bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic Finger Amputation in the U.S. Military
Authors: Jordan James A , Polmear Michael M , Wells Matthew E , Dunn John C 
Published: December 2022

ABSTRACT

Introduction
Finger amputations can lead to loss of work time and suboptimal function, particularly in the active duty military. There is a paucity of epidemiologic and outcome data for these injuries. The purposes of this study are to define key demographic data pertaining to transphalangeal finger amputations in the U.S. Military and to assess epidemiological data to define risk factors for medical readiness following finger injuries.

Materials and Methods
This was a retrospective review of the military electronic medical record of encounters between 2016 and 2019 with traumatic transphalangeal amputation ICD 10 codes S68.5 (thumb) and S68.6 (finger). Primary outcomes included median military occupational activity limitation length, ability to return to duty, and medical separation from the military.

Results
A total of 235 patients were included in the final dataset. 221 (94.0%) of these service members were able to return to full duty, although 14 (6.0%) underwent medical separation from the military because of their finger injuries. The median limited duty timeline was 6 weeks. Significant risk factors identified that led to increased rates of medical separation were the use of tobacco (odds ratio [OR] of 5.53, 95% CI 1.21–25.29), junior enlisted status (OR of 5.51, 95% CI 1.67–18.17), and thumb or index finger involvement (OR of 3.50, 95% CI 1.13–10.83).

Conclusions
Within a physically high-demand population, traumatic finger amputation can limit duties and may lead to medical separation from service. Traumatic finger amputations are common and often require 6 weeks of restricted short-term disability, particularly in a tobacco-using, young, physically active cohort.
Effects of Dextromethorphan on Nicotine-Induced Reward, Behavioral Sensitization, Withdrawal Signs, and Drug Seeking-Related Behavior in Rats
Authors: Huang Eagle Yi-Kung , Hung Hao-Yuan , Chen Yuan-Hao , Kao Jen-Hsin , Tsai Ai-Lun , Chow Lok-Hi 
Published: December 2022

Abstract

Introduction
Tobacco products are addictive, with nicotine serving as the major addictive ingredient. Chronic tobacco use or chronic administration of nicotine alone results in both physiological and psychological dependence. Our previous studies indicated that dextromethorphan (DM) could effectively attenuate the dependence of morphine and methamphetamine. Thus, we further investigated the possible effects of DM on nicotine dependence.

Aims and Methods
Conditioned place preference (CPP) test was used to examine nicotine-induced rewarding effects as well as the drug-seeking–related behavior in rats. Nicotine dependence was induced by continuous subcutaneous infusion of nicotine via an osmotic minipump for 7 days and abstinence was initiated by removal of the pump. Withdrawal signs were observed and quantified. Locomotor activity was measured to determine the behavioral sensitization induced by nicotine. To investigate the activity of mesolimbic dopaminergic neuronal activity in correlation with the effects of nicotine, the animals were sacrificed and the nucleus accumbens (NAc), dorsal striatum (DS), and medial prefrontal cortex (mPFC) were dissected and used to determine the contents of dopamine (DA) and its metabolites using high-performance liquid chromatography (HPLC).

Results
Our results showed that DM could suppress nicotine-induced rewarding effect and drug-seeking–related behavior. In addition, co-administration and post-treatment of DM could both attenuate nicotine withdrawal signs. Moreover, DM could suppress nicotine-induced behavioral sensitization. Neurochemical experiments show that co-administration and post-treatment of DM abolished nicotine-induced increase of the DA turnover rate in the mPFC, but not in the NAc and DS.

Conclusions
The results suggest that DM has a great therapeutic potential in the treatment of nicotine dependence.

Implications
Our results showed that DM could suppress nicotine-induced rewarding effect and drug-seeking–related behavior. In addition, co-administration and post-treatment of DM could both attenuate nicotine withdrawal signs. Moreover, DM could suppress nicotine-induced behavioral sensitization. Neurochemical experiments show that co-administration and post-treatment of DM abolished nicotine-induced increase of the DA turnover rate in the mPFC, but not in the NAc and DS. These results suggest that DM has a great therapeutic potential in the treatment of nicotine dependence.
871. Oral Ibrexafungerp Outcomes by Fungal Disease in Patients from an Interim Analysis of a Phase 3 Open-label Study (FURI)
Authors: Thompson George R , King Thomas , Azie Nkechi , Angulo David A , Prattes Juergen 
Published: December 2022

Abstract

Background
There are limited oral treatment options for patients with fungal infections who fail currently available antifungals or have an infection caused by resistant organisms. Ibrexafungerp is an investigational broad-spectrum glucan synthase inhibitor with activity against Candida and Aspergillus species, including azole- and echinocandin-resistant strains. A Phase 3 open-label, single-arm study of ibrexafungerp (FURI; NCT03059992) is ongoing for the treatment of patients intolerant of, or with fungal disease refractory to, standard antifungal therapy. We present an interim analysis of patient outcomes from the FURI study by fungal disease type.

Methods
FURI patients are eligible for enrollment if they have proven or probable: severe mucocutaneous candidiasis, invasive candidiasis, chronic or invasive aspergillosis, with documented evidence of failure, intolerance, or toxicity related to a currently approved standard-of-care antifungal treatment; or patients who cannot receive approved oral antifungal options (e.g., due to susceptibility), and continued IV antifungal therapy is clinically undesirable or unfeasible.

Results
An independent Data Review Committee (DRC) provided an assessment of treatment response for 113 enrolled patients in the FURI study from 27 centers in US, UK and EU treated with ibrexafungerp for mucocutaneous or invasive fungal infections from 2016–2021. Fifty-six patients (49.5%) had invasive candidiasis/candidemia, 32 (28.3%) had mucocutaneous candidiasis, 14 (12.4%) had vulvovaginal candidiasis (VVC), and 11 (9.7%) patients had aspergillosis.
Upon DRC review, the percent of patients with complete or partial response, or for VVC, clinical improvement (defined as vulvovaginal signs and symptoms score ≤ 1) was 58.4%; stable disease was 23.9%; and 11.5% had disease progression (including 2 VVC patients not meeting the criteria for clinical improvement). There was 1 death due to underlying causes, and 6 outcomes were indeterminate. The table presents outcomes by disease type.

Conclusion
Analysis of 113 patients from the FURI study indicates that oral ibrexafungerp provides a favorable therapeutic response in patients with challenging fungal disease and limited treatment options.

Disclosures
George R. Thompson, III, MD, Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Merck: Grant/Research Support|Pfizer: DSMB|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support Thomas King, MS MPH, SCYNEXIS, Inc.: employee|SCYNEXIS, Inc.: Stocks/Bonds Nkechi Azie, MD MBA FIDSA, SCYNEXIS, Inc.: employee|SCYNEXIS, Inc.: Stocks/Bonds David A. Angulo, MD, SCYNEXIS, Inc.: employee|SCYNEXIS, Inc.: Stocks/Bonds.
1583. A Case Series of Low-Level HBV Viremia After Switching to Long-Acting Injectable Cabotegravir/Rilpivirine in Patients with HIV, Hepatitis B Core Antibody Positivity, and Hepatitis B Surface Antigen Negativity
Authors: Welford Elliott , Yin Jeffrey , Hill Lucas , Wooten Darcy 
Published: December 2022

Abstract

Background
Two-drug antiretroviral therapy (ART), including long-acting injectable cabotegravir and rilpivirine (LAI CAB/RPV), is increasingly used for treatment of people with HIV. Many two-drug regimens do not contain tenofovir (TFV), and guidelines recommend ensuring patients are not chronically infected with hepatitis B virus (HBV) before switching to a TFV-free regimen since this could lead to HBV reactivation. The approach to regimen switching in patients who are HBV surface antigen (sAg) negative but who are HBV core antibody (HBcAb) positive is less clear. We describe three cases of HBV low-level viremia in patients switched to LAI CAB/RPV and who were HBcAb positive and sAg negative.

Methods
We conducted a retrospective case series of patients with HIV switching to LAI CAB/RPV who were HBcAb positive and sAg negative. We reviewed pre-switch HBV studies, history of HBV vaccination, current ART, CD4 cell count, and HIV viral load, and liver function tests (LFTs) where available. After switching to LAI CAB/RPV, we reviewed patients’ HBV DNA PCR, HBVsAg, and ART management.

Results
Of the 149 patients in our clinic who were switched to LAI CAB/RPV, 38 (25.5%) were HBcAb positive and sAg negative. Of these 38 patients, three (7.9%) developed HBV viremia (Figure 1). Two of the patients were switched back to a TFV-containing three-drug regimen with subsequent suppression of HBV DNA levels. Through shared decision-making, the third patient opted to continue LAI CAB/RBV. Repeat HBV DNA levels were detected but remained low and the patient’s sAg remained negative. All patients’ LFTs remained within normal limits. Of interest, one of the three patients had a surface antibody level of 115 mIU/mL at baseline.

Conclusion
Our case series describes three cases of HBV low-level viremia following a switch off of HBV-active ART to LAI CAB/RPV. The clinical significance of this low-level viremia is unclear and warrants further investigation. We recommend a post-hoc analysis of stored samples from patients in ATLAS, FLAIR, and ATLAS-2M who were HBcAb positive to determine if low-level HBV viremia occurred in these patients and if surface antibody levels influenced the likelihood of reactivation.

Disclosures
Lucas Hill, PharmD, AAHIVP, Gilead Sciences: Speakers Bureau.
1228. Comparison of surgical site infection between open and robotic-assisted gastrectomy in patients with gastric cancer
Authors: Kim Jinnam , Lee Se Ju , Lee Ki Hyun , Lee Eun Hwa , Baek Yae Jee , Kim Jung Ho , Ahn Jin Young , Jeong Su Jin , Ku Nam Su , Son Taeil , Choi Jun Yong , Yeom Joon-sup 
Published: December 2022

Abstract

Background
Surgical site infection is a clinically significant postoperative complication and a major cost burden of healthcare-associated infections. Although many studies compare minimally invasive surgery and open surgery, few studies have focused on surgical site infection. This study aimed to investigate the differences in the incidence of surgical site infection after open and robotic-assisted gastrectomy in patients with gastric cancer.

Methods
We retrospectively reviewed adult patients with gastric cancer who underwent open and robotic-assisted gastrectomy at a 2,400-bed tertiary hospital in Seoul from January 2015 to December 2015. Postoperative outcomes, including surgical site infection between open and robotic-assisted gastrectomy, were compared. Risk factors of surgical site infection were analyzed by logistic regression multivariable analysis.

Results
A total of 684 patients, including 448 patients who underwent open gastrectomy and 236 patients who underwent robotic-assisted gastrectomy, were enrolled. The median age was 58 years. The overall incidence of surgical site infection was 7.6%. The incidence of surgical site infection was significantly lower in the robotic-assisted gastrectomy group than in the open gastrectomy group (9.2% vs. 4.7%, p=0.035). The length of hospital stay was significantly shorter in the robotic-assisted gastrectomy group than in the open gastrectomy group (5 vs. 8 days, p&lt; 0.001). Multivariate logistic regression revealed that the operative time, history of smoking, and open gastrectomy were independent risk factors influencing the incidence of surgical site infection.

Conclusion
Robotic-assisted gastrectomy is a good multimodality treatment option for gastric cancer in terms of reduced length of hospital stay and incidence of surgical site infection.

Disclosures
All Authors: No reported disclosures.
1323. Laboratory Abnormalities in Children Undergoing Outpatient Therapy for Staphylococcus aureus Acute Hematogenous Osteomyelitis: Should We Worry?
Authors: McNeil Jonathon C , Sommer Lauren M , Joseph Marritta , Kaplan Sheldon L , Vallejo Jesus G 
Published: December 2022

Abstract

Background
Recent PIDS practice guidelines for acute hematogenous osteomyelitis (AHO) advocate for regular laboratory monitoring for adverse drug events. Data are limited however with respect to the frequency or clinical impact of antibiotic-related laboratory abnormalities (ARLA) in pediatric AHO. We reviewed the experience with ARLA in children undergoing treatment for S. aureus AHO.

Methods
Cases of S. aureus AHO in children were reviewed from 2011-2020. Eligible cases were those 1) discharged to complete therapy at home (IV or oral), 2) with baseline complete blood count (CBC), creatinine and AST/ALT obtained during the hospitalization and 3) at least one CBC, creatinine, and/or AST/ALT measurement in the outpatient setting while receiving AHO therapy. Neutropenia, thrombocytopenia and AST/ALT elevation were defined using the NIH DAIDS pediatric toxicity grading system; acute kidney injury (AKI) was defined using pRIFLE.

Results
207 subjects met inclusion criteria. Outpatient CBC was obtained in 187 subjects, creatinine in 121 and AST/ALT in 63. Patients with and without ARLA were similar with respect to age and demographics. Neutropenia developed in 12 (6.4%) and thrombocytopenia in 5 (2.7%) at a median of 23 and 18 days of therapy, respectively (Figures 1). Outpatient hematologic abnormalities were more common among subjects with MRSA, history of inpatient ARLA and those receiving certain antibiotics, specifically vancomycin (Figures 2, 3). There was no clear relationship with hematologic abnormalities and vancomycin daily dose. Neutropenia prompted modification of therapy in 1 case. No infections or bleeding events were attributable to ARLA. Three cases of outpatient AKI occurred (2.1% [vancomycin, n=1; cefazolin, n=2]); one subject had therapy discontinued. Outpatient AST/ALT elevation occurred in six (9.5%), none of which were symptomatic. Patients with AST/ALT elevation were disproportionately treated with cefazolin (p=0.006).
Panel A. The number of patients experiencing antibiotic-related laboratory abnormalities (ARLA). Panel B. Box plots depicting the timing of ARLA relative to initiation of antimicrobial therapy.

Conclusion
ARLAs, particularly neutropenia, are common in patients receiving outpatient therapy for AHO after 2-3 weeks of therapy. However, the majority of ARLA are mild and do not result in symptoms or modification of therapy. Further study is necessary to appreciate how these findings might be applicable to all cause osteomyelitis.

Disclosures
Jonathon C. McNeil, MD, Agency for Healthcare Research and Quality: Grant/Research Support|Allergan: Provided reagents for unrelated research|Nabriva: Site investigator for multicenter clinical trial Sheldon L. Kaplan, MD, MeMed: Grant/Research Support|Pfizer: Grant/Research Support.
1345. The Cascade of Care for Early Infant Diagnosis in Zimbabwe: Point of Care HIV Testing at Birth and 6-8 weeks
Authors: Aitcheson Nancy , Sacks Emma , Cohn Jennifer 
Published: December 2022

Abstract

Background
Routine birth testing of HIV exposed infants (HEI) using point of care (POC) nucleic acid testing may allow for earlier diagnosis and treatment of HIV-infected infants than current methods, but more data are needed on retention in care for those diagnosed as HIV-positive at birth and on re-testing for those with a negative HIV test at birth.

Methods
POC birth testing (within 48 hours of birth) was offered to all HEI born at ten public maternities in Zimbabwe from November 2018 to July 2019. Data from routine registers, including information on re-testing at 6–8 weeks for infants testing HIV-negative at birth and six-month retention in care among infants testing HIV-positive at birth.

Results
Of 2,854 eligible HEI, 2,806 (98.3%) received a POC HIV birth test. We identified 39 HIV-infected infants (1.4%), and 23 (59%) were started on ART. Of those, 20 infants (87%) remained on ART at six months. Of the 2,694 infants who tested negative at birth, 1,229 (46.5%) had a documented re-test at 6-8 weeks, and 7 (0.6%) of those infants tested positive.

Conclusion
Uptake of POC birth testing was high in the 10 study facilities. However, ART initiation for HIV-positive infants was low. Among infants initiated on ART, most but not all continued ART at 6 months. Among infants who tested negative at birth, rates of testing at 6-8 weeks of life were similar to national rates of testing at the same age without a birth test (56%). Improving infant HIV testing rates at 6-8 weeks, regardless of birth testing, should be a priority. Additionally, insuring that HIV-positive newborns are started and retained on ART is critical for preventing morbidity and mortality among HIV-infected infants.

Disclosures
All Authors: No reported disclosures.
1431. Evaluation of Drug-induced Liver Injury in Patients Receiving Anti-tuberculosis Medications and Subsequent Management
Authors: Acosta Carina , Barsoum Barbara , Doan Thien-Ly 
Published: December 2022

Abstract

Background
For anti-tubercular medications, the risk of drug-induced liver injury (DILI) ranges from 5-33%. DILI may be asymptomatic or may present with fever, nausea, vomiting, anorexia, and lethargy. The objective of this review is to describe the incidence of hepatotoxicity occurring with anti-tuberculosis medications, management of DILI, and re-initiation of therapy.

Methods
Adult patients prescribed pyrazinamide during their hospital stay at Long Island Jewish Medical Center were screened for inclusion criteria of DILI (liver enzymes ≥ 3x upper limit of normal [ULN] from 7/2017 to 2/2022. IRB classified this analysis as a quality improvement project. Using the electronic medical record, retrospective data was collected for those meeting criteria for DILI which included baseline demographics, concomitant hepatotoxic medications, laboratory values (e.g., alanine aminotransferase [ALT], aspartate aminotransferase [AST], timing of drug interruption, and sequence of re-initiation.

Results
A total of 108 patients were screened and then 17 were included in the analysis. DILI was found in 16% of patients. The mean age was 57 years and 53% were female. None of the patients with liver injury had a history of hepatic disease, prior DILI, or alcohol consumption. Mean baseline laboratory values were total bilirubin 0.52 mg/dL, alkaline phosphatase 166 U/L, AST 54 U/L, and ALT 40 U/L. All patients were initiated on first-line treatment for drug-susceptible tuberculosis. Thirteen patients had concomitant hepatotoxic drugs (11 acetaminophen, 4 statins, 2 azole antifungals, 1 trimethoprim/sulfamethoxazole). Fourteen patients (82%) developed DILI where AST was ≥ 10 times the ULN. Drug interruption was necessary in 16 of the 17 patients (94%). Seven patients (58%) were re-initiated on treatment according to the American Thoracic Society recommendations with a mean of 8 days after drug interruption.

Conclusion
In conclusion, the management of DILI related to anti-tubercular medications in our institution can further be standardized to reintroduce a rifamycin analog with or without ethambutol. Education on the avoidance of concomitant hepatotoxic medications such as acetaminophen and selecting the most appropriate agents to sequentially re-initiate treatment is warranted.

Disclosures
All Authors: No reported disclosures.
1866. Burden of Death Associated with SARS-CoV-2 Infection during the Pandemic in Flint, Michigan (MI): Mortality Trends over the 2-year time period
Authors: Younas Mariam , Rios-Bedoya Carlos , Osterholzer Danielle , Bachuwa Ghassan , Bachuwa Ghassan , McDonald Philip , Seedahmed Elfateh 
Published: December 2022

Abstract

Background
Approximately 2.4 million cases of SARS-CoV-2 infection have been reported in MI, leading to 35,935 deaths. We aimed to study the mortality trends in patients with SARS-CoV-2 infection during the pandemic in Flint, MI.

Methods
Hurley Medical Center, is a 443-bed inner city teaching hospital in Flint, MI. We retrospectively collected basic demographics, treatment data, and outcomes on adults (≥ 18 years (yrs) of age) with confirmed SARS-CoV-2 infection, admitted and discharged from our facility from 03/2020 through 02/2022. The 2-year span was further divided into 6-time periods (Table 1).

Results
During the 2-year study period, the overall crude 90-day mortality rate was 16% (269/1668) and the In-hospital case fatality rate was 15% (244/1668). 90-day mortality was lowest in the time period 5 (Table 1). Men comprised 50% of the cohort and were 1.5 times more likely to die than women (p-value 0.001). African Americans comprised 51% and whites 44% of the cohort. A specific race was not associated with mortality (Table 2). Non-survivors tended to be older, mean age of 68 vs 57 yrs (p-value &lt; .0001). See Table 3 for mean Body Mass Index (BMI). Hypertension (HTN) was the most common co-morbidity (61%), and was strongly associated with mortality (p-value &lt; 0.005) (Table 4). During the study period, 12% of the cohort (207/1668) had received at least one dose of available COVID-19 vaccines (including single dose of Johnson and Johnson’s Jansen vaccine). 89% of non-survivors were unvaccinated (adjusted Odds ratio for mortality 1.61, 95% CI 1.03 - 2.53, p-value 0.038).

Conclusion
Despite substantial changes in supportive care and management, SARS-CoV-2 infection regardless of the circulating variants carried a significant mortality risk. Trend towards improving mortality can partly be attributed to better supportive care-treatments, and some background immunity from prior infection or vaccination. Immunization against COVID-19 is highly protective against severe disease. Vaccination coverage in this high-risk cohort was low, at only 12%. Vaccination coverage in Flint and surrounding areas remains low at less than 50% as reported by Genesee County health department. Public health efforts should be focused at overcoming the barriers to vaccine acceptance in this high-risk unique population.

Disclosures
All Authors: No reported disclosures.