WellStar Kennestone Hospital

Background: Developing better acuity models to predict hospital re-admissions is vital to providing high qualitive outpatient palliative care services. Objective: Determine if an acuity tool could accurately predict those patients with the highest risk for hospital admission within 30 days following a palliative medicine home visit. Design: A retrospective observational study evaluating an outpatient practitioner-administered acuity model to determine how different acuity scores corresponded with specific follow-up intervals. Setting/Subjects: The study was conducted in patients’ residences, analyzing home-based outpatient palliative care visits provided by Wellstar Health System clinicians across 4 Georgia counties. Results: Two hundred and ninety-one patients were included in our study. 78% of patients did not experience a hospital admission within 30 days following their most recent palliative medicine home visit, while 22% (n = 64) did. The average overall acuity score was 10.93. The average acuity score for the individuals not admitted was 9.66, while the score for those admitted was 15.44. Conclusion: The acuity score was a significant predictor of the probability of hospitalization ( P < .0001), and the odds of a hospitalization increased by 7.0% for each additional unit in the acuity score.

Abstract Background In the United States, community-acquired Extended Spectrum Beta-lactamase (ESBL) infections are increasing. Risk factors for acquisition remain limited. Municipal water systems, access to antibiotic prescription and sanitary conditions may facilitate transmission. This study examines the relationship between residential proximity to healthcare facilities and risk of infection. Methods We conducted a 24-month retrospective study of Cobb County residents with ESBL-positive cultures from Wellstar laboratories. Exclusion criteria included hospitalization in the past 3 months, residing in a nursing facility, discharge from a rehabilitation facility within the past 6 months, culture taken ≥ 3 days after admission, antibiotic use within the past 3 months, and prior ESBL infection. Poisson regression analyzed the distance from patients' homes to the nearest clinic and hospital to create a prediction model for incidence of ESBL infections. Geospatial information systems (GIS) mapped patient homes and healthcare facilities to visualize distribution patterns. Results Among 3052 ESBL-positive cultures in 2023–2024, 73 patients met study criteria (mean age 64 years; 66.7% female). Isolates included Escherichia coli (83.5%), Klebsiella pneumoniae (11.4%), Enterobacter cloacae (3.8%), and Proteus species (1.3%) from urine (83.1%), blood (9.6%), wounds (4.8%), and sputum (2.4%). Nitrofurantoin was the most frequently prescribed outpatient empiric antibiotic (36.4%). Poisson regression revealed a 60.5% reduction in ESBL infection frequency for every 1 mile away from an outpatient facility (95% CI, 0.439–0.832; p = 0.002) and a non-significant 92.6% reduction per mile from hospitals (95% CI, 0.857–1.0; p = 0.05). Conclusion A higher frequency of first-time ESBL infections was observed among patients living closer to outpatient healthcare facilities, with a 60% decrease in infections per mile of increased distance. No significant trend was noted with hospitals. Future studies may incorporate patient demographics, antibiotic prescription patterns, community sanitary conditions and advanced GIS tools to refine predictive models and identify transmission clusters for targeted public health interventions. Disclosures All Authors: No reported disclosures

We describe a third variant of Eagle syndrome characterized by (1) neck pain (2) giant, hypertrophied styloid processes, (3) mobile styloid process due to pseudoarthrosis, and (4) combined facial nerve compression/entrapment leading to facial spasms and paralysis. Our patient presented with symptoms of Eagle syndrome, bilateral giant styloid processes, and left facial spasms progressing to left facial paresis/paralysis. CT findings included a pseudoarthrosis of the base of a giant left styloid process and overgrowth of bone superior to the styloid base. The mobile styloid process resulted in compression of the facial nerve exiting the stylomastoid foramen and facial spasms with head rotation to the left. Bony overgrowth superior to the pseudoarthrosis led to stenosis of the facial canal distal mastoid segment. Along with compression from the styloid, nerve entrapment contributed to facial paresis that progressed to facial paralysis. Left styloidectomy was performed to alleviate impingement on the facial nerve, and left canal wall-up tympanomastoidectomy with facial nerve decompression was performed to alleviate entrapment caused by bony overgrowth. Two months postoperatively, the patient's left facial paralysis improved to mild left eyelid lag without signs or symptoms of ocular exposure. The patient developed delayed first-bite syndrome successfully treated with amitriptyline. She did not report postoperative dysgeusia. Our patient's left facial paresis was initially attributed to viral neuritis, and the possibility of Eagle syndrome was not initially considered. The relative rarity and varied presentations of Eagle syndrome often create a diagnostic challenge, especially for patients with progressive symptoms. Our patient's presentation emphasizes the importance of a thorough head and neck evaluation of any patient presenting with head and neck signs or symptoms persisting for longer than 3 weeks as well as awareness of what we believe is the first description of a third variant of Eagle syndrome.

Abstract Disclosure: A. Mahmoudabadi: None. S. Patel: None. Background: Acromegaly is a rare disorder characterized by an excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) levels, typically due to a GH-secreting pituitary adenoma. This consequently leads to complications such as acral and soft tissue overgrowth, visual disturbance, insulin resistance, and dyslipidemia. In this case, we describe a patient who presented to the endocrinology clinic for uncontrolled diabetes and was subsequently diagnosed with acromegaly. Clinical Case: This is a 47-year-old male with a history of heart failure, hypertension, and type 2 diabetes mellitus (DM) who presented to the clinic with uncontrolled DM. He had failed to achieve adequate blood sugar control despite being compliant with metformin, dapagliflozin, and insulin degludec. Physical examination revealed frontal bossing, prognathism, macroglossia, and a deep voice. On further questioning, he had noticed these changes since five years prior. Anthropometry and laboratory tests were as follows: Height, 180 cm; body weight 107.5 kg; body mass index (BMI), 33.05 kg/m2 and A1c level of 15.0%. Suspicion of acromegaly was confirmed based on biochemical and imaging findings. Fasting growth hormone (GH), at 58 mU/L (reference range 0-10), and insulin-like growth factor 1 (IGF-1), at 857 nmol/L (reference range 81-263), were markedly elevated. Pituitary magnetic resonance imaging (MRI) showed a sellar and suprasellar mass (2.6 × 2.2 × 2.2 cm) extending and compressing the optic chiasm. He eventually underwent a transsphenoidal adenomectomy with neurosurgery. Following surgery, his insulin requirements went from a total daily dose of about 100 units to an inpatient dose of 30 units by his last day of admission. Conclusion: Acromegaly is prevalent in less than 3% of patients with DM, but higher rates of DM are seen in acromegalic patients with higher IGF-1 levels and longer duration of disease. The diagnosis of acromegaly can often be delayed due to missed findings on routine physical examination. This can lead to increased morbidity, mortality, and complications such as uncontrolled DM, witnessed in our patient. Surgical management of acromegaly is the mainstay of treatment and can lead to improvement of glycemic control and insulin sensitivity. Fortunately, our patient could undergo surgery, but delayed diagnosis can prevent patients from surgery if the pituitary tumor becomes too large or unresectable. Ultimately, this case highlights the importance of a thorough physical examination and keeping a wide differential diagnosis when evaluating patients with uncontrolled DM, as failure to diagnose acromegaly at an early stage may have devastating consequences on patient outcomes. Presentation: 6/3/2024

Abstract Metagenomic studies have revolutionized the study of novel phages. However these studies trade depth of coverage for breadth. We show that the targeted sequencing of a small region of a phage terminase family can provide sufficient sequence diversity to serve as an individual-specific barcode or a “phageprint’’, defined as the relative abundance profile of the variants within a terminase family. By collecting ∼700 oral samples from ∼100 individuals living on multiple continents, we found a consistent trend wherein each individual harbors one or two dominant variants that coexist with numerous low-abundance variants. By tracking phageprints over the span of a month across ten individuals, we observed that phageprints were generally stable, and found instances of concordant temporal fluctuations of variants shared between partners. To quantify these patterns further, we built machine learning models that, with high precision and recall, distinguished individuals even when we eliminated the most abundant variants and further downsampled phageprints to 2% of the remaining variants. Except between partners, phageprints are dissimilar between individuals, and neither country-of-residence, genetics, diet nor cohabitation seem to play a role in the relatedness of phageprints across individuals. By sampling from six different oral sites, we were able to study the impact of millimeters to a few centimeters of separation on an individual’s phageprint and found that such limited spatial separation results in site-specific phageprints.

Objective To evaluate and compare children undergoing cochlear implantation (CI) with myringotomy tubes (MT) placed preoperatively or intraoperatively to those without MT . Methods This was a retrospective review of pediatric patients undergoing CI between 2015 to 2020 at a tertiary care pediatric hospital. CI patients with and without MT were reviewed for the following outcomes: intraoperative findings, intraoperative and postoperative complications, and surgical time. Descriptive and bivariable statistical analysis was performed. Results 192 cochlear implant surgeries were included: 116 without MT tubes and 76 with a history of MT. Twenty-six patients had MT present at the time of CI surgery. No statistical difference existed between patients with MT (CI + MT group) and those without MT (CI – MT group) with regard to intraoperative complications (P = 0.760) and intraoperative findings (P = 0.545). MT association with total post-operative complications (GEE) showed no statistical significance (OR 2.45, 95% CI 0.83–7.22, P-value 0.105). CI + MT patients were significantly more likely to have inflamed middle ear mucosa at time of surgery (P = 0.003). CI + MT patients did not have a longer length of surgery compared to the CI – MT group (3.47 h vs 3.3 h, respectively, P = 0.342). Conclusion Our data confirms it is safe to perform CI in ears with myringotomy tubes, although the surgeon should be aware of possibly encountering increased middle ear inflammation during the surgery.