Significant Associated Risk Factors Research Articles

Metabolic Syndrome Components and Its Impact on Acute Kidney Injury After Total Joint Arthroplasty

BackgroundMetabolic syndrome (MetS) is an independent risk factor for postoperative complications. This study aimed to evaluate the associated risk of MetS for perioperative complications, especially urinary complications, in patients who underwent primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). MethodsWe used a publicly available all-payer administrative database to identify patients undergoing TKA and THA from 2016 to 2020. The primary exposure of interest was MetS. Multivariable adjusted models based on propensity score matching were used to evaluate the association of MetS components with acute kidney injury (AKI), urinary tract infection (UTI), and acute posthemorrhagic anemia (APHA) in patients who underwent TKA and THA. A counterfactual-based mediation analysis was conducted to investigate the mediating effect of APHA on the relationship between MetS and AKI. ResultsThe analysis included 2,097,940 (16.4% with MetS) THA and 3,073,310 (24.0% with MetS) TKA adult hospitalizations. Multivariable adjustment analysis indicated MetS was associated with an increased risk of AKI (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.69 to 1.89 for THA; OR 1.88, 95% CI 1.79 to 1.96 for TKA), UTI (OR 1.13, 95% CI 1.03 to 1.23 for THA; OR 1.26, 95% CI 1.17 to 1.35 for TKA), and APHA (OR 1.17, 95% CI 1.14 to 1.20 for THA; OR 1.7, 95% CI 1.15 to 1.19 for TKA). The risk of AKI increased with the number of MetS components, with ORs ranging from 2.58 to 9.46 in TKA patients and from 2.22 to 5.75 in THA patients. This increase was particularly associated with diabetes and hypertension, which were the most significant associated risk factors. Furthermore, APHA mediated the association between MetS and AKI. ConclusionsThe prevalence of MetS is increasing in TKA and THA patients. Metabolic syndrome was associated with increased risk of AKI, UTI, and APHA. The risk of AKI increased with each additional MetS component, with diabetes and hypertension contributing most. In addition, APHA may play a partial mediating role in MetS-induced AKI.

Nucleus drop following phacoemulsification surgery: Incidence, risk factors and clinical outcomes.

To determine the incidence, risk factors and clinical outcomes in patients with nucleus drop (ND) following phacoemulsification surgery at a tertiary care ophthalmic institute. Medical records of patients with ND during phacoemulsification between January'2019 and December'2022 were reviewed retrospectively. Incidence of ND was calculated overall, and according to surgical expertise levels and surgical steps. Associated pre- and intra-operative risk factors were assessed. Clinical outcome parameters [best-corrected visual acuity (BCVA) and intraocular pressure (IOP)] were compared with respect to timing of PPV (immediate vs early vs delayed), location (sulcus vs scleral fixated-IOL) and timing of IOL placement (primary vs secondary). Among 93,760 phacoemulsifications, ND was noted in 130 patients (0.1%). Significant direct and associated pre-operative risk factors were advanced cataract, glaucoma, posterior polar cataract, and diabetes mellitus. Junior medical consultants had 40 ND (mostly in non-complex cases), whereas senior medical consultants had 90 ND (mostly in complex cases). ND most frequently occurred during emulsification of nuclear fragments. Sulcus placement of IOL during primary surgery yielded significantly better visual outcome compared to secondary procedures, although timing of PPV had insignificant effect. 77.1% had BCVA of 6/12 or better at final follow-up. Timing of IOL implantation, PPV, and type of IOL did not have any significant effect on IOP. Though the incidence of ND is low, it is a dreaded complication. Accurate pre-operative evaluation, risk stratification, distribution of cases among surgeons based on their surgical expertise, and immediate or early management of ND yields better anatomical and functional outcomes.

The outcomes and complications of percutaneous interventions in chronic total coronary occlusion

BackgroundThe limited availability of complex coronary intervention facilities and qualified operators, due to the high cost associated with chronic total occlusion (CTO) percutaneous intervention (PCI) equipment and a shortage of necessary skills, has led to a scarcity of capable medical centers in Pakistan. This study seeks to examine the outcomes and potential complications associated with CTO PCI procedures conducted at the Cardiac Catheterization Laboratories of a prominent national institute in Pakistan, which handles a large volume of cases.ResultsThree hundred and six patients were included in the study in the study period of six months. The mean age was 59.49 (± 9.16) years: 256 (83.66%) were male and 50 (16.34%) were female. CTO was successfully re-vascularized in 237 (77.5%) with a complication rate of 13.7%. Two hundred and ninety-eight (97.39%) patients underwent an antegrade approach, while RCA was the most common target vessel (47.71%). Diabetes was the only significant associated risk factor with CTO PCI failure (30.43% vs. 30.43%, P-value = 0.015).ConclusionWe achieved an excellent procedural success rate with a low complication rate. CTO procedural failure is associated with a higher complication rate, and diabetes is among the risk factors that lead to higher procedural failure.

The effect of birth memory, recall level, and related factors on breastfeeding attitude of mothers in the postpartum period: a prospective study

This study was conducted to examine the effect of birth memory, recall level, and related factors on postpartum mothers’ breastfeeding attitudes. This is a correlational prospective study. The study was conducted in the postpartum clinic of a city hospital in a province located in the Central Anatolia Region of Turkey. The study included a total of 248 mothers in the early postpartum period. Data were obtained via a Personal Information Form, a Labor Monitoring Form, the Birth Memories and Recall Questionnaire (BirthMARQ), the Birth Satisfaction Scale (BSS), and the Iowa Infant Feeding Attitude Scale (IOWA). A positive correlation was found between mothers’ level of birth memory and recall and breastfeeding attitude on postpartum day 1, month 1, and month 3. In the regression analysis, emotional memory and coherence and reliving, which are the sub-dimensions of the birth memory and recall scale affecting breastfeeding attitude, were found to be significant associated risk factors for the 1st postpartum day, consistency and reliving for the 1st month, and birth memory and recall for the 3rd month. No relationship was found between mothers’ breastfeeding attitude and birth satisfaction on postpartum day 1, month 1, and month 3. Positive birth memory and recall positively affected mothers’ breastfeeding attitude. No relationship was found between mothers’ labor satisfaction and breastfeeding attitude. Supporting women for the formation of positive birth memory and recall for the labor process may positively improve breastfeeding attitudes of mothers in the postpartum period.

Characteristics of vitiligo patients with versus without associated autoimmune thyroid disease.

Clinical data are limited in patients with vitiligo with or without autoimmune thyroid disease. The objective of the study was to investigate the clinical features and basic data of patients with vitiligo, especially those with autoimmune thyroid disease. The study was a single-center retrospective study. A total of 1305 patients with vitiligo from June 2018 to May 2023 were included, and the clinical characteristics and basic information of the patients were recorded in detail. We identified an association between sex (odds ratio [OR]: 2.380; 95% confidence interval [CI]: 1.772-1.198), vitiligo duration (OR: 1.449; 95% CI: 1.076-1.952), skin involvement exceeding 5% of the body surface area (OR: 3.764; 95% CI: 2.134-6.640), negative emotions (OR: 3.076; 95% CI: 2.292-4.127), vitiligo type (OR: 1.974; 95% CI: 1.096-3.555), family history of AITD (OR: 4.979; 95% CI: 2.687-9.225), and family history of AD (OR: 2.418; 95% CI: 1.410-4.146) and patients with vitiligo. For patients with statistically significant associated risk factors, differential diagnosis and early intervention should be performed.

Prevalence, Associated Risk Factors and Major Bacterial Pathogens causing Bovine Mastitis on Selected Dairy Farms in and around Harar, Ethiopia

Aim Mastitis, an inflammation of the mammary gland, is a complex and costly disease in dairy herds. The main aim of this study was to estimate the prevalence of mastitis and associated risk factors for bacterial pathogens in lactating dairy cows. Methods A cross-sectional study was carried out. The study was conducted in Harar town and its district from November 2016 to April 2017. A total of 384 (264 crossbreds and 120 Holstein Frisian) milking cows were tested using the California mastitis test (CMT), direct diagnosis of obverse clinical mastitis, and bacterial culture in Harar City and its district. Results The result of the study indicated the prevalence of mastitis at the cow level was 58.60% (225/384), out of which 10.7% (41/384) and 47.9% (184/384) were clinical and subclinical, respectively. The quarter-level prevalence was 34.1% (513/1536); from this, the clinical and subclinical forms were 8.7% (131/1536) and 25.4% (382/1536), respectively, while 2% (31/1536) had blind teats. From 341 culture-positive samples, the following bacteria were isolated: Out of the total, Coagulase-negative Staphylococcus (CNS) (28.5%) was the most prevalent isolate, followed by Streptococcus species (27.5%), Staphylococcus aureus (21.4%), Escherichia coli species (14.4%), Micrococcus species (5.3%) and Corynebacterium species (2.9%). Age, parity, breed, production, and hygiene were significant associated risk factors, whereas management risk factors such as house types, milking systems, farming systems, and treatment history do not have a significant association with the prevalence of mastitis in the study area at this level of significance. Conclusion Based on the findings of this study, a thorough screening of high-producing and aged cows should be needed; optimum space should be required for those cows kept in intensive and closed houses to reduce the risk of contagious mastitis; attention should be paid to the informal use of drugs; and further research should be needed to view other risk factors for mastitis

Molecular prevalence and associated infection risk factors of tick-borne protozoan and rickettsial blood pathogens in small ruminants

BackgroundTick-borne blood pathogens cause highly pathogenic diseases, which are associated with substantial economic losses in ruminants. Despite this, epidemiological research on these pathogens remains neglected in many countries. This study initiated a regional epidemiological survey that included the detection of molecular prevalence, associated risk factors, and gene sequencing, combined with phylogenetic analysis, targeting the two main tick-borne blood protozoan and rickettsial pathogens of Babesia, Theileria, and Anaplasma that infect small ruminants. One hundred blood samples were collected from 76 sheep and 24 goats.ResultsMicroscopic examination of Giemsa-stained blood films revealed that 73% of the samples were infected with at least one species of the three blood pathogenic organisms. Molecular diagnosis based on the 18 S rRNA for Babesia and Theileria species and the major surface protein 4 (msp4) for Anaplasma species, revealed that 43% of the small ruminants were infected with at least one of these pathogens. The animal’s sex was the most significant associated risk factor, with 49.4% of female animals infected compared with only 4% of male animals (P < 0.05). The open breeding system recorded the highest infection rate for tick-borne blood pathogens. Homology-based and phylogenetic analyses indicated that the specific isolate species were Babesia ovis (B. ovis), Theileria ovis (T. ovis), and Anaplasma ovis (A. ovis), with sequences showing significant identities with isolates from sheep, goats, and other animal species, and geographically diverse countries in Africa, Asia, and Europe, in addition to Egypt.ConclusionThis was the first molecular evidence of B. ovis, T. ovis, and A. ovis infections in sheep and goat populations in the North Coast region of Egypt. More extensive studies are required to develop an epidemiological map of blood pathogenic organisms, while more effective control strategies are required to reduce the burden of tick-borne pathogens on small ruminants.

Prevalence, associated risk factors, and respiratory event distribution of obstructive sleep apnea in children with Down syndrome.

Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). We aimed to assess OSA prevalence in a single center cohort of children with DS, identify associated risk factors of obstructive respiratory events, and examine the influence of different sleep stages and body positions on respiratory events distribution. Single center retrospective study that included children with DS who underwent overnight polysomnogram (PSG). OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1.5-4.9 events/h), moderate (5-9.9 events/h), and severe (≥ 10 events/h). A logistic regression analysis was used to examine the association between OSA-related risk factors in normal and abnormal OAHI category and in REM and Non-REM predominant AHI groups. PSG data were available for 192 children with a median age of 5years (IQR 7). OSA prevalence was 82.3% (27.1% mild, 19.8% moderate, and 35.4% severe). A logistic regression model identified BMI and being an African American as significant predictors for OAHI severity. In children with OSA, the median OAHI was 7.6 and obstructive respiratory events were more common in REM sleep and in thesupine position. The median REM OAHI was 20 events/h (IQR: 24.4), whereas the median Non-REM OAHI was 5.2 events/h (IQR: 12.6 p < 0.0001). Similarly, supine OAHI was 11.6 (IQR: 19.3) and off supine OAHI was 6.6 (IQR: 11.6, p = 0.0004). Age was a significant predictor (p = 0.012) for Non-REM predominant OSA which was present in 15.2% of children with OSA. Children with DS have a high prevalence of OSA. Higher BMI and being an African American were significant associated risk factors for higher OAHI. Obstructive respiratory events in children with DS occur predominantly in REM sleep and in thesupine position. Non-REM predominant distribution of respiratory events was noted in older children with DS.

Prevalence and Determinants of Diabetic Retinopathy Among Type 2 Diabetic Patients in Saudi Arabia: A Systematic Review.

Diabetic retinopathy (DR) is a preventable complication of diabetes; however, it is a serious one if not early recognized and properly managed as it can lead to visual impairment. This review aimed to summarize the prevalence and determinants of DR among type 2 diabetic patients in Saudi Arabia. Eligible articles for this systematic review were quantitative observational studies that were English-published between 2015 and 2021, peer-reviewed, and conducted on patients with type 2 diabetes mellitus (DM). The studies were obtained by searching PubMed/Medline, ScienceDirect, Cochrane Library Database, and Google Scholar. The risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Out of 16 preliminary studies, 12 were eligible for inclusion in this systematic review. One study was a chart review, one was a prospective study, and the remaining were cross-sectional studies. Regarding the study tool, retinopathy was diagnosed by an ophthalmologist using fundus photography and/or slit-lamp examination in most of the studies (n=7). However, some studies reported obtaining data from patient interviews and medical files (n=4). Concerning the outcome, an overall high prevalence of DR (ranging between 6.25% and 88.1%) and some significant associated risk factors were determined, including longer duration of diabetes, older age, poor blood pressure control, poor glycemic control, and physical inactivity. Most studies showed moderate overall quality. In conclusion, DR is a common complication of type 2 diabetes in Saudi Arabia. Some avoidable risk factors are identified, through which the doctors can identify patients at high risk of DR through early screening and can, thus, initiate prompt treatment to reduce the risk of vision deterioration.

Incidence of ophthalmologic pathology and associated risk factors in orbital fractures at a level I trauma centre

ObjectifEstimer l'incidence des affections ophtalmologiques détectées lors de l'examen initial de patients en proie à une fracture orbitaire qui se sont présentés dans un centre de traumatologie de niveau I, d'une part, et les facteurs de risque connexes les plus significatifs, d'autre part. MéthodesOn a recensé, pendant une période de 2 ans, 278 fractures orbitaires chez 244 patients examinés dans un centre de traumatologie de niveau I. Le paramètre principal était l'incidence d'affections ophtalmologiques urgentes devant être traitées sans délai. Ont été enregistrés les caractéristiques démographiques des patients, leurs antécédents ainsi que les résultats de l'imagerie radiographique et de l'examen physique lors de l'examen initial et des visites de suivi. Les rapports de cotes (RC) ont été calculés avec un intervalle de confiance à 95 %. RésultatsLors de l'examen initial et des visites de suivi, 9,7 % des orbites présentaient une affection ophtalmologique. Celle-ci était urgente (syndrome orbitaire aigu et rupture du globe oculaire, notamment) chez seulement 3 patients (1,1 %); 22 patients (7,9 %) présentaient une affection semi-urgente et 4 patients (1,4 %), une affection sans caractère d'urgence. Les RC de la baisse subjective de la vision (RC = 3,5; p = 0,021), des blessures résultant de voies de fait (RC = 2,4; p = 0,036), d'un accident de travail (RC= 7,7; p = 0,004), du déficit pupillaire afférent (RC = 19,2; p = 0,017), de l'anisocorie (RC = 7,8; p = 0,001), de la limitation des mouvements extraoculaires symétriques (RC = 5,2; p = 0,003) et de la fixité pupillaire (RC = 16,9; p < 0,001) témoignent d'un lien statistiquement significatif avec la présence d'une affection ophtalmologique. En revanche, le sexe du patient, l’œil touché, l'intoxication, la prise d'anticoagulants et d'antiplaquettaires ainsi que les antécédents de chirurgie oculaire n’étaient pas associés à la présence d'une maladie ophtalmologique. ConclusionsLa plupart des fractures orbitaires ne s'accompagnent pas d'une affection ophtalmologique. La baisse subjective de la vision, les antécédents de voies de fait ou d'accident de travail et les anomalies pupillaires notées lors de l'examen étaient les principaux facteurs de risque d'affection ophtalmologique. Nos résultats mettent en lumière les éléments clés qui, relevés lors de l'examen initial, doivent inciter les premiers intervenants à consulter d'urgence un ophtalmologiste.

Asymptomatic nasopharyngeal bacterial carriage, multi-drug resistance pattern and associated factors among primary school children at Debre Berhan town, North Shewa, Ethiopia

BackgroundNasopharyngeal carriage of bacteria is the main source for transmission of pathogens across individuals and horizontal spread of organisms in the community. It is an important risk factor for the acquisition of community-acquired respiratory tract infection. It is the major public health problem among children. The asymptomatic carriage of nasopharyngeal bacteria is different globally, particularly in Africa, carriage is higher in children and decreases with increasing age, 63.2% in children less than 5 years, 42.6% in children 5–15 years, and 28.0% in adults older than 15 years.ObjectiveThe aims of this study was to determine asymptomatic nasopharyngeal bacterial carriage, multi-drug resistance pattern and associated factors among primary school children at Debre Berhan town, North Shewa, Ethiopia.MethodsInstitutional based cross-sectional study was conducted at Debre Berhan town primary schools from February 1 to April 30, 2021. Primarily, the schools were stratified into two strata, public and private primary schools. From a total of sixteen government and fourteen private primary schools, five government and five private schools were selected by using a simple random sampling technique. Socio-demographic variables and potential risk factors were assessed using a structured questionnaire. A total of 384 nasopharyngeal swab samples were collected using sterile swabs aseptically; and inoculated on Blood agar, Chocolate agar, MacConkey agar, and Mannitol salt agar. The colony was characterized to isolate bacteria, and bacterial identification was performed by Gram reaction, hemolysis patterns, colonial characteristics and pigmentation, catalase test, coagulase test, mannitol fermentation test, oxidase test, fermentation of carbohydrates, H2S production, motility, formation of indole, triple sugar iron agar (TSI), citrate utilization, lysine decarboxylase or methyl red vogues proskur utilization, urea hydrolysis and satellitism tests. Antimicrobial sensitivity tests were performed by using modified Kirby-Bauer disk diffusion method. Data were entered into statistical package Epi data 4.0.0.6 and transferred to and analyzed using SPSS software version-23. P value of < 0.05 with Odds ratio (OR) and 95% confidence interval (CIs) was considered as statistically significant.ResultsThe overall prevalence of nasopharyngeal carriage of bacterial isolate was 35.7% (95% CI 30.7–40.7%). The predominant isolates were Staphylococcus aureus 54.5% followed by coagulase-negative Staphylococcus 35.8%, and Streptococcus pyogens 4.5%. Most bacterial isolates were susceptible to chloramphenicol, ciprofloxacin, gentamycin, nitrofurantoin, azithromycin, ciprofloxacin; and the overall multidrug resistance pattern of isolated bacteria was 62.03% out of 137 bacterial isolates. Numbers of rooms ≤ 2 per house [AOR = 5.88, 95%CI 1.26–27.57], having history of hospitalization [AOR = 4.08, 95%CI 1.45–11.53], passive smoking [AOR = 4.87, 95%CI 1.49–15.97], family size of > 5 members [AOR = 2.17, 95%CI 1.24–3.81], and number of students in the classroom [AOR = 2.35,95%CI 1.37–4.02] were statistically significant associated risk factors for nasopharyngeal bacteria carriage.ConclusionAsymptomatic nasopharyngeal bacteria carriage in children is alarming for community-acquired infection. The overall multidrug resistance was very high. The risk of the carriage was increased with having a history of passive smoking, being in large family size and number of students per class. Longitudinal follow-up studies would be helpful for better understanding the infection risk in bacterial pathogen carriers.

Risk factors predicting disease severity and mortality in coronavirus disease 2019 Saudi Arabian patients.

Coronavirus disease 2019 (COVID-19) became a global pandemic that may be associated with significant associated risk factors. The aim of this study was to evaluate the factors predisposing risk to death in COVID-19 patients. This is a retrospective study that presents the demographic, clinical presentation, and laboratory findings on our patients to determine risk factors contributing to their COVID-19 outcome. We used logistic regression (odds ratios) to examine associations between clinical findings and risk of death in COVID-19 patients. All analyses were done using STATA 15. A total of 206 COVID-19 patients were investigated, 28 of them died, and 178 survived. Expired patients were older (74.04 ± 14.45 vs. 55.56 ± 18.41 in those who survived) and mainly of male gender (75% vs. 42% in those who survived). The following factors were strong predictors of death: hypertension (OR: 5.48, 95% CI: 2.10-13.59, P < 0.001), cardiac disease (OR: 5.08, 95% CI: 1.88-13.74, P = 0.001), and hospital admission (OR: 39.75, 95% CI: 5.28-299.12, P < 0.001). In addition, blood group B was more frequent in expired patients (OR: 2.27, 95% CI: 0.78-5.95, P = 0.065). Our work adds to the current knowledge about the factors predisposing to death in COVID-19 patient. In our cohort, expired patients were of older age and male gender plus they were more likely to have hypertension, cardiac disease, and hospital severe disease. These factors might be used to evaluate risk of death in patients recently diagnosed of COVID-19.

Do Blood Phenotypes of Feline AB Blood Group System Affect the SARS-CoV-2 Antibody Serostatus in Cats?

Cats are susceptible to coronavirus infections, including infection by human severe acute respiratory syndrome coronavirus (SARS-CoV). In human ABO system blood groups, alloantibodies can play a direct role in resistance to infectious diseases. Individuals with the AB blood type were over-represented in the SARS-CoV-2 infection group. Blood type AB individuals lack both anti-A and anti-B antibodies, and therefore lack the protective effect against SARS-CoV-2 infection given by these antibodies. Starting from this knowledge, this pilot preliminary study evaluated a possible association between feline blood phenotypes A, B, and AB and serostatus for SARS-CoV-2 antibodies in cats. We also investigated selected risk or protective factors associated with seropositivity for this coronavirus. A feline population of 215 cats was analysed for AB group system blood phenotypes and antibodies against the nucleocapsid (N-protein) SARS-CoV-2 antigen using a double antigen ELISA. SARS-CoV-2 seropositive samples were confirmed using a surrogate virus neutralization test (sVNT). Origin (stray colony/shelter/owned cat), breed (DSH/non DSH), gender (male/female), reproductive status (neutered/intact), age class (kitten/young adult/mature adult/senior), retroviruses status (seropositive/seronegative), and blood phenotype (A, B, and AB) were evaluated as protective or risk factors for SARS-CoV-2 seropositivity. Seropositivity for antibodies against the SARS-CoV-2 N-protein was recorded in eight cats, but only four of these tested positive with sVNT. Of these four SARS-CoV-2 seropositive cats, three were blood phenotype A and one was phenotype AB. Young adult age (1-6 years), FeLV seropositivity and blood type AB were significantly associated with SARS-CoV-2 seropositivity according to a univariate analysis, but only blood type AB (p = 0.0344, OR = 15.4, 95%CI: 1.22-194.39) and FeLV seropositivity (p = 0.0444, OR = 13.2, 95%CI: 1.06-163.63) were significant associated risk factors according to a logistic regression. Blood phenotype AB might be associated with seropositivity for SARS-CoV-2 antibodies. This could be due, as in people, to the protective effect of naturally occurring alloantibodies to blood type antigens which are lacking in type AB cats. The results of this pilot study should be considered very preliminary, and we suggest the need for further research to assess this potential relationship.

The prevalence of gestational diabetes, associated factors and feto-maternal outcome among antenatal women attending health clinics in Terengganu.

Gestational diabetes mellitus (GDM) is a known risk factor for diabetes mellitus (DM). The rising prevalence of GDM in the Asian population (11.7%) may explain the increasing incidence of DM in women. This study examined the prevalence of GDM, its associated factors and the foeto-maternal outcomes of women with GDM in Terengganu. A cross-sectional study was conducted between April and September 2019 using secondary data from antenatal records in 40 health clinics in Terengganu for 2018. All pregnant women aged 25 years and above with or without risk factors for GDM were included in the study. Those with pre-existing type 1 or 2 DM were excluded. A total of 270 respondents were included. The prevalence of GDM and its associated factors were determined using descriptive statistics followed by multiple logistic regression. The prevalence of GDM in Terengganu was 27.3% (n=72). Logistic regression analysis found that BMI at booking (adjusted OR=4.51, 95% CI 2.13-9.55, p<0.001), history of GDM (adjusted OR=5.31, 95% CI 2.17-12.99, p<0.001) and family history of DM (adjusted OR=4.24, 95% CI 2.23-8.05, p<0.001) were the significant associated risk factors. Of women with GDM, 17.7% (n=11) had postpartum pre-diabetes based on modified oral glucose tolerance at 6 weeks postpartum. Univariate analysis using chi-square tests showed a significant association of neonatal jaundice and hypoglycaemia with GDM. Because the prevalence of GDM in Terengganu is high, surveillance of GDM in highrisk pregnancies and effective glycaemic management should be emphasised to prevent adverse foeto-maternal outcomes.

Serological and Molecular Detection of Toxoplasma Gondii among Pregnant Women Giving Birth at the University Of Gondar Specialized Hospital in Gondar Town, Northwest Ethiopia

Objective: Congenital toxoplasmosis can be presented when immunosuppressed women are reactivating of this infection acquired before pregnancy in addition to women recently exposed to this disease during pregnancy, which causes of fetal death, neonatal death or congenital defects. Women mainly get this infection by ingested improperly cooked or raw meat consisting of viable tissue cysts or by contaminated foods and water within sporulated oocysts or through the placenta. Thus, this study aimed to detect Toxoplasma gondii in pregnant women using serologically and molecularly at study area. Methods: A cross-sectional study was conducted from September 2019 to October 2020 by collecting a total of 200 umbilical cord blood and matching discharged placental tissue samples from systematic randomly selected pregnant women giving birth at University of Gondar specialized hospital. Latex agglutination test and nested polymerase chain reaction were used for the detections of this infection. Findings: The overall serological, first polymerase chain reaction and nested polymerase chain reaction findings of this study were 46%, 24% and 10%, respectively. The univariant analysis indicated that seropositivity of Toxoplasma gondii antibodies were also significantly influenced by eating raw meat, eating raw vegetables, drinking raw milk, presence of domestic cat contacts and source of water (P  0.05). In the case of multivariate analysis drinking raw milk and source of water were also significantly associated to the seropositivity of Toxoplasma gondii. Moreover, there were also fair concordant between latex agglutination within first polymerase reaction (Kappa: 0.290) andnested polymerase chain reaction tests of this parasite (Kappa: 0.231). Novelty: This nested polymerase chain reaction and the Toxo-latex agglutination tests had also fair agreements in pregnant women. Moreover, Consumption of raw meat, vegetables and milk; domestic cat contacts and source of water were the potential statically significant associated risk factors for Toxoplasma gondii seropositivity. Conclusions: Generally, these comparative tests confirmed the existence of this infection in pregnant women that played up a pool of public health risks for their embryo and infants. Thus, thoroughly cooking raw meats and vegetables; pasteurized raw milk; avoid domestic cat contacts and boiling of water will be the best prevention and control strategies of this infection. Further works on its genotyping of this pathogen will be also convinced. Keywords: Latex agglutination; Nested polymerase chain reaction; Placental tissue; Pregnant women; Toxoplasma gondii; Umbilical cord blood

P184 Candida auris candidemia in COVID-19 and post-COVID-19 patients in a tertiary care hospital in North India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction Candida spp. accounts for 70%-80% of invasive bloodstream fungal infections. It is most commonly spread in long-term care facilities, caring for people with severe medical conditions. Patients hospitalized for COVID-19 are at risk for healthcare-associated infections like candidemia. Candida auris is an emerging, multidrug-resistant, healthcare-associated fungal pathogen. Candida auris is currently one of the most common clinical fungal pathogens, causing nosocomial infections. Due to its higher drug-resistance rate, C. auris is more difficult to treat, requires longer hospitalization periods, and results in higher morbidity and mortality than other Candida species.Aim and ObjectivesTo analyze the risk factors associated with C. auris candidemia in COVID-19 and post-COVID-19 patients at tertiary care center.Material and MethodsWe prospectively analyzed all positive blood samples which were received in the Microbiology department at SGPGI, Lucknow for a period of 1 year (March 2020-March 2021). Blood samples were inoculated and cultured in BACTEC Bottles (BD) and incubated for 5 days at 37°C. The bottles which flagged positive, a Gram's stain was performed and were sub-cultured on SDA for isolation of yeast colonies. Isolated yeasts were identified by phenotypic method and confirmed by MALDI-TOF MS. Demographics details of the patients were collected and recorded. The significant associated risk factors with C. auris candidemia were analyzed.ResultsA total of 13 000 blood samples were received during the 1-year study period from different departments of the hospital.1.25% (n = 163) of the blood culture samples were positive for candidemia. Out of 163 Candida culture-positive blood samples, 27.61% (n = 45) were C. auris. A total of 64% (n = 29) C. auris candidemia was seen in non-COVID-19 patients, 31.1% (n = 14) in COVID-19 patients, and two patients had a history of post-COVID-19 infection. The associated risk factors included the use of broad-spectrum antibiotics, intravenous catheterization, underlying respiratory illness, mechanical ventilation, use of steroids, and dialysis. A total of 46.6% (n = 21) mortality was seen with C. auris candidemia.Conclusions Candida auris candidemia continues to be a threat in hospitalized patients. This study shows prevalence of C. auris candidemia in COVID-19 and post-COVID-19 patients with 47% mortality. Candida auris is continuously reported from different departments in our institute, especially from intensive care units with high morbidity and mortality. An alertness, awareness and infection control practices by the healthcare personnel will help in early diagnosis and appropriate antifungal therapy and control the spread of C. auris.

Effect of Dietary Phosphorous Restriction on Fibroblast Growth 2 Factor-23 and sKlotho Levels in Patients with Stages 1-2 Chronic Kidney Disease.

Hyperphosphatemia has emerged as an independent risk factor for cardiovascular disease (CVD) and excess mortality in chronic kidney disease (CKD). The study evaluates the effect of dietary phosphorus (Ph) restriction (DPhR) at an early stage as a therapeutic strategy for delaying CKD progression and preventing CVD. Methods: This was a one-year interventional study conducted on 79 stage 1 and 2 CKD patients. The dietary phosphorus intake (DPhI), fibroblast growth factor-23 (FGF-23), sKlotho and serum phosphorous (SP) levels were analyzed. Patients were categorized into two groups based on their DPhI, recommended DPhI (RPhI) with <1000 mg/day of dietary phosphorous (dietary counselling) and high DPhI (HPhI) with >1000 mg/day (dietary intervention). For comparisons of differences between the two groups, independent t-test; for correlation analysis, Pearson correlation; for identifying the significant associated risk factors for CKD, binary logistic regression analysis and for comparing the means across the three visits, repeated measures ANOVA were used for statistical analysis. Results: The mean age and glomerular filtration rate (GFR) of CKD patients were 38 ± 12 years and 82.95 ± 16.93 mL/min/1.73 m2. FGF-23, SP, dietary protein and DPhI were significantly higher and sKlotho was significantly lower in HPhI group than RPhI group. In HPhI group; GFR, sKlotho, SP and FGF-23 correlated significantly with DPhI. Risk factors with a statistical bearing on the progression of CKD were animal-based diet, family history of CKD and hypertension. In HPhI group; GFR, DPhI, SP and FGF-23 levels significantly improved within the intervention period whereas a significant increase in sKlotho levels was observed in both the groups. Conclusion: Restricting DPhI emerged as a favorable therapeutic strategy for CKD patients for improving renal function and controlling hyperphosphatemia. The results of the present study may serve as the basis for future interventional studies with dietary phosphate restriction in the initial stages of CKD that would preserve renal function. Highlights: Early restriction of dietary phosphorus prevents decline in eGFR, elevation in FGF23 and increases Klotho levels.

Prevalence and associated risk factors of burnout amongst veterinary students in Ghana.

This study was designed as a cross-sectional study to find out the prevalence and associated risk factors of burnout among veterinary students at Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi-Ghana. A total of 74 veterinary students served as the respondents and were given online questionnaires which comprised questions on emotional exhaustion (EE), depersonalisation (DP) and reduced personal accomplishment (RPA). Data obtained were analysed using descriptive statistics, Chi-square test and regression analysis. Results indicated that on average, the EE and RPA were low with mean score of 12.72 ± 4.46 and 27.96 ± 7.94 whilst DP was high with a mean score of 20.72 ± 6.5 among veterinary students. The year of study had a significant effect (p = 0.000) on burnout with levels of high RPA (80%) and DP (70%) being more in the preclinical students as compared to the clinical students (RPA = 20%, DP = 30%). There was also a significant effect (p = 0.028) of the year of study and type of residence of the students on the high level of DP and RPA. Daily sleep hours of students had Daily sleep hours of the veterinary students were also indicated as a significant associated risk factor of burnout among veterinary students in this study as more less sleep hours (<6hours), causes high levels of DP and RPA. Age, gender and marital status, working status, exercise hours and weekly study hours of students did not count as significant predictive factors (p>0.05) of burnout.

The prevalence of gestational diabetes, associated factors and feto-maternal outcome among antenatal women attending health clinics in Terengganu

Introduction: Gestational diabetes mellitus (GDM) is a known risk factor for diabetes mellitus (DM). The rising prevalence of GDM in the Asian population (11.7%) may explain the increasing incidence of DM in women. This study examined the prevalence of GDM, its associated factors and the foeto-maternal outcomes of women with GDM in Terengganu. Methods: A cross-sectional study was conducted between April and September 2019 using secondary data from antenatal records in 40 health clinics in Terengganu for 2018. All pregnant women aged 25 years and above with or without risk factors for GDM were included in the study. Those with pre-existing type 1 or 2 DM were excluded. A total of 270 respondents were included. The prevalence of GDM and its associated factors were determined using descriptive statistics followed by multiple logistic regression. Results: The prevalence of GDM in Terengganu was 27.3% (n=72). Logistic regression analysis found that BMI at booking (adjusted OR=4.51, 95% CI 2.13–9.55, p&lt;0.001), history of GDM (adjusted OR=5.31, 95% CI 2.17–12.99, p&lt;0.001) and family history of DM (adjusted OR=4.24, 95% CI 2.23–8.05, p&lt;0.001) were the significant associated risk factors. Of women with GDM, 17.7% (n=11) had postpartum pre-diabetes based on modified oral glucose tolerance at 6 weeks postpartum. Univariate analysis using chi-square tests showed a significant association of neonatal jaundice and hypoglycaemia with GDM. Conclusion: Because the prevalence of GDM in Terengganu is high, surveillance of GDM in highrisk pregnancies and effective glycaemic management should be emphasised to prevent adverse foeto-maternal outcomes.

DETERMINANTS OF POOR SLEEP QUALITY AMONG EDUCATIONAL WORKERS

Background: In educational workers, poor sleep quality has a major impact on health and productivity. Although there are many known risk factors for poor sleep quality, data on these risk factors in Indonesian educational workers are lacking. Therefore, this study aims to determine the most influential risk factors for poor sleep quality in Indonesian educational workers. Methods: An observational analysis study with a cross-sectional design was conducted in October-December 2020 involving 81 participants at Yayasan Pendidikan Pelita Raya, Jambi. Sleep quality, vitamin D intake, and job stress were measured using the Pittsburgh Sleep Quality Index (PSQI), Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ), and Health & Safety Executive questionnaires (HSE), respectively. Data analysis was done by multiple logistic regression, with a significant level of p <0.05. Results: The median age was 29 (range 21-55) years, poor sleep quality was found in 30 (37%) participants, 42 (51.9%) of participants had low vitamin D intake, and 48 (59.2%) reported moderate-to-high stress levels. Age < 30 years (p < 0.040), moderate-to-high stress level (p < 0.013), and low vitamin D intake (p < 0.003) were significant associated risk factors for sleep quality in educational workers, with low vitamin D intake being the most influential risk factors. Conclusion: Younger age, stress level, and low vitamin D intake were determinants of poor sleep quality in educational workers, with low vitamin D intake being the most influential risk factors. Management of stress and vitamin D intake are needed to improve sleep quality in educational workers. Keywords: educational workers, Indonesia, poor sleep quality, risk factors, vitamin D intake