Background A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. In the United States, Latinx, African American, and Indigenous populations across the country have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial/ethnic minority groups is needed in order to alleviate the widespread disparity in new cases and deaths. Methods From November to December 2020 the research team conducted focus groups with members of Latinx farm-working communities in the Eastern Coachella Valley, located in the inland southern California desert region. A total of seven focus groups, six in Spanish and one in Purépecha, with a total of 55 participants were conducted. Topics covered include knowledge of the coronavirus, COVID-19 testing and vaccination. Results Using theme identification techniques, the findings identify structural factors that underly perceptions held by immigrant, migrant, and indigenous Latinx community members about COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. Conclusions This racial/ethnic minority population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Findings from the focus groups indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.
Rationale Microglia are the main immune cells in the central nervous system and participate in neuroinflammation. When activated, microglia express increased levels of the translocator protein 18 kDa (TSPO), thereby making TSPO availability a marker for neuroinflammation. Using positron emission tomography (PET) scanning, our group recently demonstrated that smokers in the satiated state had 16.8% less binding of the radiotracer [11C]DAA1106 (a radioligand for TSPO) in the brain than non-smokers. Objectives We sought to determine the effect of overnight smoking abstinence on [11C]DAA1106 binding in the brain. Methods Forty participants (22 smokers and 18 non-smokers) completed the study (at one of two sites) and had usable data, which included images from a dynamic [11C]DAA1106 PET scanning session (with smokers having been abstinent for 17.9±2.3 h) and a blood sample for TSPO genotyping. Whole brain standardized uptake values (SUVs) were determined, and analysis of variance was performed, with group (overnight abstinent smoker vs. non-smoker), site, and TSPO genotype as factors, thereby controlling for site and genotype. Results Overnight abstinent smokers had lower whole brain SUVs (by 15.5% and 17.0% for the two study sites) than non-smokers (ANCOVA, P=0.004). The groups did not significantly differ in injected radiotracer dose or body weight, which were used to calculate SUV. Conclusions These results in overnight abstinent smokers are similar to those in satiated smokers, indicating that chronic cigarette smoking leads to global impairment of microglial activation which persists into early abstinence. Other explanations for study results, such as smoking leading to reduced numbers of microglia or smokers having more rapid metabolism of the radiotracer than non-smokers, are also possible.
Background In resource-limited settings, viral load monitoring of HIV-infected patients receiving antiretroviral therapy (ART) is not readily available due to high costs. Here, we compared the accuracy and costs of quantitative and qualitative pooled methods to standard viral load testing. Methods Blood was collected prospectively from 461 patients receiving first-line ART in Mozambique who had not been evaluated previously with viral load testing. Screening for virologic failure of ART was performed quantitatively (i.e. standard viral loads) and qualitatively (one and two rounds of polymerase chain reaction; PCR). Individual samples and minipools of 5 samples were then analyzed using both methods. The relative efficiency, accuracy and costs of each method were calculated based on viral load thresholds for ART failure. Results Standard viral load testing of individual samples revealed a high rate of ART failure (19-23%) across all virologic failure thresholds, and the vast majority of the patients (93%) with viral loads >1,500 copies/ml had genotypic resistance to drugs in their ART regimen. Pooled quantitative screening and deconvolution testing had positive and negative predictive values exceeding 95% with cost savings of $11,250 compared to quantitative testing of each sample individually. Pooled qualitative screening and deconvolution testing had a higher cost savings of $30,147 for one PCR round and $25,535 for two PCR rounds compared to quantitative testing each sample individually. Both pooled qualitative PCR methods had positive and negative predictive values ≥90%, but the pooled one-round PCR method had a sensitivity of 64%. Conclusions Given the high rate of undiagnosed ART failure and drug resistance in this cohort, it is clear that virologic monitoring is urgently needed in this population. Here, we compared alternative methods of virologic monitoring to standard viral load testing of individual samples and found these methods to be cost saving and accurate. The test characteristics of each method will likely need to be considered for each local population before it is adopted.
Background A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. Across the United States, Latinx and Indigenous populations have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial-ethnic minority groups, specifically Latinx and Indigenous Latin American immigrant communities, is needed to alleviate the widespread disparity in new cases and deaths. Methods This study was carried out from August 2020 to January 2021 and used community-based participatory research to engage community partners and build the capacity of community health workers (i.e., promotores de salud) and pre-medical and medical students in conducting qualitative research. The objective of the study was to examine the structural and social determinants of health on perceptions of the coronavirus, its spread, and decisions around COVID-19 testing and vaccination. Data collection included ethnography involving observations in public settings and focus groups with members of Latinx and Indigenous Mexican farm-working communities in the Eastern Coachella Valley, located in the Inland Southern California desert region. A total of seven focus groups, six in Spanish and one in Purépecha, with a total of 55 participants were conducted. Topics covered include perceptions of the coronavirus and its spread, as well as COVID-19 testing and vaccination. Results Using theme identification techniques, the findings identify structural and social factors that underly perceptions held by Latinx and Indigenous Mexican immigrants about the virus and COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. Conclusions This immigrant population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Study findings indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.
Behavioral health census and bed hold hours were significantly associated with increased LOS and LWBS rates and with our inability to meet desired LOS and LWBS rates. These associations support the existence of a threshold where the ED has reached capacity and is no longer able to absorb BH patients. Improving BH facility access may help improve overall pediatric ED patient care.
A 42-year-old Caucasian man developed blastic plasmacytoid dendritic cell neoplasm (BPDCN) 2 years before this presentation and was treated with an unknown chemotherapy regimen, SL-401 (a recombinant human interleukin 3a protein conjugated with truncated diphtheria a-toxin, a potent inhibitor of protein synthesis) and bone marrow (BM) transplantation. He presented with pancytopenia and suspected recurrent BPDCN in the BM but without cutaneous lesions. Computed tomography imaging revealed pulmonary infiltrates, mediastinal lymphadenopathy and splenomegaly. The BM was extensively infiltrated by medium-sized, 'lymphoid' appearing cells with round to irregular nuclei, dispersed to moderately coarse chromatin, and scanty agranular cytoplasm (top left). Flow cytometric and immunohistochemical studies revealed that tumour cells expressed TCL-1, CD4, CD33, CD56, CD68 (dotlike cytoplasmic staining), CD117 (partial), CD123 (top right) and HLA-DR but lacked expression of markers for T cells, B cells, NK cells and myeloid and monocytic cells (including lack of surface or cytoplasmic CD3, CD13, CD15, CD19, CD34, myeloperoxidase, lysozyme and terminal deoxynucleotidyl transferase). Cytogenetic studies showed a complex karyotype, 44,XY,t(11;19)(q23;p13.3),dic(12;22)(p11.2;p11.2),der (13)t(1;13)(q12;q34), der(17;20)(q10;q10)[cp10]/45,idem,der (2)inv(2)(p25q21)del (2) absence of lymphoid/myeloid lineage-specific makers, the diagnosis of BPDCN was confirmed. The patient underwent treatment with SL-401, but had a poor response and ultimately succumbed to the disease. The diagnosis of BPDCN may be difficult due to variable clinical and immunophenotypic overlap with acute myeloid leukaemia (AML), particularly when recurrent KMT2A rearrangement with t(11;19)(q23;p13.3) is identified. While no consensus has been established with regard to a minimal immunophenotype to diagnose BPDCN, a confident diagnosis can be made when four antigens among CD4, CD56, CD123, TCL-1 and BDCA2/CD303 are expressed by neoplastic cells. The latter two antigens are the most reliable markers for plasmacytoid dendritic cells. Our case illustrates the importance of a comprehensive immunophenotypic analysis in establishing this diagnosis. This translocation has been previously reported in BPDCN, suggesting a role for KMT2A rearrangement in the pathogenesis of this neoplasm and also indicating a relationship to AML.
Background There is an increased emphasis on reducing exposure to ionizing radiation in pediatric patients. Guidelines from the Pediatric Emergency Care Applied Research Network help practitioners identify patients at low risk for clinically important traumatic brain injury after head injury. Objectives We seek to determine whether the institution of a pediatric track staffed by pediatric emergency medicine physicians (PEMs) within a community emergency department (ED) impacts the overall utilization of head computed tomography (CT) on children younger than 15 years with head injury. Methods We used a retrospective cohort analysis of patients under the age of 15 years presenting to a community ED in the year before and the year of institution of a pediatric emergency track. Relative risk estimates were used to determine the risk of CT use associated with nonpediatric-trained emergency providers. Results The community ED saw 11,094 patients and 14,639 patients younger than 15 years in fiscal years 2014–2015 and 2015–2016, respectively. In the year before PEMs, there were 312 children younger than 15 years seen for head injury; 47.09% received head CTs. After PEM coverage, there were 396 children younger than 15 years seen for head injury; 17.17% received head CTs. Pediatric patients with head injury were 2.2 times more likely to receive CTs before the institution of the pediatric track (95% confidence interval, 1.8–2.6). Conclusion The implementation of a pediatric emergency track demonstrated a significant decrease in CT utilization for head injury. Continued development of pediatric tracks in community EDs can lead to reduction of CTs.
The COVID-19 pandemic spread rapidly throughout the world, but some populations were more affected than others. For example, compared to other groups, a higher morbidity and mortality was documented in African Americans and individuals of Mediterranean descent. These populations are marked by both increased prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency, and lower utilization of angiotensin receptor blockers/angiotensin converting enzyme inhibitors in the treatment of hypertension. In this brief report, we suggest that G6PD status should be assessed in all COVID-19 positive individuals belonging to the two ethnic groups. If detected, N-acetylcysteine should be utilized to lower the oxidative burden and “sartans” should be prescribed as first-line therapy in hypertensive individuals.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.