Faculty Bibliography

Introduction. COVID-19 has rapidly emerged as a pandemic infection that has caused significant mortality and economic losses. Potential therapies and prophylaxis against COVID-19 are urgently needed to combat this novel infection. As a result of in vitro evidence suggesting zinc sulphate may be efficacious against COVID-19, our hospitals began using zinc sulphate as add-on therapy to hydroxychloroquine and azithromycin.Aim. To compare outcomes among hospitalized COVID-19 patients ordered to receive hydroxychloroquine and azithromycin plus zinc sulphate versus hydroxychloroquine and azithromycin alone.Methodology. This was a retrospective observational study. Data was collected from medical records for all patients with admission dates ranging from 2 March 2020 through to 11 April 2020. Initial clinical characteristics on presentation, medications given during the hospitalization, and hospital outcomes were recorded. The study included patients admitted to any of four acute care NYU Langone Health Hospitals in New York City. Patients included were admitted to the hospital with at least one positive COVID-19 test and had completed their hospitalization. Patients were excluded from the study if they were never admitted to the hospital or if there was an order for other investigational therapies for COVID-19.Results. Patients taking zinc sulphate in addition to hydroxychloroquine and azithromycin (n=411) and patients taking hydroxychloroquine and azithromycin alone (n=521) did not differ in age, race, sex, tobacco use or relevant comorbidities. The addition of zinc sulphate did not impact the length of hospitalization, duration of ventilation or intensive care unit (ICU) duration. In univariate analyses, zinc sulphate increased the frequency of patients being discharged home, and decreased the need for ventilation, admission to the ICU and mortality or transfer to hospice for patients who were never admitted to the ICU. After adjusting for the time at which zinc sulphate was added to our protocol, an increased frequency of being discharged home (OR 1.53, 95 % CI 1.12-2.09) and reduction in mortality or transfer to hospice among patients who did not require ICU level of care remained significant (OR 0.449, 95 % CI 0.271-0.744).Conclusion. This study provides the first in vivo evidence that zinc sulphate may play a role in therapeutic management for COVID-19.

Background/Purpose: Mental health problems are common and often untreated in youth with rheumatologic disease, yet their relationship with disease features is poorly understood. We engaged patients and parents on the research team to identify cross-cutting disease factors impacting mental health in this population.
Method(s): An anonymous cross-sectional online survey examined mental health experiences of patients with juvenile arthritis, juvenile dermatomyositis, or systemic lupus erythematosus. Youth ages 14-24 years and parents of youth 8-24 years were eligible. The survey was developed with patient and parent advisors, the Childhood Arthritis & Rheumatology Research Alliance (CARRA), and the Patients, Advocates, and Rheumatology Teams Network for Research and Service (PARTNERS). Participants were recruited through the Arthritis Foundation, Lupus Foundation of America, and Cure JM Foundation. Primary outcome was the presence of any clinician or self-diagnosed mental health problem. Exposures of interest included several cross-cutting disease factors: disease duration, active disease status, current steroid medication, history of disease flare following remission, and appearance-altering comorbidities (psoriasis, stretch marks, alopecia, skin ulceration, visible scarring). We used logistic regression models to examine the association between any clinician or self-diagnosed mental health problems and disease factors for the combined youth/parent sample, and for youth and parents separately. Secondarily, we examined results by mental health problem (depression, anxiety, self-harm/ suicidal ideation). Alpha values < .05 were considered significant.
Result(s): See Table 1 for sample characteristics. 447 respondents included 123 youth and 324 parents; they were not required to be dyads. Combining youth and parent responses, 210 had juvenile arthritis, 173 had juvenile dermatomyositis, and 64 had systemic lupus erythematosus. Those with and without mental health problems were comparable on many demographic and disease factors, although patients with appearance altering comorbidities were more likely to report mental health problems. Rates of clinician and self-diagnosed depression, anxiety, suicidal thoughts, and self-harm are shown in Figure 1. Adjusted logistic regression models (Table 2) indicate that having appearance altering comorbidities predicted the presence of a mental health problem in the combined youth/parent sample and in the parent-only sample. In the combined sample, appearance altering comorbidities also predicted depression and anxiety problems, whereas history of flare following remission predicted reported suicidal ideation or self-harm. Within the youth responses, there was a trend for depression to be more likely among those taking steroids (p=.053).
Conclusion(s): Certain cross-cutting rheumatologic disease factors such as appearance-altering comorbidities are predictive of mental health problems such as depression or anxiety. These findings are helpful for identifying targets for mental health screening in youth with rheumatologic disease, and should be addressed in screening recommendations.(Figure Presented)

Covid-19 is a new highly contagious RNA viral disease that has caused a global pandemic. Human-to-human transmission occurs primarily through oral and nasal droplets and possibly through the airborne route. The disease may be asymptomatic or the course may be mild with upper respiratory symptoms, moderate with non-life-threatening pneumonia, or severe with pneumonia and acute respiratory distress syndrome. The severe form is associated with significant morbidity and mortality. While patients who are unstable and in acute distress need immediate in-person attention, many patients can be evaluated at home by telemedicine or videoconferencing. The more benign manifestations of Covid-19 may be managed from home to maintain quarantine, thus avoiding spread to other patients and health care workers. This document provides an overview of the clinical presentation of Covid-19, emphasizing telemedicine strategies for assessment and triage of patients. Advantages of the virtual visit during this time of social distancing are highlighted.

INTRODUCTION/BACKGROUND:Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a newly redefined form of chronic airway disease and has not been well studied among 9/11-exposed populations with increased prevalence of asthma. We assessed the prevalence and risk factors associated with ACO in an exposure cohort of World Trade Center Health Registry (WTCHR) enrollees. METHODS:This is a longitudinal study, including enrollees with complete data on 9/11/01 exposure at enrollment (2003-2004, Wave 1), asthma and COPD diagnoses and at least 25 years of age at the time of the 2015-2016 (Wave 4) WTCHR survey. Probable ACO was defined as self-reported post-9/11 physician-diagnosed asthma and either emphysema, chronic bronchitis, or COPD. We evaluated whether probable ACO was associated with World Trade Center (WTC)-related exposures, using multivariable logistic regression. RESULTS:Of 36,864 Wave 4 participants, 29,911 were eligible for this analysis, and 1,495 (5.0%) had self-reported post-9/11 probable ACO. After adjusting for demographics and smoking status, we found 38% increased odds of having ACO in enrollees with exposure to the dust cloud, and up to 3.39 times the odds in those with ≥3 injuries sustained on 9/11. Among rescue/recovery workers, ever working on the pile, on the pile on 9/11 or 9/12/01, or working on the WTC site for >7 days showed increased odds ratios of having ACO. CONCLUSION/CONCLUSIONS:Probable ACO is associated with WTC exposures. Further study of ACO is needed to understand the development of this and other environmentally or occupationally-related airway diseases, and how to prevent these in disasters like 9/11.