Danville Community College

BackgroundHIV is an ongoing public health burden which can be controlled with interventions such as ART. In recent years, outbreaks of HIV infection have occurred related to the opioid epidemic. Inconsistencies in screening high risk patients in rural communities at health care encounters may lead to delays in care, more opportunistic infections, and further HIV transmission. Addressing screening disparities in rural communities can improve patient outcomes and reduce future outbreaks. WVU Medicine is the largest health system in WV and includes 25 hospitals located throughout the state. This study retrospectively examines 101 recently diagnosed HIV patients who received care at WVU Medicine for patterns in missed opportunities for early HIV diagnosis.Table 1Demographic Information, by FactorTable 2Patient Characteristics of Individuals who had 2 or More Pre-Diagnosis Encounters Compared to Those who Did NotMethodsThe electronic health records of 101 patients with newly diagnosed HIV who established care with the Ryan White funded WVU Positive Health Clinic from 1/1/2020-1/1/2025 were reviewed. The number of inpatient and outpatient encounters that occurred within the WVU Medicine Healthcare System one year prior to HIV diagnosis or in the period since last HIV test, were counted. Visits where the patient left prior to testing or treatment, or refused testing, were not counted. The presence of characteristic opportunistic infections was also tallied. Statistical analysis for description of binary associations was performed with the calculation of odds ratios and associated confidence intervals.Figure 1Risk Factor at Time of DiagnosisFigure 2Pre-Diagnostic Contacts, by DepartmentResults21 of the 101 patients in the study had two or more encounters with the health care system prior to diagnosis. No identified risk factor- MSM, IDU, or opportunistic infection- had a statistically significant impact on whether there were two or more healthcare contacts prior to diagnosis. The most common setting for these was the Emergency Department.ConclusionMissed testing opportunities in the Emergency Department are a consequence of volume and triage of priorities. No single risk factor had a statistically significant effect on the number of healthcare encounters prior to diagnosis, though due to size the statistical power of the study is small. Improving identification and screening procedures for patients at community and rural access hospitals, especially in Emergency Departments, may reduce the number of missed new HIV diagnoses.DisclosuresAll Authors: No reported disclosures

Abstract Introduction Disseminated tuberculosis is the presence of Mycobacterium tuberculosis in two or more non-contiguous organs. It is a rare disease with a myriad of presentations based on the organs involved. Case Presentation A 27-year-old inmate with no chronic illnesses presented with a 7-month history of dyspnea, non-productive cough, and weight loss. Chest x-rays revealed consolidation bilaterally. The Mantoux test was positive at 18 mm. Computed tomography (CT) chest revealed diffuse tree-in-bud appearance, bilateral pleural effusions, right pleural thickening, and right hilar lymphadenopathy. These findings suggested pulmonary tuberculosis (TB). CT abdomen revealed bilateral psoas abscesses, perihepatic fluid, and microabscesses in the liver and spleen. Aspirates of the psoas abscess and the perihepatic collection yielded acid-fast bacilli on smear, and PCR assays confirmed TB. The HIV test was negative. The patient was diagnosed with disseminated tuberculosis. Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (R.I.P.E.) therapy was initiated. The patient began experiencing lower back pain, headaches, right-sided hearing loss, purulent otorrhea, and generalized tonic-clonic seizures. MRI Brain revealed multiple ring-enhancing lesions and right mastoiditis. Findings raised suspicion for tuberculomas in the brain. The TORCH panel indicated past cytomegalovirus and toxoplasmosis infection. MRI of the lumbar spine showed spondylodiscitis, herniation of multiple discs, expansile bony masses to multiple ribs, intraosseous collections, and lytic lesions, suggestive of TB spondylitis and TB osteomyelitis. Despite symptom resolution, interval scans showed a new mediastinal collection and loculated empyema after 1 year. Discussion Disseminated tuberculosis is rare and highly lethal, affecting less than 2% of tuberculosis patients. Mycobacterium tuberculosis replicates in pulmonary macrophages until T-helper cells activate macrophages to control the replication. In immunocompromised patients, weakened cell-mediated immunity allows the bacteria to disseminate by lymphatic and hematogenous routes. Recent studies suggest that suppressed TNF and NF-κB signaling pathways contribute to impaired T cell IFN-γ responses, even in HIV-negative individuals. Disseminated tuberculosis can be confirmed by histopathology, microbiological evidence, and PCR. This case highlighted the complexity associated with diagnosing and managing disseminated tuberculosis. Its nonspecific symptoms and varied presentations often hinder timely diagnosis, enabling extensive multi-organ involvement. Prompt management is critical to prevent long-term complications. Patients with disseminated TB receive the standard R.I.P.E. therapy, with treatment duration adjusted according to the severity of organ involvement. A multidisciplinary approach is crucial for optimal management. Conclusion Disseminated tuberculosis is a rare form of tuberculosis with a wide range of presentations. Early diagnosis and intervention are essential to improve patient outcomes.

Hodgkin lymphoma survivors who received mantle radiation are at risk of developing secondary malignant neoplasms. There is no established recommended screening guideline for this population.We discuss the case of a patient with a history of Hodgkin lymphoma status post-mantle field radiation, thyroid cancer status post-thyroidectomy, and now breast cancer following mantle radiation. The risk of adverse effects from mantle field radiation is well documented and includes secondary cancers of the thyroid, breast, lung, and cardiovascular disease. Advances in technology have led to an international paradigm shift in the management of Hodgkin lymphoma to reduce the diameter and dose of radiation based on the patient's anatomy. However, there is no consensus regarding the optimal frequency or modality of breast cancer screening in patients with Hodgkin lymphomastatus post-mantle radiation who are now in remission. We discuss screening methods for this population, which has a high risk of developing breast cancer, and emphasize the need for personalized medicine.

In this chapter, we will focus on understanding approaches to design a GenAI solution. With the ever-evolving landscape of technology, the convergence of genetics and artificial intelligence (AI) has paved the way for groundbreaking innovations in various fields, from healthcare to agriculture and beyond. The fusion of these two powerful domains has given rise to what is known as "GenAI solutions." Designing GenAI solutions entails leveraging the capabilities of AI algorithms and machine learning techniques to analyze, interpret, and manipulate genetic information for various purposes by analyzing, modifying, or applying it in different contexts.

In this chapter, we will be deploying Azure OpenAI and interacting with the different LLM models. Azure also provides a user interface (UI) to experiment with the LLMs which we will explore. We will also be introducing additional parameters that can be used to influence the behavior of the LLM, such as Temperature, Top-p, Frequency penalty, and Presence penalty. This will prepare us for Chapter 4 , where we will learn how to ground the LLM with your own data before proceeding to architect a full-blown enterprise LLM solution based on the Retrieval Augmented Generation (RAG) architecture.