Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. Study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008-2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by demographic, socioeconomic, and health characteristics. The final model was stratified by Medicaid status (as a proxy for income), education, and neighborhood poverty. Results Of 588,232 matched hospital deliveries, 13,505 (229.6 per 10,000) had SMM. SMM rates varied by maternal age, birthplace, education, income, pre-existing chronic conditions, pre-pregnancy weight status, trimester of prenatal care entry, plurality, and parity. Race/ethnicity was consistently and significantly associated with SMM. While racial differences in SMM risk persisted across all socioeconomic groupings, the risk was exacerbated among Latinas and Asian-Pacific Islanders with lower income when compared to white non-Latinas. Similarly, living in the poorest neighborhoods exacerbated SMM risk among both black non-Latinas and Latinas. Conclusions for Practice SMM determinants in NYC mirror national trends, including racial/ethnic disparities. However, these disparities persisted even in the highest income and educational groups suggesting other pathways are needed to explain racial/ethnic differences.

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Determinants of Severe Maternal Morbidity and Its Racial/Ethnic Disparities in New York City, 2008–2012

Background and Purpose—The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate. We investigated the association of general...

Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke.

Objective
Equivocal findings have been reported on the association between maternal depression and children's growth, possibly because of the limited attention to its disproportionate impact by child sex. The relationship between the timing of maternal depression and children's growth was assessed in a population-based prospective birth cohort, with particular attention to sex differences.

Methods
The Upstate KIDS Study comprised 4,394 children followed through 3 years of age from 2008 to 2010. Maternal depression was measured antenatally by linkage with hospital discharge records before delivery and postnatally by depressive symptoms reported from questionnaires. Children's growth was measured by sex- and age-specific weight, height, weight for height, and BMI. Adjusted linear mixed effects models were used to estimate growth outcomes for the full sample and separately by plurality and sex.

Results
Antenatal depression was associated with lower weight for age (−0.24 z score units; 95% confidence interval [CI]: −0.43, −0.05) and height for age (−0.26 z score units; 95% CI: −0.51, −0.02) among singleton boys. Postnatal depressive symptoms were associated with higher weight for height (0.21 z score units; 95% CI: 0.01, 0.42) among singleton girls.

Conclusions
The findings of this study suggest that antenatal depression was associated with lower weight and smaller height only for boys, whereas postnatal depressive symptoms were associated with higher weight for height only for girls. The timing of depression and the mechanisms of sex-specific responses require further examination.

Timing of Maternal Depression and Sex-Specific Child Growth, the Upstate KIDS Study

Penile rings are used to sustain erection in order to enhance sexual pleasure. They work by reducing the outflow of blood from the cavernosal tissue. However, if left for extended periods of time severe edema, urethral fistula, gangrene, and even complete loss of the distal penis can ensue, this is known as penile ring entrapment (PRE). Management poses particular challenges due to its rarity. Herein, we report our experience with three patients from our institution that presented with PRE and include a review of the approaches others have taken. We also propose a simpler and more effective grading scale to allow for easier communication between providers, as the current grading scales do not do so.

Penile ring entrapment – A true urologic emergency: Grading, approach, and management

Background Improving the collection and quality of race and ethnicity reported in hospital data is a key step in identifying disparities in health service utilization and outcomes and opportunities for quality improvement. Objective The objective of this study was to assess the quality of race/ethnicity reported in hospital discharge data and examine the impact on the identification of disparities in select health outcomes in New York City. Research design Using the birth certificate as a gold standard, we examined the quality of hospital discharge race/ethnicity and estimated the impact of misclassification on racial/ethnic disparities in severe maternal morbidity and preventable hospitalizations. Subjects Delivery hospitalizations from the New York State hospital discharge data (Statewide Planning and Research Cooperative System) linked with 2015 New York City birth certificates. Measures Sensitivity and positive predictive value (PPV). Results The non-Hispanic white and black race had relatively high sensitivity and PPV. Hispanic ethnicity and Asian race had moderate sensitivity and high PPV, but were often misclassified as "Other." As a result, health disparities may be underestimated for those of Hispanic ethnicity and Asian race, particularly for indicators that use population denominators drawn from another source. Conclusions The quality of hospital discharge data varies by race/ethnicity and may underestimate disparities in some groups. Future research should validate findings with other data sources, identify driving factors, and evaluate progress over time.

Evaluating Race and Ethnicity Reported in Hospital Discharge Data and Its Impact on the Assessment of Health Disparities.

Penile and scrotal entrapment from a metal ring placed at the base of the penis is a rare, but important clinical dilemma encountered in urology. Emergent presentation to the urologist, after ring placement far longer than safely practiced, risks ischemic and permanent injury to penile, scrotal, and intrascrotal structures. Treating urologists should be aware of the prevalence of metal ring use, their potential complications, and the surgical approach to their safe removal. We present two patients who were identified at our institution with strangulating injuries of retained penile rings. The first patient was a healthy, 43-year-old male with a metal ring retained for 24 hours that was safely removed with industrial bolt cutters. The second patient, a 74-year-old male, died as a result of sepsis from injuries secondary to penoscrotal ischemia after >48 hour ring retention despite prompt removal at emergent presentation. Although rare, sexual practices may include the use of penoscrotal rings. When retained, ischemic injury and edema may lead to strangulation. Emergent removal may require industrial equipment that is not within the confines of normal operating room tools. Tissue injury may be severe and sepsis life-threatening, even after ring removal.

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Penile and Scrotal Strangulation due to Metal Rings: Case Reports and a Review of the Literature.

Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is a complex multistep surgery that has shown a steady increase in use for the past decade in the United States. We sought ...

Contemporary Trends in Percutaneous Nephrolithomy Across New York State: A Review of the Statewide Planning and Research Cooperative System.

Triplication of the ureter is a rare urologic finding that has been well described in the literature. Patients can present with urinary tract infections, incontinence, and calculi. We present the case of a patient with extensive stone burden with right trifid and left bifid collecting systems. Stone management was performed with a multimodal approach using a combination of endoscopic and percutaneous approaches. Our systematic and staged approach highlights a method for efficacious stone treatment in a complex endourologic case.

/pdf/percutaneous-and-endoscopic-management-of-nephrolithiasis-in-4mhwaq749f.pdf

Percutaneous and Endoscopic Management of Nephrolithiasis in a Patient with Five Native Ureters (Trifid Right and Bifid Left Collecting System).

Percutaneous cholecystostomy tube placement (PCT) is a well-established step in the treatment of acute cholecystitis and cholangitis. It can act as a bridge to optimize candidates for eventual cholecystectomy or as a definitive therapy for nonsurgical candidates. The procedure entails decompression of an infected gallbladder through a percutaneously placed transhepatic or transperitoneal catheter [ 1 Elyaderani M. Gabriele O.F. Percutaneous cholecystostomy and cholangiography in patients with obstructive jaundice. Radiology. 1979; 130: 601-602 Crossref PubMed Scopus (67) Google Scholar ]. 

Suraj Parikh

Papers

Penile and Scrotal Strangulation due to Metal Rings: Case Reports and a Review of the Literature.

Contemporary Trends in Percutaneous Nephrolithomy Across New York State: A Review of the Statewide Planning and Research Cooperative System.

Percutaneous and Endoscopic Management of Nephrolithiasis in a Patient with Five Native Ureters (Trifid Right and Bifid Left Collecting System).

National Cholecystostomy Tube Placement and Cholecystectomy Trends from 2010 to 2018.