Primary Peritoneal Carcinoma: A Rare Malignancy Presenting a Diagnostic Challenge.

With the advancement in technologies and the development of a vast variety of tests, diagnosing diseases has become relatively easy. However, certain diseases are challenging to diagnose due to their similarities with other disease processes. Primary peritoneal carcinoma (PPC) is one of the infrequent tumors that has a resemblance to an ovarian tumor, often making it hard to diagnose. The symptoms are non-specific, and by the time primary peritoneal cancer is diagnosed, the patient is usually at an advanced stage. Although diagnosis might be suspected based on presenting symptoms, it is rarely confirmed with symptomatology alone, requiring additional tumor markers or radiological studies. Sometimes it is diagnosed after surgical removal of the lesion. Several similarities have been described between PPC and ovarian cancer, with some studies explaining the differences as well. We highlight the importance of careful interpretation of imaging studies for the timely diagnosis of PPC. However, several factors can interfere with the analysis of test results leading to delays in diagnosis and management. Interpretation of imaging becomes difficult, especially in patients with significant ascites.

Predictors of Poor Outcomes for COVID-19-Associated Pneumonia in a Minority Population.

Background In December 2019, an unprecedented outbreak of pneumonia of unknown etiology emerged in Wuhan City, Hubei province in China. A novel coronavirus was identified as the causative agent and was subsequently termed COVID-19 by the World Health Organization (WHO). It rapidly became a pandemic, and it has been a significant challenge to healthcare providers to predict outcomes of the infected patients.  Objective  The aim of this study was to investigate the clinical characteristics of patients admitted for COVID-19 infection in an Inner-City Hospital in New York City, to assess the correlation between inflammatory markers and outcomes prediction in a high-risk population. Methods  We identified 235 patients who were admitted to our Hospital in NYC between March 19th and April 25th, 2020 with laboratory confirmed COVID-19 diagnosis with associated pneumonia and who also had documented inflammatory markers (D-dimer, C-reactive protein, lactate dehydrogenase, ferritin, procalcitonin) during their hospital stay.  Results  The study population was predominantly non-Hispanic black. There was no statistically significant difference between survivors and non-survivors by race and/or ethnicity (P = 0.69). Thirty-five percent of the patient population had died by the end of this study and those that died had a higher mean age compared to survivors (69.5 ± 13.6 vs 63.8 ± 15.2, P = 0.004). There is a significant difference in the D-dimer levels in patients who survivedwhen compared to those who died (P = 0.002). A higher proportion of patients that died were admitted to the ICU, (23.7% vs 55.4%, P < 0.0001) and/or intubated (18.4% vs 51.8%, P < 0.0001). Conclusion Our study demonstrated that patients who died had a significantly higher D-dimer (>3,000) when compared with survivors. Higher mean age was associated with increased mortality and admission to ICU and/or intubation.

Characteristics and outcomes of COVID-19 patients in New York City's public hospital system.

BACKGROUND: New York City (NYC) bore the greatest burden of COVID-19 in the United States early in the pandemic. In this case series, we describe characteristics and outcomes of racially and ethnically diverse patients tested for and hospitalized with COVID-19 in New York City's public hospital system. METHODS: We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed. RESULTS: 22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes. CONCLUSIONS AND RELEVANCE: This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in New York City to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

Characteristics and Outcomes of COVID-19 Patients in New York City's Public Hospital System.

Background New York City (NYC) has borne the greatest burden of COVID-19 in the United States, but information about characteristics and outcomes of racially/ethnically diverse individuals tested and hospitalized for COVID-19 remains limited. In this case series, we describe characteristics and outcomes of patients tested for and hospitalized with COVID-19 in New York City's public hospital system. Methods We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed. Results 22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes. Conclusions and Relevance This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in the United States to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

Computer access of morning report/ Harrison Club PowerPoint presentations to the medicine residents has improved their confidence in management and in preparation for the monthly exams and for the American Board of Internal Medicine: an innovative education quality improvement project at Harlem Hospital center.

Background: Morning report is an important conventional teaching activity of residency programs worldwide. Objectives: We aimed at creating a shared digital folder of the morning report/Harrison Club presentations for the training year of 2018-2019. Our primary objective was to assess the residents' satisfaction regarding its accessibility, as well as to estimate the percentage of residents who felt improvement in confidence levels in their management skills and their preparation for the monthly exams and for the American Board of Internal Medicine (ABIM). Methods: This study is a cross-sectional study comparing the three different Post-Graduate Year residents. An anonymous questionnaire was distributed to 44 participating residents, and a multivariate analysis test was conducted. Results: Most of the residents thought the morning report/Harrison Club folder was easily accessible. 86.7%, 82.4% and 83.3% found it valuable to improve their confidence in management; 80%, 70.6% and 83.3% found it valuable to improve their confidence in preparation for the monthly exams; and 86.7%, 82.4% and 83.3% found it valuable to improve their confidence in preparing for the ABIM among the PGY1, PGY2, and PGY3 residents, respectively. Conclusion: Almost all the residents agreed that they would recommend adoption of a similar digital tool in other residency programs.

A Curious Case of Inhalation Fever Caused by Synthetic Cannabinoid.

BACKGROUND: This case report describes inhalation fever as an uncommon pulmonary adverse effect of synthetic cannabinoids. CASE REPORT: A 29-year-old man was brought in for severe agitation after smoking K2, a synthetic cannabinoid. He required multiple doses of lorazepam and haloperidol for sedation. His vital signs were notable for a mild fever and tachycardia. Otherwise, the rest of his exam was unremarkable. The laboratory test was significant for leucocytosis and diffuse reticular-nodular and interstitial infiltrates on chest radiograph. Urine drug toxicology was negative. Interestingly, his symptoms and pulmonary infiltrates on the chest radiograph resolved spontaneously after 24 hours of observation. CONCLUSIONS: This patient developed transient pulmonary infiltrates and fever following the synthetic cannabinoid inhalation, as seen in self-limiting inhalation fever. Inhalation fever as a consequence of synthetic cannabinoid has not been described previously and there is a need for further research in this field.

Barriers to activation of the rapid response system.

BACKGROUND: The rapid response system (RRS) has been widely implemented in the US. Despite efforts to encourage activation of the RRS, adherence to activation criteria remains suboptimal. Barriers to adherence to RRS activation criteria remains poorly understood. OBJECTIVE: To identify barriers associated to activation of the RRS system by clinical staff. METHODS: Physicians and nurses on the medical and surgical wards of a New York City community hospital were surveyed to identify barriers to six criteria for activation of the RRS. A paper questionnaire was disseminated. We assessed familiarity with, agreement with, and recognition of perceived benefit of the RRS calling criteria using a Likert scale. Self-reported adherence to RRS activation was also measured on a Likert scale. Logistic regression was used to assess the association between the barriers and the six RRS criteria. RESULTS: Sixty eight physicians and 16 nurses completed the survey; response rates were 59% and 35%, respectively. Self-reported adherence rate was ≤25% for the six criteria. We observed that as the familiarity with, agreement with, and perceived benefit of activating the RRS increases, the self-reported adherence also increases. CONCLUSIONS: Adherence to activation of RRT based on the six criteria measured is low. As familiarity with, agreement with, and perceived benefit of the RRS activating criteria rise, self-reported adherence rates increase, with familiarity having the greatest impact. These results can be used to develop tailored interventions to increase adherence to RRT activation in health care institutions.

Endobronchial pulmonary nocardiosis.

In recent years, the reported incidence of nocardiosis, a localized or disseminated infection caused by Nocardia, has been increasing. This increase can be attributed to the improvements in diagnostic capabilities and the higher clinical index of suspicion, as well as the increased prevalence of immunosuppressed patients. We report a case of pulmonary nocardiosis in a healthy young female who presented with cough and hemoptysis, which persisted even after empiric treatment for pulmonary tuberculosis. CT scan of her chest showed infiltrates in the right upper, middle and lower lobes with pleural effusion. Bronchoscopy revealed a friable endobronchial mass. Special stains confirmed the diagnosis of nocardiosis. The patient's symptoms and clinical findings improved with trimethoprim-sulfamethoxazole. To the best of our knowledge, this is the fourth case of this illness presenting as endobronchial mass reported in the literature. Pulmonary nocardiosis should be considered in the differential diagnosis of hemoptysis, even in immunocompetent patients.