An Unusual Case of Neurosyphilis Manifesting as Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

BACKGROUND Syphilis has increased in prevalence in the United States by 72.7% from 2013 to 2017, with the highest rates recorded in men who have sex with men. There is an increased incidence of syphilis in patients with a concomitant HIV infection, estimated at a 77-fold increase. CASE REPORT This report documents an unusual case of neurosyphilis manifesting as syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a 56-year-old man with HIV/AIDS. A 56-year-old man who has sex with men with HIV/AIDS presented with a 4-day history of periumbilical abdominal pain, nausea, and constipation. A physical exam revealed slowing of baseline cognition, but was otherwise unremarkable. Urine and serum osmolality studies were consistent with SIADH as defined by the Bartter and Schwartz Criteria: serum osmolality \u3c 275 mOsm/kg, urine osmolality \u3e 100 mOsm/kg, urine sodium \u3e 20-40 mmol/L, euvolemia, and no other cause for hyponatremia identified. He was fluid-restricted, with improvement in laboratory abnormalities, further supporting the diagnosis of SIADH. A diagnostic work-up included a CT abdomen/pelvis with perirectal lymphadenopathy, colonoscopy negative for malignancy, chest CT with lymphadenopathy, and a head MRI negative for intracranial processes. The patient was ultimately found to have positive results on rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests, and was diagnosed as having neurosyphilis. He underwent penicillin desensitization and received a 14-day course of penicillin G, with recovery of sodium to normal range on discharge. CONCLUSIONS Our case highlights SIADH as an initial presenting sign of neurosyphilis with HIV infection, which has only been documented in 2 prior case reports. Our case highlights the importance of recognizing atypical presentations of neurosyphilis in patients with HIV to prevent long-term complications

Incorporating systems-level stakeholder perspectives into the clinical trial design of school-supervised asthma therapy

RATIONALE: Few evidence-based public health interventions are adopted in practice, in part due to a disconnect between the outcomes measured in clinical trials and the outcomes important to stakeholders that determine implementation in real-world practice. AsthmaLink is a school-supervised asthma therapy program which partners pediatric providers, school nurses, and families. To inform the design of a cluster randomized controlled trial of AsthmaLink, we elicited systems-level stakeholder input. METHODS: Maximum variation sampling was used to recruit 18 stakeholders to participate in semi-structured interviews that were recorded, transcribed, and open coded: Department of Public Health officials (n = 4), school officials (n = 4), pediatric practice managers (n = 3), health insurance officials (n = 4), and legislators (n = 3). Thematic analysis was used to identify common themes related to stakeholder priorities for clinical trial design and perceived barriers to AsthmaLink adoption. RESULTS: Stakeholder groups identified common priorities for the clinical trial design, including examination of the extent to which AsthmaLink (1) reduces health care utilization, (2) is cost effective (2) addresses health disparities, (3) reduces school absenteeism, and (4) educates families about asthma. Stakeholder groups reported potential barriers to AsthmaLink adoption, including challenges pertaining to (1) securing resources, staffing, and reimbursement, (2) variability across school districts, and (3) standing out amidst multiple programs vying for resources. CONCLUSIONS: Systems-level stakeholder input informed refinements to the clinical trial design of a school-supervised therapy program including outcome and implementation measures and choice of study population. Incorporating systems-level stakeholder perspectives into clinical trial design is critical to achieve adoption of evidence-based interventions into practice

A response to COVID-19 school closures: The feasibility of a school-linked text message intervention as an adaptation to school-supervised asthma therapy

BACKGROUND: School-supervised asthma therapy improves asthma medication adherence and morbidity, particularly among low-income and underrepresented minority (URM) children. However, COVID-19-related school closures abruptly suspended this therapy. In response, we developed a school-linked text message intervention. OBJECTIVE: The purpose of the study is to investigate the feasibility and acceptability of a school-linked text message intervention. METHODS: In December 2020, children previously enrolled in school-supervised asthma therapy in Central Massachusetts were recruited into this school-linked text message intervention. We sent two-way, automated, daily text reminders in English or Spanish to caregivers of these children, asking if they had given their child their daily preventive asthma medicine. Our study team notified the school nurse if the caregiver did not consistently respond to text messages. School nurses performed weekly remote check-ins with all families. The primary outcome of the study was feasibility: recruitment, retention, and intervention fidelity. Secondarily we examined intervention acceptability and asthma health outcomes. RESULTS: Twenty-six children (54% male, 69% Hispanic, 8% Black, 23% White, 93% Medicaid insured) and their caregivers were enrolled in the intervention with 96% participant retention at 6 months. Caregiver response rate to daily text messages was 81% over the study period. Children experienced significant improvements in asthma health outcomes. The intervention was well accepted by nurses and caregivers. CONCLUSION: A school-linked text messaging intervention for pediatric asthma is feasible and acceptable. This simple, accessible intervention may improve health outcomes for low-income and URM children with asthma. It merits further study as a potential strategy to advance health equity

Additional file 2 of Longitudinal disease-associated gut microbiome differences in infants with food protein-induced allergic proctocolitis

Additional file 2: Supplemental Table 1. Demographics. Demographics of the infants from the GMAP cohort selected for this nested case-control microbiome study

Additional file 3 of Longitudinal disease-associated gut microbiome differences in infants with food protein-induced allergic proctocolitis

Additional file 3: Supplemental Table 2. Summary table of all significant MaAsLin results. All MaAsLin results from 16S rRNA gene sequencing with q-values for significant taxa which met our predetermined threshold for significance (q<0.20). Mixed effects linear models using arcsine transform on relative abundances were used to determine significance. p-values were adjusted for multiple comparisons using the Benjamini-Hochberg false discovery rate (FDR) method with FDR set at <0.20. (XLS 224 kb

Additional file 1 of Longitudinal disease-associated gut microbiome differences in infants with food protein-induced allergic proctocolitis

Additional file 1: Supplemental Figure 1. Overall longitudinal microbiome composition. (A) Composition plot of the full first year of life showing the mean relative abundance of the top 15 taxa and their longitudinal taxonomic assemblage over the first year. (B) Longitudinal microbial richness (using the chao1 index) over the first year. The center line denotes the median, the boxes cover the 25th to 75th percentiles. (C) Relative abundance (arcsine transformed, AST) of key taxonomic differences mediated by important environmental factors: Bacteroides by delivery mode, Bifidobacterium by infant diet, and Lactobacillus by probiotic use. FDR-corrected q-values and coefficients are calculated from the multivariate analysis across all samples. Supplemental Figure 2. Community stability analysis calculated by Bray-Curtis beta diversity method for all consecutive sample pairs from the same subject. Each dot represents a sample pair, and is colored by the disease state of the first sample in the pair (p-values were calculated using a two sided t-test). Supplemental Figure 3. Sample subsets. (A) Flow diagram showing sample subsets used for analyses with their corresponding sample sizes and rationale. (B) A sample map showing longitudinal samples used for each subset analyzed, axes and colors as in Fig. 1. The horizontal light gray bars represent the time from diagnosis to resolution of symptoms. The ‘+’ sign represents samples that were not selected in any model. Supplemental Figure 4. Differential trajectory of Lactobacillus across disease states in infants with FPIAP compared to controls, stratified by probiotic use. Box plots of the relative abundance (AST) trajectories of Lactobacillus across disease states (from pre-symptomatic to symptomatic to resolved) compared to controls, stratified by (largely LGG-containing) probiotic use across all samples (p-values calculated using t-test)

Statistical Characterization of Hot Jupiter Atmospheres using Spitzer's Secondary Eclipses

We report 78 secondary eclipse depths for a sample of 36 transiting hot Jupiters observed at 3.6- and 4.5 microns using the Spitzer Space Telescope. Our eclipse results for 27 of these planets are new, and include highly irradiated worlds such as KELT-7b, WASP-87b, WASP-76b, and WASP-64b, and important targets for JWST such as WASP-62b. We find that WASP-62b has a slightly eccentric orbit e cos(omega) = 0.00614+/- 0.00064, and we confirm the eccentricity of HAT-P-13b and WASP-14b. The remainder are individually consistent with circular orbits, but we find statistical evidence for eccentricity increasing with orbital period in our range from 1 to 5 days. Our day-side brightness temperatures for the planets yield information on albedo and heat redistribution, following Cowan and Agol (2011). Planets having maximum day side temperatures exceeding ~ 2200K are consistent with zero albedo and distribution of stellar irradiance uniformly over the day-side hemisphere. Our most intriguing result is that we detect a systematic difference between the emergent spectra of these hot Jupiters as compared to blackbodies. The ratio of observed brightness temperatures, Tb(4.5)/Tb(3.6), increases with equilibrium temperature by 100 +/- 24 parts-per-million per Kelvin, over the entire temperature range in our sample (800K to 2500K). No existing model predicts this trend over such a large range of temperature. We suggest that this may be due to a structural difference in the atmospheric temperature profile between the real planetary atmospheres as compared to models

Statistical Characterization of Hot Jupiter Atmospheres using Spitzer's Secondary Eclipses

We report 78 secondary eclipse depths for a sample of 36 transiting hot Jupiters observed at 3.6- and 4.5 microns using the Spitzer Space Telescope. Our eclipse results for 27 of these planets are new, and include highly irradiated worlds such as KELT-7b, WASP-87b, WASP-76b, and WASP-64b, and important targets for JWST such as WASP-62b. We find that WASP-62b has a slightly eccentric orbit e cos(omega) = 0.00614+/- 0.00064, and we confirm the eccentricity of HAT-P-13b and WASP-14b. The remainder are individually consistent with circular orbits, but we find statistical evidence for eccentricity increasing with orbital period in our range from 1 to 5 days. Our day-side brightness temperatures for the planets yield information on albedo and heat redistribution, following Cowan and Agol (2011). Planets having maximum day side temperatures exceeding ~ 2200K are consistent with zero albedo and distribution of stellar irradiance uniformly over the day-side hemisphere. Our most intriguing result is that we detect a systematic difference between the emergent spectra of these hot Jupiters as compared to blackbodies. The ratio of observed brightness temperatures, Tb(4.5)/Tb(3.6), increases with equilibrium temperature by 100 +/- 24 parts-per-million per Kelvin, over the entire temperature range in our sample (800K to 2500K). No existing model predicts this trend over such a large range of temperature. We suggest that this may be due to a structural difference in the atmospheric temperature profile between the real planetary atmospheres as compared to models