RESUMO
Background: While the connection between alcohol and risky behavior is well known, a clear correlation between alcohol misuse and contracting sexually transmitted infections (STIs) has not been determined. The 4-question CAGE questionnaire-the acronym stands for attitudes and activities related to alcohol use-is often administered at primary care annual visits to screen patients for alcohol abuse. This study assessed the relationship between CAGE scores and STI results to determine if the CAGE questionnaire could help determine the need for STI screening at annual visits. Methods: All patients who received a CAGE screening from 2015 to 2022 at a Gulf South health system were included in the analysis. The primary outcome of the study was the relationship between a positive CAGE score (a score ≥2) and a positive STI result. STIs included in the primary analysis were human immunodeficiency virus (HIV), hepatitis B, syphilis, chlamydia, gonorrhea, and trichomoniasis. The correlation between a positive CAGE score and hepatitis C was examined as a secondary outcome. Results: A total of 40,022 patients received a CAGE screening during the study period, and 757 (1.9%) scored ≥2 on the CAGE questionnaire. Significant associations were found between a positive CAGE score and hepatitis B (odds ratio [OR]=2.69, 95% CI 1.91, 3.80; P<0.001), gonorrhea (OR=5.43, 95% CI 1.80, 16.39; P=0.003), and hepatitis C (OR=2.10, 95% CI 1.57, 2.80; P<0.001). No associations were found between a positive CAGE score and HIV, chlamydia, or trichomoniasis. No patients with a CAGE score ≥2 had a syphilis diagnosis; therefore, no syphilis analysis was possible. Conclusion: Based on the results of this study, patients with a CAGE score ≥2 may benefit from screening for hepatitis B, hepatitis C, and gonorrhea at their primary care annual visit. Early STI detection could lead to prompt treatment and prevent further transmission and complications.
RESUMO
Background: Although some patients with primary brain lesions remain clinically asymptomatic, others may experience a range of symptoms, including headaches, seizures, focal neurological deficits, changes in baseline mental function, and psychiatric manifestations. Distinguishing between a primary psychiatric illness and symptoms of a primary central nervous system tumor can be especially difficult for patients with a history of mental illness. A major challenge in effectively treating patients with brain tumors is first obtaining the diagnosis. Case Report: A 61-year-old female with a medical history significant for bipolar 1 disorder with psychotic features, generalized anxiety, and previous psychiatric hospitalization presented to the emergency department with worsening depressive symptoms and without focal neurologic deficits. She was initially placed on a physician's emergency certificate for grave disability, with anticipated discharge to a local inpatient psychiatric facility once she was stabilized. A frontal brain lesion, concerning for a meningioma, was found on magnetic resonance imaging and she was instead transferred to a tertiary center for urgent neurosurgical consultation. Bifrontal craniotomy with neoplasm excision was performed. The patient's postoperative course was uneventful, and continued symptom improvement was noted at the patient's 6- and 12-week postoperative visits. Conclusion: This patient's clinical course exemplifies the clinical ambiguity associated with brain tumors, the challenge of obtaining a timely diagnosis with nonspecific symptoms, and the importance of neuroimaging for patients presenting with atypical cognitive symptoms. This case report contributes to the literature about the psychiatric manifestations of brain lesions, especially in patients with concurrent mental health disorders.
