Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study.

BACKGROUND: Management of PE has become streamlined with the implementation of PE Response Teams (PERT). Race, ethnicity and insurance status are known to influence the outcomes of patients with acute PE. However, whether the implementation of PERT-based care mitigates these racial and ethnic disparities remains unknown. Our aim was to assess the association of race, ethnicity and insurance with outcomes for patients with acute PE managed by PERT. METHODS: We performed a retrospective chart review of 290 patients with acute PE, who were admitted to one of three urban teaching hospitals in the Mount Sinai Health System (New York, NY) from January 2021 to October 2023. A propensity score-weighted analysis was performed to explore the association of race, ethnicity and insurance status with overall outcomes. RESULTS: Median age of included patients was 65.5 years and 149 (51.4%) were female. White, Black and Asian patients constituted 56.2% (163), 39.6% (115) and 3.5% [10] of the cohort respectively. Patients of Hispanic or Latino ethnicity accounted for 8.3% [24] of the sample. The 30-day rates of mortality, major bleeding and 30-day re-admission were 10.3%, 2.1% and 12.8% respectively. Black patients had higher odds of major bleeding (odds ratio [OR]: 1.445; p < 0.0001) when compared to White patients. Patients of Hispanic or Latino ethnicity had lower odds of receiving catheter-directed thrombolysis (OR: 0.966; p = 0.0003) and catheter-directed or surgical embolectomy (OR: 0.906; p < 0.0001) when compared to non-Hispanic/Latino patients. Uninsured patients had higher odds of receiving systemic thrombolysis (OR: 1.034; p = 0.0008) and catheter-directed thrombolysis (OR: 1.059; p < 0.0001), and lower odds of receiving catheter-directed or surgical embolectomy (OR: 0.956; p = 0.015) when compared to insured patients, although the odds of 30-day mortality and 30-day major bleeding were not significantly different. CONCLUSION: Within a cohort of PE patients managed by PERT, there were significant associations between race, ethnicity and overall outcomes. Hispanic or Latino ethnicity and uninsured status were associated with lower odds of receiving catheter-directed or surgical embolectomy. These results suggest that disparities related to ethnicity and insurance status persist despite PERT-based care of patients with acute PE.

Validation of an HPLC method for estimation of cefotaxime from dried blood spot: alternative to plasma-based PK evaluation in neonates.

Aim: Pharmacokinetic evaluation of cefotaxime in neonates is currently a challenge due to the large volume requirement of blood for its analysis by existing methods. A dried blood spot (DBS) based method is the best alternative. Materials & methods: We validated an HPLC method for estimation of cefotaxime from DBS and plasma. Extraction employed a simple procedure using acetonitrile and buffer. Selective separation of cefotaxime was achieved on a C8 column using gradient programming. Results & conclusion: The linearity of the method ranged from 2 to 200 µg/ml with acceptable precision and accuracy for both plasma and DBS. Hematocrit was not affecting the assay accuracy. A strong correlation and interchangeability observed with the plasma method proves its clinical validity for application to PK evaluations.

Lay abstract Cefotaxime is a widely used antibiotic in the neonatal population for treating bacterial infections. At the same time, determining the dosage for this antibiotic in the vulnerable population is always a challenge for the treating doctor. In the case of neonates, organs are not fully developed and their response to drugs will be different from that of adults. In the current clinical practice, dosage for neonates is deduced from pediatric dose without addressing this difference in the response. The major challenge in addressing this issue is the collection of blood by venipuncture from neonates for drug analysis. In this report, a microsampling technique called dried blood spot is used for sampling and bioanalysis of cefotaxime. The method is validated for estimation of cefotaxime from the neonatal blood.

Variations in origin and branching pattern of hepatic arteries and their clinical significance

Hepatobiliary surgeries require extensive knowledge of variations in the origin and branching pattern of arteries extending from the coeliac trunk till the cystic artery. This study was aimed at documenting all possible variations observed in the hepatic arterial tree by meticulous dissection of livers in formalin-fixed cadavers. Twenty formalin-fixed cadavers were meticulously dissected to study the hepatic arterial variations.The common hepatic artery originated from the coeliac trunk, common hepatogastric trunk and common hepatosplenic trunk in 85%, 5%, and 5% respectively. It was absent in 5%. It gave rise to the gastroduodenal and proper hepatic arteries in 85%, trifurcated into gastroduodenal, left and right hepatic arteries in 5%, and left hepatic, right hepatic and cystic arteries in 5%. The proper hepatic artery continued from the common hepatic artery in 85%, and was absent in 15%. It bifurcated into left and right hepatic arteries in 45%, showed a trifurcating pattern in 20% cases, gave rise to 3 separate hepatic branches in 5%, and continued as left hepatic artery alone in 15%. The left hepatic artery originated either from the proper hepatic artery or was a direct continuation of it in 85%, from the common hepatic artery in 10%, and the superior mesenteric artery in 5% cases. It gave rise to the cystic artery in 5%. The right hepatic artery originated from proper hepatic artery in 70%, abdominal aorta in 5%, coeliac trunk in 10%, superior mesenteric artery in 5%, common hepatic artery trifurcation in 10%, and gave rise to the cystic artery in 80%. The cystic artery was absent in 5%. Some of the findings have been reported in other studies, while some were newly reported in the present study. Knowledge of hepatic arterial variations is necessary to prevent complications involving several specialties including interventional radiology, endovascular surgery, chemotherapeutic procedures, hepatobiliary surgery as well as living donor liver transplantation surgeries

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