Arora, Harshit

Abstract Vascular anomalies are disorders of arteries or veins which are further sub-classified as vascular malformations or vascular tumors. Vascular malformations are attributed to disorderly vascular morphogenesis, trauma, or hormonal imbalances. We present a rare case of a patient in their 30s who presented to the outpatient department with a localized post-traumatic soft tissue swelling in the temporalis region, which was soft and non-pulsatile with occurrences in periods of acute emotional stress, followed by spontaneous resolution when the same was negated by the patient. The diagnosis was established on the basis of magnetic resonance imaging and contrast enhanced computed tomography. We add to the existing limited literature on intramuscular vascular malformations of the temporalis muscle and highlight the effect of emotional stress and anxiety on vascular anomalies.

e13661 Background: MM survival has improved significantly, resulting in increased survivorship and caregiver burden and is crucial to understand the real-world impact of MM. We analyzed results from a large, prospective MM patient survey using ML models to identify key predictive factors for survivorship and caregiver burden. Methods: A 45-item questionnaire spanning sociodemographics, treatment preferences, symptom burden and caregiver impact was distributed to MM patients at Mayo Clinic and International Myeloma Foundation support groups. Questions about quality of life (QOL) and treatment satisfaction (TS) represented survivorship outcomes while caregiver workday loss (WL) and job loss (JL) were surrogates for caregiver burden. 6 ML models (multinomial, random forest (RF), XGB (XGBoost), k-NN, GBM, Naïve Bayes) with a training: testing cohort of 80:20 were used to predict each of the 4 outcomes independently, considering model accuracy, C-index, precision, recall, and F1 score (Table), and using R studio (V4.4.1) and Bluesky Statistics (V10.3.4). Results: 2,239 participants (54% male, 89% Whites) with median age 68 yrs completed the survey. 71% respondents had a college degree, 44% resided in Midwest states, 62% reported household income >$75,000, and 67% had Medicare/Medicaid. Median age at MM diagnosis was 67 yrs with 58% diagnosed within the past 5 yrs and 73% currently receiving MM treatment. 72% reported their spouse as the primary caregiver. XGB was the best predictive model for QOL with gender, household income, stem cell transplant, CAR-T therapy, support from medical staff, and symptom burden (pain, neuropathy, mental well-being) as significant predictors. The RF model was the best for TS with pain and neuropathy levels as the most impactful predictors. For caregiver burden, XGB was the best model for WL with gender, household income, CAR-T therapy, financial strain, lack of support from medical staff, self-workdays missed, self-job loss, and pain and neuropathy levels as significant predictors. For JL, RF was the best model with significant variables being workdays missed by self, increased healthcare needs, symptom burden (pain, neuropathy, and mental well-being), and restricted physical activity. Conclusions: Our study shows the significant impact of MM survivorship and efficiently identifies predictive factors associated with survivorship and caregiver burden from a large prospective dataset using validated ML models. These findings highlight the complex challenges from MM and provide contemporary ML methods to better understand their interplay such that a framework of real-world interventions can be developed. Outcome Best ML Model Accuracy C-Index Precision Recall F1 score QOL XG 0.996 0.996 0.996 0.997 0.996 TS RF 0.984 0.900 0.937 0.948 0.937 WL XGB 0.984 1.000 0.944 0.947 0.945 JL RF 0.989 0.800 0.829 0.848 0.835

Introduction: Tuberculosis (TB) of the spine is one of the rare secondary manifestations of the disease, while isolated TB of the sacrum is an even rarer finding of the disease. Case: The authors present the case of a male patient in their late 20s who was suffering from lower back pain radiating to the leg, on and off fever for 5 months, and stiffness of the lower back. X-ray and MRI showed a sacral mass-like lesion, which led to the suspicion of spinal TB. This diagnosis was later confirmed through adequate microbiological testing. Methods and Materials: A review of literature by a thorough search of the PubMed and Google Scholar databases was carried out, and a total of 42 patients with isolated TB of the sacrum were studied. Results and Conclusions: Sacrum in isolation is a rare location for spinal TB, often overlooked by primary physicians. A prompt diagnosis and early treatment of the disease will mitigate the risk of developing complications.