Cook County Hospital Research Articles

In Memoriam: Edward W. Bermes, Jr., PhD, FAACC (1932-2021).

Dr. Edward W. Bermes, Jr., PhD, FAACC, passed away peacefully at home on February 16, 2021, following a long-term illness. He was born in Chicago, Illinois on August 20, 1932. He received his BS in Chemistry from St. Mary’s College in Winona, MN, followed by a MS and Ph.D. in Biochemistry from Loyola University of Chicago (LUC). In 1958, he was appointed Chief Biochemist at Cook County Hospital. On receiving his doctoral degree in 1959, he was appointed Assistant Professor of Biochemistry in LUC’s Stritch School of Medicine (SSOM). During the 1960s, he served as Director of Biochemistry at St. Francis and West Suburban hospitals. In 1969, he was promoted to Associate Professor of Biochemistry and Pathology. Also at that time, he led the creation of a laboratory for a hospital opening on LUC’s new medical center campus (LUMC) in Maywood, IL. By then, Dr. Bermes had become an excellent teacher and welcomed more teaching opportunities. At St. Francis Hospital, he had developed a predoctoral clinical biochemistry program. He codirected it with Dr. Hugh McDonald, Chair of LUC’s Department of Biochemistry and Biophysics. Dr. McDonald was also a charter member and Past-President of AACC (1954). It was challenging to find sites to provide clinical experience for predoctoral trainees until the opening of LUMC, which also became the location for creation of a postdoctoral fellowship program in clinical chemistry. Initially funded through a NIH grant, the postdoctoral program was approved by the American Board of Clinical Chemistry in 1972. Dr. Bermes’ devotion to postdoctoral training led to his serving on the Commission on the Accreditation of Clinical Chemistry Training Programs Board of Directors, and as its president for 8 years. During his career, he trained thousands of students of medicine, graduate schools, medical technology, and clinical laboratory science as well as residents and fellows in pathology, clinical chemistry, and other disciplines. In 1983, his dedication to teaching was recognized with his receiving AACC’s Award for Outstanding Contributions in Education and Training.

Abortion Is Healthcare: Lessons From a Public Hospital

Abortion Is Healthcare:Lessons From a Public Hospital Amy Zanoni (bio) Since the Supreme Court's Dobbs v. Jackson Women's Health Organization decision, many have invoked the coat hanger and the public hospital septic abortion ward as portents of life after the fall of Roe. Illinois Governor J. B. Pritzker was one of many pro-choice advocates who made direct reference to Ward 41 at Chicago's public hospital, Cook County Hospital. But by only paying attention to the horror stories of botched abortions in the pre-Roe era, we miss the other lessons that public hospitals like Cook County can teach us: even during Roe, access to abortion was limited, hard-fought, and dependent on local conditions. Public hospitals are key to understanding the brutal consequences of policies that limit people's access to healthcare, as well as the role that local governments often play in a country with no national healthcare system. In providing care to everyone who came through its doors, the public hospital approximated the right to healthcare. When county, state, and federal lawmakers undermined the right to reproductive care, Chicagoans demanded its reinstatement at Cook County Hospital. These struggles and the hospital's history shed light on the importance of tethering demands for reproductive rights to a more expansive welfare state and healthcare system. They also help us understand the crucial importance of federal action. Cook County Hospital Before Roe The State of Illinois passed its first anti-abortion law in 1827. But making abortion illegal never prevented women from having abortions. In the twentieth century, even before Roe, "abortion was not extraordinary, but ordinary," according to historian Leslie Reagan. Women with means were often able to access safe abortions in doctors' or midwives' offices. Low-income women were more likely to self-induce abortion and, as a result, more likely to suffer complications and end up in the hospital. [End Page 33] In Chicago, more often than not, that hospital was Cook County. Opened in 1866 to fulfill the county's legal obligation to finance medical care for the indigent, County (as it was called by many Chicagoans) provided a full spectrum of healthcare to the city's marginalized people. Communities of color, especially Black Chicagoans, relied disproportionately on County, the city's only public hospital until the 1990s. Historically barred from the industrial jobs most likely to provide insurance, Black Chicagoans were uninsured at higher rates. Private hospitals also routinely discriminated against Black Chicagoans. Medicaid, created in 1965, left out many people because the program was means-tested and because many private providers did not care for publicly insured patients. Before and after Roe, County provided care, reproductive and otherwise, to Chicagoans who needed it. Public hospitals all over the country played similar roles. In 1934, County admitted 1,159 patients suffering complications related to abortion; in 1949, the number reached 1,683 patients—about thirty-two per week in a city of approximately 3.6 million. By the early 1960s, hospital personnel cared for around 5,000 patients suffering complications from abortions annually. In 1965, one abortion patient was admitted to County for every 4.1 deliveries, compared to 1 in 10.8 at other Chicago hospitals. A twenty-one-year-old woman who underwent an illegal abortion in September 1970 was one such patient. An ambulance first brought her to a private hospital less than two miles from her South Side home. But hospital personnel sent her to County, about five miles to the northwest, claiming they had no obstetric beds available and that she had not previously seen a doctor on staff. (Private hospitals routinely sent uninsured or otherwise "undesirable" patients to County, a practice advocates decried as "patient dumping.") When she arrived at County, she was hemorrhaging and, according to the Chicago Daily Defender, "reacting adversely to poisoning from the dead fetus" left in her uterus. She died soon after. Cook County Hospital After Roe Roe v. Wade made abortion legal in 1973. But it did not guarantee the right to abortion: the absence of a comprehensive healthcare system put the onus on pregnant people to find providers and pay for abortions, as scholars including Dorothy Roberts and...

1105. A Matched-Group Comparison of Interventions for COVID-19 During the First and Second Waves of the COVID-19 Pandemic in a County Hospital in Chicago.

Abstract Background The COVID-19 pandemic continually challenges the scientific community to develop and evaluate viable treatments. In May 2020, remdesivir became the first medication to receive emergency use authorization for the treatment of COVID-19, while dexamethasone became standard of care for patients requiring supplementary oxygen in late 2020. Methods This was a retrospective observational study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19) admitted in the first wave (3/2020-7/2020) and second wave (10/2020-1/2021) at Cook County Hospital. Variables on demographic, clinical data and outcomes were extracted from the EMR. The measured intervention was use of dexamethasone with remdesivir during the second wave; patients were matched by age and diabetic status to patients in the first wave who had received only remdesivir. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. Conditional logistic regression was used to examine associations between use of dexamethasone and each outcome, controlling for glucose levels, use of remdesivir and severity of disease. Results 621 patients were admitted in the first wave (3/2020-7/2020) versus 355 in the second wave (12/2020-1/2021). Median age was 55 years and 56 years, respectively. Most patients were Hispanic and Black. In the first wave, 296 patients (48%) were admitted with severe COVID-19 (defined as oxygen saturation on room air at or below 94%) versus 163 patients (46%) in the second wave. Logistic regression showed no association between use of dexamethasone and ICU admission, mortality or intubation. Use of remdesivir showed no association with any of the outcomes. Glucose and severe/critical disease were strongly associated with ICU admission (p=0.01 and p=0.003) and mortality (p=0.06 for both). Conclusion Despite promising medications, in this study the mortality and disease severity of COVID-19 was very similar to that seen in the first wave. This could be due to patients presenting with more advanced disease and undiagnosed or poorly-controlled comorbidities that may offset the potential benefit of these treatments. Enhancing access to care and decreasing health inequalities may be more worthwhile than finding a “miracle drug”. Disclosures All Authors: No reported disclosures.

BLOOD COMPONENTS AND ITS USAGE: A CLINICAL INSIGHT FROM DIAGNOSTIC LENS

Blood is a key fluid which circulates inside the body with various significant benefits. One of the most important role of it is respiration, excretion, maintenance of normal acid base balance, nutrition, regulation of water balance, regulation of body temperature, transport of hormones, vitamins, salts and transportation of various essential vitamins required inside the body etc. Blood has various components present which perform various important roles. It has red blood cells, white blood cells, platelets, plasma etc. The knowledge of the function of all the blood components helps all the medical professionals to utilize it to the maximum level for the benefit of the patients. If the patient is having low haemoglobin level, we can transfuse packet red blood cells, if the patient is suffering from thrombocytopenia due to various reasons like dengue, gynaecological reasons or any other reasons we can transfuse platelets. And if patients require coagulation factors during various medical procedures we can transfuse plasma or factor IX or factor VIII to obtain immediate relief.The usage of blood and its various components has given a new dimension in the field of medical sciences. Owing to its impact and phenomenal usage in various surgeries, the department of transfusion medicine became an integral section in every hospital. A hospital without a blood bank holds a lesser relevance as compared to the hospital which is fully equipped with all the sophisticated amenities of blood bank. It all started back in 1932 after realizing the usage of blood in various treatment the first blood bank was established in Leningrad hospital. In 1937 Bernard fantus, director of therapeutics at the cook county hospital in Chicago, establishes the first hospital blood bank in the united states. Charles Richard Drew known as father of blood bank is an eminent pioneer in this field, whose work on the banking of blood products and the plans of collecting and distributing blood saved countless lives in the trenches of World War II and the wards of military and civilian hospitals.In India owing to its vast population and maximum requirements of blood. Leela Moolgaonkar, a social reformer, started the movement of voluntary blood donation camps in Mumbai from 1954. The 1960s saw many blood banks open in different cities. Though as per the various sources the first records of the voluntary blood donation started in India at Kolkata in west Bengal during world war-II.

Raymond A Dieter, Jr. MD MS

Raymond A Dieter, Jr. MD MS

I mmunohistochemical Characterization of Microglia in a De‐identified Human Meningioma Brain Culture

Background Microglia, the resident macrophages of the central nervous system, play an important role in immune defense by removing damaged neurons and cellular plaques. When activated microglia release pro-inflammatory mediators (i.e. reactive oxygen intermediates, eicosanoids, cytokines, and metalloproteinases) which may contribute to the pathophysiology of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, and HIV encephalopathy. Although rodent microglia have been used for immunological and pharmacological research, extrapolation of observations from rat microglia to human microglia has become challenging. Methods In 2017, a research collaboration was established between Neurosurgery at Cook County Hospital and the Pharmacology Department, College of Graduate Studies, Midwestern University. Several human brain biopsies were cultured in vitro and progressively developed into human brain tissue cultures. One of the human primary cultures (culture # 464) generated from a de-identified human WHO grade I meningioma contained several cell types as determined by immunohistochemistry and described in 2019 (1). To further characterize microglia in brain culture # 464 three antibodies were used, namely against: A) cell surface integrin CD11b; B) the ionized calcium binding adaptor molecule 1 (Iba1), and C) the transmembrane proteinTMEM119. Results Immuno-histochemistry observations appear to confirm the presence of microglia in de-identified human WHO grade I meningioma brain culture # 464. Further studies will be required to confirm our current observations and determine a method to isolate viable microglia from culture # 464. Conclusions Microglia are present in de-identified human brain culture # 464. Isolation of microglia would enable pharmacological and toxicological research with marine-derived natural products and toxins in future studies (2). (1) T. Moazezi, et al. Characterization of de-identified human brain culture by immunofluorescence. Chicago Chapter of the Society for Neuroscience, 4/19/2019, abstract F7, page 69. (2) Mayer, A.M.S., et al. Toxicological Sciences 149(2):484-95, 2016. PMID: 26609141.

Easy in, tough out: the dam of health-care racism

Until the 1980s, the practice of turning away patients on the basis of their ability to pay, without evaluating or treating them, was legal and frequent in US hospitals. A 1986 study at Cook County Hospital, a public hospital in Chicago, noted that 89% of patients transferred from private hospitals to their facility were Black and Hispanic, and 87% of them were transferred because they did not have adequate insurance. Mortality was disproportionately high among those transferred, likely due to delays in stabilisation and definitive care. This practice was ultimately disrupted—although it continues today—not by institutions recognising its unethical nature and voluntarily halting it, but by the passage of the federal Emergency Medical Treatment and Active Labor Act, which requires hospitals to stabilise and treat patients before transfer, irrespective of insurance status. It took an act of Congress to change this fundamentally racist, inequitable practice. Introducing The PenumbraThere are few topics that cause as much discomfort as inequities, particularly those related to race, gender, and other social identifiers. As a frequent lecturer, I've found the issue of how inequities shape one's experience in the health-care system, whether as a patient or in the workforce, often elicits avoidance, dismissiveness, defensiveness, or even anger. Health-care curricula typically neglect discussion of structural racism or sexism, and relegate race, sex, gender, gender identity, sexual orientation, and disability to the vague and misplaced category of risk factors. Full-Text PDF Parenting in the time of COVID-19Before COVID-19, you could put any two physician parents together and we'd have a shared narrative of all our “fails” as we juggled hospital work with child rearing: missed teacher conferences, late sign-ups for activities, being the only one who didn't attend the field trip. These were all crises in the Before Times. Our lives changed abruptly with COVID-19. The ways we educated, enriched, and entertained our kids were obliterated overnight. For many parents, child care evaporated, as did the endless march of activities that helped to keep our kids happy. Full-Text PDF

The Low Prevalence of Inclusion Body Myositis in an Outpatient Rheumatology Myositis Cohort.

IntroductionSporadic inclusion body myositis (IBM) is a rare type of myopathy of unknown etiology typified by the presence of distinctive muscle fiber inclusions. IBM belongs to a larger family of conditions called the idiopathic inflammatory myopathies (IIM). This study seeks to compare the prevalence, clinical manifestations, and disease course of IBM patients to a cohort of polymyositis (PM) and dermatomyositis (DM) patients in an outpatient rheumatology myositis cohort.MethodsWe conducted a retrospective chart review of all adult patients attending rheumatology clinics at the Cook County Hospital from 2006 to 2011 with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) diagnoses of idiopathic inflammatory myopathies (IIM). Data collected included patient demographics, serial muscle strength testing, serial creatine kinase (CK), muscle biopsies, and immunosuppressive therapies received. ResultsWe identified 112 patients with IIM with the following breakdown: 66 - dermatomyositis, 42 - polymyositis, and four - IBM. These four patients represent the primary cohort. They had a mean age of 67 years (range 62-74), the mean follow-up period of 15 months (range 3-47), mean initial muscle strength in the weakest group of 3.75 (range 2-5, standard deviation [SD]=1.3), mean initial CK of 1,968 U/L (range 313-4,795, SD=1,970), mean final muscle strength in the weakest group of 3.75 (range 3-4, SD=0.5), mean final CK of 1,326 U/L (range 213-2,943, SD=1,200).ConclusionsOur IBM patients had many features similar to other described IBM cohorts, including older age, male predominance, slow progression (stable CK and muscle strength), and lack of response to immunosuppressive therapy. Interestingly, we found a low prevalence of IBM in our outpatient rheumatology IIM cohort.

A Novel Score to Predict Esophageal Varices in Patients with Compensated Advanced Chronic Liver Disease

Several criteria have been described to noninvasively predict the presence of high-risk esophageal varices in patients with compensated advanced chronic liver disease (cACLD). However, a recent study showed that treatment with β blockers could increase decompensation-free survival in patients with clinically significant portal hypertension, thereby making it important to predict the presence of any esophageal varices. We aimed to develop a simple scoring system to predict any esophageal varices. We retrospectively reviewed patients who had vibration-controlled transient elastography (VCTE) at Cook County Hospital, Chicago, USA. Patients with cACLD and liver stiffness measurement (LSM) ≥ 10kPa with esophagogastroduodenoscopy performed within one year of VCTE were analyzed. We generated a novel score to predict esophageal varices, using the beta coefficient of predictive variables. The score was validated in an external cohort at the University of Iowa Hospital, USA. There were 372 patients in the development cohort and 200 patients in the validation cohort. LSM, platelet count, and albumin were identified as predictors of esophageal varices and were included for generating the Cook County score as "platelet count * - 0.0155872 + VCTE score * 0.0387052 + albumin * - 0.8549209." The area under receiver operating curve for our score was 0.86 for any varices and 0.85 for high risk varices and avoided more endoscopies than the expanded Baveno VI criteria while maintaining a very low miss rate (negative predictive value > 99%). We propose a new, highly accurate, and easy-to-use scoring system to predict the presence of not only high-risk but any esophageal varices in patients with cACLD.

The Guthrie Boulder: A Forgotten Monument to Anesthesia in Chicago.

The Guthrie Boulder: A Forgotten Monument to Anesthesia in Chicago.

Elderly Medication Adherence Intervention Using the My Interventional Drug-Eluting Stent Educational App: Multisite Randomized Feasibility Trial.

BackgroundA lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin.ObjectiveThis study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial.MethodsPotential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants’ blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants’ group membership. The primary outcome was a feasibility analysis of recruitment and retention.ResultsThe mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients’ reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found.ConclusionsElderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education.Trial RegistrationClinicalTrials.gov NCT04439864; https://clinicaltrials.gov/ct2/show/NCT04439864

Digital Healing: People, Information, Healthcare

Digital Healing takes the reader on an evolutionary journey focusing on the deployment of electronic health record systems across the United States from 2000 to 2018. The author, Marc Ringel, M.D., studied at the Abraham Lincoln School of Medicine in Chicago, Illinois followed by postgraduate training in pediatrics at Cook County Hospital (Chicago). He later became a general practitioner in Yuma, Colorado (population 2,000) as part of the National Health Service Corps where he fell in love with rural medicine and became Board Certified as a family physician. He has also practiced in rural Wisconsin and taught at the North Colorado Family Medicine Residency Training Program in Greeley, Colorado. He is an eloquent writer and speaker, and is dedicated to writing about rural health care, telemedicine, and continuing medical education. Dr. Ringel weaves relevant scholarly references and personal stories about his role as a family medicine physician to engage the reader in a thoughtful discussion about ways in which people are better than computers and vice versa in health care.A recurrent theme throughout the book is that no matter how sophisticated or impressive technology is, the determining factor for its successful implementation is the people involved in deploying and using the technology. Personal stories and clever examples of telemedicine applications are interwoven throughout the book in a way that draws the reader in. Dr. Ringel cleverly depicts the improvement offered by electronic health records while describing the importance of the human component of health care, focusing on patients’ stories and relationships, while using clever chapter titles such as “Left-Handed Pregnant Women,” “Everybody Wants Your Data,” and “Financial and Human Costs of EHRs.” The author commands an encyclopedic knowledge of medical history and integrates it well with the rapidly evolving digital revolution that is affecting health systems throughout the world.The central thesis of the book explores the ways in which human beings can utilize digital information and resources to improve health, while also allowing people to be more human. The author intercalates stories describing entire health systems, such as those in rural and urban centers in Colorado, with individual anecdotes that highlight the strengths and limitations of electronic health records. The author’s views, particularly advocating for rural health initiatives and reducing health services disparities, are prevalent throughout the text.As a rural practitioner, Dr. Ringel recognizes the importance of interventions that address disparities in healthcare access, particularly in remote areas of the country. All forms of telemedicine are emphasized, from phone calls to virtual consults with intensivists who offer around-the-clock expertise to clinicians in remote hospitals with limited or no access to specialists.The book is carefully organized into chapters focusing on specific areas ranging from virtual reality to artificial intelligence to clinical decision support. The author avoids jargon and aims for a balanced presentation that is accessible to medical and general readers alike. This book offers a set of perspectives on the evolution of the electronic health record system, but is not a comprehensive overview of the field. The book is available in hardback and eBook formats through a variety of services. Readers of all levels of experience will enjoy this welcome reality check in today’s digitally connected world.

Linking prescription opioids and infectious diseases

In Chicago, IL, USA, in the late 1970s, hospitalisations for infective endocarditis due to Pseudomonas aeruginosa began to increase among people who inject drugs. 1 Shekar R Rice TW Zierdt CH Kallick CA Outbreak of endocarditis caused by Pseudomonas aeruginosa serotype O11 among pentazocine and tripelennamine abusers in Chicago. J Infect Dis. 1985; 151: 203-208 Crossref PubMed Scopus (45) Google Scholar Once a rare occurrence, by 1980, P aeruginosa was the most common cause of endocarditis among people who inject drugs at Cook County Hospital (Chicago). It became clear, however, that P aeruginosa did not affect all individuals injecting drugs equally. It predominantly affected those injecting pentazocine, an opioid, and tripelennamine, an antihistamine (a combination known as T's and blues), which unlike heroin, were not boiled before injecting. 2 Botsford KB Weinstein RA Nathan CR Kabins SA Selective survival in pentazocine and tripelennamine of Pseudomonas aeruginosa serotype O11 from drug addicts. J Infect Dis. 1985; 151: 209-216 Crossref PubMed Scopus (31) Google Scholar This drug combination allowed P aeruginosa serotype O11 strains to survive, while inhibiting the growth of other P aeruginosa serotypes and Staphylococcus aureus, the latter being the main pathogen associated with infections in people using heroin. 1 Shekar R Rice TW Zierdt CH Kallick CA Outbreak of endocarditis caused by Pseudomonas aeruginosa serotype O11 among pentazocine and tripelennamine abusers in Chicago. J Infect Dis. 1985; 151: 203-208 Crossref PubMed Scopus (45) Google Scholar , 2 Botsford KB Weinstein RA Nathan CR Kabins SA Selective survival in pentazocine and tripelennamine of Pseudomonas aeruginosa serotype O11 from drug addicts. J Infect Dis. 1985; 151: 209-216 Crossref PubMed Scopus (31) Google Scholar In other words, the specific drugs and the way they were injected modulated the risk for a particular infection, with T's and blues serving as a selective medium for P aeruginosa O11. Hydromorphone and the risk of infective endocarditis among people who inject drugs: a population-based, retrospective cohort studyAmong people who inject drugs, the risk of infective endocarditis is significantly higher for those exposed to controlled-release hydromorphone than to other opioids. This association might be mediated by the controlled-release mechanism and should be the subject of further investigation. Full-Text PDF

A Tribute to N. Genell Lee

A Tribute to N. Genell Lee

Outcomes of vitrectomy for diabetic tractional retinal detachment in Chicago's county health system.

PurposeTo examine outcomes of 23-gauge (23G) pars plana vitrectomy (PPV) for complex diabetic tractional retinal detachment (TRD) in Chicago’s Cook County Health and Hospitals System (CCHHS).Materials and methodsThis is a retrospective noncomparative study of diabetic TRD cases that underwent PPV at CCHHS. Primary retinal reattachment rate, visual function, and postoperative complications were analyzed.ResultsSixty nine consecutive cases were included. Primary reattachment and final attachment were achieved in 68/69 eyes (98.6%). Secondary retinal detachment was noted in 1 eye (1.4%). Vitreous hemorrhage requiring repeat PPV developed in 5 eyes (7.2%) and reoperation due to other complications was required in 4/69 eyes (5.8%). Perfluoropropane (C3F8) gas tamponade was used in 91.3% of eyes and silicone oil in 8.7% of eyes. Mean LogMAR visual acuity significantly improved from 1.84 ± 0.61 to 0.93 ± 0.66, (P<0.0001). Vision was stabilized or improved in 66 eyes (95.7%). Visual acuity of 20/200 or better was achieved in 49/69 eyes (71.0%) and 20/50 or better in 16/69 eyes (23.2%).ConclusionsEven in patients with severe and advanced diabetic TRD pathology and unique demographics as seen in CCHHS, modern vitrectomy techniques can provide excellent anatomical and visual outcomes.

Right hospital, right patients: Penetrating injury patients treated at high-volume penetrating trauma centers have lower mortality.

The recognition of the relationship between volume and outcomes led to the regionalization of trauma care. The relationship between trauma mechanism-subtype and outcomes has yet to be explored. We hypothesized that trauma centers with a high volume of penetrating trauma patients might be associated with a higher survival rate for penetrating trauma patients. A retrospective cohort analysis of penetrating trauma patients presenting between 2011 and 2015 was conducted using the National Trauma Database and the trauma registry at the Stroger Cook County Hospital. Linear regression was used to determine the relationship between mortality and the annual volume of penetrating trauma seen by the treating hospital. Nationally, penetrating injuries account for 9.5% of the trauma cases treated. Patients treated within the top quartile penetrating-volume hospitals (≥167 penetrating cases per annum) are more severely injured (Injury Severity Score: 8.9 vs. 7.7) than those treated at the lowest quartile penetrating volume centers (<36.6 patients per annum). There was a lower mortality rate at institutions that treated high numbers of penetrating trauma patients per annum. A penetrating trauma mortality risk adjustment model showed that the volume of penetrating trauma patients was an independent factor associated with survival rate. Trauma centers with high penetrating trauma patient volumes are associated with improved survival of these patients. This association with improved survival does not hold true for the total trauma volume at a center but is specific to the volume of the penetrating trauma subtype. Prognostic/Epidemiology Study, Level-III; Therapeutic/Care Management, Level IV.

Predictors and outcomes of thyroid dysfunction with immunotherapy: A single institution observational experience.

e14134 Background: Immune-related endocrine dysfunction is unique to immunotherapy (IT). We aimed to explore the clinical parameters associated with development of thyroid disorder (TD) in patients receiving IT and their outcome. Methods: We designed a retrospective study of patients treated with anti-CTLA4 and/or anti-PD1/PDL1 IT at Cook County Hospital, Chicago between January 2015 to January 2018. Patients with incomplete charts and those who received less than two cycles of IT were excluded. Demographics, clinical and pathologic data were recorded at the time of diagnosis and prior to start of IT. Pearson Chi-square, independent sample t-test and logistic regression were used for data analysis. Results: We included 104 patients in the study, out of whom 66 were male and 38 were female. Most common diagnosis was non-small cell lung cancer (42.4%) followed by squamous cell cancer of head and neck (21.2%), renal cell cancer (12.5%), small cell lung cancer (12.5%) and melanoma (8.7%). Majority of patients (91.4%) had metastasized and were treated with either Nivolumab (71.1%) or Pembrolizumab (21.2%) in the 2nd (50%) or 3rd line (29.8%) setting. Twenty-eight patients developed TD while on IT, out of whom, 13 developed hypothyroidism, 12 developed hyperthyroidism followed by hypothyroidism and 3 developed hyperthyroidism. TD developed between 1st to 6th cycle of IT in 96.5% patients. Older age (p-0.009), history of radiation (RT) to neck (p-0.007), history of RT to chest (p-0.015), history of venous thrombosis (p-0.007) and higher thyroid stimulating hormone (TSH) level (17.76±35.67) prior to starting IT (p-0.029) were significantly associated with TD. Multivariate logistic regression showed that history of RT to neck was a significant predictor of developing TD after adjustment for age, race and sex (adjusted OR 9.64, 95% CI 1.88-49.36, p-0.007). No patient reported thyroid related symptom and IT was continued uninterrupted in all patients. Levothyroxine was the drug of choice for treating hypothyroidism. No patient received steroids or antithyroid medications. Conclusions: History of radiation therapy to neck is significantly associated with development of thyroid dysfunction in patients receiving immunotherapy. Thyroid replacement therapy is sufficient to bring down the levels of TSH and immunotherapy need not be interrupted.

Interest and use of alternative/holistic therapies amongst cancer patients at a large urban safety-net hospital.

e18289 Background: Patient interest in alternative/holistic therapies during cancer treatment is common in oncology. Studies have shown that 1 in 3 cancer patients in Europe turn to alternative therapies in combination with conventional medicine. Observational studies have shown some benefit of herbal medications in treating chemotherapy-associated complications; however, there remains skepticism in clinical practice. This study was undertaken to evaluate the interest and use of alternative treatments amongst cancer patients at a large urban safety-net hospital. Methods: An anonymous optional survey was offered in a random fashion to malignant hematology/oncology patients at Cook County Hospital in downtown Chicago. Results: One hundred seventy patients completed the survey comprised of 51% men, 78% being over age 50, and 67% with a high school or higher level of education. Responses included 35% African Americans, 34% Hispanics, and 25% Caucasians. At the time of the survey 16% of patients were currently using alternative treatments, while another 12% were planning to. Eighty-seven percent stated that they believed alternative treatments were very/somewhat beneficial, 77% expressed being very/somewhat interested in their use, and 77% stated they were very/somewhat likely to use such treatments. The treatments of interest included herbal supplements/oils in 40%, meditation/prayer in 29%, and cleanses/diets in 26%. Media and internet were the primary sources of information for 41% patients, while 36% heard about these treatments from family/friends. Although 51% of patients described having some safety concerns of such therapies, 77% had not discussed with their doctor. Conclusions: Our data showed that 28% of patients were either already taking or planning to take alternative/holistic therapies in conjunction with conventional medicine for their cancer care. Data also shows that an even larger number of patients are interested in such options and perceive them to be beneficial; however, there is a general reluctance to discuss it with the treating physician. The use of complementary therapies needs to be more openly discussed in order to better guide patients and assure safety.[Table: see text]

Neurosarcoidosis in a public safety net hospital: a study of 82 cases.

To characterize clinical presentation, laboratory and imaging data, and treatment outcomes for neurosarcoidosis in an urban safety net hospital. The research database of Cook County Health and Hospitals system was queried for all cases of sarcoidosis from 2006 to 2013. These cases plus those identified through a survey of neurology faculty were reviewed and flagged if suspected to be neurosarcoidosis. Data were extracted in a standardized fashion, upon review by two experienced neurologists; patients were classified as definite, probable or possible neurosarcoidosis. Disagreements on classification were resolved by consensus conference. 1706 cases of sarcoidosis were identified, with 82 (4.8%) classified as neurosarcoidosis. The cohort was predominantly African American (89%). Six were classified as definite, 34 as probable, and 42 as possible neurosarcoidosis. Neurosarcoidosis was the presenting symptom of sarcoidosis in 74% of cases. The most common presenting phenotype was myelopathy (21.7%), followed by optic nerve/chiasm involvement (16.0%) and epilepsy (11.3%). The facial nerve was involved in only 2% of cases. Chest x-ray showed abnormalities of sarcoidosis in 43.3% of cases, while chest CT did so in 78.6%. Corticosteroids were the initial treatment in 91% of cases, and outcomes were good in 53% of cases. Neurosarcoidosis remains a challenging diagnosis with the majority of patients without a previous diagnosis of systemic sarcoidosis. Chest imaging was supportive of the diagnosis in a majority of patients. Our cohort differs from others in the literature due to a low prevalence of facial nerve involvement. Prospective registry studies are needed.

Follow-up Rates and Contraceptive Choices after Medical Abortion in Adolescents at Cook County Hospital.

To determine follow-up rates for adolescent patients who underwent medical abortion compared with adult patients, identify patient factors associated with follow-up, and evaluate contraceptive choices at the time of follow-up. A retrospective cohort study of adolescent patients (ages 15-19years) who underwent first-trimester medical abortions at John H. Stroger, Jr. Hospital of Cook County from 2014 through2017. None. Rate of follow-up after medical abortion, demographic factors associated with higher follow-up rates, and contraceptive choices by adolescents at follow-up encounters. During the study period, 8111 medication abortions were performed in our clinic. Adolescents accounted for 446 of these patients (446/8111; 5.5%). Among adolescents, the follow-up rate was 231/446 (51.8%). We determined the follow-up rates among a random sample of patients ages 20-24years (n=494) and 25-39years (n=397) to be 213/494 (43.1%), and 161/397 (40.5%), respectively. African American adolescents were significantly less likely to follow-up compared with their Hispanic and white counterparts (relative risk, 0.76; 95% confidence interval, 0.66-0.89). Those enrolled in college were significantly more likely to follow-up compared with those who reported lower levels of education (relative risk, 1.4; 95% confidence interval, 1.0-1.9). Only 2.5% of adolescents reported ever using a tier 1 contraception option before presenting for an abortion and among those who did follow-up, only 18% chose a tier 1 option for ongoing pregnancy prevention. Approximately half of our adolescent study population is at risk for undetected failed medical abortion and subsequent unplanned pregnancy.