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Item A 20-year retrospective clinical analysis of Candida infections in tertiary centre: Single-center experience(Elsevier, 2022) Muzaheed; Alshehri, Bashayer A.; Rabaan, Ali A.; El-Masry, Omar S.; Acharya, Sadananda; Alzahrani, Faisal M.; Al Mutair, Abbas; Alhumaid, Saad; Al-Tawfiq, Jaffar A.; Muhammad, Javed; Khan, Amjad; Dhama, Kuldeep; Al-Omari, Awad; Medicine, School of MedicineIntroduction: Fungal infections have risen exponentially in the last decade. In fact, candidiasis has become the most frequent type of hospital acquired infection especially in patients receiving treatment for chronic and terminal illnesses in a hospital. A retrospective analysis for a period of twenty year was undertaken to analyze the incidence rate of candidiasis, especially of Candida species, patients treated in a tertiary care center. Materials and methods: Clinical data was collected from samples of patients who were receiving tertiary care were presenting with clinically suspected fungal infections. Direct microscopy with 10% potassium hydroxide was done to visualize the presence of fungal elements, and Gram staining was done for any suspected yeast infection. The samples were inoculated on Sabouraud's Dextrose Agar and kept at 22 °C. Results: A total of 1256 samples with presumed fungal etiology were included in the study. The maximum number of fungal infections were present in elderly (70-79 years age). Females (53.8%) were more affected (45.5%). 21% isolates were identified as yeast but belonged to non-Candida fungi. Among Candida species, Candida albicans was the most dominant species (58.3%) followed by Candida glabrata (6.4%). The year-round data of fungal cases showed that the highest incident of Candida albicans infection were in January with a mean value of 3.80, while the lowest infections were reported in June, with prevalence of 2.32 of C. albicans. The twenty-year data analysis showed that the years 2001 and 2000 showed the highest incidents of C. albicans, with a mean prevalence of 7.50 and 6.83, respectively. Specimen vs fungal prevalence data showed that 38% of the C. albicans were isolated from body aspirate specimens, followed by 26% from swab specimens. Conclusion: The high prevalence of Candida spp. in the present study suggests increased susceptibility of patients with critical or chronic illnesses to fungal infections.Item A Cohort Study of Seroprevalence of Antibodies Against SARS-CoV-2 Infection Among Healthcare Workers at a Tertiary Hospital in Saudi Arabia(Dove Press, 2022-08-10) Mushcab, Hayat; Al-Tawfiq, Jaffar A.; Ghamdi, Mohammed; Babgi, Amani; Amir, Abdulrazack; Sheikh, Salwa S.; Darwisheh, Adel; Alobaid, Abrar; Jebakumar, Arulanantham Zechariah; Qahtani, Saeed; Al Sagheir, Ahmed; Medicine, School of MedicineBackground: The nature of the healthcare workers’ jobs standing at the frontline against the coronavirus disease 2019 (COVID-19) puts them at a higher risk of unknowingly contracting the disease and potentially contributing to the spread. This study aims to assess the overall positive seroconversion prevalence of SARS-CoV-2. Methods: This is a longitudinal cohort study of healthcare workers at Johns Hopkins Aramco Healthcare (JHAH). JHAH is a tertiary hospital located in Dhahran serving patients in several districts in the Eastern Province of Saudi Arabia. Participants were recruited between June and December 2020. Each participant had a serology blood test and completed the World Health Organization’s risk factor assessment questionnaire. Results: This study included 682 participants working in JHAH, representing 15.7% of our population. Out of the 682 participants, 15.2% had a positive SARS-CoV-2 rt-PCR before taking part in the study. However, only 87 tested positive for SARS-CoV-2 antibodies, a prevalence of 12.7% of all participants. Out of the 87 positives for SARS-CoV-2 antibodies, 17 participants never tested positive for COVID-19 rt-PCR, a prevalence of 2.9%. Moreover, not properly using alcohol-based hand rub or soap and water after the risk of body fluid exposure and wearing personal protective equipment when indicated were found to be statistically significant to having a positive SARS-CoV-2 IgG assay. Conclusion: Positive seroconversion rate was considerably low during the first wave of COVID-19 amongst JHAH’s healthcare workers and similar to other healthcare organizations in Saudi Arabia. Seropositivity correlated significantly with following infection prevention and control recommendations.Item Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns(American Heart Association, 2022) Baker, Anna D.; Schwamm, Lee H.; Sanborn, Danita Y.; Furie, Karen; Stretz, Christoph; Grory, Brian Mac; Yaghi, Shadi; Kleindorfer, Dawn; Sucharew, Heidi; Mackey, Jason; Walsh, Kyle; Flaherty, Matt; Kissela, Brett; Alwell, Kathleen; Khoury, Jane; Khatri, Pooja; Adeoye, Opeolu; Ferioli, Simona; Woo, Daniel; Martini, Sharyl; De Los Rios La Rosa, Felipe; Demel, Stacie L.; Madsen, Tracy; Star, Michael; Coleman, Elisheva; Slavin, Sabreena; Jasne, Adam; Mistry, Eva A.; Haverbusch, Mary; Merkler, Alexander E.; Kamel, Hooman; Schindler, Joseph; Sansing, Lauren H.; Faridi, Kamil F.; Sugeng, Lissa; Sheth, Kevin N.; Sharma, Richa; Neurology, School of MedicineBackground: There are limited data about the epidemiology and secondary stroke prevention strategies used for patients with depressed left ventricular ejection fraction (LVEF) and sinus rhythm following an acute ischemic stroke (AIS). We sought to describe the prevalence of LVEF ≤40% and sinus rhythm among patients with AIS and antithrombotic treatment practice in a multi-center cohort from 2002 to 2018. Methods: This was a multi-center, retrospective cohort study comprised of patients with AIS hospitalized in the Greater Cincinnati Northern Kentucky Stroke Study and 4 academic, hospital-based cohorts in the United States. A 1-stage meta-analysis of proportions was undertaken to calculate a pooled prevalence. Univariate analyses and an adjusted multivariable logistic regression model were performed to identify demographic, clinical, and echocardiographic characteristics associated with being prescribed an anticoagulant upon AIS hospitalization discharge. Results: Among 14 338 patients with AIS with documented LVEF during the stroke hospitalization, the weighted pooled prevalence of LVEF ≤40% and sinus rhythm was 5.0% (95% CI, 4.1-6.0%; I2, 84.4%). Of 524 patients with no cardiac thrombus and no prior indication for anticoagulant who survived postdischarge, 200 (38%) were discharged on anticoagulant, 289 (55%) were discharged on antiplatelet therapy only, and 35 (7%) on neither. There was heterogeneity by site in the proportion discharged with an anticoagulant (22% to 45%, P<0.0001). Cohort site and National Institutes of Health Stroke Severity scale >8 (odds ratio, 2.0 [95% CI, 1.1-3.8]) were significant, independent predictors of being discharged with an anticoagulant in an adjusted analysis. Conclusions: Nearly 5% of patients with AIS have a depressed LVEF and are in sinus rhythm. There is significant variation in the clinical practice of antithrombotic therapy prescription by site and stroke severity. Given this clinical equipoise, further study is needed to define optimal antithrombotic treatment regimens for secondary stroke prevention in this patient population.Item Changes in insulin sensitivity over time and associated factors in HIV-infected adolescents(Lippincott, Williams & Wilkins, 2018-03-13) Geffner, Mitchell E.; Patel, Kunjal; Jacobson, Denise L.; Wu, Julia; Miller, Tracie L.; Hazra, Rohan; Gerschenson, Mariana; Sharma, Tanvi; Silio, Margarita; Jao, Jennifer; Takemoto, Jody K.; Van Dyke, Russell B.; Dimeglio, Linda A.; Pediatric HIV/AIDS Cohort Study (PHACS); Pediatrics, School of MedicineOBJECTIVE: To compare prevalence of insulin resistance between perinatally HIV-infected (PHIV+) and perinatally HIV-exposed, but uninfected adolescents (PHEU), determine incidence of and contributory factors to new and resolved cases of insulin resistance in PHIV+, and evaluate glucose metabolism. DESIGN: Cross-sectional design for comparison of prevalence among PHIV+ and PHEU. Longitudinal design for incidence and resolution of insulin resistance among PHIV+ at risk for these outcomes. METHODS: The source population was adolescents from pediatric HIV clinics in the United States and Puerto Rico participating in the Pediatric HIV/AIDS Cohort Study, an ongoing prospective cohort study designed to evaluate impact of HIV infection and its treatment on multiple domains in preadolescents and adolescents. Insulin resistance was assessed by homeostatic model assessment of insulin resistance. Those with incident insulin resistance underwent 2-h oral glucose tolerance test and HbA1c. Baseline demographic, metabolic, and HIV-specific variables were evaluated for association with incident or resolved insulin resistance. RESULTS: Unadjusted prevalence of insulin resistance in PHIV+ was 27.3 versus 34.1% in PHEU. After adjustment for Tanner stage, age, sex, and race/ethnicity, there was no significant difference between groups. Factors positively associated with developing insulin resistance included female sex, higher BMI z score, and higher waist circumference; those associated with resolving insulin resistance included male sex and lower BMI z score. CONCLUSION: Prevalence of insulin resistance in PHIV+ and PHEU was substantially higher than that reported in HIV-uninfected nonoverweight youth, but similar to that in HIV-uninfected obese youth. Factors associated with incident or resolved insulin resistance among PHIV+ were similar to those reported in HIV-negative obese youth. However, a contributory role of HIV infection and/or its treatment to the incident risk of insulin resistance cannot be excluded.Item Comparative Analysis of Edentulism in a Sample of Mexican Adults with and without Type 2 Diabetes(MDPI, 2022) Islas-Zarazúa, Rosalina; Mora-Acosta, Mariana; Navarrete-Hernández, José de Jesús; Reynoso-Vázquez, Josefina; Villalobos-Rodelo, Juan José; Rojas-Ortega, Laura; Sosa-Velazco, Taurino Amilcar; Márquez-Corona, María de Lourdes; Medina-Solís, Carlo Eduardo; Maupomé, GerardoThe objective of the present study was to compare the prevalence of edentulism in Mexican adults with and without a diagnosis of type 2 diabetes mellitus (T2DM) when they are seeking dental care. A cross-sectional study was conducted on 1921 medical records of Mexican adults 40 years of age and older who sought dental care at clinics of a public university in Mexico. The dependent variable was edentulism, clinically determined through an oral examination. The main independent variable was the self-report of previous T2DM diagnosis made by a physician. Sociodemographic, socioeconomic and behavioral covariates were included in a multivariate binary logistic regression model. Overall edentulism prevalence was 8.4% (95% CI = 7.1–9.6). The prevalence of T2DM was 14.3% (n = 274). The prevalence of edentulism among individuals with T2DM was 13.1%, but only 7.6% among individuals without T2DM. In the multivariate binary logistic regression model, a previous T2DM diagnosis increased the probability of being edentulous 1.61 times (95% CI = 1.03–2.50). For each year a person’s age increased, the likelihood of being edentulous increased by 12% (95% CI = 10–14%). In summary, a higher prevalence of edentulism was present in Mexican adults with T2DM and in those of older age. This information may be used by dental care providers and health policymakers to improve approaches to preventive care, as well as to characterize and anticipate care needs more accurately for the adult and older adult populations.Item Correlation between caries prevalence and socioeconomic status in children ages 6 to 36 months(2000) Ching, Brent Bing Yee; Weddell, James A. (James Arthur), 1949-; Sanders, Brian J.; Tomlin, Angela; Dean, Jeffrey A.; Klein, Arthur Irving, 1922-2004The purpose of this study was to evaluate the status of a sample of children ages 6 to 36 months with regard to prevalence of tooth decay in a community with an optimum fluoridated water supply. It was determined whether a relation existed between these data and the socioeconomic level of the family. One hundred and fifty children ages 6 to 36 months born and reared in Marion County, Indiana were examined with a dental mirror, explorer and a portable light. Parents/legal guardians of these children were given a questionnaire to obtain family history. Caries prevalence for children ages 6 to 12, 13 to 18, 19 to 24, 25 to 30, and 31 to 36 months were 4%, 0%, 22%, 23%, and 26%, respectively. Age, mother's educational attainment, and Medicaid experience remained significant predictors of caries experience: the odds of caries were 1.1 times for each monthly increase in age. Gender, father's educational attainment, family household income, and single parent status remained marginally significant predictors of caries experience. Results for similar correlation studies between caries prevalence and socioeconomic status for children ages 6 to 36 months are inconsistent. Further research is needed for children ages 6 to 36 months. Caries experience begins before age one. Patients, parents, and health care professionals need to be aware that the caries process begins at an early age, and prevention should begin as early as 6 months of age.Item Correlation between caries prevalence, socioeconomic status, and cultural findings in Hispanic children ages 6 months to 8 years(2002) Kugar, Jennifer R.; Yoder, Karen S. Masbaum, 1941-; Avery, David R.; Sanders, Brian J.; Weddell, James A. (James Arthur), 1949-; Martinez Mier, Esperanza de los A. (Esperanza de los Angeles), 1967-; Mallatt, Mark E. (Mark Edward), 1950-; Dean, Jeffrey A.There has been a tremendous influx in the number of Hispanic immigrants into the US over the past couple of decades. Many newcomers have families with small children, and dental needs in this pediatric population are disproportionately high. The purpose of this study was to determine if there was any correlation between the increased prevalence of caries and socioeconomic or cultural factors in Hispanic children ages six months to eight years old. To accomplish this, 127 children were given dental examinations by a calibrated dental examiner, and their parents completed a two-page questionnaire with questions regarding socioeconomic factors, den1ographics, and cultural issues. The bivariate relation between caries status and demographic and cultural variables was examined using chi-square tests or Fisher's exact tests for categorical variables and logistic regression for continuous variables. Bivariate relation between defs and demographic and cultural variables was examined using analysis of variance (ANOVA). The mean defs for children up to age two was 1.53; ages two to five the mean defs was 7.73, and for ages six to eight, 9.18. As the prevalence of caries increases with age, the child is more likely to access dental care, but despite this, there is an overall mean 79 percent of untreated decay (of decayed, missing and filled surfaces). In the permanent dentition, the overall mean DMFS was found to be 2.22. There were several factors found to be statistically significant to the incidence of defs. If the child had dental insurance, the child was more likely to have higher defs. If a child had more siblings, the defs score was higher. If the child was on the bottle at less than age one-and-a-half, the child was less likely to have dental caries. If the child on the bottle was older than age one-and-a-half, the child was much more likely to have dental caries. The older the child is when the child goes off the bottle, the more likely the child will have a higher caries experience. There is an extraordinarily large number of untreated caries found in Hispanic children. The reasons for this are multifactorial, but involve cost, language barriers, being new to the area, and not having seen a dentist yet. Identifying those at high risk such as single mothers, those with increased numbers of siblings, and infants that are still on the bottle, or older children that are at increased jeopardy due to prolonged use of the bottle are important factors in treating those that are underserved. Local dental and community organizations could benefit from being apprised of the unmet dental need of Hispanic children and some of the contributing factors. By further investigating and understanding some of the socioeconomic and cultural issues that present barriers to care, treatment might become more accessible and available. Adverse outcomes such as missed school and opportunities for acculturation, inadequate nutrition, pain, and infection might be avoided or diminished.Item Cystic fibrosis-related diabetes: Prevalence, screening, and diagnosis(Elsevier, 2021-12-07) Khare, Swapnil; Desimone, Marisa; Kasim, Nader; Chan, Christine L.; Medicine, School of MedicineCystic fibrosis-related diabetes (CFRD) is the most common comorbidity in patients with cystic fibrosis (CF). Prevalence of CFRD increases with age and is greater with severe mutations. Other risk factors associated with CFRD are female sex, pancreatic insufficiency, liver disease, need for gastrostomy tube feedings, history of bronchopulmonary aspergillosis, and poor pulmonary function. CFRD is related to worse clinical outcomes and increased mortality. Early diagnosis and treatment have been shown to improve clinical outcomes. Screening for CFRD is recommended with an annual oral glucose tolerance test (OGTT) starting at age 10 years. Diagnosis of CFRD is made by standard American Diabetes Association (ADA) criteria during baseline health. CFRD can also be diagnosed in individuals with CF during acute illness, while on enteral feeds, and after transplant. In this review we will discuss the epidemiology of CFRD and provide an overview of the advantages and pitfalls of current screening and diagnostic tests for CFRD.Item Decline in vaccine-type human papillomavirus prevalence in young men from a Midwest metropolitan area of the United States over the six years after vaccine introduction(Elsevier, 2019-09-30) Widdice, Lea E.; Bernstein, David I.; Franco, Eduardo L.; Ding, Lili; Brown, Darron R.; Ermel, Aaron C.; Higgins, Lisa; Kahn, Jessica A.; Medicine, School of MedicinePurpose: The aim of this study was to determine changes in human papillomavirus (HPV) prevalence among young men from a Midwest metropolitan area over the six years after vaccine introduction, including HPV prevalence in men overall, in vaccinated men to examine vaccine impact and in unvaccinated men to examine herd protection. An exploratory aim was to examine associations between number of vaccine doses and HPV prevalence. Methods: Men aged 14–26 years reporting male-female and/or male-male sexual contact were recruited from a primary care clinic, sexually transmitted disease clinic, and community setting during two waves of data collection: 2013–2014 (N = 400) and 2016–2017 (N = 347). Participants completed a questionnaire and were tested for penile, scrotal and anal HPV. Changes in prevalence of any (≥1 type) and vaccine-type HPV (HPV6, 11, 16, and/or 18) were examined using propensity score weighted logistic regression. Associations between number of doses and HPV infection were determined using chi-square tests and logistic regression. Results: The proportion of men with a history of ≥1 HPV vaccine doses increased from 23% to 44% (p < 0.001) from waves 1 to 2. After propensity score weighting, infection with ≥1 vaccine-type HPV significantly decreased among all men (29% to 20%; 31% decrease; odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.44–0.88) and unvaccinated men (32% to 21%; 36% decrease; OR = 0.56, 95%CI = 0.34–0.86); there was a non-significant decrease (21%) among vaccinated men. Associations between number of doses and HPV prevalence were not statistically significant. Conclusions: Prevalence of vaccine-type HPV decreased among all, vaccinated, and unvaccinated men six years after HPV vaccine recommendation, supporting vaccine impact and herd protection. Decreases in vaccine-type HPV in all men appear to be due to decreases in unvaccinated men, suggesting that the full impact of vaccination has yet to be realized. Continued monitoring and efforts to vaccinate men prior to sexual initiation are warranted.Item Demarcated Primary Second Molar Hypomineralization: Prevalence Data and Associated Sociodemographic Determinants from Indiana(American Academy of Pediatric Dentistry, 2021) Ahmed, Azza Tagelsir; Soto-Rojas, Armando; Dean, Jeffrey; Eckert, George J.; Martinez-Mier, Esperanza Angeles; Dental Public Health and Dental Informatics, School of DentistryPurpose: Demarcated primary second molar hypomineralization (DMH-Es) is a common developmental defect of enamel, with prevalence estimates between five percent and 20 percent. From the Americas, studies exploring the problem of DMH-Es and explicitly using the European Academy of Pediatric Dentistry diagnostic criteria were limited to some South American countries, but no similar studies were available from any of the North American countries including the United States. The purpose of this study was to investigate the prevalence and sociodemographic determinants of DMH-Es among schoolchildren in Indiana, USA. Methods: Four hundred twenty-three schoolchildren (average age equals 7.6 [±2.2 standard deviation] years) were examined by a calibrated pediatric dentist. Sociodemographic data were collected from patients' questionnaires and electronic dental records. Results: DMH-Es had a prevalence estimate of six percent versus 40 percent overall of any enamel defect (AED) of the primary second molars (PSMs) and/or the permanent first molars (PFMs). Race/ethnicity was significantly associated with a higher overall prevalence of AED of PSMs but not with the prevalence estimate of DMH-Es. Older age group (10 years or older), living in central Indiana, and water fluoridation were significantly associated with a higher overall prevalence of AEDs (P<0.01) but not with the prevalence of DMH-Es. Caries experience was significantly higher in children with demarcated molar hypomineralization (DMH) of PFMs and/or PSMs than in the group without. Conclusions: DMH-Es prevalence estimate was similar to the global figures. Certain demographic characteristics were significantly associated with the overall prevalence of the enamel defects of the examined teeth.
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