Differences in Host Innate Responses among Coccidioides Isolates in a Murine Model of Pulmonary Coccidioidomycosis.

Coccidioides immitis and Coccidioides posadasii are soil-dwelling fungi and the causative agents of coccidioidomycosis, a mycosis endemic to certain semiarid regions in the Americas. The most common route of infection is by inhalation of airborne Coccidioides arthroconidia. Once a susceptible host inhales the conidia, a transition to mature endosporulated spherules can occur within the first 5 days of infection. For this study, we examined the host response in a murine model of coccidioidomycosis during a time period of infection that has not been well characterized. We collected lung tissue and bronchoalveolar lavage fluid (BALF) from BALB/c mice that were infected with a C. immitis pure strain, a C. immitis hybrid strain, or a C. posadasii strain as well as uninfected mice. We compared the host responses to the Coccidioides strains used in this study by assessing the level of transcription of selected cytokine genes in lung tissues and characterized host and fungal proteins present in BALF. Host response varied depending on the Coccidioides strain that was used and did not appear to be overly robust. This study provides a foundation to begin to dissect the host immune response early in infection, to detect abundant Coccidioides proteins, and to develop diagnostics that target these early time points of infection.

Urgent support mechanism: saving millions of COVID-19 vaccines from expiry in Africa.

Delivering COVID-19 vaccines with 4-6 weeks shelf life remains one of Africa's most pressing challenges. The Africa Centres for Disease Control and Prevention (Africa CDC) leadership recognised that COVID-19 vaccines donated to many African countries were at risk of expiry considering the short shelf life on delivery in the Member States and slow vaccine uptake rates. Thus, a streamlined rapid response system, the urgent support mechanism, was developed to assist countries accelerate COVID-19 vaccine uptake. We describe the achievements and lessons learnt during implementation of the urgent support mechanism in eight African countries. An Africa CDC team was rapidly deployed to meet with the Ministry of Health of each country alerted for COVID-19 vaccine expiry and identified national implementing partners to quickly develop operational work plans and strategies to scale up the urgent use of the vaccines. The time between the initiation of alerts to the start of the implementation was typically within 2 weeks. A total of approximately 2.5 million doses of vaccines, costing $900 000, were prevented from expiration. The urgent support has also contributed to the increased COVID-19 vaccination coverage in the Member States from 16.1% at the initiation to 25.3% at the end of the urgent support. Some of the effective strategies used by the urgent support mechanism included coordination between Africa CDC and country vaccine task forces, establishment of vaccination centres, building the capacity of routine and surge health workforce, procurement and distribution of vaccine ancillaries, staff training, advocacy and sensitisation events, and use of trusted religious scriptures and community influencers to support public health messages. The urgent support mechanism demonstrated a highly optimised process and serves as a successful example for acceleration and integration of vaccination into different healthcare delivery points.

What do hematology residents know about caring for older adults with cancer? A national survey of Canadian hematology residents' knowledge and interests.

INTRODUCTION: As the Canadian population ages, older adults comprise an increasing proportion of those diagnosed and treated for hematologic malignancies. A geriatric oncology curriculum has been recognized as a top priority in the care of older patients with cancer. It is not clear, however, whether hematology trainees receive training in geriatric oncology. We sought to understand residents' views and needs for a geriatric oncology curriculum during hematology residency in Canada. MATERIALS AND METHODS: We conducted a cross-sectional needs assessment of hematology trainees enrolled in a Canadian residency or advanced fellowship training program within hematology. The survey, which was piloted with three non-hematology residents to ensure user-friendliness, used a combination of Likert scale, multiple-choice, and open-ended questions. The survey comprised three sections: (1) demographic data, (2) current state of geriatric oncology training (amount, content) and (3) attitudes towards learning about geriatric oncology and preferred curriculum components and identified needs. The survey was administered by the study team and distributed electronically to program directors in June 2020. The program directors were asked to forward the survey to trainees registered within their Division of Hematology. Data were analyzed descriptively. RESULTS: Twenty-nine hematology residents participated (41.4% estimated response rate). Most respondents had not received geriatric oncology teaching (58.6%, n = 17) and have never been taught about geriatric oncology assessment tools (72.4%, n = 21) during hematology residency. Most respondents felt that their program should deliver a geriatric oncology curriculum (96.6%, n = 28). Respondents were most interested in learning about use of geriatric assessment tools for pre-treatment chemotherapy decision-making (86.2%, n = 25), prediction of chemotherapy toxicity (82.8%, n = 24), and to facilitate conversations regarding treatment initiation, continuation, or termination (79.3%, n = 23). DISCUSSION: Our study highlights the paucity of geriatric oncology training in hematology residency training programs. Our results highlight both the need and interest for a future dedicated geriatric oncology curriculum integrated into hematology training and provide guidance about which topics are most valued by trainees.

An Analysis of Pharmacogenomic-Guided Pathways and Their Effect on Medication Changes and Hospital Admissions: A Systematic Review and Meta-Analysis.

Ninety-five percent of the population are estimated to carry at least one genetic variant that is discordant with at least one medication. Pharmacogenomic (PGx) testing has the potential to identify patients with genetic variants that puts them at risk of adverse drug reactions and sub-optimal therapy. Predicting a patient's response to medications could support the safe management of medications and reduce hospitalization. These benefits can only be realized if prescribing clinicians make the medication changes prompted by PGx test results. This review examines the current evidence on the impact PGx testing has on hospital admissions and whether it prompts medication changes. A systematic search was performed in three databases (Medline, CINAHL and EMBASE) to search all the relevant studies published up to the year 2020, comparing hospitalization rates and medication changes amongst PGx tested patients with patients receiving treatment-as-usual (TAU). Data extracted from full texts were narratively synthesized using a process model developed from the included studies, to derive themes associated to a suggested workflow for PGx-guided care and its expected benefit for medications optimization and hospitalization. A meta-analysis was undertaken on all the studies that report the number of PGx tested patients that had medication change(s) and the number of PGx tested patients that were hospitalized, compared to participants that received TAU. The search strategy identified 5 hospitalization themed studies and 5 medication change themed studies for analysis. The meta-analysis showed that medication changes occurred significantly more frequently in the PGx tested arm across 4 of 5 studies. Meta-analysis showed that all-cause hospitalization occurred significantly less frequently in the PGx tested arm than the TAU. The results show proof of concept for the use of PGx in prescribing that produces patient benefit. However, the review also highlights the opportunities and evidence gaps that are important when considering the introduction of PGx into health systems; namely patient involvement in PGx prescribing decisions, thus a better understanding of the perspective of patients and prescribers. We highlight the opportunities and evidence gaps that are important when considering the introduction of PGx into health systems.

Osteoid osteoma of the distal clavicle.

The osteoid osteoma is a bone tumor that accounts for 10% of benign tumors. It was described in 1935 by Jaffe, as a tumor that affects the young adult population, with a predominance of males. This study aims to present a case of late diagnosis of a patient with osteoid osteoma of the distal clavicle region. Female patient, 44 years old, non-professional volleyball player, reported pain in the anterior and superior region of the shoulder girdle, specifically in the acromioclavicular joint, which worsened at night and had been treated for nine months as tendinitis of the rotator cuff and acromioclavicular joint arthritis. After confirming the diagnosis, the patient underwent open surgery with resection of the distal clavicle. At two years of follow-up, the patient presents without local pain. In the radiographic evaluation, coracoclavicular distance is preserved and there are no signs of recurrence. Tumors of the shoulder girdle are rare and are often diagnosed late. A high degree of suspicion for the diagnosis of tumors of the shoulder girdle is needed in order to avoid late diagnosis.

O osteoma osteóide é um tumor ósseo que corresponde a 10% dos tumores benignos. Foi descrito em 1935 por Jaffe, como um tumor que acomete a população adulta jovem, com predominância no sexo masculino. O objetivo do trabalho é apresentar um caso de diagnóstico tardio de uma paciente com osteoma osteóide da região da clavícula distal e relatar seu tratamento. Paciente de 44 anos, jogadora de vôlei não profissional, com dores na região anterior e superior da cintura escapular, mais especificamente na articulação acromioclavicular, as quais pioravam a noite e que era tratada havia nove meses como uma tendinite do manguito rotador e artrite da articulação acromioclavicular. Após confirmação diagnóstica, a paciente foi submetida ao tratamento cirúrgico aberto com ressecção da clavícula distal.Atualmente a paciente encontra-se com dois anos de evolução sem dor local. Na avaliação radiográfica, a distância coracoclavicular encontra-se preservada e não há sinais de recidiva. Tumores ósseos da cintura escapular são raros e frequentemente são diagnosticados tardiamente. Deve-se ter um alto grau de suspeição para o diagnóstico de neoplasias da cintura escapular, a fim de evitar o diagnóstico tardio.

Radial head fracture associated with posterior interosseous nerve injury.

Fractures of the radial head and radial neck correspond to 1.7-5.4% of all fractures and approximately 30% may present associated injuries. In the literature, there are few reports of radial head fracture with posterior interosseous nerve injury. This study aimed to report a case of radial head fracture associated with posterior interosseous nerve injury. CASE REPORT: A male patient, aged 42 years, sought medical care after falling from a skateboard. The patient related pain and limitation of movement in the right elbow and difficulty to extend the fingers of the right hand. During physical examination, thumb and fingers extension deficit was observed. The wrist extension showed a slight radial deviation. After imaging, it became evident that the patient had a fracture of the radial head that was classified as grade III in the Mason classification. The patient underwent fracture fixation; at the first postoperative day, thumb and fingers extension was observed. Although rare, posterior interosseous nerve branch injury may be associated with radial head fractures. In the present case, the authors believe that neuropraxia occurred as a result of the fracture hematoma and edema.

As fraturas da cabeça e do colo do rádio correspondem a 1,7% a 5,4% de todas as fraturas e 30% podem apresentar lesões associadas. Na literatura existem poucos casos descritos de fratura da cabeça do rádio com lesão do nervo interósseo posterior. O objetivo deste trabalho é relatar um caso de fratura da cabeça do rádio associada a lesão do nervo interósseo posterior (NIP). RELATO DE CASO: Paciente masculino, 42 anos, procurou atendimento médico após queda de skate. Relatava dor e limitação de movimento do cotovelo direito, bem como dificuldade de estender os dedos da mão ipsilateral. Durante o exame físico, evidenciou-se déficit de extensão do polegar e dos dedos da mão. A extensão do punho apresentava um leve desvio radial. Após exames de imagem, ficou evidenciado que o paciente apresentava uma fratura da cabeça do rádio tipo grau III de Mason. O paciente foi submetido à fixação da fratura; no primeiro dia do pós-operatório notou-se o retorno da extensão do polegar e dos dedos da mão. Apesar de rara, a lesão do ramo interósseo posterior pode estar associada a fraturas da cabeça do rádio. No presente caso, acredita-se que a neuropraxia se deu em decorrência do hematoma e do edema fraturário.

The Age Conundrum: A Scoping Review of Younger Age or Adolescent and Young Adult as a Risk Factor for Clinical Distress, Depression, or Anxiety in Cancer.

This scoping review was conducted to understand the extent, range, and nature of current research on adolescents and young adults (AYA) with cancer and distress, depression, and anxiety (DDA). This information is necessary to find and aggregate valuable data on the AYA population embedded in generalized studies of DDA. Keyword searches of six relevant electronic databases identified 2156 articles, with 316 selected for abstract review and 40 for full text review. Full-text reviews and data extraction resulted in 34 studies being included, which ranged widely in design, sample size, age-range categorization, analysis methods, DDA measurement tool, overall study rigor, and quality of evidence. Studies very seldom reported using theory to guide their age categorization, with only four studies giving any rationale for their age-group definitions. All 34 studies found a significant association between at least one DDA construct and the younger age group relative to the older age groups at some point along the cancer trajectory. However, age as an independent risk factor for DDA is still unclear, as the relationship could be confounded by other age-related factors. Despite the wide range of definitions and effect sizes in the studies included in this review, one thing is clear: adolescents and young adults, however defined, are a distinct group within the cancer population with an elevated risk of DDA. Widespread adoption of a standard AYA age-range definition will be essential to any future meta-analytical psycho-oncology research in this population.

Sternoclavicular dislocation: case report and surgical technique.

Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of chronic anterior dislocation of the sternoclavicular joint that was successfully treated by using a modification of the "figure of eight" reconstruction technique. This technique was shown to be safe and effective, and it allowed the patient to fully return to his sports activities.

As luxações esternoclaviculares representam menos de 5% de todas as luxações da cintura escapular. A maioria dos casos de luxação anterior da articulação esternoclavicular não apresenta sintomas. Entretanto, alguns pacientes podem desenvolver instabilidade anterior crônica e permanecer sintomáticos. Nesses casos é indicado o tratamento cirúrgico. A literatura é escassa em relação à reconstrução com uso do tendão palmar longo nos casos de instabilidade anterior traumática. Embora raras, essas lesões merecem diagnóstico rápido e tratamento eficaz para evitar complicações futuras. O objetivo deste trabalho foi relatar um caso de um atleta de motocross que evoluiu com instabilidade anterior traumática crônica da articulação esternoclavicular e foi submetido a reconstrução cirúrgica com o uso do tendão palmar longo autógeno.Paciente masculino, 33 anos, com história de luxação anterior da articulação esternoclavicular após queda durante manobra em um campeonato de motocross. Inicialmente foi empregado o tratamento conservador, com uso de tipoia funcional por três semanas, e sintomático, além da reabilitação com fisioterapia por três meses. Optamos por usar uma modificação da técnica do "oito", baseados nos estudos de Spencer e Kuhn. A incisão longitudinal de aproximadamente 10 cm foi feita no nível da articulação esternoclavicular. O enxerto do tendão palmar longo ipsilateral foi passado pelos orifícios em forma de "oito" modificado e suas extremidades foram suturadas conjuntamente. O paciente foi imobilizado com tipoia americana por quatro semanas. No fim de seis meses de seguimento não apresentava dor ou instabilidade quando solicitada a articulação esternoclavicular. Um discreto desconforto e ligeira saliência da articulação esternoclavicular permaneceu, mas não afetaram suas atividades, o que permitiu ao paciente voltar às pistas de corrida com seis meses de pós-operatório. Nosso estudo apresentou um caso de luxação anterior crônica da articulação esternoclavicular tratado com sucesso com o uso de uma modificação da técnica de reconstrução em "oito". Essa técnica mostrou ser segura e eficaz e permitiu um retorno total às atividades esportivas do paciente.

Osteoid osteoma of the distal clavicle / Osteoma osteóide da clavícula distal

ABSTRACT The osteoid osteoma is a bone tumor that accounts for 10% of benign tumors. It was described in 1935 by Jaffe, as a tumor that affects the young adult population, with a predominance of males. This study aims to present a case of late diagnosis of a patient with osteoid osteoma of the distal clavicle region. Female patient, 44 years old, non-professional volleyball player, reported pain in the anterior and superior region of the shoulder girdle, specifically in the acromioclavicular joint, which worsened at night and had been treated for nine months as tendinitis of the rotator cuff and acromioclavicular joint arthritis. After confirming the diagnosis, the patient underwent open surgery with resection of the distal clavicle. At two years of follow-up, the patient presents without local pain. In the radiographic evaluation, coracoclavicular distance is preserved and there are no signs of recurrence. Tumors of the shoulder girdle are rare and are often diagnosed late. A high degree of suspicion for the diagnosis of tumors of the shoulder girdle is needed in order to avoid late diagnosis.

RESUMO O osteoma osteóide é um tumor ósseo que corresponde a 10% dos tumores benignos. Foi descrito em 1935 por Jaffe, como um tumor que acomete a população adulta jovem, com predominância no sexo masculino. O objetivo do trabalho é apresentar um caso de diagnóstico tardio de uma paciente com osteoma osteóide da região da clavícula distal e relatar seu tratamento. Paciente de 44 anos, jogadora de vôlei não profissional, com dores na região anterior e superior da cintura escapular, mais especificamente na articulação acromioclavicular, as quais pioravam a noite e que era tratada havia nove meses como uma tendinite do manguito rotador e artrite da articulação acromioclavicular. Após confirmação diagnóstica, a paciente foi submetida ao tratamento cirúrgico aberto com ressecção da clavícula distal. Atualmente a paciente encontra-se com dois anos de evolução sem dor local. Na avaliação radiográfica, a distância coracoclavicular encontra-se preservada e não há sinais de recidiva. Tumores ósseos da cintura escapular são raros e frequentemente são diagnosticados tardiamente. Deve-se ter um alto grau de suspeição para o diagnóstico de neoplasias da cintura escapular, a fim de evitar o diagnóstico tardio.

Radial head fracture associated with posterior interosseous nerve injury / Fratura da cabeça do rádio associada a lesão do nervo interósseo posterior

ABSTRACT Fractures of the radial head and radial neck correspond to 1.7-5.4% of all fractures and approximately 30% may present associated injuries. In the literature, there are few reports of radial head fracture with posterior interosseous nerve injury. This study aimed to report a case of radial head fracture associated with posterior interosseous nerve injury. CASE REPORT: A male patient, aged 42 years, sought medical care after falling from a skateboard. The patient related pain and limitation of movement in the right elbow and difficulty to extend the fingers of the right hand. During physical examination, thumb and fingers extension deficit was observed. The wrist extension showed a slight radial deviation. After imaging, it became evident that the patient had a fracture of the radial head that was classified as grade III in the Mason classification. The patient underwent fracture fixation; at the first postoperative day, thumb and fingers extension was observed. Although rare, posterior interosseous nerve branch injury may be associated with radial head fractures. In the present case, the authors believe that neuropraxia occurred as a result of the fracture hematoma and edema.

RESUMO As fraturas da cabeça e do colo do rádio correspondem a 1,7% a 5,4% de todas as fraturas e 30% podem apresentar lesões associadas. Na literatura existem poucos casos descritos de fratura da cabeça do rádio com lesão do nervo interósseo posterior. O objetivo deste trabalho é relatar um caso de fratura da cabeça do rádio associada a lesão do nervo interósseo posterior (NIP). RELATO DE CASO: Paciente masculino, 42 anos, procurou atendimento médico após queda de skate. Relatava dor e limitação de movimento do cotovelo direito, bem como dificuldade de estender os dedos da mão ipsilateral. Durante o exame físico, evidenciou-se déficit de extensão do polegar e dos dedos da mão. A extensão do punho apresentava um leve desvio radial. Após exames de imagem, ficou evidenciado que o paciente apresentava uma fratura da cabeça do rádio tipo grau III de Mason. O paciente foi submetido à fixação da fratura; no primeiro dia do pós-operatório notou-se o retorno da extensão do polegar e dos dedos da mão. Apesar de rara, a lesão do ramo interósseo posterior pode estar associada a fraturas da cabeça do rádio. No presente caso, acredita-se que a neuropraxia se deu em decorrência do hematoma e do edema fraturário.

Luxação esternoclavicular: relato de caso e técnica cirúrgica / Sternoclavicular dislocation: case report and surgical technique

As luxações esternoclaviculares representam menos de 5% de todas as luxações da cintura escapular. A maioria dos casos de luxação anterior da articulação esternoclavicular não apresenta sintomas. Entretanto, alguns pacientes podem desenvolver instabilidade anterior crônica e permanecer sintomáticos. Nesses casos é indicado o tratamento cirúrgico. A literatura é escassa em relação à reconstrução com uso do tendão palmar longo nos casos de instabilidade anterior traumática...

Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability...