• Baxter Slattery posted an update 3 hours, 43 minutes ago

    Novel Coronavirus disease (COVID-19) has been widely described as the cause for a proinflammatory and hypercoagulable state. The inflammatory process involving the alveolar vascular endothelium in the respiratory system, is a determining factor for the onset of primary Pulmonary Artery Thrombosis (PAT) even in patients with heparin prophylactic treatment. Little is known about the efficacy of the anticoagulant therapy during the course of PAT caused by COVID-19. In this paper we describe the results obtained in patients with moderate COVID-19 disease, previously threated with prophylactic enoxaparin, who then received full Anticoagulant treatment after diagnosis of PAT. After three months Computed Tomography Pulmonary Angiography demonstrated a complete resolution of the vascular obstructive lesions in all patients, while all the coagulation tests were normal.Background The coronavirus disease 2019 pandemic is a major international public health crisis, which has led to over 3 million deaths as of April 2021. Several therapeutics have been tried for this deadly illness including antivirals, immunosuppressive agents and convalescent plasma (CP). In this study, we present our inner-city safety net hospital experience with CP therapy. Methods This was a retrospective chart review of hospitalized patients with confirmed COVID-19 who were treated with CP. Palbociclib in vivo Results A total of 60 patients received CP during the study period. The mean age for patients in this study was 58.95 years. The most common presenting symptoms were shortness of breath (85%) and cough (73%). Hypertension (65%) and diabetes mellitus (55%) were the most common comorbidities in our patients. In our multivariate regression analysis, male sex, nausea and loss of appetite at presentation were associated with improvement in oxygenation after CP. Total survival time, history of obstructive airway disease, home use of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers were associated with decreased survival, whereas Hispanic ethnicity showed a trend towards lower survival after CP therapy. Conclusions Our study highlights several important characteristics of inner-city safety net hospital patient population who might benefit from CP therapy.Background Given that nearly a quarter of the US physician workforce are international medical graduates (IMGs), many of whom remain on temporary work visas for prolonged periods due to processing delays, the pandemic has posed unique challenges to these frontline workers and has arbitrarily limited our physician workforce. Methods This is cross-sectional survey data obtained from IMGs on temporary work visas pertaining to their role in healthcare, impact of visa-related restrictions on their professional and personal lives was sent to the participants. Results A total of 2630 IMGs responded to the survey. Most of the respondents (1493, 56.8%) were physicians in active practice, with Internal Medicine (1684, 65.7%) being the predominant specialty encountered. 64.1% were practicing in Medically Underserved Areas (MUA) or Health Professional Shortage Areas (HPSA), with 45.6% practicing in a rural area. Nearly 89% of respondents had been involved with direct care of COVID-19 patients, with 63.7% assuming administrative responsibilities for COVID-19 preparedness. 261 physicians (11.5%) were subject to quarantine, while 28 (1.2%) reported a confirmed COVID-19 infection. 93% physicians expressed inability to serve in COVID-19 surge areas due to visa-related restrictions, while 57% had been approached by recruiters due to staffing shortages. 72% physicians reported that their families would be at risk for deportation in case of their disability or death. Most respondents (98.8%) felt that permanent resident status would help alleviate the above concerns. Conclusion A significant proportion of the US physician workforce is adversely impacted by work-based visa restrictions and processing backlog. Mitigating these restrictions could significantly bolster the current physician workforce and prove beneficial in our response to the COVID-19 pandemic.Background The COVID-19 is an emerging infectious disease that impacted HealthCare System worldwide and patients undergoing elective surgical procedures is associated with a high mortality rate and a complicated perioperative course. Methods A retrospective observational study, the research design was conducted utilizing the RedCap ACS COVID-19 Registry and Cerner EMR. The intent of this design is to create statistical information about confirmed COVID-19 cases admitted in an academic institution in Brooklyn, New York from March to May 2020. Results A total of 1413 patients were included in the final analysis. Of the 1413 patients, 520 Expired, 40.5% were males, and 33% were females, p = 0.004. Male patients had high mortality at a rate that is statistically significant. For race of those ‘Expired’, 38.3% white, 34.2% Black, 28.2% Asian, and Unknown 43.6%, showing statistical significance at p = 0.050. The most common co-morbidities for those not-Expired versus Expired DM, 44.6% expired versus 55.6% not-expired, HTN, 77.1% versus 22.9%, and CAD, 47.9% versus 52.1%. Comparing the data of COVID-19 patients without surgery and with those who had surgery, it was observed that 53% of those who did not have surgery went ‘Home’ versus 38.6%, of those with surgery who could not. Further examining those without surgery versus those with surgery 3.4% versus 13.3% discharge to ‘Rehab’, for ‘Other discharge’ destinations 5.9% versus 14.5%, and for ‘Expired’ 37.1% versus 31.3%. Overall, the presence of surgery had a significant impact on COVID-19 patients discharge destinations at p = less then 0.001. Conclusions The implications of change in the setting of our current clinical practice therefore require forbearance, training, preparedness, and education to efficiently maintain our essential surgical services.Background The Thrombolysis in Myocardial Infarction (TIMI) score is considered a method for early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI). It is composed of seven factors and if present, each factor contributes a value of one point toward the TIMI risk score, making it a simple tool that does not require differential weights for each factor. A higher score implies a higher likelihood of adverse cardiac events and/or risk of mortality. A TIMI risk score ≥3 recommends early invasive management with cardiac angiography and revascularization. As per CDC study in 2014, Americans living in rural areas are more likely to die from leading causes such as cardiovascular diseases. An estimated number 25,000 deaths than their urban counterparts, which coincide with a TIMI risk score of ≥3, potentially limit the utility of the TIMI risk score in risk stratification in rural catherization laboratories. The objective of this study was to assess the reliability of TIMI score as early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in rural hospital.