Low Prevalence Research Articles

Mixed Endometrioid Clear Cell Carcinoma of the Ovary: A Case Report

Background: Despite the high percentage of pure forms of epithelial ovarian cancers (EOC), mixed epithelial cancer of the ovary is extremely rare and accounts for less than 1% percent of all epithelial ovarian cancers. Because of the low prevalence; there are only a few cases of mixed epithelial cancers published in the literature. This study presents the case of a mixed endometrioid (EC)/clear cell carcinoma (CCC), diagnosed in a woman with a complaint of low back pain and a history of infertility. Case Report: We report the case of a 35-year-old woman who came to our clinic complaining of progressive back pain and a history of infertility. Imaging showed a left ovarian mass that was compatible with malignant tumors. The patient underwent open surgery and a frozen section evaluation of the tumor was done during the operation. The pathology result demonstrated mixed CCC/EC histology in the left ovary. We decided to perform a total abdominal hysterectomy as well as right salpingooophorectomy, omentectomy, bilateral pelvic lymphadenectomy, and para-aortic lymphadenectomy. Adjuvant chemotherapy was administrated postoperatively. Conclusion: Although epithelial cancers account for more than 90% of all ovarian cancers (OC), developing mixed forms of epithelial cancers is extremely rare, and there are little data available in the literature about their presentation and histopathological features. The main purpose of this article was to report a mixed CCC/EC and to discuss different aspects of this rare histologic type of OC. More research is needed to determine metastatic potential as well as the likelihood of recurrence of these unique neoplasms.

Unveiling the influence of reproductive health on poverty: a cross-sectional study in Magwi County, South Sudan

Objective: To understand the relationship between household poverty and reproductive health characteristics in Magwi County, South Sudan. Background: Household poverty is a significant issue in many countries, including South Sudan. Poverty has been identified as a major obstacle to international development, affecting various aspects of development goals such as food security and health. Despite interventions by organizations like the World Bank, poverty rates in beneficiary countries like South Sudan have not seen significant reductions, suggesting the presence of predictors of poverty from behavioral, structural, and political origins. Methods: The study was conducted using an analytical cross-sectional survey design. The study targeted female and male spouses in households and employed a multistage sampling approach to select participants. Result: The results of the study revealed that the level of household poverty in Magwi County was 42%. The prevalence of household poverty was found to be influenced by reproductive health characteristics. The use of short-acting contraception by women was associated with a higher prevalence of poverty, whereas women who had ever aborted a pregnancy had a lower prevalence of poverty. Unintended pregnancy and inconsistent condom use by men were also associated with higher poverty rates, whereas men with only one sexual partner had lower poverty rates. Conclusion: This study provides valuable insights into the relationship between household reproductive health characteristics and poverty in Magwi County, South Sudan. It emphasizes the need for comprehensive approaches that address both behavioral and structural factors to effectively reduce poverty and improve development outcomes.

Greater Adherence to Life's Essential 8 for Cardiovascular Health Is Associated With Lower Arterial Stiffness in Survivors of Cancer.

Survivors of cancer have elevated risk of cardiovascular disease, likely stemming from the negative impact of anticancer therapies on vascular function. Arterial stiffness is a strong indicator of vascular function and independent predictor of cardiovascular disease. The American Heart Association recommends Life's Essential 8 for optimal cardiovascular health. It is currently unknown, however, whether greater adherence to Life's Essential 8 is associated with low arterial stiffness in survivors of cancer. This cross-sectional study included 172 older adult (≥65 years) survivors of cancer (74±6 years; 58% female). Life's Essential 8 100-point cardiovascular health score, with higher scores indicative of better cardiovascular health, was calculated based on 8 components: diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. Participants were classified as having low (<60), moderate (60-79), or high (≥80) cardiovascular health. Pulse wave velocity (PWV) was used to assess arterial stiffness; with high arterial stiffness defined as a pulse wave velocity ≥10 m/s. The mean cardiovascular health score was 72±11 and 40 survivors (23%) had high arterial stiffness. Compared with low cardiovascular health, the odds ratio of high arterial stiffness was 0.12 (95% CI, 0.03-0.50) and 0.02 (95% CI, 0.003-0.18) for moderate and high cardiovascular health, respectively. Every 10-point increase in the cardiovascular health score was associated with a 0.43 m/s reduction in pulse wave velocity (P<0.001). Greater adherence to the American Heart Association's Life's Essential 8 was associated with lower prevalence of high arterial stiffness in older adult survivors of cancer. Prospective studies with larger samples are needed.

Parsonage-Turner syndrome, affecting suprascapular nerve and especially to infraspinatus muscles after COVID-19 vaccination in a professional wrestler, a case report and literature review of causes and treatments

BackgroundAcute peripheral neuropathy, also known as Parsonage-Turner syndrome or neuralgic amyotrophy, mostly affects the upper brachial plexus trunks, which include the shoulder girdle. It is typically accompanied by abrupt, intense pain, weakness, and sensory disruption. The etiology and causes of this disease are still unknown because of its low prevalence, however viral reactions-induced inflammation is one of its frequent causes.Case presentationHere, we introduce a professional wrestler patient who was diagnosed with PTS after vaccination and was treated, and we review some articles in this field.ConclusionWhen it comes to shoulder-girdle complaints and pain, Parsonage-Turner syndrome can be a differential diagnosis. Corticosteroids during the acute period, followed by physical therapy, appear to be an efficient way to manage pain, inflammation, muscular atrophy, and the process of recovering to full nerve regeneration.

Cardiovascular health metrics and diabetic nephropathy: a nationally representative cross-sectional study.

The pathogenesis of diabetic nephropathy is well-documented to be multifactorial. However, research available on the association between cardiovascular health and diabetic nephropathy is limited. Thus, this study aimed to investigate these potential associations and provide guidance for disease prevention. We applied Life's Essential 8 (LE8) identified by the American Heart Association, which integrates multiple health behaviors and health factors to measure cardiovascular health. This study covered 4207 adults with diabetes from the National Health and Nutrition Examination Survey spanning 2007-2018. Weighted regression models assessed the estimated effect of LE8 score on the prevalence of diabetic nephropathy as well as their corresponding clinical indicators. Weighted restricted cubic spline models discussed the possible nonlinear dose-response relationships further. Subgroup analyses clarified the effects of other covariates on correlations. After adjusting for all covariates, participants with moderate or high cardiovascular health showed a decreased prevalence of diabetic nephropathy (odds ratio [OR]:0.52; 95% confidence interval [CI]:0.42-0.63), and also a decrease in the urinary albumin-to-creatinine ratio [UACR] (β: - 0.83; 95% CI:- 1.00 to - 0.65). The prevalence of diabetic nephropathy and the level of UACR tended to decrease linearly as the total LE8 score increased (P for nonlinear > 0.05). Subgroup analyses showed that the effects of increased overall LE8 score and the specific cardiovascular health construct varied across age and obesity strata. Elevated overall LE8 score was significantly associated with a lower prevalence of diabetic nephropathy in U.S. adults, and the effects of the specific cardiovascular health construct on diabetic nephropathy and their corresponding clinical indicators varied. In all, maintaining good cardiovascular health by refining LE8 metrics may help reduce the adverse effects.

Reference Material Production and Milk Protein Concentration as Elements to Improve Bluetongue Serological Diagnosis in Bulk Tank Milk.

The serological surveillance of bluetongue in bulk tank milk is an efficient and cost-effective method for the early detection of bluetongue virus incursions in unvaccinated free areas of the disease. In addition, the availability of standardized and reliable reagents and refined diagnostic procedures with high sensitivity and specificity are essential for surveillance purposes. However, no available reference materials for bluetongue virus serological surveillance in bulk tank milk exist. This study shows the production and characterization of reference material for the implementation of a commercially available bluetongue milk ELISA test in official laboratories, as well as the evaluation of a procedure to increase the sensitivity in samples with low levels of antibodies. This procedure, based on milk protein concentration, allowed us to notably increase the ELISA test's analytical sensitivity, which is useful for milk samples from farms with low within-herd prevalence or pools of bulk tank milk samples. The standardized milk reference material produced here, together with the evaluated procedure to improve analytical sensitivity, could be applied as tools to ensure an accurate diagnosis by official laboratories in bluetongue unvaccinated free areas.

Comparison of two propensity score-based methods for balancing covariates: the overlap weighting and fine stratification methods in real-world claims data

BackgroundTwo propensity score (PS) based balancing covariate methods, the overlap weighting method (OW) and the fine stratification method (FS), produce superb covariate balance. OW has been compared with various weighting methods while FS has been compared with the traditional stratification method and various matching methods. However, no study has yet compared OW and FS. In addition, OW has not yet been evaluated in large claims data with low prevalence exposure and with low frequency outcomes, a context in which optimal use of balancing methods is critical. In the study, we aimed to compare OW and FS using real-world data and simulations with low prevalence exposure and with low frequency outcomes.MethodsWe used the Texas State Medicaid claims data on adult beneficiaries with diabetes in 2012 as an empirical example (N = 42,628). Based on its real-world research question, we estimated an average treatment effect of health center vs. non-health center attendance in the total population. We also performed simulations to evaluate their relative performance. To preserve associations between covariates, we used the plasmode approach to simulate outcomes and/or exposures with N = 4,000. We simulated both homogeneous and heterogeneous treatment effects with various outcome risks (1-30% or observed: 27.75%) and/or exposure prevalence (2.5-30% or observed:10.55%). We used a weighted generalized linear model to estimate the exposure effect and the cluster-robust standard error (SE) method to estimate its SE.ResultsIn the empirical example, we found that OW had smaller standardized mean differences in all covariates (range: OW: 0.0–0.02 vs. FS: 0.22–3.26) and Mahalanobis balance distance (MB) (< 0.001 vs. > 0.049) than FS. In simulations, OW also achieved smaller MB (homogeneity: <0.04 vs. > 0.04; heterogeneity: 0.0-0.11 vs. 0.07–0.29), relative bias (homogeneity: 4.04–56.20 vs. 20–61.63; heterogeneity: 7.85–57.6 vs. 15.0-60.4), square root of mean squared error (homogeneity: 0.332–1.308 vs. 0.385–1.365; heterogeneity: 0.263-0.526 vs 0.313-0.620), and coverage probability (homogeneity: 0.0–80.4% vs. 0.0-69.8%; heterogeneity: 0.0-97.6% vs. 0.0-92.8%), than FS, in most cases.ConclusionsThese findings suggest that OW can yield nearly perfect covariate balance and therefore enhance the accuracy of average treatment effect estimation in the total population.

Does Primary Cleft Palate Repair by Furlow Z-Plasty Technique With a Buccinator Myomucosal Flap Change Speech and Middle Ear Outcomes?

Children with repaired cleft lip and palate may present with middle ear effusion and disturbed speech due to velopharyngeal (VP) insufficiency. Furlow Z-palatoplasty with a buccinator myomucosal flap is one of the effective surgical techniques for primary cleft palate repair and lengthening of the palate. This study aimed to evaluate the effect of Furlow Z-palatoplasty with buccal myomucosal flap as a primary cleft palate repair technique on the VP function during speech and the Eustachian tube function. Forty patients with non-syndromic cleft lip and palate aged 3 to 7 years surgically repaired with Furlow palatoplasty with a buccinator myomucosal flap were assessed. Perceptual speech assessment, nasopharyngoscopic examination, otoscopic examination, and tympanometry were done for all patients to assess the speech and middle ear function. The percentage of mild hypernasality was significant in 22.5% of children with repaired cleft lip and palate, while 77.5% showed no hypernasality. Speech intelligibility was normal in 77.5% and mildly affected in 22.5% of children with repaired cleft palate. Compensatory misarticulations were recorded in 12.5% of children. Nasopharyngoscopic examination revealed adequate VP closure in 75% of children with repaired cleft palate. Twenty-five percent of children with repaired cleft lip and palate had middle ear effusion and required myringotomy with insertion of tympanostomy tubes. Primary cleft palate repair with Furlow Z-palatoplasty with buccal myomucosal flap had beneficial effects on speech outcomes. It was associated with a low prevalence of middle ear effusion, and a low number of tympanostomy tubes were needed.

Prevalence and associated risk factors of scabies and impetigo: A cross-sectional study in Tutume district, Botswana.

The epidemiology of scabies is poorly understood, particularly in regions with high disease burden. This lack of epidemiological data, especially in sub-Saharan Africa, hampers the control and preventative measures. This study is aimed at estimating the prevalence and associated risk factors of scabies and impetigo in the Nata and Sowa catchment areas of Tutume district. A cross-sectional study was conducted in the Tutume District, targeting the settlements of Manxhotae, Malelejwe, Ndutshaa, and Tshwaane. Participants were randomly selected from households in the settlements. Data were collected using questionnaires, and participants were classified as having scabies typical lesions if they met criteria B and or C of International Alliance for the Control of Scabies (IACS) consensus criteria. Statistical significance was set at p<0.05, with a 95% confidence interval for precision. A total of 429 participants were enrolled across the four settlements. The overall prevalence of scabies was found to be 18.18% (95%CI 14.8-22.1). The highest prevalence of scabies was in Manxhotae at 27.1% (95%CI 21.2-34.0) and Ndutshaa at 23.4% (95%CI 13.4-37.3). Malelejwe and Tshwaane had lower prevalence of 10.4% (95%CI 6.2-16.8) and 3.4% (95%CI 0.8-12.7), respectively. Only five (5) cases of impetigo were identified. Multivariable logistic regression analysis revealed that younger age of 0-4 years, 5-18 years and a household member with an itch were strongly associated with scabies, with adjusted odds ratios (aOR) of 7.9 (95%CI 2.4-25.6) p-value 0.001, 5.7(95%CI 2.7-11.7), p-value 0.001 and 14.3(95%CI 5.3-38.5) p-value 0.001 respectively. The prevalence of scabies in the Nata catchment area was noted to be high. The risk factors included younger age, a household member with an itch, and less frequent bathing. Prospective studies are needed to explore household disease transmission dynamics and risk factors specific to the youth.

Does an Immigrant Health Advantage Exist Among US Whites? Evidence from a Nationally-Representative Examination of Mental and Physical Well-Being.

This study examines whether an immigrant health advantage exists among US Whites, a group often used as a reference category in research on racial and ethnic health disparities. Using recent data from the National Health Interview Survey (2019-2022), I disaggregate non-Hispanic White adults (n = 41,752) by nativity status and use logistic regression models to assess differences in six measures of mental and physical health. The analysis includes self-reported conditions (depression, anxiety, fair/poor self-rated health) and diagnosed conditions that require interaction with the healthcare system (hypertension, diabetes, and chronic obstructive pulmonary disease, COPD). Foreign-born Whites have a significantly lower prevalence of each health outcome relative to US-born Whites. The immigrant health advantage remains significant for depression, anxiety, fair/poor health (i.e., self-reported conditions) and diagnosed hypertension, after adjusting for sociodemographic and healthcare characteristics. In contrast, the inclusion of these explanatory factors reduces the nativity gap in diagnosed diabetes and COPD to non-significance. Overall, the results indicate important variation in health among Whites that is missed in studies that focus on US-born Whites, alone. Scholars must continue to monitor the health of White immigrants, who are projected to grow to 20% of the US immigrant population in the years to come.

Hearing loss in Australian First Nations children at 6-monthly assessments from age 12 to 36 months: Secondary outcomes from randomised controlled trials of novel pneumococcal conjugate vaccine schedules.

In Australian remote communities, First Nations children with otitis media (OM)-related hearing loss are disproportionately at risk of developmental delay and poor school performance, compared to those with normal hearing. Our objective was to compare OM-related hearing loss in children randomised to one of 2 pneumococcal conjugate vaccine (PCV) formulations. In 2 sequential parallel, open-label, randomised controlled trials (the PREVIX trials), eligible infants were first allocated 1:1:1 at age 28 to 38 days to standard or mixed PCV schedules, then at age 12 months to PCV13 (13-valent pneumococcal conjugate vaccine, +P) or PHiD-CV10 (10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine, +S) (1:1). Here, we report prevalence and level of hearing loss outcomes in the +P and +S groups at 6-monthly scheduled assessments from age 12 to 36 months. From March 2013 to September 2018, 261 infants were enrolled and 461 hearing assessments were performed. Prevalence of hearing loss was 78% (25/32) in the +P group and 71% (20/28) in the +S group at baseline, declining to 52% (28/54) in the +P groups and 56% (33/59) in the +S group at age 36 months. At primary endpoint age 18 months, prevalence of moderate (disabling) hearing loss was 21% (9/42) in the +P group and 41% (20/49) in the +S group (difference -19%; (95% confidence interval (CI) [-38, -1], p = 0.07) and prevalence of no hearing loss was 36% (15/42) in the +P group and 16% (8/49) in the +S group (difference 19%; (95% CI [2, 37], p = 0.05). At subsequent time points, prevalence of moderate hearing loss remained lower in the +P group: differences -3%; (95% CI [-23, 18], p = 1.00 at age 24 months), -12%; (95% CI [-30, 6], p = 0.29 at age 30 months), and -9%; (95% CI [-23, 5], p = 0.25 at age 36 months). A major limitation was the small sample size, hence low power to reach statistical significance, thereby reducing confidence in the effect size. In this study, we observed a high prevalence and persistence of moderate (disabling) hearing loss throughout early childhood. We found a lower prevalence of moderate hearing loss and correspondingly higher prevalence of no hearing loss in the +P group, which may have substantial benefits for high-risk children, their families, and society, but warrant further investigation. ClinicalTrials.gov NCT01735084 and NCT01174849.

Prevalence of urinary incontinence in Brazilian para athletes

ObjectiveTo describe the prevalence of urinary incontinence (UI) in para athletes in Brazil.MethodsThis is a cross-sectional study with Brazilian para athletes with physical impairments from all para sports. The data...

Association of a healthy lifestyle with ambulatory 24-hour blood pressure among Chinese youths: a cross-sectional study.

This study aims to explore the association between a healthy lifestyle and abnormal ambulatory blood pressure (ABP) in Chinese youths. A school-based sample of 1,296 college students was investigated. A lifestyle score was calculated by synthesizing five lifestyle factors, including smoking, alcohol consumption, diet, physical activity, and sleeping. The total score ranged from 0 to 5, with a higher score indicating a healthier lifestyle. This score was then divided into three categories representing low adherence to a healthy lifestyle (0-2), medium adherence (3), and high adherence (4-5). Abnormal 24-hour blood pressure (BP) was defined as systolic BP (SBP) ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 80 mmHg. Abnormal daytime BP was determined as daytime SBP ≥ 135 mmHg and/or DBP ≥ 85 mmHg, while abnormal nighttime BP was characterized as nighttime SBP ≥ 120 mmHg and/or DBP ≥ 70 mmHg. We assessed the associations using the binomial regression model. Mean age was 18.81 years, and 74.5% were women. The prevalence of abnormal 24-hour BP, daytime BP, and nighttime BP are 4.2%, 3.7%, and 9.0%, respectively. We found that participants with high level of adherence to a healthy lifestyle had a significantly lower prevalence of abnormal 24-hour BP [prevalence ratios (PR) = 0.15, 95% CI: 0.05, 0.48] and abnormal daytime BP (PR = 0.16, 95%CI: 0.05, 0.52), when compared to those with low level of adherence and after adjusting for the potential covariates. A healthier lifestyle is associated with better ambulatory BP profile among youths.

Using an artificial intelligence platform to enhance cancer detection rates in primary care.

1560 Background: Patients with cancer who are diagnosed in a primary care setting have the best survival outcomes compared to any other route (e.g. Emergency department, routine referrals, incidental findings etc). This is primarily attributed to detection of cancer at an early stage. In the UK, the Cancer Detection Rate (CDR) metric serves as a measure of this, representing the percentage of cancer diagnoses originating from primary care referral routes. However, detecting cancer presents significant challenges, primarily due to the non-specific nature of cancer presentations, their tendency to overlap with symptoms of other conditions, and their relatively low prevalence. Artificial intelligence (AI) platforms may be able to support this endeavor but are yet to be established. C the Signs is an AI-enabled clinical decision support tool integrated into primary care practices to help clinicians stratify the risk of cancer and advise on which cancer pathway is most appropriate (if at all) for the patient’s presentation and history. Methods: An observational cohort study was undertaken between 1st May 2021 and 31st March 2022 where 35 practices (covering a population of almost 420,000) within the same geographic region in the East of England were offered the use of C the Signs, with the practices opting out as controls. All practices had the same access to referral and cancer diagnostic pathways within the region. The primary end point was to identify if C the Signs had a statistical impact on cancer detection rates in primary care through nationally linked data via Public Health England. Results: In practices utilizing C the Signs the CDR significantly increased from 58.7% in 2020-21 (prior to the implementation of C the Signs) to 66.0% in 2021-22, reflecting a significant increase of 12.3% (p &lt;0.05). In contrast, practices not using C the Signs maintained a stable CDR of 58.4% in both years. There was no statistically significant variance observed in the referral rate between the two groups, indicating no notable increase in diagnostic or referral activities. Conclusions: These findings underscore the importance of integrating cutting-edge technologies into primary care to improve cancer detection rates and facilitate early-stage diagnosis. Implementation of such advancements holds promise for reducing cancer-related mortality rates and enhancing overall patient outcomes.

Effect of screening with a pan-TRK immunohistochemistry-based algorithm on NTRK fusion detection rates.

e15135 Background: Rearrangements in the NTRK1, NTRK2, and NTRK3 genes are clinical actionable and predictive of response to TRK kinase inhibitors in solid tumors. Their detection in clinical practice is a priority, but their low prevalence (0.25-1%) poses a diagnostic challenge. In this study, we describe our immunohistochemical-based and cost-effective approach for NTRK rearrangements detection. Methods: We implemented a comprehensive NTRK testing approach at a reference center that combined clinical criteria (e.g., iodine therapy-resistant thyroid cancer); molecular biomarkers (e.g., non-small-cell lung carcinoma negative for driver alterations, colorectal carcinoma with deficient MMR and/or microsatellite instability); and histopathological criteria (identifying tumor subtypes associated with NTRK fusions, such as breast secretory carcinoma). Automated immunohistochemistry (Ventana BenchMark ULTRA IHC/ISH System) using the antibody pan-TRK (Ventana, EPR17341) was used as a screening tool. Positive results were confirmed through molecular techniques, including Next Generation Sequencing, NGS (Oncomine Focus Assay, Thermo Fisher, based on DNA and RNA) and/or FISH (NTRK3 break-apart probe, Zytovision). Results: We evaluated 172 patients (99 female/73 male), with a mean age of 52 years (SD 23.8). Eighteen (18) patients with neoplasms expressing TRK proteins were identified. Confirmatory studies using NGS identified fusions in 7 cases. In instances of poor RNA quality, FISH techniques (NTRK3) were employed, confirming the findings in an additional 3 patients. Overall prevalence of NTRK fusions was 5.8%. Histological types included the following tumor types: Thyroid carcinoma, 4 patients (one medullary and 3 papillary carcinomas, two of them in the pediatric population); soft tissue sarcomas, 3 patients (2 corresponding to infantile fibrosarcoma and a soft tissue provisional entity, "NTRK-rearranged spindle cell neoplasm”); secretory carcinoma of the breast, one patient; secretory carcinoma of the salivary gland, one patient; colorectal carcinoma, one patient, with a deficient MMR phenotype. NTRK3 gene fusions were found in 10 patients, (6 fusions with ETV6 detected by NGS and 3 detected by FISH), and NTRK1 fusion in 1 case (fusion with LMNA detected by NGS). The positive predictive value of pan-TRK immunohistochemistry as a screening tool was 0.55. Conclusions: In our experience, the comprehensive screening approach based on morphological and clinical/ molecular inclusion criteria, along with the use of immunohistochemical techniques (pan-TRK antibody), significantly enhances the detection rate of NTRK fusions (5.8% vs. 0.25-1%). Additionally, FISH provides a valuable tool in samples with poor RNA quality. This approach allows for a reduction in the impact of costly testing, such as NGS, on the healthcare system.

First report of isolation of Fusobacterium varium from liver abscesses and ruminal and colonic epithelial tissues of feedlot cattle*

ObjectiveOur objective was to isolate and determine prevalence of Fusobacterium varium in liver abscesses and the corresponding ruminal and colonic epithelial tissues and ruminal and colonic contents of feedlot cattle. Materials and MethodsA total of 96 intact liver abscess samples and matched ruminal and colonic tissues and contents from cattle, originating from feedlots that did not receive in-feed tylosin, were collected at slaughter. Liver abscesses and ruminal and colonic tissue were ho- mogenized and then plated, before and after enrichment in lactate or lysine medium with selective antibiotics, onto blood agar and selective lactate or lysine agar for isolation of Fusobacterium and to determine prevalence and concentration. Putative colonies were tested by a quantitative PCR assay targeting the hgdA gene for species confirma- tion. Results and DiscussionNone of the liver abscess samples yielded F. varium by direct plating; however, F. varium was isolated from 3 of 96 (3.1%) following enrich- ment of the homogenate in lactate or lysine medium. In contrast to liver abscesses, F. varium was isolated by direct plating from 27.1% (26/96) of ruminal epithelial and 3.1% (3/96) of colonic epithelial tissue homogenates. Overall, 10.1%, 77.1%, 44.8%, 86.5%, and 70.1% of liver abscess, ruminal, and colonic epithelial tissues and ruminal and colonic contents were positive for F. varium, respectively. Implications and ApplicationsThe increased fre- quency of isolation and high prevalence of F. varium in ruminal tissue and, to a lesser extent, in the colonic tissue confirms its ability to invade tissues and possibly cause bacterial ruminitis. However, the relatively low frequency of F. varium isolation and low prevalence in liver abscesses suggest that it is unlikely to be an etiologic agent. Inter- estingly, there is some evidence that ruminal strains of F. varium were resistant to tylosin; therefore, it would be of interest to determine the prevalence in cattle receiving in-feed tylosin.

Global perspective on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis - prevalence, clinical impact, economic implications and management strategies.

The metabolically-based liver disease, nonalcoholic fatty liver disease (NAFLD), is the most common cause of chronic liver disease currently affecting 38% of the world's adult population. NAFLD can be progressive leading to nonalcoholic steatohepatitis (NASH), liver transplantation, liver cancer, liver-related mortality and is associated with decreased quality of life from impaired physical functioning and increased healthcare resource utilisation. However, screening for NAFLD is cost-prohibitive but screening for high risk NAFLD (NAFLD with F2 fibrosis or greater) is imperative. To review the global perspective on NAFLD and NASH METHODS: We retrieved articles from PubMed using search terms NAFLD, prevalence, clinical burden, economic burden and management strategies. NAFLD/NASH shows geographical variation across the globe. Highest prevalence rates are in South America and the Middle East and North Africa; lowest prevalence is in Africa. NAFLD's economic impact is from direct and indirect medical costs and loss in worker productivity. It is projected that, over the next two decades, the total cost of NAFLD and diabetes will exceed $1.5 trillion (USD). Risk stratification algorithms identifying "high risk NAFLD" were made following non-invasive tests for NAFLD identification and fibrosis development. These algorithms should be used in primary care and endocrinology settings so timely and appropriate interventions (lifestyle and cardiometabolic risk factor management) can be initiated. To reduce the burgeoning burden of NAFLD/NASH, management should include risk stratification algorithms for accurate identification of patients, linkage to appropriate settings, and initiation of effective treatment regimens.

Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis

Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis Abstract: Background: In a progress of dementia, most people develop neuropsychiatric symptoms. However, there is little knowledge about the prevalence of these symptoms and their specific characteristics in long-term care. Aims: A differentiated investigation of the prevalence and characteristics of neuropsychiatric symptoms in people with dementia in a long-term care setting. Methods: The prevalence of neuropsychiatric symptoms of people with dementia in a long-term care setting was examined using a secondary analysis of cross-sectional data from the research projects LebenQD I and II and FallDem. The data were collected using the neuropsychiatric inventory - nursing home version. The analysis included data from 699 people with dementia from a total of 21 long-term care facilities in North Rhine-Westphalia. Results: The symptoms agitation/aggression (36%), depression/dysphoria (33%), apathy/indifference (33%), irritability/lability (30%) and aberrant motor behaviour show the highest prevalence. The symptoms hallucinations (9%) and euphoria/elation (6%) have the lowest prevalence. Conclusions: The high prevalence of specific neuropsychiatric symptoms and their characteristics in people with dementia illustrates the need for care-related or psychosocial interventions to counteract the reasons for the occurrence of the symptoms.

Characterising People who inject drugs, and association with HIV infection: A Situation Analysis in Kampala city, Uganda.

Uganda has implemented targeted interventions to address the rising burden of injection drug use, yet barriers persist in reaching persons who inject drugs (PWID). This study describes the characteristics of people who inject drugs, physical and mental health states, and associated risk behaviors, to inform the designing of programs that are tailored to client's needs and preferences. A cross-sectional survey was conducted between August and December 2023 at selected hotspots in Kampala, interviewing 499 PWID aged ≥18 years. Data was collected using a semi-structured questionnaire administered by peer educators and Uganda Harm Reduction Network (UHRN) counselors. Measurements included socio-demographics, injecting drug use and sexual risk behaviors, and medical history. HIV serostatus was dtermined by self-report and testing for participants who had no recent history of testing and consented to be tested. Binary logistic regression was used to establish the relationship between HIV infection and risky drug- and sexual behaviors of PWID. Participants were predominantly Ugandan (95.2%), male (73.2%), unmarried (55.9%), unemployed (81.8%), with higher levels of education and varying ages. Mental disorders were prevalent, with 48.7% reporting at least one underlying condition, including depression (30.8%) and anxiety (9.6%). Physical health issues were also noted, with reported cases of fever (32.9%), cough (32.5%), malaria (22%) and sexually transmitted infections (STIs) (15%).Regarding drug use patterns, the majority (82.6%) were introduced to drugs by close acquaintances, with 70.9% categorized as people who inject drugs. HIV prevalence among injecting drug users was 3.7%, with higher rates among females (8.4%) and non-Ugandans (16.7%). Being female and experiencing difficulty accessing sterile injection materials were associated with HIV-positive status, highlighting the complex interplay between socio-demographic factors, risk behaviors, and HIV infection among individuals with injecting drug use Disorder in Uganda. Our study provides a comprehensive insight into the socio-demographic, mental, physical health, and HIV risk behavoir of PWID in Kampala, Uganda. The findings indicate significant vulnerabilities to injecting drug use, mental disorders, and high-risk behaviors that predispose this population to HIV infection. Despite a low HIV prevalence compared to previous estimates, the interplay between drug use, risky injecting practices, and sexual behaviors suggests an urgent need for targeted interventions to address these intertwined challenges.

Associations between metabolic syndrome-related diseases and colorectal cancer risk: A propensity score-matched analysis using the NIH All of Us research program.

10515 Background: The risk of colorectal cancer (CRC) is known to increase in patients with metabolic disorders such as hypertension (HTN), hyperlipidemia (HLD), type 2 diabetes (T2DM), and metabolic associated fatty liver disease (MASLD). Both metabolic disorders and CRC share similar demographic, socioeconomic, geographic, and environmental risk factors. This study aims to examine the associations between metabolic syndrome-related diseases and CRC incidence, controlling for confounding risk factors. Methods: This was a propensity score matched case-control study using NIH All of UsResearch Program, Registered Tier version 7. CRC diagnoses was defined as having two or more diagnosis codes in EHR. We matched CRC patients to participants without CRC diagnosis with 1:2 ratio, aligning age, gender, race/ethnicity, income, education, region, and cigarette exposure. Income level per year ( &lt; $25K, $25-100K, &gt; $100K), education level (grade 12 or less, some college, college graduate), cigarettes exposure ( &gt; 100 cigs per lifetime), region (Northeast, Midwest, South, West) were assessed using the survey. Height and weight measurement collected at the time of enrollment was used to calculate BMI and define obese (BMI ≥ 30 kg/m2 ) and underweight (BMI &lt; 18.5 kg/m2) status. We compared the average BMI between two groups, and calculated the odds ratios for obesity, underweight status, HTN, HLD, T2DM, and MASLD to assess the likelihood of these conditions being associated with colon cancer. Results: Between the control (n = 3,528) and CRC groups (n = 1,764), there was no significant differences in matched factors. The CRC group had a similar obesity prevalence and a lower mean BMI (28.8, SD 6.9) compared to the control group (29.3, SD 6.9, p = 0.017). Underweight status was linked to a 76% increase in CRC odds (OR 1.76, CI 1.21-2.56, p = 0.003), T2DM to a 26% increase (OR 1.26, CI 1.06-1.49, p = 0.008), HTN to a 58% increase (OR 1.58, CI 1.41-1.78, p &lt; 0.001), HLD to a 32% increase (OR 1.32, CI 1.18-1.49, p &lt; 0.001), and MASLD to over a two-fold increase (OR 2.16, CI 1.78-2.61 p &lt; 0.001). Conclusions: Our study reinforces the significant link between metabolic dysregulation and CRC risk. The higher prevalence of metabolic disorders in the CRC group, despite a lower obesity prevalence and average BMI, suggests that other factors, potentially treatment effects, might contribute to these findings. Further research is warranted to elucidate the causal pathways linking metabolic disorders to the pathogenesis of CRC. [Table: see text]