Diagnostic Exams Research Articles

Cancro da Tiroide associado ao Trabalho

Introduction/framework/objectives The study of cancer and work-related etiology has been increasing, revealing some associations with previously undervalued occupational risk factors. In this sense, it is legitimate to find out whether Thyroid Cancer can be associated with certain occupational characteristics, so that occupational health and safety teams can effectively carry out its work. Thus, the aim of this review is to gather as much scientific evidence on the phenomenon as possible, to promote a healthier and safer work environment. Methodology This is a bibliographic review, initiated through a search carried out in January 2022, in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP”. Content In recent decades, this pathology has increased to about three times more, becoming one of the most frequent in some countries, which may be associated with the existence of greater medical surveillance and more regular auxiliary diagnostic exams, not least because most of the lesions detected are increasingly small and premature: although other researchers consider that the increase in incidence is real, due to ionizing radiation and worsening of the Body Mass Index. Discussion and Conclusions The work circumstances that seem to be more associated are ionizing radiation, as well as some dust and chemical agents present in demolition areas/collapsed buildings and/or mercury, although without full consensus among researchers. It will be necessary to carry out further studies to prove the etiology of work origin, which will only be possible if the Occupational Health and Safety teams are aware of the problem and carry out epidemiological studies to investigate this potential causality. Keywords: thyroid cancer, ionizing radiation, occupational health, occupational medicine and safety at work.

Large-scale diagnostic assessment in first-year university students: pre- and transpandemic comparison

COVID-19 has disrupted higher education globally, and there is scarce information about the “learning loss” in university students throughout this crisis. The goal of the study was to compare scores in a large-scale knowledge diagnostic exam applied to students admitted to the university, before and during the pandemic. Research design was quasi-experimental with static group comparisons, taking advantage of the pandemic “natural experiment,” to assess knowledge in students admitted to the National Autonomous University of Mexico. Four student cohorts were analyzed: 2017 and 2018 (prepandemic, paper-and-pencil exams), 2020 and 2021 (transpandemic, online exams). The same instruments were applied in each pair of cohorts (2017–2021; 2018–2020) to decrease instrumentation threat. Propensity score matching was used to create balanced comparable groups. 35,584 matched students from each of the 2018 and 2020 cohorts were compared and 31,574 matched students from each of the 2017–2021 cohorts. Reliability and point biserial correlation coefficients were higher in the transpandemic online applications. Knowledge scores were 2.3 to 7.1% higher in the transpandemic assessments, Spanish scores in the 2018–2020 comparison were 1.3% lower, and English results in 2021 were 7.1% lower than in 2017. Before the pandemic, there was a 3.1% higher test performance in men; this gap decreased to 0.34% during the pandemic. There was no documented learning loss in this large student population, with an increase in knowledge in the pandemic cohorts. Some influence in scores due to the online testing modality cannot be ruled out. Longitudinal follow-up is required to continue evaluating the impact of the pandemic in learning.

The impact of Covid-19 pandemic on breast cancer multidisciplinary management at the Vall d'Hebron University Hospital.

e18782 Background: The impact of breast cancer screening program interruption, restrictions and delays on diagnostic exams and access to primary care due to COVID-19 is not fully understood. We report our experience on breast cancer (BC) multidisciplinary management during 2020 in a Spanish COVID-19 reference centre, and the largest hospital in Catalonia. Methods: Cohort analysis of 2020 newly BC diagnosis, as compared to 2019 and 2018 period. Results: Overall, 54% less women were called to participate on the breast screening program and only 54% of those have accepted to take part of the program during March to May 2020 (lockdown period), as compared to 76% of acceptance in 2018/2019. Consequently, during the lockdown period there was a 38% reduction on breast oncologic surgeries and a 49% decrease on first medical oncology visits vs the same period of 2018/2019. Nevertheless, time from diagnosis to first oncologic treatment was similar between study periods. Stage IV BC diagnosis has doubled in 2020 representing 9.8% vs 4.2% and 4.8% in 2018 and 2019 respectively (p < 0.001). Medical oncologists’ decision on dose dense (dd) or weekly paclitaxel chemotherapy exposure have not changed in 2020 vs 2019. Conclusions: COVID-19 pandemic has had a strong impact on screening programs, with the double of patients being diagnosed at advanced stage in 2020, as compared to the two previous years.

Abstract 13: Barriers to Diagnostic Follow-Up for Women With a Suspicious Clinical Breast Examination at the Primary Health Center in Uttar Pradesh State in India: A Qualitative Study

Abstract Purpose: The purpose of this study was to understand key barriers to diagnostic follow-up for women with a suspicious clinical breast examination (CBE) at the primary care level in Uttar Pradesh (UP) state in India. We also explored acceptability of the use of mHealth strategies to address barriers to CBE follow up for women. Methods: We conducted 28 in-depth individual interviews with key stakeholders involved in the Breast Health Initiative in Lucknow district, UP. Primary health facilities in rural and urban settings were purposively selected based on the number of CBE screening exams conducted in the last year and the number of women with a suspicious CBE identified. We interviewed six women with a suspicious CBE at the primary health facility who did not have diagnostic follow-up, six community health workers (ASHAs), six healthcare providers from primary health facilities and four district or state-level health decisionmakers. Interviews were audio-recorded and transcribed verbatim. Coding and thematic analysis will proceed once translation of the full dataset of transcripts is complete. Results: Preliminary analyses of qualitative interviews found that cancer stigma and fear are significant barriers to both breast screening and follow-up of an abnormal CBE. Male providers and long waits at the district hospital are barriers to completing confirmatory diagnostic exams. Providers maintain that, despite community education and outreach efforts by ASHAs, lack of awareness of breast cancer and the importance of follow-up for abnormal CBE remains a barrier to early detection. Conclusion: Knowledge barriers, cultural barriers, and health system barriers challenge women’s ability to follow recommendations for diagnostic follow-up of an abnormal CBE in Uttar Pradesh, India. Multi-level strategies are needed to address these barriers. Our findings will help inform the content and approach of an mHealth patient navigation strategy that could include patient education, reminders, patient tracking, and care coordination. Citation Format: Erica Liebermann, Gulnoza Usmanova, Nadeem Akhtar, Shivani Agrawal, Vaibhav Patwardhan, Parag Bhamare, Somesh Kumar. Barriers to Diagnostic Follow-Up for Women With a Suspicious Clinical Breast Examination at the Primary Health Center in Uttar Pradesh State in India: A Qualitative Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 13.

Left Ventricular Non-Compaction Cardiomyopathy: Case Report and Review of Literature

Non-compaction cardiomyopathy (NCC) is characterized by trabeculations in either one or both ventricles. Clinical presentation is highly variable: dyspnea, palpitation, thromboembolic events, arrhythmia, or sudden cardiac death. There are currently no universally-accepted criteria for classifying and diagnosing left ventricular non-compaction (LVNC) cardiomyopathy. Transthoracic echocardiography (TTE) is the diagnostic exam of choice. The diagnosis is often missed or delayed because of a lack of knowledge about this uncommon disease. Progression of LVNC is highly variable and prognosis is very difficult to predict.
 We report a case of a 50-year-old female patient with a history of total thyroidectomy under hormonal supplementation who consults for dyspnea and paroxysmal palpitations revealing an isolated LVNC.
 This case emphasizes the importance of imaging techniques, which are, TTE and cardiac magnetic resonance imaging (MRI) in early diagnosis, management, and follow-up.

P31 A RARE CASE OF PERSISTENT ECG CHANGES AT STRESS TEST

Abstract Background Cardiac lipomas are rare benign tumors. They carry usually a good prognosis and are often an incidental finding of cardiovascular imaging exams for cardiac evaluations. Methods We present a case of left ventricular intramyocardial lipoma detected during the work–up for a positive stress test. Results This case report involves a 55–year–old male, light smoker, with a history of glucose intolerance. Height 190 cm; weight 90 kg; BMI 24.93 kg/m2 He has always played sports and since the age of 16 he performed serial cardiological assessments and stress test for competitive fitness. Already from the first evaluation the ergometric test was markedly pathological (ST segment depression greater than 1 mm in leads V3 to V6), in absence of symptoms. The subsequent diagnostic exams performed (including an exercise myocardial scintigraphy) excluded ischemic aetiology. Competitive fitness has always been reconfirmed for many years. He also performed repeated holter–ECG in absence of any arrhythmias. He was admitted because of a routine check–up. A new stress test (ECG stress test) resulted positive for ECG changes and clinically negative (fig 1) Cardiac MRI demonstrated a small intramyocardial "round like" mass of about 7 mm, located on the middle–distal segment of the left ventricle lateral wall; MRI signals were consistent with a lipom: no evidenced of delayed enanchement (fig 2) and T1 weighted scans assessed perfusion lack of the mass (fig 3). Computed tomography confirmed this diagnosis; the coronary angiography excluded significant coronary artery stenosis. Conclusion We hypnotize that cardiac lipoma in our patient caused persistent ST changes at stress ECG since young age

The Impact of COVID-19 Pandemic on Clinical Findings in Medical Imaging Exams: An Observational Study in a Nationwide Israeli Health Organization.

The outbreak of the COVID-19 pandemic had a major effect on consumption of healthcare services. Changes in the use of routine diagnostic exams, increased incidences of post-acute COVID-19 syndrome (PCS), and other pandemic-related factors, may have influenced detected clinical conditions. The study aimed to analyze the impact of COVID-19 on the use of outpatient medical imaging services and clinical findings therein, specifically focusing on the time period after the launch of the Israeli COVID-19 vaccination campaign. In addition, the study tested whether the observed gains in abnormal findings may be linked to PCS or COVID-19 vaccination. Our dataset included 572,480 ambulatory medical imaging patients in a national health organization, from January 1, 2019 to August 31, 2021. We compared different measures of medical imaging utilization and clinical findings therein, before and after the surge of the pandemic, to identify significant changes. We also inspected the changes in the rate of abnormal findings during the pandemic after adjusting for changes in medical imaging utilization. Finally, for imaging classes that showed increased rates of abnormal findings, we measured the causal associations between COVID-19 infection, hospitalization (indicative of COVID-19 complications), and vaccination and future risk for abnormal finding. To allow adjustment for a multitude of confounding factors, we used causal inference methodologies. After the initial drop in the utilization of routine medical imaging due to the first COVID-19 wave, the number of these exams has increased, but with lower proportions of older patients, patients with comorbidities, women, and vaccine-hesitant patients. Furthermore, we observed significant gains in the rate of abnormal findings, specifically in musculoskeletal magnetic resonance (MR-MSK) and brain computed tomography (CT-brain) exams. These results also persisted after adjusting for the changes in medical imaging utilization. Demonstrated causal associations included: COVID-19 infection increasing the risk for an abnormal finding in a CT-brain exams (odds ratio [OR] of 1.4, with 95% confidence interval [CI] 1.1 to 1.7); and COVID-19-related hospitalization increasing the risk for abnormal findings in an MR-MSK exam (OR 3.1, 95% CI 1.9 to 5.3). COVID-19 impacted the use of ambulatory imaging exams, with greater avoidance among patients at higher risk for COVID-19 complications: older patients, patients with comorbidities, and non-vaccinated patients. Causal analysis results imply that PCS may have contributed to the observed gains in abnormal findings in MR-MSK and CT-brain exams, respectively.

Analysis of repeated computed tomography scans and cumulative effective dose of patients in a hospital

Computed tomography exams are considered diagnostic imaging exams that generate significant radiation dose to the patient. Justification, optimization, and dose limitation are radiological protection principles used to minimize patient and staff exposure, ensuring the quality of the service provided. The objective of this study was to analyze CT scan data, analyzing the number of exams, the patients' effective cumulated dose, and the repeatability of the exams. The study data covers the 2013 to 2022 period during which a progressive increase was observed in the number of exams performed over time, with exams doubling in this period. The most used Computed Tomography protocols were brain/skull (27.4%), pelvis (17.3%), and abdomen (13.7%) during the study period. Approximately 76.3% of patients have a cumulative dose of less than 25 mSv, while about 1% accumulated more than 100 mSv. The repeatability of CT scans for the same patient over a short period varies, reaching until 17 scans in 30 days for a single patient. The results indicated a necessity to develop strategies for individual dose management methods for the institution’s internal practices. An intervention could be implemented by creating periodically updated handouts and guidelines based on professionals' knowledge.

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objectives: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment.

Artificial Intelligence in Acute Ischemic Stroke Subtypes According to Toast Classification: A Comprehensive Narrative Review

The correct recognition of the etiology of ischemic stroke (IS) allows tempestive interventions in therapy with the aim of treating the cause and preventing a new cerebral ischemic event. Nevertheless, the identification of the cause is often challenging and is based on clinical features and data obtained by imaging techniques and other diagnostic exams. TOAST classification system describes the different etiologies of ischemic stroke and includes five subtypes: LAAS (large-artery atherosclerosis), CEI (cardio embolism), SVD (small vessel disease), ODE (stroke of other determined etiology), and UDE (stroke of undetermined etiology). AI models, providing computational methodologies for quantitative and objective evaluations, seem to increase the sensitivity of main IS causes, such as tomographic diagnosis of carotid stenosis, electrocardiographic recognition of atrial fibrillation, and identification of small vessel disease in magnetic resonance images. The aim of this review is to provide overall knowledge about the most effective AI models used in the differential diagnosis of ischemic stroke etiology according to the TOAST classification. According to our results, AI has proven to be a useful tool for identifying predictive factors capable of subtyping acute stroke patients in large heterogeneous populations and, in particular, clarifying the etiology of UDE IS especially detecting cardioembolic sources.

Guideline Adherence to Benign Paroxysmal Positional Vertigo Treatment and Management in Primary Care.

To determine adherence to the 2017 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for the management and treatment of benign paroxysmal positional vertigo (BPPV) in primary care (PC) and compare whether key recommendations differed by sex, race, or insurance status. Retrospective chart review. Twenty-six clinic locations within a single healthcare system. Charts of 458 patients diagnosed with BPPV in PC between 2018 and 2022 were reviewed. Encounters where the diagnosis of BPPV was made were identified. From the clinical encounter note, demographics, symptomatology, management, and treatment were extracted. Nonparametric analyses were used to identify whether AAO-HNS guidelines differed regarding sex, race, or insurance status. Of 458 patients, 249 (54.4%) did not receive a diagnostic exam, and only 4 (0.9%) patients received imaging. Regarding treatment, only 51 (11.1%) received the Epley maneuver, with 263 (57.4%) receiving vestibular suppressant medication and 12.4% receiving a referral to a specialist. In regard to sex, race, or insurance status, there was no significant difference in receiving a Dix-Hallpike diagnostic maneuver, Epley maneuver, vestibular suppressant medication, imaging, or referral to a specialist. Our data suggestthat there continue to be gaps in the adherence to AAO-HNS guidelines; however, these gaps did not differ by sex, race, or insurance status. Care should be taken to increase the use of diagnostic and treatment maneuvers but decrease the use of vestibular-suppressant medications for the treatment of BPPV in PC.

Analysis of Student Learning Styles Using Fleming's VARK Model in Science Subject

The implementation of high-quality learning is something teachers must ensure. Consequently, teachers need to be able to design engaging learning procedures that draw students' attention to the subjects they are teaching. Understanding a student's preferred learning style is one of the necessary teachers. People with learning styles closely tied to their environments and personalities are adjusted. The process of receiving knowledge will be improved by defining the learning material to the learner's preferred learning style. One of the most used diagnostic tools for determining learning type is the VARK model. The visual, Auditory, Read/Write, and kinesthetic learning styles are divided into four divisions in the VARK paradigm. This research aims to identify the dominant learning style among science students. A qualitative descriptive methodology used one hundred junior high school students as research participants. Diagnostic exams and interviews were the tools used. Data analysis was carried out qualitatively by reducing data, presenting data, and making conclusions. According to the findings, 35% of students are kinesthetic learners, with 30% being visual, 21% being Auditory, and 14%t being Read/Write. Identifying learning tools, such as choosing learning models, creating and choosing materials, and learning media and assessment approaches that are more effective in accordance with student learning styles, can be done by developing one's understanding of learning styles.

Autoimmune psychosis: a review of diagnostic and treatment guidelines

IntroductionOver this decade, there has been progressive growth and evolution of the concept of autoimmune encephalitis. However, international consensus overly focus on major neurological signs, while discarding some attenuated presentations, sometimes with just psychiatric manifestations. It was only very recently that a new concept arouse from this disorder, named autoimmune psychosis, which can mimic schizophrenia. Unfortunately, there is still a lack of a structured approach of psychotic patients to cover this disorder. This has numerous implications, namely on management and prognosis of these patients. Not only, these patients have an increased risk of neuroleptic malignant syndrome, but it is also important to intervene early in the course of disease.ObjectivesTo conduct a review of the diagnostic and treatment guideliens of autoimmune psychosisMethodsThe authors conducted a non-systematic review, by resorting to the pubmed database, on the concept of autoimmune psychosis and updated proposals of diagnostic orienting lines.ResultsRecently, in 2016, Graus et al proposed diagnostic criteria for possible autoimmune encephalitis, in which the authors acknowledge subacute onset of psychiatric symptoms as a possible clinical manifestation. The authors accept normal diagnostic tests, provided that new neurological focal findings exist. Since then, there have been described a list of signs/symptoms, which should raise suspicion for this diagnostic on psychiatric patients, so called red flags. In accordance to diagnostic guidelines for autoimmune psychosis, defined by Pollak et, the presence of this symptoms should lead clinicians to perform diagnostic exams, as MRI, eletroencephalogram and blood serological tests and lumbar puncture. However, others criticize this initial lineup arguing that some patients could be missed, because they do not have any neurological signs, and so they propose new diagnostic criteria.ConclusionsAutoimmune psychosis represents an attenuated clinical form of autoimmune encephalitis, although demanding the same medication and prompt initiation of treatment as other autoimmune encephalitis. It is important to acknowledge that there are patients who are seronegative and that some of the diagnostic exams mentioned have sometimes limited availability. As acknowledged by Guasp et al, there are patients with first psychotic episodes that have an autoimmune etiology, but because of the lack of neurological signs, could potentially be missed of treatment. So, it is important to establish formal diagnostic guidelines for this disorder, namely orienting lines for first psychotic episodes, which is the most commson psychiatric manifestation. This also enlightens the need for neurologic and psychiatric cooperation for these patients.Disclosure of InterestNone Declared

Abstract P3-04-05: Artificial Intelligence Detects, Classifies, and Describes Lesions in Clinical Breast Ultrasound Images

Abstract Purpose Many low-middle income countries (LMIC) suffer from chronic shortages of resources that inhibit the implementation of effective breast cancer screening programs. Advanced breast cancer rates in the U.S. Affiliated Pacific Islands substantially exceed that of the United States. We propose the use of portable breast ultrasound coupled with artificial intelligence (AI) algorithms to assist non-radiologist field personnel in real-time field lesion detection, classification, and biopsy, as well as determination of breast density for risk assessment. In this study, we examine the ability of an AI algorithm to detect and describe breast cancer lesions in clinically-acquired breast ultrasound images in 40,000 women participating in a Hawaii screening program. Materials and Methods The Hawaii and Pacific Islands Mammography Registry (HIPIMR) collects breast health questionnaires and breast imaging (mammography, ultrasound, and MRI) from participating centers in Hawaii and the Pacific and links this information to the Hawaii Tumor Registry for cancer findings. From the women with either screening or diagnostic B-mode breast ultrasound exams, we selected 3 negative cases (no cancer) for every positive case matched by age, excluding Doppler and elastography images. The blinded images were read by the study radiologist to delineate all lesions and describe in terms of the BI-RADS lexicon. These images were split by woman into training (70%), validation and hyperparameter selection (20%) and testing (20%) subsets. An AI model was fine-tuned for lesion and BI-RADS category classification from a Detectron2 framework [1] pre-trained on the COCO Instance Segmentation Dataset [2]. Model performance was evaluated by computation of precision and sensitivity percentages, as well as Area under the Receiver Operator Curve (AUROC). Detections were considered positive if they overlapped a ground truth lesion delineation by at least 50% (Intersection over Union = 0.5), and a maximum of 4 detections were generated for each image. Timing experiments were run on a GPU-enabled (Nvidia Tesla V100) machine on unbatched images. Results Over the 10-year observation period, we identified 5,214 women with US images meeting our criterion. Of these, 111 were diagnosed with malignant breast cancer and 333 were selected as non-cases for a total of 444 women. These 444 women had a total of 4,623 ultrasound images with 2,028 benign and 1,431 malignant lesions identified by the study radiologist. For cancerous lesions, the AI algorithm had 8% precision at a sensitivity of 90% on the testing set. For benign lesions, a sensitivity of 90% resulted in 5% precision on the testing set. The AUROC for bounding box detections of cancerous lesions was 0.90. The AUROC for bounding box detections of benign lesions was 0.87. The model made predictions at a rate of 25 frames/second time (38.7 milliseconds per image). Conclusion Detection, segmentation, and cancer classification of breast lesions are possible in clinically-acquired ultrasound images using AI. Based on our timing experiments, the model is capable of detecting and classifying lesions in real-time during ultrasound capture. Model performance is expected to improve as more data becomes available for training. Future work would involve further fine-tuning of the model on portable breast ultrasound images and increasing model evaluation speed in order to assess utility in low-resource populations [1] Wu Y, Kirillov A, Massa F, Lo W-Y, Girshick R. Detectron2. https://github.com/facebookresearch/detectron2. [2] Lin T-Y, Maire M, Belongie S, et al. Microsoft COCO: Common Objects in Context. Computer Vision – ECCV 2014. Springer International Publishing; 2014:740-755. Citation Format: Arianna Bunnell, Dustin Valdez, Thomas Wolfgruber, Aleen Altamirano, Brenda Hernandez, Peter Sadowski, John Shepherd. Artificial Intelligence Detects, Classifies, and Describes Lesions in Clinical Breast Ultrasound Images [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-04-05.

Breast exam use during the protracted COVID-19 pandemic, by age, race, and geography.

In this study we analyzed data collected from the onset of the COVID-19 pandemic through March 31, 2022 to identify temporal shifts in breast exam volume. Screening mammography volume stabilized toward the end of the study period, while diagnostic exam volume varied over time and by age. Older women experienced a decline in diagnostic exam volume between August 2020 and April 2021 that was not observed among women aged 50 years or less (50-69 years, monthly percentage change (MPC): -6.5; and 70+ years, MPC: -15.7). With respect to breast biopsy volume, women younger than 70 years of age had increased exam volume beginning in April 2020 and June 2020, whereas a corresponding increase among older women was delayed until April 2021(70+ years, MPC: 9.3). Findings from our study suggest a temporal shift in the use of breast exams that could result in differential detection of breast cancer by age.

Symptomatological Transversality and the Absence of Pathognomonic Symptoms in Psychiatry

IntroductionThe diagnosis of the main psychiatric syndromes is still almost exclusively phenotypic and depends essentially of the recognition of characteristic signs and symptoms. The clinical evalution allows the formulation of a set of differential diagnoses, according to the pathological meaning of certain symptomatic patterns and combinations. Aside from the entire dependence on the clinical interview, there are still no complementary psychiatric diagnostic exams and it is also worth noting the absence of pathognomonic symptoms.ObjectivesThrough the presentation of the case of a patient with Bipolar Affective Disorder who manifests, during a manic episode, a Capgras delusion, we intend to approach the heterogeneity of the manifestation of some symptoms that tend to be specific of concrete psychiatric syndromes.MethodsClinical case presentation and non-systematic literature review using Pubmed plataform.ResultsAB, female, 49 years old, diagnosed with Bipolar Affective Disorder. Hospitalized for a manic episode with dysphoric mood, increased energy levels and delusional activity of grandiose and persecutory content. During hospitalization, a Capgras delusion centered on the husband emerged: he was replaced by a stranger, I was able to detect him by smell.Capgras delusion is a delusional misidentification syndrome characterized by the belief that someone close has been replaced by an imposter. Despite being a rare syndrome, vastly more common in schizophrenia, affecting about 73% of cases, it can also occur in other psychiatric conditions such as dementia syndromes and, less often, mood disorders (16.7%).Additionally, there are several examples that demonstrate the versatility of psychiatric symptom occurrence in different diagnoses, with first-rank symptoms serving as an example. Described in 1959 by Kurt Schneider, they were considered specific symptoms of schizophrenia, assuming this diagnosis based on the recognition of only one symptom. Over time, its pathognomonic character has become extinct, and its detection in mood disorders and acute psychotic disorder is relatively common.Another example is the overlap between depressive and anxious symptoms. In fact, anxiety symptoms occur in about 85% of patients diagnosed with depressive disorder and, in turn, the presence of depressive symptoms in about 90% of patients diagnosed with anxiety disorder. This evidence has allowed, over time, a review of the diagnostic criteria for these disorders, leading to a progressive blurring of the threshold between them.ConclusionsPsychiatric diagnosis is still a delicate task, totally dependent on the clinical interview. The lack of analytical and imaging tests, as well as the absence of pathognomonic symptoms, constitute a particular challenge in diagnosis. For this reason, we highlight the importance of recognizing combinations and patterns of symptoms rather than the specificity of just one symptom.Disclosure of InterestNone Declared

Abstract PD1-02: Evaluating Racial and Ethnic Disparities in Diagnostic Breast Imaging: A Retrospective Cohort Study

Abstract Purpose: The purpose of this study is to examine the association between race/ethnicity and diagnostic delays in patients with abnormal screening mammograms. Methods: HIPAA-compliant, institutional review board exempt retrospective cohort study was performed at a multi-location academic medical center located in the Midwest. Patients included women aged 40-74 years old undergoing screening mammography from 2013-2019 who received a Breast Imaging Reporting and Data System (BI-RADS) category 0 on their screening mammogram, derived from the electronic medical records. Primary outcome variables included timely follow up diagnostic imaging (< 30 days), days to diagnostic exam, timely recommended biopsy (< 60 days), and days to recommended biopsy. Primary exposure variables included race (American Indian/Alaska Native, Asian/Native Hawaiian/Other Pacific Islander, Black or African American, White) and ethnicity (Hispanic/Latino, and Not Hispanic/Latino). Binary outcomes (timely follow up diagnostic imaging, timely recommended biopsy) were analyzed using logistic regression and continuous outcomes (days to diagnostic exam, days to recommended biopsy) were analyzed using Cox proportional hazards regression, adjusted for potential confounders (insurance, age, preferred language, having primary care doctor, married or domestic partnership, availability of on-site diagnostic imaging). Results: 13,269 unique patients received BI-RADS category 0 on screening mammogram (mean age 54.6). Adjusted for potential confounders, Black (OR 0.54, 95% CI 0.42 to 0.69, p < 0.001) and Asian (OR 0.62, 95% CI 0.45 to 0.85, p = 0.004) patients were less likely to have timely follow up diagnostic imaging compared to White patients. American Indian and Hispanic patients were comparably likely to have timely follow up diagnostic imaging (p > 0.05). Black (HR 0.76, 95% CI 0.69 to 0.84, p < 0.001), Asian patients (HR 0.78, 95% CI 0.70 to 0.87, p < 0.001), and Hispanic patients (HR 0.90, 95% CI 0.82 to 0.99, p = 0.041) experienced increased days to diagnostic examinations compared with White patients. American Indian patients experienced comparable times to diagnostic examinations (p = 0.136). 22.3% of patients received recommendations for biopsy (2,796/12,535). No statistically significant differences were found in timely follow up after recommended biopsy (< 60 days) comparing Black, Asian, American Indian, and Hispanic to White patients (p > 0.05). Black, American Indian, and Hispanic patients experienced comparable days to recommended biopsy (p > 0.05). Asian patients experienced increased days to recommended biopsy (HR 0.76, 95% CI 0.58 to 0.99, p = 0.046). Conclusions: Racial/ethnic minority patients are more likely to experience diagnostic delays after screening mammograms. Further research into culturally appropriate patient navigation services and improved accessibility of diagnostic imaging centers (operating hours, same day services, transportation, parking) to reduce disparities in diagnostic imaging delays is warranted. Citation Format: Arissa Milton, Ryan Woods, Mai Elezaby, Joan Neuner, Kelly Hackett, Anand Narayan, Roberta Strigel. Evaluating Racial and Ethnic Disparities in Diagnostic Breast Imaging: A Retrospective Cohort Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD1-02.

Survey of Diagnostic and Management Practices in Small Bowel Obstruction: Individual and Generational Variation Despite Practice Guidelines.

Background: Small bowel obstruction (SBO) is a common disorder managed by surgeons. Despite extensive publications and management guidelines, there is no universally accepted approach to its diagnosis and management. We conducted a survey of acute care surgeons to elucidate their SBO practice patterns.Methods: A self-report survey of SBO diagnosis and management practices was designed and distributed by email to AAST surgeons who cared for adult SBO patients. Responses were analyzed with descriptive statistics and Chi-square test of independence at α = .05.Results: There were 201 useable surveys: 53% ≥ 50years, 77% male, 77% at level I trauma centers. Only 35.8% reported formal hospital SBO management guidelines. Computed tomography (CT) scan was the only diagnostic exam listed as "essential" by the majority of respondents (82.6%). Following NG decompression, 153 (76.1%) would "always/frequently" administer a water-soluble contrast challenge (GC). There were notable age differences in approach. Compared to those ≥50years, younger surgeons were less likely to deem plain abdominal films as "essential" (16.0% vs 40.2%; P < .01) but more likely to require CT scan (88.3% vs 77.6%; P = .045) for diagnosis and to "always/frequently" administer GC (84.0% vs 69.2%; P < .01). Younger surgeons used laparoscopy "frequently" more often than older surgeons (34.0% vs 21.5%, P = .05).Discussion: There is significant variation in diagnosis and management of SBO among respondents in this convenience sample, despite existing PMGs. Novel age differences in responses were observed, which prompts further evaluation. Additional research is needed to determine whether variation in practice patterns is widespread and affects outcomes.

P706 Monitoring asymptomatic patients with Crohn's disease: the role of intestinal ultrasound

Abstract Background Intestinal Ultrasound (IUS) is a non-invasive, widely available technique that can rapidly evaluate bowel wall thickness and provide direct visualization of bowel vascularisation and motility. Studies have shown high concordance between ultrasound and MR enterography and endoscopy for disease location and activity, and fewer technical difficulties associated with IUS. While more is known about the role of IUS in evaluating response to pharmacologic treatment in CD patients, data regarding the monitoring of asymptomatic patients are scarce. Our objective was to study the impact of IUS in the management of patients with CD in stable clinical remission in a real-world setting. Methods We conducted a retrospective, monocentric observational study in patients with CD in clinical remission (Harvey Bradshaw Index ≤ 4), not in treatment with immunomodulators/immunosuppressants, in whom annual monitoring via IUS was performed. Biochemical data including C-reactive protein (CRP) and relevant ultrasound parameters (bowel wall thickness, extension and vascularization via Limberg score) were recorded. Changes in treatment or the need for second-level diagnostic tests based on ultrasound findings were registered along with outcomes at 1 year follow-up. Results A total of 201 patients with CD underwent IUS at our center between March and May 2021. Of these, 86 were in clinical remission with mesalazine treatment/no treatment. In 49/86 (57%) of cases, significant ultrasound findings were reported. In 27/49 cases, ultrasound findings led to a treatment modification or a second-level diagnostic test. Specifically, 12 patients were started on a course of oral budesonide or metronidazole; of these, 6 were in remission at 1 year follow-up, 3 patients required surgery within 1 year, and 2 experienced a disease flare treated with a second course of budesonide. Of the 15 patients in which a second-level diagnostic test was performed, in 12 cases disease activity was confirmed: 6 were started on a course of budesonide or metronidazole with persistent clinical remission at 1 year, 2 were started on biologics, and 4 developed complications during the follow-up period and were referred for surgery. In the remaining 3 cases, the second level diagnostic test excluded active disease and the patients maintained clinical remission at 1 year follow-up. Conclusion The results of this study demonstrate how IUS can be a useful tool that can modify treatment strategies and stratify patients requiring more invasive second-level diagnostic exams, with the objective of reducing clinical relapses. Prospective, randomized studies with large cohorts are needed to confirm these findings.

Impact of the COVID-19 Pandemic on Brazilian Head and Neck Surgery Centers

ObjectiveThe outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers. MethodsAn anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April‒June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020. ResultsThe response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n=19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly. ConclusionsThe COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment. Level of evidenceEvidence from a single descriptive study.