Medicine and Health Sciences Commons^™

Universal Testing For Coronavirus Disease 2019 In Pregnant Women Admitted For Delivery: Prevalence Of Peripartum Infection And Rate Of Asymptomatic Carriers At Four New York Hospitals Within An Integrated Healthcare System., M. J. Blitz, B. Rochelson, A. C. Rausch, R. Solmonovich, W. Shan, A. Combs, M. Nimaroff

Journal Articles

No abstract provided.

Implementation Of Telehealth In Radiation Oncology: Rapid Integration During Covid-19 And Its Future Role In Our Practice., A. Goenka, Daniel Ma, S. Teckie, C. Alfano, B. Bloom, J. Hwang, L. Potters

Journal Articles

Introduction: The widespread coronavirus disease 2019 (COVID-19) has resulted in significant changes in care delivery among radiation oncology practices and demanded the rapid incorporation of telehealth. However, the impact of a large-scale transition to telehealth in radiation oncology on patient access to care and the viability of care delivery are largely unknown. In this manuscript, we review our implementation and report data on patient access to care and billing implications. As telehealth is likely to continue after COVID-19, we propose a radiation oncology-specific algorithm for telehealth.

Material and Methods: In March 2020, our department began to use telehealth for all …

We May Develop Medications Effective Against Covid-19, But Can We Distribute Them Equitably?, D. J. Kersten, A. N. Makaryus

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No abstract provided.

Clinical Mortality In A Large Covid-19 Cohort: Observational Study., M. Jarrett, S. Schultz, J. Lyall, J. Wang, L. Stier, M. De Geronimo, K. Nelson

Journal Articles

BACKGROUND: Northwell Health, an integrated health system in New York, has treated more than 15,000 inpatients with COVID-19 at the US epicenter of the SARS-CoV-2 pandemic.

OBJECTIVE: We describe the demographic characteristics of patients who died of COVID-19, observation of frequent rapid response team/cardiac arrest (RRT/CA) calls for non-intensive care unit (ICU) patients, and factors that contributed to RRT/CA calls.

METHODS: A team of registered nurses reviewed the medical records of inpatients who tested positive for SARS-CoV-2 via polymerase chain reaction before or on admission and who died between March 13 (first Northwell Health inpatient expiration) and April 30, 2020, …

Impact Of Covid-19 Pandemic On Stemi Care: An Expanded Analysis From The United States., S. Garcia, L. Stanberry, C. Schmidt, S. Sharkey, M. Megaly, M. S. Albaghdadi, P. M. Meraj, R. Garberich, H. Khalili, T. D. Henry, +20 Additional Authors

Journal Articles

OBJECTIVE: To evaluate the impact of COVID-19 pandemic migitation measures on of ST-elevation myocardial infarction (STEMI) care.

BACKGROUND: We previously reported a 38% decline in cardiac catheterization activations during the early phase of the COVID-19 pandemic mitigation measures. This study extends our early observations using a larger sample of STEMI programs representative of different US regions with the inclusion of more contemporary data.

METHODS: Data from 18 hospitals or healthcare systems in the US from January 2019 to April 2020 were collecting including number activations for STEMI, the number of activations leading to angiography and primary percutaneous coronary intervention (PPCI), …

Comparison Of Clinical And Epidemiologic Characteristics Of Young Febrile Infants With And Without Sars-Cov-2 Infection., J. Leibowitz, W. Krief, S. Barone, K. A. Williamson, P. Goenka, S. Rai, S. Moriarty, P. Baodhankar, L. G. Rubin

Journal Articles

OBJECTIVE: To determine features that distinguish febrile young infants with SARS-CoV-2 infection.

STUDY DESIGN: Retrospective single-center study included febrile infantsChildren's Medical Center of Northwell Health, New Hyde Park, New York during March 1-April 30 of 2018, 2019, and 2020. Sociodemographic and clinical features were compared between those seen during the 2020 COVID-19 pandemic and previous years, as well as between SARS-CoV-2 infected infants and SARS-CoV-2 uninfected infants (SARS-CoV-2 negative or evaluated during 2018 and 2019).

RESULTS: In all, 124 febrile infantsidentified; 38 during the 2-month study period in 2018, 33 in 2019, and 53 in 2020. During 2020, fewer febrile …

Are Children With Sars-Cov-2 Infection At High Risk For Thrombosis? Viscoelastic Testing And Coagulation Profiles In A Case Series Of Pediatric Patients, M. Al-Ghafry, B. Aygun, A. Appiah-Kubi, A. Vlachos, G. Ostovar, C. Capone, T. Sweberg, N. Palumbo, P. Goenka, L. L. Wolfe, J. M. Lipton, S. S. Acharya

Journal Articles

© 2020 Wiley Periodicals LLC The coagulopathy of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well documented in adults, with increases in D-dimer and prothrombin time found to be strong predictors of mortality, and anticoagulation shown to decrease this mortality. Viscoelastic parameters such as elevations in maximum clot firmness (MCF) on rotational thromboelastometry (ROTEM) have correlated with a hypercoagulable state in adults with SARS-CoV-2. We report our experience in children infected with SARS-CoV-2, with noted elevations in D-dimer and MCF on ROTEM (indicating hypercoagulability). Exploration of viscoelastic testing to provide additional laboratory-based evidence for pediatric-specific risk assessment …

Initial Impact Of Covid-19 On Radiology Practices: An Acr/Rbma Survey, A. Malhotra, X. Wu, H. B. Fleishon, R. Duszak, E. Silva, G. B. Mcginty, C. Bender, B. Williams, J. J. Naidich, P. C. Sanelli, +3 Additional Authors

Journal Articles

© 2020 American College of Radiology Purpose: The coronavirus disease 2019 (COVID-19) pandemic affected radiology practices in many ways. The aim of this survey was to estimate declines in imaging volumes and financial impact across different practice settings during April 2020. Methods: The survey, comprising 48 questions, was conducted among members of the ACR and the Radiology Business Management Association during May 2020. Survey questions focused on practice demographics, volumes, financials, personnel and Northwell Health adjustments, and anticipation of recovery. Results: During April 2020, nearly all radiology practices reported substantial (56.4%-63.7%) declines in imaging volumes, with outpatient imaging volumes most …

Management Of Covid-19 Myopericarditis With Reversal Of Cardiac Dysfunction After Blunting Of Cytokine Storm: A Case Report., A. Li, Y. Garcia-Bengochea, R. Stechel, B. M. Azari

Journal Articles

Background:Coronavirus disease 2019 (COVID-19) is a syndrome that has been associated with multiple cardiac complications including myopericarditis. The pathophysiology and treatment for myopericarditis in the setting of COVID-19 infection is still under investigation. Case summary:We present a case of a 60-year-old male admitted for dyspnoea due to COVID-19. He developed new ST-segment elevation, elevated cardiac enzymes, severe left ventricular dysfunction, and high inflammatory markers in the setting of haemodynamic and respiratory collapse from the viral illness. He was diagnosed with COVID-19-induced myopericarditis. He showed rapid clinical improvement with a rapid wean off pressure support, resolution of electrocardiogram (ECG) findings, and …

Racial And Ethnic Disparity And Spatiotemporal Trends In Severe Acute Respiratory Syndrome Coronavirus 2 Prevalence On Obstetrical Units In New York., M. J. Blitz, B. Rochelson, L. Prasannan, W. Shan, F. A. Chervenak, M. Nimaroff, E. Bornstein

Journal Articles

No abstract provided.

Comparative Survival Analysis Of Immunomodulatory Therapy For Coronavirus Disease 2019 Cytokine Storm., S. Narain, D. G. Stefanov, A. S. Chau, A. G. Weber, G. Marder, B. Kaplan, P. Malhotra, O. Bloom, A. Liu, M. M. Lesser, N. Hajizadeh, Northwell Covid-19 Research Consortium

Journal Articles

BACKGROUND:Cytokine storm is a marker of coronavirus disease 2019 (COVID-19) illness severity and increased mortality. Immunomodulatory treatments have been repurposed to improve mortality outcomes. RESEARCH QUESTION:Do immunomodulatory therapies improve survival in patients with COVID-19 cytokine storm (CCS)? STUDY DESIGN AND METHODS:We conducted a retrospective analysis of electronic health records across the Northwell Health system. COVID-19 patients hospitalized between March 1, 2020, and April 24, 2020, were included. CCS was defined by inflammatory markers: ferritin, > 700 ng/mL; C-reactive protein (CRP), > 30 mg/dL; or lactate dehydrogenase (LDH), > 300 U/L. Patients were subdivided into six groups: no immunomodulatory treatment (standard of care) and …

Repurposing Orthopaedic Residents Amid Covid-19: Critical Care Prone Positioning Team., O. F. Rahman, D. P. Murray, R. M. Zbeda, A. D. Volpi, A. Z. Mo, N. A. Wessling, B. A. Mina, M. S. Mendez-Zfass, C. Carpati

Journal Articles

No abstract provided.

Histopathologic Evaluation Of Placentas After Diagnosis Of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Infection., M. Gulersen, L. Prasannan, H. Tam Tam, C. N. Metz, B. Rochelson, N. Meirowitz, W. Shan, M. Edelman, K. A. Millington

Journal Articles

Background: The impact of maternal severe acute respiratory syndrome coronavirus 2 infection on placental histopathology is not well known.

Objective: To determine if any significant placental histopathologic changes occur after the diagnosis of severe acute respiratory syndrome coronavirus 2 infection during pregnancy and whether these changes are correlated with the presence or absence of symptoms associated with the infection.

Study Design: A retrospective cohort study of women diagnosed as having severe acute respiratory syndrome coronavirus 2 infection who delivered at a single center from April 9, 2020 to April 27, 2020, and had placental specimens reviewed by the Department of …

Covid-19 And Orthopaedics: Recovery After The Pandemic Surge., B. Petrone, C. R. Iturriaga, T. Mauri, N. Sgaglione

Journal Articles

The novel Coronavirus (COVID-19) pandemic has placed an immense strain on health care systems and orthopedic surgeons across the world. To limit the spread, federal and state governments mandated the cancellation of all nonurgent surgical cases to address surging hospital admissions and manage workforce and resource reallocation. During the pandemic surge, thousands of surgical cancellations have been required. We outline our experience through the onset and advance of the surge, detail our incident response and discuss the transition toward recovery. Level of Evidence: Level V.

Diabetes Is Associated With Increased Risk For In-Hospital Mortality In Patients With Covid-19: A Systematic Review And Meta-Analysis Comprising 18,506 Patients, L. Palaiodimos, N. Chamorro-Pareja, D. Karamanis, W. Li, P. D. Zavras, K. M. Chang, P. Mathias, D. G. Kokkinidis

Journal Articles

© 2020, Hellenic Endocrine Society. Purpose: Infectious diseases are more frequent and can be associated with worse outcomes in patients with diabetes. The aim of this study was to systematically review and conduct a meta-analysis of the available observational studies reporting the effect of diabetes on mortality among hospitalized patients with COVID-19. Methods: The Medline, Embase, Google Scholar, and medRxiv databases were reviewed for identification of eligible studies. A random effects model meta-analysis was used, and I2 was utilized to assess the heterogeneity. In-hospital mortality was defined as the endpoint. Sensitivity, subgroup, and meta-regression analyses were performed. Results: A total …

Coronavirus Neurosurgical/Head And Neck Drape To Prevent Aerosolization Of Coronavirus Disease 2019 (Covid-19): The Lenox Hill Hospital/Northwell Health Solution, R. S. D'Amico, D. Khatri, K. Kwan, G. Baum, Y. Serulle, D. Silva, M. L. Smith, J. A. Ellis, M. Levine, R. Ortiz, D. J. Langer, J. A. Boockvar

Journal Articles

No abstract provided.

Interim Guidance For Basic And Advanced Life Support In Adults, Children, And Neonates With Suspected Or Confirmed Covid-19 From The Emergency Cardiovascular Care Committee And Get With The Guidelines-Resuscitation Adult And Pediatric Task Forces Of The American Heart Association, D. P. Edelson, C. Sasson, P. S. Chan, D. L. Atkins, K. Aziz, L. B. Becker, R. A. Berg, S. M. Bradley, S. C. Brooks, A. A. Topjian, +17 Additional Authors

Journal Articles

No abstract provided.

Multisystem Imaging Manifestations Of Covid-19, Part 2: From Cardiac Complications To Pediatric Manifestations., M. V. Revzin, S. Raza, N. C. Srivastava, R. Warshawsky, C. D'Agostino, A. Malhotra, A. S. Bader, R. D. Patel, K. Chen, C. C. Kyriakakos, J. S. Pellerito

Journal Articles

Infection with severe acute respiratory syndrome coronavirus 2 results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. COVID-19 has been reported in most countries, and as of August 15, 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. Although COVID-19 predominantly affects the respiratory system, it has become apparent that many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease and its related complications, and proper utilization …

Behavioral Changes Without Respiratory Symptoms As A Presenting Sign Of Covid-19 Encephalitis., T. Rebeiz, K. Lim-Hing, S. Khazanehdari, K. Rebeiz

Journal Articles

The clinical presentation, diagnosis, and treatment of coronavirus disease 2019 (COVID-19) encephalitis are still being characterized. Few case reports describing COVID-19 encephalitis are available in the literature. We present a case of COVID-19 encephalitis who presented with behavioral disturbances without respiratory symptoms.

Sars-Cov-2 And Interferon Blockade, B. Diamond, B. T. Volpe, S. Van Patten, Y. Al Abed

Journal Articles

© 2020, The Author(s). The response to viral infection generally includes an activation of the adaptive immune response to produce cytotoxic T cells and neutralizing antibodies. We propose that SARS-CoV-2 activates the innate immune system through the renin-angiotensin and kallikrein-bradykinin pathways, blocks interferon production and reduces an effective adaptive immune response. This model has therapeutic implications.

Two-Needle Technique For Lumbar Radiofrequency Medial Branch Denervation: A Technical Note, K. B. Chapman, F. Schirripa, T. Oud, P. S. Groenen, R. R. Ramsook, N. Van Helmond

Journal Articles

© 2020, American Society of Interventional Pain Physicians. All rights reserved. Background: Radiofrequency ablation (RFA) of the medial branches of the dorsal rami has been reported to relieve facet joint–related back pain for 6 months to 1 year in 60% of patients. Although providing benefit in a significant proportion of patients, there remains a group of patients who do not experience any pain relief from RFA or experience only benefit from the ablation for a short period. Failure of RFA has been attributed to technical failure of coagulating the nerve or coagulation of a minimal section of the nerve, allowing …

Working With Bipolar Disorder During The Covid-19 Pandemic: Both Crisis And Opportunity, E. A. Youngstrom, S. P. Hinshaw, A. Stefana, J. Chen, K. Michael, A. Van Meter, V. Maxwell, E. E. Michalak, E. G. Choplin, E. Vieta, +3 Additional Authors

Journal Articles

© 2020, WikiJournal User Group. All rights reserved. Beyond public health and economic costs, the COVID-19 pandemic adds strain, disrupts daily routines, and com-plicates mental health and medical service delivery for those with mental health and medical conditions. Bipolar disorder can increase vulnerability to infection; it can also enhance stress, complicate treatment, and heighten interpersonal stigma. Yet there are successes when people proactively improve social connections, prioritize self-care, and learn to use mobile and telehealth effectively.

Thromboembolic Complications Of Covid-19, L. W. Mui, J. F. Lau, J. F. Lau, H. K. Lee

Journal Articles

© 2020, American Society of Emergency Radiology. The symptomology of patients afflicted with novel 2019 coronavirus disease (SARS-CoV-2 or COVID-19) has varied greatly, ranging from the asymptomatic state to debilitating hypoxemic respiratory failure caused by severe atypical viral pneumonia. Patients may also develop a hyper-inflammatory state that can lead to multi-organ failure. It has become increasingly apparent that, as part of the hyper-inflammatory state, COVID-19 infection increases susceptibility to systemic thromboembolic complications that can contribute to rapid clinical deterioration or demise. This article aims to review imaging features of various systemic thrombotic complications in six patients with moderate to severe …

Renal Infarction In Covid-19 Patient, A. Ammous, M. A. Ghaffar, E. El-Charabaty, S. El-Sayegh

Journal Articles

No abstract provided.

Cytokine Elevation In Severe And Critical Covid-19: A Rapid Systematic Review, Meta-Analysis, And Comparison With Other Inflammatory Syndromes., D. E. Leisman, L. Ronner, R. Pinotti, M. D. Taylor, P. Sinha, C. S. Calfee, A. V. Hirayama, F. Mastroiani, C. J. Turtle, C. S. Deutschman, +2 Additional Authors

Journal Articles

The description of a so-called cytokine storm in patients with COVID-19 has prompted consideration of anti-cytokine therapies, particularly interleukin-6 antagonists. However, direct systematic comparisons of COVID-19 with other critical illnesses associated with elevated cytokine concentrations have not been reported. In this Rapid Review, we report the results of a systematic review and meta-analysis of COVID-19 studies published or posted as preprints between Nov 1, 2019, and April 14, 2020, in which interleukin-6 concentrations in patients with severe or critical disease were recorded. 25 COVID-19 studies (n=1245 patients) were ultimately included. Comparator groups included four trials each in sepsis (n=5320), cytokine …

Unilateral Dorsal Root Ganglion Stimulation Lead Placement With Resolution Of Bilateral Lower Extremity Symptoms In Diabetic Peripheral Neuropathy., K. B. Chapman, B. W. Van Roosendaal, N. Van Helmond, T. A. Yousef

Journal Articles

Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation that can target specific dermatomes to obtain better coverage of the distal extremity. Previously proposed mechanisms of action for DRG-S focused on the dorsal root ganglion (DRG) itself, without consideration of orthodromic effects in the dorsal horn and antidromic effects on the nerve root and sympathetic chain. Diabetic peripheral neuropathy (DPN) is an axonal neuropathy that affects around half of all patients with diabetes mellitus, causing severe pain and sensory impairment in the distal extremities. We present a case of a patient with DPN in both feet, in addition to …

Diagnostic And Treatment Utility Of Echocardiography In The Management Of The Cardiac Patient, A. Khalili, J. Drummond, N. Ramjattan, R. Zeltser, A. N. Makaryus

Journal Articles

© The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. BACKGROUND Echocardiograms are an incredibly useful diagnostic tool due to their lack of harmful radiation, the relative ease and speed with which they can be performed, and their almost ubiquitous availability. Unfortunately, the advantages that support the use of echocardiography can also lead to the overuse of this technology. We sought to evaluate the physician perceived impact echocardiography has on patient management. AIM To evaluate the physician perceived impact echocardiography has on patient management. METHODS Surveys were distributed to the ordering physician for echocardiograms performed at our …

Dorsal Root Ganglion Stimulation Lead Fracture Within The Superficial Fascial Layers In 4 Cases, K. B. Chapman, K. V. Patel, N. Van Helmond, G. C. Chien

Journal Articles

We present 4 cases of dorsal root ganglion stimulation lead fracture. In these cases, the surgical technique involved (1) traversing fascial layers for placement of leads via a Tuohy needle in the upper low back, (2) subcutaneous tunneling from the implantable pulse generator site to the lead puncture site without dissecting below the superficial fascial plane at the puncture site, and (3) connection of the lead/extension with the generator. All fractures occurred adjacent to the original lead puncture site. These cases suggest lead entrapment within the membranous fascial plane, with tension on a thin lead, is a mechanism underlying lead …

Preoperative Nuclear Stress Testing In The Very Old Patient Population, A. N. Makaryus, J. N. Makaryus, J. A. Diamond

Journal Articles

© The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. BACKGROUND Elderly patients awaiting moderate to high-risk surgery may undergo nuclear stress testing (NST) in order to evaluate their cardiovascular risk. The prognostic utility of such testing in the very elderly (≥ 85 years) has yet to be fully evaluated. Octogenarians and nonogenarians frequently have a number of concurrent conditions including a high rate of coronary disease, and therefore the prognostic value of NST for their preoperative risk assessment has been questioned. Our evaluation assesses the ability of nuclear stress testing to predict peri-operative cardiac outcomes in …

Hrs/Ehra/Aphrs/Lahrs/Acc/Aha Worldwide Practice Update For Telehealth And Arrhythmia Monitoring During And After A Pandemic, N. Varma, N. F. Marrouche, L. Aguinaga, C. M. Albert, E. Arbelo, J. I. Choi, M. K. Chung, G. Conte, L. M. Epstein, P. D. Varosy, +13 Additional Authors

Journal Articles

No abstract provided.