Notes

Increasing the leptospirosis disease burden assessment by which includes ambulatory individuals via outpatient sections: a cross-sectional study.
Diabetes is associated with worse asthma morbidity. Metformin, which treats diabetes, may have a role among patients with asthma and glycemic dysfunction.

To determine the association between metformin use and asthma exacerbations among patients with diabetes.

We queried the Johns Hopkins electronic health record from April 1, 2013, to May 31, 2018. Adults with asthma and diabetes were followed from first hemoglobin A1c (HbA1c) test to an asthma-related systemic corticosteroid prescription, emergency department (ED) visit, or hospitalization. read more Multivariable Cox models estimated time to each outcome associated with metformin use, modeled as either time-invariant (status at HbA1c testing) or time-dependent (based on fill data). Mediation of results by HbA1c was assessed. Sensitivity analysis was performed by propensity score matching.

The cohort comprised 1749 adults with asthma and diabetes. Metformin use at entry was associated with a lower hazard of asthma-related ED visits (adjusted hazard ratio [aHR], 0.40; 95% CI, 0.22-0.75) but not steroid prescription (aHR, 0.89; 95% CI, 0.70-1.13) or hospitalization (aHR, 0.38; 95% CI, 0.13-1.12). HbA1c did not mediate the association with ED visits. With metformin exposure modeled as time-dependent, metformin use was additionally associated with lower hazard of asthma-related hospitalization (aHR, 0.30; 95% CI, 0.09-0.93). Results were consistent within a subcohort of 698 metformin users matched 11 to nonusers by propensity score.

Metformin use, independent of glycemic control and obesity, was associated with lower hazard of asthma-related ED visits and hospitalizations. Metformin may have benefit in patients with asthma and glycemic dysfunction.
Metformin use, independent of glycemic control and obesity, was associated with lower hazard of asthma-related ED visits and hospitalizations. Metformin may have benefit in patients with asthma and glycemic dysfunction.
There is no current consensus on assigning severity to food-induced allergic reactions, for example, to assess the efficacy of allergen immunotherapy. Existing severity scores lack the capability to discriminate between non-anaphylaxis reactions of different severities. Attempts are ongoing to develop a more discriminatory score, which should ideally be data-driven and validated in multiple cohorts.

To undertake an exercise using best-worst scaling (BWS) to define a potential gold standard against which severity scoring of food-induced allergic reactions can be refined.

We undertook a global survey to better understand how health care professionals rate the severity of food-induced allergic reactions, using BWS methodology. Respondents were given a number of patient case vignettes describing real-world allergic reactions and asked to select the pair that, in their opinion, reflected the maximum difference in severity. Responses were then modeled and a preference score (representing severity) determined d that can be used to guide and validate the development of improved grading systems to score food-induced allergic symptoms and highlight areas for education where there is the potential to miscategorize severity.
These data provide a methodology free of user scale bias to help define a potential, consensus-driven gold standard that can be used to guide and validate the development of improved grading systems to score food-induced allergic symptoms and highlight areas for education where there is the potential to miscategorize severity.
Coronavirus disease-2019 (COVID-19) ranges from asymptomatic to severe. Several comorbidities are associated with worse clinical outcomes. Antibiotic use is common in COVID-19 and penicillin (PCN) allergy can affect antibiotic choice and may influence COVID-19 outcomes.

To investigate the impact of PCN allergy label on COVID-19 outcomes.

For this retrospective, cohort study, a Web-based tool for population cohort research, TriNetX, was used to identify adult COVID-19 patients with and without PCN allergy label. The two cohorts were matched using 11 propensity score matching for baseline demographics and conditions associated with risk for severe COVID-19. The 30-day risks for hospitalization, acute respiratory failure, intensive care unit requirement, mechanical ventilation requirement, and mortality were then compared between groups. Because bacterial infection can drive alternative antibiotic regimens, additional analyses focused on patients without bacterial infection.

After propensity score matching, each cohort consisted of 13,183 patients. COVID-19 patients with PCN allergy had higher risks for hospitalization (risk ratio [RR]= 1.46; 95% confidence interval [CI], 1.41-1.52) acute respiratory failure (RR= 1.25; 95% CI, 1.19-1.31), intensive care unit requirement (RR= 1.20; 95% CI, 1.08-1.34), and mechanical ventilation (RR= 1.17; 95% CI 1.03-1.32) compared with patients without PCN allergy; however, there was no mortality difference (RR= 1.09; 95% CI, 0.96-1.23). Although the bacterial infection risk was higher in PCN allergic COVID-19 patients, exclusion of patients with bacterial infections yielded similar results.

Penicillin allergic patients have higher risk for worse COVID-19 outcomes and should be considered for risk mitigation strategies.
Penicillin allergic patients have higher risk for worse COVID-19 outcomes and should be considered for risk mitigation strategies.
Eosinophilic esophagitis (EoE) is a chronic allergen-mediated disease of the esophagus. Pharmacologic treatment has largely relied on repurposing corticosteroids. Ciclesonide (CIC) is a corticosteroid for the treatment of asthma with biochemical properties that improve topical potency.

To determine whether CIC decreased clinicopathological features of EoE.

We performed a retrospective cohort study of patients with EoE treated with CIC at a pediatric hospital from 2010 to 2019. Data were extracted from the electronic health record. Patients who were prescribed CIC with pre- and post-CIC endoscopic and histological data available were included for analysis.

A total of 281 patients were treated with CIC and 81 met criteria for inclusion. Use of CIC was associated with reduced symptoms including dysphagia (P < .001), abdominal pain (P < .001), vomiting (P= .01), heartburn (P= .02), and behavior changes (P= .02). Average composite endoscopic reference scores decreased from 2.54 to 1.37 (P < .001), with improvement in exudates, edema, and furrows (all P < .
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