bluuebunny/crossref_metadata_2025_split huggingface dataset:
926. Risk factors for post-letermovir cytomegalovirus (CMV) reactivation in allogeneic hematopoietic stem cell transplant (HSCT) recipients
Authors: Mendoza Maria Alejandra , Thoendel Matthew J , Razonable Raymund R , Alkhateeb Hassan 
Published: November 2023

Abstract

Background
Letermovir (LTMV) is approved for CMV prophylaxis during the first 100 days after HSCT. Thereafter, CMV reactivation (CMVr) may still occur. This study aims to evaluate the incidence and risk factors for any CMVr and clinically significant CMV infection (csCMVi) in patients who received LTMV prophylaxis.

Methods
Retrospective multicenter cohort study of HSCT patients who received 100 days of LTMV prophylaxis from 08/2018 to 09/2022. Categorical and continuous variables were compared with Fisher’s exact and Kruskal-Wallis test respectively. Logistic regression was used to identify risk factors.

Results
Of 115 HSCT patients, 28 had CMVr after LTMV prophylaxis (Table 1), including 21 with csCMVi (Table 2). Of note, 29 (25.2%) patients had breakthrough CMV during LTMV prophylaxis. Among 28 cases of post-LTMV CMVr, DNAemia occurred with a median of 38.5 (31.3 – 47) days after stopping LTMV. The median absolute lymphocyte count (ALC) at diagnosis was 1.29 (0.41 – 2.04) x109cells/L. Median peak CMV DNAemia at was 482 (100.5 – 2600) IU/mL, with a duration of 29 (20- 35) days; none had end organ disease. All were receiving immunosuppression for graft-versus-host disease treatment (n=18) or prophylaxis (n=10).
Risk factors for CMVr and csCMVi are listed in Table 3. For CMVr, univariate analysis showed that CMV D-/R+ status is associated with increased risk, while having CMV D+ donors or acute myeloid leukemia (AML) had lower risk. Multivariable analysis showed D-/R+ status and breakthrough viremia while on LTMV were associated with increased risk.
csCMVi in 21 patients were treated with valganciclovir (n=15) or IV ganciclovir (n=6) for a median duration of 37 (25.5 – 50) days. Univariate analysis showed that acute lymphoblastic leukemia (ALL) and reduced intensity conditioning were associated with increased risk, while AML had lower risk of csCMVi. On multivariable analysis, ALL, and D-/R+ had higher risk while AML had lower risk.

Demographics and clinical characteristics of allogeneic hematopoietic stem cell recipients with or without late clinically significant CMV infection

Conclusion
One in four allogeneic HSCT patients who received LTMV developed post-prophylaxis CMVr within 100 to 200 days post-transplant. CMV D-/R+ status had a higher risk for CMVr and csCMVi after LTMV discontinuation. Patients with AML had a lower risk for CMVr and csCMVi.

Disclosures
Raymund R. Razonable, MD, Allovir: Endpoint Adjudication Committee|American Society of Transplantation: Board Member|Gilead: Grant/Research Support|Novartis: DSMB|Regeneron: Grant/Research Support|Roche: Grant/Research Support
1140. Impact of an Implementation Science Initiative to Improve Vaccine Confidence for Invasive Meningococcal Disease (IMD) Prevention within American Indian (AI) Communities
Authors: Ignace Lyle , Hursman Ruth , Jimenez Jenniffer A Meza , Carter Jeffrey D , Corona Abigail K , Douglas Bonnie , Simone Laura , Molloy Leah 
Published: November 2023

Abstract

Background
Meningococcal vaccine uptake among adolescents remains suboptimal. This project aimed to identify barriers and motivators for vaccination in AI communities.

Methods
Between 12/2022 and 2/2023, 3 live family education sessions were held within AI communities in WI and ND. Healthcare provider (HCP) participants also attended a workshop to review current vaccine recommendations. Surveys were administered before/after the workshop and family education sessions.

Results
Surveys were completed by 56 family members. Baseline confidence in vaccine safety, efficacy and benefit was low, which increased after the sessions (Fig. 1). Parent understanding that the vaccine cannot cause disease improved from 51% to 82% (p =.001). Top reported barriers to vaccination were concern for immediate side effects and long-term side effects, and low perceived risk for IMD (34%, 26%, 25%, respectively). Parents identified learning more about IMD (40%), friends/family getting vaccinated (19%), and a local outbreak (12%) as top motivators to seek vaccination. When asked what they thought would motivate families to seek vaccination, HCPs leading the sessions (n=11) identified learning more about IMD (82%) and friends/family getting vaccinated (27%) only. HCP confidence in counseling families was low and improved after the sessions (Fig. 2). HCPs attending the workshop (n=28) reported discomfort contradicting patients/families as the top challenge in addressing vaccine hesitancy, and more HCPs felt confident having conversations to reduce vaccine hesitancy after the workshop (80%) than before (28%). HCP knowledge improved after the workshop, and more HCPs understood that MenACWY booster doses are not needed when initial vaccination occurs at age ≥16 (50%), and correctly identified “provider recommendation” as the top literature-reported factor influencing parental vaccine decisions (50%) compared to baseline (32% and 14%, respectively). HCP action plans for after the sessions prioritized routinely discussing vaccines at well visits (80%), providing written materials (50%) and staying current on new vaccines (50%).

Conclusion
Parent and provider knowledge and confidence improved after the program and offered insights into community-level motivators and barriers to vaccination.

Disclosures
All Authors: No reported disclosures
1151. Assessing Vaccine Hesitancy and Logistical Barriers to Undergraduate Students Receiving a Flu Vaccine
Authors: Benzaken Casey , Tan Tina Q , Jhaveri Ravi , Mithal Leena B 
Published: November 2023

Abstract

Background
Rates of annual flu vaccine receipt among college students remains significantly lower than the 2030 Healthy People target of &gt; 70%. College students are at increased risk of contracting influenza due to close living and dining conditions, and illness due to influenza can have a negative impact on school attendance and academic achievement. This study assessed the extent to which vaccine hesitancy and logistical factors impacted college students’ ability to receive a flu vaccine.

Methods
This study consisted of three surveys administered through REDCap. During the 2021-22 and 2022-23 flu seasons, we administered a baseline survey to assess intention to receive a flu vaccine and logistical barriers that students face in receiving a flu vaccine. We also assessed vaccine hesitancy using a modified Parental Attitudes about Childhood Vaccines (PACV) questionnaire. One month later, we administered a follow-up survey to assess whether students had received a flu vaccine and to rank the importance of several factors in their decision-making.
Sociodemographic information of respondents to the baseline survey.

Results
We had a total of 156 participants in the baseline survey and 97 participants in the follow-up survey. Sociodemographic information can be seen in Table 1. There was a self-reported flu vaccination rate of 63.9%. Only 4.5% of participants scored ≥50 for their adapted PACV survey, indicating that a small proportion of students are flu vaccine hesitant. Individuals who self-reported that they typically receive a flu vaccine yearly had statistically significantly (p &lt; 0.0001) lower adapted PACV scores (11.0[9.5]) compared to individuals who self-reported that they do not typically receive a flu vaccine annually or have only received the vaccines needed to enter school (31.3[21.3]). Among individuals who did not receive a flu vaccine, the top three concerns were easiness of forgetting (78.6%), inconvenience (57.2%), and lack of time (49.9%).

Conclusion
Understanding undergraduate barriers to receiving flu vaccines is critical in designing interventions that increase flu vaccine uptake in this population. Our study found that logistical barriers, rather than vaccine hesitancy, was the limiting factor in preventing college students from receiving flu vaccines.

Disclosures
Tina Q. Tan, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|Iliad: Advisor/Consultant|Merck: Advisor/Consultant|Moderna: Advisor/Consultant|Novavax: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support Ravi Jhaveri, MD, AbbVie: Grant/Research Support|AliOS: Grant/Research Support|AstraZeneca: Advisor/Consultant|Gilead: Grant/Research Support|MedImmune: Advisor/Consultant|Merck: Grant/Research Support|Saol Therapeutics: Advisor/Consultant|Seqirus: Advisor/Consultant
Associations of sleep duration and daytime sleepiness with plasma amyloid beta and cognitive performance in cognitively unimpaired, middle-aged and older African Americans
Authors: Cook Jesse D , Malik Ammara , Plante David T , Norton Derek , Langhough Koscik Rebecca , Du Lianlian , Bendlin Barbara B , Kirmess Kris M , Holubasch Mary S , Meyer Matthew R , Venkatesh Venky , West Tim , Verghese Philip B , Yarasheski Kevin E , Thomas Kevin V , Carlsson Cynthia M , Asthana Sanjay , Johnson Sterling C , Gleason Carey E , Zuelsdorff Megan 
Published: November 2023

Abstract

Study Objectives
Given the established racial disparities in both sleep health and dementia risk for African American populations, we assess cross-sectional and longitudinal associations of self-report sleep duration (SRSD) and daytime sleepiness with plasma amyloid beta (Aβ) and cognition in an African American (AA) cohort.

Methods
In a cognitively unimpaired sample drawn from the African Americans Fighting Alzheimer’s in Midlife (AA-FAiM) study, data on SRSD, Epworth Sleepiness Scale, demographics, and cognitive performance were analyzed. Aβ40, Aβ42, and the Aβ42/40 ratio were quantified from plasma samples. Cross-sectional analyses explored associations between baseline predictors and outcome measures. Linear mixed-effect regression models estimated associations of SRSD and daytime sleepiness with plasma Aβ and cognitive performance levels and change over time.

Results
One hundred and forty-seven participants comprised the cross-sectional sample. Baseline age was 63.2 ± 8.51 years. 69.6% self-identified as female. SRSD was 6.4 ± 1.1 hours and 22.4% reported excessive daytime sleepiness. The longitudinal dataset included 57 participants. In fully adjusted models, neither SRSD nor daytime sleepiness is associated with cross-sectional or longitudinal Aβ. Associations with level and trajectory of cognitive test performance varied by measure of sleep health.

Conclusions
SRSD was below National Sleep Foundation recommendations and daytime sleepiness was prevalent in this cohort. In the absence of observed associations with plasma Aβ, poorer self-reported sleep health broadly predicted poorer cognitive function but not accelerated decline. Future research is necessary to understand and address modifiable sleep mechanisms as they relate to cognitive aging in AA at disproportionate risk for dementia.

Clinical Trial Information
Not applicable.
Porta Hepatis Tuberculous Lymphadenopathy: Clinical and Imaging Features of 10 Cases
Authors: Hu Wenjuan , Hu Ming , Xia Jiafeng , Chen Shengyue , Li Xiaomeng , Sheng Chengmin , Guo Wanru , Feng Xuewen , Shangguan Yanwan , Lu Bin , Shi Yunzhen , Qiu Junke , Xu Kaijin 
Published: November 2023

Abstract
Porta hepatis tuberculous lymphadenopathy (TL) is rare, and the clinical and imaging manifestations often mimic tumors. To offer a better understanding of porta hepatis TL and thus improve its diagnosis and treatment, here, we retrospectively reviewed and analyzed 10 porta hepatis TL cases between May 2017 and November 2022. In this study, porta hepatis TL occurred predominantly in women (70%), with a mean age of 43.1 years (range, 16–70 years). Among the patients, 60% were initially suspected of malignancy (metastatic lymphadenopathy and lymphoma). The clinical manifestations were nonspecific, such as fever and weight loss, without overt abdominal malaise. Many patients showed high concentrations of serum C-reactive protein, erythrocyte sedimentation rate, alkaline phosphatase, γ-glutamyl transpeptidase and carbohydrate antigen 125. Peripheral rim-like enhancement was a characteristic finding on contrast-enhanced CT for all the patients. Pathological examination confirmed the diagnosis in 90% of patients with caseous granulomatous inflammation and positive results of Xpert MTB/RIF, quantitative real-time PCR and/or metagenomic next-generation sequencing assays. All patients underwent antituberculosis therapy with a median treatment duration of 13.5 months (range, 1–43 months). They all showed satisfactory therapeutic responses with improved symptoms and resolution on imaging after treatment. Pathological examination by biopsy remains the primary diagnostic method. A combination of the characteristic epidemiologic, clinical, imaging features and lesion biopsy for histopathology are essential for the diagnosis and treatment of TL.
Ossifying fibroma from surgical excision to periodontal management: case report
Authors: El ayachi Houda , Assimi Sihame , Sabaoui Zakia , Cherkaoui Amine 
Published: November 2023

Introduction and importance:
Peripheral ossifying fibroma is one of the commonly occurring reactive benign lesions that occurs in the gingiva, predominantly in females, especially in the anterior maxillary region of young women and in pediatric patients. It causes unsatisfactory esthetics, difficulty in maintaining good oral hygiene and difficulty in mastication.
The importance of this clinical case is to emphasize the interest of early management of the residual defect after the removal of the gum growth.

Case presentation:
A 39-year-old female patient was referred to the clinical department of periodontology, with the chief complaint of bleeding gingiva, unsatisfactory esthetics and gum growth on the interproximal area in relation to left maxillary canine and premolar region, with the size ~2 cm×1.5 cm.

Clinical discussion:
This article describes an atypical case of peripheral ossifying fibroma with the clinical, histopathologic, and radiographic features in the posterior maxilla in an adult female patient. Treatment consisted of complete surgical excision, gingival curettage, and management of keratinezed gingiva by utilizing laterally displaced flap. Clinical healing was satisfactory at 2 weeks, and excellent coverage of residual mucogingival defect with no evidence of recurrence was achieved 3 weeks postoperatively. The patient was satisfied with case resolution with a follow-up of 1 year.

Conclusion:
Although surgical excision is the treatment of choice, sometimes it may induce residual soft tissue defect, which may further precipitate functional and esthetic discrepancies if not managed.
End-organ damage due to iron overload related to blood transfusion in an 11-year-old male
Authors: Chreitah Ahmad , Aljanati Omar , Bress Fatima , Jamahiri Bushra , Alkilany Zeina , Assaf Sidra 
Published: November 2023

Introduction and importance:
Iron overload is an abnormal accumulation of iron in parenchymal organs that leads to end-organ damage which could be either primary or secondary to repeated blood cell transfusion, its manifestations usually start in middle age and rarely in childhood.

Case presentation:
The authors present a rare case of an 11-year-old male with iron overload secondary to repeated packed blood transfusion for autoimmune haemolytic anaemia. He developed type 1 diabetes, pituitary atrophy, and hepatic injury. It was difficult to maintain good control of his diabetes. He had a fatal acute circulatory collapse due to multiple organ failure.

Clinical discussion:
Iron overload is a clinical consequence of repeated blood transfusion that could result in end-organ damage, usually occurring in adolescence and is less likely at a young age as in our case. The accumulation of iron in the tissues causes diabetes mellitus due to the destruction of β cells in the pancreas, and the increase in insulin resistance in the peripheral tissues.

Conclusion:
Iron overload is a serious complication of repeated blood transfusion, which could be prevented by early treatment with iron chelators at maximum tolerated doses.
Mucopolysaccharidosis type I Hurler-Scheie syndrome: a case report
Authors: Lamichhane Samit , Sapkota Aashish , Sapkota Sanjiv , Adhikari Nishob , Aryal Shishir , Adhikari Pradeep 
Published: November 2023

Introduction and importance:
Hurler syndrome, also known as mucopolysaccharidoses type I, is a rare autosomal recessive lysosomal storage disorder with decreased activities of α-L iduronidase, resulting in the accumulation of glycosaminoglycans (GAGs) within various tissues.

Case presentation:
The authors presented a case report of a 15-year-old male who presented with a lower respiratory tract infection and was admitted to the pediatrics department with a history of facial dysmorphism, skeletal abnormalities, and corneal clouding and below-normal cognitive function which is consistent with the Hurler-Scheie syndrome. Skeletal abnormalities include inverted j-shaped sella turcica, bullet-shaped phalanges, thoracolumbar kyphosis, and acetabular dysplasia.

Clinical discussion:
Mucopolysaccharidosis I is classically divided into three syndromes, that is, Hurler syndrome (the severe form), Hurler-Scheie syndrome (the intermediate form), and Scheie syndrome (the attenuated form). Most of a doctor’s first diagnosis is based on their observation of the signs and symptoms.

Conclusion:
Early disease diagnosis, genetic counseling, and regular follow-up with recent treatment modalities can reduce mortality significantly and improve the child’s health status.
Postoperative analgesic effects of intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Ethiopia, 2023: a double-blind randomized controlled trial
Authors: Gurmu Mesfin , Mulugeta Hailemariam , Zemedkun Abebayehu , Girma Timsel , Destaw Belete , Tadessa Muhiddin , Adamu Yayeh , Hailu Seyoum 
Published: November 2023

Background:
The use of cesarean section (CS) worldwide has increased to unprecedented levels. In Ethiopia, the CS delivery rate is above the rate recommended by the WHO. The postoperative pain experience is moderate to severe in most patients during their postoperative period. The administration of intravenous dexamethasone is thought to have an analgesic effect after surgery even though the analgesic profile of preoperatively administered dexamethasone is less addressed.

Objective:
This study aimed to assess the postoperative analgesic effect of preoperative intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Southern Ethiopia.

Methodology:
A double-blinded randomized controlled trial (RCT) was done on 112 patients undergoing elective CS under spinal anesthesia who were allocated randomly into normal saline and dexamethasone groups. Total analgesic consumption, time to first analgesic request, and postoperative pain score with the numerical rating scale (NRS) were followed for 24 h in both groups. Shapiro–Wilk tests were used to check normality. Independent samples t-test was used for the comparison of means between groups, Mann–Whitney U test for non-normally distributed data, and χ
2 test for categorical variables, and P-value <0.05 was considered statistically significant with a power of 80%.

Result:
The finding of this study showed that the postoperative pain score of the dexamethasone group was significantly lower than the normal saline group at 2, 4, 6, 12, 18, and 24 h with a statistically significant P-value <0.05. There was also a significant difference in the time to the first rescue analgesic request between the two groups, with the dexamethasone group (median=347.5 min) and the normal saline group (median=230 min) with P=0.001.

Conclusion and recommendation:
The authors conclude that preoperative administration of 8 mg of dexamethasone prolongs the first analgesic request time, decreases postoperative tramadol and diclofenac consumption, and decreases the postoperative pain score. The authors recommend that researchers conduct further RCTs with a different dose of dexamethasone and on a multicenter basis.
Practice of enhanced recovery after cesarean delivery in resource-limited setting
Authors: Ibrahem Amelmasin Faris , Melkie Tadese Belayneh , Filatie Tesera Dereje , Tegegne Biresaw Ayen , Admassie Belete Muluadam 
Published: November 2023

Background:
Caesarean section is one of the most common procedures and clinician faces dual challenges with feto-maternal morbidity and mortality after caesarean delivery. Enhanced recovery after caesarean delivery protocols might effectively reduce postoperative feto-maternal morbidity and mortality. Therefore, this study aimed to assess practice of enhanced recovery after caesarean delivery among parturients who underwent elective caesarean delivery.

Methods:
A cross-sectional study design was conducted from March to June 2021 on 225 consecutive parturients scheduled for elective caesarean delivery. A semi-structured questionnaire which developed from Society of Obstetric Anesthesia and Perinatology, evidence-based recommendations regarding enhanced recovery after a caesarean (2020) to collect data. Data was collected through direct observation, reviewing the chart, and patient’s interview. Data were entered and analyzed in SPSS version 20.

Result:
Preoperative pathway; limit fasting interval (91%), haemoglobin screen and optimization (82%), and patient education (100%) found good Areas of practice Intraoperative pathway; administering postoperative nausea and vomiting prophylaxis (100%), fluid optimization (88%), neuraxial anaesthesia with a neuraxial opioid (91%), initiating multimodal analgesia (88%), optimal uterotonic administration (88%), delayed umbilical cord clamping (85%), and prophylactic antibiotic (100%) found areas with good areas of practice. Postoperative pathways; initiation of multimodal analgesia (74%) and early removal of the urinary catheter (62%) were found areas good areas of practice

Conclusion and recommendation:
The overall practice of enhanced recovery after caesarean delivery was below the target. The authors recommend that this comprehensive and specialized hospital administrator implement enhanced recovery after caesarean delivery protocol and give short-term training for health professionals’ about the protocol