Lincoln Hospital

About: Lincoln Hospital is a healthcare organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Emergency department. The organization has 1033 authors who have published 929 publications receiving 14486 citations. The organization is also known as: Lincoln Medical and Mental Health Center & Lincoln Hospital.

Lithium Toxicity in Two Coronavirus Disease 2019 (COVID-19) Patients

Abstract: Coronavirus disease 2019 (COVID-19) is a highly contagious disease, which is currently causing a devastating pandemic resulting in more than millions of infected cases worldwide. Emerging evidence reports the impact of several co-morbidities on the clinical features and outcomes of COVID-19. However, the evidence regarding the association of mental health illnesses and psychiatric treatment on the prognoses of COVID-19 is still lacking. Lithium is a commonly prescribed psychiatric medication that is also well known for its highly lethal toxicity. Many factors can fluctuate the level of lithium, such as drug interaction, illness, and infection. Prompt recognition and management of lithium intoxication is required to reduce patients' morbidity and mortality. Currently, there is no report regarding COVID-19 and lithium toxicity. Herein, we are presenting two patients with COVID-19 who initially presented with signs and symptoms of lithium toxicity. Our cases emphasize the need for special attention in taking care of patients who are taking lithium during the COVID-19 pandemic. In general, we recommend obtaining lithium levels in all patients who have been taking lithium and have the diagnosis of COVID-19.

One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression.

Abstract: Objective. To assess 1-year mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS). Background. Clinical trials have proven the beneficial effect of TAVR on mortality in patients with tricuspid AS. Individuals with bicuspid AS were excluded from these trials. Methods. A meta-analysis using literature search from the Cochrane, PubMed, ClinicalTrials, SCOPUS, and EMBASE databases was conducted to determine the effect of TAVR on 1-year mortality in patients with bicuspid AS. Short-term outcomes that could potentially impact one-year mortality were analyzed. Results. After evaluating 380 potential articles, 5 observational studies were selected. A total of 3890 patients treated with TAVR were included: 721 had bicuspid and 3,169 had tricuspid AS. No statistically significant difference between the baseline characteristics of the two groups of patients was seen outside of mean aortic gradient. Our primary endpoint of one-year all-cause mortality revealed 85 deaths in 719 patients (11.82%) with bicuspid AS compared to 467 deaths in 3100 patients (15.06%) with tricuspid AS, with no difference between both groups [relative risk (RR) 1.03; 95% CI 0.70-1.51]. Patients with bicuspid AS were associated with a decrease in device success (RR 0.62; 95% CI 0.45-0.84) and an increase in moderate-to-severe prosthetic valve regurgitation (RR 1.55; 95% CI 1.07-2.22) after TAVR compared to patients with tricuspid AS. The effect of meta-regression coefficients on one-year all-cause mortality was not statistically significant for any patient baseline characteristics. Conclusion. When comparing TAVR procedure in tricuspid AS versus bicuspid AS, there was no difference noted in one-year all-cause mortality.

Hypercapnia: is there a cause for concern?

Abstract: Concern that barotrauma may lead to further deterioration in pulmonary function in patients with ARDS has stimulated interest in developing methods of reducing it. These new modalities have had limited acceptance. The reasons for this include technical difficulties, associated complications, and the hypercapnia produced by the reduction in minute ventilation associated with diminished peak inspiratory pressure (PIP). Recent reports have shown that hypercapnia does not produce many of the adverse effects previously attributed to it. We studied the effects of moderate levels of hypercapnia produced by inverse ratio ventilation with low tidal volumes in patients with severe pulmonary dysfunction (Lung Injury Score ≥2.5)

Gastrointestinal: COVID-19 related ischemic bowel disease.

Abstract: A 49‐year‐old female with history of hypertension, diabetes, and stage 4 chronic kidney disease presented to our facility 1 month prior for shortness of breath and hypoxia to 80%. Reverse transcription–polymerase chain reaction (RT–PCR) performed on nasopharyngeal swab resulted positive for SARS‐CoV‐2 infection. She was treated with supplemental oxygen and convalescent plasma during her 2 weeks admission. She was discharged on with 2 L of home oxygen. The D‐dimer on admission and at the time of discharge was 1765 and 3486 ng/mL, respectively. Two weeks after discharge, she returned to our hospital with a 3 days history of excruciating diffuse abdominal pain melena and hematemesis. D‐dimer was 12 444 ng/mL ,and fibrinogen was 184 mg/dL. Non‐contrast CT scan revealed distended proximal jejunum with mural thickening (Fig. 1a). Exploratory laparotomy showed transmural ischemia at proximal jejunum (Fig. 1b), and 59 cm of jejunum was resected. Per the pathology report, microvascular thrombi that were partially organized within the submucosa (Fig. 2a) and cytologic changes suggestive of viral inclusion within the cytoplasm of glandular epithelial cell (Fig. 2b) were seen. Nasal swab RT–PCR test was negative for SARS‐CoV‐2 this time. She never had atrial arrhythmia shown on telemetry during these two admissions. Acute thromboembolic effects have been reported in COVID‐19 infected patients leading to ischemic stroke, myocardial infarction, pulmonary embolism, deep venous thrombosis, as well as ischemia to the mesenteric vessels. Ischemic bowel disease is a less frequent complication but has been reported worldwide. The hypercoagulable state has been thought to be related to COVID‐19 infection. Preliminary pathological evidence has shown bowel necrosis with small vessel thrombosis involving the submucosal arterioles, thereby pointing to an in‐situ thrombosis of small mesenteric vessels (Fig. 2a) rather than an embolic event. Further retrospective studies or randomized control trials are needed to guide the choice and duration of anticoagulant agent for treatment and prevention of thromboembolic events in this population. In addition, further investigation regarding antimicrobial treatment, such as antibiotics, antivirals, or anti‐inflammatory agents, in combination with anticoagulation needs to be conducted in order to see how to best facilitate recovery in these patients.

Serum inhibin A concentration in women with polycystic ovarian syndrome and the correlation to ethnicity, androgens and insulin resistance

Abstract: A prospective case-series in an academic hospital clinic was performed to determine whether there is a relationship between polycystic ovarian syndrome (PCOS) and ethnicity. Also, serum inhibin A concentrations were compared between PCOS and normal-ovulatory women. The possibility of a correlation between inhibin A, androgens and insulin resistance in PCOS women was evaluated. Serum inhibin A concentrations were measured in anovulatory PCOS patients (n=32) and in control women of reproductive age (n=16). Statistical analysis was performed using the Mann-Whitney U-test. Serum concentrations of inhibin A, follicle-stimulating hormone, LH, prolactin, thyroid-stimulating hormone, fasting glucose, insulin, testosterone, 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone sulphate (DHEAS) were measured. Inhibin A concentrations were significantly lower (4.5+/-4.8 pg/ml) when compared with the control group (13.2+/-14.4 pg/ml; P=0.003) and were not significantly different between Hispanic and Caucasian women diagnosed with PCOS. There was no correlation between inhibin A concentrations and insulin, testosterone, free testosterone, 17-OHP, or DHEAS concentrations. In PCOS women, inhibin A concentrations are similar between Hispanic and Caucasian women; however, women with PCOS, regardless of ethnicity, have a lower inhibin A concentration compared with normal-ovulatory women. No correlation was observed between inhibin A androgens and insulin resistance in women diagnosed with PCOS.