Reengineering the Discharge Transition Process of COVID-19 Patients Using Telemedicine, Remote Patient Monitoring, and Around-the-Clock Remote Patient Monitoring from the Emergency Department and Inpatient Units.

Background: At the beginning of the COVID-19 pandemic, New York City quickly became the epicenter with hospitals at full capacity needing to care for patients. At New York Presbyterian Brooklyn Methodist Hospital, we needed to develop an innovative system of how to safely discharge the massive influx of patients. Inundation of patient care with limited manpower and resources forced us to align with a third-party vendor, around-the-clock alert, to make remote patient monitoring (RPM) possible. Each patient was prescribed a pulse oximeter and nurses were assigned to monitor vital signs, speak to patients, and escalate to physicians if required. Results: We enrolled 50 patients, of whom 13 were escalated resulting in 3 emergency room visits and 1 readmission. We had a high compliance rate with high patient satisfaction in postsurveys. Discussion: Our program was unique in that it utilized telemedicine for regular patient follow-up, along with RPM through a third-party vendor. Patients were able to be safely discharged home with close follow-up through regularly obtained vitals with access to a 24/7 hotline for any emergencies, possibly preventing readmissions. Limitations include a small sample size population. Conclusions: Our experience shows that in a short period despite lack of resources, telehealth and RPM's concurrent use with a third-party vendor could be successfully utilized for safe discharges with high patient satisfaction.

Detection and confirmation of serum lipid biomarkers for preeclampsia using direct infusion mass spectrometry.

Despite substantial research, the early diagnosis of preeclampsia remains elusive. Lipids are now recognized to be involved in regulation and pathophysiology of some disease. Shotgun lipidomic studies were undertaken to determine whether serum lipid biomarkers exist that predict preeclampsia later in the same in pregnancy. A discovery study was performed using sera collected at 12-14 weeks pregnancy from 27 controls with uncomplicated pregnancies and 29 cases that later developed preeclampsia. Lipids were extracted and analyzed by direct infusion into a TOF mass spectrometer. MS signals, demonstrating apparent differences were selected, their abundances determined, and statistical differences tested. Statistically significant lipid markers were reevaluated in a second confirmatory study having 43 controls and 37 preeclampsia cases. Multi-marker combinations were developed using those lipid biomarkers confirmed in the second study. The initial study detected 45 potential preeclampsia markers. Of these, 23 markers continued to be statistically significant in the second confirmatory set. Most of these markers, representing several lipid classes, were chemically characterized, typically providing lipid class and potential molecular components using MS(2) Several multi-marker panels with areas under the curve >0.85 and high predictive values were developed. Developed panels of serum lipidomic biomarkers appear to be able to identify most women at risk for preeclampsia in a given pregnancy at 12-14 weeks gestation.

Carbamazepine induced DRESS syndrome.

We present here an 18-yr-old male who presented with intermittent fever of moderate grade and of 15 days duration, followed by maculopapular erythematous rashes over upper and lower extremities, face, and trunk developing over 10-12 days. He was suffering from recurrent seizures since last 3 months for which he was started on carbamazepine 200mg twice daily for the past 6 weeks. He was febrile on admission. Generalized lymphadenopathy with discreet, non-matted, firm and tender inguinal lymph nodes. Patch test with 1% and 5% solution of carbamazepine was strongly positive.

Discovery and Confirmation of Diagnostic Serum Lipid Biomarkers for Alzheimer's Disease Using Direct Infusion Mass Spectrometry.

Alzheimer's disease (AD) is a neurodegenerative disorder lacking early biochemical diagnosis and treatment. Lipids have been implicated in neurodegenerative disorders including AD. A shotgun lipidomic approach was undertaken to determine if lipid biomarkers exist that can discriminate AD cases from controls. The discovery study involved sera from 29 different stage AD cases and 32 controls. Lipid extraction was performed using organic solvent and the samples were directly infused into a time-of-flight mass spectrometer. Differences between AD cases and controls were detected with 87 statistically significant lipid candidate markers found. These potential lipid markers were reevaluated in a second confirmatory study involving 27 cases and 30 controls. Of the 87 candidates from the first study, 35 continued to be statistically significant in the second confirmatory set. Tandem MS studies were performed and almost all confirmed markers were characterized and classified. Using a Bayesian lasso probit regression model on the confirmed markers, a multi-marker set with AUC = 0.886 was developed comparing all stages of AD with controls. Additionally, using confirmed biomarkers, multi-marker sets with AUCs >0.90 were developed for each specific AD Clinical Dementia Rating versus controls, including the earliest stage of AD. More conservative and likely more realistic statistical analyses still found multi-marker sets that appeared useful in diagnosing AD. Finally, using ordinal modeling a set of markers was developed that staged AD accurately 70% of the time, p = 0.0079. These results suggest that these serum lipidomic biomarkers may help diagnose and perhaps even stage AD.

Discovery and Subsequent Confirmation of Novel Serum Biomarkers Diagnosing Alzheimer's Disease.

BACKGROUND: Alzheimer's disease (AD) remains challenging to diagnose, especially early disease. Having serum AD biomarkers would be of significant interest both in the clinical setting and in drug development efforts. OBJECTIVE: We applied a novel serum proteomic approach to interrogate the low-molecular weight proteome for serum AD biomarkers. METHODS: A discovery study used sera from 58 any-stage AD cases and 55 matched controls analyzed by capillary liquid chromatography-electrospray ionization-tandem mass spectrometry. Candidate biomarkers were statistically modeled and promising biomarkers were retested in a second, blinded confirmatory study (AD cases = 68, controls = 57). Biomarkers that replicated in the second study were modeled for the diagnosis of any-stage and very early stage AD. Further, they were chemically identified by tandem MS. RESULTS: The initial discovery study found 59 novel potential AD biomarkers. Thirteen recurred in more than one multi-marker panel. In a second, blinded, confirmatory study, these same biomarkers were retested in separate specimens. In that study, four markers validated comparing controls to patients with any-stage AD and also with very early AD. The four biomarkers with replicable ability to diagnose AD were then chemically identified. CONCLUSION: These results suggest novel serum AD diagnostic biomarkers can be found using this approach.

Serum biomarkers predictive of pre-eclampsia.

AIM: We sought serum biomarkers predictive of pre-eclampsia (PE). MATERIALS & METHODS: Sera obtained at 12-14 weeks of pregnancy from 24 cases who later developed PE and 24 controls with uncomplicated pregnancies were processed and analyzed using a serum proteomic approach. RESULTS: Many statistically significant serum PE biomarker candidates (n > 60) were found comparing cases and controls. In addition, logistic regression analysis modeled biomarker data resulted in 14 different multimarker combinations having high detection sensitivity and specificity (AUC >0.9). CONCLUSIONS: Developed panels of serum biomarkers appeared effective in identifying pregnant women at 12-14 weeks gestation at risk of PE later in their pregnancy.