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The 2022 global monkeypox (MPX) outbreak is the largest in history to occur outside of endemic African regions. Disease spread during this outbreak has been primarily through human-to-human transmission, with sexual contact being of particular concern. Clinical presentations have commonly featured genital, perianal, and oral lesions associated with sexual activity among men who have sex with men (MSM), who compose the vast majority of MPX cases. This review discusses the epidemiology, clinical features, and evaluation of MPX with regards to men's sexual health. Comparisons were made between MPX and its relative from the Orthopoxvirus genus, smallpox, in order to make informed inferences on the potential effects of MPX on men's sexual health. This review also discusses the role of men's health specialists and urologists in addressing the current outbreak.

Introduction: Increased hematocrit (HCT) is a common adverse effect in men on testosterone therapy (TTh). We aimed to uncover differences in HCT changes among men receiving different forms of TTh, namely intranasal gels, intramuscular injections, and subcutaneous pellets. Methods: We conducted a single-center, retrospective, matched-cohort study of patients treated for testosterone deficiency (TD) to investigate the effect of three TTh regimens on HCT. We included men who received intranasal testosterone (NT), intramuscular testosterone (TC), or subcutaneous testosterone pellet (TP) regimens between January 2011 and December 2020. We matched treatment cohorts 1:1:1 for age, body mass index (BMI), and history of obstructive sleep apnea. Those taking TTh for less than 16 weeks were excluded. Comparison between groups was performed with U-Mann Whitney test, Student t-test, ANOVA, or Kruskal Wallis test as appropriate. Results: Seventy-eight matched-cohort individuals with testosterone deficiency (TD) received either NT, TC, or TP. The most common TD symptoms prior to initiation of TTh were erectile dysfunction (38%), low libido (22%), and lack of energy (17%). Baseline serum testosterone and HCT were higher in NT (p

Tesamorelin, a synthetic growth hormone-releasing hormone, is indicated for the reduction of visceral adipose tissue (VAT) in people with HIV. Here, we performed a post hoc analysis of participants receiving tesamorelin for 26 weeks in a phase III clinical trial. Efficacy data were compared between individuals with and without dorsocervical fat, stratified by tesamorelin response. Among tesamorelin responders, VAT and waist circumference (WC) decreased in both dorsocervical fat groups and did not statistically differ (VAT P = 0.657, WC P = 0.093). These data demonstrate that tesamorelin is equally effective and should be considered in the treatment of excess VAT regardless of the presence of dorsocervical fat.

Cardiovascular disease (CVD) has become a leading cause of morbidity and mortality among people with HIV. Atorvastatin is known to reduce cardiovascular risk. We (1) compared atorvastatin concentrations between different boosted protease inhibitors (PIs) and with lipid outcomes and (2) compared pre-atorvastatin 25-OH vitamin D levels with atorvastatin concentrations and with lipid outcomes, in people with HIV with suppressed HIV-1 RNA and low-density lipoprotein cholesterol (LDL-C) 130 mg/dL.A5275 was a randomized, double-blind, placebo-controlled crossover study of atorvastatin in virally suppressed people with HIV with fasting LDL-C130 mg/dL. We analyzed results over the 20 weeks of active atorvastatin treatment. Atorvastatin was initiated at 10 mg daily and increased to 20 mg daily after 4 weeks if there were no findings of toxicity. Atorvastatin trough concentrations were measured at week 20. Participants took combination antiretroviral therapy (ART) that included a boosted PI throughout.Overall (n = 67), 70% of participants were male, and the median age was 51 years. There was no apparent association between atorvastatin trough concentrations and pre-atorvastatin vitamin D levels (r = 0.01, p = 0.9) or by boosted PI (p = 0.20). Median pre- to post-atorvastatin change was -39.0 mg/dL in fasting total cholesterol, -40.4 ng/mL in lipoprotein-associated phospholipase A2 (LP-PLA2), and -13.8 U/L in oxidized LDL, with all changes negatively correlated with atorvastatin trough concentrations (r = -0.19, -0.09, -0.21; p ≥ 0.096).No apparent associations between pre-atorvastatin vitamin D levels and outcomes were observed (all p 0.70). In virologically suppressed people with HIV, higher atorvastatin concentrations were marginally associated with greater decreases in lipid outcomes.

Solid organ transplant (SOT) recipients may be at higher risk for poor outcomes with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Convalescent plasma is an investigational therapy that may benefit immunosuppressed patients by providing passive immunity. Convalescent plasma was administered to hospitalized patients with coronavirus disease-2019 (COVID-19) at an academic transplant center in New York City. Eligible patients were hospitalized and required to have positive nasopharyngeal polymerase chain reaction (PCR) diagnosis of SARS-CoV-2 infection, be at least 18 years old, and have either dyspnea, blood oxygen saturation ≤ 93% on ambient air, respiratory frequency ≥ 30 breaths/min, partial pressure of arterial oxygen to fraction of inspired oxygen ratio 300, or lung infiltrates 50%. Thirteen SOT recipients received convalescent plasma from April 9, 2020, to May 17, 2020. The median time from symptom onset to plasma infusion was 8 days. Eight of 13 patients (62%) had de-escalating oxygenation support by day 7 post-convalescent plasma. Nine (69%) patients were discharged, 1 (7%) patients remain hospitalized, and 3 (23%) patients died. This series supports the need for additional studies on convalescent plasma use in SOT recipients with COVID-19 to better determine efficacy and identify patients who are likely to benefit.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a new human disease with few effective treatments

Background Since December 2019, Coronavirus Disease 2019 (COVID-19) has become a global pandemic, causing mass morbidity and mortality. Prior studies in other respiratory infections suggest that convalescent plasma transfusion may offer benefit to some patients. Here, the outcomes of thirty-nine hospitalized patients with severe to life-threatening COVID-19 who received convalescent plasma transfusion were compared against a cohort of retrospectively matched controls. Methods Plasma recipients were selected based on supplemental oxygen needs at the time of enrollment and the time elapsed since the onset of symptoms. Recipients were transfused with convalescent plasma from donors with a SARS-CoV-2 (severe acute respiratory disease coronavirus 2) anti-spike antibody titer of ³1:320 dilution. Matched control patients were retrospectively identified within the electronic health record database. Supplemental oxygen requirements and survival were compared between plasma recipients and controls. Results Convalescent plasma recipients were more likely than control patients to remain the same or have improvements in their supplemental oxygen requirements by post-transfusion day 14, with an odds ratio of 0.86 (95% CI: 0.75∼0.98; p = 0.028). Plasma recipients also demonstrated improved survival, compared to control patients (log-rank test: p = 0.039). In a covariates-adjusted Cox model, convalescent plasma transfusion improved survival for non-intubated patients (hazard ratio 0.19 (95% CI: 0.05 ∼0.72); p = 0.015), but not for intubated patients (1.24 (0.33∼4.67); p = 0.752). Conclusions Convalescent plasma transfusion is a potentially efficacious treatment option for patients hospitalized with COVID-19; however, these data suggest that non-intubated patients may benefit more than those requiring mechanical ventilation.

Background: Transitioning low-risk cancer survivors back to their primary care provider (PCP) has been shown to be safe but the effect on health system resources and costs has not been examined. Methods: A Well Follow-Up Care Initiative (WFCI) was implemented in the publicly funded health system. Low-risk breast cancer (BC) survivors in the WFCI intervention group were transitioned from oncologist-led cancer clinics to PCPs. We compared health system costs ($2,014 in Canadian dollars) and resource utilization in this intervention group with that in propensity-score–matched nontransitioned BC survivors (ie, controls) diagnosed in the same year, with similar disease profile and patient characteristics using publicly funded administrative databases. Results: A total of 2,324 BC survivors from the WFCI intervention group were 1:1 matched to controls and observed for 25 months. Compared with controls, survivors in the intervention group incurred a similar number of PCP visits (6.9 v 7.5) and fewer oncologist visits (0.3 v 1.2) per person-year. Fewer survivors in the intervention group (20.1%) were hospitalized than in the control group (24.4%). There were no differences in emergency visits. More survivors in the intervention group had mammograms (82.6% v 73.1%), but other diagnostic tests were less frequent. There was a 39.3% reduction in overall mean annual costs ($6,575 v $10,832) and a 22.1% reduction in overall median annual costs ($2,261 v $2,903). Overall survival in the intervention group was not worse than controls. Conclusion: Transitioning low-risk BC survivors to PCPs was associated with lower health system resource use and a lower annual cost per patient than matched controls. The WFCI model represents a reasonable approach at the population level to delivering quality care for low-risk BC survivors that seems to be cost effective.

Background Few studies have examined the impact of psychological distress on mortality. We aimed to estimate mortality rates of psychological distress and major depressive disorder (MDD) compared to a referent group with no MDD or psychological distress. Methods Our study population (N = 10 181) consisted of respondents from the Canadian Community Health Survey Cycle 1.2 linked to Ontario health administrative databases followed for up to 11 years. We used Cox proportional hazards models to assess overall, sex-specific, as well as short-term (within two years of follow-up) and long-term (follow-up ≥ two years) mortality among those with DSM-criteria MDD and psychological distress independent of MDD adjusted for socio-demographic, lifestyle and clinical factors. Results Individuals with psychological distress (n = 666) had a similar mortality rate as those with MDD (n = 428) and significantly greater adjusted hazards of death than the referent group (hazard ratio = 1.57, 95% CI = 1.14–2.15). The risk of death was greatest in the short-term among those with MDD, however, we observed a persistent 1.6-fold increased risk in both the short- and long-term among those with psychological distress compared to the referent. Women with MDD had the greatest mortality rate and died a median of 15 years earlier than women in the referent group. Limitations Psychological distress and MDD were ascertained at baseline with small number of deaths in the early follow-up period. Survey variables were prone to self-report bias with a possibility of residual confounding. Conclusions Focused longitudinal research and targeted management strategies for those with psychological distress and women with MDD are warranted.

Introduction The use of surveillance CT imaging in patients with DLBCL in remission is neither effective to detect recurrence nor cost-effective. The ASH Choosing Wisely (CW) campaign, in particular, emphasizes the lack of benefit in imaging beyond 2-years of completion of therapy. We sought to describe the practice of surveillance imaging and predictors of this practice. Methods We used population-based health system administrative databases from Ontario, Canada. We studied a cohort of all adult patients ≥18 with diffuse large B-cell lymphoma who received R-CHOP therapy for curative intent between January 1, 2004 to June 30, 2011. Based on the CW campaign, we defined an index date of 2-years after the last dose of R-CHOP as the time-frame beyond which surveillance CT imaging would be inappropriate. The cumulative incidence of receiving CT scans within 3 years after the index date (i.e. from 2- to 5-years beyond the end of treatment) represented the primary outcome of interest (established within the Ontario Health Insurance Program database). To ensure that only surveillance scans in asymptomatic patients were captured, patients were censored 6 months prior to development of recurrent disease or a new cancer diagnosis, further chemotherapy/radiation, or if they died (censored at time of death). Predictor characteristics included baseline comorbidities (John Hopkins weighted Aggregated Diagnosis Groups (ADG) comorbidity score) and income quintile (linkage of the patient postal code to Statistics Canada Census data on average household income by postal code). Results The cohort consisted of 2,838 patients treated with R-CHOP during the study period. Median age at time of first R-CHOP dosing was 63 years (IQR 52-72) and the median number of cycles received was 6 (IQR 6-8). The cumulative incidence of receiving CT imaging from the index date (2-years from end of treatment) to 3-years beyond the end of treatment was 40.1% (95% CI 38.3%-41.9%). The cumulative incidence of imaging from the index date to 5-years beyond the end of treatment was 55.6 % (95% CI 53.7%-57.5%). During the follow-up period, patients ≥65 were more likely to receive imaging than those aged Conclusion During a time-frame in which surveillance imaging is deemed unnecessary by the CW campaign (2 to 5 years beyond therapy), the practice in a large population remains excessive (>50% cumulative incidence in scanning). Patients who are older and with more comorbidities are more likely to receive scans, and may represent target populations to ensure greater compliance with the CW campaign. This study represents a real-world baseline from which future efforts to reduce surveillance imaging can be benchmarked. Disclosures No relevant conflicts of interest to declare.

There is a paucity of studies on transitions from IV insulin infusion (IVII) to subcutaneous (SC) insulin in the medical ICU (MICU).We conducted a retrospective study of patients admitted to the Cleveland Clinic MICU from June 2013 to January 2014 who received IVII. We compared blood glucose (BG) control between 3 cohorts based on timing of basal insulin dose: (1) NB (no basal), (2) IB (incorrect basal), (3) CB (correct basal) at 5 time points post-IVII discontinuation (1, 4, 8, 12, and 24h). Insulin doses used for transitioning were compared with 80% of estimated 24h IVII total. Analysis was done using chi-square, ANOVA and t-tests.There were 269 patients (NB 166, IB 45, CB 58), 55% male with a mean age 58±16years. 103 patients (38%) had a transition attempted (IB 21%, CB 17%). The NB cohort had better BG than the IB cohort at all time points (p0.001) but also lower HbA1c, prior DM diagnosis and home insulin use (p0.001). IB and CB did not have significantly different BG with mean BG180mg/dL at 4/5 time intervals. However, the dose of basal insulin used was less than 80% of estimated 24h IVII total (IB 21.4 vs 49.6U, CB 25vs 57.1U). Despite this, 15% of patients in the IB cohort and 24% of patients in the CB had hypoglycemic events.The low rates of IV to SC insulin transitions raises the question of challenges to transitions.

BackgroundPeople with schizophrenia have an increased burden of cardiovascular diseases (CVD); however, little is known about the cardiovascular risk factor profiles of non-institutionalised individuals with schizophrenia. This study estimated the prevalence of CVD risk factors in a population-based sample of Canadians with and without schizophrenia.MethodsOntario respondents of the Canadian Community Health Survey were linked to administrative health databases; using a validated algorithm, we identified 1103 non-institutionalised individuals with schizophrenia and 156 376 without schizophrenia. We examined the prevalence of eight CVD risk factors: smoking, diabetes, hypertension, obesity, physical inactivity, fruit/vegetables consumption, psychosocial stress and binge drinking. To examine temporal trends, we compared prevalence estimates from 2001–2005 to 2007–2010.ResultsThe prevalence of most CVD risk factors was significantly higher among those with schizophrenia than the general population. Obesity and diabetes prevalence increased by 39% and 71%, respectively, in the schizophrenia group vs 11% and 24%, respectively, in the non-schizophrenia group between the two time periods. Unlike the general population, smoking rates among those with schizophrenia did not decline. Almost 90% of individuals with schizophrenia had at least one CVD risk factor and almost 40% had ≥3 co-occurring risk factors.ConclusionIndividuals with schizophrenia had a greater prevalence of individual and multiple CVD risk factors compared with those without schizophrenia, which persisted over time. Our findings suggest that public health efforts to reduce the burden of CVD risk factors have not been as effective in the schizophrenia population, thus highlighting the need for more targeted interventions and prevention strategies.

Conductive membranes can offer innovative solutions for membrane fouling control while maintaining enhanced filtration performance. Here, an emerging technique, vacuum filtration assisted layer-by-layer deposition of functionalized multiwalled carbon nanotubes (MWNTs), was used to prepare conductive surfaces on polysulfone (PSf) ultrafiltration membranes. PSf membranes were functionalized with oxygen-containing negatively charged functional groups through oxygen plasma treatment. MWNT-PSf membranes were prepared with 5, 10, 15, and 20 bilayers with amine- and carboxylic-functionalized MWNTs. The prepared membranes were characterized by the thickness, contact angle, and conductivity of the membranes. Scanning electron microscopy images of the membranes confirmed uniform MWNT distribution across the membrane surface. MWNT-PSf membranes exhibited slightly reduced permeability, improved selectivity, and greater conductivity with increasing number of MWNT bilayers and demonstrated almost complete inactivation ...

Background Lipohypertrophy is defined as excess fat deposition in abdominal defined as visceral adipose tissue (VAT) as well as in the dorsocervical region, breasts, trunk, and along with possible fat deposition in liver, muscle, myocardium and epicardium. Multiple factors have been described as contributing to lipohypertrophy in people living with HIV (PLWH), including patient characteristics, antiretroviral therapy (ART) and also impaired growth hormone (GH) secretion. Tesamorelin, a synthetic form of growth-hormone-releasing hormone (GHRH), is indicated for reduction of excess abdominal fat in PLWH with lipodystrophy Methods Post-hoc analysis was done on phase 3 randomized, double-blind, multicenter trials. Patients were eligible if between 18 and 65 years of age, had confirmed HIV infection, had evidence of excess abdominal fat accumulation and on stable ART regimen for 8 weeks or more. Participants were randomized to receive tesamorelin 2 mg daily or placebo daily for 26 weeks. Only tesamorelin responders, defined as patients with at least 8% decrease in VAT and who were adherent to the medication, were used for this analysis. Results are reported for patients with and without dorsocervical (DC) fat deposition. Results Demographic characteristics of responders at week 26 are shown according to presence or absence of DC fat (Table 1). At week 26, on average, the patients with DC fat deposition had higher BMI and waist circumference (WC) than the group without DC fat. Most patients in both groups had lipoatrophy. Metabolic and anthropometric parameters were measured at week 26 in patients with and without DC fat (Table 2). There was a decrease in VAT and also an improvement in their WC at week 26 in both groups. Table 1: Baseline Characteristics of Tesamorelin Responder Subjects at Week 26, by Dorsocervical Status Table 2: Change in Abdominal Adiposity, Insulin-Like Growth Factor-1 Levels, and Metabolic Parameters Between Baseline and Week 26 Among Tesamorelin Responders Conclusion This data demonstrates that tesamorelin is effective at reducing VAT in both patients with and without DC fat. The medication was well tolerated without significant changes to metabolic based measurements. Treatment of excessive VAT with tesamorelin has seemingly positive results in fat reduction in patients with or without DC fat deposition and our study contributes to the growing literature. Disclosures Marilyn de Chantal, PhD, Theratechnologies Inc (Employee) Pedro Mesquita, PhD, Theratechnologies, Inc. (Employee) Judith A. Aberg, MD, Theratechnology (Consultant)

Purpose The ability of Strongyloides to establish auto-infection in the human host allows it to sustain subclinical infection that can go on for a lifetime. In solid-organ transplant recipients, Strongyloides can cause hyper-infection syndrome which has very high morbidity and mortality. Clinical suspicion for chronic infection should be considered for any persons with birth or travel to endemic regions, history of incarceration, homelessness and group home residence. Targeted screening based on epidemiologic risk is recommended by AST and ISHLT however, testing remains challenging due to variability in the diagnostic yield of currently available serologic assays. Methods We performed a retrospective chart review of heart transplant (HT) recipients from 2010-2019, who had Strongyloides serologic screening performed pre-transplant, with the aim to correlate results with epidemiological risk factors for infection. Results Two-hundred and fifty HT recipients were reviewed. Of these, 197 had pre-transplant Strongyloides serology performed, in accordance with institutional policy of universal pre-transplant screening. Based on serologic testing, prevalence of strongyloidiasis was 2.5%. Of the 5 patients with positive serology, all but 1 had epidemiologic risk for infection; 3 due to birth in an endemic region and 1 due to history of incarceration. Eosinophilia was noted in 3/5, all of whom were from endemic regions by birth. All with positive serologic screening were treated pre-transplant with ivermectin. One-hundred and ninety two patients tested negative for Strongyloides, and 58% (111/192) of those had epidemiological risk factors, due to birth (90) or travel to endemic regions (21). There were no cases of clinical strongyloidiasis in the study cohort. Conclusion In this population with high epidemiologic risk, we found a lower than expected rate of Strongyloides infection. Given the variability in diagnostic yield across commercially available serologic assays, these findings raise the possibility of false negative results and thus, bring into question the utility and reliability of using serologic testing alone, for screening of Strongyloides infection among HT candidates. Accordingly, a thoughtful assessment of epidemiologic risk is essential for appropriate risk stratification and management of Strongyloides in HT candidates and recipients.

Background Lone parenthood is associated with poorer health; however, the vast majority of previous studies have examined lone mothers and only a few have focused on lone fathers. We aimed to examine the self-rated health and mental health status among a large population-based cross-sectional sample of Canadian lone fathers compared with both partnered fathers and lone mothers. Methods We investigated differences in self-rated health and mental health among 1058 lone fathers compared with 20 692 partnered fathers and 5725 lone mothers using the Ontario component of the Canadian Community Health Survey (2001–2013). Multivariable logistic regression was used to compare the odds of poor/fair self-rated health and mental health between the study groups while adjusting for a comprehensive list of sociodemographic factors, stressors and lifestyle factors. Results Lone fathers and lone mothers showed similar prevalence of poor/fair self-rated health (11.6% and 12.5%, respectively) and mental health (6.2% and 8.4%, respectively); the odds were similar even after multivariable adjustment. Lone fathers showed higher odds of poor/fair self-rated health (OR 1.53, 95% CI 1.07 to 2.17) and mental health (OR 2.09, 95% CI 1.26 to 3.46) than partnered fathers after adjustment for sociodemographic factors; however, these differences were no longer significant after accounting for stressors, including low income and unemployment. Conclusions In this large population-based study, lone fathers had worse self-rated health and mental health than partnered fathers and similarly poor self-rated health and mental health as lone mothers. Interventions, supports and social policies designed for single parents should also recognise the needs of lone fathers.

Purpose: To test the feasibility and possible effects of two iPad®-based breastfeeding interventions for expectant minority women and evaluate (1) the intervention effect on exclusive breastfeeding...

Although gastric and pancreatic cancers are aggressive, there is no evidence that early detection of recurrence improves overall survival. We aimed to measure the frequency of surveillance imaging in patients after curative resection for gastric and pancreatic cancers. We performed a population-based cohort study on patients in Ontario, Canada, with a first diagnosis of gastric and pancreatic cancer in 2003–2013. Health administrative databases were linked using unique encoded identifiers to record demographics, imaging frequency, and health resource utilization. The cohort comprised 2930 patients (2151 gastric, 779 pancreatic). The median age was 69 (38% female). The cumulative incidence of CT imaging overall was 74.3% after 1 year and 82.8% by 3 years. Imaging was more likely for pancreatic cancer compared to gastric cancer (p

Background Serious neurological complications of SARS-CoV-2 are increasingly being recognized. Case We report a novel case of HHV6 myelitis with parainfectious MOG-IgG in the setting of COVID-19-induced lymphopenia and hypogammaglobulinemia. The patient experienced complete neurological recovery with gancyclovir, high dose corticosteroids, and plasma exchange. To our knowledge, this is the first case of HHV6 reactivation in the central nervous system in the setting of COVID19 infection and the first case of MOG-IgG myelitis in the setting of SARS-CoV-2 and HHV6 coinfection. Conclusion Patients with neurological manifestations in the setting of COVID19-related immunodeficiency should be tested for opportunistic infections including HHV6. Viral infection is a known trigger for MOG-IgG and therefore this antibody should be checked in patients with SARS-CoV-2 associated demyelination., Graphical abstract Unlabelled Image