Infectious Diseases Medicine Research Articles

Linda-Gail Bekker: Mentorship is critical for anyone in STEM.

Linda-Gail Bekker is a professor, chief executive officer of the Desmond Tutu HIV Foundation, and director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa. Her research interests include HIV treatment and prevention and tuberculosis, and she is active in developing community projects to promote education and research. We talked to Linda-Gail about her career, the importance of mentorship, and how rewarding it is to collaborate, mentor, and uplift other scientists.

Fibrosing cholestatic hepatitis as a variant of the course of hepatotropic viruses’ infection

Fibrosing cholestatic hepatitis is a special variant of infectious hepatitis, with a rapid progressive deterioration of liver function, and usually results in immunosuppression. It has also been reported in patients with immunocompetent status having viral hepatitis B and C. Fibrosing cholestatic hepatitis is diagnosed based on the histological examination of the liver tissue, which reveals severe damage to hepatocytes with pronounced ballooning over a weak inflammatory reaction, pericellular and perisinusoidal fibrosis, and intracellular and tubular cholestases. Analysis of the literature confirms the authors’ assumption that pathological changes in the liver, described as fibrosing cholestatic hepatitis, can develop in different conditions under the influence of various infectious agents. Despite the availability of effective antiviral therapy for hepatitis B and C, the outcomes of fibrosing cholestatic hepatitis are often unfavorable, particularly in cases not associated with solid-organ transplantation. Currently, because of the emergence of numerous drugs that selectively act on the immune system and the development of new areas of medicine such as hematology, rheumatology, oncology, transplantology, and infectious diseases, doctors in these specialties increasingly encounter severe liver damage in patients receiving specific therapy. The authors believe that doctors who do not work at liver transplantation centers underestimate the possibility of fibrosing cholestatic hepatitis development in patients with viral hepatitis B and C, in the clinic of infectious and internal diseases.

Decision Tree-Based Classification Approach to Discover Factors Affecting Vitamin D Level with Machine Learning

Purpose: Vitamin D level is emphasized as an important biomarker in determining risk factors for different diseases. Vitamin D is an important vitamin for human health and its deficiency is associated with serious health problems. Therefore, it is of great importance to detect vitamin D deficiency, which can be easily prevented and treated. The possible relationship between vitamin D deficiency and musculoskeletal pain, osteoporosis, diabetes mellitus, hypertension is frequently discussed in researches. In this research, it is aimed to analyze the factors in determining the vitamin D level and the decision rules related to it. Methods: A descriptive framework based on one of the machine learning techniques, that is decision tree is followed. The data used to create the decision rules were obtained from volunteers between the ages of 18-85 who applied to Izmir Katip Çelebi University Atatürk Training and Research Hospital Infectious Diseases and Family Medicine Polyclinics and agreed to participate in the study between 01.03.2017 and 01.09.2017. Results: It was observed that age, gender and laboratory test values are strong predictors for vitamin D level. As a result of two CART (Classification and Regression Trees) models, %90.47 and %95 predictive accuracies were observed respectively. In the first model, uric acid, age and creatine; in the second model TSH, ALP and smoking(yes) were the most important three biomarkers affecting vitamin D level. Discussion: The collected features give a comprehensive list of variables that have an effect on vitamin D in the dataset under consideration. Important findings of the study include not only the identification of these variables, but also the effective categorization determination procedures. In contrast to previous research, the Age variable is the most influential factor within the scope of this dataset, which includes demographic information on patients and their existing disorders.

How the French national authority for health assesses medicines for use in pediatrics

Children deserve to be treated with appropriate medicines based on robust assessments. Despite the introduction of new regulations, the availability of medicines for children is suboptimal because of the frequent lack of relevant clinical trials due to the difficulty of conducting such trials. Thus, the Transparency Committee (TC) of the French National Authority for Health, who oversees the assessment of medicinal products in France, set up a pediatric working group with two aims: (1) The first aim was to review all opinions on medicines for pediatric use. Out of 536 opinions delivered between 2020 and 2022, 181 (34 %) concerned medicines for pediatric use. Whereas oncology largely dominated the medicines for adults, medicines for infectious diseases, endocrinology/metabolism, neurology, and hematology mostly prevailed for children. (2) The second aim was to clarify the evaluation criteria assessed by the TC, namely, the clinical benefit (CB), the clinical added value (CAV), and the public health impact (PHI) for pediatric medicinal products. An important CB was given to 113 out of 161 (71 %) opinions on medicines for pediatric use when it concerned pathologies with a severe prognosis. The quality of the demonstration (e.g., double-blind randomized trial vs. placebo or another active medicine) played a major role in the CB level. Clinical pediatric studies were also consistently associated with higher CAV levels: levels I (major) to III (moderate) in 26 out of 42 (62 %) opinions, level IV (minor) and level V (no therapeutic progress) in 43 out of 84 (51 %) and 30 out of 43 (70 %) opinions granting a sufficient CB, respectively. Conversely, 22 out of 30 (73 %) dossiers based only on literature reviews were given a level V. The main criteria leading to the qualification of a medicine for pediatric use as providing a PHI included a significant change in the morbidity and mortality of the disease and an improvement in the care pathway. Assessments were mostly aligned on the adults in the case of subsequent extensions of indications to children. Lastly, new measures were taken aimed at shortening median delays in the assessment process in order to reduce off-label use of medicines in France.

Management of peripheral arterial disease in the context of a multidisciplinary limb program.

Peripheral artery disease (PAD) continues to increase in prevalence worldwide due to risk factors such as advanced age, diabetes mellitus, and obesity. Critical limb ischemia (CLTI) is the advanced form of PAD that can result in a lack of healing and limb loss as the most devastating consequence. Patients with PAD, especially CLTI, benefit from multidisciplinary care to optimize outcomes by reducing cardiovascular morbidity and mortality and preventing lower extremity amputation. Collaboration between various specialties allows a focus on problems involved in treating the patient with PAD including prevention, screening, medical care, wound care, infection, and revascularization when needed. Although there is no clear definition or consensus on the structure of the PAD team, certain guidelines are applicable to most clinical scenarios emphasizing "provider champions" in leading a clinical program. A vascular specialist (vascular surgery, interventional radiology, interventional cardiology) and a soft tissue specialist (podiatry, plastic surgery) are the typical "champions," often involving orthopedics, general surgery, vascular medicine, diabetology/endocrinology, infectious disease, nephrology, and rehabilitation medicine. The team should also include wound nurses, nutritionists, occupational therapists, orthotists, pharmacists, physical therapists, prosthetists, and social workers. This paper presents a brief overview of the structure of the multidisciplinary team with key components and functions of such a team to optimize treatment outcomes for PAD and CLTI.

(280) Innovative Team Approach to Sexual Health Counseling; Partnership of Urology, Infectious Disease and Pelvic Floor Therapy to Increase Access to Care

Abstract Introduction Despite the prevalence and availability of HIV (Pre-exposure Prophylaxis i.e., PrEP), the number of new AIDS diagnoses continues to outpace treatment and prevention. Stigma, discrimination, lack of access continue to remain significant barriers in the prevention of new HIV infections, especially amongst vulnerable groups (i.e. LGBTQ, women, and minorities). We present a novel strategy to address a comprehensive approach to sexual health medicine through the partnership of Urology, Infectious Disease, and Pelvic Floor therapy. Objective Men who have sex with men (M2M) who either currently use or have an interests in use of pre-exposure prophylaxis (PrEP) continue to face barriers with respect to access to care, stigma, and or availability of effective partnerships to address and offer culturally competent care. The objective of this study is to assess attitudes and barriers to conventional and novel PrEP offerings as well as to present an innovative team approach between Urology, Infectious Disease (ID) Medicine and Pelvic Floor Therapy to offer a comprehensive multidisciplinary approach to treatment and care. Methods We enrolled 6 candidates (M2M) into our PrEP clinic which offers the Apretude (Cabotegivir 600 mg/3mL) injections. We conducted interviews, focused groups, and provided questionnaires to detail their experiences, beliefs, attitudes, barriers, and considerations for therapy. Results First, the preliminary results and findings of our study has shown that the needs, considerations, and beliefs of M2M is more varied, nuanced, and divergent with need to characterize, understand, and offer more specific culturally competent care in Sexual Health Medicine with respect to PrEP. Second, M2M designation does not exclude men from having sex with the opposite gender. These man preferred injectable PrEP option. Third, the partnership of Urology, Infectious Disease and Pelvic Floor Therapy reduced barriers, increased access to care, and decreased stigma as M2M felt more comfortable in the Urological setting. Conclusions M2M patients stated hesitancy, increased stigma and “shame” in going to ID for sexual health. Additionally, for M2M who have sexual partners of the opposite sex this would further increase stigma. Urology practices are accustomed to having discussions surrounding men’s sexual health with reduced stigma. The combination of Infectious Disease has presented an innovative partnership to discuss, prevent, and treat sexuallly transmited infections amongst M2M. Disclosure No.

MATERIALS OF NOBEL SYMPOSIUM 175: PRECISION MEDICINE TRANSFORMS HEALTHCARE: A NEW TRAJECTORY FOR RESEARCH AND INNOVATION SEPTEMBER 20-22, 2023, STOCKHOLM, SWEDEN.

Nobel Symposium 175 was organized by Professor Richard Rosenquist Brandell of Karolinska Institutet and was supported by the Royal Swedish Academy of Sciences. The focus of the symposium was a discussion on the development of precision medicine in infectious and rare diseases, cancer, and complex diseases. Presentations and discussions concerned new technologies, bioinformatics, and new diagnostic and therapeutic approaches based on findings in basic research. Organization of precision medicine models and their implementation in medical practice at the national and international levels were also on the agenda. 29 scientists from different fields of medicine presented their work during a three-day exciting trip into the future of patient' care. Panel discussions shed light on the development of precision medicine for better treatment of patients.

Evaluation of interferon gamma release assay to measure t-cell response in COVID-19 patients from intensive care units and inpatient departments.

Interferon gamma release assay (IGRA) is an in vitro blood test to measure interferon gamma (IFN-γ) released from antigen-specific Tcells after stimulation with pathogen-specific peptides. In this study, it was aimed to investigate the T-cell response using IGRA and to compare various laboratory values in Coronavirus Disease (COVID-19) patients hospitalized either in hospital inpatient departments or in intensive care units. Atotal of 100 patients (50+50) who were identified as positive for COVID-19 through the molecular method in Selcuk University Faculty of Medicine Infectious Diseases Service and Reanimation Intensive Care Unit were included in the study. IFN-γ levels in blood samples collected from patients were determined using the QuantiFERON Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) (QIAGEN, Germany) kit. The patients' gender, age, c-reactive protein (CRP), aspartate aminotransferase (AST), alanine transaminase (ALT), interleukin (IL)-6, lymphocyte count, procalcitonin, and D-dimer results were obtained from the hospital automation system. Thirty-eight of the IGRA test results were negative, 44 were positive and 18 were inconclusive. The age of patients with negative IGRA test results was significantly higher (p<0.001) compared to patients with positive results. There were no significant differences between patients' IGRA test results and gender, prognosis, IL-6, lymphocyte counts, CRP, AST, and ALT values.Age, death rates, D-dimer, CRP, procalcitonin, AST and ALT values of patients hospitalized in the intensive care unit were significantly higher (p<0.001) compared to the those hospitalized in the inpatient department, while conversely, the lymphocyte values were lower (p<0.001). The relatively higher IGRA negative results in the elderly, negative and intermediate results in intensive-care patients, and low lymphocyte levels in intensive-care patients indicate that the cellular immune response is diminished and/or absent. The death rates, D-dimer, CRP, procalcitonin, AST and ALT values of the patients hospitalized in the intensive care unit were higher compared to those from the in-patient department, indicating the severity of inflammation and signaling the development of organ failure. In the light of these findings, we suggest that IGRA tests may serve as aguide in immunomodulatory therapy (Tab. 2, Fig. 2, Ref.27). Text in PDF www.elis.sk Keywords: COVID-19, interferon gamma release assay test, Tcell response.

Mitigating the Risks of Herb-Drug Interaction among Artisans in Ibadan Metropolis Through Public Health Education Survey

Background: Globally, there has been an increase in the use of herbal medicines with the general misconception that herbal medicines are absolutely effective and safe. Many people often use herbs concomitantly with orthodox medicines and this may lead to fatal complications of herb-drug interactions. This cross-sectional survey assesses the knowledge and attitude of teachers and artisans on the use of herbal medicine and the possible occurrence of herb-herb and herb-drug interactions.&#x0D; Method: A semi-structured questionnaire was used which covered demographics, cultural categorization of herbal medicine used, socio-economic factors (SEF), reason(s) for herbal medicine use, knowledge of herb-herb (HHI) and herb-drug interactions (HDI) and, and attitude to herbal medications (AHM) of the respondents. Data were entered into SPSS version 20 and analyzed using descriptive and inferential statistics.&#x0D; Results: There were 277 respondents, comprising 93 teachers, 77 drivers, and 107 mechanics. The response rate was 95.1%. Seventy-two (77.4%) teachers, 56 (72.7%) drivers and 101 (94.4%) mechanics use herbal medicine for infectious diseases while 57 (61.3%) teachers, 20 (26.0%) drivers and 83 (77.6%) use herbal medicine for non-infectious diseases. Assessment of SEF shows that a significant number (p=0.04) of participants were encouraged by friends to use herbal medicines while 63 (67.7%) teachers, 57 (74.0%) drivers, and 84 (78.5%) mechanics preferred herbal medicine to hospital management because it is affordable. Assessment of HHI shows 81 (75.7%) mechanics are aware of HHI, whereas 56 (72.7%) drivers and 69 (74.2%) teachers are not. Similarly, majority of the teachers (81, 87.1%) and drivers (47, 61.0%) were not aware of the possible occurrence of HDI while a significant (p=0.03) number (76, 71.0%) of the mechanics were aware.&#x0D; Conclusion: The respondents’ awareness of herb-herb and herb-drug interactions was poor. Public awareness program on the potential implications and health impact of herb-herb and herb-drug interactions is highly essential.

Precision medicine in infectious diseases

Infectious medicine faces avariety of challenges, such as the increase in antibiotic resistance and the emergence and spread of infectious diseases fueled by climate change and globalization. Precision medicine can provide solutions to many of these challenges. Since an untargeted request for diagnostic tests can lead to test results without clinical relevance, which can increase the use of non-indicated antibiotics, the principle aimed at is: targeted diagnostics (the right test) and consideration of patient characteristics (the right person) to optimize management (the right action). At the same time, one must always decide whether empirical therapy must be immediately initiated, even if the results of the initiated diagnostics are not yet available. In addition, many new diagnostics as well as therapies have recently been developed for the rapid detection and more specific treatment of bacterial infections. Molecular genetic methods, which offer more rapid results than classical bacterial cultures, are gaining ground as new diagnostics. New therapeutics such as bacteriophages, antibodies or antibacterial peptides allow increasingly precise treatment of certain bacterial infections. Precision medicine will also play an increasingly important role in infectious medicine in the future.

Scientific Evaluation of the Remedies Used in Turkish Folk Medicine to Treat Possible Viral Infections

Background: Plants, with their rich phytochemical treasury, are one of the main sources of drug development. However, a randomized search on plant sources for the discovery of phytochemicals with specified pharmacological activity is expensive and tedious. Therefore, it is logical to constrain the sources to increase success. In the recent four decades, the importance of traditional information has been recognized by the scientific community. Consequently, interest in field surveys for the documentation of traditional worldwide medicines has significantly increased. Aims and Methods: Infectious diseases induced by pathogenic bacteria, fungi, or viruses have been one of the most common health problems for the public, for which traditional remedies have been practiced. Since laypeople could not distinguish the microbial origin of the infection, the remedies used for treatment could not be delineated. The aim of this study was first to search the plants used in Turkish folk medicine for such infectious diseases. The second step was to find scientific evidence in the online databases for the frequently quoted plants whether they may have potential activity against virus replication. Results: A reference survey on the most frequently quoted plants revealed that 16 out of 17 were shown to possess virucide or inhibitory effects on the replication of various viruses. Conclusion: Since each virus type may have a different viral replication pattern, further detailed investigations should be carried out to reveal their exact antiviral potentials.

1869. Knowledge about and Perceptions of Latent Tuberculosis Infection (LTBI) among Physicians and Advanced Practice Providers at Tufts Medical Center

Abstract Background Mycobacterium Tuberculosis (TB) is a leading cause of infectious disease mortality worldwide. Most active TB cases result from reactivation of latent tuberculosis infection (LTBI). A large reservoir of latent TB is a major public health problem worldwide and in the United States. A better understanding of provider perspectives on LTBI could improve a sub-optimal LTBI care cascade. Methods A 13-question survey was fielded to attending physicians, fellows, and advanced practice providers working in the infectious disease, pulmonary/critical care, and general medicine departments at Tufts Medical Center (TMC), an academic tertiary care center in Boston, Massachusetts. Results The response rate of the survey was 33% (62/186). Only 17 (30.9%) providers were able to correctly identify all indications for screening. When asked how they decide who to treat, 26.8% (15/56) of providers selected that they would refer their patient to another specialist. Overall, provider confidence in LTBI management decreased along the care cascade (Figure 1). Infectious disease providers expressed more confidence in management than general medicine and pulmonary/critical care providers. The two most observed issues/barriers to care for patients were language, reported by 39 (76.5%) providers, and lack of knowledge or understanding about TB, reported by 39 (76.5%) providers. The two most selected interventions to improve LTBI care at TMC were use of in-person language interpreters, chosen by 37 (71.2%) providers, and information pamphlets available in patients’ preferred languages, chosen by 36 (69.2%) providers. Providers were asked “On a scale of 1-5, (“1” = not at all, and “5” = perfectly) “How confident are you in your ability to do the following” for the listed management tasks. Conclusion Results suggest that providers believe the largest barriers to patient LTBI treatment completion are due to a lack of patient comprehension about their infection. Improving patient understanding could be accomplished through in-person interpreters, information pamphlets about LTBI in patients’ preferred languages, and forming community partnerships to improve awareness and understanding of the risks of LTBI. Additionally, ensuring that providers feel confident in their ability to manage LTBI, are updated on screening guidelines, and have referral resources when needed, could help close the gaps in the LTBI care cascade. Disclosures All Authors: No reported disclosures

A51Educational effectiveness of a high-consequence infectious disease training course using ultraviolet simulation

High-consequence infectious diseases (HCID) are pathogens which spread easily between people, have high mortality rates, and lack effective treatment [1]. Examples include Ebola and Lassa fever. Most emerging pandemics, including COVID-19, are initially classified as HCID. Assessment of patients with suspected HCID infection is an advanced procedural skill requiring application of enhanced infection control measures including patient isolation, personal protective equipment, and decontamination. There is a risk of healthcare worker infection if procedures are not followed [2]. HCID often present in non-specialist centres; there is a need for an accessible, educationally effective HCID course for NHS staff. We developed a course for clinicians in infectious disease and emergency medicine, in collaboration with the Health &amp; Safety Executive and clinicians in the UK-HCID network. The course uses a blended approach; theoretical components are taught with online learning. Practical components are taught with high-fidelity, multidisciplinary simulation using VIOLET, a mannequin which coughs, vomits and sweats ultraviolet markers ( Ultraviolet tracers are used to replicate contact and airborne transmission of infectious pathogens in simulation scenarios Between 01/12/22 and 01/04/23, 57 specialized clinicians participated. All participants passed post-course competency-based practical assessments. Participants demonstrated significant gains in knowledge between pre- and post-course tests (mean score 61% vs. 83%, This is the first HCID simulation course internationally using ultraviolet markers to allow visualization of contamination. The course appears to be an effective educational intervention and improves learner confidence in PPE use. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Recent advances using genetic therapies against infectious diseases and for vaccination.

The development of prophylatic or therapeutic medicines for infectious diseases is one of the priorities for health organizations worldwide. Innovative solutions are required to achieve effective, safe, and accessible treatments for most if not all infectious diseases, particularly those that are chronic in nature or that emerge unexpectedly over time. Genetic technologies offer versatile possibilities to design therapies against pathogens. Recent developments such as mRNA vaccines, CRISPR gene editing, and immunotherapies provide unprecendented hope to achieve significant results in the field of infectious diseases. This review will focus on advances in this domain, showcasing the cross-fertilization with other fields (e.g., oncology), and addressing some of the logistical and economical concerns important to consider when making these advances accessible to diverse populations around the world.

Precision medicine: Transforming healthcare through personalized treatment and genomic insights

ABSTRACT This article explores the paradigm shift brought about by precision medicine in healthcare. It provides an overview of the field’s historical background, key milestones, advantages, real-life examples, major companies, products, challenges, and future prospects. Readers can expect to gain insights into the emergence of precision medicine, its impact on diagnosis and treatment, and its potential to revolutionize healthcare. The article highlights significant achievements such as the completion of the Human Genome Project, the development of targeted therapies, and the role of precision medicine in cancer, cardiovascular disease, rare diseases, infectious diseases, and mental health disorders. It also discusses prominent companies and their contributions to precision medicine. However, challenges such as the cost of genetic testing and the need for robust data infrastructure are explored. The importance of collaboration, education, awareness, regulation, and standardization is emphasized. By the end, readers will have a comprehensive understanding of precision medicine’s promise, its current state, and the steps needed for its widespread adoption, enabling them to grasp its potential impact on patient outcomes and health-care systems.

Symptoms, Treatment, and Outcomes of COVID-19 Patients Coinfected with Clostridioides difficile: Single-Center Study from NE Romania during the COVID-19 Pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic has brought new challenges across medical disciplines, particularly in infectious disease medicine. In Romania, the incidence of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) infection increased dramatically since March 2020 until March 2022. Antibiotic administration for pulmonary superinfections in COVID-19 intensified and, consequently, increased rates of Clostridioides difficile infection (CDI) were hypothesized. We conducted a single-center, retrospective, observational study on patients from North-Eastern Romania to assess clinical characteristics and outcomes of COVID-19 and Clostridioides difficile (CD) coinfection, and to identify risk factors for CDI in COVID-19 patients. The study enrolled eighty-six CDI and COVID-19 coinfected patients admitted during March 2020-February 2021 (mean age 59.14 years, 53.49% men, 67.44% urban residents) and a group of eighty-six COVID-19 patients. On admission, symptoms were more severe in mono-infected patients, while coinfected patients associated a more intense acute inflammatory syndrome. The main risk factors for severe COVID-19 were smoking, diabetes mellitus, and antibiotic administration. Third generation cephalosporins (55%) and carbapenems (24%) were the main antibiotics used, and carbapenems were significantly associated with severe COVID-19 in patients coinfected with CD during hospitalization. Coinfection resulted in longer hospitalization and poorer outcomes. The extensive use of antibiotics in COVID-19, particularly carbapenems, contributed substantially to CD coinfection.

Social media as a catalyst to improve (personal) health.

Social media as a catalyst to improve (personal) health.

Medical Knowledge Acquisition during a Pandemic: Pediatric Subspecialty in-Training Examination and Board Certification Exam Passing Rate

ObjectiveThe COVID-19 pandemic resulted in training programs restructuring their curricula. Fellowship programs are required to monitor each fellow’s training progress through a combination of formal evaluations, competency tracking, and measures of knowledge acquisition. The American Board of Pediatrics administers subspecialty in-training examinations (SITE) to pediatric fellowship trainees annually and board certification exams at the completion of the fellowship. The objective of this study was to compare SITE scores and certification exam passing rates before and during the pandemic. MethodsIn this retrospective observational study, we collected summative data on SITE scores and certification exam passing rates for all pediatric subspecialties from 2018 to 2022. Trends over time were assessed using analysis of variance (ANOVA) analysis to test for trends across years within one group and t-test analysis to compare groups before and during the pandemic. ResultsData were obtained from 14 pediatric subspecialties. Comparing prepandemic to pandemic scores, Infectious Diseases, Cardiology, and Critical Care Medicine saw statistically significant decreases in SITE scores. Conversely, Child Abuse and Emergency Medicine saw increases in SITE scores. Emergency Medicine saw a statistically significant increase in certification exam passing rates, while Gastroenterology and Pulmonology saw decreases in exam passing rates. ConclusionsThe COVID-19 pandemic resulted in restructuring didactics and clinical care based on the needs of the hospital. There were also societal changes affecting patients and trainees. Subspecialty programs with declining scores and certification exam passing rates may need to assess their educational and clinical programs and adapt to the needs of trainees’ learning edges.

(078) The Release of the AUA Testosterone Guidelines Correlate With an Increase in Testosterone Prescriptions Among Urologists

Abstract Introduction There has been a continued increase in total testosterone prescriptions since 2014. The AUA published guidelines regarding the evaluation and treatment of men with testosterone deficiency in 2018. There is a paucity of literature addressing the prescription trends of different specialties during the release of the 2018 Guidelines. Objective We aimed to elucidate the testosterone prescription trends overall and of each specialty from 2016 to 2019 as the 2018 AUA testosterone guidelines were released. Methods Publicly available data from the Center for Medicare Services (CMS) Part D Prescriber database with regards to testosterone prescriptions across a 4-year span (January 1, 2016-December 31, 2019) were analyzed. Prescribers were categorized into specialties based on their NPI. We analyzed the trends of specialties with over 100 prescribers and prescribers overall using a negative binomial model. Results Family practice, internal medicine, urology, endocrinology, nurse practitioners (NPs), physician assistants (PAs), general practice, infectious disease, and emergency medicine (listed in order of descending testosterone prescribers) were the nine specialties with over 100 testosterone prescribers. From 2016 to 2019 each specialty had an increase in the number of prescribers except for emergency medicine which had a 4% decline (Figure 1). Nurse practitioners had the largest relative increase at 118%. The average number of claims increased each year from 2016 to 2019. However, focusing on consecutive years only 2017 and 2018 significantly differ (p=0.015) with urologists having the largest increase in average yearly claims (40 to 43 claims) (Figure 2). NPs and PAs both have an increasing share of the total testosterone claims from 2016 to 2019 (Figure 3). Conclusions The number of prescribers and claims for testosterone continued to increase from 2016 to 2019 based on CMS data. Our analysis showed that only 2017 to 2018 had a statistically significant increase in average claims corresponding to the year the AUA guidelines were released. Urologists on average prescribe the most testosterone and had the highest increase in claims per provider in 2018. Additionally, NPs and PAs are prescribing an increasing share of testosterone over the course of our analysis. Disclosure No

A retrospective analysis of clinical features of patients hospitalized with SARS-CoV-2 Omicron variants BA.1 and BA.2

The causative agent of the ongoing Corona virus disease 2019 (COVID-19) pandemic, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has acquired a considerable amount of mutations, leading to changes in clinical manifestations and increased transmission. Recent studies based on animal disease models and data from the general population were reporting a higher pathogenicity of the BA.2 sublineage compared to BA.1. The aim of this study was to provide real world data on patients with the SARS-CoV-2 Omicron BA.1 and BA.2 subvariants treated at our center, highlighting similarities and differences in the clinical disease course. We retrospectively collected and analyzed the data of adult patients admitted with confirmed SARS-CoV-2 infection at the Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria. Patient characteristics including age, underlying diseases, vaccination status and outcome were compared between patients with the BA.1 and BA.2 subvariants. Between January 2022 and May 2022 we included 168 patients infected with Omicron BA.1 and 100 patients with BA.2. Patients admitted with BA.2 were significantly older, more often fully immunized and required less dexamethasone than patients with BA.1. No substantial differences were identified between patients infected with BA.1 and BA.2 regarding BMI, laboratory findings, need for supplemental oxygen, mortality and other evaluated comorbidities excepting active malignancies. The significantly larger percentage of fully immunized patients admitted with BA.2 is pointing to an increased transmissibility of this subvariant, while the comparable outcome of a somewhat older and sicker patient population might be indicative of reduced virulence.