Clinical Aspects Research Articles

Epidemiological, Etiological, Clinical, and Therapeutic Aspects of Pleural Effusion in Children at the Pediatric Department of Libreville University Hospital

Objective: This study aimed to improve the management of pediatric pleural effusion at libreville university hospital by identifying primary etiologies and proposing effective diagnostic and therapeutic strategies. Methods: A retrospective, descriptive, and analytical study was conducted from january 2017 to april 2020, including 59 children aged 1 month to 16 years hospitalized for pleural effusion. Data were analyzed using epi-info 7 software. Incomplete records and non-pleural effusion cases were excluded. Results: The prevalence of pediatric pleural effusion was 0.47%, with a male predominance (54.2%) and a peak age range of 1–5 years (50.8%). Common symptoms included fever, cough, and respiratory distress. The most frequent etiologies were staphylococcus aureus (26%) and pleuropulmonary tuberculosis confirmed by genexpert (13.6%). Chest radiographs showed unilateral effusion in 89.7% of cases, while pleural ultrasounds, performed in 62.7% of patients, confirmed effusion in 60.5%. Empirical antibiotic therapy was administered initially and later adjusted based on antibiograms. Patients diagnosed with tuberculosis received a standard antitubercular regimen, including rifampicin, isoniazid, pyrazinamide, and ethambutol. The average hospital stay was 21.6 days, and outcomes were generally favorable. Conclusion: Pediatric pleural effusion is uncommon in gabon, but pleuropulmonary tuberculosis remains a significant cause. Early diagnosis and prompt treatment, including appropriate antimicrobial therapy and standardized antitubercular regimens, are essential to improving outcomes.

A Simultaneous Presentation of Nasopharyngeal Carcinoma and Latent Cervical Tuberculosis: Insights into a Complex Case

Background: Tuberculosis infection triggers a chronic inflammatory response that can create a favorable environment for the development of cancer cells. Chronic inflammation can lead to DNA damage, increased cell proliferation, and impaired immune surveillance. Nasopharyngeal carcinoma is an aggressive malignant tumor with a very poor prognosis, despite the current oncology therapy. Methods: The case presents following clinical, imaging, and histopathological aspects, as well as the oncological follow-up of the patient over a period of 8 years. Results: This paper presents the case of a 49-year-old patient diagnosed with cervical lymph node tuberculosis while biopsied for the diagnosis of nasopharyngeal carcinoma with cervical lymph node metastases. Conclusions: The overlap of this malignancy with an infection of mycobacterial etiology complicates the outcome of the disease even more, making treatment and prognosis difficult.

Clinical and rehabilitation aspects of managing patients with meningiomas, schwannomas, ependymomas, and pituitary neuroendocrine tumors

The rehabilitation of neurooncology patients represents a critical issue due to the high incidence of brain tumors of varying locations and the severity of associated neurological symptoms, which significantly reduce the patient’s quality of life. Over the past decades, the prevalence of central nervous system tumor has increased by more than twofold in individuals aged 65 and above. Neurooncology patients represent a complex group that requires long-term restorative treatment. The early initiation of rehabilitation facilitates the recovery of impaired functions prior to the formation of persistent pathological patterns. This article examines neurorehabilitation methods using the example of the most common benign brain tumors, which include meningiomas, schwannomas, ependymomas, and pituitary neuroendocrine tumors. Significant advancements have been made in the treatment of these tumors in recent years, particularly through combined treatment modalities. A multidisciplinary approach to neurooncology is becoming increasingly recognized as a key element in global healthcare. However, the needs of these patients and their families extend beyond medical care, necessitating the involvement of psychologists, occupational therapists, speech-language pathologists, and social workers. A comprehensive approach to treatment, early restorative interventions and the development of innovative neurorehabilitation methods can facilitate a personalized strategy for patients with benign brain tumors, thereby increasing their rehabilitation potential.

Relationships between psychological, clinical aspects and eating behavior in individuals with diabetes: cross-sectional study

Introduction: Eating disorders are closely related to mental status, and individuals with diabetes have a significantly increased risk of developing an eating disorder. Objective: This study aims to evaluate the possible association of cognitive restriction, uncontrolled eating, emotional eating factors, and eating disorders with depression in individuals with diabetes. Methods: A cross-sectional study was carried out on 132 patients who were diagnosed with diabetes. The Beck Depression Inventory (BDI) was used to assess the depression status of individuals, the Three-Factor Eating Questionnaire (TFEQ-R18) to measure eating habits, and the Night Eating Questionnaire (NEQ) to obtain information about night eating behavior. All anthropometric measurements were taken by the researcher. Results: It was determined that there was a 'mild depression' state in both the Type 1 diabetes patient group (14.10±8.26) and the Type 2 diabetes patient group (14.74±7.64). A linear, moderate, and significant correlation was found between BDI scores and NEQ scores in individuals with type 1 diabetes (r=0.547, p<0.001). In individuals with type 2 diabetes, an inverse, moderate, and significant correlation was found between BDI scores and cognitive restriction scores (r=-0.406, p=0.029). For the individuals in the two groups, statistically significant differences were found in the scores obtained from the BDI, NEQ, and TFEQ-R18 in terms of the history of mental illness and obesity, diabetic diet, and hypoglycemia (p<0.05). Conclusions: In this study, it has been shown that the effect of mental illness and obesity history on current eating behavior may be on night eating behavior, cognitive restriction, and uncontrolled eating. It is likely that compliance with the diabetic diet and prevention of hypoglycemia will be reflected in eating behavior and anthropometric measurements.

Functionality and Quality of Life Within the Speech-Language Pathology Assessment Context: Analysis From the Structural Equation Modeling Perspective.

Quality of life and functionality are relevant in an approach based on the biopsychosocial model. Therefore, the objective of this study was to assess the influence of clinical, sociodemographic, and functionality aspects on the quality of life of children and adolescents undergoing speech-language evaluation. Cross-sectional analytical observational study conducted with 84 Brazilian children and adolescents. The Brazilian Economic Classification Criteria and the Pediatric Quality of Life Inventory 4.0™ were applied, and data were collected on sex, complaints, SPL diagnostic hypothesis, as well as on the Body Functions, Activities and Participation, and Environmental Factors components of the International Classification of Functioning, Disability and Health (ICF). Factor analysis and structural equation modeling were used for data analysis, with a 5% significance level applied to the final models. Male sex and clinical-care variables had a direct and negative influence on functionality in the first two models (p < 0.05). Activities and Participation had a positive direct effect on self-reported quality of life (p = 0.031; β = 0.282) and parent/caregiver-reported quality of life (p = 0.003; β = 0.387). Parent-reported quality of life was negatively influenced by complaints of oro-facial motricity alterations, while self-reported quality of life was positively influenced by the diagnostic hypothesis of speech disorders. The results show that sex and clinical-care complaints negatively influenced functionality, while Activities and Participation positively influenced quality of life. The use of structural equation modeling proved to be an important strategy for analyzing ICF and quality of life in SLP practice.

Spirituality, religion, and personal beliefs in Brazilian adults with epilepsy.

To evaluate the relationship between S/R, demographic data, and clinical variables of Brazilian adult patients with epilepsy (PWE). The scores of the WHO Quality of Life for Assessment of Spirituality, Religion, and Personal Beliefs (WHOQOL-SRPB) were related to demographic and clinical aspects, the Spirituality Self-Rating Scale (SSRS), and the Spiritual/Religious Coping Scale (SRC) of 60 PWE. The mean age was 42.8y and 35 (58.3%) patients reported regular religious practice. In the WHOQOL-SRPB, greater inner peace and harmony were observed in women, greater wholeness and integration, hope and optimism in married patients, and greater spiritual connection in patients with religious practice. The use of polytherapy with antiseizure medication (ASM) was associated with lower spiritual connection, wholeness, integration, and S/N in the WHOQOL-SRPB. The higher seizure frequency was associated with lower spiritual connection. Facet scores and total scores of the WHOQOL-SRPB were significantly correlated with positive and negative coping and a greater perception of spiritual guidance. In the PWE, the use of S/R differed according to gender, marital status, and religious practice. Clinical variables influenced the perception of S/R, which differed according to the use of ASM, frequency, and type of epileptic seizures. The greater use of coping and spiritual guidance was associated with different facets of S/R and personal beliefs.

Primary umbilical endometriosis: clinical aspects and long-term follow-up of five cases.

Umbilical endometriosis (UE) is a rare condition. We have documented the clinical characteristics, management strategies, and follow-up results for five cases treated at our hospital between 1998 and 2020, with patients aged between 31 and 44 years. Patients typically presented with umbilical swelling. In all cases, surgical removal was effective and no complications were reported. Two patients had concurrent ovarian endometriosis and one adenomyosis. No umbilical recurrence was recorded during follow-up. We believe that these findings offer valuable insights for the management of this patient population. Clinical management strategies for this disease should be tailored to each patient and carried out collaboratively by both general and gynaecological physicians.

Deciphering TGF-β1's role in drug resistance and leveraging plant bioactives for cancer therapy.

The intricate regulatory mechanisms governing TGF-β1 expression play pivotal roles in tumor progression. Key proteins such as FKBP1A, SMAD6, and SMAD7 trigger this process, modulating cell growth inhibition via p15INK4b and p21CIP1 induction. Despite TGF-β's tumor-suppressive functions, cancer cells adeptly evade its effects, fueling disease advancement. Tumor microenvironmental TGF-β1 prompts epithelial-mesenchymal transition (EMT), facilitated by transcription factors like slug, twist-1, and snail. Notably, cancer-associated fibroblasts (CAFs) amplify this effect by secreting TGF-β1, fostering drug resistance. Of particular concern is the resistance observed with BRAF/MEK inhibitors (BRAFi/MEKi), highlighting the clinical significance of TGF-β signaling in cancer therapeutics. However, emerging interest in natural anti-cancer agents, with their distinct pharmacological actions on signaling proteins offers promising avenues for therapeutic intervention. This review emphasizes the multifaceted interplay between TGF-β signaling, tumor microenvironment dynamics, and therapeutic resistance mechanisms, illuminating potential targets for combating cancer progression by plant-derived-natural-bioactive compounds. However, this review additionally explores the currently available advanced methods for detecting various types of cancer. Not only that, but it also discussed the function of plant-derived compounds in clinical aspects, as well as its limitations.

A Systematic Literature Review of Trauma Systems: An Operations Management Perspective.

Trauma systems provide comprehensive care across various settings, from prehospital services to rehabilitation, integrating clinical and social care aspects. Established in the 1970s, these systems are pivotal yet under-researched in their operational management. This study aims to fill this gap by focussing on the integration of operations management (OM) techniques to enhance the efficiency and effectiveness of trauma systems. By leveraging proven OM strategies from other healthcare sectors, we seek to improve patient outcomes and optimise system performance, addressing a crucial need for innovation in trauma care operations. A systematic literature review was conducted using the PICOTS framework to explore operational aspects of trauma systems across varied settings, from emergency departments to specialised centres. Searches were performed in 5 databases, focussing on articles published from 2006 to 2024. Keywords related to operational research and management targeted both trauma systems and emergency management services. Our method involved identifying, synthesising, and summarising studies to evaluate operational performance, with a specific emphasis on articles that applied operational research/management techniques in trauma care. All eligible articles were critically appraised using 2 quality assessment tools. Employing Donabedian's framework to analyse the quality of trauma systems through structure, process, and outcome dimensions, our systematic review included 160 studies. Of these, 5 studies discussed the application of the Donabedian evaluation framework to trauma systems, and 14 studies examined structural elements, focussing on the location of healthcare facilities, trauma resource management, and EMS logistics. The 63 studies on process indicators primarily assessed triage procedures, with some exploring the timeliness of trauma care. Meanwhile, the 78 outcome-oriented studies predominantly evaluated mortality rates, alongside a smaller number assessing functional outcomes. Existing evaluation metrics primarily focussed on triage accuracy and mortality are inadequate. We propose expanding these metrics to include patient length of stay (LOS) and rehabilitation trajectory analyses. There is a critical gap in understanding patient flow management and long-term outcomes, necessitating focussed research on LOS modelling and improved rehabilitation data collection. Addressing these areas is essential for optimising trauma care and improving patient recovery outcomes.

WCN25-3340 Pediatric Acute Renal Failure in Chad: Epidemiological, Clinical and Evolutionary Aspects

WCN25-3340 Pediatric Acute Renal Failure in Chad: Epidemiological, Clinical and Evolutionary Aspects

Assessing Communication Impairments in a Rare Neurodevelopmental Disorder: The SCN2A Clinical Trials Readiness Study.

SCN2A-related disorders (SCN2A-RDs) entail severe impairments in multiple domains that could serve as nonseizure outcomes in clinical trials. This study evaluated the fitness for purpose of several clinical instruments with both standardized and alternative scoring and with some measures used out of their intended age range for assessing communication in SCN2A-affected participants. Parents of SCN2A-affected children were recruited through FamilieSCN2A Foundation outreach for a combined cross-sectional and longitudinal study. They completed assessments of their children at study entry and 6 and 12 months later. Assessments included the Vineland Adaptive Behavior Scale (VABS-3), Adaptive Behavior Assessment System (ABAS), Communication Matrix, and Communication and Symbolic Behavior Scale (CSBS). Analyses examined floor and ceiling effects, inter-rater and test-retest reliability, discrimination among different levels of functional impairment, and sensitivity to clinical aspects of SCN2A-RDs. Of 65 participants (28 females, median age 6.4 years, IQR 4.1-10.5), 56 (86%) had epilepsy. Eleven (17%) used speech as their primary communication mode; 84% were considered ineffective communicators. The mean Vineland composite standardized score (SS) was 34 (IQR 26-46). Cross-sectionally, standardized scores decreased with increasing age. There were substantial floor effects for receptive (75%) and expressive (83%) communication. SSs discriminated poorly between verbal vs nonverbal and communicative vs noncommunicative participants and were not sensitive to features reflecting epilepsy severity (e.g., epileptic spasms and number of current medications). By contrast, Vineland growth scale value (GSV) and ABAS, Matrix, and CSBS raw scores had minimal floor effects; most increased with age. These alternative scores distinguished clearly between participants with different levels of communication and were sensitive to aspects of epilepsy severity. Longitudinally, SSs decreased, but other scores remained relatively stable over a year. SCN2A-RD is characterized by severe-to-profound impairment with a SS <4 SDs of the norm-referenced mean. Owing to severe floor effects and their insensitivity to markers of communication function, age-standardized scores (e.g., Vineland SS) are not fit for purpose in clinical trials or other settings for evaluating nonseizure outcomes such as communication. GSVs and alternative scoring and assessments have much better measurement profiles in all these regards and should be considered in future precision medicine trials for SCN2A-RDs and other similar rare diseases.

Evaluation of immunohistochemical TRPC3 and TRPC6 expression patterns in human endometriosis.

Although to date the pathogenesis of endometriosis remains largely unexplained, it is known that processes of migration, proliferation and revascularization and thus calcium as a messenger substance play an important role. Consecutively, the present study examines the immunohistochemical expression of the calcium transient receptor potential channels 3 and 6 (TRPC3 and TRPC6) in ectopically located (outside the uterine cavity) endometrial tissue. Laparoscopically collected and histomorphologically verified endometriosis tissues from several different intraabdominal locations were examined (n = 20) and immunohistochemical stainings were performed with anti-TRPC3 and anti-TRPC6 antibodies (Alomone Labs, Jerusalem). Hereby, eutopic endometrium served as a healthy control cohort (n = 6). Staining patterns were evaluated using a modified immunoreactive score (IRS) and exploratory statistical analysis was performed, aiming to determine relations of staining intensities with associated clinical parameters such as rASRM stage and location. We determined a strong cytoplasmatic TRPC3 and TRPC6 expression in all ectopic endometrial glandular formations, albeit with focally varying staining intensities. Within our cohort, we did not verify a statistically significant difference of TRPC3 and TRPC6 expression between endometriosis patients and a healthy control group or between different clinical affections (rASRM stages). Our study confirms - to our knowledge for the first time - the successful immunohistochemical assessment of TRPC3 and TRPC6 in endometriosis, setting the basis for future studies aiming at evaluating not only clinical aspects of TRPC3 and TRPC6 expression but also shedding light on its function in the pathophysiological context of endometriosis.

A byte for arts: Digital applications meet artistic expressions

The use of artistic expression for diagnostics and therapy has a long tradition, which already started a century ago with psychological assessment tools using drawings to explore personality traits and inner emotions. With the advent of technical and digital achievements, these methods were adapted and integrated in corresponding therapeutic systems. This article outlines the relationship of arts and information technology from the very beginning in the fields of clinical and educational applications and human interaction aspects and gives examples of current developments. In particular, it illustrates the use of digital tools which focus on the process evaluation of arts therapies such as digital drawing applications to analyze the drawing process as a tool for the prediction of Alzheimer’s disease, or a digital device to analyze movement patterns in a landscaping task to investigate depressive moods. From a methodological point of view, these methods which integrate qualitative and quantitative research methods can be used to evaluate the impact of creative arts therapies even in small patient samples which is shown in two examples. Finally, critical questions on the impact of digitalization are addressed and an outlook towards future developments particularly in the field of music therapy is given.

Dysnatremia and Dyskaliaemia in Resuscitation: Epidemiological, Clinical, Therapeutic and Evolutionary Aspects

Introduction: Ionic disorders are an imbalance between the ions entering and leaving the body. We studied dysnatremia and dyskaliaemia in patients admitted in resuscitation department. Patients and Method: This is a retrospective, descriptive and analytical study of dysnatremias and dyskaliaemias in patients hospitalized in the resuscitation department Peace Hospital of Ziguinchor from January 1st, 2021 to December 31th, 2021. The objectives were to assess the prevalence of these ionic disorders in resuscitation, to clarify the epidemiological profile, to identify clinical and paraclinical signs, to evaluate management and to monitor the evolution of patients. Results: During the study period, the Peace Hospital resuscitation service recorded 287 hospitalizations, among which we identified 66 cases of ionic disorders (dysnatremias and dyskaliaemias) at admission. We found a frequency of 22.9% of hospitalized patients. The average age was 40.71 ± 23.83 years. Males were the most represented in 53%. The majority of patients, 62.1%, came from outside the city of Ziguinchor. Diabetes was the most common medical history in 50% of patients. Patients were from 53% of emergency department. Stroke was the most common cause in 16.7%. Dysnatremias were found in 57 patients, or 86.4%. Dyskaliaemias were found in 32 patients or 48.5%. Clinical signs were marked by the disorder of consciousness in 37.9%. Electrical signals were more marked by the flattened/negative T wave and ST depression in 60%. We reported a 53% mortality rate. Deaths occurred in 60% within 72 hours of hospitalization. Severe malaria and hyperkalemia were factors of poor prognosis. Conclusion: The ionic disorders, frequent in resuscitation, are of multifactorial origin. They are associated with significant morbidity and mortality and require early and accurate management.

Estudio de problemas de sueño y dolor crónico. Análisis comparativo entre pacientes que acuden a servicios especializados frente a atención primaria

Pain occupies a consultations in health services around the world, 20% in Spain. Half of these patients have sleep problems. It is important to evaluate how sleep is affected by pain intensity, comorbidities and treatment in patients in specialized services such as the Pain Unit (UDO), and the Pharmacy Office (OF) where they come from various specialties. Patients with and without complaints about their sleep were surveyed. All patients answered a questionnaire that covered clinical aspects (pain intensity), comorbidities that affected sleep (HAD- anxiety and depression), and sleep (Pittsburgh and MOS-S tests). RESULTS: 192 patients with pain were recruited (UDO=137, OF=55), aged between 46 and 77 years, all of them with pain intensity that ranged between 5.2/10 in the OF, and 6.9/10 in the UDO. High anxiety values ​​were found in the group of OF patients, as in those from the UDO, as well as high depression values ​​in a subgroup of the UDO patients. The sleep values ​​of the MOS-S tests were found to be especially altered (mainly shortness of breath and high drowsiness), and the Pittsburgh result gave a total value that indicated the need for medical control. Pain is a multidimensional entity, and there may be many aspects that may be worsening sleep. However, what is indisputable is that there is work to improve the quality of life of these patients. Keywords: Pain; Chronic; Sleep; Anxiety; Depression

Clinical and surgical aspects of treating fractures and dislocations of the acromial end of the clavicle

Clinical and surgical aspects of treating fractures and dislocations of the acromial end of the clavicle

P-2270. Spectrum of Invasive Mold Sinusitis in Adults with Hematological Malignancies

Abstract Background Invasive mold sinusitis (IMS) occurs exclusively in immunocompromised patients. In patients with hematologic malignancies, it is associated with mortality and may affect cancer-related survival by causing delay of the chemotherapy regimen. Clinical characteristics of patients with IMS Methods The records of adult patients with hematologic malignancies and proven or probable IMS over a 10-year period at a tertiary care hospital in Medellin, Colombia were retrospectively reviewed. Clinical aspects and results were evaluated Microbiological data of IMS Results We identified 24 episodes of IMS in 23 patients. In all cases manifested with nasal congestion, 27% of the episodes occurred in acute leukemias, 50% in refractory disease and 22.2% in medullary aplasia and hematopoietic stem cell transplantation; 16.6% manifested as a breakthrough infection. 21 episodes were related to neutropenia at the time of diagnosis. Aspergillus spp. was isolated in 12 (52.1%) episodes, Fusarium spp. in 6 (26%). Other etiologies were Curvularia spp., Hormographiella aspergillata, Tropicoporus tropicalis, Rhizomucor spp., Cladosporium and Lasiodiplodia spp. In 5 episodes there was fungal coinfection mainly with Aspergillus spp. In 26% of the cases the sinusitis was related to invasive pulmonary aspergillosis (IPA). The galactomannan antigen test was positive in patients with IPA and negative in cases of isolated sinusitis. All patients underwent surgical debridement and had positive histology and microbiological isolation with morphological and/or molecular identification. 13 episodes were treated with voriconazole and the response was defined as complete and partial in 10 and 8 of the episodes respectively. 7 patients died, 5 due to refractory hematological disease and one attributable to infection as it was rhinosinusal mucormycosis. Conclusion IMS is an expected complication of cytotoxic chemotherapy and is usually associated with profound and prolonged neutropenia. It is related to high mortality given the underlying malignant disease. Although Aspergillus spp. is the most common etiology, there are other molds that must be taken into account for better therapeutic guidance and therefore the need for invasive diagnosis is highlighted. Disclosures All Authors: No reported disclosures

P-2168. The Intervention of Infectious Diseases Physicians Might Enhance the Value of Broad-Range 16S rRNA Gene Polymerase Chain Reaction in the Clinical Aspect

Abstract Background Evaluation of Broad-Range 16S rRNA gene polymerase chain reaction (BRPCR) has been reported to aim in diagnosing infection by detecting and identifying bacterial genes in clinical specimens from patients with suspected infections. However, collecting the right specimens at the right time and determining whether the bacteria detected by BRPCR are the true cause or contamination requires infectious disease expertise. We investigate whether there is an association between the detection of bacteria that caused infection using BRPCR and intervention by Infectious Diseases (ID) physicians. Methods We reviewed the patients who underwent BRPCR at Osaka City General Hospital between April 2017 and March 2024. The collected items are age, sex, bacteria detected by BRPCR, determination of whether the bacteria if detected, caused infection, or were contaminated, and with or without the intervention of ID physicians (consultation to ID physicians). Then we analyzed the correlation between the intervention of ID physicians and the identification of the bacteria that caused the infection by BRPCR using Fisher's exact test. We also investigated whether the BRPCR results had affected the final diagnosis. Results There was a total of 149 clinical specimens from 138 patients. Of these, 84 (60%) were male, with a median age of 48 years (IQR 6-72). Bacteria were identified in 101 (67.7%) clinical specimens. In 70 specimens of them, the identified bacteria were presumed to have caused the infection. Of the 70 specimens, 56 had interventions by ID physicians. Whereas there were 79 specimens in which bacteria were identified but were presumed to be contaminants, and in which bacteria were not identified, of which 49 had intervention by ID physicians. The results showed an association between the intervention of ID physicians and the identification of the bacteria that caused the infection by BRPCR (p=0.0196). In 29 (19.4%), the final diagnosis changed from infectious to non-infectious based on the results of BRPCR. Conclusion Interventions by ID physicians might relate to identifying the bacteria causing an infection using BRPCR, and that might lead to enhancing the value of BRPCR. Disclosures All Authors: No reported disclosures

Instrumental balance assessment in Parkinson's disease and parkinsonism. A systematic review with critical appraisal of clinical applications and quality of reporting

IntroductionPatients with Parkinson's disease (pwPD) and atypical parkinsonism usually complain of impaired balance. Instrumental posturography is widely used to quantitatively assess static balance in pwPD but many posturographic parameters and protocols have been suggested. We aimed to appraise the use of static posturography in pwPD and atypical parkinsonism, and identify gaps hindering its translation into clinical routine.MethodsA systematic review on four databases. Study methodology, clinical aspects, assessment protocol, technical aspects, and transferability to clinical practice were critically appraised by a set of quality questions, scored on three levels (0, 0.5, 1). Total scores were used to assess overall studies' quality.Results132 studies were included. The majority (105/132) was rated medium-quality. The domains “transferability to clinical practice” and “assessment protocol” received the lowest scores. The main flaw hindering portability to clinical settings was the lack of a stated rationale behind the choice of a specific protocol and the selection of the posturographic parameters. Missing reporting about the technical aspects employed to manage posturographic data and comprehensive instructions given to the patients further contributed to lower quality.DiscussionWe provided recommendations for enhancing the clinical transferability of studies on static posturography to assess pwPD, including (1) discussing the rationale for choosing the assessment protocols and posturographic parameters, (2) detailing the inclusion criteria and select appropriate samples, and (3) reporting all the technical information to replicate the procedures and computations.Systematic review registrationInternational Prospective Register of Systematic Reviews (PROSPERO) on 6th February 2024 (ID CRD42024500777), https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024500777.

P-2114. Pattern of Clinical Characteristics, Outcome and Comparison of Carbapenem Resistant and Carbapenem Sensitive Klebsiella Species Infections from a Tertiary Care Hospital, Karachi, Pakistan

Abstract Background The prevalence of carbapenem resistant (CR) Klebsiella species (KS) is greater than 60 % in South Asia with high morbidity and mortality. Data on clinical aspects of KS from Pakistan is scarce. We aimed to study clinical characteristics, outcome and risk factors for mortality among KS infection Methods A prospective study conducted from September 2022 to March 2023. All patients greater than 18 years with active KS infection were included. Age, gender, clinical features, Charlson co-morbidity index, source of infection, previous hospitalization, source control and appropriate empirical antibiotics received were noted. Outcome was documented as admitted, discharged or death at day 14. CRKS and carbapenem sensitive (CSKS) were compared.Table 1:Demographics, Risk factors and outcome of CRKS and CSKS infection. Results Out of 217, 128 (58.9%) CRKS and 89 (41%) CSKS infection. The median age was 48 years, 39.6% female. Around 114 (52%) had previous hospitalization. Bacteremia 103(47.5) was most common. At day 14, all-cause mortality was 29%. CRKS infection was significantly associated with recent hospitalization, fever, altered mental status, ICU admission and mechanical ventilation. Pneumonia was more common with CRKS (p=value 0.004). Among CRKS, 4 (3.2%) received appropriate empirical antibiotics and had poor bacterial clearance (p=0.048). A survival curve shows significant high mortality in CRKS over 14 days. On multivariate analysis patients with CRKS did not receive appropriate empirical antibiotics.Table 1:Demographics, Risk factors and outcome of CRKS and CSKS infection. Conclusion We found a very high proportion of CRKS infection with high morbidity and mortality. Patients with CRKS infection did not receive appropriate empirical antibiotics. Timely availability of antibiogram with good infection control practices are critical in preventing mortality and spread this highly pathogenic organism. Disclosures All Authors: No reported disclosures