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.

Multi-parametric cardiovascular magnetic resonance with regadenoson stress perfusion is safe following pediatric heart transplantation and identifies history of rejection and cardiac allograft vasculopathy.

Abstract: BACKGROUND The progressive risk of graft failure in pediatric heart transplantation (PHT) necessitates close surveillance for rejection and coronary allograft vasculopathy (CAV). The current gold standard of surveillance via invasive coronary angiography is costly, imperfect and associated with complications. Our goal was to assess the safety and feasibility of a comprehensive multi-parametric CMR protocol with regadenoson stress perfusion in PHT and evaluate for associations with clinical history of rejection and CAV. METHODS We performed a retrospective review of 26 PHT recipients who underwent stress CMR with tissue characterization and compared with 18 age-matched healthy controls. CMR protocol included myocardial T2, T1 and extracellular volume (ECV) mapping, late gadolinium enhancement (LGE), qualitative and semi-quantitative stress perfusion (myocardial perfusion reserve index; MPRI) and strain imaging. Clinical, demographics, rejection score and CAV history were recorded and correlated with CMR parameters. RESULTS Mean age at transplant was 9.3 ± 5.5 years and median duration since transplant was 5.1 years (IQR 7.5 years). One patient had active rejection at the time of CMR, 11/26 (42%) had CAV 1 and 1/26 (4%) had CAV 2. Biventricular volumes were smaller and cardiac output higher in PHT vs. healthy controls. Global T1 (1053 ± 42 ms vs 986 ± 42 ms; p < 0.001) and ECV (26.5 ± 4.0% vs 24.0 ± 2.7%; p = 0.017) were higher in PHT compared to helathy controls. Significant relationships between changes in myocardial tissue structure and function were noted in PHT: increased T2 correlated with reduced LVEF (r = - 0.57, p = 0.005), reduced global circumferential strain (r = - 0.73, p < 0.001) and reduced global longitudinal strain (r = - 0.49, p = 0.03). In addition, significant relationships were noted between higher rejection score and global T1 (r = 0.38, p = 0.05), T2 (r = 0.39, p = 0.058) and ECV (r = 0.68, p < 0.001). The presence of even low-grade CAV was associated with higher global T1, global ECV and maximum segmental T2. No major side effects were noted with stress testing. MPRI was analyzed with good interobserver reliability and was lower in PHT compared to healthy controls (0.69 ± - 0.21 vs 0.94 ± 0.22; p < 0.001). CONCLUSION In a PHT population with low incidence of rejection or high-grade CAV, CMR demonstrates important differences in myocardial structure, function and perfusion compared to age-matched healthy controls. Regadenoson stress perfusion CMR could be safely and reliably performed. Increasing T2 values were associated with worsening left ventricular function and increasing T1/ECV values were associated with rejection history and low-grade CAV. These findings warrant larger prospective studies to further define the role of CMR in PHT graft surveillance.

Bovine Arch and Stroke Laterality.

Abstract: Background Left-hemispheric strokes are more frequent and often have a worse outcome than their right-hemispheric counterparts. This study aimed to evaluate whether cardioembolic stroke laterality is affected by anatomical characteristics of the aortic arch. We hypothesized that laterality varies between patients with bovine versus standard arch. Methods and Results We retrospectively identified 1598 acute cardioembolic strokes in patients with atrial fibrillation from our institutional stroke database (2009-2017). Inclusion criteria were acute anterior circulation ischemic infarct and availability of both arch and brain imaging (magnetic resonance imaging or computed tomography). Alternative causes of stroke and anomalous arch were excluded. Imaging was reviewed for stroke characterization and laterality and arch branching pattern. Bovine arch denotes a common origin of the brachiocephalic trunk and left common carotid artery. Strokes were classified as bilateral (left or right). Univariate analysis was performed using chi-square tests. The final cohort comprised 615 patients, mean age 77 years (SD 11.8 years) with 376 women (61%) and 33% white, 30% black, and the remainder mixed/Hispanic. Standard arch (n=424) stroke distribution was left 43.6% (185), right 45.1% (191), and bilateral 11.3% (48). Bovine arch (n=191) stroke distribution was left 51.3% (98), right 35.6% (68), and bilateral 13.1% (25). Bovine arches were associated with more left-sided strokes compared with standard arches (P=0.018). There was an association between black race and bovine arch (P=0.0001). Conclusions Bovine aortic arch configuration is associated with left hemispheric laterality of cardioembolic stroke. This study enriches the understanding that arch anatomy influences stroke laterality and highlights the need for further research into the causative hemodynamic factors.

Variation in mortality of HIV/SARS-CoV-2 coinfected patients in the Bronx, New York City.

Abstract: Coronavirus disease 2019 (COVID-19) pandemic has caused tremendous strain on global health care systems and impacted the human quality of life worldwide. HIV patients are vulnerable to certain fatal infection due to their deficient immune functions. Nonetheless, the immunocompromised state may prevent HIV patients from severe hyper-immunity respond to COVID-19. To date, the impact of HIV on the clinical courses and outcomes of COVID-19 is inconclusive, and study answering this matter is evolving. We recently published the case series of nine HIV/SARS-CoV-2 co-infected patients admitted to our hospital during the early-wave of the pandemic in New York City, which contained the worrying mortality at 78%. Herein, we presented the clinical features and outcomes of another five confirmed COVID-19 patients with HIV infection who admitted to our hospital during the resolving pandemic phase of NYC, which showed an improved mortality rate at 20%. Notwithstanding, 60% of patients still had severe COVID-19 complicated with acute respiratory distress syndrome (ARDS) and shock. The extremely high mortality rate in our case series may be due to the mortality biases, the delay in corticosteroids administration, different vulnerability of patients, and the limitation of healthcare resources. This article is protected by copyright. All rights reserved.

Ethnic disparity in mortality after diagnosis of colorectal cancer among inner city minority New Yorkers.

Abstract: BACKGROUND: Ethnic disparities in colorectal cancer (CRC) mortality are observed in the United States. The authors studied this among minority New Yorkers with CRC. METHODS: In a study of CRC patients in a New York City teaching hospital, 5-year data on demographics and clinical features were reviewed. Adjusted cancer-related deaths and early deaths (within 6 months of diagnosis) were compared among African Americans (AAs) and Hispanics. Descriptive analyses, odds ratios (ORs), and 95% confidence intervals (CIs) are reported. A P value of <.05 was considered significant. RESULTS: Among 202 CRC subjects, we noted the following: Hispanics, 148 (73%); AAs, 54 (27%); women, 107 (53%); mean age, 64.5 years; and screening colonoscopy, 44 (22%). CRC was diagnosed by colonoscopy in 157 (78%) and by surgery in 45 (22%) cases. One hundred twenty-two (60%) had stage 0-II CRC, and 69 (34%) had proximal colonic lesions. Fifty-four of 202 patients died during the study period (median, 27 months), of whom 24 (11.9%) were early deaths. Significantly higher odds of death (OR, 3.98; 95% CI, 2.03-7.81), especially early death (OR, 5.94; 95% CI, 2.42-14.6) was observed among AAs. There was no difference in demographic and other clinical features, or treatment between Hispanics and AAs (P = nonsignificant). CONCLUSIONS: The first to compare inner city minority subjects with CRC, the authors observed increased odds of death in AAs, despite similar clinical features and living environment. Tumor behavior or host response among AAs could explain this difference. Aggressive therapeutic and early detection strategies need to be tested in a large randomized study setting to substantiate our study findings. Cancer 2009. © 2009 American Cancer Society.