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1. A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

Author: Huang, Laurence, Triplette, M, Attia, EF, Akgun, KM, Hoo, GWS, Freiberg, MS, Butt, AA, Wongtrakool, C, Goetz, MB, Brown, ST, and Graber, CJ
Published: 2017

2. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Troeger, C, Blacker, BF, Khalil, IA, Rao, PC, Cao, S, Zimsen, SRM, Albertson, S, Stanaway, JD, Deshpande, A, Farag, T, Forouzanfar, MH, Abebe, Z, Adetifa, IMO, Adhikari, TB, Akibu, M, Lami, FH, Al-Eyadhy, A, Alvis-Guzman, N, Amare, AT, Amoako, YA, Antonio, CAT, Aremu, O, Asfaw, ET, Asgedom, SW, Atey, TM, Attia, EF, Avokpaho, EFGA, Ayele, HT, Ayuk, TB, Balakrishnan, K, Barac, A, Bassat, Q, Behzadifar, M, Bhaumik, S, Bhutta, ZA, Bijani, A, Brauer, M, Brown, A, Camargos, PAM, Castaneda-Orjuela, CA, Colombara, D, Conti, S, Dadi, AF, Dandona, L, Dandona, R, Do, HP, Dubljanin, E, Edessa, D, Elkout, H, Endries, AY, Fijabi, DO, Foreman, KJ, Fullman, N, Garcia-Basteiro, AL, Gessner, BD, Gething, PW, Gupta, R, Gupta, T, Hailu, GB, Hassen, HY, Hedayati, MT, Heidari, M, Hibstu, DT, Horita, N, Ilesanmi, OS, Jakovljevic, MB, Jamal, AA, Kahsay, A, Kasaeian, A, Kassa, DH, Khader, YS, Khan, EA, Khan, MN, Khang, Y-H, Kim, YJ, Kissoon, N, Knibbs, LD, Kochhar, S, Koul, PA, Kumar, GA, Lodha, R, Razek, HM, Malta, DC, Mathew, JL, Mengistu, DT, Mezgebe, HB, Mohammad, KA, Mohammed, AM, Momeniha, F, Murthy, S, Nguyen, CT, Nielsen, KR, Ningrum, DNA, Nirayo, YL, Oren, E, Ortiz, JR, Mahesh, PA, Postma, MJ, Qorbani, M, Quansah, R, Rai, RK, Rana, SM, Ranabhat, CL, Ray, SE, Rezai, MS, Ruhago, GM, Safiri, S, Salomon, JA, Sartorius, B, Savic, M, Sawhney, M, She, J, Sheikh, A, Shiferaw, MS, Shigematsu, M, Singh, JA, Somayaji, R, Sufiyan, MB, Taffere, GR, Temsah, M-H, Thompson, MJ, Tobe-Gai, R, Topor-Madry, R, Tran, BX, Tran, TT, Tuem, KB, Ukwaja, KN, Vollset, SE, Walson, JL, Weldegebreal, F, Werdecker, A, West, TE, Yonemoto, N, Zaki, MES, Zhou, L, Zodpey, S, Vos, T, Lim, SS, Naghavi, M, Murray, CJL, Mokdad, AH, Hay, SI, Jr, RRC, and Infecti, GBDLR
Subjects: Adult, Aged, 80 and over, Male, Adolescent, Incidence, Infant, Newborn, Infant, Respiratory Tract Infections/epidemiology, Biostatistics, Middle Aged, Global Health, Survival Analysis, Young Adult, Cost of Illness, Risk Factors, Child, Preschool, Prevalence, Humans, Female, Topography, Medical, Virus Diseases/epidemiology, Child, Epidemiologic Methods, Bacterial Infections/epidemiology, Aged
Abstract: Background Lower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages. Methods We used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and healthcare data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatiotemporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000–16 using the risk factors associated with LRI in GBD 2016. Findings In 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475–720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749–1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584–2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445–1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7–69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden. Interpretation Our findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world’s most susceptible populations.
Published: 2019

3. Increased risk of radiographic emphysema in HIV is associated with elevated soluble CD14 and nadir CD4

Author: Attia, EF, Akguen, KM, Wongtrakool, C, Goetz, MB, Rodriguez-Barradas, MC, Rimland, D, Brown, ST, Hoo, GWS, Kim, J, Lee, PJ, Schnapp, LM, Sharafkhaneh, A, Justice, AC, and Crothers, K
Subjects: Adult, Male, Respiratory System, Clinical Sciences, Lipopolysaccharide Receptors, HIV Infections, Comorbidity, Severity of Illness Index, Risk Assessment, Sensitivity and Specificity, Sex Factors, Reference Values, Confidence Intervals, Odds Ratio, Humans, Nonparametric, Antigens, Statistics, Age Factors, virus diseases, respiratory system, Middle Aged, Prognosis, CD4, respiratory tract diseases, Radiography, Logistic Models, Cross-Sectional Studies, Pulmonary Emphysema, Multivariate Analysis, CD4 Antigens, Female, CD14, Biomarkers
Abstract: BackgroundThe association between HIV and emphysema remains incompletely understood. We sought to determine whether HIV is an independent risk factor for emphysema severity and whether markers of HIV severity and systemic biomarkers of inflammation (IL-6), altered coagulation (D-dimer), and immune activation (soluble CD14) are associated with emphysema.MethodsWe performed a cross-sectional analysis of 114 participants with HIV infection and 89 participants without HIV infection in the Examinations of HIV-Associated Lung Emphysema (EXHALE) study. Participants underwent chest CT imaging with blinded semiquantitative interpretation of emphysema severity, distribution, and type. We generated multivariable logistic regression models to determine the risk of HIV for radiographic emphysema, defined as > 10% lung involvement. Similar analyses examined associations of plasma biomarkers, HIV RNA, and recent and nadir CD4 cell counts with emphysema among participants with HIV infection.ResultsParticipants with HIV infection had greater radiographic emphysema severity with increased lower lung zone and diffuse involvement. HIV was associated with significantly increased risk for > 10% emphysema in analyses adjusted for cigarette smoking pack-years (OR, 2.24; 95% CI, 1.12-4.48). In multivariable analyses restricted to participants with HIV infection, nadir CD4 < 200 cells/μL (OR, 2.98; 95% CI, 1.14-7.81), and high soluble CD14 level (upper 25th percentile) (OR, 2.55; 95% CI, 1.04-6.22) were associated with increased risk of > 10% emphysema. IL-6 and D-dimer were not associated with emphysema in HIV.ConclusionsHIV is an independent risk factor for radiographic emphysema. Emphysema severity was significantly greater among participants with HIV infection. Among those with HIV, nadir CD4 < 200 cells/μL and elevated soluble CD14 level were associated with emphysema, highlighting potential mechanisms linking HIV with emphysema.
Published: 2014

4. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author: Dicker, Daniel, Nguyen, Grant, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdel-Rahman, Omar, Abdi, Alireza, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abdurahman, Ahmed Abdulahi, Abebe, Haftom Temesgen, Abebe, Molla, Abebe, Zegeye, Abebo, Teshome Abuka, Aboyans, Victor, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen ME, Accrombessi, Manfred Mario Kokou, Acharya, Pawan, Adebayo, Oladimeji M, Adedeji, Isaac Akinkunmi, Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Adetokunboh, Olatunji O, Adhena, Beyene Meressa, Adhikari, Tara Ballav, Adib, Mina G, Adou, Arsène Kouablan, Adsuar, Jose C, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Gina, Aggarwal, Rakesh, Aghayan, Sargis Aghasi, Agrawal, Sutapa, Agrawal, Anurag, Ahmadi, Mehdi, Ahmadi, Alireza, Ahmadieh, Hamid, Ahmed, Mohamed Lemine Cheikh brahim, Ahmed, Sayem, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akanda, Ali S, Akbari, Mohammad Esmaeil, Akibu, Mohammed, Akinyemi, Rufus Olusola, Akinyemiju, Tomi, Akseer, Nadia, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alebel, Animut, Aleman, Alicia V, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Ali, Raghib, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine A, Alonso, Jordi, Al-Raddadi, Rajaa M, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Anlay, Degefaye Zelalem, Ansari, Hossein, Ansariadi, Ansariadi, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Appiah, Seth Christopher Yaw, Aremu, Olatunde, Areri, Habtamu Abera, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna K, Asadi-Lari, Mohsen, Asayesh, Hamid, Asfaw, Ephrem Tsegay, Asgedom, Solomon Weldegebreal, Assadi, Reza, Ataro, Zerihun, Atey, Tesfay Mehari Mehari, Athari, Seyyed Shamsadin, Atique, Suleman, Atre, Sachin R, Atteraya, Madhu Sudhan, Attia, Engi F, Ausloos, Marcel, Avila-Burgos, Leticia, Avokpaho, Euripide F G A, Awasthi, Ashish, Awuah, Baffour, Ayala Quintanilla, Beatriz Paulina, Ayele, Henok Tadesse, Ayele, Yohanes, Ayer, Rakesh, Ayuk, Tambe B, Azzopardi, Peter S, Azzopardi-Muscat, Natasha, Badali, Hamid, Badawi, Alaa, Balakrishnan, Kalpana, Bali, Ayele Geleto, Banach, Maciej, Banstola, Amrit, Barac, Aleksandra, Barboza, Miguel A, Barquera, Simon, Barrero, Lope H, Basaleem, Huda, Bassat, Quique, Basu, Arindam, Basu, Sanjay, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Behzadifar, Meysam, Béjot, Yannick, Bekele, Bayu Begashaw, Belachew, Abate Bekele, Belay, Aregawi Gebreyesus, Belay, Ezra, Belay, Saba Abraham, Belay, Yihalem Abebe, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Berhane, Adugnaw, Berman, Adam E, Bernabe, Eduardo, Bernstein, Robert S, Bertolacci, Gregory J, Beuran, Mircea, Beyranvand, Tina, Bhala, Neeraj, Bhatia, Eesh, Bhatt, Samir, Bhattarai, Suraj, Bhaumik, Soumyadeeep, Bhutta, Zulfiqar A, Biadgo, Belete, Bijani, Ali, Bikbov, Boris, Bililign, Nigus, Bin Sayeed, Muhammad Shahdaat, Birlik, Sait Mentes, Birungi, Charles, Bisanzio, Donal, Biswas, Tuhin, Bjørge, Tone, Bleyer, Archie, Basara, Berrak Bora, Bose, Dipan, Bosetti, Cristina, Boufous, Soufiane, Bourne, Rupert, Brady, Oliver J, Bragazzi, Nicola Luigi, Brant, Luisa C, Brazinova, Alexandra, Breitborde, Nicholas J K, Brenner, Hermann, Britton, Gabrielle, Brugha, Traolach, Burke, Kristin E, Busse, Reinhard, Butt, Zahid A, Cahuana-Hurtado, Lucero, Callender, Charlton S K H, Campos-Nonato, Ismael R, Campuzano Rincon, Julio Cesar, Cano, Jorge, Car, Mate, Cárdenas, Rosario, Carreras, Giulia, Carrero, Juan J, Carter, Austin, Carvalho, Félix, Castañeda-Orjuela, Carlos A, Castillo Rivas, Jacqueline, Castro, Franz, Catalá-López, Ferrán, Çavlin, Alanur, Cerin, Ester, Chaiah, Yazan, Champs, Ana Paula, Chang, Hsing-Yi, Chang, Jung-Chen, Chattopadhyay, Aparajita, Chaturvedi, Pankaj, Chen, Wanqing, Chiang, Peggy Pei-Chia, Chimed-Ochir, Odgerel, Chin, Ken Lee, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal, Choi, Jee-Young J, Christensen, Hanne, Christopher, Devasahayam J, Chung, Sheng-Chia, Cicuttini, Flavia M, Ciobanu, Liliana G, Cirillo, Massimo, Claro, Rafael M, Cohen, Aaron J, Collado-Mateo, Daniel, Constantin, Maria-Magdalena, Conti, Sara, Cooper, Cyrus, Cooper, Leslie Trumbull, Cortesi, Paolo Angelo, Cortinovis, Monica, Cousin, Ewerton, Criqui, Michael H, Cromwell, Elizabeth A, Crowe, Christopher Stephen, Crump, John A, Cucu, Alexandra, Cunningham, Matthew, Daba, Alemneh Kabeta, Dachew, Berihun Assefa, Dadi, Abel Fekadu, Dandona, Lalit, Dandona, Rakhi, Dang, Anh Kim, Dargan, Paul I, Daryani, Ahmad, Das, Siddharth K, Das Gupta, Rajat, das Neves, José, Dasa, Tamirat Tesfaye, Dash, Aditya Prasad, Weaver, Nicole Davis, Davitoiu, Dragos Virgil, Davletov, Kairat, Dayama, Anand, Courten, Barbora de, De la Hoz, Fernando Pio, De leo, Diego, De Neve, Jan-Walter, Degefa, Meaza Girma, Degenhardt, Louisa, Degfie, Tizta T, Deiparine, Selina, Dellavalle, Robert P, Demoz, Gebre Teklemariam, Demtsu, Balem Betsu, Denova-Gutiérrez, Edgar, Deribe, Kebede, Dervenis, Nikolaos, Des Jarlais, Don C, Dessie, Getenet Ayalew, Dey, Subhojit, Dharmaratne, Samath Dhamminda, Dhimal, Meghnath, Ding, Eric L, Djalalinia, Shirin, Doku, David Teye, Dolan, Kate A, Donnelly, Christl A, Dorsey, E Ray, Douwes-Schultz, Dirk, Doyle, Kerrie E, Drake, Thomas M, Driscoll, Tim Robert, Dubey, Manisha, Dubljanin, Eleonora, Duken, Eyasu Ejeta, Duncan, Bruce B, Duraes, Andre R, Ebrahimi, Hedyeh, Ebrahimpour, Soheil, Edessa, Dumessa, Edvardsson, David, Eggen, Anne Elise, El Bcheraoui, Charbel, El Sayed Zaki, Maysaa, Elfaramawi, Mohammed, El-Khatib, Ziad, Ellingsen, Christian Lycke, Elyazar, Iqbal R F, Enayati, Ahmadali, Endries, Aman Yesuf Yesuf, Er, Benjamin, Ermakov, Sergey Petrovich, Eshrati, Babak, Eskandarieh, Sharareh, Esmaeili, Reza, Esteghamati, Alireza, Esteghamati, Sadaf, Fakhar, Mahdi, Fakhim, Hamed, Farag, Tamer, Faramarzi, Mahbobeh, Fareed, Mohammad, Farhadi, Farzaneh, Farid, Talha A, Farinha, Carla Sofia e Sá, Farioli, Andrea, Faro, Andre, Farvid, Maryam S, Farzadfar, Farshad, Farzaei, Mohammad Hosein, Fazeli, Mir Sohail, Feigin, Valery L, Feigl, Andrea B, Feizy, Fariba, Fentahun, Netsanet, Fereshtehnejad, Seyed-Mohammad, Fernandes, Eduarda, Fernandes, Joao C, Feyissa, Garumma Tolu, Fijabi, Daniel Obadare, Filip, Irina, Finegold, Samuel, Fischer, Florian, Flor, Luisa Sorio, Foigt, Nataliya A, Ford, John A, Foreman, Kyle J, Fornari, Carla, Frank, Tahvi D, Franklin, Richard Charles, Fukumoto, Takeshi, Fuller, John E, Fullman, Nancy, Fürst, Thomas, Furtado, João M, Futran, Neal D, Galan, Adriana, Gallus, Silvano, Gambashidze, Ketevan, Gamkrelidze, Amiran, Gankpe, Fortune Gbetoho, Garcia-Basteiro, Alberto L, Garcia-Gordillo, Miguel A, Gebre, Teshome, Gebre, Abadi Kahsu, Gebregergs, Gebremedhin Berhe, Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Gelano, Tilayie Feto, Gelaw, Yalemzewod Assefa, Geleijnse, Johanna M, Genova-Maleras, Ricard, Gessner, Bradford D, Getachew, Sefonias, Gething, Peter W, Gezae, Kebede Embaye, Ghadami, Mohammad Rasoul, Ghadimi, Reza, Ghasemi Falavarjani, Khalil, Ghasemi-Kasman, Maryam, Ghiasvand, Hesam, Ghimire, Mamata, Ghoshal, Aloke Gopal, Gill, Paramjit Singh, Gill, Tiffany K, Gillum, Richard F, Giussani, Giorgia, Goenka, Shifalika, Goli, Srinivas, Gomez, Ricardo Santiago, Gomez-Cabrera, Mari Carmen, Gómez-Dantés, Hector, Gona, Philimon N, Goodridge, Amador, Gopalani, Sameer Vali, Goto, Atsushi, Goulart, Alessandra C, Goulart, Bárbara Niegia Garcia, Grada, Ayman, Grosso, Giuseppe, Gugnani, Harish Chander, Guimaraes, Andre Luiz Sena, Guo, Yuming, Gupta, Prakash C, Gupta, Rahul, Gupta, Rajeev, Gupta, Tanush, Gyawali, Bishal, Haagsma, Juanita A, Hachinski, Vladimir, Hafezi-Nejad, Nima, Hagos, Tekleberhan B, Hailegiyorgis, Tewodros Tesfa, Hailu, Gessessew Bugssa, Haj-Mirzaian, Arya, Haj-Mirzaian, Arvin, Hamadeh, Randah R, Hamidi, Samer, Handal, Alexis J, Hankey, Graeme J, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Haririan, Hamidreza, Haro, Josep Maria, Hasan, Mehedi, Hassankhani, Hadi, Hassen, Hamid Yimam, Havmoeller, Rasmus, Hay, Roderick J, Hay, Simon I, He, Yihua, Hedayatizadeh-Omran, Akbar, Hegazy, Mohamed I, Heibati, Behzad, Heidari, Mohsen, Hendrie, Delia, Henok, Andualem, Henry, Nathaniel J, Heredia-Pi, Ileana, Herteliu, Claudiu, Heydarpour, Fatemeh, Heydarpour, Pouria, Heydarpour, Sousan, Hibstu, Desalegn Tsegaw, Hoek, Hans W, Hole, Michael K, Homaie Rad, Enayatollah, Hoogar, Praveen, Horino, Masako, Hosgood, H Dean, Hosseini, Seyed Mostafa, Hosseinzadeh, Mehdi, Hostiuc, Sorin, Hostiuc, Mihaela, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Htet, Aung Soe, Hu, Guoqing, Huang, John J, Husseini, Abdullatif, Hussen, Mohammedaman Mama, Hutfless, Susan, Iburg, Kim Moesgaard, Igumbor, Ehimario U, Ikeda, Chad Thomas, Ilesanmi, Olayinka Stephen, Iqbal, Usman, Irvani, Seyed Sina Naghibi, Isehunwa, Oluwaseyi Oluwakemi, Islam, Sheikh Mohammed Shariful, Islami, Farhad, Jahangiry, Leila, Jahanmehr, Nader, Jain, Rajesh, Jain, Sudhir Kumar, Jakovljevic, Mihajlo, James, Spencer L, Javanbakht, Mehdi, Jayaraman, Sudha, Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jha, Ravi Prakash, Jha, Vivekanand, Ji, John S, Johnson, Sarah Charlotte, Jonas, Jost B, Joshi, Ankur, Jozwiak, Jacek Jerzy, Jungari, Suresh Banayya, Jürisson, Mikk, K, Madhanraj, Kabir, Zubair, Kadel, Rajendra, Kahsay, Amaha, Kahssay, Molla, Kalani, Rizwan, Kapil, Umesh, Karami, Manoochehr, Karami Matin, Behzad, Karch, André, Karema, Corine, Karimi, Narges, Karimi, Seyed M, Karimi-Sari, Hamidreza, Kasaeian, Amir, Kassa, Getachew Mullu, Kassa, Tesfaye Dessale, Kassa, Zemenu Yohannes, Kassebaum, Nicholas J, Katibeh, Marzieh, Katikireddi, Srinivasa Vittal, Kaul, Anil, Kawakami, Norito, Kazemeini, Hossein, Kazemi, Zhila, Karyani, Ali Kazemi, K C, Prakash, Kebede, Seifu, Keiyoro, Peter Njenga, Kemp, Grant Rodgers, Kengne, Andre Pascal, Keren, Andre, Kereselidze, Maia, Khader, Yousef Saleh, Khafaie, Morteza Abdullatif, Khajavi, Alireza, Khalid, Nauman, Khalil, Ibrahim A, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khan, Muhammad Shahzeb, Khan, Muhammad Ali, Khang, Young-Ho, Khanna, Tripti, Khater, Mona M, Khatony, Alireza, Khazaie, Habibolah, Khoja, Abdullah T, Khosravi, Ardeshir, Khosravi, Mohammad Hossein, Khubchandani, Jagdish, Kiadaliri, Aliasghar A, Kibret, Getiye D Dejenu, Kim, Cho-il, Kim, Daniel, Kim, Jun Y, Kim, Young-Eun, Kimokoti, Ruth W, Kinfu, Yohannes, Kinra, Sanjay, Kisa, Adnan, Kissimova-Skarbek, Katarzyna, Kissoon, Niranjan, Kivimäki, Mika, Kleber, Marcus E, Knibbs, Luke D, Knudsen, Ann Kristin Skrindo, Kochhar, Sonali, 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Chris, Lorch, Scott A, Lorkowski, Stefan, Lotufo, Paulo A, Lozano, Rafael, Lucas, Tim C D, Lunevicius, Raimundas, Lyons, Ronan A, Ma, Stefan, Mabika, Crispin, Macarayan, Erlyn Rachelle King, Mackay, Mark T, Maddison, Emilie R, Maddison, Ralph, Madotto, Fabiana, Magdy Abd El Razek, Hassan, Magdy Abd El Razek, Muhammed, Maghavani, Dhaval P, Majdan, Marek, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Malik, Manzoor Ahmad, Malta, Deborah Carvalho, Mamun, Abdullah A, Manamo, Wondimu Ayele, Manda, Ana-Laura, Mansournia, Mohammad Ali, Mantovani, Lorenzo Giovanni, Mapoma, Chabila Christopher, Marami, Dadi, Maravilla, Joemer C, Marcenes, Wagner, Marina, Shakhnazarova, Martinez-Raga, Jose, Martins, Sheila C O, Martins-Melo, Francisco Rogerlândio, März, Winfried, Marzan, Melvin B, Mashamba-Thompson, Tivani Phosa, Masiye, Felix, Massenburg, Benjamin Ballard, Maulik, Pallab K, Mazidi, Mohsen, McGrath, John J, McKee, Martin, Mehata, Suresh, Mehendale, Sanjay Madhav, Mehndiratta, Man Mohan, 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Pond, Constance Dimity, Popova, Svetlana, Postma, Maarten J, Pourmalek, Farshad, Pourshams, Akram, Poustchi, Hossein, Prabhakaran, Dorairaj, Prakash, V., Prakash, Swayam, Prasad, Narayan, Qorbani, Mostafa, Quistberg, D Alex, Radfar, Amir, Rafay, Anwar, Rafiei, Alireza, Rahim, Fakher, Rahimi, Kazem, Rahimi-Movaghar, Afarin, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Muhammad Aziz, Rahman, Sajjad ur, Rai, Rajesh Kumar, Rajati, Fatemeh, Rajsic, Sasa, Raju, Sree Bhushan, Ram, Usha, Ranabhat, Chhabi Lal, Ranjan, Prabhat, Ranta, Anna, Rasella, Davide, Rawaf, David Laith, Rawaf, Salman, Ray, Sarah E, Razo-García, Christian, Rego, Maria Albertina Santiago, Rehm, Jürgen, Reiner, Robert C, Reinig, Nickola, Reis, Cesar, Remuzzi, Giuseppe, Renzaho, Andre M N, Resnikoff, Serge, Rezaei, Satar, Rezaeian, Shahab, Rezai, Mohammad Sadegh, Riahi, Seyed Mohammad, Ribeiro, Antonio Luiz P, Riojas, Horacio, Rios-Blancas, Maria Jesu, Roba, Kedir Teji, Robinson, Stephen R, Roever, Leonardo, Ronfani, Luca, Roshandel, Gholamreza, Roshchin, Denis O, Rostami, Ali, Rothenbacher, Dietrich, Rubagotti, Enrico, Ruhago, George Mugambage, Saadat, Soheil, Sabde, Yogesh Damodar, Sachdev, Perminder S, Saddik, Basema, Sadeghi, Ehsan, Moghaddam, Sahar Saeedi, Safari, Hosein, Safari, Yahya, Safari-Faramani, Roya, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahebkar, Amirhossein, Sahraian, Mohammad Ali, Sajadi, Haniye Sadat, Salahshoor, Mohamadreza, Salam, Nasir, Salama, Joseph S, Salamati, Payman, Saldanha, Raphael de Freita, Salimi, Yahya, Salimzadeh, Hamideh, Salz, Inbal, Sambala, Evanson Zondani, Samy, Abdallah M, Sanabria, Juan, Sanchez-Niño, Maria Dolore, Santos, Itamar S, Santos, João Vasco, Santric Milicevic, Milena M, Sao Jose, Bruno Piassi, Sardana, Mayank, Sarker, Abdur Razzaque, Sarrafzadegan, Nizal, Sartorius, Benn, Sarvi, Shahabeddin, Sathian, Brijesh, Satpathy, Maheswar, Savic, Miloje, Sawant, Arundhati R, Sawhney, Monika, Saxena, Sonia, Sayyah, Mehdi, Scaria, Vinod, Schaeffner, Elke, Schelonka, Kathryn, Schmidt, Maria Inê, Schneider, Ione J C, Schöttker, Ben, Schutte, Aletta Elisabeth, Schwebel, David C, Schwendicke, Falk, Scott, James G, Sekerija, Mario, Sepanlou, Sadaf G, Serván-Mori, Edson, Shabaninejad, Hosein, Shackelford, Katya Anne, Shafieesabet, Azadeh, Shaheen, Amira A, Shaikh, Masood Ali, Shakir, Raad A, Shams-Beyranvand, Mehran, Shamsi, MohammadBagher, Shamsizadeh, Morteza, Sharafi, Heidar, Sharafi, Kiomar, Sharif, Mehdi, Sharif-Alhoseini, Mahdi, Sharma, Meenakshi, Sharma, Jayendra, Sharma, Rajesh, She, Jun, Sheikh, Aziz, Sheth, Kevin N, Shi, Peilin, Shibuya, Kenji, Shifa, Girma Temam, Shiferaw, Mekonnen Sisay, Shigematsu, Mika, Shiri, Rahman, Shirkoohi, Reza, Shiue, Ivy, Shokraneh, Farhad, Shrime, Mark G, Shukla, Sharvari Rahul, Si, Si, Siabani, Soraya, Siddiqi, Tariq J, Sigfusdottir, Inga Dora, Sigurvinsdottir, Rannveig, Silpakit, Nari, Silva, Diego Augusto Santo, Silva, João Pedro, Silveira, Dayane Gabriele Alve, Singam, Narayana Sarma Venkata, Singh, Jasvinder A, Singh, Virendra, Sinha, Anju Pradhan, Sinha, Dhirendra Narain, Sitas, Freddy, Skirbekk, Vegard, Sliwa, Karen, Soares Filho, Adauto Martin, Sobaih, Badr Hasan, Sobhani, Soheila, Soofi, Moslem, Soriano, Joan B, Soyiri, Ireneous N, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Srinivasan, Vinay, Srivastava, Rakesh Kumar, Starodubov, Vladimir I, Stathopoulou, Vasiliki, Steel, Nichola, Stein, Dan J, Steiner, Caitlyn, Stewart, Leo G, Stokes, Mark A, Sudaryanto, Agu, Sufiyan, Mu'awiyyah Babale, Sulo, Gerhard, Sunguya, Bruno F, Sur, Patrick John, Sutradhar, Ipsita, Sykes, Bryan L, Sylaja, P.N., Sylte, Dillon O, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Tadakamadla, Santosh Kumar, Takahashi, Ken, Tandon, Nikhil, Tassew, Aberash Abay, Tassew, Segen Gebremeskel, Tavakkoli, Mohammad, Taveira, Nuno, Tawye, Nega Yimer, Tehrani-Banihashemi, Arash, Tekalign, Tigist Gashaw, Tekle, Merhawi Gebremedhin, Temesgen, Habtamu, Temsah, Mohamad-Hani, Temsah, Omar, Terkawi, Abdullah Sulieman, Teshale, Manaye Yihune, Tessema, Belay, Teweldemedhin, Mebrahtu, Thakur, Jarnail Singh, Thankappan, Kavumpurathu Raman, Thirunavukkarasu, Sathish, Thomas, Laura Anne, Thomas, Nihal, Thrift, Amanda G, Tilahun, Binyam, To, Quyen G, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Torre, Anna E, Tortajada-Girbés, Miguel, Tovani-Palone, Marcos Roberto, Towbin, Jeffrey A, Tran, Bach Xuan, Tran, Khanh Bao, Tripathi, Suryakant, Tripathy, Srikanth Prasad, Truelsen, Thomas Clement, Truong, Nu Thi, Tsadik, Afewerki Gebremeskel, Tsilimparis, Nikolao, Tudor Car, Lorainne, Tuzcu, E Murat, Tyrovolas, Stefano, Ukwaja, Kingsley Nnanna, Ullah, Irfan, Usman, Muhammad Shariq, Uthman, Olalekan A, Uzun, Selen Begüm, Vaduganathan, Muthiah, Vaezi, Afsane, Vaidya, Gaurang, Valdez, Pascual R, Varavikova, Elena, Varughese, Santosh, Vasankari, Tommi Juhani, Vasconcelos, Ana Maria Nogale, Venketasubramanian, Narayanaswamy, Vidavalur, Ramesh, Villafaina, Santo, Violante, Francesco S, Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vollset, Stein Emil, Vos, Theo, Vosoughi, Kia, Vujcic, Isidora S, Wagner, Gregory R, Wagnew, Fasil Wagnew Shiferaw, Waheed, Yasir, Wang, Yanping, Wang, Yuan-Pang, Wassie, Molla Mesele, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Weiss, Jordan, Weldegebreal, Fitsum, Weldegwergs, Kidu Gidey, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Widecka, Justyna, Widecka, Katarzyna, Wijeratne, Tissa, Winkler, Andrea Sylvia, Wiysonge, Charles Shey, Wolfe, Charles D A, Wondemagegn, Sintayehu Ambachew, Wu, Shouling, Wyper, Grant M A, Xu, Gelin, Yadav, Rajaram, Yakob, Bereket, Yamada, Tomohide, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Yasin, Yasin Jemal, Ye, Pengpeng, Yearwood, Jamal A, Yentür, Gökalp Kadri, Yeshaneh, Alex, Yimer, Ebrahim M, Yip, Paul, Yisma, Engida, Yonemoto, Naohiro, Yoon, Seok-Jun, York, Hunter W, Yotebieng, Marcel, Younis, Mustafa Z, Yousefifard, Mahmoud, Yu, Chuanhua, Zachariah, Geevar, Zadnik, Vesna, Zafar, Shamsa, Zaidi, Zoubida, Zaman, Sojib Bin, Zamani, Mohammad, Zare, Zohreh, Zeeb, Hajo, Zeleke, Mulugeta Molla, Zenebe, Zerihun Menlkalew, Zerfu, Taddese Alemu, Zhang, Kai, Zhang, Xueying, Zhou, Maigeng, Zhu, Jun, Zodpey, Sanjay, Zucker, Inbar, Zuhlke, Liesl Joanna J, Lopez, Alan D, Gakidou, Emmanuela, and Murray, Christopher J L
Subjects: Child mortality, Alnæmi, Dánartíðni, Heilsufar, GBD, Börn, Dauði, Almennar lyflækningar, Fullorðnir, General & Internal Medicine, parasitic diseases, Psychology, age-specific mortality, Estimating adult mortality, Medicine (all), HIV, 11 Medical And Health Sciences, General Medicine, All-cause mortality, humanities, Countries, Death, mortality, national, Sálfræði, Health, GBD, mortality, Human medicine, Trends
Abstract: The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Data for this research was provided by MEASURE Evaluation, funded by the United States Agency for International Development (USAID). Views expressed do not necessarily reflect those of USAID, the US Government, or MEASURE Evaluation. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with licence no. SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law-2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data., Background Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing., Research reported in this publication was supported by the Bill & Melinda Gates Foundation, the University of Melbourne, Public Health England, the Norwegian Institute of Public Health, St. Jude Children's Research Hospital, the National Institute on Aging of the National Institutes of Health (award P30AG047845), and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163).
Published: 2018

5. Postinfectious Pulmonary Complications: Establishing Research Priorities to Advance the Field: An Official American Thoracic Society Workshop Report.

Author: Auld SC, Sheshadri A, Alexander-Brett J, Aschner Y, Barczak AK, Basil MC, Cohen KA, Dela Cruz C, McGroder C, Restrepo MI, Ridge KM, Schnapp LM, Traber K, Wunderink RG, Zhang D, Ziady A, Attia EF, Carter J, Chalmers JD, Crothers K, Feldman C, Jones BE, Kaminski N, Keane J, Lewinsohn D, Metersky M, Mizgerd JP, Morris A, Ramirez J, Samarasinghe AE, Staitieh BS, Stek C, Sun J, and Evans SE
Subjects: Humans, COVID-19 epidemiology, Respiratory Tract Infections epidemiology, SARS-CoV-2, Societies, Medical, United States epidemiology, Biomedical Research, Lung Diseases therapy, Lung Diseases etiology
Abstract: Continued improvements in the treatment of pulmonary infections have paradoxically resulted in a growing challenge of individuals with postinfectious pulmonary complications (PIPCs). PIPCs have been long recognized after tuberculosis, but recent experiences such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have underscored the importance of PIPCs following other lower respiratory tract infections. Independent of the causative pathogen, most available studies of pulmonary infections focus on short-term outcomes rather than long-term morbidity among survivors. In this document, we establish a conceptual scope for PIPCs with discussion of globally significant pulmonary pathogens and an examination of how these pathogens can damage different components of the lung, resulting in a spectrum of PIPCs. We also review potential mechanisms for the transition from acute infection to PIPC, including the interplay between pathogen-mediated injury and aberrant host responses, which together result in PIPCs. Finally, we identify cross-cutting research priorities for the field to facilitate future studies to establish the incidence of PIPCs, define common mechanisms, identify therapeutic strategies, and ultimately reduce the burden of morbidity in survivors of pulmonary infections.
Published: 2024
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6. HIV and diabetes impair M. tuberculosis -specific interferon-gamma responses on QuantiFERON-TB Gold Plus testing.

Author: Zifodya JS, Kreniske JS, Temu TM, Masyuko SJ, Attia EF, Mogaka JN, Onyango D, Page ST, Crothers K, Kinuthia J, Farquhar C, and LaCourse SM
Abstract: Competing Interests: Conflicts of interest: none declared.
Published: 2024
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7. Venous Thromboembolism Among People With HIV: Design, Implementation, and Findings of a Centralized Adjudication System in Clinical Care Sites Across the United States.

Author: Crane HM, Nance RM, Ruderman SA, Haidar L, Tenforde MW, Heckbert SR, Budoff MJ, Hahn AW, Drumright LN, Ma J, Mixson LS, Lober WB, Barnes GS, McReynolds J, Attia EF, Peter I, Moges T, Bamford L, Cachay E, Mathews WC, Christopolous K, Hunt PW, Napravnik S, Keruly J, Moore RD, Burkholder G, Willig AL, Lindstrom S, Whitney BM, Saag MS, Kitahata MM, Crothers KA, and Delaney JAC
Subjects: Humans, United States epidemiology, Risk Factors, Viremia complications, Venous Thromboembolism epidemiology, Venous Thromboembolism complications, HIV Infections complications, Venous Thrombosis complications
Abstract: Background: People with HIV (PWH) are at increased risk for venous thromboembolism (VTE). We conducted this study to characterize VTE including provoking factors among PWH in the current treatment era., Methods: We included PWH with VTE between 2010 and 2020 at 6 sites in the CFAR Network of Integrated Clinical Systems cohort. We ascertained for possible VTE using diagnosis, VTE-related imaging, and VTE-related procedure codes, followed by centralized adjudication of primary data by expert physician reviewers. We evaluated sensitivity and positive predictive value of VTE ascertainment approaches. VTEs were classified by type and anatomic location. Reviewers identified provoking factors such as hospitalizations, infections, and other potential predisposing factors such as smoking., Results: We identified 557 PWH with adjudicated VTE: 239 (43%) had pulmonary embolism with or without deep venous thrombosis, and 318 (57%) had deep venous thrombosis alone. Ascertainment with clinical diagnoses alone missed 6% of VTEs identified with multiple ascertainment approaches. DVTs not associated with intravenous lines were most often in the proximal lower extremities. Among PWH with VTE, common provoking factors included recent hospitalization (n = 134, 42%), infection (n = 133, 42%), and immobilization/bed rest (n = 78, 25%). Only 57 (10%) PWH had no provoking factor identified. Smoking (46%), HIV viremia (27%), and injection drug use (22%) were also common., Conclusions: We conducted a robust adjudication process that demonstrated the benefits of multiple ascertainment approaches followed by adjudication. Provoked VTEs were more common than unprovoked events. Nontraditional and modifiable potential predisposing factors such as viremia and smoking were common., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Published: 2024
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8. What Can Big Data Teach Us About Air Pollution and Pneumonia?

Author: Sack C and Attia EF
Subjects: Humans, Big Data, Particulate Matter adverse effects, Air Pollution adverse effects, Pneumonia epidemiology, Air Pollutants analysis
Published: 2023
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9. Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey.

Author: Burns KEA, Moss M, Lorens E, Jose EKA, Martin CM, Viglianti EM, Fox-Robichaud A, Mathews KS, Akgun K, Jain S, Gershengorn H, Mehta S, Han JE, Martin GS, Liebler JM, Stapleton RD, Trachuk P, Vranas KC, Chua A, Herridge MS, Tsang JLY, Biehl M, Burnham EL, Chen JT, Attia EF, Mohamed A, Harkins MS, Soriano SM, Maddux A, West JC, Badke AR, Bagshaw SM, Binnie A, Carlos WG, Çoruh B, Crothers K, D'Aragon F, Denson JL, Drover JW, Eschun G, Geagea A, Griesdale D, Hadler R, Hancock J, Hasmatali J, Kaul B, Kerlin MP, Kohn R, Kutsogiannis DJ, Matson SM, Morris PE, Paunovic B, Peltan ID, Piquette D, Pirzadeh M, Pulchan K, Schnapp LM, Sessler CN, Smith H, Sy E, Thirugnanam S, McDonald RK, McPherson KA, Kraft M, Spiegel M, and Dodek PM
Subjects: Adult, Male, Humans, Child, United States epidemiology, Female, Cross-Sectional Studies, Pandemics, Intensive Care Units, Adaptation, Psychological, Surveys and Questionnaires, North America, COVID-19, Burnout, Professional epidemiology, Physicians
Abstract: Objectives: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic., Design: Cross-sectional survey using four validated instruments., Setting: Sixty-two sites in Canada and the United States., Subjects: Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs., Intervention: None., Measurements and Main Results: We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures., Conclusions: Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness., Competing Interests: Dr. Burns disclosed that the Canadian Critical Care Society (CCSS) paid for the statistical analyses. Dr. Lorens received funding from the CCCS. Drs. Lorens and Kerlin disclosed work for hire. Drs. Viglianti, Kohn, Peltan, and Schnapp received support for article research from the National Institutes of Health (NIH). Dr. Fox-Robichaud’s institution received funding from the Canadian Institutes of Health Research and Hamilton Academic Hospitals. Dr. Mathews’ institution received funding from the National Heart, Lung, and Blood Institute (NHLBI); he received funding from Roivant/Kinevant Sciences. Dr. Jain is supported by the National Institute on Aging (NIA) T32AG019134, the Pepper Scholar Award from Yale Claude D. Pepper Older American Independence Center (P30AG021342), NIA of the NIH GEMSSTAR Award (R03AG078942), Parker B. Francis Fellowship Award, and Yale Physician-Scientist Development Award. Drs. Akgun and Crothers disclosed government work. Dr. Gershengorn received funding from the American Thoracic Society (ATS), Gilead Sciences, and Southeastern Critical Care Summit. Dr. Martin’s institution received funding from BARDA; he received funding from Genetech. Dr. Stapleton disclosed that she is chair of DSMB for Altimmune and a member of the ATS Board of Directors 2019–2021 (elected to Chair the Critical Care Assembly which includes a position on the Board). Dr. Attia’s institution received funding from the NHBLI (NHLBI K23 HL129888 and R03 [pending]), the Centers for Aids Research, and Pediatric HIV/AIDS Cohort Study. Dr. Maddux’s institution received funding from the National Institute of Child Health and Human Development (K23HD096018) and the Francis Family Foundation. Dr. Bagshaw received funding from Baxter and Bioporto. Dr. Crothers’ institution received funding from the NIH and Veteran’s Affairs. Dr. Peltan’s institution received funding from Regeneron and Asahi Kasei Pharma; he received funding from the NIH (K23GM129661) and Janssen. Dr. Schnapp received funding from UptoDate and Elsevier. Dr. Kraft’s institution received funding from the NIH, the American Lung Association, Sanofi, and AstraZeneca Consulting; she received funding from Sanofi, Astra-Zeneca, Chiesi Speaking, and UptoDate; she disclosed she is a cofounder and Chief Medical Officer of RaeSedo LLC. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)
Published: 2022
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10. Global influenza surveillance systems to detect the spread of influenza-negative influenza-like illness during the COVID-19 pandemic: Time series outlier analyses from 2015-2020.

Author: Cobb NL, Collier S, Attia EF, Augusto O, West TE, and Wagenaar BH
Subjects: Humans, Pandemics, Population Surveillance methods, SARS-CoV-2, Time Factors, COVID-19 epidemiology, Influenza, Human diagnosis, Influenza, Human epidemiology, Virus Diseases
Abstract: Background: Surveillance systems are important in detecting changes in disease patterns and can act as early warning systems for emerging disease outbreaks. We hypothesized that analysis of data from existing global influenza surveillance networks early in the COVID-19 pandemic could identify outliers in influenza-negative influenza-like illness (ILI). We used data-driven methods to detect outliers in ILI that preceded the first reported peaks of COVID-19., Methods and Findings: We used data from the World Health Organization's Global Influenza Surveillance and Response System to evaluate time series outliers in influenza-negative ILI. Using automated autoregressive integrated moving average (ARIMA) time series outlier detection models and baseline influenza-negative ILI training data from 2015-2019, we analyzed 8,792 country-weeks across 28 countries to identify the first week in 2020 with a positive outlier in influenza-negative ILI. We present the difference in weeks between identified outliers and the first reported COVID-19 peaks in these 28 countries with high levels of data completeness for influenza surveillance data and the highest number of reported COVID-19 cases globally in 2020. To account for missing data, we also performed a sensitivity analysis using linear interpolation for missing observations of influenza-negative ILI. In 16 of the 28 countries (57%) included in this study, we identified positive outliers in cases of influenza-negative ILI that predated the first reported COVID-19 peak in each country; the average lag between the first positive ILI outlier and the reported COVID-19 peak was 13.3 weeks (standard deviation 6.8). In our primary analysis, the earliest outliers occurred during the week of January 13, 2020, in Peru, the Philippines, Poland, and Spain. Using linear interpolation for missing data, the earliest outliers were detected during the weeks beginning December 30, 2019, and January 20, 2020, in Poland and Peru, respectively. This contrasts with the reported COVID-19 peaks, which occurred on April 6 in Poland and June 1 in Peru. In many low- and middle-income countries in particular, the lag between detected outliers and COVID-19 peaks exceeded 12 weeks. These outliers may represent undetected spread of SARS-CoV-2, although a limitation of this study is that we could not evaluate SARS-CoV-2 positivity., Conclusions: Using an automated system of influenza-negative ILI outlier monitoring may have informed countries of the spread of COVID-19 more than 13 weeks before the first reported COVID-19 peaks. This proof-of-concept paper suggests that a system of influenza-negative ILI outlier monitoring could have informed national and global responses to SARS-CoV-2 during the rapid spread of this novel pathogen in early 2020., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: TEW: Funding for studies of respiratory infection from NIH and CDC. The other Authors have declared no competing interests.
Published: 2022
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11. Characteristics and Outcomes of US Patients Hospitalized With COVID-19.

Author: Peltan ID, Caldwell E, Admon AJ, Attia EF, Gundel SJ, Mathews KS, Nagrebetsky A, Sahetya SK, Ulysse C, Brown SM, Chang SY, Goodwin AJ, Hope AA, Iwashyna TJ, Johnson NJ, Lanspa MJ, Richardson LD, Vranas KC, Angus DC, Baron RM, Haaland BA, Hayden DL, Thompson BT, Rice TW, and Hough CL
Subjects: Aged, Female, Hospital Mortality, Hospitalization, Humans, Intensive Care Units, Male, Middle Aged, Pandemics, Respiration, Artificial, Retrospective Studies, SARS-CoV-2, COVID-19 therapy
Abstract: Background: Understanding COVID-19 epidemiology is crucial to clinical care and to clinical trial design and interpretation., Objective: To describe characteristics, treatment, and outcomes among patients hospitalized with COVID-19 early in the pandemic., Methods: A retrospective cohort study of consecutive adult patients with laboratory-confirmed, symptomatic SARS-CoV-2 infection admitted to 57 US hospitals from March 1 to April 1, 2020., Results: Of 1480 inpatients with COVID-19, median (IQR) age was 62.0 (49.4-72.9) years, 649 (43.9%) were female, and 822 of 1338 (61.4%) were non-White or Hispanic/Latino. Intensive care unit admission occurred in 575 patients (38.9%), mostly within 4 days of hospital presentation. Respiratory failure affected 583 patients (39.4%), including 284 (19.2%) within 24 hours of hospital presentation and 413 (27.9%) who received invasive mechanical ventilation. Median (IQR) hospital stay was 8 (5-15) days overall and 15 (9-24) days among intensive care unit patients. Hospital mortality was 17.7% (n = 262). Risk factors for hospital death identified by penalized multivariable regression included older age; male sex; comorbidity burden; symptoms-to-admission interval; hypotension; hypoxemia; and higher white blood cell count, creatinine level, respiratory rate, and heart rate. Of 1218 survivors, 221 (18.1%) required new respiratory support at discharge and 259 of 1153 (22.5%) admitted from home required new health care services., Conclusions: In a geographically diverse early-pandemic COVID-19 cohort with complete hospital folllow-up, hospital mortality was associated with older age, comorbidity burden, and male sex. Intensive care unit admissions occurred early and were associated with protracted hospital stays. Survivors often required new health care services or respiratory support at discharge., (©2022 American Association of Critical-Care Nurses.)
Published: 2022
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12. Pediatric Pneumonia: Another Problem Plagued by Inequity in Health Care.

Author: Attia EF, Kaufman JD, and Maleche-Obimbo E
Subjects: Child, Humans, Healthcare Disparities, Pneumonia epidemiology, Pneumonia therapy
Published: 2022
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13. A cross-sectional analysis of diagnosis and management of chronic obstructive pulmonary disease in people living with HIV: Opportunities for improvement.

Author: Zifodya JS, Triplette M, Shahrir S, Attia EF, Akgun KM, Soo Hoo GW, Rodriguez-Barradas MC, Wongtrakool C, Huang L, and Crothers K
Subjects: Chi-Square Distribution, Cross-Sectional Studies, Diagnostic Errors statistics & numerical data, Female, HIV Infections complications, HIV Infections physiopathology, HIV Infections psychology, Humans, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive physiopathology, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive therapy, Quality Improvement
Abstract: Abstract: Chronic obstructive pulmonary disease (COPD) is common in people living with HIV (PLWH). We sought to evaluate the appropriateness of COPD diagnosis and management in PLWH, comparing results to HIV-uninfected persons.We conducted a cross-sectional analysis of Veterans enrolled in the Examinations of HIV-Associated Lung Emphysema study, in which all participants underwent spirometry at enrollment and reported respiratory symptoms on self-completed surveys. Primary outcomes were misdiagnosis and under-diagnosis of COPD, and the frequency and appropriateness of inhaler prescriptions. Misdiagnosis was defined as having an International Classification of Diseases (ICD)-9 diagnosis of COPD without spirometric airflow limitation (post-bronchodilator forced expiratory volume in 1-second [FEV1]/Forced vital capacity [FVC] < 0.7). Under-diagnosis was defined as having spirometry-defined COPD without a prior ICD-9 diagnosis.The analytic cohort included 183 PLWH and 152 HIV-uninfected participants. Of 25 PLWH with an ICD-9 diagnosis of COPD, 56% were misdiagnosed. Of 38 PLWH with spirometry-defined COPD, 71% were under-diagnosed. In PLWH under-diagnosed with COPD, 85% reported respiratory symptoms. Among PLWH with an ICD-9 COPD diagnosis as well as in those with spirometry-defined COPD, long-acting inhalers, particularly long-acting bronchodilators (both beta-agonists and muscarinic antagonists) were prescribed infrequently even in symptomatic individuals. Inhaled corticosteroids were the most frequently prescribed long-acting inhaler in PLWH (28%). Results were overall similar amongst the HIV-uninfected.COPD was frequently misdiagnosed and under-diagnosed in PLWH, similar to uninfected-veterans. Among PLWH with COPD and a likely indication for therapy, long-acting inhalers were prescribed infrequently, particularly guideline-concordant, first-line long-acting bronchodilators. Although not a first-line controller therapy for COPD, inhaled corticosteroids were prescribed more often., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
Published: 2021
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14. Community-Acquired Pneumonia and Risk of Cardiovascular Events in People Living With HIV.

Author: Zifodya JS, Duncan MS, So-Armah KA, Attia EF, Akgün KM, Rodriguez-Barradas MC, Marconi VC, Budoff MJ, Bedimo RJ, Alcorn CW, Soo Hoo GW, Butt AA, Kim JW, Sico JJ, Tindle HA, Huang L, Tate JP, Justice AC, Freiberg MS, and Crothers K
Subjects: Adult, Aged, Cardiovascular Diseases diagnosis, Cardiovascular Diseases therapy, Cohort Studies, Community-Acquired Infections diagnosis, Community-Acquired Infections therapy, Female, HIV Infections therapy, Hospitalization, Humans, Incidence, Male, Middle Aged, Pneumonia diagnosis, Pneumonia therapy, Survival Rate, United States, Cardiovascular Diseases epidemiology, Community-Acquired Infections epidemiology, HIV Infections complications, Pneumonia epidemiology, Veterans statistics & numerical data
Abstract: Background Hospitalization with community-acquired pneumonia (CAP) is associated with an increased risk of cardiovascular disease (CVD) events in patients uninfected with HIV. We evaluated whether people living with HIV (PLWH) have a higher risk of CVD or mortality than individuals uninfected with HIV following hospitalization with CAP. Methods and Results We analyzed data from the Veterans Aging Cohort Study on US veterans admitted with their first episode of CAP from April 2003 through December 2014. We used Cox regression analyses to determine whether HIV status was associated with incident CVD events and mortality from date of admission through 30 days after discharge (30-day mortality), adjusting for known CVD risk factors. We included 4384 patients (67% [n=2951] PLWH). PLWH admitted with CAP were younger, had less severe CAP, and had fewer CVD risk factors than patients with CAP who were uninfected with HIV. In multivariable-adjusted analyses, CVD risk was similar in PLWH compared with HIV-uninfected (hazard ratio [HR], 0.89; 95% CI, 0.70-1.12), but HIV infection was associated with higher mortality risk (HR, 1.49; 95% CI, 1.16-1.90). In models stratified by HIV status, CAP severity was significantly associated with incident CVD and 30-day mortality in PLWH and patients uninfected with HIV. Conclusions In this study, the risk of CVD events during or after hospitalization for CAP was similar in PLWH and patients uninfected with HIV, after adjusting for known CVD risk factors and CAP severity. HIV infection, however, was associated with increased 30-day mortality after CAP hospitalization in multivariable-adjusted models. PLWH should be included in future studies evaluating mechanisms and prevention of CVD events after CAP.
Published: 2020
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15. Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study.

Author: Lee KK, Bing R, Kiang J, Bashir S, Spath N, Stelzle D, Mortimer K, Bularga A, Doudesis D, Joshi SS, Strachan F, Gumy S, Adair-Rohani H, Attia EF, Chung MH, Miller MR, Newby DE, Mills NL, McAllister DA, and Shah ASV
Subjects: Developing Countries, Humans, Air Pollution, Indoor adverse effects, Cost of Illness, Global Health statistics & numerical data
Abstract: Background: 3 billion people worldwide rely on polluting fuels and technologies for domestic cooking and heating. We estimate the global, regional, and national health burden associated with exposure to household air pollution., Methods: For the systematic review and meta-analysis, we systematically searched four databases for studies published from database inception to April 2, 2020, that evaluated the risk of adverse cardiorespiratory, paediatric, and maternal outcomes from exposure to household air pollution, compared with no exposure. We used a random-effects model to calculate disease-specific relative risk (RR) meta-estimates. Household air pollution exposure was defined as use of polluting fuels (coal, wood, charcoal, agricultural wastes, animal dung, or kerosene) for household cooking or heating. Temporal trends in mortality and disease burden associated with household air pollution, as measured by disability-adjusted life-years (DALYs), were estimated from 2000 to 2017 using exposure prevalence data from 183 of 193 UN member states. 95% CIs were estimated by propagating uncertainty from the RR meta-estimates, prevalence of household air pollution exposure, and disease-specific mortality and burden estimates using a simulation-based approach. This study is registered with PROSPERO, CRD42019125060., Findings: 476 studies (15·5 million participants) from 123 nations (99 [80%] of which were classified as low-income and middle-income) met the inclusion criteria. Household air pollution was positively associated with asthma (RR 1·23, 95% CI 1·11-1·36), acute respiratory infection in both adults (1·53, 1·22-1·93) and children (1·39, 1·29-1·49), chronic obstructive pulmonary disease (1·70, 1·47-1·97), lung cancer (1·69, 1·44-1·98), and tuberculosis (1·26, 1·08-1·48); cerebrovascular disease (1·09, 1·04-1·14) and ischaemic heart disease (1·10, 1·09-1·11); and low birthweight (1·36, 1·19-1·55) and stillbirth (1·22, 1·06-1·41); as well as with under-5 (1·25, 1·18-1·33), respiratory (1·19, 1·18-1·20), and cardiovascular (1·07, 1·04-1·11) mortality. Household air pollution was associated with 1·8 million (95% CI 1·1-2·7) deaths and 60·9 million (34·6-93·3) DALYs in 2017, with the burden overwhelmingly experienced in low-income and middle-income countries (LMICs; 60·8 million [34·6-92·9] DALYs) compared with high-income countries (0·09 million [0·01-0·40] DALYs). From 2000, mortality associated with household air pollution had reduced by 36% (95% CI 29-43) and disease burden by 30% (25-36), with the greatest reductions observed in higher-income nations., Interpretation: The burden of cardiorespiratory, paediatric, and maternal diseases associated with household air pollution has declined worldwide but remains high in the world's poorest regions. Urgent integrated health and energy strategies are needed to reduce the adverse health impact of household air pollution, especially in LMICs., Funding: British Heart Foundation, Wellcome Trust., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Published: 2020
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16. Immune imbalance and activation are associated with lower lung function in youth with perinatally acquired HIV.

Author: Attia EF, Jacobson D, Yu W, Crowell CS, Maleche-Obimbo E, Williams PL, West TE, Burchett SK, Kattan M, Colin AA, Eskander S, Chung MH, Crothers K, and Shearer WT
Subjects: Adolescent, Adult, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, Child, Female, Forced Expiratory Volume, Humans, Kenya, Lung physiopathology, Lymphocyte Count, Male, United States, Young Adult, HIV Infections immunology, HIV Infections physiopathology, HIV Infections transmission, Infectious Disease Transmission, Vertical
Published: 2020
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17. Endothelial Activation, Innate Immune Activation, and Inflammation Are Associated With Postbronchodilator Airflow Limitation and Obstruction Among Adolescents Living With HIV.

Author: Attia EF, Bhatraju PK, Triplette M, Kosamo S, Maleche-Obimbo E, West TE, Richardson BA, Zifodya JS, Eskander S, Njiru CD, Warui D, Kicska GA, Chung MH, Crothers K, Liles WC, and Graham SM
Subjects: Adolescent, Anti-HIV Agents therapeutic use, Biomarkers blood, Bronchodilator Agents, Child, Cross-Sectional Studies, Female, HIV Infections drug therapy, Humans, Inflammation blood, Lung Diseases, Obstructive drug therapy, Male, Respiratory Function Tests methods, Spirometry, Tomography, X-Ray Computed, Young Adult, HIV Infections complications, Immunity, Innate, Inflammation metabolism, Lung Diseases, Obstructive complications
Abstract: Background: Chronic inflammation, innate immune activation, T-cell imbalance and endothelial activation have been linked with lung diseases. We sought to determine whether markers of these pathophysiologic pathways were associated with spirometry and chest computed tomography (CT) abnormalities among adolescents living with HIV (ALWH)., Setting: Coptic Hope Center for Infectious Diseases in Nairobi, Kenya., Methods: We performed a cross-sectional study of ALWH (10-19 years old). Participants underwent chest CT, spirometry, and venipuncture for serum biomarkers. We also collected demographic, anthropometric, T-cell subset, antiretroviral therapy, and exposure data. We compared characteristics and biomarkers by airflow obstruction [postbronchodilator FEV1/FVC z-score (zFEV1/FVC) < -1.64]. We used multivariable linear regression to determine associations of log10-transformed biomarkers and chest CT abnormalities with lower postbronchodilator zFEV1/FVC (airflow limitation). We performed exploratory principal components analysis on biomarkers, and determined associations of factors with postbronchodilator zFEV1/FVC and chest CT abnormalities., Results: Of 47 participants with acceptable quality spirometry, 21 (45%) were female, median age was 13 years and 96% had perinatally-acquired HIV. Median CD4 was 672 cells/µL. Overall, 28% had airflow obstruction and 78% had a chest CT abnormality; airflow obstruction was associated with mosaic attenuation (P = 0.001). Higher endothelial activation (sVCAM-1, sICAM-1), inflammation and innate immune activation (serum amyloid-A, sTREM-1, sCD163), and T-cell imbalance (lower CD4/CD8) markers were associated with airflow limitation. Factors comprising endothelial and innate immune activation were associated with airflow limitation., Conclusions: Endothelial activation, innate immune activation, T-cell imbalance, and chronic inflammation are associated with airflow limitation and obstruction, providing insights into chronic lung disease pathophysiology among ALWH.
Published: 2020
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18. Validation of the global lung initiative 2012 multi-ethnic spirometric reference equations in healthy urban Zimbabwean 7-13 year-old school children: a cross-sectional observational study.

Author: Madanhire T, Ferrand RA, Attia EF, Sibanda EN, Rusakaniko S, and Rehman AM
Subjects: Adolescent, Child, Cross-Sectional Studies, Female, Humans, Male, Racial Groups, Reference Values, Urban Health, Zimbabwe, Spirometry
Abstract: Background: The 2012 Global Lung Function Initiative (GLI 2012 ) provide multi-ethnic spirometric reference equations (SRE) for the 3-95 year-old age range, but Sub-Saharan African populations are not represented. This study aimed to evaluate the fit of the African-American GLI 2012 SRE to a population of healthy urban and peri-urban Zimbabwean school-going children (7-13 years)., Methods: Spirometry and anthropometry were performed on black-Zimbabwean children recruited from three primary schools in urban and peri-urban Harare, with informed consent and assent. Individuals with a history or current symptoms of respiratory disease or with a body mass index-z score (BMI) < - 2 were excluded. Spirometry z-scores were generated from African-American GLI 2012 SRE, which adjust for age, sex, ethnicity and height, after considering all GLI 2012 modules. Anthropometry z-scores were generated using the British (1990) reference equations which adjust for age and sex. The African-American GLI 2012 z-score distribution for the four spirometry measurements (FVC, FEV 1 , FEV 1 /FVC and MMEF) were evaluated across age, height, BMI and school (as a proxy for socioeconomic status) to assess for bias. Comparisons between the African-American GLI 2012 SRE and Polgar equations (currently adopted in Zimbabwe) on the percent-predicted derived values were also performed., Results: The validation dataset contained acceptable spirometry data from 712 children (344 girls, mean age: 10.5 years (SD 1.81)). The spirometry z-scores were reasonably normally distributed, with all means lower than zero but within the range of ±0.5, indicating a good fit to the African-American GLI 2012 SRE. The African-American GLI 2012 SRE produced z-scores closest to a normal distribution. Z-scores of girls deviated more than boys. Weak correlations (Pearson's correlation coefficient < 0.2) were observed between spirometry and anthropometry z-scores, and scatterplots demonstrated no systematic bias associated with age, height, BMI or socioeconomic status. The African-American GLI 2012 SRE provided a better fit for Zimbabwean paediatric spirometry data than Polgar equations., Conclusion: The use of African-American GLI 2012 SRE in this population could help in the interpretation of pulmonary function tests.
Published: 2020
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19. Global Health-related Training Opportunities. A National Survey of Pulmonary and Critical Care Medicine Fellowship Programs.

Author: North CM, Attia EF, Rudd KE, Siddharthan T, Papali A, Çoruh B, Carter EJ, Christiani DC, Richards JB, Huang L, Engelberg R, Checkley W, and West TE
Subjects: Attitude of Health Personnel, Career Choice, Curriculum, Education, Medical, Graduate, Global Health, Humans, Needs Assessment, Surveys and Questionnaires, United States, Emergency Medicine education, Fellowships and Scholarships, Pulmonary Medicine education, Teaching standards
Abstract: Rationale: Clinical and research training opportunities in global health are of increasing interest to medical trainees, but little is known about such opportunities in U.S.-based pulmonary and pulmonary/critical care medicine (PCCM) fellowship programs. Objectives: Summarize currently available global health-related training opportunities and identify potential barriers to implementing global health curricula among U.S.-based PCCM fellowship programs. Methods: We sent a confidential, online, targeted needs assessment to PCCM fellowship program directors and associate program directors. Data collected included program demographics, currently available global health-related clinical and research training opportunities, potential barriers to the implementation of global health-related programmatic content, and perceived interest in global health-related training opportunities by current and/or prospective trainees. To evaluate for nonresponse bias, we performed an online search to identify global health-related training opportunities offered by nonresponding programs. Results: Out of 171 surveyed programs, 63 PCCM fellowship programs (37%) provided survey responses. Most responses ( n = 56, 89%) were from combined PCCM training programs; 66% ( n = 40) of programs offered at least one component of global health-related clinical or research training. Overall, 27% ( n = 17) had a Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant (National Institutes of Health T32), 73% ( n = 46) had fewer than 35 faculty members, and 51% ( n = 32) had at least one faculty member conducting global health-focused research. Most responding programs (66%, n = 40) offered at least one global health-related educational component. Among programs that would like to offer global health-related training components, the most common barriers included competing priorities for lecture content and a lack of in-division mentors with global health experience, a champion for global health-related activities, and established partnerships outside the United States. Conclusions: PCCM program leaders are interested in offering global health-related training opportunities, but important barriers include lack of mentorship, dedicated fellowship time, and established global partnerships. Future research is needed to better understand global health-related interests and training needs of incoming fellows and to design creative solutions for providing global health-related training across academic institutions with variable global health-related training capacities.
Published: 2019
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20. Tuberculosis and other bacterial co-infection in Cambodia: a single center retrospective cross-sectional study.

Author: Attia EF, Pho Y, Nhem S, Sok C, By B, Phann D, Nob H, Thann S, Yin S, Noce R, Kim C, Letchford J, Fassier T, Chan S, and West TE
Subjects: Adult, Aged, Bacterial Infections epidemiology, Cambodia epidemiology, Coinfection microbiology, Cross-Sectional Studies, Female, HIV Infections complications, HIV Infections epidemiology, Humans, Male, Middle Aged, Respiratory Tract Infections epidemiology, Retrospective Studies, Tertiary Care Centers, Tuberculosis epidemiology, Bacterial Infections complications, Coinfection epidemiology, Respiratory Tract Infections complications, Sputum microbiology, Tuberculosis complications
Abstract: Background: Cambodia, a lower middle-income country of about 16 million individuals in southeast Asia, endures a high burden of both tuberculosis and other lower respiratory infections. Differentiating tuberculosis from other causes of respiratory infection has important clinical implications yet may be challenging to accomplish in the absence of diagnostic microbiology facilities. Furthermore, co-infection of tuberculosis with other bacterial lower respiratory infections may occur. The objective of this study was to determine the prevalence and etiologies of tuberculosis and other bacterial co-infection and to analyze the clinical and radiographic characteristics of patients presenting with respiratory infection to a provincial referral hospital in Cambodia., Methods: We performed a retrospective, cross-sectional analysis of laboratory and clinical data, on patients presenting with respiratory symptoms to a chest clinic of a 260-bed provincial referral hospital in Cambodia. We analyzed mycobacterial and bacterial sputum test results, and demographics, medical history and chest radiography., Results: Among 137 patients whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, the median age was 52 years, 54% were male, 3% had HIV infection, and 26% were current smokers. Nearly all had chronic respiratory symptoms (> 96%) and abnormal chest radiographs (87%). Sputum testing was positive for tuberculosis in 40 patients (30%) and for bacteria in 60 patients (44%); 13 had tuberculosis and bacterial co-infection (9% overall; 33% of tuberculosis patients). Clinical characteristics were generally similar across pulmonary infection types, although co-infection was identified in 43% of patients with one or more cavitary lesions on chest radiography. Among those with bacterial growth on sputum culture, Gram negative bacilli (Klebsiella and Pseudomonas spp.) were the most commonly isolated., Conclusions: Among patients with symptoms of respiratory infections whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, 9% of all patients and 33% of tuberculosis patients had tuberculosis and bacterial co-infection. Greater availability of microbiologic diagnostics for pulmonary tuberculosis and bacterial infection is critical to ensure appropriate diagnosis and management.
Published: 2019
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21. Acute wheeze in the pediatric population: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data.

Author: Katz MA, Marangu D, Attia EF, Bauwens J, Bont LJ, Bulatovic A, Crane J, Doroshenko A, Ebruke BE, Edwards KM, Fortuna L, Jagelaviciene A, Joshi J, Kemp J, Kovacs S, Lambach P, Lewis KDC, Ortiz JR, Simões EAF, Turner P, Tagbo BN, Vaishnavi V, and Bonhoeffer J
Subjects: Acute Disease, Child, Data Collection methods, Humans, Immunization adverse effects, Adverse Drug Reaction Reporting Systems standards, Data Collection standards, Immunization statistics & numerical data, Practice Guidelines as Topic, Respiratory Sounds immunology
Published: 2019
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22. Adolescent age is an independent risk factor for abnormal spirometry among people living with HIV in Kenya.

Author: Attia EF, Maleche-Obimbo E, West TE, Ndukwe-Wambutsi L, Kiptinness C, Cagle A, McGrath CJ, Mugambi CK, El Antouny NG, Eskander S, Chung MH, and Crothers K
Subjects: Adolescent, Adult, Age Factors, Child, Cross-Sectional Studies, Female, Humans, Kenya epidemiology, Lung Diseases diagnosis, Lung Diseases pathology, Male, Middle Aged, Prevalence, Prospective Studies, Radiography, Thoracic, Risk Factors, Tomography, X-Ray Computed, Young Adult, HIV Infections complications, Lung Diseases epidemiology, Spirometry
Abstract: Objectives: As life expectancy of people living with HIV (PLWH) improves in low-income and middle-income countries (LMICs), the spectrum of HIV-related pulmonary complications may reflect a greater burden of chronic lung diseases as in high-income countries. We determined whether the risk of abnormal spirometry was greater among adolescent compared with adult PLWH at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya, and evaluated the role of other cofactors for abnormal spirometry., Design: We prospectively enrolled adolescent and adult PLWH for this cross-sectional study., Methods: Data collection included standardized questionnaires, clinical assessment, and prebronchodilator and postbronchodilator spirometry. Adolescents additionally underwent noncontrast chest computed tomography. Multivariable logistic regression determined associations of adolescent age with abnormal spirometry, adjusting for cofactors., Results: Of 427 PLWH, 21 (40%) adolescents and 64 (17%) adults had abnormal spirometry. Among adolescents, 80% had abnormal chest CTs, and 79% had at least one respiratory symptom. Adolescent age (adjusted odds ratio 3.22; 95% confidence interval 1.48-6.98) was independently associated with abnormal spirometry, adjusting for recent CD4, HIV clinical stage, low BMI, indoor kerosene use, smoking pack-years, and prior pulmonary tuberculosis. Additional important cofactors for abnormal spirometry included prior pulmonary tuberculosis (3.15; 1.70-5.58), kerosene use (1.77; 1.04-3.04) and smoking pack-years (1.05; 1.00-1.10). Adolescent age, prior pulmonary tuberculosis, and smoking pack-years were significantly associated with airflow limitation., Conclusion: Adolescent age was independently associated with increased risk of abnormal spirometry, particularly airflow limitation. Studies to improve prevention, detection, and management of chronic lung disease across the lifespan among PLWH are needed in LMICs.
Published: 2018
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23. Impact of HIV infection on α 1 -antitrypsin in the lung.

Author: Stephenson SE, Wilson CL, Crothers K, Attia EF, Wongtrakool C, Petrache I, and Schnapp LM
Subjects: Bronchoalveolar Lavage Fluid, Cohort Studies, Female, HIV isolation & purification, HIV Infections virology, Humans, Male, Middle Aged, Pulmonary Emphysema etiology, Pulmonary Emphysema pathology, Biomarkers blood, HIV Infections complications, Pulmonary Emphysema blood, Trypsin Inhibitors blood, alpha 1-Antitrypsin blood
Abstract: Emphysema is one of the most common lung diseases in HIV + individuals. The pathogenesis of HIV-associated emphysema remains unclear; however, radiographic distribution and earlier age of presentation of emphysema in the lungs of HIV + patients are similar to deficiency of α 1 -antitrypsin (A1AT), a key elastase inhibitor in the lung. Reduced levels of circulating A1AT in HIV + patients suggest a potential mechanism for emphysema development. In the present study we asked if A1AT levels and activity in the bronchoalveolar lavage fluid (BALF) differ in HIV + and HIV - patients with and without emphysema. A1AT levels were measured by ELISA in plasma and BALF from a cohort of 21 HIV + and 29 HIV - patients with or without emphysematous changes on chest CT scan. To analyze A1AT function, we measured elastase activity in the BALF and assessed oxidation and polymerization of A1AT by Western blotting. Total A1AT was increased in the BALF, but not in the plasma, of HIV + compared with HIV - patients, regardless of the presence or absence of emphysema. However, antielastase activity was decreased in BALF from HIV + patients, suggesting impaired A1AT function. Higher levels of the oxidized form of A1AT were detected in BALF from HIV + than HIV - patients, which may account for the decreased antielastase activity. These findings suggest that, in the lungs of HIV + patients, posttranslational modifications of A1AT produce a "functional deficiency" of this critical elastase inhibitor, which may contribute to emphysema development.
Published: 2018
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24. Markers of chronic obstructive pulmonary disease are associated with mortality in people living with HIV.

Author: Triplette M, Justice A, Attia EF, Tate J, Brown ST, Goetz MB, Kim JW, Rodriguez-Barradas MC, Hoo GWS, Wongtrakool C, Akgün K, and Crothers K
Subjects: Female, HIV Infections mortality, Humans, Longitudinal Studies, Lung diagnostic imaging, Lung pathology, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive mortality, Respiratory Function Tests, Survival Analysis, Tomography, X-Ray Computed, Biomarkers analysis, HIV Infections complications, HIV Infections pathology, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive pathology
Abstract: Objective: Aging people living with HIV (PLWH) face an increased burden of comorbidities, including chronic obstructive pulmonary disease (COPD). The impact of COPD on mortality in HIV remains unclear. We examined associations between markers of COPD and mortality among PLWH and uninfected study participants., Design: Longitudinal analysis of the Examinations of HIV-Associated Lung Emphysema (EXHALE) cohort study., Methods: EXHALE includes 196 PLWH and 165 uninfected smoking-matched study participants who underwent pulmonary function testing and computed tomography (CT) to define COPD and were followed. We determined associations between markers of COPD with mortality using multivariable Cox regression models, adjusted for smoking and the Veterans Aging Cohort Study (VACS) Index, a validated predictor of mortality in HIV., Results: Median follow-up time was 6.9 years; the mortality rate was 2.7/100 person-years among PLWH and 1.7/100 person-years among uninfected study participants (P = 0.11). The VACS Index was associated with mortality in both PLWH and uninfected study participants. In multivariable models, pulmonary function and CT characteristics defining COPD were associated with mortality in PLWH: those with airflow obstruction (forced expiratory volume in 1 s/ forced vital capacity <0.7) had 3.1 times the risk of death [hazard ratio 3.1 (95% confidence interval 1.4-7.1)], compared with those without; those with emphysema (>10% burden) had 2.4 times the risk of death [hazard ratio 2.4 (95% confidence interval 1.1-5.5)] compared with those with ≤ 10% emphysema. In uninfected subjects, pulmonary variables were not significantly associated with mortality, which may reflect fewer deaths limiting power., Conclusion: Markers of COPD were associated with greater mortality in PWLH, independent of the VACS Index. COPD is likely an important contributor to mortality in contemporary PLWH.
Published: 2018
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25. Risk Factors for Hypoxia and Tachypnea Among Adolescents With Vertically-acquired HIV in Nairobi.

Author: Attia EF, Weiss NS, Maleche Obimbo E, McGrath CJ, Cagle A, West TE, El Antouny NG, Attwa M, Crothers K, and Chung MH
Subjects: Adolescent, Child, Cross-Sectional Studies, Female, Humans, Hypoxia complications, Kenya epidemiology, Male, Risk Factors, Tachypnea complications, HIV Infections complications, HIV Infections epidemiology, Hypoxia epidemiology, Infectious Disease Transmission, Vertical statistics & numerical data, Tachypnea epidemiology
Abstract: Background: Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya., Methods: We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for demographics, and HIV severity estimated odds ratios for risk of hypoxia and tachypnea associated with potential risk factors., Results: Overall, 11% of adolescents had hypoxia and 55% had tachypnea. Advanced HIV [adjusted odds ratio (aOR): 2.41] and low CD4 (aOR: 1.74) were associated with greater hypoxia risk, but confidence intervals (CIs) were wide and included the null (95% CI: 0.93-6.23 and 0.69-4.39, respectively). Low CD4 (aOR: 2.45, 95% CI: 1.39-4.32), current antiretroviral therapy use (aOR: 0.48, 95% CI: 0.27-0.86) and stunted growth (aOR: 3.46, 95% CI: 1.94-6.18) were associated with altered tachypnea risk., Conclusions: Hypoxia and tachypnea are common among adolescents with vertically-acquired HIV. There was a suggestion that advanced HIV and low CD4 were associated with greater hypoxia risk. Low CD4, lack of antiretroviral therapy use and stunted growth are risk factors for tachypnea. Our findings highlight the chronic lung disease burden in this population and may inform diagnostic algorithms.
Published: 2017
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26. Bronchiectasis and other chronic lung diseases in adolescents living with HIV.

Author: Attia EF, Miller RF, and Ferrand RA
Subjects: Adolescent, Africa South of the Sahara epidemiology, Bronchiectasis epidemiology, Bronchiectasis etiology, Chronic Disease, Humans, Lung Diseases etiology, Lung Diseases, Interstitial epidemiology, Lung Diseases, Interstitial etiology, Pulmonary Disease, Chronic Obstructive epidemiology, Pulmonary Disease, Chronic Obstructive etiology, HIV Infections complications, Lung Diseases epidemiology
Abstract: Purpose of Review: The incidence of pulmonary infections has declined dramatically with improved access to antiretroviral therapy (ART) and cotrimoxazole prophylaxis, but chronic lung disease (CLD) is an increasingly recognized but poorly understood complication in adolescents with perinatally acquired HIV., Recent Findings: There is a high prevalence of chronic respiratory symptoms, abnormal spirometry and chest radiographic abnormalities among HIV-infected adolescents in sub-Saharan Africa, wherein 90% of the world's HIV-infected children live. The incidence of lymphocytic interstitial pneumonitis, the most common cause of CLD in the pre-ART era, has declined with increased ART access. Small airways disease, particularly constrictive obliterative bronchiolitis and bronchiectasis, are emerging as leading causes of CLD among HIV-infected adolescents in low-income and middle-income countries. Asthma may be more common in high-income settings. Likely risk factors for CLD include recurrent pulmonary infections, air pollution, HIV-related immune dysfunction, and untreated HIV infection, particularly during critical stages of lung development., Summary: Globally, the importance of HIV-associated CLD as a cause of morbidity and mortality is increasing, especially as survival has improved dramatically with ART and growing numbers of children living with HIV enter adolescence. Further research is urgently needed to elucidate the natural history and pathogenesis of CLD, and to determine optimal screening, diagnostic and treatment strategies.
Published: 2017
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27. A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV.

Author: Triplette M, Attia EF, Akgün KM, Soo Hoo GW, Freiberg MS, Butt AA, Wongtrakool C, Goetz MB, Brown ST, Graber CJ, Huang L, and Crothers K
Subjects: Adult, Cross-Sectional Studies, Female, HIV Infections complications, HIV Infections diagnostic imaging, Humans, Lymphocyte Count, Male, Middle Aged, Pulmonary Emphysema complications, Pulmonary Emphysema diagnostic imaging, Radiography, Thoracic, Respiratory Function Tests, Risk Factors, Tomography, X-Ray Computed, CD4-CD8 Ratio, HIV Infections immunology, Pulmonary Emphysema immunology
Abstract: Objectives: The prevalence of emphysema is higher among HIV-infected (HIV+) individuals compared to HIV-uninfected persons. While greater tobacco use contributes, HIV-related effects on immunity likely confer additional risk. Low peripheral blood CD4+ to CD8+ T-lymphocyte (CD4/CD8) ratio may reflect chronic inflammation in HIV and may be a marker of chronic lung disease in this population. Therefore, we sought to determine whether the CD4/CD8 ratio was associated with chronic obstructive pulmonary disease (COPD), particularly the emphysema subtype, in a cohort of HIV+ subjects., Methods: We performed a cross-sectional analysis of 190 HIV+ subjects enrolled in the Examinations of HIV Associated Lung Emphysema (EXHALE) study. Subjects underwent baseline laboratory assessments, pulmonary function testing and chest computed tomography (CT) analyzed for emphysema severity and distribution. We determined the association between CD4/CD8 ratio and emphysema, and the association between CD4/CD8 ratio and pulmonary function markers of COPD., Results: Mild or greater emphysema (>10% lung involvement) was present in 31% of subjects. Low CD4/CD8 ratio was associated with >10% emphysema in multivariable models, adjusting for risk factors including smoking, current and nadir CD4 count and HIV RNA level. Those with CD4/CD8 ratio <0.4 had 6.3 (1.1-39) times the odds of >10% emphysema compared to those with a ratio >1.0 in fully adjusted models. A low CD4/CD8 ratio was also associated with reduced diffusion capacity (DLCO)., Conclusions: A low CD4/CD8 ratio was associated with emphysema and low DLCO in HIV+ subjects, independent of other risk factors and clinical markers of HIV. The CD4/CD8 ratio may be a useful, clinically available, marker for risk of emphysema in HIV+ subjects in the antiretroviral therapy (ART) era., Competing Interests: The authors have declared that no competing interests exist.
Published: 2017
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28. Latent Tuberculosis Infection Test Agreement in the National Health and Nutrition Examination Survey.

Author: Ghassemieh BJ, Attia EF, Koelle DM, Mancuso JD, Narita M, and Horne DJ
Subjects: Adolescent, Adult, Black or African American statistics & numerical data, Age Distribution, Aged, Asian statistics & numerical data, Child, Ethnicity statistics & numerical data, Female, Hispanic or Latino statistics & numerical data, Humans, Interferon-gamma Release Tests methods, Latent Tuberculosis epidemiology, Latent Tuberculosis ethnology, Logistic Models, Male, Middle Aged, Nutrition Surveys, Prevalence, Reproducibility of Results, Sex Distribution, Tuberculin Test methods, United States epidemiology, White People statistics & numerical data, Young Adult, Interferon-gamma Release Tests statistics & numerical data, Latent Tuberculosis diagnosis, Tuberculin Test statistics & numerical data
Abstract: Rationale: Latent tuberculosis infection (LTBI) test discordance is poorly understood., Objectives: To determine the frequency and predictors of tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT) discordance in the U.S., Methods: We analyzed data from a representative sample of the U.S. population ages 6 years and older who participated in the 2011-2012 National Health and Nutrition Examination Survey. We determined prevalence estimates of test positivity, calculated test agreement and kappa statistics, and performed multivariable logistic regression to determine predictors of discordance., Measurements and Main Results: LTBI prevalence among the U.S. born ranged from 0.6% to 2.8%, depending on how LTBI was defined, with test agreement 97.0% and kappa 0.27 (95% confidence interval, 0.18-0.36). Prevalence among the foreign born ranged from 9.1% to 20.3%, depending on how LTBI was defined, with test agreement 81.6% and kappa 0.38 (95% confidence interval, 0.33-0.44). TST(+)/QFT(-) discordance was associated with age, male sex, black race, Mexican-American ethnicity, previous TB exposure, and past LTBI treatment in U.S.-born participants, but only with higher lymphocyte count in foreign-born participants. TST(-)/QFT(+) discordance was associated with older age, previous TB exposure, and past LTBI treatment in U.S.-born participants and with older age, male sex, and past LTBI treatment in foreign-born participants., Conclusions: In the largest population-based sample of concurrently performed TST and QFT tests in a low tuberculosis incidence population, prevalence estimates depended heavily on how LTBI was defined and test agreement was only fair. We identified several predictors of discordance warranting further study.
Published: 2016
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29. Global Health Education in Pulmonary and Critical Care Medicine Fellowships.

Author: Siddharthan T, North CM, Attia EF, Christiani DC, Checkley W, and West TE
Subjects: Clinical Competence, Cultural Competency, Humans, International Cooperation, United States, Critical Care, Education, Medical, Graduate, Fellowships and Scholarships, Global Health, Pulmonary Medicine
Abstract: A growing number of pulmonary and critical care medicine fellowship programs in the United States offer global health training opportunities. Formal, integrated global health programs within pulmonary and critical care fellowships are relatively new but are built on principles and ideals of global health that focus on the mutually beneficial exchange of knowledge and social justice. Although core competencies consistent with these overarching themes in global health education have not been formalized for pulmonary and critical care trainees, relevant competency areas include clinical knowledge, international research training, cultural competency, and clinical and research capacity building. Existing global health education in U.S. pulmonary and critical care medicine training programs can generally be classified as one of three different models: integrated global health tracks, global health electives, and additional research years. Successful global health education programs foster partnerships and collaborations with international sites that emphasize bidirectional exchange. This bidirectional exchange includes ongoing, equitable commitments to mutual opportunities for training and professional development, including a focus on the particular knowledge and skill sets critical for addressing the unique priorities of individual countries. However, barriers related to the availability of mentorship, funding, and dedicated time exist to expanding global health education in pulmonary and critical care medicine. The implementation of global health training within pulmonary and critical care medicine programs requires continued optimization, but this training is essential to prepare the next generation of physicians to address the global aspects of respiratory disease and critical illness.
Published: 2016
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30. Non-infectious Pulmonary Diseases and HIV.

Author: Triplette M, Crothers K, and Attia EF
Subjects: Anti-HIV Agents therapeutic use, Coinfection, Genetic Predisposition to Disease, HIV Infections drug therapy, HIV Infections immunology, HIV Infections physiopathology, Humans, Hypertension, Pulmonary genetics, Hypertension, Pulmonary immunology, Hypertension, Pulmonary physiopathology, Lung virology, Lung Neoplasms diagnosis, Lung Neoplasms genetics, Lung Neoplasms physiopathology, Prevalence, Pulmonary Disease, Chronic Obstructive genetics, Pulmonary Disease, Chronic Obstructive immunology, Pulmonary Disease, Chronic Obstructive physiopathology, Risk Factors, Smoking adverse effects, HIV Infections complications, Hypertension, Pulmonary complications, Lung physiopathology, Lung Neoplasms complications, Pulmonary Disease, Chronic Obstructive complications
Abstract: Pulmonary complications remain among the most frequent causes of morbidity and mortality for individuals with HIV despite the advent of antiretroviral therapy (ART) and improvement in its efficacy and availability. The prevalence of non-infectious pulmonary diseases is rising in this population, reflecting both an increase in smoking and the independent risk associated with HIV. The unique mechanisms of pulmonary disease in these patients remain poorly understood, and direct effects of HIV, genetic predisposition, inflammatory pathways, and co-infections have all been implicated. Lung cancer, chronic obstructive pulmonary disease (COPD), and pulmonary hypertension are the most prevalent non-infectious pulmonary diseases in persons with HIV, and the risk of each of these diseases is higher among HIV-infected (HIV+) persons than in the general population. This review discusses the latest advances in the literature on these important complications of HIV infection.
Published: 2016
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31. Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) Is Elevated in Bronchoalveolar Lavage Fluid of Patients with Acute Respiratory Distress Syndrome.

Author: Attia EF, Jolley SE, Crothers K, Schnapp LM, and Liles WC
Subjects: Aged, Angiopoietin-1 analysis, Angiopoietin-2 analysis, Bronchoalveolar Lavage, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Respiratory Distress Syndrome diagnosis, Selectins analysis, Severity of Illness Index, Bronchoalveolar Lavage Fluid chemistry, Respiratory Distress Syndrome metabolism, Vascular Cell Adhesion Molecule-1 analysis
Abstract: Introduction: Pulmonary vascular endothelial activation has been implicated in acute respiratory distress syndrome (ARDS), yet little is known about the presence and role of endothelial activation markers in the alveolar space in ARDS. We hypothesized that endothelial activation biomarkers would be differentially expressed in bronchoalveolar lavage fluid from patients with ARDS compared with healthy volunteers, and that biomarker concentrations would be associated with ARDS severity., Methods: We performed a cross-sectional analysis of data from 26 intubated patients with ARDS undergoing evaluation for clinically suspected ventilator-associated pneumonia and five healthy volunteers. Patients underwent bronchoalveolar lavage a median of five days after intubation. Healthy volunteers also underwent bronchoalveolar lavage. Endothelial activation biomarkers (soluble vascular cell adhesion molecule-1 [sVCAM-1], soluble endothelial selectin [sESEL], angiopoietin-1 [Ang-1] and angiopoietin-2 [Ang-2]) were measured in bronchoalveolar lavage fluid. Clinically suspected ventilator-associated pneumonia was confirmed with microbiologic culture data., Results: Patients with ARDS had significantly higher median sVCAM-1 concentrations in the bronchoalveolar lavage fluid compared with healthy volunteers (985 vs 119 pg/mL, p = 0.03). Additionally, there was a trend toward greater bronchoalveolar lavage fluid sVCAM-1 concentrations among patients with moderate/severe compared to mild ARDS (1395 vs 209 pg/mL, p = 0.06). We did not detect significant differences in bronchoalveolar lavage fluid levels of sESEL, Ang-1 or Ang-2 between patients with ARDS and healthy volunteers. Median bronchoalveolar lavage fluid biomarker levels did not differ between patients with and without microbiologically-confirmed ventilator-associated pneumonia., Conclusions: sVCAM-1 concentrations were significantly higher in the bronchoalveolar lavage fluid of patients with ARDS compared to healthy controls, and tended to be higher in moderate/severe ARDS compared to mild ARDS. Our findings add to the growing evidence supporting the concept that endothelial activation plays an important mechanistic role in the pathogenesis of ARDS. Further studies are necessary to characterize the role and/or clinical significance of sVCAM-1 and other endothelial activation markers present in the alveolar space in ARDS.
Published: 2016
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32. ATS Core Curriculum 2015: Part IV. Adult Critical Care Medicine.

Author: Poston JT, McSparron JI, Hayes MM, Damm T, Patel JJ, Decker BK, Attia EF, Çoruh B, Cai X, Kimberly WT, Poisson SN, Sokol S, Csikesz N, Levinson AT, Thomson CC, and Luks AM
Subjects: Adult, Humans, United States, Critical Care, Critical Illness therapy, Curriculum, Education, Medical, Graduate methods, Internal Medicine education, Soft Tissue Infections therapy
Published: 2015
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33. Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans.

Author: Attia EF, McGinnis KA, Feemster LC, Akgün KM, Butt AA, Graber CJ, Fine MJ, Goetz MB, Rodriguez-Barradas MC, Pisani MA, Tindle HA, Brown ST, Soo Hoo GW, Rimland D, Gibert CL, Huang L, Freiberg MS, Hough CL, and Crothers K
Subjects: Adult, Community-Acquired Infections, Female, Hospitalization, Humans, Male, Middle Aged, Risk Factors, Viral Load, HIV Infections complications, Pneumonia, Bacterial complications, Pneumonia, Pneumocystis complications, Pulmonary Disease, Chronic Obstructive complications, Tuberculosis, Pulmonary complications, Veterans
Abstract: Background: Pulmonary infections remain more common in HIV-infected (HIV+) compared with uninfected individuals. The increase in chronic lung diseases among aging HIV+ individuals may contribute to this persistent risk. We sought to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for different pulmonary infections requiring hospitalization among HIV+ patients., Methods: We analyzed data from 41,993 HIV+ Veterans in the nationwide Veterans Aging Cohort Study Virtual Cohort from 1996 to 2009. Using International Classification of Diseases, Ninth Revision codes, we identified baseline comorbid conditions, including COPD, and incident community-acquired pneumonia (CAP), pulmonary tuberculosis (TB), and Pneumocystis jirovecii pneumonia (PCP) requiring hospitalization within 2 years after baseline. We used multivariable Poisson regression to determine incidence rate ratios (IRRs) associated with COPD for each type of pulmonary infection, adjusting for comorbidities, CD4 cell count, HIV viral load, smoking status, substance use, vaccinations, and calendar year at baseline., Results: Unadjusted incidence rates of CAP, TB, and PCP requiring hospitalization were significantly higher among persons with COPD compared to those without COPD (CAP: 53.9 vs. 19.4 per 1000 person-years; TB: 8.7 vs. 2.8; PCP: 15.5 vs. 9.2; P ≤ 0.001). In multivariable Poisson regression models, COPD was independently associated with increased risk of CAP, TB, and PCP (IRR: 1.94, 95% confidence interval [CI]: 1.64 to 2.30; IRR: 2.60, 95% CI: 1.70 to 3.97; and IRR: 1.48, 95% CI: 1.10 to 2.01, respectively)., Conclusions: COPD is an independent risk factor for CAP, TB, and PCP requiring hospitalization among HIV+ individuals. As the HIV+ population ages, the growing burden of COPD may confer substantial risk for pulmonary infections.
Published: 2015
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34. Increased risk of radiographic emphysema in HIV is associated with elevated soluble CD14 and nadir CD4.

Author: Attia EF, Akgün KM, Wongtrakool C, Goetz MB, Rodriguez-Barradas MC, Rimland D, Brown ST, Soo Hoo GW, Kim J, Lee PJ, Schnapp LM, Sharafkhaneh A, Justice AC, and Crothers K
Subjects: Adult, Age Factors, Biomarkers blood, Comorbidity, Confidence Intervals, Cross-Sectional Studies, Female, HIV Infections blood, HIV Infections diagnosis, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Prognosis, Pulmonary Emphysema blood, Radiography, Reference Values, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Sex Factors, Statistics, Nonparametric, CD4 Antigens blood, HIV Infections epidemiology, Lipopolysaccharide Receptors blood, Pulmonary Emphysema diagnostic imaging, Pulmonary Emphysema epidemiology
Abstract: Background: The association between HIV and emphysema remains incompletely understood. We sought to determine whether HIV is an independent risk factor for emphysema severity and whether markers of HIV severity and systemic biomarkers of inflammation (IL-6), altered coagulation (D-dimer), and immune activation (soluble CD14) are associated with emphysema., Methods: We performed a cross-sectional analysis of 114 participants with HIV infection and 89 participants without HIV infection in the Examinations of HIV-Associated Lung Emphysema (EXHALE) study. Participants underwent chest CT imaging with blinded semiquantitative interpretation of emphysema severity, distribution, and type. We generated multivariable logistic regression models to determine the risk of HIV for radiographic emphysema, defined as > 10% lung involvement. Similar analyses examined associations of plasma biomarkers, HIV RNA, and recent and nadir CD4 cell counts with emphysema among participants with HIV infection., Results: Participants with HIV infection had greater radiographic emphysema severity with increased lower lung zone and diffuse involvement. HIV was associated with significantly increased risk for > 10% emphysema in analyses adjusted for cigarette smoking pack-years (OR, 2.24; 95% CI, 1.12-4.48). In multivariable analyses restricted to participants with HIV infection, nadir CD4 < 200 cells/μL (OR, 2.98; 95% CI, 1.14-7.81), and high soluble CD14 level (upper 25th percentile) (OR, 2.55; 95% CI, 1.04-6.22) were associated with increased risk of > 10% emphysema. IL-6 and D-dimer were not associated with emphysema in HIV., Conclusions: HIV is an independent risk factor for radiographic emphysema. Emphysema severity was significantly greater among participants with HIV infection. Among those with HIV, nadir CD4 < 200 cells/μL and elevated soluble CD14 level were associated with emphysema, highlighting potential mechanisms linking HIV with emphysema.
Published: 2014
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34 results on '"Attia EF"'

1. A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

2. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

3. Increased risk of radiographic emphysema in HIV is associated with elevated soluble CD14 and nadir CD4

4. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

5. Postinfectious Pulmonary Complications: Establishing Research Priorities to Advance the Field: An Official American Thoracic Society Workshop Report.

6. HIV and diabetes impair M. tuberculosis -specific interferon-gamma responses on QuantiFERON-TB Gold Plus testing.

7. Venous Thromboembolism Among People With HIV: Design, Implementation, and Findings of a Centralized Adjudication System in Clinical Care Sites Across the United States.

8. What Can Big Data Teach Us About Air Pollution and Pneumonia?

9. Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey.

10. Global influenza surveillance systems to detect the spread of influenza-negative influenza-like illness during the COVID-19 pandemic: Time series outlier analyses from 2015-2020.

11. Characteristics and Outcomes of US Patients Hospitalized With COVID-19.

12. Pediatric Pneumonia: Another Problem Plagued by Inequity in Health Care.

13. A cross-sectional analysis of diagnosis and management of chronic obstructive pulmonary disease in people living with HIV: Opportunities for improvement.

14. Community-Acquired Pneumonia and Risk of Cardiovascular Events in People Living With HIV.

15. Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study.

16. Immune imbalance and activation are associated with lower lung function in youth with perinatally acquired HIV.

17. Endothelial Activation, Innate Immune Activation, and Inflammation Are Associated With Postbronchodilator Airflow Limitation and Obstruction Among Adolescents Living With HIV.

18. Validation of the global lung initiative 2012 multi-ethnic spirometric reference equations in healthy urban Zimbabwean 7-13 year-old school children: a cross-sectional observational study.

19. Global Health-related Training Opportunities. A National Survey of Pulmonary and Critical Care Medicine Fellowship Programs.

20. Tuberculosis and other bacterial co-infection in Cambodia: a single center retrospective cross-sectional study.

21. Acute wheeze in the pediatric population: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data.

22. Adolescent age is an independent risk factor for abnormal spirometry among people living with HIV in Kenya.

23. Impact of HIV infection on α 1 -antitrypsin in the lung.

24. Markers of chronic obstructive pulmonary disease are associated with mortality in people living with HIV.

25. Risk Factors for Hypoxia and Tachypnea Among Adolescents With Vertically-acquired HIV in Nairobi.

26. Bronchiectasis and other chronic lung diseases in adolescents living with HIV.

27. A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV.

28. Latent Tuberculosis Infection Test Agreement in the National Health and Nutrition Examination Survey.

29. Global Health Education in Pulmonary and Critical Care Medicine Fellowships.

30. Non-infectious Pulmonary Diseases and HIV.

31. Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) Is Elevated in Bronchoalveolar Lavage Fluid of Patients with Acute Respiratory Distress Syndrome.

32. ATS Core Curriculum 2015: Part IV. Adult Critical Care Medicine.

33. Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans.

34. Increased risk of radiographic emphysema in HIV is associated with elevated soluble CD14 and nadir CD4.

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34 results on '"Attia EF"'

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