Kings County Hospital Research Articles

The association of race with thyroid eye disease presentation and outcomes.

Classification of thyroid eye disease (TED) is largely based on guidelines developed in Europe and North America. Few studies have investigated the presentation and treatment of TED in Black populations. The objective is to examine the manifestations of TED in secondary and tertiary care center-based populations with a significant proportion of Black patients. Retrospective chart review identifying patients with a reported race/ethnicity and a presenting clinical diagnosis of TED at Kings County Hospital and SUNY Downstate Medical Center and affiliated clinics from January 1, 2010 through July 31, 2021. Main outcome measures include age of disease onset, sex, smoking status, insurance status, postal code of residence, clinical exam features, number of follow-up visits, length of follow-up, and treatments received. Of the 80 patients analyzed, 49 were Black (61.2%) and 31 were White (38.8%). Between Black and White patients, there were differences in the mean age of presentation (48.1 [range 21-76] vs 56.8 [range 28-87] years, P=0.03), insurance status (51.0% vs 77.4% private insurance, P=0.02), and mean follow up length among those with multiple visits (21.6 [range 2-88] vs 9.7 [range 1-48] months, P=0.02). The distribution of EUGOGO scores were not significantly different between Black and White patients. On initial presentation, fewer Black patients had chemosis (OR 0.21, 95% CI, 0.08 to 0.57, P=0.002), and caruncular swelling (OR 0.19, 95% CI, 0.06 to 0.59, P=0.002) compared to White patients. During the overall disease course, fewer Black patients had subjective diplopia (OR 0.20, 95% CI, 0.07 to 0.56, P=0.002), chemosis (OR 0.24, 95% CI, 0.09 to 0.63, P=0.004), and caruncular swelling (OR 0.18, 95% CI, 0.07 to 0.51, P=0.001) compared to White patients. Black patients received oral steroids (42.9% vs 67.7%, P=0.03), intravenous steroids (18.4% vs 16.1%, P=0.8), orbital decompression surgery (16.7% vs 6.5%, P=0.19), and teprotumumab (22.9% vs 22.6%, P=0.99) at similar rates. Black patients presented with fewer external exam findings suggestive of active TED compared to White patients, but the rate of compressive optic neuropathy and decompression surgery were similar in the two groups. These differences may be due to disease phenotypes, which warrant further study.

Estrogen receptor positive breast cancer in an Afro-Caribbean cohort.

e12550 Background: Estrogen receptor-positive breast cancer (EBC) accounts for 78% of breast cancer (BC) cases in the United States, and with better prognosis compared to other BC subtypes. There is limited information on the incidence, presentation, and outcomes of BC in black women from the Caribbean. We describe the clinicopathologic features and treatment outcomes of EBC in this underrepresented immigrant patient population. Methods: This is a retrospective study conducted at Kings County Hospital, a public hospital in a Brooklyn, New York neighborhood with the second highest population of Afro-Caribbeans in the United States. Demographics and clinicopathological data of patients diagnosed with BC from 2015-2018 were collected from the hospital’s tumor registry. Descriptive statistics and Chi-square testing were used to analyze the data. Results: Of the 299 women with a BC diagnosis, 185 (62%) had EBC, with median age of 61, and median BMI of 29.9. Stratification by menopausal status revealed 75% of these patients were post-menopausal. 37% of pre-menopausal and 28% of post-menopausal women presented with lymph node involvement (LNI). At diagnosis, 61% of patients had localized disease, 30% regional LNI, and 9% distant metastases. Sub-analysis revealed 25%, 22%, 28%, 16% and 9% with stages 0, I, II, III and IV respectively. 39% of patients presented with Nottingham Grade 3, 50% with Grade 2, and 11% with Grade 1 disease. 25% of patients without LNI had Oncotype Dx testing. 22% of these had Recurrence Score (RS) less than 11, 50% RS 11-25, and 28% RS 26 or higher. Of the 27 patients who received neoadjuvant treatment, 22% had complete pathologic response, 37% had partial response, and 33% had disease progression. 81% of patients self-identified as Afro-Caribbean, 27% reported first- or second-degree relatives with a BC diagnosis and 22% first-degree relatives with non-breast malignancy. At time of data analysis, at median of 6 years, 75% of all patients were relapse and progression-free. Lasting response was correlated with cancer stage (p < 0.01) but independent of tumor grade and Oncotype Dx RS (p = 0.18 and p = 0.29, respectively). Conclusions: In our study, Afro-Caribbean women with EBC presented with high-grade tumors and high incidence of regional LNI. Pre-menopausal women had a higher incidence of nodal involvement. Notable was a strong family history of cancer implying inherited or familial cancer syndromes. Progression-free survival was lower than expected and correlates with disease stage, but not with low Oncotype Dx RS. Further research is warranted to investigate better prognostic tools for this population.

Abstract P4-03-05: HER2 + Breast Cancer in Afro-Caribbean Women in New York City

Abstract Background: Human Epidermal Growth Factor receptor 2 (HER2) protein overexpression and/or amplification positive breast cancer accounts for 14% of breast cancer cases in the United States. The use of anti-HER2 targeted therapy in combination with chemotherapy has resulted in better response rates leading to better outcomes in patients with this breast cancer subtype. Few studies directly investigate breast cancer outcomes in Afro-Caribbean women in the U.S, and fewer studies have investigated HER2 positive (HER2+) disease in this patient group. We describe the clinicopathologic characteristics and outcomes of HER2+ breast cancer in this minority patient group. Methods: This is a retrospective study conducted at Kings County Hospital (KCH), a public hospital in Brooklyn, a New York City borough with the highest population of Afro-Caribbeans in the United States, outside of Miami, Florida. Data of patients diagnosed with breast cancer from 2015-2018 was collected from the hospital’s tumor registry. Clinical and pathologic data was collected and analyzed with descriptive statistics and Chi-square testing. Results: A total of 299 women with breast cancer were screened and 18% (54) had HER2+ disease. 63% (34) of these patients were post-menopausal, with median age 56. 78% self-identified as Afro-Caribbean. 19% (11) of patients reported first- or second-degree relatives with a breast cancer diagnosis, 22% (13) reported first-degree relative with non-breast malignancy. Half of the patients younger < 45 years age reported a positive family history of any type of cancer. 74% of patients presented with Nottingham Grade 3 disease, 31% with localized disease, without lymph node involvement, 52% with regional lymph node involvement, and 17% with distant metastasis. 63% of patients were estrogen receptor (ER) positive and 37% were ER negative. Post-menopausal women presented with higher rates of lymph node involvement at 70.4% vs. 50% in pre-menopausal women (p=0.17). 41% (22) of patients received neoadjuvant chemotherapy while 31% received adjuvant therapy with standard chemotherapy and anti-HER2 targeted treatment. Of the 22 patients who received neoadjuvant treatment, 14% had complete pathologic response, 68% had partial response, and 18% had disease progression. Treatment response to neoadjuvant therapy was independent of lymph node status (90.9% in local disease vs. 85.7% in lymph node involvement, p=0.66). The median progression free survival was 48 months, overall survival at 7 years was not reached, and mortality rate was 16.7%. Conclusions: In our analysis, Afro-Caribbean patients with HER2+ breast cancer presented with high grade tumor, high incidence of regional lymph node involvement, and ER positive tumors. Noteworthy was the presence of strong family history of cancers, suggestive of familial or inherited cancers. Pathologic complete response to neoadjuvant chemotherapy was remarkably less than anticipated, and further research is warranted to study tumor biology and responses to standard HER2 systemic therapies in these patients.

Definitive treatment choice among Black immigrants with prostate cancer: Analysis of patient surveys distributed at a single safety-net institution.

Large-scale prostate cancer (PCa) database reviews have found a consistent discrepancy in the mortality rate in Black patients compared to their White counterparts. Furthermore, differences in PCa treatment and outcomes among Black men of different ethnic origins have also been identified. Due to the heterogeneity of PCa-impacted communities and the unclear impact of patient immigration status on treatment outcomes, we sought to determine the demographic factors associated with treatment choice for definitive treatment of PCa in our single institution's patient population of Black immigrants. We distributed surveys to all patients in the Kings County Hospital Center urologic oncology clinic from February 2019 to February 2020 and collected relevant health information via EMR. The survey collected demographic information regarding age, education, health insurance, employment status, socioeconomic status, country of birth, and years living in the United States (US). Out of the 253 patients surveyed, the majority of patients surveyed were Black and foreign born. There were no significant differences in demographic data between US-born and foreign-born patients except number of years living in the United States. In the intermediate risk group, patients living in the United States for <10 years chose surgery significantly more often than US-born patients (90.9% vs. 50.0%, p = 0.036). On multivariate analysis, patients that chose surgery were more likely to be older when diagnosed (odds ratio [OR] = 1.21) and less likely to be born in the United States than in African or Caribbean countries (OR = 0.054). In our study of a majority-Black population, we found that patients born in the United States were less likely than their foreign counterparts to opt for surgery, as previous studies have shown. The choice of definitive treatment modality for Black men with intermediate risk PCa was found to be influenced by age at diagnosis and immigration status.

Triple negative breast cancer presentation in Afro-Caribbean women in New York City.

e18726 Background: In the United States, triple negative breast cancer (TNBC) accounts for 10-15% of all breast cancers. It also has a higher incidence and worse prognosis in black women. There is paucity of information on the incidence and presentation of breast cancer in black women from the Caribbean. The clinical and pathologic profile of TNBC in this immigrant underrepresented patient group is described here. Methods: This is a retrospective study performed at Kings County Hospital (KCH), a safety net hospital in Central Brooklyn, New York City with a predominantly Afro-Caribbean patient population. Data from patients diagnosed with breast cancer from 2015-2018 were collected from the institution’s tumor registry and the clinical and pathologic data of these patients were collected and analyzed with descriptive statistics and chi square testing. Results: Of the total 299 female patients with a breast cancer diagnosis, 60 patients (20%) had TNBC with median age 57 and Nottingham grade 3 in 90% (54) of the patients. At presentation, 43% (26) presented with localized disease, 55% (33) with lymph node involvement (regional), and 2% (1) with distant metastasis. When stratified by menopausal status, 46 patients (77 %) were post-menopausal and remainder pre-menopausal. Premenopausal women presented with higher rates of regional disease at 64% with compared to 50% in the postmenopausal women (p = 0.5444). BMI was similar in both groups (p = 0.9879). Of the 37 patients with documented country of origin, 84% (31) were from the Caribbean, and 27% of these patients identified as medical tourists from the Caribbean. 25% (15) of all patients reported 1st or 2nd degree relative with breast cancer and 18% (11) reported a first degree relative with malignancy other that breast cancer. 100% of patients younger than 44 years reported a family history of cancer. Genetic testing information was unavailable to these patients. Of the twenty patients (33%) that received neoadjuvant chemotherapy with standard treatment, two achieved complete response, 15 partial response, and 3 without response to treatment. Conclusions: In our study of African-Caribbean patients with breast cancer, the incidence of TNBC was high at 20% with most presenting with high-grade tumors, regional lymph node involvement, and young age at diagnosis. Notably this represents a high-risk cohort with significant family history of breast and other cancers suggestive of inherited or familial cancers. Response to standard neoadjuvant chemotherapy was less than expected, encouraging the need to consider neoadjuvant immunotherapy in these patients.

EDITORIAL COMMENT

In this study, Seiden and colleagues1 assessed the utility of genomic testing to risk stratify 63 Black men with prostate cancer eligible for active surveillance (AS) at King's County Hospital Center, which serves a predominantly under-represented minority population in Brooklyn. In 63% of the cohort, genomic testing was discordant with initial risk stratification, with 28 men being reclassified to a higher National Comprehensive Cancer Network (NCCN) risk category and this was independent of a pre-biopsy prostate specific antigen (PSA) >10 ng/ml, abnormal digital rectal examination (DRE) and a high Prostate Imaging-Reporting and Data System (PI-RADS) score.

A Closer Look At Chronic Heart Failure Patients During The Covid-19 Pandemic

IntroductionDuring the early peak of the COVID-19 pandemic, several measures were instituted to reduce the risk of exposure among patients to the novel SARS-CoV-2 virus, including the implementation of a virtual healthcare encounter system. Unfortunately, this resulted in considerable interruptions in the dispensation of healthcare services to chronically ill patients, particularly among patients with chronic heart failure (CHF).HypothesisWe aim to study whether the patients who presented to the Kings County Hospital Emergency Department (KCH ED) with symptoms of CHF exacerbation in the months following the COVID-19 pandemic peak in New York City were impacted due to the interruption in their regular cardiology outpatient clinic visits.MethodsThe COVID-CHF study is a single-center, retrospective study of patients with CHF that presented to the KCH ED between 05/01/2020 - 12/31/2020 with CHF exacerbation symptoms, selected utilizing ICD-10 codes for admission diagnoses. Continuous variables are reported as mean ± standard deviations or median (interquartile range), while categorical variables are presented as numbers with frequencies. All analyses were performed on Microsoft Excel and R software.ResultsA total of 268 patients were included in our study, with the mean age 65.7±13.8 years and 45% female. The burden of comorbidities was high, with >50% of patients having hypertension, diabetes mellitus, and chronic kidney disease. Of the total patient population, only 61 (22.8%) patients attended a televisit appointment during the preceding pandemic months. At ED presentation, the primary presenting symptom was shortness of breath (86%), and the average hospital stay per visit was 3 (2-6) days. The projected mortality risk, according to the MAGGIC score, was 16 ± 10% at 1 year and 35 ± 17% at 3 years for our patient population. Although the gap between clinic visits and ER visits did not increase the mortality risk, patients presenting with worse New York Heart Association (NYHA) class symptoms had higher mortality risk (Figure). At discharge, 82% of patients were prescribed diuretics and 81% beta-blockers. Two patients died during admission and 3 patients died after discharge.ConclusionsIn our study, we noticed that despite the implementation of a virtual healthcare system during the COVID-19 pandemic, less than one-fourth of CHF patients were able to utilize it, and consequently, there was an increase in ED visits for acute CHF exacerbations in the ensuing months. Additionally, a worse grade of presenting symptoms was associated with higher mortality risk. Key Words: COVID-19, Heart Failure, Virtual Health

Clotting of Hemodialysis Access in Patients with COVID-19 in an Inner-City Hospital

Background: An increased incidence of thrombotic complications in patients with coronavirus disease 2019 (COVID-19) has been reported. Severe acute kidney injury (AKI) is one of the major clinical manifestations of COVID-19 with the need for renal replacement therapy. It was observed that hemodialysis (HD) accesses tended to thrombose more often in the COVID-19 population than in non-COVID-19 patients. We hypothesize that the hypercoagulable state of COVID-19 is associated with higher incidence of access clotting. Method: In this retrospective single-centered study at Kings County Hospital in New York City, 1,075 patients with COVID-19 were screened, and 174 patients who received HD from January 3, 2021 to May 15, 2020 were enrolled to examine the risk factors of dialysis access clotting in patients with COVID-19. Results: Of the 174 patients, 109 (63%) were COVID-19 positive. 39 (22.6%) patients had dialysis access clotting at least once during their hospitalization, and they had significantly higher body mass index (BMI) (p = 0.001), higher rates of COVID-19 (p = 0.015), AKI (p < 0.001), higher platelet counts (p = 0.029), higher lactate dehydrogenase levels (p = 0.009), and lower albumin levels (p = 0.001) than those without access malfunctions. Low albumin levels (p = 0.008), AKI (p = 0.008), and high BMI (p = 0.018) were risk factors associated with HD access clotting among COVID-19 patients. Conclusion: Patients with COVID-19 who receive HD for AKI with high BMI are at a higher risk of clotting their HD access.

If We Make It, Will They Take It? Attitudes Toward the Acceptability of Chlamydia Point-of-Care Testing Among Adolescents and Young Adults.

Adolescent women, 15 to 19 years of age, have the highest rate of Chlamydia trachomatis infection in the United States. The objective of this study was to ascertain knowledge and experience of C. trachomatis and acceptance of C. trachomatis point-of-care testing (POCT) if made available over-the-counter (OTC). Currently, there are no tests for C. trachomatis available OTC for purchase. Patients attending adolescent clinics at University Hospital of Brooklyn and Kings County Hospital received an anonymous 12-item questionnaire. Both clinics serve predominantly African and Caribbean American urban populations. Questions included demographics, sexual orientation, chlamydia knowledge, testing history, prior infection, partner notification, and acceptance of OTC POCT for C. trachomatis. Surveys from 151 patients (116 women, 35 men) aged 12 to 21 years (mean age, 17.6 years) were analyzed. Only 34 of the 151 (22.5%) respondents understood C. trachomatis transmission; 31 (20.5%) knew its complications. Sixty-seven (44.4%) would purchase an OTC test but 101 (66.8%) would pay no more than $20. All 151 patients reported that they would follow-up with doctor if positive; 143 (94.7%) would notify partners, although 5 of the 31 (16.1%) women with prior infection did not notify partners. Nearly half (44%) of adolescents in our population would be interested in using a potential OTC test for C. trachomatis. Cost was a major disincentive. Knowledge of infection remains cursory. However, those with a history of C. trachomatis infection and familiar with its complications were more interested in purchasing a home test. Although 100% of the respondents reported that they would follow-up with their physician if they tested positive, past behavior suggests that partner notification might be suboptimal.

MP11-18 THE CONCORDANCE BETWEEN CONVENTIONAL COMPUTED TOMOGRAPHY AND NUCLEAR MEDICINE BONE SCINTIGRAPHY IN THE IDENTIFICATION OF PROSTATE CANCER METASTASES TO BONE

You have accessJournal of UrologyProstate Cancer: Staging (MP11)1 Sep 2021MP11-18 THE CONCORDANCE BETWEEN CONVENTIONAL COMPUTED TOMOGRAPHY AND NUCLEAR MEDICINE BONE SCINTIGRAPHY IN THE IDENTIFICATION OF PROSTATE CANCER METASTASES TO BONE Corey Weinstein, Benjamin Seiden, So Yeon Pak, Nikhil Karsala, Thy Vo, Natalie Sun, Yonatan Akivis, Akya Myrie, Jack Barnett, Sarah Shidid, Ashanda Esdaille, and Llewellyn Hyacinthe Corey WeinsteinCorey Weinstein More articles by this author , Benjamin SeidenBenjamin Seiden More articles by this author , So Yeon PakSo Yeon Pak More articles by this author , Nikhil KarsalaNikhil Karsala More articles by this author , Thy VoThy Vo More articles by this author , Natalie SunNatalie Sun More articles by this author , Yonatan AkivisYonatan Akivis More articles by this author , Akya MyrieAkya Myrie More articles by this author , Jack BarnettJack Barnett More articles by this author , Sarah ShididSarah Shidid More articles by this author , Ashanda EsdailleAshanda Esdaille More articles by this author , and Llewellyn HyacintheLlewellyn Hyacinthe More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001984.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The AUA/ASTRO/SUO 2017 Guidelines recommend the use of cross sectional imaging (CT or MRI) and Nuclear Medicine Bone Scan(NMBS) for staging high-risk localized prostate cancer (PCa). Studies have compared PET/CT with NMBS in identifying Osseous Metastasis (OM) in PCa, but data on the use of CT for this purpose is limited. We compared detection rates of OM between CT and NMBS in men receiving initial staging scans for PCa. METHODS: Patients who underwent NMBS and CT as part of the initial imaging workup for metastatic PCa at Kings County Hospital and Downstate Medical Center from 2014-2019 were identified through retrospective chart review. Exclusion criteria were patients with PCa and additional malignancy, undergoing imaging for recurrence, dual scans done ≥3 months apart, and those on androgen deprivation therapy. Presence of OM was determined by radiologic interpretation reports and confirmed with bone biopsy or clinical follow up. Cohen’s kappa(κ) was used to assess concordance. Sensitivity, specificity, positive and negative predictive values(PPV and NPV) were calculated. All analysis was conducted using IBM SPSS Statistic 27. RESULTS: 141 male patients with dual scans were included in this study. Table one shows patient characteristics. 123(87.2%) of our patients had concordant imaging results (κ=0.704). 18 (12.8%) had discordant findings. When stratified by concordant pairs, both CT and NMBS accurately diagnosed 88/92(95.7%) and 31/31(100%) non-metastatic and metastatic cases, respectively. Amongst the entire cohort, CT accurately diagnosed 97/104(93.3%) and 32/37(86.5%) non-metastatic and metastatic cases, respectively. NMBS accurately diagnosed 91/104(87.5%) and 36/37(97.3%) non-metastatic and metastatic cases, respectively. A NPV of 95.1% and a PPV of 91.9% were calculated for CT. CONCLUSIONS: Our study shows high concordance, good inter-rater reliability (κ=0.704), and comparable specificity and sensitivity between CT and NMBS in detecting OM in PCa. Potential benefits of CT as a singular staging tool for PCa also include soft tissue retroperitoneal staging, serendipitous detection of abdominal/pelvic pathology, reduced healthcare costs secondary to clinically redundant evaluations. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e186-e186 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Corey Weinstein More articles by this author Benjamin Seiden More articles by this author So Yeon Pak More articles by this author Nikhil Karsala More articles by this author Thy Vo More articles by this author Natalie Sun More articles by this author Yonatan Akivis More articles by this author Akya Myrie More articles by this author Jack Barnett More articles by this author Sarah Shidid More articles by this author Ashanda Esdaille More articles by this author Llewellyn Hyacinthe More articles by this author Expand All Advertisement Loading ...

In Memoriam: José Baselga's Journey in Cancer Medicine.

In Memoriam: José Baselga's Journey in Cancer Medicine.

Effect of SARS-CoV-2 Infection on Pregnancy Outcomes in an Inner-City Black Patient Population.

While data have shown that Black populations are disproportionately affected by COVID-19, few studies have evaluated birth outcomes in these understudied populations. This study hypothesized that SARS-CoV-2 infection would confer worse maternal and neonatal outcomes in a predominantly Black and underserved population in Brooklyn, New York City. In particular, SARS-CoV-2 is associated with higher rates of preterm birth, cesarean delivery, postpartum hemorrhage, lower APGAR scores, and neonatal resuscitation. Demographic factors and comorbidities were compared between the SARS-CoV-2 positive and negative groups. A retrospective cohort study was conducted in hospitalized patients who gave birth at Kings County Hospital from April 10 through June 10, 2020. Demographic and clinical data were obtained from the electronic medical record. Patients were categorized based on SARS-CoV-2 infection status and peripartum outcomes were analyzed. We used the Fisher exact test for categorical variables and the Wilcoxon rank-sum test for continuous variables. P < 0.05 was considered significant. There were no differences in obstetric or neonatal outcomes between the SARS-CoV-2 positive and negative cohorts. Most SARS-CoV-2 positive patients were asymptomatic on admission. The rates of maternal comorbidities were similar in the SARS-CoV-2 positive and negative groups. In this predominantly Black population in Brooklyn, SARS-CoV-2 infection did not confer increased risk of adverse obstetric or neonatal outcomes, despite the prevalence of comorbidities. The impact of SARS-CoV-2 infection on pregnancy outcomes is complex and may differ on a community level. Determining how COVID-19 is associated with perinatal outcomes in this minoritized patient population will augment our understanding of health disparities in order to improve care.

Impact of Fellow Participation During Colonoscopy on Adenoma Detection Rates.

An endoscopist's adenoma detection rate (ADR) is inversely related to interval colorectal cancer risk and cancer mortality. Previous studies evaluating the impact of gastroenterology fellow participation in colonoscopy on ADR have generated conflicting results. We aimed to determine the impact of fellow participation, duration of fellowship training, and physician sex on ADR and advanced ADR (AADR). We retrospectively analyzed average-risk patients undergoing screening colonoscopy at Veterans Affairs New York Harbor Healthcare System Brooklyn Campus and Kings County Hospital Center. Review of colonoscopy and pathology reports were performed to obtain adenoma-specific details, including the presence of advanced adenoma and adenoma location (right vs. left colon). There were 893 colonoscopies performed by attending only and 502 performed with fellow participation. Fellow participation improved overall ADR (44.6% vs. 35.4%, p < 0.001), right-sided ADR (34.1% vs. 25.2%, p < 0.001), and AADR (15.3% vs. 8.3%, p < 0.001); however, these findings were institution-specific. Year of fellowship training did not impact overall ADR or overall AADR, but did significantly improve right-sided AADR (p-value for trend 0.03). Female attending physicians were associated with increased ADR (47.1% vs. 37.0%, p = 0.0037). Fellow sex did not impact ADR. Fellow participation in colonoscopy improved overall ADR and AADR, and female attending physicians were associated with improved ADR. Year of fellowship training did not impact overall ADR or AADR.

Improving SCD compliance in trauma patients at Kings County Hospital Center: a quality improvement report

Venous thromboembolism (VTE) is the fourth most commonly reported complication in trauma patients. For these patients, thromboprophylaxis is a standard of care. Patient compliance with sequential compression devices (SCDs), a...

Abstract A090: Community partnerships expand access to tumor molecular profiling

Abstract Background: In oncology, the promise of precision medicine relies fundamentally on the identification of genetic mutations that can be targeted therapeutically. Tumor molecular profiling is becoming standard of care for many cancers, however, not all cancer patients have access to genetic testing of their tumors. Lack of access to tumor molecular profiling for underrepresented minority (URM) patients contributes to cancer health disparities faced by URMs on two fronts. First, genomic profiling may provide real-time information that can alter a patient’s course of treatment, if actionable mutations are identified. Second, lack of understanding of genomic differences based on racial and ethnic ancestry may lead to ineffective treatments for URMs. Community partnerships provide one way to improve access to tumor molecular profiling for URMs. Objective: Memorial Sloan Kettering Cancer Center’s (MSKCC) Cancer Health Equity Research Program (CHERP) partners with community hospitals/centers (Kings County Hospital, Queens Cancer Center and the Ralph Lauren Cancer Center) to increase access to MSK-IMPACT™ (Integrated Mutation Profiling of Actionable Cancer Targets). MSK-IMPACT™ is a targeted tumor sequencing test used to detect gene mutations and other genetic aberrations in cancer. MSKCC staff work on-site at CHERP partner sites to assist in patient accrual, specimen collection, and specimen shipping to MSKCC. By collaborating with community sites, whose populations are predominantly URMs, MSKCC increases the diversity of the IMPACT biobank while also providing cutting-edge treatment and prevention options to patients based on IMPACT results. Results: Since opening IMPACTED (IMPACT to End Disparities) at our CHERP partner sites in 2016, 391 patients have consented to have their tumor sequenced (as of June 2019). Consistent with the aims of CHERP, the IMPACTED cohort is diverse, including 60% Black, 12% Asian, 20% other/unknown and 25% Hispanic. Two hundred fifty-six patients have had samples successfully sequenced using MSK-IMPACT™, 43% of which had at least one actionable alteration identified. Additionally, 14 patients have had positive germline results, revealing mutations that were not identified prior to their participation on IMPACT. Discussion: MSKCC’s partnerships with several community cancer providers had led to the successful enrollment of almost 400 URMs onto MSKCC’s MSK-IMPACT™ study, which seeks to identify the molecular drivers of a patient’s cancer. Providing access to tumor molecular profiling is a necessary first step to addressing cancer disparities experiences by URMs. However, access alone is not sufficient. Challenges still remain in finding appropriate treatment options, including clinical trials, when mutations are identified and in getting patients access to treatments when they are available. Working closely with our community partners will help us to address these challenges and decrease cancer disparities experiences by URMs. Citation Format: Thomas Reynolds, Kellie Jack, Margaret Kemeny, Linda Bulone, Jason Gonsky, Lewis J. Kampel, David Hyman, David B. Solit, Claire Conklin, Shadai McMillan, Nicole DeSimone, Jesse Galle, Sandy Naupari, Carol L. Brown. Community partnerships expand access to tumor molecular profiling [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A090.

Abstract B059: African American pancreatic cancer microRNAs profile to identify links to drug resistance and tumor progression

Abstract Pancreatic cancer is a deadly disease with only 8% of the patients surviving 5 years (1). Recent data published for African Americans (AA) showed that this population has the highest death rate and shortest survival of any racial/ethnic group in the US for most cancers (2). The causes of this disparity are unknown; some of them may be socioeconomic as well as barriers to high-quality cancer prevention, early detection, and treatment information and services. It is clear that there is a gap between AA and Caucasian Americans (CA) concerning the development and death from pancreatic cancer. We hypothesize that there also are molecular differences in the tumors from AA and CA patients that contribute to this disparity. Importantly, The Cancer Genome Atlas (TCGA) numbers for pancreatic cancer reveals that only 7 out of 185 cases of pancreatic cancer are from African American patients. This clearly shows a prominent under-representation of tumor-related genetic information for the AA population. MicroRNAs (miRNAs) are able to regulate dozens of targets, especially those involved in cancer, making them a potential tool to study differences between populations. It is known that patients develop drug resistance against gemcitabine and one factor could be due to differential expression of miRNAs (3). The analysis of potential miRNA differences in AA and CA tumors would be a starting point to study the function(s) and mechanisms to understand the gap between these populations. We analyzed the tumor miRNAs expression of the TCGA 7 AA patients and compared the expression with 10 CA patients from TCGA to understand the main differences in expression between the two sets of samples. Using R studio, we found 26 miRNAs significantly different between CA and AA tumors. Some of them are involved in pathways related with tumor progression, cell invasion and tumor growth. We are interested in miRNAs involved in upregulating drug resistance against gemcitabine such as miR21, miR 155, or miR 196 as well as those miRNAs that dowregulate resistance to treatment like miR148, miR200 or miR34. Importantly, these miRNAs have been defined only in CA pancreatic tumor samples. We are collecting retrospective pancreatic cancer cases at SUNY Downstate Medical Center and Kings County Hospital Center to study the expression of miRNAs using Illumina technology in our AA population in Brooklyn, NY. These tissues will be matched for age, gender, body mass index, and for stage and site of disease to the best of our ability. Adjacent normal tissues will serve as standard controls. We will use CA PDAC cases from TCGA for comparison. This work is in progress. In conclusion, we found in our analysis 26 miRNAs differentially expressed between AA and CA using TCGA data. We expect to see a difference in expression of miRNAs using samples from our patient population. In addition, we are interested to see if our patients have a different expression pattern of miRNAs related to drug resistance and if this could explain the poor response often seen in AA PDAC patients. Citation Format: Maria Munoz-Sagastibelza, Mohamed Alshal, Sayed Imtiaz, Jenny E. Paredes Sanchez, Mubarak Akadri, Raavi Gupta, Maksim Agaronov, Ellen Li, Jovanny Zabaleta, Laura Martello-Rooney. African American pancreatic cancer microRNAs profile to identify links to drug resistance and tumor progression [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B059.

Post-cataract surgery hyperreflective lesions within corneal incisions suspected to be silicone oil from disposable blades.

To investigate hyperreflective lesions within the paracentesis and main wound incisions after cataract surgery performed with disposable blades. Kings County Hospital, Brooklyn, New York, USA. Retrospective study. This is a retrospective study of 14 patients after cataract surgery with disposable corneal incision blades for the paracentesis and main wound. Anterior segment photographs were reviewed from preoperative and postoperative evaluations. Anterior segment optical coherence tomography (OCT) of the paracentesis and main wounds was included. Fourteen eyes from 14 patients were included in this study. Eleven patients had anterior segment photographs and 2 patients had anterior segment OCT showing hyperreflective lesions within the main wound and paracentesis. One patient had intraoperative photographs showing these hyperreflective lesions appearing immediately after wound construction. No patients had complications related to these findings. Cleaned disposable keratome blades had silicone oil applied to them, and then, main wounds were constructed on pig eyes that showed similar hyperreflective corneal lesions as the 11 patients presented. To the authors' knowledge, this was the first study to show hyperreflective lesions within corneal incisions after anterior segment surgery. The hypothesis was that trace amounts of silicone oil on the disposable blades was the etiology; this did not seem to have any negative consequences for the patients.

Case 3: Rapidly Expanding Neck Mass Leading to Cardiopulmonary Arrest in a 14-year-old Boy.

1. Stanley Lee, MD* 2. Ahmed Aly, MBBS* 3. Paayal Bhakta, MD* 4. Karthikeyan Parameswaran, MBBS* 5. Valeriy Chorny, MD* 6. Rohit Pinto, MD* 7. Jianying Zeng, MD† 8. Richard Hong, MD‡ 9. Melvyn Braiman, MD* 1. *Department of Pediatrics, 2. †Department of Pathology, and 3. ‡Department of Radiology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY A 14-year-old boy is transferred from an outside hospital with a 1-day history of severe left upper neck swelling and pain without any known precipitating factors. Three years ago the patient had a similar episode: a painful left neck mass was diagnosed as lymphadenitis and treated with amoxicillin without sequelae. In the emergency department, vital signs and a complete blood count are within normal limits. The mass is soft and tender to palpation, measuring 1.0 × 1.5 cm. A computed tomographic (CT) scan with contrast reveals an expansile lesion stemming from the left aspect of the hyoid bone compressing the trachea (Fig 1). The ENT team performs a bedside laryngoscopy and confirms a rightward tracheal deviation and compression. Figure 1. Expansile lesion of the hyoid bone causing a rightward tracheal deviation. A computed tomographic scan of the neck revealing a 1.3-cm lesion from the left hyoid bone (blue arrow) with an associated 11.2-cm soft tissue mass expanding through the thoracic outlet. The lesion led to a rightward tracheal deviation and compression (red arrow). On admission to the inpatient unit, the patient is alert, oriented, and in mild distress due to pain, but his vital signs remain within normal limits. The neck mass remains very tender to palpation and has expanded to 4.0 × 5.0 cm on physical examination, a few hours after the initial measurement. His neck has limited movement, and there are no signs of respiratory distress, stridor, drooling, or retractions. He is able to speak in full sentences. He has some difficulty in swallowing solids but is tolerating liquids. He is started on …

Abstract 185: The Expanded Benefit of Neprilysin Inhibitor Therapy on 30 Day Readmissions: A Useful Tool at a Safety Net Hospital

Introduction: Heart failure (HF) related hospitalizations contribute to the ever-increasing financial burden of chronic disease. There are approximately 6.5 million individuals in the US with HF, with an estimated annual cost of $39 billion. Within the arsenal of strategies developed to curb this trend, pharmacological therapy has shown to be very effective. Whilst many drugs are favored for their ability to reduce mortality and morbidity, neprilysin-inhibitors (ARNI) have recently shown to reduce 30-day readmissions in patients with HF, presenting an expanded indication to favor its usage. Methods: A retrospective review of patients discharged from the Kings County Hospital Center from October 1 st 2017 to June 30 th 2018 with a diagnosis of heart failure was conducted. Inclusion required follow up in the Heart Health Clinic at Kings County Hospital and discharge therapy with a beta-blocker and either an ACE-I, ARB or ARNI. Patients were divided into 2 groups, those continued on an ACE-i/ARB versus those who were transitioned to an ARNI. The end outcome was a 30-day all-cause readmission for heart failure at any point after enrollment. Time to event was calculated using the date the drug was started. If the drug was started prior to being enrolled, we used the date that the patient was enrolled in the study. Demographic data was extracted via chart review and analyzed by descriptive statistics. A Kaplan-Meier survival analysis was done to compare the time-to-event between both study cohorts. Results: There were 101 patient discharges. There was no statistically significant age or gender difference between cohorts. The mean age in the ARNI group was 60.4 and in the ACE-i/ARB group was 64.7. A 30-day readmission occurred in 3 (10.7%) of the 28 patients in the intervention group, compared with 21 (28.8%) of the 73 patients with ACE-i/ARB therapy. The patients transitioned to ARNI therapy had a better event free survival with a 62.8% reduction in 30-day readmission events (log rank p=0.046). Conclusion: There is statistically significant reduction in 30-day all-cause readmission following the initiation of ARNI therapy in the treatment for HF. While this trend was shown in a prospective post-hoc analysis of the initial PARADIGM-HF trial, our study presents a unique patient benefit group. Kings County Hospital serves as a safety net hospital that has a large volume of uninsured, low socioeconomic status patients, with a large African American influence, and compounded social and environmental factors that make them highly prone to CHF readmissions. It underscores the need for clinically useful strategies to reduce the burden of CHF related readmissions especially for hospitals located in low socioeconomic areas at risk for penalties.

Abstract 286: The Heart Failure Clinic: Empowering the Armor Against 30-day All-cause Readmissions

Introduction: Heart failure related recurrent hospitalizations are widely recognized as a source of burden to both patients and the health system. Hospital discharges represent a transition of care from a controlled environment to one of lesser physician oversight and can often become a catalyst for readmission. One strategy in reducing this burden is the implementation of dedicated heart failure clinics by providing ease of transition whilst ensuring disease specific care. Methods: A retrospective review of all patients discharged from the Kings County Hospital Center from October 1 st 2017 to June 30 th 2018 with a discharge diagnosis of heart failure was conducted. Patients following in the Heart Clinic (HC) were compared to those who opted for their standard follow up (SF). The option of following in the HC (intervention group) was made at the time of discharge. All included cases were followed for 30 days after discharge to determine whether an all-cause readmission occurred at any New York City Health and Hospitals affiliated hospital. Demographic data was extracted via chart review and analyzed by descriptive statistics. A Kaplan-Meier survival analysis was done to compare the time-to-event between both study cohorts. Results: There were 258 patient discharges after exclusion-criteria were applied. Overall, a sicker population was present in the HC cohort evidenced by greater NYHA Class 3 and 4 symptomatology (54.1% vs 30.4%, p=0.007) and more patients with an ejection fraction &lt;30% (58.2% vs 36.8%, p=0.014). A Kaplan Meier analysis was conducted for the 9 months of follow up. Readmission within 30 days of discharge occurred in 5 (5.4%) of the 93 patients in the intervention group, compared with 27 (16.4%) of the 165 patients without intervention. The Heart clinic group had a better event free survival with a 67.1% reduction in readmission (log rank p=0.009). The mean time to readmission in the HC cohort was lower at 27.1 days compared to 29.5 days in the SF cohort (p=0.002). Conclusion: Our study revealed a 67.1% reduction in 30-day all-cause readmission following the initiation of the clinic. There is noticeable clinical interpretation of this outcome since the heart clinic patients were a sicker cardiac population at a safety net hospital that has a large volume of uninsured, low socioeconomic status patients. The compounded biological, social and environmental factors make the case load highly prone to CHF readmissions and underscores the need for a clinically useful strategy in fighting the high morbidity, mortality and economic burden of chronic heart failure. The presented study has wide implications in promoting high quality care, reducing readmission penalties, and minimizing the cost associated with inpatient admission, especially in centers where tight financial operating margins can be a barrier to allocation of resources.