Faculty Bibliography

OBJECTIVE:To evaluate the association of the built environment and neighborhood resources with exercise, diet, and body mass index (BMI). METHOD/METHODS:Person-level data were collected from 533 veterans with uncontrolled hypertension. Neighborhood measures were: (a) census-tract level walkability; and (b) healthy food proximity (HFP). Robust or logistic regression (adjusting for age, race, education, comorbidity, and clustered by provider) was used to evaluate associations between neighborhood and exercise duration (hours/week), exercise adherence (% adherent), saturated fat index (0-10), Healthy Eating Index (HEI; 0-100), HEI adherence (≥ 74 score), stage of change (SOC) for exercise and diet (% in action/maintenance), BMI (kg/m²), and obesity (BMI ≥ 30 kg/m²). RESULTS:= .034. CONCLUSIONS:Geographical location is associated with exercise and diet. Environment-tailored health recommendations could promote healthier lifestyles and decrease obesity-related cardiovascular disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

OBJECTIVES/OBJECTIVE:Uncertain language in chest radiograph (CXR) reports for the diagnosis of pneumonia is prevalent. The purpose of this study is to validate an a priori stratification of CXR results for diagnosing pneumonia based on language of certainty. DESIGN/METHODS:Retrospective chart review. SETTING AND PARTICIPANTS/METHODS:CXR reports of 2,411 hospitalized patients ≥ 18 years, admitted to medicine, who received a CXR and noncontrast chest CT within 48 hours of emergency department registration at two large academic hospitals (tertiary and quaternary care) were reviewed. METHODS:test; a P value of .0031 was considered significant to account for multiple comparisons. RESULTS:CXR reports for the diagnosis of pneumonia revealed the following distribution: 61% negative, 32% uncertain, and 7% positive; CT reports were 55% negative, 22% uncertain, and 23% positive for the diagnosis of pneumonia. There were significant differences between CXR categories compared with CT categories for diagnosis of pneumonia (P < .001). Negative CXR results were not significantly different than the uncertain category with the most uncertain language (P = .030) but were significantly different from all other uncertain categories and positive results (each P < .001). Positive CXR results were not significantly different than the least uncertain category (most certain language) (P = .130) but were significantly different from all other categories (each P < .001). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Language used in CXR reports to diagnose pneumonia exists in categories of varying certainty and should be considered when evaluating patients for pneumonia.

BACKGROUND:Pediatric MetS prevalence varies due to lack of consensus on evaluative criteria and associated thresholds, with most not recommending a diagnosis <10 years. However, MetS risk components are becoming evident earlier in life and affect races and ethnicities disproportionately. OBJECTIVES:To compare the prevalence of MetS based on existing definitions and elucidate racial- and ethnic-specific characteristics associated with MetS prevalence. METHODS:The baseline and follow-up samples included 900 and 557 children 7-10 years, respectively. Waist circumference, BMI percentile, blood pressure, fasting plasma glucose (FPG), insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C) were measured. Agreement between MetS definitions was quantified via kappa statistics. MetS and risk factor prevalence and the predictability of metabolic parameters on MetS eight months later was evaluated via logistic regression. McFadden pseudo-R2 was reported as a measure of predictive ability, and the Akaike information criterion evaluated fit of each model. RESULTS:The baseline sample was 55.0% male and 71.6% Hispanic, followed by non-Hispanic White (NHW) (17.3%) and non-Hispanic Black (NHB) (11.1%), with an average age of 9.2 years. MetS prevalence ranged from 7.6% to 21.4%, highest in Hispanic (9.0%-24.0%) and lowest in NHB children (4.0%-14.0%). Highest agreement was between Ford et al. and Cook et al. definitions (K = 0.88) and lowest agreements were consistently with the International Diabetes Federation criteria (K ≤ 0.57). Compared to NHW children, Hispanic children had higher odds for MetS (OR: 1.7; p = 0.03) and waist circumference, HDL-C, and FPG risk factors (p < 0.05), while NHB children had higher odds for the FPG risk factor (p ≤ 0.007) and lower odds for the plasma triglycerides risk factor (p = 0.002), across multiple MetS definitions. In longitudinal analyses, HDL-C was the strongest independent predictor of MetS in Hispanic and NHW children (p < 0.001 and p < 0.01, respectively), while plasma triglycerides was the strongest independent predictor of MetS in NHB children (p < 0.05). CONCLUSIONS:MetS prevalence was high in children ≤10 years, and proposed criteria are susceptible to racial and ethnic bias, diagnosing some populations more than other populations with high cardiovascular risk. Earlier preventative measures should be imposed in clinical settings, accounting for racial and ethnic differences, to mitigate disease onset.

Introduction: Biloma is an extrahepatic bile collection secondary to iatrogenic or traumatic biliary tree disruption. It is a rare complication of laparoscopy cholecystectomy with an incidence rate of approximately 2.5%. Without proper management, biloma can become infected and cause life-threatening complications such as peritonitis, biliary fistula, bilhemia and hemobilia. Here we described a case of complicated biloma after laparoscopic cholecystectomy. Case Description/Methods: The patient was a 24-year-old female with a past medical history of hypertension, obesity, and recent laparoscopic cholecystectomy complicated by hepatic subcapsular biloma. It was managed by biliary stent placement via endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous drainage during the previous hospitalization. However, 6 days later, she presented with fever, chills, nausea, and right upper quadrant pain. Vital signs were fever 102.3 F and tachycardia 110 to 120 per min. The CT abdomen revealed decreased size in perihepatic fluid collection with air bubbles (14 x 11 x 18 cm; Figure). It also showed a common bile duct stent in place and a percutaneous drainage catheter tip in the inferior aspect of the collection. Lab results showed leukocytosis to 10.3, normal AST/ALT, total/direct bilirubin 2.1/12 mg/dL, and GGT 152 U/L. Broad-spectrum antibiotics were given in ED. The surgery team performed a laparoscopic lavage and discovered that the drain was not connected with the biloma. Two new drains were placed during the operation. She was discharged with PO antibiotics, and an outpatient follow-up was scheduled for drain removal.
Discussion(s): The management of biloma depends on the severity of the disease. Endoscopic therapy, such as a transpapillary biliary stent placement, can decrease the transpapillary pressure gradient, thus allowing preferential transpapillary bile flow rather than accumulation at the leaking site. However, given that stent placement does not reabsorb formed collection, patients failing ERCP should undergo percutaneous drainage or bile duct repair.Iatrogenic biloma can be detected by post-operational physical exams and image studies. Laparoscopic lavage with drainage should be considered in unresolved or infected biloma due to the high risk of peritonitis

Introduction: Epidemiologic studies continue to show disparities in CRC screening. Demographic factors including age, gender, race/ethnicity, level of education, and primary language affect the chance of having age-appropriate CRC screening. The endpoint of this study was to investigate potential differences in CRC screening by gender, race/ethnicity, and primary language in one of the largest Federally Qualified Health Center (FQHC) networks in the U.S.
Method(s): In this retrospective, observational study, data was obtained from the electronic medical records (EMR) of 12,663 patients aged 50-75 years old seen at Family Health Centers at NYU Langone during the period between August 2019 and July 2020.
Result(s): CRC screening was done in n54034 (56.6%) females, but only n52531 (45.7%) males. In terms of race/ethnicity, CRC screening was done in n54002 (58.9%) in Hispanics, n5723 (63.7%) Non- Hispanic Asians, n5 1341 (40.5%) Non-Hispanic African/Americans and n5 468 (34.4%) Non-Hispanic-Whites. In terms of language, CRC screening was done in n5 2842 (42.4%) English-speaking patients, n5 3071 (62%) Spanish-speaking patients and n5 575 (66.8%) Chinese-speaking patients.
Conclusion(s): Age-appropriate CRC screening rates differed by gender, race/ethnicity, and primary language. The lower age-appropriate CRC screening rate in males is consistent with what we know about CRC screening trends in the U.S. Surprisingly, the age-appropriate CRC screening rate was higher in Non-Hispanic Asians and Hispanics, and in those who speak a language other than English. Additionally, the ageappropriate CRC screening rate was higher in non-Hispanic African Americans than in Non-Hispanic-Whites. (Table). Improvement in CRC screening in Hispanics, Non-Hispanic Asians, and non-Hispanic African Americans has likely been due to EMR best practice and care gap flags which prompt providers to screen patients. Within the immigrant population, both literacy and culture have been shown to have a strong impact on health care utilization. Diminishing disparities in screening further may require increasing patient education that is culturally sensitive and accessible for patients with low health literacy

Introduction: The United States Preventive Services Taskforce lowered the recommended starting age for colorectal cancer (CRC) screening in average-risk adults from 50 to 45 years due to a rapid increase in young CRC incidence and overall favorable benefit-to-burden ratio in the US. This recommendation has not been widely adopted by other countries partially because the burden of young CRC in these countries is unclear compared to the United States Methods: The incidence rates of early-onset CRC in young adults (defined as the onset of CRC in individuals aged between 20 to 49 years) from 1990 to 2019 were collected from the Global Health Data Exchange (GHDx) results tool (available at https://vizhub.healthdata.org/gbd-results). Data from 204 countries and geographic areas were available. The socio-demographic index (SDI) was used to categorize countries and geographic areas by development (low, low-middle, middle, high-middle, and high).
Result(s): The global incidence rate of young CRC increased from 4.2/100,000 to 6.7/100,000 from 1990 to 2019, with an annual percentage change (APC) of 1.6%. The increase in CRC incidence rate was faster in young adults than in individuals aged 50-74 years (APC 0.6%). In the high HDI region, the CRC incidence rate decreased in adults aged 50-74 years old while it increased in adults 20-49 years old from 1995 to 2019 (Table). The increase in young CRC incidence rate was consistently observed in all five SDI regions and 185 out of 204 countries and territories (Figure a). Middle (120.8%), high-middle (98.5%), and lowmiddle (63.7%) SDI regions experienced the most rapid increase in young CRC incidence rate, while the high SDI region had the highest incidence rate by 2019 (11.5 per 100,000). By 2019, nine countries and territories (Taiwan, Monaco, Portugal, Andorra, Japan, China, Bulgaria, Hungary, and Slovakia) had higher young CRC incidence rates than the United States (Figure b); CRC screening for average-risk adults aged 45-49 years should be studied in these countries. A concerning 142 countries had a higher annual percentage increase of young CRC than the United States, which warrants further attention and investigation. (Table) (Figure a/b)
Conclusion(s): The global incidence, mortality, and DALYs of young CRC increased from 1990 to 2019. The increase in young CRC incidence was prevalent in most countries worldwide. Several countries were found to have higher incidence rates or faster increase in young CRC, which warrants further attention

Introduction: Inborn errors of immunity are a group of primary immunodeficiency disorders caused by over 400 genetic defects. Enteropathy has been common in PID patients, which presents with chronic diarrhea, malabsorption, growth delay, iron deficiency, and failure to thrive. This article systemically reviewed the clinical presentations, treatments, and genetic defects of enteropathy observed in PIDD.
Method(s): We have reviewed published cases with the clinical diagnosis of both enteropathy and PIDD using 3 databases (Pubmed, Scopus, EMBASE). A total of 346 cases met our inclusion criteria.
Result(s): The most common enteropathy-associated PIDD is common variable immunodeficiency (32.4%), IPEX (21%), selective IgA deficiency (18.1%), and hypogammaglobulinemia (7.9%; Figure). Celiac disease (26.2%) is the most common enteropathy presentation in PIDD, followed by IPEX (20.7%), autoimmune enteropathy (6.4%), and CVID enteropathy (5.8%). Selective IgA deficiency and CD/Celiac like disease were also frequently reported. More than half of documented PIDD-related CD showed positive serology test results and histopathological findings. Eighty-eight percent of PIDD-related CD cases are responsive to a gluten-free diet. FOXP3 mutation (70) was the most common gene mutation in PIDD, followed by CTLA-4 (17), CD55 (8), NFKB1 (8), GoF-STAT1 (5), GoF-STAT3 (5), and C1-INH (4; Table)). CTLA-4 mutation was found related to CVID, hypogammaglobulinemia, and autoimmune enteropathy. NFKB1was found mainly linked to CVID. We observed frequent giardiasis (21), norovirus (3), CMV (4), Candidiasis (2), and histoplasmosis (2) infections causing enteropathy in PIDD. No significant difference in treatments of the enteropathy between PIDD and non-PIDD was noticed.
Conclusion(s): Enteropathy can be common clinical presentations in IEIs. With early recognition of clinical manifestations and enteropathy-associated gene mutation, PIDD can be diagnosed and treated timely, preventing complications and mortalities

Introduction: Gastrointestinal bleeding from vascular malformation is hard to treat. Thalidomide has been shown with therapeutic effects in several studies. We performed a meta-analysis for its efficacy on GI bleeding due to vascular malformation.
Method(s): MEDLINE, the Cochrane Library, and EMBASE were searched up to June 5th. The following keywords were used: "Arteriovenous Malformation", "AVM", "Angioectasia", "Angiodysplasia", "Vascular Malformation", "Telangiectasia", "Thalidomide", "Contergan", "Thalomid", "a-Phthalimidoglutarimide". Observational studies and clinical trials that utilized Nivolumab for refractory esophageal cancer were included. Bleeding cessation rates were studied as primary outcomes. Data were analyzed with STATA version 16.0 (Stata Corp, College Station, TX, USA).
Result(s): A total of 405 manuscripts were identified and four observational or clinical studies with 194 patients meeting inclusion criteria. Patient median or mean ages were more than 50 in all 4 studies and 89 (45.4%) individuals were male. The dose of thalidomide ranged from 50 mg to 200 mg per day. The duration was from 3 months to 45 months. For patients with gastrointestinal bleeding from vascular malformation, thalidomide has a bleeding cessation rate of 41% (95%, 28%-60%) in 6-12 months.
Conclusion(s): Many of the studies claimed that thalidomide was able to decrease bleeding cessation rates significantly, while our meta-analysis with all available studies did not show a significant decrease in bleeding cessation rates compared to the non-thalidomide group reported by Wang's study (41% vs 46%) (Figure). Several studies showed that thalidomide was helpful in the yearly bleeding episodes, yearly red blood cell transfusion requirement, transfusion dependence, overall and bleeding-related hospitalization rate, endoscopic treatment requirement, and hemoglobin level changes, but none of the above topics had enough data to perform a meta-analysis. Therefore, further studies are needed to evaluate the efficacy of thalidomide on Gastrointestinal bleeding from vascular malformation, besides the bleeding cessation rates