scholarly journals 666. Human Granulocytic Anaplasmosis and Ehrlichiosis Presenting to an Upstate New York Emergency Department

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S241-S241
Author(s):  
Michael Waxman ◽  
Jennifer White ◽  
Elizabeth M Dufort ◽  
Abigale Eichelman ◽  
Kathleen Stellrecht ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Medical Center ◽  
Tick Bite ◽  
Laboratory Findings ◽  
Positive Polymerase Chain Reaction ◽  
Human Granulocytic Anaplasmosis ◽  
North East ◽  
The North ◽  
Granulocytic Anaplasmosis

Abstract Background Human granulocytic anaplasmosis (HGA) is an increasingly common tickborne infection in the North-East United States. Statewide incidence of human cases of anaplasmosis in New York (excluding New York City) increased 407% from 2010–2017, with a corresponding increase in Anaplasma phagocytophilum prevalence in ticks. While previous observational studies have described the clinical features of HGA, there has been little documentation of HGA diagnosed in the emergency department (ED) setting. Methods Demographic and clinical data were extracted from electronic records of cases with a positive polymerase chain reaction (PCR) for HGA or the closely related clinical entity ehrlichiosis from 2016 to 2017. HGA and ehrlichiosis PCR were performed by the Albany Medical Center laboratory on patients treated in the ED. Basic descriptive analyses were performed. Results During the 2-year period, there were 37 cases of PCR-positive HGA and four cases of PCR-positive ehrlichiosis treated in the ED. Electronic data were available for extraction for 40 of these cases. Mean age was 54 years old (range 7–94 years). Thirty-four (85%) patients presented with fever, and 9 (23%) reported a tick bite or tick exposure. Twenty-two (55%) patients had leukopenia; 32 (80%) thrombocytopenia; 26 (65%) hyponatremia; 24 (60%) elevated transaminases; 38 (95%) at least one of these laboratory abnormality; and 13 (33%) all four laboratory abnormalities. Twenty-four patients (60%) were given the empiric diagnosis of a tickborne illness upon disposition from the ED, with 19 (48%) patients admitted to the hospital. Conclusion To our knowledge, this study represents the first description of patients diagnosed with HGA (and ehrlichiosis) in the ED setting. Because of the inherent testing bias, further study is needed to establish the true ED prevalence of HGA in highly endemic regions. Notably, only 23% reported either a tick bite or tick exposure, highlighting the need to consider this for diagnosis in patients presenting to the ED with consistent symptoms and laboratory findings in endemic areas. Further study might explore whether there exists a collection of laboratory findings that could accurately identify HGA in ED patients. Disclosures All authors: No reported disclosures.

scholarly journals A Traumatic Tick Bite: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 210-213
Author(s):  
Daniel Finnin ◽  
Christopher Hanowitz
Keyword(s):  
Case Report ◽  
Symptomatic Improvement ◽  
Tick Bite ◽  
Facial Trauma ◽  
Laboratory Findings ◽  
Human Granulocytic Anaplasmosis ◽  
Presenting Symptoms ◽  
Granulocytic Anaplasmosis ◽  
Prophylactic Dose ◽  
Tick Borne Disease

Introduction: Human granulocytic anaplasmosis is a tick-borne disease with an increasing incidence associated with morbidity and mortality. Uncertainty remains whether a prophylactic dose of doxycycline is effective in prevention. Case Report: We present a case of an 80-year-old female with syncope, resultant facial trauma, and fever two weeks after a tick bite for which she received prophylaxis. Workup revealed anaplasmosis, and treatment led to symptomatic improvement. Conclusion: We review the presenting symptoms, laboratory findings, and treatment of anaplasmosis, as well as give caution about the limitations in prescribing a prophylactic dose of doxycycline following a tick bite.

Assessing the risk of human granulocytic anaplasmosis and lyme borreliosis after a tick bite in Bavaria, Germany

2015 ◽  
Vol 305 (7) ◽  
pp. 736-741 ◽  
Author(s):  
Beatrix von Wissmann ◽  
Wolfgang Hautmann ◽  
Andreas Sing ◽  
Cecilia Hizo-Teufel ◽  
Volker Fingerle
Keyword(s):  
Lyme Borreliosis ◽  
Tick Bite ◽  
Human Granulocytic Anaplasmosis ◽  
Granulocytic Anaplasmosis

A Team-Based Approach to Autopsy Education: Integrating Anatomic and Clinical Pathology at the Rotation Level

2014 ◽  
Vol 138 (3) ◽  
pp. 322-327 ◽  
Author(s):  
Tiffany Michele Hébert ◽  
Sara Maleki ◽  
Ljiljana V. Vasovic ◽  
Jeffrey L. Arnold ◽  
Jacob J. Steinberg ◽  
...  
Keyword(s):  
New York ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Clinical Pathology ◽  
Holistic Approach ◽  
Final Diagnosis ◽  
Perceived Usefulness ◽  
Final Report ◽  
Laboratory Findings ◽  
Depth Analysis

Context.—Pathology residency training programs should aim to teach residents to think beyond the compartmentalized data of specific rotations and synthesize data in order to understand the whole clinical picture when interacting with clinicians. Objective.—To test a collaborative autopsy procedure at Montefiore Medical Center (Bronx, New York), linking residents and attending physicians from anatomic and clinical pathology in the autopsy process from the initial chart review to the final report. Residents consult with clinical pathology colleagues regarding key clinical laboratory findings during the autopsy. This new procedure serves multiple functions: creating a team-based, mutually beneficial educational experience; actively teaching consultative skills; and facilitating more in-depth analysis of the clinical laboratory findings in autopsies. Design.—An initial trial of the team-based autopsy system was done from November 2010 to December 2012. Residents were then surveyed via questionnaire to evaluate the frequency and perceived usefulness of clinical pathology autopsy consultations. Results.—Senior residents were the most frequent users of clinical pathology autopsy consultation. The most frequently consulted services were microbiology and chemistry. Eighty-nine percent of the residents found the clinical pathology consultation to be useful in arriving at a final diagnosis and clinicopathologic correlation. Conclusion.—The team-based autopsy is a novel approach to integration of anatomic and clinical pathology curricula at the rotation level. Residents using this approach develop a more holistic approach to pathology, better preparing them for meaningful consultative interaction with clinicians. This paradigm shift in training positions us to better serve in our increasing role as arbiters of outcomes measures in accountable care organizations.

scholarly journals An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029261 ◽  
Author(s):  
Brenda Lynch ◽  
John Browne ◽  
Claire Mary Buckley ◽  
Orla Healy ◽  
Paul Corcoran ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
North East ◽  
The North ◽  
Number Of Patients ◽  
Geographical Regions ◽  
The Impact

ObjectivesTo understand the impact of emergency department (ED) reconfiguration on the number of patients waiting for hospital beds on trolleys in the remaining EDs in four geographical regions in Ireland using time-series analysis.SettingEDs in four Irish regions; the West, North-East, South and Mid-West from 2005 to 2015.ParticipantsAll patients counted as waiting on trolleys in an ED for a hospital bed in the study hospitals from 2005 to 2015.InterventionThe system intervention was the reconfiguration of ED services, as determined by the Department of Health and Health Service Executive. The timing of these interventions varied depending on the hospital and region in question.ResultsThree of the four regions studied experienced a significant change in ED trolley numbers in the 12-month post-ED reconfiguration. The trend ratio before and after the intervention for these regions was as follows: North-East incidence rate ratio (IRR) 2.85 (95% CI 2.04 to 3.99, p<0.001), South IRR 0.68 (95% CI 0.51 to 0.89, p=0.006) and the Mid-West IRR 0.03 (95% 1.03 to 2.03, p=0.03). Two of these regions, the South and the Mid-West, displayed a convergence between the observed and expected trolley numbers in the 12-month post-reconfiguration. The North-East showed a much steeper increase, one that extended beyond the 12-month period post-ED reconfiguration.ConclusionsFindings suggest that the impacts of ED reconfiguration on regional level ED trolley trends were either non-significant or caused a short-term shock which converged on the pre-reconfiguration trend over the following 12 months. However, the North-East is identified as an exception due to increased pressures in one regional hospital, which caused a change in trend beyond the 12-month post reconfiguration.

Annual Meeting of the (American) African Studies Association

1969 ◽  
Vol 7 (2) ◽  
pp. 319-322
Author(s):  
Helen Kitchen
Keyword(s):  
New York ◽  
Annual Meeting ◽  
Pacific Coast ◽  
The United States ◽  
African Studies ◽  
North East ◽  
The North ◽  
The Pacific ◽  
Middle West ◽  
The University

The membership of the African Studies Association now numbers 1,731— 734 fellows, 618 associates, and 379 student associates. Some 700 of these participated in the eleventh annual meeting of the Association. Although attendance was considerably below the 1,300 registered at the New York Hilton in 1967 and the nearly 1,000 who made their way to the University of Indiana in 1966, there is no indication that this reflects a declining interest in African studies in the United States. Rather, the A.S.A. custom of bringing its annual meetings in turn to scholars in the north-east, on the Pacific coast, and in the Middle West results in predictable fluctations in registration.

scholarly journals Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

BMJ ◽  
2020 ◽  
pp. m1996 ◽  
Author(s):  
Michael G Argenziano ◽  
Samuel L Bruce ◽  
Cody L Slater ◽  
Jonathan R Tiao ◽  
Matthew R Baldwin ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Symptom Onset ◽  
Medical Center ◽  
Kidney Injury ◽  
Bimodal Distribution ◽  
Presenting Symptoms

Abstract Objective To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units. Design Retrospective manual medical record review. Setting NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City. Participants The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records. Main outcome measures Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. Results Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital. Conclusions Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.

scholarly journals Timber Supply Projections for Northern New England and New York: Integrating a Market Perspective

2003 ◽  
Vol 20 (4) ◽  
pp. 175-185 ◽  
Author(s):  
Paul E. Sendak ◽  
Robert C. Abt ◽  
Robert J. Turner
Keyword(s):  
New York ◽  
New England ◽  
Timber Harvest ◽  
Forest Resource ◽  
Reference Case ◽  
Growing Stock ◽  
North East ◽  
The North ◽  
Long Run ◽  
Atlas Model

Abstract The North East State Foresters Association (NEFA) commissioned a study that resulted in the publication of a report titled, “A Forest Resource Model of the States of New York, Vermont, New Hampshire, and Maine.” In this article we used the integrated NEFA computer simulation framework to go beyond the reported results and further explore the effects on the forest resource in terms of timber harvest, inventory, and price under various market and demand assumptions. Five scenarios were run through the integrated SRTS-ATLAS model to project long-run effects on timber inventory (growing stock) and price. Besides reflecting differing assumptions about demand and supply, these scenarios defined different markets, thus affecting how the wood harvest was allowed to move across the region in response to demand. Regionally, at the end of the 50 yr projection period, cubic-foot growth and harvest were approximately in balance in the Reference Case, the scenario that we felt was most likely. Initial inventory on all timberland was 66.7 billion ft3. By 2050, inventory volume increased 13% to 75.4 billion ft3. Net growth declined over the 50 yr period from 35.3 to 32.1 ft3 ac-1 yr-1, while harvest increased from 26.6 to 31.9 ft3 ac-1 yr-1. Regional real price increased approximately 1.1% yr-1 over the period. Changes in the resource situation in one state affect the situation in the other states. There is a mutual dependence in markets that policy makers need to recognize. The integration of a market module into the NEFA modeling process added the interplay of market forces and improved upon the policy information available from the model.

scholarly journals Abundance of Ixodes persulcatus ticks in Komi Republic as a function of an air temperature

2020 ◽  
Vol 9 (5-6) ◽  
pp. 811-816 ◽  
Author(s):  
A. A. Tronin ◽  
N. K. Tokarevich ◽  
B. R. Gnativ
Keyword(s):  
Air Temperature ◽  
Komi Republic ◽  
Tick Bite ◽  
Stable Phase ◽  
Tick Population ◽  
Ixodes Persulcatus ◽  
North East ◽  
The North ◽  
Administrative Units ◽  
The Impact

The sharp rising incidence of tick-borne encephalitis (TBE) in Komi Republic at the North-east of European Russia was recorded last decades. Tick-bite incidence also was grown. Rapid rise of TBE incidence growth and Ixodidae ticks depends on a number of factors, and the impact of climate change being one of them. Ixodes persulcatus ticks is considered as a main vector of TBE in Komi. Our objective is to estimate the influence of air temperature change on the tickbite incidence and Ixodes persulcatus population in Komi. Komi Republic is located near the Polar circle where the northern frontier of Ixodes persulcatus ticks situated and we expected the growth of tick’s population. The number of Komi inhabitants seeking medical care after tick bites in 1992–2014 was considered. Gridded monthly air temperature data with grid size 0.5 degree were recalculated to temperature referred to Komi administrative units. The time series of annual number of tick victims from 1992 till 2014 and model air temperature from 1948 till 2016 for all Komi administrative units were compiled. We analyzed the data on tick-bite incidence in Komi administrative units in relation to changes in local annual average air temperature within the study area. The linear dependence of the tick-bite incidence on air temperature was established when of the tick-bite incidence is represented in logarithm form. The tick population depends not only on temperature but humidity, landcover and hosts. Described areas of Komi belong to humid climate, where precipitations exceed evaporation. Most of the Komi territory is covered by taiga with underwood, grass and bush. Hosts of the first and the major levels are represented by birds and rodents. The dependence of tick-bite incidence and temperature looks like “Malthus’s law”, but the development of population depends on temperature not on time. The exponential growth in the nearest future will ceased and the population will proceed to stable phase. Ticks population in Komi Republic is moving to the North and the air temperature determines the dynamics of population.

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