Background Serum (1-- >3)-b-D-glucan (BDG) assay is a noninvasive serological marker that can be used as an adjunct to the diagnosis of invasive candida infections, Pneumocystis jiroveci pneumonia (PJP) as well as aspergillosis. There is limited data in serial monitoring of serum BDG in those fungal infections after treatment was initiated. Figure 1:Serial serum BDG levels of each subject after treatment initiation Methods This is a cross-sectional study of subjects with proven fungal infection (invasive candidiasis, aspergillosis or PJP) and with increased serum BDG >500 pg/ml who were admitted to University of Kentucky (UK) hospitals or clinics from 01/2012 to 01/2021. It was approved by institutional IRB. We compared at least two measures of the serum β-D-glucan levels obtained within two to eight weeks after initial diagnosis to evaluate the levels of β-D-glucan during and post-treatment. A decrease in BDG level is defined as any value below 500 pg/ml; normal serum BDG level as < 80 pg/ml. Results Of 26 subjects included in this cohort, 14 (51.8%) subjects had invasive candidiasis, six (22.2%) subjects had PJP, and six (22.2%) subjects had invasive aspergillosis. Twelve patients did not have a repeat BDG level after at least two separate levels with >500 pg/ml. Ten (38.5%) subjects had a decline in BDG level 2-3 weeks after starting treatment. Serum BDG level did not return to within normal limits at week 4 of treatment except one patient. A repeat serum BDG level was seen decline at three weeks of treatment in four of six (66.6%) subjects with PJP, six weeks of treatment in three of six (50.0%) subjects with invasive aspergillosis and 8 weeks of treatment in six of 14 (42.8%) patients with invasive candidiasis. Two subjects had persistent elevation of BDG 8 weeks after treatment. (Figure 1) Conclusion Serial serum BDG level was not routinely done for monitoring the treatment response in this cohort. There was no linear decline in serum BDG level even after appropriate treatment in invasive fungal infections. A decline in serum BDG level was best observed among subjects with PJP pneumonia. It appears that the duration of a decline in serum BDG level was shorter in patients with PJP and longer in patients with invasive candidiasis. Disclosures All Authors: No reported disclosures.
Introduction Physicians’ attitude towards a healthy lifestyle is important as it determines their extent of acceptance of these habits leading to overall well-being. Physicians with healthy lifestyle habits are more confident in advocating the same to their patients and their patients are keener in adopting lifestyle modifications. This study aimed to evaluate the lifestyle habits, wellbeing, and mental health of physicians in Pakistan. Methods A multi-center, cross-sectional survey was conducted with physicians across Pakistan from August to October 2020. A total of 1406 participants were gathered by the non-probability convenient sampling technique. Data were collected physically from the participants. A semi-structured, self-administered questionnaire comprising socio-demographic information, lifestyle habits, mental well-being, and well-being, in general, was filled. Mental wellbeing was assessed using the Warwick Edinburg Mental Wellbeing Scale (WEMWBS) comprising 14-positive items scored on a 1-5 point Likert scale where 1 corresponds to “none of the time” and 5 corresponds to “all of the time.” The score ranges from a minimum of 14 to a maximum of 70 points. Higher scores are associated with higher levels of mental wellbeing. Data were stored and analyzed using IBM-SPSS v.23 (IBM Corp., Armonk, NY). Results In this survey, there were 1284 (91.3%) males and 122 (8.7%) females with a mean age of 44.09 ± 11.18 years. More than half (n=768; 53.0%) of the physicians reported their general health as “good," 1045 (73%) were satisfied with their work-life balance, 206 (14%) had seen a physician for their health in the last six months, and 358 (25%) never had a routine medical checkup. When WEMWBS was applied, participants ≤40 years scored significantly higher than the older age group (p<0.01). Male physicians also scored significantly higher on WEMWBS (52.35 ± 8.78) as compared to their female counterparts (p<0.01). WEMWBS scores also varied significantly across various levels of expertise - with consultants scoring the highest (52.67 ± 9.02) and others scoring the lowest (48.63 ± 8.58; p=0.02). Physicians practicing in the public hospitals only (53.05 ± 9.02), scored higher on WEMWBS as compared to those in the private hospitals (51.28 ± 8.12) as well as those practicing in private clinics only (49.57 ± 8.82; p<0.01). Physicians who perceived their health as excellent scored highest on WEMWBS (53.55 ± 9.31), than those who considered their health good (51.68 ± 8.40), poor (50.71 ± 9.27), or fair (48.70 ± 8.15; p<0.01). The correlation analysis showed a significant negative correlation of WEMWBS scores with health in general (2.5% variation) and age (0.92% variation; p<0.01). Conclusion Physicians in our study were mostly satisfied with their general health and work-life balance. Nevertheless, their mental health well-being was not satisfactory, as assessed by WEMWBS. There is a dire need for lifestyle modifications among the medica...
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