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Serota, David P., Colleen Kelley, Jesse T. Jacob, Susan M. Ray, Marcos C. Schechter, and Russell Kempker. "1020. Injection Drug Use-Associated Staphylococcus aureus Bacteremia in a Large Urban Hospital in Atlanta, Georgia." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S304. http://dx.doi.org/10.1093/ofid/ofy210.857.
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Abstract Background Infectious complications of injection drug use (IDU) have increased with the expanding opioid epidemic in the southeast. We assessed the incidence, clinical presentation, and treatment outcomes of IDU-associated Staphylococcus aureus (SA) bacteremia (SAB). Methods We created a retrospective cohort of all adults with community acquired (CA) SAB over 5 years presenting to Grady Memorial Hospital, a 1,000-bed urban county hospital in Atlanta, GA. Charts were reviewed by infectious diseases physicians to obtain clinical and laboratory characteristics, including substance use disorder (SUD), and determine if SAB was IDU-associated. The study period was divided into three periods (P1 = March 2012–January 2014, P2 = January 2014–December 2015, P3 = December 2015–November 2017) to evaluate changes in the incidence of IDU-SAB over time using Poisson regression. Results Among 321 patients with a first episode of CA-SAB, 24 (7%) were IDU-SAB. The number of IDU-SAB cases in each period increased (P1 = 4, P2 = 7, and P3 = 13 [P = 0.07 for trend]). The median age of IDU-SAB patients was 38 (IQR 31–57), 11 (46%) were black, and 15 (63%) had chronic hepatitis C virus infection. Heroin was the most common injected drug (92%) followed by cocaine (25%); multiple drugs were injected in 29%. All but two patients (92%) had a complication of SAB, most commonly endocarditis (50%) and septic pulmonary emboli (38%). The median hospitalization was 23 days (IQR 19.5–37.5) and 5 patients (12%) left the hospital against medical advice (AMA). Readmission for persistent or recurrent SA infection during the study period was common (42%), and three (13%) died ≤6 months from initial presentation, including two with prior discharge AMA. Half of the discharge summaries did not mention SUD as a hospital problem. Outpatient SUD treatment was recommended to eight (33%) patients and a recommendation of abstinence was the intervention for 12 (50%). Conclusion Increasing IDU-SAB was observed over 5 years in our urban Atlanta hospital, primarily due to heroin use. Most cases were associated with complications of SAB with a long length of stay and frequent readmission, but few patients received treatment or harm reduction interventions for their SUD. These data will raise awareness and direct resources to expanding evidence-based opioid use disorder treatment for patients with infectious complications of IDU. Disclosures All authors: No reported disclosures.
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Reef, Susan E., Brent A. Lasker, Dona S. Butcher, Michael M. McNeil, Ruth Pruitt, Harry Keyserling, and William R. Jarvis. "Nonperinatal Nosocomial Transmission ofCandida albicans in a Neonatal Intensive Care Unit: Prospective Study." Journal of Clinical Microbiology 36, no. 5 (1998): 1255–59. http://dx.doi.org/10.1128/jcm.36.5.1255-1259.1998.
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Nosocomial Candida albicans infections have become a major cause of morbidity and mortality in neonates in neonatal intensive care units (NICUs). To determine the possible modes of acquisition of C. albicans in hospitalized neonates, we conducted a prospective study at Grady Memorial Hospital, Atlanta, Ga. Clinical samples for fungal surveillance cultures were obtained at birth from infants (mouth, umbilicus, and groin) and their mothers (mouth and vagina) and were obtained from infants weekly until they were discharged. All infants were culture negative for C. albicans at birth. Six infants acquired C. albicansduring their NICU stay. Thirty-four (53%) of 64 mothers were C. albicans positive (positive at the mouth, n = 26; positive at the vagina, n = 18; positive at both sites, n = 10) at the time of the infant’s delivery. A total of 49 C. albicans isolates were analyzed by restriction endonuclease analysis and restriction fragment length polymorphism analysis by using genomic blots hybridized with the CARE-2 probe. Of the mothers positive for C. albicans, 3 of 10 were colonized with identical strains at two different body sites, whereas 7 of 10 harbored nonidentical strains at the two different body sites. Four of six infants who acquired C. albicanscolonization in the NICU had C. albicans-positive mothers; specimens from all mother-infant pairs had different restriction endonuclease and CARE-2 hybridization profiles. One C. albicans-colonized infant developed candidemia; the colonizing and infecting strains had identical banding patterns. Our study indicates that nonperinatal nosocomial transmission of C. albicans is the predominant mode of acquisition by neonates in NICUs at this hospital; mothers may be colonized with multiple strains of C. albicans simultaneously; colonizing C. albicans strains can cause invasive disease in neonates; and molecular biology-based techniques are necessary to determine the epidemiologic relatedness of maternal and infant C. albicans isolates and to facilitate determination of the mode of transmission.
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Schechter, Marcos C., Maya Fayfman, Lubna SMF. Khan, Sierra Patterson, David Ziemer, Guillermo Umpierrez, Ravi Rajani, and Russell R. Kempker. "459. Gaps in Diabetic Foot Care in an Inner-City Hospital." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S225—S226. http://dx.doi.org/10.1093/ofid/ofz360.532.
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Abstract Background Diabetic foot disease is the leading cause of preventable limb loss in the United States. Care continuum models to measure gaps in care are lacking. Methods Retrospective cohort study conducted in an urban safety-net hospital in Atlanta, GA (Grady Memorial Hospital). All patients admitted between January-May 2016 with diabetes-related foot ulcer, osteomyelitis, or for lower-extremity amputation were included. A care continuum model for inpatient and post-discharge outpatient metrics was developed based on national guidelines and available diabetes care continuum models (figure). We followed patients for 12 months after initial hospital admission. Results Among 123 patients, the median age was 56 (IQR 48–64) years and most were male (67%) and black (83%) (table). Prior to hospital admission, 12% of patients had a major amputation (above ankle) and 21% had a minor amputation (below ankle). Tobacco use (34%), homelessness (29%), and no medical insurance (20%) rates were high. Few patients (28%) had hemoglobin A1c (Hb1Ac) at goal (≤7.5%) and 10% had end-stage renal disease. Regarding inpatient care metrics, 59% had a median glucose at goal on the day of discharge (≤180 gm/dL). Few patient patients had a noninvasive vascular test (13%) or received a wound offloading device (16%) during hospitalization. Regarding post-discharge outpatient metrics, 33% had wound care ≤30 days after hospitalization, 14% with tobacco use at baseline quit, and 24% had Hb1c ≤7.5%. Emergency room (ER) visits and hospital readmissions within 12 months post-discharge were common (77% and 66%, respectively). Only 54% were retained in care (≥2 clinic visits ≥90 days apart). Outcomes during 12 months after the first day of initial hospital admission were poor: 6% died, 23% had a new major amputation and 22% had a new minor amputation. Including major amputations prior to initial hospital admission, 37% of patients died or were living with a major amputation 12 months after hospitalization. Conclusion Our care continuum model demonstrated large gaps in diabetic foot care. Over a third of these patients died or were living with major limb loss and there were high rates of ER visits and hospital readmissions. Implementing measures to close gaps in care could improve outcomes. Disclosures All authors: No reported disclosures.
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El Rassi, Fuad, Eldrida Randall, Sidney F. Stein, Hanna Jean Khoury, James R. Eckman, and Morgan L. McLemore. "Temperature and Humidity Effects on Acute Vaso-Occlusive Pain Episodes in Sickle Cell Disease." Blood 126, no. 23 (December 3, 2015): 992. http://dx.doi.org/10.1182/blood.v126.23.992.992.
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Abstract Background: Sickle cell patients suffer from painful vaso-occlusive episodes (VOE) that interrupt patients' lives and productivity and lead to emergency department visits and hospitalizations and, on occasion, death. The VOE in sickle cell disease (SCD) accounts for 90% of hospital admissions for patients with SCD and constitute a financial burden on both patients and hospitals. Efforts to prevent pain crises have failed to establish a causal relationship in about 40% of reported cases. The remaining 60% of known causes of VOE are related to dehydration, febrile illness, and infections. The Emory University Sickle Cell Center at Grady Memorial hospital has been providing specialized services for SCD patients for 30 years. The center includes a 24/7 acute care unit (ACU) that is staffed by SCD providers who specialize in the management of VOE. The patients are started on intravenous narcotics and fluids within 30 minutes of presenting to the ACC. After eight hours of management, the patient is then either discharged home if the VOE is controlled or admitted to the hospital for continued management. Annually, around 3000 ACU visits are recorded with a 17% hospital admission rate. When patients are questioned on the reason for their presentation, “weather change” is frequently reported as the trigger of the VOE. A review of the literature reveals scant data to support the hypothesis that weather-related changes trigger sickle cell pain crises. Methods: In a retrospective evaluation of patient visits over the last 4 years, we identified temperature and humidity measurements for that period of time and attempted to correlate them with the frequency of ACU visits. We used the “weatherspark” website that records weather changes for the city of Atlanta because > 90% of our patients reside in the city. Results: The four-year review of weather data and ACU visits did not show a direct correlation between graphs of temperature and humidity, and the number of ACU visits. The annual number of visits to the ACU was 2930, 2467, 3195 and 3370 for the years 2011, 2012, 2013 and 2014 respectively. The average admission rate was 16.6% overall, and the admission rate in the years 2011, 2012, 2013 and 2014 was 12.4%, 14.9%, 19.6% and 19.6% respectively. The attached figure has an example of the year 2013 charts for temperature, humidity, sickle cell acute care visits and hospital admission graphs. Conclusion: The retrospective analysis does not reflect a direct correlation between the temperature and humidity graphs and the number of ACU visits and hospital admissions. Given the volume of data analyzed, it is unlikely that there is any correlation between temperature and humidity variations and either acute care visits or admissions. Atlanta, GA- ACU visits, Hospital admissions, Temperature and Humidity Charts for 2013: DATA from weatherspark.com Figure 1. Figure 1. Figure 2. Figure 2. Figure 3. Figure 3. Disclosures No relevant conflicts of interest to declare.
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Adamkiewicz, Tom, Mohamed Mubasher, Folashade Omole, Melvin R. Echols, Jason Payne, Tennille Leak-Johnson, Jan Morgan-Billingslea, et al. "Sickle Cell Disease (SCD) As a Risk for COVI19 Compared to Those without SCD Among Patients Admitted in a Large Urban Center, As Estimated By PCR Sars-v-2 Positive Vs Negative Testing." Blood 138, Supplement 1 (November 5, 2021): 4170. http://dx.doi.org/10.1182/blood-2021-148846.
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Abstract A diagnosis of SCD is considered to be at risk for COVD19. To further define the association between SCD and infection with COVID-19, we estimated risk, by comparing presence or absence of COVID19 infections in individuals with and without SCD admitted concurrently to a large urban health care facility (Grady Memorial Hospital, Atlanta, GA; 960 beds, 5th largest public hospital in the US). Primary outcome was a positive or negative COVID-19 diagnosis as defined bySARS-CoV-2 PCR testing. A patient was considered to be COVID-19 positive if tested positive withSARS-CoV-2 PCR for the first time, anytime during the study period, irrespective of number of tests. A patient was considered to be COVID-19 negative if patient had no positive tests during the study period, and had one or moreSARS-CoV-2 PCR negative tests. For COVID19 positive patients, the admission of theSARS-CoV-2 PCR positive test was included in the analysis. For COVID19 negative patients, the first admission with aSARS-CoV-2 PCR negative test was considered for analysis. For this interim analysis, SCD was defined by ICD10 and registry data. Clinical diagnosis such as obesity and respiratory failure were defined by ICD10 coding. Data was obtained from quarterly centralized Epic EMR data extractions. Analysis of outcome of COVID19 positive vs negatives was stratified in four separate analysis: all admissions, ICU admissions, those with respiratory failure and those who died. Multivariate dichotomous logistic regression analyses modeled binary outcome effect of SCD, adjusted for age (<40 vs. > 40 years), sex at birth (females vs. males) and obesity (SAS version 9.4 was used for statistical analyses and overall significance level was set at 0.05). To ensure population homogeneity analysis was conducted on patient ages 20 to 60 years that were Black/African American and admitted from the Emergency Department for a short stay and/or the medicine service (variable interactions at a p<0.01). The study was approved by the institutional review board and by the hospital research oversight committee. Overall, between 3/23/2020 and 6/30/2020, 23697 patients were admitted once or more to Grady Memorial Hospital with one or more PCR sars-cov-2 test, of these 405 were patients with SCD (1.7%). Of the total, 2566 patients (10.8%) tested positive for COVID-19, and 48 patients with SCD (11.8%) were positive. Of 7041 (29.7%) were part of the study population, 332 (4.7%) where patients with SCD (hemoglobin [hb] SS/Sbeta0 =252, hbSC n=55, hbS beta thalassemia+ or hbS beta thalassemia undetermined n=21). Among patients without SCD, 36.3% were female, (n=2557) and among patients with SCD, 53.6% (n=178). The mean age of patients without SCD was: 51.1 years (standard deviation [std]) +/- 19.5 years), and for those with SCD: 35.0 years (std +/- 12.0 years). Results of univariate and multivariate analysis are presented in the table. In conclusion, in a Black/African American patients admitted from the Emergency Room for observation and/or the internal medicine service, when adjusted for age, gender and obesity, with SCD are at a significant increased risk for admissions with COVID-19 infection in general as well as ICU admission or admission with respiratory failures. Further studies can help articulate the risk associated with SCD as well as its potential interaction with other factors, with attention to confounders. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Lovasik, Brendan P., Priya R. Rajdev, Steven C. Kim, Jahnavi K. Srinivasan, Walter L. Ingram, and Blayne A. Sayed. "“The Living Monument”: The Desegregation of Grady Memorial Hospital and the Changing South." American Surgeon 86, no. 3 (March 2020): 213–19. http://dx.doi.org/10.1177/000313482008600330.
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Grady Memorial Hospital is a pillar of public medical and surgical care in the Southeast. The evolution of this institution, both in its physical structure as well as its approach to patient care, mirrors the cultural and social changes that have occurred in the American South. Grady Memorial Hospital opened its doors in 1892 built in the heart of Atlanta's black community. With its separate and unequal facilities and services for black and white patients, the concept of “the Gradies” was born. Virtually, every aspect of care at Grady continued to be segregated by race until the mid-20th century. In 1958, the opening of the “New Grady” further cemented this legacy of the separate “Gradies,” with patients segregated by hospital wing. By the 1960s, civil rights activists brought change to Atlanta. The Atlanta Student Movement, with the support of Dr. Martin Luther King Jr., led protests outside of Grady, and a series of judicial and legislative rulings integrated medical boards and public hospitals. Eventually, the desegregation of Grady occurred with a quiet memo that belied years of struggle: on June 1, 1965, a memo from hospital superintendent Bill Pinkston read “All phases of the hospital are on a non-racial basis, effective today.” The future of Grady is deeply rooted in its past, and Grady's mission is unchanged from its inception in 1892: “It will nurse the poor and rich alike and will be an asylum for black and white.”
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Seybold, Ulrich, Nancy White, Yun F. Wang, J. Sue Halvosa, and Henry M. Blumberg. "Colonization With Multidrug-Resistant Organisms in Evacuees After Hurricane Katrina." Infection Control & Hospital Epidemiology 28, no. 6 (June 2007): 726–29. http://dx.doi.org/10.1086/518350.
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After Hurricane Katrina, 50 patients were evacuated to Grady Memorial Hospital in Atlanta, Georgia, with limited medical records. The infection control department ordered contact precautions for 16 Patients. Surveillance cultures performed on admission identified colonization with multidrug-resistant (MDR) bacteria in 9 patients (18%). Presence of a wound was the strongest predictor for MDR colonization. More data are needed to reliably predict MDR bacterial colonization.
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Sun, Phoebe Mou, Wanda Wilburn, B. Denise Raynor, and Denise Jamieson. "Sickle cell disease in pregnancy: Twenty years of experience at Grady Memorial Hospital, Atlanta, Georgia." American Journal of Obstetrics and Gynecology 184, no. 6 (May 2001): 1127–30. http://dx.doi.org/10.1067/mob.2001.115477.
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Forrest, Alexandra D., Danielle M. Vuncannon, Jane E. Ellis, Zvi Grunwald, and Frederick S. Kaplan. "Fibrodysplasia Ossificans Progressiva and Pregnancy: A Case Series and Review of the Literature." Case Reports in Obstetrics and Gynecology 2022 (September 16, 2022): 1–5. http://dx.doi.org/10.1155/2022/9857766.
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Objective. To evaluate maternal and fetal outcomes in pregnant patients with fibrodysplasia ossificans progressiva (FOP; OMIM#135100), an ultrarare genetic disorder characterized by progressive heterotopic ossification of soft tissues and cumulative disability. Methods. This is a retrospective case series of three patients with FOP who were admitted to Grady Memorial Hospital in Atlanta, Georgia, from to February 2011 to July 2021. Results. Three women delivered preterm infants at our institution. These cases posed unique anesthetic and obstetric technical challenges, particularly when securing the airway and performing cesarean delivery. Importantly, each patient received perioperative glucocorticoids for prevention of further heterotopic ossification. Conclusion. FOP is a unique clinical diagnosis encountered by obstetricians and requires multidisciplinary management for optimal outcomes.
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Robles García, M. B., J. J. Díaz Argüello, W. R. Jarvis, G. Orejas Rodríguez-Arango, and C. Rey Galán. "Factores de riesgo asociados con bacteriemia nosocomial en recién nacidos de bajo peso al nacimiento. Hospital Grady Memorial, Atlanta." Gaceta Sanitaria 15, no. 2 (2001): 111–17. http://dx.doi.org/10.1016/s0213-9111(01)71530-0.
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Goswami, Neela D., Jonathan Colasanti, Jonathan J. Khoubian, Yijian Huang, Wendy S. Armstrong, and Carlos del Rio. "A Minority of Patients Newly Diagnosed with AIDS Are Started on Antiretroviral Therapy at the Time of Diagnosis in a Large Public Hospital in the Southeastern United States." Journal of the International Association of Providers of AIDS Care (JIAPAC) 16, no. 2 (February 15, 2017): 174–79. http://dx.doi.org/10.1177/2325957417692679.
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Prompt antiretroviral therapy (ART) initiation after AIDS diagnosis, in the absence of certain opportunistic infections such as tuberculosis and cryptococcal meningitis, delays disease progression and death, but system barriers to inpatient ART initiation at large hospitals in the era of modern ART have been less studied. We reviewed hospitalizations for persons newly diagnosed with AIDS at Grady Memorial Hospital in Atlanta, Georgia in 2011 and 2012. Individual- and system-level variables were collected. Logistic regression models were used to estimate the odds ratios (ORs) for ART initiation prior to discharge. With Georgia Department of Health surveillance data, we estimated time to first clinic visit, ART initiation, and viral suppression. In the study population (n = 81), ART was initiated prior to discharge in 10 (12%) patients. Shorter hospital stay was significantly associated with lack of ART initiation at the time of HIV diagnosis (8 versus 24 days, OR: 1.14, 95% confidence interval: 1.04-1.25). Reducing barriers to ART initiation for newly diagnosed HIV-positive patients with short hospital stays may improve time to viral suppression.
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McKee, Megan Jean, Danny Nguyen, Seham Al Haddad, Elsa Paplomata, Marjorie Adams Curry, Yuan Liu, Ruth O'Regan, and Amelia Bruce Zelnak. "Adherence rates to endocrine therapy among African American women with stage I-III, hormone receptor-positive breast cancer treated at Grady Memorial Hospital in Atlanta, Georgia." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e11582-e11582. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e11582.
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e11582 Background: Breast cancer mortality has historically been higher in African American (AA) women compared to Caucasian women. Controlling for tumor characteristics, biological markers and comorbidities does not account for the disparity. Previous studies have shown that AA women are more likely to have a high 21-gene recurrence score compared to Caucasian women. Another potential variable affecting treatment outcomes is adherence to adjuvant endocrine therapy (ET). We conducted a retrospective review of pharmacy records at Grady Memorial Hospital (GMH) to examine the non-adherence rate among predominantly AA patients (pts). Methods: Pharmacy database records were examined for pts filling prescriptions for tamoxifen, anastrozole, or letrozole at GMH in Atlanta, Georgia from 2004-2009. Baseline characteristics were obtained by chart review. Pts were excluded if they had metastatic disease, DCIS, less than 60 days of eligible prescription, were male, deceased during the study period, benign disease, or no documentation of breast cancer in the electronic medical record (EMR). Non-adherence was defined as those filling less than 80% of eligible days covered by her prescription. Results: 679 pts were identified who filled prescriptions for tamoxifen, anastrozole, or letrozole at Grady pharmacy from 2004-2009. Pts who were excluded had metastatic disease (152), DCIS (101), had less than 60 days of eligible prescription (65), had no documentation of breast cancer in the EMR (25), were male (6), deceased before 2009 (5), or had benign disease (9). Of the 316 pts eligible for the study, median age was 60 (26 to 94) at time of diagnosis, 86% were AA, and 39% were node positive. 167 pts filled prescriptions for tamoxifen, 95 for anastrozole, and 54 for letrozole. The non-adherence rate for tamoxifen was 50%, anastrozole 38%, and letrozole 48%. Overall non-adherence rate was 46%. Conclusions: The overall non-adherence rate to adjuvant ET among a predominately AA population seen in a county hospital was similar to previously reported rates. Non-adherence to ET in this underserved AA pt population does not fully account for disparate outcomes.
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Gruen, Judah, Joseph Sharp, and Stephanie Sweitzer. "1349. How Anchored is the Chancre? A Chart Review of Syphilis Treatment by a Safety Net Emergency Department in Atlanta, GA." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S761—S762. http://dx.doi.org/10.1093/ofid/ofab466.1541.
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Abstract Background Since reaching its nadir in 2000, syphilis has re-emerged as a public health threat in the U.S. The incidence of syphilis is disproportionately high in Atlanta, the epicenter of the HIV epidemic in the U.S. South. Given that syphilis infection is a strong predictor of HIV infection, identifying patients with syphilis is an important and underutilized method for connecting patients to HIV prevention and care services. Emergency departments (EDs) act as a critical access point to care in safety net health systems. We describe the recognition and empiric treatment of syphilis in the ED of Grady Healthcare System, a safety net hospital serving Atlanta. Methods We performed a retrospective chart review on all reactive rapid plasma reagin (RPR) tests collected from patients 18 years and older at the Grady ED from 5/1/20 to 10/31/20. We abstracted reported reason for testing, diagnosis, treatment administered, and location of treatment from the electronic health record. Results From 5/1/20 to 10/31/20, 148 patients with reactive RPR tests were identified. Reasons for testing were broad and included the evaluation of neurologic symptoms (47), genital/anal lesions (31), and a history of syphilis (18) (Table 1). 74 patients had presumed active syphilis (50%), 34 had previously treated syphilis (23%), 12 had false positives (8%), and 28 had an unclear diagnosis (19%) (Table 2). Of those with presumed primary syphilis who were discharged from the ED, 53% (8/15) received empiric treatment in the ED; 59% (10/17) of those with secondary syphilis received empiric treatment prior to discharge. Of the patients discharged from the ED, clinical follow up was indicated for 52% (31/59) given lack of empiric treatment or of confirmed prior treatment. Contact was attempted for 39% (12/31), but only 29% (9/31) were ultimately treated at Grady. Table 1: Abstracted Reasons for Testing for Syphilis in the ED For ED patients from 5/1/20-10/31/20 who had reactive RPRs, reasons for syphilis testing were taken from the chief complaint, history, or medical decision making documentation of ED providers, admitting providers, or consultants. Table 2: Syphilis Diagnoses of ED patients with reactive RPRs ED patients with a positive RPR from 5/1/20-10/31/20 were chart reviewed to determine their diagnosis. Previous RPR, treponemal antibodies, CSF results, media images, progress notes, and descriptions by medical staff were reviewed to attempt to retroactively determine the most likely syphilis diagnosis. Conclusion Reactive RPRs were common in this acute care setting and most represented active syphilis infection. Empiric treatment was most likely to be provided for patients with clear syphilis syndromes. However, a majority of patients who were discharged without empiric treatment did not receive follow up. Institutional protocols for following up reactive tests after discharge represent an opportunity to connect patients with syphilis treatment and HIV prevention services. Disclosures All Authors: No reported disclosures
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Harrington, Kristin, Yun Wang, Paulina Rebolledo, Zhiyong Liu, Qianting Yang, and Russell R. Kempker. "253. Evaluation of a Cryptococcal Antigen Lateral Flow Assay and the Burden of Cryptococcal Disease: A Cohort Study at Grady Memorial Hospital in Atlanta, Georgia." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S141—S142. http://dx.doi.org/10.1093/ofid/ofz360.328.
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Abstract Background While Cryptococcus neoformans is a major cause of morbidity and mortality among HIV-infected persons worldwide, there is scarce recent data on disease prevalence in the United States, including in Southeastern states, where HIV rates are high. We sought to determine the prevalence of cryptococcal disease and compare the performance of a cryptococcal antigen (CrAg) lateral flow assay (LFA) vs. latex agglutination (LA) test. Methods All patients from Grady Memorial Hospital in Atlanta, Georgia who had a serum or cerebrospinal fluid (CSF) sample sent for CrAg LA testing as part of routine management from November 2017 to July 2018 were included. The LFA was performed on all samples by research staff; results were not available to clinicians. Rates of disease and agreement between the LA test and LFA were calculated. Results Among 467 patients, 570 LA tests were performed; 417 on serum and 153 on CSF (87 patients with multiple tests performed). Mean age was 44 years, and most were male (n = 322, 69%). Most patients had HIV (n = 371, 79%); median CD4 count was 73 cells/mm3 and 77% were not receiving ART. Among HIV-infected individuals, testing was performed equally in the inpatient and outpatient setting. Cryptococcal testing was done in 53 persons without apparent risk factors. Thirty-three (7%) patients had a positive serum or CSF test. Five (1%) patients had both a positive serum and CSF LA test and LFA. While the overall agreement between the LA test and LFA was substantial to high for CSF (κ = 0.71) and serum (κ = 0.93), respectively, there were important discrepancies. Four patients with a negative serum LA test had a positive serum LFA. Five patients had false-positive CSF LA tests, determined by negative CSF LFA testing, India ink, and CSF and fungal cultures. All were treated with amphotericin and flucytosine with one patient experiencing a severe anaphylactic reaction to amphotericin. Conclusion We found a moderately high rate of cryptococcal disease and important discrepancies between the LA test and LFA. The LFA appeared to be more sensitive for cryptococcemia and more specific for meningitis. Clinical implications of these findings include earlier detection and treatment of cryptococcemia, and averting unnecessary treatment of meningitis with costly medications associated with high rates of adverse events. Disclosures All authors: No reported disclosures.
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Martin-Doyle, William, Kerry L. Kilbridge, Susan Regan, Christopher Paul Filson, Quoc-Dien Trinh, Sierra Williams, and Viraj A. Master. "Providers’ inability to estimate health literacy among African American (AA) patients (pts) with early prostate cancer (PCa)." Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 77. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.77.
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77 Background: Providers’ estimates of a pt’s health literacy are important for communication and shared decision making among men with early PCa. We explored differences between providers’ estimates of health literacy and measured health literacy among AA pts in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Providers (n=18) estimated the health literacy of 124 newly diagnosed, early-stage, AA PCa pts after discussions with each pt regarding his PCa treatment options, categorized as ≤Grade (Gr) 3; Gr 4-6; Gr 7-8; and High school. At a subsequent visit, prior to choosing his cancer treatment, each pt’s health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), using the same categories. Domains of numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods. Concordance between estimated and actual health literacy was evaluated via Cohen’s Kappa coefficient (1.00 = perfect agreement). Results: Despite their discussions with the pts, providers consistently overestimated pts’ health literacy. Agreement between provider estimates and pts’ measured values was consistently low (32.0%-37.6%). These rates were approximately what would be expected by chance. Among the 75 patients with the lowest levels of health literacy, agreement was even lower (12.3%-35.6%). In this group 26.7% of provider assessments were off by ≥2 REALM categories. Conclusions: Healthcare providers are surprisingly ineffective at estimating the health literacy of their pts with early stage PCa. This poor accuracy may diminish providers’ ability to communicate successfully with pts and engage in shared decision making, especially among pts with poor health literacy. [Table: see text]
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Adams, Jenna C., Hope H. Biswas, Sheree L. Boulet, Kamini Doraivelu, Michele K. Saums, Lisa Haddad, and Denise J. Jamieson. "Factors Associated with Antenatal Influenza Vaccination in a Medically Underserved Population." Infectious Diseases in Obstetrics and Gynecology 2020 (January 27, 2020): 1–7. http://dx.doi.org/10.1155/2020/5803926.
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Influenza infection in pregnant women is associated with increased risk of morbidity and mortality. Despite recommendations for all women to receive the seasonal influenza vaccine during pregnancy, vaccination rates among pregnant women in the U.S. have remained around 50%. The objective of this study was to evaluate clinical and demographic factors associated with antenatal influenza vaccination in a medically underserved population of women. We conducted a retrospective cohort study at Grady Memorial Hospital, a large safety-net hospital in Atlanta, Georgia, from July 1, 2016, to June 30, 2018. Demographic and clinical characteristics were abstracted from the electronic medical record. The Kotelchuck index was used to assess prenatal care adequacy. Relative risks and 95% confidence intervals for associations between receipt of influenza vaccine and prenatal care adequacy, demographic characteristics, and clinical characteristics were calculated using multivariable log-binominal models. Among 3723 pregnant women with deliveries, women were primarily non-Hispanic black (68.4%) and had Medicaid as their primary insurance type (87.9%). The overall vaccination rate was 49.8% (1853/3723). Inadequate prenatal care adequacy was associated with a lower antenatal influenza vaccination rate (43.5%), while intermediate and higher levels of prenatal care adequacy were associated with higher vaccination rates (66.9–68.3%). Hispanic ethnicity, non-Hispanic other race/ethnicity, interpreter use for a language other than Spanish, and preexisting diabetes mellitus were associated with higher vaccination coverage in multivariable analyses. Among medically underserved pregnant women, inadequate prenatal care utilization was associated with a lower rate of antenatal influenza vaccination. Socially disadvantaged women may face individual and structural barriers when accessing prenatal care, suggesting that evidenced-based, tailored approaches may be needed to improve prenatal care utilization and antenatal influenza vaccination rates.
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Smith, Bradley L., Allison M. Hester, Valeria D. Cantos, Tiffany R. James, and Meredith H. Lora. "1280. A Pharmacist-led PrEP Program at the Epicenter of the HIV Epidemic in Atlanta; Our Experience." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S461. http://dx.doi.org/10.1093/ofid/ofz360.1143.
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Abstract Background Atlanta, GA ranks third in the nation for highest rates of new HIV diagnoses, disproportionally affecting Black men and women. Pre-exposure prophylaxis (PrEP) is underutilized in this population due to multiple barriers to uptake, including limited access to PrEP delivery programs. The advantages of a primary pharmacy-led PrEP program include: relatively low service fees, perform and assess point-of-care testing, and provide adherence counseling. Similar programs across the United States have been shown to effectively increase PrEP uptake and optimize retention in care. Grady Health System (GHS), the fifth largest public hospital system in the United States, is located at the epicenter of the HIV epidemic: downtown Atlanta. It encompasses 11 different primary care clinics, accounting for 850,000 outpatient visits per year. In August 2018, we launched a developmental pilot of a GHS pharmacy-based tele-PrEP program, aiming to optimize PrEP access for vulnerable populations who would otherwise not be able to obtain it. PrEP services are provided directly to the community and through a consultative support program for all clinical sites within the GHS system. The key pilot interventions included developing a user-friendly electronic medical record (EMR)-based PrEP order sets and brief provider education interventions in 6 GHS primary care clinics, to increase PrEP awareness among non-HIV clinicians. Methods We conducted a retrospective process evaluation of the pilot PrEP program based on the PrEP continuum of care. Results Over 9 months, 95 referrals were received from providers within the GHS clinics. Of the 95 patients referred, 56 (59%) started PrEP. Two patients were started on post-exposure prophylaxis prior to initiation of PrEP. Forty-five patients (81%) remain on PrEP as of April 2019. Six clients were diagnosed with 9 STIs on screening (4 syphilis, 2 gonorrhea, 2 chlamydia, 1 lymphogranuloma venereum). There have been no HIV seroconversions in patients on PrEP. Conclusion Utilizing a pharmacy-based PrEP program to train and support clinical providers in a large, hospital system can facilitate PrEP uptake and retention for patients in primary care. Disclosures All authors: No reported disclosures.
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Martin-Doyle, William, Christopher Paul Filson, Susan Regan, Quoc-Dien Trinh, Sierra Williams, Viraj A. Master, and Kerry L. Kilbridge. "Health literacy is a barrier to shared decision making in early prostate cancer (PCA) among African American (AA) men." Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 84. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.84.
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84 Background: ASCO, AUA, ASTRO and SUO endorse shared decision making for men with localized PCa. We explored treatment decisions among providers and their AA patients (pts) in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Following their visit, 18 providers documented the PCa treatment options they had discussed with 124 newly diagnosed, early-stage, African American PCa pts. At a subsequent visit, prior to choosing their cancer treatment, pts were asked to name the options they had discussed with their provider. Demographics were collected. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods (Kilbridge K, et al. J Clin Oncol 27:2015-2021, 2009). Chi-square, t-tests and multivariate logistic regression were used to identify variables associated with correct understanding of treatment choices. Results: Just 23.4% of pts correctly understood their treatment options. In univariate analysis, only health literacy was statistically significantly associated with comprehension of PCa treatment options (p < 0.05). In a multivariate logistic model adjusting for age, education, income, numeracy, comprehension of common PCa terms, and anatomic knowledge; health literacy remained the only significant predictor of pts’ comprehension of their treatment choices (OR 3.8, 95% CI 1.2-11.9, p = 0.021). Even among the 49 pts with the highest level of health literacy, only 34.7% correctly understood their cancer treatment options (compared to 16.0% among low literacy patients). Conclusions: Successful shared decision making requires pts to understand their treatment choices. Information presented by healthcare providers may be overwhelming for newly diagnosed pts, particularly those with lower health literacy. Our study suggests that even pts with the highest level of health literacy may need additional support to understand their PCa treatment options.
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Paulukonis, Susan, Todd Griffin, Mei Zhou, James R. Eckman, Robert Hagar, Angela Bauer Snyder, Lisa Feuchtbaum, Althea M. Grant, and Mary Hulihan. "Sickle Cell Disease Mortality in California and Georgia 2004-2008." Blood 124, no. 21 (December 6, 2014): 439. http://dx.doi.org/10.1182/blood.v124.21.439.439.
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Abstract On-going public health surveillance efforts in sickle cell disease (SCD) are critical for understanding the course and outcomes of this disease over time. Once nearly universally fatal by adolescence, many patients are living well into adulthood and sometimes into retirement years. Previous SCD mortality estimates have relied on data from death certificates alone or from deaths of patients receiving care in high volume hematology clinics, resulting in gaps in reporting and potentially biased conclusions. The Registry and Surveillance System for Hemoglobinopathies (RuSH) project collected and linked population-based surveillance data on SCD in California and Georgia from a variety of sources for years 2004-2008. These data sources included administrative records, newborn screening reports and health insurance claims as well as case reports of adult and pediatric patients receiving care in the following large specialty treatment centers: Georgia Comprehensive Sickle Cell Center, Georgia Regents University, Georgia Comprehensive Sickle Cell Center at Grady Health Systems and Children's Healthcare of Atlanta in Georgia, and Children's Hospital Los Angeles and UCSF Benioff Children's Hospital Oakland in California. Cases identified from these combined data sources were linked to death certificates in CA and GA for the same years. Among 12,143 identified SCD cases, 640 were linked to death certificates. Combined SCD mortality rates by age group at time of death are compared to combined mortality rates for all African Americans living in CA and GA. (Figure 1). SCD death rates among children up to age 14 and among adults 65 and older were very similar to those of the overall African American population. In contrast, death rates from young adulthood to midlife were substantially higher in the SCD population. Overall, only 55% of death certificates linked to the SCD cases had SCD listed in any of the cause of death fields. Thirty-four percent (CA) and 37% (GA) had SCD as the underlying cause of death. An additional 22% and 20% (CA and GA, respectively) had underlying causes of death that were not unexpected for SCD patients, including related infections such as septicemia, pulmonary/cardiac causes of death, renal failure and stroke. The remaining 44% (CA) and 43% (GA) had underlying causes of death that were either not related to SCD (e.g., malignancies, trauma) or too vague to be associated with SCD (e.g., generalized pulmonary or cardiac causes of death. Figure 2 shows the number of deaths by state, age group at death and whether the underlying cause of death was SCD specific, potentially related to SCD or not clearly related to SCD. While the number of deaths was too small to use for life expectancy calculations, there were more deaths over age 40 than under age 40 during this five year period. This effort represents a novel, population-based approach to examine mortality in SCD patients. These data suggest that the use of death certificates alone to identify deceased cases may not capture all-cause mortality among all SCD patients. Additional years of surveillance are needed to provide better estimates of current life expectancy and the ability to track and monitor changes in mortality over time. On-going surveillance of the SCD population is required to monitor changes in mortality and other outcomes in response to changes in treatments, standards of care and healthcare policy and inform advocacy efforts. This work was supported by the US Centers for Disease Control and Prevention and the National Heart, Lung and Blood Institute, cooperative agreement numbers U50DD000568 and U50DD001008. Figure 1: SCD-Specific & Overall African American Mortality Rates in CA and GA, 2004 – 2008. Figure 1:. SCD-Specific & Overall African American Mortality Rates in CA and GA, 2004 – 2008. Figure 2: Deaths (Count) Among Individuals with SCD in CA and GA, by Age Group and Underlying Cause of Death, 2004-2008 (N=615) Figure 2:. Deaths (Count) Among Individuals with SCD in CA and GA, by Age Group and Underlying Cause of Death, 2004-2008 (N=615) Disclosures No relevant conflicts of interest to declare.
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Yun, Hyun Don, Tehseen Dossul, Leon Bernal-Mizrachi, Jeffrey Switchenko, Chukwuma Ndibe, Abiola Ibraheem, Amelia Langston, Rebecca Pentz, and Edmund K. Waller. "Non-Inferior Clinical Outcomes for Lymphoma and Myeloma Patients Referred from a County Hospital to an Academic Transplant Center for Autologous Stem Cell Transplantation." Blood 124, no. 21 (December 6, 2014): 6002. http://dx.doi.org/10.1182/blood.v124.21.6002.6002.
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Abstract Introduction Disparities in clinical care have been described for patients who have limited insurance coverage or social support. We hypothesized that patients with relapsed Hodgkin's lymphoma (HL), non-Hodgkin's lymphoma (NHL), or multiple myeloma (MM) treated at an urban county hospital for whom autologous stem cell transplant (ASCT) was indicated would face barriers for referral to a private academic transplant center, and would have inferior survival compared with similar patients treated primarily at the transplant center. We analyzed a series of patients with HL, NHL, or MM treated at the county hospital and determined referral rates, frequency of ASCT, and overall survival rates compared to similar patients treated primarily at the transplant center. Methods Following IRB-approval, charts of consecutive patients with HL (n=39), NHL (n=96), or MM (n=80) treated at Grady Memorial Hospital, a county hospital of Atlanta, between 2007 and 2013 were reviewed. Abstracted data included clinical indication for ASCT by histology (MM patients, and relapsed patients with HL and NHL), reasons for non-referral, decision whether to offer ASCT at the academic center, and survival following referral. Censored data were used to calculate the follow up period for each group. Kaplan-Meier survival plots were generated for subsets of referred patients. Results A total of 215 patients with diagnosis of HD, NHL, MM were identified. Information for 12 (6%) patients was not available. The remaining 203 patients constituted the study group. 43 patients were referred for ASCT consults and 160 patients were not referred. Patients not referred for ASCT included: 21 (13%) with Karnofsky performance status (KPS) <60%; 71 (45%) in remission; 16 (10%) with NHL histology in which ASCT is not indicated including newly diagnosed follicular lymphoma, marginal zone lymphoma, peripheral T-cell lymphoma (PTCL), and chronic lymphocytic leukemia; 9 (6%) with refractory disease; 14 (9%) who refused referral, or who lost to follow up, or referred to a VA hospital; 5 (3%) who died before referral; 5 (3%) with age >70 years; 1 (1%) with psychosocial barriers; 6 (4%) who were illegal immigrants; 4 (3%) noncompliant to medical regimens; 2 (1%) with substance abuse; and 1 (1%) lacking adequate social support for ASCT. Among the 43 referred patients, 27 patients were transplanted, 16 were not transplanted. Among transplanted patients, 19 patients had MM, 5 had NHL, and 3 had HL. Reasons for non-transplant included: recommendation to continue conventional maintenance and chemotherapy for MM [n=5 (31%)]; comorbid conditions and KPS <60% [n=4 (25%)]; refractory/progressive diseases [n=4 (25%)]; disease not indicated for ASCT [n=2 (13%)] including PTCL, good response to the current chemotherapy in HL; and noncompliance with treatment [n=1 (6%)]. Two patients in the transplant group were excluded in the analysis of survival due to lack of data on the date of diagnosis. Median follow-up for all referred patients from the time of diagnosis was 4.2 [1.5-14.2] years including a follow-up of 3.3 years [1.5-14.2] in the transplant group, and 5.8 years [1.7-8.0] in non-transplant group. 8-year survival of transplanted patients from the date of diagnosis was 78.6% versus 48.8% for patients not transplanted. (log-rank test, p-value=0.14) (See figure). From the date of ASCT, 8-year survival of transplanted patients was 77.3%. Among transplanted patients, 8-year survival from the date of ASCT was 68.9% for MM patients with no deaths noted to-date in patients with NHL or HL who underwent ASCT. Post-transplant survival among referred patients was not inferior to post-transplant survival among patients treated primarily at the transplant center. Conclusion In the era immediately prior to implementation of the Affordable Care Act (ACA), the process of referral of patients with MM, NHL, or HL from a county hospital to an academic tertiary care center for ASCT appeared appropriate, without significant barriers based upon insurance or social support status. Post-referral decisions whether to proceed to ASCT were made based upon established criteria. Post-ASCT survivals among referred patients were comparable or superior to those of patients treated primarily at the transplant center and published series. Further evaluation is needed to assess the impact of the ACA on access to ASCT. Figure Figure. Disclosures No relevant conflicts of interest to declare.
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Hassan, Khaled. "RISK FACTORS FOR INNER CITY ASTHMA PATIENTS." International Journal of Medical and Biomedical Studies 5, no. 1 (January 15, 2021). http://dx.doi.org/10.32553/ijmbs.v5i1.1650.
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Asthma patients in inner cities have the highest prevalence of asthma and the highest death rates in America. The purpose of this study was to evaluate sensitization and exposure to common indoor allergens seen for asthma treatment at Grady Memorial Hospital, Atlanta, Ga. Eighty asthma patients were enrolled in the emergency department and 64 in hospital clinics in this study. Neither sensitization nor visibility In this population, cat allergens are prevalent. The findings show that black asthma patients are exposed to high levels of mite and cockroach allergens in downtown Atlanta and that a high percentage of patients with asthma are sensitized to these allergens; a significant risk factor for asthma in this population is the combination of sensitization and exposure.
Keywords: asthma; mechanical ventilation, status asthmaticus , Pathophysiology epidemiology mechanisms.
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Aaland, Mary. "Through the Eyes of Dr Sherman – That 10 percent Header: Roger T. Sherman Lecture." American Surgeon, April 7, 2022, 000313482210867. http://dx.doi.org/10.1177/00031348221086784.
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As chief of surgery at Grady Memorial Hospital in Atlanta Roger Sherman trained generations of trauma surgeons, including me. Our relationship had three phases, each with a specific lesson that stayed with me throughout my career: first, the interview for a fellowship; second, my training at Grady, or “Grady 101;” and third, relating to important people outside of surgical practice, which I understood to be “that 10 percent” that really, really disliked me. I was caught during a time when there was a severe contraction of the number of training programs in surgery. Despite the red flag of having gone to four different residencies, Dr. Sherman still decided to offer me fellowship position. Training at Grady meant seeing more patients with severe trauma and burns than most surgeons see in a lifetime, with an autonomy that was coupled with responsibility and the expectation of accountability. The 10 percent often included non-surgical consultants and administrators that might be adversarial at first but could provide support if they were informed about the impact of their decisions on patients. Being part of Dr. Sherman’s staff was a privilege. In his words “surgery … is an awesome responsibility afforded to only a few … a high honor surpassed only by being trusted to teach others this demanding and marvelous craft.”
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Marshall, Ashley, Jasmin Minaya-Junca, Rashon Lane, Kara Macleod, Diane Wirth, and Anekwe Onwuanyi. "Abstract 14483: Association Between Four Selected Social Determinants of Health and Readmissions for Patients in the Grady Heart Failure Program, 2018-2019." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.14483.
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Introduction: African Americans have a higher prevalence of heart failure (HF) than white Americans due in part to social determinants of health (SDOH). The Grady Heart Failure Program (GHFP) at Grady Memorial Hospital (GMH) in Atlanta aims to reduce readmissions for primarily low income, underinsured, African American patients with congestive HF. The GHFP addresses barriers to access to care through a community health worker, mobile health visits, transportation support, and low-cost medication. This study examines whether four key SDOH variables from Healthy Planet, a population health module in GMH’s electronic medical record, are associated with readmissions for GHFP patients. Methods: We analyzed data on demographics (race, sex, ethnicity) and SDOH variables (homelessness, financial resource strain, inability to afford medications, and issues with transportation to medical appointments) from Healthy Planet linked to HF-related readmissions from the GHFP’s dashboard. A total of 420 patients in the GHFP were included in this analysis from May 2018-April 2019. We evaluated the relationship between SDOH variables and any HF-related readmission and any 30-day HF-related readmission within the 12-month study period using Fishers exact tests. Results: Of the 420 patients, 92% were non-Hispanic African American, 62% were male, and 22% were uninsured. In the year prior to their first GHFP consult, 22% experienced homelessness, 49% had financial resource strain, 30% were unable to buy needed medications, and 46% had difficulty with transportation to medical appointments. A total of 76 patients (18%) were readmitted (range 1-5 readmissions), and 26 (6.2%) were readmitted within 30 days (range 1-4 readmissions within 30 days) over 12 months. No SDOH variables were associated with any 30-day HF-related readmission. Transportation issues were associated with any HF-related readmission ( P =0.04). Conclusions: While the majority of GHFP patients experienced SDOH-related barriers to care, none were associated with any 30-day readmissions and only transportation issues were associated with any readmissions. Future studies and models will examine whether the GHFP’s efforts to address social needs have led to a decline in 30-day readmission rates.
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Natu, Aditya, Prateek Kumar, Michael R. Frankel, and Srikant RANGARAJU. "Abstract 13: Aptamer-Based Plasma Proteomics Nominates Biomarkers Of Neurological Severity, Stroke Diagnosis And Age." Stroke 54, Suppl_1 (February 2023). http://dx.doi.org/10.1161/str.54.suppl_1.13.
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Background: Plasma protein biomarkers measured in the hyperacute setting that are associated with stroke diagnosis or with clinical neurological severity, can be diagnostically and prognostically meaningful in patient care. We hypothesized that high-throughput proteomics can identify panels of plasma proteins that can differentiate stroke mimics from ischemic and hemorrhagic stroke, and are associated with neurological severity. Methods: From a clinically-characterized biorepository of 320 plasma samples collected at time of patient presentation to the Emergency Room at Grady Memorial Hospital (Atlanta), 40 samples (10 stroke mimics, 10 intracerebral hemorrhage [ICH], 20 acute ischemic stroke [AIS]) were included (Fig A). 7,000 proteins were measured per sample using aptamer-based proteomics (SomaLogic). A combination of differential-expression and variance partitioning analyses (VPA) identified proteins associated with diagnosis (mimic vs ICH vs AIS), neurological severity (NIHSS), age and sex. Results: Cohort characteristics are shown (Fig B). VPA identified top proteins that accounted for majority of variance in several traits (Fig C). One-way ANOVA identified >400 proteins showing group-wise differences, of which a panel of 56 proteins collectively distinguished mimics from both AIS and ICH, ICH from both mimics and AIS, as well as distinguished between AIS based on NIHSS (Fig D). The pattern of expression of these 56 plasma proteins across diagnostic groups is shown in Fig E. We also identified plasma biomarkers associated with increasing age, indicative of age-related vascular dysfunction. Conclusions: This pilot study of AIS, ICH and stroke mimics demonstrates the applicability of aptamer-based proteomics as a promising approach for plasma protein biomarker discovery in stroke. We identified acute plasma protein biomarkers of neurological severity, diagnostic group and age-related vascular dysfunction that need further validation.
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Effoe, Valery S., Melvin R. Echols, Fengxia Yan, Temidayo Abe, and Anekwe Onwuanyi. "Abstract 17200: Improving the Early Detection of Cardiac Amyloidosis: Experience From a Large Urban Academic Center." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.17200.
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Introduction: Cardiac amyloidosis (CA) is associated with a poor prognosis and the condition is often overlooked or the diagnosis is delayed by an average of 2 years. With the availability of treatment, identifying patients early in the course of the disease could significantly improve outcomes associated with CA. We describe the characteristics of patients with suspected CA and factors associated with obtaining a 99m Technetium-pyrophosphate ( 99m Tc-PYP) scan. Methods: We systematically reviewed and abstracted data from electronic medical records of 199 patients at the Grady Memorial Hospital in Atlanta, Georgia, between January 2018 to October 2019. Eligible patients had an echocardiographic left ventricular posterior wall (LVPWd) or interventricular septal wall (IVSd) thickness in diastole ≥ 1.4 cm and no evidence of aortic stenosis. Descriptive analyses were performed using SAS 9.4. Results: Mean age of sample was 65 ± 13 years (96% blacks, 40% women). Over 72% had health insurance, 87% had an LV ejection fraction > 50%, 52% had a diagnosis of heart failure (HF), and 31% had associated peripheral neuropathy. Fifty-nine (30%) patients had a 99m Tc-PYP scan, 10 had a cardiac MRI and only 1 had an endomyocardial biopsy. Of the 4 patients with confirmed CA, mean age was 79 ± 5 years, mean IVSd was 1.7 ± 02 cm and mean LV mass index was 184 ± 33. All 4 patients were black males, had a 99m Tc-PYP scan and 3/4 had health insurance. Table 1 compares characteristics of patients who received a 99m Tc-PYP scan with those who did not. Overall, age, sex, health insurance status, presence of HF and LVH were not associated with the odds of obtaining a 99m Tc-PYP scan. Conclusion: These preliminary results appear to demonstrate variability in diagnostic testing for CA among patients with similar demographic and bioclinical profiles. Understanding the reasons for these differences may be key in improving early testing and diagnosis of CA among our patient population.