulp canal obliteration or pulp necrosis. The objective of this systematic review was to gather existing data on lateral luxation injuries to immature teeth to evaluate their overall prognosis. METHODS: A systematic search was conducted using Medline, Pubmed, Scopus, Lilacs, EMBASE and Cochrane databases in October 2017. Reference lists were also hand-searched to identify additional literature. Prospective and retrospective observational studies were included. A total of 502 articles were screened and six articles were included in the study. RESULTS: Pulp canal obliteration was the most frequent complication of immature teeth with lateral luxation (31.3%). This was followed by pulp necrosis (17.5%), inflammatory resorption (5.7%), and surface resorption (3.2%). Due to the heterogeneity of the studies, a meta-analysis was not attempted. There was great variation in the reported outcomes among the studies. CONCLUSION: Accurate prognosis evaluation of traumatic dental injuries is difficult due to the nature of current studies being retrospective or prospective cohort studies. Lateral luxation is a common traumatic dental injury and has life-long concerns for a patient. It is important for future studies to report on the same outcomes to increase the quality of evidence regarding prognosis and treatment interventions, not only for lateral luxation injuries, but for all traumatic dental injuries.

Clinical guideline highlights for the hospitalist: Management of COVID-19.

GUIDELINE TITLE: 2023 IDSA Guidelines on the Treatment and Management of Patients with COVID-19 RELEASE DATE: 06/26/2023 PRIOR VERSION (S): 2021 DEVELOPER: Infectious Diseases Society of America FUNDING SOURCE: Infectious Diseases Society of America TARGET POPULATION: Patients with COVID-19 Infection.