ART adherence, essential to preventing disease progression for people living with HIV (PLHIV), remains challenged by factors like poor mental health condition, insufficient social support, and substance use. This study investigates the roles of social support and substance use as mediators in the relationship between mental health and antiretroviral therapy (ART) adherence among PLHIV in a multisite, international context. Cross-sectional data from N = 1598 PLHIV across eight countries were analyzed using parallel mediation analyses in R. Results indicated that both social support and substance use independently mediated the relationship between mental health and ART adherence. Hallucinogens mediated the mental health-adherence link. Cocaine, Amphetamine-type stimulants, inhalants, and opioids directly influenced adherence but did not mediate this relationship. In contrast, no significant effects were observed for tobacco, alcohol, cannabis or sedatives. This large-scale, nurse-led, international study offers critical insights into the roles of social support and substance use as psychosocial influencers in the cascade of care for PLHIV. Clinical implications include prioritizing educative, preventative, and harm-reductive approaches to specific substances that impact ART adherence. Findings may also inform interventions that emphasize strengthening social support to improve adherence in ART and care while addressing substance use as a barrier to care and well-being.
OBJECTIVES:Puerto Rico's 2024-2025 dengue epidemic highlighted the need to understand how complementary surveillance systems capture cases and severity. We compared the Sentinel Enhanced Dengue Surveillance System (SEDSS) and the Passive Arboviral Disease Surveillance System (PADSS) in capturing characteristics of dengue cases during this epidemic and assessed their complementary roles in epidemic monitoring and public health preparedness. METHODS:We analyzed laboratory-confirmed dengue cases reported in SEDSS and PADSS from January 1, 2024, through January 31, 2025. SEDSS recruits at sentinel sites, collecting clinical, epidemiological, and laboratory data, while PADSS relies on clinician-initiated reporting across the island. We used descriptive statistics, cross-correlation analyses, and generalized additive models to compare temporal trends, demographic characteristics, clinical features, and severe dengue outcomes. RESULTS:SEDSS enrolled 373 dengue patients (7.0% of tested patients), while PADSS reported 6488 dengue patients (60.1% of tested patients). Both systems showed aligned epidemic peaks, although PADSS detected more cases overall. Compared with PADSS patients, SEDSS patients were younger (median age = 22 vs 27 y) and had higher proportions of warning signs, including mucosal bleeding (21.7% vs 6.9%), hemoconcentration (4.4% vs 0.1%), and restlessness (31.1% vs 7.5%) (P < .001 for all). Severe dengue was more common in SEDSS patients (9.1% vs 5.6%; P = .02), likely due to more detailed clinical data, with the highest rates among patients aged 10 to 19 years (16.3%) and <10 years (10.5%). SEDSS captured severe plasma leakage (6.2%), which was not recorded in PADSS. PADSS provided broader geographic coverage. CONCLUSIONS:SEDSS captures detailed clinical data, whereas PADSS provides broader coverage and higher case counts. Integrating both systems strengthens epidemic response, resource allocation, and public health decision-making.
Schwannomas are benign, slow-growing tumors that arise from Schwann cells of the peripheral nerve sheath. Pulmonary schwannomas are extremely uncommon, accounting for approximately 0.2% of all lung tumors and representing a small fraction of tracheobronchial neoplasms. We present a case involving a 49-year-old non-smoking male with a history of Crohn's disease who reported a persistent productive cough, dyspnea, and a subjective sensation of airway obstruction that did not improve with nebulized therapy. Chest CT revealed an endobronchial lesion obstructing the right mainstem bronchus. Flexible bronchoscopy demonstrated a vascular, pedunculated mass occupying approximately 80% of the bronchial lumen, and transbronchial biopsies were obtained. Histopathological and immunohistochemical analysis confirmed a diagnosis of schwannoma, with strong S100 positivity. The patient subsequently underwent rigid bronchoscopy with argon plasma coagulation, followed by complete tumor resection using a cryoprobe, resulting in successful airway restoration. This report highlights the importance of considering rare benign neoplasms in patients with persistent respiratory symptoms and emphasizes the role of bronchoscopic intervention in both diagnosis and definitive treatment.
