Documented History Research Articles

Abstract TP333: Racial disparities in the management of newly diagnosed diabetes mellitus in Acute Ischemic Stroke

Introduction: Diabetes Mellitus (DM) is a significant risk factor for acute ischemic stroke (AIS) and the incidence of newly diagnosed DM in AIS is higher in certain ethnicities. We aim to examine prescribing patterns of anti-hyperglycemic medications (anti-DM) in hospitalized AIS patients with newly diagnosed with DM. We also examine ethnic disparities in prescribing patterns amongst Hispanic and Non-Hispanic patients. Methods: We retrospectively examined prospectively collected data from an IRB-approved stroke registry at two academic Comprehensive Stroke Centers (CSCs). We included patients with a new diagnosis of AIS with no documented history of DM between 1/1/2013 and 6/30/2024. We examined baseline demographics, comorbidities, ethnicity, insurance status, acute stroke treatment, NIHSS, A1c, blood glucose and their association with anti-DM prescribing patterns. We also evaluated prescribing differences in Hispanic versus Non-Hispanic groups. Data was analyzed using correlation matrix, Pearson’s and Spearman’s correlation coefficients, and Chi-squared and t test, as appropriate. Results: A total of 2870 AIS patients were identified in the study period. Of these, 20.1% (n=578) were Hispanic, 42.5% (n=1219) were female, and 47.8% (n=1373) had Medicare as their payment source. New diagnosis of DM occurred in 6.0% (n=52/863), and 52.0% (n=27) were prescribed anti-DM at discharge. Overall, only a history of previous stroke was independently associated with prescribing anti-DM on discharge (p=0.03). Of patients with new DM, Hgb A1c (p=0.01) and blood glucose (p=0.006) were significantly associated with prescribing anti-DM on discharge. Patients with Medicaid (p=0.04) and no previous medical history (p=0.02) were less likely to receive anti-DM. Mean Hgb A1c was higher in patients that were prescribed anti-DM vs not prescribed anti-DM (8.82 vs. 7.13; p=0.007, 95% CI: -2.87 to -0.52). There was no difference in prescribing anti-DM in Hispanic vs. Non-Hispanic groups. Conclusions: In this study at two academic CSCs, there was no significant difference in prescribing anti-DM medications in Hispanic vs. Non-Hispanic groups, but insurance status may be associated with prescribing patterns. The provision of systematic care helped reduce healthcare disparity in AIS patients with newly diagnosed DM.

P-2242. Tick-borne Illness Seroprevalence and Meat Allergy (Alpha-Gal Syndrome): A Series of 15 Cases in Long Island, NY

Abstract Background Alpha-gal syndrome (AGS) is a described meat allergy to an oligosaccharide, galactose-alpha-1,3-galactose (alpha-gal), present on mammalian cells and appears to be associated with the Amblyomma Americanum or lone star tick (LST) bite. Suffolk county, NY has an alarmingly high number of cases of AGS. Immunoglobulin E (IgE)-mediated allergic symptomatology has been reported following ingestion of mammalian meat and its by-products though with variable allergy manifestation. The goal of this pilot study was to identify characteristics and clinical manifestations in a cohort of patients with AGS and try to identify possible risk factors for severe manifestations.Table 1:Demographics, atopy history, alpha-gal IgE, serum total IgE and ratios, tick bite history and tick type, onset of symptoms after tick bite, tick-borne infection in patients identified with AGS, N=15.AGS, Alpha-gal syndrome; LST, Lone star tick; IgE, Immunoglobulin E Methods A retrospective study was performed to identify adult patients referred to Allergy Clinic at the Stony Brook Hospital between 2018 and 2023 with symptoms and laboratory testing consistent with AGS. Demographics, atopy history, alpha-gal IgE and serum total IgE ratios, allergy manifestation, tick type and tick-borne infections were obtained from chart review.Figure 1:Comparison of mean alpha-gal IgE/serum total IgE ratios in patients with anaphylaxis (N=10) and non-anaphylactic (N=5) manifestations to meat consumption. The mean alpha-gal IgE/serum total IgE ratio in the anaphylaxis group was 18.9% and the mean alpha-gal IgE/serum total IgE ratio in the non-anaphylaxis group was 12.3%. There was no statistically significant difference in mean alpha-gal IgE/serum total IgE ratio between the anaphylaxis and non-anaphylaxis groups (p = 0.5). Results We identified 15 adults (mean age: 51 years; male 66.7%; 93% White), with clinical presentation consistent with AGS. Out of the 15 subjects, 9 had history of atopy (60%). All patients reported a history of tick bite, of whom 7 recognized as LST (46.7%). One third of the cases were tested for tick-borne co-infections (n= 10). One met CDC criteria for Lyme disease and 1 had Babesiosis. All patients had elevated alpha-gal IgE/serum total IgE ratio (mean 16.8%, range 2.1-71.4); anaphylaxis group mean ratio was 18.9% versus 12.3% in non-anaphylaxis group (p=0.5). Patients had variability in severity of allergy manifestation: 10 (66.7%) with anaphylaxis, 6 (40%) with skin manifestation, 1 (6.7%) with gastrointestinal symptoms.Figure 2. Overview of allergy manifestation reported by patients; anaphylaxis as per AAAAI criteria, N=15.Gastrointestinal; Skin manifestations i.e. urticaria, angioedema, hives; Other i.e itchy throat, eye swelling; AAAA,: American Academy of Allergy, Asthma & Immunology. Conclusion Observational data suggests that alpha-gal IgE/total IgE ratio may not be related to disease severity, but the sample size was small. Although, most patients in this cohort did not have a documented history of a previous tick-borne illness despite tick exposure, it is important for Infectious Diseases physicians to be aware of AGS, as many patients are referred after tick bites. Further research regarding risk factors for severe disease is warranted to recognize those at greatest risk to prompt more rapid allergy evaluation. Disclosures All Authors: No reported disclosures

P-1822. Management of Patients with a History of Penicillin Allergy: A Retrospective Observational Study from Saudi Arabia

Abstract Background It has been estimated that 8 to 25% of populations studied globally are labeled penicillin-allergic. However, almost 90% of these patients may not have a true allergy upon work-up, which led prescribers to substitute β-lactams unnecessarily with other broadspectrum antibiotics. Therefore, the aim of this study was to describe how patients with a history of penicillin allergy are treated for infectious diseases, and determine the cost associated with alternative antibiotics.Table I.Baseline characteristics of patients with a documented history of penicillin allergy. Methods A retrospective observational study conducted in a tertiary-care teaching hospital in Riyadh, Saudi Arabia. Approval was obtained from the Institutional Review Board, and electronic health records (EHRs) of patients were included if they were 18 years old and older, labeled to have penicillin allergy, and were admitted in medical wards or treated as outpatients. Results Among the 235 included patients, the type and severity of allergy reactions were not reported in the majority of patients 200 (85%) and were described in only 35 (15%) patients, which 27 (12%) of them had IgE-mediated allergic reactions (angioedema, anaphylaxis, bronchospasm, and urticaria). None of the cases were referred to an immunologist. Most common antibiotic indications included surgical prophylaxis 81 (33%), followed by respiratory 64 (27%) and gastrointestinal infections 40 (17%). For patients with documented penicillin allergy, macrolides were the most used alternative antibiotics followed by clindamycin, cephalosporins, and fluroquinolones in 63 (26%), 56 (24%), 50 (21%), and 30 (12%) patients, respectively. Conclusion This study reveals that mislabeling penicillin allergies in Riyadh's tertiary hospital leads to using less effective antibiotics, increasing adverse reactions, infections, and healthcare costs. It emphasizes improving allergy verification to enhance antibiotic use and reduce expenditures. Disclosures All Authors: No reported disclosures

P-2351. Assumptions and Realities: Unraveling Varicella Zoster Virus Immunity in Unvaccinated Populations

Abstract Background In countries without universal vaccination for chickenpox in childhood, a very high seroprevalence for varicella zoster virus (VZV) IgG in adults is often assumed. Consequently, some suggest vaccinating at-risk adults against herpes zoster, even if they lack a documented history of chickenpox, under the assumption of immunity. However, this presumption may not accurately reflect today's epidemiological landscape. Neglecting the risk of primary infection post-childhood could lead to severe outcomes in vulnerable adults, pregnant patients, and increase the likelihood of exposure for caregivers, potentially resulting in secondary transmission. Graphic 1. Sample distribution by gender and age group. Methods A retrospective study was conducted on VZV serology among individuals aged 11 and above, from February 2014 to March 2024, who were unvaccinated and lacked known chickenpox history, within a Portuguese hospital. Graphic 2. Varicella Zoster Virus IgG seroprevalence by gender and age group. Results Analysis of 613 patients (68% women, median age 39 years), all with high VZV infection risk due to comorbidities or immunosuppression, revealed an 83.6% VZV IgG positivity rate, increasing with age. Among working age individuals aged 21-60,12% were seronegative for VZV and 19.2% of women of childbearing age 16-40 showed no immunity. Conclusion Although common, the presence of antibodies against VZV is not universal after childhood in unvaccinated populations. Vaccination for herpes zoster is not indicated for the prevention of primary infection, so assuming immunity may fail to prevent it in a population at risk. Prevention of chickenpox relies on specific vaccination, or the use of immunoglobulin when the former is contraindicated, which implies recognition of this susceptibility. Serology remains a useful tool, especially for at-risk individuals and caregivers, and should be considered in women of reproductive age and immunocompromised individuals. Disclosures All Authors: No reported disclosures

P-1377. Rates of Screening of Sexually Transmitted Infections in Male Military Trainees who Present with Dysuria

Abstract Background A high burden of sexually transmitted infections (STIs) exists among trainees entering United States Air Force Basic Military Training (BMT). While women entering training are universally screened for STIs, men, who account for the majority of trainees, are rarely tested. The rates of testing among symptomatic men who present with dysuria during BMT are unknown. Furthermore, rates of follow-up testing among male service members who present with dysuria during BMT are unknown. Demographics of 82 men diagnosed with dysuria or urinary tract infection during BMT, 2019-2023 Methods All male basic trainees who received a diagnostic code of dysuria or urinary tract infection between 2019-2023 were retrospectively analyzed to evaluate their diagnostic workup and follow-up over the three years after diagnosis. To assess the impact of presumptive STI therapy on subsequent follow-up, patients who received empiric treatment for STIs were compared to those who did not, with a focus on evaluating future STI testing rates and incidence. Nominal variables were compared using Fisher’s Exact Test while continuous variables were analyzed using the Mann-Whitney U test. Diagnostic Workup and follow-up for male basic trainees diagnosed with dysuria or urinary tract infection compared by receipt of empiric antibiotics for sexually transmitted infections Results Of the 102,382 men who entered BMT during the study period, 82 (0.08%) were diagnosed with dysuria or a urinary tract infection during training. Dysuria accounted for the majority of diagnoses (79%) (Table 1). 70% of symptomatic men were tested for gonorrhea and chlamydia (GC/CT). Among those tested, 23% had a positive GC/CT test. Only 25 (30%) received any additional follow-up STI testing in their next 3 years in the military, with a positivity rate of 12%. Those who were empirically treated for STIs were more likely to have a documented sexual history (80% vs. 45%, p=0.004), receive a GC/CT test (96% vs. 57%, p=0.002), and have additional STI testing in the 3 years after diagnosis (46% vs. 23%, p=0.04) (Table 2). Conclusion There is limited data on the diagnostic workup and follow-up of men presenting with symptoms of dysuria during BMT. This study found that despite a high positivity rate for STIs in symptomatic men, sexual history documentation and STI screening were inconsistent in this population. As males account for the vast majority of basic trainees, efforts to accurately capture the burden of STIs are imperative to limit the impact on military populations. Disclosures All Authors: No reported disclosures

P-1392. Sexual History Documentation Among Veterans with a Sexually Transmitted Infection (STI)

Abstract Background Sexual health discussions in routine healthcare encounters can help identify sexually transmitted infection (STI) risk. We measured the prevalence of sexual history completion in Veterans with an STI and association between STI testing and offer of HIV pre-exposure prophylaxis (PrEP).Table 1.Summaries of levels of sexual history and STI tests ordered by sample sites (N=285)a Pearson Chi-Square Test of Independence Methods We conducted a retrospective review of a Veteran cohort with a STI documented on a clinical encounter between December 2020-December 2021 at five Veterans Affairs (VA) facilities in the southern United States. Primary care, emergency room, and specialty clinic visits were included, and infectious disease clinic visits excluded. STI was defined as a positive result for chlamydia, gonorrhea, and/or syphilis. The CDC’s definition of an appropriate sexual history utilizing the “5 Ps” (partners, practices, protection, pregnancy, and past STIs) was used as the reference standard. Level of sexual history taken was categorized as none (0 Ps), minimal (1-2 Ps), moderate (3 Ps), or full (4-5 Ps for a male, 5 Ps for female). Chi-square tests and logistic regression were used for analyses.Table 2.Associations of demographic characteristics with extent of sexual history taken during the encounter and HIV testing controlling for VA site. (N=285)a Multinomial logistic regression, log likelihood testb p-value of relative risk ratio (RRR), adjusted for study sitec Number of sites included = 283d Other included American-Indian/Alaska Native (1), Asian(1), Hispanic/Latino(6), Native Hawaiian/Pacific Islander(2), Multiple races(6) Results We included 285 records in the review. A sexual history was not conducted (0 Ps) in 43% (122/285) of encounters. There were statistically significant differences in obtaining sexual history and number of STI tests ordered across VA facilities (p< .001 and .006, respectively). No evidence of documentation occurred for sexual practices (93%), history of STIs (78%), and sexual partners (67%). Males were less likely to receive a full sexual health history (p=.01) and HIV testing (53 vs 72%, p=.007) compared to females. Only 4 (1%) Veterans were offered PrEP. After controlling for facility, a statistically significant association between the extent of documented sexual history and STI tests ordered (p=.019). No significant associations were observed between extent of history or HIV testing for Veterans’ age, race, or provider type.Table 3.Associations of extent of sexual health history taken and tests ordered after controlling for VA site. (N=285)a Multinomial logistic regression, log likelihood testb p-value of relative risk ratio (RRR), adjusted for study sitec Other included American-Indian /Alaska Native1), Asian (1), Hispanic/Latino (6), Native Hawaiian/Pacific Islander (2), Multiple races (6) Conclusion Incomplete assessment of sexual history was common in outpatient visits and varied by facility for Veterans with a STI. There was a relationship between increasing level of sexual history and number of STI tests ordered. Future work includes identifying systematic interventions to support standardization of sexual history taking. Disclosures All Authors: No reported disclosures

P-2340. Single-Center Inpatient Measles Analysis During a Congregate Setting Outbreak; Comparing Vaccine History between Measles Positive and Negative Cohorts

Abstract Background Chicago’s 2024 measles outbreak affected many new arrivals living in congregate settings with unknown or poorly documented vaccination history. Despite post-exposure prophylaxis provided at shelters, many families still developed measles. Frequency of measles exposure in congregate settings certainly plays a role in infection, but vaccination history and source should also be evaluated.Table.Characteristics of Measles Patients Under Investigation (PUI) stratified by PCR result * One case received IGIM and five received 1 MMR post-exposure prophylaxis dose given at the shelter between 10—30 days prior to rash onset (median: 11 days), ∞ including vaccine strain case, # n=7, ^n=10, ^^Countries of origin: Venezuela, Peru, Ecuador Methods Data was abstracted from 12 measles PCR positive and 13 measles PCR negative patient charts from 3/10/24—4/23/24 including measles vaccination history, IgG antibody titers, concurrent infections and measles complications. Relative risks and p-values were calculated using MedCalc Software Ltd (Version 22.023). Results From 3/10/24—4/23/24, 12 measles PCR positive patients were admitted with median age 16 years (range 13 months—43 years) including 3 parent-child dyads; serotyping through the Illinois Department of Public Health reported one vaccine strain and 11 wild type cases. Of the 11 wild type measles cases, 3 (27%) had concurrent infections; (2 of 3 group A streptococcus culture positive (oropharynx); 1 of 3 was rhinovirus/enterovirus positive (nasopharyngeal PCR); 8 of 11 (73%) had at least 1 measles complication including dehydration (4), acute otitis media (3), pneumonia (1), and hepatitis (2). Comparing vaccine history between measles negative and positive cohorts, there was a non-significant trend towards history of international vaccination in the measles positive cohort. History of current congregate setting residence and exposure to a known measles case were significantly associated with measles positivity with a relative risk of 2.2. Conclusion Inpatient data is lacking during the 2024 international measles surge and new arrivals' vaccination history documentation is inconsistent. A trend towards international measles vaccine receipt in a measles positive cohort highlights the importance of US public health efforts to offer MMR vaccination to new arrivals. Limitations of this report include small cohort sizes and recall bias. Additional data is needed to describe the impact of improper vaccine storage and handling on vaccine effectiveness in the current international measles epidemic. Disclosures All Authors: No reported disclosures

Lubelskie Centrum Dokumentacji Historii Sportu, czyli o sposobie pielęgnowania dziejów lokalnego sportu

The raising interest in local history and the almost universal belief that its important component is the history of sports, become a reason to reflect on the “infrastructure” of research conducted in this area. This issue includes, e.g., the creation of specialized archives and libraries. Models as to methods of reducing the discomfort of research can be provided, e.g., by the Museum of Sports and Tourism in Warsaw, a sort of central institution dealing with the history of sports. On a small scale and at no cost, while collecting its own experience, local sports are also being nurtured by the Lublin Sports History Documentation Center. This is a unique research project successfully conducted at the Institute of History of the Maria Curie-Skłodowska University (Lublin) since 2013. The Center is at once a publishing house, a virtual archive, a library and, finally, a substitute for a sports periodical. Thanks to its openness to the outside world, the Center unifies and integrates the circles of professional and non-professional researchers of the history of local sports.

Background characteristics and neuropathological findings of medico-legal autopsy cases with acute head injury and chronic alcohol use

Chronic alcohol use is often associated with traumatic brain injury (TBI). This study aimed to compare background characteristics, injury circumstances, primary head injuries, and secondary brain injuries among TBI cases with and without a documented history of chronic alcohol use. The sample comprised neuropathologically examined medico-legal autopsy cases with acute head injuries from Helsinki, Finland, over the years 2016-2022. Data on chronic excessive alcohol use were collected from medical records and police files; other background and circumstantial data were collected from medical records, police files, and cause-of-death investigation documents; and data on primary head injuries and secondary brain injuries were collected from autopsy and neuropathology reports. The dataset comprised 47 cases, of whom 19 had a history of chronic alcohol use (40.4%). Assault was the most common circumstance of injury among chronic alcohol users (47.4%) while falls prevailed among control cases (32.1%); unknown circumstances were common among both groups. There were no statistically significant differences in the prevalence of primary head injuries or postinjury survival between the groups. As for secondary brain injuries, hypoxic-ischaemic neuronal injury was significantly more common among chronic alcohol users in the frontal cortex (84.2% vs. 28.6%), parietal cortex (84.2% vs. 32.1%), hippocampus (63.2% vs. 25.0%), and lenticular nucleus (73.7% vs. 21.4%). Our findings suggest that chronic alcohol users may not necessarily have more diverse or complex primary injuries, but they may have more extensive secondary injuries. Further research should aim to explore the potential aetiology of hypoxic-ischaemic neuronal injury among chronic alcohol users.

Results of one-year follow-up of patients with severe myocarditis associated with COVID-19 on glucocorticoid therapy

The aim of the study – to investigate the effectiveness and safety of glucocorticoid therapy in patients with severe myocarditis associated with COVID-19.Materials and methods. The results are based on data obtained from 72 patients with severe acute myocarditis (AM) and heart failure (HF) with reduced left ventricular ejection fraction (LVEF ≤ 40 %). Patients were divided into two groups: the group 1 included 34 patients with AM, who had a documented history of coronavirus disease ≤ 3 months before the onset of clinical symptoms of AM; the group 2 consisted of 38 patients with AM, who had no history of coronavirus disease. All patients received optimal therapy for heart failure during all period of follow-up and immunosuppressive therapy with glucocorticoids (GKs) within first 6 months from the onset of AM. Patients underwent for echocardiography with speckle tracking and cardiac magnetic resonance (CMR). The studies were conducted three times: in the first month from the onset of clinical symptoms of myocarditis, after 6 months, and after 12 months of observation.Results and discussion. After 6 months of follow-up, improvements in the structural and functional state of the heart were observed in both groups, with group 1 showing greater increases in LVEF and LGSS by 13.1 % and 22.2 %, respectively (p<0.05). Additionally, group 1 exhibited a reduction in the number of LV segments affected by inflammatory changes and the total number of damaged segments by 28.4 % and 18.3 %, respectively, compared to group 2 (p<0.05–0.001). After 12 months results of CMR demonstrated significantly less myocardial damage in group 1 compared to group 2: the total number of LV segments affected by inflammation and/or fibrosis was 39.0 % lower (p<0.001). The most common complications of GKs therapy after 6 months were obesity (13.88 %) and leukocytosis (12.50 %), while hypokalemia occurred in 6.94 % of cases. Complications such as arterial hypertension, hyperglycemia, functional hypercortisolism, and myalgia were recorded in 4.16 % of cases. After 12 months, a significant reduction or complete resolution of GC-associated complications was observed in most patients: only 7 cases (9.72 %) of pathology associated with GC therapy were recorded.Conclusions. In patients with acute severe myocarditis with a history of coronavirus disease, glucocorticoid therapy demonstrated greater efficacy in improving the structural and functional state of the heart after 6 months of follow-up compared to patients without a history of COVID-19. The use of glucocorticoids in patients with severe myocarditis was associated with the development of complications in more than a half of patients within the first 6 months of follow-up, while after 12 months, there was a significant reduction in their frequency or their complete regression. During the 12-month observation period, none of the patients developed diseases or pathological conditions associated with glucocorticoid use that required inpatient treatment.

‘Confederate agencies’: William Knight, document phenomenology and the ‘vibrant materiality’ of the nineteenth century museum lists at Marischal College, Aberdeen

ABSTRACT This paper uses Gorichanaz and Latham’s document phenomenology as a method for understanding early museum documentation, specifically, the collection or museum lists of William Knight of the Marischal College and University of Aberdeen. It seeks to provide an examination of the historical context of the production of these documents, the temporal and social contexts of their interpretation in the contemporary period as archival sources, and to develop scholarly interpretation and discourse regarding museum documentation history, theory and practice. In the museological literature, documents are typically relegated to being containers of data for objects, but this paper demonstrates that documents are instead an exemplary case of what Bennett terms ‘vibrant matter’; they are temporal, contingent, febrile, and evocative.

A Patient of Secondary Malignant Fibrous Histiocytoma of the Head Following Trauma and Review of the Literature.

Malignant fibrous histiocytoma (MFH) is a malignancy originating from soft tissues and ranks among the most prevalent soft tissue sarcomas in adults. The considerable complexity and heterogeneity of MFH contribute to an obscure pathogenesis, presenting with atypical clinical manifestations and pathologic features that complicate the clinical diagnostic process. Typically, MFH manifests in the extremities, trunk, and retroperitoneum, while occurrences in the head and neck regions are exceedingly rare. A thorough review of extant literature indicates that fewer than 5 cases of MFH secondary to a documented history of trauma have been reported globally. This article delineates an exceptionally rare instance of secondary MFH of the head subsequent to trauma, elaborating on the diagnostic and therapeutic procedures undertaken. It seeks to enrich the understanding of MFH treatment and pathogenesis and, by reviewing pertinent literature, aims to elucidate the clinical characteristics and prognostic outlook of MFH.

Computer-assisted medical history taking prior to patient consultation in the outpatient care setting: a prospective pilot project

BackgroundFeeding patients’ self-reported medical history into the diagnostic care process may accelerate workflows in clinical routine.MethodsWe prospectively piloted a novel medical history documentation system in a German cardiological outpatient practice and evaluated its feasibility and perceived usefulness. Based on a generic software that allows to record structured information, a customized solution for the cooperating practice was developed and implemented. Prior to the consultation of the physician, the patient used a tablet that guided the user through a structured comprehensive workflow to document the medical history. The retrieved information was arranged by the software into a ready-to-use text format, presented to the physician in an editable form and added to her report. Three user-centered endpoints were explored: i) Appropriateness—measured by the duration of a patient interview; ii) Patient acceptance—assessed by three questions to patients; iii) Usefulness—operationalized by multiple ratings of the physician.ResultsA total of 2,513 patients were approached of which 2,415 provided complete histories. The system was assessed as appropriate for the practical workflow in terms of time and workflows. The patient-system interaction was rated favourably by patients including elderly ones. The system was regarded useful by the physician, reducing her daily workload by about one hour.ConclusionsAutomated history-taking tools deployed before consultation could support physicians in obtaining patients’ medical histories, thereby reducing professionals’ perceived workload. The technical and methodological limitations of our study should be respected, calling for additional future evaluations.

Evaluation of Some Haematological Inflammatory Parameters in Type 2 Diabetes Mellitus and its Relationship with Glycemic Control and Disease Complications

Background: Haematological inflammatory indices is a cheap, available and practical laboratory markers reflect the inflammatory process. purpose: to investigate the association between some haematolgical indices and diabetes control and complications in Iraqi diabetic patients. Methods: In a case-control study, 78 patients with a documented history of type 2 diabetes mellitus (T2DM) were recruited and matched in regard to age and sex with 57 non diabetic volunteers. RBS, HbA1c and CBP were analyzed. Results: diabetic patients had higher but non-significant increments in platelets, absolute neutrophil count, absolute lymphocyte count, Neutrophil Lymphocyte ratio (NLR), and Platelets Lymphocyte ratio (PLR) in comparison to controls. The mean platelets count was significant higher in patients with poor glycemic control in compared to patients with good glycemic control, (269.3 ± 16.53 vs. 206.33 ± 20.26) respectively, (P <0.001) while the NLR and PLR not associated with glycemic control. The studied hematological indices were associated but with no statistical significant with diabetic complications (P< 0.05). Conclusion: hematological parameters not associated with diabetes control or complications in Iraqi patients.

The Effect of Using a Standardized Questionnaire on Sexual History Documentation and Testing to Diagnose Gonorrhea and Chlamydia Among Men Who have Sex with Men with HIV.

Background: Most Neisseria gonorrhoea (GC) and Chlamydia trachomatis (CT) infections in men who have sex with men (MSM) are diagnosed at extragenital sites. However, testing at these sites is often lacking. The purpose of this study was to determine if a standardized questionnaire administered by physicians and clinical assistants improves documentation of sex activity and increases extragenital testing and diagnoses of GC and CT among MSM.Methods: A standardized sexual history questionnaire was implemented on 11/1/2022. Electronic medical records of 664 MSM with HIV, including 1064 encounters, were reviewed to compare pre- and post- implementation sexual history documentation, adequacy of documentation, extragenital GC and CT testing, and GC and CT diagnoses. Analysis included Chi-square and exact tests and logistic regression adjusting for physician cluster effects.Results: The standardized questionnaire was used by 53.7% of physicians and 85.9% of coordinators. Documentation of whether sexual activity occurred increased from 79.3% [95%confidence interval (CI) 0.758- 0.828] in the pre-intervention pre-COVID-19 period to 95.2% (95% CI 0.925-0.970) in the post-intervention period with an adjusted odds ratio of 4.7 (95% CI 2.7-8.8). Specific questions about anal and oral sex increased from 42.0% to 88.1% (p < 0.001) and 23.7% to 88.7% (p < 0.001), respectively. Anal and pharyngeal testing increased from 14.4% to 20.2% (p = 0.040) and 17.2% to 23.3% (p = 0.045), respectively.Conclusions: This study demonstrates that using a standardized questionnaire during clinical encounters can improve documentation of sexual activity and testing for GC and CT at extragenital sites.

Long-Term Impact of Recurrent Acute Otitis Media on Balance and Vestibular Function in Children.

Recurrent acute otitis media (rAOM) is a common disease in childhood, but its impact on the vestibular system remains poorly understood. The present study aimed to evaluate the long-term effects of rAOM on balance and vestibular function in pediatric patients. A total of 55 children, aged 8 years (25 males and 30 females), with a documented history of rAOM, no AOM episodes in the past year, and no previous ear surgery were assessed. Static posturography was used to assess postural instability, measuring sway area (SX, mm2) under four conditions: eyes open and eyes closed, with and without foam pads. Vestibular function was evaluated using the video head impulse test (v-HIT) to quantify vestibulo-ocular reflex (VOR) gain and corrective saccades across all six semicircular canals. Children with a history of rAOM demonstrated significantly greater postural instability than healthy controls (p < 0.001 for all test conditions). The number of AOM episodes was the primary factor influencing balance dysfunction, with children who had more than eight episodes showing the most pronounced deficits in postural stability (p < 0.05). In some cases, the v-HIT revealed hypofunction in the right anterior (14.5%), left posterior (7.3%), left lateral (5.5%), left anterior (3.6%), and right posterior (3.6%) semicircular canals. The results of this study suggest that rAOM can lead to lasting balance and vestibular dysfunction, highlighting the importance of early monitoring and potential rehabilitation.

Clinicopathological investigation of Newcastle disease in commercial poultry farms at Bogura district of Bangladesh

Newcastle disease (ND) now seems endemic in commercial poultry industry of Bangladesh with continuous significant high prevalence and regular outbreaks. High morbidity, up to 100% mortality rate and high economic loss of ND makes it major constraints of poultry industries. We find out the prevalence of ND in dead, sick and apparently healthy poultry at Bogura district of Bangladesh. From July 2020 to June 2021, we observed a total of 500 birds including 31 sick and dead birds randomly from 10 commercial poultry farms of Bogura district. The prevalence was assessed through clinical observations and the documented history of individual birds. For pathological analysis, 31 samples from sick and deceased birds were collected, and detailed examinations of gross lesions and histopathological changes in the cecal tonsils and proventriculus were conducted. Wide ranges of clinical signs are observed in affected birds and it can be diagnosed based on clinical signs and pathological studies. The prevalence of Newcastle disease was 14.20% in apparently healthy birds and 26.6% in sick and dead birds. ND prevalence increased in summer (56%) and decreased in rainy season (11.5%) and highest at the age group of (5-36) weeks of age. Grossly, numerous infected birds had lesions such as pin-point hemorrhage on proventriculur gland, hemorrhage in the trachea, congested and consolidated lungs, button-like ulcers in the caeca, and hemorrhagic caecal tonsils. Microscopically, there was hemorrhage in the lamina propria associated with lymphatic nodules of the caecal tonsil, sloughing of glandular epithelial cells and infiltration of inflammatory cells in the lumen of the proventriculur gland, congestion around the lobule of the proventriculus, and hyperemia on glandular epithelial cells of the proventriculur gland. This research revealed Newcastle disease remains endemic in Bangladesh's poultry industry, causing high prevalence, seasonal outbreaks, and severe economic losses. Asian Australas. J. Biosci. Biotechnol. 2024, 9(3), 45-55

Naloxone coprescribing best practice advisory for patients at high risk for opioid-related adverse events.

To implement an electronic health record best practice advisory (BPA) to promote coprescribing of naloxone to patients at high risk of serious opioid-related adverse events (ORADEs). This pre-post quasi-experimental study evaluated 9 months of opioid and naloxone prescription data before and after BPA implementation. The Froedtert & the Medical College of Wisconsin enterprise is comprised of 45 ambulatory clinics and 10 hospitals, including the only adult Level 1 trauma center in eastern Wisconsin. Patients who received opioid prescriptions in the preimplementation time period (n = 106,615 prescriptions) and post-implementation time period (n = 107,352 prescriptions) were included. BPA activation criteria included entry of a prescription with a morphine equivalent daily dose of 50 or greater with at least a 5-day supply, concomitant opioid and benzodiazepine prescription, or opioid prescription entry for a patient with a documented history of opioid overdose. The BPA defaulted to coprescribe naloxone, while also providing suppression options. The primary endpoint was the change in naloxone prescription rate for patients on chronic opioid therapy (COT) with a morphine milligram equivalent daily dose (MEDD) per day of 50 or greater. The naloxone coprescription rate for COT patients with a MEDD of 50 or greater increased from 12.2 percent (95 percent confidence interval [CI] 10.4-14.4) to 34.79 percent (95 percent CI 31.8-38.2) after the BPA was implemented (odds ratio 2.85, 95 percent CI 2.37-3.42, p-value < 0.001). Use of BPA increased the rate of naloxone coprescribing for patients at risk of serious ORADE.

Cognitive symptoms and medical history prior to mild cognitive impairment and dementia diagnosis: a retrospective case‐control study using Dutch primary care data

AbstractBackgroundGeneral practitioners (GPs) play a crucial role in recognizing cognitive deficits and diagnosing dementia. Currently, dementia diagnosis in primary care is prone to be missed or delayed. Electronic health records from GPs can offer insights into the trajectory leading up to a dementia diagnosis. Our aim was to characterize prior medical history of health conditions known to be associated with dementia and cognitive concerns in dementia cases and controls using Dutch primary care data.MethodIn this retrospective case‐control study using data from the ABOARD‐GP Cohort (2011‐2022), we identified dementia cases and an equal number of controls (matched on birth year, sex, general practice and registration year). A prior medical history of cardiovascular disease, diabetes, hypercholesterolemia, cerebrovascular disease, psychiatric conditions, sleep disturbances, osteoporosis/arthritis, and fracture was assessed. Cognitive concerns mentioned during a GP consultation was operationalized as mentioning of (1) memory/concentration/orientation complaints/disorders, (2) overall decline, and/or (3) Mini‐Mental State Examination. Logistic regression compared each condition in medical history between dementia cases and controls. Time from first recorded cognitive concern to dementia diagnosis was estimated.ResultWe identified 70,628 dementia cases and 70,628 controls (mean age 80 years, 60% female) (Table 1). We found significant associations between all conditions in medical history and a dementia diagnosis. Cerebrovascular disease and psychiatric conditions, the two strongest associations, corresponded to a 58% and 59% higher odds of having a dementia diagnosis. Prior cognitive concerns mentioned during GP consultations were recorded in 47% of dementia cases (Table 2), indicating that over half had no documented history of cognitive concerns. For those with mentioning of a cognitive concern, the mean time from first cognitive concern to diagnosis was 2.14 years.ConclusionThis study using GP data shows that cases with dementia were more likely to have pre‐existing health conditions than controls. One hypothesis for this could be that these conditions are known risk factors for dementia. Alternatively, individuals with these other conditions have previously sought medical attention from a GP, facilitating the detection of cognitive concerns. These results underscore the importance of timely recognition of cognitive symptoms and addressing risk factors to reduce the impact on cognitive health.

Comparison of Oral (Prednisolone) Versus Intravenous (Hydrocortisone) Steroids in Acute Exacerbation of Bronchial Asthma in Hospitalized Patients

Objective: To compare the efficacy of oral versus intravenous corticosteroids in improving peak expiratory flow (PEF) in patients admitted with acute exacerbation of asthma. Methodology: This randomized controlled trial was conducted from October 17, 2018, to April 16, 2019, at the Department of Pulmonology, PIMS, Islamabad. A total of 166 patients (18–65 years, both genders) with a documented history of bronchial asthma presenting with acute exacerbation were enrolled. Patients were randomly assigned to Group A (intravenous hydrocortisone 100 mg every 8 hours for 72 hours) or Group B (oral prednisolone 60 mg once daily for 72 hours). Both groups received standard bronchodilator therapy with nebulized salbutamol 2.5 mg/2.5 ml four times daily and as needed. PEF was measured before and after salbutamol at baseline, every 6 hours for 72 hours, and twice daily until discharge. The percentage change in PEF from baseline was assessed at 72 hours and compared using an independent sample t-test. Results: At baseline, mean PEF was 409.3 ± 65.4 L/min in Group A and 408.7 ± 69.2 L/min in Group B (p=0.956). After 72 hours, PEF improved to 545.3 ± 64.4 L/min in Group A and 539.7 ± 67.2 L/min in Group B (p=0.594). The mean percentage change in PEF was 34.2% ± 6.4 in Group A and 33.1% ± 6.5 in Group B (p=0.274). Conclusion: Oral corticosteroids were found to be equally effective as intravenous corticosteroids in treating acute asthma exacerbations. Given their cost-effectiveness, ease of administration, and patient comfort, oral corticosteroids should be preferred whenever possible.