Epidemiological Risk Factors Research Articles

Analysis of epidemiological trends and risk factors in high-risk areas for pulmonary tuberculosis: an observational longitudinal study in Xinjiang, China

ObjectiveTo explore the spatial and temporal variations in the long-term risk of developing tuberculosis (TB) and the factors influencing it in order to contribute to the goal of eradicating TB.DesignObservational...

Epidemiological features and risk factors of human psittacosis in Hangzhou City, eastern China

ObjectivesThis study aimed to investigate the epidemiological characteristics and risk factors associated with human psittacosis in Hangzhou city, eastern China.MethodsThe human psittacosis data from 2021 to 2024 were obtained from the China information system for diseases control and prevention infectious disease surveillance system. Epidemiological investigations were carried out on the patients' past medical history, clinical manifestations, chest CT results and treatment status. A community-based 1:3 matched case-control study was performed to investigate the risk factors associated with Chlamydia psittaci infection.ResultsDuring the study period, 137 confirmed cases of human psittacosis were identified through laboratory tests, of which 24 (17.52%) were classified as critical cases, including one fatality. The epidemic curve indicated that the majority of cases occurred between October and March. Among the cases, 48.91% were female, and the median age was 63 years. There were more female cases among those aged <60 years, while there were more male cases among those aged ≥60 years. Multivariate logistic regression analysis revealed that the presence of bird habitats within 500 m of the living area [odds ratio (OR) = 3.81, 95% confidence interval (CI) = 2.19–6.61], parrots kept (OR = 2.95, 95%CI = 1.10–7.89) and poultry kept (OR = 2.15, 95%CI = 1.02–4.53) remained significantly associated with the risk of disease infection.ConclusionsHuman psittacosis has become a notable public health concern in Hangzhou city, with an increase in psittacosis cases reported in recent years. Exposure to poultry, birds, or environments contaminated with Chlamydia psittaci was associated with infection. Urgent actions to reduce psittacosis cases and mitigate the impact of outbreaks are needed, including strengthening surveillance, raising public awareness, and promoting collaboration between the agricultural and health sectors.

Epidemiological surveys, antibiotic resistance, and related risk factors of Helicobacter pylori in Quanzhou, China: a cross-sectional study

This study aims to investigate the prevalence and association between characteristics, dietary habits, and other factors associated to Helicobacter pylori (H. pylori) infection, as well as the resistance of H. pylori to antibiotics and risk factors in Quanzhou. A minimally invasive string test combined with qPCR was used to investigate the relationship between H. pylori infection and several factors that were evaluated using a survey. Logistic analyses were performed to estimate the risk factors for the prevalence and antibiotic resistance of H. pylori. The H. pylori prevalence amounted to 52.60%, the clarithromycin and levofloxacin resistance rate of H. pylori were 48.92% and 44.59%, respectively. Logistic analyses showed that takeaway food emerged as a protective factor for H. pylori infection, while the consumption of soy products reduced the risk of clarithromycin resistance. Furthermore, high sugar, spicy food, frequent tea drinking, and hyperlipidemia increased the risk of H. pylori infection. Finally, the frequency of oral hygiene had an impact on levofloxacin resistance. The prevalence and resistance rate of H. pylori was found to be high in Quanzhou. Our results also showed that diet, hygiene, and disease prevention awareness play an importance role in H. pylori prevention and treatment.

Concurrent transmission of Zika virus during the 2023 dengue outbreak in Dhaka, Bangladesh.

During the 2023-dengue outbreak in Bangladesh, a diagnostic evaluation study was conducted to investigate concurrent Zika virus (ZIKV) and dengue virus (DENV) transmission in Dhaka in 2023. The study explored to simultaneously detect the presence of ZIKV, DENV, and/or CHIKV while considering relevant clinical and epidemiological risk factors, using a real-time multiplex RT-PCR system. Following this, it was planned to sequence the selected samples to identify genetic variations of the ZIKV infections within the population. This study was designed as a diagnostic evaluation, where participants meeting the inclusion criteria were prospectively recruited with written informed consent. A total of 399 febrile individuals were screened, with 185 meeting the inclusion criteria of having a fever onset within 2-5 days, along with one of the following clinical features, e.g. headache, myalgia, arthralgia or bone pain, rash, nausea, vomiting, or diarrhea and 152 undergoing real-time RT-PCR testing. Five ZIKV-positive cases were identified, including one DENV-ZIKV co-infection. Phylogenetic analysis revealed the ZIKV strains were part of the Asian lineage, closely related to Cambodian and Chinese strains from 2019. All ZIKV-positive cases were male, residing within a one-kilometer radius, with no prior travel history, suggesting community-level transmission. This study marks the first identification of ZIKV in Dhaka city and the first report of ZIKV-DENV co-infection in Bangladesh that highlights the diagnostic challenges posed by the symptomatic similarities between ZIKV and other arboviruses and underscores the need for enhanced surveillance and public health interventions to mitigate the spread and impact of ZIKV in dengue-endemic regions.

P-1881. Don't Know Much About Geography? Decision Support for Frontline Clinicians Evaluating Patients with Suspected High Consequence Infectious Diseases

Abstract Background High Consequence Infectious Diseases (HCIDs) are acute infectious diseases characterized by high case-fatality rates, few (if any) rapidly accessible treatments, and person-to-person spread in the absence of appropriate transmission-based precautions. Rapid identification and isolation of suspected cases is critical, however, diagnosis is challenging because HCIDs can manifest with nonspecific symptoms and specialized knowledge about the geography of current outbreaks, as well as HCID-specific exposure risk factors and incubation periods, are not uniformly known to healthcare personnel (HCP) performing patient evaluations. Clinical Decision Support Systems (CDSS) embedded within the electronic health record (EHR) may facilitate assessment.Figure 1:EvalHCID Clinical Decision Support System DemonstrationFrom top to bottom, EvalHCID automatically imports travel information from the routine travel screening conducted during initial patient triage. Additional travel can be manually entered, with an itinerary of up to 4 countries. By cross-referencing a system-wide database of circulating HCIDs, EvalHCID automatically loads an interface to evaluate HCIDs relevant to the patient’s travel history. By subtracting symptom onset date from the last day in country, symptom development outside the relevant incubation period can be identified. Methods We describe the design and development of an EHR-embedded CDSS tool, linked to a travel and symptom screening, and referencing a regularly updated worldwide HCID Watch List, to assist HCP in the evaluation of a returning traveler with infectious symptoms. Performance and user experience of the tool are described.Figure 2:EvalHCID Clinical Decision Support System DemonstrationFrom top to bottom, EvalHCID facilitates collection of epidemiological history that would place a traveler at high risk for the development of an HCID (in this case, the Middle East Respiratory Syndrome). Based on the data entered into EvalHCID, a recommendation regarding risk stratification and next steps is given. Relevant resources are also provided. Results The Evaluate for High Consequence Infectious Disease (EvalHCID) CDSS facilitates identification of patients with travel, symptom, and epidemiological risk factors warranting Person Under Investigation (PUI) status for viral hemorrhagic fevers (including Lassa Fever, Crimean-Congo Hemorrhagic Fever, Marburg Virus Disease, and Ebola Virus Disease) as well as Novel Influenza and the Middle East Respiratory Syndrome (Figures 1 and 2). Using integrated, adaptable logic concordant with public health guidance, EvalHCID can be deployed to rapidly identify patients who meet PUI criteria, while allowing patients who do not meet PUI criteria to proceed with an otherwise appropriate clinical evaluation (Figure 3).Figure 3:EvalHCID Clinical Decision Support System LogicBy incorporating travel history, the dates of travel and symptom onset, relevant symptoms, and epidemiological risk factors, EvalHCID assists frontline healthcare personnel in risk-stratifying returning travelers for HCIDs. Conclusion With highly specialized and accessible HCID expertise embedded within the EHR, HCP identification of patients at high risk for HCIDs is augmented, enabling rapid initiation of appropriate isolation when indicated for PUIs. At the same time, through speeding the evaluation of low-risk patients, care can be improved by allowing diagnosis of more likely clinical conditions. Disclosures All Authors: No reported disclosures

P-345. The Changing Dynamics of the Candida auris Outbreak in Southern California

Abstract Background The current global outbreak of Candida auris poses a serious public health threat. With both high levels of antifungal resistance and a propensity for nosocomial spread, Candida auris has the potential to cause devastating outbreaks within healthcare facilities, especially amongst long-term and intensive care patients. As in many viral and bacterial pathogens, pathogen genomics has proven to be an indispensable piece of the outbreak response toolkit by contributing information useful in diagnosis, drug-resistance testing, and epidemiologic investigations. Phylogenetic analysis of C. auris reveals introduction of Clade I to Southern CaliforniaFigure 1.A) Distribution of sequenced C. auris case clade membership during study period. B) Maximum-likelihood phylogenetic tree constructed from concatenated SNP sites of sequenced C. auris isolates with antifungal resistance data. MIC breakpoints: Fluconazole ≥ 32, Micafungin ≥ 4, Amphotericin B Intermediate ≥ 2, Resistant ≥ 4 Methods At our large healthcare system located in Los Angeles, patients admitted with epidemiologic risk factors such as residence in a long-term care facility undergo admission screening for C. auris via combined axillary/inguinal swab. Microbiologic data from 213 C. auris isolates collected either via admission screening or from clinical cultures, including 91 isolates with paired whole-genome sequencing data, were used to conduct an in-depth investigation of the changing dynamics of the local C. auris outbreak. Phylogenetic analysis was employed to investigate the relationships between isolates. Results Transmission of C. auris between 2021 and 2023 remained high, with an average of 59 patients per year determined to be colonized or infected with C. auris. While the local outbreak has overall been dominated by Clade III isolates that are resistant to fluconazole but susceptible to echinocandins and amphotericin B, phylogenetic analysis identified the first known introduction of Clade I to Southern California in late 2022, which may have led to the first amphotericin B resistant case within our healthcare system. Genotypes of ERG11 and FKS1 genes were found to correlate with fluconazole resistance and echinocandin susceptibility. Two cases identified nearly one month apart in an intensive care unit were genetically identical, supporting epidemiologic suspicion of in-hospital transmission. Conclusion Continued genomic surveillance of C. auris contributed to an enhanced understanding of local outbreak dynamics, helping inform and guide empirical treatments and epidemiologic investigations. Disclosures All Authors: No reported disclosures

373. Closing Care Gaps: Optimizing Pre-Transplant Trypanosoma cruzi Testing

Abstract Background Chronic Trypanosoma cruzi infection can be asymptomatic, but T.cruzi can reactivate and cause disease among transplant recipients following immunosuppression. Prior to transplant it is recommended to perform 2-step testing among candidates at high risk of exposure, defined as patients who were born or had prolonged residence in Mexico, Central, or South America. We reviewed transplant recipients at our institution to identify the frequency of testing, percentage with positive testing, and whether testing was being performed in the appropriate high-risk population.Figure 1:Percentage of transplant patients tested by organ type. Methods We identified patients who underwent organ transplant from January 1, 2018 – April 18 2024 and determined how many patients underwent T.cruzi testing. Among those with positive tests, we identified the proportion with epidemiologic risk factors; we also determined whether appropriate confirmatory testing was obtained. We identified 40 randomly selected patients registered as Spanish-speaking in our electronic medical record (EMR), reviewed their charts to determine whether they were at high risk of exposure, and identified if they received screening.Figure 2:Number of patients with high epidemiologic risk who were tested vs not tested for T.cruzi, among 40 patients reviewed. Results Among 1399 patients who underwent transplant (104 lung, 101 heart, 212 liver, 918 kidney, 62 multiorgan, 2 pancreas), 180 (12.9%) were tested for T.cruzi (Figure 1). Twelve of 180 tests (6.7%) were initially positive; only 8/12 (75%) positive tests were among patients with high risk for T.cruzi. Ten of 12 positive tests were sent for confirmatory testing and 2 tests were not sent or followed up. Only one patient had a positive confirmatory test and underwent post-transplant monitoring. Of 40 patients identified as Spanish-speaking in the EMR, all 40 had high epidemiologic risk but only 18 (45%) underwent appropriate pre-transplant T.cruzi testing (Figure 2). Conclusion We identified several care gaps in our pre-transplant T.cruzi testing, including over-testing among patients without epidemiologic risk, under-testing among patients with risk for prior T.cruzi exposure, and incomplete confirmatory testing. Our data highlight an opportunity for specific testing guidance and education to optimize patient care. Disclosures All Authors: No reported disclosures

P-2319. A 5-year Single Center Review of Strongyloides stercoralis Seropositivity in Cardiac Transplant Candidates in Central Texas

Abstract Background Strongyloides stercoralis is a parasitic nematode that chronically infects an estimated 30 - 100 million individuals worldwide and is mainly found in tropical, subtropical, and warm temperate regions. In solid organ transplant recipients, Strongyloides can cause disseminated disease or hyperinfection, which has an extremely high mortality rate. According to the American Society of Transplantation, all potential solid organ donors and recipients with risk factors for Strongyloides infection should undergo serologic screening. Our study aimed to identify the prevalence of Strongyloides seropositivity in patients evaluated for cardiac transplantation. We also aimed to identify demographic characteristics and risk factors associated with seropositivity, and any side effects of treatment. Table 1 Total number of Strongyloides seropositive (SSp) and seronegative (SSn), total number of patients that received cardiac transplant, demographic characteristics, and country of origin. Methods This study was a single-center, retrospective chart review of patients aged 18 or older who underwent cardiac transplant evaluation and serologic screening for Strongyloides at Baylor Scott & White Medical Center in Temple, Texas, between March 2019 and March 2024. A positive test was defined as > 1.1 Index Value (IV), negative as < 1.0 IV, and equivocal as 1.0-1.1 IV. Data was collected and managed using Research Electronic Data Capture (REDCap). Bivariate analyses were completed to test the association between the Strongyloides Seropositive (SSp) and Strongyloides Seronegative (SSn) groups. All statistical analyses were performed in SAS 9.4. Table 2 Pre-transplantation serologic results SSp and SSn. Abbreviations: Herpes Simplex Virus (HSV), Cytomegalovirus (CMV), Ebstein Bar virus (EBV), Varicella Zoster Virus (VZV), Human T-lymphotropic virus-1 (HTLV-1), human immunodeficiency virus (HIV). Results 259 patients underwent screening for cardiac transplant and Strongyloides. 11.58% tested positive or equivocal for Strongyloides. Epidemiological risk factors were not associated with seropositivity. All patients who underwent cardiac transplantation received appropriate treatment with no side effects. There were no cases of disseminated infection. Table 3 Travel history to endemic including tropic regions of Southeast Asia and the Appalachian region in the US, history of homelessness, history being barefoot, symptoms at diagnosis (Gastrointestinal, cutaneous, or respiratory symptoms), and treatment history. Conclusion Our study provides insight into the prevalence of Strongylodies in Texas. Based on our results, targeted screening may miss many seropositive patients. Given the lack of epidemiological risk factors within our SSp population and rising concern for indigenous cases within Texas, we recommend consideration of universal Strongyloides screening for solid organ transplant donors and recipients. Disclosures All Authors: No reported disclosures

Epidemiological Features, Clinical Symptoms, and Environmental Risk Factors for Notifiable Japanese Encephalitis in Taiwan From 2008 to 2020: Retrospective Study.

Japanese encephalitis (JE) is a zoonotic parasitic disease caused by the Japanese encephalitis virus (JEV), and may cause fever, nausea, headache, or meningitis. It is currently unclear whether the epidemiological characteristics of the JEV have been affected by the extreme climatic conditions that have been observed in recent years. This study aimed to examine the epidemiological characteristics, trends, and potential risk factors of JE in Taiwan from 2008 to 2020. Specifically, the study focused on gender, age, season, residential area, clinical manifestations, high-risk areas, and the impact of environmental and climate factors. This study reviewed publicly available annual summary data on reported JE cases in the Taiwan Centers for Diseases Control between 2008 and 2020. This study collected 309 confirmed domestic patients and 4 patients with imported JE. There was an increasing trend in the incidence of JE, 0.69-1.57 cases per 1,000,000 people, peaking in 2018. Case fatality rate was 7.7% (24/313). Comparing sex, age, season, and place of residence, the incidence rate was highest in males, 40- to 59-year-old patients, summer, and the Eastern region, with 1.89, 3.27, 1.25, and 12.2 cases per million people, respectively. The average coverage rate of the JE vaccine for children in Taiwan is 94.9%. Additionally, the major clinical manifestations of the cases included fever, unconsciousness, headache, stiff necks, psychological symptoms, vomiting, and meningitis. The major occurrence places of JE included paddy fields, pig farms, pigeon farms, poultry farms, and ponds. For air pollution factors, linear regression analysis showed that SO2 (ppb) concentration was positively associated with JE cases (β=2.184, P=.02), but O3 (ppb) concentration was negatively associated with them (β=-0.157, P=.01). For climate factors, relative humidity (%) was positively associated with JE cases (β=.380, P=.02). This study is the first to report confirmed cases of JE from the surveillance data of the Taiwan Centers for Diseases Control between 2008 and 2020. It identified residence, season, and age as risk factors for JE in Taiwan. Air pollution and climatic factors also influenced the rise in JE cases. This study confirmed that JE remains a prevalent infectious disease in Taiwan, with its epidemic gradually increasing in severity. These findings empower clinicians and health care providers to make informed decisions, guiding their care and resource allocation for patients with JE, a disease that significantly impacts the health and well-being of the Taiwanese population.

Bone Stress Injury Epidemiology and Risk Factors in Female Off-Road Runners: A Systematic Review.

Off-road running is a growing sport with little research investigating injury profiles of female participants. Bone stress injuries (BSIs) are a particularly detrimental injury with little known about their incidence and risk factors in female off-road runners. Collate and review the available evidence reporting epidemiological data and risk factors associated with BSI in female off-road runners. Systematic literature review, without meta-analyses. MEDLINE OVID, PubMed, SPORTDiscus, and MEDLINE EBSCO. Searches were finalized in July 2024. Studies that reported injury surveillance statistics and/or risk factors associated with BSIs in female off-road runners. Seventeen eligible studies were included, of which all reported surveillance statistics and 2 reported risk factors associated with BSI among 897 female runners. Owing to the scarcity of data, cross-country runners were included in the population of off-road runners. Most BSIs were high severity and in the lower leg, with an overall incidence ranging from 0 to 34.39 BSIs per 100,000 athlete-exposures and prevalence ranging from 0% to 40.9%. Study characteristics were reported alongside risk of bias, quality, and level of evidence assessment outcomes from varying tools. Eight significant intrinsic risk factors were associated with BSIs in female off-road runners: increasing age, disrupted menstruation, previous BSI, increased female triad risk, and lower calcium, vitamin D, and calorie intake. Limited by the number of studies available reporting data on the specific target population, which highlights the need for performing high-quality prospective studies in the future, this review summarizes the current epidemiological data and risk factors associated with BSIs in female off-road runners.

Epidemiological characteristics and risk factors for heart failure in Japanese patients with type 2 diabetes: A retrospective analysis of the J-DREAMS database.

To determine the epidemiological characteristics and risk factors for heart failure (HF) among Japanese patients with type 2 diabetes. A retrospective cohort analysis, using J-DREAMS database, was conducted from December 2015 to January 2020 with type 2 diabetes. The primary objectives were to describe patient characteristics stratified by HF history at baseline and new HF events during follow-up. The secondary objectives were to clarify the association between HF history or new HF events and clinical characteristics. The association between renal disease stage and HF was also studied. Among 18,250 adult patients with type 2 diabetes, 3,613 (19.8%) patients had HF history and the mean age was 68.46 years, predominantly male (66.4%) with 13.32 years of mean duration of type 2 diabetes. Patients with HF history had a higher proportion of patients with nephropathy (51.2%) and coronary heart disease (55.6%) than those without HF history. Coronary heart disease (CHD) and deteriorating renal function were strongly associated with both HF history (CHD adjusted odds ratio [OR]: 7.41, 95% confidence interval [CI]: 6.05-9.08; eGFR G5 stage adjusted OR: 6.56, 95% CI: 2.97-14.49) and new HF events (CHD adjusted OR: 1.63, 95% CI: 1.17-2.29; eGFR G4 stage adjusted OR: 3.42, 95% CI: 1.81-6.47). Comorbidities, especially CHD and deteriorating renal function, were strongly associated with HF history and new HF events among Japanese patients with type 2 diabetes. The study results suggested the importance of early intervention to treat comorbidities and maintain renal function.

Occupational Infections Among Workers in Europe: Protocol for a Scoping Review.

Workers may be exposed to different infectious agents, putting them at risk of developing occupational diseases. This can occur in many ways, through deliberate use of specific microorganisms or through potential exposure from close contact with biological material. Infection prevention and control measures against biohazards can reduce the risk of infection among workers. During the last few decades, an increasing proportion of workers in Europe have been exposed to infectious biological agents in their workplace. Knowledge gaps on this topic in Europe have limited our understanding of the overall phenomenon in occupational settings. This study aims to understand the extent and type of evidence on the epidemiology of occupational or work-related infections caused by bacterial, viral, fungal, and parasitical agents in European countries, the factors affecting their occurrence among workers, and the burden of disease among workers due to occupational risk. The review will be conducted following the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. This review will consider studies that include data on the epidemiology of occupational infections, risk factors and determinants, and burden of disease among workers employed in specific occupational sectors in European countries in the period 2010-2023. The search will include MEDLINE, Web of Science, and Scopus databases. Independent reviewers (including GD, SC, AR, PD, and SM) will screen the titles, abstracts, and full texts of the selected studies. Data extraction will be performed using a tool developed by the researchers. The data will be mapped and analyzed according to the type of extracted data. The literature search through different scientific databases started in April 2024 and is expected to be completed by December 2024. The findings will be extracted using an ad hoc data extraction tool, and relevant results will be presented in narrative and tabular form. This scoping review aims to provide rigorous evidence to fill the knowledge gap in the epidemiology of occupational or work-related infections in European countries, the factors affecting their occurrence, and the burden of disease in different professional settings. Such findings could improve the understanding of this complex occupational phenomenon in the European context, enabling more accurate and up-to-date surveillance of infections incurred in the workplace. PRR1-10.2196/59606.

Epidemiological status, development trends, and risk factors of disability-adjusted life years due to diabetic kidney disease: A systematic analysis of Global Burden of Disease Study 2021.

Approximately 40% of individuals with diabetes worldwide are at risk of developing diabetic kidney disease (DKD), which is not only the leading cause of kidney failure, but also significantly increases the risk of cardiovascular disease, causing significant societal health and financial burdens. This study aimed to describe the burden of DKD and explore its cross-country epidemiological status, predict development trends, and assess its risk factors and sociodemographic transitions. Based on the Global Burden of Diseases (GBD) Study 2021, data on DKD due to type 1diabetes (DKD-T1DM) and type 2diabetes (DKD-T2DM) were analyzed by sex, age, year, and location. Numbers and age-standardized rates were used to compare the disease burden between DKD-T1DM and DKD-T2DM among locations. Decomposition analysis was used to assess the potential drivers. Locally weighted scatter plot smoothing and Frontier analysis were used to estimate sociodemographic transitions of DKD disability-adjusted life years (DALYs). The DALYs due to DKD increased markedly from 1990 to 2021, with a 74.0% (from 2,228,000 to 3,876,000) and 173.6% (from 4,123,000 to 11,279,000) increase for DKD-T1DM and DKD-T2DM, respectively. In 2030, the estimated DALYs for DKD-T1DM surpassed 4.4million, with that of DKD-T2DM exceeding 14.6million. Notably, middle-sociodemographic index (SDI) quintile was responsible for the most significant DALYs. Decomposition analysis revealed that population growth and aging were major drivers for the increased DKD DALYs in most GBD regions. Interestingly, the most pronounced effect of positive DALYs change from 1990 to 2021 was presented in high-SDI quintile, while in low-SDI quintile, DALYs for DKD-T1DM and DKD-T2DM presented a decreasing trend over the past years. Frontiers analysis revealed that there was a negative association between SDI quintiles and age-standardized DALY rates (ASDRs) in DKD-T1DM and DKD-T2DM. Countries with middle-SDI shouldered disproportionately high DKD burden. Kidney dysfunction (nearly 100% for DKD-T1DM and DKD-T2DM), high fasting plasma glucose (70.8% for DKD-T1DM and 87.4% for DKD-T2DM), and non-optimal temperatures (low and high, 5.0% for DKD-T1DM and 5.1% for DKD-T2DM) were common risk factors for age-standardized DALYs in T1DM-DKD and T2DM-DKD. There were other specific risk factors for DKD-T2DM such as high body mass index (38.2%), high systolic blood pressure (10.2%), dietary risks (17.8%), low physical activity (6.2%), lead exposure (1.2%), and other environmental risks. DKD markedly increased and varied significantly across regions, contributing to a substantial disease burden, especially in middle-SDI countries. The rise in DKD is primarily driven by population growth, aging, and key risk factors such as high fasting plasma glucose and kidney dysfunction, with projections suggesting continued escalation of the burden by 2030.

Epidemiological Risk Factors for Acute Kidney Injury Outcomes in Hospitalized Adult Patients: A Multicenter Cohort Study

Epidemiological Risk Factors for Acute Kidney Injury Outcomes in Hospitalized Adult Patients: A Multicenter Cohort Study

Identification of serotype O3b and high-risk clone ST37 of Klebsiella pneumoniae revealed by comparative genomic analysis.

Epidemiological risk factors such as the demography of a place, environment, food, livestock, and companion animals are known sources of Klebsiella pneumoniae infection. Whole-genome sequencing (WGS) has become a powerful tool to complement traditional microbiological characterization of foodborne pathogens. Moreover, K. pneumoniae has several species complexes (KpSC) and is very difficult to differentiate using routine microbiological methods. The present study aims to investigate the prevalence of K. pneumoniae in fish available in the retail market using WGS. Isolation of K. pneumoniae, identification of K. pneumoniae isolates, and determination of the minimum inhibitory concentration (MIC) were performed. Whole-genome sequencing of K. pneumoniae genomes and phylogenomic analysis were conducted for visual comparison of the genomes. Furthermore, genomes of non-human origin that were submitted from India to the NCBI database were downloaded and included in the comparative analysis. The findings showed that many antibiotic-resistant genes (ARGs) are prominent, including acrD, BaeR, cpxA, mdtB, mdtC, CRP, H-NS, KpnE, KpnF, KpnG, KpnH, acrA, acrB, marA, ramB, oqxA, oqxB, LptD, and emrR. Four fish-sourced isolates had different blaSHV resistance gene variants. The presence of ARGs for aminoglycosides [aac(3)-IId], fluoroquinolones (oqxA, oqxB), and fosfomycin (fosA5, fosA6) in these K. pneumoniae isolates from fish sources was found. One of the CIFT-K6 isolates had the uncommon serotype of K. pneumoniae O3b with the high-risk clone "ST37." The ST515 sequence type was present in two K. pneumoniae isolates (CIFT-K7 and CIFT-K8), but the O3b serotype and ST192 allele type were present in the CIFT-K10 isolate. To the best of our knowledge, this research study represents the first Indian report of K. pneumoniae linked to fish, specifically the high-risk clone 'ST37' and two other STs, 515 and 192. The most common plasmid type detected in all four isolates was IncFIB, and 75% of the isolates were IncFII and IncHI1B. The prevalence of ARGs linked to efflux pump resistance mechanisms is highlighted by the analysis of genome sequence data.

Rapid response strategies to sanitary and epidemiological emergencies in Russian Federation regions considering particular epidemiological scenarios (in case of cholera outbreaks)

Relevance. Currently, cholera poses a serious external infection risk for the Russia. Any region of Russia is at risk of cholera infestation/importation, while importation events shall be considered as a real threat to the sanitary and epidemiological wellbeing of the population. Every Russian region is characterized by a set of individual factors and conditions affecting cholera infection risks, as well as preparedness of medical and testing lab capacities. In such environment, every region of Russia is in critical need of region-specific stochastic epidemiological forecasting is critically demanded in the case of cholera infestation importation. Ability to select a most efficient rapid response strategy in every forecasted scenario is no less relevant.The study objective is to use the developed epidemiological risk assessment score for cholera infestation/importation in individual regions of Russia to eventually establish the probability for each of the three potential epidemiological scenarios, as well as to guide scenario-specific rapid response strategies.Methodology. Epidemic risk assessment score for cholera infestation/importation in Russia was developed based on region-specific quantitative evaluation of the potential epidemiological risk at public mass events and the overall epidemiological capacity in case of cholera exposure. Modifications included ranking the sets of assessment score indicators by cholera epidemiological risk exposure with a few extra sets of indicators, such as region-specific product output, economic factors, emergency incidence rate and scope of consequences. Stochastic scenarios are based on retrospective data analyzing the links between the initial epidemiological risk factors, preparedness of medical and laboratory services, and real country specific data regarding the development of the epidemiological situation amid cholera outbreaks.Results and discussion. The study develops a region-specific epidemiological risk assessment score for cholera infestation/importation for Russian Federation regions to provide an insight into the impacts of epidemiological risk factors and counter-epidemic preparedness capacities of every region, considering the implementation of each of the three potential epidemiological situation scenarios (negative, limited spreading, and favorable). The paper elaborates strategies and solutions to provide efficient rapid response in case of either scenario.Conclusion. The developed epidemiological risk assessment score for cholera infestation/importation in individual regions of Russia allows to evaluate the probability for each of the three epidemiological scenarios in a particular region depending on the total score, as well as to select most efficient scenario-specific rapid response strategies.

Ovine Toxoplasmosis Sero-Status, Risk Factors Analysis, and Estimation of Haematological and Serum Biochemical Alterations.

Toxoplasmosis is a significant food-borne protozoal disease in humans and animals. The study aimed to find out Toxoplasma seropositivity in sheep, estimate epidemiological risk factors and assess haemato-biochemical parameter changes. Blood samples were collected from 276 indigenous sheep in five districts surrounding Sulaymaniyah Province in the northern region of Iraq. Toxoplasmosis was determined by detecting anti-Toxoplasma antibodies by ELISA. The impact of various risk factors on seropositivity was evaluated. Haematological and serum biochemical changes from naturally infected sheep were analysed using commercial kits. The overall seroprevalence of Toxoplasma antibodies among the studied population was 41.67%. Sharazoor district had a higher prevalence rate of 46.15% than Bakrajo, with the lowest frequency rate of 38.18%. Ewes with an abortion history had a higher risk for seropositivity of about 47.4% (OR=1.4, 95% CI: 0.9-1.6). Sampling season and herd size are other risk factors, with higher seropositivity at 42.5% (OR=1.1, 95% CI: 0.8-1.4) during the dry season and among small flocks ≤100 animals/farm at 43.6% (OR=1.1, 95% CI: 0.7-1.4). Toxoplasma prevalence was correlated with animals' ages; a higher seropositivity of 43.3% was found among older sheep (OR=0.8, 95% CI: 0.6-1.2). Seropositive sheep had significantly higher total leukocyte, lymphocyte and granulocyte counts but significantly lower haemoglobin, haematocrit and total erythrocyte counts. The serum levels of total protein and albumin were significantly reduced, with increased blood urea nitrogen and creatinine concentrations. Also, AST enzyme activity represents a higher value in positive sheep with toxoplasmosis. Toxoplasma infection among the ovine population is common. Its impact on livestock productivity should not be neglected. A potential risk for humans through infected sheep could be a hazardous source for public health.

Clinical Implications of Breast Cancer Intrinsic Subtypes.

Estrogen receptor-positive (ER+) and estrogen receptor-negative (ER-) breast cancers have different genomic architecture and show large-scale gene expression differences consistent with different cellular origins, which is reflected in the luminal (i.e., ER+) versus basal-like (i.e., ER-) molecular class nomenclature. These two major molecular subtypes have distinct epidemiological risk factors and different clinical behaviors. Luminal cancers can be subdivided further based on proliferative activity and ER signaling. Those with a high expression of proliferation-related genes and a low expression of ER-associated genes, called luminal B, have a high risk of early recurrence (i.e., within 5years), derive significant benefit from adjuvant chemotherapy, and may benefit from adding immunotherapy to chemotherapy. This subset of luminal cancers is identified as the genomic high-risk ER+ cancers by the MammaPrint, Oncotype DX Recurrence Score, EndoPredict, Prosigna, and several other molecular prognostic assays. Luminal A cancers are characterized by low proliferation and high ER-related gene expression. They tend to have excellent prognosis with adjuvant endocrine therapy. Adjuvant chemotherapy may not improve their outcome further. These cancers correspond to the genomic low-risk categories. However, these cancers remain at risk for distant recurrence for extended periods of time, and over 50% of distant recurrences occur after 5years. Basal-like cancers are uniformly highly proliferative and tend to recur within 3-5years of diagnosis. In the absence of therapy, basal-like breast cancers have the worst survival, but these also include many highly chemotherapy-sensitive cancers. Basal-like cancers are often treated with preoperative chemotherapy combined with an immune checkpoint inhibitor which results in 60-65% pathologic complete response rates that herald excellent long-term survival. Patients with residual cancer after neoadjuvant therapy can receive additional postoperative chemotherapy that improves their survival. Currently, there is no clinically actionable molecular subclassification for basal-like cancers, although cancers with high androgen receptor (AR)-related gene expression and those with high levels of immune infiltration have better prognosis, but currently their treatment is not different from basal-like cancers in general. A clinically important, minor subset of breast cancers are characterized by frequent HER2 gene amplification and high expression of a few dozen genes, many residing on the HER2 amplicon. This is an important subset because of the highly effective HER2 targeted therapies which are synergistic with endocrine therapy and chemotherapy. The clinical behavior of HER2-enriched cancers is dominated by the underlying ER subtype. ER+/HER2-enriched cancers tend to have more indolent course and lesser chemotherapy sensitivity than their ER counterparts.

Assessment of epidemiological risk factors of humeral fractures using x-ray findings of patients presenting at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria: A 2-year review

Assessment of epidemiological risk factors of humeral fractures using x-ray findings of patients presenting at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria: A 2-year review

EPIDEMIOLOGY AND RISK FACTORS OF BREAST CANCER: A GLOBAL PERSPECTIVE ON INCIDENCE, MORTALITY, AND PREVENTION STRATEGIES

Breast cancer is the most prevalent malignancy among women worldwide, contributing significantly to global cancer mortality. This review provides a detailed examination of the epidemiological trends, molecular subtypes, and risk factors associated with breast cancer, with a focus on disparities in incidence, mortality, and survival across populations. Incidence rates are highest in developed regions, attributed to lifestyle and environmental factors, while mortality rates are disproportionately higher in developing countries due to limited healthcare access and aggressive tumor biology. The analysis highlights the pivotal role of genetic predispositions, such as BRCA mutations, alongside modifiable risk factors, including physical inactivity, obesity, alcohol consumption, and radiation exposure. Hormonal influences, reproductive behaviors, and dietary patterns further modulate individual risk profiles. Emerging evidence underscores the impact of socioeconomic disparities and ethnicity on breast cancer outcomes, particularly among African American and Hispanic women, who often present with more aggressive triple-negative subtypes and worse prognoses. Advancements in early detection, such as widespread mammography, have improved survival rates in developed countries, though challenges persist in low-resource settings. The review emphasizes the significance of understanding molecular subtypes—Luminal A, Luminal B, HER2-enriched, and triple-negative breast cancer—and their implications for targeted therapies. Innovations in genetic screening, personalized medicine, and lifestyle interventions are poised to transform prevention and treatment strategies globally. This review underscores the necessity of addressing healthcare inequities, promoting lifestyle modifications, and advancing molecular research to reduce the global burden of breast cancer. Future efforts should focus on integrating public health initiatives, enhancing access to diagnostic tools, and developing cost-effective therapies tailored to diverse populations. Bridging the gap between resource-rich and resource-limited regions is imperative for achieving equity in breast cancer care and outcomes.