Sporotrichosis in a U.S. Army Basic Trainee

ABSTRACT Lymphocutaneous sporotrichosis is a mycotic disease caused by traumatic inoculation of the dimorphic fungus Sporothrix schenckii, found ubiquitously in decaying vegetation. The potential for outbreaks, difficulty with timely diagnosis, as well as the prolonged treatment course and recovery from surgical intervention can have a substantial impact on the medical readiness of service members. Treatment with the antifungal therapy of choice, itraconazole, requires close patient monitoring for the duration of treatment for clinical response, drug tolerance, as well as therapeutic drug levels. We present a case of a U.S. Army enlistee with sporotrichosis contracted during basic training, highlighting the impact of delayed diagnosis and prolonged treatment course and recovery on medical readiness.

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How delayed treatment benefits and harms would impact the optimal timing of statin initiation for cardiovascular primary prevention

10.1101/608216 ◽

2019 ◽

Author(s):

Rodney A. Hayward ◽

Greggory Schell ◽

Jennifer G. Robinson ◽

Jeremy B. Sussman ◽

Mariel S. Lavieri

Keyword(s):

Thought Experiment ◽

Relative Effectiveness ◽

Additional Treatment ◽

Additional Benefit ◽

Prolonged Treatment ◽

Optimal Timing ◽

Duration Of Treatment ◽

The Impact ◽

Term Benefit

AbstractBackgroundGenetic studies suggest that the relative risk reduction (RRR) of statins may increase over time, potentially resulting in much greater long-term benefit if statins are started before cardiovascular (CV) risk is high.MethodsWe used a nationally representative sample of American adults to estimate effects of initiating a statin when 10-year CV risk reaches 5%, 10% or 15%. We examined scenarios in which a statin’s initial RRR (30%) gradually doubles over 10 to 30 years of treatment.ResultsInitiating a statin when 10-year CV risk is 5% resulted in a mean of 20.1 years on a statin before age 75 (8 years more than starting when CV risk reaches 10%). If a statin’s RRR doubles over 20 years, starting when CV risk is 5% would save about 5.1 to 6.1 additional QALYs per 1000 additional treatment years than starting when CV risk is 10%. Most of this additional benefit was accrued by those who reach a 5% risk at a younger age. Due to the prolonged treatment period, however, early treatment could also result in net harm if the treatment slowly increased a major complication of aging, such as muscular or neurological aging.ConclusionsIn a thought experiment exploring the impact of delayed effects, we found that if the relative effectiveness of statin therapy gradually doubles over a 10 to 30 year period, starting a statin when 10-year CV risk is 5% could have much more long-term benefit than starting a statin when CV risk is 10%. Most of the additional benefit occurred in those at elevated age-adjusted CV risk. Unfortunately, given the long duration of treatment, substantial delayed statin harms, if present, could outweigh these potential benefits and result in substantial net harm.

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The Digital Divide and K-12 Student Computer Use

10.28945/2926 ◽

2005 ◽

Author(s):

James N. Morgan ◽

Craig A. VanLengen

Keyword(s):

Digital Divide ◽

Computer Use ◽

Census Data ◽

Internet Access ◽

Demographic Characteristics ◽

The Internet ◽

Substantial Impact ◽

Limited Basis ◽

K 12 ◽

The Impact

The divide between those who have computer and Internet access and those who do not appears to be narrowing, however overall statistics may be misleading. Measures of computer availability in schools often include cases where computers are only available for administration or are available only on a very limited basis (Gootman, 2004). Access to a computer and the Internet outside of school helps to reinforce student learning and emphasize the importance of using technology. Recent U.S. statistics indicate that ethnic background and other demographic characteristics still have substantial impact on the availability and use of computers by students outside of the classroom. This paper examines recent census data to determine the impact of the household on student computer use outside of the classroom. Encouragingly, the findings of this study suggest that use of a computer at school substantially increases the chance that a student will use a computer outside of class. Additionally, this study suggests that computer use outside of the classroom is positively and significantly impacted by being in a household with adults who either use a computer at work or work in an industry where computers are extensively used.

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Disease monitoring of biologic treatment in IBD: early impact and future implications of COVID-19 pandemic

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101563 ◽

2020 ◽

pp. flgastro-2020-101563

Author(s):

Stephanie Shields ◽

Allan Dunlop ◽

John Paul Seenan ◽

Jonathan Macdonald

Keyword(s):

Clinical Care ◽

Chronic Illnesses ◽

Therapeutic Drug ◽

Disease Monitoring ◽

Biologic Treatment ◽

Faecal Calprotectin ◽

Routine Clinical Care ◽

Risk Of Disease ◽

Inflammatory Bowel ◽

The Impact

COVID-19 has dominated life in 2020 with, at the time of writing, over 4.9M global cases and >320 000 deaths. The impact has been most intensely felt in acute and critical care environments. However, with most UK elective work postponed, laboratory testing of faecal calprotectin halted due to potential risk of viral transmission and non-emergency endoscopies and surgeries cancelled, the secondary impact on chronic illnesses such as inflammatory bowel disease (IBD) is becoming apparent. Data from the Scottish Biologic Therapeutic Drug Monitoring (TDM) service shows a dramatic drop in TDM testing since the pandemic onset. April 2020 saw a 75.6% reduction in adalimumab testing and a 36.2% reduction in infliximab testing when compared with February 2020 data, a reduction coinciding with the widespread cancellation of outpatient and elective activity. It is feared that disruption to normal patterns of care and disease monitoring of biologic patients could increase the risk of disease flare and adverse clinical outcomes. Urgent changes in clinical practice have been instigated to mitigate the effects of the pandemic on routine clinical care. Further transformations are needed to maintain safe, effective, patient-centred IBD care in the future.

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Effect of Obesity on Clinical Failure of Patients Treated with Beta-Lactams

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab212 ◽

2021 ◽

Author(s):

Nathan A Pinner ◽

Natalie G Tapley ◽

Katie E Barber ◽

Kayla R Stover ◽

Jamie L Wagner

Keyword(s):

Treatment Failure ◽

Clinical Outcomes ◽

Hospital Length Of Stay ◽

Source Control ◽

Definitive Treatment ◽

Therapeutic Drug ◽

Obese Patients ◽

Definitive Therapy ◽

All Cause Mortality ◽

The Impact

Abstract Background Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a beta-lactam (BL) have worse clinical outcomes compared to non-obese patients and to identify if therapeutic drug monitoring (TDM) may be beneficial. Methods This multi-center, retrospective cohort included hospitalized adults admitted from July 2015-July 2017 treated with a BL as definitive monotherapy against a Gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required >1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): non-obese (BMI ≤29.9 kg/m 2) and obese (BMI ≥30.0 kg/m 2). The primary outcome was clinical treatment failure, and secondary were hospital length of stay (LOS), inpatient all-cause mortality, and 30-day all-cause readmission. Results There were 257 (43.6%) obese patients and 332 (56.4%) non-obese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by 3 rd generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) non-obese patients (p<0.001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than non-obese patients (p=0.002), but no differences were found for all-cause mortality (p=0.117) or infection-related readmission (0=0.112). Conclusions Obese patients treated with BLs have higher rates of treatment failure and longer hospitalization periods than non-obese patients. Future studies are needed to assess the impact of TDM and specific dosing recommendations for targeted infection types.

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The impact of an electronic hospital system on therapeutic drug monitoring

Journal of Clinical Pharmacy and Therapeutics ◽

10.1111/jcpt.13497 ◽

2021 ◽

Author(s):

Paul Firman ◽

Karen Whitfield ◽

Ken‐Soon Tan ◽

Alexandra Clavarino ◽

Karen Hay

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Therapeutic Drug ◽

Hospital System ◽

The Impact ◽

Electronic Hospital

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The Impact of COVID‐19 on Pregnancy and Therapeutic Drug Development

British Journal of Pharmacology ◽

10.1111/bph.15582 ◽

2021 ◽

Author(s):

Allyah Abbas‐Hanif ◽

Homira Rezai ◽

S. Faraz Ahmed ◽

Asif Ahmed

Keyword(s):

Drug Development ◽

Therapeutic Drug ◽

The Impact

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Impact of immunogenicity on clinical efficacy and toxicity profile of biologic agents used for treatment of inflammatory arthritis in children compared to adults

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x211002685 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2110026

Author(s):

Chinar R. Parikh ◽

Jaya K. Ponnampalam ◽

George Seligmann ◽

Leda Coelewij ◽

Ines Pineda-Torra ◽

...

Keyword(s):

Side Effects ◽

Clinical Efficacy ◽

Inflammatory Arthritis ◽

Biologic Agents ◽

Adult Patients ◽

Therapeutic Drug ◽

Biologic Drugs ◽

Therapeutic Implications ◽

The Impact ◽

First Time

The treatment of inflammatory arthritis has been revolutionised by the introduction of biologic treatments. Many biologic agents are currently licensed for use in both paediatric and adult patients with inflammatory arthritis and contribute to improved disease outcomes compared with the pre-biologic era. However, immunogenicity to biologic agents, characterised by an immune reaction leading to the production of anti-drug antibodies (ADAs), can negatively impact the therapeutic efficacy of biologic drugs and induce side effects to treatment. This review explores for the first time the impact of immunogenicity against all licensed biologic treatments currently used in inflammatory arthritis across age, and will examine any significant differences between ADA prevalence, titres and timing of development, as well as ADA impact on therapeutic drug levels, clinical efficacy and side effects between paediatric and adult patients. In addition, we will investigate factors associated with differences in immunogenicity across biologic agents used in inflammatory arthritis, and their potential therapeutic implications.

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Review on Urban Heat Island in China: Methods, Its Impact on Buildings Energy Demand and Mitigation Strategies

Sustainability ◽

10.3390/su13020762 ◽

2021 ◽

Vol 13 (2) ◽

pp. 762

Author(s):

Liu Tian ◽

Yongcai Li ◽

Jun Lu ◽

Jue Wang

Keyword(s):

Energy Consumption ◽

Urban Heat Island ◽

Building Energy ◽

Design Stage ◽

Heat Island ◽

Building Energy Consumption ◽

Rapid Urbanization ◽

Substantial Impact ◽

Urban Heat ◽

The Impact

High population density, dense high-rise buildings, and impervious pavements increase the vulnerability of cities, which aggravate the urban climate environment characterized by the urban heat island (UHI) effect. Cities in China provide unique information on the UHI phenomenon because they have experienced rapid urbanization and dramatic economic development, which have had a great influence on the climate in recent decades. This paper provides a review of recent research on the methods and impacts of UHI on building energy consumption, and the practical techniques that can be used to mitigate the adverse effects of UHI in China. The impact of UHI on building energy consumption depends largely on the local microclimate, the urban area features where the building is located, and the type and characteristics of the building. In the urban areas dominated by air conditioning, UHI could result in an approximately 10–16% increase in cooling energy consumption. Besides, the potential negative effects of UHI can be prevented from China in many ways, such as urban greening, cool material, water bodies, urban ventilation, etc. These strategies could have a substantial impact on the overall urban thermal environment if they can be used in the project design stage of urban planning and implemented on a large scale. Therefore, this study is useful to deepen the understanding of the physical mechanisms of UHI and provide practical approaches to fight the UHI for the urban planners, public health officials, and city decision-makers in China.

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Matrix-assisted laser desorption ionisation (MALDI) mass spectrometry (MS): basics and clinical applications

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2019-0868 ◽

2020 ◽

Vol 58 (6) ◽

pp. 883-896 ◽

Cited By ~ 3

Author(s):

Muhammad Zubair Israr ◽

Dennis Bernieh ◽

Andrea Salzano ◽

Shabana Cassambai ◽

Yoshiyuki Yazaki ◽

...

Keyword(s):

Mass Spectrometry ◽

Laser Desorption ◽

Maldi Mass Spectrometry ◽

Clinical Applications ◽

Clinical Diagnostics ◽

Maldi Ms ◽

Therapeutic Drug ◽

The Impact ◽

Matrix Assisted Laser ◽

Matrix Assisted Laser Desorption

AbstractBackgroundMatrix-assisted laser desorption ionisation (MALDI) mass spectrometry (MS) has been used for more than 30 years. Compared with other analytical techniques, it offers ease of use, high throughput, robustness, cost-effectiveness, rapid analysis and sensitivity. As advantages, current clinical techniques (e.g. immunoassays) are unable to directly measure the biomarker; rather, they measure secondary signals. MALDI-MS has been extensively researched for clinical applications, and it is set for a breakthrough as a routine tool for clinical diagnostics.ContentThis review reports on the principles of MALDI-MS and discusses current clinical applications and the future clinical prospects for MALDI-MS. Furthermore, the review assesses the limitations currently experienced in clinical assays, the advantages and the impact of MALDI-MS to transform clinical laboratories.SummaryMALDI-MS is widely used in clinical microbiology for the screening of microbial isolates; however, there is scope to apply MALDI-MS in the diagnosis, prognosis, therapeutic drug monitoring and biopsy imaging in many diseases.OutlookThere is considerable potential for MALDI-MS in clinic as a tool for screening, profiling and imaging because of its high sensitivity and specificity over alternative techniques.

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The Impact of the Coronavirus Disease (COVID-19) on the Health and Social Needs of Sex Workers in Singapore

Archives of Sexual Behavior ◽

10.1007/s10508-021-01951-8 ◽

2021 ◽

Author(s):

Rayner Kay Jin Tan ◽

Vanessa Ho ◽

Sherry Sherqueshaa ◽

Wany Dee ◽

Jane Mingjie Lim ◽

...

Keyword(s):

Food Insecurity ◽

Sex Work ◽

Sex Workers ◽

Social Needs ◽

Medical Services ◽

Substantial Impact ◽

Sex Worker ◽

Permanent Resident ◽

The Impact ◽

Depth Interviews

AbstractWe evaluated the impact of the coronavirus disease (COVID-19) on the sex work industry and assessed how it has impacted the health and social conditions of sex workers in Singapore. We conducted a sequential exploratory mixed methods study amidst the COVID-19 pandemic from April to October 2020, including in-depth interviews with 24 stakeholders from the sex work industry and surveyor-administered structured surveys with 171 sex workers. COVID-19 had a substantial impact on sex workers' income. The illegality of sex work, stigma, and the lack of work documentation were cited as exclusionary factors for access to alternative jobs or government relief. Sex workers had experienced an increase in food insecurity (57.3%), housing insecurity (32.8%), and sexual compromise (8.2%), as well as a decrease in access to medical services (16.4%). Being transgender female was positively associated with increased food insecurity (aPR = 1.23, 95% CI [1.08, 1.41]), housing insecurity (aPR = 1.28, 95% CI [1.03, 1.60]), and decreased access to medical services (aPR = 1.74, 95% CI [1.23, 2.46]); being a venue-based sex worker was positively associated with increased food insecurity (aPR = 1.46, 95% CI [1.00, 2.13]), and being a non-Singaporean citizen or permanent resident was positively associated with increased housing insecurity (aPR = 2.59, 95% CI [1.73, 3.85]). Our findings suggest that COVID-19 has led to a loss of income for sex workers, greater food and housing insecurity, increased sexual compromise, and reduced access to medical services for sex workers. A lack of access to government relief among sex workers exacerbated such conditions. Efforts to address such population health inequities should be implemented.

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