AN UNUSUAL THROMBOTIC EVENT IN ACUTE COVID-19 INFECTION

THE IMPACT OF CHRONIC KIDNEY DISEASE IN WOMEN UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: ANALYSIS FROM THE WOMEN'S INTERNATIONAL TRANSCATHETER AORTIC VALVE IMPLANTATION (WIN-TAVI) REGISTRY

ASSESSING THE SAFETY AND CLINICAL OUTCOMES OF BETA-BLOCKERS IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION WITH CONCOMITANT COCAINE USE. A META-ANALYSIS

CONCURRENT ACUTE MYOCARDIAL INFARCTION AND CEREBROVASCULAR ACCIDENT CAUSED BY LIBMAN-SACKS ENDOCARDITIS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS

PROVIDER BARRIERS TO LINKING PATIENTS WITH COMMUNITY HEALTH COACHES AT AN URBAN CLINIC

TWO CASES OF ATYPICAL PRESENTATIONS OF MYCOPLASMA PNEUMONIAE INFECTIONS

IMPACT OF DAY OF ADMISSION AND TIME TO DIAGNOSTIC ARTHROCENTESIS ON MORTALITY AND OTHER OUTCOMES IN SOLID-ORGAN TRANSPLANT RECIPIENTS WITH SEPTIC ARTHRITIS: A NATIONWIDE ANALYSIS

AN UNCOMMON PRESENTATION, AN UNUSUAL ASSOCIATION: A STROKE, DEMYELINATING DISORDER OR AN INFECTION?

LOWER ESOPHAGEAL SPHINCTER AND PERISTALTIC PRESSURES INCREASE WITH AGE IN PATIENTS WITHOUT A MAJOR ABNORMALITY ON HIGH RESOLUTION ESOPHAGEAL MANOMETRY

Background
Very late stent thrombosis (ST) is a concern in the era of drug-eluting stents (DESs), and ST is associated with peri-DES coronary artery aneurysmal lesions or coronary evaginations. An increasing number of cases of concurrent systemic allergic reaction and ST have been reported as Kounis syndrome (KS) in the literature. The number of patients with very late ST caused by KS is small, and further investigation of the potential pathophysiology is required.

Case summary
We report a case of KS that manifested as systemic urticaria followed by very late ST 14 years after placement of two sirolimus-eluting stents (SESs). Three months after the event of ST, coronary evaginations at the stented segments were detected on intravascular optical coherence tomography.

Discussion
Coronary evaginations are associated with local hypersensitivity, stent malapposition, uncovered strut, and flow disturbance that may predispose to ST. Systemic allergic reactions are known to promote platelet adhesion and aggregation. This case of KS suggests a pathophysiology in which the synergic effects between the coronary evaginations and a systemic allergic reaction may contribute to very late ST.

A CASE REPORT OF KOUNIS SYNDROME PRESENTING WITH A RASH, VERY LATE STENT THROMBOSIS AND CORONARY EVAGINATIONS

DOUBLE-BARREL BILATERAL ILIAC ARTERY STENTING USING BILATERAL RADIAL ARTERY ACCESS

BACKGROUND/INTRODUCTION: RAD-AID works to expand access to radiology services around the globe. In many sites this may include introducing basic X-ray and ultrasound services to health care, and in others it may involve developing innovative technological advances to basic imaging services already provided to patients. During the past year, RAD-AID has been planning to expand cloud IT architectures to many of these sites. Incorporating cloud storage for digital information and patient data reflects many advancements in the provision of health care, from expanding access to imaging in rural areas where there may not physically be radiologists to improving health data efficiencies by organizing data to best provide care to patients. RAD-AID has been working to implement these services in countries across the world, including sites in South America, Africa, and Asia. A key component of this project expansion is ensuring that using the cloud for patient data, and storing patient health information in a secure cloud, is in line with the country’s internal regulatory policies and laws.

METHODS: This research examines regulations on cloud services and health data of ten countries where RAD-AID works closely with local partners on technological advancement in radiology, including Laos, Guyana, Nigeria, Nepal, Rwanda, Vietnam, Ghana, Tanzania, Ethiopia, and India. Internet searches for original text of government regulations and policies, news articles, and discussions with physicians working in these countries formed the basis for this research.

RESULTS: Laos’ 2017 Law on the Protection of Electronic Data prohibits against “[circulating data] without authorization from the owner.” Guyana’s 2007 Regulations Made Under the Health Facilities Licensing Act mandate that every healthcare facility is required to have policies in place to maintain the confidentiality of patient records. Nigeria has further specific mandates included in The National Health Act, 2014 regarding confidential patient data, patient consent to access medical data, and control measures to protect this data. RAD-AID is in the process of implementing cloud storage in these three countries; similar laws also exist in other countries where RAD-AID may implement this new storage platform with local partners.

CONCLUSION: Many countries have broad national policies about patient privacy but few specific policies about using the cloud for data storage in healthcare. However, many countries are in the process of creating governmental policies as they relate to the cloud. In close collaboration with in-country partners, global health teams should be aware of these regulations to ensure that the implementation of new health technology protects patient data and expands access to care, while also being guided by the country’s policies on health data and cloud infrastructure.

EXAMINING INTERNATIONAL REGULATORY CLOUD STORAGE FRAMEWORKS TO EXPAND ACCESS TO RADIOLOGY IN GLOBAL HEALTH SETTINGS

URIC ACID LEVEL IS ASSOCIATED WITH SEVERITY OF HEART FAILURE WITH PRESERVED EJECTION FRACTION

BACKGROUND/INTRODUCTION: Hypertension is one of the most encountered problem in the primary care setting. It is also an important health care quality metric. Poorly controlled hypertension leads to adverse cardiovascular outcomes including myocardial infarction, heart failure, stroke and chronic kidney disease. Yet achieving adequate blood pressure control remains a challenge not only because of the complex pathophysiology of the disease but also because it is influenced by socioeconomic factors. Social complexities, economic disadvantage, cost related medication non-adherence and poor health literacy are some of the factors that act as barriers in controlling this condition. In early 2019 we discovered that only 59% of the patients at our resident run primary care clinic had blood pressure less than 140/90. The aim of our resident driven QI project was to improve BP control to a network goal of 75% over a period of 6 months.
METHODS: This project was implemented at the Ryan Adair center, a federally qualified health center located in the Central Harlem neighborhood in New York City. The clinic is also a primary care practice site for internal medicine residents. The population is predominantly African American and Hispanic with many patients enrolled in Medicaid and with limited English proficiency. Rent burden and multiple chronic comorbidities are also noteworthy among this population. We used the Plan-Do-Study-Act method to carry out our clinic-based project. PGY1’s at the site served as the QI project leaders with faculty oversight. A total of 5 cycles were implemented during the study period. Cycle 1 focused on nurse education regarding proper blood pressure measurement. Cycle 2 focused on home blood pressure monitoring including patient education on proper technique and the importance of maintaining a daily log. Cycle 3 focused on assessment of health literacy via a patient questionnaire. Cycle 4 focused on provider education by ensuring that our patients were prescribed an appropriate medication regimen based on ACC/AHA Guidelines. Cycle 5 focused on referring patients with continued poor control to community health coaches to identify barriers like nutrition, medication access, and health literacy.
RESULTS: Using our clinic’s online hypertensive registry (DRVS), we tracked on a monthly basis, the percentage of hypertensive patients who had controlled blood pressure (<140/90). Over a six-month period, percent of patients at goal went from 59% in February 2019 to 73% in July 2019. Continued trending indicated that BP goals remained above 66% for up to 10 months after initiation of this project.
CONCLUSION: We demonstrated a sustained, meaningful improvement in hypertensive control among an economically-disadvantaged, racially diverse urban patient population. Accurate nurse measurements, engagement of patients in self-management, and resident education on evidence-based medication standards have all contributed to this success. Recent d

IMPROVING HYPERTENSION CONTROL AMONG AN UNDERSERVED URBAN PATIENT POPULATION

THE PREVALENCE AND PREDICTORS OF RESISTANT HYPERTENSION IN HIGH-RISK OVERWEIGHT AND OBESE PATIENTS: A CROSS-SECTIONAL STUDY BASED ON THE 2017 ACC/AHA GUIDELINES

DETERMINANTS OF PATIENT-REPORTED PERFORMANCE OF BIOLOGICAL TREATMENT IN AXIAL SPONDYLOARTHRITIS: A QUESTIONNAIRE-BASED CROSSSECTIONAL STUDY

A PERNICIOUS PRESENTATION

ENDOCRINE EMERGENCIES

OUTCOMES OF LIVER TRANSPLANTATION FOR BUDD-CHIARI SYNDROME IN THE MELD ERA

Background: Studies have shown that a diagnosis of schizophrenia is associated with lower utilization of stents and higher mortality among patients with an acute myocardial infarction. We wished to investigate difference in outcomes and utilization of other procedures in a large population.
Methods: In a retrospective cohort study, using the 2014 Nationwide Inpatient Sample (NIS), we analyzed adult patients with AMI,
who had a diagnosis of schizophrenia. We performed univariate analysis of age, sex, race, hospital location, hospital teaching status, insurance type, hospital bed size, Charlson Comorbidity Index and other relevant comorbidities and we included variables with p<0.2 in the multivariate logistic regression model.
Results: A total of 115,042 patients with AMI were examined. As compared to patients without schizophrenia, patients with a diagnosis of schizophrenia (n=625) were younger (AMI: 61± 0.5, vs 67 ± 0.1, p<0001); and had a higher prevalence of diabetes mellitus (37% vs 31%, p<0.008). Schizophrenia was associated with lower utilization of stents, OR= 0.48, p<0.001. Furthermore, patients with schizophrenia and AMI were less likely to receive stent implantation within 48 hours, OR=0.50, p<0.001. A smaller proportion of patients with schizophrenia were treated with coronary artery bypass grafts, OR=0.61, p=0.0017. The use of fibrinolytic therapy, invasive catheterization, mechanical ventilation, implantable cardioverter-defibrillator, and short-term mechanical circulatory support was similar in patients with schizophrenia as compared with patients without this diagnosis. Patients with schizophrenia and AMI were more likely to be in acute heart failure exacerbation, OR= 1.29, p=0.04. Although the hospital length of stay was longer in patients with schizophrenia, Coef.=0.97, p=0.003, total charges were lower, Coef. = -12241$, p=0.014, presumably due to lower rates of revascularization. Hospital mortality was similar between the two groups.
Conclusion: Patients with schizophrenia appear to be less aggressively treated. Although there is a higher incidence of heart failure exacerbations in patients with AMI and schizophrenia, hospital mortality is similar.

A DIAGNOSIS OF SCHIZOPHRENIA IS ASSOCIATED WITH LOWER UTILIZATION OF STENTS AND CORONARY ARTERY BYPASS GRAFTS AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: A NATIONWIDE ANALYSIS USING THE NATIONAL INPATIENT SAMPLE DATABASE OF 2014

PERICARDIOCENTESIS AND PERICARDIOTOMY: A NATIONAL COMPARISON OF UTILIZATION, COST AND OUTCOMES

HOME-BASED CARDIAC REHABILITATION AND MORTALITY IN PATIENTS WITH CARDIOVASCULAR DISEASE: RESULTS FROM THE SAN FRANCISCO HEALTHY HEART PROGRAM

SYNTHESIZING MARKERS OF KIDNEY INJURY IN ACUTE DECOMPENSATED HEART FAILURE: SHOULD WE EVEN KEEP LOOKING?

TELLING GREAT STORIES: IMPROVING COMMUNICATION SKILLS AND RESIDENT WELL-BEING THROUGH STORYTELLING

[2019-2020 Research Week Abstract Book](https://issuu.com/georgina.osorio/docs/1st_annual_mount_sinai_morningside__f91ffc12fb7eb1?fr=sNzQ1MzE0NzM3MDY)

1st Annual Mount Sinai Morningside and Mount Sinai West Internal Medicine Residency Program’s Research Week

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