This study explores the general knowledge of Human Papillomavirus vaccine (HPV) and cervical cancer screening (CCS) among Somali men in the U.S., who are major decision-makers in Somali households. HPV infects both men and women, and causes genital warts and cervical cancer (CC). High mortality from CC persists among minorities due to low uptake of preventive tools. Eleven questions assessed general knowledge of HPV and CCS among 30 Somali male respondents. The knowledge of HPV and CCS by education level, age, and years lived in the U.S., was assessed using the health belief model. Most respondents had no knowledge of HPV vaccine and CCS, and low perceived susceptibility to HPV infection. There is need for more research on Somali men's attitude to HPV vaccine and CCS uptake among Somali adolescents and women.

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Introduction: Since their introduction, electronic cigarette use has increased and was even proposed as an alternative to traditional tobacco use. Recently, a series of patients with acute respiratory failure due electronic cigarette, or vaping, associated lung injury (EVALI) in 2019 has been described which has largely been attributed to tetrahydrocannabinol (THC) containing vaporizer itself, as well as vitamin E acetate. Several case series have been published regarding the acute presentation, diagnosis and management. In addition to diagnosis and management of EVALI, we sought to describe potential long-term effects of lung parenchyma in these patients. Methods: A retrospective review was performed on 16 patients with clinically diagnosed EVALI at OSF St Francis Medical Center between August 01 2019 and February 1 2020. Relevant demographic and clinical data were collected in patients diagnosed with EVALI. Results: Of the 16 patients in the study the median age (IQR) age was 25.25 (20-29) and 94% were male. The predominant presenting symptoms were dyspnea (94%), cough (56%), nausea 63%), vomiting (63%), abdominal pain (50%), diarrhea (50%), and fever (63%). 2 (13%) patients required endotracheal intubation. Common features of computerized tomography (CT) scan were bilateral diffuse ground glass opacity (93%), septal thickening (53%), and subpleural sparing (47%). Bronchoalveolar lavage (BAL) was obtained in 3 patients and all demonstrated neutrophil predominance of 69% (56-90). One BAL was significant for hemosiderin laden macrophages. Post hospital follow up pulmonary function tests were obtained in 3 and 2 of these were significant for obstructive lung disease. Conclusions: In this case series of patients diagnosed with vaping associated lung injury, obstructive lung disease may be seen on pulmonary function testing and surveillance of these patients should occur regardless of duration.

Along with corticosteroids, patients with anti-synthetase syndrome associated interstitial lung disease (ILD) require a corticosteroid-sparing agent, such as azathioprine, rituximab, or cyclophosphamide. However, there is no study that demonstrates the superiority of one agent, making it difficult to choose one over the other given their high side effect profile. CASE PRESENTATION: A 67 years old female who had symptoms of left shoulder, arms, and eye pain that started 5 months ago, and dyspnea with exertion that started 7 months prior to presenting with worsening dyspnea. Initial work up was significant for elevated CK and aldolase, and positive ANA, anti Jo-1 and anti SS-A. CT was significant for NSIP pattern; and workup for infection was negative. Her initial oxygen requirement was 6 L. She was started on prednisone 60 mg daily, but her dyspnea progressed, getting into respiratory failure that required intubation. She was switched from prednisone to methylprednisolone 1 g/ day for 3 days. She also received 2 doses of IV cyclophosphamide 1000 mg, followed by a total of 3 doses of IV Rituximab 700 mg that was initiated 8 days later. She was extubated 6 days later to facemask ventilation. She had frequent episodes of worsening dyspnea that occurred after a corticosteroid tapering attempt, therefore, requiring increased corticosteroids. She was eventually weaned to 2 liters of oxygen and discharged with home oxygen and a tapered dose of prednisone. DISCUSSION: Anti-synthetase syndrome is part of the idiopathic inflammatory myopathies (IIM) in which antibodies develop against aminoacyl tRNA. The diagnostic criteria for antisynthetase syndrome is the presence of tRNA synthetase autoantibody in addition to clinical features, such as ILD and/or myositis. The most commonly identified antibody is anti-Jo-1; other less common antibodies include: anti-PL12 and anti-PL7. ILD Anti-synthetase syndrome is more severe, rapidly progressing and leads to a high mortality when compared to ILD in the other IIMs. Corticosteroid-monotherapy in these patients is known to cause frequent lung disease reoccurrence. Therefore, an additional agent needs to be added in refractory cases. Azathioprine is a commonly used agent in conjunction with prednisone, but not well studied. Multiple other case studies showed improvement in lung function and/or pulmonary symptoms in patients who received Rituximab as the adjunctive medication. The treatment options that can be used in antisynthetase ILD lies at the discretion of the physician. In our case, the use of corticosteroids, Rituximab, and cyclophosphamide appeared to have significant clinical outcome. CONCLUSIONS: To better treat patients with this condition, high clinical suspicion is needed, and patients may benefit from early rituximab therapy. Future studies that compare the effect of corticosteroid-sparing agents would help on deciding the best treatment agents.

Since their introduction, electronic cigarette use has increased and was even proposed as an alternative to traditional tobacco use. Recently, a series of patients with acute respiratory failure due electronic cigarette, or vaping, associated lung injury (EVALI) in 2019 has been described which has largely been attributed to tetrahydrocannabinol (THC) containing products and its ingredients. Proposed mechanisms of lung injury have been attributed to the vaporizer itself, as well as vitamin E acetate. Several case series have been published regarding the acute presentation, diagnosis and management. In addition to diagnosis and management of EVALI, we sought to describe potential long-term effects of lung parenchyma in these patients. METHODS: A retrospective review was performed on 16 patients with clinically diagnosed EVALI at OSF St Francis Medical Center between August 01 2019 and February 1 2020. Relevant demographic and clinical data were collected in patients diagnosed with EVALI. RESULTS: Of the 16 patients in the study the median age (IQR) age was 25.25 (20-29) and 94% were male. The predominant presenting symptoms were dyspnea (94%), cough (56%), nausea (63%), vomiting (63%), abdominal pain (50%), diarrhea (50%), and fever (63%). 2 (13%) patients required endotracheal intubation. Common features of computerized tomography (CT) scan were bilateral diffuse ground glass opacity (93%), septal thickening (53%), and subpleural sparing (47%). Bronchoalveolar lavage (BAL) was obtained in 3 patients and all demonstrated neutrophil predominance of 69% (56-90). One BAL was significant for hemosiderin laden macrophages. Post hospital follow up pulmonary function tests were obtained in 3 and 2 of these were significant for obstructive lung disease. CONCLUSIONS: In this case series of patients diagnosed with vaping associated lung injury, obstructive lung disease may be seen on pulmonary function testing and surveillance of these patients should occur regardless of duration. CLINICAL IMPLICATIONS: Patients with any history of vaping or electronic cigarette use should be screened for obstructive lung disease with full pulmonary function testing.