A vaccine against cytomegalovirus: how close are we?

The pursuit of a vaccine against the human cytomegalovirus (HCMV) has been ongoing for more than 50 years. HCMV is the leading infectious cause of birth defects, including damage to the brain, and is a common cause of complications in organ transplantation. The complex biology of HCMV has made vaccine development difficult, but a recent meeting sponsored by the National Institute of Allergy and Infectious Diseases in September of 2023 brought together experts from academia, industry, and federal agencies to discuss progress in the field.

Seasonal effect of PM exposure in patients with COPD: a multicentre panel study.

: Exposure to particulate matter <2.5 μm (PM) is linked to chronic obstructive pulmonary disease (COPD), but most studies lack individual PM measurements. Seasonal variation and their impact on clinical outcomes remain understudied.

Common Variable Immunodeficiency Associated With Noninfectious Pulmonary Complications and Its Treatment: Beyond Immunoglobulin Therapy.

Common variable immunodeficiency (CVID) is a type of primary immunodeficiency that presents as a heterogenous disorder characterized by hypogammaglobinemia, poor response to vaccines, recurrent sinopulmonary infections, and can have noninfectious systemic manifestations. We performed a single-center, retrospective, observational study of five patients with noninfectious complications of CVID. All patients had CVID as defined by the European Society of Immunodeficiencies criteria and had received intravenous immunoglobulin therapy.

Monoallelic expression can govern penetrance of inborn errors of immunity.

Inborn errors of immunity (IEIs) are genetic disorders that underlie susceptibility to infection, autoimmunity, autoinflammation, allergy and/or malignancy. Incomplete penetrance is common among IEIs despite their monogenic basis. Here we investigate the contribution of autosomal random monoallelic expression (aRMAE), a somatic commitment to the expression of one allele, to phenotypic variability observed in families with IEIs.

Outcomes of maxillomandibular advancement (MMA) by dentofacial class: A systematic review and meta-analysis.

The aim of this paper was to systematically review and compare the Apnoea-Hypopnoea Index (AHI), Lowest O Saturation (LSAT), Oxygen Desaturation Index (ODI), Epworth Sleep Scale (ESS), and Body Mass Index (BMI) between dentofacial (skeletal) classes I, II, and III before and after maxillomandibular advancement (MMA) for Obstructive Sleep Apnoea (OSA). The PubMed, Scopus, and CINAHL databases were searched from inception to 23 November 2022. Two reviewers screened for articles that reported occlusion/malocclusion class type as I, II, or III, and reported preoperative and postoperative AHI, LSAT, ODI, ESS, and/or BMI.

Vaccination with different group 2 influenza subtypes alters epitope targeting and breadth of hemagglutinin stem-specific human B cells.

The conserved influenza hemagglutinin stem, which is a target of cross-neutralizing antibodies, is now used in vaccine strategies focused on protecting against influenza pandemics. Antibody responses to group 1 stem have been extensively characterized, but little is known about group 2. Here, we characterized the stem-specific repertoire of individuals vaccinated with one of three group 2 influenza subtypes (H3, H7, or H10).

Penicillin allergy management strategies relevant for clinical practice - a narrative review.

Penicillin allergy is the most commonly reported drug allergy, with prevalence rates ranging from 6% to 31% across various populations and geographic areas. The penicillin allergy label is linked to higher mortality and morbidity rates, extended hospital stays, increased readmission rates, and a greater reliance on second-line antibiotics. Research indicates that nearly 99% of those labeled as penicillin-allergic can tolerate the drug.

Subsequent pregnancies in the IMPAACT 2010/VESTED Trial: high rate of adverse outcomes in women living with HIV.

Introduction: Women with HIV (WHIV) have higher risks of adverse pregnancy outcomes, particularly in the absence of antiretroviral treatment(ART), and timing of ART may impact risk.

Methods: In IMPAACT 2010 (VESTED), 643 pregnant WHIV in 9 countries were randomized 1:1:1 to initiate ART: dolutegravir (DTG)+emtricitabine(FTC)/tenofovir alafenamide(TAF); DTG+FTC/tenofovir disoproxil fumarate (TDF) or efavirenz (EFV)/FTC/TDF. We describe adverse pregnancy outcomes in women with a subsequent pregnancy during 50 weeks of postpartum follow-up: spontaneous abortion (<20 weeks), stillbirth (≥20 weeks), preterm delivery (<37 weeks) and small-for-gestational-age (SGA).

Interventions to improve quality of life and knowledge in Hypersensitivity Pneumonitis, a survey of clinician practices and perspectives.

Background: Behavioral and educational interventions are promising approaches to improve health-related quality of life (HRQOL), however few have been studied in Hypersensitivity Pneumonitis (HP) or other interstitial lung diseases (ILD). The objective of this study was to gather ILD clinicians' current practices and perspectives on the management of HRQOL and disease-specific education in HP, knowledge and attitudes about behavioral and educational interventions, and identify potential clinician perceived barriers to address during intervention development.

Methods: An electronic survey was administered to ILD clinicians across the United States.

Patient Insights on Integrating Sleep Apnea Testing into Routine Stroke and TIA Care.

AHA/ASA guidelines recommend patients with ischemic stroke or transient ischemic attack (TIA) be considered for obstructive sleep apnea (OSA) evaluation, given the high prevalence of OSA and improved outcomes for cerebrovascular disease when OSA is treated. However, OSA testing has not been incorporated into routine cerebrovascular management. We interviewed 30 patients hospitalized for acute stroke/TIA at six Veterans Affairs facilities participating in a stepped-wedge implementation trial to improve timely OSA testing after stroke/TIA.

Idiopathic non-mast cell angioedema: Treatment insights from global experts.

Idiopathic non-mast cell angioedema (INMA) is a rare disease typified by recurrent attacks of cutaneous and subcutaneous swelling. Every attack carries the potential for severe morbidity and, in the case of laryngeal involvement, mortality. Whereas therapies approved for hereditary angioedema (HAE) have been used in the care of patients with INMA, little is known with regard to their efficacy for the treatment of this disease.

Appraisal of the evidence linking hereditary α-tryptasemia with mast cell disorders, hypermobility and dysautonomia.

Since its first description more than a decade ago, our understanding of the clinical impact of hereditary alpha-tryptasemia has continued to evolve. First considered to be a genetic disorder with a subset of patients having a syndromic presentation composed of connective tissue abnormalities, symptoms of autonomic dysfunction, and findings of mast cell activation, we now know that hereditary alpha-tryptasemia is a common genetic trait and modifier of mast cell-mediated reactions. More recent studies have shown some previously held associations with congenital hypermobility and postural orthostatic tachycardia syndrome (POTS) to be lacking, and illuminated previously unappreciated associations with clonal and nonclonal mast cell disorders.

Clinical remission in patients with severe eosinophilic asthma treated with mepolizumab: A analysis of RELIght study.

Remission of asthma can occur as part of the natural history of the disease; however, the use of biologics can result in disease remission in some patients. In this post hoc analysis of the RELIght study, we aimed to evaluate clinical remission in real life among patients treated with mepolizumab, to detect possible differences between "remitters" and "nonremitters," and to evaluate possible predictors of remission. Clinical remission was defined as the absence of asthma exacerbations, discontinuation of oral corticosteroids (OCS), achievement of asthma control (Asthma Control Test [ACT] ≥ 20), and stable or improved lung function.

Efficacy of parenteral bronchodilators on ventilatory outcomes in pediatric critical asthma: a national cohort study.

To evaluate the association of parenteral epinephrine and terbutaline use on ventilatory support in children admitted to the intensive care unit (ICU) with critical asthma in the United States. Data were obtained from the Pediatric Health Information System data base for children ages 2 to 18 years admitted to the ICU with a diagnosis of asthma exacerbation from January 1, 2016, to December 31, 2023. The primary outcomes included noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV) use after receipt of terbutaline and/or epinephrine.

Health disparities investigated in a primary care penicillin allergy removal pathway.

Unconfirmed penicillin allergies over time lead to poor health outcomes and increased health-care cost. Health disparities (HD) can create barriers in optimizing penicillin allergy care. The objective was to characterize HDs in our primary care-led amoxicillin challenge (PLAC) delabeling pathway within a universal coverage health care system.

Molecular dependencies and genomic consequences of a global DNA damage tolerance defect.

Background: DNA damage tolerance (DDT) enables replication to continue in the presence of fork stalling lesions. In mammalian cells, DDT is regulated by two independent pathways, controlled by the polymerase REV1 and ubiquitinated PCNA, respectively.

Results: To determine the molecular and genomic impact of a global DDT defect, we studied Pcna;Rev1 compound mutants in mouse cells.

Non-invasive management of severe subcutaneous emphysema in a pediatric asthma exacerbation: a case report and review.

Background: Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE) are rare, severe, and potentially life-threatening complications associated with asthma exacerbation. Most of these conditions are benign and self-limiting. However, the overlapping symptoms between asthma exacerbation and pneumomediastinum (PM) may delay diagnosis.

Bilateral internal superior laryngeal nerve injections for unexplained chronic cough.

Objective: Internal Superior laryngeal nerve (iSLN) injections with steroids and anesthetic for Unexplained Chronic Cough (UCC) was initially described as a unilateral injection. This study reports the safety profile and patient-reported outcomes of concurrent bilateral iSLN injections for UCC.

Study Design: Retrospective chart review.

What is the robustness of randomized controlled trials supporting rhinosinusitis guidelines?

Purpose: To determine the robustness of randomized controlled trials (RCTs) supporting the current rhinosinusitis guideline; International Consensus Statement on Allergy and Rhinology: rhinosinusitis (ICAR-RS).

Materials & Methods: RCTs referenced by ICAR-RS with primary dichotomous outcomes were analyzed. The Fragility Index (FI) was calculated for trials with statistically significant findings.

miRNAome-metabolome wide association study reveals effects of miRNA regulation in eosinophilia and airflow obstruction in childhood asthma.

Background: There are important inter-relationships between miRNAs and metabolites: alterations in miRNA expression can be induced by various metabolic stimuli, and miRNAs play a regulatory role in numerous cellular processes, impacting metabolism. While both specific miRNAs and metabolites have been identified for their role in childhood asthma, there has been no global assessment of the combined effect of miRNAs and the metabolome in childhood asthma.

Methods: We performed miRNAome-metabolome-wide association studies ('miR-metabo-WAS') in two childhood cohorts of asthma to evaluate the contemporaneous and persistent miRNA-metabolite associations: 1) Genetic Epidemiology of Asthma in Costa Rica Study (GACRS) (N = 1121); 2) the Childhood Asthma Management Program (CAMP) (N = 312 and N = 454).

Type 2 biomarkers in olfactory cleft mucus correlate with SNOT-22 in chronic rhinosinusitis independent of nasal polyp status.

Background: Quantitative mucus cytokine analysis to examine the sinonasal microenvironment may bridge the gap between patient-reported outcome measures (PROMs) and empirical measures of inflammation in patients with chronic rhinosinusitis (CRS).

Objective: Investigate the correlation between mucus cytokine levels and Sino-Nasal Outcome Test (SNOT-22) scores, including individual subdomains.

Methods: Patients with CRS were prospectively recruited between 2016 and 2021 into a multi-institutional observational study.