scholarly journals Understanding the Link Between Obesity and Severe COVID-19 Outcomes: Causal Mediation by Systemic Inflammatory Response

2021 ◽  
Author(s):  
Andrea S Foulkes ◽  
Caitlin Selvaggi ◽  
Daniel Shinnick ◽  
Heidi Lumish ◽  
Eunyoung Kim ◽  
...  
Keyword(s):  
New York ◽  
Massachusetts General Hospital ◽  
Medical Center ◽  
Columbia University ◽  
Mediating Role ◽  
Inflammatory Pathways ◽  
Established Risk Factor ◽  
Causal Pathway ◽  
Therapeutic Opportunity ◽  
Nonobese Patients

Abstract Background Obesity is an established risk factor for severe COVID-19 outcomes. The mechanistic underpinnings of this association are not well-understood. Objective To evaluate the mediating role of systemic inflammation in obesity-associated COVID-19 outcomes. Methods This hospital-based, observational study included 3828 SARS-CoV-2-infected patients who were hospitalized February to May 2020 at Massachusetts General Hospital (MGH) or Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP). We use mediation analysis to evaluate whether peak inflammatory biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], D-dimer, ferritin, white blood cell count and interleukin-6) are in the causal pathway between obesity (BMI ≥ 30) and mechanical ventilation or death within 28 days of presentation to care. Results In the MGH cohort (n = 1202), obesity was associated with greater likelihood of ventilation or death (OR = 1.73; 95% CI = [1.25, 2.41]; P = 0.001) and higher peak CRP (P < 0.001) compared with nonobese patients. The estimated proportion of the association between obesity and ventilation or death mediated by CRP was 0.49 (P < 0.001). Evidence of mediation was more pronounced in patients < 65 years (proportion mediated = 0.52 [P < 0.001] vs 0.44 [P = 0.180]). Findings were more moderate but consistent for peak ESR. Mediation by other inflammatory markers was not supported. Results were replicated in CUIMC/NYP cohort (n = 2626). Conclusion Findings support systemic inflammatory pathways in obesity-associated severe COVID-19 disease, particularly in patients < 65 years, captured by CRP and ESR. Contextualized in clinical trial findings, these results reveal therapeutic opportunity to target systemic inflammatory pathways and monitor interventions in high-risk subgroups and particularly obese patients.

Emergency Utilization and Trends in a Community Dental Clinic in Northern Manhattan: A Retrospective Study

2020 ◽  
Vol 44 (3) ◽  
pp. 135-141
Author(s):  
Evan Cyrkin ◽  
Aaron Myers ◽  
Jaffer Shariff ◽  
Richard Yoon
Keyword(s):  
New York ◽  
Medical Center ◽  
Columbia University ◽  
Dental Clinic ◽  
Chi Square ◽  
Design Data ◽  
Frequency Distributions ◽  
Chi Square Test ◽  
Dental Records ◽  
First Time

Purpose: To evaluate utilization and trends associated with patients who presented with emergencies at a community dental clinic at Columbia University Medical Center, New York, NY. Study design: Data from deidentified dental records of patients aged 0–12 years old who presented as emergencies for oral and dental reasons for 2012, 2013, and 2014 were collected. Variables analyzed included demographic information, oral diagnosis, and current health status. Frequency distributions analysis, chi-square test and analysis of variance (ANOVA) test were performed using Stata 13.0. Results: There were 4,328 dental and oral-related emergencies with a mean age of 6-years-old. Approximately 50% were females, 71% were Hispanic, and 90% had Medicaid managed care. Most emergencies (49%) were caries-related, 41% were considered atraumatic in nature, and approximately 10% were traumatic. About 10% of patients presented with comorbidities and 37% were either first-time patients or patients that presented exclusively for emergencies. Acute tooth pain (45%) caused by dental caries was the most common chief complaint. The trends for emergency presentations showed a significant decrease (p<.001) between years 2012–2014 for caries-related visits and a significant increase (p<.001) between 2012–2013 and 2012–2014 for atraumatic visits. Conclusions: Caries-related dental diagnoses were more common than trauma-related diagnoses. The most common caries-related diagnosis was pulp necrosis for both primary and permanent dentitions while the most common traumarelated diagnosis was subluxation for the primary dentition and enamel-dentin fracture for the permanent dentition.

Small-Bowel Allograft Biopsies in the Management of Small-Intestinal and Multivisceral Transplant Recipients: Histopathologic Review and Clinical Correlations

2012 ◽  
Vol 136 (7) ◽  
pp. 761-771 ◽  
Author(s):  
Helen Remotti ◽  
Sukanya Subramanian ◽  
Mercedes Martinez ◽  
Tomoaki Kato ◽  
Margret S. Magid
Keyword(s):  
New York ◽  
Small Bowel ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Lymphoproliferative Disease ◽  
Close Monitoring ◽  
Columbia University ◽  
Barr Virus

Context.—Intestinal transplant has become a standard treatment option in the management of patients with irreversible intestinal failure. The histologic evaluation of small-bowel allograft biopsy specimens plays a central role in assessing the integrity of the graft. It is essential for the management of acute cellular and chronic rejection; detection of infections, particularly with respect to specific viruses (cytomegalovirus, adenovirus, Epstein-Barr virus); and immunosuppression-related lymphoproliferative disease. Objective.—To provide a comprehensive review of the literature and illustrate key histologic findings in small-bowel biopsy specimen evaluation of patients with small-bowel or multivisceral transplants. Data Sources.—Literature review using PubMed (US National Library of Medicine) and data obtained from national and international transplant registries in addition to case material at Columbia University, Presbyterian Hospital, and Mount Sinai Medical Center, New York, New York. Conclusions.—Key to the success of small-bowel transplantation and multivisceral transplantation are the close monitoring and appropriate clinical management of patients in the posttransplant period, requiring coordinated input from all members of the transplant team with the integration of clinical, laboratory, and histopathologic parameters.

Milton Packer, MD, Director, Center for Biostatistics and Clinical Science at UT Southwestern

2004 ◽  
Vol 52 (7) ◽  
pp. 421-424
Keyword(s):  
Heart Failure ◽  
New York ◽  
Health Care Policy ◽  
Clinical Investigation ◽  
Medical Center ◽  
Heart Association ◽  
Clinical Science ◽  
Columbia University ◽  
Cardiovascular Research ◽  
Editorial Boards

Milton Packer, MD, is the director of the Center for Biostatistics and Clinical Science and holder of The Gayle and Paul Stoffel Distinguished Chair in Cardiology. He is the former chief of the Division of Circulatory Physiology at the Columbia University College of Physicians and Surgeons and the past director of the Heart Failure Center at the Columbia-Presbyterian Medical Center in New York City. One of the leading experts in the pathophysiology and treatment of heart failure, Dr. Packer has made significant contributions to heart failure research and has been instrumental in the introduction of a number of new treatments. The author of more than 200 papers, he has won numerous honors for teaching and has lectured around the world on the treatment of heart failure, having been honored with a number of prestigious named lectureships. He has served or currently serves on the editorial boards of many major medical journals, including Circulation and the Journal of the American College of Cardiology. He has also been elected to a number of societies, including the American Society for Clinical Investigation. He is currently on the executive committees of both the American Heart Association and the American College of Cardiology and is past-president of the Heart Failure Society of America. Dr. Packer is a primary consultant to the National Institutes of Health and the US Food and Drug Administration on the management of heart failure and on matters related to cardiovascular research, drug development, and health care policy.

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