HUBUNGAN KADAR KOLESTEROL DENGAN KEJADIAN KLAUDIKASIO KEHAMILAN DI WILAYAH KERJA PUSKESMAS LINTAU BUO UTARA

Pada dasarnya kolesterol menyerang semua bagian tubuh yang memiliki pembuluh darah. Kolesterol bisa menyumbat pembuluh darah jantung, tapi bisa juga mempengaruhi kaki.2,3 Menurut Direktur Terapi di Montefiore Medical Centre, sebanyak 12 juta orang di Amerika memiliki kolesterol yang menyerang bagian kaki. Berita baiknya, penyakit ini bisa diobati.1,4Ditenggarai salah satu penyebab klaudikasio pada ibu hamil adalah penyumbatan aliran darah oleh kolesterol.5 Tujuan penelitian ini adalah untuk mengetahui hubungan kadar kolesterol dengan kejadian klaudikasio selama kehamilan. Penelitian ini merupakan penelitian observasional dengan desain penelitian cross-sectional. Jumlah sampel sebanyak 30 responden yang dipilih secara consecutive sampling. Kemudian hasil pemeriksaan akan dilakukan analisis bivariat dengan uji chi-square. Adapun hasil penelitian menyatakan bahwa terdapat hubungan bermakna antara kadar kolesterol dengan kejadian klaudikasio selama kehamilan dengan nilai p 0,001 dan dapat ditarik kesimpulan semakin tinggi kolesterol selama kehamilan maka semakin tinggi risiko mengalami klaudikasio selama kehamilan.

Open craniofacial reconstruction for coronal craniosynostosis

Here the authors demonstrate open craniofacial reconstruction for the correction of craniosynostosis, using techniques refined by Dr. James T. Goodrich at Montefiore Medical Center. They present the operative management of a case of unilateral coronal synostosis in a 12-month-old child, who presented with right forehead prominence and calvarial asymmetry. The patient had an excellent correction of her head shape with an uneventful postoperative course. This video highlights the authors’ multidisciplinary approach to complete cranial vault remodeling, utilizing a Marchac bandeau construct and split calvarial graft mosaic technique. The video can be found here: https://vimeo.com/519489422.

Teamwork and Leadership Under Fire at the Epicenter of the COVID-19 Epidemic in the Bronx

The first Covid-19 patient was admitted to Montefiore Medical Center (MMC) on March 10, 2020. Soon thereafter there was a rapid and exponential surge of Covid-19 admissions to MMC that could have resulted in catastrophic consequences if MMC had been overwhelmed, as happened in Europe. To adjust to this crisis our institution, under the inspiring leadership of Dr. Philip Ozuah, President and CEO of Montefiore Medicine, adopted an “all hands on deck” approach, mobilizing our entire workforce to expand our units to accommodate the growing number of patients being admitted. Given that the internal medicine (IM) and ICU units are part of the department of medicine (DOM), the DOM was at the center of this mobilization. The DOM is the largest department at MMC and mobilizing it required careful planning, seamless teamwork, and strong leadership. To achieve that goal, we applied a framework that we designate the “3C framework,” denoting Coordination, Communication, and Collaboration. In this report we describe the many initiatives the Montefiore Einstein DOM implemented during the Covid-19 pandemic using the 3C framework. These included establishing the Medicine Covid-19 Taskforce to lead our efforts, starting a daily newsletter for up-to-date communications, rapidly expanding the ICU and IM units, converting most specialty inpatient consults to eConsults, coordinating research studies, and more. The goal of this report is to serve as a guide on how the 3C framework helped us organize, mobilize, and energize the department of medicine effectively and efficiently during this unprecedented crisis.

A Bronx Tale: Disparities in Access to Neurologic Telemedicine During the COVID-19 Pandemic

Objective:To determine whether there is a disparity in access to telemedical care that may be a function of socioeconomic status, language, or other demographic factors during the peak of the COVID-19 pandemic at a highly impacted urban center (Montefiore Medical Center) in Bronx, NY.Methods:We retrospectively investigated potential patient characteristics that might be associated with an increased likelihood of receiving a telephone visit as opposed to a televideo visit for patients followed in the pediatric neurology, adult epilepsy and general neurology practices at Montefiore Medical Center during the 30-day period starting April 2, 2020, at the peak of COVID-19 pandemic in New York.Results:We found that patients who had telephone encounters, as opposed to televideo encounters, were overall older, less likely to have commercial insurance, and more likely to have Medicaid. Among pediatric patients, a preferred language other than English was also associated with a higher proportion of telephone encounters. New patients in both the adult and pediatric groups were more likely to have televideo visits.Conclusions:Our findings identify demographic factors, including age, insurance type, and language preference, which may play a role in access to televideo encounters among neurology patients in an urban center during the COVID-19 pandemic. We suggest several potential practice, institution, and community-based interventions which might further expand access to televideo care for neurology patients.

Abstract 16489: Comparison of Severity of Illness at Presentation and Outcomes for Patients With Acute Cardiovascular Syndromes Before and During Covid-19 Pandemic

Introduction: The New York Governor Andrew M. Cuomo’s executive order N202.25 on March 7, 2020, canceled all elective, semi-urgent procedures, including cardiovascular interventions such as coronary angiography and angioplasty due to SARS- Cov2 (COVID 19) pandemic. New York City was devastated by COVID 19 infection carrying the highest incidence, prevalence, and mortality rates in the US. Importantly, a 4. 4.83-fold increase in death rate at home was reported. We hypothesized that the COVID19 surge postponed the patient's decision to seek medical attention leading to an increase in cardiovascular-related hospital mortality. Methods: We conducted a retrospective observational study examining the incidence, prevalence, complication rate, and mortality from cardiovascular diseases in hospitalized patients during COVID 19 surge. We performed a patient chart review of a cohort with acute cardiovascular events (STEMI, NSTEMI, Stroke, CHF) during the COVID 19 surge who were hospitalized at Montefiore Medical Center between March 7, 2020, and April 21, 2020, and compared it to a similar cohort from the preceding year (March 7, 2019 and April 21, 2019). Results: During the dates (March 7- April 21, 2020), there was a significant decrease in NSTEMI, stroke, and CHF admissions (P<0.05). (Figure 1) Respectively, fewer cardiac catheterization procedures were performed for patients presenting with NSTEMI, UA, and shock. There was no difference in the number of STEMI admissions. Troponin T levels at presentation were significantly higher (P<0.05), and increased prevalence of wall motion abnormalities and LVEF < 50% (P<0.05). Mortality for HF asdmissions was 20% in 2020 compared to 0.02% in 2019. Conclusions: Montefiore Medical Center admitted and treated significantly fewer patients with acute cardiovascular syndromes during the COVID19 surge. Non-COVID patients presented with delayed MI. All HF patients (COVID+Non-COVID) carried a significantly higher mortality rate.

Utilization & Barriers to Curative Therapies Among Adult Aplastic Anemia Patients in a Multiethnic Urban Underserved Cohort

Introduction Acquired Aplastic Anemia (AA) is a rare life-threatening immune-mediated bone marrow disorder. AlloHSCT is the only available curative therapy for SAA with a 3 year survival probability for adults between 72-80% in the United States. (D'Souza et all, Biol BMT 2020). The management of AA is complex and requires complicated regimens, recruitment of a BM donor, supportive care and close monitoring of hematopoietic response to therapy. Patients unable to follow closely with their physician or who lack sufficient social support are often deemed inappropriate candidates for BMT. The Bronx is one of the poorest urban counties in the US. 27.4% of Bronx residents live below the poverty line and 59% speak a language other than English at home. The socioeconomic circumstances for many Bronx residents present a multitude of health challenges that lead to poor health outcomes. Delivering the complex diagnosis and treatment strategies required for AA, a rare disease, can be particularly challenging for this population. Through this retrospective cohort study, we sought to find out the rate of utilization of curative therapies among patients with severe aplastic anemia in the Bronx, NY and to identify barriers to their care. We hypothesized that despite several social & financial barriers, SAA patients that can avail of IST +/- AlloHSCT at a tertiary care center will have similar survival trends as the national standard. Methods Our study used a data search tool called Clinical Looking Glass to identify adult patients diagnosed with AA at Montefiore Medical Center (MMC) between 2000 and 2018. Under an IRB approved protocol, we extracted all patients with a bone marrow biopsy performed between 2000 and 2018 and an ICD-9 diagnosis code of AA. Only patients aged 17 and above at the time of the index date (BM biopsy) were included. We also reviewed each chart to ensure the diagnosis of AA was confirmed by the BM biopsy. We performed a retrospective chart review of each patient in our cohort using our electronic medical records. Clinical data collected included patient demographic information, AA classification, date of diagnosis, date of last follow up or date of death, type of therapy received, and identification of socioeconomic barriers to receiving appropriate care. Results Thirty three adult patients (aged 17 and above at time of BM biopsy-confirmed diagnosis) were diagnosed with AA at Montefiore Medical Center between 2000 and 2018. Age at diagnosis ranged from 17-79, with a mean age of 36 and median age 28. Fifty five percent of patients were younger than 30 at the time of diagnosis. Forty two percent of patients were female and 57.6% were male. Fifty two percent of patients were African American or Black, 27.3% were Hispanic, 12.1% were White, and 9.1% were Asian or Asian Indian. Forty two percent of cases were non-severe, 18.2% were severe, and 36.4% were very severe. Additionally, approximately 70% of our cohort was unmarried. Thirty (90%) of the patients were treated with IST (CSA + ATG), and ten (30.3%) were also treated with eltrombopag. Of the 18 patients with severe and very severe disease, seven patients (38.9%) underwent AlloHSCT. Twenty five patients (76%) were noted to be alive at the time of data-cut off for analysis (March 2020), 4 of which were post-AlloHSCT. 45% of patients in our cohort noted significant social & financial barriers to their care. Discussion: Our study demonstrates that despite significant socio-economic barriers to care, adult patients with SAA that are treated with IST +/- AlloHSCT when indicated, have overall survival that equals the national standard. Notably, our patient cohort was more than 75% Black and Hispanic.Race in the US is strongly correlated to socioeconomic status, education, and health insurance status. Some specific social barriers were identified in provider notes. These included difficulty finding a donor match, recent immigration, housing & financial insecurity, difficulty keeping follow up appointments due to transportation issues, lack of adequate health insurance. We believe the first step toward addressing the inequities in AA treatment is the continued acknowledgement of social barriers to care and addressing them in a timely manner. Socio-demographic research should inform health policy and guide interventions to ultimately reduce inequities in access and treatment for rare diseases in some of the most vulnerable in our population. Figure Disclosures No relevant conflicts of interest to declare.

Infarction of the Splenium of the Corpus Callosum in the Age of COVID-19

Background and Purpose: Ischemic infarction of the corpus callosum is rare and infarction isolated to the corpus callosum alone rarer still, accounting for much <1% of ischemic stroke in most stroke registries. About half of callosal infarctions affect the splenium. Methods: During a 2-week period, at the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City, 4 patients at Montefiore Medical Center in the Bronx were found to have ischemic lesions of the splenium of the corpus callosum, 2 with infarction isolated to the corpus callosum. Results: All patients tested positive for COVID-19 and 3 had prolonged periods of intubation. All had cardiovascular risk factors. Clinically, all presented with encephalopathy and had evidence of coagulopathy and raised inflammatory markers. Conclusions: Infarction of the splenium of the corpus callosum is exceedingly rare and a cluster of such cases suggests COVID-19 as an inciting agent, with the mechanisms to be elucidated.

A-83 The Applicability of the Word Accentuation Test (WAT) in a Diverse Spanish Speaking Population: A Pilot Study

Objective A valid estimate of premorbid ability (PA) is important when attempting to identify cognitive decline. Measures of PA in English have been widely validated, but there is a lack of PA instruments for Spanish speakers. The findings of a pilot study assessing the feasibility of using the Word Accentuation Test (WAT) as a PA measure in a diverse, traditionally underserved, Spanish speaking population are described. Method The WAT was administered as part of comprehensive neuropsychological evaluations and neurobehavioral status exams (NBSE) completed with Spanish speaking patients at Montefiore Medical Center (MMC) in a 6-month period. Sixty-one patients completed the WAT- 12 as part of comprehensive testing (mean age 60 (SD 11.05) range 43-80, 67% female) and 49 during NBSEs within the context of multidisciplinary memory disorders clinics (mean age 74.35 (SD 8.60) range 51-93, 80% female). T-tests and correlations with WAT performances were completed. Results Overall, our population correctly read an average of 19.67 (SD 7.61) words. There was no statistical difference by gender or age, but years of education predicted WAT performance (p = .004). For those individuals who had comprehensive cognitive evaluations, WAT scores were correlated with performance on the vocabulary subtest of the EIWA-III (p = .003). All patients without severe dementia were able to complete the task. Conclusions Analysis of pilot data from our diverse Spanish population demonstrated that the WAT is an PA appropriate task that appears to have good correlation with years of education and vocabulary performance. Additional research is necessary to validate the measure in this cohort and other cohorts.