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.

Cafe Au Lait Macules

Abstract: Cafe-au-lait macules (CALMs) are common hyperpigmented and flat skin lesions found in the general population. They are usually present at birth (congenital) or occur early in life. They may grow in number and size with age. The color varies from light brown to dark brown, and they may be present on any body parts, but the most common location is the trunk and the extremities. The term cafe-au-lait is a French word meaning "coffee with milk."There are two main types of CALMs. CALMs with regular and clearly demarcated margins ("coast of California"), which is more common. They range in size from a few millimeters to several centimeters (>20cm) and may be present as solitary or multiple spots. The second type of CALM has an irregular margin ("coast of Maine"), which is less common and is usually larger and solitary. The "coast of Maine" pattern is seen in a segmental pigmentary disorder, while the "coast of California" pattern is seen neurofibromatosis 1 (NF1) and related conditions.CALMs are seen in 95% of patients with NF1. Although solitary CALMs are common in the general population and are familial and inherited as autosomal dominant, multiple spots accompanied by other manifestations may indicate an underlying genetic disorder, and they require further evaluation. A family history of CALMs should be evaluated in any patient with multiple CALMs.

The Association Of Race With Outcomes Among Parturients Undergoing Cesarean Section With Perioperative Epidural Catheter Placement: A Nationwide Analysis

Abstract: Background In obstetrical health care, disparities have been documented in different aspects of maternal care and outcomes. Prior epidemiological studies have shown that labor analgesia is underused in African-American and Hispanic groups, which means there may be inadequate labor pain control in these groups. Differences in usage have been attributed primarily to insurance, educational levels and perceptional influences such as fear of paralysis and chronic low back pain. In cesarean section deliveries, race and ethnicity affect the choice of anesthesia considered. How race and ethnicity affect maternal outcomes in cesarean sections with epidural placements generally has been unexplored. Disparities in health care utilization are shown to contribute to the disparities in health outcomes. Methods This is a retrospective analysis using data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project (AHRQ-HCUP), the National Inpatient Sample (NIS) database from January 2003 to December 2013, which is a 20% stratified sample of the nonfederal hospitals in the United States. Women undergoing cesarean section (International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes 74.0, 74.1, 74.2, 74.4, 74.99) with perioperative epidural catheter placement (ICD-9-CM procedure codes 3.90, 3.91) were included for analysis. Results The final cohort used for analysis included 87,076 patients. There were significant differences in the distribution of patient characteristics across the race groups. The majority of health care coverage for Caucasians and Asians was private insurance, while for African-American, Hispanic and Native American was Medicare and Medicaid. Almost all the examined comorbid conditions were statistically significant and highest in the African-American group, including hypertension, obesity, diabetes, and renal failure, except for congestive heart failure that was highest in the Asian group. Cesarean sections took place mostly in an urban teaching hospital across all groups. Discharge to home was the predominant destination after recovery. The mean cost of hospitalization was 14,604 dollars per stay and the mean length of stay was 3.7 days. In our cohort, the adverse event rate was very small. Our findings indicate racial differences in comorbidities which occurred more often in minorities. Adverse maternal outcomes of hematoma, blood transfusion, cardiac arrest, and ventricular fibrillation occurred more frequently in minority groups undergoing cesarean sections with epidural catheter placements throughout the period of 2003-2013. Conclusion From using the NIS database, our findings indicate racial differences in comorbidities which occurred more often in minorities. Adverse maternal outcomes of hematoma, blood transfusion, cardiac arrest, and ventricular fibrillation occurred more frequently in minority groups undergoing cesarean sections with epidural catheter placements throughout the period of 2003-2013. Further population studies are warranted to determine the biological or perception etiologies that are contributing to these disparities.

PCP chemoprophylaxis is essential for lymphopenic dermatomyositis patients treated with immunomodulators.

Abstract: A 48-year-old man presented with lower extremity weakness and rash. Physical examination revealed symmetrical proximal muscle weakness, extremity erythematous plaques, Gottron papules, and periorbital edema with a heliotrope hue. Serology revealed elevated titers of aminotransferases, aldolase, creatine kinase, and erythrocyte sedimentation rate. Skin biopsy suggested acute collagen vascular disease, and electromyography revealed proximal irritable myopathy. Muscle biopsy of the quadriceps was performed; however, the limited muscle tissue obtained failed to show signs of inflammation and the negative result was attributed to sampling error. The patient fulfilled the Bohan and Peter criteria for dermatomyositis (DM) based on clinical presentation and characteristic electromyography findings. His initial total lymphocyte count was 784/mm, and his CD4 cell count was 318/mm. The patient responded to 60 mg/day of prednisone over a period of 7 days, and was discharged with nearcomplete recovery of muscle strength and decreased serum levels of muscle enzymes and aminotransferases. However, 2 weeks later, he again presented with profound dyspnea, fever, cough, tachycardia, bilateral knee pain, and facial swelling. Arterial blood gas analysis revealed hypoxemia and respiratory alkalosis. Chest radiography was normal, but chest computed tomography (CT) scan showed diffuse pleural thickening with extensive peripheral reticular nodular infiltrates. The patient received antibiotics for possible hospital-acquired pneumonia. Despite treatment, he continued to complain of dyspnea associated with rapid respiratory deterioration, and he ultimately required intubation. His total lymphocyte count was 300/mm, and his CD4 cell count was 259/mm. Bronchoscopy and bronchoalveolar lavage revealed Pneumocystis jirovecii organisms by staining and cytopathology. Subsequently, he was treated with intravenous trimethoprim–sulfamethoxasole and prednisone for Pneumocystis carinii pneumonia (PCP). His clinical status remained tenuous for several days, and he died of progressive respiratory failure. PCP is an opportunistic infection that is reported frequently in DM patients treated with immunosuppressants. The incidence of PCP in immune-compromised DM patients is anywhere between 10% and 40%. The frequency of PCP may relate to the intensive immunosuppression used rather than to an inherent immune defect in DM. PCP evaluated independently in non-HIV patients with connective tissue diseases (CTDs) exhibited significant morbidity and mortality that compares directly to PCP in HIV patients. A recent review suggested a higher incidence of PCP with considerable mortality in DM patients when compared with other CTDs. However, there is currently no consensus to aid physicians in adequately identifying patients who are at high-risk for PCP infection and would benefit from prophylaxis. The total lymphocyte and CD4 subset counts may be currently the only measurable prognostic factors. Prior studies have shown that low lymphocyte counts were negatively associated with PCP occurrence in immunocompromised patients. Furthermore, the CD4 lymphocyte subset may be superior to the total lymphocyte count, as has been clearly demonstrated in HIV/AIDS. Review of the available literature showed a relative paucity of data. We identified 4 other reported cases wherein low total lymphocyte and CD4 cell counts during the course of therapy were associated with significant morbidity and even mortality (Table 1), which argues for the need for early initiation of PCP prophylaxis in susceptible individuals. Some investigators consider DM patients who receive immunosuppressants and have total lymphocyte counts <800/lL or CD4 counts <200/lL to be candidates for routine PCP chemoprophylaxis. We propose that all DM patients should be screened with peripheral lymphocyte counts at the time of diagnosis, and those with lymphopenia should receive PCP prophylaxis prior to the initiation of prednisone or other