Female Age Research Articles

Neuromuscular and biochemical responses of the hamstrings to a Flywheel Russian belt Deadlift in women and men

ABSTRACT The purpose of the study was to analyze hamstrings muscle damage and recovery after a novel Flywheel Russian belt Deadlift (FRBD) exercise using neuromuscular tests and associated biochemical markers of structural damage. Maximal voluntary isometric contraction (MVIC) torque and rate of force development (RFD) over several time-intervals by the 90º hip :20º knee test (standing isometric test for the hamstrings) and range of motion (ROM) Jurdan test (combination of active knee extension test and modified Thomas test), together with serum biomarkers of muscle damage and oxidative stress, were tested at baseline and +24h, +48h and +72h in healthy, untrained and physically active 15 females (age= 21.5±3.4 years) and 15 males (age= 21.4±1.9 years). FRBD-induced muscle damage was observed as a reduction in MVIC torque and RFD at all time-intervals until +72h. Also, hamstrings neuromuscular capacity reductions were associated with serum biomarkers of structural and oxidative damage. However, only males showed ROM changes. Overall, the FRBD triggered a decrease in hamstrings neuromuscular capacities, and an upregulation of biochemical markers of structural and oxidative damage until +72h. The 90º hip :20º knee test provides an adequate reliability to screen hamstrings recovery in both women and men after flywheel training, through MVIC torque and both early and late RFD.

Spatial Variations in the Risk Factors of Hypertension Across Different Age Groups in Indian Adults: Insights from the Fifth Round of NFHS (2019-21)

Abstract Background: Hypertension (HTN) is the second leading risk factor for men, accounting for 125 million disability-adjusted life years (DALYs) in men and 90 million in women making it the leading risk factor globally. The study was planned to determine the prevalence and patterns of different risk factors of HTN and how they vary across different stages of life in adulthood and to develop a comprehensive risk score to predict HTN and observe its variations across the other states of India. Methodology: This study is based on secondary data analysis provided by the fifth round of the National Family Health Survey (NFHS), and the survey was conducted among women aged 15–49 years and men aged 15–54 years. Demographic details, history of smoking and alcohol intake, presence of other morbidities, measurement of physical parameters, and blood pressure (BP) were the critical information collected from the population. The comprehensive risk score was also developed. Results: Age-wise prevalence of HTN was 34% among males older than 45 years and 28% among females of the same age. The presence of diabetes was also found to be a significant risk factor. Statistical HTN analysis has shown a significant correlation between BP values and total risk scores in males and females (P < 0.001). Conclusion: Assessing the risk factor profile can be highly beneficial as the two distributions are closely in sync, that is, where risk factor scores are lower, prevalence is higher.

Three-Dimensional Geometric Morphometric Characterization of Facial Sexual Dimorphism in Juveniles

Background: The characterization of facial sexual dimorphic patterns in healthy populations serves as valuable normative data to tailor functionally effective surgical treatments and predict their aesthetic outcomes and to identify dysmorphic facial traits related to hormonal disorders and genetic syndromes. Although the analysis of facial sexual differences in juveniles of different ages has already been investigated, few studies have approached this topic with three-dimensional (3D) geometric morphometric (GMM) analysis, whose interpretation may add important clinical insight to the current understanding. This study aims to investigate the location and extent of facial sexual variations in juveniles through a spatially dense GMM analysis. Methods: We investigated 3D stereophotogrammetric facial scans of 304 healthy Italians aged 3 to 18 years old (149 males, 155 females) and categorized into four different age groups: early childhood (3–6 years), late childhood (7–12 years), puberty (13–15 years), and adolescence (16–18 years). Geometric morphometric analyses of facial shape (allometry, general Procrustes analysis, Principal Component Analysis, Procrustes distance, and Partial Least Square Regression) were conducted to detail sexually dimorphic traits in each age group. Results: The findings confirmed that males have larger faces than females of the same age, and significant differences in facial shape between the two sexes exist in all age groups. Juveniles start to express sexual dimorphism from 3 years, even though biological sex becomes a predictor of facial soft tissue morphology from the 7th year of life, with males displaying more protrusive medial facial features and females showing more outwardly placed cheeks and eyes. Conclusions: We provided a detailed characterization of facial change trajectories in the two sexes along four age classes, and the provided data can be valuable for several clinical disciplines dealing with the craniofacial region. Our results may serve as comparative data in the early diagnosis of craniofacial abnormalities and alterations, as a reference in the planning of personalized surgical and orthodontic treatments and their outcomes evaluation, as well as in several forensic applications such as the prediction of the face of missing juveniles.

Duodenal Peptic Ulcer Perforation in the Puerperium Case Report Series

Peptic ulcers, and complications such as perforation, are rare during pregnancy and the puerperium. Accordingly, many clinicians may place these diagnoses low on their differential diagnosis. We present two case reports of primigravida, advanced maternal age females with history of irritable bowel syndrome and nonsteroidal anti-inflammatory drug (NSAID) use found to have perforated duodenal ulcers after Cesarean section. Postpartum surgical abdomens may not present with classic guarding and rigidity. A low threshold for imaging and identification of risk factors are critical to timely diagnosis and management.

Variation in Rates of Neonatal Opioid Withdrawal Syndrome and Opioid-related Hospitalizations in New York State, 2018

Background and Objective Rates of neonatal opioid withdrawal syndrome (NOWS) among infants and opioid-related hospitalizations among adults have increased in recent decades. We examined rates of NOWS births and opioid-related hospitalizations among adult females of childbearing age overall and by sociodemographic and geographic factors using hospitalization data. Methods We used data from the New York State Inpatient Database for 2018 from the Healthcare Cost and Utilization Project. We identified infants with NOWS and opioid-related hospitalizations using diagnosis codes and calculated rates of NOWS per 1,000 live births and opioid-related hospitalizations per 1,000 hospitalizations among females of childbearing age. We compared rates by geographic and sociodemographic factors and examined the correlation between county-level rates. Results The NOWS rate was 4.66 per 1,000 live births, while the rate of opioid-related hospitalizations was 36.6 per 1,000 hospitalizations. There was variation by county and sociodemographic factors including urban-rural classification, race and ethnicity, insurance payer, and median income. We found the highest rates for both NOWS and opioid-related hospitalizations in non-metropolitan areas, among patients with public insurance, and among non-Hispanic White or Native American populations. There was a significant linear correlation (r=0.28; p=0.03) between county-level rates; however, only 32% of counties were concordant in quartiles for both measures. Conclusion Our findings indicate variation in rates of NOWS and opioid-related hospitalizations by geographic and sociodemographic factors, with only moderate concordance in county-level rates. These findings may provide a nuanced interpretation by examining measures impacting both women and infants and have important implications in prioritizing treatment access.

Intraocular Pressure Reference Values Comparing Two Rebound Tonometers (TonoVet and TonoVet Plus) in Male Camels (Camelus dromedarius).

To determine the intraocular pressure (IOP) reference values in healthy male camels using two rebound tonometers: TonoVet (TV) and TonoVet Plus (TV+), and to compare measurements between both devices and in different body positions. Thirty-four healthy, captive, adult (8-24 years and a median age of 14), male camels belonging to a zoological collection in Fuerteventura, Spain. All camels underwent general physical examination, slit lamp biomicroscopy, and tonometry, under minimal physical restraint (headstall and chute). Three consecutive readings were acquired with TV and/or TV+ in the right and/or left eyes in standing and/or sitting positions, whenever possible. Comparisons between groups were made when paired data for the test variable was available for the same eye (for tonometer and body position) or for the same animal (for left and right eyes) using paired t-tests. The mean IOP (± standard error and range) in standing position was 18.51 mmHg (0.52, 10.33-24.33 mmHg) for TV and 19.53 mmHg (0.50, 12.33-26.33 mmHg) for TV+. In sitting position, the IOP was 14.70 mmHg (0.49, 11.33-18.33 mmHg) for TV and 16.28 mmHg (0.47, 13-19.66 mmHg) for TV+. Measurements for both TV and TV+ were significantly higher (p = 0.003 and p = 0.011, respectively) in standing position. Recordings with TV+ were significantly higher than with TV, in any body position (p < 0.001 and p = 0.006, respectively). There were no statistically significant differences between right and left eyes, except for TV+ in standing position, with the IOP in the left eye being significantly higher (20.58 mmHg versus 18.51 mmHg, p = 0.004). To the authors' knowledge, this is the first report estimating the IOP reference values in male camels comparing two different rebound tonometers. Measurements for both TV and TV+ were significantly higher in the standing position. Recordings with TV+ were significantly higher than with TV (in any body position). Further studies with female individuals and different age groups are warranted.

Abstract TP363: Cognitive Consequences of IL-6 Trans-Signaling Inhibition in Aged Mice: A Comparative Study of Males and Females

Introduction: IL-6 is a pro-inflammatory cytokine typically low in healthy young individuals but elevated after stroke, correlating with worse outcomes. IL-6 binds to soluble IL-6 receptors, which then interact with the glycoprotein gp130, initiating pro-inflammatory trans-signaling. In young mice, gp130Fc administration showed dose-dependent benefits. To test this in older individuals, gp130Fc (0.5 mg/kg, intraperitoneally) was given to aged mice 4 hours after middle cerebral artery occlusion. This dose caused 80% mortality in aged males within 72 hours, while all females survived. A lower dose (0.25 mg/kg) improved survival to 70% in aged males. Aged females had higher baseline plasma IL-6, which may explain their higher dose tolerance. Aging is associated with cognitive decline, leading us to hypothesize that inhibiting IL-6 trans-signaling could improve cognitive function in older animals. Methods: Aged (18-19 months) C57BL/6 male and female mice were used to assess cognitive deficits following gp130Fc treatment. The mice received either saline or gp130Fc at doses of 0.25 mg/kg (for males) and 0.5 mg/kg (for females) via intraperitoneal injection a week before behavioral testing and at day 14. Cognitive function was evaluated using several tests: Y-Maze on day 7, Novel Object Recognition Test (NORT) on day 14, and Object Location (OL) on day 21. From days 22-26, mice underwent training on the Barnes Maze, with testing on day 27. Mice were euthanized on day 28. Results: Older animals exhibited similar deficits in short-term memory as assessed on the Y maze, NORT, and OL task regardless of sex, but aged females showed worse long-term memory retention compared to age-matched males, as assessed by the Barnes Maze. Female mice took longer to escape and made more incorrect entries (P&lt;0.05) than males. Inhibition of peripheral IL-6 trans-signaling worsened (P&lt;0.05) long-term memory retention in aged males compared to vehicle-treated animals, whereas gp130Fc treatment improved long-term memory retention in aged females. Conclusion: This study demonstrates that aged female mice exhibit more pronounced cognitive impairments than their male counterparts. Inhibition of IL-6 trans-signaling with gp130Fc ameliorates cognitive deficits in aged females but exacerbates cognitive decline in aged males.

Elevation of erythrocyte creatine post-puberty unrelated to erythrocyte lifespan: Implications from the lack of correlation between HbA1c and erythrocyte creatine.

HbA1c levels are affected by both glycemia and erythrocyte lifespan. Erythrocyte creatine (EC) indicates mean erythrocyte age. Although EC levels differ between adolescent males and females, with higher levels in females, the mechanism remains unclear. We examined the EC and HbA1c levels in non-diabetic children. This study included 85 children aged 3-18years (male/female: 44/41) without diabetes or anemia. Data on EC, age, HbA1c, glycated albumin (GA), casual plasma glucose (PG), and complete blood count were measured. We examined correlation among EC, age, and HbA1c levels separately in males and females. Additionally, we compared women with and without menstruation. Age, EC, HbA1c, GA, and PG levels were comparable between the sexes. HbA1c levels were not correlated with age in either group (males: R=0.063, p=0.684; females: R=0.112, p=0.486). In males, EC levels were not correlated with age (R=0.089, p=0.567), but showed a negative trend with HbA1c (R=0.281, p=0.065). In females, EC levels were positively correlated with age (R=0.557, p<0.001), but not with HbA1c (R=0.140, p=0.383). Females with menstruation had higher EC levels (1.64±0.43µmol/g Hb) than those without menstruation (1.23±0.23µmol/g Hb, p=0.004): however, HbA1c differences were not significant (5.44±0.28% vs, 5.41±0.22%, p=0.771). No significant correlation was observed between EC and HbA1c levels in non-diabetic and non-anemic children. However, the discrepancy between HbA1c and EC levels in relation to age in females was observed. These findings indicate that in females, but not in males, EC may be falsely elevated irrespective of erythrocyte lifespan after puberty.

Tumor lysis syndrome in colorectal cancer: A systematic review of clinical characteristics.

122 Background: Tumor lysis syndrome (TLS) is an oncologic emergency resulting from the release of potassium, phosphorus, and nucleic acids from tumor cells. While rare in colorectal cancer (CRC), TLS is linked with high mortality, and literature is limited. This study aims to summarize the clinical characteristics of patients with TLS in CRC. Methods: We conducted a systematic review of TLS in CRC through a comprehensive literature search in PubMed and manual searches from January 1st, 1993, up to September 13th, 2024. Keywords included "Tumor Lysis Syndrome," "Colorectal Cancer," and "Colon Cancer." 32 studies were found, identifying 11 spontaneous and 22 therapy-related TLS cases. Quantitative and qualitative data were extracted for descriptive analysis. Results: A total of 33 patients (16 males and 15 females) had a mean age of 56.5 ± 17.8 years at TLS diagnosis. The mean ages for males and females were 58.3 ± 7.1 and 55.8 ± 13.7 years, respectively (p=0.59). The primary histology was adenocarcinoma (92%) followed by neuroendocrine (8%) (data unavailable for 9 patients). Among 15 patients with grading information, Grade 2 tumors were most common (53%), followed by Grade 3 (40%) and Grade 1 (7%). Staging data was available for 32 patients. Most patients had Stage IV disease (94%), with frequent metastases to the liver (93%), lungs (30%), and bones (10%). Hyperuricemia is present in all patients (1 patient without data). Acute kidney injury (AKI) was present in all patients (4 patients without data). Hyperphosphatemia was found in 82% of patients (5 patients without data). Hypocalcemia was noted in 52% (10 patients without data), and hyperkalemia was found in 74% (6 patients without data). Out of the 33 patients, 11 experienced spontaneous TLS (33%) and 22 had therapy-related TLS (67%). Duration of TLS onset following therapy was available for 17 patients, including one outlier at 30 days on Capecitabine. The mean duration for therapy-related TLS, excluding the outlier, was 3.8 ± 2.5 days. Among the 22 patients on therapy, 59% received 5-Fluorouracil (5-FU)-based treatment. 31% of those receiving 5-FU had combination therapy with Bevacizumab. Death occurred in 59% of patients, with data missing for 4 patients. Conclusions: TLS in colorectal cancer (CRC) is associated with a mortality rate of up to 59% and shows no gender preference. Identifying predictive factors is crucial for TLS prophylaxis. Patients with TLS in CRC often present with Stage IV disease, liver metastasis, hyperuricemia, and acute kidney injury (AKI).

Modelling the impact and cost-effectiveness of upcoming Zika virus vaccines on congenital Zika syndrome.

Zika virus (ZIKV) continues to circulate in Southeast Asia following the 2015-2016 global epidemic, posing an ongoing risk of importation and disease spread for Singapore, a tropical city-state in the region. The virus remains a threat to pregnant women and their fetuses due to the risk of Congenital Zika Syndrome (CZS). Vaccines currently in development offer hope for reducing ZIKV infections and CZS cases. We developed an agent-based compartmental model, incorporating Singapore's demographic dynamics, to simulate ZIKV epidemic trajectories and project the national disease burden of CZS over the next decade. We proposed eight vaccination strategies targeting females of child-bearing age and evaluated their cost-effectiveness-in terms of the incremental cost-effectiveness ratio (ICER)-across scenarios with varying vaccine efficacy, protection duration, coverage rate, vaccination cost, and pre-existing immunity levels in the population. Continuous high importation of ZIKV could lead to multiple small outbreaks in the next decade. Total CZS case numbers over the next decade were projected to be 68 (95% confidence interval [CI]: 66-70), 51 (95% CI: 49-52), and 32 (95% CI: 31-33) under scenarios of 0%, 2%, and 5% pre-existing immunity, respectively. While mass vaccination for females would avert up to 66 (95% CI: 64-69), 49 (95% CI: 48-50), and 31 (95% CI: 30-31) CZS cases, respectively, the cost-effectiveness of these strategies should be evaluated on a case-by-case basis. The pre-pregnancy vaccination strategy demonstrated consistent cost-effectiveness regardless of vaccine protection duration, vaccine efficacy, vaccine price, or pre-existing immunity level in the population. Localised outbreaks driven by importation are likely to persist in Singapore. The pre-pregnancy vaccination strategy is consistently cost-effective and should be considered. Mass vaccination may also be viable with the availability of a low-cost vaccine providing long-term protection.

Bone Densitometry Parameters in Females with Ehlers–Danlos Syndrome—Does the Hypermobile Subtype Increase the Risk of Low Bone Mass in Patients with Ehlers–Danlos Syndrome?

Background: The purpose of this study was to assess bone densitometry parameters in patients with classical and hypermobile Ehlers–Danlos syndrome (EDS) and to determine whether the hypermobile subtype increases the risk of low bone mass, which is particularly important in this patient group, since the genetic mutation responsible for this subtype is still unknown. Material and Methods: In order to conduct this study, we collaborated with the EDS society in Poland. A total of 30 females of reproductive age who were included in the study were divided into two groups: Group 1—those with classical EDS (n = 9) and Group 2—those with hypermobile EDS (n = 21). Routine laboratory test results, bone turnover markers, and densitometry parameters were evaluated and compared. Results: The study groups showed no differences in terms of densitometry parameters or markers of calcium–phosphate metabolism. A multivariate logistic analysis demonstrated no increase in the risk of low bone mass (defined as a Z-score lower than -2) in patients with hypermobile EDS (OR 0.067 [95% Cl 0.0–20.927]; p = 0.356). Conclusions: The hypermobile subtype of EDS does not increase the risk of low bone mass; there were no significant differences between patients with hypermobile EDS and those with classical EDS in terms of either densitometry parameters or markers of calcium–phosphate metabolism. Although patients with hypermobile EDS are not at a higher risk of developing low bone mineral density, they should be regularly monitored for any calcium and phosphate metabolism abnormalities.

Ultrasonographic characteristics of peripheral neuropathy in systemic lupus erythematosus.

To explore the ultrasonographic characteristics of SLE-related peripheral neuropathy (PN) using nerve ultrasound. Patients with SLE were recruited consecutively between December 2022 and June 2023. Detailed clinical assessment and nerve ultrasound were conducted on each SLE patient and healthy control (HC) at predetermined sites of peripheral nerves. The upper limit of the CSA for each nerve location was defined as 95th percentile in healthy controls for the identification of nerve enlargement. Nerve conduction studies (NCS) and relevant ancillary examinations were conducted on all SLE patients for comparisons. A total of 32 SLE female patients and age- and gender-marched 52 HC were finally recruited. At M6 (P=0.041) point of median nerve, U1 (P<0.001) and U6-10 (P<0.001, =0.008, <0.001, <0.001, <0.001, respectively) points of ulnar nerve, the CSA in SLE patients were remarkably higher than that in HC. Mild and moderate nerve enlargement were detected in 12 and 20 SLE patients, respectively. Only 12 tested nerves showed both axonal damage in electrophysiological studies and nerve enlargement under ultrasound. Nerve enlargement was extremely common in SLE patients, mainly in the forms of mild to moderate and focal thickening in upper limbs. There was significant inconsistency between NCS and ultrasound in detecting peripheral nerve involvement and a combined examination using NCS and nerve ultrasound might be more effective in detecting SLE-related PN.

Vaccination Coverage and Attitudes in Children and Adults on Biologic Therapies: Cocooning Strategies, Undervaccination Factors and Predictors of Favorable Attitudes

Background: Infections pose a significant risk of morbidity and mortality to patients on biologics, with the vaccination of both patients and their close contacts serving as a key preventive measure. Despite its importance, there are limited data on the vaccination coverage for this group, and no studies have examined the vaccination status of patients’ close contacts. Objectives: To assess vaccination rates among patients on biologics and their household contacts, identifying reasons for inadequate vaccination and examining factors influencing vaccination status and attitudes is crucial. Methods: A cross-sectional study was conducted from September 2022 to February 2023 at the two hospitals in Heraklion, Crete, including adult and pediatric patients on biologics. Data were collected through medical records and interviews and analyzed using Microsoft Excel 2016 and MedCalc2006. Results: Among the 446 adults, vaccination rates were as follows: 83% for COVID-19, 73.8% for influenza, 64.5% for the pneumococcal conjugate vaccine, 29.6% for the pneumococcal polysaccharide vaccine, and 4% for Tdap. Among the 26 children included, those with basic immunization schedule coverage exceeded 96%, but rates for the vaccines usually administered at adolescence were lower (Tdap: 47.8%, HPV: 42.1%, MenACWY: 66.7%). COVID-19 vaccination was at 38.5%. Regarding the additional vaccines recommended due to treatment-induced immunosuppression, 69.2% of pediatric patients received the annual influenza vaccine, while only 19.2% received the pneumococcal polysaccharide vaccine. Household contacts demonstrated low vaccination rates (&lt;59%), except for COVID-19 (81%). Female gender (p &lt; 0.007) and older age (by 1 year, p &lt; 0.001) were associated with favorable attitudes and higher coverage in adults, while in pediatric patients, no statistically significant associations were found. A lack of physician recommendation was the primary reported reason for not being vaccinated. Conclusions: Significant vaccination gaps exist among patients on biologics and their close contacts, largely due to inadequate physician recommendations. Raising awareness and strengthening healthcare provider roles are essential to improve coverage in this high-risk group.

Advancing African American and hispanic health literacy with a bilingual, personalized, prevention smartphone application.

Many online health information sources are generic and difficult to understand, but consumers want information to be personalized and understandable. Smartphone health applications (apps) offer personalized information to support health goals and reduce preventable chronic conditions. This study aimed to determine how the HealthyMe/MiSalud personalized app (1) engaged English-speaking African American and Spanish-speaking Hispanic adults, and (2) motivated them to set goals and follow preventive recommendations. Our study adds to the literature on digital health, health information seeking, and prevention. We used a multi-method approach, including community and participatory design principles, to learn about potential African American and Hispanic adult health app users and evaluate the app in two usability tests and a 12-month field test. Ninety-six African American and Hispanic adults downloaded the HealthyMe/MiSalud app and used it for a minimum of 36 weeks. We found they wanted personalized information on core prevention topics, and their health histories and goals affected how they rated topic relevance. African American females ages 18-34 were more likely to save an article aligned with family health history, and African American females aged 35-49, males age 50-64, and African American males overall were more likely to save an article aligned with their health goals. Our study revealed that a prevention app with personalized recommendations can support health information seeking and health literacy. These findings can help app developers, public health practitioners, and researchers when designing apps for groups of varying identities.

Epidemiological Profile of the Victims Involved in Road Traffic Accidents (RTA) and ICD-10 Classification Attending an Emergency Department: A Descriptive Study

Abstract Road traffic injuries are the leading cause of death for children and young adults aged 5-29 years. They cause approximately 1.3 million deaths every year, with 20 to 50 million more people suffering nonfatal injuries and many incurring a disability as a result of their injury. A retrospective record-based descriptive study was performed to analyze the epidemiological profile of the patients attending with road traffic accidents (RTA) to emergency/casualty department in a tertiary care hospital. The purposive sample from the last 7 months with those affected from RTA cases came to casualty and undergone treatment during the study duration and the exclusion criteria were brought dead patients. Out of 397 victims, 309 (77.8%) were male and 88 (22.2%) were female and mean age with SD 37.19 ± 13.9 years. Majority 143 (36.0%) had self-fall, 64 (16.1%) 2-wheeler vs pedestrian, 63 (15.9%) 2-wheelers vs 4-wheeler, 55 (13.9%) under 2-wheelers vs 2-wheeler. Majority were happened on Saturday 60 (15.1%), Sundays 71 (17.9%) and the rest on an average of 50 incidents in a day; out of them, the incident happened at evening 98 (24.7%) night 136 (34.2%) morning 109 (27.5%), and in the afternoon time 54 (13.6%), respectively. Accidents have male predominance, with more victims from adults and middle age 21-40 years. Most common category of the victim was motorcycle rider, followed by pedestrians, and as per ICD-10 classification, the common mechanism of incident happened was motorcycle rider noncollision transport accident (Code: V28).

Endocrine-Disrupting Chemicals and Female Reproductive Aging.

Female reproductive aging often affects women's emotional, physical, and physiological well-being. Ovarian aging is characterized by fluctuations in reproductive hormones and determines the age at which menopause occurs. Understanding potentially modifiable factors that influence this process is essential for addressing health disparities, improving quality of life, and informing relevant public health strategies. This review synthesizes in vivo, in vitro, and epidemiological findings about the effects of endocrine-disrupting chemicals (EDCs), specifically heavy metals and perfluoroalkyl and polyfluoroalkyl substances (PFAS) on female reproductive aging. Most in vivo and in vitro studies have demonstrated that heavy metals alter ovarian morphology, folliculogenesis, and steroidogenesis. Evidence regarding the effects of PFAS is limited and inconsistent. Epidemiological studies have consistently shown that heavy metals are associated with a higher risk of diminished ovarian reserve (indicated by decreased anti-Müllerian hormone) and earlier menopause, with limited findings regarding reproductive hormone changes. PFAS exposure has been associated with decreased estradiol and earlier menopause but not significantly with ovarian reserve. Gaps in the literature require more comprehensive epidemiological research on the effects of EDCs on female reproductive aging, including ovarian reserve, age at menopause, and vasomotor symptoms, to inform future interventions to reduce hazardous exposures and improve women's health.

P-1680. Retrospective Review of Adherence to Institutional Pneumonia Antimicrobial Guidelines at Hospital Admission

Abstract Background Literature supports the importance for institutions to have antimicrobial guidance accessible for providers in order to improve patient outcomes and antimicrobial stewardship (AMS). However, guideline adherence when prescribing for community acquired infections tends to be poor and includes more broad-spectrum antibiotics than required. We performed a review to assess adherence to our institutional pneumonia guidelines. Methods A retrospective chart review was conducted on all adult patients admitted to a Medicine or Hospitalist team at WVU Hospitals with an admission diagnosis of community acquired pneumonia (CAP)/pneumonia between January – June 2023. Demographic and clinical characteristics were collected as well as outcomes of interest: empiric antimicrobials and adherence to our institutional pneumonia guidelines. Data was collected and analyzed via WVU REDCap. Results We identified 154 patients with admission diagnosis of CAP to internal medicine services; however, 37 were excluded, as they were transfers from the ICU or outside facilities. Demographics showed 49.4% of the patients were female and median age was 69 years. 30% received antibiotics in preceding 90 days, with 77% of these for prior pneumonia. Identified comorbidities included: COPD (51.5%), Type II Diabetes (31.7%), CHF (43.6%), active malignancy (23.8%) and immunosuppressed (35.6%) (Figure 1). The median Patient Severity Index score was 91 (26-277). Adherence to institutional guidelines was 59% and of those non-adherent, 81% were over treated (Figure 2). Frequency of appropriate antibiotic use included: 24.8% ampicillin/sulbactam, 52.1% doxycycline, 33.3% ceftriaxone, and 12.8% azithromycin. Most common inappropriate antibiotic use included cefepime 28.2% and vancomycin 23.9%. Conclusion At 59% adherence to our pneumonia guidelines, this data shows there is a need for education and increased accessibility to institutional guidelines. Our QI intervention will include educational sessions on AMS guidelines and our CAP order panel, how to access the guidelines (via AMS app or webpage) and placement of guideline links within antibiotic orders. This study will also serve as a basis for assessing empiric treatment of other common infections and adherence to institutional AMS guidelines. Disclosures All Authors: No reported disclosures

P-381. Enhancing Economic Outcomes by Strategic Investment in Orthopedic Surgical Infection Control

Abstract Background This study aims to assess the financial impact of investments in combating hospital-acquired infections, particularly surgical site infections (SSIs) in orthopedic procedures.Figure 1The infection prevention programs to prevent Surgical Site Infections (SSIs) Methods A retrospective cohort study from January 2019 to September 2023 included patients undergoing knee arthroplasty (KA), hip arthroplasty (HA), and open fracture reduction (OFR), defining SSI according to CDC criteria. Costs per SSI patient were retrieved from literature sources: $13,539.50 for hospital costs (LUNA et al., 2022) and $7,523.77 for direct treatment costs, adjusted for inflation (STARLING et al., 2022).Figure 2.Chart of Year-to-Year Surgical Site Infection Rates, Stratified by Type of Orthopedic Surgery Chart of Year-to-Year Surgical Site Infection Rates, Stratified by Type of Orthopedic Surgery Results During the baseline period, January 2019 to to December 2022, 4,258 patients underwent orthopedic surgeries: HA (11%), KA (9%), OFR (80%). Of these, 2,439 were female (57%), 1,819 male (43%), mean and median age 51 years, standard deviation 21 years. 68 patients died in-hospital (1.6%), 239 diagnosed with SSI (5.6%). Postoperative infection increased mortality risk over twofold: without infection (1.5% mortality risk), with infection (3.8% mortality risk), relative risk 2.5, p-value=0.014. SSI was associated with prolonged hospitalization; average length of stay doubled with infection (18.2 days) compared to without (9 days), p-value: 0.001. Comparing infection risks from 2019-2022 (5.6%) to 2023 (1.4%) post-investment in infection control demonstrated a risk reduction. Relative risk (0.25) p-value &amp;lt; 0.001.Table 1.Annual Comparative Analysis of Surgical Site Infection Rates by Orthopedic Surgery Type Conclusion SSIs in orthopedic surgeries pose dual risks, increasing readmissions and impairing hospital performance. Investing in SSI reduction enhances patient care, safety, and yields significant financial returns. This study underscores the ROI of infection prevention, especially targeting orthopedic surgical infections. Preventing SSIs can yield monthly savings of $25,781.49 to $46,393.48Table 2.Reduction in Costs, Hospital Stay Duration, and Prevented Deaths Associated with Surgical Site Infections after Orthopedic Surgeries Disclosures All Authors: No reported disclosures

P-2178. Can serum ferritin be used as a marker of severity in dengue fever?: a prospective observational study from North India

Abstract Background Dengue has a variable clinical course and there is no standardised marker for predicting dengue severity. Studies have shown higher ferritin levels in dengue compared to other febrile illnesses. Prospective studies to show correlation of ferritin with dengue severity are lacking. Demographic profile and workflow From 134 patients 99 were selected for the study , 35 were excluded as per the exclusion criteria (figure 1 flowchart). Majority of the patients were young (figure 3) with male predominance (figure 2), the male female percentages and age did not vary significantly across different grades of severity (table1 and figure 4). Methods Single centre prospective observational study conducted over 2 years. Patients of chronic inflammatory diseases, thalassemia, haematological malignancy or severe anemia (Hb &amp;lt; 7gm/dl) were excluded. Two ferritin samples 3 days apart measured by automated BECKMAN COULTER DxI.800 immunoassay analyzer. Clinical features and median ferritin value across different dengue severties In Figure 5 the pie chart shows that majority of the patients were dengue without warning signs , approximately 1/5th were severe dengue. Figure 6 shows that initial clinical features were more or less similar in the three groups of severities , however bleeding, pain abdomen , vomiting were more common in severe dengue group. Table 2 showing median ferritin values of day 0 and day 3 ferritin in different severity groups and whether their differences are statistically significant between each groups or not. The Box and whisker plots in figure 7, 8 and 9 shows the same with corresponding p values and Median ferritin level annotated. Results Total study population was 99 patients with median age of 28 years (24.5-34.5) and male predominance (68%). 2009 WHO classification wise 43% were dengue without warning signs 36% dengue with warning signs and 21% were severe dengue patients. Both day 0 and day 3 ferritin median value were higher across all three groups and the difference were statistically significant (p=0.00002 and p=0.045 respectively). Day 0 ferritin median value difference was statistically significant between severe dengue and dengue without warning sign (0.00001) and warning sign group (p=0.0003). In case of early ferritin sample (within day 7 of illness) it was significantly different between all groups. Serum ferritin also showed strong positive correlation with AST, ALT and negative correlation with Albumin levels. ROC curve analysis showed that a ferritin cut off of 9185 ng/ml with AUC 0.811, standard error 0.06 and 95% CI of 0.69-0.92 could differentiate severe from non severe dengue with 52.4% sensitivity and 97.4% specificity. For early ferritin sample cut off becomes 2132 ng/ml with a 70% sensitivity and 82.4% specificity with AUC 0.821, standard error 0.085 and 95% CI of 0.65-0.98. Multivariate logistic regression shows baseline platelet counts &amp;lt; 50000 cells/uL [OR 4.7, p=0.02, 95% CI 1.19-18.54] and Albumin &amp;lt; 3.5 gm/dL [OR 6.33 p=0.007 95% CI 1.67-24.06] to be independent predictors of severe dengue. Day 0 ferritin level &amp;gt; 9185ng/mL gave an Odd’s ratio of 10.47 with p=0.052 and 95% CI [0.98-112]. Correlation of ferritin with various biochemical parameters and Ferritin cutoff value to differentiate Severe from Non severe dengue by ROC curve Table 3 and Figure 10 Scatter plot showing strong positive correlation between serum ferritin and SGOT/ SGPT levels, and negative correlation with serum albumin level .Figure 11 ROC curve analysis showing the ferritin cutoff being 9185ng/ml to differentiate between severe and non severe dengue. If sample taken within day 7 of illness the cut off becomes 2132 ng/ml (Figure 12) Conclusion Ferritin can be a useful biomarker for differentiating different grades of dengue severity especially if sample taken in the 1st week of illness. Serum ferritin cut off values can be used to predict severe dengue. Multivariate Logistic regression to find independant predictor of severe Dengue Table 4 showing Multivariate logistic regression result, which reveals baseline platelet count &amp;lt;50000 and Albumin level &amp;lt;3.5gm/dL to be independent predictor of severe dengue.Day 0 Ferritin cutoff of 9185 ng/dL as per the ROC curve analysis shows that the Odds of prediction of severe dengue is 10.47 (p=0.052 and 95% CI 0.98-112). Disclosures All Authors: No reported disclosures

P-26. Increasing HPV Vaccination Rates in an Underserved Urban Population

Abstract Background Uninsured individuals are found to have lower rates of human papillomavirus (HPV) vaccination initiation compared to insured patients. Our primary care clinic is based in an urban setting, and is primarily comprised of non-English-speaking and uninsured individuals. Previous review of the clinic’s HPV vaccination rate showed 13% of patients were fully vaccinated against HPV and 24% were partially vaccinated, lower than the national rates of 21.5% and 39.5%, respectively. This study aimed to improve the rate of HPV vaccination to meet the national average. Methods This retrospective chart review evaluated all males age 18-21 and females age 18-26 who attended a primary care visit at our clinic between January 1st 2021 to February 29th 2024. A quality improvement initiative was implemented from January 1st, 2023 to November 1st, 2023, and included educating the medical team, crafting informational pamphlets, and fostering discussions with patients. HPV vaccination rates were examined pre-intervention (January 1st, 2023-January 1st, 2023) and post-intervention (November 1st, 2023 to February 29th, 2024. Results 379 patients were included in the pre-intervention group: 311 (82%) female, 68 (18%) male, and 93 patients were included post-intervention: 84 (90%) female and 9 (10%) male. The rate of patients fully vaccinated against HPV increased from 13% (n=51/379) from the pre-intervention group compared to 27% (n=27/93) in the post-intervention group. The rate of unvaccinated patients decreased from 63% (n=240/379) to 34% (n=32/93). This change in vaccination rates was statistically significant (p&amp;lt; 0.01). Conclusion Implementation of a quality improvement initiative to educate the medical staff and patients allowed for a statistically significant increase in the rate of HPV vaccination in an urban primary care practice. Continued collection of vaccination data from our clinic will allow for further guidance on how to target vaccine uptake in this population. Disclosures All Authors: No reported disclosures