A number of studies have investigated the natural history of asthma in pregnancy. Most of the data suggests that the course of asthma for a given patient is unpredictable. Turner, et al.7 summarize the data from all of the English-language literature of studies on the effect of pregnancy on astha. Of 1054 cases examined, 49% of the asthma conditions remained unchanged, 22% got worst and 29% became better.7 Theophylline has been used safely during pregnancy. A review of the literature by O'Brien, showed that no teratogenic effects were associated with the use of theophylline in 117 cases and aminophylline in 76 cases examined.39,40 Blood concentration in newborns have been found to be similar to concentrations in the mothers.41,42,43 Problems developed because theophylline clearance may be altered during pregnancy and necessitate dosage adjustments and careful drug level monitoring.44 RATIONALE FOR STUDY Campbell, et al.45 developed a caffeine urinary metabolic ratio, in which they were able to demonstrate a correlation between changes in metabolic rations and clearance. The change in the metabolic ration explained the alteration in clearance and determined the specific Cytochrome P-450 system involved. Various physiologic changes occurring during pregnancy can cause changes in drug disposition. Pharmacokinetic parameters that need to be considered are plasma protein binding capacity, absorption, drug metabolizing enzyme activity, renal excretory function and volume of distribution.44,46,47 This study was developed to determine if changes in theophylline disposition during pregnancy were due to changes in drug metabolizing enzyme activity. A urinary test was designed to investigate the ratios of unchanged theophylline and theophylline metabolites to monitor changes in the various Cytochrome P-450 isoenzyme systems. Changes in the ratios could provide a noninvasive procedure to assess the effect of modulating agents or conditions (such as pregnancy) on theophylline metabolizing enzyme activity.

Thesis advisor: Samuel Richardson / HbA1c levels are the most frequently used test for diagnosis and prognosis of diabetes mellitus. Recent studies have shown the biases this test has in particular cohorts, that was not noted when it was originally accepted by the American Diabetes Association in 2008. This study examined how these biases affect HbA1c’s ability as a predictor for complications that arise due to diabetes in specific cohorts, those of ethnicity, age, weight, and other patient attributes, compared to other established diabetes prognosis tests. We discovered that both glucose and HbA1c share similar biases as predictors for particular cohorts (the high glucose, high BMI, Asian, African, and Hispanic descent cohorts), HbA1c works better as a predictor when it is combined with the results of a glucose test and more characteristics of the patient compared to a HbA1c test alone with fewer variables, and glucose and HbA1c are better predictors for different diseases, respectively, that may arise due to diabetes mellitus. / Thesis (BA) — Boston College, 2020. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Economics.

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Hepatitis C virus (HCV) infection is a chronic blood-borne disease that affects > 4,000,000 individuals in the United States. The majority of individuals with HVC infection acquire a chronic hepatitis that predisposes them to the complications of cirrhosis and hepatoma. Chronic HCV infection is, however, associated with multiple extrahepatic manifestations as well, including recently recognized effects on the lung. These include primary effects on lung function, as well as secondary effects in the settings of progressive liver disease and drug treatment for HCV. In this article, we discuss the emerging clinical data that support a role for HCV infection in lung disease, describe the multiple pulmonary manifestations of this viral infection, and outline the therapies available for specific pulmonary complications of chronic HCV infection.

Obesity in children and adolescents has increased exponentially around the world. Furthermore, the COVID-19 pandemic has led to a higher pediatric obesity rate. The excess adipose tissue generates a dysregulation of adiponectin, ghrelin, and leptin, among others. Metabolic alterations can develop cardiovascular disease, dyslipidemias, arterial hypertension, type 2 diabetes mellitus, nonalcoholic fatty liver disease, sleep disorders, and higher risk of COVID-19 severity. Obesity has different therapeutic approaches such as behavioral weight loss programs, pharmacologic treatments, and surgical procedures. Therefore, timely diagnosis and treatment are important to decrease the mortality in obesity among pediatric population.

Biological disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of Rheumatoid Arthritis, particularly TNF-α inhibitors, have been shown to improve patient outcome by slowing or halting radiographic damage. However, similar to most immunemodulators, there is an increased risk of infections co-incident with Tumour necrosis factor (TNF)-α inhibitor use, particularly the risk of activated latent tuberculosis infection (LTBI). Therefore, local and international guidelines recommend pre-screening for tuberculosis (TB) prior to the initiation of TNF-α therapy in rheumatoid arthritis (RA) patients. Also of critical importance in South Africa is the need for clinicians to be aware of environmental risk factors such as TB being highly endemic. Thus, a qualitative analysis was performed to investigate rheumatologists’ perceptions of TB co-incident with TNF-α inhibitors. Method: Physicians (n=18) practising rheumatology in the private and public healthcare sectors in Gauteng were interviewed to obtain their perceptions and attitudes related to TB co-incident with TNF-α inhibitor use. Interviews were audio-recorded and the transcripts analysed using thematic content analysis. Results: The determinants of health equity: Affordability, accessibility and availability of medicines (specifically TNF-α inhibitors) was reported to be different for the public care versus the private care patient. The high cost of TNF-α inhibitors warranted funding predominantly by the private medical schemes. A higher occurrence of latent TB infection was reported by physicians practising in the public or combined practice compared to the occurrence of LTBI in the private sector (21.4%versus 1.5%). The majority of study participants advocated pre-screening of TB, prior to the initiation of TNF-α inhibitors, in RA. However, it was suggested that because of the high occurrence of LTBI in the public sector, Isoniazid preventative therapy (IPT) should be compulsory, irrespective of the patient’s TB status, for the duration of TNF-α therapy. Most study participants supported local South African Rheumatism and Arthritis Association (SARAA) guideline recommendation to re-screen for TB by chest x-ray (CXR), every 6 months. However, the value of re-screening using diagnostic tools, purified protein derivative (PPD) skin test or interferon-gamma release assays (IGRAs) was queried due to the possibility of false readings. The occurrence of associated active TB in RA patients on TNF-α inhibitors was reported to be 0.07% in the private or combined practice versus 3.00% in the public sector. Forty percent of TB cases were reported to be extra-pulmonary. Despite active vigilance, some physicians reported that active TB month occurred months after the cessation of TNF-α inhibitor therapy. [Similar findings were observed from the British Society for Rheumatology Biologics Register (BSRBR)]. The majority of patients that developed TB co-incident with TNF-α inhibitors were treated successfully with TB chemotherapy. Only 1 of 12 patients died of extra-pulmonary TB, following compassionate use of infliximab in public care. Conclusion: Physicians practising rheumatology in Gauteng were of the opinion that there is a TB risk associated with the use of TNF-α inhibitors for the management of rheumatoid arthritis, as South Africa is a TB endemic country. Most acknowledged that these biological DMARDs were efficacious in slowing or halting radiographic progression in rheumatoid arthritis, but emphasised the need to take steps to prevent TB reactivation in the immuno - compromised RA patients and to remain overtly vigilant for active TB. In clinical practice, physicians mentioned that the monitoring and management of TB associated with TNF-α inhibitors appears to follow the socio-economic status of the RA patient and that distinct recommendations should be made for the public healthcare as well as the private healthcare sectors. Different opinions emanated from different physicians relating to the adequacy of local SARAA guidelines for the prevention of TB associated with TNF-α inhibitors. Some physicians mentioned that local guidelines were sufficient, whilst other physicians mentioned that the diagnostic tools were inadequate in the South African setting and that additional precautions should be taken in the form of IPT for the full duration of TNF-α therapy for all candidates, irrespective of TB status determined during pre-screening. As the science of biological DMARDs evolves with the rapid development of new medicinal therapies, physicians showed a preference to consider alternative non TNF-α biological DMARDs that had a lower risk of associated TB, specifically in high-risk RA patients. Physicians’ overall perception of the management of RA with TNF-α inhibitor therapy was that the risk-benefit assessment of these interventions, as well as patient preference and economic considerations should be taken into account.

Life Cycle and Transmission Toxoplasmosis is a disease produced by infection with the protozoan Toxoplasma gondii, an intracellular parasite which was first isolated from the North African rodent, Cyterodactylus gondii, in 1908. Since that time, this organism has been shown to have worldwide distribution and is probably the most common parasite of mammals, birds and reptiles (Remington., 1960). In 1965, Hutchinson described toxoplasma oocysts in cat feces, but it was not until 1970 that the life cycle of the organism was disclosed. The felidae represent the primary host for toxoplasma and are the only animals known to harbor the intestinal form (Frenkel., 1973). The oocysts are shed by the cat within 3 to 5 days after infection and sporulate within the feces in another 3 to 4 days. This oocyst is fairly resistant to drying and disinfectants and may remain infective in fairly moist soil for up to several years (Jacobs.. 1974). (Figure 1)

Indiana University-Purdue University Indianapolis (IUPUI) / Cancer treatment-related fatigue (CTRF) is recognized as a prevalent and bothersome symptom for patients with cancer. In a model of the CTRF experience, CTRF representation, or the beliefs, thoughts and emotions surrounding the experience of CTRF, is believed to mediate the relationship between CTRF intensity and CTRF distress. To date, there is no reported measure of CTRF representation. The purpose of this descriptive, cross-sectional study guided by Leventhal’s Common Sense Model of Self-Regulation was to evaluate an instrument designed to measure CTRF representation, the CTRF Representation scale (CTRFRep), based on an existing measure, the Illness Perception Questionnaire (IPQ-R). The study included 47 patients (mean age=57.7 years) receiving radiation therapy for cancer interviewed one month post-treatment. 77% of patients had fatigue during treatment. Three content experts and one theory expert assessed content validity of the CTRFRep. The content experts included three behavioral oncology nurse researchers whose focus is on symptom management and/or fatigue. The theory expert was a nurse researcher who is an expert in the area of self-regulation theory. As tested, the CTRFRep consisted of 105 items in 10 subscales addressing beliefs about the Identity, Timeline (Acute vs. Chronic/Cyclical), Consequences (positive/negative), Cause, Control (Treatment/Personal), Symptom Coherence, and Emotional Representation of CTRF. When evaluating psychometrics, the Identity and Cause subscales are analyzed independent of the other subscales. For the Identity subscale, symptoms most reported as related to CTRF were lack of energy, loss of strength, and feeling blue. For the Cause subscale, the most common beliefs regarding causes of CTRF were cancer treatment(s), having cancer, and stress or worry. Results indicate adequate reliability in six of eight remaining subscales (α>=0.70); the item N in those subscales was reduced from 56 to 34. To address construct validity, logistic regression assessed whether CTRFRep mediated the relationship between CTRF intensity and CTRF distress. After controlling for negative affect, the Identity and Consequences subscales were significant mediators – the Acute vs. Chronic Timeline and Emotional Representation scales were partial mediators – of the relationship between CTRF intensity on CTRF distress. These findings indicate fatigue is a problem for people undergoing treatment for cancer, and the CTRFRep may be a reliable and valid measure of CTRF representation for patients undergoing radiation treatment for cancer. Small sample size prevented successful factor analysis of the CTRFRep. Further research of the CTRFRep is warranted.

Splenic injury is an uncommon complication following a colonoscopy procedure. Splenic laceration typically presents with post-procedural abdominal pain. We present a case of non-specific shoulder pain, following an uneventful routine colonoscopy and highlight the importance of maintaining a high degree of clinical suspicion for the general gastroenterologist.