scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

scholarly journals COVID-19 Related Deaths in an Urban Academic Medical Center in Brooklyn – A Descriptive Case Series

2020 ◽  
Author(s):  
James Andrew McCracken ◽  
Mohamed Nakeshbandi ◽  
Jeffrey Arace ◽  
Wayne J Riley ◽  
Roopali Sharma
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Black Population ◽  
International Travel ◽  
Normal Limits ◽  
Academic Medical ◽  
Patients At Risk

Abstract Background Available studies are lacking in analysis of baseline demographics and hospital presentation of patients at risk of expiring due to coronavirus disease 2019 (COVID-19), particularly Black American patients. We conducted a retrospective chart review to determine similarities in demographics and hospital presentation among patients who expired due to COVID-19 at an academic medical center in Brooklyn, New York.Study design and methods This is a retrospective observational study of 200 patients who expired due to complications of COVID-19. Patients were included in this study if they had laboratory-confirmed SARS-CoV-2 infection and expired during their admission. Data were collected on patients who expired between March 17 and April 16, 2020. Results A vast majority of patients were Black Americans (89%) with no history of international travel who had more than one comorbidity (81%), with the most common comorbidities being hypertension (84·5%), diabetes mellitus (57·5%), and obesity (41·5%). Fifty-five percent of our patient population had three or more comorbidities. Among patients with available data, C-reactive protein, lactate dehydrogenase, and ferritin values were elevated above normal limits at admission. Dyspnea was the most common presenting symptom (92·5%). Most (90·5%) presented within the first week of symptoms, with a median time of symptoms prior to expiration being 8·42 days (IQR 5·57 – 12·72). Interpretation Socioeconomic status and healthcare inequalities have greatly affected the Black population of Brooklyn, New York, and these disparities become even more apparent in COVID-19 infection. Patients presenting with numerous comorbidities and elevated inflammatory markers represent a population at high risk of in-hospital mortality.

scholarly journals Olfactory-Specific Quality of Life Outcomes after Endoscopic Endonasal Surgery of the Sella

2021 ◽  
Vol 12 ◽  
pp. 215265672110450
Author(s):  
Milap D. Raikundalia ◽  
Ryan J. Huang ◽  
Lyndon Chan ◽  
Tracy Truong ◽  
Maragatha Kuchibhatla ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Tumor Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Retrospective Case ◽  
Endoscopic Endonasal ◽  
Related Quality ◽  
Snot 22

Objective To assess olfactory outcomes as measured by an olfactory-specific quality of life (QOL) questionnaire in patients undergoing EESBS for sellar lesions. Design Retrospective case series. Setting Tertiary academic medical center. Participants In total, 36 patients undergoing EESBS for lesions limited to the sella were evaluated. Main Outcome Measures The following were performed before and three months after surgery: 22-Item Sinonasal Outcomes Test (SNOT-22), University of Pennsylvania Smell Identification Test (UPSIT), and the Assessment of Self-reported Olfactory Functioning (ASOF), which has three domains: subjective olfactory capability scale (SOC), smell-related problems (SRP), and olfactory-related quality of life (ORQ). Results Median age at surgery was 52.5 years, with a median tumor size of 1.8 cm (range: 0.2 to 3.9 cm). Pre- and postoperative median scores were 35 [34, 36.2] and 34.5 [32, 36] for UPSIT, 21 [7.5, 33.5] and 21.5 [6.8, 35.7] for SNOT-22, 10 [9, 10] and 9 [8, 10] for ASOF-SOC, 5 [4.8, 5] and 4.5 [4, 5] for ASOF-SRP, and 5 [5, 5] and 5 [4.5, 5] for ASOF-ORQ. There was no significant change in the two of the three domains of the ASOF. Correlation between ASOF and UPSIT scores were weak. Older age and larger tumor size were associated with worsened olfaction after surgery. Conclusions Patients did not experience significant changes in olfactory-specific QOL three months after EESBS, as measured by two domains of the ASOF. The ASOF may serve as a useful adjunctive tool for assessing olfaction after surgery. The lack of correlation between UPSIT and ASOF suggests the need for more research in subjective olfactory-related quality of life after surgery.

Abstract TP332: Utilizing a Neuro Intermediate Unit in Caring for Post-Thrombolysis Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Leah C Ramos ◽  
Cynthia Steffen ◽  
Sarah Gay ◽  
Julio Chalela
Keyword(s):  
Blood Pressure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Stroke Care ◽  
Stroke Patients ◽  
Retrospective Case ◽  
Case Series Study ◽  
Intermediate Unit ◽  
The Mean

Background: Historically stroke patients receiving intravenous tPA are admitted to an intensive care unit (ICU). Providing post-tPA care in a non-ICU setting could result in cost reduction and allow allocation of ICU beds to other critically ill patients. We sought to determine if care can be provided safely and effectively for post-tPA patients in a Neuro Intermediate Unit (NIU). Materials and Methods: This is a retrospective case series study performed in a tertiary academic medical center with a comprehensive, accredited, stroke program. We analyzed ischemic stroke patients admitted to our NIU during a 24-month period. A standardized data collection form was used to abstract data from medical records. Results: During a 24-month period 104 patients were admitted for post-tPA stroke care. The sample is composed of 60 males and 44 females. The median age was 69.5 and the mean age was 67.96. The sample is composed of 72 (69%) White and 32 (31%) Black patients. The mean admission NIHSS was 9.32. The most common stroke risk factors were hypertension (76%), diabetes mellitus (25%), hyperlipidemia (51%), tobacco use (21%), atrial fibrillation (21%), prior stroke (26%), congestive heart failure (20%), and coronary artery disease (21%). Mean admission systolic blood pressure was 143.5 mm Hg. For blood pressure management, 18% of the patients received medication by intravenous push and 5.7% by continuous infusion to meet established goals. Gastrointestinal hemorrhage was seen in 1.9%, intracranial hemorrhage in 3.8%, and blood transfusions needed in 1.9%. Insulin drips were needed to control persistent hyperglycemia in 3.8%. Sepsis occurred in 0.96% patients. The rate of fatality was 3.8%. Excellent functional outcome as defined as Modified Rankin Score (mRS) less than 2 was seen in 46% of patients and minimal to no disability (mRS < 1 ) was seen in 35.6%. Conclusions: In this retrospective study, stroke patients receiving intravenous tPA admitted to an NIU had similar outcomes and complications to that described in previous data. Significant cost savings can be accomplished by admitting thrombolysis patients to an NIU without compromising patient safety. Specialized nursing care available in a stroke unit is a key component in improving patient outcome.

scholarly journals Cerebrovascular Complications of COVID-19

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Jeffrey M. Katz ◽  
Richard B. Libman ◽  
Jason J. Wang ◽  
Pina Sanelli ◽  
Christopher G. Filippi ◽  
...  
Keyword(s):  
New York ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Clinical Laboratory ◽  
Case Series ◽  
Outcome Data ◽  
Retrospective Case ◽  
Systemic Complications ◽  
Cerebrovascular Complications ◽  
Global Pandemic

Background and Purpose: Coronavirus disease 2019 (COVID-19) evolved quickly into a global pandemic with myriad systemic complications, including stroke. We report the largest case series to date of cerebrovascular complications of COVID-19 and compare with stroke patients without infection. Methods: Retrospective case series of COVID-19 patients with imaging-confirmed stroke, treated at 11 hospitals in New York, between March 14 and April 26, 2020. Demographic, clinical, laboratory, imaging, and outcome data were collected, and cases were compared with date-matched controls without COVID-19 from 1 year prior. Results: Eighty-six COVID-19–positive stroke cases were identified (mean age, 67.4 years; 44.2% women). Ischemic stroke (83.7%) and nonfocal neurological presentations (67.4%) predominated, commonly involving multivascular distributions (45.8%) with associated hemorrhage (20.8%). Compared with controls (n=499), COVID-19 was associated with in-hospital stroke onset (47.7% versus 5.0%; P <0.001), mortality (29.1% versus 9.0%; P <0.001), and Black/multiracial race (58.1% versus 36.9%; P =0.001). COVID-19 was the strongest independent risk factor for in-hospital stroke (odds ratio, 20.9 [95% CI, 10.4–42.2]; P <0.001), whereas COVID-19, older age, and intracranial hemorrhage independently predicted mortality. Conclusions: COVID-19 is an independent risk factor for stroke in hospitalized patients and mortality, and stroke presentations are frequently atypical.

scholarly journals Evaluation of Subepithelial Abnormalities of the Appendix by Endoscopic Ultrasound

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Lance T. Uradomo ◽  
Peter E. Darwin
Keyword(s):  
Endoscopic Ultrasound ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Proximal Colon ◽  
Retrospective Case ◽  
Academic Medical ◽  
Subepithelial Lesions ◽  
Selection Of Patients ◽  
Selection Of

Background. The use of through-the-scope (TTS) miniprobe catheter endoscopic ultrasound is a valuable technique for evaluating subepithelial lesions in the proximal colon. Few reports include the evaluation of the appendix by EUS. Objective. To describe endoscopic and endosonographic characteristics of subepithelial lesions of the appendix. Methods. Retrospective case series in a single academic medical center. Adult patients referred for evaluation of subepithelial lesions of the appendix identified by colonoscopy between April 1, 2003 to February 29, 2008. Data were abstracted from an electronic endoscopic database for all patients undergoing miniprobe endoscopic ultrasound examination of the appendix. Medical records were reviewed for patient followup and outcomes. Results. Nine cases were identified. Seven (78%) patients were female. Seven (78%) utilized the 12 MHz miniprobe device and two (22%) used the 20 MHz device. Three mucoceles were described and confirmed by surgical resection. Cases also included one inverted appendix, one gastrointestinal stromal tumor, and one lipoma. In three cases, no abnormality was found. Conclusions. EUS evaluation of the appendix is feasible with standard miniprobe devices and may assist in the selection of patients who may benefit from surgical management.

scholarly journals COVID-19 related deaths in an urban academic medical center in Brooklyn – A descriptive case series

2020 ◽  
Author(s):  
James Andrew McCracken ◽  
Mohamed Nakeshbandi ◽  
Jeffrey Arace ◽  
Wayne J Riley ◽  
Roopali Sharma
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Black Population ◽  
International Travel ◽  
Normal Limits ◽  
Academic Medical ◽  
Patients At Risk

Abstract Background Available studies are lacking in analysis of baseline demographics and hospital presentation of patients at risk of expiring due to coronavirus disease 2019 (COVID-19), particularly Black American patients. We conducted a retrospective chart review to determine similarities in demographics and hospital presentation among patients who expired due to COVID-19 at an academic medical center in Brooklyn, New York. Study design and methods This is a retrospective observational study of 200 patients who expired due to complications of COVID-19. Patients were included in this study if they had laboratory-confirmed SARS-CoV-2 infection and expired during their admission. Data were collected on patients who expired between March 17 and April 16, 2020. Results A vast majority of patients were Black Americans (89%) with no history of international travel who had more than one comorbidity (81%), with the most common comorbidities being hypertension (84·5%), diabetes mellitus (57·5%), and obesity (41·5%). Fifty-five percent of our patient population had three or more comorbidities. Among patients with available data, C-reactive protein, lactate dehydrogenase, and ferritin values were elevated above normal limits at admission. Dyspnea was the most common presenting symptom (92·5%). Most (90·5%) presented within the first week of symptoms, with a median time of symptoms prior to expiration being 8·42 days (IQR 5·57 – 12·72). Interpretation Socioeconomic status and healthcare inequalities have greatly affected the Black population of Brooklyn, New York, and these disparities become even more apparent in COVID-19 infection. Patients presenting with numerous comorbidities and elevated inflammatory markers represent a population at high risk of in-hospital mortality.

scholarly journals Treatment of Hypertriglyceridemia with Aggressive Continuous Intravenous Insulin

2021 ◽  
Vol 24 ◽  
pp. 336-342
Author(s):  
Abigail Hoff ◽  
Kara Piechowski
Keyword(s):  
Median Time ◽  
Triglyceride Level ◽  
Insulin Infusion ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Retrospective Case ◽  
Intravenous Insulin ◽  
Academic Medical ◽  
Severe Hypertriglyceridemia

Purpose: Severe hypertriglyceridemia requiring hospitalization for intravenous insulin to lower triglycerides and prevent complications of pancreatitis is becoming an increasing problem with little consensus treatment evidence. This is the largest case series to date to evaluate this under-studied area of literature. The objective of this study was to determine the average time to triglyceride lowering less than 500 mg/dL. Methods: This was a retrospective case series from March 2018 to March 2020 at a single rural academic medical center. 23 patients were included who received weight-based intravenous insulin at 0.1 units/kg/hour through a hypertriglyceridemia management order-set over a two-year period. Results: The median triglyceride level at initiation of the insulin infusion was 3759 mg/dL with an interquartile range of 5555. The median time to a triglyceride level less than 1000 mg/dL and 500 mg/dL was 45 hours (1.8 days) and 75 hours (3.1 days) respectively. Patients remained on intravenous insulin for a median of 60 hours (2.5 days). Conclusions: In this largest case series to date evaluating the use of intravenous insulin for the treatment of hypertriglyceridemia, a weight-based insulin infusion demonstrated reduction of triglyceride levels to less than 1000 mg/dL in approximately 2 days and less than 500 mg/dL in approximately 3 days.

scholarly journals Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 229-245
Author(s):  
René Hage ◽  
Carolin Steinack ◽  
Fiorenza Gautschi ◽  
Susan Pfister ◽  
Ilhan Inci ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Clinical Laboratory ◽  
Invasive Mechanical Ventilation ◽  
Case Series ◽  
Outcome Data ◽  
Transplant Recipients ◽  
Retrospective Case ◽  
Laboratory Findings ◽  
Case Series Study ◽  
Lung Transplant Recipients

We report clinical features, treatments and outcomes in 18 lung transplant recipients with laboratory confirmed SARS-CoV-2 infection. We performed a single center, retrospective case series study of lung transplant recipients, who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. Clinical, laboratory and radiology findingswere obtained. Treatment regimens and patient outcome data were obtained by reviewing the electronic medical record. Mean age was 49.9 (22–68) years, and twelve (67%) patients were male. The most common symptoms were fever (n = 9, 50%), nausea/vomiting (n = 7, 39%), cough (n = 6, 33%), dyspnea (n = 6, 33%) and fatigue (n = 6, 33%). Headache was reported by five patients (28%). The most notable laboratory findings were elevated levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). Computed Tomography (CT) of the chest was performed in all hospitalized patients (n = 11, 7%), and showed ground-glass opacities (GGO) in 11 patients (100%), of whom nine (82%) had GGO combined with pulmonary consolidations. Six (33%) patients received remdesivir, five (28%) intravenous dexamethasone either alone or in combination with remdesivir, and 15 (83%) were treated with broad spectrum antibiotics including co-amoxicillin, tazobactam-piperacillin and meropenem. Four (22%) patients were transferred to the intensive care unit, two patients (11%) required invasive mechanical ventilation who could not be successfully extubated and died. Eighty-nine percent of our patients survived COVID-19 and were cured. Two patients with severe COVID-19 did not survive.

Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

2021 ◽  
pp. 000348942110212
Author(s):  
Nathan Kemper ◽  
Scott B. Shapiro ◽  
Allie Mains ◽  
Noga Lipschitz ◽  
Joseph Breen ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Proportion ◽  
Internal Auditory Canal ◽  
Patient Characteristics ◽  
Management Plan ◽  
Case Review ◽  
Retrospective Case ◽  
Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

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