Tsehootsooi Medical Center

American Indian (AI) communities in the Southwest have a high burden of invasive pneumococcal disease (IPD) and COVID-19. Through laboratory-based surveillance, the impact of the pandemic on IPD incidence and serotype distribution was evaluated in two AI communities. IPD rates were lower during the pandemic (21.8 vs. 39.0/100 000 pre-pandemic). Rates increased in 2021 compared to 2020 but not to pre-pandemic levels. Cases with SARS-CoV-2 co-infection had a higher case fatality rate (45.2% vs. 17.6% without co-infection). No significant change in serotype distribution was observed. Continued surveillance in these communities is critical to understand the changing IPD burden as the pandemic evolves.

We assessed the impact of pneumococcal conjugate vaccines on pneumococcal otitis media (OM) among children living in Navajo and White Mountain Apache Tribal lands. During the PCV7 era (2000-2009), the proportion of vaccine-type OM declined. However, vaccine-type OM (predominantly 3, 19A, and 19F) persisted in the PCV13 era (2010-2019).

Full-thickness burns almost always require skin grafting because the severity prevents the natural regenerative process. Here, we illustrate the potential to promote natural skin regeneration utilizing growth factors and regenerative proteins in purified amniotic fluid (PAF). A 24-year-old female suffered from full-thickness burns to her legs resulting from a rogue firework. This initiated a treatment plan involving extensive rehabilitation and skin grafting. Instead, the patient was treated with PAF (4 mL) administered topically over 2 days. Forty-five minutes following application, her pain decreased from 10/10 to 2/10. After two treatments her overall recovery time decreased by 75%–leaving her physicians surprised at the obviated need for skin grafting. Topical PAF relieved pain within minutes, making it easier to clean the affected area, enhancing sleep, and allowing more range of motion and autonomy. The efficiency of PAF to reduce pain allowed the patient to discontinue the use of prescribed hydrocodone, an opioid that is fueling an epidemic of abuse and addiction. Accelerated recovery time allowed the patient to return to work sooner, having broader economic implications on medical costs and personal time off. Finally, PAF enhanced the body’s own capacity to heal itself, avoiding painful and costly grafting and decreasing additional donor site scarring.

OATP1B1 mediates the transport of a diverse range of amphiphilic organic compounds that include bile acids, steroid conjugates and hormones. This retrospective pharmacogenetic study was conducted to assess the impact of the OATP1B1 c.521T>C single nucleotide polymorphism (SNP) on the pharmacokinetics of the steroidal aromatase inhibitor drug exemestane in healthy volunteers. Exemestane (25mg) was administered orally to 14 healthy post-menopausal women. All of the 14 subjects were sampled for pharmacokinetic (PK) analyses and retrospectively genotyped for OATP1B1 c.521T>C (rs 4149056). Of the 14 subjects enrolled in the study, five were carriers of the minor C allele (OATP1B1 c.521TC+CC) and the remaining nine were carriers of the OATP1B1 c.521TT genotype. PK was assessed over 8hours post-dosing. Our results showed statistically significant differences (P=.04) in the plasma exemestane AUC0-8 between the OATP1B1 genotype groups. Our data also showed statistically significant differences (P=.04) in the plasma AUC0-8 of 17-hydroexemestane (the major biologically active metabolite) between the OATP1B1 genotype groups. Our data suggest that the OAPTP1B1 c.521T>C SNP may influence exemestane pharmacokinetics in humans.

From among 273 live-born infants at Fort Defiance, Arizona, Indian Hospital between February 1970 and February 1971, half were followed by prevailing health care practices of the Indian Health Service; the other half by aggressive follow-up which included home visits, contact after missed appointments, and periodic record review to determine achievement of health care goals. At approximately 1 year of age, health status of almost all infants was determined by physical examination, Denver Development Test, and laboratory tests and by record review of illnesses experienced and health services received during the first year of life. Study and control infants differed at statistically significant levels in achievement of first-year health care goals (completed immunizations, tuberculin test, number of well child visits) but not in mortality, morbidity, and hospitalization rates; number of visits for health care; and findings on physical, developmental and laboratory examination. These findings were in agreement with those of similar studies and support the conclusion that medical care is only one, and likely not the major, determinant of infant health.