left-sided effusion. A left pleural catheter was placed, and a pleurodesis was performed. The patient showed symptomatic improvement but remained hospitalized for malnutrition and deconditioning.
progression of KS contributed to his recurrent chylothorax. Treatment included thoracostomy with subsequent pleurodesis, lymphangiography and glue embolization. Improved nutritional status and effective HIV and KS management are recommended for preventing recurrence.
Discussion: This patient’s nonadherence with antiretroviral therapy and subsequent
FINANCIAL IMPLICATIONS OF ROUTINE HOMOCYSTEINE LEVEL TESTING FOR VENOUS THROMBOEMBOLISM AND STROKE: AN INSTITUTIONAL REVIEW. Anaiya Singh, Shiva Jashwanth Gaddam, Poornima Ramadas; Louisiana State University, Shreveport, LA.
Introduction: Increased homocysteine levels have been linked to various cardiovascular outcomes like stroke(s) and the development of thrombophilia(s), prompting its measurement as a potential marker for risk assessment. Current guidelines and recommendations have not shown any clinical benefit in routine testing of serum homocysteine levels and do not alter management. Our study aimed to explore the financial impact of this testing, which is still used, despite clinical evidence at our institution. Method: To analyze the financial impact and utilization pattern of clinically insignificant testing of serum homocysteine levels in patients with thrombophilia(s) and stroke(s), we collected data on 362 patients who underwent testing of serum homocysteine levels between 12/2019 to 12/2022, and analyzed results for about 136 patients. We excluded patients for whom this test was ordered other than workup of thrombophilia(s) and stroke(s) to calculate the financial burden imposed by this clinically unnecessary testing. The median age of
testing was 31+/-4 years, with males (48) constituting 35.3% and females contributing (88) 64.7%. Gene testing was done for 84 patients with TIAs and CVAs and in 52 patients with venous thromboembolic events (VTEs). Out of all the 136 patients tested for the gene mutations, 25 were covered by Medicare, 62 by Medicaid and 49 were covered by private- based insurance. Serum homocysteine levels testing lead to a cost of around 320 USD per test as a part of the hypercoagulability workup. Discussion: Our analysis revealed an unwarranted expenditure of 43,520 USD for serum homocysteine level testing for workup of thrombophilia(s) and stroke(s). We intend to disseminate this data within our institution and provide physician education, regarding the clinical insignificance and high costs associated with this test. This initiative was designed to reduce unnecessary testing to lower patient expenses and decrease overall healthcare costs while creating an awareness regarding unnecessary testing with limited clinical outcomes.
GRANULOMATOSIS WITH POLYANGIITIS MASKED AS CHRONIC OTOMASTOIDITIS. Courtney Baldwin; Ochsner Clinic Foundation, New Orleans, LA.
Introduction: Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis associated with PR3-ANCA that affects small-sized arteries within the respiratory tract and kidneys. The incidence rate of GPA is 0.4 to 11.9 cases per million people per year. Ear, nose and throat manifestations are most common and include nasal or oral ulcers, discharge, and hearing loss.
Case: A 32-year-old woman with a history of asthma and childhood seizures presented with recurrent ear infections. She had completed multiple rounds of antibiotics for otitis media without relief, leading to bilateral myringotomy with tympanostomy and tube placement for chronic otomastoiditis. One month after tube placement,
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