Three-Tiered COVID-19 Cohorting Strategy and Implications for Memory-Care

An outbreak of SARS-CoV-2 in a skilled nursing facility (SNF) can be devastating for residents and staff. Difficulty identifying asymptomatic and presymptomatic cases and lack of vaccination or treatment options make management challenging. We created, implemented, and now present a guide to rapidly deploy point-prevalence testing and 3-tiered cohorting in an SNF to mitigate an outbreak. We outline key challenges to SNF cohorting.

Determination of Campesterol, Stigmasterol, and Beta-Sitosterol in Saw Palmetto Raw Materials and Dietary Supplements by Gas Chromatography: Collaborative Study

An interlaboratory study was conducted to evaluate a method for the determination of campesterol, stigmasterol, and beta-sitosterol in saw palmetto raw materials and dietary supplements at levels >1.00 mg/100 g based on a 23 g sample. Test samples were saponified at high temperature with ethanolic KOH solution. The unsaponifiable fraction containing phytosterols (campesterol, stigmasterol, and beta-sitosterol) was extracted with toluene. Phytosterols were derivatized to trimethylsilyl ethers and then quantified by gas chromatography with hydrogen flame ionization detection. Twelve blind duplicates, one of which was fortified, were successfully analyzed by 10 collaborators. Recoveries were obtained for the sample that was fortified. The results were 99.8, 111, and 111% for campesterol, stigmasterol, and beta-sitosterol, respectively. For repeatability, the relative standard deviation (RSDr) ranged from 3.93 to 17.3% for campesterol, 3.56 to 22.7% for stigmasterol, and 3.70 to 43.9% for beta-sitosterol. For reproducibility, the RSDR ranged from 7.97 to 22.6%, 0 to 26.7%, and 5.27 to 43.9% for campesterol, stigmasterol, and beta-sitosterol, respectively. Overall, the Study Director approved 5 materials with acceptable HorRat values for campesterol, stigmasterol, and beta-sitosterol ranging from 1.02 to 2.16.

Determination of Isoflavones in Soy and Selected Foods Containing Soy by Extraction, Saponification, and Liquid Chromatography: Collaborative Study

Isoflavones are biologically active compounds occurring naturally in a variety of plants, with relatively high levels found in soybeans. Twelve laboratories participated in a collaborative study to determine the aglycon isoflavone content of 8 test samples of soy and foods containing soy. The analytical method for the determination of isoflavones incorporates a mild saponification step that reduces the number of analytes measured and permits quantitation versus commercially available, stable reference standards. Test samples were extracted at 65°C with methanol–water (80 + 20), saponified with dilute sodium hydroxide solution, and analyzed by reversed-phase liquid chromatography with UV detection at 260 nm. Isoflavone results were reported as μg/aglycon/g or μg aglycon equivalents/g. The 8 test samples included 2 blind duplicates and 4 single test samples with total isoflavone concentrations ranging from approximately 50 to 3000 μg/g. Test samples of soy ingredients and products made with soy were distributed to collaborators with appropriate reference standards. Collaborators were asked to analyze test samples in duplicate on 2 separate days. The data were analyzed for individual isoflavone components, subtotals of daidzin–daidzein, glycitin–glycitein, and genistin–genistein, and total isoflavones. The relative standard deviation (RSD) for repeatability was 1.8–7.1%, and the RSD for reproducibility was 3.2–16.1% for total isoflavone values of 47–3099 μg/g.

1203. Epidemiology of Respiratory Viruses in Influenza-Vaccinated Healthcare Workers During an H1N1-Dominant Season

Background

Respiratory pathogens are an important cause of morbidity and mortality in hospitalized patients and nosocomial spread of such pathogens is known to occur. However, little is known about the epidemiology of respiratory viruses in healthcare workers (HCW).

Methods

Between December 28, 2018 and April 26, 2019 enrolled HCW completed a weekly symptom diary, including presence or absence of respiratory symptoms, flu exposure history and whether they received medical attention. Vaccination and flu infection history were collected on enrollment. Participants self-collected flocked nasopharyngeal (NP) swabs every other week and if they reported any symptom on the weekly diary. These were tested using a multiplex PCR platform (Biofire, Salt Lake City, UT) with targets for 14 respiratory viruses. Symptomatic HCW with influenza or respiratory syncytial virus (RSV) were notified and followed policy regarding work restriction.

Results

66 HCWs provided baseline data and 57 continued data submission (9 withdrew). The active participants included 13 nurses (22.8%), 7 advanced practice providers (12.3%), 18 physicians (31.6%), and 19 other (33.3%). Participants received quadrivalent inactivated flu vaccine this season (2 self-reported/unknown type). Compliance was 89.8% (749 of 834) with weekly diary completion and 83.3% (378/454) for biweekly NP swabs. Thirty-nine unique participants reported symptoms on weekly diaries 100 times and submitted 88 total “symptomatic” NP swabs (88% compliance). Of these, 16 swabs revealed any pathogen (18.2%) and 3 had influenza H3N2 (18.8%) (only one reported fever). Other pathogens identified are detailed in Figure 1. 12 of the 366 asymptomatic swabs were positive for respiratory viruses (23.3%, see Figure 1). No participant had asymptomatic influenza.

Conclusion

Pauci-symptomatic influenza has been previously described by our group and others and is noted even in this small cohort. While asymptomatic flu was not found, there were several cases of other asymptomatic respiratory viruses in HCW. Analysis of the impact on patients is still underway from this cohort but the initial data suggest that patients are at risk of contracting healthcare-acquired respiratory infection even from health care providers.

Disclosures

All authors: No reported disclosures,

Clinical Characteristics and Outcomes Among Older Women with HIV

OBJECTIVES

To inform the development of HIV care strategies for older women with HIV infection, an understudied group, we compared the psychosocial, behavioral, and clinical characteristics of HIV-positive women aged ≥50 (older women) with those aged 18-49 (younger women).

METHODS

We examined factors among HIV-positive women in care using data from the 2009 through 2013 cycles of a nationally representative sample of HIV-positive adults in care (Medical Monitoring Project). We compared psychosocial, clinical, and behavioral factors among women aged ≥50 years at interview versus those aged <50 years. We calculated weighted frequency estimates and performed logistic regression to compute adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) for the comparison of characteristics among women aged ≥50 versus <50 years.

RESULTS

Of 22,145 participants, 6186 were women; 40.7% (CI 39.1-42.3) were ≥50 years, and 32.7% of older women reported being sexually active. Compared with women <50 years, women aged ≥50 years were more likely to be dose adherent (aPR = 1.19; CI 1.07-1.33), prescribed antiretroviral therapy and have sustained viral load suppression (aPR = 1.03; CI 1.00-1.18), and were less likely to report any depression (aPR = 0.92; CI 0.86-0.99), to report condomless sex with a negative or unknown partner if sexually active (aPR = 0.56; CI 0.48-0.67), and to have received HIV/sexually transmitted infection (STI) prevention counseling from a healthcare provider (aPR = 0.82; CI 0.76-0.88).

CONCLUSIONS

These data suggest that older women in HIV care have more favorable outcomes in some clinical areas, but may warrant increased HIV/STI prevention counseling from their care providers, especially if sexually active.

Reduced insulin-stimulated GLUT4 bioavailability in stroke-prone spontaneously hypertensive rats

AIMS/HYPOTHESIS

Insulin-stimulated glucose transport is impaired in a genetic model of hypertension, the stroke-prone spontaneously hypertensive rat (SHRSP), yet the molecular mechanisms that underlie this defect in the animals remain unclear.

METHODS

We examined the effects of insulin on the trafficking of the insulin-responsive glucose transporter GLUT4 to the plasma membrane in isolated adipocytes from SHRSP and normotensive control Wistar-Kyoto (WKY) rats.

RESULTS

Treatment of isolated adipocytes with insulin resulted in trafficking of GLUT4 to the plasma membrane. There was no significant difference in the magnitude of insulin-stimulated GLUT4 trafficking from intracellular membranes to the plasma membrane between strains. In contrast, we demonstrated that there is a significant reduction in GLUT4 accessible to the glucose photolabel Bio-LC-ATB-BGPA at the plasma membrane of SHRSP adipocytes compared with control rats.

CONCLUSIONS/INTERPRETATION

We propose that a large proportion of GLUT4 translocated to the plasma membrane in response to insulin is not able to bind substrate and catalyse transport in the SHRSP. Therefore, there is a reduction in bioavailable GLUT4 in SHRSP animals that is likely to account, at least in part, for the reduced insulin-stimulated glucose uptake.

Cd36 and molecular mechanisms of insulin resistance in the stroke-prone spontaneously hypertensive rat

Insulin resistance is of pathogenic importance in several common human disorders including type 2 diabetes, hypertension, obesity and hyperlipidemia, but the underlying mechanisms are unknown. The spontaneously hypertensive rat (SHR) is a model of these human insulin resistance syndromes. Quantitative trait loci (QTLs) for SHR defects in glucose and fatty acid metabolism, hypertriglyceridemia, and hypertension map to a single region on rat chromosome 4. Genetic analysis of an SHR derived from a National Institutes of Health colony led to the identification of a causative mutation in the SHR Cd36. We have investigated glucose and fatty acid metabolism in the stroke-prone SHR (SHRSP). We demonstrate defects in insulin action on 2-deoxy-D-glucose transport (SHRSP 3.3 +/- 1.5 vs. 21.0 +/- 7.4 pmol x min(-1) x [20 microl packed cells](-1), SHRSP vs. WKY, respectively, P = 0.01) and inhibition of catecholamine-stimulated lipolysis (P < 0.05 at all concentrations of insulin) in adipocytes isolated from SHRSP. In contrast, basal levels of catecholamine-stimulated nonesterified free fatty acid (NEFA) release and plasma levels of NEFA are similar in SHRSP and WKY. These results are in agreement with the data on the SHR.4 congenic strain, which suggested that the QTL containing Cd36 mutations accounted for the entire defect in basal catecholamine action but only for approximately 40% of the SHR defect in insulin action. In the SHR, both abnormalities appear consequent of defective Cd36 expression. Because Cd36 sequence and expression are apparently normal in SHRSP, it is likely that the molecular mechanism for defective insulin action in this strain is caused by a gene(s) different than Cd36.

Sex hormones induce insulin resistance in 3T3-L1 adipocytes by reducing cellular content of IRS proteins

AIM/HYPOTHESIS

Numerous studies have suggested a relation between sex hormones and insulin sensitivity but the ability of sex hormones to directly influence insulin action in peripheral tissues has not been investigated.

METHODS

We have examined the effects of estriol, estradiol and estrone on insulin action in cultured 3T3-L1 adipocytes, a useful model of adipocytes.

RESULTS

Treatment of these cells with each of these sex hormones resulted in a statistically significant reduction in the ability of insulin to stimulate glucose transport independently of a reduction in total cellular GLUT-4 content. This diminished ability of insulin to stimulate glucose transport was accompanied by a reduction in the total cellular content of insulin receptor substrates -1 and -2 and the p85alpha subunit of phosphatidylinositol 3'-kinase. By contrast, cellular content of protein kinase B was unchanged by hormone treatment but the magnitude of insulin-stimulated kinase activity was statistically significantly reduced after incubation with each of the sex hormones tested. We have further shown that treatment of 3T3-L1 adipocytes with these hormones alters the subcellular distribution of insulin receptor substrate proteins such that the particulate and soluble pools of these proteins were differentially affected by hormone treatment.

CONCLUSION/INTERPRETATION

These data show that sex hormones can directly induce a state of insulin resistance in 3T3-L1 adipocytes in culture. The mechanism of this defect seems to be at least in part due to decreased cellular content and altered subcellular distribution of insulin receptor substrate proteins which in turn results in a reduction in proximal insulin-stimulated signalling cascades.

An initial assessment of the risk approach to antenatal management in Malaysia

This study was the first assessment of a nationwide risk approach system to antenatal management introduced to Malaysia in 1989. Three rapid, record-based surveys on three different study groups were conducted to determine risk factor prevalence, accuracy of risk assignment, action after risk assignment and the relationship of risk level and place of delivery. The most frequent risk factors were short birth interval, high parity and first pregnancy. Accuracy of risk assignment was highest at the lowest levels of risk and poorest at the highest levels. Women at the lowest levels of risk were more likely to be seen by a doctor than women at highest risk. These was a trend to deliver in hospital, rather than at home, as level of risk increased; but many women at high risk still delivered at home. Recommendations are made on modifications to the system prior to future evaluation.