Clinical Presentation Of Patients Research Articles

Differences in the Clinical Presentation of Patients with Adrenocorticotropic Hormone–Dependent Cushing’s Syndrome

Differences in the Clinical Presentation of Patients with Adrenocorticotropic Hormone–Dependent Cushing’s Syndrome

Aetiology, Clinical Presentation and Outcome of Patients Presenting with Acute Flaccid Paralysis in a Tertiary Care Hospital

Objective: To determine the aetiology, clinical presentation and outcome of patients presenting with acute flaccid paralysis.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Pediatric Medicine, Agha Khan Hospital, Karachi Pakistan, from Jan 2015 to Dec 2019.
 Methodology: Medical record of 150 children fulfilling the selection criteria were selected. The clinical presentations of the patient were recorded in terms of the following: fever, cough, vomiting, weakness, difficulty in swallowing, altered sensorium, changes in heart rate and blood pressure and difficulty in breathing. The outcome of children with acute flaccid paralysis, i.e. clinical improvement in symptoms, complete recovery or death during the hospital stay, was noted. 
 Results: The mean age of patients was 10.13±5.01 years. The most common disease at presentation was Guillain bare syndrome 55(36.7%), followed by viral myositis 37(24.7%). Weakness was noted in all patients (100%), fever and headache in 64(42.7%), vomiting in 25(16.7%), and difficulty in breathing in 19(12.7%). After treatment, some improvement was noted in 104(69.3%) cases, while 27(18.0%) patients had no improvement; residual neurological disability was noted in 19(12.7%) cases, and 3(2.0%) died during follow-up.
 Conclusion: Acute Flaccid Paralysis (AFP) in children is a big challenge for physicians, and Guillian Barre Syndrome is the most common cause of acute flaccid paralysis in children. It almost invariably presents with weakness of the body. Keywords: Acute flaccid paralysis, Aetiology, Clinical presentation, Residual neurological disability.

Correlation between MRI Features of Adenomyosis and Clinical Presentation.

This study aimed to explore the correlation between MRI features, clinical risk factors, and symptoms associated with adenomyosis. Overall, 112 patients with pathologically confirmed adenomyosis were included in this retrospective study. MRI findings and clinical presentation, including visual analog scale (VAS) scores, cancer antigen 125 (CA-125) and hemoglobin levels, and parity, were analyzed. Additionally, 131 patients undergoing active surveillance were included to validate the MRI parameters and clinical presentations. Associations between MRI parameters and adenomyosis-related clinical presentations were assessed. Patients with operated adenomyosis were younger and had larger lesions, which were more frequently of the diffuse type and posterior localization, coexisting ovarian endometriosis, deep infiltrating endometriosis, myometrial cysts, and diffusion restriction than the non-operated lesions (p < 0.05). Patients with operated adenomyosis also exhibited higher VAS scores and CA-125 levels, and nulliparity was more common in this group (p < 0.05). In contrast, patients with non-operated adenomyosis showed a higher frequency of entire localization and fibroids (p < 0.05). Among the MRI parameters, size and classification were associated with the VAS and CA-125 levels. Myometrial cysts were associated with CA-125 levels. Classification was also associated with hemoglobin levels, and posterior localization was associated with parity. We identified a significant correlation between MRI features and clinical presentation in patients with adenomyosis.

SDPS-36 CLINICAL PRESENTATION IS A USEFUL PROGNOSTIC MARKER IN PATIENTS WITH BRAIN METASTASES

Abstract BACKGROUND Brain metastases are the most common malignant intracranial tumors and a leading cause of cancer-associated death. The influence on survival of their clinical presentation is scarce. AIM To determine if the clinical presentation of patients with brain metastases is associated with survival. METHODS A retrospective database of patients with brain metastases seen at a single center from 2010 to 2022 was analyzed. Clinical presentation and its association with survival were measured individually and adjusted for other prognostic variables. RESULTS From 822 patients, the most common symptoms were headache 53%, focal weakness 35%, visual disorders 24%, nausea/vomiting 23%, seizures 22%, and altered mental status 18%. Clinical presentations associated with survival after multivariate analysis were no symptoms [HR 0.55 (95%CI 0.39-0.79), P = 0.001], focal weakness [HR 1.21 (95%CI 1.01-1.44), P = 0.032], altered mental status [HR 1.24 (95%CI 1.01 – 1.52), P = 0.038], and visual disorders [HR 1.29 (95%CI 1.07-1.46), P = 0.007. Adding the clinical information to the graduated prognostic score improved its prognostic performance measured by both the C-statistic and the Akaike information criteria. CONCLUSION Clinical symptoms should be considered in all patients with brain metastases for they are associated with outcomes.

Correlational Analysis of Nasal Resistance and Acoustic Rhinometry Measurements With the Localization of Fungus Balls in the Paranasal Sinuses.

Objective: To investigate the reason for fungal balls (FBs) being localized in paranasal sinuses, we analyzed the clinical presentations of patients with FB rhinosinusitis (FBS). Methods: Clinical data, anatomical variation (ie, nasal septal deviation, concha bullosa, and Haller cell), as well as measurements of nasal resistance (NR), nasal cavity volume (NCV), and nasal cross-sectional area (NCA) using active anterior rhinomanometry and acoustic rhinometry were collected from FBS patients hospitalized in our hospital between January 2021 and December 2022. A retrospective analysis was conducted using IBM SPSS 19.0 to perform the Shapiro-Wilk test, t-test and logistic regression analysis. Results: A total of 95 FBS patients, including 33 male and 62 female patients, were included in this study. FBs in maxillary sinus were the most common (83, 87.4%), followed by sphenoid sinus (9, 9.5%). Logistic multivariate regression analysis revealed that a higher left-to-right NR ratio was associated with an increased likelihood of FBs being present in the left sinus [Odds ratios (OR) = 0.185; 95% CI, 0.061-0.558; P < .01]. When the ratio of the left-to-right second-minimum NCA was higher and the FB was more in the right sinus (OR = 3.194; 95% CI, 1.593-6.405; P = .001). Additionally, when the difference between left and right NCV was greater and FB occurred more commonly in the right sinus (OR = 1.435; 95% CI, 1.196-1.721; P < .001). Nonetheless, the presence of nasal septum deviation and concha bullosa did not significantly contribute to FB formation. Conclusions and significance: The differences in NR, NCA, and NCV between the affected and unaffected sides of nasal cavity are risk factors for the FB formation. To reduce FBS recurrence, it is important to focus on improving nasal ventilation during the surgical treatment.

Susceptibility to preoperative seizures in glioma patients with elevated homocysteine levels.

Seizures are a common clinical presentation in patients with glioma and substantially impact patients' quality of life. Hyperhomocysteinemia is defined as abnormally high serum levels of homocysteine (Hcy) and is reportedly linked to susceptibility to various nervous system diseases. However, it remains unclear whether and how hyperhomocysteinemia and its associated genetic polymorphisms promote seizures in glioma patients. We retrospectively reviewed all medical data from 127 patients with malignant gliomas, who underwent initial tumor resection by our team between July 2019 and June 2021 and had preoperative measurements of serum Hcy levels. According to whether they had at least one seizure before surgery, they were divided into the seizure and nonseizure groups. We also detected polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene and measured intratumoral Hcy levels in these patients. Hyperhomocysteinemia was a susceptibility factor for preoperative seizures in glioma patients according to both univariate analyses (P < 0.001) and multivariate logistic regression analyses (OR 1.239, 95% CI 1.062-1.445, P = 0.007). Patients with the MTHFR C677T variant exhibited elevated serum Hcy levels (P = 0.027) and an increased prevalence of preoperative seizures (P = 0.019). Intratumoral Hcy levels were positively correlated with serum Hcy levels (R = 0.231, P = 0.046) and were elevated in patients with hyperhomocysteinemia (P = 0.031), the MTHFR C677T variant (P = 0.002) and preoperative seizures (P = 0.003). High intratumoral Hcy levels, rather than hyperhomocysteinemia or the MTHFR C677T variant, emerged as an independent risk factor for preoperative seizures (OR 1.303, 95% CI 1.015-1.673, P = 0.038). Furthermore, the effects of hyperhomocysteinemia on epileptic susceptibility were reduced to nonsignificance when intratumoral Hcy was controlled to the same level between groups. Glioma patients with hyperhomocysteinemia and the MTHFR C677T variant were susceptible to preoperative seizures, suggesting their potential as biomarkers for the management of seizures in glioma patients. The elevation of intratumoral Hcy is a possible mechanism underlying this susceptibility.

Differences in clinical presentations of patients seeking care for treatment-resistant depression across sexual orientations and gender identities.

Sexual and/or gender minority (SGM) individuals experience higher rates and greater severity of depressive disorders than non-SGM persons. SGM individuals are more likely than non-SGM individuals to seek mental health treatment and to present to treatment with unique characteristics that should be accounted for when considering treatment recommendations. Patients seeking care for treatment-resistant depression (TRD) are offered a variety of evidence-based interventions ranging in modality and invasiveness (eg, psychotherapy and neuromodulation). The current study used data from a TRD clinical research program to examine whether SGM (N = 52) and non-SGM (N = 202) patients differed in their clinical presentations and the treatment recommendations offered to them. We found that SGM patients were younger, had a more severe history of childhood trauma, and reported greater current suicidality than non-SGM patients. There were no significant differences in treatment recommendations between groups. This study adds to nascent literature investigating clinical characteristics of SGM populations seeking mental health care and provides foundational evidence for the unique treatment considerations necessary for SGM individuals seeking treatment for TRD. Research into whether treatment outcomes differ for SGM and non-SGM individuals with TRD is encouraged, given clinical differences in trauma history and suicidality.

Identification of novel clusters of co-expressing cytokines in a diagnostic cytokine multiplex test.

Cytokines are mediators of the immune system that are essential for the maintenance, development and resolution of immune responses. Beneficial immune responses depend on complex, interdependent networks of signaling and regulatory events in which individual cytokines influence the production and release of others. Since disruptions in these signaling networks are associated with a wide spectrum of diseases, cytokines have gained considerable interest as diagnostic, prognostic and precision therapy-relevant biomarkers. However, currently individual cytokines testing has limited value because the wider immune response context is often overlooked. The aim of this study was to identify specific cytokine signaling patterns associated with different diseases. Unbiased clustering analyses were performed on a clinical cytokine multiplex test using a cohort of human plasma specimens drawn from individuals with known or suspected diseases for which cytokine profiling was considered clinically indicated by the attending physician. Seven clusters of co-expressing cytokines were identified, representing common patterns of immune activation. Common expression profiles of the cytokine clusters and preliminary associations of these profiles with specific diseases or disease categories were also identified. These findings increase our understanding of the immune environments underlying the clinical presentations of patients of inflammatory, autoimmune and neoplastic diseases, which could then improve diagnoses and the identification of evidence-based treatment targets.

Spectrum of Etiologies and Clinical Presentation of Patients with Extraocular Motility Disorders Presenting to a Neuro-Ophthalmology Clinic

Objective: To provide an account on the demographics, etiology, co-morbidities, presentation findings and frequency of patients with cranial nerve palsies presenting to our Neuro-Ophthalmology clinic. Study Design: Cross-sectional study. Place and Duration of Study: Department of Neuro-Ophthalmology, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan from Dec 2017 to Jun 2022. Methodology: A total of 82 patients were included in the study. The data was compiled on a single proforma by a single investigator which included Co-morbidities, presentation findings (ptosis, headache, diplopia, extra-ocular movements, Anisocoria, Visual Acuity for both eyes, Media and Fundus examination findings). Contrast Enhanced MRI (CEMRI) results were also tabulated where performed. Potential causes such as diabetes mellitus, hypertension, space occupying lesions, aneurysms and injury were also documented for each patient. Results: A total of 22 patients had 3rd nerve palsy, 9(40.91%) out of them had partial 3rd nerve palsy while 6(27.31%) had ischemic 3rd nerve palsy. Out of 45 cases of 4th and 6th nerve palsy, 13(28.90%) patients had ischemic fourth nerve palsy and 13(28.90%) patients had ischemic 6th nerve palsy, followed by post-traumatic fourth nerve palsy. Conclusion: We have provided an account of the possible etiologies and presentation findings in patients presenting with ocular motility disorders in our setting. Diabetes Mellitus was the most common microvascular cause for ischemic cranial nerve palsies. More sinister pathologies like myasthenia gravis, often presenting as mimickers of isolated cranial nerve palsies were quite common in our study.

Neuropsychiatric symptoms and imbalance of atrophy in behavioral variant frontotemporal dementia.

Behavioral variant frontotemporal dementia is characterized by heterogeneous frontal, insular, and anterior temporal atrophy patterns that vary along left-right and dorso-ventral axes. Little is known about how these structural imbalances impact clinical symptomatology. The goal of this study was to assess the frequency of frontotemporal asymmetry (right- or left-lateralization) and dorsality (ventral or dorsal predominance of atrophy) and to investigate their clinical correlates. Neuropsychiatric symptoms and structural images were analyzed for 250 patients with behavioral variant frontotemporal dementia. Frontotemporal atrophy was most often symmetric while left-lateralized (9%) and right-lateralized (17%) atrophy were present in a minority of patients. Atrophy was more often ventral (32%) than dorsal (3%) predominant. Patients with right-lateralized atrophy were characterized by higher severity of abnormal eating behavior and hallucinations compared to those with left-lateralized atrophy. Subsequent analyses clarified that eating behavior was associated with right atrophy to a greater extent than a lack of left atrophy, and hallucinations were driven mainly by right atrophy. Dorsality analyses showed that anxiety, euphoria, and disinhibition correlated with ventral-predominant atrophy. Agitation, irritability, and depression showed greater severity with a lack of regional atrophy, including in dorsal regions. Aberrant motor behavior and apathy were not explained by asymmetry or dorsality. This study provides additional insight into how anatomical heterogeneity influences the clinical presentation of patients with behavioral variant frontotemporal dementia. Behavioral symptoms can be associated not only with the presence or absence of focal atrophy, but also with right/left or dorsal/ventral imbalance of gray matter volume.

Characteristics of adults newly diagnosed with idiopathic hypersomnia in the United States

BackgroundIdiopathic hypersomnia is a debilitating sleep disorder; however, little is known about the clinical presentation of patients receiving this diagnosis. MethodsA retrospective cohort study of IBM® MarketScan® claims (January 2014 to September 2019) was conducted. Analysis cohorts included adults ≥18 years of age from the MarketScan population and a subset newly diagnosed with idiopathic hypersomnia. Diagnosis required ≥2 idiopathic hypersomnia claims separated by ≥1 and ≤180 days, and continuous enrollment ≥12 months before the diagnosis date. Descriptive statistics were reported for diagnosing medical specialties, objective sleep laboratory testing utilization, and comorbidities in the 12 months prior to diagnosis. ResultsFrom the general MarketScan cohort (N = 32,948,986), 4980 patients (0.015%) were newly diagnosed with idiopathic hypersomnia (mean age, 42.7 years; 66.9% female). The most common diagnosing medical specialties were pulmonary medicine (23.3%), neurology (14.4%), and internal medicine (11.4%). Only 44.4% of patients received objective sleep laboratory testing during the 12 months prior to diagnosis. The most common comorbidities were sleep apnea (49.5%), mood disorders (32.1%), depressive and anxiety disorders (31.0%, 30.7%, respectively), hyperlipidemia (30.1%), headache/migraine (23.9%), diabetes or use of diabetes/obesity medication (19.8%), hypertension (15.0%), and history of cardiovascular disease (14.3%). ConclusionsThese results suggest that idiopathic hypersomnia is diagnosed by multiple medical specialists, and less than half of clinicians utilize proximate sleep laboratory testing prior to patient diagnosis in real-world settings. Furthermore, patients commonly have cardiovascular, metabolic, and psychiatric comorbidities. Healthcare providers should consider these comorbidities and cardiometabolic risks when evaluating treatment options for idiopathic hypersomnia.

Thulium fiber laser cystolithotripsy under local anesthesia: A day care procedure.

Bladder stones account for 5% of all urolithiasis. Patients present with LUTS or acute urinary retention. Thus, warranting an early intervention. Minimally invasive approach with laser lithotripsy is the present gold standard to treat bladder stones. To evaluate the outcomes of TFL (60 W) for bladder stones performed under local anesthesia as a day-care procedure. This was a retrospective single-center study conducted after obtaining IRB approval. Study period was between June 2021 and June 2022 were included. All patients were operated under local anesthesia as a day care procedure. The procedure was carried out using an 18 Fr laser sheath and calculus dusted using TFL energy (15-30 W). Parameters including operative time in minutes, complications were recorded. Patients were encouraged oral and normal voiding in the immediate post-op period. A total of 47 patients with bladder stones presented during this period. Of these, 30 underwent laser lithotripsy (TFL) for bladder calculi. The clinical presentation of patients was LUTS in 28 (93%) and 5 (16%) patients had AUR. The average size of the stone in this series was 15 ± 2.8 mm. The mean duration of laser lithotripsy was 15 ± 5.4 min. Energy to dust the stone was variable with mean LASER energy of 18.23 ± 10 W. All patients tolerated the procedure well and none required conversion to conventional anesthesia. One patient failed to void in the post-op period. 100% clearance rate was documented in all patients. Thulium fiber laser for transurethral cystolithotripsy of bladder stones under local anesthesia is a feasible technique with minimal morbidity and good outcome.

Factors Associated with Unfavorable Clinical Presentations in Patients with Ruptured BrainArteriovenous Malformations

Rupture of brain arteriovenous malformations (bAVMs) carries potentially devastating consequences. For patients presenting with ruptured bAVMs, several clinical grading systems have been shown to predict long-term patient morbidity and may be taken into consideration when making clinical decisions. Unfortunately, use of these scoring systems is typically limited to their prognostic value and offer little to patients in therapeutic benefit. Tools are needed not only to predict prognosis for patients experiencing ruptured bAVMs but to gain insight into what characteristics predispose patients to poor long-term outcomes before they rupture. Our objective was to find clinical, morphologic, and demographic variables that correlate with unfavorable clinical grades on presentation in patients with ruptured bAVMs. We retrospectively reviewed a cohort of patients with ruptured bAVMs. Linear regression models were used to test whether Glasgow Coma Scale (GCS) and Hunt-Hess scores on presentation(outcomes) were associated with patient and arteriovenous malformation (AVM) characteristics (predictors) individually. GCS and Hunt-Hess were assessed following bAVM rupture for 121 brain cases. The median age at rupture was 28.5 years, and 62 (51%) were female. Smoking history was associated with worse GCS; current and past smokers had GCS scores 1.33 points lower on average than nonsmokers (95% confidence interval [CI] -2.59 to -0.07, P= 0.039) and had worse Hunt-Hess scores (0.42, 95% CI 0.07-0.77, P= 0.019). Associated aneurysms were associated with worse GCS (-1.60, 95% CI -3.16 to -0.05, P= 0.043) and trended towards worse Hunt-Hess scores (0.42 points, 95% CI -0.01 to 0.86, P= 0.057). Patient smoking status and presence of an AVM associated aneurysm were shown to have modest correlations with unfavorable clinical grades (Hunt-Hess, GCS) on presentation, with unfavorable clinical grades being associated with long-term patient prognosis following bAVM rupture. Further investigation using AVM-specific grading scales and external data are needed to determine the utility of these and other variables in clinical practice for patients with bAVM.

Retinal Vascular Occlusion after Severe Acute Respiratory Syndrome Coronavirus Vaccination: A Vaccine Adverse Events Reporting System Database Analysis

To evaluate the cases of retinal vessel occlusion following COVID-19 vaccination and evaluate the onset interval and clinical presentations in patients diagnosed with vaccine associated retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Retrospective study of the cases reported to the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Events Reporting System (VAERS) between December 11, 2020 and July 1, 2022. Patients diagnosed with retinal vessel occlusion following vaccination with BNT162b2, mRNA-1273, and Ad26.COV2.S globally. We performed a descriptive analysis of the patient demographics and clinical presentation in patients with retinal vessel occlusion. The correlation between the vaccines and continuous and categorical variables were assessed. We performed the post-hoc analysis to evaluated the association between RAO and RVO onset post-vaccination, and vaccine and dosage. Finally, a 30-day reverse analysis for RAO and RVO onset following administration of vaccine. A major limitation in the methods of this study is the lack of control group for assessing the risk of retinal vessel occlusive disease in patients who received the vaccine compared to the patients who were unvaccinated. The crude reporting rate of retinal vessel occlusion following SARS-CoV-2 vaccine. The ocular and systemic presentations, onset duration and short term risk of RAO and RVO following vaccination. During the study period, 1351 retinal vessel occlusion cases were reported globally. The crude reporting rates of retinal vessel occlusion for BNT162b2, mRNA-1273, and Ad26.COV2.S were 0.36, 0.41, and 0.69, respectively. The majority of the retinal vessel occlusion cases were reported following BNT162b2 (n=606, 74.17%). The mean age of patients with RVO and RAO was 58.54 ± 16.06 years and 64.63 ± 16.16 years, respectively. In the cohort, 817 and 433 patients were diagnosed with RVO and RAO, respectively. Most cases of RVO (41.12%) and RAO (48.27%) were reported within the first week post-vaccination. We observed that the mean onset interval for RVO was significantly longer in patients who received Ad26.Cov2.S (54.07 ± 88.98 days) compared to BNT162b2 (18.07 ± 28.66 days) and mRNA-1273 (22.85 ± 38.13 days) vaccines (p<0.0001). This was further confirmed by post-hoc analysis, which revealed a significantly longer onset duration for the Ad26.Cov2.S compared to BNT162b2 and mRNA 1273 vaccines (p<0.0001). The reverse Kaplan Meier 30-day risk analysis showed a significant a higher risk of RVO onset following BNT162b2 compared to other vaccines(p<0.0001). The low crude reporting rate highlights a low safety concern for retinal vessel occlusion following SARS-CoV-2 vaccination. This study provides insights into possible temporal association between reported retinal vessel occlusion events with SARS-CoV-2 vaccines, however further insights are needed to understand the underlying immunopathological mechanisms that promote thrombosis of retinal vasculature on vaccine administration.

Neonatal Botulism: A Case Series Suggesting Varied Presentations

Infantile botulism is an uncommon diagnosis and rarer still in the neonatal period. We describe three cases of neonatal-onset botulism that presented with symptoms typically (hypotonia, constipation, facial diplegia) or atypically seen in older infants (encephalopathy, seizures, and hypothermia). Our series shows a wider spectrum of clinical presentations in patients with neonatal-onset botulism. Our report also suggests that neonatal-onset botulism should be considered more broadly in the hypotonic infant, especially as the condition is treatable with intravenous botulinum-specific immune globulin.

Demographics and Clinical Presentations of Patients Visiting the Emergency Department During the Holy Month of Ramadan: A Three-Year Retrospective Study in a Muslim-Majority Country.

Background and objective Ramadan is the Muslim's holiest month; it is a time when believers engage in special practices that include fasting from dawn till dusk and making cultural and dietary modifications in their everyday lives. The impact of Ramadan on human activity, sleeping patterns, and circadian rhythms of hormones have been addressed in the literature. Fasting, which constitutes the main pillar of practices during Ramadan and lasts from sunrise to sunset, can significantly affect common health conditions, leading many to seek medical care in theEmergency Department (ED). Hence, it is important to understand the pattern of ED visits and understand the impact caused by fasting during this holy monthin a Muslim-majority country. In light of this, this study aimedto gather new insights intothe pattern of ED visits during Ramadan at a busy tertiary care center in the period from 2019 to 2021. Methods This study was conducted by reviewing the hospital health information system to gather relevant information in May 2022. Data of patients who visited the ED during Ramadan were collected, as well asduring a month prior to and after Ramadan for the purpose of comparison. Sociodemographic characteristicsand clinical profiles were collected for analysis. Results The total number of ED visits in thethree months of Ramadan during the study period (three years) was 33,142, all of which were included in our analysis. Sociodemographic data were analyzed for patients who visited the ED during the month of Ramadan and the two lunar months that precede and succeed Ramadan (Shaban and Shawal). Fever was the most common complaint (16.5%), followed by abdominal pain (14%). When analyzing the findings based on patient age groups, fever was found to be the most prevalent complaint in bothadults (15.6%) and pediatric patients (34.4%). Of the total ED patient visits, 7,527 patients were admitted for further care, and197 patientsdeceased. Conclusion Our study findings illustrate the change in ED visit patterns during the month of Ramadan in a Muslim-majority country. Also, the type of complaints was affected significantly due to the ongoing coronavirus disease 2019 (COVID-19) pandemic during the study period. The outcomes in patients reflected substantial progress and outcomesin the ED. These findings highlight that analyzing EDdata can help provide accurate information that can be used to help modify/adjust the quality of services provided in the ED. However, these modificationsmay affect all hospital facilities, not just the ED.

Scapular Kinematics and Patterns of Scapular Dyskinesis in Rotator Cuff Tears: A Prospective Cohort Study.

Scapular dyskinesis (SD) is a condition of loss of normal mobility or function of the scapula. SD is frequently observed in patients with other shoulder disorders, such as rotator cuff (RC) tears. This study evaluates the different presentations in clinical outcomes and range of motions (ROMs) in patients suffering from RC tears with and without SD. A total of 52 patients were enrolled, of which 32 patients with RC tears and SD (group A) and 20 patients with RC tears without SD (group B). Statistically significant differences between the groups in terms of clinical outcomes were identified. There were statistically significant differences in terms of flexion (p = 0.019), extension (p = 0.015), abduction (p = 0.005), and external rotation at 90° (p = 0.003) and at 0° (p = 0.025). In conclusion, this prospective study demonstrated that SD influences the clinical presentation of patients with RC tears in terms of clinical outcomes and ROMs, apart from internal rotation. Further studies will need to show whether these differences occur regardless of SD type.

Proposing the “continuum of UTI” for a nuanced approach to antimicrobial stewardship

Background: Historically, diagnosis of urinary tract infections (UTIs) has been divided into 3 categories based on symptoms and urine culture results: not UTI, asymptomatic bacteriuria (ASB), or UTI. However, some populations (eg, older adults, catheterized patients) may not present with signs or symptoms referrable to the urinary tract or have chronic lower urinary tract symptoms (LUTS), making the diagnosis of UTI challenging. We sought to understand the clinical presentation of patients who receive urine tests in a cohort of diverse hospitals. Methods: This retrospective descriptive cohort study included all adult noncatheterized inpatient and ED encounters with paired urinalysis and urine cultures (24 hours apart) from 5 community and academic hospitals in 3 states (NC, VA, GA) between January 1, 2017, and December 31, 2019. Trained abstractors collected clinical and demographic data using a 60-question REDCap survey. The study group met with multidisciplinary experts (ID, geriatrics, urology) to define the “continuum of UTI” (Table 1), which includes 2 new categories: (1) LUTS to capture patients with chronic lower urinary tract symptoms and (2) bacteriuria of unclear significance (BUS) to capture patients who do not clinically meet criteria for ASB or UTI (eg, older adults who present with delirium and bacteriuria). The newly defined categories were compared to current guideline-based categories. We further compared ASB, BUS, and UTI categories using a lower bacterial threshold of 1,000 colony-forming units. Results: In total, 220,531 encounters met study criteria. After using a random number generator and removing duplicates, 3,392 encounters were included. Based on current IDSA guidelines, the prevalence of ASB was 32.1% (n = 975), and prevalence of patients with “not UTI” was 1,614 (53%). Applying the expert panel’s new “continuum of UTI” definitions, the prevalence of “not UTI” patients decreased to 1,147 (37.7%), due to reassignment of 467 patients (15.3%)to LUTS. The prevalence of ASB decreased by 24% due to reassignment to BUS. Lowering the bacterial threshold had a slight impact on the number of definitive UTIs (14.9 vs 15.9%) (Table 1). Conclusions: Our rigorous review of laboratory and symptom data from a diverse population dataset revealed that diagnostic uncertainty exists when assessing patients with suspicion for UTI. We propose moving away from dichotomous approach of ASB versus UTI and using the “continuum of UTI” for stewardship conversations. This approach will allow us to develop nuanced deprescribing interventions for patients with LUTS or BUS (eg, watchful waiting, shorter course therapy) that account for the unique characteristics of these populations.Disclosures: None

Systemic Risk Factors and Clinical Profile of Retinal Vein Occlusion in a Tertiary Eye Care Hospital in Northern Uttar Pradesh- A Case Control Study

Objective: To assess the various risk factors and clinical presentation in patients with Retinal Vein Occlusion presenting to a tertiary eye care hospital in Uttar Pradesh.

Diagnostic potential of routine brain MRI and high-resolution, multi-contrast vessel wall imaging in the detection of internal carotid artery dissection.

Cervical artery dissection (CAD) is one of the major causes of stroke and most commonly occurs at the site of the extracranial internal carotid artery (ICA). This study aimed to assess the value of routine brain MRI, clinical information, and high-resolution, multi-contrast vessel wall MR imaging (hrVWI) for the timely detection of ICA dissection. A total of 105 patients with CAD and 105 without CAD were recruited for this study. The lesion type in the patients was determined based on images from different modalities, including brain MRI, magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography (DSA), ultrasonography, and hrVWI and clinical information. Each lesion was reviewed to determine the type following a stepwise procedure by referring to (1) brain MRI only; (2) brain MRI and clinical information; (3) hrVWI only; and (4) hrVWI, CTA, DSA, and clinical information. Typical clinical presentations of patients with potential CAD include headache, neck pain, and/or Horner's syndrome. Representative imaging signs in the brain MRI included a crescentic or circular iso- or hyperintensity around the lumen, a curvilinear and isointense line crossing the lumen, or aneurysmal vessel dilation. Based on brain MRI alone, 54.3% (57/105) of the patients with CAD were correctly classified, and the accuracy increased to 73.3% (77/105) when clinical information was combined (P < 0.001) with high specificity and low sensitivity. Further analysis showed that hrVWI had the superior capability in detecting CAD, with a sensitivity and a specificity of 95.1% and 97.0%, respectively. The combination of brain MRI and clinical information could be used for the diagnosis of CAD; however, hrVWI should be sought for uncertain cases.