High Prevalence Research Articles

Prevalence and determinants of intestinal parasitic infection among primary school children in Iraq 2022

Introduction: Intestinal parasitic infections are still common in developing countries including Iraq, particularly in children. They are mostly associated with unsafe, low-quality drinking water and poor personal and environmental sanitation. Objective: To determine the prevalence and risk factors of intestinal parasitic infection among primary school children. Methods: A cross-sectional study was conducted on 450 primary school students selected randomly using a stratified sampling technique. The list of all students from grades 1–6 was arranged alphabetically and served as a sampling frame. In this study, undertaken between September 2021 and March 2022 A structured questionnaire was used together with data on environmental, socio-demographic and behavioural factors. Stool specimens were collected from all study subjects and were examined for intestinal parasites using direct smear (mount examination) and Formal-ether concentration techniques. Results: Among 450 primary school children 60% (268) had intestinal parasites. Male: Female ratio is 1:1. Most infected children were from rural areas (63.1%), students whose mothers were housewives (72.4%), and about half of the parents had primary or intermediate educational levels. Enterobiusvermicularis was the most common intestinal helminth infection (27.6%), whereas Entamoebahistolytica was the most common protozoa infection (16.4%). On applying binary logistic regression analysis, rural residence of the students, not enough family income, Conclusion: low educational level of the mothers, Poor hand washing practice before eating, after playing outside and hand washing without soap and similar material, poor hygienic facilities like faulty sewage carriage system at school, sharing the same bed, mixed sources of drinking water were the sole factors significantly associated with increased odds of high prevalence of intestinal parasitic infection among primary school children.

Secretary bird optimization algorithm based on quantum computing and multiple strategies improvement for KELM diabetes classification.

The classification of chronic diseases has long been a prominent research focus in the field of public health, with widespread application of machine learning algorithms. Diabetes is one of the chronic diseases with a high prevalence worldwide and is considered a disease in its own right. Given the widespread nature of this chronic condition, numerous researchers are striving to develop robust machine learning algorithms for accurate classification. This study introduces a revolutionary approach for accurately classifying diabetes, aiming to provide new methodologies. An improved Secretary Bird Optimization Algorithm (QHSBOA) is proposed in combination with Kernel Extreme Learning Machine (KELM) for a diabetes classification prediction model. First, the Secretary Bird Optimization Algorithm (SBOA) is enhanced by integrating a particle swarm optimization search mechanism, dynamic boundary adjustments based on optimal individuals, and quantum computing-based t-distribution variations. The performance of QHSBOA is validated using the CEC2017 benchmark suite. Subsequently, QHSBOA is used to optimize the kernel penalty parameter [Formula: see text] and bandwidth [Formula: see text] of the KELM. Comparative experiments with other classification models are conducted on diabetes datasets. The experimental results indicate that the QHSBOA-KELM classification model outperforms other comparative models in four evaluation metrics: accuracy (ACC), Matthews correlation coefficient (MCC), sensitivity, and specificity. This approach offers an effective method for the early diagnosis and prediction of diabetes.

Prevalence of Low Bone Mineral Density among Narikuravar Women of 18–45 Years of Age in Sakkimangalam Village, Madurai, 2021

Abstract Background: Low bone mineral density comprising of both osteopenia and osteoporosis is a major health problem affecting 81% of elderly women. It is a silent disease causing bone fractures, thereby decreasing the quality of life. However, the real basis lies in the failure to achieve adequate bone mass at a young age due to nutritional and other factors. Women, especially tribes, lack a healthy diet. Studies on bone mineral density (BMD) among tribes were scarce. Hence, the need for the present study is observed. Material and Methods: 1. To estimate the prevalence of low BMD among Narikuravar women of 18–45 years. 2. To determine the association of BMD with sociodemographic factors and dietary calcium intake. A community-based cross-sectional study was conducted in Narikuravar colony, Sakkimangalam village, Madurai. Out of 210 women aged 18–45 (obtained from Family Register), 146 eligible participants were interviewed using a validated semi-structured questionnaire. BMD was measured using calcaneal USG and WHO T score calculated. Analysis was done by SPSS 21.0. Simple proportions were calculated. The Chi-square test and correlation were used to find an association. Results: Based on the WHO T score, the prevalence of low BMD was 55.5% (n = 81). One hundred percent of study participants had a calcium intake less than the daily requirement. Low BMD was significantly associated (P < 0.05) with lower educational status, alcohol, increasing age (r = −0.750), and low calcium intake (r = 0.188). Conclusions: A high prevalence of low BMD warrants early screening at the primary care level itself to improve quality of life in the future. Health education on nutrition, physical activity, and alcohol cessation can be given in multiple sessions.

Reflections of adolescent motherhood on infant and young child feeding practices: the case of Uganda

BackgroundAge-appropriate breastfeeding and adequate complementary feeding play a crucial role in reducing under-5 mortality rates, malnutrition, and mortality worldwide. Given the high prevalence of adolescent pregnancy in Uganda, we aimed to assess the competence of adolescent mothers in infant and young child feeding (IYCF) using data from the 2016 Uganda Demographic Health Survey.MethodOur sample comprised the last children aged 6–23 months of mothers aged 15–29 years, totaling 2594 mother-infant pairs; 402 were aged 15–19 years, 1,388 were aged 20–29 years with their first delivery before the age of 20, and 804 were aged 20–29 years with their first delivery at 20 years or older. We utilized complex sample logistic regression analysis to examine the interactions between adolescent motherhood and IYCF indicators during the previous day of the survey.ResultsThe rates of ongoing breastfeeding, bottle feeding, minimum meal frequency, minimum dietary diversity, minimum acceptable diet, egg and/or flesh food consumption, zero vegetable or fruit consumption, and unhealthy food consumption were found to be 77.7%, 16.3%, 37.5%, 28.7%, 14.2%, 41.7%, 31.6%, and 14.7%, respectively. Multivariate complex sample logistic regression revealed that women with a history of adolescent pregnancy had lower odds of achieving minimum meal frequency, and higher odds of zero vegetable or fruit consumption.ConclusionAdolescent mothers and women who give birth during their teenage years are particularly vulnerable to inadequate infant and young child nutrition practices. Targeted interventions and education programs should be implemented to promote optimal complementary feeding practices among mothers in Uganda.

Association of poor sleep quality with clinical variables in nontuberculous mycobacterial pulmonary disease.

The high prevalence of poor sleep quality in patients with chronic respiratory diseases makes it an important clinical topic. However, the prevalence and characteristics of poor sleep quality in those with nontuberculous mycobacterial pulmonary disease and its association with clinical variables remain unclear. This retrospective study involved patients with nontuberculous mycobacterial pulmonary disease between June 2017 and May 2022. The prevalence of poor sleep quality was measured by the Pittsburgh Sleep Quality Index was used to and its association with clinical variables including age, sex, laboratory data, pulmonary function, respiratory symptoms, mental health, health-related quality of life, and physical function was assessed. The median age of 233 participants was 65 years, with poor sleep quality present in 123 patients (52.8%) who were older, female, and unemployed with dyspnea, anxiety symptoms, low health-related quality of life, and low exercise capacity. Many reported that they "cannot get to sleep within 30min," "wake up in the middle of the night or early morning," "have to get up to use the bathroom," "cannot breathe comfortably," or "cough or snore loudly." Multivariate logistic regression analysis indicated a significant association between poor sleep quality, female sex, and low health-related quality of life. Our results suggested that for the patients in this study, a multidisciplinary management that considers poor sleep quality is required and assessment of sleep quality as a screening is needed.

Pulmonary Function Assessment with Spirometry in Symptomatic Post-COVID-19 Patients: A Cross-Sectional study at Dhaka Medical College Hospital

Background: The emergence of COVID-19 has posed challenges in managing the disease and mitigating its long-term effects, particularly on the respiratory system. This study assessed lung function abnormalities through spirometry in symptomatic post-COVID-19 patients in a tertiary care hospital in Bangladesh. Methods: This cross-sectional study was conducted at Dhaka Medical College Hospital over one year. A total of 100 post-COVID-19 patients with shortness of breath and/or cough 6-8 weeks post-discharge were included. Patients underwent face-to-face interviews, clinical history reviews including previous investigations findings and spirometry tests. Spirometry assessments were classified as normal or restrictive. The severity of restrictive changes were graded from mild to very severe. FEV1 and FVC were measured, and the FEV1/FVC ratio was calculated. Data were analyzed using SPSS Version 25. Results: The mean age of participants was 51.3±7.27 years, with a male predominance (70% male). Common symptoms included cough (86%), shortness of breath (54%), and weakness (41%). Spirometry showed that 66% had restrictive changes, with mean FEV1 at 61.04±10.69% and FVC at 73.02±12.73%. Restrictive changes in spirometry were significantly predominant in severe COVID-19 cases (p<.05) and were associated with pre-existing conditions like hypertension, diabetes, and smoking history (p<.05). Logistic regression revealed higher odds of restrictive changes with older age, smoking history, disease severity, and the presence of diabetes and hypertension. Conclusion: This study reported a high prevalence of restrictive changes in spirometry in post-COVID-19 patients, associated with disease severity and pre-existing comorbidities. J Bangladesh Coll Phys Surg 2025; 43: 13-19

A brief overview of chikungunya-related pain.

Pain is an important symptom associated with the arboviral disease caused by the Chikungunya virus (CHIKV). For a significant number of patients, this symptom can persist for months or even years, negatively affecting their quality of life. Unfortunately, pharmacological options for this condition are limited and only partially effective, as the underlying mechanisms associated with CHIKV-induced pain are still poorly understood. The re-emergence of CHIKV has led to new outbreaks, and the expected high prevalence of pain in these global events requires new scientific advances to find more effective solutions. Here we review the main aspects of pain caused by CHIKV infection, such as the anatomy of the affected sites, the prevalence and management of this symptom, the diversity of possible cellular and molecular mechanisms, and finally highlight a promising meningeal pathway to elucidate the mechanisms involved in the unsolved problem of CHIKV-associated pain.

Lamotrigine promotes reentrant ventricular tachycardia in murine hearts.

In 2021, the US Food and Drug Administration issued a safety warning concerning lamotrigine use in patients with underlying cardiac disorders. This warning was based on invitro data that predicted class Ib antiarrhythmic activity for lamotrigine. Therefore, we investigated the proarrhythmic potential of lamotrigine in the murine heart and compared its effect with flecainide. Murine hearts were perfused with clinically relevant concentrations of lamotrigine 3.8 μg/mL (15 μmol·L-1) or flecainide .4 μg/mL (1 μmol·L-1). Ex vivo electrocardiography revealed a high prevalence of ventricular tachycardia (VT) in lamotrigine-perfused hearts (7/9 hearts), whereas only two hearts exposed to flecainide evidenced VT. Optical voltage mapping showed that lamotrigine preferentially decreased ventricular conduction velocity (CV) in the longitudinal direction at all pacing frequencies tested (-22% ± 8.6%, -30% ± 15.4%, and -33% ± 13.3% for pacing frequency of 200-ms, 180-ms, and 150-ms cycle length, respectively, p ≤ .05) compared to the transverse direction, which only slowed CV at the fastest pacing frequency (-15% ± 16% for pacing frequency of 150-ms cycle length, p ≤ .01). Notably, the preferential CV slowing in the longitudinal direction altered the anisotropic ratio, giving rise to a functional substrate for reentrant VT. In contrast, flecainide slowed CV uniformly in both longitudinal and transverse directions (-30% ± 8.5% vs. -27% ± 5.3%, -32% ± 9.4% vs. -29% ± 6.9%, and - 29% ± 8.3% vs. -27% ± 10% for pacing frequency of 200-ms, 180-ms, and 150-ms cycle length, respectively, p ≤ .05). Our findings provide mechanistic insight into the proarrhythmic impact of lamotrigine.

Assessment of serum levels of 8-hydroxy-2’ deoxyguanosine and f2-isoprostanes in newly diagnosed adult hypertensive with clinical depression in NAUTH, Nnewi, Nigeria

Despite the high prevalence of depression and hypertension, the relationship between the two diseases has received little attention. The potential roles of some biomarkes of oxidative stress in disease progression and management is very crucial. Aim: The present study therefore, evaluated the serum levels of 8-hydroxy-2’ deoxyguanosine (8-OHdG) and F-2 isoprostanes in newly diagnosed hypertensive individuals with and without depression at Nnamdi Azikiwe University Teaching Hospital, Nnewi. Method: This was a cross sectional study carried out on randomly selected 121 consented adult male and female participants within the ages of 18-65 years which comprises 30 newly diagnosed hypertensive individuals without depression (Hypertensive), 31 hypertensive individuals with depression selected from the department of internal medicine. 30 non hypertensive with depression (Depressive) and 30 apparently healthy non-hypertensive individuals without depression which served as control selected among the hospital staff. Their bio-data was obtained from their hospital records. 3 ml of venous blood were collected from each of the participants, dispensed into a plain container, centrifuged and serum separated into another container and stored at -20 0C for the assessment of serum 8-OHdG using Enzyme Linked Immunosorbent Assay (ELISA) Method. Result: The result showed that Hypertensive individuals with and without clinical depression (107.08±22.05, 129.16±82.49) had significantly higher serum level of 8-OHdG when compared with control group (53.95±28.25) (P<0.05 respectively). Hypertensive individuals (129.16±82.49) also had significantly higher 8-OHdG level when compared with non-hypertensive with depression (63.31±37.30) (P<0.05). Hypertensive individuals with depression (9.94±7.14) and depressive individuals (8.99±5.84) also had significantly higher F2-Isoprostanes level when compared with control (5.15±1.47) (P<0.05 respectively). There was a moderately strong positive correlation between 8-OHdG level and body mass index in both hypertensive and depressive individuals (r=0.682, P<0.05). Conclusion: The study observed higher 8-OHdG and F2-Isoprostanes in individuals with hypertension with and without clinical depression. In addition, there is evidence that oxidative stress is related to inflammation and endothelial activation in individuals with both conditions leading to disease severity.

Postoperative Brace Prescription Practices for Elective Lumbar Spine Surgery: A Questionnaire-Based Study of Spine Surgeons in Japan.

The efficacy of postoperative braces for degenerative lumbar disorders has long been debated, with conflicting reports regarding the promotion of bone fusion and pain relief. The current aspects of postoperative brace prescriptions have been previously reported in Western countries but not in Asia. This study aimed to elucidate prescription practices in Japan and identify factors influencing prescription decisions. The survey was conducted at a spine group research meeting comprising spine surgeons from multiple institutions. The questionnaire assessed aspects of postoperative brace prescription, including the type, purpose, and duration of usage, categorized by surgical procedures for degenerative lumbar disorders: endoscopic decompression, open surgery decompression, and fusion involving 1 or more than 3 levels. The respondents' backgrounds, scientific knowledge of postoperative braces, nonscientific reasons, and basis for prescription decisions were also investigated. There were 63 valid responses. The overall postoperative brace prescription rate was 83%, with 66% for decompression and 98% for fusion procedures, surpassing the rates reported in Western studies. The primary prescription purpose was to slow down patient activity (83%, double the previously reported rates). Prescription rates for endoscopic and open surgical decompression were significantly correlated with facility attributes and annual number of surgeries. Scientific knowledge of postoperative braces was lacking in 56% of respondents, with scientific evidence being the least frequent decision for brace prescription (14%). Nonscientific reasons influenced the prescription decisions of 84% of participants. The postoperative brace prescription rate among spine surgeons in Japan was significantly higher than that in Western studies, largely due to nonscientific factors such as physician reassurance and the intention to slow down patient activity. Comprehensive, evidence-based guidelines are needed regarding consistent brace usage to optimize patient outcomes. This study highlights the high postoperative brace prescription rates among spine surgeons in Japan, which are significantly influenced by nonscientific factors, such as tradition, physician reassurance, and patient satisfaction, rather than scientific evidence. These findings underscore the need for evidence-based guidelines to improve consistency in postoperative brace usage. The results are particularly relevant in regions with aging populations and a high prevalence of osteoporosis, providing insights for improving postoperative management strategies and patient outcomes in Japan as well as in similar demographic settings globally.

Depression and antidepressant use among Iraqi doctors, an investigative study using beck depression inventory

Introduction: Doctors are more likely to experience depression because they are subjected to more stress at work than members of many other professions. Long hours, heavy workloads, increasing severity and difficulty of the work and ongoing patient interaction with illness and emergencies, high level of accountability, fast shift within healthcare, organizational limitations such as discriminatory practices and intimidation a lack of independence, inadequate assistance, a decrease in job satisfaction, low morale, and an inability to handle personal responsibilities are just some of the stresses that healthcare workers face. Objectives: The present study aims to evaluate the prevalence of depression and antidepressant utilization among Iraqi doctors, an investigative study using the Beck Depression Inventory. Method: This is a cross-sectional study with a convenience sample conducted on Iraq's medical population using a multi-item questionnaire over 6 months (March – September 2022). Beck's Depression Inventory was used, which contains 21 questions. We used this scale to screen for depression based on self-report. The answers were collected by an online questionnaire that was aimed at the medical population. The test link was distributed amongst doctors groups and answers were limited to one response. Results: The results revealed that there was a high prevalence of depression and use of antidepressants among Iraqi doctors Conclusion: Due to the stressful nature of their line of work, doctors have a higher risk of developing depression and are more likely to seek treatment with antidepressants.

2624 Exploring the experience of older people in care homes with the Administration of Oral Medication

Abstract Introduction Residents of care homes for older people experience multi-factorial problems when being given oral medication. A systematic integrated mixed-methods review of the literature revealed that practices of modifying tablets, crushing and mixing with food, in attempts to administer medication, remain widespread internationally. There is a high prevalence of swallowing problems. Care home routines are time pressured, and there are incidences of disempowering practices and language associated with processes of medication administration. The literature presented very little from the residents’ experience, largely representing them as passive recipients in the activity. Objective The aim of this study was to explore the experience of residents of care homes for older people who need help from care staff to take their medication. Its purpose was to answer a single research question, ‘What is the experience of residents of care homes when oral medication is administered?’ Methods Observation of an episode of medication administration and semi-structured interviewing were conducted with eight residents between the ages of 84 and 95 from care homes in Scotland. Data was analysed in accordance with a Gadamerian philosophy of hermeneutics, with a commitment to understanding and representing the participants’ experience. Results Four themes emerged from the data, ‘Being in control/relinquishing control’, ‘Being comfortable in routine’, ‘Trusting’, and ‘Swallowing’. Interpretive exploration of these themes revealed the importance of facilitating individual routines when taking medication, and that a trusting relationship with staff and with the medication can be an indicator of vulnerability. The risks to autonomy in relation to taking medication, and an imbalance of power for care home residents who are given medication to take emerged as an overarching concept. Conclusion Recommendations focus on the potential for empowering practices in relation to taking medication, both for those who provide care, and for those who prescribe medication.

The behaviour of TB patients in East Lombok through a health belief model approach

BackgroundTuberculosis (TB) is a global health problem, including in Indonesia, with East Lombok as a high prevalence region. Although control programmes have been implemented, TB cases remain high. Patient behaviours that are less supportive of treatment, such as non-compliance and social stigma, pose a challenge to TB control efforts in this area. This study aims to explore the behaviour of people with tuberculosis (TB) in East Lombok using the Health Belief Model (HBM) approach.Participants and procedureThe method applied was a cross-sectional design, involving 112 respondents with TB who were registered at the Puskesmas. Data were collected through interviews using a questionnaire measuring components of HBM, including perceived vulnerability, severity, benefits, barriers, cues to action, and self-efficacy.ResultsThe analysis showed that perceived vulnerability (p = 0.022), perceived benefits (p = 0.006), perceived barriers (p = 0.045), cues to action (p = 0.004), and self-efficacy (p = 0.009) had a significant influence on the health behaviour of TB patients. Patients with high perceived vulnerability were 1.617 times more likely to adhere to treatment, while those with high perceived barriers were 31.6% less likely to adhere. Social support from family and health professionals also played an important role in improving adherence.ConclusionsFrom this study emphasise the need for interventions designed to increase positive perceptions and reduce perceived barriers, as well as consider the local social and cultural context to improve TB treatment adherence in East Lombok.

P-1762. Assessing the Clinical Impact of Carbapenem Pre-authorization in a High ESBL Prevalence Setting: A Focus on the Middle East

Abstract Background Hospitals commonly employ preauthorization as a strategy to optimize carbapenems utilization. However, there is paucity of data regarding carbapenem restriction in environments with a high prevalence of extended-spectrum beta-lactamase (ESBL) organisms. This study aims to assess the impact of implementing a preauthorization policy for carbapenems on patient clinical outcomes and appropriateness of use. Methods An observational retrospective cohort study comparing data collected for patients from pre-restriction period between December 2021 and May 2022, and post-restriction period between June 2022 and December 2023 who were prescribed carbapenems including ertapenem or meropenem. The restriction policy was implemented in June 2022. We included adult patients ( > 18 years old) with active infections in acute care units (ACU). Results A total of 244 patient were included in the study with 131 in pre implementation period and 113 in post implementation period. The appropriate indication of carbapenems use was significantly higher in the post-restriction group 69.9% (79) vs the pre-restriction group 55.7% (73) (P=0.025). No significant difference was found between the two groups in terms of appropriateness of treatment duration (P=0.425). Antibiotic de-escalation was significantly higher in the pre-restriction group 60.3% (79) vs the post-restriction group 35.4% (40) (P< 0.001). The 30-day all cause mortality was significantly lower in the post-restriction group 7.1% (8) vs the pre-restriction group 19.8% (26) (P=0.005). Length of hospital stay (LOS) was significantly lower in the post-restriction group compared to the pre-restriction group; 6 vs 9 days (P=0.002). Furthermore, the 30-day readmission rate was 32.1% (42) of patients in the pre-restriction group vs 20.4% (23) in the post-restriction group (P=0.043). Table 2 Conclusion Despite ESBL high prevalence, preauthorization policy for carbapenems prescription showed efficacy to optimize their use in terms of, both, appropriateness, and duration. Lower 30-day mortality, LOS and readmissions within ACU patients also confirmed better clinical outcomes. Larger studies are needed to corroborate these findings. Disclosures All Authors: No reported disclosures

P-291. Whole genome sequencing (WGS) demonstrates high relatedness between carbapenemase-producing Klebsiella pneumoniae isolates cultured from paired rectal swab and blood specimens among hospitalized patients in Greece

Abstract Background Intestinal colonization with carbapenem-resistant organisms (CRO) may be considered to inform empiric antibiotic selection for symptomatic infection. However, it is unclear how often gut colonizing CRE isolates are related to bloodstream isolates in hospitalized patients with bacteremia, especially in areas with high CRO prevalence. Minimum spanning tree of isolate relatedness Isolates and corresponding patient number (P1-P6) and rectal (R) or blood (B) specimen are noted within circles and allelic differences are numerated on linking lines between the circles. Group 1 and 3 isolates are possibly related to each other. Created with BioRender.com. Methods Patients with paired K. pneumoniae carbapenemase (KPC)-producing K. pneumoniae isolates cultured from surveillance rectal specimens and clinically collected blood specimens collected within 1-8 days of each other between 2019-2023 were identified at 3 Greek hospitals. Isolates were frozen and shipped to a reference laboratory in the U.S for whole genome sequencing (WGS) using Illumina MiSeq. Assembly and core genome multilocus sequence typing (cgMLST) analysis were performed with Ridom SeqSphere+ software. Isolate relatedness was based on the total number of allelic differences between each isolate: < 15, related; 16-50, possibly related; ≥ 51, unrelated. Results One hundred eight paired isolates were identified from 54 unique patients; 6 pairs and 12 total isolates underwent cgMLST. In 5 of 6 pairs (83%), the rectal isolate was collected prior to the bloodstream isolate. Rectal and bloodstream isolates were related to one another in 5 of 6 (83%) pairs and were unrelated in 1 pair. Two pairs collected from 2 distinct patients admitted to the same intensive care unit (patients 2 and 3, Figure) were possibly related (16-50 allelic differences) to each other. Conclusion In this pilot evaluation conducted in a setting of high CRO prevalence, KPC-producing K. pneumoniae isolated from paired rectal and blood specimens from individual patients were often related to each other, suggesting that intestinal colonization by this organism could inform empiric antibiotic treatment for bacteremia. Two patients from the same hospital unit had isolates that were possibly related, suggesting within hospital transmission. WGS is a powerful tool that can inform clinical and infection control practices. WGS of the remaining K. pneumoniae pairs and additional Acinetobacter baumannii pairs is ongoing. Disclosures Robin Patel, MD, I already disclosed so please pull from disclosure for other abstracts: Advisor/Consultant|I already disclosed so please pull from disclosure for other abstracts: Grant/Research Support|I already disclosed so please pull from disclosure for other abstracts: Honoraria

Exploring drivers and prevention strategies for sexual violence among adolescent girls and young women in Kicukiro, Rwanda

IntroductionSexual violence against adolescent girls and young women (AGYW) is a pervasive issue globally, with particularly high prevalence in sub-Saharan Africa. This study explores the drivers and prevention strategies for sexual violence among AGYW in Kicukiro, Rwanda.MethodsA descriptive exploratory design guided by the socioecological model and feminist standpoint theory was employed. In-depth interviews were conducted with 13 AGYW participating in a mentorship program and 5 male community members. Data was analyzed using thematic analysis to identify key drivers and potential prevention strategies.ResultsFour themes emerged: (1) empowering mentorship programs, (2) tiered drivers of sexual violence, (3) optimizing violence-mitigating resources, and (4) interference with judicial processes. Key drivers of sexual violence included substance use, transactional sexual relationships, inadequate family protection, entrenched gender stereotypes, and limited legal literacy.ConclusionFindings underscore the need for multifaceted interventions that address systemic and cultural barriers, strengthen legal frameworks, and expand community-based programs. Addressing sexual violence requires a holistic approach, integrating empowerment initiatives, robust community engagement, and legal reforms to create safer environments for AGYW. The mentorship program's success suggests scalability across other settings.

P-1365. Cefazolin Inoculum Effect in Methicillin Susceptible Staphylococcus aureus Recovered From the Nasal Cavity of Patients in Intensive Care Units in Colombia

Abstract Background Cefazolin is an alternative for the treatment of MSSA infections and first choice option for surgical prophylaxis. The cefazolin inoculum effect (CzIE), the increase in the MIC at high bacterial inocula is associated to therapeutic failures and increased mortality in deep-seated MSSA infections. The prevalence of the CzIE among nasal colonizing MSSA from ICU patients is currently unknown. The aim of this study was to investigate the CzIE in nasal MSSA recovered from patients admitted to ICUs in Colombia. Methods We evaluated 33 MSSA isolates recovered from nasal swabs of 29 patients admitted to ICU at 6 high-complexity Colombian hospitals (2019-2023). CFZ MIC using gold standard broth microdilution at high inoculum was done. The modified nitrocefin-based rapid test to identify the CzIE was performed, and diagnostic performance metrics were calculated. Whole genome sequencing was used to characterize BlaZ types and allotypes, Clonal Complexes CC and Accessory Gene Regulator (Agr) types. Results The CzIE was identified in 54.5% of nasal MSSA isolates. A high prevalence of nasal colonization with MSSA exhibiting the CzIE was detected (59%, 17 patients). Among 18 MSSA with the CzIE, type A BlaZ was the predominant β-lactamase (61%) and BlaZ-2 was the most common allotype (50%). Whereas among 15 MSSA lacking the CzIE, BlaZ type C was the most frequent (47%) and BlaZ-1 was the allotype predominant (40%). A high diversity of genetic lineages with eight CC was detected among the 33 MSSA. CC30 was the predominant lineage in MSSA displaying the CzIE (44%), while CC5 and CC30 (27% each one) were the most common in MSSA without the CzIE. Agr-III and Agr-I were predominant Agr types in 56% and 47% of MSSA with the CzIE and lacking the CzIE, respectively. Compared to the gold standard the modified rapid test identified nasal MSSA isolates showing the CzIE with a sensitivity of 100%, specificity of 93% and an overall accuracy of 97%. Conclusion We found an unexpected high prevalence (59%) of ICU patients colonized by MSSA exhibiting the CzIE, showing similar genetic features to MSSA with CzIE from invasive infections. Furthermore, our findings suggest that the nasal cavity of ICU patients may represent a reservoir for the dissemination of MSSA showing the CzIE, highlighting the importance of screening and surveillance. Disclosures All Authors: No reported disclosures

Barriers and facilitators of integrated hepatitis B, C, and HIV screening among pregnant mothers and newborns attending maternal and newborn clinics in Koboko District, Uganda: a qualitative inquiry of providers’ perspective

BackgroundHIV and HBV remain significant public health challenges characterized by high prevalence, morbidity, and mortality, especially among women of reproductive age in Uganda. Patients with HBV do not receive routine counselling and education, and there are limited resources for laboratory investigation coupled with a high loss to follow-up. This study set out to assess barriers and facilitators of integrated viral hepatitis B C and HIV care model to optimize screening uptake among mothers and newborns at health facilities in Koboko District, west Nile sub-region, Uganda.MethodsAn exploratory qualitative descriptive study that used an inducted and deductive thematic analysis approach was used at Health Centre III (HC IIIs) level in an institutional setting. The study participants (Key Informants) were both clinical and administrative health workers involved in the delivery of Hepatitis B, C, and HIV services. Data was audio recorded using a recording device and then transcribed after all interviews were conducted. Data was then analyzed using thematic analysis.ResultsThe facilitators of integration were established to be; High burden of hepatitis B infection, team spirit by the health workers, reduced long waiting time, availability of medical products such as HBV and HCV test kits, integration of HBV and HIV into Health Management Information System (HMIS) 2 data collection tools and availability of support from implementing partners such as Infectious Disease Institute which offered mentorship and training on integration and support supervision. While the barriers included; Knowledge gaps among healthcare workers, limited Health education, Language barriers that made communication between health workers and mothers difficult, constant stock out of test HBV kits, no supplies for HCV kits, and inadequate staffing.ConclusionThe need to reduce ‘lost opportunity’ by pregnant mothers in accessing HBV, HVC, and HIV at one point of care underscores the necessity of integrated care. Strong team spirit, reducing patient waiting times, and enhancing the incorporation of HBV and HIV into the HMIS2 form are essential steps. Additionally, support from implementing partners like IDI, is pivotal. Several barriers impede effective integration. Addressing knowledge gaps among healthcare workers, providing transportation, minimizing language barriers during health education, addressing insufficient human resources, and preventing frequent stock-outs of test kits for HBV and HCV are crucial to enhancing the effectiveness and efficiency of integration.

P-1466. Prevalence of Antimicrobial Resistance among Invasive Escherichia coli Disease Patients in the United States

Abstract Background Invasive E. coli disease (IED) poses a substantial public health concern globally. Anti-microbial resistance (AMR) displayed by some E. coli strains further limits the treatment options. We sought to identify and synthesize evidence on prevalence of AMR among adult IED patients in the United States. Figure 1. PRISMA flowchart Methods A systematic literature review was conducted in EMBASE, MEDLINE, and MEDLINE In-Process databases to identify studies of prevalence of AMR E. coli among adult IED patients, published January. 2010–September. 2023. Figure 2. Antimicrobial resistance of E. coli isolates to antibiotics across patient groups Results Seventeen publications met eligibility criteria and were included (Fig. 1). The review reports study-specific prevalence from these included studies. Variation in AMR was observed across study designs (retrospective: 12; cross-sectional: 1; prospective: 4) with varying population characteristics, and 19-year time period (2002–2020) (Fig. 2). Four studies had high prevalence (≥50%) of ampicillin-resistant E. coli. Extended-spectrum cephalosporin resistance (ESC-R) increased over time in two studies (2003–2007: 4.1% & 2008–2013: 7.9% among veterans with bacteremia; and 2009: 5.4% & 2016: 12.9% for IED-related visits). One study reported higher prevalence of E. coli AMR among older as opposed to younger patients for ESC-R (18-49 years: 6%; > 65 years: 10%) and FQ-R (18-49 years: 18%; > 65 years: 31%). Similar trends were observed for E. coli multidrug resistance (≤69 years: 10% vs > 69 years: 19%) in one study. FQ/ESC co-resistance increased over time, from 11% in 2013 to 14% in 2017 (p < .0001). In one study, AMR rates were lower during Summer for amoxicillin/clavulanic acid (17% vs 29%; p=.02), cefazolin (6% vs 19%; p < .001), trimethoprim/sulfamethoxazole (9% vs 27%; p < .001) and ceftriaxone (2% vs 6%; p=.04). Prevalence of ampicillin resistance was not seasonal. Regional variation in AMR was observed, with FQ-R varying between 10.5% in Denver Health Clinic to 28.9% in Cleveland Clinic. Prevalence of FQ/ESC co-resistance varied geographically; highest prevalence ( > 13%) occurred in several regions. Conclusion Prevalence of AMR E. coli in the US increased overall, in certain high-risk groups, over time, with also regional and seasonal variation. There is an unmet need for additional data on AMR prevalence in IED, and a critical need for preventive measures. Disclosures Sanjukta Basu, Ph.D, Amaris Consulting: Advisor/Consultant Ziyan (Jenny) Wei, Msc, Amaris Consulting: Advisor/Consultant Atara Laor, BSc., Amaris Consulting: Advisor/Consultant Liga Bennetts, PhD, Amaris Consulting: Advisor/Consultant Antoine El Khoury, PhD, Janssen Global Services: Advisor/Consultant|Janssen Global Services, LLC: Employee of Janssen Global Services, LLC Nina Ahmad, MD, Janssen Global Services, LLC: Employee of Janssen Global Services, LLC Jeroen Geurtsen, PhD, Janssen Vaccines & Prevention BV: Advisor/Consultant|Janssen Vaccines & Prevention BV: Employee of Janssen Vaccines & Prevention BV Maureen P. Neary, PhD, MS, Janssen Global Services, LLC: Employee of Janssen Global Services, LLC

Diabetic Peripheral Neuropathy: Navigating Controversies and Pioneering Advances

This review examines Diabetic Peripheral Neuropathy (DPN), a significant complication of diabetes affecting nearly half of diabetic patients. DPN is crucial to understand due to its high prevalence and profound impact on patients’ quality of life, causing pain, sensory loss, motor dysfunction, and heightened risks of foot ulcers and amputations. As a leading cause of disability, grasping DPN’s pathophysiology, early diagnosis, and treatment options are essential for alleviating its burden. Key facets of DPN include its complex pathophysiology stemming from chronic hyperglycemia, oxidative stress, inflammation, and vascular problems that damage nerves. The review highlights the rising rates of diabetes and DPN in regions like Saudi Arabia, noting that factors such as poor glycemic control, prolonged diabetes duration, and comorbidities like hypertension significantly contribute to DPN progression. Diagnostic challenges are also addressed; traditional nerve conduction studies are gold standards yet limited in detecting early-stage neuropathy, especially small-fiber damage. Emerging methods, like skin biopsy and corneal confocal microscopy, show promise for earlier detection. Treatment mainly focuses on glycemic control and pain management without reversing nerve damage. Innovative therapies targeting DPN mechanisms include antioxidant treatments, anti-inflammatory agents, and phytomedicine, which utilizes bioactive compounds for their neuroprotective effects. The review concludes by stressing the need for ongoing research into DPN's molecular mechanisms and the development of personalized medicine approaches, which could significantly enhance patient outcomes.Keywords: Diabetic Peripheral Neuropathy; DPN induced disability; DPN Pathophysiology; DPN treatment; DPN controversies