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Utilizing Antiviral Prescription Data as a Predictor of Increasing COVID-19 Incidence: A Retrospective Study of Citywide Data

Kaul, Christina; Cohen, Gabriel M; Silverstein, Matthew; Wallach, Andrew B; Diago-Navarro, Elizabeth; Foote, Mary K
ISSN: 2328-8957
CID: 5375712

COVID-19 Reinfection and Disease Severity in the New York City Health + Hospitals System

Smolen, Jenny R; Filardo, Thomas D; George, Annie; Bhuiyan, Sakil; Kalava, Sowmya; Shahin, Noor; Farkas, Jonathan; Mantis, Jazila; Saliaj, Merjona; Mukerhee, Vikramjit; Salama, Carlos; Eckhardt, Benjamin; Cohen, Gabriel
ISSN: 2328-8957
CID: 5375722

HIV Diagnosis and the Clinical Course of COVID-19 Among Patients Seeking Care Within the New York City Public Hospital System During the Initial Pandemic Peak

Kaplan-Lewis, Emma; Banga, Jaspreet; Khan, Maria; Casey, Eunice; Mazumdar, Medha; Bratu, Simona; Abdallah, Marie; Pitts, Robert; Leider, Jason; Hennessey, Karen; Cohen, Gabriel M; Cleland, Charles M; Salama, Carlos
Reports conflict on how HIV infection influences the clinical course of COVID-19. The New York City (NYC) public hospital system provides care for over 14,000 people with HIV, was central in responding to the COVID-19 pandemic, and is therefore in a unique position to evaluate the intersection of these concurrent infections. Retrospective chart review of patients presenting to NYC Health and Hospitals (NYC H+H) diagnosed with COVID-19 infection from March 1, 2020, through April 28, 2020, compared people living with HIV (PLWH) and a propensity-matched (PM) control group of patients without HIV to evaluate associations between HIV status and COVID-19 outcomes. Two hundred thirty-four PLWH presented for COVID-19 testing and 110 (47%) were diagnosed with COVID-19. Among 17,413 patients with COVID-19 and without HIV, 1:n nearest neighbor propensity score matching identified 194 patients matched on age, sex, race, and any comorbidity. In the sample with COVID-19 (N = 304), PLWH (9.1%) had lower rates of mortality than controls [19.1%; PM odds ratio (PM-OR): 0.41, 95% confidence interval (CI): 0.19-0.86]. Among hospitalized COVID-19 patients (N = 179), HIV infection was associated with lower rates of mechanical ventilation (PM-OR: 0.31, 95% CI: 0.11-0.84) and mortality (PM-OR: 0.40, 95% CI: 0. 17-0.95). In the extended pandemic period through April 2021, aggregate data by HIV status suggested elevated hospitalization and mortality rates in PLWH versus people without HIV. These results suggest that the direct biological impacts of the HIV virus do not negatively influence COVID-19-related outcomes when controlling for comorbidity and demographic variables.
PMID: 34780305
ISSN: 1557-7449
CID: 5046482

Surge and Mortality in ICUs in New York City's Public Healthcare System

Toth, Alexander T; Tatem, Kathleen S; Hosseinipour, Nicole; Wong, Taylor; Newton-Dame, Remle; Cohen, Gabriel M; George, Annie; Sessa, Thomas; Postelnicu, Radu; Uppal, Amit; Davis, Nichola J; Mukherjee, Vikramjit
OBJECTIVES/OBJECTIVE:To evaluate the impact of ICU surge on mortality and to explore clinical and sociodemographic predictors of mortality. DESIGN/METHODS:Retrospective cohort analysis. SETTING/METHODS:NYC Health + Hospitals ICUs. PATIENTS/METHODS:Adult ICU patients with coronavirus disease 2019 admitted between March 24, and May 12, 2020. INTERVENTIONS/METHODS:None. MEASUREMENTS AND MAIN RESULTS/RESULTS:Hospitals reported surge levels daily. Uni- and multivariable analyses were conducted to assess factors impacting in-hospital mortality. Mortality in Hispanic patients was higher for high/very high surge compared with low/medium surge (69.6% vs 56.4%; p = 0.0011). Patients 65 years old and older had similar mortality across surge levels. Mortality decreased from high/very high surge to low/medium surge in, patients 18-44 years old and 45-64 (18-44 yr: 46.4% vs 27.3%; p = 0.0017 and 45-64 yr: 64.9% vs 53.2%; p = 0.002), and for medium, high, and very high poverty neighborhoods (medium: 69.5% vs 60.7%; p = 0.019 and high: 71.2% vs 59.7%; p = 0.0078 and very high: 66.6% vs 50.7%; p = 0.0003). In the multivariable model high surge (high/very high vs low/medium odds ratio, 1.4; 95% CI, 1.2-1.8), race/ethnicity (Black vs White odds ratio, 1.5; 95% CI, 1.1-2.0 and Asian vs White odds ratio 1.5; 95% CI, 1.0-2.3; other vs White odds ratio 1.5, 95% CI, 1.0-2.3), age (45-64 vs 18-44 odds ratio, 2.0; 95% CI, 1.6-2.5 and 65-74 vs 18-44 odds ratio, 5.1; 95% CI, 3.3-8.0 and 75+ vs 18-44 odds ratio, 6.8; 95% CI, 4.7-10.1), payer type (uninsured vs commercial/other odds ratio, 1.7; 95% CI, 1.2-2.3; medicaid vs commercial/other odds ratio, 1.3; 95% CI, 1.1-1.5), neighborhood poverty (medium vs low odds ratio 1.6, 95% CI, 1.0-2.4 and high vs low odds ratio, 1.8; 95% CI, 1.3-2.5), comorbidities (diabetes odds ratio, 1.6; 95% CI, 1.2-2.0 and asthma odds ratio, 1.4; 95% CI, 1.1-1.8 and heart disease odds ratio, 2.5; 95% CI, 2.0-3.3), and interventions (mechanical ventilation odds ratio, 8.8; 95% CI, 6.1-12.9 and dialysis odds ratio, 3.0; 95% CI, 1.9-4.7) were significant predictors for mortality. CONCLUSIONS:Patients admitted to ICUs with higher surge scores were at greater risk of death. Impact of surge levels on mortality varied across sociodemographic groups.
PMID: 33861549
ISSN: 1530-0293
CID: 4846392

Comorbidity and clinical factors associated with COVID-19 critical illness and mortality at a large public hospital in New York City in the early phase of the pandemic (March-April 2020)

Filardo, Thomas D; Khan, Maria R; Krawczyk, Noa; Galitzer, Hayley; Karmen-Tuohy, Savannah; Coffee, Megan; Schaye, Verity E; Eckhardt, Benjamin J; Cohen, Gabriel M
BACKGROUND:Despite evidence of socio-demographic disparities in outcomes of COVID-19, little is known about characteristics and clinical outcomes of patients admitted to public hospitals during the COVID-19 outbreak. OBJECTIVE:To assess demographics, comorbid conditions, and clinical factors associated with critical illness and mortality among patients diagnosed with COVID-19 at a public hospital in New York City (NYC) during the first month of the COVID-19 outbreak. DESIGN/METHODS:Retrospective chart review of patients diagnosed with COVID-19 admitted to NYC Health + Hospitals / Bellevue Hospital from March 9th to April 8th, 2020. RESULTS:A total of 337 patients were diagnosed with COVID-19 during the study period. Primary analyses were conducted among those requiring supplemental oxygen (n = 270); half of these patients (135) were admitted to the intensive care unit (ICU). A majority were male (67.4%) and the median age was 58 years. Approximately one-third (32.6%) of hypoxic patients managed outside the ICU required non-rebreather or non-invasive ventilation. Requirement of renal replacement therapy occurred in 42.3% of ICU patients without baseline end-stage renal disease. Overall, 30-day mortality among hypoxic patients was 28.9% (53.3% in the ICU, 4.4% outside the ICU). In adjusted analyses, risk factors associated with mortality included dementia (adjusted risk ratio (aRR) 2.11 95%CI 1.50-2.96), age 65 or older (aRR 1.97, 95%CI 1.31-2.95), obesity (aRR 1.37, 95%CI 1.07-1.74), and male sex (aRR 1.32, 95%CI 1.04-1.70). CONCLUSION/CONCLUSIONS:COVID-19 demonstrated severe morbidity and mortality in critically ill patients. Modifications in care delivery outside the ICU allowed the hospital to effectively care for a surge of critically ill and severely hypoxic patients.
PMID: 33227019
ISSN: 1932-6203
CID: 4676412

ID-psych addiction rounds: A new model to address opioid use disorder for patients on the infectious disease consult service [Meeting Abstract]

West, W; Eckhardt, B; Cohen, G M
Background. ID physicians often treat the infectious sequelae of opioid use dis-order (OUD) and are uniquely poised to link hospitalized patients to substance use resources. In a large safety net hospital, we launched a multi-disciplinary initiative to -cation-assisted treatment (MAT). We used infections as "sentinel" events to identify patients with OUD and described the clinical characteristics of the high-risk patient population jointly consulted by ID and Psychiatry teams. This healthcare workforce initiative aimed to expand the role of ID providers in the opioid epidemic and decrease barriers to buprenorphine prescribing. Every 2 weeks, ID fellows identified patients on their consult lists with infectious complications of OUD. Focused discussions were then held with the Psychiatry service and discussion of each patient continued at subsequent case confer-ences with attention paid to re-engaging those lost to follow-up. We performed chart abstraction of demographic and clinical characteristics as part of a quality improve-Results. From October 2018 to March 2019, 23 patients were discussed at 10 case conferences with input from attendings, fellows, housestaff, social workers, and repre-sentatives from a novel Primary Care Safety Net program. The average patient age was 43 (range 24-50). Patients were predominantly male (65%), heroin users (90%) with high rates of HIV (22%) and untreated HCV (40%). ID-related infections included endocarditis (39%), osteomyelitis (31%), skin and soft-tissue infections (17%) and spinal abscesses (17%). The median time for a patient to be presented at an ID-Psych Addiction Rounds was 7 days (IQR 4.5-11.5). The mean length of hospitalization was 30 days (range 2-112). MAT was initiated in 75% of patients (41% buprenorphine; 59% methadone). The 30-day lost to follow-up rate was exceedingly high, with 80% of post-hospital appointments being missed. Conclusion. ID physicians can effectively link hospitalized patients with OUD to substance use resources. A multi-disciplinary approach is key to addressing the opioid epidemic. Future work should explore how to create effective post-hospital transitions to decrease those lost to follow-up
ISSN: 2328-8957
CID: 4295952

Hemophagocytic Lymphohistiocytosis Due to Primary HHV-8 Infection in a Liver Transplant Recipient

Cohen, Gabriel M; Langer, Arielle L; Sima, Hamid; Chang, Charissa; Troy, Kevin; Taimur, Sarah
Human herpesvirus-8 (HHV-8) remains best known as an oncogenic virus, but nonneoplastic disease manifestations, such as bone marrow failure or hemophagocytic lymphohistiocytosis (HLH) have gained greater recognition in recent years. In organ transplantation, HHV-8 infection commonly occurs with reactivation of latent virus among recipients from endemic regions of the world or due to transmission from the organ donor. We describe a case of HHV-8-associated HLH in a liver transplant recipient at increased risk for primary infection. Our case highlights the risk of non-donor-derived, posttransplant primary HHV-8 infection, and demonstrates that HLH can be a life-threatening complication of this infection.
PMID: 30584592
ISSN: 2373-8731
CID: 3560102

Community-Acquired Cavitary Pseudomonas Pneumonia Linked to Use of a Home Humidifier

Woods, Eric; Cohen, Gabriel; Bressman, Eric; Lin, David; Zeitouni, Nathalie E; Beckford, Colleen; Hamula, Camille; van Bakel, Harm; Sullivan, Mitchell; Altman, Deena R; Caplivski, Daniel
Pseudomonas aeruginosa is an opportunistic pathogen that rarely causes pneumonia in otherwise healthy patients. We describe a case of community-acquired P. aeruginosa pneumonia in a previously healthy individual who likely acquired the infection from a home humidifier.
PMID: 29527364
ISSN: 2090-6625
CID: 3148042

An Unsuspected Tooth: Spontaneous Tooth Aspiration Leading to Cardiac Arrest [Case Report]

Cohen, Gabriel M; Jacobson, Lee S; Richards, Jeremy B
PMID: 27079351
ISSN: 1538-2990
CID: 3195372

More than Meets the Eye. A 23-Year-Old Woman with Rapidly Progressive Respiratory Failure, Mucositis, and Rash [Case Report]

Parris, Ritika S; Cohen, Gabriel M; Leahey, P Alexander; Gold, Howard S; McSparron, Jakob I
PMID: 26653193
ISSN: 2325-6621
CID: 3195362