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Mpox in the Emergency Department: A Case Series

Musharbash, Michael; DiLorenzo, Madeline; Genes, Nicholas; Mukherjee, Vikramjit; Klinger, Amanda
INTRODUCTION/UNASSIGNED:We sought to describe the demographic characteristics, clinical features, and outcomes of a cohort of patients who presented to our emergency departments with mpox (formerly known as monkeypox) infection between May 1-August 1, 2022. CASE SERIES/UNASSIGNED:We identified 145 patients tested for mpox, of whom 79 were positive. All positive cases were among cisgender men, and the majority (92%) were among men who have sex with men. A large number of patients (39%) were human immunodeficiency virus (HIV) positive. There was wide variation in emergency department (ED) length of stay (range 2-16 hours, median 4 hours) and test turnaround time (range 1-11 days, median 4 days). Most patients (95%) were discharged, although a substantial proportion (22%) had a return visit within 30 days, and 28% ultimately received tecrovirimat. CONCLUSION/UNASSIGNED:Patients who presented to our ED with mpox had similar demographic characteristics and clinical features as those described in other clinical settings during the 2022 outbreak. While there were operational challenges to the evaluation and management of these patients, demonstrated by variable lengths of stay and frequent return visits, most were able to be discharged.
PMCID:10855293
PMID: 38353186
ISSN: 2474-252x
CID: 5635742

Mpox in the Emergency Department: A Case Series

Musharbash, Michael; Dilorenzo, Madeline; Genes, Nicholas; Mukherjee, Vikramjit; Klinger, Amanda
Introduction: We sought to describe the demographic characteristics, clinical features, and outcomes of a cohort of patients who presented to our emergency departments with mpox (formerly known as monkeypox) infection between May 1"“August 1, 2022. Case Series: We identified 145 patients tested for mpox, of whom 79 were positive. All positive cases were among cisgender men, and the majority (92%) were among men who have sex with men. A large number of patients (39%) were human immunodeficiency virus (HIV) positive. There was wide variation in emergency department (ED) length of stay (range 2"“16 hours, median 4 hours) and test turnaround time (range 1"“11 days, median 4 days). Most patients (95%) were discharged, although a substantial proportion (22%) had a return visit within 30 days, and 28% ultimately received tecrovirimat. Conclusion: Patients who presented to our ED with mpox had similar demographic characteristics and clinical features as those described in other clinical settings during the 2022 outbreak. While there were operational challenges to the evaluation and management of these patients, demonstrated by variable lengths of stay and frequent return visits, most were able to be discharged.
SCOPUS:85178946971
ISSN: 2474-252x
CID: 5622452

The Role of a Tertiary Level Safety Net Hospital in New York City's 2022 Mpox Outbreak

Lo Piccolo, Anthony J; Wallach, Andrew; McPherson, Tristan D; Mgbako, Ofole; Fagan, Ian; Pitts, Robert A; Klinger, Amanda; Foote, Mary; Garcia, Elizabeth A; Zucker, Jason E; Chan, Justin; Bails, Douglas B; Cohen, Gabriel M; Tennill, Patricia Ann; Wong, Marcia; Mukherjee, Vikramjit
Similar to the early phases of the COVID-19 pandemic, New York City was the national epicenter of the ongoing 2022 mpox (formerly monkeypox) outbreak. Cases quickly began to rise in July 2022, primarily in gay, bisexual, or other men who have sex with men. Tools in the form of a reliable diagnostic test, an effective vaccine, and a viable treatment option have been available from the onset, although logistically complex to roll out. The special pathogens program at NYC Health + Hospitals/Bellevue, the flagship facility for the largest public hospital system in the United States, collaborated with multiple departments within Bellevue, the hospital system, and the NYC Department of Health and Mental Hygiene, to swiftly establish ambulatory testing, immunizations, patient-centered inpatient care, and outpatient therapeutics. With the ongoing mpox outbreak, hospitals and local health departments must prepare a systemwide response to identify and isolate patients and provide high-quality care. Findings from our experience can help guide institutions in developing a multipronged, comprehensive response to the ongoing mpox outbreak.
PMID: 36862506
ISSN: 2326-5108
CID: 5427702

Evolving oxygenation management reasoning in COVID-19

Liu, Steven; Sweeney, Cara; Srisarajivakul-Klein, Nalinee; Klinger, Amanda; Dimitrova, Irina; Schaye, Verity
The initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.
PMID: 32827395
ISSN: 2194-802x
CID: 4586752

CARDIAC SARCOIDOSIS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION AND VENTRICULAR FIBRILLATION [Meeting Abstract]

Mukhopadhyay, Amrita; Klinger, Amanda; Faridi, Kamil; Godishala, Anuradha; Pinto, Duane; Zimetbaum, Peter; Feinberg, Loryn
ISI:000429659704200
ISSN: 0735-1097
CID: 5263682

Perceptions and Attitudes regarding Sexually Transmitted Infection (STIs) and Family Planning among Adolescents in Northern Madagascar

Klinger, Amanda; Asgary, Ramin
The prevalence of sexually transmitted infections (STIs) and early pregnancy are high among adolescents in Madagascar. We applied a qualitative descriptive approach to evaluate perceptions, attitudes, and misconceptions regarding STIs and contraception among female and male adolescents ages 15-19 years (n = 43) in Northern Madagascar in 2014 using focus group discussions with open-ended questions. Data were coded and analyzed for major themes. Participants were in the 6th to 12th grade in school; 53% were female. Despite high levels of awareness, significant stigma against and misconceptions about STIs, condom use, and sexual practices existed. Many participants did not know how to use condoms and felt uncomfortable suggesting condoms with regular partners, despite acknowledging infidelity as a frequent problem. Male participants were more willing to use condoms as contraception for unwanted pregnancy than for prevention of STIs. Most participants held misconceptions about side effects of contraceptives, including infertility, cancer, and preventing bad blood from leaving the woman's body. Systematic and community-wide health education and formal reproductive health curricula in schools may improve attitudes and stigma regarding STIs and family planning. These strategies need to be developed and employed via collaboration among faith-based, community and non-governmental organizations, schools, and governmental health and social service agencies.
PMID: 27093243
ISSN: 1541-0331
CID: 2079942

Implementation and evaluation of a curriculum to teach reproductive health to adolescents in northern Madagascar

Klinger, Amanda; Asgary, Ramin
BACKGROUND: In Madagascar, prevalence of sexually transmitted infections (STIs) and unplanned pregnancies are high among adolescents. Limited reproductive health education is available. METHODS: In northern Madagascar, in 2014, we assessed the baseline knowledge, attitudes and self-efficacy regarding STIs/HIV and family planning among 155 adolescents, and designed and implemented a 6-week reproductive health curriculum for adolescents using complementary teaching methods. We evaluated the curriculum through pre- and post-curriculum surveys of adolescents using paired t-tests. RESULTS: Pre-test survey revealed a general lack of knowledge regarding different types of STIs. Post-curriculum, there was a significant improvement in the following educational domains: general knowledge of HIV/AIDS, other STIs and family planning (49%+/-17% to 65%+/-15%) (p<0.001), self-efficacy and use of contraceptives (57%+/-26% to 70%+/-26%) (p<0.01), and the overall combined scores of knowledge, attitude and self-efficacy (53%+/-14% to 68%+/-14%) (p<0.001). Open-ended questions revealed significant misconceptions and stigma regarding oral and anal sex and usage of condoms. CONCLUSIONS: Important misconceptions and knowledge gaps regarding reproductive health exist amongst adolescents. The comprehensive reproductive health curriculum with complementary teaching methods was feasible, well-received and effective, and could be considered for integration into the schools' curricula.
PMID: 26346692
ISSN: 1876-3405
CID: 1772472

Adult Autoimmune Enteropathy Involving Small Bowel and Colon [Meeting Abstract]

Klinger, Amanda E; Smukalla, Scott; Hajdu, Cristina H; Balzora, Sophie
ISI:000363715902069
ISSN: 1572-0241
CID: 1854562

Cumulative exposure to medical radiation for children requiring surgery for congenital heart disease

Glatz, Andrew C; Purrington, Kristen S; Klinger, Amanda; King, Amanda R; Hellinger, Jeffrey; Zhu, Xiaowei; Gruber, Stephen B; Gruber, Peter J
OBJECTIVE:To describe cumulative radiation exposure in a large single-center cohort of children with congenital heart disease (CHD) and identify risk factors for greater exposure. STUDY DESIGN/METHODS:A detailed medical radiation exposure history was collected retrospectively for patients aged <18 years who underwent surgery for CHD between January 1, 2001, and July 22, 2009. Cumulative per patient exposure was quantified as the effective dose in millisieverts (mSv) and annualized (mSv/year). RESULTS:A total of 4132 patients were subjected to 134,715 radiation examinations at a median follow-up of 4.3 years (range, 0-8.6 years). Exposure clustered around the time of surgery. The median exposure was 14 radiologic tests (the majority of which were plain film radiographs) at an effective dose of 0.96 mSv (the majority of which was from cardiac catheterization), although this distribution had a very wide range. Almost three-quarters (73.7%) were exposed to <3 mSv/year, and 5.3% were exposed to >20 mSv/year. Neonates, children with genetic syndromes, and children requiring surgery for cardiomyopathy, pulmonary valve, single ventricle, or tricuspid valve diseases were more likely to have higher exposure levels, and those requiring surgery for aortic arch anomalies or atrioventricular septal defects were more likely to have lower levels. CONCLUSION/CONCLUSIONS:Children with CHD requiring surgery are exposed to numerous medical forms of ionizing radiation. Although the majority of patients receive <3 mSv/year, there are identifiable risk factors for higher exposure levels. This may have important health implications as these patients age.
PMID: 24321535
ISSN: 1097-6833
CID: 3980392