Proactive Screening Research Articles

Association of primary hyperparathyroidism with pituitary adenoma and management issues.

The co-occurrence of primary hyperparathyroidism (PHPT) and pituitary adenomas (PAs) is often indicative of underlying genetic syndromes such as Multiple Endocrine Neoplasia type 1 (MEN1) and, less commonly, MEN4. Although both conditions can occur sporadically, their simultaneous presence warrants evaluation for genetic mutations, with MEN1 mutations being the most frequent cause. The management of concurrent PHPT and PAs, especially in MEN1 patients, presents unique challenges. Management complexities arise from the syndromic nature, involving both surgical and medical interventions tailored to each condition. PHPT often manifests earlier and more aggressively in MEN1, requiring surgical intervention. However, recurrence rates remain high due to multiglandular involvement. Pituitary adenomas in MEN1 are primarily prolactinomas, and treatment with dopamine agonists results in significant tumour control in most cases. Overall, PAs associated with MEN1 are generally responsive to medical therapy, but careful long-term monitoring is essential. The utility of genetic screening cannot be overstated, as it aids in early detection, risk stratification, and management of both the index case and affected family members by cascade screening. A multidisciplinary approach is crucial for optimizing outcomes, with ongoing surveillance to manage recurrence and associated complications. In summary, the co-occurrence of PHPT and PAs, particularly in the context of MEN1, necessitates an integrated management strategy. Genetic testing is key in confirming diagnosis and guiding treatment, while surgical and medical interventions should be tailored to the extent and nature of glandular involvement. Close monitoring for recurrence and proactive family screening are essential components of long-term care.

Case report of familial hypercholesterolemia with internal carotid neck swelling

ABSTRACT Familial hypercholesterolemia is a multi-gene disorder affecting 1 in 200-500 individual which is characterized by increased level of total cholesterol and low density lipoprotein (LDL) which deposit cholesterol reach protein leading to xanthomas, corneal arcus and prone to develop risk for atherosclerosis and coronary heart disease. 11 year female, born of consanguineous marriage attended with yellowish patches (Xanthelasma) bilaterally present over upper eyelid, buttock since 5-6 years. In family history younger girl along with both parents has Xanthelasma. In investigations, routine blood, urine and ECG& ECHO was normal except lipid profile of patient and sibling was abnormal. Child was treated with atorvastatin and dietary advice. In follow up after 3 month, child had complained of neck pain and swelling to left side. Then USG neck and Color Doppler showed reduced diastolic flow of left ICA and type two plaques and type 111 plaque in Rt common carotid artery. Anti-platelets was added and referred to cardiologist for coronary angiography which showed LAD – proximal mid distal diffuse plaque, LCX- proximal eccentric plaque. This case highlights the significance of conscious and proactive genetic screening for familial hypercholesterolemia especially in consanguineous marriage, to diagnose, treat and prevent mortality with premature coronary artery disease.

Thyroid disorders and the incidence of type 2 diabetes: insights from a 10-year cohort study in Germany.

Thyroid dysfunctions, such as hypothyroidism, hyperthyroidism, are known to influence metabolism, but their long-term impact on the development of type 2 diabetes mellitus (T2D) in humans remains elusive. Thus, this study aimed to assess the cumulative incidence and association between thyroid disorders and T2D development. We conducted a retrospective cohort study using data from the Disease Analyzer database (IQVIA™) from 2005 to 2022. The study included 158,674 patients with thyroid disorder and an equal number of matched patients without thyroid disorder. Propensity score matching was performed to balance age, sex, co-diagnoses between the cohorts. Kaplan-Meier curves and Cox regression models were used to assess the cumulative incidence and hazard ratios (HR) for new-onset T2D. After a 10-year follow-up period, the cumulative incidence of T2D was higher in patients with thyroid disorder compared to the non-thyroid disorder cohort (p<0.001). The HRs for T2D were 1.34 (95% CI: 1.28-1.39) for hypothyroidism and 1.30 (95% CI: 1.21-1.39) for hyperthyroidism. The strongest associations were observed in younger age groups for both hypothyroidism and hyperthyroidism. Thyroid disorders, including hypothyroidism and hyperthyroidism, are associated with an increased incidence of new-onset T2D. These findings suggest the need for proactive screening and management of glucose metabolism in patients with thyroid dysfunctions, particularly in younger individuals, independent of metabolic risk factors.

Diabetes and Cataracts Development-Characteristics, Subtypes and Predictive Modeling Using Machine Learning in Romanian Patients: A Cross-Sectional Study.

Background and Objectives: Diabetes has become a global epidemic, contributing to significant health challenges due to its complications. Among these, diabetes can affect sight through various mechanisms, emphasizing the importance of early identification and management of vision-threatening conditions in diabetic patients. Changes in the crystalline lens caused by diabetes may lead to temporary and permanent visual impairment. Since individuals with diabetes are at an increased risk of developing cataracts, which significantly affects their quality of life, this study aims to identify the most common cataract subtypes in diabetic patients, highlighting the need for proactive screening and early intervention. Materials and Methods: This study included 201 participants with cataracts (47.6% women and 52.4% men), of whom 105 also had diabetes. With the use of machine learning, the patients were assessed and categorized as having one of the three main types of cataracts: cortical (CC), nuclear (NS), and posterior subcapsular (PSC). A Random Forest Classification algorithm was employed to predict the incidence of different associations of cataracts (1, 2, or 3 types). Results: Cataracts have been encountered more frequently and at a younger age in patients with diabetes. CC was significantly more frequent among patients with diabetes (p < 0.0001), while the NS and PSC were only marginally, without statistical significance. Machine learning could also contribute to an early diagnosis of cataracts, with the presence of diabetes, duration of diabetes, or diabetic polyneuropathy (PND) having the highest importance for a successful classification. Conclusions: These findings suggest that diabetes may impact the type of cataract that develops, with CC being notably more prevalent in diabetic patients. This has important implications for screening and management strategies for cataract formation in diabetic populations.

Prevalence of Idiopathic Macular Hole in a Specialized Ophthalmological Referral Center: A Retrospective Cross-Sectional Study (2018-2022).

An idiopathic macular hole (IMH) is a foveal opening in the neurosensory retina caused by perifoveal vitreomacular traction and detachment. IMH prevalence varies considerably across populations,highlighting a need for further investigation, especially in underrepresented groups such asHispanics. This retrospective, descriptive, cross-sectional study analyzed IMH prevalence in a Hispanic population over four years. Electronic records of patients were reviewed at a single referral center.All patients aged 18 years and above who presented for a first-time comprehensive ophthalmology evaluation were included. IMH diagnosis was clinically made and confirmed with optical coherence tomography (OCT). Data analysis involved descriptive and inferential statistics, adhering to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Of 116,655 electronic records analyzed from March 2018 to July 2022, 397 subjects were identified in our analysis. The estimated prevalence of IMH was 0.34% (95% confidence interval (CI): 0.307-0.375), with a female-to-male ratio of 4:1. The mean age of the participants was 67.75 ± 9.38 years.Initial visual acuity, laterality, comorbidities, and clinical findings were assessed.No significant gender differences were documented. Subgroup analyses revealed significant age discrepancies based on comorbidities and clinical symptoms. Our study provides insight into the prevalence of IMHs in a Hispanic population.Its findings are similar to those published for other populations.The observed prevalence emphasizes the importance of proactive screening for IMHs in older patients, especially if they are women. Clinical markers such as the Watzke-Allen sign are helpful in the early detection of IMHs.

Gestational Diabetes Mellitus Prevalence and Risk Factors - A Study from a Tertiary Care Centre in North India

Introduction: Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) pose significant global health challenges. The increasing global prevalence of GDM and its associated complications underscores the need for proactive screening and management. The study aimed to evaluate the prevalence of GDM and its associated risk factors in a tertiary care hospital in North India Methodology: A prospective cross-sectional study conducted at Max Super Speciality Hospital, New Delhi, during 2016-2017, enrolled 900 pregnant women (aged 18-50 years) from the antenatal outpatient department (OPD). Primary objective: To assess impaired oral glucose tolerance prevalence (IADPSG criteria) at 24th-28th weeks. The data covered demographic, socioeconomic, obstetric, and medical details. Descriptive statistics were used to summarize the variables. Chi-square or Fisher's tests were applied to categorical data, while continuous data were analysed using independent t-tests. Multiple regression analysis was conducted to identify risk factors. Results: GDM was diagnosed in 7.4% of participants. Prevalence was highest in the age group &gt;35 years (36.2%, p=0.000), and a significant association was found between increasing body mass index (BMI) and GDM (p=0.04). Adverse obstetric history, including previous abortions and GDM in prior pregnancies, increased the risk of GDM. Complications during pregnancy, such as macrosomia (present in 1 patient with GDM and none in non-GDM), foetal distress (9.09% in GDM), and preeclampsia (4.7% in GDM), were higher in women with GDM. Vaginal delivery prevalence was higher in non-GDM, while GDM had a higher rate of caesarean section delivery (p&lt;0.005). Conclusion: The study discloses a 7.4% GDM prevalence in North Indian tertiary care, accentuating rising diabetes trends. Identified risk factors inform antenatal screening, highlighting the need for early GDM management to mitigate complications and prevent future diabetes. Single-centre limitations emphasise the necessity for broader population studies for accurate prevalence rates.

Understanding risk factors for perinatal distress in Syrian refugee mothers: insights from Lebanon.

The perinatal period is a critical phase in a woman's life, marked by unique mental health challenges. This study focuses on Syrian mothers in Lebanon, a vulnerable population often exposed to displacement and conflict-related stressors. The aim is to identify risk factors for perinatal distress, including symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), among Syrian mothers within one year of giving birth. Data collection included quantitative assessments using the Refugee Health Screener-13 (RHS-13), and qualitative insights from in-depth interviews. The assessment period was extended to cover the year following childbirth to provide a broader perspective on perinatal distress. The study revealed significant risk factors, specifically a history of mental illness and chronic disease. While maternal age and number of children were considered potential risk factors, they were not statistically significant in the quantitativeanalysis but were highlighted in the qualitative interviews. This research offers valuable insights for healthcare providers, policymakers, and organizations working with Syrian refugee women in Lebanon. Addressing these risk factors can improve mental health outcomes for perinatal women affected by war and displacement, underscoring the need for proactive mental health screening during pregnancy and postpartum.

Abstract 4120458: Predictors of School Non-Engagement in School Aged Children and Adolescents Born with Heart Disease

Introduction: School engagement, or caring about doing well and doing required homework, is an important factor for academic success and may contribute to poorer academic outcomes in children born with heart disease (HD), compared to heart-healthy peers. Factors that influence lack of school engagement in children born with HD are not well known. Research Question: What factors predict school non-engagement in students with HD? Aims: To identify factors that predict school non-engagement in students with HD to assist in earlier detection and support for students at increased risk. Methods: We analyzed data from the 2022 National Survey of Children’s Health (NSCH), using procedures for complex weighted survey data. School-related outcomes in children ages 6 to 17 years born with and without HD were compared using Chi-square tests. Multivariate logistic regression was used to examine predictors of school non-engagement in students with HD. Results/Data: Of 54,065 NSCH responses, 34,284 were children ages 6 to 17 years, and 826 of these were born with HD. Children born with HD had lower school engagement (p&lt;0.001) and missed more days of school (p&lt;0.001) than peers not born with HD, but grades were not different between groups. Students born with HD were more likely than peers not born with HD to be bullied (p = 0.001), have a diagnosis of anxiety (3.71% vs 1.95%, p&lt;0.001) or depression (3.56% vs 2.09%, p =0.012), require a Special Education Plan (34.9% vs 16.1%, p&lt;0.001), or to receive mental health services (23% vs 14%, p &lt;0.001). Multivariate logistic regression identified factors that significantly predicted school non-engagement in students born with HD, including diagnosis of attention deficit/hyperactivity disorder (ADHD) (aOR 1.94, 95% CI [1.20, 4.58], p=0.013), behavior/conduct problems (aOR 2.77, 95% CI [1.46, 5.23], p=0.002), or learning disability (aOR 3.44, 95% CI [1.79, 6.59], p&lt;0.001). Sociodemographic variables, days of missed school, anxiety, depression, intellectual disability, autism spectrum disorder, and speech disorder were not significant predictors of school non-engagement. Special healthcare needs status neared significance in predicting lack of school engagement (p = 0.056) Conclusions: We identified ADHD, behavior/conduct problems, and learning disabilities as predictors of school non-engagement in students with HD. This information can be used to identify at-risk students born with HD who may benefit from proactive screening and support.

Food insecurity in a diverse community pediatric gastroenterology clinic: Screening strategies and insights.

We aimed to evaluate the prevalence of food insecurity (FI) in the community pediatric gastroenterology(GI) subspecialty clinic at Texas Children's Hospital (TCH) West Campus and to assess the utilization of services through our partnership with a local food bank. From July 1, 2023, to February 29, 2024, all patients seen in the pediatric GI clinic at TCH West Campus were screened for FI using the validated Hunger Vital Sign tool and given the opportunity to consult with a local food bank representative. A retrospective chart review was then performed on patients who completed the implemented FI screening process. 13.4% of the total patients screened positive for FI. Hispanic patients (p < 0.0001), patients with the preferred language of Spanish (p < 0.0001), those enrolled in Medicaid or Children's Health Insurance Program (p < 0.0001), and patients with obesity (body mass index ≥ 30.0, p = 0.0003) were more likely to screen positive for FI. Poor weight gain/failure to thrive and steatotic liver disease were significantly more common in those with FI (p < 0.0001 and p = 0.0003, respectively), while celiac disease, abdominal pain, and blood in stool were more common in those without FI (p = 0.0003, 0.0475, and 0.0404, respectively). As a result of our implemented FI screening process, 68.4% of those screening positive opted for resource referral, with 50.7% successfully receiving assistance in combating FI. Identifying the potential impact of FI in common pediatric GI conditions calls for proactive screening and more holistic, patient-centered approaches in clinical practice.

NCMP-30. GLUCOCORTICOID-INDUCED HYPERGLYCEMIA IN BRAIN TUMOR PATIENTS: A SINGLE CENTER RETROSPECTIVE STUDY

Abstract BACKGROUND Glucocorticoid (GC) therapies are integral in managing brain tumor-associated cerebral edema and neurological deficits in the neuro-oncology perioperative setting. Despite their effectiveness, GCs can induce significant morbidity, including hyperglycemia. METHODS This single-center retrospective study at the University of North Carolina neurological surgery department examines the incidence and risk factors for glucocorticoid-induced hyperglycemia in brain tumor patients treated with high-dose GCs. Data from clinical databases, electronic medical records, laboratory systems, and pathology information banks will be utilized. Documented glucose measurements, glycated hemoglobin test (HbA1c) and clinical outcomes (mortality, infection, hypoglycemia) in brain cancer patients treated with Glucocorticoid (GC) that developed hyperglycemia will be compared with brain tumor patient with normoglycemia. RESULTS We will document the total number of brain tumor patients referred over the study period, eligibility rates, and the percentage that developed glucocorticoid-induced diabetes (defined as two glucose measurements ≥200 mg/dL within the first week of treatment). Timing of hyperglycemia onset, treatments received, and risk factors for developing glucocorticoid-induced diabetes will also be analyzed. CONCLUSIONS The findings could underscore the necessity for proactive screening for glucocorticoid-induced diabetes in brain tumor patients to mitigate the associated morbidity. This study may guide future research on the benefits of optimized glucose control on clinical outcomes in patients with GC-induced hyperglycemia. Keywords: brain tumor, steroid-induced hyperglycemia, glucocorticoid-induced diabetes, dysglycemia, risk factors, outcomes.

Incidence and Risk Factors of Infection After Fracture Fixation: A Multicenter Cohort Study.

Infection after fracture fixation (IAFF) is a severe complication. There are few multicenter studies targeting IAFF. This paper identifies independent risk factors associated with IAFF by analyzing multicenter clinical data. Appropriate interventions should be implemented to reduce the risk of IAFF. This is a multicenter retrospective cohort study. This study screened medical records of patients who underwent internal fixation for fractures at participating medical institutions from January 1, 2011, to December 31, 2020. Data extraction included demographic characteristics, disease features, surgical variables, and laboratory indicators. Logistic regression analysis was employed to identify the relationship between relevant risk factors and IAFF. Research data were sourced from the hospital's electronic medical record system and self-constructed databases. In our study, 202 patients who underwent internal fixation for fractures experienced postoperative infections, which corresponds to an overall incidence rate of approximately 1.7%. The predominant pathogen identified in these infections was Staphylococcus aureus. A multifactorial analysis indicated that several factors were independently associated with the occurrence of IAFF. These factors included BMI ranges of 24.0-27.9 and 28.0-31.9, smoking, a high ASA score, high-energy trauma, diabetes, open fracture, seasonal timing of the surgery (summer), bone grafting, drainage duration, surgical duration ≥ 180 min, and A/G ratio < 1.2. We strongly recommend that orthopedic surgeons perform comprehensive preoperative assessments on fracture patients to identify factors that may increase the risk of infection. Through the implementation of targeted interventions and beneficial modifications to these modifiable risk factors, it is possible to lower the incidence of IAFF. Additionally, proactive screening, risk stratification, and thorough patient education should be prioritized for patients with high risk but nonmodifiable factors.

Circulating Autoantibodies in Adults with Hashimoto's Thyroiditis: New Insights from a Single-Center, Cross-Sectional Study.

Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder characterized by elevated anti-thyroid peroxidase (A-TPO) antibodies. HT frequently coexists with other autoimmune conditions, which are marked by organ-specific and non-organ-specific autoantibodies, reflecting a deregulated immune response. However, the burden and clinical significance of these circulating autoantibodies in adult patients with HT remains unclear. A cross-sectional study was conducted at the University Hospital "R. Dulbecco" in Catanzaro, Italy, from November 2023 to May 2024, involving 200 euthyroid adults. The study population comprised 100 A-TPO-positive HT patients and 100 A-TPO-negative controls, matched for age and sex. Laboratory assessments included thyroid function tests and detection of autoantibodies [e.g., antinuclear antibodies (ANA), anti-parietal cell antibodies (APCA), and anti-neutrophil cytoplasmic antibodies (ANCA)]. Cytokine profiles were also measured using sensitive chemiluminescent multi-array technology. HT patients were predominantly female (77.0%) with a median age of 56 years. Compared to controls, HT patients had higher median thyroid stimulating hormone (TSH) levels (2.215 vs. 1.705 μIU/mL, p = 0.025). Circulating autoantibodies were more prevalent in the HT group, with higher rates of APCA positivity (16.3% vs. 4.1%, p = 0.008) and atypical ANCA positivity (27.3% vs. 10.2%, p = 0.003). This suggests an increased risk for autoimmune gastritis and systemic inflammation. Additionally, HT patients with positive atypical ANCA showed elevated inflammatory cytokines, particularly interleukin-1 alpha (IL-1α), in female patients (p = 0.035). HT is significantly associated with a higher prevalence of circulating autoantibodies, such as APCA and atypical ANCA, which may indicate a heightened risk for autoimmune gastritis and broader autoimmune involvement. Detecting these autoantibodies in HT patients could serve as markers for more severe autoimmune dysfunction. These findings emphasize the need for proactive screening, especially in older patients and those with elevated A-TPO levels. Further research is essential to better understand the clinical implications and develop targeted management strategies for these patients.

Self-care practices and associated factors among hypertensive patients at public hospitals in North Shewa zone, Ethiopia.

Hypertension significantly contributes to premature mortality worldwide, highlighting the need for effective self-care to manage its complications. However, there is limited research on self-care practices among hypertensive patients in Ethiopia. This study assessed self-care practices and associated factors in hypertensive patients at public hospitals in North Shewa zone, Amhara Region, Ethiopia. A hospital-based cross-sectional study was conducted with 450 participants using multi-stage sampling and interviewer-administered questionnaires. Data were processed with Epi-Data 4.6.0.6 and analyzed using SPSS 23. Descriptive statistics summarized the results, while bivariable and multivariable logistic regression identified factors associated with self-care practices. Crude and adjusted odds ratios with 95% confidence intervals were calculated, with significance at p < 0.05. Out of 450 participants, 231 (51.3, 95% CI: 46.4-55.6%) exhibited poor hypertension self-care practices. Factors associated with poor self-care included having a college-level education (AOR = 0.27, 95% CI: 0.07-0.95), university-level education (AOR = 0.36, 95% CI: 0.13-0.98), being widowed/widower (AOR = 5.30, 95% CI: 1.05-27.2), poor knowledge of hypertension (AOR = 4.51, 95% CI: 2.44-8.59), inadequate stress management (AOR = 3.10, 95% CI: 1.64-5.74), and first diagnosis during a check-up (AOR = 7.72, 95% CI: 4.22-13.8). This study highlights inadequate self-care among hypertensive individuals, affected by factors such as education, marital status, knowledge, stress management, and diagnostic practices. Personalized interventions focusing on health education, stress management, and proactive screening are essential for improving health outcomes. Additionally, psychological support enhances emotional well-being and self-care engagement in hypertension patients, leading to better health outcomes and quality of life.

Asymptomatic bacteriuria screening for developing countries using a modified water quality test kit.

Between 2% and 15% of pregnant women unknowingly experience asymptomatic bacteriuria (ASB), defined as ≥105 CFU per milliliter of urine in the absence of symptoms. ASB increases the risk of adverse pregnancy outcomes including pyelonephritis, preterm labor, and low-birth weight infants. While pregnant women in the United States are routinely screened for ASB, those in developing countries with limited resources and funding lack an accurate mechanism for ASB screening. Aquagenx water quality test kits detect Escherichia coli, the most common causative agent of ASB, and total coliform bacteria in drinking water via colorimetric and fluorescent indicators. We found that the Aquagenx system is compatible with human urine and then proceeded to develop an ASB screening protocol using disposable inoculating loops. Our protocol diagnosed artificial ASB- samples (104 CFU/mL E. coli) with a false positive (FP) rate of 33% (n = 18) and ASB+ (105 CFU/mL E. coli) with a false negative (FN) rate of 5.6% (n = 18). Clinical sample testing with our protocol revealed a FP rate of 0% in ASB- samples (n = 28) and a FN rate of 0% in ASB+ samples caused by coliforms (n = 13). Aquagenx did not detect ASB in nine clinical samples with non-coliform etiological agents due to the limitations of the technology. However, with very high accuracy for detection of E. coli and other causative agents that collectively account for 90.1% of ASB cases, these kits could be used as a diagnostic ASB screening tool in developing countries in which there is currently no alternative to urine culture.IMPORTANCEAsymptomatic bacteriuria (ASB) affects 2%-15% of pregnant women and can result in adverse maternal and fetal outcomes if left undetected and untreated. In the United States and other developed nations, pregnant women are regularly screened for ASB via urine culture. However, in low-resource countries where bacterial culture is not available, dipstick testing is used. Although accurate in cases of symptomatic bacteriuria, dipstick detection is ineffective for detecting ASB. Here, we made use of an existing water quality field test for ASB urine screening, which would be readily deployable in low-resource settings. We optimized a dilution protocol for sampling patient urine within the detection limits of the Aquagenx kit technology. Overall, we were able to detect ASB samples with Gram-negative pathogens that collectively account for 90% of all ASB cases. Utilization of this repurposed technology for proactive medical screening may help prevent adverse pregnancy and birth outcomes due to ASB.

7172 Osteoporosis Associated with Antiretroviral Therapy - Case report

Abstract Disclosure: C.E. Guillen Lopez: None. L.A. Sanchez Ato: None. A. Patel: None. A. Molkina: None. T. Ayub: None. L. Robles: None. A. Arce Gastelum: None. Osteoporosis presents a substantial public health challenge, contributing significantly to morbidity and mortality through fractures. While postmenopausal osteoporosis is common, secondary osteoporosis affects a significant number of patients, including over 30% of postmenopausal and 50-80% of men. People living with HIV (PLWH) experience age-related medical comorbidities earlier and more extensively than those without HIV. The compromised bone health in PLWH is attributed to factors associated with the virus, antiretroviral therapy (ART) side effects, and health disparities such as inadequate nutrition, low body weight, hypogonadism, vitamin D deficiency, and increased recreational substance use. More recently, it has become apparent that vertebral fractures are more common in PLWH, with a prevalence of 11.1% and a 2.30-fold more significant risk than the general population. Low bone mass density (BMD) is twice as common in PLWH, increasing to 3 times as common in PLWH on ART. ART initiation leads to transient bone loss with nucleotide reverse transcriptase inhibitors such as tenofovir disoproxil fumarate (TDF) and protease inhibitors, causing higher BMD loss. In contrast, integrase and specific reverse-transcriptase inhibitors have minimal adverse effects on BMD. The newer formulation, tenofovir alafenamide (TAF), is believed to have a more favorable impact on bone health than TDF. The repercussions of diminished bone health, particularly osteoporotic fractures, have significant medical and economic implications. They are leading to early mortality, disability, and a loss of independence. The HIV Medicine Association (HIVMA) and Infectious Diseases Society of America (IDSA) recommend BMD screening for all HIV-infected patients at 50 years. 58-year-old male PLWH reveals a history of osteoporosis with multiple spinal (L1, L4-5, S1) and bilateral wrist fractures on TDF for 15 years. The patient has been treated with bisphosphonates. Alendronate was initially prescribed, but due to acid reflux side effects, zoledronic acid was a better option. Despite various ART regimens, Dolutegravir/Lamivudine was started four years ago without further fractures. Recent bone density assessments showed improvement in the lumbar spine, returning to a normal range with a T-score of 0.6. However, the left femoral neck remains at -2.5, and the right femoral neck is at -2.2, showing minimal change. To enhance BMD in PLWH on ART, transitioning to alternatives with lower bone loss associations and using bisphosphonates as tolerated are suggested. As the HIV-infected population ages, proactive screening for low BMD is vital to manage evolving health needs and prevent bone-related complications. A holistic approach includes evaluation for secondary etiologies of osteoporosis, medical treatment, and vitamin D and calcium supplementation. Presentation: 6/3/2024

A Proactive Telephonic Outreach Program to Address Unmet Social Needs of Children in Immigrant and Refugee Families at a Federally Qualified Health Center.

We developed a telephonic outreach and care coordination program for children in immigrant and refugee families (CIRF) at a federally qualified health center (FQHC) in North Carolina to address unmet health-related social needs (HRSN). Participants were recruited between December 2020 and October 2021. Eligible children were ages 0-5, non-English speaking, and were seen at the FQHC in the 2years prior. A bicultural/bilingual case manager completed telephonic outreach to caregivers of participants with HRSN screening. Bilingual patient navigators made follow-up calls to assess connection to resources and to develop strategies for addressing unmet needs. Three hundred forty-two families received outreach; 212 (62.0%) completed the baseline questionnaire. The majority (N = 160, 75.5%) completed at least one follow-up. The majority (N = 186, 88.1%) were Spanish-speaking, and over two-thirds (N = 149, 70.3%) were uninsured. Most participants had between 3-5 HRSNs identified (N = 121, 57.1%); "employment" (n = 158, 74.5%) and "food" (n = 138, 65.1%) were the most common. Despite repeated assistance, the majority of participants struggled to link to a community resource for their highest priority need (N = 123, 78.3%). Proactive phone-based HRSN screening may be a feasible and effective intervention to facilitate the identification of social needs for CIRF. The delivery of the intervention in languages other than English may have further contributed to program acceptability. Despite program feasibility and acceptability, community-level barriers to the resolution of HRSNs persist. While similar care coordination models can be considered to identify the high burden of unmet HRSN among CIRF, addressing the limited capacity of community-based resources for this population will be a critical component to ensuring the sustainability of such programs.

Early Detection For Better Results In The Treatment Of Asymptomatic Cases Of Valvular Heart Disease

Valvular heart disease (VHD) often progresses asymptomatically, leading to delayed diagnosis and treatment, which worsens patient outcomes. Early detection of VHD in asymptomatic cases is crucial to improve treatment effectiveness and long-term prognosis. This study aims to investigate the impact of early detection on treatment outcomes in asymptomatic VHD patients. A cross-sectional study was conducted involving 200 patients diagnosed with VHD, categorized into two groups: those diagnosed early through screening and those diagnosed later after the onset of symptoms. Data were collected through medical records, echocardiograms, and patient interviews. Statistical analysis revealed that early detection significantly improved patient outcomes, with lower rates of complications, better valve repair success, and reduced mortality compared to those diagnosed later. Discussion centers on the importance of routine screenings in at-risk populations and the need for better diagnostic protocols to catch asymptomatic cases early. The conclusion highlights that early detection of asymptomatic VHD leads to better treatment outcomes, underlining the necessity of proactive screening measures to manage VHD effectively.

Prevalence of Osteoporosis and Indications for Bone-Treatment In Older Adults Living with Frailty Enrolled in a Local Integrated Care Programme

Abstract Background Osteoporosis is estimated to affect more than 250,000 adults in Ireland, with 29.4% (€463.3 million) of the total healthcare cost attributable to osteoporosis-related fracture management, resulting in significant health and economic impact.(1,2) As such, early identification of osteoporosis and addressing associated risk factors are crucial steps in reducing osteoporosis-associated morbidity and mortality. This retrospective audit aims to assess the prevalence of osteoporosis and indications for initiating bone treatment among older adults living with frailty enrolled in the Limerick Integrated Care Programme for Older Persons (ICPOP). Methods All older adults attending ICPOP between 01/06/2023 to 29/02/2024 were included in the data collection. Data collected included patient age, gender, presence of vitamin D deficiency (&amp;lt;50), presence of osteopenia or osteoporosis via DEXA scan results, history of fragility fractures, and bone health treatment and its indication. Results A total of 310 patients (192 female, 118 male; age 70–98) attended ICPOP during the specified time period. DEXA scans identified osteopenia in 109 patients and osteoporosis in 69 patients. 86 patients experienced a history of fragility fractures, of which 30 were confirmed to have osteoporosis on DEXA. 93 patients (30.3%) displayed vitamin D deficiency, with the majority (81.7%) not previously receiving vitamin D supplementation. 151 patients were in receipt of bone treatment, of which 86 patients (56.9%) were newly commenced on bone treatment following interaction with ICPOP. The indications were osteoporosis on DEXA scan (44 patients), history of recent fragility fracture (20 patients), and high FRAX score (22 patients). Conclusion The increase in detection of risk factors and presence for osteoporosis, and initiating bone health treatment, achieved by way of an integrated care programme for older persons highlights the importance of proactive screening and timely initiation of treatment.

A cross-sectional study on the prevalence of eating disorders in liver transplanted patients with type 2 diabetes and/or overweight/obesity

Liver transplantation (LT) associates with weight gain and metabolic complications. However, risk of eating disorders post-transplantation and factors influencing their onset remain poorly understood. This study aimed to fill this knowledge gap by characterizing the risk of having eating disorders or Orthorexia Nervosa (ON) according to the EAT-26, BES and Bratman screening questionnaires in 104 liver transplant recipients (mean age 62.5 years; median time from LT 6 years) with type 2 diabetes and/or overweight/obesity. Eighty-two patients (78.9 %) had diabetes; mean BMI was 30.1 ± 5.9 kg/m2. Risk of eating disorders was observed in 6.9 %–10.8 % and the risk of orthorexia (Bratman test score > 4) was observed in 60.5 % of patients. A significant association was found between BMI and the likelihood of having eating disorders considering EAT-26 (OR = 0.17, p = .009). The absence of a direct link between diabetes and the risk of having eating disorders suggest multifactorial influences on post-transplant eating behaviors. The study highlights the importance of proactive screening to evaluate eating behaviors in liver transplant recipients to define tailored interventions and optimize post-transplant outcomes. Limitations refer to the observational nature of the study and the absence of pre-transplant data. Further research is warranted to validate these findings, elucidate temporal relationship between transplantation and the onset of eating disorders, and explore potential mechanisms underlying these associations. Such insights are crucial for developing effective strategies to mitigate the impact of eating disorders on post-transplant health and well-being.

Epidemiological Characteristics and Spatiotemporal Clustering of Pulmonary Tuberculosis Among Students in Southwest China From 2016 to 2022: Analysis of Population-Based Surveillance Data.

Pulmonary tuberculosis (PTB), as a respiratory infectious disease, poses significant risks of covert transmission and dissemination. The high aggregation and close contact among students in Chinese schools exacerbate the transmission risk of PTB outbreaks. This study investigated the epidemiological characteristics, geographic distribution, and spatiotemporal evolution of student PTB in Chongqing, Southwest China, aiming to delineate the incidence risks and clustering patterns of PTB among students. PTB case data from students monitored and reported in the Tuberculosis Information Management System within the China Information System for Disease Control and Prevention were used for this study. Descriptive analyses were conducted to characterize the epidemiological features of student PTB. Spatial trend surface analysis, global and local spatial autocorrelation analyses, and disease rate mapping were performed using ArcGIS 10.3. SaTScan 9.6 software was used to identify spatiotemporal clusters of PTB cases. From 2016 to 2022, a total of 9920 student TB cases were reported in Chongqing, Southwest China, with an average incidence rate of 24.89/100,000. The incidence of student TB showed an initial increase followed by a decline, yet it remained relatively high. High school students (age: 13-18 years; 6649/9920, 67.03%) and college students (age: ≥19 years; 2921/9920, 29.45%) accounted for the majority of student PTB cases. Patient identification primarily relied on passive detection, with a high proportion of delayed diagnosis and positive etiological results. COVID-19 prevention measures have had some impact on reducing incidence levels, but the primary factor appears to be the implementation of screening measures, which facilitated earlier case detection. Global spatial autocorrelation analysis indicated Moran I values of >0 for all years except 2018, ranging from 0.1908 to 0.4645 (all P values were <.05), suggesting strong positive spatial clustering of student PTB cases across Chongqing. Local spatial autocorrelation identified 7 high-high clusters, 13 low-low clusters, 5 high-low clusters, and 4 low-high clusters. High-high clusters were predominantly located in the southeast and northeast parts of Chongqing, consistent with spatial trend surface analysis and spatiotemporal clustering results. Spatiotemporal scan analysis revealed 4 statistically significant spatiotemporal clusters, with the most likely cluster in the southeast (relative risk [RR]=2.87, log likelihood ratio [LLR]=574.29, P<.001) and a secondary cluster in the northeast (RR=1.99, LLR=234.67, P<.001), indicating higher reported student TB cases and elevated risks of epidemic spread within these regions. Future efforts should comprehensively enhance prevention and control measures in high-risk areas of PTB in Chongqing to mitigate the incidence risk among students. Additionally, implementing proactive screening strategies and enhancing screening measures are crucial for early identification of student patients to prevent PTB outbreaks in schools.