68 (95% CI, 1.43 to 5.04) and 4.18 (CI, 2.12 to 8.26), respectively. This risk was most striking among those aged 60 years or younger and men. Increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics was not detected.

Deaths occurring outside a health care setting and not captured in membership files may have been missed.

Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations. Our capitated system with more equalized health care access may explain the absence of effect of racial/ethnic and socioeconomic disparities on death. Our data highlight the leading role of severe obesity over correlated risk factors, providing a target for early intervention.

Roche-Genentech.

Roche-Genentech.This prospective cohort study aimed to evaluate the long-term effects of virtual simulation on nursing education by measuring undergraduate nursing students’ mental health literacy. Students’ beliefs about the helpfulness of specific interventions for managing depression and schizophrenia were compared between the simulation cohort (n = 149) and the non-simulation cohort (n = 150) from a school of nursing in the U.S. Students in the simulation cohort showed significant increase in knowledge and acceptance of available treatment options for managing depression and schizophrenia over a one-year period. The finding supports the use of virtual simulation in undergraduate mental health nursing education with active faculty engagement.

To describe the presentation and management of atypical subretinal lesions following initiation of antitubercular therapy for a tubercular choroidal granuloma.

An 18-year-old female was diagnosed with choroidal granuloma and shallow exudative retinal detachment in the left eye. Biopsy from a cervical lymph node was positive for tuberculosis. She was treated with antitubercular therapy (ATT) and oral steroids. After one week of therapy exudative detachment increased markedly and discrete yellowish-white subretinal lesions appeared first in the inferior periphery, then temporally and later involved the macula leading to a drop in visual acuity. A diagnosis of paradoxical worsening was considered and she was managed with a higher dose of oral corticosteroids, intravitreal methotrexate and intravitreal ranibizumab. The granuloma healed and the subretinal lesions as well as exudative detachment gradually resolved with improvement in visual acuity.

Subretinal yellow-white lesions may develop as a paradoxical response to ATT.

Subretinal yellow-white lesions may develop as a paradoxical response to ATT.We report a rare case of bilateral tuberculous uveitis associated with tuberculin skin testing (TST) in an otherwise healthy junior high school student. A 12-year-old boy presented with severely decreased vision in both eyes and a history of an intradermal PPD (purified protein derivative) skin test 12 days earlier. The best-corrected visual acuity (BCVA) was 20/1000 in both eyes (OU). Ocular examination showed multifocal grayish-yellow choroidal tubercles. Laboratory examinations, including T-SPOT.TB, revealed no abnormal findings. He was diagnosed with tuberculous uveitis. Combined corticosteriod and anti-tuberculosis therapy (ATT) was given. The BCVA improved to 20/25, and the choroidal tubercles faded away. Our case suggests that TST may induce bilateral uveitis in rare cases.

The biological effect of phototherapy, which involves using visible light for disease treatment, has attracted recent attention, especially in dermatological practice. Light-emitting diode (LED) irradiation increases dermal collagen level and reduces inflammation. It has been suggested that thermal therapy and LED irradiation can modulate inflammatory processes. However, little is known about the molecular mechanism of the anti-inflammatory effects of thermal therapy and LED irradiation.

This study was to determine the anti-inflammatory effect of thermal therapy combined with LED irradiation on trimellitic anhydride (TMA)-induced acute contact hypersensitivity (CHS) mouse model.

Twenty-four BALB/c mice were randomly divided into the following groups Vehicle group, TMA group, TMA + alternating thermal therapy group (Alternating group), and TMA + alternating + LED group (LED group). Ear swelling was measured based on the thickness of ear before and after each TMA challenge. Vascular permeability was evaluated by the extravasation of Evans blue dye. Serum IgE level, Th1/Th2/Th17 cytokines, and related transcription factors were measured using ELISA kits, and histological examination was illustrated in ear tissue.

The LED group showed reduction in ear swelling response, vascular permeability, serum IgE levels, Th2/Th17 cytokine levels, and inflammatory cell infiltration. Moreover, the LED group showed increased Th1 cytokine levels.

These results indicate that thermal therapy combined with LED irradiation alleviated TMA-induced acute CHS in the mouse model. Thermal therapy and phototherapy should be considered as a novel therapeutic tool for the treatment of skin inflammation.

These results indicate that thermal therapy combined with LED irradiation alleviated TMA-induced acute CHS in the mouse model. Thermal therapy and phototherapy should be considered as a novel therapeutic tool for the treatment of skin inflammation.

The increasing number of elderly psoriatic patients presents a challenge for dermatologists. Biologicals and small-molecule inhibitors in the general population have demonstrated a sufficient efficacy and safety profile; yet, studies about their use in the geriatric population are lacking. In this study, we evaluated the efficacy and safety of biological and apremilast among psoriatic patients ≥65 years old.

Clinical records of patients over 65 years old receiving biological drugs or apremilast were retrospectively reviewed. Efficacy was evaluated using Psoriasis Area and Severity Index (PASI) score at treatment onset and weeks 12, 24, 52 and 3 years. Adverse events were also recorded.

A total of 154 patients with a mean age of 70.7 ± 6.3 years-old were included in our study. Secukinumab, ustekinumab and brodalumab showed fast-acting results, while the sustained efficacy of secukinumab, ustekinumab, infliximab, adalimumab and brodalumab was also notable. Overall, 30 out of 154 (19.5%) patients reported side effects. Lower respiratory system infections (

 = 6; 3.9%) and hepatic enzyme elevation (

 = 6; 3.9%) were the most frequently observed events.

Biologicals and apremilast demonstrate adequate efficacy in elderly psoriatic patients. Incidence and severity of reported adverse events were similar to those reported among patients of younger age in relevant clinical studies.

Biologicals and apremilast demonstrate adequate efficacy in elderly psoriatic patients. Incidence and severity of reported adverse events were similar to those reported among patients of younger age in relevant clinical studies.Vitamin D deficiency is associated with a range of chronic diseases, including childhood obesity. Prevalence of vitamin D deficiency in obese children and adolescents ranges from 6.5% to 57%. This cross-sectional study included 92 obese patients with body mass index z-score >2 and 39 subjects in the control group. Anthropometric and laboratory patient assessment were performed, including the fasting 25-hydroxyvitamin D (25(OH)D). Adherence to the Mediterranean diet was assessed by Mediterranean Diet Quality Index for children and adolescents (KIDMED index), while physical activity was evaluated by Physical Activity Questionnaire (PAQ). Serum levels of 25(OH)D were significantly lower in obese subjects compared to the control group (52.0 ± 17.93 vs. 64.09 ± 25.82 nmol/L, P = .003). The subgroup of obese patients with metabolic syndrome (MS) had significantly lower levels of serum vitamin D when compared to the subgroup of obese patients without MS and the control group (46.99 ± 17.11 vs. 54.58 ± 17.93 vs. 64.09 ± 25.82 nmol/L, P = .003). Obese patients with MS had lower PAQ score when compared to obese without MS and the control group (2.32 ± 0.55 vs. 2.49 ± 0.67 vs. 2.85 ± 0.63 nmol/L, P = .002), while no significant differences were observed in the KIDMED index (4.23 ± 1.81 vs. 4.21 ± 2.13 vs. 4.87 ± 2.29, P = .251), respectively. PAQ score was in positive correlation with serum levels of 25(OH)D (r = 0.305, P  less then  .001). This study demonstrated that obese children and adolescents have significantly lower values of serum 25(OH)D. The positive correlation between vitamin D and PAQ score points to the importance of physical activity in the prevention of further cardiovascular complications and MS.There is widespread agreement that medical education should include multi-source, multi-method, and multi-purpose forms of assessment and thus should move towards cohesive systems of assessment. One possibility that fits comfortably with a system of assessment framework is to organize assessments around a competency based medical education model. However conceptually appealing a competency based medical education model is, discussions are sparse regarding the details of determining competence (or the pass/fail point) within each competency. In an effort to make discussions more concrete, we put forth three key issues relevant to implementation of competency-based assessment (1) each competency is measured with multiple assessments, (2) not all assessments produce a score for a competency as a good portion of assessment in medical school is narrative, and (3) competence decisions re-occur as assessments cumulate. We agree there are a host of other issues to consider, but think the practical action-oriented issues we set forth will be helpful in putting form into what is now largely abstract discussions.National and international guidelines recommend droplet/airborne transmission and contact precautions for those caring for coronavirus disease 2019 (COVID-19) patients in ambulatory and acute care settings. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, an acute respiratory infectious agent, is primarily transmitted between people through respiratory droplets and contact routes. A recognized key to transmission of COVID-19, and droplet infections generally, is the dispersion of bioaerosols from the patient. Increased risk of transmission has been associated with aerosol generating procedures that include endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, noninvasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation. The knowledge that COVID-19 subjects can be asymptomatic and still shed virus, producing infectious droplets during breathing, suggests that health care workers (HCWs) should assume every patient is potentially infectious during this pandemic. Taking actions to reduce risk of transmission to HCWs is, therefore, a vital consideration for safe delivery of all medical aerosols. Guidelines for use of personal protective equipment (glove, gowns, masks, shield, and/or powered air purifying respiratory) during high-risk procedures are essential and should be considered for use with lower risk procedures such as administration of uncontaminated medical aerosols. Bioaerosols generated by infected patients are a major source of transmission for SARS CoV-2, and other infectious agents. In contrast, therapeutic aerosols do not add to the risk of disease transmission unless contaminated by patients or HCWs.