bluuebunny/crossref_metadata_2025_split huggingface dataset:
1028. Clinical and radiologic characteristics of calcified parenchymal neurocysticercosis: A large series of a non-endemic region
Authors: Berto Moreano Cesar G , Machiavello Francisco J , Mazzini Jorge , Sacchi Robert , Coyle Christina 
Published: December 2022

Abstract

Background
Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system and a common cause of seizures. Approximately, one-third of patients with epilepsy in endemic regions have NCC. Calcified parenchymal cysticercosis (CaNCC) was previously referred to as an inactive form of NCC, however, recent data suggests that the antigenic parasitic material within this lesion can intermittently elicit a host inflammatory response. The clinical and radiologic characteristics associated with calcified lesions have not yet been well characterized.

Methods
We describe the clinical, radiologic, and serologic characteristics of a large series of patients with calcified parenchymal NCC who presented to Jacobi Medical Center, New York.

Results
Of 302 cases of NCC, 87 patients (32.5%) had exclusively CaNCC. Most individuals were female (50.7%) and born in Mexico (32.2%); the mean age was 38.4 ± 15.3 years and the median time from migration was 12 years [IQR 4-20 years]. The most common presentation was seizures (52.9%); among these patients, 23 individuals (53.5%) had perilesional edema on imaging which was always associated with enhancement on MR T1 image after gadolinium injection. Thirty-seven patients (42.5%) presented with headaches; among these, only 6 patients (16.2%) had perilesional edema at presentation. Nine patients (10.3%) were diagnosed incidentally. The Western blot was positive in 19 patients (21.8%) and the cysticercosis antigen in serum was negative in all cases.

Conclusion
This large series of patients with CaNCC in a non-endemic area highlights the clinical spectrum of this form of NCC. Seizures were the most common symptom. Perilesional edema around calcified lesions was seen in 50% of individuals presenting with seizures, similar to findings in endemic regions. Headaches also were frequent; the pathophysiology is yet not well understood. Unlike extraparenchymal disease, serum antigen is not positive in CaNCC. Enhancement of the corresponding calcifications after gadolinium was frequently seen on MRI. More research on individuals with CaNCC is needed to better understand why certain calcified lesions develop perilesional edema. It is clear that CaNCC is not inactive and the etiology of both headaches and seizures is probably multifactorial.

Disclosures
All Authors: No reported disclosures.
1030. Epidemiology and Microbiologic Characteristics of Post-operative Central Nervous System Infections following Endoscopic Endonasal Surgery
Authors: Shah Sunish , Durkin Joseph , Byers Karin E , Snyderman Carl H , Gardner Paul A , Shields Ryan K 
Published: December 2022

Abstract

Background
Endoscopic Endonasal Surgery (EES) is an innovative surgical technique to remove brain tumors and lesions. Post-operative central nervous system (CNS) infections following EES are poorly described. The objective of this study was to define the epidemiology and characteristics of post-EES CNS infections.

Methods
Adult patients who underwent EES between 1/2010 and 7/2021 were evaluated and included if microbiologically confirmed CNS infection occurred within 30 days of EES. Suspected contaminants, ventricular drain colonization, and pre-EES CNS infections were excluded.

Results
Overall, 2005 patients underwent EES; 1.8% (37/2005) developed CNS infection. The median [IQR] age was 51 [42-60] years, 32.4% (12/37) were female, and 54% (20/37) had a prior EES. The most common indications for EES were tumor resection [67.6% (25/37)] and cerebrospinal fluid (CSF) leak repair [24.3% (9/37)]. Post-operative CSF leaks were documented in 70.3% (26/37) of patients and 24.3% (9/37) had an extra-ventricular drain or shunt in place for &gt;48 hours at the time of infection. Ceftriaxone prophylaxis was prescribed in 64.9% (24/37) of cases and other regimens varied. The median [IQR] time from EES to diagnosis of CNS infection was 12 [6-19] days. The most common pathogens were S. aureus, Enterobacterales, and P. aeruginosa(Fig 1). Among 20 patients with prior EES, pathogens included S. aureus (5/20), Enterobacterales (3/20), Enterococcus spp. (3/20) and polymicrobic infections (3/20). Overall, 35.1% (13/37) of patients developed CNS infection due to a pathogen susceptible to pre-EES prophylaxis. Among those colonized with MRSA at time of EES, 75% (3/4) developed MRSA CNS infection compared to 6.1% (2/33) of non-colonized MRSA patients (P=0.005). The overall 30-day mortality rate was 2.7% (1/37). Figure:Microbiology
A polymicrobic case was defined as &gt;1 pathogen isolated from CSF (n=1) or from rhinocerebral tissue if CSF cultures were negative (n=11). Among polymicrobic cases (n=12), P. aeruginosa (n=5), Enterococcus spp. (n=4). and S. aureus (n=3) were predominant. Cases labeled as other consisted of Trichoderma spp, A. xylosoxidans, P. acnes, S. epidermidis, Peptostreptococcus spp.

Conclusion
CNS infection post-EES is rare and causative pathogens vary. Given the predominance of S. aureus, antimicrobial prophylaxis should ensure adequate coverage of this pathogen in addition to sinus flora, and programs may benefit from screening patients for MRSA colonization pre-EES. Our data also suggest that prophylaxis should target Gram-negative and other colonizing bacteria among patients with prior EES.

Disclosures
Ryan K. Shields, PharmD, MS, Infectious Disease Connect: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Roche: Grant/Research Support.
1035. The Microbiological Pattern and Outcome of Community Acquired Brain Abscess: A Single Centre Study from Pakistan
Authors: Sayeed Muneeba A 
Published: December 2022

Abstract

Background
Brain abscess is a potentially life-threatening infection. Streptococci and bacteroides are considered the predominant causative organisms in community acquired brain abscesses. Recommended empirical therapy is therefore ceftriaxone and metronidazole. Our objective was to assess the microbiological pattern and outcome in patients admitted with brain abscess in the neurosurgery unit of a tertiary care hospital in Karachi, Pakistan.

Methods
A retrospective study was conducted on all patients admitted with community acquired brain abscess at the Neurosurgery Department of Shaheed Mohtarma Benazir Bhutto Institute of Trauma from Jun 2018- Nov 2019. Demographic, microbiological, management and outcome data was gathered from medical records.

Results
Twenty-three patients were identified of which 13 were males (56.5%). Mean age was 18 (2-65) years. Predisposing factor was an otogenic focus in 17 (73.9%), and head trauma in 3 (13%). Of 23 patients, site of abscess was frontal in 7 (30.4%), occipital in 8 (34.7%), parietal in 4 (17.3%), and temporal in 3 (13%). Single brain abscess was seen in 18 (78.2%). Abscess was drained in all 23 patients (100%) patients and pus culture positive in 16, of which 8 (50%) were poly-microbial. Isolates were 6 (%) Bacteroides, 6 Streptococci, 5 Enterobacteriace, 3 Staphylococcus aureus, 3 Enterococci, 1 Hemophilus, 1 Acinetobacter and 1 Brevibacterium. Of 6 bacteroides isolates, 2 were resistant to metronidazole while only 3 of 10 aerobes isolated were susceptible to ceftriaxone. All patients did well with resolution of abscess/es after an average of 41.2 days of therapy.

Conclusion
The microbiological spectrum and antimicrobial susceptibility pattern of community acquired brain abscess is changing. Ceftriaxone and metronidazole may no longer be appropriate empirical therapy in these patients.

Disclosures
All Authors: No reported disclosures.
1042. Inflammatory Representation of COVID-19 at the Time of Hospitalization: An Insight into the Mild, Moderate, Severe and Critical COVID-19 Disease
Authors: Bhargava Ashish , Patel Hemang , Akagi Elisa , Sharma Mamta , Santos Claudia V , Zhao Wei , Salaytah Natali , Kondapi Goutham , Mangukia Nilamben , Coyle Meredith M , Riederer Kathleen M , Johnson Leonard B , Saravolatz Louis 
Published: December 2022

Abstract

Background
The ongoing state of the COVID-19 pandemic necessitates the characterization of the biological basis of disease severity. We aimed to correlate the clinical severity of illness upon hospitalization with inflammatory sero-biomarker levels.

Methods
A single-center prospective cohort study was conducted at a 776-bed tertiary care urban academic medical center in Detroit, Michigan. Adults with confirmed reverse-transcriptase-polymerase-chain-reaction assay for COVID-19 were recruited in equal numbers into four disease severity categories, as defined by the WHO, upon hospital admission from January 8th, 2021 to September 1st, 2021. Electronic medical charts were reviewed. In addition to clinical markers, cytokines and chemokines were assessed to gain detailed understanding of COVID-19 pathology.

Results
We included 200 patients with 50 patients each in the mild, moderate, severe and critical illness. The mean age of the cohort was 58.6.±15.9 yrs, 104 (52%) were males, and 135(67.5%) were blacks. The common comorbidities were hypertension (67.5%), diabetes (37%) and chronic lung diseases (26.5%). At the time of admission, oxygen therapy was needed in 49.5% but intubation in only 0.5%.

Conclusion
We noted COVID-19 severity dependent changes in the clinical representation as well as the biomarker profiles. Clinical markers such as CRP, LDH, D-dimer and Ferritin were relatable to COVID-19 severity. Inflammatory cytokines and chemokines such as CCL-2, CXCL-10, IL-1ra, IL-6 and TNF-alpha also varied with the severity of disease. Our results provide a system level insight into the inflammatory state of COVID-19 at the time of hospital representation.

Disclosures
All Authors: No reported disclosures.
1050. Breath Sample Collection from Individuals Infected with SARS-CoV-2: Biosafety Methodology
Authors: Lopez Marcela , Lopez Marcela , Stainton Emma , Chun Leanne X , Tam Grace K , Thiessen Rosita , Carrington Yuan J , Idziak Luke , Hannon Ami M , Duanmu Youyou , Trounce Milana Boukhman , Altamirano Jonathan , Ricco Antonio J , Li Jing , Li Jing , Maldonado Yvonne A , Govindarajan Prasanthi 
Published: December 2022

Abstract

Background
Breath samples collected from patients infected with respiratory viruses are necessary for viral detection using breath analyzer devices. Given the highly transmissible nature of many of these illnesses, sample collection requires a multi-layered approach to ensure the safety of the research staff responsible for obtaining and transporting these samples. Our team established a protocol to minimize exposure to and transmission of COVID-19 when collecting breath samples.

Methods
We collected breath samples from 64 participants, of which 31 (48.4%) were positive for SARS-CoV-2 at the time of their visit. Before we started sample collection, biosafety inspection was conducted. We used a five-pronged approach to enhance safety and minimize transmission. First, we collected specimens in an outdoor space while the patients were seated in their vehicles. Second, we used a disposable mouthpiece and a one-way valve to fill a 1L TEDLAR bag. Third, patients were instructed to close the valve tightly before returning it to the staff. Fourth, we placed the bag in secondary containers which were placed in tertiary containers to minimize any contact with aerosols in the TEDLAR bag. In the last step, we placed a portable HEPA filter near the indoor sample processing unit to minimize exposure and air contamination with the samples. Study staff donned all forms of necessary personal protective equipment, including gloves, gowns, N95 respirators, and protective eyewear, during sample collection and transportation.

Results
A total of 64 breath samples were collected from 64 adult participants from February to March 2022. A total of 30 participants (46.9%) were within 7 days of their initial diagnosis. All participants were able to successfully collect samples without additional resources or attempts. All samples were able to be transported successfully into the lab. No staff contracted COVID-19 during the study period.

Conclusion
Layered safety measures, including protective equipment, physical barriers, and well-ventilated environments mitigated the risks associated with breath sample collections from infected participants.

Disclosures
Yvonne A. Maldonado, MD, Pfizer: Grant/Research Support|Pfizer: Member, DSMB, Pfizer Meningococcal Vaccine clinical trial.
1051. Cardiac Assessment in Children with MIS-C: Late Magnetic Resonance Imaging Features
Authors: Arslan Sema Yıldırım , Bal Zümrüt Şahbudak , Bayraktaroğlu Selen , Özenen Gizem Güner , Bilen Nimet Melis , Levent Ertürk , Ay Oğuzhan , Özkaya Pınar Yazıcı , Özkınay Feriştah Ferda , Çiçek Candan , Çinkooğlu Akın , Aksu Güzide , Ak Güneş , Kurugöl Nuri Zafer 
Published: December 2022

Abstract

Background
Multisystem Inflammatory Syndrome (MIS-C), a new entity in children which developed 2-4 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is a severe condition. It can affect the multisystem, while the most severe manifestation is cardiac involvement. Left ventricular dysfunction, cardiogenic shock, coronary artery dilatation/aneurysm, valvulitis, pericardial effusion, arrhythmia, and conduction abnormalities were reported in approximately 80% of children with cardiovascular system involvement. It is still unclear the duration of the cardiac symptoms, and even they are permanent or persistent. Few studies evaluated persistent cardiac abnormalities by cardiac magnetic resonance imaging (MRI). Therefore, we aimed to assess persisting cardiac abnormalities with MIS-C by cardiac MRI and compare them with echocardiograms.

Methods
A retrospective study was conducted at a tertiary-level University Hospital between June 2020-July 2021. Thirty-four children diagnosed with MIS-C according to the criteria defined by the Centers for Disease Control and Prevention were retrospectively evaluated.

Results
The study included 17 males and 17 females with a mean age of 9.31±4.72 years. Initial echocardiographic evaluation showed cardiac abnormality in 18 (52.9%) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) &lt; 55%, 5 (14.7%) LV fractional shortening &lt; 30%, 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients at follow-up; coronary dilatation persisted in 2 of 5 (40 %) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients. We didn’t detect abnormal T1 levels, whereas 9 (29%) had isolated elevated T2 values. 19 (61.3%) of 31 patients had at least one of the following findings: pericardial effusion, right ventricular dysfunction, LVEF abnormality.

Conclusion
Cardiac involvement persisted at a higher rate which was shown by cardiac MRI in the late period, particularly pericardial effusion. Cardiac MRI may be suggested for all MIS-C patients at a later phase. Prospective studies with larger sample sizes are needed to determine long-term cardiac effects.

Disclosures
All Authors: No reported disclosures.
1054. Comparison of Post-Acute COVID-19 Symptoms in Infected Individuals Pre- and Post-Vaccination
Authors: McDonald Dylan , Logue Jennifer , Franko Nicholas M , Kemp Megan M , McCulloch Denise J , Chow Eric J , Chu Helen Y 
Published: December 2022

Abstract

Background
A constellation of debilitating symptoms, known as post-acute sequelae of COVID-19 (PASC), has been described in those in those with prior SARS-CoV-2 infection. While SARS-CoV-2 vaccination remains an effective way to prevent severe illness, PASC in individuals infected after vaccination is not well characterized.

Methods
A cohort of adults with laboratory confirmed SARS-CoV-2 infection were enrolled as cases and longitudinally followed between March 2020-March 2022 in the greater Seattle region. Demographic and acute illness surveys capturing baseline symptoms, infection severity and medical care were administered at enrollment (Table). Controls with no history of SARS-CoV-2 infection were concurrently followed.
Symptom surveys were given at 6 months post-infection. Vaccination status was self-reported. We defined PASC as the presence of one or more symptoms that persisted for at least 4 weeks after acute SARS-CoV-2 infection. Table.Demographic and Illness Characteristics of Study Participants*Days since illness onset refers to the days passed since infection date. **Comorbidities included hypertension, diabetes mellitus, chronic obstructive pulmonary disease, cardiovascular disease, chronic liver disease, chronic kidney disease, HIV, current use of immunosuppressants or diagnosis of cancer.

Results
Of 369 cases and 93 controls 57% (median age 44.7 years; 59.3% female) and 30% (median age 50.0 years; 50.0% female), completed the 6-month survey, respectively (Table). A total of 174 cases were infected prior to vaccination and 35 were post-vaccination.
A total of 58 (28%) cases reported symptoms at 6 months, compared to 5 (18%) controls (Figure). In participants infected pre-vaccination, 32% reported PASC symptoms, compared to 6% of those infected post-vaccination (Figure; P=0.001).

Conclusion
Our study found that the proportion of individuals reporting PASC at 6 months after infection was significantly higher among those infected before SARS-CoV-2 vaccination than those who were infected after. This suggests that timing of vaccination relative to SARS-CoV-2 infection may be associated with the development of PASC symptoms. Symptoms were still reported among many individuals with PASC who were vaccinated after their infection. Further research is required to understand the underlying mechanisms of PASC, and to characterize PASC in those infected after vaccination and with variant of concerns.

Disclosures
Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.
1065. Patient-Reported Reasons for Non-Participation in Inpatient COVID-19 Clinical Research: Results from a Multi-Center VA Embedded Randomized Trial
Authors: Reyes Dassum Samira , Ferguson Ryan , Woods Patricia , Flynn Maura , Visnaw Karen , Schiller Sara J , Monach Paul , Leatherman Sarah , Branch-Elliman Westyn 
Published: December 2022

Abstract

Background
Early in the COVID-19 pandemic, no evidence-proven therapeutics were approved, and thus participation in a clinical trial was often the only way to access experimental medications. However, in the US, participation in medical research is low. Patient-stated factors impacting enrollment decisions are poorly characterized. Thus, the aim of this study was to identify patient-reported reasons for declining enrollment in a COVID-19 clinical trial.

Methods
As part of an open-label, pragmatic randomized trial across five VAs from 4/10/20 – 2/3/21, SARS-COV-2 positive inpatients with moderate to severe disease were screened for eligibility. Potentially eligible patients received an informed consent packet with a letter explaining the study and were then contacted remotely to assess willingness to participate. If eligible patients declined to participate, if willing, they were asked an open-ended question about the reasons behind their decision. If they were not able to provide a specific answer, then general categories were offered. Qualitative responses were analyzed using a directed content analysis approach; responses were categorized using previously defined factors that have contributed to decisions not to enroll in other clinical therapeutics trials, primarily conducted in oncology.

Results
Among 417 patients screened, 162 met eligibility criteria. Of these, 53 consented (32.7%), 102 declined to participate (62.9%), and 7 were unable to give consent. Themes and examples of reasons for declining participation are presented in Table 1. Among the patients who declined to participate, the four most cited factors were limited perceived benefit, competing priorities, physician or family influence and presence of comorbidities. Several patients reported that their decision was influenced by physician or family recommendation to decline, which was reported as physician lack of support for participation due to the presence of comorbidities or physician perceived lack of benefit given clinical improvement prior to study enrollment.

Conclusion
Understanding reasons and attitudes driving enrollment may help investigators address them during the recruitment process and increase participation in clinical trials in the US.

Disclosures
Karen Visnaw, RN, Hologic Inc: Stocks/Bonds|Liquidia Corporation: Stocks/Bonds Paul Monach, MD, PhD, Celgene / Bristol-Myers Squibb: Advisor/Consultant|ChemoCentryx: Advisor/Consultant|Gilead: Grant/Research Support|Kiniksa: Advisor/Consultant Westyn Branch-Elliman, MD, MMSc, DLA Piper,LLC/Medtronic: Advisor/Consultant|Gilead Pharmaceuticals: Grant/Research Support.
1071. Retrospective study evaluating the cytokine dynamics in COVID-19 patients who were treated with casirivimab/imdevimab
Authors: Sugita Akiho , Ishikane Masahiro , Iwamoto Noriko , Sugiyama Masaya , Teruya Katsuji , Hojo Masayuki , Mizokami Masashi , Ohmagari Norio 
Published: December 2022

Abstract

Background
Neutralizing antibody therapy such as casirivimab/imdevimab is known to significantly reduce the viral load of SARS-CoV-2, but there is limited study on the clinical prognosis of neutralizing antibody therapy, especially in Asia, and the dynamics of cytokines is unknown worldwide. Several cytokines have been investigated as biomarkers to predict oxygen demand, among which CCL17 and INF3 have received approved and covered by the national health insurance in Japan.

Methods
Between July 2021 - December 2021, patient’s demographic, laboratory, radiological findings, prognosis, and cytokine kinetics (IFN-λ3, CCL17) at National Center for Global Health and Medicine, Tokyo, Japan, were analyzed using medical charts and serum samples. Univariate analysis was performed using Fisher's exact probability test and Mann-Whitney U test to evaluate the clinical characteristics of the group with oxygen demand compared with those of the group without oxygen demand.

Results
Thirty-four patients were analyzed. The median age of the cohort was 57.5 years (IQR 52.8-67.3), and 25 (73.5%) were male. Eight patients (23.5%) had been fully vaccinated and three patients (8.8%) had been vaccinated once. The severity of disease before casirivimab/imdevimab was asymptomatic in two (5.9%), mild in 12 (35.3%), moderate in 20 (58.8%) cases. Of the 17 cases in which mutant strains were identified, 16 were delta strains. The IFN-λ3 level (pg/mL) before casirivimab/imdevimab was significantly higher (7.6 vs. 17.2, p = 0.005), while the CCL17 level (pg/mL) was significantly lower (148.8 vs. 64.2, p = 0.036) in the group with oxygen demand during the therapeutic course compared to those in the group without oxygen demand. After casirivimab/imdevimab was administered, the IFN-λ3 level decreased to a median of 0.0 (IQR 0.0-0.3), while the CCL17 level increased to median of 220.3 (IQR 135.8-304.8), with no statistically significant differences between both groups (Figure 1). None of the patients became seriously ill.
Figure 1A and 1B show the changing of the cytokine dynamics in COVID-19 patients who were treated with casirivimab/imdevimab on IFN-λ3 level and CCL17 level, respectively.

Conclusion
There was a statistically significant difference between IFN-λ3 and CCL17 levels before casirivimab/imdevimab in both groups. Our results suggest that casirivimab/immudevimab may improve the clinical prognosis for COVID-19 patients with delta strains.

Disclosures
All Authors: No reported disclosures.