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Author(s): DVS Kiran Kumar [1]; Asisha Mathensingh [1]; Muruga Bharathy Kalimuthu [1]; Philip George [2]; Ronald Carey Albert Benton [1]; Raji Thomas [3]; Rajiv Micheal [4]; Suma Susan Mathew [2]; [...], Background: Stroke patients commonly have dysphagia that can lead to aspiration pneumonia and, in some cases, death. The risk factors for poor outcomes have not been described well in a South Indian population. Objective: We aimed to assess the incidence of dysphagia and subsequent pneumonia and mortality in a cohort of stroke patients. Materials and Methods: We screened 472 consecutive stroke patients, among whom 100 were included. Each patient was assessed by the clinician, speech therapist, and ENT surgeon. We calculated the stroke scores - National Institute of Health Stroke Score (NIHSS), modified Rankin score - as well as the swallowing scores, that is, Mann's and Functional Oral Intake Scale (FOIS) score, and performed video laryngoscopy. We evaluated dysphagia, aspiration pneumonia, removal of nasogastric tube, and death for up to 3 months after the diagnosis. Results: Of 100 stroke patients, we found that 77 had dysphagia. Twenty-seven (35%) developed pneumonia; 16/27 (59.3%) died within 3 months of ictus. Among the 48 who did not develop pneumonia, six died (12.5%). Compared to a consensus definition of dysphagia, Mann's score less than 177 rules in dysphagia, while a score more than 187 rules out dysphagia. Higher NIHSS score and weak gag reflex were the independent factors for dysphagia. Most patients with dysphagia improved. Dysphagia is significantly associated with pneumonia (35%) and high mortality (20.8%). Conclusions: Dysphagia was seen in 77% of our stroke patients; 28% developed pneumonia. In 3 months, majority recovered from dysphagia. Higher NIHSS scores and a weak gag were independent predictors of dysphagia. Also, 35% with dysphagia developed pneumonia, among whom the mortality was 59.3%. Keywords: Cohort, dysphagia, mortality, pneumonia, stroke

Sporadic outbreaks of influenza A virus (IAV) infections have been reported in pinnipeds in the United States and Europe, most commonly in harbor (Phoca vitulina) and gray (Halichoerus grypus) seals [...]

Sub-Saharan Africa has the highest HIV infection incidence and prevalence in the world (1,2). Although incidence is declining (3), more progress is needed to reduce transmission to a sufficient level [...]

Lassa fever is an acute viral hemorrhagic illness caused by Lassa virus (LASV), an enveloped RNA virus of the Arenaviridae family (1). Lassa fever is endemic to West Africa, causing [...]

INTRODUCTION In 2020, 29.8% of Australia's population was born overseas and over 7.6 million migrants were living in Australia [1]. In 2019, there were 2.43 million temporary migrants in Australia [...], : Introduction:: Overseas‐born gay and bisexual men (GBM) are overrepresented in HIV diagnoses in Australia. We assessed social and sexual behaviours, and the use of HIV prevention and testing, by region of birth and length of residence in Australia. We sought to identify similarities and differences between recently arrived and non‐recently arrived GBM from non‐English‐speaking countries to improve targeting and engagement with HIV testing and prevention. Methods:: Data were collected in national repeated, behavioural surveillance surveys conducted across Australia during 2019–2021. Logistic regression was used to identify factors that differentiated between recently arrived ( Results: Among 24,707 participants in 2019–21, 2811 (11.4%) were from high‐income English‐speaking countries, 714 (2.9%) were recently arrived overseas‐born GBM and 3833 (15.5%) were non‐recently arrived migrants. Recently arrived GBM were most likely to be born in Asia (36.1%) and Europe (21.1%). Compared with non‐recently arrived GBM, recently arrived GBM from non‐English‐speaking countries were younger (aOR = 0.95, 95% CI = 0.94–0.96, p Conclusions: Recently arrived GBM from non‐English‐speaking countries reported similar levels of risk of HIV acquisition to longer‐term residents in Australia, but lower levels of PrEP awareness and use, and more reliance on HIV testing services which are free or low cost. It is necessary to enhance access to HIV testing and prevention among recently arrived GBM in Australia.

INTRODUCTION In 2021, the global population of children who are perinatally HIV exposed but HIV negative (CHEU) was almost 16 million, with another one million CHEU born annually [1, 2]. [...], : Introduction: Several HIV‐related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding. Methods: A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013–2017). All WLHIV initiated antenatal efavirenz‐based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2‐week recall) and neurodevelopment (BSID‐III, measured at ∼12 months’ age) were compared across bio‐social strata using generalised linear regression models, with interaction terms; maternal data included interview‐based measures for HD (AUDIT‐C), IPV (WHO VAW) and HFIS. Results: Among 872 breastfeeding mother‐infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p > 0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight‐for‐age Z‐score (WAZ) was 0.06 (−0.14; 0.25) for food insecure CHU; −0.26 (−0.42; −0.10) for food secure CHEU; and −0.43 (−0.61; −0.25), for food insecure CHEU. Results were similar for underweight (WAZ < −2), infectious‐cause hospitalisation, cognitive and motor delay. HIV‐IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV‐HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD‐unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD‐exposed CHU; 3.57 (0.84; 15.13) for HD‐unexposed CHEU and 6.01 (2.22; 16.22) for HD‐exposed CHEU. Conclusions: These data suggest that maternal HIV‐related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.

Presenters Anna Gilbert, BS, Elisabeth Callen, PhD, Cory Lutgen, BS, BSc, Sanjay Batish, MD, Daijah Jones, [...], Context: Adverse Childhood Experiences (ACEs) are a set of early life events associated with toxic stress and long-term health consequences. The more ACEs a person has experienced, the greater their risk of physical and mental illness later in life. It has been proposed that gun violence, an increasingly common experience for children in the United States, should be considered an ACE due to its lifelong physical and psychosocial impacts. The SaFETy Score is a set of four questions that can be used in clinical settings to predict an adolescent&apos;s risk of gun violence exposure. Objective: This study evaluated the relationship between ACEs and lifetime gun violence exposure, as well as future gun violence risk as measured by the SaFETy Score. Study Design and Analysis: Longitudinal quantitative study. Multivariate linear regression with gun violence exposure and SaFETy score as the independent variables and ACE score as the dependent variable. Setting: Four semi-urban to rural primary care practices in eastern North Carolina. Population Studied: Patients age 14-24 at participating practices. Intervention/Instrument: Surveys at baseline and six months post-baseline assessed patient demographics, SaFETy score, ACE score, violence exposure, peer influences, and parental support. Outcome Measures: ACE score, SaFETy score, and lifetime gun violence exposure Results: The majority of the patients were female (69%), non-Hispanic or Latinx (73%), and had at least a high school diploma or GED (63%). In terms of race, 45% were white and 36% were Black or African-American. The majority (58%) had an ACE Score of one to three, which indicates intermediate risk for adverse health outcomes. One-quarter (25%) had an ACE score of four or more, indicating a high level of risk. Over half (55%) reported being exposed to gun violence in their lifetime. ACE Score was associated with both lifetime gun violence exposure and SaFETy Score (p=0.001 for both). Conclusions: In this study, ACEs were correlated with both lifetime gun violence exposure and SaFETy score, suggesting that gun violence exposure is more common in rural and suburban North Carolina youth who have also experienced other childhood traumas.

The traditional model of laboratory testing in healthcare starts with the patient recognizing the need to see a physician (Figure 1). In nonemergent cases, the patient must make an appointment [...], * Context.--Convenience, avoidance of doctor&apos;s appointments, curiosity, and the desire to take control of one&apos;s health are driving interest toward direct-to-consumer (DTC) testing. DTC is laboratory testing that is initiated by the consumer without a physician order. The results are reported back directly to the consumer. DTC testing is an exciting addition to the traditional healthcare model for consumers who want knowledge of their health status and disease risk, ancestry, and their body&apos;s expected response to certain medications based on their genotype. Objectives.--To discuss the perceived and potential benefits and risks involved in DTC testing. Data Sources.--Recent published literature on DTC testing. Conclusions.--The benefits of DTC testing are enticing and are driving the DTC testing market. Consumers must weigh the perceived benefits with the potential risks, including privacy concerns, the possibility of receiving confusing health information, and/or information that could generate unexpected emotions, misdiagnosis, and over-testing.

Author(s): Elizabeth V. Robilotti [sup.1] [sup.2] [sup.3] , N. Esther Babady [sup.1] [sup.4] , Peter A. Mead [sup.1] [sup.3] , Thierry Rolling [sup.1] , Rocio Perez-Johnston [sup.5] , Marilia Bernardes [...], As of 10 April 2020, New York State had 180,458 cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 9,385 reported deaths. Patients with cancer comprised 8.4% of deceased individuals.sup.1. Population-based studies from China and Italy suggested a higher coronavirus disease 2019 (COVID-19) death rate in patients with cancer.sup.2,3, although there is a knowledge gap as to which aspects of cancer and its treatment confer risk of severe COVID-19.sup.4. This information is critical to balance the competing safety considerations of reducing SARS-CoV-2 exposure and cancer treatment continuation. From 10 March to 7 April 2020, 423 cases of symptomatic COVID-19 were diagnosed at Memorial Sloan Kettering Cancer Center (from a total of 2,035 patients with cancer tested). Of these, 40% were hospitalized for COVID-19, 20% developed severe respiratory illness (including 9% who required mechanical ventilation) and 12% died within 30 d. Age older than 65 years and treatment with immune checkpoint inhibitors (ICIs) were predictors for hospitalization and severe disease, whereas receipt of chemotherapy and major surgery were not. Overall, COVID-19 in patients with cancer is marked by substantial rates of hospitalization and severe outcomes. The association observed between ICI and COVID-19 outcomes in our study will need further interrogation in tumor-specific cohorts. Analysis of a large, single-center cohort of patients with cancer who were infected with COVID-19 uncovers factors associated with disease severity and interactions with anti-cancer therapies

INTRODUCTION Human papillomavirus (HPV) is the leading sexually transmitted infection (STI) worldwide. Most sexually active people become infected with HPV at some point in their lives [1?3]. HPV types with [...], : Introduction: As the leading sexually transmitted infection worldwide, human papillomavirus (HPV) may disproportionately affect transwomen. We aimed to estimate anal HPV prevalence, especially focusing on high?risk (hr)?HPV types and evaluate their associated factors among transwomen living in Rio de Janeiro, Brazil. Methods: Transwomen enrolled in a respondent?driven sampling (RDS)?based survey conducted between August 2015 and January 2016 self?collected anal samples, which were promptly stored at minus 80°C. After DNA extraction, HPV detection and genotyping were performed using the PapilloCheck test. We estimated HPV prevalences and evaluated the correlates of anal hr?HPV infection using a regression logistic model. Results: Out of 345 transwomen, 272 (78.8%) were included in this analysis (122 [44.9%] HIV?positive). No participant had ever received HPV vaccination. Among participants enrolled, 212 (77.9%) were positive for any anal HPV type and 165 (60.7%) for hr?HPV. Most common hr?HPV were as follows: HPV16 (17.6%), HPV68 (14.7%), HPV39 (14.3%), HPV56 (12.5%), HPV51 (11.4%) and HPV52 (11.0%). HIV?positive transwomen had three times the odds of having an hr?HPV compared to HIV?negative transwomen. Participants who had a current rectal Neisseria gonorrhoeae infection had 3.7 times the odds of being coinfected with hr?HPV. Among HIV?positive transwomen, neither antiretroviral therapy use, undetectable viral load, current and nadir CD4 counts were associated with anal hr?HPV infection. Conclusions: Brazilian transwomen in our study exhibit some of the highest population?specific rates of HPV and hr?HPV. There is an urgent need to elucidate the burden of HPV infection, prevalence of HPV?related diseases and access to and uptake of HPV vaccination among transwomen, especially from low? and middle?income settings.

I. INTRODUCTION The consequences of trauma can be devastating and long-term. Children, trauma, victimization, and the legal system are complex topics and can become overwhelming when combined. Yet, due to [...]

Background: We report longitudinal trends in alcohol and recreational drug use and their associations with clinical outcomes in a Thai cohort of people living with HIV who are men who [...]

Introduction Biomedical HIV prevention technologies, such as antiretroviral pre?exposure prophylaxis (PrEP), hold enormous potential to substantially reduce HIV acquisition in high?risk populations globally. To maximize impact and minimize costs, PrEP [...], : Introduction: To maximize impact and minimize costs, antiretroviral pre?exposure prophylaxis (PrEP) interventions should be offered to those at highest risk for HIV infection. The risk score derived from the VOICE trial is one tool currently being utilized to determine eligibility in adolescent PrEP trials in sub?Saharan Africa. This study is aimed at evaluating the utility of the risk score in predicting HIV incidence among a cohort of adolescent girls in rural South Africa. Methods: We utilized data from HIV Prevention Trials Network (HPTN) 068, a phase III randomized controlled trial conducted in rural Mpumalanga province, South Africa. School?attending young women aged 13 to 20 years were enrolled into the trial from 2011 to 2012 and followed for up to three years. A risk score based on individual?level risk factors measured at enrolment was calculated for HPTN 068 participants who completed a one?year follow?up visit and were HIV seronegative at enrolment. Possible scores ranged from 0 to 10. A proportional hazards model was then used to determine if risk score at enrolment was predictive of incident HIV infection at follow?up and an area under the curve analysis was used to examine the predictive ability of the score. Results and Discussion: The risk score had limited variability in the HPTN 068 sample. Scores ?5 identified 85% of incident infections from 94% of the sample, compared to the VOICE sample in which scores ?5 identified 91% of incident infections from only 64% of participants. The risk score did not predict HIV incidence after one year of follow?up (hazard ratio = 1.029; 95% confidence interval (CI): 0.704, 1.503, p =.884) and showed poor predictive ability (area under the curve = 0.55; 95% CI: 0.44, 0.65). Certain individual risk factors that comprise the risk score may be context specific or not relevant for adolescent populations. Additional factors should be considered when assessing risk for the purposes of determining PrEP eligibility. Conclusions: The VOICE risk score demonstrated low utility to predict HIV incidence in the HPTN 068 sample. Findings highlight the need for an age and developmentally appropriate tool for assessing risk for HIV infection among adolescents. Use of the VOICE risk score for determining PrEP eligibility in younger populations should be carefully considered.

Abbreviations Introduction While there is an urgency to bring newer and more potent antiretroviral drugs developed in resource?rich settings to resource?limited settings as quickly as possible, evaluation of the safety [...], : Introduction: The unexpected identification of a neural tube defect (NTD) safety signal with preconception dolutegravir (DTG) exposure in the Botswana Tsepamo birth outcomes study brought into sharp focus the need for reliable data on use of new antiretrovirals in pregnancy, improved pharmacovigilance systems to evaluate safety of new drugs being introduced into populations including women of reproductive potential, and balanced risk?benefit messaging when a safety signal is identified. Discussion: The Tsepamo study NTD safety signal and accompanying regulatory responses led to uncertainty about the most appropriate approach to DTG use among women of reproductive potential, affecting global DTG roll?out plans, and limiting DTG use in adolescent girls and women. It also revealed a tension between a public health approach to antiretroviral treatment (ART) and individual choice, and highlighted difficulties interpreting and messaging an unexpected safety signal with uncertainty about risk. This difficulty was compounded by the lack of high?quality data on pregnancy outcomes from women receiving ART outside the Tsepamo surveillance sites and countries other than Botswana, resulting in a prolonged period of uncertainty while data on additional exposures are evaluated to refute or confirm the initial safety signal. We discuss principles for evaluating and introducing new drugs in the general population that would ensure collection of appropriate data to inform drug safety in adolescent girls and women of reproductive potential and minimize confusion about drug use in this population when a safety signal is identified. Conclusions: The response to a signal suggesting a possible safety risk for a drug used in pregnancy or among women who may become pregnant needs to be rapid and comprehensive. It requires the existence of appropriately designed surveillance systems with broad population coverage; data analyses that examine risk?benefit trade?offs in a variety of contexts; guidance to transform this risk?benefit balance into effective and agreed?upon policy; involvement of the affected community and other key stakeholders; and a communication plan for all levels of knowledge and complexity. Implementation of this proposed framework for responding to safety signals is needed to ensure that any drug used in pregnancy can be rapidly and appropriately evaluated should a serious safety alert arise.

Introduction Current risk assessment frameworks are designed primarily for the evaluation of one chemical at a time (Clahsen et al. 2019; Lebret 2015), even though most human exposures, especially in [...], Background: Risk assessment of chemical mixtures or complex substances remains a major methodological challenge due to lack of available hazard or exposure data. Therefore, risk assessors usually infer hazard or risk from data on the subset of constituents with available toxicity values. Objectives: We evaluated the validity of the widely used traditional mixtures risk assessment paradigms, Independent Action (IA) and Concentration Addition (CA), with new approach methodologies (NAMs) data from human cell-based in vitro assays. Methods: A diverse set of 42 chemicals was tested both individually and as mixtures for functional and cytotoxic effects in vitro. A panel of induced pluripotent stem cell (iPSCs)-derived models (hepatocytes, cardiomyocytes, endothelial, and neurons) and one primary cell type (HUVEC) were used. Bayesian concentration-response modeling of individual chemicals or their mixtures was performed for a total of 47 phenotypes to derive point-of-departure (POD) values. Probabilistic IA or CA was conducted to estimate the mixture effects based on the bioactivity profiles from the individual chemicals and compared with mixture bioactivity. Results: All mixtures showed significant bioactivity, even though some were constructed using individual chemical concentrations considered "low" or "safe." Even though CA is much more accurate as a predictor of mixture effects in comparison with IA, with CA-based POD typically within an order of magnitude of the actual mixture, in some cases, the bioactivity of the mixtures appeared to be much greater than that of their components under either additivity assumption. Discussion: These results suggest that CA is a preferred first approximation for predicting mixture toxicity when data for all constituents are available. However, because the accuracy of additivity assumptions varies greatly across phenotypes, we posit that mixtures and complex substances need to be directly tested for their hazard potential. NAMs provide a practical solution that rapidly yields highly informative data for mixtures risk assessment. https://doi.org/10.1289/EHP7600