Eastern Virginia Medical School

Air pollution has long been recognized as a threat to human health. There is growing evidence that exposure to air pollution increases the risk of upper airway inflammatory disease including allergic and non-allergic rhinitis, and chronic rhinosinusitis. Recent improvement in air pollution measurement, including wearable pollution monitors, may improve our understanding of patient exposures. In this piece, we summarize salient literature and interventions.

Introduction Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by eczematous lesions, intense itch, and skin pain. The chronic nature of the disease requires safe and effective long term treatment options. Upadacitinib (UPA) is a Janus kinase inhibitor approved for the treatment of moderate-to-severe AD in adults and adolescents. Materials and Methods Patients in the randomized, double-blind, multicenter, placebo-controlled, phase 3 Measure Up 1 (NCT03569293), Measure Up 2 (NCT03607422), and AD Up (NCT03568318) trials were pooled for analysis. Adolescents and adults (aged 12–75 years) with moderate-to-severe AD were randomized 1:1:1 to receive once-daily oral monotherapy with UPA 15 mg, UPA 30 mg, or placebo (Measure Up 1, Measure Up 2) or in conjunction with topical corticosteroids (AD Up). The first 16 weeks of each study were placebo-controlled, double-blinded with a blinded extension period of up to 524 weeks. Patients who were initially randomized to UPA maintained their original treatment. Patients initially randomized to placebo were rerandomized (1:1) to blinded UPA 15 mg or UPA 30 mg. Treatment-emergent adverse events (TEAEs) and adverse events of special interest (AESI) were assessed by exposure-adjusted rates per 100 patient-years (PY) for the entire treatment period. Results A total of 2683 patients were treated with either 15 mg (N = 1337) or 30 mg (N=1346) of UPA with a total of 9623.7 PYs of exposure. Overall rates for TEAEs were higher with UPA 30 mg than UPA 15 mg. Serious AE, and AE leading to discontinuation were generally similar between UPA 15 mg and 30 mg. Rates of TEAEs leading to death remained low in both groups (both UPA 15 mg and 30 mg, 0.1 events per 100PY [E/100PY]). Rates of AESIs were: serious infections (UPA 15 mg, 2.2E/100PY; UPA 30 mg, 2.7 E/100 PY), herpes zoster (UPA 15 mg, 3.2 E/100PY; UPA 30 mg, 5.1 E/100PY), nonmelanoma skin cancer (NMSC; UPA 15 mg, 0.4 patients per 100 patient-years [n/100PY]; UPA 30 mg 0.5 n/100PY), malignancy excluding NMSC (UPA 15 mg, 0.3 n/100PY; UPA 30 mg, 0.4 n/100PY), adjudicated major adverse cardiovascular events (UPA 15 mg, 0.2 n/100PY; UPA 30 mg, < 0.1 n/100PY), and adjudicated venous thromboembolic events (UPA 15 mg, 0.1 n/100PY; UPA 30 mg, 0.2 n/100PY). Incidence rates for MACE, VTE and malignancy were similar or below background rates observed in real-world AD populations. Conclusions This integrated analysis of three phase 3 trials with over 9600 patient-years of exposure demonstrates consistently low rates of adverse events of special interest throughout 7 years of upadacitinib treatment. Rates were generally similar between doses and did not exceed background incidence rates in real-world atopic dermatitis populations, supporting the established benefit-risk profile of upadacitinib for moderate-to-severe atopic dermatitis.

Ethical awareness is fundamental to nursing and midwifery practice, influencing how students recognize and respond to ethical dilemmas in clinical settings. While ethics is well covered in nursing curricula, gaps often remain between theoretical knowledge and practical application. This study aimed to assess the levels of ethical knowledge, perception, and awareness among undergraduate nursing and midwifery students at Babcock University, Nigeria, and to examine the relationships among these constructs. A descriptive cross-sectional design was employed. A total of 206 undergraduate nursing and midwifery students were surveyed using a structured, self-administered questionnaire. Data were analyzed using descriptive statistics, correlation analysis, and regression models to determine associations between ethical knowledge, perception, and awareness. Most students demonstrated high knowledge of general ethical principles, with nearly all respondents familiar with patient rights and informed consent. Positive perceptions of ethics were more strongly correlated with ethical awareness ( r = 0.42, p < .001) than knowledge alone ( r = 0.29, p < .001). Regression analysis confirmed perception as a stronger predictor of ethical awareness. Furthermore, senior-level students with greater clinical exposure had significantly higher ethical awareness. While gender was reported in the demographics (87.4% female, 12.6% male), no statistical test demonstrated gender as a determinant of awareness. The findings highlight that while factual knowledge of ethics is strong, students' perceptions and experiential learning play a more decisive role in shaping ethical awareness. Ethics education should therefore emphasize reflective, practice-based, and culturally sensitive approaches to better prepare students for complex clinical decision-making. La conciencia ética es fundamental en la práctica de enfermería y partería, ya que influye en cómo los estudiantes reconocen y responden a los dilemas éticos en los entornos clínicos. Aunque la ética está ampliamente cubierta en los planes de estudio de enfermería, suelen existir brechas entre el conocimiento teórico y la aplicación práctica. Este estudio tuvo como objetivo evaluar los niveles de conocimiento, percepción y conciencia ética entre estudiantes de licenciatura en enfermería y partería de la Universidad Babcock, Nigeria, y examinar las relaciones entre estos constructos. Se empleó un diseño descriptivo transversal. Un total de 206 estudiantes de licenciatura en enfermería y partería fueron encuestados mediante un cuestionario estructurado y autoadministrado. Los datos se analizaron utilizando estadística descriptiva, análisis de correlación y modelos de regresión para determinar asociaciones entre conocimiento, percepción y conciencia ética. La mayoría de los estudiantes demostró un alto conocimiento de los principios éticos generales, con casi todos los encuestados familiarizados con los derechos del paciente y el consentimiento informado. Las percepciones positivas sobre la ética se correlacionaron más fuertemente con la conciencia ética ( r = 0.42, p < .001) que el conocimiento por sí solo ( r = 0.29, p < .001). El análisis de regresión confirmó la percepción como un predictor más fuerte de la conciencia ética. Además, los estudiantes de niveles avanzados con mayor exposición clínica presentaron una conciencia ética significativamente más alta. Aunque el género se reportó en la demografía (87.4% mujeres, 12.6% hombres), ninguna prueba estadística mostró al género como determinante de la conciencia. Los hallazgos destacan que, si bien el conocimiento factual de la ética es sólido, las percepciones de los estudiantes y el aprendizaje experiencial desempeñan un papel más decisivo en la formación de la conciencia ética. Por lo tanto, la educación en ética debe enfatizar enfoques reflexivos, prácticos y culturalmente sensibles para preparar mejor a los estudiantes frente a la toma de decisiones clínicas complejas.

Transition metals such as iron and manganese are critical for cellular metabolism, redox balance, and immune function, and they also influence host–pathogen interactions. Vaginitis is characterized by mucosal inflammation that may alter local trace-element homeostasis. We hypothesize that inflammatory conditions such as vaginitis may be associated with altered cervicovaginal iron and manganese levels. We performed a prospective, single-center cohort study at the University of Debrecen (Hungary) between April 2023 and April 2024, enrolling 80 women ≥ 18 years with vulvovaginal complaints. Participants were assessed at baseline and at weeks 4, 8, and 12 with clinical evaluation and cervicovaginal lavage (CVL) sampling, collected using metal-free instruments. Participants were randomized 1:1 to receive either fluconazole alone or a single baseline oral fluconazole plus an intravaginal zinc-containing hydrogel. CVL samples were digested and analyzed for iron and manganese using ICP-OES. Group comparisons were performed using linear mixed-effects models with a random intercept for participant. CVL Fe concentrations were higher in women with culture-positive vaginitis compared with controls (mean ± SD: 56.36 ± 24.84 vs. 44.64 ± 20.11), with a significant between-group difference in mixed-effects models (Δ = 8.82, 95% CI 0.74 to 16.89; p = 0.032). Mn concentrations did not differ between vaginitis and controls (1.42 ± 0.73 vs. 1.09 ± 0.77; p = 0.542). In subgroup analyses, Fe remained significantly higher in vaginitis compared with controls among women who did not use the hydrogel (60.69 ± 26.53 vs. 47.27 ± 21.87; p = 0.041), whereas the difference was attenuated and no longer significant among hydrogel users (53.64 ± 23.62 vs. 41.75 ± 17.71; p = 0.148). Within the vaginitis cohort, Fe and Mn concentrations were similar across culture-defined phenotypes (bacterial-positive vs. fungal-positive) and between fungal culture-negative and fungal-positive samples. Culture-positive vaginitis was associated with higher total cervicovaginal iron concentrations, while manganese remained largely unchanged. Adjunct topical zinc therapy appeared to temper the vaginitis-associated elevation in iron, consistent with improved mucosal integrity and reduced inflammation-driven iron availability. Total Fe and Mn concentrations in CVL did not distinguish vaginitis phenotypes, supporting their use primarily as reference values and motivating future work focused on bioavailable metal fractions and metal-binding host proteins. The study protocol was approved by the Hungarian National Institutional Review Medical Research Council (approval No. 3282-7/2023/EUIG).

Abstract Objective Maternal anemia in pregnancy is associated with many adverse maternal, fetal, and neonatal outcomes. The role of social determinants of health (SDOH) in the development of maternal anemia and other adverse outcomes is continually evolving. One such newer tool, the Social Vulnerability Index (SVI), measures an individual's community‐level SDOH, with higher SVI denoting higher vulnerability. Our objective was to evaluate the association between SVI, maternal anemia, and other adverse perinatal outcomes. Methods Retrospective cohort study of pregnant individuals delivering singletons at a gestational age ≥23 weeks at a single center from 2014 to 2018. Patients with sickle cell disease, on anticoagulation, or with a PO Box, missing address, or residential address that could not be geocoded, were excluded. SVI scores were assigned to each patient based on their geographic home address and categorized into SVI tertiles: low (SVI 0–0.33), moderate (0.33–0.66), and high vulnerability (0.67–1.00). The primary outcome was anemia per ACOG guidelines (hemoglobin or hematocrit less than 11 g/dL and 33% in the first trimester, respectively, 10.5 g/dL and 32% in the second trimester, respectively, and 11 g/dL and 33% in the third trimester, respectively). Secondary outcomes included select labor outcomes, a composite of postpartum maternal morbidity, and a composite of neonatal morbidity. Multivariable logistic regression models estimated the association between moderate and high SVI and outcomes, compared to low SVI. The mean overall SVI score and SVI theme scores were compared for patients with and without anemia; individual SVI theme components were also analyzed. A mediation analysis using bootstrapping evaluated the contribution of anemia to the other adverse perinatal outcomes associated with SVI. Results Of 13,951 individuals, 3989 (29%) lived in a low SVI area, 3976 (29%) lived in a moderate SVI area, and 5986 (43%) lived in a high SVI area. Patient characteristics varied significantly based on the SVI, as high SVI areas had patients who were younger, non‐Latinx Black, single, publicly insured, and more likely to have greater body mass index (BMI), chronic hypertension, and substance use issues; moderate SVI areas had more Latinx patients with diabetes; and low SVI areas had patients who were older, nulliparous, married, and privately insured. Compared to patients with low SVI, those with greater vulnerability had significantly higher odds of anemia (moderate SVI: aOR, 1.11 [1.00–1.24]; high SVI: aOR, 1.18 [1.05–1.32]). Preeclampsia, composite postpartum maternal morbidity, and neonatal morbidity also increased with increasing vulnerability. Patients with anemia had higher mean SVI scores overall and across the four SVI themes. In mediation analysis, 36% of the association between SVI and maternal morbidity was significantly mediated by anemia ( p &lt; 0.001), while 19% of the association between SVI and neonatal morbidity was mediated by anemia ( p = 0.009). Conclusion Patients living in moderate and high areas of social vulnerability are more likely to have anemia and other adverse perinatal outcomes. While some increase in the perinatal morbidity associated with increasing SVI is mediated through anemia, other factors and social determinants of health are likely also contributory.