Retrospective Case-control Study Research Articles

Tibial Malalignment Is an Independent Predictor of Nonunion After Intramedullary Nailing of Tibial Shaft Fractures.

This study aimed to assess the relationship between postoperative alignment and nonunion in patients with tibial shaft fractures treated with intramedullary nailing. Retrospective case-control study. Single academic trauma center. Adult patients with closed or open tibial shaft fractures (42A-C) treated with intramedullary nailing from 2007 to 2018. Case patients with nonunion were compared with control patients with radiographic evidence of healing in terms of the postoperative tibial alignment measured in the coronal and sagittal planes. Of the 192 included patients (median age, 38 years; 76% male), 51 patients had a nonunion, and 141 patients had united fractures and served as the control group. A strong association between postoperative tibial malalignment in 1 plane and nonunion (odds ratio, 3.0; 95% confidence interval, 1.1-8.3; P = 0.03) was demonstrated. This association was even greater for malalignment in both coronal and sagittal planes (odds ratio, 5.7; 95% confidence interval, 2.1-16.1; P < 0.001) after controlling for confounders. After controlling for confounding factors, postoperative malalignment in the coronal or sagittal plane was associated with significantly increased odds of tibial shaft nonunion after intramedullary nailing. Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.

Effects of phloroglucinol on uterine peristalsis after frozen embryo transfer in patients experiencing recurrent implantation failure: A retrospective case-control study.

To retrospectively investigate the efficacy of phloroglucinol administration after freeze-thawed embryo transfer in patients experiencing recurrent implantation failure (RIF). A total of 139 infertile couples who experienced RIF undergoing in vitro fertilisation and embryo transfer were divided into the control (n=66) and the phloroglucinol (n=73) groups. Women in the phloroglucinol group received 80mg phloroglucinol 30min after transfer, then once daily up to day 3 after the embryo transfer. Those in the control group did not receive phloroglucinol. Administration of phloroglucinol was associated with significantly higher rates of positive pregnancy tests [52.1% versus (vs) 30.3%], clinical pregnancy (45.2% vs 27.3%), and live births (38.4% vs 21.2%) compared with the control group (p<0.05). Notably, patients with uterine peristalsis exceeding 3 waves/min exhibited significant improvement in positive pregnancy tests (67.6% vs 38.5%), implantation (50% vs 24.6%), and clinical pregnancy rates (58.8% vs 33.3%) following phloroglucinol intervention (p<0.05). Results suggested that the administration of phloroglucinol after frozen embryo transfer may improve pregnancy outcomes in patients who experienced RIF, primarily in those with uterine peristalsis >3 waves/min.

Investigating disparity in labor epidural analgesia management in black vs. white women: a retrospective case-control study (2018-2022).

Disparities in labor epidural analgesia (LEA) management could reduce maternal satisfaction and increase risk. We compared times from the first administration of breakthrough pain medication (top-up) to LEA replacement to evaluate disparities across race. In this retrospective cohort study (01-01-2018 to 12-31-2022), all patients with LEA and maternal race/ethnicity of non-Hispanic White or Black were eligible. Patients with a scheduled cesarean delivery, previous back instrumentation, or maternal age<18 were excluded. We used a Cox Proportional Hazards model to evaluate our primary outcome. Predefined top-up medications given≥60minutes from initial LEA placement and before replacement were valid. Any replacement≥60minutes from the initial LEA was valid. We also studied secondary outcomes incidence of epidural replacement and postoperative patient satisfaction. There were 11,168 total patients receiving LEA, with 479 (5.5%) replacements in White patients and 127 (5.0%) in Black patients. There were 387 (3.5%) LEAs with a top-up followed by replacement within 24hours. After adjusting for confounders, no association was detected between race and LEA management (Hazard Ratio 0.82; 95% CI 0.63, 1.06; P=0.13). We failed to detect an association between patient race and the incidence of replacement (P=0.23). We found that race (P=0.02) and LEA replacement (P<0.001) were associated with increased odds of lower postpartum satisfaction. We didn't detect disparity in treatment at our institution with standardized LEA management protocols. However, Black women and those with LEA replacements were less satisfied. Future studies should evaluate the generalizability and explore interventions that improve patient satisfaction.

The use of dural sealant patches for reinforcement of durotomy repair: a systematic review.

Dural sealant patches (DSPs) are a useful adjunct when closing the dura during cranial or spinal surgery to avoid cerebrospinal fluid (CSF) leakage or infection. Authors of this paper systematically review the outcomes and incidence of CSF leakage and infection with the use of a DSP versus conventional practice. The MEDLINE, Embase, Cochrane Library, and Scopus databases were searched, and clinical trials and prospective or retrospective case-control and cohort studies with a low-risk of bias and involving any solid DSP used in adults for cranial or spinal cases were included. Studies that used a DSP in combination with another method of dural sealant closure, used a DSP as a dural substitute rather than an adjunctive closure device, or used hydrogel or polymer gel (i.e., nonsolid) dural sealant "patches" were excluded. A meta-analysis of comparative studies reporting outcomes relating to CSF leakage was performed together with a subgroup analysis for each DSP type. For comparative studies reporting outcomes relating to infection, a separate meta-analysis was conducted. Across the 7 noncomparative studies included, 669 patients received TachoComb (n = 421, 1 study), TachoSil (n = 8, 1 study), Liqoseal (n = 40, 1 study), TissuePatchDural (n = 144, 2 studies), or Hemopatch (n = 56, 2 studies). Across the 6 comparative studies included, 1013 patients received TachoSil (n = 784, 3 studies), TissuePatchDural (n = 147, 2 studies), or Hemopatch (n = 82, 1 study). When considering the rates of CSF leakage or infection, 2/6 comparative studies found DSPs to be significantly more effective than current practice, while the remaining 4/6 demonstrated noninferiority compared to current practice. All studies considered the DSPs to be safe. A meta-analysis revealed significant improvements in the incidence of CSF leakage with the use of a DSP overall, but the improvements in CSF leak rates for the TachoSil and TissuePatchDural subgroups did not reach statistical significance. The single study evaluating Hemopatch did find statistically significant improvements in CSF leak rates. There were no significant differences in infection between the DSP groups. There was a significant improvement in the incidence of CSF leaks with the use of DSPs. Comparisons among DSP types and evaluations of outcomes relating to infection should be the focus of further research in this area.

Vesicoureteral Reflux in Transplanted Kidney Among Children With Congenital Anomalies of Kidney and Urinary Tract: Case-Control Study Assessing Impact on Renal Function and Graft Survival.

Congenital anomalies of the kidney and urinary tract (CAKUT) are a common cause of kidney failure in childhood. Renal transplantation is the modality of treatment used for kidney failure that promotes improved quality of life for pediatric patients. It is believed that patients with CAKUT are more predisposed to developing graft reflux in the post-transplant period, but its influence on graft survival is poorly understood. A comparative analysis between patients with and without VUR in the graft was made to determine the impact of reflux on graft function and survival in pediatric CAKUT patients. A retrospective case-control study of patients undergoing first renal transplantation between April 2008 and October 2021 was done. The study included CAKUT individuals who underwent voiding cystourethrogram after transplantation. Patients were stratified into a group without reflux in the transplanted kidney (controls) and a group with reflux (cases). Six-year graft and patient survivals were calculated and compared using Kaplan-Meier curves and the log-rank test. A total of 257 CAKUT patients were studied. Of this group, 63 (24%) underwent voiding cystourethrogram after transplantation, and 48 (76%) had reflux in the transplanted kidney. Estimated six-year survival of the graft was 72% in the control group versus 96% in the case group (log-rank 0.889). The median follow-up time after transplantation in years was 7.6 in controls and 6.6 in cases (p = 0.383). Pediatric patients with CAKUT who presented reflux in transplanted kidneys had similar graft and patient survivals compared to patients without reflux.

Emergency planned re-infusion therapy and hospitalisation for community-acquired pneumonia: a retrospective case-control study.

Community-acquired pneumonia (CAP) is a frequent reason for emergency department visits and leads to increased direct medical costs, particularly due to hospitalisation. This study aims to examine the differences between emergency planned re-infusion therapy and hospitalisation in patients with CAP. This retrospective case-control study involved 1889 CAP patients treated at the Emergency Internal Medicine Department of Class A tertiary Hospital in China from 1 January 2020 to 31 December 2022. Patients were divided into groups receiving either emergency planned re-infusion therapy or hospitalisation. Independent sample t tests and χ2 tests were used to compare the clinical outcomes and economic impacts between the two groups across different pneumonia severity index (PSI) classifications. The study enrolled 1889 CAP patients. For PSI I-II patients, the improvement rates were 99.51% in the emergency planned re-infusion therapy group and 99.69% in the hospitalisation group, showing no statistically significant difference (P > 0.05). Similarly, no significant difference was observed for PSI III patients (84.16 vs. 89.82%). However, significant differences emerged for PSI IV patients, with improvement rates of 50% in the emergency planned re-infusion therapy group and 90.59% in the hospitalisation group (P < 0.001). Statistically significant differences were also noted in treatment duration (5.13 ± 1.65 days vs. 7.60 ± 3.93 days, P < 0.001) and total treatment costs (1921.57 Chinese Yuan (CNY) ± 923.16 vs. 9083.80 CNY ± 3583.55, P < 0.001) between the two groups. Emergency planned re-infusion therapy for CAP is an effective and cost-efficient alternative that can reduce both treatment duration and costs, particularly for patients with PSI I-III. It is recommended that emergency physicians give priority to emergency re-infusion therapy for patients with PSI I-III. In addition, it is recommended that hospitals strengthen the classification and treatment training programmes for emergency department physicians to recognise the patients with PSI I-IV. The hospital's ethics committee (XMCGIRB2024034-01).

Effects of early supplemental parenteral nutrition on new-onset infection in adults with acute severe stroke: a single-center retrospective case–control study

BackgroundEarly adequate feeding reduces mortality in patients with acute severe stroke. Supplemental parenteral nutrition (SPN) may address enteral nutrition (EN) deficiency and mitigate the risk of nosocomial infection. The benefit of the EN plus early SPN strategy over the full EN strategy is unknown in acute severe stroke patients.MethodsWe retrospectively enrolled 20 patients with acute severe stroke in the SPN group who received EN plus early SPN (more than 50% of the energy target within 72 h after admission). Forty control patients in the EN group who received full EN were matched by age, sex and lesion site. The time to new-onset pneumonia or nosocomial infections was analyzed by Student’s t test and the Breslow generalized Wilcoxon test.ResultsThe baseline characteristics did not differ significantly between the SPN group and the EN group, except for higher serum leukocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratios in the SPN group (P < 0.05). Compared with that in the EN group, the time to new-onset pneumonia was significantly delayed in the SPN group (7.6 days vs. 5.2 days; mean difference, 2.5 days; 95% CI, 0.65 to 4.31; P = 0.009), as was the time to new-onset nosocomial infections (7.1 days vs. 4.8 days; mean difference, 2.3 days; 95% CI, 0.46 to 4.07; P = 0.015). Kaplan–Meier analysis revealed similar cumulative probabilities of new-onset pneumonia and new-onset nosocomial infections in the two groups (P > 0.05). The rates of digestive intolerance events were similar between the two groups (40% in the SPN group vs. 52.5% in the EN group, P = 0.361).ConclusionsIn patients with acute severe stroke, the application of EN plus early SPN could delay the onset of pneumonia and nosocomial infections especially in the early phase.

Noncardiac chest computerized tomography scan as a predictor for plaque presence in coronary artery.

Coronary artery calcium, a marker of coronary atherosclerosis, is often identified on noncoronary chest computed tomography (CT). We wanted to evaluate the correlation between the presence of coronary plaques in coronary artery catheterization and coronary calcifications as shown in noncardiac chest CT. A retrospective case-control study consisting of cases (N = 63) and controls (N = 29), aged 18-70 years old, residing in northern Israel and treated in the Intensive Cardiac Care Unit of Ziv Medical Center, between January 2020 and November 2022. All participants underwent coronary catheterization and noncoronary CT scans in the 5 years before the catheterization procedure. Data were taken from the participants' electronic files while considering the potential of cardiovascular risk factors. The 92 participants had a mean age of 60.1 ± 10.3 years old. Multivariate logistic regression adjusted to age, sex, and hyperlipidemia showed that calcified coronary artery as shown on a previous noncardiac CT scan was positively and significantly associated with increasing risk of coronary plaque as presented in coronary catheterization: odds ratio = 5.93 (95% confidence interval: 1.85-19.07, P < 0.01) and was also associated with male sex who were more likely to have plaque on coronary catheterization than females: odds ratio = 3.77 (95% confidence interval: 1.29-11.32, P < 0.05). Coronary calcifications on a previous noncoronary CT scan and sex are positively and significantly associated with coronary plaque risk as present in coronary catheterization. Coronary evaluation on CT scans is important for early detection of coronary disease. Early treatment can avoid coronary disease complications and increase patient survival.

Serum Levels of Thyroid Hormones and Thyroid Peroxidase Antibodies in Different Types of Glaucoma

Abstract Aim of this study is to analyze connection between thyroid hormones disbalance and thyroid peroxidase antibodies in serum and different types of glaucoma. This was a hospital-based, retrospective case-control study. Eighty-seven patients were recruited for outdoor department of Clinic of ophthalmology for the routine ophthalmological examination from an endocrinologist, with laboratory analysis of serum levels of thyroid hormones and thyroid peroxidase antibodies test. We specifically included patients with primary open-angle glaucoma and pseudoexfoliation glaucoma, since these two types of glaucoma are highly reported clinically. Based on laboratory analysis, we divided patients into three groups: primary open-angle glaucoma patients with hypothyroidism, pseudoexfoliation glaucoma patients with hypothyroidism and control group that included healthy subjects. In our research, we found that there were discrete differences between glaucoma patients and control subjects in serum levels of free triiodothyronine and free thyroxine. In other words, these differences were insignificant. Patients with primary open-angle glaucoma and pseudoexfoliation glaucoma had increased serum levels of thyroid stimulating hormone, when compared to patients in control group. This study highlights the interaction between thyroid hormones and glaucoma development. Laboratory analysis of glaucoma patients confirmed thyroid peroxidase antibodies levels greater than normal. Control group had physiological range of thyroid peroxidase antibodies. These findings support autoimmune theory of glaucoma development.

Raynaud Syndrome Associated with Medication for Attention-Deficit/Hyperactivity Disorder: A Systematic Review.

Raynaud syndrome (RS) is a peripheral vasculopathy characterised be impaired acral perfusion typically manifesting as skin discolouration with pallor, cyanosis and/or erythema, and increased sensitivity to cold. RS may be primary or secondary to systemic disease, lifestyle and environmental factors or medication. RS has been reported with medication to treat ADHD, but we found no recent comprehensive overview of the literature. The aim of this review is to evaluate the evidence in the published literature for Raynaud syndrome associated with medication for ADHD. We systematically searched PubMed and Embase from inception to 12 June 2024 for articles published in English describing cases of RS in individuals treated with stimulant medication, atomoxetine, guanfacine or clonidine. Identified cases were assessed against the Naranjo Adverse Drug Reaction Scale criteria to determine the probability of a causal relationship with the medication. The initial search identified 197 articles. A total of 61 cases were identified from 15 case reports, 5 case series, 1 retrospective case-control study, and 1 retrospective cohort study. No randomised, controlled studies were identified. Implicated medications included methylphenidate, (dex)amfetamine and, more rarely, atomoxetine. Most cases were mild and resolved within weeks of discontinuation, dose reduction or switch to an alternative medication. A few cases associated with systemic disease were reported, leading to ulceration, gangrene and the need for amputation or revascularisation in some individuals. Assessment of 28 cases using the Naranjo criteria suggested a 'possible' causative role of ADHD medication in 13 cases, a 'probable' role in 13 cases and a 'definite' role in two cases. Due to the uncontrolled nature of all but one of the available studies, a causal relationship between medication for ADHD and RS could not be determined reliably. However, in view of the possibility of severe sequelae, albeit in rare cases, routine monitoring for signs of RS is recommended in individuals treated with CNS stimulants or atomoxetine, especially when initiating treatment or increasing the dose. Large database studies in which individuals act as their own controls should be conducted to clarify any association between treatment with these medications and RS, controlling for confounding factors.

P-1042. Comparison of clinical characteristics and outcomes of patients with candidemia caused by Candida auris versus other Candida species – A retrospective case-control study at a community hospital in the Bronx

Abstract Background Conflicting data exists on the mortality rate of Candida auris fungemia compared to other Candida species. The purpose of this study was to compare the clinical outcomes and characteristics of hospitalized patients with candidemia due to C. auris versus non-C. auris species. Methods This retrospective case-control study included adult patients with microbiologically confirmed candidemia at an urban hospital in New York City from January 2018 to August 2023. Data collected included demographics, medical history, microbiology data, antifungal treatment, in-hospital mortality, length of hospital stay (LoS), recurrence rate, mycological eradication, and discharge status. Descriptive statistics and t test were utilized for continuous variables, and categorical data was analyzed by Fischer’s exact test with significance set at a p-value &amp;lt; 0.05. Results Out of 171 candidemia cases, 17% were due to C. auris and 83% were due to other Candida species, mainly C. albicans (29%) and C. glabrata (19%). Average patient age was 65 years and majority were of Hispanic descent (49%) with common comorbidities including diabetes (55% vs. 43%; p = 0.044) and chronic kidney disease (14% vs. 25%; p = 0.093) in C. auris vs. non-C auris groups, respectively. More C. auris patients required mechanical ventilation (86% vs. 63%; p = 0.019), and had central lines placed (93% vs. 67%; p = 0.002). All C. auris isolates were susceptible to echinocandins but resistant to fluconazole. C. auris patients had a non-significantly higher crude rate of in-hospital mortality (62% vs. 49%; p = 0.075) with a longer mycological eradication time (mean 5 vs. 3 days; p = 0.196). Median time to mortality was longer in C. auris patients (76 days vs. 30 days, p &amp;lt; 0.0006). These patients also had longer hospital stays (median 111 vs. 40 days, p &amp;lt; 0.002) and nonsignificant higher recurrence rates (14% vs. 6%; p = 0.091). More C. auris survivors were discharged to long-term care facilities (78% vs. 56%). Conclusion Patients with C. auris fungemia had a significantly longer median time to mortality and LoS, in addition to a non-significantly higher rate of recurrence and mortality. Disclosures All Authors: No reported disclosures

Fresh frozen plasma, fibrinogen concentrate, and antithrombin concentrate administration for obstetrical disseminated intravascular coagulation by the Japanese previous and new criteria.

The purpose of this study is to clarify the frequencies of fresh frozen plasma (FFP) ± fibrinogen concentrate administration (fibrinogen concentrate [FC] therapy) and antithrombin (AT) concentrate administration (AT therapy) for the women with obstetrical disseminated intravascular coagulation (DIC). Two retrospective multicenter case-control studies as Study-1 (January-December 2018) and Study-2 (July 2022-June 2023) were conducted. Study-1 was the historical control of Study-2. All participants experienced a blood loss of ≥1000 mL during vaginal delivery or ≥2000 mL during cesarean section. All participants were subsequently assigned to the DIC group or non-DIC group. Study-1 comprised 175 women (obstetrical DIC, 27; control, 148; by the previous criteria) and Study-2 comprised 175 women (obstetrical DIC, 9; control, 166; by the new criteria). The frequencies of FFP (±FC therapy) or FC therapy in DIC group were significantly higher than non-DIC group in Study-1 (88.9% vs. 25.0%, 44.4% vs. 4.0%) and Study-2 (100% vs. 24.7%, 77.8% vs. 5.4%); however, the frequencies of AT therapy were similar. Furthermore, in the DIC group, all women with fibrinogen <150 mg/dL received FFP ± FC therapy in Study-1 (n = 19) and Study-2 (n = 8); however, those with AT activity <70% received AT therapy (16.7% [4/24] and 12.5% [1/8], respectively). We revealed an association between the high frequency of FFP ± FC therapy and lower fibrinogen levels, but a low frequency of AT therapy regardless of AT activity, in obstetrical DIC regardless of diagnosis criteria.

P-2262. Outcomes of Patients with Severe Persistent BK Polyomavirus DNAemia

Abstract Background BK polyomavirus (BKPyV) is the leading cause of polyomavirus associated nephropathy (PyVAN) in kidney transplant recipients (KRT). The goal of this study was to determine risk factors and outcomes associated with severe persistent BKPyV (SPBK).Figure 1A:Total estimated length of stay in a lymphocyte state: SPBK vs LBK Methods This is a single center, matched retrospective case control study of KTR with SPBK compared to 1) KTR with low/no BKPyV-DNAemia (LBK) and 2) KTR with high, transient BKPyV-DNAemia (HTBK). Definitions were as follows, SPBK: BKPyV load &amp;gt; 6 log10 for &amp;gt;90 consecutive days. LBK: BKPyV load remaining &amp;lt; 3 log10. HTBK: BKPyV load &amp;gt;4 log10 for &amp;lt; 90 consecutive days, all within the first 2 years post-transplant. SPBK were exact matched 1:3 to LBK controls on race, sex, donor type immunosuppression protocol, and genetic matched with robust Mahalanobis distance on age. SPBK cases were exact matched 1:2 with HTBK controls on race, gender, immunosuppression protocol, and genetic matched with robust Mahalanobis distance on age and donor type. Differences between case and control groups were analyzed using Wilcoxon-rank sum test and Fisher’s exact test. A multistate Markov model was used to evaluate whether time spent in a state of lymphopenia (&amp;lt; 1,000 cells/µL) was associated with SPBK.Figure 1A:Total estimated length of stay in a lymphocyte state: SPBK vs HTBK Results 20 KTR with SPBK were matched to 60 LBK and 40 HTBK. Significantly more SPBK experienced acute cellular rejection within the first 2 years of transplant relative to LBK (75% vs 27%, p&amp;lt; 0.001) and HTBK (22%, p&amp;lt; 0.001). SPBK had a longer estimated duration of lymphopenia in the first 200 days post-transplant relative to LBK and HTBK (SPBK: 107.5 days, 95% CI 92.1, 122.7 vs LBK: 68.5 days, 95% CI 55.3, 84.8, vs HTBK 70.3 days 95% CI 58.8, 82.4, Figure 1A-B). Median eGFR at 6 months post-transplant for SPBK was lower than patients with LBK and HTBK (44 vs 56, p=0.016; 44 vs 60, p=0.004, respectively). Burden of lab draws was significantly higher for SPBK vs LBK and HTBK (69 days vs 55, p&amp;lt; 0.001; 69 days vs 56, p=0.006, respectively). Total cost of labs was $7836 for SPBK vs $4,691 for LBK (p&amp;lt; 0.001) and $5922 for HTBK (p&amp;lt; 0.001). Conclusion Patients with SPBK spent more time in a state of lymphopenia in the first 200 days post-transplant vs LBK and HTBK. SPBK is associated with worse renal function at 6 months post-transplant and is accompanied by a higher burden of lab draws and cost. Disclosures Christian P. Larsen, MD, PhD, Bristol-Myers Squibb: Advisor/Consultant|CareDx: Advisor/Consultant|Eledon: Advisor/Consultant

P-1356. Risk factors associated with community-onset infections due to clinically moderate to high-risk AmpC producing organisms

Abstract Background The Enterobacterales order is among the most common group of bacteria relevant in clinical practice. Among them are inducible AmpC-producing Enterobacterales (AE). This unique group of bacteria may produce AmpC enzymes if induced in the setting of certain beta-lactam antibiotics, limiting the number of effective treatment options. Previous data have suggested that inappropriate antibiotics used empirically for AE increase the risk of treatment failure, but limited data are available to describe the risk factors associated with community-onset (CA) AE to help guide empiric therapy. Methods This was a retrospective case-control study of patients admitted to University Hospital from 2021 to 2023 with a CA Enterobacter cloacae, Klebsiella aerogenes, or Citrobacter freundii clinical isolate. The first clinical isolate was included for each patient. Patients were matched at a rate of 1:1 to a patient with a CA Enterobacterales organism without 3rd generation cephalosporin resistance. Patients were matched according to infection, age (+/- 5 years), and sex at birth. The primary outcome was to evaluate risk factors associated with CA AE infections. Results A total of 176 patients were included in this study, 88 in each group. In a univariate analysis, prior hospitalization (OR, 3.3 [95% CI, 1.72-6.4]), surgical intervention (OR, 5.8 [95% CI, 1.62-20.9]), exposure to any antibiotic (OR, 2.2 [95% CI, 1.15-4.14]), exposure to 1st generation cephalosporins (OR, 2.8 [95% CI, 1.09-7.07]), and exposure to cefepime (OR, 3.3 [95% CI, 1.03-10.72]) within 3 months were associated with an increased risk of a CA AE. Being Hispanic or Latino was associated with a decreased risk of having a CA AE in a univariate analysis and was the only variable statistically significant in a multivariable analysis (OR, 0.34 [95% CI, 0.15-0.74]). Conclusion Our findings suggest that patients with prior hospitalization, surgical intervention, exposure to any antibiotic, to 1st generation cephalosporins, and to cefepime within 3 months may be associated with an increased risk of a CA AE in a univariate analysis, although no association was seen in a multivariable analysis. In contrast, Hispanic or Latino patients may be at a decreased risk for CA AE. A larger sample size may be warranted to validate these findings. Disclosures All Authors: No reported disclosures

P-2154. Cryptosporidium in pregnancy and the impact upon pregnancy outcomes

Abstract Background Cryptosporidiosis, an infectious disease caused by the protozoan parasite Cryptosporidium, poses a significant threat to individuals with compromised immune systems. Over the past four years, a notable rise in the incidence of cryptosporidiosis has been observed in Israel, including among pregnant women. Despite this increase, little is known about the impact of cryptosporidiosis on obstetrical outcomes. The objective of this study was to evaluate the influence of Cryptosporidium infection on pregnancy outcomes.Figure 1Epidemic curve, cryptosporidiosis in pregnant women, Maccabi Healthcare Services Methods A retrospective case-control study. Pregnant women with positive results on multiplex real-time PCR stool tests for Cryptosporidium were compared to pregnant women with negative results, matched by age, week of pregnancy during the stool test, and sector. Medical records of the study cohort were reviewed for symptoms, treatments, pregnancy outcomes including termination, gestational age, birth weight, Apgar score, and head circumference. Significance was determined using Fisher's exact or Chi-square tests.Table 1Baseline patient characteristics and symptoms, pregnant women infected with cryptosporidium Results Between January 2020 and December 2023, 2512 pregnant women underwent PCR stool testing. Of them, 96 individuals were positive for Cryptosporidium, mostly in 2022 (Figure 1). Their median age was 31 years and ranged 23-42 years with medium-high socioeconomic status (37 and 39 women, respectively) (Table 1). Among those who tested positive, 93 out of 96 (96.7%) reported symptoms of diarrhea, and the infection was self-limiting in all cases, with none requiring specific treatment. In comparison to matched controls, no statistically significant differences were observed in the rates of intrauterine growth retardation, birth weight, delivery week, miscarriage, Apgar score, and head circumferences among the infants born to mothers with Cryptosporidium infection. Conclusion This study sheds light on the clinical course of Cryptosporidium infection in pregnant women, emphasizing a generally favorable outcome without the necessity for therapeutic intervention. Further research may be warranted to explore the potential long-term effects and to refine preventive measures for this specific population. Disclosures Shirley Shapiro Ben David, MD, GSK: Lecturer|Pfizer: Grant/Research Support|Pfizer: Lecturer

P-1494. Factors Associated with Intravenous Sodium Stibogluconate Treatment Failure in Mucocutaneous Leishmaniasis: A Case-Control Study in Cusco, Peru, 2012-2022

Abstract Background Mucocutaneous leishmaniasis is a neglected infectious disease primarily affecting impoverished individuals across various regions worldwide. Untimely diagnosis and treatment often result in lasting physical and psychological consequences for patients, significantly impacting their quality of life. Currently, first-line pharmacotherapy consists of pentavalent antimonials, with a treatment failure rate of over 30%. We explored factors associated with intravenous sodium stibogluconate (Sb) treatment failure in mucocutaneous leishmaniasis. Methods This retrospective case-control study was conducted at Antonio Lorena Hospital in Cusco, Peru, from 2012 to 2022. Clinical records meeting the criteria of confirmed mucocutaneous leishmaniasis through smear, culture, PCR, or histopathology, with completion of a 30-day intravenous Sb treatment regimen, were analyzed. To calculate the sample size, proportions for independent cases and controls were used, with an Odds Ratio of 2. Moderate to severe disease was defined as more than two mucosal areas compromised with dyspnea. Cases were defined as individuals experiencing treatment failure after the initial 30-day antimonial cycle; whereas controls were those successfully cured after one 30-day antimonial cycle. Adjusted odds ratios were calculated using a logistic regression model. Ethics approval was obtained for the study. Results A total of 124 clinical records were included, with a 49.6% intravenous Sb treatment failure rate in mucocutaneous leishmaniasis after the 30-day treatment. Of these, 75.8% (94/124) were male, 53.2% (66/124) were farmers, 17.7% (22/124) had comorbidities, 69.4% (86/124) had more than 12 months of disease, and 66.1% (82/124) had moderate to severe disease. The intravenous Sb treatment failure was associated with disease duration over 12 months (OR: 5.77, 95% CI: 2.01-16.52, p=0.001), comorbidities (OR: 21.12, 95% CI: 3.89–114.89, p&amp;lt; 0.001), and moderate-severe disease (OR: 2.63, 95% CI: 1.05–8.72, p=0.048). Conclusion Our case-control study suggests that intravenous Sb treatment failure is associated with disease duration over 12 months, comorbidities, and moderate to severe disease. However, further studies are needed to elucidate this association. Disclosures All Authors: No reported disclosures

Validating the Accuracy of Parkinson's Disease Clinical Diagnosis: A UK Brain Bank Case-Control Study.

Despite diagnostic criteria refinements, Parkinson's disease (PD) clinical diagnosis still suffers from a not satisfying accuracy, with the post-mortem examination as the gold standard for diagnosis. Seminal clinicopathological series highlighted that a relevant number of patients alive-diagnosed with idiopathic PD have an alternative post-mortem diagnosis. We evaluated the diagnostic accuracy of PD comparing the in-vivo clinical diagnosis with the post-mortem diagnosis performed through the pathological examination in 2 groups. In this retrospective case-control study, patients and healthy subjects who consented to the post-mortem pathological diagnosis at the UK Brain Bank were consecutively enrolled from the UK Brain Bank. Medical records were reviewed to classify participants and performance metrics were further calculated using neuropathological diagnosis as the gold standard. Four thousand five hundred seventy one subjects were eligible for the study. The clinical diagnosis group was: 1,048 Parkinson's patients and 1,242 healthy subjects. Pathology diagnosis group were: 996 Parkinson's patients and 1,288 subjects with no post-mortem abnormality. For the group of clinical diagnosis, PD diagnosis showed: sensitivity of 99%, specificity of 86%, accuracy of 90.96%, F1-Score 0.89, and a receiver operating characteristics area under the curve (ROC AUC) 0.925 (SE ± 0.006) [95% confidence interval [CI]: 0.913, 0.937], 𝑝<0.001. In this group, the most frequent pathology diagnosis among clinically misdiagnosed PD (false positive) patients was dementia with Lewy bodies (19.4%). Conversely, the most frequent clinical diagnosis among PD missed clinical diagnosis (false negative) patients was Alzheimer's disease (18.5%). Our findings confirm a still significant diagnostic error and emphasize the need for more fine and homogeneous criteria to classify idiopathic Parkinson's patients correctly. ANN NEUROL 2025.

Return to work after proximal humeral fractures: a single center study comparing conservative versus operative treatment.

Adequate treatment of proximal humeral fractures (PHF) is essential for restoring shoulder function and expediting return-to-work (RTW). This study aims to assess the impact of conservative and operative treatments on RTW and PHF recovery. In a retrospective case-control study, 858 patients (aged 18-68) treated for PHF between 2018 and 2021 were included. Questionnaires were sent to 342 operatively treated patients (Operative group (OG)) and 191 conservatively treated matched controls (Conservative group (CG)). Assessments covered RTW, functional outcomes (DASH, ASES), and quality of life (EQ-5D). A Kaplan-Meier analysis explored RTW in weeks. With a 61% response rate, 73 eligible participants (40 OG, 33 CG) contributed. Of respondents, 67.1% were female, and 60% were employed pre-trauma. Almost 70% of employed patients RTW, with no significant difference between groups (log rank, p=0.36). Among those returning to work, OG tended to resume 4 weeks later than CG (OG 10.5, IQR 22 vs.CG 6.00, IQR 8 weeks, p=0.07). DASH, ASES, and quality of life VAS scores showed no statistical difference between groups (p=0.542, p=0.257, p=0.530, respectively). The RTW proportion did not differ between operatively and conservatively treated PHF patients, though the former tended to return 4 weeks later. Functional outcomes demonstrated no significant differences. Further adequately powered studies are necessary to establish a standardized aftercare protocol for PHF, enhancing patient care and minimizing work disability.

Retrospective evaluation of patients admitted to the intensive care unit due to obstetric reasons in terms of maternal near-miss, a five-year case-control study

BackgroundMaternal Near-Miss (MNM) has become globally recognized as an indicator of pregnancy, birth and the first 42 days of postpartum care services. The World Health Organization has taken a new approach to detail and better analyze maternal deaths. The clinic-based criteria to evaluate maternal care and the quality of related care services have been developed.MethodsThis is a retrospective case-control study that was conducted in a tertiary hospital. In the study, the medical files of all patients admitted to the intensive care unit during the five-year period between 2018 and 2022 were examined. All patients who met the MNM criteria of WHO during pregnancy, birth and puerperium were included in the case group of the study. Meanwhile, the participants in the control group were selected from mothers who gave birth in the same hospital between August 15 and October 31, 2023 and did not develop any complications during puerperium, using the systematic sampling method. Data collection was performed using an interviewer-administered structured questionnaire and data abstraction.ResultsIn this five-year period, 198 mothers were diagnosed with MNM. In our study, the prevalence of MNM was found as 218/100.000. The most common laboratory changes that met the MNM criteria were elevated lactate levels (38.89%), acidosis (24.24%) and acute thrombocytopenia. Patients were most frequently admitted to the intensive care unit due to hemorrhage (23.74%), placental abruption (18.18%), pre-eclampsia (15.66%) and cesarean Sect. (10.10%), respectively. The frequency of co-morbidities (Diabetes mellitus, Hypertension, Asthma, Hypothyroidism, etc.) in patients diagnosed with MNM (n = 48; 26.67%) was found to be 5.5 times that of the control group (n = 25; 6.20%) (p < 0.001).ConclusionsIt can be said that co-morbidities directly affect the course of motherhood. the education level and family income were found higher in the MNM group compared to the control group. In this regard, the results of our study differ from the studies in the literature in terms of the effects of the education level of mothers and the economic status of families. The effects of socioeconomic and cultural factors on MNM may vary.

Sex-specific analysis of individual and ski geometry-related risk factors for ACL injuries in recreational alpine skiing: A case-control study

Introduction In recreational alpine skiing, female skiers experience knee injuries at twice the rate of male skiers, with the risk of anterior cruciate ligament (ACL) injuries being three times higher in women (Posch et al. 2021). In addition to individual factors such as, e.g., age or skill level, ski geometry parameters may also influence the risk of ACL injuries (Ruedl et al., 2022). Therefore, the aim of this study was to assess sex-specific effects of individual factors and ski geometry parameters on ACL injury risk in recreational skiers. Methods A retrospective questionnaire-based case-control study was conducted during 6 consecutive winter seasons from 2014/15 to 2019/20. According to Ruedl et al. (2022) individual factors as age, body height, skill level and risk-taking behavior were self-reported, while ski geometry data (ski length, side-cut radius, and widths of the tip, waist, and tail) were recorded from each participant’s skis. Additionally, ski length was relativized to body height. Results A total of 1,817 recreational skiers (49.1% female) participated in this study, of whom 21.6% (n=392, 57.9% female) sustained an ACL injury. The risk of ACL injury was 1.6 times higher in females (95% CI: 1.2-2.0). In both sexes, ACL-injured skiers were significantly older, by approximately five years, compared to uninjured controls (females: 42 vs. 37 years; males: 44 vs. 39 years). In females, a more risky behavior was associated with a reduced ACL injury risk (OR 0.7, 95% CI: 0.4-0.9), while in males, more risky behavior increased the risk (OR 3.5, 95% CI: 2.4-5.0). A lower skill level increased ACL injury risk in both females (OR 3.2, 95% CI: 2.4-4.6) and males (OR 2.2, 95% CI: 1.5-3.2). Ski geometry parameters did not differ significantly in females; however, ACL-injured males used skis with significantly narrower mean values of tip, waist, and tail width compared to uninjured controls. Discussion/Conclusion According to the existing literature, our findings indicate a significantly higher risk of ACL injury in females. Increasing age and lower skill levels were associated with a heightened ACL injury risk in both sexes, while a risky behavior might increase ACL injury risk in males only. Ski geometry parameters appear to have no significant impact on ACL injury risk in females, whereas males with ACL injuries tended to use skis with narrower widths. In addition to enhancing skill levels through ski lessons and modifying individual behavior on the slopes to reduce ACL injuries among recreational skiers of both sexes, equipment-related factors could be easily addressed by male skiers when purchasing or borrowing ski equipment. References Posch, M., Schranz, L., Lener, M., Tecklenburg, K., Burtscher, M., &amp; Ruedl, G. (2021). In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation. Knee Surgery, Sports Traumatology, Arthroscopy, 29(6), 1790–1796. https://doi.org/10.1007/s00167-020-06221-z Ruedl, G., Posch, M., Tecklenburg, K., Schranz, L., Greier, K., Faulhaber, M., Scher, I., &amp; Burtscher, M. (2022). Impact of ski geometry data and standing height ratio on the ACL injury risk and its use for prevention in recreational skiers. British Journal of Sports Medicine, 56, 1104-1109. https://doi.org/10.1136/bjsports-2021-105221