Post Period Research Articles

Validation of Electrochemical Biosensor based Hand-held Device for the Measurement of Blood Glucose in Lactating Buffaloes (Bubalus bubalis)

Background: Bovine ketosis is a major metabolic disorder emerging as a result of negative energy balance in the post calving period and subsequent lactation of lactating dairy animals. The measurement of the concentration of blood glucose was reported to be helpful for the early diagnosis of subclinical ketosis in buffaloes. Also, blood glucose will provide the overall energy status of the buffalo. Methods: The experiment was conducted on 56 healthy lactating Murrah buffaloes. Blood samples were collected in two slots for two consecutive days in the morning hour in an anticoagulant-added sodium fluoride bulb and in clot activator plain tubes by jugular venipuncture. Also, glucose concentration was measured by a handheld device (“Gluco One”, Model BG-03) by puncturing the small branches of the ear vein and the results were recorded. The estimation of blood glucose plasma and serum was done by standard laboratory enzymatic method i.e. Glucose Oxidase- Peroxidase (GOD-POD) on an automated chemistry analyzer. Result: There was no significant difference between the mean values of plasma glucose measured by the GOD-POD method and by the biosensor. But the regression analysis showed the blood glucose in plasma do not have a significant correlation with that measured by biosensor. The glucose measured in serum is significantly less than in plasma and measured by the biosensor. It is advisable to use fluoride-added preservative anticoagulant tubes and not to use a serum for the estimation of blood glucose.

HPB SO66 - Has the Complexity of Laparoscopic Cholecystectomies Increased Following the COVID-19 Pandemic?

Abstract Background Laparoscopic cholecystectomy (LC) is recognized for its diverse complexity between cases, which profoundly influences perioperative progression and patient outcomes. It is notoriously difficult to accurately predict surgical complexity pre-operatively. The COVID-19 pandemic notably contributed to substantial delays in the definitive management of gallstone disease. The present study aimed to compare the intraoperative complexity grading of LCs performed post-pandemic with data previously reported in the literature. Method A prospectively collected database of all LCs and laparoscopic common bile duct exploration (LCBDE) performed between August 2022 and June 2024 was analysed. The database was populated from a single benign biliary center by two specialized biliary surgeons. The study focused on clinical and intraoperative parameters, with particular emphasis on assessing the cholecystectomy operative difficulty using the Nassar scale. Parameters from the database were compared with previously published data from a single surgeon over a 29-year period (n=5,391 cases). P value was calculated using Pearson uncorrected chi-square test. Results 201 patients were eligible for inclusion. Median age was 54 years (IQR 40-66) and 124 (61.7%) were female. 86 (42.8%) were emergency cases. 118 (58.7%) patients were classed as socially and economically deprived. 80 (39.8%) cases were carried out for acute cholecystitis and 48 (23.9%) were for gallstone pancreatitis. 52 (25.8%) underwent LC alone, 89 (44.3%) also had intra-operative cholangiogram and 60 (29.9%) underwent LCBDE. Grade-1 LC (33.2% vs 8%, p<0.001) were significantly less prevalent than grade-4 LC (14.2% vs 33.8%, p<0.001) in the post pandemic period when compared to the previous published data. Conclusion The present study suggests there has been an increase in the complexity and operative difficulty of LC in the immediate post COVID-19 pandemic period. The reasons are likely multifactorial, however delays in the timely management of gallstone disease, resulting in repeated episodes of acute inflammation is hypothesised to be the key driving factor. Minimising a delay to definitive treatment through the establishment of efficient dedicated biliary care pathways could reduce the incidence of complex LC. Further work is required to determine if reducing the incidence of complex LC has a beneficial impact on complications and length of hospital stay.

Dropout from Maternity Continuum of Care and Associated Factors Among Mothers Who Gave Birth After War in Adigrat Town, Tigray, Northern Ethiopia 2024

<i>Background: </i>Maternity continuum of care is the continuity of maternal health care services given to mothers during antenatal period, child birth and post natal period. It is one of the strategic programs meant to lower the death rates of mothers, newborns, and children. In spite of this, a large number of moms discontinue their participation in maternal continuum care. Dropout from the maternity continuum of care is prevalent public health issue in underdeveloped nations, such as Ethiopia. <i>Methods: </i>Community based quantitative cross-sectional study was carried out among 357 mothers who gave birth in the 12 months in Adigrat town. Systematic sampling method was used to obtain study participants. Data was collected using pretested, semi- structured and face to face interviewer administered questioner. Bivariable and multivariable logistic regression model was fitted. Variables having p-value less than 0.2 in bivariable analysis was entered to multivariable logistic regression model. In multivariable logistic regression adjusted odds ratio with 95% confidence interval was used to determine strength and direction of the association between dependent and independent variables. <i>Results:</i> The overall magnitude of drop out from the maternity continuum of care was 237 (66.4%) [95%CI (61.3-70.9)], 60.6% drop out from ANC visit, 5.6% drop out from skill birth attendant and 58.9% drop out from PNC. Mothers never heard on maternal health care service (AOR=4.179 (1.107, 15.783), service out of health facility (AOR =5.136 (1.988, 13.267) noabortionhistory (AOR=1.424 (1.113, 12.133), unplannedpregnancy (AOR=5.478 (1.902, 15.777), less than 4 ANC visit (AOR= 5.583 (2.598, 11. 997) and mothers attitude (AOR=15.049 (2.489, 32.997) were statically significant factors associated with drop out from maternity continuum of care. <i>Conclusion and discussion: </i>This study showed that magnitude of drop out from maternity continuum of care was high as compared to WHO recommendations. As a result concerned stakeholders and policy makers should initiate more than four ANC visit, create awareness on harmful traditional practice, bad pregnancy history, support mothers to use family planning to prevent unplanned pregnancy, and work on attitude change of the community.

Changes in Fish Communities Before and After Establishment of Northern Snakehead in an Estuarine Marsh of the Chesapeake Bay Watershed

Abstract Northern Snakehead Channa argus an invasive freshwater piscivore discovered in the Potomac River in 2004, has spread throughout the Chesapeake Bay (Maryland, USA). The first incidental reports of Northern Snakehead in Blackwater National Wildlife Refuge (Chesapeake Bay) occurred during 2012. Since that time, Northern Snakehead have become established and has formed the basis for a popular harvest fishery in the Blackwater River drainage. This increase in abundance has caused concern about competition and predation on other species. To determine whether the fish community has changed in composition or relative abundance in Blackwater River drainage (Blackwater River and Little Blackwater River) since the introduction of Northern Snakehead, we replicated fish community surveys from 2006 and 2007 (pre-snakehead) and compared those fish community composition with data collected from 2018 to 2019 (post-snakehead). Subsequent seasonal surveys of fishes between 2021 and 2023 helped to substantiate our findings. Including pre-snakehead and post-snakehead survey periods, we caught 35 species (32 fish species and 3 invertebrate species) totaling 51,781 individuals. With few exceptions, species richness was similar between periods, with 27 fishes caught pre-snakehead and 26 species caught post-snakehead. However, of 22 species that we captured during both pre-snakehead and post snakehead survey periods, 19 declined in relative abundance, which was supported during subsequent seasonal surveys. These changes led to four of six sites having significantly different fish communities between survey periods. Fish communities experienced declines in relative abundances of popular prey species for Northern Snakehead: White Perch Morone americana, sunfish Lepomis, and killifishes Fundulus. Our study is among the first to document long-term fish community changes following establishment of Northern Snakehead in its introduced range.

Unraveling Influenza Sentinel Surveillance in Pakistan 2008-2024: Epidemiological Insights during the Pre and post Pandemic period of COVID-19

Unraveling Influenza Sentinel Surveillance in Pakistan 2008-2024: Epidemiological Insights during the Pre and post Pandemic period of COVID-19

Nomogram-based prediction of MACE in older adults with STEMI

Abstract Introduction Despite the significant progress made in diagnosing and treating patients with ST elevation myocardial infarction (STEMI), high-risk subgroups such as older adults (those over 65 years-old) still face considerable residual risk of major adverse cardiovascular events (MACE) following treatment for their index event. Thus, it is crucial to create accurate, validated, and actionable tools to stratify patients according to their risk of MACE after admission for STEMI. Purpose Utilizing clinical data obtained from a registry of patients diagnosed with STEMI, this study aims to develop a nomogram that can reliably predict the likelihood of MACE incidence. Methods Using a large electronic single-center registry, all consecutive patients with STEMI, undergoing primary percutaneous coronary intervention (PCI), and aged 65 and above were identified. Demographic, laboratory, clinical and intra-procedural variables were examined. Univariate and multivariate logistic regression analyses were utilized to identify those factors which were independently associated with MACE incidence in the post PCI follow-up period. A nomogram was developed in a training set, and performance metrics such as receiver operating curves (ROC), calibration plots, and decision curve analysis were used for validation in a testing set. Analyses were performed using tidyverse and rms packages in R programming language. Results 1946 patients were included in the study and split into 70% training and 30% testing sets. Both groups were similar in terms of baseline demographic and clinical characteristics. Mean follow-up period was 17 months. Total MACE incidence in the post PCI follow-up period was 18%. Thirty-eight factors with limited missing information (<5%) were examined for their relationship with MACE incidence and after performing univariate and multivariate analysis 8 were selected for construction of the nomogram: left-ventricular ejection fraction (LVEF), serum creatinine, hemoglobin and fasting blood glucose levels, presence of valvular heart disease, post PCI TIMI flow grade, diameter of the stent placed in the culprit lesion, and presence of shock in the post PCI setting. The area under the curve (AUC) for MACE prediction in post PCI follow-up period showed acceptable discrimination (c-statistic=73%, 95%CI 71.2% to 76.3%). Calibration plots demonstrated that the nomogram model was well-calibrated, and its predictions were closely aligned with observed outcomes. Additionally, decision curve analysis indicated that the model exhibited strong discriminatory ability in predicting MACE. Conclusions A nomogram developed using a combination of laboratory, clinical, and procedural parameters reliably predicts future risk for MACE in older adults following STEMI. Future implementation of this model may identify the highest risk individuals to target more aggressive preventive efforts in a vulnerable cohort of patients.Plot 1Plot 2

The use of a point of care high sensitivity troponin in the investigation of patients presenting to the Emergency Department with undifferentiated chest pain

Abstract Background In 2012 in a hospital, New Zealand, a chest pain pathway was instituted for the use in patients presenting to the Emergency Department (ED) with undifferentiated chest pain. This reduced hospital admissions and ED length of stay (LOS) without adversely affecting outcomes. The pathway consists of risk stratification combined with ECG and troponin testing. The pathway suggests, but does not enforce, that low risk patients can be discharged after a single troponin, intermediate risk patients are for serial troponins (which can be done in ED or the next day in the community), with further testing if appropriate, and high risk patients are reviewed by Cardiology or General medicine. In August 2023, Siemens point of care high sensitivity troponin I (POC-hsTnI) was introduced for the use in ED, although Beckman laboratory troponin I (Lab–hsTnI) is still available. A POC test reduces result turnaround times but until recently there has been a lack of POC assays fulfilling criteria for "high sensitivity". Purpose To ascertain whether the availability of a POC-hsTnI in the ED is a viable option for use in the chest pain pathway Methods A 1 month "snap shot" of all consecutive patients presenting to the ED with chest pain was undertaken and the patients followed for adverse events using electronic notes review. October 2023 was selected for the post POC-hsTnI period and compared with April 2022. Results There were 688 patients presenting to ED with undifferentiated chest pain during October 2023 with a type 1 acute myocardial infarction (AMI) rate of 80 (11.6%), median age 58 (41-72), female 335 (48.7%). POC-hsTnI was used in isolation in 377 (54.8%), in conjunction with Lab-hsTnI in 218 (31.7%) and Lab-hsTnI was used alone in 93 (13.5%). The median turnaround time for POC-hsTnI was 11 minutes (10-11) compared with Lab-hsTnI 87 minutes (61-129). The POC-hsTnI was less sensitive for AMI than the Lab-hsTnI on presentation using the upper reference limit, 72.1% (60.6-81.6) versus 91.5% (83.0-96.4). However, when used with risk stratification, there were no excess adverse events (cardiac death or AMI) at 4 months in patients discharged with a diagnosis of non-cardiac chest pain – 7 (1.4%) (n=495) versus 5 (1.2%), (n=424) in 2022. Median LOS in the ED was 4.4 hours (2.9-6.2) versus 4.0h (3.0-5.9) in 2022. However, a higher proportion of patients had a second cTn: 414 (60.2%) versus 309 (48.4%) and a lower proportion had their second troponin the next day in the community, 28 (6.7%) versus 56 (18.1%). Conclusion The use of a POC-hsTnI is a practical solution to reduce turnaround times for troponin results and has the potential to reduce LOS or allow serial troponins to be measured in a timely manner during their ED visit, obviating the need for a next day community troponin. Whilst POC-hsTnI has a lower early sensitivity for AMI, the use of POC-hsTnI as part of a pathway does not adversely affect outcomes.

Value-based versus usual care for heart failure patients leads to reduction in cost, hospital admissions and improved survival

Abstract Background OptumCare (OC) in our city, Nevada established a heart failure (HF) program comprised of a team of outpatient cardiologists including two who are board certified in advanced heart failure. Referred patients are enrolled in the HF program once HF is diagnosed by a cardiologist. Patients are managed by an interdisciplinary team of cardiologists, advanced practice clinicians (APC), registered nurse case managers (RNCM), and a social worker. Patients at higher risk for HF admissions are enrolled in remote patient telemonitoring. In contrast, OC in Arizona utilizes a "usual" care approach of fee-for-service contracted cardiology groups to manage HF patients in outpatient and in-patient settings. Purpose A head-to-head comparison was performed between the cohort of patients enrolled in HF program in OC Nevada (treatment group) and patients with HF diagnosis in OC Arizona (control group). The groups were compared on the following measures: medical cost, hospital admissions, and survival rates. Methods In this retrospective study, a 1:1 iterative propensity score (PS) matching was performed to closely approximate patient demographics and comorbidities, which resulted in 818 matched pairs (total n=1,636) of the patients with program enrollment or 1st HF diagnosis between March 1, 2019 and June 30, 2022. For Difference-in-Difference Analysis (Diff-in-Diff), generalized linear models were used on PS matched data to test the difference in difference in medical cost and utilizations changes between control and treatment group over a six month period. Log-Binomial regression was used to estimate the relative risk of post period 30-day readmission and hospice enrollment. Kaplan Meier Estimator was used to test the difference in survival rates over time. Results Average age of patients was 77.6 years old, and 49% were female. The treatment group resulted in significantly lower overall medical costs per member per month (PMPM), significantly less emergency room (ER) visits, less acute hospital and skilled nursing facility (SNF) admissions, and shorter overall hospital length of stays. The control group was twice as likely to be readmitted to the hospital. Lastly, the treatment group had a significantly better survival rate than the control group. 19% of the patients in the control group expired within 12 months of enrollment vs. 10% of the patients in the treatment group expired during the same time period. Average survival was 142 days in the control group vs. 200 days in the treatment group. Conclusions A value-based care approach involving a multidisciplinary team in an outpatient-based cardiology HF program resulted in statistically significant improvement in medical costs, acute care visits/admissions, and survival rates compared to "usual" care approach for HF patients.

Demonetization and its effects on Indian economy

Indian government has taken a bold decision on note ban on 08/11/2016. Central government was a judicious, well-thought out and well-implemented step, and whether it would really eradicate all the existing black money. Here I have utilized the opinions of great expert on economics, financial economist and intellectual politicians. This study will help us to know about the positive and negative impact of note ban decision taken by Indian government. This study is purely based on secondary data, which is collected from news papers, magazines, websites from internet, some useful books related to topic etc. This paper entails the problems related to pre and post demonetization period and thereby to find out solutions and to provide suggestions in order to overcome the problem. Demonetization is the process of withdrawal of a particular form of currency from circulation. The purpose of the study is to compare and analyse the impact of demonetization on Indian economy during pre and post period. The older denominations must be replaced with the new ones. The findings of the study reveal that India will achieve a significant growth by adopting the demonetization strategy and will create a huge positive impact on the entire economy in a long run. This paper also shows that it was quick step taken by the government of India without any measures which people had to face a lot of consequences in standing in the long queues to exchange their older denominations.

Beyond 2030: structures for achieving sustainable development

With 2030 quickly approaching and hence the end of the Sustainable Development Goal (SDG) timeline, it is necessary to start the conversation as to what the post-2030 international development goals, that will take over from the SDGs, will look like. Building on the experiences of implementing the Millennium Development Goals (MDGs) and SDGs, there is the possibility of making the post-2030 goals the most efficient and successful to date. This perspective explores the lessons that have been learnt from the MDGs and SDGs, and together with a consideration of emerging global trends develops proposals for post-2030 goals and targets. In total seven goals are suggested: (1) Operate within planetary boundaries (2) Create growth within resource limits (3) Provide access to basic services for all (4) Eliminate poverty and hunger (5) Reduce inequality (6) Deliver good health and education for all (7) Build strong institutions and international partnerships. The goals are categorised as being: (i) Environmental and Economic (ii) Physical Assets (iii) Social, and (iv) Collaboration. System interdependencies and possible causal connections between the proposed post-2030 goals are also explored. A novel approach of five yearly assessments of the risks involved if the targets are not met, together with suggestions for corrective action is discussed, which will help inform governments and decision makers of the urgent actions needed. To avoid a disruptive future, careful formulation of the post SDG period beyond 2030 is urgently needed to provide a fair and consistent framework to hold both government and industry to account at local, national, and international levels. This will require the strengthening of existing international institutions and strategies for the financing of development.

Marketing Strategy Proposal to Rebound the Declining Revenue of Burger King Indonesia in the Covid Aftermath Period

The primary objective of this study is to propose a marketing strategy to address the decrease in revenue experienced by Burger King Indonesia in the year 2022 following the COVID-19 pandemic as practical guidance for Burger King Indonesia and other businessmen to navigate the complexities of the current market landscape. This study is still necessary to understand that shifting consumer behavior, changes in market conditions, and business operational disruptions are the causes of the problem. The research design uses a thematic analysis method involving the available company data, relevant marketing theories, and the results of questionnaires, community surveys, and interviews with managers and customers. By analyzing the effects of the pandemic faced by Burger King Indonesia, this research aims to pinpoint strategic areas for improvement. Diverse analyses are used, such as VRIO Framework, STP, Marketing Mix, PESTEL, PORTER's Five Forces, Competitor analysis, SWOT, TOWS analysis, and author’s interview and questionnaire surveys to determine the present circumstances of Burger King Indonesia. The proposed marketing strategy highlights the importance of five specific actions in their implementation: product innovation, digital transformation, sustainability campaign, promotion via mobile app, and partnership and collaborations with delivery services to adapt to evolving consumer preferences. To address this goal, Burger King Indonesia must make strategic adjustments parallel to the present circumstances by understanding consumer preferences, optimizing operations, promoting sustainability initiatives, and strengthening its brand position. Through the implementation of this comprehensive strategy, Burger King Indonesia aims to improve customer satisfaction, foster loyalty, and attain overall market success in the post pandemic period. This strategy not only addresses the immediate challenges posed by the pandemic but also positions Burger King Indonesia for long-term success.

Evaluation of an education program upon women's knowledge toward management of Breast Self – Examination(BSE)

To determine the evaluation of education program on women's knowledge regarding managing BSE. The present quasi- experimental study, Non-probability (purposive), sample consisting of (260) women who are employee, and students in both colleges (Nursing college, Medical and Health Techniques College). The sample consist of two groups, study group (130) including those in (Nursing college), and control group (130) in (Medical and Health Techniques College). A questionnaire was constructed which included, Demographic information, Reproductive information, Family history, Previous medical history, and information about women's knowledge toward management of breast self examination (BSE). Instrument validity and reliability was determined. Data were collected through the use of the questionnaire, the application of the educational program a post-test was done for the study only which use the lectures, booklets, training practice of BSE, and video film. Analysis of data was performed through the application of descriptive and inferential statistical data analysis approach. Revealed that the women in the study group had benefited from the implementation of the educational program; their knowledge regarding managing BSE was adequately improved and developed. The study illustrated significant difference between women's knowledge means in pre and post test periods regarding their managing for BSE. Implementation of proposed model of continuous medical education for women for BSE within the scope of their work.

Reduction of hemodialysis catheter-related blood stream infections in intensive care units after systematic use of taurolidine-citrate-heparin locking solution.

Dialysis catheter-associated bacteremia in Intensive Care Units (ICUs) increases morbidity and mortality, prolongs hospital admission and increases admission costs. Taurolidine-Citrate-Heparin Locking Solution (TCHLS) is a catheter-locking solution with a broad antimicrobial activity against gram-positive and gram-negative bacteria and fungi. The aim of this study was to analyze the effect of systematic sealing of hemodialysis catheters in the ICUs of the Hospital Clínic de Barcelona on the incidence of hemodialysis catheter-related blood stream infections (CRBSI). CRBSI episodes of patients who underwent intermittent hemodialysis (IHD) during ICU admission were reviewed. TCHLS was established as a routine dialysis catheter sealing solution in the hospital ICUs in 2015. As a control group an historic pre-TCHLS group from 2010 to 2014 was used. The post-TCHLS period comprised from 2015 to 2018. A total of 243 and 266 patients required IHD in the pre- and post TCHLS periods, respectively. The number of CRBSI in the pre-TCHLS period was 18 (7.43%) as compared to 9 (3.38%) in the post-TCHLS period (p = 0.043). All infections were from percutaneous catheters except for three catheters that were tunneled. There was no association between the location of the catheter and the incidence of CRBSI. The most frequent isolated microorganisms were Gram positive bacteria (48.38%), with a global predominance of Staphylococcus epidermidis (32.25%). There were no significant differences in the median days from the start of hemodialysis to the onset of bacteremia (23.5 days in pre-TCHLS group vs 21 days in the post-TCHLS). There were also no significant differences between the days of ICU stay in the CRBSI in both groups or in mortality, being the overall mortality of 65.9%. In our population, the systematic application of TCHLS in the sealing of dialysis catheters in critically ill patients reduces the incidence of CRBSI in ICUs.

Mortality and Place of Residence One Year Post Stroke in an Irish Cohort

Abstract Background Transition from hospital to community post stroke is a critical period in a patient's recovery. Understanding where post-stroke patients are living a year after discharge can provide valuable insights into the effectiveness of discharge planning and rehabilitation strategies. We aimed to identify location of patients one year post stroke and examine the influences on that location. Methods We performed a retrospective cohort study of stroke patients admitted to an acute hospital over a one-year period. Data on demographics, function, length of stay, stroke severity, mortality and discharge location were obtained from the in-hospital stroke registry. Patients were interviewed one year post stroke and follow up data on place of residence obtained. Results 260 strokes occurred during the 1-year period. 11% died as inpatients and 5% were uncontactable leaving 206 stroke patients included in this study. Twenty-five patients (12%) died between discharge and 1 year follow up. 150 (73%) returned home post discharge rising to 157 (76%) one year post stroke. 32 (16%) were discharged to nursing homes falling to 22 (11%) at one year. Patients in nursing homes were older (80 vs 68 years, p = 0.001), had longer inpatient stays (37 vs 9 days, p = 0.000) and had higher Modified Rankin Scores (5 vs 2, p=0.0001). Conclusion Almost one in four stroke patients died within the first year of stroke consistent with international data. Mortality was highest in the acute post stroke period, but half of all deaths occurred post hospital discharge highlighting the importance of secondary vascular prevention and advanced care planning in this population. Older age, higher functional dependence and longer length of hospital stay were all associated with nursing home admission. Post stroke morbidity and mortality remains high after hospital discharge. Further study is needed to understand cause of death in the post discharge period in this population.

A Retrospective Assessment of Guideline Adherence and Treatment Outcomes From Clostridioides difficile Infection Following the IDSA 2021 Clinical Guideline Update: Clostridioides difficile Infection

Abstract Background The 2021 update to the Infectious Diseases Society of America Clostridioides difficile infection (CDI) guidelines recommended fidaxomicin as the preferred treatment over vancomycin for patients with initial and recurrent CDI. Few studies have examined how treatment patterns and clinical outcomes of hospitalized CDI patients changed after the postguideline update or contemporary real-world outcomes of fidaxomicin vs vancomycin. Methods This retrospective, observational study used the PINC AI Healthcare Database on adult patients who received CDI treatment between 1/2020 and 6/2021 (pre period) and between 10/2021 and 9/2022 (post period). We examined treatment patterns of fidaxomicin, vancomycin, and metronidazole, as well as clinical and health care resource use outcomes of patients treated exclusively with fidaxomicin vs vancomycin, using nearest-neighbor propensity matching and hierarchical regression methods. As a sensitivity analysis, we repeated the fidaxomicin vs vancomycin comparisons among patients with recurrent and nonrecurrent index infections. Results A total of 45 049 patients with CDI from 779 US hospitals met initial inclusion criteria. Comparing the pre vs post periods, the proportion of patients treated with fidaxomicin increased from 5.9% to 13.7% (P < .001), vancomycin use decreased from 87.9% to 82.9% (P < .001), and metronidazole use decreased from 21.6% to 17.2% (P < .001). When comparing fidaxomicin vs vancomycin in the post period, fidaxomicin was associated with lower CDI recurrence (6.1% vs 10.2%; P < .001) and higher sustained clinical response (91.7% vs 87.8%; P < .001). Ninety-day postdischarge costs were not significantly different between groups. A sensitivity analyses showed similar findings. Conclusions Since the 2021 guideline update, fidaxomicin use has increased significantly but could be further utilized given its association with better clinical outcomes and no increase in postdischarge costs.

387 Impacts of rumen protected omega-6 fatty acid supplementation on cow reproduction and calf growth

Abstract Maternal nutrition during pregnancy is crucial for proper fetal development. Rumen protected omega-6 (ω-6) fatty acids (FA) may improve health and reproductive success in beef cattle. Previous research studied the effects of supplementing ω-6 on cow production either during late gestation or post-breeding but not during both stages. Our objective was to determine the effects of ω-6 supplementation during late gestation and post-breeding on cow reproduction and calf pre-weaning growth. Eighty cows were assigned to either a saturated FA control (C) or rumen protected ω-6 supplements for 40 d before parturition (PRE) and/or 35 d after artificial insemination (AI, POST) using a 2 × 2 factorial: PRE C-POST C(n = 19); PRE C-POST ω-6(n = 19); PRE ω-6-POST ω-6(n = 17); PRE ω-6-POST C(n = 18). Cows were fed ad libitum hay and water when on/off supplementation periods. Supplements were provided in low moisture tubs. Individual animal intake of supplement was measured by a GrowSafe system. Cow body weights and plasma FA concentrations were measured prior to and after supplementation during each period. Calves were weighed at birth, branding, 150 d old and weaning. Reproductive measurements included postpartum estrus activity, estrus response at fixed-time AI (FTAI), and pregnancy rates. Blood plasma for progesterone analysis was collected on d 7 post-AI on all cows. Corpus luteum (CL) area was measured on d 7 via transrectal ultrasonography on a subset of cows during the POST period (PRE ω-6-POST ω-6 n = 8; PRE C-POST C n = 8; PRE C-POST ω-6 n = 8; PRE ω-6-POST C n = 8). The relationship between supplement intake and plasma FA concentration was analyzed via linear regression, and all other variables were analyzed via ANOVA. Supplement intakes within treatments and between the PRE and POST supplemental periods were highly variable. Body weights remained similar for cows (P = 0.52), but POST ω-6 calves had larger weaning weights than POST C calves (P = 0.02). There was a positive linear relationship (r2 = 0.14, P < 0.03) between supplement intake and plasma FA for PRE ω-6 and POST ω-6. Positive linear relationships between intake and plasma ω-6 FA concentration were observed for PRE C (r2 = 0.11, P < 0.05), PRE ω-6 (r2 = 0.2, P < 0.007) and POST ω-6 (r2 = 0.31, P = 0.0005). Post-partum estrus activity was similar (P = 0.81) between PRE C and PRE ω-6 cows, and estrus response at FTAI was similar (P = 0.13) between POST C and POST ω-6 cows. POST ω-6 cows had larger CL areas than POST C cows (P = 0.03); however, blood progesterone concentrations at d 7 did not differ between treatments (P = 0.65). There was no difference in conception to FTAI between POST C and POST ω-6 (P = 0.08). These results indicate that free choice ω-6 FA supplementation during late gestation and post-AI result in large variation in intake between cows that influence plasma concentrations, but did not markedly alter reproductive measures in mature beef cows.

ThP5.1 - The Influence of the COVID-19 Pandemic on the Complexity of Laparoscopic Cholecystectomy

Abstract Aim The operative difficulty of Laparoscopic Cholecystectomy (LC) varies widely. This can affect the operative time, complications, post-operative course and ultimately patient outcomes. The COVID-19 pandemic caused substantial delays in the definitive management of gallstone disease. The aim of the present study was to compare the intraoperative difficulty grading of post COVID-19 pandemic LCs with previously published data. Methods This comparative study analyses a prospectively maintained database of all LCs performed by two biliary surgeons in a single centre between August 2022 to January 2024. Clinical and intra-operative findings including operative difficulty grading using the Nassar scale were recorded. This data was then compared to the previously published data from a single surgeon spanning 29 years (n=5,391). Results 149 patients were included; the median age was 56 years (IQR 45-66). 88 (51.1%) were female. 71 (47.7%) LC’s were completed as part of an emergency admission. The median Scottish Index of Multiple Deprivation was 5 (IQR 3-7). 45 (30.2%) underwent LC alone, 63 (42.2%) also received an operative cholangiography and 41 (27.5%) underwent common bile duct exploration. Grade 1 LC (4.8% vs 33.2%, p<0.001) were significantly less prevalent than grade 4 LC (37.4% vs 14.2%, p<0.001) in the post pandemic period when compared to the previous published data. Conclusion The present study suggests that LCs are more challenging post pandemic. The contributing factors are likely diverse, but extended waiting times and multiple emergency admissions leading to delays in definitive management are presumed to play significant role. Urgent attention is warranted to establish biliary pathways that guarantee timely and definitive management of gallstones for patients.

A Study On The Screening Of Congenital Heart Disease Using Pulse Oximetry In Asymptomatic Newborns Delivered In Tertiary Care Centre

Introduction: Congenital Heart Disease is the most common congenital abnormality in newborns and has been recognized as one of the leading causes of death in the first year of life. The global incidence of CHD is estimated at 8 per 1000 live births. Using pulse oximetry critical and many of the asymptomatic CHD can be identified in the immediate post natal period. This strategy will help in early identification and its intervention. Objective: To assess the effectiveness of pulse oximetry as a screening tool for detection of CHD in asymptomatic newborn. Methods: It was a Hospital based Cross sectional study conducted in the Department of Obstetrics and Gynaecology, in collaboration with the Department of Paediatrics, of a tertiary hospital in North Eastern State from May 2022 to April 2024. Results: The mean birth weights of the neonates were2.93±0.29 Kg and the mean gestational age was 37.74±1.56 weeks. 4% of all neonates screened with pulse oximetry showed positive result. Among them 4 (2%) neonate were diagnosed with CHD. Out of the 4 neonates diagnosed with CHD, 3 were diagnosed with VSD and 1 with PDA. Conclusion: Eight (8) i.e 4% of the neonates were screened with positive pulse oximetry and out of which four (4) were diagnosed with CHD. Proportion of neonates who were screened positive in pulse oximetry with positive echocardiographic findings were significantly higher than those who screened negative (p value <0.001). Therefore, the pulse oximetry screening for detection of CHD among asymptomatic neonates in our study showed a moderate sensitivity (75%), high specificity (97.4%) and negative predictive value (99.47%) and a reasonably low positive predictive value (37.5%), respectively

Reconstructing diet after the fall of the Wari Empire in the central Andean Highlands: A study of human dental calculus

Stable isotopes from bones and teeth have been used to reconstruct human lifeways in bioarchaeological research for over 30 years. Recently, there have been efforts to use less invasive methods of analysis that meet ethical standards and do not compromise the integrity of human skeletal remains. To that end, this study examines dental calculus from human teeth as a proxy for paleodietary reconstruction. This current work builds on a handful of studies that have tested the use of dental calculus for reconstructing diet, which have shown mixed results. This study contributes to those ongoing efforts to improve methods and capacities in paleodiet research. The sample is comprised of dental calculus from individuals from the Wari (600–1000 CE) and post-Wari periods (1000–1400 CE). Individuals from both time periods with stable carbon and nitrogen isotope data from the calculus are directly compared to the stable isotope results from human bone collagen, dental carbonates, and bone carbonates. Results from dental calculus show δ13C that range from -20.5 ‰ to −12.3 ‰, consistent with the use of C4 plants (maize) as a major component of the diet. The δ13C from calculus are isotopically lighter and more varied than those obtained from collagen, and this is likely explained by the distinct composition of calculus compared to that of bone collagen and apatite. The δ15N from calculus range from +8.9 ‰ to +18.8 ‰, which is heavier than expected for highland maize-based diets in the Peruvian Andes. This may be explained by 15N enrichment from aridity or crop fertilization (e.g., camelid dung), especially during the post Wari period, a time of social upheaval and severe drought. The differences in stable isotope values may also be partially explained by the diet-sourced isotopes in bone collagen (e.g., averaging the last 5–10 years of life) versus that of dental calculus (e.g., averaging the last few years of life). Documenting these differences in stable isotope ratios from distinct components may aid in richer understandings of past diets and provide additional ways to compare diet through time and space. Indeed, as more researchers begin analyzing the stable isotope ratios from dental calculus, we can minimize destructive techniques and make direct comparisons between studies that use dental calculus. We suggest that this is an important expansion of our analytical toolkit.

Fat burning capacity in a mixed macronutrient meal protocol does not reflect metabolic flexibility in women who are overweight or obese.

Metabolic flexibility, the ability to switch from glucose to fat as a fuel source, is considered a marker of metabolic health. Higher fat oxidation is often associated with greater flexibility and insulin sensitivity, while lower fat oxidation is linked to metabolic inflexibility and insulin resistance. However, our study challenges the universal validity of this relationship, uncovering a more nuanced understanding of the complex interplay between fuel source switching and fat oxidation, especially in the presence of insulin resistance. In an 8-week controlled feeding intervention, overweight to obese women with insulin resistance (as defined by McAuley's index) were randomized to consume either a diet based on the Dietary Guidelines for Americans 2010 (DGA) or a 'Typical' American Diet (TAD), n = 22 each. Participants were given a high-fat mixed macronutrient challenge test (MMCT) (60% fat, 28% carbohydrates, and 12% protein) at weeks 0, 2, and 8. Plasma lipids, metabolome, and lipidome were measured at 0, 0.5, 3, and 6h postprandial (PP); substrate oxidation measures were also recorded at 0,1 3, and 6h PP. Metabolic flexibility was evaluated as the change in fat oxidation from fasting to PP. Mixed model and multivariate analyses were used to evaluate the effect of diet on these outcomes, and to identify variables of interest to metabolic flexibility. Intervention diets (DGA and TAD) did not differentially affect substrate oxidation or metabolic flexibility, and equivalence tests indicated that groups could be combined for subsequent analyses. Participants were classified into three groups based on the % of consumed MMCT fat was oxidized in the 6h post meal period at weeks 0, 2 and 8. Low fat burners (LB, n = 6, burned <30% of fat in MMCT) and high fat burners (HB, n = 7, burned > 40% of fat in MMCT) at all weeks. Compared to LB, HB group had higher fat mass, total mass, lean mass, BMI, lower HDLc and lower RER (p < 0.05), but not different % body fat or % lean mass. During week 0, at 1h PP, LB had an increase in % fat oxidation change from 0h compared to HB (p<0.05), suggesting higher metabolic flexibility. This difference disappeared later in the PP phase, and we did not detect this beyond week 0. Partial least squares discriminant analysis (PLSDA (regular and repeated measures (sPLSDA)) models identified that LB group, in the late PP phase, was associated with higher rates of disappearance of acylcarnitines (AC) and lysophosphatidylcholines (LPC) from plasma (Q2: 0.20, R2X: 0.177, R2Y: 0.716). In women with insulin resistance, a high fat burning capacity does not imply high metabolic flexibility, and not all women with insulin resistance are metabolically inflexible. LPCs and ACs are promising biomarkers of metabolic flexibility.