bluuebunny/crossref_metadata_2025 huggingface dataset:
P-678. Comparison between the Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Three Waves of the Pandemic
Authors: Mares Porto Barbara , Pereira Daniella Nunes , Kopittke Luciane , Asevedo Alisson , Gomes Angélica Gomides dos Reis , Behring Angelinda , Lima Beatriz , Silva Carla , Barros Cláudia , Pereira Elayne , Conceição de Oliveira Evelim Thainara , Vigil Flavia , Crestani Gabriela , Santos Lais , Moreira Leila Beltrami , Reis Marco , Bicalho Maria , Muller Vanessa , Tupinambás Unaí , Marcolino Milena Soriano
Published: January 2025

Background

Throughout the COVID-19 pandemic, new SARS-CoV-2 variants emerged, each prevailing during a certain time period and defining the pandemic waves that were observed all over the world. Even in different countries, such waves presented many similarities, such as the period of occurrence, clinical characteristics of those who were infected by the SARS-CoV-2 virus, COVID-19 outcomes and governmental public policies to stop the spread of the disease. Their major differences are believed to be related to the SARS-CoV-2 variant circulating at the time, as well as the availability of vaccines, patient vulnerabilities, resource availability and knowledge in patient management.

Methods

This study is part of a multicentric retrospective cohort, entitled the Brazilian COVID-19 Registry, which included adult patients (≥18 years), with laboratory-confirmed COVID-19, admitted between March 2020 and August 2022 in 41 hospitals in six Brazilian states. The primary outcome was in-hospital mortality. Secondary outcomes included: intensive care unit (ICU) admission, need for mechanical ventilation, kidney replacement therapy (KRT) thromboembolic event, nosocomial infection, acute heart failure and septic shock.

Results

The median age decreased in the second wave and increased in the third compared to the first. The total number of comorbidities was higher during the third wave and lower in the second. When evaluating symptoms, in the third wave, anosmia, ageusia and fever were less common when compared to the other waves , while neurological manifestations were more frequent. The frequency of admission to the intensive care unit and in-hospital mortality reduced throughout the pandemic.

Conclusion

The study showed that clinical manifestations and outcomes changed between the three COVID-19 waves. In the second phase of the pandemic, patients hospitalized with Covid-19 were younger and had fewer comorbidities. The risk of severe disease has decreased substantially since the start of the pandemic. However, the new strains are under continued investigation, because of the unknown impacts in severity and vaccine effectiveness, the response to existing therapies and the accuracy of diagnostic tools.

Disclosures

All Authors: No reported disclosures
P-679. Risk Factors Shared Among Common Respiratory Viruses
Authors: Waxse Bennett , Tran Tam , Mo Huan , Denny Joshua
Published: January 2025

Background

Upper respiratory infections affect patients of all ages, with severity influenced by demographics, comorbidities, and immunosuppression. Studies often determine risk factors associated with severe disease, but rarely are multiple upper respiratory pathogens compared within the same cohort. Using electronic health record (EHR) phenotyping of 267,031 participants with relevant EHR data enrolled in the National Institute of Health’s All of Us Research Program (All of Us), we identified and validated cohorts of participants, and revealed shared risk factors for severity among upper respiratory viruses.

Methods

We developed EHR phenotype algorithms for eight respiratory viruses using pathogen-specific billing codes, test results, and treatment-dose antivirals. We identified episodes of infection over 90-day periods and validated these using CDC national detection rates over the same period. We then used multivariable logistic regression to compare demographics and identify predictors of hospital admission, adjusting for age, sex, self-identified race and ethnicity, BMI, smoking status, and EHR record length.

Results

Scaled episode and testing counts paralleled CDC data, with expected seasonal trends observed for influenza, parainfluenza, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus (hMPV), SARS-CoV-2, and human coronavirus (hCOV) (RSV, hCOV, influenza, and SARS-CoV-2 shown in Figure 1). Across viruses, hospital admission was associated with older age, male sex, underweight, severe obesity, self-identified Black race, and smoking (Table 1). Notably, significant predictors of admission included COPD, asthma, heart failure, ischemic heart disease, hypertension, diabetes, chronic kidney disease, and immunodeficiency, even after adjusting for confounding variables (Figure 2).

Conclusion

In this study we established and validated an EHR phenotyping algorithm, and demonstrated that clinical risk factors — particularly cardiopulmonary, metabolic, and immunological comorbidities — are associated with severe outcomes among multiple upper respiratory viruses. These results suggest that universal prevention interventions may mitigate the impact of respiratory viral infections in high-risk populations.

Disclosures

All Authors: No reported disclosures
P-704. Sustained decline in the incidence of hospital-acquired Influenza A/B, Parainfluenza, and Respiratory Syncytial Virus (RSV) infections at the NIH Clinical Center
Authors: Forrester LaToya A , Odom Robin T , Scaletta Joseph , Michelin Angela V , Han Alison , Henderson David K
Published: January 2025

Background

Respiratory viral infections can result in significant morbidity and mortality for immunocompromised patients. The role of universal masking in hospitals to reduce the spread of respiratory infections remains controversial. The NIH Clinical Center serves immunocompromised patients and continued masking policies into 2024 (masking throughout the hospital April 8, 2020-June 4, 2023 and masking only in patient care from June 5, 2023 onward). We conducted a retrospective review of hospital-acquired Influenza A/B, Parainfluenza, and RSV infections from January 2010 to March 2024 to determine if masking policies were associated with a reduction in hospital transmission of selected respiratory viruses.

Methods

Incubation periods for each respiratory virus was established. Infections occurring after the incubation periods were considered hospital-acquired. Medical chart reviews were conducted to ascertain date of symptom onset and history of respiratory viral infection. Quantitative data analysis was performed.

Results

Between January 2010 and March 2024, 127 hospital-acquired Influenza A/B, Parainfluenza, and RSV infections were identified. Forty-five Influenza A/B, 42 Parainfluenza and 37 RSV infections were identified in the pre-masking period (January 2010 to April 7, 2020) vs. 0 Influenza A/B, 2 Parainfluenza and 1 RSV infections identified in the masking period (April 8, 2020 to March 31, 2024). Interrupted time-series analysis was significant for all hospital-acquired respiratory viral infections (p < 0.001).

Conclusion

Masking was temporally associated with a decrease in all hospital-acquired respiratory viral infections. Pandemic mitigation measures, including symptomatic screening of building entrants, physical distancing, and asymptomatic testing of staff, may have contributed to this decline; however, when these strategies were relaxed and masking continued, hospital-acquired respiratory viral infections remained low. Wearing masks in the hospital may provide benefit for hospitalized immunocompromised patients.

Disclosures

All Authors: No reported disclosures
P-708. Risk Factors Associated with Lower Respiratory Tract Infections in Adult Patients with Respiratory Syncytial Virus Infections
Authors: Sharma Mamta , Szpunar Susan M , Bhargava Ashish , Saravolatz Louis
Published: January 2025

Background

Respiratory Syncytial Virus (RSV) is known to cause severe disease in elderly individuals and patients with underlying cardiopulmonary or immunocompromised conditions. Little is known about the factors associated with the lower respiratory tract infections (LRTI).

Methods

A multicenter historical cohort study was conducted on adult patients hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Medical records were reviewed after IRB approval. LRTI was defined as an acute respiratory disorder meeting at least three out of four criteria: respiratory signs/symptoms (cough/ dyspnea/ tachypnea), fever, oxygen saturation below 94%, and abnormal chest x-ray at the time of hospital admission. Data were analyzed using Student’s t-test, the chi-squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0.

Results

Of 360 patients, 143 (39.7%) had LRTI. The mean (sd) age of patients with LRTI was 69.1 + 15.3 years, and 76 (53.1%) were female. The mean Charlson Weighted Index of Comorbidity score was 2.5 + 2.1. Factors associated with LRTI in univariable analysis were age, sex, asthma, time period (TP) (pre-COVID (2017-2019) and COVID (2020-2021), maximum temperature within 24 hours of admission (Tmax), lowest diastolic blood pressure, oxygen requirement and neutrophil count at admission, infectious disease (ID) consultation, and antibiotics given for >1 day. Predictors for LRTI in multivariable logistic regression were COVID TP (odds ratios [OR], 2.0; 95% CI 1.2-3.4), Tmax ([OR], 1.2; 95% CI 1.0-1.5), oxygen requirement at presentation (OR, 2.1; 95% CI 1.2-3.4), ID consultation ([OR], 2.7; 95% CI 1.6-4.4), antibiotics given for >1 day (OR, 3.7; 95% CI 2.2-6.2) while female sex was inversely related to LRTI episodes ([OR], 0.4; 95% CI 0.3-0.7) .

Conclusion

Our study finds that COVID time period, maximum temperature within 24 hours of admission, oxygen requirement at admission, ID consultation, and antibiotics given >1 day were significantly associated with LRTI among adult patients with RSV infection. Female sex was less likely to have LRTI. Further studies needed to confirm these findings.

Disclosures

All Authors: No reported disclosures
P-720. Are we aware of the RSV problematic in the Dominican Republic?
Authors: Rojas-Fermin Rita A , Guzman-Marte Anel E , Sanchez-Marmolejos Ann S , Guzman-Ricardo Francisco , Reyes Yeison , Calcano Ruben
Published: January 2025

Background

Respiratory Syncytial Virus (RSV) is a common cause of respiratory illness that could have a severe presentation in infants and elderly patients. As in other LATAM countries, RSV diagnosis is limited due to a lack of testing or access, and there is scarce data on the epidemiology, clinical impact, and mortality. Our aim was to characterize the disease in patients admitted to a hospital setting.

Distribution of admitted patients by age

Source: Statistical registry of the authors

Methods

We performed a retrospective review of admitted patients in a tertiary 289-bed hospital with a respiratory molecular panel from January 2022 to December 2023 (n = 715). RSV-positive patients (n = 91) were selected, and their clinical and demographic information, co-morbidities, risk factors, and outcomes were reviewed on their electronic medical record.

Microbial frequency in RSV coinfected patients

Source: Statistical registry of the authors

Results

Out of 91 patients, 58.2% (53/91) were male, 75.8% were ≤2 years old, and 8.8% were ≥60 years old. The RSV positivity rate for all ages (0–84 years old) was 12.7% and 53.4% (69/129) for ≤2 years old. All cases were detected near the second semester of each year (May–December 2022 and July–December 2023).

Out of 50 patients with RSV as the only pathogen confirmed through testing, 32 developed respiratory complications (bronchiolitis and pneumonia), and 14% required critical care. Whereas 41 patients had the simultaneous presence of other pathogens, among them, 31 patients had ≥2 respiratory viruses detected.

The most frequent symptoms in RSV-only patients were cough (79.12%), dyspnea (67.3%), and wheezing (63.74%). Asthma was the most common respiratory comorbidity (16.48%), followed by low birth weight and preterm. The mortality rate was 4/91 (4.39%); among them were 2 patients < 6 months old with congenital cardiopathy and 2 elderly (69/78y) with Klebsiella pneumoniae-bacteremia.

Distribution of viral isolates from admitted patient respiratory and pneumonia panel samples.

Source: Statistical registry of the authors

Conclusion

RSV should be considered an all-ages respiratory infection, and it was found alone or in association with other respiratory pathogens mainly near the second semester each year. Studies like these are necessary in low-middle income countries like the Dominican Republic to address the burden of RSV and the impact that the vaccine applied during pregnancy and the elderly can have on disease prevention and complications. We encourage early and affordable diagnostic tests to curb the spread of RSV and reduce admissions.

Disclosures

Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-738. A Microbiological Profile of Necrotizing Fasciitis at a Tertiary Referral Hospital in a Low/Middle Income Country
Authors: Challita Caren , Abdallah Tamara , Zeid Daou Christopher Abi , Sawaya Tania , Hallal Ali , Madi Naji , Rizk Nesrine
Published: January 2025

Background

: Necrotizing fasciitis (NF), an uncommon, fatal infection of the skin and soft tissues, carries a significant mortality risk, with rates reaching as high as 76% despite prompt surgical interventions. While polymicrobial infections were more likely to be encountered, few studies reported a monomicrobial predominance. Despite its relevance, there is a notable lack of data in the Eastern Mediterranean region. We aimed to investigate the microbiological profile among patients diagnosed with necrotizing fasciitis in a tertiary referral center in Lebanon, with a particular focus on Multidrug-resistant organisms (MDROs) and Antimicrobial Resistance (AMR), given their increasing prevalence and the challenges they pose in clinical management.Table 1:Distribution of Organisms

Methods

A retrospective chart review of hospitalized cases between 2011 and 2021. The study population included adult patients diagnosed with NF during this period. Data included microbiological characteristics, with focus on Multidrug-resistant organisms (MDROs).Figure 1:Yearly Trend of MDROs Among Isolated Organisms

Results

41 cases of NF were identified showing a mortality rate of 37%. 46 % of cases had polymicrobial infections versus 42% monomicrobial. The predominant gram negative pathogen was E.coli in both types of infections followed by the gram positive pathogen, Enterococcus species. No difference in the type of infection was noticed in the survival group compared to a predominance of polymicrobial infection in the non-survival group. Fungi were recovered represented in 5.4% of cases and were part of a polymicrobial infection. Out of all the isolated organisms, 21.2% showed patterns of resistance (Extended Spectrum Beta Lactamase, Multidrug resistant, Vancomycin Resistant Enterococcus, and Carbapenem Resistant Enterobacteriaceae) with a yearly incremental rise.

Conclusion

This 10-year study emphasizes the urgency of prompt surgical intervention and tailored antibiotic treatment for NF, particularly in the context of increasing AMR and the presence of MDROs, contributing crucial regional data on NF demographics, comorbidities, and microbiology

Disclosures

All Authors: No reported disclosures
P-739. Injection-Related Skin Ulcers: a Common and Poorly Addressed Risk Factor for Rehospitalization among People who Inject Drugs in the CHOICE+ Cohort
Authors: Traver Edward C , Vaish Ishan Kumar , Omari Habib , Flores Hannah E , Stevens Jasmine , Derenoncourt Meghan , Reece Becky , Steck Alaina , Kuo Irene , Fujita Ayako Wendy , Raman Sumitha , Catalanotti Jillian S , Carpenter Joseph E , Kattakuzhy Sarah , Rosenthal Elana S
Published: January 2025

Background

Injection-related skin ulcers (IRSU) are a cause of acute bacterial infection among people who inject drugs (PWID). We aimed to measure the prevalence, characteristics, and risk factors for IRSU, and the risk of readmission, among a cohort of PWID hospitalized for infections.

Table 1

SD, standard deviation.

Methods

CHOICE+ is a multisite retrospective cohort study of adults hospitalized at four healthcare systems with infections due to injection opioid use between 1/1/2018 and 3/31/2022. Data were collected by abstraction of the electronic medical record and were analyzed by chi-square, multivariable logistic regression, and unpaired t-test. Factors statistically significant for IRSU in bivariate analysis were examined by multivariate logistic regression. Detailed data on IRSU were recorded from the Baltimore site.

Table 2

GWU, George Washington University; MOUD, medication for opioid use disorder; UMB, University of Maryland Baltimore; WVU, West Virginia University.

Results

Of 1652 included patients, 221 (13%) had a documented IRSU. Key demographics were similar between those with and without IRSU (Table 1). The odds of IRSU were higher among those who were positive for fentanyl and older age (Table 2). Baseline IRSU was associated with increased odds of readmission (aOR 1.4, p = 0.02) and a greater number of readmissions within 1 year (1.2 v. 0.9, p = 0.01, Figure 1).

Among 116 patients from Baltimore with documented IRSU and detailed data, IRSU was the primary reason for admission in 66%. Xylazine use was not noted in any records. Most patients had < 4 ulcers and ulcers < 10 cm. 13% of patients received sharp debridement and 6% were treated with limb amputation. IRSU was more frequently addressed in the discharge note if IRSU was the primary reason for admission (71% v 50%, p < 0.05). Only 16 (14%) patients were advised or scheduled to attend an outpatient wound care appointment; only 3 (3%) did so within 30 days of discharge (Figure 2).

Figure 1

**, p=0.01.

Conclusion

Among PWID hospitalized for infection, IRSU were common, especially among older patients and those testing positive for fentanyl. Xylazine exposure was likely under-assessed. Importantly, IRSU was associated with an increased risk of hospital readmission, but outpatient planning and follow up were rare. Clinicians caring for PWID must address IRSU alongside other infectious diseases, addiction, and harm reduction interventions.

Figure 2

Discharge planning and outpatient care within 30 days of discharge. DC, discharge; *, p=0.048)

Disclosures

Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support
P-745. Skin and Soft-tissue Infections among Military Recruits
Authors: Mende Katrin , Igo Matthew , Seibert-Parzyszek Ian , Carson M Leigh , Davies Julian , Stewart Laveta , Tribble David
Published: January 2025

Background

Skin and soft-tissue infections (SSTIs), commonly Staphylococcus aureus, are an important cause of morbidity in congregate military populations with high rates among military recruits. We characterized SSTI epidemiology over an ∼10-year period at a military training facility in GA (largest U.S. training facility; ∼30,000 recruits per year).

Methods

SSTI data were collected from US Army Infantry recruits during basic training, through four studies (2 observational and 2 interventional studies spanning 2010-2019) and pooled into a single resource for retrospective research. SSTI characteristics (syndromes and diagnosis timing) and microbiology are described.

Results

The study population includes 3288 recruits who developed SSTIs during the training period for a total of 3690 SSTIs. Median age was 19 years and median time for initial SSTI development was 7 (IQR 4 -11) weeks of training. Cellulitis (N=1600, 43%) and abscesses (N=1098, 30%) were most common and median time to diagnosis was 7 (IQR 4-11) and 8 (IQR 4-11) weeks of training, respectively. Cultures were collected from 1620 (44%) SSTIs, including 77% of abscesses. Methicillin-resistant and methicillin-susceptible S. aureus (MRSA and MSSA) were identified in 784 (48%) and 610 (38%) cultures, respectively (Table). Other findings include coagulase-negative staphylococci (4%), group A streptococci (0.2%), and group B streptococci (0.4%). A total of 373 recruits had ≥ 2 SSTIs and 55% of the subsequent 402 SSTIs were abscesses. Median time to 2nd and 3rd SSTIs was 10 (IQR 7.5-12) and 12 (IQR 10-13) weeks of training, respectively. There was a significant difference among the bacterial distribution for abscesses (p< 0.001) with MRSA contributing the highest proportion (62%), followed by MSSA (28%). MRSA was also identified with 64% of the 166 subsequent SSTIs with cultures.

Conclusion

Cellulitis and abscesses are frequent infections affecting military recruits during high-intensity congregate training. The most common bacteria with purulent infections (i.e., abscesses), as well as subsequent infections, was MRSA. Pooling data from multiple studies allows for examination of syndromes and etiology to inform targeted interventions.

Disclosures

David Tribble, MD, DrPH, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response
P-759. Re-examining Respiratory Isolation for Tuberculosis: A review of isolation practices for people diagnosed with tuberculosis at a major academic medical center in 2022-2023
Authors: Moreira Aliya , Hassneiah Dana , Nathavitharana Ruvandhi
Published: January 2025

Background

Respiratory isolation to reduce tuberculosis (TB) transmission is routinely implemented yet adversely affects employment, education, food/housing security, and mental health. The National TB Coalition of America recently published guidelines on shortened respiratory isolation for TB in community settings, recommending five days of isolation post initiation of effective treatment in most circumstances. We sought to examine current isolation practices for people diagnosed with TB at an academic medical center.Table 1:Baseline characteristics of the study group

Methods

We undertook a retrospective record review to identify patients for whom the ICD-10 codes A15-A19 for TB had been utilized at Beth Israel Deaconess Medical Center in Boston from 2022-2023. We included people with TB disease and extracted data that included duration of isolation, results of smear, culture, and Xpert MTB/RIF testing, timing of smear conversion, documented discharge requirements, and patient perspectives on isolation requirements. Quantitative data were analyzed descriptively. Qualitative data were analyzed thematically.Table 2:Duration of admission, isolation, and treatment in relation to different factors (Mean ± SD)

Results

After reviewing 173 records, we identified 14 patients diagnosed with TB disease during a hospitalization, of whom eight had pulmonary TB (PTB), five had extrapulmonary TB (EPTB), and one had both PTB/EPTB. Six (43%) had some form of drug-resistance, predominantly isoniazid-resistant TB (29%). The majority (93%) were non-US born. The duration of inpatient isolation was 15.2 ± 8.3 days (mean ± standard deviation) (16.2 days for PTB, 13.4 days for EPTB). After TB treatment was initiated, patients remained in isolation for 10.6 ± 10.1 days (11.9 days for PTB, 8.2 days for EPTB). Inpatient stays were extended by 1.6 days after patients were documented as medically ready for discharge due to the need for Department of Public Health clearance. Qualitative data highlighted patients with TB experienced adverse events such as social isolation, stigma, language barriers, and delirium.Table 3:Key quotations from chart documentation regarding impact of isolation

Conclusion

Our data highlight the long duration of inpatient isolation for people with TB, including after the initiation of treatment and in those with EPTB, and its negative impacts on patients. Implementation research is needed to understand the acceptability and reach of new isolation recommendations.

Disclosures

All Authors: No reported disclosures
P-766. Patient Experiences of Deferring Treatment for Further Evaluation and Monitoring after a Trace Xpert Ultra Result
Authors: Visek Caitlin , Mukiibi James , Nantale Mariam , Nalutaaya Annet , Biché Patrick , Sung Joowhan , Kayondo Francis , Akampurira Joab , Mukiibi Michael , Kiyonga Rogers , Katamba Achilles , Kendall Emily A
Published: January 2025

Background

For people with “trace” sputum results (PWTS) on Xpert MTB/RIF Ultra, further evaluation and monitoring rather than reflex TB treatment may be appropriate. Patients’ preferences regarding treatment deferral have not been explored.

Reported anxiety among participants with trace positive sputum over 6 months of follow up

Methods

We enrolled PWTS identified through community screening or clinic-based diagnostic evaluation, in Kampala, Uganda. They underwent extensive clinical, microbiological, and radiographic TB evaluation, and those with uncertain TB status were offered treatment deferral with periodic reassessment for up to 2 years. At 0, 1, and 6 months, PWTS were asked about their experience, including their perceived likelihood of having TB and associated anxiety, whether they would choose treatment if not being closely monitored, and the acceptability of extensive diagnostic testing. PWTS and matched Xpert-positive and -negative individuals were asked to choose, in a vignette, between more sensitive and more specific TB tests.

Reported inclination toward TB treatment among participants with trace positive sputum over 6 months of follow up

Results

We enrolled 273 PWTS (128 from community; 145 from clinics), 217 people with positive results, and 252 with negative Xpert results. Among PWTS, treatment was recommended or started within 1 day of enrollment for 32/273 (12%), mostly based on recommendations of non-study clinicians in people with HIV, and within 1 month for 98/273 (36%), of whom 52/98 (53%) had Xpert or culture confirmation. Most PWTS (220/272, 81%) reported little to no anxiety at baseline and continued to report low levels of anxiety over time if they remained untreated, while many (25/52, 48%) PWTS with moderate or high initial levels of anxiety started treatment within 1 month (Fig 1). At baseline, 153/272 (56%) said they would seek TB treatment if monitoring were not offered, and most who remained untreated maintained the same preference over time (Fig 2). Most participants, including 65% of PWTS, preferred a highly sensitive test despite the risk of false positives when positive predictive value was 50%, and 47% favored sensitivity even when positive predictive value decreased to 17% (Table 1). PWTS rated laboratory and radiologic testing as valuable and minimally burdensome.

Table 1

Participants’ preferences regarding TB test sensitivity versus specificity

Conclusion

From the patient perspective, close monitoring rather than immediate treatment after a trace result may be acceptable.

Disclosures

All Authors: No reported disclosures
P-785. Construction and Validation of a Clinical Diagnostic Model for Active Tuberculosis in Patients with Systemic Lupus Erythematosus
Authors: Zhang Lifan , Zhao Lidan , Liu Yuchen , Shi Xiaochun , Liu Xiaoqing
Published: January 2025

Background

Systemic Lupus Erythematosus (SLE), an autoimmune disease, involves multiple immune dysfunctions. The progression of M.tb infection is closely related to the host's immune status. Abnormal immune functions increase the risk of active tuberculosis (ATB), particularly in patients with autoimmune diseases. Meanwhile, both SLE and ATB’s clinical symptoms includes several overlaps, resulting in a diagnosis challenge when without etiological evidence.

Forest plot showing the results of univariate logistic regression in the discovery cohort

Methods

We included 66 SLE patients with ATB hospitalized at Peking Union Medical College Hospital from 1975 to 2017, and 132 age matched SLE patients without ATB as the discovery cohort. An external validation cohort was drawn from the ETHERTB cohort, which covers rheumatic and immune disease patients from 13 tertiary hospitals in China. Univariate Logistic regression analysis was used in the discovery cohort to identify risk factors for ATB among SLE patients. A neural network algorithm was used to construct the clinical diagnostic model. The external validation cohort was used to validate the diagnostic potential of our model.

models developed

Importance of all risk factors (A) and variables included in our model (B). Neural network-based model architecture (C).

Results

In the discovery cohort, fever (OR=47.2), night sweats (OR=5.3), cough (OR=14.5), weight loss (OR=70.1), moderate to severe SLE disease activity (SLEDAI-2000 5-9, OR=5.1; SLEDAI-2000≥10, OR=6.7), close contact with TB (OR=7.8), T-SPOT.TB (OR=1.004), and the use of specific immunosuppressants such as azathioprine (AZA) (OR=3.4), leflunomide (LEF) (OR=2.7), cyclosporine A (CYSA) (OR=3.8), and a maximum daily dose of 30 mg of corticosteroids (OR=14.9) were identified as risk factors for ATB in SLE patients. Variables including fever, night sweats, cough, weight loss, TB contact, T-SPOT.TB, SLEDAI-2000, and maximum daily corticosteroids dose were included in the diagnostic model based on an importance threshold of 0.5. The model's AUC was 0.96(95%Cl: 0.927-0.996), with a sensitivity of 85.3%, specificity of 96.0%, and an accuracy of 93.7%. In the external validation cohort, the AUC was 0.88(95Cl: 0.800-0.963), sensitivity 84.4%, specificity 88.1%, and accuracy 88.0%.

Evaluation of diagnosis model

Distribution of risk scores in the discovery cohort (A) and validation cohort (B), and ROC curves in the discovery (C) and validation cohorts (D).

Conclusion

Our study constructed and validated a diagnostic model for ATB in SLE patients. The model demonstrated good diagnostic potential, which could assist in diagnosis in the absence of etiological evidence.

Disclosures

All Authors: No reported disclosures
On the Role of Loewner Entropy in the Statistical Mechanics of the 2D Ising System
Authors: Shibasaki Yusuke
Published: January 2025

The fundamental properties of the 2D Ising system were formulated using the Loewner theory. We focus on the role of the complexity measure of the 2D geometry, referred to as the Loewner entropy, to derive the statistical-mechanical relations of the 2D Ising system by analyzing the structure of the interface (i.e. the phase separation line). For the mixing property of the discrete Loewner evolution, we assume that the Loewner driving force ${\eta }_s( n )$ obtained from the interface has a stationary property, where the autocorrelation function $\langle {{\eta }_s( 0 ){\eta }_s( n )} \rangle$ converges in the long time limit. Using this fact, we reconstruct the continuous Loewner evolution driven by the diffusion process whose increments correspond to the sequence of ${\eta }_s( n )$, and derive the fractal dimension of the generated curve. We show that these formulations lead to a novel expression of the Hamiltonian and the grand canonical ensemble of the system, which also are applicable to the nonequilibrium state of the system. In addition, the relations on the central limit theorem governing the local fluctuation of the interface, the nonequilibrium free energy, and the fluctuation–dissipation relation were derived using the Loewner theory. The present results suggest a possible form of a complexity-based theory for 2D statistical-mechanical systems that is applicable to nonequilibrium states.
Performance of spondyloarthritis-specific health utilities based on the ASAS Health Index: an ancillary analysis from the ASAS-HI validation study
Authors: Calixto Omar-Javier , Kiltz Uta , Bautista-Molano Wilson , Boonen Annelies , van Kuijk Sander , Essers Ivette , van der Heijde Désirée , Braun Juergen , Baraliakos Xenofon
Published: January 2025

Objectives

To compare the Spondyloarthritis (SpA)-specific universal utility estimation from ASAS Health Index (U-ASAS-HI) with generic utilities and to understand the contribution of health outcomes, personal- and country-level factors to the U-ASAS-HI.

Methods

This was an ancillary analysis of the ASAS-HI international validation study. SpA patients who completed the ASAS-HI, 5-level EuroQol-5D (EQ-5D-5L) and Short Form-36 (SF-36) questionnaires were selected, and utilities calculated. Correlations between U-ASAS-HI and generic utility values were tested. Potential explanatory variables were evaluated in a linear multivariable mixed-effects model analysis with multilevel modelling fitted by country.

Results

The number of patients included was 1425, with a mean (s.d.) age of 42 (13.5) years, with 65% male. The mean (s.d.) utility scores were for EQ-5D-5L 0.75 (0.11), for short-form 6-dimension (SF-6D) 0.72 (0.24), and for U-ASAS-HI 0.42 (0.29). Correlation between U-ASAS-HI and EQ-5D-5L and SF-6D was strong (r = 0.75 and r = 0.72, respectively; P < 0.001). The linear mixed-effects model showed that worse disease activity (ASDAS) and lower physical function (BASFI) were associated with lower U-ASAS-HI. Additionally, younger age, female gender, higher comorbidity score and symptoms of depression were associated with lower U-ASAS-HI. SpA subtype had no influence on health utility. The random effects model indicated an intercept s.d. of 0.045 with a 5.5% variance ratio between countries and the total U-ASAS-HI variation.

Conclusion

The U-ASAS-HI captures the physical and mental impact of SpA, as well as personal contextual factors such as age, gender and comorbidities. The influence of the country of residence seems negligible. The U-ASAS-HI algorithm has sufficient support to be used in health economic evaluations for SpA patients across different countries.
Evaluating the efficacy of very high-dose oral prednisolone in West syndrome: in Uttar Pradesh, India, a resource-limited setting
Authors: Prabha Chandra , Kanta Chandra , Bhriguvanshi Arpita , Verma Sanjeev Kumar
Published: January 2025

Managing West syndrome (WS) becomes arduous in regions where access to adrenocorticotropic hormone and vigabatrin is limited, particularly in developing nations. This study aimed to evaluate the efficacy of very high-dose oral prednisolone in children diagnosed with WS. Children aged 2–36 months presenting with WS were consecutively enrolled and given oral prednisolone @ 8 mg/kg/day (maximum 40 mg) for two weeks followed by tapering doses over the subsequent two weeks. Weekly follow-ups were conducted until therapy completion, followed by bi-weekly assessments for three months. Responses (primary outcome) were assessed at two weeks and categorized as complete (spasm-free), partial (>25% reduction), or no response (<25% reduction). Neurodevelopmental outcomes, clinical–radiological profiles, safety, and therapy response predictors were also assessed. Of the 80 children, 73.7% exhibited a complete response, while 21.2% and 5% showed partial and no response, respectively. The mean age at spasm onset and presentation was 4.98 ± 4.37 months and 14.36 ± 7.13 months, respectively. Perinatal brain injury accounted for 87.5% of WS cases. Adverse effects, including weight gain (8.7%), irritability, hypertension, and disturbed sleep (3.7% each), were noted. Spasm cessation at 2 weeks, appropriate gestational age, and the absence of other seizure types were predictive of a favorable response. High-dose oral prednisolone emerges as an effective, low-cost, and safer first-line treatment option with minimal adverse effects in the Uttar Pradesh region in India, and this would likely be true in other resource-limited settings.
Additive effects of curcumin and glucosamine on knee function, cartilage protection, and subchondral bone preservation in a post-traumatic osteoarthritis rat model
Authors: Li Jiming , Huo Shaofeng , Huang Cuishan , Cheng Wenxiang , Liang Shan , Chen Wenrong , Fang Suqiong , Qin Ling , Chen Peng , Lin Ligen , Wang Xinluan
Published: January 2025

Background:

Osteoarthritis (OA) increasingly become a global public health concern. Curcumin and glucosamine, both widely used as dietary supplements for OA, have shown distinct therapeutic effects. However, curcumin’s low bioavailability and the debated efficacy of glucosamine limit their broader clinical use.

Objective:

Investigate the combined effects of curcumin and glucosamine on knee function, subchondral bone preservation, and cartilage protection in post-traumatic OA rat.

Methods:

Post-traumatic OA was induced in Lewis rats through medial meniscus transection (MMT) surgery. Rats were treated for 8 weeks with curcumin phospholipid liposome (C, 120 mg/kg/day), glucosamine (G, 190 mg/kg/day), or a combination of both (CG, C: G=1:3, 63/190 mg/kg/day). Knee width was measured weekly, and weight-bearing was assessed twice weekly. Subchondral bone and cartilage changes were analyzed using micro-CT, toluidine blue staining, and the OARSI (Osteoarthritis Research Society International) score. Collagen II expression in cartilage was evaluated by immunohistochemistry.

Results:

Curcumin phospholipid liposomes significantly reduced joint swelling by up to 4.1% (P<0.001) and improved weight-bearing force by 24.2% at week 2 (P<0.01) and 14.9% at week 8 (P<0.05) in comparison with the MMT group. Analysis of Micro-CT indicated an increase in bone volume (11.6%) and bone mineral content (13.0%) (P<0.05). Histological analysis showed a 28.8% reduction in OARSI scores (P<0.01) and a 53.1% increase in collagen II expression (P<0.005). Glucosamine treatment reduced joint swelling by up to 5.7% (P<0.0001), improved weight-bearing by 31.6% (P<0.001) at week 2, and significantly increased bone volume (30.4%) and bone mineral content (29.9%) (P<0.05). The combined treatment further reduced swelling by up to 6.6% (P<0.0001) and improved the R/L weight-bearing ratio by 24.7% (P<0.0001) at week 8. It also enhanced bone volume (28.6%), bone mineral content (29.7%, and anisotropy degree (59.3%) (P< 0.05). Additionally, the combination therapy decreased OARSI scores by 27.1% (P<0.01) and enhanced the expression of collagen II by 54.2% (P<0.005), indicating enhanced cartilage and subchondral bone protection.

Conclusion:

Curcumin showed superior protection for cartilage, while glucosamine mainly benefited subchondral bone. Combined treatment demonstrated additive effects, improving both knee structure and physical function in OA, offering enhanced pain relief, anti-inflammatory action, and joint preservation.
Short-term costs of alcohol-associated hepatitis care in different clinical settings
Authors: Nguyen Chi Mai , Su Jing , Li Yang , Healey Ryan , Jiang Shihui , Li Jiangqiong , Chalasani Naga , Gawrieh Samer , Liangpunsakul Suthat , Tu Wanzhu
Published: January 2025

Background:

Alcohol-associated hepatitis (AH) leads to high rates of mortality and health care costs. Understanding the immediate costs after an AH diagnosis and identifying key cost factors is crucial for health care policies and clinical decisions.

Objectives:

This study quantifies medical costs within 30 days of an AH diagnosis across outpatient (OP), emergency department (ED), and inpatient (IP) settings. It also explores concurrent diagnoses and their effects on care costs.

Methods:

We conducted a retrospective cohort study using deidentified data from Optum’s Clinformatics Data Mart. The cohort included individuals aged 21 years and older diagnosed with AH from January 1, 2016, to September 30, 2023. Patients were categorized by care setting (OP, ED, or IP). Costs were calculated for the 30 days before and after AH diagnosis and adjusted to 2023-dollar values. Comorbidities were identified using Elixhauser comorbidity software, and multivariable linear regression models were used to analyze medical costs.

Results:

The cohort included 34,974 individuals diagnosed with AH: 8048 in OP (23%), 2736 in ED (7.8%), and 24,190 in IP (69.2%). Average spending in the 30 days prior to AH diagnosis was $7334 for OP, $5740 for ED, and $14,458 for IP. Following AH diagnosis, average costs rose to $8345 for OP, $20,990 for ED, and $88,655 for IP, reflecting increases of 14%, 266%, and 413%, respectively. Significant cost drivers in IP included comorbidities associated with moderate-to-severe liver disease, metabolic syndrome, liver transplant, and mortality during the 30-day follow-up period.

Conclusions:

Immediate costs following an AH diagnosis are substantial, particularly for IP care. Costs increase significantly with high-cost comorbidity clusters and among patients who die, underscoring the need for effective management of comorbidities in AH care.
Hepatocyte Rho-associated kinase signaling is required for mice to survive experimental porphyria-associated liver injury
Authors: Herrera Jessica M. , Weng Yun , Lieberthal Tyler J. , Paoletti Marcus , Chang Tammy T.
Published: January 2025

Background:

Rho-associated kinases 1 and 2 (ROCK1 and ROCK2) regulate critical cell functions, including actomyosin contractility, apoptosis, and proliferation. Some studies suggest that ROCK inhibition may serve as a treatment for liver fibrosis. More investigation is needed to understand the role of hepatocyte ROCK signaling in vivo, especially in the context of profibrotic liver injury.

Methods:

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mice were given adeno-associated virus serotype 8 (AAV8)-thyroid hormone-binding globulin (TBG)-Cre to produce targeted gene deletion in hepatocytes, or given AAV8-TBG-Null to generate littermate controls (WT). Mice were then placed on a 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet to induce liver injury.

Results:

Upon DDC-induced liver injury, mice with hepatocyte-specific deletion of ROCK1 alone (R1 KO) or ROCK2 alone (R2 KO) demonstrated minimal differences compared to WT. In contrast, mice with hepatocyte-specific deletion of both ROCK1 and ROCK2 (DKO) showed pervasive early mortality, increased hepatocellular injury, and decreased hepatic function. DDC-injured DKO mice demonstrated markedly distorted liver histology characterized by large cavities in the parenchyma. RNA-seq analysis showed upregulation of cell death, inflammatory, and profibrotic pathways in DDC-injured DKO liver as compared to DDC-injured WT liver. Cdkn1a (gene encoding p21) was one of the most highly upregulated genes in the DKO liver in response to DDC-induced injury. Correspondingly, there was increased hepatocyte nuclear localization of p21 and expression of cleaved caspase-3 in DDC-injured DKO liver, consistent with the activation of p21-mediated caspase-3–dependent apoptotic cell death pathways. ROCK1/ROCK2-deficient primary hepatocytes demonstrated increased susceptibility to both caspase-3–mediated apoptosis and caspase-3–independent forms of cell death in a cell intrinsic manner.

Conclusions:

ROCK signaling plays a critical role in mediating hepatocyte cell survival pathways in response to liver injury.
Visual and Orthoptic Development After DSAEK for CHED in Children Younger than 8 years: Case Series and Literature Review
Authors: Neugebauer Antje , Gietzelt Caroline , Fricke Julia , Hedergott Andrea , Bachmann Björn , Cursiefen Claus
Published: January 2025

Purpose:

Congenital hereditary endothelial dystrophy (CHED) impairs the sensitive phase of visual development. We examined results of Descemet stripping automated endothelial keratoplasty (DSAEK) for CHED regarding the critical period for amblyogenic factors.

Methods:

Retrospective analysis of 11 eyes of 6 consecutive patients with CHED younger than 8 years treated with DSAEK and a PubMed-based literature search on management and optimal timing of the intervention.

Results:

Our series encompasses 11 eyes of 6 children who received 6 DSAEKs and 5 non- or partial DSAEKs. Mean age at surgery was 3.45 years (0.59–7.44). In 3 eyes, further interventions were necessary, 2 were Re-DSAEKs for early graft failure. At final visit, all 10 transplants with a follow-up >1 month were clear, and 2 corneas showed slight stromal opacification. Final visual acuity was 0.8–0.2 logMAR (mean 0.49) in 9 eyes with sufficient follow-up time in cooperative patients. Mean follow-up was 47 months. Six eyes showed postoperative hyperopia > 5D. We found literature reports on 58 DSAEK/non-DSAEK procedures in 36 children with CHED under 8 years, including 11 children under 2 years. Data show a trend for better visual outcomes of DSAEK in CHED at younger age. Non-DSAEKs seem to be associated with more graft complications.

Conclusions:

DSAEK for CHED in young children is an option for achieving corneal transparency with a trend toward better outcomes of surgery at younger age. The special features of amblyopia in CHED make studies with follow-up times to reach age for reliable acuity testing and recovery from amblyopia worthwhile.
Preoperative Optimization of Patients Undergoing Orthopedic Foot and Ankle Surgery: A Single Institution Cohort
Authors: Kessel Julia , Cleveland Rebecca J. , Lalli Trapper , Tennant Joshua , Woody Jennifer
Published: January 2025

Introduction:

Careful preoperative patient preparation for orthopedic foot and ankle surgery can help manage postoperative expectations and avoid suboptimal outcomes. Our quality improvement initiative aimed to reduce emergency department (ED) visits within 30 days postsurgery by enhancing preoperative education.

Methods:

We focused on four outcomes associated with receipt of written preoperative information: (1) related ED visits within 30 days of surgery, (2) average number of patient portal messages, (3) phone calls initiated by patients, and (4) staff team experience survey results. All patients undergoing foot and ankle surgery by two surgeons at one institution from July 2023 to January 2024 were included.

Results:

Through a series of six plan, do, study, act (PDSA) cycles lasting 1 month each, we evaluated 431 patients (55.9% female, 61.4% White, 92.4% English speakers). Patients who received written preoperative information were significantly less likely to present to the ED for related concerns within 30 days of surgery compared with those receiving no written preoperative information (p = .0068). In addition, we observed fewer portal messages and phone calls from patients receiving written preoperative information (p = .3644, p = .0541).

Conclusions:

An increase in the use of standardized written preoperative information yields decreased ED visits and frequency of inquiries from patients through portal messages and phone calls.
Examining Long-Haul Truck Driver Needs and Preferences to Improve the Truck Stop Environment
Authors: McKeown Mackenzie L. , Crizzle Alexander M.
Published: January 2025

Structured Abstract

Objective

This study examined and compared the truck stop needs and preferences of long-haul truck drivers (LHTD) based on gender.

Methods

LHTD were recruited from various provincial and federal trucking associations and trucking companies across Canada. A sample of 406 drivers completed an online survey that consisted of questions on demographics, health conditions and behaviours, and preferences for truck stop amenities.

Results

LHTD reported that parking, healthy and affordable foods, showers, washrooms, and exercise facilities with basic equipment are the most important amenities needed at truck stops. Compared to men, women were significantly more likely to desire a picnic area at truck stops; all other amenities were consistently desired by both genders.

Conclusions

Improvements to the truck stop environment are needed to support the health and wellness of LHTD.