Eliminating hepatitis B vaccination disparities for West African immigrants.

BACKGROUND: Hepatitis B virus (HBV) infection is endemic in West Africa. There has been a significant increase in the Bronx West African (WA) community. To achieve HBV elimination, vaccination of non-immune individuals is important. Unfortunately, vaccine uptake in immigrant populations is at this time very limited. METHODS: An educational program was conducted by medical providers of WA origin in collaboration with local faith-based organizations, after which free HBV screening was offered. Non-immune individuals were initially recommended to contact their medical provider or referred to the Department of Health for vaccination. Beginning in 2021, the program offered vaccination. A questionnaire including reasons for vaccination in the program was offered. FINDINGS: Among the first500 individuals screened,34.6 % required vaccination. Among those screened before program vaccine availability, 72.2 % initiated the vaccination series,with38.2 % obtainingit at an outside setting and34 % returning when available through the program.Among patients screened after program vaccineavailability, 92.1 % initiated the series.Of those receiving vaccination in the program and completing the questionnaire,70.7 % had access to care but chose vaccination by the program because of the trust instilled by WA personnel. INTERPRETATION: Our findings demonstrate the effectiveness of integrating vaccination into an HBV screening program for an immigrant population. It emphasizes the importance of timeliness and cultural sensitivity.

A Rare Case of New-Onset Ulcerative Colitis in a Nonagenarian.

Ulcerative colitis (UC) is one of two major types of inflammatory bowel disease (IBD). It is defined as a chronic idiopathic inflammatory disease limited to the colorectal mucosal layer and characterized by relapsing and remitting episodes of inflammation. UC almost invariably involves the rectum and extends proximally in a continuous distribution to part or the entire colon. Development of disease after 75 years of age is uncommon, with new-onset over the age of 80 accounting only for 1% of all new diagnoses. We present a case of a new onset UC in a 90-year-old patient presenting with painless hematochezia.

Non Ischemic Cardiomyopathy in a 54-Year-Old Khat Consuming Yemeni Male Presenting with Worsening Exertional Dyspnea, T Wave Inversions in V5-V6 and Normal Coronary Artery Angiography.

BACKGROUND Khat (Catha edulis) is a plant cultivated in Ethiopia, East African, and the Arabian Peninsula. Long-term khat consumption has been associated with increased rates of periodontal diseases, esophagitis, psychosis, and cardiovascular issues such as cerebrovascular accidents, myocardial ischemia, and ischemic cardiomyopathy (CM). We report a case of khat-induced non-ischemic CM in a patient with no other known cardiovascular risk factors and highlight a cardiovascular effect of chronic khat consumption. CASE REPORT A 54-year-old Yemeni man with no known medical history but a chronic khat chewer presented with worsening exertional dyspnea for 6 months and associated pedal edema. Laboratory studies were remarkable for elevated B-type natriuretic peptide (BNP). Electrocardiogram (EKG) revealed normal sinus rhythm with non-specific T wave inversions (TWI) in V5-V6. A computed tomography (CT) scan of the chest showed bilateral pleural effusions with interlobular septal thickening. Transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction (LVEF) of 16-20% and global CM. Coronary angiography revealed normal coronaries. CONCLUSIONS Chronic khat consumption is being recognized as a dangerous habit with serious health consequences and its association with ischemic CM is well documented. The findings of ischemic cardiac changes of acute coronary syndrome in a patient with normal coronary arteries raises the possibility that khat toxicity was associated with coronary artery spasm due to its amphetamine-like stimulatory effects. Although further research is required to substantiate this relationship, it is imperative that khat consumption be considered a risk factor when assessing for CM.

Breaking down barriers for hepatitis B screening in the Bronx West African community through education in collaboration with faith-based organizations: A cohort study.

Background: Many residents of the Bronx are from West Africa where chronic hepatitis B is endemic. Hepatitis B screening is low in West African immigrant communities due to multiple possible cultural and socioeconomic factors. Methods: A culturally sensitive educational program on hepatitis B with a special emphasis on the relevance for the West African community was developed. Arrangements were made with leaders of West African faith-based organizations to conduct educational programs following religious services after which a survey was completed to assess changes in attitudes towards the infection and motivation for testing. Arrangements were then made for serologic testing at which time hypertension screening was also performed. Findings: Nine events in which a total of 550 people attended were held. Among the 339 (61.6%) participants who completed the questionnaire, 325 of the participants (95.1%) reported improved understanding, and 236 (67.0%) indicated greater comfort in sharing a meal and talking with an infected individual. Two hundred seventy-four participants (82.7%) indicated an intention to undergo testing, and 339 (97.8%) indicated that they would encourage family and friends to undergo screening. Three hundred thirty-two of the 550 participants (60.3%) requested serologic testing. Among those requesting testing, 224 (67.5%) underwent testing. Interpretation: A culturally sensitive educational program in collaboration with faith-based organizations is effective in motivating people from West Africa to undergo screening for hepatitis B at which time other preventative health care measures such as hypertension screening can be performed. Funding: Check Hep B Navigation Program funded by the New York Council, Gilead Sciences, Albert Einstein College of Medicine Global Health Center and generous donations by Friends and Family of Jason Marks and the 41-74 Club of NY. Bayan: XXX. fage: Yawancin mazauna Bronx sun fito ne daga Yammacin Afirka inda cutar hepatitis B ke ci gaba da yaduwa. Binciken hepatitis B yana da karanci a cikin al'ummomin baƙi na Yammacin Afirka saboda yuwuwar abubuwan al'adu da na tattalin arziƙi. Hanyoyi: An haɓaka wani shirin ilmantarwa na al'adu kan cutar hepatitis B tare da ba da fifiko na musamman ga dacewa ga al'ummar Yammacin Afirka. An yi shiri tare da shugabannin ƙungiyoyin addinan Afirka ta Yamma don gudanar da shirye-shiryen ilimi bayan ayyukan addini bayan haka aka kammala bincike don tantance halaye game da kamuwa da cutar da himma don gwaji. Sannan an yi shirye -shirye don gwajin serologic wanda a lokacin ne kuma aka yi gwajin hawan jini. Sakamakon: An gudanar da abubuwa tara wanda jimlar mutane 550 suka halarta. Daga cikin mahalarta 339 (61.6%) da suka kammala tambayoyin, 325 daga cikin mahalarta (95.1%) sun ba da rahoton ingantacciyar fahimta, kuma 236 (67.0%) sun nuna ƙarin ta'aziyya wajen raba abinci da yin magana da mai cutar. Mahalarta ɗari biyu da saba'in da huɗu (82.7%) sun nuna niyyar yin gwaji, kuma 339 (97.8%) sun nuna cewa za su ƙarfafa dangi da abokai don yin gwajin. Dari uku da talatin da biyu daga cikin mahalarta 550 (60.3%) sun buƙaci gwajin serologic. Daga cikin wadanda ke neman gwaji, 224 (67.5%) sun yi gwaji. Fassara: shirin ilmantarwa mai mahimmanci na al'adu tare da haɗin gwiwar ƙungiyoyi masu imani suna da tasiri wajen motsa mutane daga Yammacin Afirka don yin gwajin cutar hepatitis B a lokacin da za a iya yin wasu matakan kula da lafiya kamar rigakafin hawan jini. Kuɗi: Shirin Hep B Navigation Programme wanda Majalisar New York, Kimiyya ta Gilead, Cibiyar Kiwon Lafiya ta Duniya ta Albert Einstein da Cibiyar Kyauta ta Abokai da Iyalan Jason Marks da 41-74 Club na NY suka bayar.

Seizure and delirium secondary to carboplatin and pantoprazole therapy-induced hypomagnesemia in a cancer patient.

Active surveillance and treatment of hypomagnesemia along with strict avoidance of concurrent offending agents is essential to prevent its grave clinical consequences among patients on carboplatin therapy.

Aortic thrombosis and renal infarction in a young female with patent foramen ovale and COVID-19 antibody.

Thrombotic complications in patients with prior COVID-19 infection raises concern for a persistent hypercoagulable state among these patients. Thus, there is a dire need for further research aimed at anticoagulation guidelines for the same.

Predicting Preeclampsia with Noninvasive Measures of Endothelial Dysfunction: A Pilot Study.

Objective This study evaluates the assessment of endothelial function and its prediction for preeclampsia among women with high-risk factors. Study Design A prospective cohort study of 107 pregnant women at 20 weeks or greater gestation with risk factors for developing preeclampsia. Endothelial dysfunction was assessed using peripheral arterial tonometry by generating a reactive hyperemia index (RHI) score. An index score of <1.67 was defined as endothelial dysfunction. The primary outcome was preeclampsia. Logistic regression was used to predict preeclampsia from RHI scores, body mass index, gestational age at RHI evaluation, history of preeclampsia, history of pregestational diabetes mellitus, chronic hypertension, and fetal number. A receiver operating characteristic plot was constructed to predict preeclampsia from the RHI score. Results Among 107 women, 99 had interpretable RHI scores. Among those with an abnormal RHI ( n = 61), 17 (28%) developed preeclampsia. Among women with a normal score ( n = 38), six (16%) developed preeclampsia ( p = 0.166). After logistic regression, there was no significant association. A receiver operating characteristic plot also revealed no association between RHI score and preeclampsia. Conclusion An abnormal RHI score using peripheral arterial tonometry indicating endothelial dysfunction was not predictive of developing preeclampsia in this cohort. Future studies are needed to further evaluate this relationship.

Comparing the Predictive Power of Preoperative Risk Assessment Tools to Best Predict Major Adverse Cardiac Events in Kidney Transplant Patients.

BACKGROUND: Patients undergoing kidney transplantation have increased risk of adverse cardiovascular events due to histories of hypertension, end-stage renal disease, and dialysis. As such, they are especially in need of accurate preoperative risk assessment. METHODS: We compared three different risk assessment models for their ability to predict major adverse cardiac events at 30 days and 1 year after transplant. These were the PORT model, the RCRI model, and the Gupta model. We used a method based on generalized U-statistics to determine statistically significant improvements in the area under the receiver operator curve (AUC), based on a common major adverse cardiac event (MACE) definition. For the top-performing model, we added new covariates into multivariable logistic regression in an attempt to create further improvement in the AUC. RESULTS: The AUCs for MACE at 30 days and 1 year were 0.645 and 0.650 (PORT), 0.633 and 0.661 (RCRI), and finally 0.489 and 0.557 (Gupta), respectively. The PORT model performed significantly better than the Gupta model at 1 year (p=0.039). When the sensitivity was set to 95%, PORT had a significantly higher specificity of 0.227 compared to RCRI's 0.071 (p=0.009) and Gupta's 0.08 (p=0.017). Our additional covariates increased the receiver operator curve from 0.664 to 0.703, but this did not reach statistical significance (p=0.278). CONCLUSIONS: Of the three calculators, PORT performed best when the sensitivity was set at a clinically relevant level. This is likely due to the unique variables the PORT model uses, which are specific to transplant patients.

A Retrospective Cohort Study on Rehospitalization following Expanded Criteria Donor Kidney Transplantation.

BACKGROUND: Expanded criteria donor (ECD) kidneys are commonly used but are associated with increased graft failure. Graft failure is in turn related to rehospitalization within thirty days post transplant. Our goal was to determine whether ECD kidneys independently lead to rehospitalization within 30 days, 1 year, and 2 years after transplant. METHODS: All adult first-time recipients of deceased donor kidneys transplanted from 2003-2012 at our center were reviewed. Models included demographics, medical comorbidities, center for disease control high-risk kidney, ECD kidney, ischemia times, cause of renal failure, immunosuppressive regimen, positive psychiatric screening, alcoholism, surgeon, year the transplant was performed, years on dialysis before transplant, and the number of inpatient hospitalizations within 6 months prior to transplant. We conducted Andersen-Gill modeling and propensity score matching followed by logistic regression. We also used multivariable linear regression to predict average length of stay during rehospitalization. RESULTS: More ECD patients had a rehospitalization at 1 year (70.3% versus 59%, log-rank test p=0.014). Thirty-day and 2-year time marks were not significant. Andersen-Gill models predicting successive hospitalizations yielded HR of 1.42 (p=0.002) and 1.32 (p=0.015) for ECD patients at 1 and 2 years of after transplantation, respectively. Propensity score matching and logistic regression showed a significant relative risk of 1.630 at one year (p=0.033) and 1.313 at two years (p=0.268). There was no significant association between ECD and subsequent lengths of hospital stay. CONCLUSION: Receiving an ECD kidney is independently associated with multiple readmissions within 2 years of transplant but unrelated to length of stay.