Ocean Medical Center

Ocean acidification (OA) is reported to entail a detrimental impact on calcifying organisms. Nevertheless, patellid limpets - P. caerulea, P. rustica, and P. ulyssiponensis - are able to persist in extremely low pH conditions inside the Castello Aragonese CO2 vent systems (Ischia Island), suggesting that they may have developed tolerance to OA, through plasticity and/or adaptive mechanisms. The aim of this study is to evaluate the long-term strategies adopted by limpets that spent their entire life cycle in naturally acidified conditions and the short-term ones induced by a 30-day in situ transplant experiment. Regarding native limpet populations, P. caerulea exhibited increasing size and higher energy resources in the extremely acidified site, potentially related to different food availability or to reduction in competition and/or predatory pressure; furthermore, no effects on oxidative stress, biomineralization and neurotoxicity occurred. Similarly, P. ulyssiponensis didn't exhibit any significant effects among different pH conditions regarding biochemical endpoints. Conversely, P. rustica displayed a significant modulation of almost all biochemical parameters, possibly due to its different position on the rocky shore. The short-term exposure of P. caerulea produced a decrease in protein content and an increase in glycogen content in the extreme acidified site, with an induction of superoxide dismutase and glutathione-S-transferases activities in the intermediate pH site. Overall, our study revealed that different species of the same genus may have developed distinct responses to OA and suggested different mechanisms to cope with short and long-term exposure to low pH conditions.

Obesity is an important risk factor associated with atrial fibrillation (AF). The impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on recurrent AF among patients undergoing catheter ablation is not well described. This study aimed to evaluate the effect of GLP-1 RA on the recurrence of AF among obese patients after catheter ablation. Utilizing the TriNetX research network, we identified patients aged over 18 with obesity (BMI ≥ 30) who underwent AF ablation from January 1, 2015, to December 1, 2022, using Current Procedural Terminology codes. Patients were categorized based on their baseline GLP-1 RA use. Through propensity-score matching, each cohort comprised 1558 patients. The primary outcome encompassed a composite of cardioversion, initiation of new antiarrhythmic drug (AAD) therapy, or redo AF ablation. Additional outcomes during the 12-month follow-up included AF readmission, heart failure readmissions, readmissions due to ischemic stroke, and mortality, with a separate analysis done for patients with BMI > 40. GLP-1 RA use in patients with obesity undergoing AF ablation was linked to a significantly reduced risk of cardioversion, new AAD therapy, and the need for redo AF ablation (hazard ratio [HR] 0.72 [0.65-0.80]; p < 0.001). At 12 months, individuals on GLP-1 agonists exhibited a lower likelihood of mortality (HR 0.61 [0.40-0.93]; p < 0.001). Although all other secondary outcomes were lower in the GLP-1 RA group, there was no significant difference in ischemic stroke between the groups. These results were consistent among patients with BMI > 40, although apart from ischemic stroke, there was no difference in mortality between the two groups. The utilization of GLP-1 RA in individuals with obesity is linked to a decreased likelihood of arrhythmia recurrence following AF ablation, leading to a reduced requirement for cardioversion, AAD therapy, or redo AF ablation.

Abstract Introduction: Severe asthma complicated by allergic bronchopulmonary aspergillosis (ABPA), sarcoidosis, and bronchiectasis poses significant management challenges. We present a case of a 71-year-old male with a history of severe asthma on biologic therapy, who developed worsening dyspnea and was found to have Stenotrophomonas maltophilia. This case underscores the complexities of managing chronic respiratory diseases in patients with environmental exposures and highlights the role of hypersensitivity pneumonitis in overlapping pulmonary conditions. Case Report: A 71-year-old male with a history of sarcoidosis, severe persistent asthma on biologic therapy and home oxygen, ABPA, bronchiectasis (recently complicated by Proteus bronchitis treated with trimethoprim/sulfamethoxazole), morbid obesity, and obstructive sleep apnea presented with worsening dyspnea over 6 months. He had a remote smoking history, increasing oxygen requirements, and was on high-dose steroids, ipratropium-albuterol nebulizers, triple therapy inhaler, montelukast, tezepelumab, and omalizumab. Notably, he owned parakeets and previously had elevated IgE and positive Chlamydia psittacosis serologies. He was afebrile and mildly hypoxic on 4L nasal cannula. Exam revealed coarse lung sounds with expiratory wheezing. Labs were significant for mild leukocytosis and elevated serum IgE at 1964 IU/mL. A CT chest revealed upper lung-predominant bronchiectasis and tree-in-bud nodularity, suggestive of chronic infection or hypersensitivity pneumonitis. Respiratory pathogen panel, Chlamydia/Chlamydophila serum titers, and multiple opportunistic infectious markers were negative. Hypersensitivity pneumonitis panel showed elevated IgG to Alternaria alternata, Cladosporium herbarum, Penicillium notatum, and Phoma spp. Bronchoscopy revealed Aspergillus on cytology, with cultures growing Stenotrophomonas maltophilia and Aspergillus. His asthma regimen was continued with the addition of inhaled budesonide. He was initially treated with ceftriaxone and azithromycin, later switched to levofloxacin, and discharged on a 10-day course of minocycline with a prednisone taper. Discussion: This case highlights the complexities of managing severe asthma in patients with multiple comorbidities and environmental exposures. The patient's history of bird ownership and previous elevated IgE levels suggest a potential link to hypersensitivity pneumonitis, a condition often exacerbated by inhalation of organic antigens found in bird droppings and feathers. Furthermore, the development of Stenotrophomonas maltophilia and Aspergillus infections in this context emphasizes the importance of vigilant monitoring for opportunistic infections in immunocompromised patients. Biologic therapies, while effective for severe asthma, can increase susceptibility to infections, necessitating careful management of comorbid conditions. This case illustrates the need for a multidisciplinary approach in managing such patients, integrating pulmonology, infectious disease, and allergy expertise to optimize treatment outcomes and mitigate risks associated with environmental exposures.

Conservation of marine biodiversity requires an understanding of the habitats needed to support and replenish species of interest. It also requires knowledge about the abundance and diversity of multispecies assemblages. Variation in the distribution and composition of kelp forests, one of the most productive marine coastal habitats globally, can have major influences on reef fishes-a group of ecologically and socioeconomically important species. In the face of widespread and escalating loss of kelp forests, quantification of these effects is urgently needed to assess and project cascading impacts on biodiversity. Here, we evaluate relationships between kelp forests and associated reef fish populations using a global meta-analysis of experimental kelp removals and comparative surveys of kelp and adjacent non-kelp habitats. These analyses show that kelp forests increase the abundance of reef fishes, though the significance of this effect varied depending on the structural complexity of kelp forests. In experimental studies, kelp forests have a significant positive effect on fish species richness, revealing that kelp act as true foundation species by supporting the diversity of associated multispecies assemblages. Importantly, regardless of kelp forest morphology and type of study (observational or experimental studies), kelp forests enhance the recruitment of early life history stages suggesting they are nursery habitats for many reef fish taxa. Lastly, kelp forests differentially affected species with different functional traits; small body size fishes from low trophic levels (e.g., herbivore and detritivores, micropredators, and mesopredators) and large body size fish from higher trophic level (e.g., piscivores, general carnivores) were both facilitated by kelp forests. Taken together, these results indicate that the loss of kelp forest, particularly those with more complex morphology, can reduce total abundance and diversity of fish, with possible cascading consequences for coastal ecosystem function.

IntroductionHuman papillomavirus (HPV) is a well-documented cause of cervical cancer, leading to significant mortality that may be decreased through screening and the administration of HPV vaccination. Our understanding of New Zealand immigrants' knowledge, attitudes, and perceptions of the HPV vaccine is limited. Preliminary research shows that immigrants have low knowledge and negative perceptions of the HPV vaccine and that cervical cancer and HPV awareness was low among African parents. This study examines the knowledge, attitudes, and perceptions of African parents in New Zealand towards the HPV vaccine.MethodA cross-sectional study of 100 African parents was conducted in New Zealand on a randomly selected sample from different African community groups. A self-report questionnaire was used for data collection.ResultsOf the 100 parents who completed the survey, 51 (51%) were women and 49 (49%) were men. Only 45 (45%) of the parents had a high level of knowledge of the HPV vaccine, while 44 (44%) had a low level of knowledge and 11 (11%) had only moderate knowledge. Most of the parents 75 (75%) had a positive attitude toward the HPV vaccine and 71 (71%) had a positive perception of the utilization of the vaccine. A positive relationship was identified between the level of knowledge and attitude (gamma = 0.66, p-value = 0.02) and between the level of knowledge and perception (gamma = 0.73, p-value < 0.001). Parental attitudes towards HPV vaccination uptake were largely influenced by (i) their level of education 88 (88%), (ii) their concerns about the vaccine’s adverse effects 85 (85%), (iii) inadequate knowledge and information about the vaccine 92 (92%), and (iv) public health concerns 89 (89%).ConclusionThe level of knowledge of the HPV vaccine among 44 (44%) participants in this study was low, though most parents had positive attitudes and perceptions toward the HPV vaccine and were willing to allow their children to be vaccinated against HPV infection. Inadequate knowledge and concerns about the vaccine's adverse effects were some of the main factors influencing the parents' negative attitudes toward the uptake of the HPV vaccine and more education is needed among African parents to improve their knowledge of the HPV vaccine and to address their concerns about the adverse effects of the vaccine. Improved knowledge and education of the HPV vaccine may promote higher vaccine uptake among African parents.

Abstract Disclosure: F.F. Foo: None. G. Naronowicz: None. M.S. Akula: None. S.W. Holland: None. J. Cheng: None. R. Ong: None. K. Hu: None. K. Chalasani: None. Background: Autoimmune lymphocytic infundibuloneurohypophysitis (LINH) is a potential cause of panhypopituitarism with biopsy being the gold standard for diagnosis. This report illustrates a unique case of LINH, detailing the methods employed in diagnosis and treatment. Case Presentation: A 77-year-old man with a history of myelofibrosis, type 1 diabetes mellitus, and history of Nocardia meningitis requiring craniotomy over 20 years ago presented to the hospital for evaluation of neutropenic fever. On arrival, he was also found to be in diabetic ketoacidosis and was admitted to ICU for intravenous insulin infusion and antibiotics. Over the course of his stay, the patient reported increased urine output which was initially attributed to his hyperglycemia, however his symptoms continued to worsen even when euglycemic. Lab studies revealed serum Na 153 mmol/L, urine osmolarity 215 mOsm/Kg, urine specific gravity &amp;lt;=1.005 and a net fluid balance of -6,756 mL over three consecutive shifts, which was consistent with diabetes insipidus. MRI revealed thickening of the infundibular stalk with central hypoenhancement, abnormal increased T2 hyperintense signal, and loss of the normal posterior pituitary bright spot. While LINH was strongly suspected, various alternative diagnoses, including bacterial invasion and chemotherapy-induced effects, were considered and excluded. Due to the abnormal MRI findings, further testing was done to evaluate for other endocrinopathies. These tests resulted in Cortisol: 11.63 ug/dL, ACTH: 41 pg/mL, TSH: 0.07 ng/dL, FT4: 0.74 uIu/mL. The patient was started on levothyroxine for central hypothyroidism in addition to continuing desmopressin. Additionally, copeptin and vasopressin-cell autoantibody were checked as they have been recorded to be potential biomarkers for LINH. The Copeptin and vasopressin-cell autoantibody testing were both negative and unfortunately we were unable to check for the additional biomarker Rabphilin-3A due to laboratory limitations. However, after ruling out other causes, the patient was given a diagnosis of LINH based on imaging and his development of central diabetes insipidus and central hypothyroidism. Conclusion: LINH is a potential cause of central diabetes insipidus. Acknowledging the significance of LINH, despite its rarity, underlines the importance of continued monitoring as other endocrinopathies can develop later on. While biopsy remains the gold standard for diagnosis, alternative approaches such as imaging and biomarkers can facilitate confirmation. Presentation: 6/2/2024