Provider Confidence in Counseling Preconception, Pregnant, and Postpartum Patients Regarding COVID-19 Vaccination

Objective: To assess knowledge and confidence in COVID-19 vaccine counseling among practitioners who provide care to pregnant persons and to describe factors associated with confidence in counseling. Study Design: A web-based anonymous survey was distributed via email to a cross-sectional convenience sample of OB/GYN, Primary Care, and Internal Medicine faculty at three hospitals in a single healthcare network in Massachusetts. Individual demographics and institution-specific variables were included in the survey along with questions assessing both attitudes toward COVID-19 illness in pregnancy as well as confidence in counseling regarding the use of the vaccine for pregnant patients. Results: Almost all providers (151, 98.1%) reported already receiving or being scheduled to receive a COVID-19 vaccine, and a majority of providers (111, 72.1%) reported that they believe the benefits of the mRNA COVID-19 vaccine in pregnancy outweigh the risks. Forty-one (26.6%) reported feeling very confident in counseling patients who primarily speak English about the evidence for mRNA vaccination in pregnancy, and 36 (23%) reported feeling very confident in counseling patients who are not primarily English-speaking. Forty-three providers (28.1%) expressed strong confidence in their comfort talking to individuals with vaccine hesitancy based on historic and continued racism and systemic injustices. The sources that survey respondents most commonly used to find information regarding COVID-19 vaccination in pregnancy were the CDC (112, 74.2%), hospital-specific resources (94, 62.3%) and ACOG (82, 54.3%). Conclusion: While providers reported high personal uptake of COVID-19 vaccination and felt that the benefits of vaccination outweigh the risks in pregnancy, less than one-third felt very confident in counseling pregnant patients about available evidence for mRNA vaccine safety in pregnancy. Ensuring that providers feel comfortable bridging the gap between their belief that the vaccine is beneficial for pregnant patients and their comfort with holding conversations with patients regarding vaccination is paramount in order to ensure equitable access to vaccines for pregnant patients. Keywords Pregnancy, vaccine hesitancy, COVID-19, prenatal, postpartum, preconception, vaccine counseling

Efficacy of Albendazole Against Strongylus sp. and Hematology Changes on Equine in Yogyakarta Special Region

The infestation of Strongylus sp. in horses can cause losses to horse breeders, including anorexia, anemia, gastrointestinal diseases and can cause death and decrease the horse population in DIY. Albendazole was a Benzimidazole preparation that is often used to treat worms in ruminants. This study also aims to determine the effect of Albendazole on blood images before and after treatment. The material used in this study were 10 horses with male and female sex, over 3 years old, and infected with Strongylus sp. with an infestation rate of 200 EPG in faeces. Before treatment of drug was carried out, the faeces was examined with Mc Master method. After treatment with Albendazole, the worm eggs were examined three times at intervals of three days. Routine examination of worm eggs and blood was carried out at the Laboratory of the Department of Internal Medicine, Faculty of Veterinary Medicine, Universitas Gadjah Mada. The results showed that the EPG number decreased from the 0th, 3rd, 6th and 9th day of examinations. The average number of EPG on the 0th day was 990 eggs/gram, and the examination on the 9th day showed the number of eggs was 0 eggs/gram. The results of the hematology examination also showed no significant difference except for the high number of eosinophils on the 12th day after drug administration. The conclusion from this research is that Albendazole as a worm medicine can kill Srongylus sp. however, it does not affect the horse's hematology and health status.

Association of Urinary Interferon Gamma Protein-10 Levels and Low Levels of Cluster of Differentiation 4 Serum in Patients with Tuberculosis-Human Immunodeficiency Virus Coinfection

BACKGROUND: Tuberculosis (TB) infection caused by Mycobacterium tuberculosis was the most frequent opportunistic infection in human immunodeficiency virus (HIV) patients that lead to increasing of morbidity and mortality. Very low cluster of differentiation 4 (CD4) levels causing problem in TB/HIV diagnostic because unspecific clinical manifestation. Urine interferon gamma protein-10 (IP10) examination is a method that is relatively easier and safer to do, so it can be used as an alternative method in establishing the diagnosis TB/HIV. AIM: The aim of this study was to investigate the association between urinary IP-10 and level of CD4 serum in patients with TB/HIV coinfection. MATERIALS AND METHODS: This study was conducted at the Department of Internal Medicine, Faculty of Medicine, Dr. M. Djamil Hospital, Padang, Indonesia, involved 30 patients with active TB/HIV coinfection whose urine and blood serum were collected to evaluate IP-10 and CD4 level. RESULTS: There is a significant relationship between urine IP10 levels as a biomarker for the diagnosis of active pulmonary TB in HIV patients and serum CD4 levels in TB-HIV coinfected patients with moderate correlation strength. CONCLUSION: Further research is needed with a larger sample size to see the effect of low serum CD4 levels on the sensitivity of urine IP10 diagnosis.

Hypoadrenocorticism in dogs – the Mad Hatter of veterinary internal medicine

Hypoadrenocorticism arises from insufficient adrenal gland function and is also known as Addison’s disease, a rarely occurring disease (0.1%) in dogs. Due to its oscillatory course and overall nonspecific symptoms, it is a diagnostic challenge for clinicians, and is often misdiagnosed or unattended among other differentials. There are two forms of hypoadrenocorticism: primary and secondary. The aim of this study was to analyse the data of dogs suffering from Addison’s disease, treated at the Clinic for Internal Medicine, Faculty of Veterinary Medicine, University of Zagreb, Croatia and to compare them with data from similar institutions worldwide. The archive of Clinic for Internal Medicine, Faculty of Veterinary Medicine, Zagreb, Croatia was searched to investigate and statistically analyse signalment, clinical and laboratory data, and the duration of symptoms, treatment protocols and outcome of canine hypoadrenocorticism. The study group included 14 dogs (36% male and 64% female) diagnosed with hypoadrenocorticism. All dogs had a history of gastrointestinal symptoms, i.e. vomiting in 100%, diarrhoea in 64% and melena in 7%. Hypovolemic shock was noted in 57%, hypothermia in 64% and bradycardia in 29% of cases. The most frequently observed laboratory abnormalities were an increase in BUN (86%), creatinine (57%) and potassium concentration (79%), and a decrease in sodium (71%), Na/K ratio (86%), cholesterol (21%) and glucose concentration (21%). Duration of symptoms (till ACTH stimulation test performance) was broad, from 2 – 2190 days (median 90±1195.5 days). The outcome was favourable in 100% cases after initiation of adequate treatment.

Abstract 233: Quality of Collaboration Between Cardiologists and Internists During Inpatient Consultations

Background: Collaboration between cardiologists and internists is essential to providing safe, effective, and patient-centered cardiovascular care. The objective of this study was to determine the quality of collaboration between these clinicians during inpatient consultations and identify areas for improvement. Methods: We surveyed hospitalists, general internal medicine faculty, and resident physicians from inpatient general medicine services and consulting cardiology attendings and fellows at a large tertiary care hospital over a two month period. Respondents were asked to rate each other’s level of collaboration on a 5-point ordinal response scale and answer multiple choice and free-response questions on consultation practices and personal preferences. Results: Overall, 92 of 155 (59%) eligible hospitalists, general internal medicine faculty, and resident physicians completed the primary survey. Collaboration with cardiology consultants was rated as high or very high quality by 72% of respondents. There was no significant difference between ratings of collaboration quality based on respondents’ level of training. Internists identified resistance or disagreement with indication for consultation, difficulty receiving a timely response, and poor follow-up communication as the largest barriers to high quality collaboration. Most internists preferred receiving recommendations by page, phone, or written in a consult note, rather than in person. Internists appreciated close communication throughout the consultation process. For longitudinal consultations, internists preferred when an intention to sign-off was communicated by page or wrote in that day’s consult note. In total, 9 cardiology attendings and fellows completed the specialty survey. Cardiologists reported providing recommendations the same day for routine consultations, or within 2-3 hours when urgent. Most consultants communicated their recommendations thru page, phone conversations, or written consult note. Providing recommendations in person was rare. Half of cardiology attendings and fellows rated collaboration with internists as high or very high quality. There was no significant difference between their ratings of collaboration with hospitalists and residents. Cardiologists appreciated when outside hospital records had already been obtained. They identified receiving an unclear reason for consult, consulting prior to initial work-up, late in the day, or when an outpatient appointment was more appropriate as the largest barriers to high quality collaboration. Conclusions: While cardiologists and internists appear to agree on modes of communication, they have different perceptions of timeliness and disagreements on appropriateness of consultations. Further research is needed to design and study interventions that address these barriers to high quality collaboration.