Citations

ABSTRACT. This cross-sectional descriptive study was conducted at the University of Health Sciences, Lahore, over 5 years (2016–2020) to explore the association of Panton–Valentine leucocidin (pvl) genes and staphylococcal cassette chromosome mec (SCCmec) types with hospital-acquired (HA) and community-acquired methicillin-resistant Staphylococcus aureus (MRSA). Panton–Valentine leucocidin genes in MRSA have been found in HA-MRSA strains, thereby raising the prevalence of highly virulent and resistant strains. Furthermore, the usage of staphylococcal cassette chromosome mec (SCCmec) typing is crucial for understanding the epidemiology and evolution of MRSA. The isolates of Staphylococcus aureus were acquired from clinical samples of the patients. Gram staining, catalase, coagulase, and DNAse tests were used for S. aureus confirmation. The methicillin resistance genes A and C (mecA and mecC) genes were detected to confirm MRSA by using a 30 µg cefoxitin disk. Panton–Valentine leucocidin gene identification and SCCmec typing (types I–V and XI) were conducted through polymerase chain reaction testing. Only 440 strains of MRSA were isolated, and 31.6% were positive for the pvl gene. The most prevalent SCCmec type among the MRSA isolates was type III, which was found in 42.7% of isolates. The pvl gene was detected in 74% of SCCmec types IV and V and in only 14% of SCCmec types I, II, III, and IIIA. This study revealed the dynamic adaptability of MRSA strains within healthcare settings, with the cooccurrence of the pvl gene and various SCCmec types highlighting the complexity of MRSA epidemiology. The urgent implementation of comprehensive strategies that integrate molecular surveillance and infection control measures is crucial for mitigating MRSA.

Background: Evaluate survival outcomes of PN compared to RN in patients with T1-2, N0, M0 cRCC. Methods: Patients with cRCC were identified using the National Cancer Database (NCDB). Inclusion criteria included T1-2, N0, M0 disease, treatment with either PN or RN, and a Charleston Deyo co-morbidity score of 0. Patients with missing survival data, advanced staging, or incomplete surgical information were excluded. Propensity score matching was performed to create identical groups with respect to age, sex, and race. Kaplan–Meier survival curves, multinomial logistic regression, and cox proportional hazard models were used for statistical analysis. Results: Of the 476 eligible propensity matched patients, 238 (50.0%) underwent PN and 238 (50.0%) underwent RN. PN was associated with better survival (mean: 186 vs. 170 months, P < 0.05) and lower odds of death (OR = 3.43; 95% CI, 2.05-5.76; P < 0.05). Five- and ten-year survival rates for PN were 95.2% and 91.1%, compared to 87.4% and 76.0% for RN. Patients treated with PN were significantly more likely to come from a higher income quartile and be treated at an academic/research facility. Conclusion: Partial nephrectomy demonstrates superior survival and shorter hospital stays compared to radical nephrectomy in localized cRCC, reinforcing its role as the preferred surgical approach.

Breast cancer is one of the most common cancers in females. In low- and middle-income countries like Pakistan, reported incidence and prevalence remain unreliable. The aim was to evaluate Pakistani women’s knowledge, attitude, and perception of breast cancer. This cross-sectional study was conducted among Pakistani women from Punjab, Pakistan. A self-administered online questionnaire was formulated to collect data from the participants from September 24, 2022, to October 24, 2022. The questionnaire included sociodemographic data, knowledge questions regarding breast cancer risk factors, knowledge questions about symptoms of breast cancer, and questions assessing the participants’ attitudes toward mammography screening. For knowledge questions, a score of more than 7 out of 13 was considered good knowledge. For attitude questions, regression analysis was done and a score of more than 5 out of 11 was considered a positive attitude. Data was analyzed using SPSS version 25 (Chicago). 796 women participated in this study. Out of 796 participants, 543 (68.2%) were between 20 and 30 years of age, and 43 (5.4%) were more than 40 years old. The level of knowledge regarding breast cancer risk factors was suboptimal. 523 (65.7%) of the participants thought that breast cancer risk increases with advancing age and 218 (27.4%) thought that early menarche increases the risk of developing breast cancer. 471 (59.2%) mentioned that mammography is an effective tool for detecting breast cancer, and 30 (3.8%) thought that there is a cure for breast cancer. According to regression analysis, higher education, higher monthly household income, and married marital status were significantly associated with good knowledge related to breast cancer. Although most of the population is aware of breast cancer’s risk factors and symptoms, they avoid screening such as mammography. Public awareness projects could help increase women’s knowledge of breast cancer signs, symptoms, and screening.

11157 Background: Metastatic cancers are the leading cause of mortality in the United States (US). In this study of death certificates, obtained from data registry spanning from 1999 to 2024, we examined mortality trends among individuals suffering from any metastatic cancer in US. Methods: Our aim was to analyze the trends in mortality among US residents by demographic characteristics and predict future years based on the existing data by Autoregressive Integrated Moving Average (ARIMA) forecasting modeling. The national mortality data from the multiple causes of death files in the CDC WONDER Database were queried by applying the ICD-10 codes as C77-C79 for secondary cancers. Trends in age-adjusted mortality rate (AAMR) were assessed and results were expressed as average annual percentage changes (AAPC) from Join point regression. Results: There were a total of 2,098,842 deaths due to metastatic cancers in US from 1999-2024 with a crude mortality rate of 25.97 per 100,000 population, about 52% of them being males and 48% were females. Mortality rates (AAMR) continue to trend down from 1999-2008 in both gender, but showed an increase from 2009 onwards with females showed significant AAPC of +0.44. ARIMA predictive model exhibits a significant decline of mortality rates up to the year 2050 in Black population (AAMR: 24.45), Northeast region (AAMR: 10.84) and metropolitan areas (AAMR: 19.93). Conclusions: These findings provide valuable insights of mortality patterns among US population with metastatic malignant diseases. Certain subgroups with specific demographic and geographic characteristics such as White Population, non-metropolitan areas and those belonged to West region had higher future prediction of AAMR. ARIMA forecasting model for predicting AAMR in metastatic cancer population in U.S. Variables AAMR in 1999 Lowest AAMR (year) AAMR in 2024 AAPC ARIMA forecast (2050) Total 27.65 18.34(2008) 29.13 +0.30(0.20 – 0.40)* 29.90 Gender Female 23.89 15.73(2008) 26.23 +0.44(0.34 – 0.54)* 26.04 Male 33.48 22.03(2008) 33.19 +0.06(-0.32 – 0.44) 32.31 Race White 27.74 18.70(2008) 30.89 +0.51(0.40 – 0.63)* 32.95 Black 35.32 21.30(2014) 30.67 -0.54(-1.43 – 0.36) 24.45 Hispanic 19.07 12.93(2008) 21.68 +0.42(0.30 – 0.55)* 24.68 Asian or Pacific Islander 16.32 11.60(2008) 19.37 +0.54(0.25 – 0.89)* 23.15 American Natives 20.35 15.19(2005) 21.68 +0.33(-0.15 – 1.15) 24.28 Census Region Northeast 27.29 15.62(2014) 20.53 -1.03(-1.57 – -0.49)* 10.84 Midwest 29.51 18.55(2010) 31.96 +0.35(0.21 – 0.47)* 30.74 South 28.23 19.18(2008) 30.77 +0.43(0.31 – 0.56)* 33.30 West 24.81 17.18(2008) 30.72 +0.97(0.77 – 1.19)* 39.18 Urbanization † Metropolitan 27.17 17.76(2008) 24.66 -0.46(-0.60 – -0.33)* 19.93 Non-metropolitan 29.87 20.73(2010) 30.39 +0.02(-0.75 – 0.80) 26.56 AAMR per 100,000 population. † For urbanization, AAMR 1999-2020. *P-value <0.05.

e23316 Background: Daprodustat, a hypoxia-inducible factor prolyl hydroxylase (HIF-PHD) inhibitor, prevents the degradation of HIF and promotes erythropoiesis. It was recently approved by the United States Food and Drug Administration (FDA) for the treatment of chronic kidney disease (CKD) associated anemia. This systematic review and meta-analysis aims to compare the efficacy of daprodustat and the standard recombinant human erythropoietin therapy (rhEPO) in the management of CKD-associated anemia among patients on dialysis. Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was performed, using relevant key terms. over PubMed/Medline, Cochrane Library, Google Scholar, and clinicaltrials.gov from inception to 15th January 2025. Only randomized clinical trials comparing the impact daprodustat relative to the standard rhEPO therapy among CKD patients on dialysis were included. The analysis was conducted using Comprehensive Meta-analysis Software via a random effect model. Results: Our preliminary search revealed 1375 articles. Following comprehensive screening, five articles, with 3940 participants, were considered eligible for inclusion. Among participants, 2132 were randomized to the intervention arm and 1808 to the control group. Mean change in hemoglobin from baseline was reported by all five studies and pooled comparison revealed non-inferiority among the two treatments (Std diff: -0.072; SE: 0.123; p-value:0.557) with a high heterogeneity (I 2 = 80.196%). The second outcome, adjusted treatment difference, was reported by three studies and again no treatment was found to be inferior to each other (Std diff: 0.112; SE: 0.091; p-value:0.217), with moderate heterogeneity (I 2 = 69.790). Conclusions: Daprodustat demonstrates non-inferiority to standard rhEPO therapy for the management of CKD-associated anemia in patients undergoing hemodialysis. Pooled effect size for change in hemoglobin from baseline. Study name Statistics for each study Author, Year Std diff in means Standard error Variance Lower limit Upper limit Z-Value p-Value Holdstock et al. 2016 (0.5 mg) -0.988 0.348 0.121 -1,671 -0.305 -2.836 0.005 Holdstock et al. 2016 (2 mg) -0.834 0.343 0.118 -1.507 -0.162 -2,433 0.015 Holdstock et al. 2016 (5 mg) 0.236 0.335 0.112 -0.420 0.893 0.706 0.480 Meadowcrot et al. 2018 0.124 0.178 0.032 -0.224 0.472 0.698 0.485 Akizawa et al. 2020 0.000 0.122 0.015 -0.240 0.240 0.000 1.000 Singh et al. 2021 0.234 0.037 0.001 0.162 0.306 6.342 0.000 Coyne et al. 2022 -0.080 0.105 0.011 -0.286 0.126 -0.763 0.446 Combined -0.072 0.123 0.015 -0.312 0.168 -0.587 0.557

Abstract Introduction: Tuberculosis (TB), a substantial cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals, accounted for 161,000 deaths among HIV-co-infected patients in 2023. Tuberculosis preventive therapy can play a detrimental role in reducing the global burden. However, prolonged treatment duration compromises adherence and ultimately efficacy. This systematic review and meta-analysis aimed to assess the treatment adherence and effectiveness of rifapentine-isoniazid prevention therapy relative to the standard isoniazid therapy. Methods: This study was conducted following the PRISMA guidelines. A comprehensive literature search was conducted over PubMed/Medline, Google Scholar, Cochrane Library, and ClinicalTrials.gov from inception till 28 October 2024. Recruited articles were screened against the predefined inclusion criteria, and relevant data was extracted into a spreadsheet. Comprehensive Meta-Analysis (CMA) was used for data synthesis. Results: This meta-analysis included four studies containing data from 8,068 patients, with 5640 randomized to the rifapentine-isoniazid group while 2428 received isoniazid. Tuberculosis incidence varied from 0.21 to 2.0 and 0.63 to 1.9 per 100 person-years in the rifapentine-isoniazid arm and isoniazid alone group respectively. However, the pooled analysis showed a non-significant difference between the two groups (OR: 1.12; CI: 0.65 to 1.93; p=0.69) as shown in Figure 1. Similarly, no significant difference was noted across deaths in each group (OR: 0.76; CI: 0.43 to 1.34; p=0.35). While the two preventive therapies were non-inferior in terms of effectiveness, a significant improvement in treatment completion was observed with the rifapentine-isoniazid group (OR: 5.14; CI: 2.96 to 8.96; p&lt;0.0001). Conclusion: The short-term rifapentine-isoniazid preventive therapy was non-inferior to the standard isoniazid therapy, however, a marked improvement in treatment completion was noted with the former.

Abstract Introduction:AFOP is a pattern of lung injury with intra-alveolar fibrin balls and organizing pneumonia. In 2013, the ATS/ERS revised their classification of idiopathic-interstitial-pneumonia to include acute-fibrinous-organizing-pneumonia(AFOP) in their rare histologic patterns. Methods: MEDLINE(PubMed), EMBASE, and Cochrane were searched for AFOP-related case reports/case series. Mesh terms used included (“acute fibrinous and organizing pneumonia” OR AFOP OR “acute fibrinous organizing pneumonia” OR (“acute fibrinous” AND “organizing pneumonia”) OR (“acute fibrinous” AND “organizing pneumonia”). A total of 177 patients were synthesized in these 169 articles, 9 of which were case series and the rest individual case reports. A quality review and data extraction was done on Covidence using a JBI checklist.Results:Mean age of 52.2 +/- 17.4 years with 55% of them were males. The associations were; malignancy (16%), smoking (14%), organ transplant (13%), Hypertension (10%), and use of immunosuppressive agents (6%) were frequent risk factors. Cough (73%), shortness of breath (71%), and fever (61%) were found highly frequent symptoms. Predominant radiological findings were multifocal infiltrates/consolidation (50%) and ground glass appearance (39%). Leukocytosis and inflammatory markers were elevated in most cases. Transbronchial/EBUS (32%), open surgical (29%), imaging-guided (22%), and VATS (14%) were common modes of lung biopsy. Treatment is usually steroids (88%) and antibiotics (69%). Death occurred in 23% of the cases, clinical or radiological improvement was achieved in 69%, while only three recurrences were reported. Most cases are either idiopathic or associated with myelodysplastic syndrome as causative factors reported by authors. DiscussionAFOP presents non-specific symptoms and a community-acquired pneumonia-like clinical picture. Treatment included antibiotics, corticosteroids, and other immunosuppressants with variable outcomes. Discontinuation of suspected drug was the sole treatment strategy reported in some cases. Partial lobectomy/lesion resection was a successful treatment in some instances with localized disease.The survival in AFOP was significantly worse than obliterative bronchiolitis (median time to death 101 vs. 294 days; P = 0.02). A statistically non-significant trend towards higher mortality associated with higher body mass index (BMI) and a long interval between symptom onset and diagnosis of AFOP was reported by Kim et al. in a cohort from South Korea. Conclusion:AFOP being a rare histological pattern of acute lung injury, is a relatively new entity that requires a better clinical and radiologic understanding for the clinical challenge it poses. This systematic review will be able to provide answers to clinicians to think in that direction and manage acute lung injury accordingly.