scholarly journals Choroidal Neovascularization and Macular Hemorrhage: Real-World Experience During the New York City COVID-19 Lockdown

2021 ◽  
pp. 247412642199366
Author(s):  
Kyle D. Kovacs ◽  
Luis A. Gonzalez ◽  
M. Abdallah Mahrous ◽  
Anton Orlin ◽  
Thanos D. Papakostas ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
York City ◽  
Anticoagulation Therapy ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Individual Risk ◽  
Specific Risk ◽  
Macular Hemorrhage

Purpose: This work reviews ocular, systemic, and demographic factors contributing to presentation of choroidal neovascular membrane (CNVM)–associated macular hemorrhage after the New York City coronavirus disease 2019 (COVID-19) lockdown. Methods: A retrospective, consecutive case series was conducted of all established patients presenting with macular hemorrhage between March 22, 2020, and August 10, 2020. Results: Fourteen patients (mean age 82.2 years) were evaluated. Ten patients had active CNVMs, 1 had an inactive lesion that was last injected 2 years prior, and 3 had new conversions from nonexudative age-related macular degeneration. In the actively treated CNVM group there was a delay in expected follow-up from 50.4 days to 125 days. Eight patients with previously active CNVM (73%) had a history of prior macular hemorrhage. Eight patients (57%) were on some form of antiplatelet or anticoagulation therapy. Twelve patients (86%) had COVID-19–specific risk factors besides age, and all but 1 patient (93%) delayed care without discussion with a physician. Ten patients (71%) had more than 1 week of symptoms prior to presentation. Twelve patients (86%) had signs of CNVM on prior optical coherence tomography. Conclusions: Adequate documentation of potential risks for hemorrhage (particularly prior hemorrhage or presence of subclinical type 1 CNVM), as well as COVID-19–specific risk factors, would aid triage of clinic appointments in future lockdowns. High-risk patients would likely benefit from direct physician communication discussing their individual risk profiles to alleviate anxiety over clinic visits and communicate their risk of severe vision loss.

scholarly journals Incidence of Thrombosis and Associated Risk Factors in Hospitalized COVID-19 Patients in a New York City Hospital System

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-33
Author(s):  
Poy P. Theprungsirikul ◽  
Sunil E. Saith
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
York City ◽  
Smoking Status ◽  
Thrombotic Event ◽  
Case Series ◽  
Acute Limb Ischemia ◽  
City Hospital ◽  
Hospital System

Introduction: As of August 10, 2020, there have been over 5 million cases of the 2019 novel coronavirus disease (COVID-19) in the United States, resulting in 162,000 deaths. New York City became the first epicenter, with several case series based on over 56,000 hospitalizations and 18,900 deaths. These case series expanded our understanding of a broader clinical spectrum of COVID-19, extending beyond the initial descriptions of a viral pneumonia. This clinical spectrum has included arterial and venous thrombotic events. Factors upon admission, which are associated with development of thrombosis in hospitalized COVID-19 patients is less well defined. Our aim is to characterize the incidence of thrombosis and the associated clinical and demographic risk factors of patients hospitalized across a New York City hospital system. Methods: We conducted a retrospective observational study of all patients, age 18 and older, hospitalized with a reverse transcriptase-polymerase chain reaction (RT-PCR) confirming severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between March 13 and April 4, 2020 in two hospitals in New York City. Clinical demographics, admission labs and medications prior to admission were collected. Thrombotic events were identified manually by chart review and were defined as experiencing arterial and/or venous thrombotic events, including pulmonary embolism (PE), deep vein thrombosis (DVT), cerebrovascular accident (CVA), myocardial infarction (MI), acute limb ischemia, and splenic infarct, among others. Results: There were 1,352 patients hospitalized during the study period. Overall median age was 62 years (IQR: 49-72), with 455 females (33.7%). There were 160 (11.8%) thrombotic events, including 102 with venous thromboembolism (VTE), 45 with PE, 69 with DVT, 32 with CVA and 55 with other thrombotic events (e.g. MI, acute limb ischemia, and splenic infarct). Females were 46% less likely than males to experience a thrombotic event (OR: 0.54 [CI: 0.36-0.79]). Patients who racially self-identify as Asian or Pacific Islander were observed to have a 2.06 odds compared to other races of having a thrombotic event with COVID-19 (95%[CI: 1.27-3.34]). Age, admission BMI, ethnicity, smoking status, and comorbidities were not associated with the incidence of thrombosis during hospitalization. Thrombotic events were associated with higher mortality in hospitalized COVID-19 patients (35% vs 25.3%, p = 0.009). Conclusion: Traditional risk factors (age, obesity, ethnicity, smoking status, and comorbidities) were not associated with an increased risk for thrombotic events in COVID-19 patients, while admission laboratory values (d-dimer, ESR, CRP, and ferritin) among patients experiencing an event were significantly different, highlighting the impact of the cytokine storm in mediating thrombotic events. Since the incidence of thrombosis associated with COVID-19 infection may vary according to clinical demographics, further investigation to identify high risk patients may enable us to consider the role of adjunctive treatment, such as therapeutic coagulation. Disclosures No relevant conflicts of interest to declare.

scholarly journals A risk index for COVID-19 severity is associated with COVID-19 mortality in New York City

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wil Lieberman-Cribbin ◽  
Naomi Alpert ◽  
Raja Flores ◽  
Emanuela Taioli
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
York City ◽  
Underserved Populations ◽  
Risk Index ◽  
Data Repository ◽  
Severe Illness ◽  
Mortality Data ◽  
Cross Sectional

Abstract Background New York City (NYC) was the epicenter of the COVID-19 pandemic, and is home to underserved populations with higher prevalence of chronic conditions that put them in danger of more serious infection. Little is known about how the presence of chronic risk factors correlates with mortality at the population level. Here we determine the relationship between these factors and COVD-19 mortality in NYC. Methods A cross-sectional study of mortality data obtained from the NYC Coronavirus data repository (03/02/2020–07/06/2020) and the prevalence of neighborhood-level risk factors for COVID-19 severity was performed. A risk index was created based on the CDC criteria for risk of severe illness and complications from COVID-19, and stepwise linear regression was implemented to predict the COVID-19 mortality rate across NYC zip code tabulation areas (ZCTAs) utilizing the risk index, median age, socioeconomic status index, and the racial and Hispanic composition at the ZCTA-level as predictors. Results The COVID-19 death rate per 100,000 persons significantly decreased with the increasing proportion of white residents (βadj = − 0.91, SE = 0.31, p = 0.0037), while the increasing proportion of Hispanic residents (βadj = 0.90, SE = 0.38, p = 0.0200), median age (βadj = 3.45, SE = 1.74, p = 0.0489), and COVID-19 severity risk index (βadj = 5.84, SE = 0.82, p <  0.001) were statistically significantly positively associated with death rates. Conclusions Disparities in COVID-19 mortality exist across NYC and these vulnerable areas require increased attention, including repeated and widespread testing, to minimize the threat of serious illness and mortality.

Clinical and Demographic Risk Factors for COVID-19 during Delivery Hospitalizations in New York City

2021 ◽  
Author(s):  
Desmond Sutton ◽  
Timothy Wen ◽  
Anna P. Staniczenko ◽  
Yongmei Huang ◽  
Maria Andrikopoulou ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
Logistic Regression ◽  
York City ◽  
Demographic Data ◽  
Outcome Data ◽  
Demographic Risk ◽  
Demographic Risk Factors ◽  
Zip Code

Objective This study was aimed to review 4 weeks of universal novel coronavirus disease 2019 (COVID-19) screening among delivery hospitalizations, at two hospitals in March and April 2020 in New York City, to compare outcomes between patients based on COVID-19 status and to determine whether demographic risk factors and symptoms predicted screening positive for COVID-19. Study Design This retrospective cohort study evaluated all patients admitted for delivery from March 22 to April 18, 2020, at two New York City hospitals. Obstetrical and neonatal outcomes were collected. The relationship between COVID-19 and demographic, clinical, and maternal and neonatal outcome data was evaluated. Demographic data included the number of COVID-19 cases ascertained by ZIP code of residence. Adjusted logistic regression models were performed to determine predictability of demographic risk factors for COVID-19. Results Of 454 women delivered, 79 (17%) had COVID-19. Of those, 27.9% (n = 22) had symptoms such as cough (13.9%), fever (10.1%), chest pain (5.1%), and myalgia (5.1%). While women with COVID-19 were more likely to live in the ZIP codes quartile with the most cases (47 vs. 41%) and less likely to live in the ZIP code quartile with the fewest cases (6 vs. 14%), these comparisons were not statistically significant (p = 0.18). Women with COVID-19 were less likely to have a vaginal delivery (55.2 vs. 51.9%, p = 0.04) and had a significantly longer postpartum length of stay with cesarean (2.00 vs. 2.67days, p < 0.01). COVID-19 was associated with higher risk for diagnoses of chorioamnionitis and pneumonia and fevers without a focal diagnosis. In adjusted analyses, including demographic factors, logistic regression demonstrated a c-statistic of 0.71 (95% confidence interval [CI]: 0.69, 0.80). Conclusion COVID-19 symptoms were present in a minority of COVID-19-positive women admitted for delivery. Significant differences in obstetrical outcomes were found. While demographic risk factors demonstrated acceptable discrimination, risk prediction does not capture a significant portion of COVID-19-positive patients. Key Points

scholarly journals Estimation of HIV Prevalence, Risk Factors, and Testing Frequency among Sexually Active Men Who Have Sex with Men, Aged 18–64 Years—New York City, 2002

2007 ◽  
Vol 84 (2) ◽  
pp. 212-225 ◽  
Author(s):  
Susan E. Manning ◽  
Lorna E. Thorpe ◽  
Chitra Ramaswamy ◽  
Anjum Hajat ◽  
Melissa A. Marx ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
York City ◽  
Hiv Prevalence ◽  
Sexually Active ◽  
Testing Frequency ◽  
Sex With Men

Cardiovascular Disease Risk Factors Among Immigrant and US-Born Adults in New York City

2021 ◽  
pp. 003335492110075
Author(s):  
Claudia Chernov ◽  
Lisa Wang ◽  
Lorna E. Thorpe ◽  
Nadia Islam ◽  
Amy Freeman ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
New York ◽  
New York City ◽  
Health Insurance ◽  
York City ◽  
The United States ◽  
Nutrition Examination Survey ◽  
Health And Nutrition

Objectives Immigrant adults tend to have better health than native-born adults despite lower incomes, but the health advantage decreases with length of residence. To determine whether immigrant adults have a health advantage over US-born adults in New York City, we compared cardiovascular disease (CVD) risk factors among both groups. Methods Using data from the New York City Health and Nutrition Examination Survey 2013-2014, we assessed health insurance coverage, health behaviors, and health conditions, comparing adults ages ≥20 born in the 50 states or the District of Columbia (US-born) with adults born in a US territory or outside the United States (immigrants, following the National Health and Nutrition Examination Survey) and comparing US-born adults with (1) adults who immigrated recently (≤10 years) and (2) adults who immigrated earlier (>10 years). Results For immigrant adults, the mean time since arrival in the United States was 21.8 years. Immigrant adults were significantly more likely than US-born adults to lack health insurance (22% vs 12%), report fair or poor health (26% vs 17%), have hypertension (30% vs 23%), and have diabetes (20% vs 11%) but significantly less likely to smoke (18% vs 27%) (all P < .05). Comparable proportions of immigrant adults and US-born adults were overweight or obese (67% vs 63%) and reported CVD (both 7%). Immigrant adults who arrived recently were less likely than immigrant adults who arrived earlier to have diabetes or high cholesterol but did not differ overall from US-born adults. Conclusions Our findings may help guide prevention programs and policy efforts to ensure that immigrant adults remain healthy.

Risk Factors for New Neurological Diagnoses in Hospitalized COVID-19 Patients: A Case-Control Study in New York City

2021 ◽  
Author(s):  
Kiran Thakur ◽  
Victoria T. Chu ◽  
Christine Hughes ◽  
Carla Y. Kim ◽  
Shannon Fleck-Dardarian ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
York City ◽  
Case Control Study ◽  
Case Control ◽  
Control Study

scholarly journals Sex-related differences in the clinical presentation and risk factors for mortality in patients hospitalized with Coronavirus Disease 2019 in New York City

2021 ◽  
Author(s):  
Jyoti S Mathad ◽  
Myung Hee Lee ◽  
Andrea Chalem ◽  
Melissa K Frey ◽  
Eloise Chapman-Davis ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
Viral Load ◽  
York City ◽  
Clinical Presentation ◽  
Independent Predictor

Abstract We evaluated sex-related differences in symptoms and risk factors for mortality in 4798 patients hospitalized with Covid-19 in New York City. When adjusted for age and comorbidities, being male was an independent predictor of death with mortality significantly higher than females, even with low SARS-CoV-2 viral load at admission.

scholarly journals Factor XI Deficiency in Pregnant Women: A Case-Series from a New York City Hospital

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 16-16
Author(s):  
Guilherme Sacchi De Camargo Correia ◽  
Sridevi Rajeeve ◽  
Lawrence Cytryn
Keyword(s):  
New York ◽  
New York City ◽  
Blood Loss ◽  
Pregnant Women ◽  
York City ◽  
Outpatient Service ◽  
Case Series ◽  
Neuraxial Block ◽  
Pregnancy And Delivery ◽  
The Mean

Factor XI (FXI) deficiency is a rare bleeding disorder. In the general population, prevalence is estimated to be 1:1 million people for the homozygous presentation (PMID: 25100430). Nonetheless, in individuals of Ashkenazi and Iraqi Jewish ancestry, the prevalence of heterozygous cases is approximately 8% (PMID: 7811996). However, these numbers may be underestimates, as some patients are asymptomatic and, so, not accounted for. Pregnant women are a special population, as FXI deficiency may pose an increased risk during pregnancy and delivery. This study describes the experience of a General Hematology Outpatient Service to which pregnant women with FXI deficiency are referred. This case series aims to describe the clinical course of these patients, and any complications and interventions they may have experienced during pregnancy and delivery. This retrospective study identified a group of 49 patients with FXI deficiency who were evaluated by a single practitioner at the Hematology Outpatient Service at Mount Sinai West, in New York City, between October 2016 and February 2020. Patients were found to be FXI deficient on routine genetic screening early in their obstetric care. Their charts were reviewed, including epidemiological data, notes from Hematology and Obstetric Clinics and from the admission for delivery and laboratory results. Four patients were excluded from the final analysis: 3 who were not pregnant, and 1 who did not have FXI deficiency. Patients were seen in by the Hematology Service at least once during their pregnancy. FXI activity was measured at least twice during pregnancy: at the initial visit, and at about gestational week 37. The data were analyzed to obtain the mean and standard deviation for the most relevant clinical parameters. A comparison between FXI activity at the first visit and at last visit near term was made with a paired T-test. The included group of 45 patients presented a mean age at delivery of 34.09 years (range 26-45 years). Genetic data was available for 42 patients, with 2.38% being homozygous. Ethnicities were described for 39 patients, and 71.79% were identified as Ashkenazi Jewish. Among 39 patients who had their FXI gene (gene NM_000128.3) mutations described, the c.901T&gt;C, p.F301L mutation was present in 61.54% of them. The mean FXI activity measured in the first appointment was 60.18%, (range 4-220%), while the mean FXI activity in week 37 of pregnancy was 52.08% (range 13-118%). When comparing the FXI activity on the first appointment and around week 37, no statistically significant difference was found (p=0.17). Four patients received preventive interventions on delivery. One patient was treated with Tranexamic Acid (TXA) and Fresh Frozen Plasma (FFP) transfusion due to a FXI activity of 21% on week 37, and received general anesthesia. Two patients received transfusion of FFP alone: 1 of them due to an elevated aPTT (57.4s) on delivery date, with no anesthesia on delivery; and the other one as a preventive measure in a patient with a FXI of 45% on week 37, but who was planned for a neuraxial block. A FXI activity of 40% is the cutoff for a neuraxial block by the Anesthesiology Department at our hospital. One patient was treated with TXA due to a borderline FXI activity of 42% and a personal history of bleeding on surgical procedures. She had an opioid patient-controlled analgesia on delivery. For the detailed data regarding mean blood loss on delivery, postpartum blood loss, and complete Hematologic and Obstetric data, see tables 1 and 2, and figures 1 and 2. Figure 3 presents a data comparison between the 2 most common genotypes observed. In our case series, no patient experienced bleeding complications during pregnancy or delivery. Monitoring FXI levels and aPTT throughout pregnancy and before delivery remains as the standard medical care (PMID: 27699729). The difference between FXI levels earlier in pregnancy and near delivery was not statistically significant, as noted in previous studies (PMID: 15199489). Checking FXI activity throughout pregnancy may not be necessary, and one measurement might be enough. Further study might be able to answer this question, as the optimal management of these patients remains a work in progress. Evidence for a reliable threshold FXI activity at which neuraxial anesthesia could be safely performed will be a valuable finding. Continuation of our study will allow for further data regarding the management of FXI deficient pregnant women. Disclosures No relevant conflicts of interest to declare.

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