Independent Predictors Of Higher Levels Research Articles

Time estimation is associated with the levels of distress in patients prior to starting radiotherapy

Purpose or ObjectiveThe aim of this study was to explore the potential relationship between the time estimation and psychological distress in patients with solid tumors prior to starting radiotherapy. Materials and MethodsIn this multicenter study were included a total of 344 patients with solid tumors (197 with and 147 without metastatic disease). The time estimation was assessed by evaluating each subjects prospective estimation of how fast 1 min passed compared to the actual time. The median value (35sec) of subjective perception of time was used to group cases into two categories for experience of time. We used the National Comprehensive Cancer Network Distress Thermometer at the beginning of treatment to determine the levels of distress, where it measures distress on a scale from 0 to 10. Patients scoring 4 or above (73.5 %) were regarded as having high levels of distress. ResultsThe time estimation distributions significantly changed according to the level of distress. ROC analysis revealed that at the optimal cut off value of time estimation, patients with low and high distress levels can be discriminated with an AUC = 0.80 (95 % CI: 0.75– 0.85, p < 0.001) and with a sensitivity of 77.8 % and specificity of 73.3 %. In a multivariate logistic regression model, fast time estimation was an independent predictor of high levels of distress (OR 0.136; 95 % CI, 0.072–––0.256, p < 0.001). ConclusionTime estimation is a novel potent indicator of high levels of distress in cancer patients prior starting of radiotherapy.

Exploring the presence and impact of sensory differences in children with Developmental Coordination Disorder

BackgroundChildren with Developmental Coordination Disorder (DCD) can experience sensory differences. There has been limited exploration of these differences and their impact on children with DCD. Aimsi) To explore the presence and impact of sensory differences in children with DCD compared to children without DCD; ii) To examine whether sensory differences are related to motor ability, attention deficit hyperactivity disorder (ADHD), or autistic traits. MethodParents of children (8–12 years) with (n = 23) and without (n = 33) DCD used standardised questionnaires to report on their children’s sensory differences, autistic traits, and ADHD traits. Motor abilities were assessed through the Movement Assessment Battery for Children-2. Data were explored both categorically (between-groups) and dimensionally. ResultsChildren with DCD had significantly higher levels of sensory differences than children without DCD. Sensory differences also had a significantly greater impact on daily activities for children with DCD. Higher levels of ADHD and autistic traits, but not motor ability, were significant independent predictors of higher levels of sensory difference. ConclusionChildren with DCD experience high levels of sensory differences, which impact on their daily lives. These sensory differences may be a marker for additional neurodivergence in children with DCD. Practitioners should consider the sensory needs of children with DCD. What this paper addsThis paper provides insight into the sensory features of children with DCD and the impact that sensory differences can have on daily living. Using parent-report, we found that children with DCD had increased sensory differences relative to children without DCD. These included increased hyperresponsiveness, increased hyporesponsiveness, and increased sensory interests, repetitions, and seeking behaviours (SIRS). We also found that sensory differences had a greater impact on daily living for children with DCD compared to children without DCD. Across the whole sample, autistic traits predicted hyperresponsivity and hyporesponsivity patterns; whereas traits of hyperactivity and impulsivity predicted SIRS. Motor abilities did not uniquely predict sensory differences, suggesting that other traits of neurodivergence may contribute to the sensory differences in DCD. Taken together, these findings highlight the necessity of considering sensory needs when supporting children with DCD. They also suggest that if sensory differences are identified in children with DCD, it may be due to the presence of co-occurring neurodivergent traits or conditions.

The role of chronic physical illness and job dissatisfaction on burnout’s risk among medical interns in Oman: a study of prevalence and determinants

BackgroundMedical interns are at risk of burnout due to several organizational and individual factors. There is scarcity of studies exploring the role of chronic physical illness and job dissatisfaction on burnout experience among medical interns. This study examined the prevalence of burnout syndrome and explored whether chronic physical illness and job dissatisfaction could independently predict burnout syndrome among medical interns in Oman. This cross-sectional study was conducted among a random sample of medical interns enrolled in the Omani internship program. One-hundred and eighty interns participated in this study and filled in a self-reported questionnaire that included Maslach Burnout Inventory (MBI), Job Satisfaction Survey (JSS), and data related to physical illness.ResultsThe prevalence of burnout syndrome was 15%. Having a physical illness (OR = 7.285, 95% CI = 1.976–26.857, P = 0.003) and job dissatisfaction (OR = 16.488, 95% CI = 5.371–50.614, P = 0.0001) was significant independent predictors of high levels of the EE subscale. In addition, having a physical illness (OR = 4.678, 95% CI = 1.498–14.608, P = 0.008) and being dissatisfied (OR = 2.900, 95% CI = 11.159–7.257, P = 0.023) were significant independent predictors of the high DP subscale. Having physical illness was independent predictors of the low personal accomplishment subscale (OR = 0.258, 95% CI = 0.088–0.759, P = 0.014).ConclusionsBurnout syndrome is prevalent among medical interns in Oman. Job dissatisfaction and chronic physical illness are risk factors for burnout syndrome. Internship programs should consider these factors when designing burnout mitigative strategies.

Post-Covid-19 Hemostatic Characteristics of Convalescent Patients: The Bergamo Experience

Introduction: Severe COVID-19 patients present with a hypercoagulable state, complement activation and endothelial perturbation, which result from an excessive inflammatory response. Thromboinflammation is one important mechanism underlying the COVID-19-associated coagulopathy and the increased risk of thrombosis. Bergamo city is one of the first and most affected area by SARS-CoV-2 infection in the world. For this reason, since the beginning we were actively involved in recruiting convalescent COVID-19 patients, in a program of selection of candidates for convalescent plasma donation. In a large cohort of convalescent COVID-19 patients, we aimed to characterize markers of coagulation activation and endothelial perturbation, in order to explore whether the COVID-19-related hemostasis activation might persist afterwards and evaluate its possible association with the degree of severity of the previous infection, and/or with demographic characteristics, or anti-SARS-CoV-2 antibody levels.Methods: In 392 convalescent COVID-19 patients (216M/176F, median age: 46 years) plasma levels of fibrinogen, protein C, protein S, factor V, factor VIII, factor XIII, D-dimer, von Willebrand factor (vWF), prothrombin fragment F1+2 were measured at the recruitment, i.e. 1-5 months from recovery. Samples were tested for the anti-SARS-CoV-2 antibodies, including anti-S IgG (Anti-S Ab) and anti-N IgG (Anti-N Ab) antibodies at enrollment and at each scheduled subsequent visits.Results: Levels of fibrinogen, D-dimer, von Willebrand factor, protein S and protein C were significantly higher (p<0.05) in patients who were hospitalized for severe COVID-19 as compared to patients who were treated at home. There was no correlation between levels of coagulation biomarkers and days from end of symptoms. Male gender, age > 40 years, and severe form of COVID-19 were identified as independent predictors of high levels of both anti-S and anti-N Ab (p<0.001). Among hemostatic biomarkers, fibrinogen (p<0.01) and vWF (p<0.05) independently predict high levels of anti-S Ab. In particular, vWF levels positively correlated with anti-S Ab levels (vWF-antigen r=0.188; vWF-activity r=0.241 and vWF-RiCof r=0.223, p<0.01). Evaluation of anti-SARS-CoV2 antibody levels at different time points during follow up revealed that 30% of patients displayed high levels of anti-S Ab until more than 8 months from the end of symptoms.Conclusions: Convalescent patients, with a history of severe COVID-19 had a persistent endothelium activation, despite of disease clinical remission even after 9 months from end of symptoms. Furthermore, fibrinogen and vWF levels predicted high levels of Anti-S Ab. Among demographic characteristics, gender, age and severe disease can be predictors of increased antibody response. These findings suggest that inflammation, coagulation and endothelial dysfunction may persist after recovery and may explain the findings of persistent clinical symptoms reported in these patients after healing from COVID-19. DisclosuresFalanga: Bayer: Honoraria; Leo Pharma: Honoraria; Pfizer: Honoraria; Sanofi: Honoraria.

Personality Trait Interactions in Risk for and Protection against Social Anxiety Symptoms

Previous attempts to identify personality traits that enhance inclination to social anxiety (SA) have been limited by a tendency to focus on selected traits in isolation, rather than examining their interactions. Additional research is needed to better understand whether and how these dimensions are linked to SA. In a prospective study, it was examined how interactions between the Big Five personality factors predict SA symptoms. A total of 135 individuals, aged 18–50 years, were recruited. Personality traits were measured at baseline, and SA symptoms were assessed one month later. Results showed that low emotional stability was an independent predictor of higher levels of SA. Additionally, two significant interactions emerged: the interactions between extraversion and openness, and between openness and agreeableness predicted SA symptoms. At high openness, higher extraversion was associated with significantly lower levels of SA, suggesting that the interaction provides incrementally greater protection against SA. Thus, extraverts are likely to be protected against social anxiety symptoms, but more so the more open they are. Moreover, at high levels of agreeableness, low openness has been shown to be uniquely predictive for higher levels of SA symptoms, indicating that the combined effect of openness with agreeableness may be more important to SA than either trait in isolation. These findings highlight the importance of testing interaction effects of personality traits on psychopathology.

One-minute time interval estimation as a novel ultrashort tool for distress screening.

Our study explores the potential relationship between time estimation and level of distress in cancer patients prior to starting chemotherapy. Time estimation was assessed in 262 chemonaïve patients with solid tumors by evaluating each subject's prospective estimation of how fast 1min passed compared to the actual time. The median value (40s) of time estimation was used to stratify the patients into two categories of fast and slow time estimation. The National Comprehensive Cancer Network Distress Thermometer was used at the beginning of treatment to evaluate levels of distress. Patients scoring 4 or above (51.9%) were regarded as having high levels of distress. The pattern of the time estimation distributions significantly changed according to the level of distress. Patients with a fast time estimation had significantly higher levels of distress (4.55 ± 3.1) than patients with a slow time estimation (3.3 ± 2.9) (p = 0.001). ROC analysis revealed that at the optimal cutoff value of time estimation, patients with low and high distress levels can be discriminated with an AUC = 0.60 (95% CI: 0.53-0.67, p = 0.005) and with a sensitivity of 62.5% and specificity of 53.2%. Moreover, in a multivariate logistic regression model, fast time estimation was an independent predictor of high levels of distress. Time estimation is a novel potent indicator of high levels of distress in cancer patients. This test is an easily performed, time-saving, and nonintrusive ultrashort screening tool that is even suitable for patients who are not willing to reveal their level of distress via direct questionnaires.

Abstract TMP28: Aging Predicts Levels of Antiangiogenic Factors and Stroke in Intracranial Atherosclerosis

Introduction: Stroke risk more than doubles each decade after the age of 55. In patients with intracranial atherosclerosis (ICAS), the SAMMPRIS study showed that individuals 60 years or older had a higher risk of recurrent stroke or death (17%) than younger patients (12%) despite intensive medical management (IMM). In prior studies, an antiangiogenic profile has been associated with higher rates of failure to IMM in stroke. The purpose of this study is to evaluate the hypothesis that aging is an independent predictor of higher circulating levels of antiangiogenic factors endostatin and angiostatin in ICAS. Methods: Prospective observational longitudinal study of circulating angiogenic factors in 74 patients with ICAS treated medically. Patients with ICAS greater than 70% had angiostatin and endostatin measured in duplicate via ELISA at baseline and were followed for 6 months. Mixed model analysis was performed for the outcome variables endostatin and angiostatin. Predictor variables included age, gender, smoking history, hypertension (HTN), hyperlipidemia (HLD), Diabetes 2, obesity, coronary artery disease (CAD) and peripheral artery disease (PAD). Classification and regression tree (CART) analysis were used to select the threshold age for the longitudinal model. Results: Age was a significant independent predictor of higher levels of endostatin (p=0.002) and angiostatin (p&lt;0.001). Age older than 52 was significantly associated with higher levels of endostatin (p=0.03), and age older than 70 with higher levels of angiostatin (p=0.005). Additional significant factors associated with higher levels of antiangiogenic circulating factors included PAD, HTN, HLD, and obesity. Conclusion: Aging is a significant independent predictor of elevated antiangiogenic circulating factors, which are associated to failure to IMM in ICAS. Antiangiogenesis can potentially represent a common path for multimorbidity of advanced age.

Sitting time, physical fitness impairments and metabolic abnormalities in people with bipolar disorder: An exploratory study

A sedentary lifestyle is an independent risk factor for cardiovascular disease and mortality. Little is known however about sedentary behavior in people with bipolar disorder (BD). The primary aim of this study was to explore associations between sitting time (as a proxy for a sedentary lifestyle) and physical fitness and metabolic parameters in BD. A secondary aim was to investigate associations between psychiatric symptoms, psychotropic medication use and sitting time. Thirty-nine (21♀) participants (43.7±12.4 years) completed a full metabolic screening, the sitting time item of the International Physical Activity Questionnaire, the Quick Inventory of Depressive Symptomatology self-report and the Hypomania Checklist-32. Additionally participants performed the Eurofit-test battery and 6-min walk test. The mean time spent sitting per day for the entire sample was 7.0±3.0h. A higher body mass index, worse physical fitness and higher antipsychotic medication dose were identified as independent predictors of higher levels of sitting behavior. The model explained 76.5% of the variability in the sitting time. Given that a sedentary lifestyle is an independent predictor of cardiovascular disease, future interventions specifically targeting time spend sitting are warranted in BD, with a particular emphasis on those with high body mass index and low fitness levels.

Cultural and Cognitive Determinants of Personal Control in Older African Americans with Diabetes

The study was funded by Pennsylvania Department of Health's Commonwealth Universal Research Enhancement (CURE) Program (SAP#4100051727). To describe the determinants of personal control over diabetes complications in older African Americans (N=123) with type 2 diabetes. We administered structured instruments to assess perceptions of personal control, time orientation, religiosity, depression, and cognition in this cross-sectional study. More years of education (p ≤ .001), better Clock Drawing (p ≤ .001), higher levels of Religiosity (p ≤ .04), and lower Present Time Orientation (p ≤ .01 ) were independent predictors of higher levels of Personal Control. Risk perceptions of control over diabetes complications vary among older African Americans according to cultural constructs, executive function, and education. This finding highlights the cultural diversity in this population and the potential impact of culturally-determined views and cognitive function on health behaviors. Cognitive screening of older persons with diabetes and interventions that incorporate perceptions of time and religion to increase rates of eye examinations are needed.

Challenging Behaviours, Co-morbidities, Service Utilisation and Service Access among Community-dwelling Adults with Severe Traumatic Brain Injury: A Multicentre Study

Objective: To examine patterns, predictors and unmet needs of service utilisation and access to mental health and/or drug and alcohol services among community-dwelling adults with severe traumatic brain injury, and compare those who displayed challenging behaviours with those not displaying challenging behaviour.Design: Retrospective multicentre study.Subjects: All active clients (n= 507) of the New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP) community rehabilitation teams.Methods: Clinician-rated data were collected on client challenging behaviours, mental health and functional status, service utilisation and unmet needs. Between-groups analyses (challenging behaviour versus no challenging behaviours) were conducted to examine patterns of service utilisation and unmet needs. Predictors for service utilisation were tested by multiple linear regression.Results: Challenging behaviours were associated with higher use of BIRP and non-BIRP services and greater levels of unmet needs. Challenging behaviour was an independent predictor of higher levels of service utilisation, in conjunction with pre- and post-injury mental health and drug and alcohol co-morbidities and geographic location. Only 15.3% of the 111 clients with challenging behaviours and co-morbid drug and alcohol problems accessed a drug and alcohol service, while another 32.4% had unmet needs for such services.Conclusion: Challenging behaviours make an independent contribution to increased levels of service utilisation after severe traumatic brain injury.

Cytomegalovirus replication in semen is associated with higher levels of proviral HIV DNA and CD4+ T cell activation during antiretroviral treatment.

Asymptomatic cytomegalovirus (CMV) replication occurs frequently in the genital tract in untreated HIV-infected men and is associated with increased immune activation and HIV disease progression. To determine the connections between CMV-associated immune activation and the size of the viral reservoir, we evaluated the interactions between (i) asymptomatic seminal CMV replication, (ii) levels of T cell activation and proliferation in blood, and (iii) the size and transcriptional activity of the HIV DNA reservoir in blood from 53 HIV-infected men on long-term antiretroviral therapy (ART) with suppressed HIV RNA in blood plasma. We found that asymptomatic CMV shedding in semen was associated with significantly higher levels of proliferating and activated CD4(+) T cells in blood (P < 0.01). Subjects with detectable CMV in semen had approximately five times higher average levels of HIV DNA in blood CD4(+) T cells than subjects with no CMV. There was also a trend for CMV shedders to have increased cellular (multiply spliced) HIV RNA transcription (P = 0.068) compared to participants without CMV, but it is unclear if this transcription pattern is associated with residual HIV replication. In multivariate analysis, the presence of seminal plasma CMV (P = 0.04), detectable 2-long terminal repeat (2-LTR), and lower nadir CD4(+) (P < 0.01) were independent predictors of higher levels of proviral HIV DNA in blood. Interventions aimed at reducing seminal CMV and associated immune activation may be important for HIV curative strategies. Future studies of anti-CMV therapeutics will help to establish causality and determine the mechanisms underlying these described associations. Importance: Almost all individuals infected with HIV are also infected with cytomegalovirus (CMV), and the replication dynamics of the two viruses likely influence each other. This study investigated interactions between asymptomatic CMV replication within the male genital tract, levels of inflammation in blood, and the size of the HIV DNA reservoir in 53 HIV-infected men on long-term antiretroviral therapy (ART) with suppressed HIV RNA in blood plasma. In support of our primary hypothesis, shedding of CMV DNA in semen was associated with increased activation and proliferation of T cells in blood and also significantly higher levels of HIV DNA in blood cells. These results suggest that CMV reactivation might play a role in the maintenance of the HIV DNA reservoir during suppressive ART and that it could be a target of pharmacologic intervention in future studies.

Loss of PTEN Expression Is Associated With IGFBP2 Expression, Younger Age, and Late Stage in Triple-Negative Breast Cancer

To investigate the association between PTEN loss and IGFBP2 expression in a series of triple-negative breast cancers and to relate this expression to basal cytokeratin expression and clinicopathologic features. One hundred and one formalin-fixed and paraffin-processed triple-negative breast cancer cases from the University of Malaya Medical Centre were tested immunohistochemically for cytokeratins 5/6 and 14, PTEN, and IGFBP2. The resulting slides were scored for proportion and intensity of staining. Loss of tumor nuclear and cytoplasmic staining for PTEN occurred in 48.3% of cases and was significantly associated with younger age at diagnosis (47 years compared with 57 years in those without PTEN loss; P = .005). Independent predictors of PTEN loss were late stage at presentation (P = .026), cytokeratin 5/6 positivity (P = .028), and IGFBP2 expression (P = .042). High levels of IGFBP2 expression were seen in 32% of cases; an independent predictor of high levels was cytokeratin 14 negativity (P = .005). PTEN loss and high levels of IGFBP2 expression were associated with poorer survival, but neither of these trends was significant. PTEN loss is a frequent event in triple-negative breast cancers and is significantly associated with younger age at onset of breast cancer, late stage, and IGFBP2 expression.

Impact of diabetes on uric acid and its relationship with the extent of coronary artery disease and platelet aggregation: A single-centre cohort study

BackgroundSerum uric acid (SUA) elevation has been associated with the main determinants of atherosclerosis and metabolic syndrome, although an independent relationship between SUA and coronary artery disease (CAD) has never been confirmed. Recent reports suggested a central role of SUA in diabetic patients, possibly being an early marker of impaired glucose metabolism and best predicting the risk of cardiovascular events in these patients. Aim of current study was to evaluate the relationship between diabetes and uric acid and its association with the extent of CAD and platelet aggregation among diabetics. MethodsIn diabetic patients undergoing coronary angiography, fasting samples were collected for uric acid levels assessment. Coronary disease was defined for at least 1 vessel stenosis>50% as evaluated by QCA. ResultsDiabetes was observed in 1173 out of 3280 (35.7%) diabetes was related to age, hypercholesterolemia, hypertension, BMI, renal failure, previous MI or coronary revascularization (p<0.001, respectively) and smoking (p=0.001). Diabetics were more frequently treated with ACE-inhibitors, ARBs, b-blockers, calcium-antagonists, diuretics, statins (p<0.001, respectively), and ASA (p=0.004). Diabetics displayed higher glycemia and HbA1c (p<0.001), higher creatinine and triglycerides (p<0.001) but lower total and HDL cholesterol (p<0.001) and haemoglobin (p<0.001).No significant difference was found in SUA levels between diabetic and non diabetic patients (p=0.09). In fact, we identified age, renal failure, hypertension, smoking, BMI, use of diuretics, statins, haemoglobin, triglycerides and HDL cholesterol levels as independent predictors of higher levels of uric acid (3rd tertile,≥6.7mg/dl or 0.39mmol/l).Among diabetic patients, no relationship was found between uric acid and the extent of coronary artery disease (p=0.27; adjusted OR [95%CI]=0.93 [0.76-1.1], p=0.48), or severe (LM-trivessel) CAD (P=0.05; adjusted OR [95%CI]=1.01 [0.86-1.18], p=0.94). Furthermore, SUA levels did not influence platelet aggregation. ConclusionAgeing, BMI, renal failure, hypertension, smoking, use of statins and diuretics, haemoglobin, HDL cholesterol and tryglicerides levels but not diabetes or glycemic control are independent predictors of hyperuricemia. Among diabetic patients, higher SUA is not independently associated with the extent of CAD or with platelet aggregation.

P03-413 - Stress in first-year Egyptian and Saudi female medical students: a cross cultural comparison

IntroductionCollege students, especially freshmen, are particularly prone to stress due to the transitional nature of college life. However most of studies in this context were conducted in Western Europe and North America with only few recent studies conducted in the Arab world. This study sought to determine whether there was a difference in perceived stress levels of female medical students at Mansoura University, Egypt, and King Faisal University, Saudi Arabia.MethodsThe sample consisted of first year female medical students. The self-reported questionnaire covered four categories, including 13 items, of sources of stress (stressors).Perceived stress scale and Hospital Anxiety and Depression Scale were used to measure stress, anxiety and depression.ResultsThere is no significant difference between the two groups regarding number of stressors. However, Saudi students were more likely to cite emotional problems, excessive workload and fear of future. The most common items in Egyptian students were financial and environmental problems. Prevalence of stress and clinical anxiety was higher in the Saudi sample. Logistic regression analyses of independent predictors of high level of stress among both groups combined were Saudi nationality, larger family size, clinical depression and clinical anxiety.ConclusionsPerceived stress and anxiety are frequent among Saudi students. This information could be useful in designing preventive mental health programs that should be an integral part of the routine clinical facilities caring for medical students to help them to cope with the increasing demands of medical education.

A comprehensive histopathological evaluation of vascular medial fibrosis: Insights into the pathophysiology of arterial stiffening

Objective Medial vascular fibrosis contributes to arterial stiffening and reduced compliance, increasing the risk of cardiovascular events. We undertook the first comprehensive histopathologic study of medium-to-large caliber blood vessels (carotid, coronary, dorsalis pedis, internal mammary, iliac, mesenteric, pulmonary, and renal arteries) in 100 autopsy subjects to characterize medial fibrosis in relation to cardiovascular risk factors. Methods and results Masson Trichrome staining of vascular tissue microarrays (TMAs) was digitally analyzed to determine the percent fibrosis (% collagen) of over 700 vascular segments. The percent fibrosis of the tunica media was strongly correlated within subjects across all systemic blood vessels (average r = 0.53), suggesting that fibrosis is a global process independent of the predilection of the vessel towards the development of atherosclerosis. Hypertension, diabetes, age and poor renal function were significantly associated with increased systemic vascular fibrosis ( p ≤ 0.03). By multivariable analysis, only poor renal function ( p = 0.003) was an independent predictor of higher levels of fibrosis. Finally, in a subset of 13 individuals we observed a significant correlation between pre-mortem pulse pressure and systemic vascular fibrosis ( p < 0.001). Conclusions This study demonstrates that vascular fibrosis is a global process associated with diseases of aging and elevated pulse pressures.

Long‐Term Serologic Responses to thePneumocystis jiroveciiMajor Surface Glycoprotein in HIV‐Positive Individuals With and WithoutP. jiroveciiInfection

The immune responses to Pneumocystis jirovecii major surface glycoprotein (Msg) in individuals with human immunodeficiency virus (HIV) infection are poorly understood. We examined the sequential serologic responses to recombinant Msg carboxyl terminus fragments (MsgC1, MsgC3, MsgC8, and MsgC9) by enzyme-linked immunosorbent assay in a cohort of individuals with HIV infection for the 5.5 years before death and autopsy. Analyses included mean antibody levels by status at death (Pneumocystis pneumonia, P. jirovecii colonization, or neither), factors associated with high antibody levels, and antibody responses before and after active Pneumocystis pneumonia. Patients who died from Pneumocystis pneumonia had higher levels of antibody to MsgC8 than did patients who died from other causes. Previous episode of Pneumocystis pneumonia, geographic location, and age were independent predictors of high levels of anitbodies to most or all Msgs. Failure to take Pneumocystis pneumonia prophylaxis was associated with high levels of antibody to MsgC1. Patients who developed and recovered from active Pneumocystis pneumonia during the study exhibited an increase in serum antibody levels that persisted for months after the infection, whereas patients who developed another acquired immunodeficiency syndrome-defining illness did not. Serum antibodies to Msgs are important markers of P. jirovecii infection in patients with HIV infection and are influenced by host and environmental factors in complex ways.

House dust mite allergen in US beds: Results from the first national survey of lead and allergens in housing

Background: Although exposure to house dust mite allergen is a major risk factor for allergic sensitization and asthma, nationwide estimates of dust mite allergen levels in US homes have not been reported. Objective: The purpose of this study was to estimate the prevalence of dust mite allergen in beds of US homes and to identify predictors of dust mite allergen concentration. Methods: Data were obtained from the first National Survey of Lead and Allergens in Housing, a cross-sectional survey of 831 permanently occupied noninstitutional housing units that permitted resident children. Dust mite allergen concentration (Der f 1 plus Der p 1) was determined from a dust sample collected from a bed. The percentages of homes with concentrations at or greater than detection, 2.0 μg/g bed dust, and 10.0 μg/g bed dust were estimated. Independent predictors of allergen concentration were assessed with multivariable linear regression. Results: The percentages of US homes with dust mite allergen concentrations at or greater than detection, 2.0 μg/g, and 10.0 μg/g were 84.2% (SE, 1.73), 46.2% (SE, 2.0), and 24.2% (SE, 2.1), respectively. Independent predictors of higher levels were older homes, non-West census regions, single-family homes, no resident children, lower household income, heating sources other than forced air, musty or mildew odor, and higher bedroom humidity. Conclusion: Most US homes have detectable levels of dust mite allergen in a bed. Levels previously associated with allergic sensitization and asthma are common in US bedrooms. Predictors can be used to identify conditions under which homes are more likely to have increased dust mite allergen levels. (J Allergy Clin Immunol 2003;111:408-14.)

Characteristics Associated with Recent Recreational Exercise Among Women 20 to 44 Years of Age

ABSTRACT Data on 1,501 control women from a multi-center, population-based, case-control study of breast cancer were used to examine characteristics associated with recreational exercise during the year prior to the interview among women 20 to 44 years of age. In a univariate analysis, higher levels of recreational exercise were associated with: higher education; higher family income; white race; previous participation in recreational exercise above the median level at ages 12 to 13 and at age 20; being nulliparous; ever lactating; being a never or past smoker; having a low current Quetelet's index (QI: weight in kilograms divided by height in meters squared); and living in Atlanta or Seattle (compared to New Jersey). In a multiple linear regression model, independent predictors of higher levels of recreational exercise were: participation in higher levels of exercise at 20 years of age; having a low current QI; and never having smoked. Though all women should be encouraged to participate in exercise, these findings identity subgroups of women that may need targeting when developing exercise intervention programs.

An Address on the Pathology of Syphilis: Being an Introduction to a Debate at the Pathological Society of London

<h3>Abstract</h3> <h3>Rationale</h3> whether systemic dissemination of SARS-CoV-2 has any impact on COVID-19 severity and also on the immunological alterations observed in this disease is largely unknown. <h3>Objectives</h3> We determined the association of plasma SARS-CoV-2 RNA with clinical severity, laboratory findings and immunological parameters in a cohort of 250 patients with confirmed COVID-19 infection. <h3>Methods</h3> Three groups of patients were studied: 50 outpatients, 100 hospitalised ward patients, and 100 critically ill. The association between plasma SARS-CoV-2 RNA and severity was evaluated using multivariate ordinal logistic regression analysis and Generalized Linear Model (GLM) analysis with a binomial distribution. The association between plasma SARS-CoV-2 RNA and laboratory parameters was evaluated using multivariate GLM with a gamma distribution. <h3>Measurements and Main Results</h3> The prevalence of SARS-CoV-2-RNA viremia increased in parallel with severity of infection (22% in outpatients, 36 % in those hospitalised in wards, and 82% in those at the ICU). In hospitalised patients, the presence of SARS-CoV-2-RNA viremia was independently associated to critical illness: (adjusted OR= 8.30 [CI95%=4.21 - 16.34], <i>p</i> &lt; 0.001). SARS-CoV-2-RNA viremia was an independent predictor of higher levels of ferritin, LDH and cytokines (involving CXCL10, CCL-2, IL-15, IL-10, IL-1ra and GCS-F), and lower of lymphocytes, monocytes and platelets counts <h3>Conclusions</h3> SARS-CoV-2-RNA viremia is a robust marker of critical illness in COVID-19. Our findings support that hypercytokinemia in COVID-19 is a reactive event in response to the dissemination of viral material at the systemic level. <h3>“At a Glance Commentary”</h3> <h3>Scientific Knowledge on the Subject</h3> there is a limited number of works evaluating the presence of SARS-CoV-2 RNA in the serum or plasma of patients with COVID-19, involving few patients, most of them with non-severe disease. In consequence, the impact that the presence of SARS-CoV-2 RNA viremia has on disease biology and severity is largely unknown. <h3>What This Study Adds to the Field</h3> to our knowledge, this is the first study comparing the prevalence of SARS-CoV-2-RNA viremia in outpatients (n=50), patients admitted to the ward (n=100), and critically ill patients (n=100) with COVID-19. Multivariate analysis demonstrates that the presence of SARS-CoV-2-RNA viremia in those COVID-19 patients needing hospitalization translates into an 8-fold increase in the risk of presenting critical illness. Presence of viremia in COVID-19 patients is associated with high levels of ferritin and LDH, hypercytokinemia (increased levels of CXCL10, CCL2, IL-10, IL-1ra, G-CSF &amp; IL-15), lymphopenia and low monocyte and platelet counts. These data indicate that SARS-CoV-2-RNA viremia could be a driver of immunological dysregulation and severe disease in COVID-19 This article has an online data supplement, which is accessible from this issue’s table of content online at www.atsjournals.org