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Recreational hiking in the mountains is a common activity, whether for a single day or for several days in a row. We sought to measure blood pressure (BP) response during a 10-day trek at moderate-altitude elevation (6500&ndash, 13,000 feet) and observe for uncontrolled hypertension and/or adverse cardiovascular outcomes. A total of 1279 adult participants completed an observational study of resting BP during a 10-day trek in the Sangre de Cristo mountains. Following initial recruitment, participants were issued a trail data card to record BP measurements at day 0 (basecamp), day 3, day 6 and day 9. BP was measured using a sphygmomanometer and auscultation. Demographic data, height, weight, home altitude, daily water and sports drink intake, existence of pre-arrival hypertension and BP medication class were also recorded. We observed a rise in mean blood pressure for the cohort during all exposures to moderate altitudes. The increases were greatest for individuals with pre-existing hypertension and/or obesity. There were no observed life-threatening cardiovascular events for participants. We conclude that for individuals with a modestly controlled blood pressure of 160/95 mmHg, hiking at a moderate altitude is a safe activity.

Background Post-transplant weight gain affects 50–90% of kidney transplant recipients adversely affecting survival, quality of life, and risk for diabetes and cardiovascular disease. Diet modification and physical activity may help prevent post-transplant weight gain. Methods for effective implementation of these lifestyle modifications are needed. The objective of this study is to assess the feasibility and acceptability of a remotely delivered nutrition and physical activity intervention among kidney transplant recipients. Secondary aims were to estimate the effectiveness of the intervention in producing changes in physical activity, qualify of life, fruit and vegetable intake, and consumption of whole grains and water from baseline to 6 months. Methods A randomized controlled study for stable kidney transplant recipients between 6 and 12 months post-transplantation was conducted. Participants were randomly assigned 1:1 to a technology-based, lifestyle modification program (intervention) or to enhanced usual care (control). Results The first 10 kidney transplant recipients screened were eligible and randomized into the intervention and control groups with no significant between-group differences at baseline. Health coaching attendance (78%) and adherence to reporting healthy behaviors (86%) were high. All participants returned for final assessments. The weight in controls remained stable, while the intervention arm showed weight gain at 3 and 6 months. Improvements were found for physical activity, quality of life, and fruit and vegetable intake in both groups. All participants would recommend the program to other transplant recipients. Conclusions Our data suggest that a remotely delivered televideo nutrition and physical activity intervention is feasible and valued by patients. These findings will aid in the development of a larger, more prescriptive, randomized trial to address weight gain prevention. Trial registration Clinicaltrials.gov Identifier NCT03697317. Retrospectively registered on October 5, 2018.

OBJECTIVES: Kidney transplant recipients often experience weight gain in the first year after transplantation and this weight gain is associated with higher rates of cardiovascular disease, new-onset diabetes, metabolic syndrome and loss of graft function. The purpose of this study was to examine the characteristics of transplant recipients at our institution and describe post-transplant weight change. METHODS: Utilizing the institution's research data repository, we searched for adult kidney transplant patients from January 2014 through February 2019. Percent weight change at 6 and 12 months was calculated as a percentage of total body weight from time of transplant. Weight gain was defined as an increase of 5% or more while weight stable was classified as no weight change or less than 5% gain. Weight loss was defined as losing 5% or more of body weight from baseline. RESULTS: Of 598 cases, the sample was predominantly male (n = 361; 60%), married (n = 355; 59%) and white (n = 415; 69%). At transplant, mean age was 51.3 ± 13.5 years and mean weight was 85.26 ± 20.10 kg (males = 90.62 ± 20.73 kg; females = 77.53 ± 16.33 kg). At 6 months post-transplant, 87% of recipients (n = 518) had recorded weights. Of those individuals, 26% (n = 133) experienced weight gain (mean + 11.9%; median + 9.9%), gaining on average 8.9 ± 5.09 kg. Thirty one % (n = 163) lost weight (mean −10.3%; median - 8.8%), and 43% (n = 222) were weight stable. At 12 months post-transplant, 78.1% (n = 467) of patients had recorded weights. Of those individuals, 42% (n = 195) experienced weight gain (mean + 13%, median + 10%), 18% (n = 86) lost weight (mean −10.95%, median - 8.94%), and 40% (n = 185) maintained baseline weight. Those who gained weight during this period experienced a 10.16 ± 6.00 kg increase. CONCLUSIONS: Post-transplant weight gain is a critical issue among our institution's kidney transplant recipients with more than 40% gaining significant weight, placing them at risk for early mortality and decreased graft survival. Healthcare professionals should continue to educate and direct recipients to weight management programs to control the amount of weight gained following transplantation. Helping kidney transplant recipients prevent unnecessary weight gain is essential to their prolonged survival and quality of life. FUNDING SOURCES: None.

A four-year-old female spayed mongrel dog was presented in May 2015 with a two-year history of poorly controlled atopic dermatitis (AD) and increased pruritus over the last few months. Current medications included Apoquel, prednisone, diphenhydramine and cephalexin. A deep skin scrape revealed Demodex canis and Demodex cornei and superficial cytology revealed coccoid bacteria. Aerobic skin culture revealed meticillin-resistant Staphylococcus pseudintermedius (MRSP) and dermatophyte culture grew Microsporum canis . Therapy included discontinuation and taper of immunosuppressive medications, oral enrofloxacin and ivermectin and Malaseb shampoo. Complete resolution of demodicosis, dermatophytosis and MRSP was accomplished in four months. Long-term control of AD was established by using low-dose prednisone therapy with no relapse in infectious disease. This case illustrates the risk of development of multiple infectious diseases secondary to immunosuppression with multimodal drug therapy for treatment of AD, and it exemplifies the importance of performing in-house diagnostic testing.

33 Background: With growing numbers of childhood cancer survivors (CCS), having systems for survivorship care coordination is imperative. While studies have compared the comfort and knowledge between primary care and oncology physicians in providing CCS care, few have analyzed primary and subspecialty care rates. Referral trends can be informative for institutions developing systems of care. Correlative measures with referral needs may help institutions prioritize process development for patients. Methods: Retrospective chart reviews were completed on 117 adult CCS from Survivorship Transition Clinic (STC) between 2014-2017. Upon arrival, STC patient self-reports were recorded regarding existing PCP status. Patients with PCPs were enrolled in survivorship consultation care, those without enrolled in survivorship and PCP care. Referrals were tracked by electronic medical record. Two oncology providers performed blinded independent reviews treatment summaries and scored treatments using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Final scores were matched with data on subspecialty referral patterns. Results: Of 117 patients, 65 (57%) needed both PCP and survivorship care while 50 (43%) had established PCPs. ITR3 scores were low intensity (1 or2) for 54 patients and high intensity (3 or 4) for 63 patients. The low intensity group had 157 total referrals (3 per patient) compared to 391 total referrals (6 per patient) in the high intensity group. The top 5 subspecialty referrals (by patients referred) were psychological services (46), dermatology (44), fertility (29), hematology / oncology / BMT (22), cardiology (20). Conclusions: Our care coordination trends suggest many CCS do not have established PCPs despite their complex care needs. Not surprisingly, higher intensity treatment correlates with higher subspecialty care needs. Psychological care remains the most prevalent need in our patient population. [Table: see text]