Special Issue:
Challenges and Opportunities in AIDS
Carl GA Jacob, PhD, Auxiliary Professor
School of Nursing, Nursing History Research Unit, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Room 313, Ottawa, Ontario, Canada K1N 6N5
Daniel Lagacé-Roy, PhD, Full Professor
Department of Military Leadership and Psychology, Royal Military College of Canada, PO Box 17000, Station Forces, Kingston, Ontario, Canada K7K 7B4
Abstract
The HIV/AIDS pandemic was a major crisis at the end of the 20th century. A defining moment in the history of health-related infections. It led to the transformation of its proponents, as well as their medical practice. This paper is an addendum to a research paper previously published in SAGE Open in 2019. The previously published paper used data from a study conducted by Jacob, in 2012. The data was gathered using semi-structured interviews with six Canadian gay physicians from different Canadian HIV/AIDS treatment centres. The study aimed to answer the following research question: What are the lived journeys of gay physicians while attempting to treat, care for, and cure/heal their HIV/AIDS patients during the pandemic, from 1981 to 2009? The results deduced from a qualitative and interpretive data analysis, as well as a literature review for the published research paper, suggest that through reflection on their experiences during the HIV/AIDS pandemic, they transformed their personal and professional identities, and rethought their relationship with their patients, as well as their professional, pharmaceutical, and community networks. The addendum, using unpublished information from the study and additional information from a literature review of material published by other proponents after the publication of the paper, aims to substantiate the testimonies of six Canadian gay physicians who fought against the HIV/AIDS pandemic and who advocated for their HIV/AIDS patients. In fact, these results are evidence of an untold and valuable period in medical history. For some, it will serve as a reminder. For others, it will be novel and even foreign. It was a time marked by a major crisis that mobilized gay physicians who were personally and professionally affected by their HIV/AIDS patients, and who were forever transformed by their response to the pandemic.
Charles Olomofe, MBChB, MPH, FWACP, DrPH
East Tennessee State University – College of Public Health: Department of Biostatistics and Epidemiology
Billy Brooks, MPH, DrPH
East Tennessee State University – College of Public Health: Department of Biostatistics and Epidemiology
Megan Quinn, MSc, DrPH
East Tennessee State University – College of Public Health: Department of Biostatistics and Epidemiology
Funmike Olomofe, LLB, BL, LLM
East Tennessee State University – College of Clinical and Rehabilitative Health Sciences: Department of Social Work
Jonathan Moorman, MD, PhD
East Tennessee State University – Center of Excellence in Inflammation, Infectious Disease, and Immunity
Abstract
Background: The administration of the COVID-19 vaccine at some points in the COVID-19 pandemic resulted in a significant reduction in the spread, risk of complications, and death from coronavirus infection. However, in the face of hesitancy against COVID-19 vaccination springing from the novelty of the vaccines and safety concerns, vulnerable population to COVID-19 infection such as people living with HIV/AIDS (PLWHA) were showing higher hesitancy to COVID-19 vaccines than the general population. This scoping review aims to identify factors COVID-19 vaccine hesitancy among people living with HIV/AIDS.
Methods: A scoping review was conducted to identify and summarize studies from all over the world on COVID-19 vaccine uptake/hesitancy among people living with HIV/AIDS.
The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Extension for scoping reviews was used. Articles written in English, peer-reviewed, published within the years 2021-2023, and conducted in any part of the world with sample population being PLWHA, and with an outcome of uptake/hesitancy towards the COVID-19 vaccine were included.
Results: Fourteen articles met the inclusion criteria and were included in this review. The primary study settings were clinic and hospital-based and online self-reported. The prevalence of COVID-19 vaccine hesitancy was as high as 90.8% in an online survey done in the US and as low as 27.5% in a facility-based survey in China. The most common factors mentioned associated with COVID-19 vaccination were the fear of side effects of the COVID-19 vaccine, concerns about the safety of the vaccine, medical mistrust, vaccine novelty, disclosure of HIV status, and perceived interference with highly active antiretroviral therapy (HAART). Male gender, race, good knowledge of COVID-19 prevention practice, having a CD4 count > 200 cells (p=0.032) and lower or undetectable viral load (p<0.001) were identified as predictors of COVID-19 uptake.
Key findings: This wide margin in the prevalence of COVID-19 vaccine hesitancy between the US and China may be connected to the differences in the political climate, public perception and policies, and racial histories between the two countries. This review showed that those less willing to receive COVID-19 vaccination among people living with HIV/AIDS were those with high viral load and low CD4 count as they are more likely to have contact with healthcare system and more receptive of vaccination. Therefore, to limit the burden of COVID-19 vaccine hesitancy and the impact of COVID-19 disease among people living with HIV/AIDS, it is imperative for interventions to target people living with HIV/AIDS with suboptimal viral load and CD4 count (who are less likely to have contact with the healthcare system) as this predispose them to severe COVID-19 infection. A statistically significant association was found between COVID-19 vaccine hesitancy and black people living. So, it is important to address the root causes of negative perception and systemic racism experienced by the black race for steps to be made towards improving COVID-19 vaccine hesitancy and reducing the burden of disease among black people living with HIV/AIDS.
Carol K. Sigelman
Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA 20052
Abstract
Despite the importance for their health and well-being of children’s acquiring knowledge and understanding of disease, surprisingly little work has been done to compare children’s thinking about different diseases at different ages to determine whether and how thinking about familiar diseases shapes thinking about newly encountered diseases. The present study reports a new analysis of interviews with 156 children that were conducted in 1992, when AIDS represented a new and life-threatening but not well understood health threat. The aim was to compare thinking about the causality of a familiar disease, influenza, and a then-unfamiliar disease, AIDS, among third, fifth, and seventh graders. Comparisons of the two diseases and three grade levels focused on: (a) level of understanding based on cognitive-developmental theory and (b) three features defining children’s intuitive theories of disease (a biological ontology or vocabulary, causal propositions featuring an invisible germ or virus, and logical coherence). Scores on all four resulting summary measures and on all but one of eight causal propositions collectively constituting a scientific explanation of each disease, increased with age, with growth especially pronounced from third grade to fifth and seventh grades. Summary scores were moderately intercorrelated, both within each disease and across the two diseases. Folk beliefs about cold weather causing flu and casual contact causing AIDS declined with age. Levels of knowledge and understanding of the two diseases were more often similar than different. However, children’s thinking about flu was ahead of their thinking about AIDS in some respects, especially among the youngest children and especially with respect to symptomology. At the same time, exposure to information during the AIDS epidemic appeared to enable children describing AIDS causality to replace the generic term germ used for flu with the more specific term virus and to better understand that a person must have a disease or its pathogen to transmit it, that the causal agent for a disease is disease-specific, and that the body resists germs and viruses. Implications for better understanding the development of disease concepts and filling gaps in children’s knowledge and understanding in the era of COVID-19 are discussed.
Ali Zare Dehnavi
Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, USA; Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Seyed Ali Dehghan Manshadi
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Seyed Ahmad Seyed Alinaghi
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Behnam Amini
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Fatemeh Rashidi
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Masoumeh Farrokh Ashtiani
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Hoda khoshnevis
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Adel Tabrizi Tochaee
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Salehi
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Cristina Mussini
University of Modena and Reggio Emilia, Modena, Italy
Abstract
There is limited information about COVID-19 vaccines in people living with HIV (PLWH). We aimed to compare the immunogenicity and effectiveness of the Sinopharm BIBP COVID-19 inactivated vaccine between PLWH and non-HIV individuals in the Omicron era. We evaluated the production of receptor-binding domain (RBD), spike, SARS-CoV-2 IgG, and neutralizing antibodies in both PLWH (case) and individuals without HIV (control) groups three months after they received the second dose of the vaccine. All participants were also followed during three months after the second dose for the COVID-19 infection and its outcomes (hospital admission, need to intensive care unit, and mortality). A total of 250 individuals comprising 150 PLWH and 100 people without HIV were recruited. The mean age was 42.2 years. The infection rate was significantly higher in non-HIV individuals than in PLWH (63% vs. 21.3%, p < 0.001). The hospitalization rate in the PLWH group was significantly hig1her than that in the non-HIV group (5.3% vs. 1%, p = 0.009). There were no significant differences in the mean levels of Spike antibody (84.4 ± 34.4 vs. 95 ± 109.5 RU/mL), RBD antibody (65.6 ± 42 vs. 69 ± 42.3 RU/mL), and SARS-CoV-2 IgG (2.9 ± 2.5 vs. 3 ± 2.3 Index) between the groups. The mean value of neutralizing antibodies was significantly higher in non-HIV individuals (34 ± 23.3 vs. 26.2 ± 20 µg/mL, p = 0.005). The Sinopharm BIBP COVID-19 inactivated vaccine can be as immunogenic in PLWH as in non-HIV individuals. This vaccine is likely more effective in preventing Omicron-associated hospitalization in non-HIV individuals.
Moses Katbi
Office of HIV/AIDS & TB, United States Agency for International Development, Nigeria
Tyra Fom
Institutional Capacity Strengthening (ICS) program, Tony Blair Institute for Global Change, West Africa
Adefisayo Adedoyin
USAID MELSA project, Social Impact, Nigeria
Kent Klindera
United States Agency for International Development, Washington, USA
Olugbenga Stephen Asaolu
Office of HIV/AIDS & TB, United States Agency for International Development, Nigeria
Doreen Magaji
Office of HIV/AIDS & TB, United States Agency for International Development, Nigeria
Angela Agweye
Office of HIV/AIDS & TB, United States Agency for International Development, Nigeria
Iyiola Faturiyele
United States Agency for International Development, Washington DC, USA
Abstract
Background: Pre-exposure prophylaxis (PrEP) is recommended for people at substantial risk of acquiring HIV to prevent new infections. The Nigeria PEPFAR program through USAID funded the implementation of PrEP for Key Population (KP) groups including Men Who Have Sex with Men (MSM), People who inject drugs (PWIDS), and Female sex Workers (FSW) in July 2020. We assessed the number of new infections averted and the financial resources saved because of this intervention.
Methodology: HIV-negative clients from the key population community in North- East Nigeria eligible for PrEP were enrolled over a 7-month period (July 2020 – February 2021). Eligibility criteria used include being at substantial risk for HIV infection based on a screening test administered. The person-month was calculated by using the duration the participants were retained on PrEP. The incidence 15.4/100 person-years of HIV among MSM at high risk of HIV infection in the TRUST study conducted in Nigeria was used to calculate the expected positive cases if PrEP was not provided for those enrolled using the formula (15.4/100 * X) where X is number of person-years. We compared the expected positive to the actual positive seen among KPs while on PrEP within the study period. The cost-effectiveness of being on PrEP was calculated by multiplying the standard cost per HIV infection averted ($13, 267 per HIV infection averted) by the No of HIV averted.
Results: We enrolled a total of 1,197 eligible HIV-negative KPs within the study period (189 were retained for seven months, 407 for four months, 585 for 3 months, and 18 for 1 month). A total of 4722 person-months (394 person-years) were accumulated over the period of the study. Using the incidence of 15.4/100 person-years, the expected positive cases if PrEP was not provided was 61 (15.4/100 *394). With the use PrEP, no client seroconverted to be HIV positive. This means that within the 7-month period, 61 HIV infections were averted. At the cost of $13,267 per HIV infection averted for PrEP, the project saved $809,287 for averting 61 HIV infections in seven months of using PrEP among HIV-negative KPs involved in high-risk behaviors.
Conclusion: This study shows that PrEP is effective in averting new infections among key population groups. Placing high-risk groups such as KPs on PrEP is cost-effective due to the money saved from new infections averted. Increased funding for proven and innovative strategies on PrEP enrolment, retention, and adherence of eligible clients should be expanded for KPs.
Albaladejo Bernal R
Clínica de Intervención Cognitiva y Neurociencia (Clic)
Muguerza García J
Clínica de Intervención Cognitiva y Neurociencia (Clic)
Zambrano Bernal D
Clínica de Intervención Cognitiva y Neurociencia (Clic)
Asensio Nieto C
Hospital de día Quirónsalud Talavera
Harguindey Antolí-Candela A
Instituto de Otorrinolaringología y Cirugía de Cabeza y Cuello de Madrid (IOM); Hospital Universitario HM Sanchinarro, eDatajuicers.
Albaladejo Bernal S
Abstract
Background: The aging of the world´s population have led to an increase in the prevalence of neurodegenerative diseases.
Aims: The study aims to analyze the prevention of cognitive impairment through the application of audiocognitive rehabilitation (NeuRea Method) on people with hearing impairment.
Methods: A total of 409 patients met the inclusion criteria. They were divided into an Experimental (EG) and a Control Group (CG). The EG underwent an audiological and speech therapy program. These programs included neuroadaptation adjustment of hearing aids and rehabilitation of impaired auditory and cognitive functions. Patients without cognitive alterations in EG also received cognitive training. The CG did not receive any interventions. Both groups were cognitively assessed at the beginning and at the end of the study.
Results: Results showed that 85.16% of the EG obtained better results in the cognitive test, and no one contained worse results, compared to a 3% improvement in CG, 4% obtained worse results. 81% of the EG patients without cognitive impairment also improved.
Conclusion: The NeuRea method can be used as an additional treatment for wearing hearing aids to improve the language comprehension capacity of people with hearing loss, reduce their cognitive load, and improve their cognition whether already altered or not.
DENIZE CRISTINA OLIVEIRA
UNIVERSIDADE DO ESTADO DO RIO DE JANEIRO, RIO DE JANEIRO, BRASIL
Hellen Pollyanna Mantelo Cecilio
Universidade Federal de Mato Grosso do Sul. Três Lagoas, Mato Grosso do Sul, Brasil
Themis Apostolidis
Aix-Marseille Université. Marselha, França
Tadeu Lessa da Costa
Universidade Federal do Rio de Janeiro. Macaé, Rio de Janeiro, Brasil
Rodrigo Leite Hipólito
Universidade Federal Fluminense. Niterói, Rio de Janeiro, Brasil
Daniela Sousa Oliveira
Universidade do Estado da Bahia. Guanambi, Bahia, Brasil
Juliana Pereira Domingues
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brasil
Renata Lacerda Marques Stefaisk
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brasil
Yndira Ita Machado
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brasil
Antonio Marcos Tosoli Gomes
Sergio Correa Marques
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brasil
Abstract
Background: Time perspective can be an important variable for the understanding the quality of life of people living with HIV/AIDS.
Aims: The objective was to examine the relation between quality of life and time perspective among persons living with HIV receiving care from public health services in Brazil.
Methods: Data were collected at four public health services in Brazil. Hierarchical regression analyses were then performed for each of six quality of life domains.
Results: The subscales associated with high quality of life in physical and level of independence domains were low past-negative and high future orientation; psychological and environmental domains were low past-negative, high past-positive and high future orientations; social relations domain were high past-positive and high future orientations; and spirituality, religion and personal beliefs domain was low past-negative orientation.
Conclusion: The hypothesis that time constructs have implications for the experience of the disease and for evaluation of quality of life was proven determined by positive orientations like future and past-positive and past-negative orientation.
Robert G. Lisziewicz
VERDI Solutions; Vienna, Austria
Felipe Oviedo
Microsoft AI for Good Research Laboratory; Redmond, USA
Andras G. Szasz
VERDI Solutions; Vienna, Austria
Juan L. Ferres
Microsoft AI for Good Research Laboratory; Redmond, USA
Franco Lori
VERDI Solutions; Vienna, Austria/ Research Institute for Genetic and Human Therapy; Milano, Italy
Julianna Lisziewicz
VERDI Solutions, GMBH
Abstract
Background: The COVID-19 pandemic has necessitated the development of efficient diagnostic tools to predict T-cell responses, which are crucial for viral clearance and protection against reinfection. Current diagnostic tests lack the ability to predict the epitope repertoire of an individual that induces T-cell responses.
Methods: We developed VERDI, a new machine learning-based diagnostic tool that leverages the sequence data of all the six HLA class I alleles of an individual to rank all putative epitopes based on their potential to induce T-cell responses. VERDI was trained on a comprehensive clinical dataset of 920 SARS-CoV-2 epitopes and validated using an independent dataset collected for the FDA-approved T-detect COVID test. We compared VERDI’s performance with existing HLA-allele-based models through statistical analyses.
Results: Our findings reveal that VERDI’s top-ranked epitopes accurately represent the individual’s epitope repertoire that participates in T-cell responses. VERDI outperformed current models, improving T-cell response prediction recall by threefold and precision by eightfold. It exhibited exceptional diagnostic accuracy, precision, and recall in predicting the potency of the top 20 epitopes. Despite experimental limitations that allow testing of only 1% of putative epitopes, VERDI accurately predicted 30% of these, implying a potentially higher accuracy if broader testing were feasible. Notably, the mean potency of the top-ranked epitopes predicted by VERDI, which reflects the strength of an individual’s SARS-CoV-2-specific T-cell responses, exhibited a Gaussian distribution.
Conclusions: VERDI is the first diagnostic tool that uses the complete HLA genotype data to predict the breadth and strength of an individual’s T-cell responses to SARS-CoV-2 infection. Its ability to accurately identify the potency of epitopes involved in individual T-cell responses and its superior performance compared to the state-of-the-art make it a new resource for personalized vaccine design and disease management.
Shirley Lecher
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
David Bressler
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Monte Martin
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Abstract
Introduction: Waste generated from HIV viral load testing and SARS CoV-2 for diagnosis of COVID-19 contains potentially hazardous guanidinium thiocyanate. Guanidinium thiocyanate may be toxic to humans and if not properly disposed of can pollute waters and harm aquatic life. Sub-Saharan African countries are particularly challenged by limited resources to suitably manage waste generated at health care facilities and laboratories. There is a need to identify waste management challenges and develop strategies to mitigate this type of laboratory testing waste in resource limited countries.
Methods: HIV viral load data used for this analysis were standardized monitoring evaluation and reporting Presidents Emergency Plan for AIDS Relief datasets for Malawi, Mozambique, South Africa, and Zimbabwe. COVID-19 data was obtained from the Johns Hopkins Coronavirus Resource Center.
Discussion: Inadequate management of HIV viral load and COVID-19 guanidinium thiocyanate waste due to lack of policy, guidelines and appropriate procedures for containment, poses a significant public health threat to the environment. Recognizing this gap, the United States Centers for Disease Control and Prevention has decided to provide technical expertise, raise awareness, and work with other international partners to disseminate knowledge and find solutions for the Presidents Emergency Plan for AIDS Relief supported countries in sub-Saharan Africa. The World Health Organization guidelines on safe management of waste from healthcare activities were proposed as a starting point to develop country-specific guidelines.
Conclusions: The United States Centers for Disease Control and Prevention, in collaboration with other international partners, is diligently working to provide technical assistance to countries for training and development of mitigation strategies to appropriately manage guanidinium thiocyanate containing waste. Waste management is a growing problem as molecular testing for HIV, COVID-19, and other emerging diseases increase.
Nishan Gantayat Alok Gangaramany
Final Mile Consulting – New York, NY 10007
Ram Prasad
Final Mile Consulting – New York, NY 10007
Rosemary Pierce-Messick
Final Mile Consulting – New York, NY 10007
Rujuta Kumbhojkar
Final Mile Consulting – New York, NY 10007
Abstract
Background: Despite a declining trend in Human immunodeficiency virus (HIV) prevalence across sub-Saharan Africa, specific vulnerable groups continue to be disproportionately impacted (29.9% for sex workers, 12.9% for gay men having sex with men (MSM) vs 5.9% for adults). In the face of this challenge, it is critical to tailor demand creation for prevention, in particular self-care, for maximum impact and cost-efficiency. This study seeks to provide a behavioral understanding towards HIV prevention that shape the efficacy of prevention strategies among priority populations (female sex workers, MSM and adolescent girls and young women) in southern and eastern Africa.
Methods: This study involved a literature review of 110 articles, focusing on HIV prevention in priority populations, behavioral interventions, and policy priorities from governments and funders. Additionally, insights were gained from 11 in-depth interviews and a workshop with 10 experts at the AIDS Impact 2023 conference. Participants included behavioral researchers and program leaders from Global Fund, United States Agency for International Development (USAID), U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Bill and Melinda Gates Foundation, FHI360, Population Services International and Genesis Analytics. A user-centric behavioral framework was devised to identify actionable drivers and barriers in HIV prevention during the consultation exercise.
Results: The study highlights the importance of shared and effective self-care in enhancing HIV prevention, particularly in vulnerable groups. The behavioral framework integrates the decision-making contexts and the health ecosystem layers to inform research and demand strategy. Key findings include: (1) effective self-care is not the same as continuous use of Pre-exposure prophylaxis and therefore, programs and policies need to measure them differently; (2) users exercise choice through a combination of prevention products and focus on a few may be sub-optimal, and (3) perceived risk is transient and hence risk-based messaging lacks sustained relevance.
Conclusion: Effective self-care strategies extend beyond overcoming access and availability issues. Examining the underlying factors causing the barriers is essential. The behavioral framework presented here suggests that: (a) Self-care is a shared responsibility between the user and healthcare system and (b) demand creation should be de-medicalised, away from products and towards meeting the needs and preferences of users.
Nicholas HL Chua
Mount Elizabeth Novena Hospital, Specialist Pain International Clinic, 38 Irrawaddy Road, #09-43 Mt Elizabeth Novena Specialist Medical Centre, Singapore, Singapore
Thomas John & Eric Buchser
Abstract
Lumbar epidural spinal cord stimulation (SCS) was used to improve motor function in a 50-yr old patient who suffered hemiparesis due to a basal ganglia haemorrhagic stroke. Spinal cord stimulation targeted at the dorsal root afferent fibres at the conus improved the tonic control of the muscles at the knee and ankle joints. This allowed the patient better left knee and foot motor control. The improvement was documented initially during ambulation on a treadmill using decreasing body weight support and subsequently when using walking aids. Our observation is consistent with previous human data suggesting that in humans with brain lesions, the stimulation of preserved neural circuitry can increase spontaneous muscle tone in affected muscles and improve locomotion.
Stella Bruce
Neuroscience Undergraduate Program, University of Southern California
Kimberly Cockerham
Private Practice, San Diego, CA
Abstract
Patients presenting with neuro-ophthalmic disorders pose a diagnostic challenge when they present to community hospital emergency departments (ED) where expertise in neuro-ophthalmology is often limited. Many have no ophthalmology coverage or have a call group composed of general ophthalmologists who are not comfortable managing neuro-ophthalmic disorders. The limited familiarity with neuro-ophthalmology and the lack of essential equipment, such as a fundus camera or optical coherence tomography (OCT), contribute to a substantial gap in accurate and timely diagnosis and treatment. This deficiency results in patients making multiple visits to the emergency department, where they receive limited or no treatment, and this overall increases the risk of disease progression and potentially blindness.
Advocating for standardized protocols and integrating technological advancements will aid non-ophthalmologist physicians and mid-level physician extenders in the initial assessment and management of patients with acute visual issues. Additionally, improving the accessibility of neuro-ophthalmological services through telehealth, and diagnostic aids (such as smartphone-based fundus cameras) in emergency department settings is essential to avoid overlooked or misdiagnosed neuro-ophthalmological disorders.
We describe two common scenarios that illustrate the diagnostic journey of patients. One is a young patient presenting with headache and vague visual symptoms and the other is an elderly patient with unilateral visual loss and vague headaches. We will focus on the crucial role of the fundus camera/OCT in identifying disc edema but also discuss the key questions that help guide diagnosis.
Dimitrios Panagopoulos
Consultant Pediatric Neurosurgeon, Neurosurgical Department, Pediatric Hospital of Athens, Agia
Georgios Strantzalis
Consultant Pediatric Neurosurgeon, Neurosurgical Department, Pediatric Hospital of Athens, Agia
Maro Gavra
Consultant Pediatric Neurosurgeon, Neurosurgical Department, Pediatric Hospital of Athens, Agia
Stefanos Korfias
Consultant Pediatric Neurosurgeon, Neurosurgical Department, Pediatric Hospital of Athens, Agia
Ploutarchos Karydakis
Consultant Pediatric Neurosurgeon, Neurosurgical Department, Pediatric Hospital of Athens, Agia
Abstract
In an effort to maximize extent of resection (EOR) regarding gliomas, intraoperative MRI (i-MRI) and 5-aminolevulinic acid (5-ALA) have been developed. Our study aimed to investigate the comparative contribution of 5-aminolevulinic acid and i-MRI in maximizing EOR in gliomas.
We searched the PubMed and ScienceDirect services for randomized controlled trials, controlled trials and interrupted time series studies evaluating the effect of i-MRI on gross total resection (GTR) rates and on overall survival in glioma patients. Our primary study endpoint was the definition of the percentage of patients who were offered GTR. Other relevant points of interest included the determination of overall and progression-free survival and subgroup analyses for level of evidence.
I-MRI aids in achieving GTR (odds ratio 2.71, p<0.0001). Magnet field strength does not affect significantly either GTR rates (p=0.08). The cost of the procedure is dependent on the workload of the i-MRI system. These data suggest that i-MRI or 5-ALA improves progression-free and overall survival, although there are several restrictions related to their effectiveness and reliability.
I-MRI and 5-ALA are considered to be effective adjuncts in the achievement of GTR of gliomas. When these methods are compared, there is no definite conclusion regarding which method is more effective.
Tom Humphries
Department of Communication, University of California at San Diego, La Jolla, CA 92093, USA
Gaurav Mathur
Department of Linguistics, Gallaudet University, Washington DC, 20002, USA
Donna Jo Napoli
Department of Linguistics, Swarthmore College, Swarthmore, PA, 19081, USA
Christian Rathmann
Department of Deaf Studies and Sign Language Interpreting, Humboldt-Universität zu Berlin, Berlin, Germany
Abstract
Sign languages are complex and intact human languages essential to the development and health of deaf children and adults. Yet, still, many families and medical professionals think the optimal option for deaf children is to be raised with spoken language, usually including a cochlear implant. Cochlear implants, however, have variable outcomes with language acquisition. Medical professionals, especially pediatricians, need to update their knowledge and understanding of best practices to ensure they more appropriately support families to protect the overall health of their deaf child. The child who does not have a firm first language foundation is at risk of poor (neuro-) cognitive, psycho-social, and socio-emotional development. Developmental delays and life-long, irreparable damages can and should be prevented. Ultimately, securing a firm first language foundation is a matter of health. It is essential to back away from the concept of one-choice-fits-all and, instead, begin with exposing the deaf child to a visually accessible sign language in a multimodal and multilingual environment as soon as it is known that the child is deaf. With a sign language as the linguistic foundation, other practices automatically make more sense –including hearing aids and/or cochlear implants – and those other practices have a greater chance of success, even the development of spoken language(s) (including speech) and written language(s), which has been shown to be supported by the presence of visually accessible sign language(s) in the child’s environment.
In order to aid pediatricians in advising parents, we have prepared a list of factors on which families of deaf newborns or newly-deafened young children need guidance, complete with discussion and citations of relevant recent work. We have been working as a team in this area for the past dozen years. Thus, we also list our publications. The goal here is to ensure deaf individuals’ right to inclusion in society in terms of education, employment, health, cultural life and all other aspects of being human and of societal participation. The use of a sign language(s) allows deaf people to be included; the preclusion of a sign language carries the risk of low quality of life and of language deprivation.
Vasanthi Dasari
Transcell Oncologics, Technology Business Incubator, Hyderabad Central University, Hyderabad, India.
Paparao Bolimera
Transcell Oncologics, Technology Business Incubator, Hyderabad Central University, Hyderabad, India.
Swati Shukla
Transcell Oncologics, Technology Business Incubator, Hyderabad Central University, Hyderabad, India.
Rahul Ganar
Quantiphi Inc, 33 Boston Post Rd W, Marlborough, MA 01752, USA.
Timothy Elwell
Quantiphi Inc, 33 Boston Post Rd W, Marlborough, MA 01752, USA.
Rajat Goyal
International AIDS Vaccine Initiative, Unit No. 810, 8th Floor, Emaar Capital Tower – 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana-122002 India.
Subhadra Dravida
Abstract
Polyvalent antivenom potency tested for every batch and at four different stages of production is a regulatory requirement to be followed by the industry. Antivenom manufacturers have been following the gold standard test methodology for estimating median effective dose in mice for ages. Here, we report a non-animal New Approach Methodology that aligns with 3Rs in animal testing agenda, leveraging in vitro human stem cell technology for recreating microphysiological system complemented with process automation, Artificial Intelligence and Machine Learning digital workers’ effective utilization in the assay system to measure Naja naja snake antivenom potency. In vitro neutralization performed on specially configured human Microphysiological System acquired phenotype data sets at 20X magnification were analyzed against benchmark panels in the trained prediction model while the Artificial Intelligence predicted median effective dose value of venom-antivenom mixture was 3.9μL, showing a potency value of 2.04 mg recorded as the readout. This method adopted in the antivenom producer’s workflow will reduce reliance on mice-based testing and showcases potential for acceptance of robust alternative strategy to traditionally practiced protocols.
H. M. Morales-Fajardo, MSc
School of Engineering, Universidad Autónoma del Estado de México, México
J. Rodríguez-Arce, PhD
School of Engineering, Universidad Autónoma del Estado de México, México; School of Medicine, Universidad Autónoma del Estado de México, México; Tecnologico de Monterrey, School of Engineering and Sciences, México
B. E. Ruvalcaba-Ramos, PhD
Institute of Neurosciences, CUCBA, Universidad de Guadalajara, México
S. Montes de Oca, PhD
Tecnologico de Monterrey, School of Engineering and Sciences, México
Abstract
This study presents a streamlined approach to pandemic management by simplifying COVID-19 data analytics. It focuses on the significant role of mobility patterns in forecasting case trajectories. Utilizing open mobility data from Google and Apple, a novel predictive model is proposed that aids health authorities in scenario projection and case monitoring. This model facilitates informed decision-making with minimal economic impact during future outbreaks.
Key findings highlight the profound link between mobility changes and COVID-19 case trends, emphasizing the necessity of integrating mobility data into predictive models. The model employing linear and polynomial regression analyses and incorporating the effective reproduction number, Rt, and the influence mobility changes have on population forecasts can be extended up to 90 days.
The study acknowledges limitations, particularly the reliance on mobility data that does not fully encompass all variables affecting virus transmission. Moreover, it explores the mental health implications of mobility restrictions, suggesting a broader impact of pandemic management strategies.
The proposed model is a practical tool for managing pandemics through mobility data analysis, underscoring the need for comprehensive studies on the broader effects of mobility changes to guide public health policies.
Lianne A Urada
San Diego State University School of Social Work and University of California, San Diego, Department of Medicine
Macy McClung
San Diego State University School of Social Work
Rhea Van Brocklin
Christie’s Place, Inc., San Diego, California
Jill Blumenthal
University of California, San Diego, Department of Medicine
Abstract
Background: Peer navigation is an evidence-based model for engaging and retaining women living with HIV in medical care. Participants of an adapted Lotus peer navigation group intervention were hypothesized to have more self-perceived HIV self-care and advocacy behaviors following their participation than non-Lotus participants at an agency serving cisgender women and their families affected by HIV in San Diego, California.
Methods: The peer navigation intervention, Lotus, was adapted to include new modules on substance use, human trafficking, and intimate partner violence and piloted to compare its overall effects with a comparison group (2018-2019). Ninety-five cisgender women living with HIV (WLWH) completed posttest surveys measuring their perceived changes in peer advocacy and self-advocacy following their participation in a pilot of an adapted Lotus. Participants of the four-session Lotus group intervention (n=34) were compared to non-Lotus participants who engaged in other types of group activities at the agency (n=61). The Lotus group participants included a cohort of cisgender women > 50 years old, English and Spanish speaking women, and a mixed age and race/ethnicity group. All clients of Christie’s Place, an organization for women living with HIV in San Diego, were eligible if they were not actively using illicit substances substances in the past year. Cross-sectional bivariate analyses were run to determine differences between intervention and comparison groups. The groups were not randomized.
Results: Among 95 participants, 17% were White, 14% Black/African American, 44% Hispanic/Latino, and 25% Other/Mixed race/ethnicity with median age 51 years (IQR: 45-60). Eleven Latina, 9 White, 6 Black/African American, and 8 Other/Mixed individuals participated in Lotus. In bivariate analyses, Lotus WLWH living with HIV at posttest took their HIV medications correctly (p=0.040) and attended their healthcare/other service appointments as advised/scheduled 3 times more often than non-Lotus WLWH (p=0.014). They advocated for themselves within medical and social service settings 6 times more often (p<0.001) and talked openly with their doctor 4 times more often (p=0.028). They were also twice as likely to talk more often with their partner about safer sex (p=0.022) and PrEP (p=0.037) and a peer about safer sex (p=0.001). They were 3 times more likely to help a peer understand how HIV medications can improve their health (p=0.001). Medical records showed all Lotus intervention participants as virally suppressed one year after their participation.
Conclusions: Participants of an HIV peer navigation intervention experienced significant changes in self-reported self-advocacy outcomes. Peer navigation training interventions remain critical for medication adherence and self-advocacy among cisgender WLWH.
Robert J Arnold, SLP.D, CCC-SLP
Chief Clinical Officer, Applied Clinical Scientist, Southeastern Biocommunication Associates, LLC., Birmingham, AL, 35216, USA.
Nina Bausek, PhD
Research Collaborator, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
Christopher S Gaskill, PhD, CCC-SLP
Consulting Voice Scientist, Southeastern Biocommunication Associates, LLC., Birmingham, AL, 35216. USA.
Tarek Midani, BSBME, M.Eng.
Consulting Biomedical Engineer, Southeastern Biocommunication Associates, LLC., Birmingham, AL, 35216. USA.
Abstract
Background: Dysarthria frequently occurs as a result of stroke and adversely impacts speech sound production, making it more difficult for the listener to understand what the person with dysarthria is attempting to communicate. This in turn may lead to social isolation, depression, and increased cost of care. Some studies have underscored the importance of respiratory muscle strengthening as it relates to improvement of speech intelligibility. This retrospective investigation examined the effects of a combined Respiratory Muscle Training (cRMT) protocol upon speech intelligibility in persons post single cerebrovascular accident (CVA).
Methods: The clinical data of 10 patients who requested pro bono speech therapy for the diagnosis and treatment of dysarthria following a single stroke was utilized for this study. The intervention group was treated with three 5-minute sessions with cRMT each day for 28 consecutive days. The control group received no cRMT and no other therapeutic exercise intervention during the time period. Respiratory and speech intelligibility were assessed pre- and post-intervention in terms of peak expiratory flow, subject self-perception of intelligibility, and word level intelligibility.
Results: After 28 days of cRMT, the intervention group (IG) exhibited significant gains compared to the control group (CG) in peak expiratory flow (PEF) (IG: 73.12% vs CG: 4.66%), Self-Perception of Intelligibility (IG: 72.38% vs CG: 0.83%), and the word task of the Assessment of Intelligibility of Dysarthric Speech (AIDS) (IG: 43.92% vs. CG: 0%).
Conclusion: These data suggest cRMT is a feasible and effective treatment for improving breath support and speech intelligibility in persons with dysarthric speech.
Inês Rego de Figueiredo
Unidade de Transplantes, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central
Miguel Martins
Serviço de Medicina 2.3, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central
Carolina Midões
Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário Lisboa Central
Joana Branco Ferrão
Serviço de Medicina Intensiva, Hospital Professor Doutor Fernando da Fonseca
Abstract
Opportunistic infections affect patients with immunocompromised status and are caused by common microorganisms with more severe presentations, or atypical organisms that do not cause disease in the immunocompetent. The type of infection varies with the type of immune dysfunction.
Patients with cell-mediated immune dysfunction tend to be infected with a range of viral infections, intracellular bacteria, and fungi. This contrasts to patients with defects in humoral immunity, where infections with encapsulated bacteria, and enteric organisms such Giardia lamblia and enteroviruses predominate. Patients with phagocytic defects are especially prone to infections with Gram-negative bacteria and fungi, whilst those with complement disorders are prone to recurrent infections with encapsulated bacteria. In contrast to patients with primary immunodeficiencies, which usually present with only one defect of the above, acquired immunodeficiencies present with a variety of those, and clinical presentations are diversified.
The epidemic of HIV and AIDS shed some light into infections that were before extremely rare, by making them frequent, but with the advent of anti-retroviral therapy their clinical presentation has shifted. Also, the emergence of novel immunotherapies for cancer and autoimmune diseases, allied with an increase in organ transplant has increased the pool of immunosuppressed patients without HIV, which present differently regarding opportunist infections.
Rapid and specific microbiologic diagnosis is essential. Newer microbiologic assays have improved the diagnosis and management of opportunistic infections.
Our aim was to revise and summarize the most frequent opportunist infections, and how their presentation and course compares in different immunosuppressed diseases (HIV and non-HIV).
