Mount Sinai Morningside/West Internal Medicine Residency Program Research Week Abstract Book

Second Annual Icahn School of Medicine Mount Sinai Morningside/West Internal Medicine Residency Research Week

PROGRAM AND ABSTRACTS May 10-14, 2021

Table of Contents Introduction Selection Committee and Oral Presentations List of Abstracts with Virtual Posters Abstracts with Virtual Posters List of Abstracts 2020-2021 Abstracts 2020-2021 List of Publications 2020-2021 Index of Virtual Posters Index of Resident Authors

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Mount Sinai Morningside/West Internal Medicine Residency Second Annual Virtual Research Week May 10-14, 2021

Georgina Osorio, MD, MPH

John A. Andrilli, MD, FACP Program Director Internal Medicine Residency Mount Sinai Morningside/West

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Mount Sinai Morningside/West Internal Medicine Residency Research Week Selection Committee 2020-2021

COMMITTEE MEMBERS Georgina Osorio, MD, MPH, Chair John Andrilli, MD Ruchika Batswara, MD

Selection committee members did not participate in the discussion or voting for abstracts in which they were involved or with which they had any additional conflict of interest.

Presenters were selected using a double-blind review process.

Priya Chokshi, MD Johanna Contreras, MD Caroline Dooley, MD Deborah Edelman, MD Jennifer Fung, MD Tamara Goldberg, MD Katherine Hawkins, MD Krystle Hernandez, MD Marcelo Hernandez, MD Raymonde Jean, MD Maanit Kohli, MD Shane Murray, MD Frank Nelson, MD Alejandro Prigollini, MD Faye Reiff-Pasarew, MD James Salonia, MD Mangalore Shenoy, MD Vasundhara Singh, MD David Weininger, MD Geeta Varghese, MD Heather Viola, MD

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Abstracts selected to be oral presentations on Thursday, May 13, 2021 at 8AM.

BASIC SCIENCE Fionnuala Crowley, PGY1 ABSTRACT #10: SERUM IDENTIFICATION OF MYC-AMPLIFICATION IN SMALL CELL LUNG CANCER PATIENTS USING DROPLET DIGITAL PCR

CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW Jeewendra Dulal, PGY2 ABSTRACT #14: ESCHERICHIA COLI ENDOCARDITIS OF NATIVE MITRAL VALVE

CLINICAL RESEARCH Mengdan Xie, PGY2 ABSTRACT #68: LIQUID NITROGEN SPRAY CRYOTHERAPY IS EFFECTIVE AND SAFE WHEN USED IN THE MANAGEMENT OF EARLY ESOPHAGEAL ADENOCARCINOMA: SYSTEMATIC REVIEW AND META-ANALYSIS

QUALITY IMPROVEMENT Ines Robles Aponte, PGY2 ABSTRACT #55: IDENTIFYING RESIDENT BARRIERS IN RECOGNIZING AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH

MEDICAL EDUCATION Binbin Zheng-Lin, PGY3 Abstract #71: MEDICAL MARIJUANA KNOWLEDGE AND ATTITUDES AMONGST INTERNAL MEDICINE RESIDENTS

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List of List of Abstracts Abstracts with with Virtual Virtual Posters Posters

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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HYPERCALCEMIA IS A PREDICTOR OF WORSE IN-HOSPITAL OUTCOMES IN PATIENTS WITH ATRIAL FIBRILLATION: A 2016 NATIONAL INPATIENT SAMPLE ANALYSIS Robert Abed1, Rawann Nassar1, Patrick Lam1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

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SEEING IS BELIEVING: THE CRUCIAL ROLE OF CARDIAC IMAGING IN SUSPECTED CARDIAC SARCOIDOSIS Jose Aguilar-Gallardo1, Alaa Omar2, Glenmore Lasam2, Javier Arreaza1, Johanna Contreras1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

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ASSESSING THE IMPACT OF TELEMEDICINE ON DIABETIC PATIENTS AT AN UNDERSERVED URBAN CLINIC Shruti Anand1, Ines Robles Aponte1, Dipal Patel1, Tamara Goldberg1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

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EFFECT OF EXPERT CONSULTATION AND MEDICAL OPTIMIZATION ON SHORT TERM OUTCOMES IN PATIENTS HOSPITALIZED WITH ACUTE DECOMPENSATED HEART FAILURE Javier Arreaza1, Ga Hee Kim1, Andrew Kim1, Jeewendra Dulal1, Alaa Omar2, Johanna Contreras1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

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ASYMPTOMATIC ISOLATED EXTERNAL ILIAC ARTERY DISSECTION IN A YOUNG MALE WITH HIV/AIDS Nikhil Bachoo1, Matthew Tracey1, Andrew S. Choi1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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DE-ESCALATION OF ASPIRIN FOR PRIMARY PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN THE PRIMARY CARE SETTING Joshua Berookhim1, Michael Kahen1, Gabriela Bernal1, Subrat Das1, Brian Berookhim1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Quality of Care and Outcomes Research (QCOR) Scientific Sessions that was held virtually on May 15, 2020.

PREVENTION OF HEART FAILURE EVENTS WITH SGLT-2 INHIBITORS ACROSS A SPECTRUM OF CARDIO-RENAL METABOLIC RISK Kirtipal Bhatia1, Vardhmaan Jain2, Kartik Gupta3, Agam Bansal2, Arieh Fox1,4, Arman Qamar5, Kevin Damman6, Muthiah Vaduganathan7 1

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Cleveland Clinic, Cleveland, OH, United States; 3Henry Ford Hospital, Detroit, MI, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, United States; 6University Medical Center Groningen, Groningen, Netherlands; 7Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, United States

Published in the European Journal of Heart Failure, 2021. PMID: 33609071

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A RARE CASE OF HIT WITH NORMAL PLATELET COUNTS Lauren Botero1, Matthew Karr1, Lawrence Cytryn1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

NO SIGNIFICANT DIFFERENCES IN MORTALITY AMONG STROKE VERSUS NON STROKE PATIENTS UNDERGOING PERCUTANEOUS ENDOSCOPIC GASTROSTOMY, NATIONAL INPATIENT SAMPLE STUDY 2016 Bing Chen1, Omar Mahmoud1, Priya Simoes1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

SERUM IDENTIFICATION OF MYC-AMPLIFICATION IN SMALL CELL LUNG CANCER PATIENTS USING DROPLET DIGITAL PCR Fionnuala Crowley1, Hannah Bye2, Bojan Macanovic3, Pauline O’Dea3, Derek Power3, Anna Minchom4, Michael Hubank2, Dearbhaile Collins3

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2NIHR Centre for Molecular Pathology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; 3Cork University Hospital, Cork, Ireland; 4The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom

Presented at the European Society of Medical Oncology (ESMO) Congress Annual Meeting that was held virtually from September 19, 2020 to October 18, 2020.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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THE IMPACT OF HEALTH LITERACY, SOCIOECONOMIC STATUS, AND RACIAL DISPARITY IN HEALTH OUTCOMES Lady Njemeh Danso1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

PROOF OF CONCEPT: INTERPRETATION OF EKGS WITH IMAGE RECOGNITION AND CONVOLUTIONAL NEURAL NETWORKS Subrat Das1, Matthew Epland2, Jiang Yu3, Ranjit Suri4

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Komodo Health, Inc, New York, NY, United States; 3New York University, New York, NY, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020.

AN ELUSIVE MIMICKER OF ABDOMINAL AORTIC ANEURYSM Abraham Derman1, Mohammad Asad1, Manoj Bhandari1, Jacqueline Tamis-Holland1,2, Jonathan Bella1, Patrick Lam1 1

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY, United States

Presented at the 10th Annual Graduate Medical Education (GME) Research Day, Icahn School of Medicine at Mount Sinai; New York, NY, United States that was held on June 7, 2019.

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ESCHERICHIA COLI ENDOCARDITIS OF NATIVE MITRAL VALVE Jeewendra Dulal1, Andrew Kim1, Javier Arreaza1, Ga Hee Kim1, Alaa Omar2, Mikhail Khaitov1,3, Johanna Contreras1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

ESOPHAGO-GASTRIC OUTLET OBSTRUCTION IN THE ABSENCE OF A HIATAL HERNIA SHOULD BE EVALUATED BY ENDOSCOPY AND IMPEDANCE PLANIMETRY Maan El Halabi1, Xiaocen Zhang1, Elijah Verheyen1,2, Justin Field1,2, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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METRONOMIC CHEMOTHERAPY FOR PATIENTS WITH METASTATIC BREAST CANCER: REVIEW OF EFFECTIVENESS AND POTENTIAL USE DURING PANDEMICS Johny E. Fares1, Paul El Tomb2, Lana E. Khali3, Rula W. Atwani3, Hiba A. Moukadem3, Ahmad Awada4, Nagi E. El Saghir3 1

Lankenau Medical Center, Wynnewood, PA, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3 University of Beirut Medical Center, Beirut, Lebanon; 4Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

Published in Cancer Treatment Reviews, 2020. PMID: 32769038

EFFECT OF HEPATITIS C VIRUS INFECTION ON HEART TRANSPLANTS IN THE CURRENT ERA Tomohiro Fujisaki1, Takahisa Mikami2,3, Toshiki Kuno 2, Noah Moss4, Shinobu Itagaki4 1

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Tufts Medical Center, Boston, MA, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020. Published in Transplantation, 2021.

PMID: 33496557

SERIAL CHANGES IN SPECIFIC IGE AND IGG TO METHYLENE DIISOCYANATE IN A WORKER WITH OCCUPATIONAL ASTHMA Simeon Gotzev1, Joshua Lipszyc2, Carrie A. Redlich3, Adam V. Wisnewski3, Susan Tarlo2

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of Toronto, Toronto, Canada; 3Yale University, New Haven, CT, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; San Francisco, CA, United States that was held on May 13-18, 2016.

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A CASE OF COVID19-INDUCED RHABDOMYOLYSIS Angelica Gutierrez1, Georgina Osorio1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

TOTAL NEOADJUVANT THERAPY VERSUS STANDARD THERAPY IN LOCALLY ADVANCED RECTAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS Anup Kasi1, Shivani Handa2, Saqib Abbasi1, Raed Al-Rajabi1, Anwaar Saeed1, Joaquina Baranda1, Weijing Sun1 1

Kansas University Medical Center, Kansas City, KS, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in JAMA Network Open, 2020. PMID: 33326026

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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CARDIOVASCULAR OUTCOMES IN PATIENTS WITH SLEEP APNEA TREATED WITH POSITIVE AIRWAY PRESSURE: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Yasmin I. Herrera1, Joseph Poon1, Kam Sing Ho1, Valeria Santibanez1,2, Archana Pattupara1, Raymonde Jean1, David Steiger1,2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

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IS THERE AN OPTIMAL DOOR-TO-TREATMENT TIME FOR ACUTE PULMONARY EMBOLISM? A NATIONAL PROPENSITY MATCH ANALYSIS Kam Sing Ho1, Paaras Kohli1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Shabnam Nasserifer1, Andre Sotelo2, Raymonde Jean1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, United States

Presented at the European Respiratory Society (ERS) International Annual Meeting that was held virtually from September 6-9, 2020.

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AN ANALYSIS OF MEDTRONIC MINIMED 670G INSULIN PUMP USE IN CLINICAL PRACTICE AND THE IMPACT ON GLYCEMIC CONTROL, QUALITY OF LIFE, AND COMPLIANCE Maxwell E. Horowitz1, William Kaye2, Gary Pepper3, Kathryn Reynolds3, Shital Pater3, Kort Knudson3, Geetanjali Kale3, Maria Gutierrez3, Leslie Cotto3, Barry S. Horowitz2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Metabolic Research Institute, Inc., West Palm Beach, FL, United States; 3 Palm Beach Diabetes and Endocrine Specialists, West Palm Beach, FL, United States

Presented at the Endocrine Society Annual Meeting that was held virtually from March 20-23, 2021.

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DOES HEMODIALYSIS IMPACT ACUTE CORONARY SYNDROME MANAGEMENT IN END-STAGE RENAL DISEASE PATIENTS: A 5 YEAR NATIONWIDE ANALYSIS Claire Huang Lucas1, Robert Abed1, Jan Lopes1, Lingling Wu1, Ameesh Isath1, Bing Yue1, Xin Wei1, Eyal Herzog1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

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DOES THE USE OF INTRACARDIAC ECHOCARDIOGRAPHY DURING ATRIAL FIBRILLATION CATHETER ABLATION IMPROVE OUTCOMES AND COST? Ameesh Isath1, Syed Waqas Haider2, Gregory Siroky2, Stuthi Perimbeti1, Ashish Correa2, Davendra Mehta2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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DE-ESCALATION OF ASPIRIN FOR PRIMARY PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN THE PRIMARY CARE SETTING Joshua Berookhim1, Michael Kahen1, Gabriela Bernal1, Subrat Das1, Brian Berookhim1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Quality of Care and Outcomes Research (QCOR) Scientific Sessions that was held virtually on May 15, 2020.

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A RARE CASE OF HIT WITH NORMAL PLATELET COUNTS Matthew Karr1, Lauren Botero1, Lawrence Cytryn1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

A CONVOLUTED ROAD TO THE RIGHT DIAGNOSIS: RETROPERITONEAL ABSCESS IN A POORLY CONTROLLED DIABETIC Frida Kassim1, Jonathan Jamito1, Andrew Choi1, Jeanine Albu1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

LONG TERM OUTCOMES OF THE EXCLUDED RECTUM IN CROHN’S DISEASE: RESULTS FROM THE CAPER (CONSORTIUM TO ASSESS PROGNOSIS OF THE EXCLUDED RECTUM) STUDY Gassan Kassim1, Anketse Debebe2, Clara Yzet2, Nilendra Nair2, Aurada Cholapranee3, Cindy Traboulsi4, Keith Sultan3, David T. Rubin4, Jean-Frederic Colombel2, David Sachar2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY, United States; 4University of Chicago, Chicago, IL, United States

Presented at New York Crohn's and Colitis Organization (NYCCO) Annual Meeting that was held virtually on February 4, 2021.

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NONINVASIVE BIOMARKERS FOR PREDICTION AND DIAGNOSIS OF HEART TRANSPLANTATION REJECTION Yeraz Khachatoorian1, Vahe Khachadourian2, Eleanor Chang3, Erick R. Sernas4, Elaine F. Reed3, Mario Deng3, Brian D. Piening5, Alexandre C. Pereira6, Brendan Keating7, Martin Cadeiras4 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia; 3David Geffen School of Medicine, Los Angeles, CA, United States; 4 University of California Davis, Davis, CA, United States; 5Providence Health and Services, Portland, OR, United States; 6University of São Paulo, São Paulo, SP, Brazil; 7University of Pennsylvania, Philadelphia, PA, United States

Published in Transplantation Reviews, 2021. PMID: 33401139

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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CALCIPHYLAXIS IN ASSOCIATION WITH HUNGRY BONE SYNDROME: A POSSIBLE RISK FACTOR? Javier Arreaza1, Ga Hee Kim1, Andrew Kim1, Jeewendra Dulal1, Peter Goulden1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Endocrine Society Annual Meeting that was held virtually from March 20-23, 2021.

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A PERFECT STORM OF UNCOMMON PATHOGENS IN AN IMMUNOCOMPETENT HOST: RESPIRATORY ISOLATION OF CUNNINGHAMELLA BERRHOTHELIAE, ASPERGILLUS NIGER, STAPHYLOCOCCUS PSEUDOINTERMEDIUS, AND ADENOVIRUS IN A PATIENT WITH NECROTIZING PNEUMONIA Christian Olivo Freites1, Deep Patadia1,2, Joseph Saabiye1,2, Paaras Kohli1, Christina Stavropoulos1, James Salonia1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; Dallas, TX, United States that was held on May 17-22, 2019.

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FAMILY HISTORY AIDS DIAGNOSIS OF AMYOTROPHIC LATERAL SCLEROSIS IN A YOUNG PATIENT Shu Min Lao1, Geeta Varghese1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

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PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH OUT-OFHOSPITAL CARDIAC ARREST: SOCIODEMOGRAPHIC AND IN-HOSPITAL MORTALITY DISPARITIES Jan Lopes1, Claire Huang Lucas1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

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TEMPORAL TRENDS IN SUBCUTANEOUS RHYTHM MONITOR IMPLANTATION IN THE UNITED STATES (2016-2018) Marta Lorente-Ros1, Lingling Wu1, Bharat Narasimhan1, Yeraz Khachatoorian1, Patrick W. Lam1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Submitted to the Heart Rhythm Society Annual Scientific Meeting that will be held virtually from July 28-31, 2021.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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PROGNOSTIC SIGNIFICANCE OF HOSPITALIZATION STATUS AT SECOND CYCLE OF HYPOMETHYLATING AGENT INDUCTION THERAPY IN ACUTE MYELOID LEUKEMIA PATIENTS INELIGIBLE FOR INTENSIVE CHEMOTHERAPY Douglas Tremblay1, Rafael Madero-Marroquin2, Guido Lancman1, Alexander Coltoff3, Jonathan Feld1, Jessica Caro4, Emily Sherlock1, Nicole Zubizarreta1, Erin Mosher1, Marina Kremyanskaya1, Alla Keyzner1, Michal Bar-Natan1, Shyamala C. Navada1, Lewis R. Silverman1, Janice L. Gabrilove1, John Mascarenhas1 1

Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Columbia University, New York, NY, United States; 4New York University School of Medicine, New York, NY, United States 2

Presented at the American Society of Hematology (ASH) Annual Meeting that was held virtually from December 5-8, 2020. Published in the Journal of Palliative Medicine, 2020. PMID: 33174777

UTILIZATION OF AIRWAY PRESSURE RELEASE VENTILATION AS A RESCUE STRATEGY IN COVID-19 PATIENTS: A RETROSPECTIVE ANALYSIS Omar Mahmoud1, Deep Patadia1,2, James Salonia1

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

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DERMATOMYOSITIS: A RARE PRESENTATION OF METASTATIC PROSTATE CANCER Iman Makki1, Binbin Zheng-Lin1, Clare Bryce2, Sadhna Ahuja2, Sridevi Rajeeve2, Vaibhav Patel2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

IMPROVING GLYCEMIC CONTROL OF CANCER PATIENTS ADMITTED TO MOUNT SINAI WEST Zoe McKinnell1, Lauren Botero1, Mangalore Shenoy1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

THE ASCVD-10 RISK ESTIMATE AS A PREDICTOR FOR TRUE RESISTANT HYPERTENSION IN HIGH-RISK OVERWEIGHT AND OBESE HYPERTENSIVE SUBJECTS: A CROSS-SECTIONAL STUDY Faris I. Haddadin1, Claire Huang Lucas1, Lingling Wu1, Joshua Berookhim1, Sananda Moctezuma1, Alba Munoz Estrella1, Karan Sud1, Dipal Patel1, Edgar Argulian1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS ROLE OF IMMUNOSUPPRESSIVE THERAPY IN THE MANAGEMENT REFRACTORY POST-PROCEDURAL PERICARDITIS Bharat Narasimhan1, Mohit K. Turagam2, Jalaj Garg3, Domenico G. Della Rocca4, Rakesh Gopinathannair5, Luigi Di Biase6, Jorge Romero6, Suneet Mittal1, Sanghamitra Mohanty4, Andrea Natale4, Dhanunjaya Lakkireddy5

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Medical College of Wisconsin, Milwaukee, WI, United States; 4 Texas Cardiac Arrhythmia Institute, Austin, TX, United States; 5Kansas City Heart Rhythm Institute, Overland Park, KS, United States; 6Montefiore Medical Center, Bronx, NY, United States

Accepted for publication in the Journal of Cardiovascular Electrophysiology, 2021.

In press.

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ESRD, A HARBINGER OF WORSE IN-HOSPITAL OUTCOMES IN PATIENTS WITH PULMONARY EMBOLISM Robert Abed1, Rawann Nassar1, Claire Lucas Huang1, Nikhil Bachoo1, Karim El-Hachem1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

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DIABETES’ COST TO US TAXPAYERS: THIRTY-DAY READMISSION AND RESOURCE UTILIZATION AMONG DIABETICS PATIENTS ADMITTED WITH STEMI Shabnam Nasserifar1, Kam S. Ho1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Presented at the Endocrine Society Annual Meeting that was held virtually from March 28-31, 2020.

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TRENDS IN USAGE OF TELEMEDICINE DURING AND POST COVID19 PANDEMIC SURGE IN NYC 2020 Pratyusha Nunna1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

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PROGNOSTIC VALIDATION OF PARTITION VALUES FOR QUANTITATIVE PARAMETERS TO GRADE FUNCTIONAL TRICUSPID REGURGITATION SEVERITY

BY CONVENTIONAL ECHOCARDIOGRAPHY Denisa Muraru1,2, Marco Previtero3, Roberto Carlos Ochoa Jimenez1,4, Andrada Camelia Guta1,5, Stefano Figliozzi3, Dario Gregori3, Daniele Bottigliengo3, Gianfranco Parati1,2, Luigi Paolo Badano1,2 1

Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy; 2University of Milano-Bicocca, Milan, Italy; 3University of Padova School of Medicine, Padua, Italy; 4Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Presented in EuroEcho 2019 Congress; Vienna, Austria that was held from December 4-7, 2019. Published in European Heart Journal – Cardiovascular Imaging, 2021. PMID: 33247930 15

LIST OF ABSTRACTS WITH VIRTUAL POSTERS MORBID OBESITY BUT NOT OBESITY IS ASSOCIATED WITH INCREASED MORTALITY IN PATIENTS UNDERGOING ERCP Bing Chen1, Chia-Hung Yo2, Ramya Patel1, Bolun Liu3, Ke-Ying Su4, Wan-Ting Hsu5, Chien-Chang Lee4,6 1

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Far Eastern Memorial Hospital, New Taipei City, Taiwan; 3John H. Stronger, Jr. Hospital of Cook County, Chicago, IL, United States; 4National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; 5Harvard T. H. Chan School of Public Health, Boston, MA, United States; 6Center of Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan

Accepted for publication in the United European Gastroenterology Journal, 2021.

In press.

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PULMONARY BAROTRAUMA DURING NON-INVASIVE VENTILATION IN PATIENTS WITH COVID-19 INFECTION Archana Pattupara1, Vivek Modi1, Julia Goldberg1, Kam Singh Ho1, Kirtipal Bhatia1, Yasmin Herrera1, Joseph Ghassibi1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

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A TRUE BICUSPID AORTIC VALVE IN A PATIENT WITH INFECTIVE ENDOCARDITIS Christopher Perez Lizardo1, Nina Kukar1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

ROUTINE LABORATORY VALUES CAN PREDICT THERAPY-RELATED MYELOID NEOPLASMS IN PATIENTS WITH NEW CYTOPENIAS AFTER TREATMENT FOR BREAST CANCER Giulia Petrone1, Charles Gaulin2, Andriy Derkach3, Sean Devlin3, Ashwin Kishtagari4, Rekha Parameswaran3, Eytan M. Stein3 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mayo Clinic, Phoenix, AZ, United States; 3Memorial Sloan Kettering Cancer Center, New York, NY, United States; 4Cleveland Clinic, Cleveland, OH, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held virtually from December 5-8, 2020.

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EMERGENT COLECTOMY RATES DECREASED WHILE ELECTIVE ILEAL POUCH RATES WERE STABLE OVER TIME Maia Kayal1, Aparna Saha1, Priti Poojary2, Sudarshan Paramsothy1, Robert Hirten1, Louis Cohen1, Zane Gallinger1, Saurabh Mehandru1, Judy Cho1, Alexander Greenstein1, Girish Nadkarni1, Marla C. Dubinsky1, Jean-Frederic Colombel1, Benjamin Cohen1, Ryan Ungaro1 1

Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Presented at the Digestive Diseases Week (DDW) Meeting; Washington, DC, United States held from June 2-5, 2018. Published in International Journal of Colorectal Disease, 2019. PMID: 31512019 16

LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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CLINICAL OUTCOMES IN DIABETIC VERSUS NON-DIABETIC PATIENTS WITH SEVERE COVID-19 INFECTION Joseph Poon1, Kam Sing Ho1, Yasmin Herrera1, Raymonde Jean1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

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ENDOCRINE TREATMENT OF TRANSGENDER INDIVIDUALS: CURRENT GUIDELINES AND STRATEGIES James Christopher John Prince1, Joshua D. Safer 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in Expert Review of Endocrinology and Metabolism, 2020. PMID: 32990485

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LYME DISEASE: TREATMENT AND RECOMMENDATIONS Itay Rabinovitz1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

FAVORABLE OUTCOMES AMONG PATIENTS WITH T-CELL/HISTIOCYTE-RICH LARGE B-CELL LYMPHOMA TREATED WITH HIGHER-INTENSITY THERAPY IN THE RITUXIMAB ERA Edith T. Robin1, Esther Drill2, Connie L. Batlevi2, Philip Caron2, Lorenzo Falchi2, Audrey Hamilton2, Paul A. Hamlin2, Steven M. Horwitz2, Andrew M. Intlekofer2, Erel Joffe2, Anita Kumar2, Matthew J. Matasar2, Ariela Noy2, Colette Owens2, Maria L. Palomba2, Ildefonso Rodriguez-Rivera2, David J. Straus2, Santosha Vardhana2, Gottfried R. von Keudell2, Andrew D. Zelenetz2, Craig H. Moskowitz2, Alison J. Moskowitz2 1

Mount Sinai Morningside/West Hospital, Icahn School of Medicine, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held virtually from December 5-8, 2020.

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IDENTIFYING RESIDENT BARRIERS IN RECOGNIZING AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH Ines Robles Aponte1, Shruti Anand1, Sananda Moctezuma1, Pratyusha Nunna1, Dipal Patel1, Tamara Goldberg1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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USEFULNESS OF SARCOPAENIA INDEX FOR PREDICTING OUTCOMES IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT Francisco J. Romeo1,2, Ignacio Miguel Seropian1, Juan Guido Chiabrando1, Juan Valle Raleigh1, Maximiliano Smietniansky2, Mariela Cal2, Mariano Falconi2, Vadim Kotowicz2, Carla R. Agatiello2, Daniel H. Berrocal2 1

Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020.

FACTOR XI DEFICIENCY IN PREGNANT WOMEN: A CASE-SERIES FROM A NEW YORK CITY HOSPITAL Guilherme Sacchi De Camargo Correia¹, Sridevi Rajeeve², Lawrence Cytryn1

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1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the European Association for Haemophilia and Allied Disorders (EAHAD) Annual Meeting that was held virtually from February 3-5, 2021.

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FACTORS INFLUENCING PATIENTS’ ABILITY TO SELF-MANAGE AND CONTROL TYPE 2 DIABETES Yeriko Santillan1, Tamara Goldberg1, Olufunke Olushoga1, Theresa Mack1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

JEJUNAL GIST: AN UNUSUAL CAUSE OF ACUTE MASSIVE GASTROINTESTINAL BLEEDING Suraj M. Shah1, Yingheng Lui1, Ilan Weisberg2

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States that was held on October 25-30, 2019.

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IMPROVING PALLIATIVE CARE DELIVERY IN THE INTENSIVE CARE UNIT: A QUALITY IMPROVEMENT PROJECT Jacqueline Sheehan1, Kam Sing Ho1, Charles Gaulin2, Setareh Alipour3, Gustavo Contreras Anez1, Jennifer Fung1, Christie Mulholland1, Howard Anthony Arabelo1, Janet Shapiro1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States; 3University of Connecticut Health, Farmington, CT, United States

Accepted at the Annual Assembly of Hospice and Palliative Care; San Diego, CA, United States that was scheduled to be held from March 18-21, 2020.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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PUZZLING PICTURE: CLINICAL COURSE OF TOXICITY, WITHDRAWAL, AND ASEPTIC MENINGITIS FROM ORAL BACLOFEN USE Shabari Shenoy1, Travis Burnett1, Akunna Ihemaguba2, Tulsi Shah1, Michelle Sterpi1, Kirtipal Bhatia1, Amita Buddhdev1, Maanit Kohli1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mario School of Pharmacy, Rutgers University, NJ, United States

Presented at the Society of Hospital Medicine (SHM) Converge Annual Meeting that was held virtually from May 3-7, 2021.

A COMPREHENSIVE PROGRAM OF POST AMI CARE IMPROVES MEDICATION PRESCRIPTION UPON DISCHARGE Michel Skaf1, Wojciech Rzechorzek2, Kirtipal Bhatia1, Subrat Das1, Claire Huang Lucas1, Jan Lopes1, Basera Sabharwal3, Lingling Wu1, Syed Ahsan2, Jacqueline Tamis-Holland1,4

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1 Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Westchester Medical Center, Valhalla, NY, United States; 3Mount Sinai Morningside, Icahn School of Medicine, New York, NY, United States; 4BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

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TRENDS AND IN-HOSPITAL OUTCOMES OF SPLANCHNIC VEIN THROMBOSIS ASSOCIATED WITH GASTROINTESTINAL MALIGNANCIES: A NATIONWIDE ANALYSIS Shivani Handa1, Kamesh Gupta2, Michelle Sterpi1, Ahmad Khanc3, Abhinav Hoskote1, Anup Kasid4 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2UMMS-Baystate Medical Center, Springfield, MA, United States; 3 West Virginia University-Charleston Area Medical Center, Charleston, WV, United States; 4Kansas University Medical Center, Kansas City, KS, United States

Published in Gastrointestinal Tumors, 2021 and Journal of Clinical Oncology, 2020.

IT’S STRONGYLOIDES BUT WHAT ELSE COULD IT BE? Hendrik Sy1, Sara Zalcgendler1, Deborah Edelman1, Dipal Patel1

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

IMPROVING MANAGEMENT OF HYPERKALEMIA IN HOSPITAL INPATIENTS Ciaran Twomey Brenner1, Caroline Dooley1, Bertin Salguero Porres1, Kimberly Sarosky1, Ruchika Batwara1, Janet Shapiro1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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ENDOSCOPIC ULTRASOUND CAN IDENTIFY PATHOGNOMONIC FEATURES OF AUTOIMMUNE PANCREATITIS THAT DISTINGUISH IT FROM PANCREATIC CANCER: A MATCHED CASE-CONTROL STUDY Angad S. Uberoi1, Jeong Yun Yang2, Amir Taree2, Alexandros Polydorides2, Rebekah E. Dixon2, Nikhil A. Kumta2, Satish Nagula2, Christopher J. DiMaio2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Digestive Disease Week (DDW) that will be held virtually from May 21-23, 2021.

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SAFETY AND COMPLICATIONS OF CATHETER ABLATION FOR ATRIAL FIBRILLATION: PREDICTORS OF COMPLICATIONS FROM AN UPDATED ANALYSIS THE NATIONAL INPATIENT DATABASE Lingling Wu1, Bharat Narasimhan1, Kam S. Ho1, Yingying Zheng2, Arti N. Shah1, Bharat K. Kantharia1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2East Carolina University, Greenville, NC, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

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LIQUID NITROGEN SPRAY CRYOTHERAPY IS EFFECTIVE AND SAFE WHEN USED IN THE MANAGEMENT OF EARLY ESOPHAGEAL ADENOCARCINOMA: SYSTEMATIC REVIEW AND META-ANALYSIS Mengdan Xie1, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Digestive Disease Week (DDW) that will be held virtually from May 21-23, 2021.

IMPACT OF LEFT ATRIAL APPENDAGE CLOSURE DURING CORONARY BYPASS SURGERY ON STROKE AND ATRIAL FIBRILLATIONS READMISSION Zhuoran Yang1, Lingling Wu1, Bharat Narasimhan1, Kam S. Ho1, Yingying Zheng2, Arti N. Shah1,3,4, Bharat K. Kantharia1,3,4

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Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2East Carolina University, Greenville, NC, United States; 3NYC Health and Hospitals, Elmhurst, New York, United States, 4Cardiovascular and Heart Rhythm Consultants, New York, NY, United States

Submitted to the Heart Rhythm Society Annual Scientific Meeting that will be held virtually from July 28-31, 2021.

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DIABETES DISTRESS, ITS PREVALENCE AND CLINICAL DETERMINANTS IN PATIENTS WITH TYPE II DIABETES Heba Jioussy Yassin1, Tamera Goldberg1, Theresa Mack1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

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LIST OF ABSTRACTS WITH VIRTUAL POSTERS

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MEDICAL MARIJUANA KNOWLEDGE AND ATTITUDES AMONGST INTERNAL MEDICINE RESIDENTS Iman Makki1, Binbin Zheng-Lin1, Maanit Kohli1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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Abstracts Abstracts with with Virtual Virtual Posters Posters

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ABSTRACT #1 CLINICAL RESEARCH CARDIOVASCULAR DISEASE HYPERCALCEMIA IS A PREDICTOR OF WORSE IN-HOSPITAL OUTCOMES IN PATIENTS WITH ATRIAL FIBRILLATION: A 2016 NATIONAL INPATIENT SAMPLE ANALYSIS Robert Abed1, Rawann Nassar1, Patrick Lam1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: To our knowledge, there is no strong evidence highlighting the effect of hypercalcemia on atrial fibrillation outcomes. Using the 2016 NIS, this work aims to compare in-hospital outcomes among patients with atrial fibrillation with or without concurrent hypercalcemia.

METHODS: Data was obtained from the 2016 NIS database. The primary outcome was inpatient mortality.

Secondary outcomes were hospital length of stay and total hospital charge. A series of univariate and multivariate regression analyses were conducted on STATA 15.1.

RESULTS: In this dataset, 871,029 observations met the criteria for inpatients who were diagnosed with atrial fibrillation. Among these, 5,313 patients had hypercalcemia versus 865,716 in whom serum calcium levels were not elevated. Among patients who experienced atrial fibrillation, those with hypercalcemia demonstrated higher inpatient mortality (OR, 1.66; 95% CI, 1.50-1.83) as compared to those without elevated serum calcium levels. Furthermore, those with hypercalcemia experienced on average an additional 1.53 days of hospitalization as compared to those without elevated serum calcium levels (β1=1.53; 95% CI, 1.25-1.81).

Lastly, those with elevated serum calcium levels incurred higher costs of hospitalization, averaging $9,614 more than those without elevated serum calcium levels (95% CI, $6457-$12771).

CONCLUSION: Among patients who experienced atrial fibrillation, those with elevated serum calcium levels had higher inpatient mortality, increased length of hospital stay, as well as increased total cost of hospitalization as compared to those without hypercalcemia. Despite the restrictions of our study, we believe that these significant findings should encourage further investigation into the role of serum calcium levels in patients with atrial fibrillation, both as a marker to predict mortality, as well as a key target of inpatient therapeutic approach.

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ABSTRACT #2 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW CARDIOVASCULAR DISEASE SEEING IS BELIEVING: THE CRUCIAL ROLE OF CARDIAC IMAGING IN SUSPECTED CARDIAC SARCOIDOSIS Jose Aguilar-Gallardo1, Alaa Omar2, Glenmore Lasam2, Javier Arreaza1, Johanna Contreras1 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

BACKGROUND/INTRODUCTION: Cardiac sarcoidosis is traditionally a histologic diagnosis. However, in the absence of histologic evidence, an appropriate imaging modality is essential for diagnostic evaluation.

CASE PRESENTATION: A 79-year-old male with history of lung cancer and heart failure with EF=45% presented with shortness of breath, chest pain, bipedal pitting edema, and bibasilar crackles. Echocardiogram revealed an EF of 35%. Telemetry showed short runs of ventricular tachycardia (VT). Coronary angiogram demonstrated nonobstructive cardiomyopathy. CMR revealed delayed gadolinium enhancement at the basal midventricular septum, inferior wall, and posterior right ventricular insertion with spared subendocardium (Figure 1A). The pattern of myocardial scarring in CMR is suggestive of cardiac sarcoidosis. Myocardial biopsy was attempted, but unsuccessful. Steroids were started empirically. Subsequent CMR FDG-PET revealed bilateral hilar uptake and diffuse uptake in cardiac basal inferior, medial anteroseptal regions (Figure 1B), and papillary muscle. The patient fulfilled all 5 major and 1 minor Japanese Circulation Society 2016 clinical findings strongly suggestive of cardiac sarcoidosis. Symptoms improved on steroids with no further episodes of VT. CONCLUSION: In nonischemic cardiomyopathy with mid-range EF and VT, CMR and FDG-PET are useful modalities to commit to the diagnosis of cardiac sarcoidosis. In the absence of proven biopsy tissue results, imaging can play a central role in arriving to a definitive diagnosis.

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ABSTRACT #3 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE ASSESSING THE IMPACT OF TELEMEDICINE ON DIABETIC PATIENTS AT AN UNDERSERVED URBAN CLINIC Shruti Anand1, Ines Robles Aponte1, Dipal Patel1, Tamara Goldberg1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

BACKGROUND/INTRODUCTION: The COVID-19 pandemic has highlighted the racial and ethnic disparities that plague our healthcare system. These studies also highlight that in people with poorly controlled chronic health conditions such as hypertension, diabetes mellitus, and obesity, the severity of the COVID-19 infection is greater. With this study, we focus on the impact of the pandemic on an existing chronic condition, diabetes mellitus. The pandemic resulted in redeployment of our resident providers to the inpatient setting, resulting in disruption of the patient-physician relationship at Ryan Adair. The patients and the providers had to quickly adapt to a telehealth platform which was a novel challenge to both. We sought to define the use and impact of telemedicine for a low-income, urban population during the COVID-19 pandemic.

METHODS: This project is conducted at Ryan Adair Health Center, a Federally Qualified Health Center (FQHC) located in the Central Harlem neighborhood of Manhattan that serves as a primary care training site for our Internal Medicine Residents. To understand the impact of telehealth access, we focused on a single cohort that included all diabetic patients seen by resident providers within 3 months prior to the pandemic surge. We examined data for these patients over three discrete time periods: “pre-pandemic” (12/15/20193/15/2020), “pandemic surge” (3/16/2020-5/31/2020), and “post-surge” (6/1/2020-8/15/2020). This data was tracked every three months to understand use and impact over the course of the pandemic. The variables measured included HbA1c and the number and type of visits. We compared pre-pandemic HbA1c values with post-surge values. We stratified tele-visits into telephone versus tele-video visits. A non-interventional retrospective chart review study design was used.

RESULTS: Among our pre-pandemic cohort of diabetic patients (n= 225), 35.1% (n=79) engaged in tele-visits during the pandemic surge, 6.66% engaged in onsite visits, and 56% had no engagement. For patients who engaged in tele-visits during the surge, the average HbA1c improved by 0.172%. For patients without televisits during the surge, the average HbA1c worsened by 0.42%. Among the subgroup of high-risk diabetics during the pre-pandemic period (HbA1c >9), those with improved HbA1c had more tele-visits during both the surge and the post-surge periods compared to those whose HbA1c worsened (improvement of 1.73% versus worsening of 1.9%). Among those who accessed tele-visits during the surge period, 79.74% were phone-only (n=63), 7.59% (n=6) were tele-video only while 12.6% (n=10) were both.

CONCLUSION: Our data suggest that telemedicine access improved average HbA1c outcomes among a low-income urban diabetic population. During the surge, HbA1c decreased or remained unchanged with telemedicine encounters, while patients without engagement in tele-visits showed worsening HbA1c levels. A surprising result was that 79% of tele-visits were conducted via phone-only, suggesting a benefit for use of this modality toward improving diabetes control for our population. Most patients in our cohort had no engagement in care during the surge period, highlighting the need to explore barriers to telehealth access. The true impact of HbA1c reduction through tele-visits may represent an underestimation, since resident providers were redeployed to the inpatient setting during the surge, thus patients were seen by providers unknown to them.

Exploration of data over the coming months will help elucidate the impact of provider continuity during televisits on HbA1c outcome.

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ABSTRACT #4 CLINICAL RESEARCH CARDIOVASCULAR DISEASE EFFECT OF EXPERT CONSULTATION AND MEDICAL OPTIMIZATION ON SHORT TERM OUTCOMES IN PATIENTS HOSPITALIZED WITH ACUTE DECOMPENSATED HEART FAILURE Javier Arreaza1, Ga Hee Kim1, Andrew Kim1, Jeewendra Dulal1, Alaa Omar2, Johanna Contreras1 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

BACKGROUND/INTRODUCTION: We aimed to study the effect of optimization of medical treatment on short term outcomes, 90-day mortality and 30-day readmission, in hospitalized acute decompensated heart failure patients not optimized on goal directed medical therapy (GDMT) at baseline.

METHODS/RESULTS: Retrospectively, 175 patients [69 ± 14 years; 70 (40%) females; NYHA: 3.1±0.5] acute decompensated heart failure patients not on optimal GDMT were studied. Heart failure consultation done in 107 (62%) patients guided diuresis management, GDMT, and intravenous inotropes [34 (20%) patients]. 21 (12%) patients died and 26 (15%) were readmitted. After adjustment for age, sex, risk factors, and inotropes, decreased mortality was found to be associated with weight loss, hemoglobin levels>10 g/dl on discharge, inpatient diuretic use, and maximization of tolerated GDMT on discharge, while elevated systolic blood pressure (SBP) on discharge was associated with readmission. Heart failure consultation was associated with lower weight, serum sodium, and a trend towards more diuretic use and maximization of GDMT (p<0.001, =0.001, 0.008, 0.08, 0.07, respectively). Weight loss on discharge was associated with improvement in renal function and BNP levels (p=0.02, <0.001, respectively).

CONCLUSION: Inpatient medical optimization of acute decompensated heart failure patients (euvolemia, maximization of goal directed medical therapy) was linked to less short-term mortality. Early expert consultation and optimal diuresis helped to achieve these goals. High SBP was linked to short term rehospitalization.

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ABSTRACT #5 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW CARDIOVASCULAR DISEASE/INFECTIOUS DISEASES ASYMPTOMATIC ISOLATED EXTERNAL ILIAC ARTERY DISSECTION IN A YOUNG MALE WITH HIV/AIDS Nikhil Bachoo1, Matthew Tracey1, Andrew S. Choi1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Iliac artery dissection is a rare entity caused by atherosclerotic and nonatherosclerotic processes which is usually encountered as an incidental finding on abdominal imaging. While connective tissue disorders such as Marfan syndrome, Ehlers Danlos syndrome, or fibromuscular dysplasia are the leading causes of non-atherosclerotic iliac artery dissection, vasculitic processes involving the arterial media might play a role with HIV infection as the underlying cause.

CASE PRESENTATION: A 38-year-old male patient with no comorbidities presented to the emergency department with chest pain, syncope, and left-sided groin pain. He was seated and smoking a cigarette prior to the syncopal event. His vital signs were stable and normotensive. Physical examination was reassuring for the lack of signs of acute limb ischaemia, aortic dissection, or stroke. ECG and cardiac biomarkers were not concerning for acute coronary syndrome. CTA chest ruled out thoracic aortic dissection and the syncope was deemed to be a vasovagal event. He also underwent a scrotal ultrasound which ruled out testicular torsion.

CTA-AP revealed a long segmental dissection of the right external iliac artery without significant atherosclerotic disease and mesenteric lymphadenopathy (Figure 1-2). He denied any recent trauma, intervention to the right groin, or prolonged physical exertion. There was no family history of premature atherosclerotic or connective tissue disease. Laboratory investigation was notable for positive HIV-1/2 p24Ag and HIV-1/2 Ab with a HIV viral load=194,000 copies/mL and CD4 count 193 cells/mm3. Lipid panel was WNL with LDL 71. HbA1c was 5.5. He was treated conservatively with anticoagulation (warfarin) and HAART initiated for HIV/AIDS. Repeat imaging at 48 hours showed a stable dissection. The patient was advised to continue a year of anticoagulation and obtain periodic repeat imaging with US doppler.

DISCUSSION: HIV’s pernicious effects on the arterial wall are manifold. HIV accelerates atherosclerosis through proinflammatory cellular changes. Additionally, the development of leukocytoclastic vasculitis involving the vasa vasorum has been postulated along with the direct involvement of the vascular smooth muscle which results in the thinning of the medial layer. Aneurysmal disease has also been encountered in HIV infected patients.

CONCLUSION: Uncontrolled HIV-induced large vessel vasculopathy can lead to significant morbidity and mortality and is an important reason to institute an early treatment of HIV infection.

Figure 1 and 2. CT-abdomen/pelvis of patient

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ABSTRACT #6 QUALITY IMPROVEMENT CARDIOVASCULAR DISEASE DE-ESCALATION OF ASPIRIN FOR PRIMARY PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN THE PRIMARY CARE SETTING Joshua Berookhim1, Michael Kahen1, Gabriela Bernal1, Subrat Das1, Brian Berookhim1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Quality of Care and Outcomes Research (QCOR) Scientific Sessions that was held virtually on May 15, 2020.

BACKGROUND/INTRODUCTION: For several decades, aspirin (ASA) has been used as primary prevention against ASCVD in adults. In 2018, three major trials (ASPREE, ARRIVE, and ASCEND) redefined our understanding of ASA and showed a net harm rather than benefit when ASA is used for primary prevention of ASCVD. These trials greatly impacted the current 2019 ACC/AHA Primary Prevention Guidelines, which now recommend the following: (a) Low-dose ASA might be considered for primary prevention of ASCVD in select higher ASCVD adults aged 40-70 years who are not at increased bleeding risk and (b) Low-dose ASA should not be administered for primary prevention of ASCVD among adults over the age of 70. The objective of the project was to re-evaluate the use and indications of ASA in our patient population and appropriately remove ASA when no longer indicated. With proper resident education and intervention, we hypothesized that we could reduce the number of inappropriate ASA prescriptions by 10%.

METHODS: During a 6-month observational period, 254 patients at Ryan Health/Adair (a Federally Qualified Health Center which also serves as a primary care site for an Internal Medicine Residency clinic) were found to be taking ASA, and of those 140 patients were found to be on ASA for primary ASCVD prevention. The interventions included implementation of an algorithm that reflected the most up to date guidelines. The intervention lasted 3 months. Any patient that was found to be on ASA inappropriately was discontinued.

RESULTS: During this period, ASA was successfully removed from 25 patients’ medication list, with an overall reduction by 17.9%. Of the 25 patients, 20% were over the age of 70, 80% were between the ages of 40-70, and 48% were male. In the remaining 115 patients in which ASA was continued, 27.8% were over the age of 70, 69.6% were between the ages of 40-70, 2.6% were under the age of 40, and 49.6% were male. The successful ASA removal group comprised of 44% Hispanic/Latino, 44% African-American, 4% White, and 8% unidentified. The ASA non-removal group comprised of 34.8% Hispanic/Latino, 44.3% African-American, 5.2% White, and 15.7% unidentified. Additionally, 80% of the patient taken off ASA spoke English, while only 69.6% of patient in the ASA non-removal group spoke English.

CONCLUSION: Several differences were found between the two groups. Some key limitations between the two groups included (a) unclear past medical history leading to physicians being uncomfortable with removing ASA, (b) inability to speak in patient’s native language to facilitate proper discussion about ASA removal, and (c) patient refusal to stop ASA. Next steps include further cardiac testing (CT coronaries, stress test) to better characterize the risk of patients with unclear history. However, overall, there is likely a net benefit in prioritizing ASA removal in the primary care setting now that it is no longer recommended in key populations.

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ABSTRACT #7 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/NEPROLOGY PREVENTION OF HEART FAILURE EVENTS WITH SGLT-2 INHIBITORS ACROSS A SPECTRUM OF CARDIO-RENAL METABOLIC RISK Kirtipal Bhatia1, Vardhmaan Jain2, Kartik Gupta3, Agam Bansal2, Arieh Fox1,4, Arman Qamar5, Kevin Damman6, Muthiah Vaduganathan7 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Cleveland Clinic, Cleveland, OH, United States; 3Henry Ford Hospital, Detroit, MI, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, United States; 6University Medical Center Groningen, Groningen, Netherlands; 7Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, United States 2

Published in the European Journal of Heart Failure, 2021. PMID: 33609071 BACKGROUND/INTRODUCTION: Trials have tested the safety and efficacy of sodium-glucose-cotransporter2 inhibitors (SGLT2i) across various disease states. We performed a meta-analysis of randomized controlled trials (RCTs) to estimate the relative and absolute effects of SGLT2i in prevention of heart failure (HF) events across different risk groups.

METHODS: We conducted a systematic review and meta-analysis of large, placebo-controlled RCTs with >1,000 participants evaluating HF hospitalization and the composite of cardiovascular (CV) death or HF hospitalization. Due to varying durations of therapeutic exposure and follow-up, absolute risk reductions and number needed to treat (NNT) were calculated based on incidence rates (per 100 patient-years).

RESULTS: Across 71,553 patients enrolled in 10 late-phase RCTs, SGLT2i reduced the risk of HF hospitalization by 31% (HR, 0.69; 95% CI, 0.64-0.74; I2=0%) and the composite outcome of CV death or HF hospitalization by 24% (HR, 0.76; 95% CI, 0.72-0.80; I2=1.37%) compared with placebo (Figure 1A and 1B).

The number of patient-years of treatment exposure needed to prevent 1 CV death or HF hospitalization ranged from 19-26 (with HF) to 72-125 (chronic kidney disease) to 96-400 (in high-risk type 2 diabetes) (Figure 2). The mixed-effects meta-regression analysis showed that the benefits of SGLT2i on HF hospitalizations or the composite outcome (CV death or HF hospitalization) were not influenced by age, sex and change in intermediate markers (glycated hemoglobin, systolic blood pressure, and body weight) (all p≥0.10).

CONCLUSION: Despite wide variation in baseline risks and disease states evaluated, SGLT2i demonstrated comparable relative risks reductions in preventing HF events. Patients at highest baseline risk derived the greatest absolute benefits in preventing HF events. These composite estimates may help guide targeted implementation of SGLT2i for the prevention of HF events in type 2 diabetes and chronic kidney disease and in the treatment of HF with reduced ejection fraction.

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Figure 1A: Pooled relative effect sizes of SGLT-2 inhibitors on heart failure (HF) hospitalization

Figure 1B: Composite of cardiovascular (CV) death or HF hospitalization

Figure 1: Pooled relative effect sizes of SGLT-2 inhibitors on heart failure (HF) hospitalization (A) and composite of cardiovascular (CV) death or HF hospitalization (B) across trials. Abbreviations: HR, hazard ratios; CI, confidence interval; T2DM, type 2 diabetes mellitus; CKD, chronic kidney disease; HFrEF, heart failure with reduced ejection fraction 30

Figure 2: Relationship between baseline risk and treatment benefits with SGLT2i on heart failure (HF) hospitalization (top panel) and composite of cardiovascular (CV) death or HF hospitalization (bottom panel).

Size of circles correspond to sample size of trial population. Red dotted line reflects fitted line across trials.

Number-needed-to-treat (NNT) estimated based on incidence rates (per 100 patient-years [py]) and reflects the number of patient-years exposure to prevent 1 HF event. Abbreviations: CKD, chronic kidney disease; HF, heart failure; T2D, type 2 diabetes

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ABSTRACT #8 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY A RARE CASE OF HIT WITH NORMAL PLATELET COUNTS Matthew Karr1*, Lauren Botero1*, Lawrence Cytryn1

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

*These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Heparin-Induced Thrombocytopenia (HIT) occurs when antibodies are directed against platelet factor 4, PF4, which is part of a heparin-PF4 complex. These IgG antibodies activate platelets which can lead to fatal arterial and venous thrombosis. These thromboses, if left untreated, are associated with 20% mortality and other serious complications. HIT will continue to persist until both heparin is eliminated and a new non-heparin anticoagulant is started. The HIT antibodies typically develop over 5-8 days, thus the HIT antibodies usually only form after a patient has a heparin exposure of about a week. However, rapid decline in platelet count within 12 hours of heparin exposure can occur if the patient was previously treated with heparin within 100 days. Thrombocytopenia with a platelet count <150,000 is seen in 85-90% of patients, but all demonstrate a 50% reduction in platelet count after heparin exposure. However, instances of HIT can be difficult to detect, particularly when the patient has a concomitant initial thrombocytosis.

CASE PRESENTATION: A 46-year-old female with sciatica and recent diagnosis of arterial thrombosis of the right common iliac artery (status post right lower extremity angiogram, femoral/popliteal/AT/PT thrombectomy with 4-compartment fasciotomy on 2/17/2021) presented with a cold painful right lower extremity and was found to have a thrombus beginning at the level of the right common iliac artery. She was managed with a heparin drip with plan for bridge to warfarin, but she had progressive ischemia, with mottling of her lower leg even despite multiple revascularization attempts. Her initial platelet count was 669K, but the repeat that evening was 259K, and the heparin drip was switched to argatroban. She was found to have a positive serotonin release assay and HIT antibody, positive lupus anticoagulant, and an iron of 16 with soluble transferrin receptor of 76.8.

DISCUSSION: Thrombocytosis is often subdivided into two groups: reactive thrombocytosis and myeloproliferative neoplasms. The etiology of reactive thrombocytosis can be very broad, including postsurgical, anemia, infection, inflammation, or reduced sequestration. As the patient’s platelets were elevated prior to surgery, we postulate that the initial thrombocytosis was likely driven by a combination of anemia (admission Hgb of 8.3) and infection (fluid cultures were positive for Bacillus cereus on 2/25/2021). The patient experienced a platelet drop greater than 50% within 16 hours of heparin exposure. This case of HIT was either an initial presentation from the antibodies formed during the previous treatment or the re-exposure caused an acute HIT response. Her platelet count fully recovered within 1 week after heparin was discontinued.

CONCLUSION: Patients with reactive thrombocytosis experiencing heparin-induced thrombocytopenia will experience a large drop in platelet count, but the overall platelet count may remain normal as a result of the initial thrombocytosis. It is critically important to keep heparin-induced thrombocytopenia on the differential despite what may be a deceiving platelet count within normal range.

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ABSTRACT #9 CLINICAL RESEARCH GASTROENTEROLOGY NO SIGNIFICANT DIFFERENCES IN MORTALITY AMONG STROKE VERSUS NON STROKE PATIENTS UNDERGOING PERCUTANEOUS ENDOSCOPIC GASTROSTOMY, NATIONAL INPATIENT SAMPLE STUDY 2016 Bing Chen1, Omar Mahmoud1, Priya Simoes1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a frequently performed procedure in patients with stroke. This study aimed to investigate the differences in in-hospital outcomes for stroke patients compared with non-stroke patients undergoing PEG. METHODS: In this retrospective study, the 2016 National Inpatient Sample database was analyzed by using ICD-10 Code for hospitalizations with a procedure code of PEG. Those patients were further divided into the stroke or non-stroke group based on whether they had a primary or secondary diagnosis as ischemic or hemorrhage stroke. Patients who were younger than 18 were excluded from this analysis. The primary outcome of interest was in-hospital all-cause mortality. The secondary outcomes of interest were the rate of aspiration pneumonia, length of stay, and total cost of the hospital admission. Multivariate regression was used to adjust for age, gender, race, incomes, insurance, hospital characteristics, and comorbidities. STATA 14 (College Station, TX) was used for analysis.

RESULTS: A total of 27,500 patients with stroke underwent PEG in 2016, which made up 19.4% of all PEGs performed. Compared with patients without stroke, patients in the stroke group were older (69.1 versus 67.1 years, p<0.001), more likely to be female (48.0% versus 42.9%, p<0.001), and had a higher Charlson Comorbidity Index (4.20 versus 3.01, p<0.001). Compared with the non-stroke group, the in-hospital all-cause mortality was not significantly different in stroke group (6.52% versus 6.74%) with an adjusted odds ratio (aOR) of 0.95 (95% CI, 0.83-1.08; p=0.416). However, stroke patients had a higher rate of aspiration pneumonia (25.64% versus 20.99%, p<0.001), length of stay (21.6 days versus 19.8 days, p<0.001), and total cost of hospital admission ($61745 versus $53972, p<0.001). In the subgroup analysis of stroke patients undergoing PEG, Hispanic ethnicity (aOR, 1.65; 95% CI,1.14-2.38; p<0.01), and coexisting aspiration pneumonia (aOR, 1.53; 95% CI, 1.21-1.94; p<0.001) were associated with higher mortality.

CONCLUSION: Among patients undergoing PEG, stroke patients did not have a significantly different inhospital all-cause mortality compared to non-stroke patients. However, they had a higher rate of aspiration pneumonia, length of stay, and total cost of hospital admission.

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ABSTRACT #10 BASIC SCIENCE HEMATOLOGY/ONCOLOGY SERUM IDENTIFICATION OF MYC-AMPLIFICATION IN SMALL CELL LUNG CANCER PATIENTS USING DROPLET DIGITAL PCR Fionnuala Crowley1, Hannah Bye2, Bojan Macanovic3, Pauline O’Dea3, Derek Power3, Anna Minchom4, Michael Hubank2, Dearbhaile Collins3 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; NIHR Centre for Molecular Pathology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; 3Cork University Hospital, Cork, Ireland; 4The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom 2

Presented at the European Society of Medical Oncology (ESMO) Congress Annual Meeting that was held virtually from September 19, 2020 to October 18, 2020.

BACKGROUND/INTRODUCTION: Small cell lung cancer (SCLC) comprises approximately 15% of all lung cancers. It has a poor prognosis with a median overall survival (OS) of 7 months. Comprehensive genomic analyses of SCLC have reported MYC-amplification as a frequent oncogenic event in up to 30% of tumors and this correlates with an aggressive tumor phenotype and reduced OS. MYC status therefore has a prognostic role and is a potential future biomarker of response and/or treatment METHODS: Recruitment for this study is ongoing. Blood from newly diagnosed or relapsed SCLC patients was analyzed for circulating tumor DNA (ctDNA). Droplet digital PCR (ddPCR) detected the presence/absence of MYC C/L/N amplifications in ctDNA. A result was reported as amplified if the ratio of MYC gene/reference gene was >2. Borderline amplified was reported if the ratio was 1.5-2. MYC amplifications were correlated with clinicopathological details and OS. RESULTS: Currently 30 patients have been recruited to this ongoing study. Results for the first 14 patients are presented. Half the patients were male with a median age of 65 years. The majority (86%) were newly diagnosed. Most patients (86%) were ECOG 0, 1, or 2. ddPCR results revealed two patients had MYC-L amplifications (ratios, 2.98 and 9.95). One additional patient had borderline MYC-C amplification (ratio, 1.83).

Both patients with MYC-L amplified ctDNA presented with superior vena cava obstruction and were both T4N3 at time of diagnosis. Both are undergoing first-line chemotherapy and no radiological assessment has been performed to date.

CONCLUSION: SCLC has a dismal prognosis with a dire need to improve treatment options. We have a high number of SCLC patients in our center in Ireland. These patients can deteriorate quickly and become ineligible for clinical trials which require pre-screening. MYC amplification may not only offer prognostic information but is indirectly targetable, in addition to direct MYC inhibitors in development. Real time ddPCR of ctDNA in patient plasma is an effective, cost-efficient method for serum identification of MYC amplification with results available within 3-5 days of blood draw, permitting complex pre-screening in a timely manner to allow prognostication, trial recruitment and a future actionable mutation.

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ABSTRACT #11 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/GASTROENTEROLOGY THE IMPACT OF HEALTH LITERACY, SOCIOECONOMIC STATUS, AND RACIAL DISPARITY IN HEALTH OUTCOMES Lady Njemeh Danso1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

BACKGROUND/INTRODUCTION: Assess the impact of health literacy and socioeconomic status on health outcomes and evaluate the effect of racial disparities in health outcomes.

CASE PRESENTATION: A 55-year-old African-American woman with past medical history significant for chronic intermittent hypomagnesemia, hyponatremia, and hypokalemia, alcoholic cirrhosis, hypertension, and depression presented to the emergency department with complaint of bilious vomiting, non-bloody diarrhea, and unintentional weight loss. Extensive chart review revealed that the patient has had symptoms for more than 5 years. She intermittently followed with a Nephrology clinic. Extensive imaging revealed only one small hepatic nodule. Blood work which included renin and aldosterone levels were normal. However, fo r significant time periods, she was lost to follow up. Over the past year, this patient presented to the emergency department (ED) eight times with similar complaints. During these ED visits, the patient did not want to be admitted for unknown reasons. Her symptoms continued to worsen and in November 2020, the patient was admitted to the hospital for severe electrolyte abnormalities related to ongoing diarrhea. She was started on oral magnesium and potassium supplements, without improvement of her symptoms. Her symptoms were associated with poor appetite, intermittent paresthesia of the fingers, lower extremity weakness, muscle cramps, and palpitations.

She denied changes in her diet, abdominal pain, constipation, headache, seizures, or loss of consciousness.

DISCUSSION: From extensive review of 109 encounters from 11/12/2018 to 12/10/2020, we discovered that the patient had been seen by multiple subspecialty providers in different hospital systems as well as numerous Residents and Attending physicians. As such, there was no individual who knew the full longitudinal history of the patient. Fragmentation of care and lack of shared decision making both compounded the delay in appropriate diagnosis for this patient. The impacts of care fragmentation include higher healthcare costs, lower quality of life, and worse outcomes. We hypothesized that low health literacy, low socioeconomic status, and racial disparities in health care largely contributed to her delayed diagnosis and treatment, resulting in greater morbidity and mortality risk.

CONCLUSION: It is important to recognize the impact of health literacy on the health outcomes of patients.

We should also recognize and address the socioeconomic barriers that might delay diagnosis and treatment resulting in poor health outcomes. Finally, it is important to check our implicit biases to be able to provide quality care to our patients.

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ABSTRACT #12 CLINICAL RESEARCH CARDIOVASCULAR DISEASE PROOF OF CONCEPT: INTERPRETATION OF EKGS WITH IMAGE RECOGNITION AND CONVOLUTIONAL NEURAL NETWORKS Subrat Das1, Matthew Epland2, Jiang Yu3, Ranjit Suri4 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Komodo Health, Inc, New York, NY, United States; 3New York University, New York, NY, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020.

BACKGROUND/INTRODUCTION: EKGs are the cornerstone of management in cardiovascular diseases.

There have been multiple efforts to computerize the EKG interpretation with algorithms, which unfortunately are machine specific and proprietary. We propose the development of an image recognition model which can be used to read EKG strips (which use standard notations) and hence be used universally.

METHODS: A convolutional neural network (CNN) was trained to classify 12-lead EKGs between seven clinically important diagnostic classes: normal sinus rhythm, atrial fibrillation (AF), first-degree atrioventricular block, left bundle branch block, right bundle branch block, ST depression (STD), and ST elevation (STE). Prelabeled EKG recordings (6-60s) from a publicly available data set on PhysioNet were used to construct the images. The EKG images displayed the 12 channel traces of 2.5 seconds each, on a consistent 4 x 3 grid at a resolution of 800 x 800 pixels. The data set (23,336 images) was divided into training, validation, and test sets; containing 70%, 15%, and 15% of the images, respectively. An austere variation of the MobileNetV3 model was trained from the ground up on the labeled training set. Stochastic gradient descent (SGD) was used to minimize the cross-entropy loss. Training was halted when the training loss had not improved from its previous minimum by at least 0.05% over the past 10 epochs.

RESULTS: The model was trained over 37 epochs in batches of 32 images. The model’s performance was tested using the test set (which was not used for development of the model) and precision, recall, and F1 scores were calculated. The precision per class varies from 52-91%. We obtained the highest precision for detection of AF at 91%. The precision for diagnosing STD and STE were 73% and 52%, respectively. The overall accuracy of the model was 79%.

CONCLUSION: We used a labeled dataset of EKG images to develop a convolutional neural network model to predict seven different diagnostic classes with good accuracy. This is a novel approach to EKG interpretation as an image recognition problem and thus generates the ability to create diagnostic algorithms that are not dependent on proprietary voltage signals generated by commercial EKG machines. With the addition of more images to the data set and higher computing power we are confident that we can achieve enhanced accuracy.

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ABSTRACT #13 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW CARDIOVASCULAR DISEASE AN ELUSIVE MIMICKER OF ABDOMINAL AORTIC ANEURYSM Abraham Derman1, Mayank Yadav1,2, Mohammad Asad1, Manoj Bhandari1, Jacqueline Tamis-Holland1,2, Jonathan Bella1, Patrick Lam1 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY, United States

Presented at the 10th Annual Graduate Medical Education (GME) Research Day, Icahn School of Medicine at Mount Sinai; New York, NY, United States that was held on June 7, 2019.

BACKGROUND/INTRODUCTION: Permanent pacemaker (PPM) generator change is a common and very low risk procedure. Phrenic nerve capture is an uncommon complication where electrical impulses, intended to pace the myocardium, instead, also stimulate the phrenic nerve, resulting in a diaphragmatic contraction.

Although a benign condition with more of an unpleasant sensation, it can present to hospital with pulsatile abdomen and can mimic with abdominal aortic aneurysm (AAA).

CASE PRESENTATION: A 73-year-old African American male, long time smoker with comorbidities of chronic obstructive pulmonary disease and heart failure with reduced ejection fraction presented to the emergency room with a complaint of a pulsating abdomen that began one day following PPM generator change. Patient denied any chest pain, abdominal pain, dizziness, syncope, or any trauma. On the exam, patient was not in distress and lying comfortably. Pulse rate was 93 bpm and bilaterally symmetrical and blood pressure was 101/60 mmHg. Abdomen was visibly pulsating, non-tender, and the pulsations were synchronous with the pulse. No obvious mass could be palpated.

DISCUSSION: Although there was clear temporal relation of the current presentation with the PPM generator change, a pulsating abdomen in a patient with a significant history of smoking and heart disease, requires an investigation to rule out rapidly expanding AAA. Moreover, as no manipulation was done to the intracardiac leads during the procedure. A bedside ultrasound was performed and it ruled out any significant AAA. Device interrogation was done and coronary sinus lead was found to be the culprit. The lead was pacing the phrenic nerve which in turn led to diaphragmatic contractions which were synchronous with the pulse. The vector (direction and size) of electric stimulus was adjusted which led to immediate cessation of the abdominal pulsations. Patient was later safely discharged home.

CONCLUSION: This case illustrates the importance of good history taking, critical analysis of new symptoms with a priority to rule out the most life-threatening condition first while simultaneously assessing for other less concerning but reversible causes. The effective and timely use of bedside ultrasound proved versatile and crucial to rule out AAA and help avoiding contrast and radiation exposure of computed tomography.

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ABSTRACT #14 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW CARDIOVASCULAR DISEASE/INFECTIOUS DISEASES ESCHERICHIA COLI ENDOCARDITIS OF NATIVE MITRAL VALVE Jeewendra Dulal1, Andrew Kim1, Javier Arreaza1, Ga Hee Kim1, Alaa Omar2, Mikhail Khaitov1,3, Johanna Contreras1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Morningside Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

BACKGROUND/INTRODUCTION: Escherichia coli (E. coli) bacteremia is common but infective endocarditis (IE) caused by E. coli is rare (reported incidence: 0.51-1%). Gram-negative endocarditis is largely limited to the so-called “HACEK” group, however, E. coli accounts for one-third of non-HACEK, gram-negative bacilli IE and is the most common gram-negative bacillus to cause IE. Here, we present a case of IE caused by E. coli in a woman with previously undiagnosed uncontrolled diabetes mellitus.

CASE PRESENTATION: A 56-year-old female with previously undiagnosed diabetes mellitus (DM, admission HbA1c: 13.6%) presented with altered mental status and right sided weakness. She also had intermittent chills, fever, back pain, nausea, and vomiting for 3 days prior to admission. Computed tomography (CT) scan of the head revealed recent infarct in the occipital lobe and the posterior cerebral artery vascular territory, which was deemed out of the window for fibrinolytic therapy. A dirty turbid urine analysis sample in the setting of back pain prompted a CT evaluation of abdomen and pelvis which revealed left emphysematous pyelonephritis.

Urine culture was positive for E. coli and blood cultures grew E. coli on 3 separate occasions. A transthoracic echocardiogram showed a mobile vegetation (1.2 x 1 cm) attached to the anterior leaflet of the mitral valve.

The hospital course was complicated by intubation for airway protection and intensive care unit admission during which she suffered from multiple organ failure. Subsequent magnetic resonance imaging of the head showed bilateral hemispheric embolic infarcts and incipient uncal herniation. She passed away 2 weeks after the initial presentation from asystolic cardiac arrest.

DISCUSSION: Endocarditis due to non-HACEK gram-negative bacteria including E. coli is traditionally considered a disease of intravenous drug users but recent studies suggest epidemiological changes such that the incidence may increase in patients with implanted endovascular devices including prosthetic valves, permanent pacemakers, implantable cardioverter-defibrillators, and in immunosuppressed patients.

Interestingly, few studies have reported that the majority of E. coli endocarditis was found to affect native valve without prior degenerative disease, especially in patients with risk factors including DM, malignancy, excessive alcohol consumption, and renal replacement therapy. Urinary tract is the most common source of infection.

Similarly, our patient had undiagnosed DM and a urinary tract infection in the form of emphysematous pyelonephritis without history of prior degenerative valvular disease. Reportedly, hospitalization due to endocarditis related to non-HACEK gram-negative bacteria is encountered in more than 50% of cases with an in-hospital mortality that is as high as 24% with or without cardiac surgery.

CONCLUSION: Although rare, the incidence of infective endocarditis caused by E. coli seems to be increasing, especially in older population with the aforementioned risk factors. Thus, attention among physicians is needed given the aggressive course and significant mortality burden of infective endocarditis caused by E. coli.

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ABSTRACT #15 CLINICAL RESEARCH GASTROENTEROLOGY ESOPHAGO-GASTRIC OUTLET OBSTRUCTION IN THE ABSENCE OF A HIATAL HERNIA SHOULD BE EVALUATED BY ENDOSCOPY AND IMPEDANCE PLANIMETRY Maan El Halabi1, Xiaocen Zhang1, Elijah Verheyen1,2, Justin Field1,2, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Esophago-gastric junction outflow obstruction (EGJOO) is diagnosed on high resolution esophageal manometry (HREM) when there is an elevated median integrated relaxation pressure (IRP) of the lower esophageal sphincter (LES), but there is sufficient peristalsis to exclude achalasia.

The clinical significance of EGJOO has yet to be established. The presence of a hiatal hernia (HH) disrupts the normal alignment of the LES and crural diaphragm. Our aim was to determine how a HH affects key HREM parameters in EGJOO patients, and to assess the accuracy of this diagnosis when a significant HH is absent.

METHODS: All HREM procedures performed at a large referral-based motility center between 2013 and 2020 were reviewed. Cases with EGJOO but no other abnormalities were included. They were divided into 3 groups according to hiatal hernia length: no HH, HH 0.1-1.9 cm, and HH of at least 2 cm. HREM parameters were analyzed by subgroup, after which endoscopy records were evaluated for patients without a HH of 2 cm in length.

RESULTS: A total of 1330 HREM reports were reviewed, of which 190 cases had only EGJOO (Table 1). HH was absent in 99 patients (52.1%), with 56 patients (29.5%) having a HH of 0.1-1.9 cm in length and 35 patients (18.4%) having a HH of at least 2 cm. Analysis confirmed LES resting pressure (LESRP), integrated relaxation pressure (IRP), distal contractile integral and esophageal length were significantly lower in the presence of a HH (Table 2). There were 18 EGJOO cases without a HH of at least 2 cm where post-HREM with impedance planimetry was performed (EndoFLIP 2.0, Medtronic GI Health, Sunnyvale CA). Of this group, 5 patients (29%) had normal LES distensibility and an endoscopically normal esophagus. The other 12 patients (71%) showed reduced LES distensibility; all patients had visual evidence of an obstructing lesion such as a fibrotic ring or para-esophageal hernia.

CONCLUSION: Mean LESRP and IRP each were at least 2.5 mmHg greater in the absence of a hiatal hernia.

These findings raise concern for a diaphragmatic contribution to LES pressure that could generate false positive results for esophago-gastric junction outflow obstruction, including 5 of 17 cases with normal impedance planimetry. The remaining patients all had evidence of an obstructing lesion. To both confirm the accuracy of the diagnosis and allow for therapeutic intervention when present, endoscopy with impedance planimetry is appropriate whenever esophago-gastric junction outflow obstruction is found on high resolution esophageal manometry and there is no clinically significant hiatal hernia.

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Demographics Subjects (N [%]) Age (mean ± SD, year) Height (mean ± SD, cm) Gender Female Male

No HH 99 (52.1%) 60.2 + 13.2 162.7 + 11.4

HH < 2 cm 56 (29.5%) 59.2 + 14.8 160.5 + 7.5

HH ≥ 2 cm 35 (18.4%) 57.3 + 13.5 158.8 + 16.6

62 (62.6%) 37 (37.4%)

40 (71.4%) 16 (28.6%)

22 (62.9%) 13 (37.1%)

p-value

0.04 0.45

Indications

0.72

Dsyphagia 52 (52.6%) Reflux 29 (29.3%) Others 18 (18.1%) *Other: chest pain, cough, food regurgitation, aerophagia

33 (58.9%) 15 (26.8%) 8 (14.3%)

21 (60%) 7 (20%) 7 (20%)

Table 1. Baseline Demographic Characteristics HH: Hiatal Hernia

Chicago Classification v3.0 Diagnosis: EG Junction Outlet Obstruction No HH

HH < 2 cm

HH ≥ 2 cm

Subjects (N (%))

99 (52.1%)

56 (29.5%)

35 (18.4%)

LESRP in mmHg (mean ± SD)

44.2 + 13.1

37.2 + 12.8

36.3 + 19.1

<0.01

IRP in mmHg (mean ± SD)

21.5 + 6.8

18.9 + 3.9

16.5 + 5.1

0.03

IRP in mmHg (median ± SD)

21.1 + 6.7

18.7 + 4.3

16.3 + 5.2

<0.01

3190 + 3095

1747 + 1134

1589 + 1331

<0.01

CFV in cm/sec (mean ± SD

3.8 + 8.6

5.5 + 6.1

4.4 + 3.7

0.25

DL in seconds (mean ± SD) Esophageal Length (mean ± SD, cm)

6.6 + 1.7

6.5 + 1.7

7.1 + 2.1

0.4

23.5 + 2.4

22.6 + 2.5

20.6 + 2.9

<0.01

DCI in mmHg ·sec·cm (mean ± SD

p-value

Table 2. High Resolution Esophageal Manometry Findings HH: hiatal hernia; IRP: integrated relaxation pressure; DCI: distal contractile integral; CFV: contractile front velocity; DL: distal latency; LESRP: lower esophageal sphincter resting pressure

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ABSTRACT #16 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY METRONOMIC CHEMOTHERAPY FOR PATIENTS WITH METASTATIC BREAST CANCER: REVIEW OF EFFECTIVENESS AND POTENTIAL USE DURING PANDEMICS Johny E. Fares1, Paul El Tomb2, Lana E. Khali3, Rula W. Atwani3, Hiba A. Moukadem3, Ahmad Awada4, Nagi E. El Saghir3 1

Lankenau Medical Center, Wynnewood, PA, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3American University of Beirut Medical Center, Beirut, Lebanon; 4Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

Published in Cancer Treatment Reviews, 2020. PMID: 32769038 BACKGROUND/INTRODUCTION: Metronomic chemotherapy (M-CT) is defined as dose dense administration of chemotherapy at lower doses than maximum tolerated dose but at shorter free intervals, to obtain a near continuous exposure of cancer cells to those potentially effective drugs. This review will focus on the use of MCT in advanced breast cancer (ABC).

METHODS: Many clinical trials proved the efficacy and tolerability of different monotherapies and combinations of chemotherapeutic agents administered in metronomic doses in ABC. This is a review of efficacy and safety of metronomic chemotherapy trials.

RESULTS: M-CT has shown effectiveness and reduced toxicity in many small trials. M-CT is well tolerated, has low toxicity and low costs.

CONCLUSION: M-CT is a reasonable option for second and later lines of chemotherapy in metastatic breast cancer including those with prior anthracycline or taxane exposure, older patients and patients with comorbidities, and even as first-line in certain groups of patients. The acceptable efficacy and low toxicity of oral metronomic chemotherapy makes it a reasonable option during COVID-19 pandemic as well as in the post-COVID-19 era. M-CT option is now listed in ESO/ESMO (ABC3 and ABC5) and AGO Guidelines for patients with ABC who do not require a rapid tumor response.

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ABSTRACT #17 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/INFECTIOUS DISEASES EFFECT OF HEPATITIS C VIRUS INFECTION ON HEART TRANSPLANTS IN THE CURRENT ERA Tomohiro Fujisaki1, Takahisa Mikami2,3, Toshiki Kuno 2, Noah Moss4, Shinobu Itagaki4 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Tufts Medical Center, Boston, MA, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020. Published in Transplantation, 2021. PMID: 33496557 BACKGROUND/INTRODUCTION: The effect of hepatitis C virus (HCV) infection in recipients or donors on heart transplants is less known in the current era after the introduction of direct-acting antiviral agents (DAAs) in 2011.

METHODS: Using the United Network for Organ Sharing registry, 24,871 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV infected recipients and in utilization of HCV infected donors and their effect on the transplant outcomes were investigated in the past era versus the current era separated by 2011, using Cox proportional hazard regression.

RESULTS: HCV antibody positive recipients (n=520, 2.1%) had stable prevalence (p=0.18). They had a lower survival estimate when compared to HCV antibody negative recipients in the past era (55.3% versus 70.9% at 7 years; hazard ratio (HR), 1.56; 95% confidence interval (CI),1.27-1.91; p<0.001), however not in the current era (73.1% versus 71.5% at 7 years; HR, 1.00; 95% CI, 0.75-1.32; p=0.98) (pinteraction<0.001) (Figure I). Organ use from HCV antibody positive donors (n=371, 1.5%) was concentrated in the recent years (p<0.001) and provided the similar survival estimate up to 2 years (84.2% versus 87.6%; HR, 0.97; 95% CI, 0.65-1.44; p=0.87) (Figure II). The similar findings were confirmed with a subgroup cohort with positive nucleic acid amplification test (NAT).

CONCLUSION: Positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes in the current era. Graft utilization from positive HCV antibody or NAT positive donors are rapidly more prevalent and appear to be promising up to 2 years post-transplant.

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Figure I. Survival after heart transplant with recipient HCV antibody positive or negative, stratified by the eras (A: 2005-2011; B: 2011-2019)

Figure II. Survival after heart transplant with donor HCV antibody positive or negative in the current era, 2011-2019

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ABSTRACT #18 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW PULMONARY/CRITICAL CARE SERIAL CHANGES IN SPECIFIC IGE AND IGG TO METHYLENE DIISOCYANATE IN A WORKER WITH OCCUPATIONAL ASTHMA Simeon Gotzev1, Joshua Lipszyc2, Carrie A. Redlich3, Adam V. Wisnewski3, Susan Tarlo2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Toronto, Toronto, Canada; 3Yale University, New Haven, CT, United States

2

Presented at the American Thoracic Society (ATS) Annual Meeting; San Francisco, CA, United States that was held on May 13-18, 2016.

BACKGROUND/INTRODUCTION: Occupational asthma (OA) is a form of adult-onset asthma caused by specific agents (i.e. sensitizers, and/or irritants) in the workplace, subdivided into immunological/sensitizerinduced OA and non-immunological/irritant-induced OA. There is a need for improved recognition, diagnosis, and monitoring of patients with occupational asthma.

CASE PRESENTATION: In this report, we describe a case of a 46-year-old male who developed immunogenic-mediated occupational asthma to methylene-diphenyl diisocyanate (MDI) who was found to have serologic elevations in MDI-specific IgE/IgG in an exposure dependent pattern. Diagnosis of asthma was confirmed by spirometry and a positive methacholine challenge. The exposure (methylene diphenyl diisocyanate) was identified through review of material safety data sheets (MSDS) for workplace materials and confirmed as a cause of occupational asthma through exposure specific avoidance. Serial methacholine challenges were done at 3-4 months, 27 months, and 40 months to assess for resolution of asthma following exposure avoidance. Serum levels of MDI-specific IgE and IgG antibodies were measured using ELISA at 6, 9, 14, 27, and 40 months after the initial incident. Symptoms and a methacholine challenge normalized (>16 mg/ml) following a rigorous avoidance strategy at 40 months after the acute episode. MDI-specific antibody levels decreased over time following exposure avoidance, with calculated half-lives of 4.7 months and 10.3 months for IgE and IgG respectively.

CONCLUSION: MDI-specific serology may be helpful in diagnosis and monitoring of disease activity following exposure avoidance strategies.

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ABSTRACT #19 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW INFECTIOUS DISEASES A CASE OF COVID-19 INDUCED RHABDOMYOLYSIS Angelica Gutierrez1, Georgina Osorio1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Creatine kinase levels are typically markedly elevated, and muscle pain and myoglobinuria may be present. The severity of illness ranges from asymptomatic elevations in serum muscle enzymes to life-threatening disease associated with extreme enzyme elevations, electrolyte imbalances, and acute kidney injury.

CASE PRESENTATION: A 26-year-old male with history of obesity who presented to the emergency department (ED) with body aches for 1 week, chills, insomnia, and anorexia. He reported his girlfriend had tested positive for COVID-19 infection the week prior. In the ED, he appeared comfortable, was afebrile, mildly tachycardic, and his SO2 was normal on room air. CPK was found to be >400.000, AST 2451, ALT 570, acetaminophen level <1 rest of CMP within normal limits. Urinalysis was positive for large blood with no red blood cells seen microscopically. COVID19 nasal PCR was positive. CXR (Figure 1) showed questionable RLL hazy opacity. The patient was admitted and received aggressive IVF therapy with subsequent improvement in CPK to 8000s, Creatinine levels remained normal. Patient had a satisfactory hospital course and was discharged home 4 days later.

DISCUSSION: Influenza A and B are the most commonly reported viruses associated with myositis in the US. The clinical spectrum of muscle involvement associated with viral infection ranges from benign myalgias to rhabdomyolysis. The mechanism of rhabdomyolysis was not clear and various mechanisms have been postulated in viral myositis. Immunological mechanisms play an important role in muscle damage by crossreactivity between the virus and myocytes. Direct invasion of the myocytes like other viral illnesses can be another mechanism. Exaggerated immunological reaction resulting in cytokine storms frequently seen in COVID-19 infection could lead to muscle damage. In this patient, there was no obvious cause for rhabdomyolysis. He denied any strenuous activity prior to the presentation, seizures, no evidence of trauma, denied alcohol usage, and his urine drug screen was negative and ethanol level at admission was undetectable. After excluding the common causes, the medical team reached a conclusion that rhabdomyolysis in this patient was secondary to COVID-19. Coronavirus disease 2019 remains a global public health emergency. Mostly associated with respiratory compromise, can also result in several extrapulmonary manifestations.

CONCLUSION: Viral myositis progressing to rhabdomyolysis is uncommon, but can be life threatening. There is limited literature regarding rhabdomyolysis in COVID-19. Clinicians should be aware that this could be a presentation of COVID-19, even without severe respiratory compromise.

Figure 1. Patient’s chest X-ray (CXR) on admission 46

ABSTRACT #20 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY TOTAL NEOADJUVANT THERAPY VERSUS STANDARD THERAPY IN LOCALLY ADVANCED RECTAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS Anup Kasi1, Saqib Abbasi1, Shivani Handa2, Raed Al-Rajabi1, Anwaar Saeed1, Joaquina Baranda1, Weijing Sun1 1

Kansas University Medical Center, Kansas City, KS, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in JAMA Network Open, 2020. PMID: 33326026 BACKGROUND/INTRODUCTION: Standard therapy of locally advanced rectal cancer (LARC) includes concurrent chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy. An alternative strategy known as Total Neoadjuvant Therapy (TNT) involves administration of CRT+ neoadjuvant chemotherapy prior to surgery with the goal of delivering uninterrupted systemic therapy to eradicate micro-metastases. A comparison of these two approaches has not been systematically reviewed previously. The objectives of the study were to determine the differences in pathologic complete response (PCR) rates, disease free survival (DFS), overall survival (OS), rates of sphincter preserving surgery (SPS) and ileostomy between patients receiving TNT versus standard CRT followed by surgery and adjuvant chemotherapy (CRT+A).

METHODS: Medline (via PubMed) and Embase (via OVID) were searched from inception through July 2020.

Randomized controlled trials or prospective / retrospective cohort studies comparing outcomes in patients with locally advanced rectal cancer who received TNT vs CRT+A. Data regarding the first author, publication year, location, sample size, PCR rates, SPS rates, ileostomy rates, DFS, and OS were extracted using PRISMA guidelines and pooled using a random-effects model. Main Outcomes and Measures: rates of PCR, SPS, ileostomy, DFS, and OS. RESULTS: After reviewing 2,165 reports, 7 studies including a total of 2416 patients of whom 1206 received TNT were selected. The median age for the patients receiving TNT ranged from 57-69 years, with 58-73% being males. The pooled prevalence of PCR was 29.9% (range: 17-38%) in the TNT group and 14.9% (range: 4-21%) in the CRT+A group. TNT was associated with a higher chance of achieving a PCR (OR, 2.44; 95% CI, 1.99-2.98). No statistically significant difference in the proportion of SPS (OR, 1.06; 95% CI, 0.73-1.54) or ileostomy (OR, 1.05; 95% CI, 0.76-1.46,) between recipients of TNT and CRT+A was observed. Only 3 studies presented data on DFS and pooled analysis showed a significantly higher odds of improved disease free survival in patients who received TNT (OR, 2.07; 95% CI, 1.20-3.56; I2=49%). Data on overall survival was not consistently reported.

CONCLUSION: Total neoadjuvant therapy is a promising strategy in locally advanced rectal cancer, with superior pathologic complete response rates compared to standard therapy. However, the long-term impact on disease recurrence and the overall survival need to be explored in future studies.

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ABSTRACT #21 CLINICAL RESEARCH PULMONARY/CRITICAL CARE CARDIOVASCULAR OUTCOMES IN PATIENTS WITH SLEEP APNEA TREATED WITH POSITIVE AIRWAY PRESSURE: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Yasmin I. Herrera1, Joseph Poon1, Kam Sing Ho1, Valeria Santibanez1,2, Archana Pattupara1, Raymonde Jean1, David Steiger1,2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

BACKGROUND/INTRODUCTION: Sleep Apnea is known to be associated with increased cardiovascular morbidity and mortality. Positive airway pressure (PAP) provides symptomatic relief, whether delivered continuously (CPAP) or as adaptive servo-ventilation (ASV). However, it is not clear whether treatment with PAP reduces cardiovascular (CV) risk.

METHODS: Randomized clinical trials (RCT) that evaluated the treatment of sleep apnea with usual care (UC) plus PAP versus UC alone, and reported cardiovascular outcomes were identified via PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). Data were combined using a random-effects meta-analysis model for each of the following outcomes: all-cause mortality, CV mortality, non-CV mortality, myocardial infarction (MI), stroke, hospitalization for heart failure (HF), hospitalization for unstable angina, and a subgroup analysis of major adverse CV events (CV mortality, MI, and stroke) according to adherence to PAP (<4 vs ≥4 h/d).

RESULTS: A total of 11 prospective RCT (10 CPAP; 1 ASV), enrolling 8,521 patients, fulfilled the inclusion criteria. The respective event rate for UC plus PAP versus UC alone for all-cause mortality, 8.2% and 7.5% (RR, 1.10; 95% CI, 0.97–1.26; p=0.14); for CV mortality, 7.8% and 6.7% (RR, 1.14; 95% CI, 0.90–1.43; p=0.27); for non-CV mortality, 2.3% and 2.7% (RR, 0.84; 95% CI, 0.63–1.12; p=0.24); for MI, 3.6% and 3.5% (RR, 1.06; 95% CI, 0.80–1.40; p=0.69); for stroke, 3.1% and 3.4% (RR, 0.93; 95% CI, 0.70–1.25; p=0.63); for hospitalization for HF, 11.3% and 11.0% (RR, 1.02; 95% CI, 0.91–1.15; p=0.68); and for hospitalization for unstable angina, 6.2% and 6.0% (RR, 1.03; 95% CI, 0.7–1.43; p=0.86). The subgroup analysis showed a decreased risk of MACE in the 4 studies with good adherence (≥4 h/d) to PAP versus no PAP, with an event rate of 4.8% (RR, 0.58; 95% CI, 0.34-0.99; p=0.05), this effect is attenuated in the subgroup of studies with poor adherence (<4 h/d) to PAP, event rate 8.5% (RR, 1.05; 95% CI, 0.87-1.27; p=0.63).

CONCLUSION: Among patients with sleep apnea, treatment with PAP was not associated with reduction of all-cause mortality, CV mortality, stroke, or hospitalization for HF or unstable angina, as compared to usual care alone. However, the prevalence of MACE seems to be related to the use of PAP for ≥4 hours per night.

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ABSTRACT #22 CLINICAL RESEARCH PULMONARY/CRITICAL CARE IS THERE AN OPTIMAL DOOR-TO-TREATMENT TIME FOR ACUTE PULMONARY EMBOLISM? A NATIONAL PROPENSITY MATCH ANALYSIS Kam Sing Ho1, Paaras Kohli1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Shabnam Nasserifer1, Andre Sotelo2, Raymonde Jean1 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, United States

Presented at the European Respiratory Society International Annual Meeting that was held virtually from September 6-9, 2020.

BACKGROUND/INTRODUCTION: Acute pulmonary embolism is a life-threatening medical condition.

Currently, there is insufficient data on the optimal door-to-treatment time among patients admitted with massive PE requiring systemic thrombolytics (ST). This study was conducted to determine the relationship between early vs late systemic thrombolytics on morbidity, and health care resource utilization in patients admitted to the hospital in the United States with acute PE. METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Adults (≥ 18 years) with a principal diagnosis of acute PE and a procedure of systemic thrombolysis were identified using ICD-9 codes as described in the literature. The primary outcome was in-hospital mortality.

Secondary outcomes were length of hospital stay (LOS), total hospitalization costs, and 30-day readmission rates. Propensity score using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using a multivariate logistic regression model.

RESULTS: In total, 156,293 hospital admissions with a primary diagnosis of acute PE. 4,181 (2.6%) all acute PE patients had systemic thrombolysis within 24 hours of admission. The rest had ST after 24 hours or no ST during their hospital admission. The in-hospital mortality is similar during the index admission between early and late ST (p=0.97). However, the 30-day readmission rate was significantly lower for the early ST cohort in comparison with the late ST cohort (7.05% versus 19.5%, p<0.02). The most common reason for readmission was sepsis. The LOS during index admission was significantly longer for early ST group versus late ST (6.7 versus 5.1 days, p<0.01). Similarly, the total hospital cost was also more expensive for early ST group versus late group (p<0.001). Early ST was an independent predictor for lower 30-day readmission (OR, 0.291; p<0.001); whereas, late ST was a predictor for higher 30-day readmission (OR, 3.44; p<0.001).

CONCLUSION: Early use of ST was associated with a lower 30-day readmission rate, higher LOS, and higher total hospital cost.

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ABSTRACT #23 CLINICAL RESEARCH ENDOCRINOLOGY AN ANALYSIS OF MEDTRONIC MINIMED 670G INSULIN PUMP USE IN CLINICAL PRACTICE AND THE IMPACT ON GLYCEMIC CONTROL, QUALITY OF LIFE, AND COMPLIANCE Maxwell E. Horowitz1*, William Kaye2, Gary Pepper3, Kathryn Reynolds3, Shital Pater3, Kort Knudson3, Geetanjali Kale3, Maria Gutierrez3, Leslie Cotto3, Barry S. Horowitz2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Metabolic Research Institute, Inc., West Palm Beach, FL, United States; 3Palm Beach Diabetes and Endocrine Specialists, West Palm Beach, FL, United States 2

Presented at the Endocrine Society Annual Meeting that was held virtually from March 20-23, 2021. *Recipient of the Helmsley Charitable Trust Abstract Award in Type 1 Diabetes BACKGROUND/INTRODUCTION: This study evaluated the use of the Medtronic MiniMed 670G system in adults with type 1 diabetes mellitus from a large endocrinology practice and its impact on glycemic control, quality of life (QoL), compliance, and safety.

METHODS: 84 participants completed one site visit for data collection. Percentage of time in range (TIR: 70180 mg/dL), hyperglycemia (>180 mg/dL), hypoglycemia (<70 mg/dL), HbA1c, average blood glucose (ABG), and other metrics were evaluated at the last visit using the system (LVMM) and compared between the last visit on previous insulin therapy (LVPT). Participants completed three questionnaires to assess QoL. Continuation of auto mode was determined to assess compliance.

RESULTS: The mean percentage of TIR at LVPT was 46.26 ± 18.82% while that at LVMM was 73.39 ± 12.95%. This represents a significant increase in percentage of TIR of 27.13% (p<0.001). Time in hyperglycemia from LVPT to LVMM was significantly decreased by 23.90% (p<0.001). Time in hypoglycemia from LVPT to LVMM was significantly decreased by 3.22% (p=0.004). The overall mean HbA1c was increased by 0.09% (p=0.337). For those with HbA1c greater than or equal to 7.5% at LVPT, HbA1c was significantly decreased by 0.48% (p=0.007). For those with HbA1c less than 7.5% at LVPT, HbA1c was significantly increased by 0.38% (p<0.001). Patients with LVPT HbA1c less than 7.5% had a significant reduction in hypoglycemia (<70 mg/dL) by 4.84% (p=0.001). QoL questionnaires revealed high satisfaction and 86% of participants continued auto mode.

CONCLUSION: The use of the Medtronic MiniMed 670G system resulted in TIR above the recommended target and a significant increase in percentage of TIR compared to previous insulin therapy. While there was no significant change in HbA1c in the overall population, those with higher HbA1c values at baseline had a reduced percentage of time in hyperglycemia, while those with lower HbA1c values had a reduced percentage of time in hypoglycemia, indicating improvement in parameters specific to each subgroup. This level of glycemic control and high degrees of satisfaction and compliance may reduce the potential for adverse events.

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ABSTRACT #24 CLINICAL RESEARCH CARDIOVASCULAR DISEASE DOES HEMODIALYSIS IMPACT ACUTE CORONARY SYNDROME MANAGEMENT IN END-STAGE RENAL DISEASE PATIENTS: A 5 YEAR NATIONWIDE ANALYSIS Claire Huang Lucas1, Robert Abed1, Jan Lopes1, Lingling Wu1, Ameesh Isath1, Bing Yue1, Xin Wei1, Eyal Herzog1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Acute coronary syndrome (ACS) is a leading cause of mortality among patients with non-dialytic end stage renal disease [CKD Stage V (CKD V)] and end stage renal disease requiring hemodialysis (ESRD) and should be managed aggressively. Prior studies highlighted treatment disparities for ACS among ESRD patients. This study aims at examining the extent of management disparities and if hemodialysis status affects this disparity with a large retrospective cohort data.

METHODS: We reviewed the Nationwide Inpatient Sample from 2010 to 2014 to identify adult hospitalizations with primary diagnosis of ACS (ST-elevation and non-ST-elevation myocardial infarction, and unstable angina) to compare rates of cardiac procedures (Left heart catheterization-LHC, Percutaneous Coronary Intervention PCI, Coronary Artery Bypass Graft-CABG) among groups of population of interest (control versus CKD V; control versus ESRD). Patients with a history of kidney transplant, CKD stage I to IV, unspecified CKD, and unspecified renal failure were excluded from the study.

RESULTS: Overall, 519,376 hospitalizations with primary diagnosis of ACS were identified and among them, 6,889 CKD V patients and 17,204 with ESRD. Propensity matching and multivariate regression analysis accounting for the complex survey design of the data showed statistically significant (all p<0.01) lower procedural rates among the CKD V group for LHC (OR, 0.44; 95% CI, 0.40-0.48), PCI (OR, 0.65; 95% CI, 0.60-0.71), and CABG (OR, 0.81; 95% CI, 0.70-0.94) compared to control group. In ESRD group, the analysis also shows a statistically significant (all p<0.01) lower rate for LHC (OR, 0.63; 95% CI, 0.59-0.66), PCI (OR, 0.64; 95% CI, 0.60-0.67), and CABG (OR, 0.76; 95% CI, 0.70-0.83) than the control group.

CONCLUSION: This analysis shows persistent less aggressive management after ACS in CKD V and ESRD population, with a dramatically lower all-procedure rate compared to control group. For both groups, treatment disparities compared to control group for CABG were relatively smaller than for LHC and PCI procedures.

Hemodialysis status does not appear to impact the revascularization strategy.

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ABSTRACT #25 CLINICAL RESEARCH CARDIOVASCULAR DISEASE DOES THE USE OF INTRACARDIAC ECHOCARDIOGRAPHY DURING ATRIAL FIBRILLATION CATHETER ABLATION IMPROVE OUTCOMES AND COST? Ameesh Isath1, Syed Waqas Haider2, Gregory Siroky2, Stuthi Perimbeti1, Ashish Correa2, Davendra Mehta2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020. Published in Journal of Interventional Cardiac Electrophysiology, 2020. PMID: 32743700 BACKGROUND/INTRODUCTION: Intracardiac echocardiography (ICE) use during catheter ablation of atrial fibrillation (AF) provides real-time information to guide transseptal access, for monitoring the ablation and recognition of pericardial bleed. We describe trends of ICE use, impact on complications, and its in-hospital outcomes.

METHODS: The national in-patient sample database was queried from 2001-2014 for diagnosis of AF based on ICD-9-CM 427.31 with a catheter ablation procedure code (37.34) in the same hospitalization and its associated complications. ICE was identified using ICD-9-CM procedure code (37.28). Statistical Analysis System (SAS) was used for analysis.

RESULTS: There were an estimated total 299,152 patients who underwent AF ablation from 2001 to 2014 of which ICE was used in 46,688 (15.6%) patients. The use of ICE significantly increased from 0.08% in 2001 to 15.7% in 2014. In-hospital mortality was significantly lower in patients in whom ICE was used (0.11% versus 0.54%, p<0.0001). Complications were 52% lower in procedures using ICE versus without ICE (HR [95%CI]; 0.48 [0.44-0.51]). The rate of cardiac complications was also lower in ICE-users (3.67% versus 4.51%; p=0.025). The use of ICE during AF ablation resulted in significantly higher cost of hospitalization ($98,436 ± $597 versus $81,300 ± $310; p<0.0001), but this was offset by a decreased length of hospital stay (2.1 ± 0.02 versus 4 ± 0.02 days; p<0.0001).

CONCLUSION: The use of ICE during AF ablation has increased over the years and is associated with lower in-hospital mortality and procedural complications, shorter LOS but an increased cost of hospitalization.

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ABSTRACT #26 QUALITY IMPROVEMENT CARDIOVASCULAR DISEASE DE-ESCALATION OF ASPIRIN FOR PRIMARY PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN THE PRIMARY CARE SETTING Joshua Berookhim1, Michael Kahen1, Gabriela Bernal1, Subrat Das1, Brian Berookhim1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Quality of Care and Outcomes Research (QCOR) Scientific Sessions that was held virtually on May 15, 2020.

BACKGROUND/INTRODUCTION: For several decades, aspirin (ASA) has been used as primary prevention against ASCVD in adults. In 2018, three major trials (ASPREE, ARRIVE, and ASCEND) redefined our understanding of ASA and showed a net harm rather than benefit when ASA is used for primary prevention of ASCVD. These trials greatly impacted the current 2019 ACC/AHA Primary Prevention Guidelines, which now recommend the following: (a) Low-dose ASA might be considered for primary prevention of ASCVD in select higher ASCVD adults aged 40-70 years who are not at increased bleeding risk and (b) Low-dose ASA should not be administered for primary prevention of ASCVD among adults over the age of 70. The objective of the project was to re-evaluate the use and indications of ASA in our patient population and appropriately remove ASA when no longer indicated. With proper resident education and intervention, we hypothesized that we could reduce the number of inappropriate ASA prescriptions by 10%.

METHODS: During a 6-month observational period, 254 patients at Ryan Health/Adair (a Federally Qualified Health Center which also serves as a primary care site for an Internal Medicine Residency clinic) were found to be taking ASA, and of those 140 patients were found to be on ASA for primary ASCVD prevention. The interventions included implementation of an algorithm that reflected the most up to date guidelines. The intervention lasted 3 months. Any patient that was found to be on ASA inappropriately was discontinued.

RESULTS: During this period, ASA was successfully removed from 25 patients’ medication list, with an overall reduction by 17.9%. Of the 25 patients, 20% were over the age of 70, 80% were between the ages of 40-70, and 48% were male. In the remaining 115 patients in which ASA was continued, 27.8% were over the age of 70, 69.6% were between the ages of 40-70, 2.6% were under the age of 40, and 49.6% were male. The successful ASA removal group comprised of 44% Hispanic/Latino, 44% African American, 4% White, and 8% unidentified. The ASA non-removal group comprised of 34.8% Hispanic/Latino, 44.3% African American, 5.2% White, and 15.7% unidentified. Additionally, 80% of the patient taken off ASA spoke English, while only 69.6% of patient in the ASA non-removal group spoke English.

CONCLUSION: Several differences were found between the two groups. Some key limitations between the two groups included (a) unclear past medical history leading to physicians being uncomfortable with removing ASA, (b) inability to speak in patient’s native language to facilitate proper discussion about ASA removal, and (c) patient refusal to stop ASA. Next steps include further cardiac testing (CT coronaries, stress test) to better characterize the risk of patients with unclear history. However, overall, there is likely a net benefit in prioritizing ASA removal in the primary care setting now that it is no longer recommended in key populations.

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ABSTRACT #27 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY A RARE CASE OF HIT WITH NORMAL PLATELET COUNTS Matthew Karr1*, Lauren Botero1*, Lawrence Cytryn1

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

*These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Heparin-Induced Thrombocytopenia (HIT) occurs when antibodies are directed against platelet factor 4, PF4, which is part of a heparin-PF4 complex. These IgG antibodies activate platelets which can lead to fatal arterial and venous thrombosis. These thromboses, if left untreated, are associated with 20% mortality and other serious complications. HIT will continue to persist until both heparin is eliminated and a new non-heparin anticoagulant is started. The HIT antibodies typically develop over 5-8 days, thus the HIT antibodies usually only form after a patient has a heparin exposure of about a week. However, rapid decline in platelet count within 12 hours of heparin exposure can occur if the patient was previously treated with heparin within 100 days. Thrombocytopenia with a platelet count <150,000 is seen in 85-90% of patients, but all demonstrate a 50% reduction in platelet count after heparin exposure. However, instances of HIT can be difficult to detect, particularly when the patient has a concomitant initial thrombocytosis.

CASE PRESENTATION: A 46-year-old female with sciatica and recent diagnosis of arterial thrombosis of the right common iliac artery (status post right lower extremity angiogram, femoral/popliteal/AT/PT thrombectomy with 4-compartment fasciotomy on 2/17/2021) presented with a cold painful right lower extremity and was found to have a thrombus beginning at the level of the right common iliac artery. She was managed with a heparin drip with plan for bridge to warfarin, but she had progressive ischemia, with mottling of her lower leg even despite multiple revascularization attempts. Her initial platelet count was 669K, but the repeat that evening was 259K, and the heparin drip was switched to argatroban. She was found to have a positive serotonin release assay and HIT antibody, positive lupus anticoagulant, and an iron of 16 with soluble transferrin receptor of 76.8.

DISCUSSION: Thrombocytosis is often subdivided into two groups: reactive thrombocytosis and myeloproliferative neoplasms. The etiology of reactive thrombocytosis can be very broad, including postsurgical, anemia, infection, inflammation, or reduced sequestration. As the patient’s platelets were elevated prior to surgery, we postulate that the initial thrombocytosis was likely driven by a combination of anemia (admission Hgb of 8.3) and infection (fluid cultures were positive for Bacillus cereus on 2/25/2021). The patient experienced a platelet drop greater than 50% within 16 hours of heparin exposure. This case of HIT was either an initial presentation from the antibodies formed during the previous treatment or the re-exposure caused an acute HIT response. Her platelet count fully recovered within 1 week after heparin was discontinued.

CONCLUSION: Patients with reactive thrombocytosis experiencing heparin-induced thrombocytopenia will experience a large drop in platelet count, but the overall platelet count may remain normal as a result of the initial thrombocytosis. It is critically important to keep heparin-induced thrombocytopenia on the differential despite what may be a deceiving platelet count within normal range.

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ABSTRACT #28 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW ENDOCRINOLOGY/INFECTIOUS DISEASES A CONVOLUTED ROAD TO THE RIGHT DIAGNOSIS: RETROPERITONEAL ABSCESS IN A POORLY CONTROLLED DIABETIC Frida Kassim1, Jonathan Jamito1, Andrew Choi1, Jeanine Albu1

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Retroperitoneal abscesses are rare and usually have an insidious clinical presentation that frequently lacks abdominal signs and symptoms. This often leads to diagnostic delays and worse outcomes. Here we draw attention to this challenge.

CASE PRESENTATION: A 56-year-old male presented to the emergency department with left foot pain after hitting his foot a few days ago. He had a history of poorly controlled type 2 diabetes complicated by polyneuropathy, hypertension, and smoking. He was non-compliant with his medications and his most recent hemoglobin A1c was 15%. On presentation, patient was febrile and tachycardic with labs significant for leukocytosis suggesting sepsis. On physical exam, he was found to have a foul-smelling necrotic foot with crepitus on palpation. Foot x-ray revealed extensive subcutaneous gas at the forefoot. He was started on broad spectrum IV antibiotics and underwent below the knee amputation for left foot wet gangrene. Patient endorsed vague scrotal pain and was noted to have scrotal erythema raising suspicion for scrotal cellulitis.

Despite continued antibiotic therapy, he remained tachycardic with persistent leukocytosis that was slowly down-trending. However, given his clinical improvement, low suspicion for ongoing infection, and negative blood cultures, he was discharged. A day later, the patient returned complaining of dyspnea. Pulmonary embolism (PE) was suspected in light of his recent surgery and tachycardia. He underwent a chest CT that was negative for PE, but revealed a large left pleural effusion and a peri-nephric lesion, which was further characterized on CT abdomen/pelvis as a 16-cm left retroperitoneal multiloculated mass, extending from the left thigh to the spleen, and displacing the left kidney. Sampling of purulent fluid from the mass confirmed the diagnosis of a retroperitoneal abscess. Left thoracentesis was also performed draining 1.3 liters of exudative effusion, consistent with sympathetic pleural effusion from diaphragmatic irritation on the left. Empyema was ruled out. The abscess was drained percutaneously and antibiotics were resumed. With that, the patient’s tachycardia and leukocytosis finally resolved. Blood and fluid cultures were negative.

CONCLUSION: Retroperitoneal abscess is a serious condition that necessitates early diagnosis and treatment. The presenting symptoms tend to be extra-abdominal, such as referred pain to the lower limb, or painful groin swelling. Scrotal pain and erythema in this poorly controlled diabetic might have been a subtle sign of retroperitoneal abscess, but it also might have been the source of his retroperitoneal abscess formation by contiguous spread. It is important to consider this potentially life-threatening diagnosis in susceptible patients, including those with diabetes, malignancy, and chronic renal failure.

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ABSTRACT #29 CLINICAL RESEARCH GASTROENTEROLOGY LONG TERM OUTCOMES OF THE EXCLUDED RECTUM IN CROHN’S DISEASE: RESULTS FROM THE CAPER (CONSORTIUM TO ASSESS PROGNOSIS OF THE EXCLUDED RECTUM) STUDY Gassan Kassim1, Anketse Debebe2, Clara Yzet2, Nilendra Nair2, Aurada Cholapranee3, Cindy Traboulsi4, Keith Sultan3, David T. Rubin4, Jean-Frederic Colombel2, David Sachar2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY, United States; 4University of Chicago, Chicago, IL, United States 2

Presented at New York Crohn's and Colitis Organization (NYCCO) Annual Meeting that was held virtually on February 4, 2021.

BACKGROUND/INTRODUCTION: Despite significant progress made in the treatment of Crohn’s disease (CD) there is still a need for fecal diversion in many refractory patients. The long-term outcome of the retained rectum following this surgery is still not fully understood. We reviewed our experience at two large New York City (NYC) Health Systems (Mount Sinai Health System and Northwell Health System) as well as at University of Chicago.

METHODS: A database of all CD patients followed at our health systems was searched for all CD between 1990-2014 who underwent diversionary surgery and who had retained excluded rectums for at least 6 months post-operatively. Medical records were reviewed for baseline characteristics, indications for diversion, and outcomes of excluded rectums. Cases from The Mount Sinai Hospital previously reported were not included in this study.

RESULTS: Among 1083 CD patients identified in our databases, 158 patients met our inclusion criteria.

Baseline characteristics are listed in Table 1. Indications for rectal exclusion and fecal diversion were severe perianal disease in 58/158 (36.7%), acute/refractory disease in 52/158 (33%), internal fistulas in 29/158 (18.4%), bowel stricture 8/158 (5%), colon cancer 3/158 (1.9%), and unclear 8/158 (5%). Primary outcomes are detailed in Figure 1. 73/158 (46.2%) patients underwent completion proctocolectomy. All were symptomatic and the indications are highlighted in Figure 1. Hence, 85/158 (53.8%) still had retained rectums at the time of last follow-up; 43/85 (50.6%) had been reconnected while 42/85 (49.4%) remained excluded. Out of 43/85 patients who had been reconnected, 25 (58.2%) were symptom-free and 18 (41.9%) continued to have problems. Among the 42/85 with continued rectal exclusion, 13 (31%) were asymptomatic and 29 (69%) experienced ongoing troubles. On intent-to-treat basis, among the 158 cases, 38 retained their rectums without further problems (24%), while 120 (76%) either ultimately lost their rectums or remained symptomatic with retained rectums (reconnected/excluded). Only about one-quarter of patients in our long-term follow-up study maintained their rectums in situ without ongoing symptoms. The ideal outcome that patients and clinicians strive for (symptom free reconnected rectum) was achieved in only 25/158 (16%) of cases. 4 patients developed neoplasia (2.5%): 1 rectal dysplasia, 1 rectal carcinoma, and 2 anal carcinomas.

CONCLUSION: While many factors enter the decision whether to remove or retain an excluded rectum beyond 6 months in cases of Crohn’s disease, it could be helpful for patients and clinicians alike to know that in our multicenter cohort, only about one-quarter of patients in long-term follow-up maintained their rectums in situ without ongoing symptoms.

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Table 1: Baseline characteristics

Figure 1: Primary outcomes for all patients who underwent diversionary surgery and who had retained excluded rectums for at least 6 months post-operatively 57

ABSTRACT #30 BASIC SCIENCE CARDIOVASCULAR DISEASE NONINVASIVE BIOMARKERS FOR PREDICTION AND DIAGNOSIS OF HEART TRANSPLANTATION REJECTION Yeraz Khachatoorian1, Vahe Khachadourian2, Eleanor Chang3, Erick R. Sernas4, Elaine F. Reed3, Mario Deng3, Brian D. Piening5, Alexandre C. Pereira6, Brendan Keating7, Martin Cadeiras4 1 Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States ; 2

Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia; 3David Geffen School of Medicine, Los Angeles, CA, United States; 4University of California Davis, Davis, CA, United States; 5Providence Health and Services, Portland, OR, United States; 6University of São Paulo, São Paulo, SP, Brazil; 7University of Pennsylvania, Philadelphia, PA, United States

Published in Transplantation Reviews, 2021. PMID: 33401139 BACKGROUND/INTRODUCTION: For most patients with end-stage heart failure, heart transplantation is the treatment of choice. Allograft rejection is one of the major post-transplantation complications affecting graft outcome and survival. Recent advancements in science and technology offer an opportunity to integrate genomic and other omics-based biomarkers into clinical practice, facilitating noninvasive evaluation of allograft for diagnostic and prognostic purposes. Omics, including gene expression profiling (GEP) of blood immune cell components and donor-derived cell-free DNA (dd-cfDNA) are of special interest to researchers. The levels of ddcfDNA increase and subsequently reduce following treatment, several studies evaluated its potential clinical utility for allograft rejection monitoring. In the field of transcriptomics, AlloMap, GEP of peripheral blood mononuclear cells (PBMC), can identify 11 differentially expressed genes and help with detection of moderate and severe acute cellular rejection in stable heart transplant recipients. In recent years, the utilization of GEP of PBMC for identifying differentially expressed genes to diagnose acute antibody-mediated rejection and cardiac allograft vasculopathy has yielded promising results. The miRNAs are another transcriptomic biomarker that are secreted into circulation during allograft rejection and can serve as a potential noninvasive biomarker for allograft rejection monitoring. It has been found that the same miRNA can manifest different expression in different cells depending on rejection type. In the field of proteomics, biomarkers involved in cellular and antibody-mediated responses, acute phase inflammatory pathways, and metabolism can also potentially be used as noninvasive measures for the diagnosis of acute heart allograft rejection.

DISCUSSION: The current clinical practice for rejection monitoring mainly utilizes non-molecular approaches, including EMB sampling and manual review by pathologists, cardiac echocardiography, and cardiac magnetic resonance imaging. With new omics-based biomarker discoveries in the field of solid organ transplantation, individualized prediction of allograft rejection appears to be on the horizon, where highly precise and accurate strategies could be used to improve outcomes in heart transplant patients. Nevertheless, there is a gap between the new biomarker discoveries and validation of their utilization in clinical practice. Most studies evaluating the performance of biomarkers have methodological limitations, including small study sample sizes.

CONCLUSION: There is a need for future research among diverse groups of populations to assess the reproducibility and the generalizability of results from existing studies. Moreover, the integration of several omics studies together in multi-omics approach could further our understanding about the correlations between different omics and lead to discovery of new biomarkers.

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ABSTRACT #31 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW ENDOCRINOLOGY/NEPHROLOGY CALCIPHYLAXIS IN ASSOCIATION WITH HUNGRY BONE SYNDROME: A POSSIBLE RISK FACTOR? Javier Arreaza1, Ga Hee Kim1, Andrew Kim1, Jeewendra Dulal1, Peter Goulden1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Endocrine Society Annual Meeting that was held virtually from March 20-23, 2021.

BACKGROUND/INTRODUCTION: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare complication seen in, although not limited to, patients with end-stage renal disease (ESRD). The abnormal regulation of calcium and phosphorus homeostasis in this patient group results in intravascular calcium deposition. Patients with ESRD often develop secondary and tertiary hyperparathyroidism, the treatment of this may be challenging. When patients do not respond to medical therapy, parathyroidectomy is a treatment option that may be complicated by hungry bone syndrome (HBS). We present a case of a patient with calciphylaxis who developed HBS after parathyroidectomy, involving refractory symptomatic hypocalcemia requiring brief escalation of care to the ICU setting.

CASE PRESENTATION: The patient is a 41-year-old male who presented with ulcers complicating calciphylaxis. He had a previous history of ESRD complicating hypertension on hemodialysis. Upon admission, The PTH was elevated at 2200 with a normal corrected Ca of 8.7 and phosphorus (Phos) of 8.5. He was found to have a non-displaced pathologic fracture of the right femoral neck. Treatment was commenced with cinacalcet, phosphate binder, and sodium thiosulfate. CT scan of the neck nodular parathyroid hyperplasia affecting all four glands. His hyperparathyroidism was managed expectantly to optimize his condition before surgery. He underwent a subtotal parathyroidectomy—his postoperative period complicated by hungry bone syndrome. Repeat labs showed a PTH of 444, phosphorus of 6.1, corrected calcium of 7.4, and ionized calcium of less than 4. Despite oral calcium and calcitriol therapy, he required ICU transfer with a prolonged QTc and showed an improvement of calcium level and resolution of paresthesia with intravenous calcium.

CONCLUSION: Calciphylaxis is an uncommon and potentially fatal illness seen in ESRD patients associated with calcium and phosphate homeostasis abnormalities. Whether or not calciphylaxis may increase the risk of hungry bone syndrome inpatient undergoing parathyroidectomy is unknown; however, hungry bone syndrome requiring intensive ICU management has been reported in this group. Some patients may require a higher level of care to treat refractory hypocalcemia. It is arguable that calciphylaxis may serve to signal those patients at greater risk.

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ABSTRACT #32 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE A PERFECT STORM OF UNCOMMON PATHOGENS IN AN IMMUNOCOMPETENT HOST: RESPIRATORY ISOLATION OF CUNNINGHAMELLA BERRHOTHELIAE, ASPERGILLUS NIGER, STAPHYLOCOCCUS PSEUDOINTERMEDIUS, AND ADENOVIRUS IN A PATIENT WITH NECROTIZING PNEUMONIA Christian Olivo Freites1, Deep Patadia1,2, Joseph Saabiye1,2, Paaras Kohli1, Christina Stavropoulos1, James Salonia1 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting; Dallas, TX, United States that was held on May 17-22, 2019.

BACKGROUND/INTRODUCTION: Fungal pneumonia is a rare disease in the immunocompetent. Pulmonary mucormycosis and invasive aspergillosis are entities that commonly affect patients with hematological malignancies, especially during neutropenic states. We report a rare coexistence of a viral, fungal, and bacterial pathogen in an otherwise immunocompetent patient.

CASE PRESENTATION: A 60-year-old female, traveler nurse, active smoker with chronic obstructive pulmonary disease (COPD) presented with progressive shortness of breath for 2 weeks. Additional information revealed close contact with her pet dog being treated for a skin illness. Initial workup showed profound hypoxemia, transaminitis, hyponatremia, and AKI. Influenza/RSV, Legionella urinary antigen, and a rapid HIV test were negative. A nasopharyngeal swab was positive for Adenovirus. CT scan of the chest revealed emphysematous changes and a left lower lobe consolidation. Vancomycin, Cefepime, and Azithromycin were all initiated due to severe pneumonia. Her medical status rapidly declined, and she progressed to septic shock requiring multiple vasopressors, acute hypoxemic respiratory failure and severe ARDS requiring mechanical ventilation and paralysis, and acute kidney injury requiring continuous veno-venous hemofiltration. Respiratory cultures grew methicillin resistant Staphylococcus pseudointermedius and antibiotics were continued to treat this pathogen. The patient continued to deteriorate, and a repeat CT scan of the chest revealed multiple, bilateral pulmonary cavitary lesions consistent with necrotizing pneumonia. A bronchoscopy was performed which revealed copious, black secretions with bronchoalveolar cultures positive for Cunninghamella berrhotheliae and Aspergillus niger. Liposomal amphotericin was initiated for antifungal coverage. Following the addition of antifungal coverage there was a gradual clinical improvement with resolution of septic shock and ARDS. CONCLUSION: Invasive aspergillosis has been described in COPD patients, with systemic steroids being the major risk factor. Cunninghamella berrhotheliae has rarely been described in pediatric patients with hematological malignancies. S. pseudointermedius is a dog pathogen that causes skin diseases in canines and rarely causes severe lung infections in humans. We believe that our patient was initially debilitated due to Adenovirus infection. S. pseudointermedius was likely acquired from her infected canine. The viral and bacterial infections likely made her susceptible to a secondary fungal infection, which may have been latent prior to this critical illness.

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ABSTRACT #33 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/NEUROLOGY FAMILY HISTORY AIDS DIAGNOSIS OF AMYOTROPHIC LATERAL SCLEROSIS IN A YOUNG PATIENT Shu Min Lao1, Geeta Varghese1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

BACKGROUND/INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease usually occurring in ages 40-70s. Majority of cases are sporadic while 5-10% are inherited. Risk factors include age, family history, and cigarette smoking. Initial presentations can be vague and include muscle weakness and fasciculation in any limb, dysarthria, or dysphagia due to loss of upper or lower motor neurons. Regardless of initial symptoms, progressive weakness of all muscles will eventually occur and lead to respiratory compromise.

CASE PRESENTATION: A 27-year-old male with a history of genital herpes presented to the primary care clinic for left leg weakness which started two months ago after a fall onto his left hip. Since then, he reported difficulty walking up stairs and had multiple falls due to weakness. He denied fever, leg pain, back pain, numbness, tingling, urinary incontinence, and/or skin rash. Social history was significant for being a nonsmoker and no illicit drug use. He initially reported a vague family history of ALS in his mother who passed away at age 40 years. He has two healthy siblings. Physical exam was significant for mild left thigh atrophy, 4/5 motor strength in left hip flexion and extension, 4/5 in left plantarflexion, 5/5 in left knee flexion and extension. Muscle strength of the right lower extremity was 5/5 in hip and knee flexion and extension. Left leg was mildly internally rotated upon ambulation and noted to have difficulty with heel walking. The remaining neurological exam was normal. No spinal tenderness noted. Initial workup included a normal bilateral hip x-ray and lumbar MRI with no evidence of herniated disc or stenosis. Patient was referred to a physiatrist and started physical therapy. He was referred to Neurology due to progressive worsening weakness in proximal muscles and continued frequent falls. Patient then started experiencing twitching and loss of grip strength in his left arm. The Neurologist performed further workup including EMG and lumbar puncture. The patient finally revealed to the Neurologist an extensive family history of ALS which included his mother, uncle, maternal grandfather, and great grandfather. With this prominent family history and findings on the EMG, he was diagnosed with a genetic variant of ALS. CONCLUSION: Our patient presented with single limb onset which spread to other muscle groups over a few months. The initial working diagnosis was neuromuscular injury but as his condition progressed and a strong family history was revealed, ALS moved up on the differential and was eventually confirmed. Obtaining an accurate family history can be difficult due to the time constraints or patients’ cooperation, but is important to complete as it can help reach a diagnosis more quickly. Without it, we may even miss the diagnosis.

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ABSTRACT #34 CLINICAL RESEARCH CARDIOVASCULAR DISEASE PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST: SOCIODEMOGRAPHIC AND IN-HOSPITAL MORTALITY DISPARITIES Jan Lopes1, Claire Huang Lucas1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: The evidence showing that percutaneous coronary intervention (PCI) has a positive impact on the out-of-hospital cardiac arrest outcomes dates from the early 1990s. However, it has also been shown that it has been underused, especially in the setting of non-shockable rhythms. The objective of this study is to identify how the use of PCI correlated to hospital outcomes, and what are the characteristics of the patients that underwent PCI versus those who did not.

METHODS: This is a retrospective cohort study in which we used the 2016 National Inpatient Sample (NIS) database, the most recent to date. It is a large publicly available inpatient database in the United States. It contains patient and hospital information, including diagnosis, socio-demographic information, type of insurance, procedures done during the admission, hospital location, bed size, etc. We included only patients ≥18 years-old admitted to a hospital in the USA in 2016 with the primary diagnosis of cardiac arrest or ventricular fibrillation, taking into consideration the principal discharge diagnosis ICD-10 code. Stata® (StataCorp LLC, College Station, Texas, USA) was utilized for all statistical analysis.

RESULTS: 25,545 patients met the inclusion criteria, 1,347 of which underwent PCI during admission. The mean age was 63.9 years, with no statistically significant difference between patients who did or did not undergo PCI. The majority of the patients admitted with cardiac arrest were male (61.5%) and of White race (67.3%), with the difference significantly more pronounced among those who underwent PCI (81.4% of males, and 74.2% of White race). Individuals of Black race had a lower chance of undergoing PCI (OR, 0.41; p<0.001) compared with their White counterparts, while individuals identified as Other race had a higher chance of undergoing the procedure (OR, 1.77; p=0.045), there was no statistically significant difference between Whites and individuals of Hispanic, Asian, or Native American races. Patients with private insurance had a higher chance of undergoing PCI, if compared to Medicare and Medicaid users (OR of 0.49 and 0.39, respectively, p<0.001 for both). Old myocardial infarction (OR, 1.79; p<0.001), coronary artery disease (OR, 17.95; p<0.001), new myocardial infarction (OR, 7.69; p<0.001), cardiogenic shock (OR, 2.69; p<0.001), and ventricular fibrillation (OR, 5.99; p<0.001) were correlated with the use of PCI during the admission. The adjusted mortality OR comparing patients who underwent or did not undergo PCI was 0.32 (p<0.001), 0.59 (p=0.013), and 0.18 (p<0.001), respectively, for all cardiac arrest, VF arrest, and non-VF arrest. Patients who underwent PCI had also a longer hospital stay and higher hospitalization costs.

CONCLUSION: In this retrospective cohort study, we found that there is discrepancy in the use of PCI in terms of the gender, race, and insurance of the patients. Furthermore, the procedure is associated with lower inhospital mortality, regardless of the type of cardiac arrest, longer hospital stays, and higher costs.

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ABSTRACT #35 CLINICAL RESEARCH CARDIOVASCULAR DISEASE TEMPORAL TRENDS IN SUBCUTANEOUS RHYTHM MONITOR IMPLANTATION IN THE UNITED STATES (2016-2018) Marta Lorente-Ros1, Lingling Wu1, Bharat Narasimhan1, Yeraz Khachatoorian1, Patrick W. Lam1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Submitted to the Heart Rhythm Society Annual Scientific Meeting that will be held virtually from July 28-31, 2021.

BACKGROUND/INTRODUCTION: Subcutaneous rhythm monitors (SCRM) have emerged as an integral tool in cardiac rhythm monitoring. With a plethora of indications and newly emerging literature, the current utilization trends remain unclear. Our study analyzes temporal trends in SCRM implantation among hospitalized patients in the United States.

METHODS: We queried the National Inpatient Sample (2016-2018) using ICD-10 procedure codes to identify hospitalizations for SCRM implantation. Trends in patient characteristics, indications for implantation as well as procedural details were analyzed using the Cochran-Armitage test where appropriate.

RESULTS: A significant increase in inpatient SCRM implantation was observed between 2016 to 2018 (from 18,714 to 27,980 p<0.001). Mean age and sex distribution were largely equivalent over time. However, a significant increase in mean comorbidity burdens as reflected by Charlson comorbidity scores ≥2 was observed (59.8% to 66.8%; p<0.001). Implantation for stroke evaluation has increased significantly and remains the most common indication for implantation (39% to 50%; p<0.001). During the same period, rates of implantation for syncope and atrial fibrillation (AF) have declined. Of note, our data is purely reflective of inpatient implantation and it is possible that outpatient implantation might have different trends.

CONCLUSION: Inpatient subcutaneous rhythm monitor implantation has increased substantially from 20162018 with stroke evaluation emerging as the most common indication.

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ABSTRACT #36 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY PROGNOSTIC SIGNIFICANCE OF HOSPITALIZATION STATUS AT SECOND CYCLE OF HYPOMETHYLATING AGENT INDUCTION THERAPY IN ACUTE MYELOID LEUKEMIA PATIENTS INELIGIBLE FOR INTENSIVE CHEMOTHERAPY Douglas Tremblay1, Rafael Madero-Marroquin2, Guido Lancman1, Alexander Coltoff3, Jonathan Feld1, Jessica Caro4, Emily Sherlock1, Nicole Zubizarreta1, Erin Mosher1, Marina Kremyanskaya1, Alla Keyzner1, Michal Bar-Natan1, Shyamala C. Navada1, Lewis R. Silverman1, Janice L. Gabrilove1, John Mascarenhas1 1

Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Columbia University, New York, NY, United States; 4New York University School of Medicine, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was virtually held from December 5-8, 2020. Published in the Journal of Palliative Medicine, 2020. PMID: 33174777 BACKGROUND/INTRODUCTION: Hypomethylating agents (HMAs) are used as induction therapy for patients with acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy. They are frequently initiated in the hospital and some patients remain hospitalized through the initiation of cycle 2 (C2). Clinicians are often faced with the decision to administer C2 while the patient is still hospitalized, however, there is a paucity of prognostic information to guide treatment decisions in this common scenario.

METHODS: We conducted a retrospective review of patients diagnosed with treatment naïve, de novo and secondary AML who were ineligible for induction chemotherapy at a single, tertiary, referral center. Patients were included if they received induction therapy with an HMA between 7/1/2008 and 7/1/2018. Exclusion criteria included receipt of intensive induction chemotherapy and inadequate electronic medical documentation.

Patients were divided into four groups: patients who were discharged after completion of C1 and received C2 as an outpatient (discharged after C1), patients who received C1 and C2 during the same hospitalization (C1 C2 continuous hospitalization), those who received one total cycle (C1 only), and patients who received C1 as an outpatient (C1 outpatient). The groups were analyzed separately for the primary outcome of overall survival (OS), calculated by Kaplan Meier analysis.

RESULTS: Out of 105 patients identified who received an HMA, 100 patients were identified who met inclusion/exclusion criteria and their baseline characteristics are included in Table 1. Most patients had de novo AML (39.0%), although 33.0% and 19.0% of patients had AML secondary to myelodysplastic syndrome (MDS) and myeloproliferative neoplasm (MPN), respectively. Additionally, 8 patients (8.0%) had therapy related AML. The majority of patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 1 or 2 at induction. Patients who received C1 as an outpatient had a significantly better performance status than those who did not (p=0.033) Decitabine was the most common HMA (57.0%) administered and was most often on 5-day schedule. Eight patients (8.0%) were continually hospitalized until C2, 5 because of active medical issues (most often fevers requiring intravenous antibiotics), 2 had physical debility precluding discharge home, and 1 was receiving intrathecal chemotherapy twice weekly for central nervous system involvement of AML. The median OS was 15.6 months (95% CI, 2.66-28.6) in patients who received C1 outpatient, 10 months (95% CI, 6.67-13.43) in patients discharged after C1, 4 months (95% CI, 2.40-6.40) in the C1-C2 continuous hospitalization group, and 1 month (95% CI, 0.61-1.30) in those who only received C1 as shown in Figure 1. Patients discharged after C1 had a significantly longer OS compared to the C1-C2 continuous hospitalization group (p=0.003). There was a trend (p=0.054) towards worse survival in patients who received C1 only compared to patients hospitalized continually from C1-C2.

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CONCLUSION: Continued hospitalization from C1 to C2 of HMA therapy led to an extremely poor median survival of 4 months in this cohort, compared to 10 months in patients who were able to be discharged after C1 and receive C2 as an outpatient. Patients who only received a single cycle of HMA did not have a significantly different survival as compared to patients who were continually hospitalized from C1 to C2. While this is a small retrospective series, these data suggest that AML patients still requiring hospitalization at time of C2 of HMA therapy should be re-evaluated for alternative therapeutic approaches including hospice given poorer outcomes.

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ABSTRACT #37 CLINICAL RESEARCH PULMONARY/CRITICAL CARE/INFECTIOUS DISEASES UTILIZATION OF AIRWAY PRESSURE RELEASE VENTILATION AS A RESCUE STRATEGY IN COVID-19 PATIENTS: A RETROSPECTIVE ANALYSIS Omar Mahmoud1, Deep Patadia1,2, James Salonia1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Will be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that is scheduled to be held virtually from May 14-19, 2021. Submitted to the Journal of Intensive Care Medicine, 2021.

BACKGROUND/INTRODUCTION: Airway Pressure Release Ventilation (APRV) is a pressure controlled intermittent mandatory mode of ventilation characterized by inverse ratio and high mean airway pressure.

Several studies have demonstrated that APRV can improve oxygenation and lung recruitment in patients with ARDS. Although most patients with COVID-19 meet the Berlin criteria for ARDS, hypoxic respiratory failure due to COVID-19 may differ from traditional ARDS as patients often present with severe, refractory hypoxemia and significant variation in respiratory system compliance. The aim of this study was to evaluate the effectiveness of APRV as a rescue mode of ventilation in critically ill patients diagnosed with COVID-19 and refractory hypoxemia.

METHODS: We conducted a retrospective analysis of patients admitted with COVID-19 requiring invasive mechanical ventilation who were treated with a trial of APRV for refractory hypoxemia. We compared P/F ratio, ventilatory ratio and ventilation outputs before and during APRV. The Shapiro–Wilk test was used to test for normal distribution. Student’s t-test and Wilcoxon signed-rank tests were used to compare parametric and nonparametric data respectively. Multivariate analysis was utilized to study the correlation between inspiratory to expiratory time ratio (I:E), airway pressure and change in P/F ratio. Kaplan Meier survival analysis was performed to evaluate the factors affecting the thirty-day survival probability from the onset of refractory hypoxemia and beginning of APRV. RESULTS: There were 60 patients who met the inclusion criteria. Mean age was 65 years, 36.6% of the patients were female and in-hospital mortality was 80%. Compared with traditional mechanical ventilation, APRV improved the P/F ratio (131.75 versus 103, p=0.0001), FiO2 requirements (80% versus 100%, p=0.0034), PaCO2 (45.8 mmHg versus 54 mmHg, p=0.0051), and Ventilatory ratio (2.32 versus 2.85, p=0.0054). There was an increase in tidal volume per predicted body weight during APRV (7.86 mL/Kg versus 6.58 mL/Kg, p<0.0001) and a decrease in total minute ventilation (10.87 L/min versus 12.39 L/min, p=0.0005).

On multivariate analysis, higher I:E and airway pressure were associated with greater improvement of P/F ratio. Patients with history of diabetes mellitus, hypertension, elevated D-dimer, and African-Americans had a lower thirty-day survival probability.

CONCLUSION: In patients with COVID-19 and refractory hypoxemia, APRV may promote alveolar recruitment, decrease dead space ventilation and equilibrate the distribution of ventilation and perfusion in different regions of the lungs resulting in improved oxygenation, alveolar ventilation and carbon dioxide clearance. These effects are more pronounced with higher airway pressure. This study contributes to the growing evidence on the positive effects of APRV on oxygenation and ventilation. Prospective studies are urgently needed to evaluate the potential benefits of APRV on clinical outcomes in patients with COVID-19 and severe hypoxemia.

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ABSTRACT #38 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY DERMATOMYOSITIS: A RARE PRESENTATION OF METASTATIC PROSTATE CANCER Iman Makki1, Binbin Zheng-Lin1, Clare Bryce2, Sadhna Ahuja2, Sridevi Rajeeve2, Vaibhav Patel2 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Dermatomyositis (DM) is an idiopathic inflammatory myopathy with various cutaneous manifestations. There is a strong association between DM and malignancy with an estimated 5-7 fold increase in cancer incidence in DM patients compared to the general population. Dermatomyositis as a paraneoplastic manifestation has been reported in several malignancies notably ovarian, gastric, colon, cervical, pancreatic, and lung cancer, but rarely in prostate cancer.

CASE PRESENTATION: A 64-year-old male with past medical history of hypertension, gout, and type II diabetes mellitus was admitted to the hospital following a mechanical fall after which he sustained shoulder and facial trauma. On further evaluation, the patient was found to have dysphagia, dysphonia, proximal upper extremity and lower extremity weakness, and rashes. The dysphagia began one month prior to presentation and the rashes appeared two months prior. Physical exam was notable for erythematous and scaly-dry skin in V-neck pattern, Gottron’s papules, facial and periorbital erythema with scaly skin, periungual erythema, oropharyngeal salivary pooling, proximal bilateral upper and lower extremity weakness with intact distal extremity strength and wasting of the bilateral quadriceps and hamstrings. Labs were notable for elevated creatine kinase (CPK) 296, positive Anti-p155/140 antibodies which are directed against transcription intermediate family-1 (TIF-1). Further workup with a computed tomography scan (CT) of the abdomen and pelvis revealed extensive pelvic and abdominal lymphadenopathy, centered in the pelvis, and therefore suspicious for either nodal metastasis from prostate adenocarcinoma versus lymphoma. A right inguinal lymph node biopsy was done and confirmed the diagnosis of metastatic adenocarcinoma of prostatic primary. Staging workup via bone scan and MRI showed diffuse osseous metastases in the thoracolumbar spine. Consequently, the patient was started on Bicalutamide and Leuprolide as therapy for the underlying prostate cancer by the inpatient Oncology team. The Neurology service was consulted for the muscle weakness and were immediately concerned for dermatomyositis. Hence, they recommended empiric treatment with steroids which were initiated and a biopsy of the left deltoid muscle was obtained. Biopsy results revealed skeletal muscle with perifascicular atrophy and mild mixed inflammatory infiltrate, suggestive of DM. Hence, in the setting of the patient's clinical presentation confirmed the diagnosis of DM likely paraneoplastic. The patient was started on intravenous immunoglobulins (IVIG) in addition to steroids for treatment of DM. The patient’s hospital course was complicated by worsening dysphagia necessitating percutaneous gastric tube placement (PEG), worsening dysphonia, as well as hypoxic respiratory failure requiring a brief intensive care unit admission and non-invasive positive pressure ventilation. Patient slowly regained his speech and his respiratory status improved. He was able to be discharged to a subacute rehab after 37 days of inpatient stay. The patient is still requiring a PEG tube for feeding but his dysphagia has significantly improved, and his rashes have almost resolved. His muscle strength is slowly recovering. He continues to get IVIG sessions and steroids as well as Leuprolide injections every three months for treatment of his metastatic prostate cancer. His prostate specific antigen (PSA) a marker which is usually elevated in prostate cancer and was markedly elevated in this patient began to decline significantly which usually indicates a positive response to therapy.

CONCLUSION: This case illustrates the importance of screening for an underlying malignancy in any patient presenting with DM. Because of the rarity of DM physicians should maintain a high index of suspicion and screen for more cancers than only those reported to be commonly associated with DM. Cases have shown that systemic manifestations of paraneoplastic DM tend to improve following treatment of the underlying malignancy.

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ABSTRACT #39 QUALITY IMPROVEMENT ENDOCRINOLOGY/HEMATOLOGY/ONCOLOGY IMPROVING GLYCEMIC CONTROL OF CANCER PATIENTS ADMITTED TO MOUNT SINAI WEST Zoe McKinnell1, Lauren Botero1, Mangalore Shenoy1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Cancer patients are vulnerable to hypo- and hyperglycemic events.

Factors including weight loss and medications such as steroids make these patients particularly susceptible.

Poor glycemic control in cancer patients can lead to increased morbidity and mortality by causing symptoms such as fatigue and weakness and by increasing susceptibility to infections. We hypothesize that this happens both in the inpatient setting when patients are placed on incorrect insulin dosages and in the outpatient setting when patients are continued on diabetic medication regimens predating their cancer diagnosis. Our goal is to reduce the number of hypo- and hyperglycemic episodes by 10% from baseline for the period from April 2021 to September 2021 among cancer patients admitted to Mount Sinai West.

METHODS: All baseline data was obtained via EPIC report. The following was data points were requested: 1) MRNs of all patients admitted to Mount Sinai West with a diagnosis of cancer, malignancy, metastatic, carcinoma, and/or sarcoma from 9/1/2019-2/28/2020 (6 months, off-peak pandemic).

2) For all the qualifying patients, the following data was additionally requested: • List of diagnosis • Blood glucose (POCT finger sticks requested but BMP glucose levels were reported) • Date of admission • Date of discharge • Most recent HbA1c (date and value) • List of inpatient medications • List of outpatient medications • Age High glucose was defined as over 200 and low glucose was defined as less than 90. Patients admitted for surgical procedures were excluded.

RESULTS: A total of 99 patients met the criteria. The average length of stay (LOS) for all patients was 4.4 days. Patients with high glucose events had an average length of stay of 6.4 days and patients with low glucose events had an average LOS of 4.8 days. 9 patients had a high glucose event and 14 patients had a low glucose event. The 8AW unit had the highest number of patients with high glucose events (5/10 , 50%), followed by 9A (2/21, 0%). The 10A unit had the highest number of patients with low glucose events (4/23, 17%) followed by 9A (3/21, 14%). Patients with gastrointestinal cancer were most likely to have a low glucose event (7/15, 46%) and patients with prostate cancer were least likely to have a low glucose event (2/35, 6%).

Lastly, only 2/9 patients with high glucose had a hemoglobin A1c.

DISCUSSION: These findings reveal that length of stay and certain hospital units have more high glucose events, and that patients admitted with GI cancers have more low glucose events. It should be noted that glucose levels from the basic metabolic panel were recorded and some cancer diagnoses were missing from the EPIC data report such as breast and pancreas cancer.

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DATA/TABLES: High Glucose >200 9

Low Glucose<90 14

Glucose control by unit: Unit 10A 10B 14B 14MS 8AW 8B 9A 9B

High Glucose 2 0 0 0 5 0 2 0

Normal Glucose 90-200 76

Low Glucose 4 1 0 0 1 1 3 0

Normal Glucose 17 1 7 2 4 12 16 2

LOS and glucose: Average length of stay: 4.4 days LOS (days) High glucose 6.44 Low glucose 4.79 Normal glucose 4.13 Cancer type and glucose trends Cancer type GI Thyroid Parotid Prostate Leiomyosarcoma of the uterus PCV Squamous cell of base of tongue Trachea Vaginal

High glucose 1 4 2 2 0 0 0

Low glucose 7 4 0 1 1 0 0

Normal glucose 7 29 4 32 0 1 1

0 0

1 0

1 1

Age and glucose trends Average age was 58.3years High glucose Low glucose Normal glucose

Average age 63.9 58.8 57.6

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ABSTRACT #40 CLINICAL RESEARCH CARDIOVASCULAR DISEASE THE ASCVD-10 RISK ESTIMATE AS A PREDICTOR FOR TRUE RESISTANT HYPERTENSION IN HIGHRISK OVERWEIGHT AND OBESE HYPERTENSIVE SUBJECTS: A CROSS-SECTIONAL STUDY Faris I. Haddadin1, Claire Huang Lucas1, Lingling Wu1, Joshua Berookhim1, Sananda Moctezuma1, Alba Munoz Estrella1, Karan Sud1, Dipal Patel1, Edgar Argulian1

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: The estimates of 10-year risk for atherosclerotic disease (ASCVD-10) is applicable for individuals who are 40- to 79-years-old without prior cardiovascular disease. While multiple components of the risk estimator are shared risk factors for many cardiovascular diseases, the ASCVD-10 does not consider the BMI value and limited studies examined the relationship between the ASCVD-10 risk score and resistant hypertension.

METHODS: This is a cross-sectional study based on an outpatient primary care practice conducted between October, 2017 to October, 2018. Subjects with hypertension with either high-risk overweight (BMI ≥ 27 and ≤ 29.9 kg/m2 plus ≥1 obesity-related comorbid conditions) and subjects with obesity (BMI ≥ 30 kg/m2) were included. Subjects with prior ASCVD were excluded. Apparent treatment-resistant hypertension detected with an average of two blood pressure (BP) readings at the office was confirmed with home BP measurement to exclude pseudo-resistance and verify true resistant hypertension (TRH). BP cutoff of >130/80 mmHg was used. Multivariate logistic regression adjusted for significantly different baseline variables among subjects with TRH versus non-TRH was used to examine the performance of ASCVD-10 in predicting true resistant hypertension. Variables that are part of the ASCVD-10 score were excluded from the adjustment.

RESULTS: We identified 595 eligible subjects. Mean age was 60.4 years and 381 (64.1%) were females.

Apparent treatment-resistant hypertension was detected in 69 subjects but only 35 subjects had true resistant hypertension after home BP measurement confirmation. Subjects with TRH compared to non-TRH were more likely to be of Black race (51.4% versus 33.1%, p=0.022), to have chronic kidney disease (34.2% versus 11.3%, p<0.001), higher mean BMI (36.9 versus 33.1 kg/m2, p<0.001), diastolic heart failure (42.9% versus 12.5%, p<0.001), dyslipidemia (60% vs. 41.9%, p=0.037), and diabetes mellitus (71.4% versus 36.8%, p<0.001). After adjustment to the variables mentioned previously that are not part of the ASCVD-10 risk calculator components, a higher ASCVD-10 score predicted the presence of true resistant hypertension (OR, 1.04 for each 1% of the ASCVD-10 score; 95% CI, 1.01-1.07; p=0.039).

CONCLUSION: The ASCVD-10 risk score can possibly be used as a predictor for the risk of having or developing resistant hypertension in subjects with obesity or high-risk overweight.

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ABSTRACT #41 CLINICAL RESEARCH CARDIOVASCULAR DISEASE ROLE OF IMMUNOSUPPRESSIVE THERAPY IN THE MANAGEMENT REFRACTORY POSTPROCEDURAL PERICARDITIS Bharat Narasimhan1, Mohit K. Turagam2, Jalaj Garg3, Domenico G. Della Rocca4, Rakesh Gopinathannair5, Luigi Di Biase6, Jorge Romero6, Suneet Mittal1, Sanghamitra Mohanty4, Andrea Natale4, Dhanunjaya Lakkireddy5 1Mount

Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Medical College of Wisconsin, Milwaukee, WI, United States; 4Texas Cardiac Arrhythmia Institute, Austin, TX, United States; 5Kansas City Heart Rhythm Institute, Overland Park, KS, United States; 6Montefiore Medical Center, Bronx, NY, United States 2Mount

Accepted for publication in the Journal of Cardiovascular Electrophysiology, 2021. In press.

BACKGROUND/INTRODUCTION: A significant rise in epicardial based interventions over the past two decades has been associated with a proportionate rise in complications – most notably, pericarditis. Post procedural pericarditis is often particularly refractory to conventional therapies with no current consensus regarding its optimal management. To assess the safety and efficacy of a novel immunosuppressive regimen combination Methotrexate/Prednisone (cMtx/P) - in the management of severe refractory post-procedural pericarditis (rPPP).

METHODS: In this multi-center, non-randomized, retrospective, observational study, 408 consecutive patients diagnosed with persistent post-procedural pericarditis between 2017-2019 were included. Patients with refractory symptoms despite 3 months of conventional therapy were initiated on a 4-week regimen of oral steroids. Persistence of symptoms at this point, i.e. rPPP (n=25; Catheter based=18, Open surgical=7) prompted therapy with Methotrexate (7.5 mg to 15 mg weekly) with folate supplementation along with low dose prednisone (5 mg, oral) for a further 3 months. Patients were followed for a total of 11.3 ± 1.8 months.

RESULTS: Treatment refractory rPPP occurred in 6.1% of the study population prompting immunosuppressive therapy with cMtx/P. All patients demonstrated complete symptom resolution following 3 months of treatment with an 85% decline in clinically significant pericardial effusions. One patient developed recurrent pericarditis during the 11-month follow-up. Therapy was well tolerated with no significant drug related adverse effects.

CONCLUSION: Combination Methotrexate/Prednisone therapy is a safe and effective adjunct in the management of post-procedural pericarditis refractory to standard therapy.

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ABSTRACT #42 CLINICAL RESEARCH NEPHROLOGY/PULMONARY/CRITICAL CARE ESRD, A HARBINGER OF WORSE IN-HOSPITAL OUTCOMES IN PATIENTS WITH PULMONARY EMBOLISM Robert Abed1, Rawann Nassar1, Claire Lucas Huang1, Nikhil Bachoo1, Karim El-Hachem1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

BACKGROUND/INTRODUCTION: There is yet to be compelling evidence supporting the relationship between end-stage renal disease (ESRD) and outcomes in pulmonary embolism hospitalizations. In fact up until now, current severity scoring systems for pulmonary embolism outcomes do not account for the presence of ESRD. Using the 2016 National Inpatient Sample, our goal was to compare in-hospital outcomes of patients admitted for pulmonary embolism and concurrent ESRD to those with normal renal function.

METHODS: Data was obtained from the 2016 National Inpatient Sample. The primary outcome was inpatient mortality. Secondary outcomes were total hospital charge and inpatient length of stay. Multivariate linear and logistic regression analyses were conducted on STATA 15.1.

RESULTS: In our dataset 36,959 observations met the criteria for adult inpatients who were admitted for pulmonary embolism. Among this population, 432 patients had a concurrent diagnosis of ESRD, while 33,681 patients had no diagnosis of abnormal kidney function. Of these, 2846 patients had pulmonary embolism as well as a diagnosis of chronic kidney disease, but not ESRD. Among patients who were admitted for pulmonary embolism, those with ESRD demonstrated higher inpatient mortality (OR, 1.61; 95% CI, 1.09-2.38) as compared to those with no diagnosis of abnormal kidney function. Furthermore, those with ESRD experienced on average an additional 3.42 days (95% CI, 1.60-5.24 days) of hospitalization and an additional 52% increase in total hospital charge as compared to those with no diagnosis of abnormal kidney function.

CONCLUSION: Among patients hospitalized for pulmonary embolism, those with a concurrent diagnosis of ESRD have a higher inpatient mortality as compared to those with no diagnosis of abnormal kidney function.

Moreover, ESRD was associated with increased length of stay and a higher total hospital charge in this patient population. Despite the limitations of this study, these findings prompt investigation into the prognosticating potential of ESRD in patients with pulmonary embolism as well as possible incorporation of ESRD into future severity scoring systems.

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ABSTRACT #43 CLINICAL RESEARCH ENDOCRINOLOGY DIABETES’ COST TO US TAXPAYERS: THIRTY-DAY READMISSION AND RESOURCE UTILIZATION AMONG DIABETICS PATIENTS ADMITTED WITH ST-ELEVATION MYOCARDIAL INFARCTION Shabnam Nasserifar1, Kam S. Ho1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Endocrine Society Annual Meeting that was held virtually from March 28-31, 2020.

OBJECTIVE: To determine the relationship between diabetes and thirty-day readmission, mortality, morbidity, and health care resource utilization in patients admitted with ST-Elevation Myocardial Infarction (STEMI) in the United States.

METHODS: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (≥18 years) with a primary diagnosis of STEMI, along with a secondary diagnosis of diabetes were identified using ICD-9 codes as described in the literature. The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders. Independent risk factors for readmission were identified using a Cox proportional hazards model.

RESULTS: In total, 116,124 hospital admissions among adults with a primary diagnosis of STEMI were identified, of which 18.05% were diabetics. 1:1 PS matching was performed based on demographic (age, gender, hospital status, etc.) and clinical characteristics (Charlson comorbidity score). The 30-day rate of readmission among diabetics and non-diabetics with STEMI were 9.31% versus 6.18% (p<0.001). The most common readmission for both groups was recurrent myocardial infarction. During the index admission for STEMI, the length of stay (LOS) among diabetics and non-diabetics patients were not statistically different (4.74 versus 4.58 days, p=0.12). However, the total hospital cost for the diabetic patients was statistically different ($27,027 versus $24,807, p<0.001). Most importantly, diabetics patients’ in-hospital mortality rate during their index admission was significantly higher (10.20% versus 5.92%, p<0.001). Amongst those readmitted, the LOS, total hospital cost, or in-hospital mortality among diabetics were not statistically different when compared to their counterparts during their readmission. Diabetes (HR, 1.60; 95% CI, 1.27-2.02; p<0.001) was an independent predictor associated with higher risks of readmission. Other independent predictors associated with increased 30-day readmission include acute exacerbation of CHF, acute exacerbation of COPD, acute kidney injury, secondary diagnosis of pneumonia, history of COPD, history of ischemic stroke, history of atrial fibrillation and atrial flutter, history of chronic kidney disease, history of iron deficiency, and use of mechanical ventilator.

CONCLUSION: In this study, diabetics patients admitted with STEMI have a higher 30 days of readmission rate, total hospital cost, and in-hospital mortality (p<0.001) than their non-diabetic counterparts.

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ABSTRACT #44 CLINICAL RESEARCH GENERAL INTERNAL MEDICINE TRENDS IN USAGE OF TELEMEDICINE DURING AND POST COVID19 PANDEMIC SURGE IN NYC 2020 Pratyusha Nunna1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

BACKGROUND/INTRODUCTION: The COVID-19 pandemic has thrust telemedicine to center stage in the U.S. healthcare landscape. Telemedicine, video and voice visits, has maintained access to medical care at a safe distance. In addition, its use has opened new avenues of application in continuity of chronic care. The way telemedicine is utilized in an urban, underserved population is not well-defined.

METHODS: This project takes place at a Federally Qualified Health Center located in Central Harlem in Manhattan that serves as a training site for Internal Medicine Residents. Demographically, 45% of the patients identify as African-American, 31% Latino, and 58% live below 100% of the Federal Poverty Level (FPL). With this cross-sectional study, we attempt to identify trends in the adoption and use of telemedicine services during and post COVID-19 pandemic Spring 2020 surge in NYC and its potential correlation to health disparities in our patient population.

RESULTS: We analyzed results based on age, zip code, and preferred language. During our study period of March to August 2020, 51% (n=2898) of all visits were tele-visits. From March-May, 2020 (COVID-19 spring surge), 64% of visits were tele-visits. The elderly (>65 years) had 360 tele-visits of which 11% were video visits, lowest of all three groups. The highest utilization (43%) was seen in the 45-64 years age group. From June-August, 2020 (post-surge), there was a 36% decrease in tele-visits with the steepest decline seen in the elderly. Analysis of Central Harlem zip code data for the surge reveals that out of 816 tele-visits, 22% were video. Post surge, there was an overall decrease in the number of visits but an increase in video (n=594 with 33% video). Sixteen zip codes with the highest FPL (>30%) had 17% tele-visits with 25% video. Again, post surge there was a drop in tele-visits, but an increase in video by 35%. Primary language was English in 84% (74% voice and 26% video) of visits and Spanish in 12% (80% voice and 20% video) of tele-visits. Post surge, English was the preferred language in 89% of visits (65% voice, 35% video) with Spanish in 9% (87% voice and 13% video).

CONCLUSION: The data reveals that despite a willingness to adopt telemedicine services and continue usage post surge, there are potential barriers to optimum utilization of video visits. Older age, technology awareness, and the need for interpreter services are all limiting factors. Further investigation into patient related factors is needed. From these trends, we hope to propose solutions to overcoming these barriers to healthcare access for chronic disease management well beyond the pandemic.

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ABSTRACT #45 CLINICAL RESEARCH CARDIOVASCULAR DISEASE PROGNOSTIC VALIDATION OF PARTITION VALUES FOR QUANTITATIVE PARAMETERS TO GRADE FUNCTIONAL TRICUSPID REGURGITATION SEVERITY BY CONVENTIONAL ECHOCARDIOGRAPHY Denisa Muraru1,2, Marco Previtero3, Roberto Carlos Ochoa Jimenez1,4, Andrada Camelia Guta1,5, Stefano Figliozzi3, Dario Gregori3, Daniele Bottigliengo3, Gianfranco Parati1,2, Luigi Paolo Badano1,2 1

Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy; 2University of Milano-Bicocca, Milan, Italy; 3University of Padova School of Medicine, Padua, Italy; 4Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Presented in EuroEcho 2019 Congress; Vienna, Austria that was held from December 4-7, 2019. Published in European Heart Journal – Cardiovascular Imaging, 2021. PMID: 33247930 BACKGROUND/INTRODUCTION: Quantitative echocardiography parameters are seldom used to grade tricuspid regurgitation (TR) severity due to relative paucity of validation studies and lack of prognostic data. Our aim was to assess the relationship between TR severity and the composite endpoint of death and hospitalization for congestive heart failure (CHF); and to identify the threshold values of vena contracta width (VCavg), effective regurgitant orifice area (EROA), regurgitant volume (RegVol), and regurgitant fraction (RegFr) to define low, intermediate, and high-risk TR based on patients’ outcome data.

METHODS: A cohort of 296 patients with at least mild TR underwent 2D, 3D, and Doppler echocardiography.

We built statistical models (adjusted for age, NYHA class, left ventricular ejection fraction, and pulmonary artery systolic pressure) for VCavg, EROA, RegVol, and RegFr to study their relationships with the hazard of outcome. The tertiles of the derived hazard values defined the threshold values of the quantitative parameters for TR severity grading.

RESULTS: During 47-month follow-up, 32 deaths and 72 CHF occurred. Event-free rate was 14%, 48%, and 93% in patients with severe, moderate, and mild TR, respectively. Severe TR was graded as VCavg > 6 mm, EROA > 0.30 cm2, RegVol > 30 mL, and RegF > 45%.

CONCLUSION: This outcome study demonstrates the prognostic value of quantitative parameters of TR severity and provides prognostically meaningful threshold values to grade TR severity in low, intermediate, and high risk.

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ABSTRACT #46 CLINICAL RESEARCH GASTROENTEROLOGY MORBID OBESITY BUT NOT OBESITY IS ASSOCIATED WITH INCREASED MORTALITY IN PATIENTS UNDERGOING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY A NATIONAL COHORT STUDY Bing Chen1, Chia-Hung Yo2, Ramya Patel1, Bolun Liu3, Ke-Ying Su4, Wan-Ting Hsu5, Chien-Chang Lee4,6 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Far Eastern Memorial Hospital, New Taipei City, Taiwan; 3John H. Stronger, Jr. Hospital of Cook County, Chicago, IL, United States; 4National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; 5 Harvard T. H. Chan School of Public Health, Boston, MA, United States; 6Center of Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan 2

Accepted for publication in the United European Gastroenterology Journal, 2021. In press.

BACKGROUND/INTRODUCTION: The relationship between body weight and outcomes of ERCP (endoscopic retrograde cholangiopancreatography) is unclear. This study aimed to investigate the impact of obesity and morbid obesity on mortality and ERCP-related complications in patients who underwent ERCP. METHODS: We conducted a US population-based retrospective cohort study using the Nationwide Readmissions Databases (2013-2014). A total of 159,264 eligible patients who underwent ERCP were identified, of which 137,158 (86.12%) were normal weight, 12,522 (7.86%) were obese, and 9,584 (6.02%) were morbidly obese. The primary outcome was in-hospital mortality. The secondary outcomes were the length of stay, total cost, and ERCP-related complications. Multivariate analysis and propensity score matching analysis were performed. The analysis was repeated in a restricted cohort to eliminate confounders.

RESULTS: Patients with morbid obesity, as compared to normal-weight patients, were associated with a significantly higher in-hospital mortality (HR, 5.54; 95% CI, 1.23-25.04). Obese patients were not associated with significantly different mortality comparing to normal weight (HR, 1.00; 95% CI, 0.14-7.12). Patients with morbid obesity were also found to have an increased length of hospital stay and total cost. The rate of ERCPrelated complications was comparable among the three groups except for a higher cholecystitis rate after ERCP in obese patients.

CONCLUSION: Morbid obesity, but not obesity was associated with increased mortality, length of stay, and total cost in patients undergoing ERCP.

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ABSTRACT #47 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW PULMONARY/CRITICAL CARE PULMONARY BAROTRAUMA DURING NON-INVASIVE VENTILATION IN PATIENTS WITH COVID-19 INFECTION Archana Pattupara1, Vivek Modi1, Julia Goldberg1, Kam Singh Ho1, Kirtipal Bhatia1, Yasmin Herrera1, Joseph Ghassibi1 1

Mount Sinai Morningside/West Hospital, Icahn School of Medicine, New York, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

BACKGROUND/INTRODUCTION: The pathophysiology of respiratory distress in hospitalized patients with COVID-19 is not yet fully understood. Spontaneous pulmonary barotrauma (PBT) is a pulmonary complication typically seen in intubated patients. However, in the related viral epidemic of SARS in 2002, 6.6% to 15% of patients on non-invasive ventilation (NIV) were described to have developed PBT, with severe alveolar destruction as the suggested mechanism. Within the COVID-19 pandemic, isolated case studies have described bulla and PBT, and a systematic review of imaging has suggested PBT to be a sign of disease progression. In this single center retrospective case series, two patients with confirmed COVID-19 infection who developed PBT on NIV were identified in a New York City hospital from March 2020 to April 2020 and were included in this study.

CASE PRESENTATION: Both patients were non-smokers with no pre-existing lung disease. The first patient was a 58-year-old woman with a history of pemphigus vulgaris, and the second patient was a 69-year-old man with a history of hypertension and type 2 diabetes mellitus. Both patients were started on treatment with hydroxychloroquine, azithromycin, therapeutic anticoagulation, high dose steroids, and were enrolled in the hospital’s Remdesivir trial. Both patients required oxygen therapy which included escalation from nasal cannula to continuous positive airway pressure (CPAP), and both were encouraged to self-prone. The first patient was found to have a large left pneumothorax, pneumomediastinum, and extensive subcutaneous emphysema on day 18 of hospitalization while on CPAP of 12 cm H2O, requiring surgical chest tube placement. The second patient developed a small left apical pneumothorax, pneumomediastinum, and extensive subcutaneous emphysema on day eight of hospitalization while on CPAP of 14 cm H2O. Both patients eventually required intubation for worsening hypoxemia and later succumbed to their illness.

CONCLUSION: In this case series, we identified two patients who developed spontaneous pulmonary barotrauma without being subjected to invasive ventilation or very high levels of PEEP. Both patients had poor outcomes, suggesting that COVID-19 may be associated with alveolar destruction, especially in the setting of steroid use. Glucocorticoid use may interfere with lung healing which could increase the risk of alveolar rupture.

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ABSTRACT #48 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW CARDIOVASCULAR DISEASE A TRUE BICUSPID AORTIC VALVE IN A PATIENT WITH INFECTIVE ENDOCARDITIS Christopher Perez Lizardo1, Nina Kukar1 1Mount

Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Bicuspid aortic valve is the most common congenital heart anomaly, affecting between 1 and 2 percent of the general population. It occurs as a result of a fusion of two of the cups during development, leading to unequal cusp size. There are three main types of bicuspid valve, the type 1 is the most common, has one raphe between the right and left coronary cusps, seen in 75% of cases.

CASE PRESENTATION: A 34 year-old-male with past medical history of C6 radiculopathy was seen at the emergency department complaining of a 4-day history of subjective fever, generalized myalgias, and diarrhea. He endorsed cocaine and alcohol use within 3 days prior to presentation. At arrival, he was febrileand tachycardic.

Labs were remarkable for lactic acidosis and acute kidney injury. EKG showed sinus tachycardia. Physical examination was remarkable for a 4/6 systolic murmur over the left third intercostal space and purplish tender lesions, on the left first toe and the right third digit. Transthoracic echocardiogram was consistent with mobile echodensities on the anterior cusp of the tricuspid valve, a type 0 anteroposterior bicuspid valve and a small restrictive membranous ventricular septal defect with left to right flow. A transesophageal echocardiogram confirmed the vegetations on the tricuspid valve and a peri-membranous ventricular septal defect with infected aneurysmal tissue (Picture 1). Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. The hospital course was complicated by recurrent fevers, despite appropriate antibiotic therapy and clearing of blood cultures. Additional imaging showed chronic left frontal and left occipital lobe infarcts and bilateral pulmonary septic emboli. Repeated echocardiogram showed expansion of the infected tissue to the base of the right aortic cusp. The patient then underwent tricuspid annuloplasty and leaflet reconstruction with patch as well as mechanical aortic valve replacement using a 25mm On-X valve and was discharged on warfarin as well as nafcillin.

DISCUSSION: This patient had type 0, which has no raphes, also known as pure bicuspid valve, seen in only 5% of cases (Picture 2). Other coexisting congenital defects can be present, most commonly coarctation of the aorta and ventricular septal defect. These lesions can potentially increase the risk of having endocarditis. Although he had no prior history of intravenous drug use, his cocaine use is another risk factor to take into consideration. The sympathomimetic and prothrombotic effects of cocaine can lead to further vascular damage and predispose to bacterial invasion. Snorted cocaine can also serve as a vehicle for staphylococcus present in the nasal cavity.

Other complications of bicuspid aortic valve includevalve dysfunction, aortic aneurysms due to abnormal systolic flow.

CONCLUSION: A bicuspid aortic valve is among the most common congenital heart anomalies. The presence of other concomitant heart defects is not uncommon. These variations in anatomy cause turbulence in blood flow increasing the risk for infective endocarditis. Although intravenous drug use is a commonly known risk factor for endocarditis, inhalation could also play an important role as it can carry Staphylococci from the nasopharynx into the bloodstream.

Picture 1: Mid-esophageal short axis view of the aortic valve. At 12 o’clock the left atrium. At 9 o’clock the right atrium. Notice the type 0 true bicuspid aortic valve and the aneurysmal. Ventricular septal defect at 7 o’clock

Picture 2: Mid-esophageal short axis view of the tricuspid valve. Notice the vegetations. The aortic valve is open in the frame.

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ABSTRACT #49 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY ROUTINE LABORATORY VALUES CAN PREDICT THERAPY-RELATED MYELOID NEOPLASMS IN PATIENTS WITH NEW CYTOPENIAS AFTER TREATMENT FOR BREAST CANCER Giulia Petrone1, Charles Gaulin2, Andriy Derkach3, Sean Devlin3, Ashwin Kishtagari4, Rekha Parameswaran3, Eytan M. Stein3 1

Mount Sinai Morningside/West Hospital Center, New York, NY, United States; 2Mayo Clinic, Phoenix, AZ, United States; Memorial Sloan Kettering Cancer Center, New York, NY, United States; 4Cleveland Clinic, Cleveland, OH, United States

3

Presented at the American Society of Hematology (ASH) Annual Meeting that was virtually held from December 5-8, 2020.

BACKGROUND/INTRODUCTION: Therapy-related myelodysplastic syndrome (t-MDS) and therapy-related acute myeloid leukemia (t-AML) occur in 0.6% to 1.8% women treated for breast cancer (BC) with chemotherapy and radiation. Cytopenias in BC patients can be secondary to BC marrow infiltration, chemotherapy effect or t-MDS/t-AML, and are usually evaluated with a bone marrow biopsy (BMBx). The aim of this study was to identify predictors of t-MDS/t-AML in patients with BC and cytopenias to avoid unnecessary BMBx. METHODS: We used the Memorial Sloan Kettering Cancer Center institutional database to identify patients with BC and cytopenias who were referred for BMBx between 2002-2018. Characteristics associated with the risk of t-MDS/t-AML in patients with BC and cytopenias were evaluated by multivariate logistic regression and included in a predictive model. The average area under the receiver operating characteristic curve (AUC) of the final predictive model was estimated by 10-fold cross-validation. The same analysis was conducted on BC patients without bone metastasis, and univariate analysis was performed on a smaller subset of patients with bone metastasis.

RESULTS: 359 BC patients underwent BMBx to evaluate cytopenias. 206 were included and 107 had t-MDS/tAML. By multivariate analysis, ANC1.5K/mcL (OR, 0.11), Hgb12.2g/dL (OR, 0.12), PLT100K/mcL (0.33), the presence of known bone metastasis (OR, 0.05), exposure to chemotherapy (OR, 0.31) and a time from BC diagnosis to BMBx < 15 months (OR, 0.11) significantly decreased the likelihood of t-MDS/t-AML. The average AUC was 0.88. In the subset without bone metastasis (n=156), 101 patients were diagnosed with t-MDS/t-AML and our variables had similar effects on the risk of t-MDS/t-AML. The average AUC was 0.85. Of the 50 patients with known bone metastasis, 6 had t-MDS/t-AML. An ANC1.5K/mcL was the only variable associated with a decreased risk of t-MDS/t-AML in this subpopulation. A scoring system was created to assign probability of t-MDS/t-AML in the whole cohort and the non-bone metastatic cohort.

CONCLUSION: In BC patients with unexplained cytopenias, the use of clinical and laboratory parameters can assist clinicians to determine the likely underlying etiology of cytopenias in BC patients and determine the need for and timing of a BMBx.

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ABSTRACT #50 CLINICAL RESEARCH GASTROENTEROLOGY EMERGENT COLECTOMY RATES DECREASED WHILE ELECTIVE ILEAL POUCH RATES WERE STABLE OVER TIME: A NATIONWIDE INPATIENT SAMPLE STUDY Maia Kayal1, Aparna Saha1, Priti Poojary2, Sudarshan Paramsothy1, Robert Hirten1, Louis Cohen1, Zane Gallinger1, Saurabh Mehandru1, Judy Cho1, Alexander Greenstein1, Girish Nadkarni1, Marla C. Dubinsky1, Jean-Frederic Colombel1, Benjamin Cohen1, Ryan Ungaro1 1

Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Mount Sinai

Presented at the Digestive Diseases Week (DDW) Meeting; Washington, DC, United States that was held from June 2-5, 2018. Published in International Journal of Colorectal Disease, 2019. PMID: 31512019 BACKGROUND/INTRODUCTION: Despite advances in biologic therapy, approximately 10-15% of ulcerative colitis (UC) patients require surgery. We aimed to (1) examine the rates of emergent colectomy and elective ileal pouch anal anastomosis (IPAA) over time among UC patients in the USA and (2) investigate dispar ities in surgery rates by patient demographics.

METHODS: Data from the Nationwide Inpatient Sample (NIS) from 2000 to 2014 were analyzed. Inclusion criteria were admissions with a primary UC ICD-9-CM diagnosis code and age > 18 years of age. Emergent cases were defined as those admitted through the emergency room with an outcome ICD-9-CM code for subtotal colectomy. Elective IPAA cases were defined with an outcome ICD-9-CM code for IPAA, used as a surrogate measure of colectomy. Patient and hospital-level demographics were analyzed. Temporal trends of colectomy were analyzed utilizing joinpoint-regression analysis with calculation of annual percentage change (APC).

RESULTS: A total of 470,708 admissions were included over the 14-year period. Emergent colectomy rate significantly declined (APC - 7.35%, p=0.0002), while the rate of elective IPAA remained stable (APC - 0.21%, p=0.80). Emergent colectomy rates declined similarly across all demographics, though not as marked among patients age 50 and older and Medicare patients. Elective IPAA rates were significantly lower among Blacks and patients with public insurance.

CONCLUSION: There has been a significant decline in emergent UC colectomy rates in the USA; however, the overall need for surgery appears unchanged given stable IPAA rates. This suggests a limited impact on overall surgery rates with a shift from emergent to elective procedures.

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ABSTRACT #51 CLINICAL RESEARCH ENDOCRINOLOGY/INFECTIOUS DISEASES CLINICAL OUTCOMES IN DIABETIC VERSUS NON-DIABETIC PATIENTS WITH SEVERE COVID-19 Joseph Poon1, Kam Sing Ho1, Yasmin Herrera1, Raymonde Jean1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

BACKGROUND: Diabetes has been shown in recent studies to be highly prevalent in critically ill patients with severe coronavirus disease 2019 (COVID-19). However, data comparing clinical outcomes in diabetic and non-diabetic patients remained limited. We aim to compare characteristics and clinical outcomes of diabetic and non-diabetic critically ill patients with severe COVID-19.

METHODS: Following institutional review board approval, we identified 115 patients who were admitted to the intensive care unit (ICU) for severe COVID-19. De-identified patient data was retrospectively collected and analyzed using Stata version 15.1 (StatCorp). Data reported here are those which are available through April 28 2020.

Results: We identified 115 patients who were admitted to the ICU for severe COVID-19. The population had a mean age of 63.44 years, 67% were male, the mean BMI was 33.30. The mean duration of symptoms prior to hospitalization was 6.35 days. Comorbidities were common, 68 patients had a Charlson comorbidities index equal to or above 3. The most common comorbidities included hypertension (65%), diabetes (41%) and hyperlipidemia (35%). The most common symptoms were dyspnea (81%), cough (75%), and fever (68%).

When comparing diabetic with non-diabetic patients, there was a similar number of patients requiring invasive and non-invasive mechanical ventilation. There were no significant differences in their clinical management with regards to the use of hydroxychloroquine, azithromycin, steroids, and tocilizumab. Both populations had similar rates of shock requiring vasopressors and renal failure requiring renal replacement therapy. There were no significant differences in the rate of acute kidney injury and hepatic injury between both groups. Nondiabetics had higher rates of troponin elevation (48 non-diabetics versus 42 diabetics). Diabetic patients were more likely to experience hospital mortality (OR, 2.94; 95% CI, 1.32-6.52; p=0.08) and were less likely to be discharged home (OR, 0.38; 95% CI, 0.17-0.83; p=0.02) when compared with non-diabetic patients.

CONCLUSIONS: Diabetics experience higher rates of mortality and are less likely to be discharged when compared with non-diabetic patients. Further studies to evaluate management strategies in diabetic patients with severe COVID-19 may be useful given the increased risk for mortality in this population.

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Variables

Overall (N=115)

Age (years)

63.44 ± 15.78 (19-94)

Age category < 50 years 50 to 70 years ≥ 70 years

23 46 46

Gender Male Female

78 37

Race White African American Asian Hispanics Others

33 35 5 34 8

Insurance Medicaid Medicare Private Uninsured

13 50 37 15

BMI

33.30 ± 9.72

BMI Category < 30 30 to 34 ≥ 35

60 18 37

Table 1: Baseline demographics and characteristics of critically ill COVID-19 patients

Characteristics

Overall (N=115)

Diabetes (N=47)

Non-Diabetics (N=68)

p-value (Student’s t test)

6.35 ± 3.90

5.95 ± 4.17

6.63 ± 3.69

0.38

93 86 78

42 31 26

51 55 52

0.04 0.08 0.02

Comorbidities Hypertension Hyperlipidemia Coronary CAD Asthma COPD CKD

75 41 14 17 6 16

40 21 9 3 3 11

35 20 5 14 3 5

0.001 0.10 0.08 0.02 0.65 0.03

Charlson Comorbidity Index 0 1 2 3+

17 16 14 68

0 3 5 39

17 13 9 29

0.001 0.04 0.67 0.001

Clinical Symptoms Symptom duration prior to hospital admission (days) Symptoms Dyspnea Cough Fever Comorbid Conditions - number

Table 2: Clinical symptoms and comorbid conditions of diabetic and non-diabetic COVID-19 patients 82

Characteristics

Overall (N=115)

Diabetes (N=47)

Non-Diabetics (N=68)

p-value (Student’s t test)

Oxygen Therapy Oxygen support NIPPV Invasive MV

49 66

16 31

33 35

0.12 0.13

Hydroxychloroquine and Azithromycin

107

44

63

0.99

Steroids

61

24

37

0.85

Tocilizumab

41

12

29

0.08

Experimental Drugs

Complications during Hospitalization (number) Shock requiring vasopressors

60

27

33

0.25

Troponin elevation

90

42

48

0.04

Acute hepatic injury

28

13

15

0.51

Acute kidney injury

56

29

27

0.09

Renal replacement therapy

30

13

17

0.83

Table 3: Clinical management and complications of diabetic and non-diabetic COVID-19 Patients Abbreviation: NIPPV - Non-invasive positive pressure ventilation (including high-flow nasal cannula and bi-level positive airway pressure; Invasive MV - invasive mechanical ventilation

Variables

Odds Ratio Standard Deviation 95% Confidence Interval p-value Upper C.I.

Lower C.I.

Death

2.94

1.19

1.32

6.52

0.008

Discharge home

0.38

0.15

0.17

0.83

0.02

Table 4: Diabetes and Disposition outcomes with propensity score matching in COVID-19 patients Propensity matching used to adjust for age, gender, race, insurance, FIO2, CRP and BMI

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ABSTRACT #52 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW ENDOCRINOLOGY ENDOCRINE TREATMENT OF TRANSGENDER INDIVIDUALS: CURRENT GUIDELINES AND STRATEGIES James Christopher John Prince1, Joshua D. Safer1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in Expert Review of Endocrinology and Metabolism, 2020. PMID: 32990485 BACKGROUND/INTRODUCTION: This review summarizes gender affirming medical and surgical care available to transgender individuals, along with proposals to improve medically and culturally appropriate care.

Transgender individuals are those whose gender identity differs from that recorded at birth (usually based on visualization of external sexual anatomy). In order to align the body with the patient’s gender identity, clinicians can provide hormone therapy (HT) to bring sex hormone levels to the range associated with the patient’s gender identity. At steady state, monitoring for maintenance of levels, as well as for known risks and complications, is required. Treating clinicians should have knowledge of trans assessment criteria, hormone therapy, surgical options, primary care, and mental health needs of transgender patients.

METHODS: A narrative literature review was conducted using PubMed and EMBASE with articles then selected for relevance. The initial search terms were: androgen suppression, antiandrogen, breast development, chest reconstruction, cisgender, estrogen, fertility preservation, gender-affirming surgery, gender identity, gender incongruence, genital reconstruction, hormone replacement, hyperlipidemia, orchiectomy, prolactin, prostate atrophy, spermatogenesis, spironolactone, testosterone, thrombogenesis, transgender, and virilization.

RESULTS: Despite the wide acceptance of the current model underlying gender-affirming care for transgender and gender non-binary people, substantial barriers to care for transgender individuals remain. The largest of those barriers remains the lack of providers willing to provide the necessary care for transgender and gender non-binary persons.

CONCLUSION: Although guidelines exist and examples of training are available, systematic formal training must be implemented to truly mainstream high-quality gender-affirming health care.

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ABSTRACT #53 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW INFECTIOUS DISEASES LYME DISEASE: TREATMENT AND RECOMMENDATIONS Itay Rabinovitz1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Lyme disease is the most common vector-borne infectious disease, caused by the bite of an infected Ixodes tick with the bacterium, Borrelia burgdorferi. Untreated Lyme disease can produce a wide range of diseases, depending on the stage of infection: early localized as erythema migrans, and early disseminated and late disease as Lyme carditis, arthritis, and neuroborreliosis. The diagnosis and treatments of the disease varied manifestations are discussed here as per the current guidelines.

DIAGNOSIS AND MANAGEMENT: Prophylaxis treatment: Indication for prophylaxis treatment is within 72 hours of removal of an identified highrisk tick bite; i.e. identified Ixodes species; highly endemic area; duration of tick attachment for ≥36 hours. The preferred antibiotic for prophylaxis treatment is a single dose of oral doxycycline 200 mg.

Erythema migrans- Clinical diagnosis rather than laboratory testing is indicated in patients with a potential tick exposure in a disease endemic area who have skin lesions compatible with erythema migrans. In patients with skin lesions atypical for erythema migrans, two-steps antibody testing should be performed.

Treatment includes oral antibiotic therapy with a 10-day course of Doxycycline 100 mg twice daily OR 14-day course of Amoxicillin 500 mg three times daily OR 14-day course of Cefuroxime axetil 500 mg twice daily. If unable to take the above treatments, though possibly less effective, Azithromycin 500 mg once daily as a second-line agent.

Neuroborreliosis: Testing for Lyme disease is recommended in patients with a plausible exposure to ticks infected with B. burgdorferi presenting with meningitis, painful radiculoneuritis, mononeuropathy multiplex, acute cranial neuropathies or evidence of spinal cord inflammation. The recommended testing is serum antibody testing. CSF analysis is not necessary for diagnosis. Treatment of acute neurological manifestations will be with 14-21 day-course of IV Ceftriaxone 2 grams once daily, Cefotaxime 2 grams every 8 hours, Penicillin G 18-24 MU per day divided into doses given every 4 hours, or oral Doxycycline. If evidence of parenchymal involvement of the brain or spinal cord, should treat with intravenous antibiotic. Facial palsy can be treated with oral Doxycycline.

Lyme carditis: Patients with acute myopericarditis of unknown cause in an appropriate epidemiologic setting, should be tested for Lyme disease. Mild Lyme carditis, defined as 1st degree AV block with PR interval <300 ms, and severe carditis defined as either symptomatic carditis, 1st degree AV block with PR interval ≥300 ms, 2nd or 3rd degree AV block. Treatment includes of 14–21 day course of antibiotic therapy. For severe Lyme carditis, should start with IV Ceftriaxone until there is evidence of clinical improvement, then can switch to oral antibiotics to complete treatment. Oral choices are Doxycycline, Amoxicillin, and Cefuroxime, all which can be started for mild Lyme carditis.

Lyme arthritis: Diagnosed with serum antibody testing. In seropositive patients with treatment decisions that require more definitive information, should obtain PCR of synovial fluid or tissue. Treatment includes 28 daycourse of oral antibiotic, Doxycycline or Amoxicillin. For patients with no or minimal response for treatment, a second 2-4-week course of IV ceftriaxone will be preferred over a second 4-week course of oral antibiotics. If failed one course of oral antibiotics and one course of IV antibiotics, consider referral to a rheumatologist for possible use of DMARDs. CONCLUSION: Early diagnosis and treatment of Lyme disease can result in complete and rapid recovery and can help prevent the late manifestations of the disease. Identifying the different forms of disseminated Lyme disease is needed for tailored antibiotic treatment and to prevent varying degrees of permanent damage.

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ABSTRACT #54 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY FAVORABLE OUTCOMES AMONG PATIENTS WITH T-CELL/HISTIOCYTE-RICH LARGE B-CELL LYMPHOMA TREATED WITH HIGHER-INTENSITY THERAPY IN THE RITUXIMAB ERA Edith T. Robin1, Esther Drill2, Connie L. Batlevi2, Philip Caron2, Lorenzo Falchi2, Audrey Hamilton2, Paul A. Hamlin2, Steven M. Horwitz2, Andrew M. Intlekofer2, Erel Joffe2, Anita Kumar2, Matthew J. Matasar2, Ariela Noy2, Colette Owens2, Maria L. Palomba2, Ildefonso Rodriguez-Rivera2, David J. Straus2, Santosha Vardhana2, Gottfried R. von Keudell2, Andrew D. Zelenetz2, Craig H. Moskowitz2, Alison J. Moskowitz2 1

Mount Sinai Morningside/West Hospital, Icahn School of Medicine, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held virtually from December 5-8, 2020.

BACKGROUND/INTRODUCTION: T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is an uncommon variant of diffuse large B cell lymphoma (DLBCL), characterized by low content of lymphoma cells in a background of extensive infiltrate of T-cells and histiocytes. Historically, was considered an aggressive variant of DLBCL with poorer outcomes and 3-year OS <50%. To date, most series evaluating outcomes for patients (pts) with THRLBCL were published in the pre-rituximab era. Recent analysis suggested better outcomes for pts treated in the rituximab era. However, data regarding treatment patterns and outcomes in the rituximab era is limited. We aimed to describe the clinical characteristics, prognostic factors, response to treatment, and outcome among patients diagnosed with THRLBCL at Memorial Sloan Kettering Cancer Center (MSKCC) in the rituximab era.

METHODS: Retrospective review of all cases of THRLBCL at MSKCC from January 2000 to October 2019.

Data included demographic and clinical characteristics, pathology results, disease stage and sites of involvement, treatment regimen, and outcome. Fisher’s exact test and Wilcoxon test were used to assess associations between patients’ characteristics and treatment regimen, and between categorical or continuous characteristics and response to treatment. The likelihood ratio test was used to assess significance of Cox regression univariate models.

RESULTS: Our cohort included 67 patients for analysis. Median follow up duration among survivors was 3.4 years (range: 0.4-10.8 years). The majority were males. Median age at diagnosis was 41 years (range: 19-86 years). Most of the patients were diagnosed at stage IV. Thirty-five patients had an involvement of more than 1 extra-nodal site. The most common site was bone (60%). Bone marrow biopsy was positive in 14 patients.

Univariate analysis was performed for age, gender, ethnicity, stage, extra-nodal sites, B symptoms, performance status, elevated LDH, IPI score ≥ 3, and history of NLPHL. None of these factors was significantly associated with response rate, event free survival (EFS), or overall survival (OS). Frontline treatment included R-CHOP or R-CHOP based treatment in 48%, R-EPOCH in 12%, R-CHOP/R-ICE (4 cycles of R-CHOP-14 followed by 3 cycle of R-ICE) in 33% and other regimens in 7.5%. Fifty-one (76%) patients had a complete response (CR) to frontline treatment. Among these patients, 6 relapsed. Sixteen (24%) patients had refractory disease. Eighteen received additional therapy. In the whole cohort, 3-year EFS was 68% and 3-year OS was 85%. In a sub-group analysis of patients who received R-CHOP/R-ICE versus R-CHOP or R-EPOCH, CR rates were 95% and 70% respectively (p=0.014). The R-CHOP/R-ICE regimen was also associated with higher 3 years EFS of 86% compared to 62% (p=0.049) and a better 3-year OS of 100% compared with 79% (p=0.016). The 2 treatment groups were not significantly different with regards to baseline characteristics.

CONCLUSION: Our study demonstrates better outcomes among patients with THRLBCL compared to available historical data from the pre-rituximab era. In addition, with the limitation of a retrospective, singlecenter study, our data suggests that for newly diagnosed THRLBCL, treatment with a higher intensity regimen, such as R-CHOP/R-ICE, may be associated with favorable outcome.

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ABSTRACT #55 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE IDENTIFYING RESIDENT BARRIERS IN RECOGNIZING AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH Ines Robles Aponte1, Shruti Anand1, Sananda Moctezuma1, Pratyusha Nunna1, Dipal Patel1, Tamara Goldberg1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

BACKGROUND/INTRODUCTION: Social determinants of health (SDH) are important predictors of health outcomes. The World Health Organization defined SDH as “conditions in which people are born, grow, live, work and age.” Since 2016, our Internal Medicine Ambulatory curriculum has introduced Residents to principles of equitable patient care including how SDH impact the health outcomes of our patients. This study examines the impact of the curriculum on resident knowledge and practice habits as they relate to SDH and health disparities. During phase one of this project, we invited all Internal Medicine Residents at a large urban program to complete an online survey in the Fall of 2020. Through this survey, we isolated potential knowledge gaps and barriers. Phase 2 of the project will focus on peer-to-peer resident education on screening for SDH, documenting findings as assessments (Z-codes) and writing social prescriptions. We also hope to create resource sheets for both resident providers and patients.

METHODS: To assess the effect of these interventions, we will measure changes in the use of EMR-based SDH screening tools, Z-codes assessments, and utilization of patient education regarding specific interventions and referrals. We will also re-survey the residents to track changes in perception and practices for addressing SDH and health disparities.

RESULTS: Of 126 potential subjects, 65 (52%) completed the survey. While 98.5% of them noted the importance of SDH on health outcomes, only 7.7% knew how to use the screening tool in the clinic EMR, 3.1% knew to document SDH as an assessment and 31.1% noted knowledge gaps in recognizing SDH as a barr ier.

Other barriers included lack of appropriate time in clinic and uncertainty in available resources once SDH was identified. Most (84%) did consider it to be a physician’s responsibility to address SDH. CONCLUSION: Addressing SDH during a clinical encounter is a key component to improving health outcomes. Our survey identified numerous barriers to recognizing and addressing SDH in our residency clinic.

We showed that despite a formal, established curriculum on SDH and health disparities, residents remain unprepared to apply that knowledge in a practical manner. Our educational interventions aim to decrease these knowledge-to-practice gaps. Through this repeated application, we hope that addressing SDH becomes as second nature as checking vital signs.

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ABSTRACT #56 CLINICAL RESEARCH CARDIOVASCULAR DISEASE USEFULNESS OF SARCOPAENIA INDEX FOR PREDICTING OUTCOMES IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT Francisco J. Romeo1,2, Ignacio Miguel Seropian1, Juan Guido Chiabrando1, Juan Valle Raleigh1, Maximiliano Smietniansky2, Mariela Cal2, Mariano Falconi2, Vadim Kotowicz2, Carla R. Agatiello2, Daniel H. Berrocal2 1

Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020. *Recipient of the Paul Dudley White International Scholar Award for the highest rank abstract from Argentina.

BACKGROUND/INTRODUCTION: Sarcopenia, a marker of biological senescence, is a robust prognostic indicator of outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). However, there are no serum markers routinely available for estimating skeletal muscle mass (SMM).

The present study aimed to describe a new sarcopenia index (SI, serum creatinine value/cystatin C value x 100) and investigate its association with outcomes after TAVR. METHODS: The study cohort comprised 100 patients ≥ 65 years of age (mean=83.9 ± 5.7 years; 36% men) who underwent transfemoral TAVR at Hospital Italiano de Buenos Aires, Argentina from 2016 to 2018. The mean Society of Thoracic Surgeons (STS) score was 3.3 ± 1.7. Sarcopenia was defined according to ROC curve for SI (AUC 0.731; 95% CI, 0.599-0.863; p=0.001) for predicting the primary endpoint. Both all-cause mortality and/or readmissions for congestive heart failure (CHF) were defined as the primary endpoint within the first year after TAVR. RESULTS: According to SI cutoff, half of the study population (SI ≤ 66) was sarcopenic before TAVR. The 30day mortality increased significantly in the lowest SI tertile (sarcopenia+) group (12, 3, and 0%, p=0.05, respectively). SI strongly correlated with “timed-up” and “go and gait speed,” but not with body mass index and baseline C-reactive protein levels. Overall survival was worse (Log-rank test, p=0.02) and CHF readmissions were more prevalent in the lowest SI tertile (Log-rank test, p=0.01). On Cox regression analysis, a low SI (SI ≤ 66) had a significantly higher risk of the primary endpoint (adjusted hazard ratio, 4.01; 95% CI, 1.31-12.27; p=0.015) CONCLUSION: SI, a novel-non-invasive method for assessing SMM was able to predict mid-term mortality and CHF readmissions. We suggest careful consideration of sarcopenia prior to TAVR in order to decide the best treatment approaches.

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ABSTRACT #57 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY FACTOR XI DEFICIENCY IN PREGNANT WOMEN: A CASE-SERIES FROM A NEW YORK CITY HOSPITAL Guilherme Sacchi De Camargo Correia¹, Sridevi Rajeeve², Lawrence Cytryn1

1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the European Association for Haemophilia and Allied Disorders (EAHAD) Annual Meeting that was held virtually from February 3-5, 2021.

BACKGROUND/INTRODUCTION: Factor XI (FXI) deficiency (FXID) has an estimated prevalence of 1:1000000 cases for the homozygous presentation in the general population. In people of Ashkenazi and Iraqi Jewish ancestry, the prevalence of heterozygous cases is about 8%. Still, FXID may pose an increased risk in pregnancy and delivery. This case series describes the experience of a General Hematology Outpatient Service (GHOS) with pregnant women with FXID. METHODS: This study analyzed the data of 49 patients with FXID who were evaluated at least once at the GHOS at Mount Sinai West between October 2016 and February 2020. FXID was diagnosed on routine genetic screening early in their obstetric care. 4 patients were excluded from the final analysis: 3 were not pregnant, and 1 did not have FXID. FXI activity (FXIA) was measured at least twice during pregnancy: at the first visit and at about gestational week (GW) 37. The mean (M) and standard deviation for the most relevant clinical data were obtained. FXIA at the first visit and near term were compared with a paired T-test.

RESULTS: The group of 45 patients had a mean age at delivery of 34.09 years. 2.38% of the cases with available data were homozygous. Of 39 cases with ethnicities described, 71.79% were Ashkenazi Jewish. FXI gene mutations data was available for 39 cases, mutation c.901T>C, p.F301L was present in 61.54%. The M FXIA in the first visit was 60.18%, being 52.08% around GW37. No statistically significant difference was found (p=0.17) between these 2 FXIA values. 4 patients were treated prophylactically on delivery: 1 patient received Tranexamic Acid (TXA) and Fresh Frozen Plasma (FFP) for a FXIA of 21% on GW37, and received general anesthesia; 2 patients received FFP [1 patient due to an elevated aPTT (57.4s) on delivery date, with no anesthesia on delivery; and the other patient as prevention for a FXI of 45% on GW37, who was planned for a neuraxial block (NB)]; lastly, 1 patient received TXA for a FXIA of 42% with a prior history of bleeding on surgeries and an opioid patient-controlled analgesia on delivery. No bleeding complications were verified during pregnancy or delivery.

CONCLUSION: There was no statistical difference between FXIA earlier in pregnancy and around GW37, as such, checking FXIA throughout pregnancy may be unnecessary. Future study may answer this question and establish a reliable threshold FXIA at which NB could be safely performed as the optimal management of these patients remains a work in progress.

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ABSTRACT #58 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE/ENDOCRINOLOGY FACTORS INFLUENCING PATIENTS’ ABILITY TO SELF-MANAGE AND CONTROL TYPE 2 DIABETES Yeriko Santillan1, Tamara Goldberg1, Olufunke Olushoga1, Theresa Mack1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

BACKGROUND/INTRODUCTION: Since most guidelines suggest that self-management is a critical pillar of optimal diabetes care, it is essential to understand the barriers to self-care among high-risk diabetic populations to improve overall control. The study was conducted to identify the factors impacting selfmanagement of diabetes in an urban, underserved population.

METHODS: Our project was conducted at a Federally Qualified Health Center in New York City that serves as a primary care training site for Internal Medicine Residents. The clinic population is ethnically diverse and financially-burdened, with the majority of patients falling below the federal poverty level. In 2019, the rate of uncontrolled diabetics (A1c ≥ 9%) was between 25-32%. To better understand barriers to diabetic self-care among this population, we conducted a retrospective case study of 161 patients seen at our clinic between January 2017 and January 2019. The following was collected: age, sex, zip code, history of psychiatric diagnoses, applicable Z codes based on social/educational history, number of primary care visits, number of visits with a nutritionist, number of visits with a certified diabetic educator (CDE), number of hemoglobin A1c results and their values, and number of missed appointments. We then stratified patients who achieved an A1c < 9 by the end of the study period and those who remained ≥ 9, and compared the above variables using odds ratio.

RESULTS: Of 161 patients with hemoglobin A1c ≥ 9, 44% attained a hemoglobin A1c < 9 by January 2019.

Women were more likely to remain uncontrolled than the men in our study (OR, 1.22). Patients who did not achieve glycemic control were more likely to have poor health literacy (OR, 2.6), life-management problems (i.e., cognitive and/or physical issues limiting ability to adhere with medications and manage daily tasks) (OR, 4.27), to be under- or uninsured (OR, 1.78), have a concomitant mental illness (OR, 1.44), and to have missed appointments with their primary provider (OR, 1.42). Patients who did not attend a nutritionist or CDE appointment were just as likely to achieve glycemic control as those who did (OR, 1.0).

CONCLUSION: This retrospective chart review sheds light on key variables contributing to long-term diabetic control among a low-income, underserved urban population. Decreased number of missed appointments with a PCP was associated with better control, yet we found no difference in control between those who were engaged in care with a CDE or nutritionist and those who were not. Life-management problems and poor health literacy had the greatest association with poor control. These results help guide our intervention priorities such as reducing no-shows, routinely screening and documenting social barriers to care, focusing on resources to mitigate these barriers, and providing patients with literacy-appropriate educational material. A limitation of this project was that social barriers were not documented in s a standardized way, suggesting the importance of educating our resident providers about Z codes.

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ABSTRACT #59 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY JEJUNAL GIST: AN UNUSUAL CAUSE OF ACUTE MASSIVE GASTROINTESTINAL BLEEDING Suraj M. Shah1, Yingheng Lui1, Ilan Weisberg2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology Annual Meeting; San Antonio, TX, United States that was held on October 25-30, 2019.

BACKGROUND/INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are rare, making up 0.1-3% of all gastrointestinal (GI) tumors. While most commonly found in the stomach, GISTs in jejunum are among the rarest subtypes. The majority of GISTs present with occult GI hemorrhage. Here we present a case of massive GI bleeding due to a jejunal GIST in a young woman with BRCA2 gene mutation.

CASE PRESENTATION: A 30-year-old woman presented with 1 day of melena and symptomatic anemia.

Medical history was notable for BRCA2 gene mutation. Family history was significant for colon cancer in her maternal grandfather and breast cancer in her maternal aunt. On admission, there was melena in the rectal vault and her abdomen was soft, non-tender with no palpable masses. She was anemic with hemoglobin 6.8 g/dL. Emergent EGD revealed no blood or source of bleeding identified. After a rapid bowel preparation, an urgent colonoscopy showed melena in the entire colon and examined terminal ileum, however no culprit lesion was identified. Patient was hemodynamically unstable subsequently so an urgent computed tomography angiogram was performed and revealed active GI bleeding from the jejunal artery. A 3.1 x 2.2 cm mass with peripheral hemorrhage in the left upper quadrant was seen. The patient then underwent emergent embolization of two jejunal branches. An exploratory laparotomy was subsequently performed with resection of a proximal jejunal mass. Histology confirmed a spindle-cell GIST with positive staining for c-kit (CD117). Given the size, low-grade, and mitotic rate of 1/50 high-power field, no adjuvant therapy was needed. Magnetic resonance imaging surveillance was recommended.

DISCUSSION: Bleeding jejunal GIST is a rare cause of acute massive GI bleeding. GISTs can be particularly difficult to diagnose because of their endoscopic inaccessibility. The majority of GISTs are thought to be a result of activating mutations of proto-oncogenes c-KIT (CD117) or PDGFR-alpha. These then increase tyrosine kinase receptor activity and result in the proliferation of stem cells. No reports yet suggest a direct association between a BRCA2 germline mutation and small bowel neoplasms.

CONCLUSION: This case highlights a dramatic presentation of massive hemorrhage from a GIST, especially when confined to the small bowel. Further studies are needed to establish whether an association exists between BRCA mutations and GIST as well as other small bowel neoplasms.

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ABSTRACT #60 QUALITY IMPROVEMENT PALLIATIVE CARE/PULMONARY/CRITICAL CARE IMPROVING PALLIATIVE CARE DELIVERY IN THE INTENSIVE CARE UNIT: A QUALITY IMPROVEMENT PROJECT Jacqueline Sheehan1, Kam Sing Ho1, Charles Gaulin2, Setareh Alipour3, Gustavo Contreras Anez1, Jennifer Fung1, Christie Mulholland1, Howard Anthony Arabelo1, Janet Shapiro1 1Mount

Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Sloan Kettering Cancer Center, New York, NY, United States; 3University of Connecticut Health, Farmington, CT, United States 2Memorial

Accepted at the Annual Assembly of Hospice and Palliative Care; San Diego, CA, United States that was scheduled to be held from March 18-21, 2020.

BACKGROUND/INTRODUCTION: Approximately one in five deaths in the United States occurs during or shortly after admission to the intensive care unit (ICU). Enhancing palliative care delivery in the ICU reduces length of stay (LOS), facilitates transition to lower acuity settings, and strengthens continuity of care. Our baseline data indicated that many patients who met triggers and survived the medical ICU (MICU) did not receive palliative care consultative services. This research aimed to evaluate the impact of a modified triggerbased consultative model on palliative care delivery in the MICU. METHODS: All patients admitted to the Mount Sinai St. Luke’s MICU February 1, 2019 - May 31, 2019 who met triggers for palliative care, were reviewed and directly communicated between MICU and palliative care attendings. The primary outcome was the total number of palliative care consultations that originated from the MICU. Secondary outcomes included time from hospital and MICU admission to consultation, LOS, and mortality. Variables were compared to the pre-intervention period, February 1, 2018 - May 31, 2018, using a two-tailed t-test. Statistical analysis was performed using Stata® version 15.

RESULTS: Palliative care consultations originating from the MICU significantly increased from 35 to 54 (p< 0.04) following the intervention. Time from hospital and MICU admission to consultation was similar in both groups (8.31 versus 5.9 days, p=0.52; 5.5 versus 4.4 days, p=0.79). Hospital and MICU LOS did not change following the intervention (20.8 versus 19.2 days, p=0.43; 13.4 versus 11 days, p=0.34). Overall mortality was comparable following the intervention (65.7% versus 61.1%, p=0.06).

CONCLUSION: The implementation of a modified trigger-based palliative care consultative model in the MICU increased palliative care delivery. Assessing the impact of palliative care delivery on symptom management, emotional support, and disposition is warranted.

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ABSTRACT #61 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GENERAL INTERNAL MEDICINE PUZZLING PICTURE: CLINICAL COURSE OF TOXICITY, WITHDRAWAL, AND ASEPTIC MENINGITIS FROM ORAL BACLOFEN USE Shabari Shenoy1, Travis Burnett1, Akunna Ihemaguba2, Tulsi Shah1, Michelle Sterpi1, Kirtipal Bhatia1, Amita Buddhdev1, Maanit Kohli1 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mario School of Pharmacy, Rutgers University, NJ, United States

Presented at the Society of Hospital Medicine (SHM) Converge Annual Meeting that was held virtually from May 3-7, 2021.

BACKGROUND/INTRODUCTION: Baclofen, an analog of the neurotransmitter gamma-aminobutyric acid (GABA), acts at the level of the brain and spinal cord. It is approved by the FDA for the treatment of spasticity from spinal cord lesions and multiple sclerosis. Baclofen is used off-label to maintain alcohol abstinence and treatment of AW, with numerous studies that support and contradict the rationale behind it. Acute baclofen toxicity manifests as delirium, hallucinations, impaired consciousness, and autonomic disorders, whereas chronic toxicity can manifest as hallucinations, impaired memory, catatonia, and acute mania. Baclofen withdrawal can present with visual, auditory, tactile hallucinations, delusions, fluctuating consciousness, fever, and hyperthermia.

CASE PRESENTATION: A 64-year-old male with a medical history of left-occipital stroke and alcohol use disorder presented with progressively worsening dizziness and weakness of his extremities for six months. The complaints were associated with numbness of fingertips and toes with gait instability resulting in repeated falls.

He correlated the symptoms with starting baclofen (taking 160-200 mg/day). He endorsed drinking 3-4 glasses of wine daily (for 30 years) with a recent increase in alcohol intake. On examination, he had a wide-based gait, his initial labs, urine-toxicology, and neurological imaging were unremarkable. On admission, the differential diagnosis for the weakness was Wernicke’s encephalopathy versus alcohol withdrawal. Suspicion for Wernicke’s encephalopathy was low, given lack of oculomotor dysfunction, no T2 FLAIR hyperintensities on MRI, and normal thiamine levels. On day 3, he was somnolent, confused, and disoriented, with periodic neurological physical examinations revealing waxing and waning pattern of alertness. Repeat imaging studies and electroencephalogram did not reveal mass effect, infarct, or seizures. Electromyography was not suggestive of Acute Inflammatory Demyelinating Polyneuropathy. The possibility of withdrawal from baclofen was considered, and the medication was re-introduced. On day 7, although the patient’s mental status improved significantly, he spiked fevers to 101F. Lab work revealed markedly elevated ESR and CRP with negative blood and urine cultures. Lumbar puncture revealed elevated protein 204.8 mg/dL (0-40 mg/dL). The rest of the parameters, including cultures and viral panel, were negative, suggesting aseptic meningitis. In the absence of other etiologies, aseptic meningitis due to baclofen use was considered, and the baclofen was gradually tapered and discontinued. The patient’s mental status progressively improved, and his presenting complaints resolved.

DISCUSSION: Although cases of aseptic meningitis after intrathecal administration of baclofen have been reported, cases of aseptic meningitis after oral baclofen use are rare. Our patient presented with symptoms consistent with baclofen toxicity and developed manifestations of withdrawal during the hospital course with evidence of aseptic meningitis on CSF studies. A comprehensive evaluation for nutritional, infectious, and inflammatory causes was negative, and the diagnosis was established with observed clinical improvement on restarting the baclofen and slowly tapering it.

CONCLUSION: It is important to consider withdrawal from off-label medications and identify clinical presentations early. Although rare, aseptic meningitis from oral baclofen should be included among the differentials in cases such as the one presented above.

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ABSTRACT #62 QUALITY IMPROVEMENT CARDIOVASCULAR DISEASE A COMPREHENSIVE PROGRAM OF POST AMI CARE IMPROVES MEDICATION PRESCRIPTION UPON DISCHARGE Michel Skaf1, Wojciech Rzechorzek2, Kirtipal Bhatia1, Subrat Das1, Claire Huang Lucas1, Jan Lopes1, Basera Sabharwal3, Lingling Wu1, Syed Ahsan2, Jacqueline Tamis-Holland1,4 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Westchester Medical Center, Valhalla, NY, United States; 3Mount Sinai Morningside, Icahn School of Medicine, New York, NY, United States; 4BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY, United States 2

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

BACKGROUND/INTRODUCTION: Approximately 12% of pts with acute myocardial infarction (AMI) are readmitted within 30 days (30-D-Admit). Educational programs and discharge care plans for patients with AMI may improve compliance with medical therapy, overall outcomes, and reduce 30D-Admit. We hypothesized that a comprehensive program aimed at patient education and improving processes of care after AMI would result in reduced 30D-admit.

METHODS: We examined pts with AMI enrolled in our Quality Improvement Program (AMI-QIP) focused on patient education, improving discharge prescriptions, and ensuring early follow-up. Patients not enrolled in this program due to a lack an AMI liaison at the time of discharge acted as controls. We compared baseline variables, disease characteristics, hospital course, discharge medications, and 30D-admit between the two groups.

RESULTS: 207 patients in our AMI-QIP (age 65 ± 1 years; female 33%) were compared with 207 controls (age 65 ± 1 years; female 31%). AMI-QIP patients had less triple vessel (27% versus 39%, p=0.007) and Left Main disease (4% versus 10%, p=0.03), received more PCI (74% versus 62%, p=0.008), and were less likely to be medically managed (10% versus 21%, p=0.003). There were otherwise no significant differences in baseline variables or hospital course between the two groups. Beta Blocker (94% versus 88%, p=0.04), statins (100% versus 93%, p=0.001), and P2Y12 inhibitors (94% versus 81%, p=0.001) were more frequently prescribed for AMI-QIP patients. AMI-QIP patients were also more likely to be given a follow-up appointment (85% versus 76%, p=0.035) prior to discharge. Multi-variate analysis showed that enrollment in our AMI-QIP was independently associated with greater odds of receiving statins (OR, 6.4; 95% CI, 1.9-20.5; p=0.002), P2Y12Y inhibitors (OR, 13.3; 95% CI, 6.4-27.6; p<0.001), a trend toward receiving beta blockers (OR ,1.8; 95% CI, 0.9-3.6; p=0.07), and a follow-up appointment (OR, 1.5; 95% CI, 0.9-2.5; p=0.08). 30D-admit was not significantly different between the two groups (10% versus 8%, p=0.39).

CONCLUSION: Establishing a program aimed to improve the post-discharge care of patients with an AMI improves medication prescription and trends toward better follow-up appointment scheduling prior to discharge. However, our AMI-QIP did not result in reduced 30D-admit.

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ABSTRACT #63 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY TRENDS AND IN-HOSPITAL OUTCOMES OF SPLANCHNIC VEIN THROMBOSIS ASSOCIATED WITH GASTROINTESTINAL MALIGNANCIES: A NATIONWIDE ANALYSIS Shivani Handa1, Kamesh Gupta2, Michelle Sterpi1, Ahmad Khanc3, Abhinav Hoskote1, Anup Kasid4 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; UMMS-Baystate Medical Center, Springfield, MA, United States; 3West Virginia University-Charleston Area Medical Center, Charleston, WV, United States; 4Kansas University Medical Center, Kansas City, KS, United States 2

Published in Gastrointestinal Tumors, 2021 and Journal of Clinical Oncology, 2020.

BACKGROUND/INTRODUCTION: Gastrointestinal cancers have a strong association with splanchnic vein thrombosis (SVT), yet the hospitalization data is unknown.

METHODS: We analyzed around 78 million discharges from the 2007–2017 Nationwide Inpatient Sample with an inclusion criterion of adult patients admitted for portal or hepatic vein thrombosis as a primary diagnosis with a gastrointestinal or hepatobiliary malignancy as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models.

RESULTS: Out of the total 32,324 hospitalizations for SVT, 3,220 (10%) were associated with a GI malignancy, of which hepatocellular carcinoma (HCC) and pancreatic cancer were the most common. Portal vein thrombosis accounted for 95% of these hospitalizations. Admissions for pancreatic cancer-associated SVT have increased by 7.2 times from 2007 to 2017. Patients with SVT and concomitant GI malignancies were significantly older and had a higher comorbidity score than those with SVT without GI malignancy. Risk of inpatient mortality for SVT patients were significantly higher for patients with gastric cancer (rate: 12.1%; OR, 8.6; 95% CI, 1.8–39.7) and HCC (rate: 7.6%; OR, 2.77; 95% CI, 1.5–4.8) as compared to non-GI malignancy-related SVT. Odds of variceal bleeding were significantly higher for patients with HCC (OR, 1.67; 95% CI, 1.2–2.34) than patients without GI malignancy.

CONCLUSION: Digestive cancer-associated SVTs constitute 10% of all SVT related hospitalizations and are significantly increasing in the past decade. We report the baseline characteristics and predictors of inpatient mortality in this study.

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ABSTRACT #64 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW INFECTIOUS DISEASES IT’S STRONGYLOIDES BUT WHAT ELSE COULD IT BE? Hendrik Sy1, Sara Zalcgendler1, Deborah Edelman1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

BACKGROUND/INTRODUCTION: The rate of Strongyloides stercoralis infection can be as high as 46% in the immigrant population. S. stercoralis, a soil-transmitted helminth, can live its entire life cycle completely in a human host and can persist for decades through autoinfection.

CASE PRESENTATION: A 68 year-old man with coronary artery disease presented to our clinic for a follow-up visit. The patient was born in an internal farming region in Liberia and emigrated to the U.S. in the 1970s. He continued to travel to Liberia biannually. Chart review revealed persistent, asymptomatic eosinophilia since establishing care in 2017 with a maximum of 1634 cells/microL. Given his epidemiological exposures, our clinical concern was a chronic infection with S. stercoralis. Strongyloides IgG returned positive and a peripheral blood smear was normal except for mild eosinophilia. We did not treat with Ivermectin immediately given the risk of precipitating ocular or cerebral edema if he had a concomitant Loa loa infection. He was referred to an Infectious Disease clinic for further guidance. A thick smear to evaluate for Loa loa was negative and the patient was treated with Ivermectin. Serial stool exams for Schistosoma mansoni and haematobium were recommended.

DISCUSSION: This case highlights the importance of incorporating epidemiologic exposures in the evaluation of incidental laboratory abnormalities. Despite varied presentation, strongyloidasis is often asymptomatic. The most common clinical finding is an elevated eosinophil count. However, the potential long-term health consequences can be severe. Hyperinfection syndrome due to disseminated strongyloidiasis, a complication that can occur decades after infection, is associated with immunosuppression and high-dose steroids. It has a mortality rate of over 50%. The first step in screening patients is by serology. Examination of stool has low sensitivity in uncomplicated infections. The first line treatment for Strongyloides infection is Ivermectin. A relative contraindication to Ivermectin is a concomitant infection with Loa loa which is co-endemic in Central and West Africa. Immigrants from these areas should be screened for Loa loa infection prior to initiating treatment due to the risk of fatal encephalopathy with Ivermectin. Loa loa is not detectable on stool examination and is diagnosed by presence and quantification of microfilariae on thin and thick blood smear. If positive, Albendazole for 7 days is the treatment alternative.

CONCLUSION: Though often overlooked, persistent eosinophilia, especially in immigrants or travelers from endemic countries should prompt further evaluation of parasitic infection. Understanding the epidemiology of the African region our patient was from was pertinent for clinical reasoning and guided further diagnosis and treatment for a potentially fatal disease.

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ABSTRACT #65 QUALITY IMPROVEMENT NEPHROLOGY IMPROVING MANAGEMENT OF HYPERKALEMIA IN HOSPITAL INPATIENTS Ciaran Twomey Brenner1, Caroline Dooley1, Bertin Salguero Porres1, Kimberly Sarosky1, Ruchika Batwara1, Janet Shapiro1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Hyperkalemia is a common problem encountered in the inpatient setting, but management varies greatly between providers. There is a paucity of clear guidelines on this subject, although Kidney Disease Improving Global Outcomes (KDIGO) released a summary statement in 2020. The aim of this project was to review current practice regarding hyperkalemia in a single hospital setting, and to formulate a strategy to standardize management and reduce adverse events.

METHODS: A questionnaire was sent to all Nephrologists working at Mount Sinai Morningside (MSM) to assess how local practice compares with KDIGO summary on management of hyperkalemia. A search was performed looking for uses of hyperkalemia order set in the hospital’s electronic medical record (EMR) system within a 1-month period. Demographic data was collected for patients as well as documentation of ECG, laboratory data, treatment modalities used, and evidence of treatment complications.

RESULTS: 6 nephrologists responded to the questionnaire, treatment modalities varied greatly, and there was no consistent approach particularly for mild hyperkalemia (5.5-6.0) in the absence of renal disease. There were 57 uses of hyperkalemia order set in 42 patients. Mean serum potassium 6.07 mEq/L prior to treatment (range, 4.9-7.8). 10.5% of treated episodes were based on a hemolyzed sample. ECG was performed in 64.9% of patients. The treatments most frequently were rapid acting insulin with 50% dextrose (84%), GI binders (54%), and IV calcium (44%). Furosemide (17%), hemodialysis (14%), and albuterol (7%) use was less common. Of patients receiving insulin therapy, 32% had no documented glucose within two hours of insulin administration. There were six episodes of documented hypoglycemia (12.5%), with low weight, reduced GFR, and low baseline glucose identified as potential risk factors.

CONCLUSION: Our project revealed an inconsistent approach to hyperkalemia management among providers at MSM. Areas of concern included ECG documentation and treatment of hyperkalemia on hemolyzed labs.

Particularly concerning was the preferential use of insulin therapy over other treatment modalities and a concurrent high rate of hypoglycemia following treatment. Future work will focus on reducing harm through physician education on risk factors for hypoglycemia and adjusting the hyperkalemia order set to include an option for low-dose insulin.

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ABSTRACT #66 CLINICAL RESEARCH GASTROENTEROLOGY ENDOSCOPIC ULTRASOUND CAN IDENTIFY PATHOGNOMONIC FEATURES OF AUTOIMMUNE PANCREATITIS THAT DISTINGUISH IT FROM PANCREATIC CANCER: A MATCHED CASE-CONTROL STUDY Angad S. Uberoi1, Jeong Yun Yang2, Amir Taree2, Alexandros Polydorides2, Rebekah E. Dixon2, Nikhil A. Kumta2, Satish Nagula2, Christopher J. DiMaio2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

To be presented at the Digestive Disease Week (DDW) that will be held virtually from May 21-23, 2021.

BACKGROUND/INTRODUCTION: Endoscopic ultrasound (EUS) is a mainstay in the work-up of autoimmune pancreatitis (AIP). However, there is debate about the role of EUS-guided fine needle biopsy (FNB) in patients who are being evaluated for pancreatic disease but do not have typical radiographic or serologic features o f AIP. The identification of specific features on EUS may help alert endo-sonographers to when AIP may be present, and thus guide the appropriate use of FNB. The aim of this study is to identify EUS features associated with AIP. METHODS: This is a single-center retrospective study. Patients with a histopathological diagnosis of AIP were identified from a pathology database. The study group was age-matched to a control group of patients with biopsy proven pancreatic cancer (PC). Data pertaining to demographics, clinical history, radiological and lab findings, EUS features and histopathology was collected. Histopathological specimens and EUS images were reviewed by dedicated experts. Continuous variables were presented as mean and standard deviation.

Intergroup differences between AIP and PC were assessed using the two-sample t-test for continuous data.

For nominal data, the chi-squared test was performed unless the frequencies in the contingency table were ≤ 5, in which case the Fisher Exact test was used.

RESULTS: In the final analysis, 25 patients with biopsy proven AIP were compared to 25 age-matched patients with PC. Baseline demographics and clinical presentation are shown in Table 1. There were no significant differences in the clinical presentations of the two groups. Patients with AIP more commonly had a history of other autoimmune conditions. EUS features that were significantly more common in AIP compared to PC included diffuse pancreatic parenchymal hypo-echogenicity (60% versus 0%, p<0.001), anechoic fluid rim (36% versus 0%, p=0.002), and thickened bile duct wall (32% versus 0%, p=0.004) (Table 2). Nine (36%) AIP patients had none of these features, but all did have a focal mass. EUS features that were significantly more common in PC compared to AIP included focal mass (100% versus 36%, p<0.001), bile duct dilation (60% versus 28%, p=0.02), and dilated pancreatic duct (56% versus 28%, p=0.04). There was no significant difference in the presence of pancreatic atrophy, vascular involvement, or abnormal lymph nodes between the two groups.

CONCLUSION: There are significant differences in EUS features in patients with autoimmune pancreatitis compared to pancreatic cancer. Pancreatic cancer patients are more likely to exhibit a focal mass with biliary and/or pancreatic duct dilation. On the other hand, the features of diffuse pancreatic parenchymal hypoechogenicity, anechoic fluid rim, and thickening of the bile duct wall were found exclusively in autoimmune pancreatitis patients. As such, in patients with unexplained pancreatic disease undergoing EUS evaluation, the presence of these features should raise suspicion for autoimmune pancreatitis and FNB should be considered.

98

AIP (n=25)

Pancreatic Cancer (n=25)

p-value

66.6 ± 14.1

66.9 ± 13.7

0.94

Female (%)

6 (24)

13 (52)

0.04

Male (%)

19 (76)

12 (48)

-

White (%)

16 (64)

15 (60)

0.77

Black (%)

1 (4)

5 (20)

0.19

Other race (%)

7 (28)

5 (20)

0.74

Hispanic Latinx (%)

3 (12)

3 (12)

1.00

Non-Hispanic (%)

22 (88)

22 (88)

1 (4)

3 (12)

0.61

Ex-Smoker (%)

10 (40)

9 (36)

0.77

Never Smoker (%)

14 (56)

13 (52)

0.78

Current (%)

12 (48)

14 (56)

0.57

Prior (%)

5 (20)

9 (36)

0.21

Never (%)

5 (20)

1 (4)

0.19

Unknown (%)

3 (12)

1 (4)

0.61

BMI (mean ± SD)

25.3 ± 3.9

26.4 ± 6.8

0.48

Diabetes (%)

11 (44)

7 (28)

0.24

Autoimmune Disease (%)

6 (24)

0 (0)

0.02

Acute Pancreatitis (%)

3 (12)

1 (4)

0.61

Chronic Pancreatitis (%)

0 (0)

0 (0)

Family History of Pancreatic Disease (%)

1 (4)

6 (24)

0.09

Abdominal Pain (%)

14 (56)

16 (64)

0.56

Jaundice (%)

10 (40)

9 (36)

0.77

Weight Loss (%)

13 (52)

17 (68)

0.25

Steatorrhea (%)

3 (12)

2 (8)

1.00

Age (mean ± SD)

Race

Ethnicity

History of Smoking Current Smoker (%)

History of Alcohol Use

Table 1. Patient demographic and clinical features

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AIP (n=25)

Pancreatic Cancer (n=25)

p-value

Diffuse Hypoechogenicity (%)

15 (60)

0 (0)

<0.001

Focal Mass (%)

9 (36)

25 (100)

<0.001

Anechoic Fluid Rim (%)

9 (36)

0 (0)

0.002

Thick Bile Duct Wall (%)

8 (32)

0 (0)

0.004

Bile Duct Dilation (%)

7 (28)

15 (60)

0.02

Pancreatic Duct Dilation (%)

7 (28)

14 (56)

0.04

Pancreatic Atrophy (%)

5 (20)

6 (24)

1.00

Vascular Invasion (%)

3 (12)

1 (4)

0.61

Enlarged Abnormal Lymph Node(s) (%)

5 (20)

5 (20)

1.00

Table 2. EUS features

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ABSTRACT #67 CLINICAL RESEARCH CARDIOVASCULAR DISEASE SAFETY AND COMPLICATIONS OF CATHETER ABLATION FOR ATRIAL FIBRILLATION: PREDICTORS OF COMPLICATIONS FROM AN UPDATED ANALYSIS THE NATIONAL INPATIENT DATABASE Lingling Wu1, Bharat Narasimhan1, Kam S. Ho1, Yingying Zheng2, Arti N. Shah1, Bharat K. Kantharia1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; East Carolina University, Greenville, NC, United States

2

Presented at the American College of Cardiology (ACC) Annual Meeting that was held virtually from March 28-30, 2020.

BACKGROUND/INTRODUCTION: Catheter ablation is increasingly employed in the management of atrial fibrillation (AF). Data regarding safety of ablation of AF is largely derived from controlled clinical trials. We aim analyze safety and complications of AF ablation performed in a ‘real world’ setting outside of clinical trials and obtain insights on predictors of complications.

METHODS: We utilized the National Inpatient Sample (NIS) database, to identify all patients who underwent AF ablations between 2015 and 2017 using International Classification of Disease -Tenth revision codes.

Complications were defined as per the Agency for Health Care Research and Quality Guidelines. Statistical tests including multivariate logistic regression were performed to determine predictors of complications.

RESULTS: Among 14,875 cases of AF ablation between 2015 and 2017, a total of 1,884 complications were identified among 1,080 (7.2%) patients. Patients with complications were likely to be older and female with a higher burden of comorbidities. A 27% increase in complications was observed from 2015 to 2017, driven by an increase in pericardial complications. Multivariate regression analysis revealed that pulmonary hypertension [adjusted odds ratio (aOR)=1.99, p=0.041] and chronic kidney disease (aOR=1.67, p=0.024) were independent predictors of complications. Centers with higher procedural volumes were associated with lower complication rates.

CONCLUSION: Complication rates related to AF ablations remain substantially high. Presence of pulmonary hypertension and chronic kidney disease are predictive of higher procedural complications. Furthermore, hospital procedure volume is an important factor that correlates with complication rates.

101

ABSTRACT #68 CLINICAL RESEARCH GASTROENTEROLOGY LIQUID NITROGEN SPRAY CRYOTHERAPY IS EFFECTIVE AND SAFE WHEN USED IN THE MANAGEMENT OF EARLY ESOPHAGEAL ADENOCARCINOMA: SYSTEMATIC REVIEW AND METAANALYSIS Mengdan Xie1, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Digestive Disease Week (DDW) that is scheduled to be held virtually from May 21-23, 2021.

BACKGROUND: Liquid nitrogen spray cryotherapy (LNC) is an effective therapy for endoscopic ablation of Barrett’s esophagus (BE) and related neoplasia. Multiple studies have demonstrated efficacy, safety and tolerability for treating BE and superficial (T1) esophageal adenocarcinoma (EAC). The aim of this study was to systematically review the efficacy and safety of LNC in treating T1 EAC. METHODS: Relevant articles and abstracts were searched in PubMed, Web of Science, Embase, and Scopus.

Studies were included if T1 EAC patients were treated with LNC and rates of complete eradication of intraluminal cancer (CE-C), dysplasia (CE-D), or intestinal metaplasia (CE-IM) were reported after at least two LNC sessions. Studies that evaluated squamous cell cancer, used non-LNC cryotherapy, lacked CE rates, were not original research or were not in English were excluded. A random effects model was used to calculate pool proportions for CE rates. Rates of serious adverse events (SAEs), defined as stricture, hemorrhage, perforation, and/or severe pain requiring endoscopic intervention, transfusion, or hospitalization, were used to evaluate LNC safety.

RESULTS: A total of 16 studies with 359 patients met criteria, including 13 studies with 271 patients which qualified for the efficacy evaluation. A majority (58%) of these cases had persistent T1 EAC despite prior endoscopic resection (ER), radiofrequency ablation (RFA), or other ablative therapy. Concurrent ER was performed in 35% of these patients. The pooled CE-C rate for all T1 EAC was 74% (95% CI, 66-81%). For the 208 cases with EAC confined to the mucosa (T1a), pooled rates were 82% for CE-C (74-90%), 76% for CE-D (65-87%), and 65% for CE-IM (49-81%). A somewhat lower pooled CE-C rate of 53% (40-65%) was found for the 63 cases with EAC involving submucosa (T1b). SAEs occurred in 9.7% of LNC cases, most commonly strictures (8.8%), GI bleeding (0.6%), and perforation (0.3%).

CONCLUSION: ER combined with ablative therapy is the standard of care for BE with associated T1a EAC. This meta-analysis shows at least 82% of these patients can achieve CE-C when LNC is selected as the ablative modality. While CE-C rates were as high as 97% in some included studies, the pooled rate in this meta-analysis likely is lower due to a majority of patients having failed ER or other eradication methods.

Therefore, the CE-C rate for LNC in treatment naïve T1a EAC may be even higher. RFA for BE with highgrade dysplasia or intramucosal carcinoma has published rates of 87% (83-91%) for CE-D and 74% (59-89%) for CE-IM, which are non-inferior to the LNC pooled rates in this study. Even T1b tumors, where esophagectomy is the preferred intervention, achieved CE-C after LNC in about half of patients. This impressive efficacy, combined with low SAE rates, suggests liquid nitrogen spray cryotherapy should be a preferred option in treating early esophageal adenocarcinoma and associated Barrett’s esophagus.

102

ABSTRACT #69 CLINICAL RESEARCH CARDIOVASCULAR MEDICINE IMPACT OF LEFT ATRIAL APPENDAGE CLOSURE DURING CORONARY BYPASS SURGERY ON STROKE AND ATRIAL FIBRILLATIONS READMISSION Zhuoran Yang1, Lingling Wu1, Bharat Narasimhan1, Kam S Ho1, Yingying Zheng2, Arti N. Shah1,3,4, Bharat K. Kantharia1,3,4 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; East Carolina University, Greenville, NC, United States; 3NYC Health and Hospitals, Elmhurst, New York, United States, 4 Cardiovascular and Heart Rhythm Consultants, New York, NY, United States 2

Submitted to the Heart Rhythm Society Annual Scientific Meeting that will be held virtually from July 28-31, 2021.

BACKGROUND/INTRODUCTION: Whether surgical left atrial appendage closure (sLAAC) during coronary bypass surgery improves outcome is largely unknown. We aimed to compare short-term outcomes and readmissions following coronary bypass graft surgery (CABG) with concomitant sLAAC to those without.

METHODS: We analyzed the Nationwide Readmissions Database from 2016-2018 using ICD-10 diagnosis codes to identify hospitalization that underwent CABG following which patients were subcategorized based on whether sLAAC was performed. Among patients who survived their index admission, we employed propensity matching (1:3) to adjust for age, sex, comorbidities, CHA₂DS₂-VASc scores, previous atrial fibrillation (AF) history, heart failure, and hospital characteristics. The primary outcomes included unplanned AF and strokerelated readmissions at 1 year.

RESULTS: A total of 38,704 patients underwent CABG with sLAAC were identified with 116,588 propensity matched controls. Patients undergoing sLAAC were older with higher CHA₂DS₂-VASc scores and comorbidity burdens (Table 1). After propensity match, confounders are well balanced. Over a mean follow-up of 154 days, Cox proportional hazard analysis revealed that sLAAC was associated with higher risk of readmission due to AF at one year (HR, 1.79; 95% CI, 1.51-2.11; p<0.001; Figure 1). Subgroup analysis revealed that this association is independent of previous AF status, with larger effect on patient who has previous AF history (HR, 1.80; 95% CI, 1.51-2.15; p<0.001; Figure 2) compared to those without (HR, 1.73; 95% CI, 1.11-2.58; p=0.014; Figure 3). Analysis on stroke readmission demonstrate a trend toward reducing stroke readmission with sLAAC but it failed to reach statistical significance (HR, 0.83; 95%CI, 0.65-1.05; p=0.1335; Figure 4).

CONCLUSION: Our analysis of 1-year outcomes found that CABG with sLAAC was associated with higher risk of AF readmission without clear benefit of reducing stroke.

103

CABG without sLAAC N=574,554

CABG with sLAAC N=38,704

CABG without sLAAC matched control

p-value

N=116,588 Patient characteristics Age, Years

65.95±0.04

69.43±0.12

69.56±0.06

0.34

Female

24.74%

23.22%

22.94%

0.4663

Charlson Comorbidity Index

2.52±0.01

2.75±0.01

2.81±0.02

0.1067

CHADVASC2

3.30±0.01

3.66±0.01

3.72±0.01

0.003

0

1.71%

0.89%

0.77%

0.0759

1

10.48%

6.70%

6.28%

2

87.80%

92.39%

92.94%

Atrial Fibrillation

32.90%

69.97%

70.48%

0.6566

Heart Failure

24.04%

34.61%

34.09%

0.5444

Previous Stroke

8.93%

11.68%

11.45%

0.4305

Teaching Hospital

89.07%

77.21%

78.39%

0.5363

Urban Hospital

97.30%

98.89%

98.59%

0.0093

Small

9.49%

10.60%

7.64%

0.0720

Medium

24.38%

19.89%

21.19%

Large

66.47%

69.49%

71.15%

Comorbidity

Hospital characteristics

Hospital bed size

Table 1. Baseline Clinical Characteristics

104

Figure 1．1-Year Kaplan Meier Curves of CABG with sLAAC and without sLAAC for Freedom from Atrial Fibrillation Readmission. CABG: Coronary Artery Bypass Graft Surgery. sLAAC: Surgical Left Atrial Appendage Closure.

Figure 2. 1-Year Kaplan Meier Curves of CABG with sLAAC and without sLAAC with Previous History of AF for Freedom from AF Readmission. CABG: Coronary Artery Bypass Graft Surgery. sLAAC: Surgical Left Atrial Appendage Closure. AF: Atrial Fibrillation

105

Figure 3. 1-Year Kaplan Meier Curves of CABG with sLAAC and without sLAAC without Previous History of AF for Freedom from AF Readmission. CABG: Coronary Artery Bypass Graft Surgery. sLAAC: Surgical Left Atrial Appendage Closure. AF: Atrial Fibrillation

Figure 4. 1-year Kaplan Meier Curves of CABG with sLAAC and without sLAAC for Freedom from Stroke Readmission. CABG: Coronary Artery Bypass Graft Surgery. sLAAC: Surgical Left Atrial Appendage Closure.

106

ABSTRACT #70 CLINICAL RESEARCH ENDOCRINOLOGY/GENERAL INTERNAL MEDICINE DIABETES DISTRESS, ITS PREVALENCE AND CLINICAL DETERMINANTS IN PATIENTS WITH TYPE II DIABETES Heba Jioussy Yassin1, Tamera Goldberg1, Theresa Mack1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

BACKGROUND/INTRODUCTION: The correlation between depression and poor diabetic control has been well established. However, emerging literature suggests that diabetes distress, independent of depression, can have a profound impact on self-management and diabetic outcome and necessitates a different management strategy. We conducted the study in order to identify the prevalence of diabetes distress among a vulnerable, underserved urban patient population in our outpatient community health center, to compare two screening tools’ ability to capture diabetic patients at risk for poor outcomes, caused by behavioral and psychosocial factors, and to investigate the correlation between diabetes distress and poor diabetes mellitus control.

METHODS: This cross-sectional study was implemented at the Ryan Adair clinic, a Federally Qualified Health Center (FQHC) in Harlem that serves as a primary care training site for our Internal Medicine Residents. We identified all patients with diabetes who presented to the clinic over a four-week period. A well-validated diabetes distress screening tool (PAID5) was administered to each patient by a physician. We retrospectively reviewed the charts of those patients to identify HbA1C values, smoking status, BMI, lipid panel, PHQ2, preexisting mental problems, and known complications of diabetes. PAID5 cutoffs were deemed positive at a threshold score of 8. PHQ2 of 3 was considered the cutoff to screen positive for depression. The cohort was divided into two groups based on diabetes distress status. The average HbA1C as well as the prevalence of uncontrolled DM (defined as HbA1C≥9) was compared between each group.

RESULTS: A total of 69 patients were screened during the study period. 42% of the cohort population screened positive for diabetes distress, whereas, only 3% of those screened positive for depression based on PHQ-2. While 57% of those who screened positive for diabetes distress were found to have uncontrolled diabetes, only 24% of diabetic patients with no DD had uncontrolled disease. The average HbA1C for all the participants in the positively-screened group was 9.6% and in the second group it was 7.72%. Behavioral parameters were also noted to be different between the two groups. Those with diabetes distress were more obese (BMI: 34.7 versus 31.6), with more tendency to smoke (27% versus 22.5%). Lipid profile were similar between both groups.

CONCLUSION: Diabetes distress is an under-diagnosed condition that has been proved to have a profound impact on the course and outcomes of type II diabetes. This study demonstrates a remarkably high prevalence of diabetes distress among our underserved, vulnerable population and that was found to correlate with poorly controlled diabetes. In an era where social determinants of health play a key role in illness trajectory, it is highly important to identify a condition like diabetes distress and personalize an early intervention. More research is needed to assess for the most efficient management for diabetes distress.

107

ABSTRACT #71 MEDICAL EDUCATION GENERAL INTERNAL MEDICINE MEDICAL MARIJUANA KNOWLEDGE AND ATTITUDES AMONGST INTERNAL MEDICINE RESIDENTS Iman Makki1*, Binbin Zheng-Lin1*, Maanit Kohli1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

*These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Mounting evidence suggests the safety and efficacy of medical marijuana in treating chronic ailments, including chronic pain, epilepsy, and anorexia. Despite evidence-based benefits, physicians have reported gaps in their knowledge related to medical marijuana and its derivatives. In this study, we examine the knowledge of Internal Medicine Residents on marijuana and their attitude towards its medical use.

METHODS: In this descriptive cross-sectional study, Internal Medicine Residents from Mount Sinai Morningside-West program were surveyed. All trainees from the post-graduate year (PGY) one to three were eligible and included preliminary and categorical residents. An anonymous online questionnaire with 12 standardized queries was created using SurveyMonkey® and distributed via Microsoft® Teams, institutional emails, and smartphone messaging applications. The survey consisted of demographics questions, trainees’ self-assessment on medical marijuana use, and their stance on medical marijuana education during residency training.

RESULTS: This is one of the largest academic programs in the United States and is composed of a preliminary internship of 20 trainees and a categorical residency with 125 residents. Approximately 74% of the in-training physicians are international medical graduates. 86 (59%) out of 145 residents completed the questionnaire, of which 39 (45%) and 47 (55%) were female and male, respectively. PGY-1 trainees had the highest participation rate of 42% (n=36), followed by 32% in PGY-2 (n=28), and 26% in PGY-3 (n=22). While the majority (n=60, 70%) of trainees had considered prescribing medical cannabinoids for their patients, only six (7%) residents felt they had an adequate amount of knowledge (Figure 1). Regarding indications and contraindications of medical marijuana, almost all residents endorsed having “none to some knowledge” (n=83, 97% and n=80, 93%, respectively). 85 (99%) expressed “none” to “some familiarity” with marijuana dosing, whereas only four (5%) reported “substantial knowledge” on different formulations of medical cannabinoid products. Of notable significance, 71 (83%) participants were “unsure” where to find pertinent information and 79 (92%) “agreed” on the necessity of implementing medical education on this substance (Figure 2).

CONCLUSION: To the best of our knowledge, this is the first study that indicated a critical lack of medical marijuana-related knowledge in surveyed internal medicine residents, despite their willingness to receive a pertinent educational curriculum. In a population with growing cannabis consumption, physician training on the indication, toxicity, and drug interaction of cannabinoids is warranted.

108

Figure 1. In-training Internal Medicine Residents Self-Perception of Their Knowledge on Medical Cannabis

Figure 2. Internal Medicine Residents’ Opinion on Resources and Education on Medical Cannabis

109

Table 1. Full Survey with Twelve Standardized Questions Q1

Would You consider Prescribing Medical Marijuana for your patient?

Q2

How would you describe your knowledge about medical marijuana?

Q3

How would you describe your knowledge about Indications or Uses of Medical Marijuana?

Q4

How would you describe your knowledge about Risks / Side Effects and Contraindications of Medical Marijuana?

Q5

How would you describe your knowledge about marijuana dosage?

Q6

How would you describe your knowledge about the different types/forms of marijuana products?

Q7

Do you feel you have adequate knowledge of where to find information about medical marijuana?

Q8

Is there a need for more medical education about Marijuana?

Q9

What is your gender?

Q10

What is your age?

Q11

Which race/ethnicity best describes you?

Q12

What is your post-graduate training year?

110

List of of Abstracts Abstracts 2020-2021* List 2020-2021*

*Research/Scholarly Work presented in 2020-2021; does not include presentations already submitted as a poster.

111

111

LIST OF ABSTRACTS 2020-2021

72

ALCOHOL-ASSOCIATED CIRRHOSIS IS ASSOCIATED WITH HIGHER MORTALITY AND MORBIDITY IN PATIENTS ADMITTED FOR SEPSIS COMPARED WITH CIRRHOSIS OF OTHER ETIOLOGIES, NATIONAL INPATIENT SAMPLE STUDY 2016 Bing Chen1, Sanjana Luther1,2, Omar Mahmoud1, Frank Nelson1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

73

ATRIAL FIBRILLATION IS NOT ASSOCIATED WITH HIGHER IN-HOSPITAL MORTALITY FOR PATIENTS ADMITTED WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING Bing Chen1, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Submitted to the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020. Published in the American Journal of Gastroenterology, 2020.

74

ENDOSCOPY FOR HOSPITALIZED PATIENTS WITH ATRIAL FIBRILLATION IS SAFE: ANALYSIS FROM THE 2016 NATIONAL INPATIENT SAMPLE Bing Chen1, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

75

MICROSCOPIC COLITIS IS ASSOCIATED WITH A SIGNIFICANTLY INCREASED RISK OF INFLAMMATORY BOWEL DISEASE IN THE U.S. POPULATION: A NATIONAL COHORT STUDY Bing Chen1, Maan El Halabi1, Omar Mahmoud1, Frank Nelson1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

76

THE BURDEN OF CONCURRENT AUTOIMMUNE DISEASES IN HOSPITALIZED PATIENTS WITH CELIAC DISEASE: A NATIONAL COHORT STUDY Bing Chen1, Maan El Halabi1, Omar Mahmoud1, Frank Nelson1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

112

LIST OF ABSTRACTS 2020-2021

77

EVALUATING THE ROLE OF AROMATASE INHIBITORS IN THE TREATMENT OF ENDOMETRIAL STROMAL SARCOMAS Fionnuala Crowley1, Karen Anne Cadoo2, Sarah Chiang2, Jennifer Jean Mueller2, Martee Leigh Hensley2, Roisin Eilish O'Cearbhaill2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

To be presented at the American Society of Clinical Oncology (ASCO) Annual Meeting that will be held virtually from June 4-8, 2021.

78

ACCURACY OF EXERCISE INDUCED ST ELEVATIONS IN LEAD AVR IN THE DIAGNOSIS OF SIGNIFICANT LEFT MAIN OR PROXIMAL LEFT ANTERIOR DESCENDING ARTERY STENOSIS: A SYSTEMATIC REVIEW Vardhmaan Jain1, Subrat Das2, Kirtipal Bhatia2, Devika Aggarwal3, Agam Bansal1, Bharat Narasimhan2, Nirupama Krishnamurthi2, Lily Martin2, Aditya Joshi2, Arman Qamar4, Samir Kapadia1, Nina Kukar2 1 Cleveland Clinic, Cleveland, OH, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Beaumont Hospital, Royal Oak, MI, United States; 4Northshore University Hospital, Chicago, IL, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020. Published in the American Journal of Cardiology, 2021. PMID: 33453173

79

CREATION AND VALIDATION OF A NOVEL SEX-SPECIFIC MORTALITY RISK SCORE IN LVAD PATIENTS Aditi Nayak1, Yingtian Hu1, Yi-An Ko1, Rebecca Steinberg1, Subrat Das2, Anurag Mehta1, Chang Liu1, John Pennington3, Rongbing Xie3, James K. Kirklin3, Robert L. Kormos4, Jennifer Cowger5, Marc A Simon4, Alanna A Morris1 1

Emory University, Atlanta, GA, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3University of Alabama, Birmingham, AL, United States; 4University of Pittsburgh Medical Center, Pittsburgh, PA, United States; 5Henry Ford Health System, Detroit, MI, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020.

EFFECTIVE SCIENTIFIC COMMUNICATION: NEEDS ASSESSMENT SURVEY Subrat Das1, Nicole Littman1, Georgina Osorio1 1

80

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medicine Education, Icahn School of Medicine’s 18th Annual Education Research Day that was held virtually on April 27, 2021.

113

LIST OF ABSTRACTS 2020-2021

CYTOMEGALOVIRUS ILEITIS: A RARE CAUSE OF SUB-ACUTE DIARRHEA Maan El Halabi1, Oluwasayo Adeyemo1,2, Nebras Zeizafoun1, Michael Smith1

81

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

82

DIAGNOSIS OF A GRAVE DISEASE IN A SEEMINGLY ASYMPTOMATIC WOMAN: BUDD CHIARI WITH PORTAL VEIN THROMBOSIS IN SETTING OF POLYCYTHEMIA VERA Maan El Halabi1, Jack Husney1,2; Bing Chen1, Jose Concepcion1, Gil Ascunce1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

IT’S SO MUCH MORE THAN JUST CARCINOID: CASE OF MIXED GASTRIC NEUROENDOCRINE CARCINOMA Maan El Halabi1, Neelesh Rastogi1,2, Jack Husney1,2, Sun A. Kim1, Edward Lung1

83

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

84

LOWER ESOPHAGEAL SPHINCTER PRESSURES ARE SIGNIFICANTLY REDUCED IN PATIENTS WITH A HIATAL HERNIA BUT NO MAJOR ABNORMALITY ON ESOPHAGEAL MANOMETRY Maan El Halabi1, Xiaocen Zhang1, Elijah Verheyen1,2, Justin Field1,2, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

METASTATIC GASTRIC CARCINOMA MASQUERADING AS A PEDUNCULATED BLEEDING GASTRIC POLYP Maan El Halabi1, Heath Ward2, Elijah Verheyen1,2, Ilan Weisberg2, Gabriel Levi2

85

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

114

LIST OF ABSTRACTS 2020-2021

86

OUTCOMES OF ENDOSCOPY VERSUS SURGERY FOR AMPULLARY ADENOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS Maan El Halabi1, Angad Uberoi1, Gaurav Kakked1, Gassan Kassim1, Samantha Walsh1, Christopher J. DiMaio2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

87

WHOLE EXOME SEQUENCING OF 3 PATIENTS WITH BRUGADA SYNDROME IN THE MIDDLE EAST: NOVEL VARIANTS IN KNOWN GENES IN RELATION TO A RANGE OF PHENOTYPES Athar Khalil1*, Farah Abdulhai2*, Joseph Elias2,3, Mohammad Sabra2,4, Jad Ballout2,5, Patrick Zakka6, Khalid Al Muti7, Maurice Khoury2, Bernard Abi-Saleh2, George Nemer1*, Marwan M. Refaat1,2* 1

American University of Beirut, Beirut, Lebanon; 2American University of Beirut, Beirut, Lebanon; Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Indiana University, Indianapolis, IN, United States; 5University of Kentucky, Lexington, KY, United States; 6Emory University, Atlanta, GA; 7Cleveland Clinic, Abu Dhabi, United Arab Emirates 3

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

BIFURCATION PCI TECHNIQUE IN THE ERA OF NEWER-GENERATION DRUGELUTING STENTS: INSIGHTS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS Tomohiro Fujisaki1*, Toshiki Kuno2*, Yohei Numasawa3, Hisato Takagi4, Sripal Bangalore5

88

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan; 4Shizuoka Medical Center, Shizuoka, Japan; 5New York University Grossman School of Medicine, New York, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

EFFECT OF HEPATITIS C VIRUS INFECTION AMONG RECIPIENTS ON HEART TRANSPLANTS IN THE CURRENT ERA Tomohiro Fujisaki1, Takahisa Mikami2, Toshiki Kuno2, Noah Moss3, Sripal Bangalore4 1

89

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine, New York, NY, United States; 4New York University Grossman School of Medicine, New York, NY, United States

Presented at the Society General Internal Medicine (SGIM) Mid-Atlantic Meeting that was held virtually on November 13, 2020.

115

LIST OF ABSTRACTS 2020-2021

90

POTENT P2Y12 INHIBITORS VS. CLOPIDOGREL IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME: INSIGHTS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS Tomohiro Fujisaki1, Toshiki Kuno2*, Tomo Ando3, Alexandros Briasoulis4, Hisato Takagi5, Sripal Bangalore6 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Kawasaki Saiwai Hospital, Kawasaki, Japan; 4University of Iowa Hospitals and Clinics, Iowa City, IA, United States; 5Shizuoka Medical Center, Shizuoka, Japan; 6 New York University Grossman School of Medicine, New York, NY, United States

Presented at the Society General Internal Medicine (SGIM) Mid-Atlantic Meeting that was virtually held on November 13, 2020. Published in American Heart Journal, 2021.

PMID: 33737060

91

IMPACTS OF SOCIAL DETERMINANTS OF HEALTH ON DUAL ANTIPLATELET THERAPY FOR ACUTE CORONARY SYNDROME Christopher Gold1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

DISMANTLING THE OBESITY PARADOX IN ACUTE PULMONARY EMBOLISM Kam S. Ho1, Shabnam Nasserifar1, Paaras Kohli1, Joseph Poon1, Yasmin Herrera1, Archana Pattupara1, Andre Sotelo2, Raymonde Jean1

92

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, United States

Presented at the European Respiratory Society (ERS) Annual Meeting that was held virtually from September 7-9, 2020.

93

GO EASY WITH THE FLUIDS? INCREASED MORTALITY IN ACUTE RESPIRATORY DISTRESS SYNDROME WITH HYPERVOLEMIA Kam S. Ho1, Paaras Kohli1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Shabnam Nasserifar1, Andre Sotelo2, Raymonde Jean1 1

Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, United States 2

Presented at the European Respiratory Society (ERS) Annual Meeting that was held virtually from September 7-9, 2020.

116

LIST OF ABSTRACTS 2020-2021 HYDROXYCHLOROQUINE AND COVID-19: A META-ANALYSIS Kam Sing Ho1, Yasmin Herrera1, Archana Pattupara1, Joseph Poon1, Bharat Narasimhan1, Justin Poon1,2 1

94

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

95

IS THERE AN OPTIMAL DOOR-TO-TREATMENT TIME FOR ACUTE PULMONARY EMBOLISM? A NATIONAL PROPENSITY MATCH ANALYSIS Kam S. Ho1, Paaras Kohli1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Shabnam Nasserifar1, Andre Sotelo2, Raymonde Jean1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, United States

Presented at the European Respiratory Society (ERS) Annual Meeting that was held virtually from September 7-9, 2020.

96

SEIZURES AS THE INITIAL PRESENTATION OF COVID-19: A NOVEL CASE OF SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE Kam Sing Ho1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

97

THE MOUNT SINAI COVID-19 EXPERIENCE: 4,300 HOSPITALIZED PATIENTS IN NEW YORK CITY Kam Sing Ho1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Justin Poon1,2, David Steiger1,2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

98

SUSPICIOUS FOR SOMETHING PERNICIOUS Krystle Hernandez1, Kirtipal Bhatia1, Jonathan Albert Jamito1, Ana Arevalo1, Shivani Handa1, Yasmin Herrera1, David Weininger Cohen1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held virtually from July 20-24, 2020.

117

LIST OF ABSTRACTS 2020-2021

99

APPLICATION OF FECAL MICROBIOTA TRANSPLANTATION BEYOND THE FIELD OFGASTROENTEROLOGY Gassan Kassim1, Ryan Ungaro2, Ari Grinspan2, David Sachar2, Jean-Frederic Colombel2, Eyal Klang3 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

TIME TRENDS IN GUT MICROBIOME CLINICAL TRIALS IN GASTROENTEROLOGY Gassan Kassim1, Ryan Ungaro2, David Sachar2, Jean-Frederic Colombel2, Eyal Klang3 1

100

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

101

INFECTIVE ENDOCARDITIS DUE TO GROUP B STREPTOCOCCUS IN A TRANSGENDER FEMALE Persio Lopez Loyo1, Chandrashekar Bohra1, Adrian Nugent1, Yeraz Khachatoorian1, Edgar Argulian1, Vaani Garg1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

SEVERE METHEMOGLOBINEMIA CLINICALLY PRESENTING AS ACUTE CORONARY SYNDROME Arsalan Rehmani1, Yeraz Khachatoorian1, Angel De La Cruz Tejada1,2, Nassim Krim1,2

102

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

103

AN UNCOMMON CAUSE OF ACUTE KIDNEY INJURY AFTER PROLONGED SEIZURE Archana Pattupara1, Maria Athena Riego1, Paaras Kohli1, H.S. Gupta1, James Salonia1, Susannah Kurtz1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

118

LIST OF ABSTRACTS 2020-2021 AN UNUSUAL CASE OF LOWER EXTREMITY WEAKNESS AND SHOCK IN A YOUNG WOMAN FROM THYMIC CARCINOMA Archana Pattupara1, Maria Athena Riego1, Jon Stoever,1,2 J.T. Guerra1, Kusum S. Mathews3

104

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

PERICARDIAL EFFUSION ASSOCIATED WITH CRYPTOCOCCAL MENINGITIS IN A RENAL TRANSPLANT PATIENT Christopher Perez Lizardo1, Avinash Singh1,2, Jennifer Fung1

105

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

MISDIAGNOSIS OF ASTHMA IN A PATIENT WITH HYPEREOSINOPHILIC SYNDROME WITH CARDIAC INVOLVEMENT Maria Athena Riego1, Justin Poon1,2, Roshni Naik1

106

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

IMMUNOTHERAPY INDUCED PNEUMONITIS Dishant J. Shah1, Christian M. Lo Cascio1,2 1

107

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

108

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY PLACEMENT INCREASES 30-DAY HOSPITAL READMISSION RATES IN ADVANCED DEMENTIA PATIENTS Jacqueline Sheehan1, Kam Sing Ho1, Jennifer Fung1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Annual Assembly of Hospice and Palliative Care Annual Meeting that was held virtually from February 17-19, 2021.

119

LIST OF ABSTRACTS 2020-2021 IMPACT OF COVID-19 PANDEMIC ON HOUSE-STAFF Patrick Tobin-Schnittger1, Georgina Osorio1, Raymonde Jean1, Katherine Mark1

109

110

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

RARE TERMINAL ILEUM MIGRATION OF LUMEN-APPOSING METAL STENT USED FOR PANCREATIC PSEUDOCYST DRAINAGE Sanjana Luther1,2, Angad Uberoi1, Frank Nelson1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

STATINS FOR THE PREVENTION OF POST-ERCP PANCREATITIS Angad Uberoi1, Maan El Halabi1, Gaurav Kakked1, Sanjana Luther1,2, Kirtipal Bhatia1, Christopher DiMaio3

111

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

112

ENDOSCOPIC THERAPY VERSUS SURGICAL INTERVENTION IN MANAGING T1AN0M0 AND T1BN0M0 ESOPHAGEAL CANCER: A MORTALITY ANALYSIS Mengdan Xie1, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Digestive Disease Week (DDW) that will be held virtually from May 21-23, 2021.

KLEBSIELLA PNEUMONIAE LIVER ABSCESS ASSOCIATED WITH CHRONIC KETAMINE ABUSE Mengdan Xie1, Rita Jammal1,2, George McKinley1, David Frager1

113

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

114

OUTCOMES OF ATRIAL FIBRILLATION/FLUTTER PATIENTS HOSPITALIZED FOR LOWER GASTROINTESTINAL BLEEDING: RESULTS OF A NATIONAL COHORT Mengdan Xie1, Bing Chen1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Digestive Disease Week (DDW) that will be held virtually from May 21-23, 2021.

120

LIST OF ABSTRACTS 2020-2021

115

DURATION OF POST-AUTOLOGOUS HEMATOPOIETIC CELL TRANSPLANT ANEMIA AND THROMBOCYTOPENIA ARE ASSOCIATED WITH PROLONGED HOSPITAL LENGTH-OF-STAY FOR MULTIPLE MYELOMA PATIENTS Binbin Zheng-Lin1, Nirupama Krishnamurthi1, Benjamin Diamond2, Kylee H. Maclachlan2, Francesco Maura2, Ola Landgren2, David J. Chung2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held virtually from December 5-8, 2020.

116

NEUTROPHIL-TO-LYMPHOCYTE RATIO AND PLATELET-TO-LYMPHOCYTE RATIO AT ADMISSION ARE PREDICTORS FOR WORSE FUNCTIONAL OUTCOME IN CEREBRAL VENOUS SINUS THROMBOSIS Binbin Zheng-Lin1, Qian Wang2, Biyue Dai3, Cynthia Zevallos3, Darko Quispe Orozco3, Mudassir Farooqui3, Jorge Ares Morcuende4, Santiago Ortega-Gutierrez3 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Carver College of Medicine, University of Iowa, IA, United States; 4 University of Alcalá, Alcalá de Henares, Madrid, Spain

Presented at the American Society of Hematology (ASH) Annual Meeting that was held virtually from December 5-8, 2020.

121

Abstracts2020-2021 2020-2021 Abstracts

122

122

ABSTRACT #72 CLINICAL RESEARCH GASTROENTEROLOGY ALCOHOL-ASSOCIATED CIRRHOSIS IS ASSOCIATED WITH HIGHER MORTALITY AND MORBIDITY IN PATIENTS ADMITTED FOR SEPSIS COMPARED WITH CIRRHOSIS OF OTHER ETIOLOGIES, NATIONAL INPATIENT SAMPLE STUDY 2016 Bing Chen1, Sanjana Luther1,2, Omar Mahmoud1, Frank Nelson1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Many studies have shown that patients with cirrhosis are prone to develop sepsis, sepsis-induced organ failure, and death. The aim of this study was to investigate if there are differences in mortality and morbidity in patients admitted to the hospital with sepsis and an underlying diagnosis of alcohol-associated cirrhosis versus cirrhosis of other etiologies.

METHODS: In this retrospective study, we analyzed the 2016 National Inpatient Sample database using ICD10 codes for hospitalizations with a principal diagnosis as sepsis and a secondary diagnosis as alcoholassociated cirrhosis or cirrhosis of other etiologies. The exclusion criteria for this analysis were patients younger than 18 years of age, elective admissions, and sepsis which was related to obstetric complications.

The primary outcome evaluated was mortality. The secondary outcomes were the length of stay (LOS), total cost, acute kidney injury (AKI), acute respiratory failure, and mechanical ventilation use. Multivariate regression was used to adjust for age, gender, race, incomes, insurance, hospital characteristics, and comorbidities.

STATA 14 was used for analysis.

RESULTS: There were a total of 69,390 patients admitted for sepsis with cirrhosis, of which 28,225 had alcohol-associated cirrhosis. Septic patients with alcohol-associated cirrhosis, compared to patients with cirrhosis of other etiologies were overall younger (56.8 years versus 63.6 years, p<0.01), more likely male (52.1% versus 47.9%, p<0.01), and had a higher rate of spontaneous bacterial peritonitis (15.1% versus 7.2%, p<0.01). With regards to the primary outcome, we observed higher mortality (24.5% versus 19.8%; adjusted odds ratio (aOR), 1.34, p<0.01) in the alcohol-associated cirrhosis group. We also found a LOS (9.3 days versus 8.2 days; adjusted coefficient, 0.91 days; p<0.01), higher total cost ($27,932 versus $22,784; adjusted coefficient, $4,017; p<0.01), more AKI (53.4% versus 48.6%; aOR, 1.48; p<0.01), more acute respiratory failure (30.9% versus 25.4%; aOR, 1.25; p<0.01), and more use of mechanical ventilation (27.5% versus 19.2%; aOR, 1.97; p<0.01) in the alcohol-associated cirrhosis group.

CONCLUSION: Alcohol-associated cirrhosis was associated with higher in-hospital mortality and morbidity in patients admitted for sepsis compared with cirrhosis of other etiologies. A more comprehensive strategy with early and specific intervention is needed to improve outcomes in this population.

123

Table 1. Comparison of characteristics of septic patients with alcohol-associated cirrhosis versus cirrhosis of other etiologies

Table 2. Adjusted odds ratio (OR) of in-hospital outcomes 124

ABSTRACT #73 CLINICAL RESEARCH GASTROENTEROLOGY ATRIAL FIBRILLATION IS NOT ASSOCIATED WITH HIGHER IN-HOSPITAL MORTALITY FOR PATIENTS ADMITTED WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING* Bing Chen1, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Submitted to the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020. Published in the American Journal of Gastroenterology, 2020. *Abstract was not presented.

BACKGROUND/INTRODUCTION: Atrial fibrillation (AF) was a common underlying disease in patients who had upper gastrointestinal bleeding (UGIB). Our aim was to investigate the effect of AF on mortality for patients hospitalized with non-variceal UGIB. METHODS: All admissions with UGIB as the primary diagnosis from the 2016 National Inpatient Sample database were identified using ICD-10 codes. Exclusion criteria for this analysis included age less than 18 years and a diagnosis of variceal bleeding. Hospitalizations were subdivided by whether coding identified a concurrent diagnosis of AF. Multivariate regression adjusted for age, gender, income, insurance, hospital characteristics, and comorbidities. The primary outcome of interest was in-hospital all-cause mortality. Secondary outcomes included the percentage of patients who had an endoscopy, length of stay, and total cost of hospitalization.

STATA 15 (College Station, TX) was used for analysis.

RESULTS: There were a total of 254,370 adult hospitalizations in 2016 with a primary diagnosis of non-variceal UGIB, of which 53,685 (21.1%) had concurrent AF. Patients with AF were older, more likely to be White, and had a higher Charlson comorbidity index than non-AF patients (Table 1). Overall in-hospital mortality was significantly higher in the AF group, with a crude odds ratio of 1.88 (p<0.001) (Table 2). However, after adjusting for demographics and comorbidities, AF was associated with significantly lower mortality, with an adjusted odds ratio of 0.69 (p=0.001). With respect to secondary outcomes, AF was associated with a lower rate of endoscopy, a shorter length of hospital stay, and a lower total cost of hospitalization.

CONCLUSION: AF patients admitted for non-variceal UGIB in 2016 were older and had more comorbidities than those without AF. After adjusting for comorbidities and demographics, AF patients had lower in-hospital mortality along with shorter and less expensive hospital stays. Lower mortality could be explained by AF patients receiving closer monitoring due to an arrhythmia, making them less likely to experience a fatal cardiac event. Another possible explanation is that a higher percentage of AF patients had UGIB resulting from blood thinners used to treat AF. This etiology is relatively easier and faster to treat successfully than others. Prospective studies that evaluate mortality and hospital stay based on endoscopic findings would help clarify whether AF affects mortality for specific UGIB etiologies.

125

AF Group (n=53,685; 21.1%)

Non-AF Group (n=200,685, 78.9%)

p-value

76.8 45.8%

64.4 46.5%

<0.001 <0.001 <0.001

81.8% 9.1% 4.5% 2.6% 0.3% 1.6%

67.5% 16.0% 9.7% 3.2% 0.9% 2.6%

Chronic heart failure

47.1%

13.9%

<0.001

Valvular diseases

15.2%

4.6%

<0.001

Pulmonary circulation disorders

11.2%

3.0%

<0.001

Peripheral vascular disorders

15.2%

8.7%

<0.001

65.0%

<0.001

Mean Age (yrs) Sex, Female Race White Black Hispanic Asian or Pacific Islander Native American Other Comorbidities

Hypertension

83.2%

Chronic pulmonary diseases

30.3%

20.5%

<0.001

Diabetes

20.5%

13.0%

<0.001

Renal failure

39.3%

21.1%

<0.001

Liver disease

8.2%

16.5%

<0.001

Peptic ulcer diseases

8.7%

10.8%

<0.001

Metastatic cancer

2.3%

2.7%

=0.007

Solid tumor without metastasis

4.7%

5.0%

=0.201

Coagulopathy

14.7%

12.7%

<0.001

2.6

<0.001

Charlson Comorbidity Index 3.4 Table 1. Basic characteristics of UGIB patients with and without AF

In-hospital all-cause mortality Rate of endoscopy

AF Group Group N: 53,685 (21.1%) 3.07%

Non-AF Group N: 200,685 (78.9%)

Crude adds ratio/Coefficient (95%CI), p-value

Adjusted odds ratio/Coefficient (95%CI), p-value

1.65%

81.29%

82.34%

1.88 (1.31-1.65), p<0.001 0.93 (0.88-0.98) p=0.011 1.10 (0.99-1.22), p<0.001 2220 (1904-2537), p<0.001

0.69 (0.55-0.86), p=0.001 0.91 (0.82-1.00), p=0.059 -0.42 (-0.67- -0.17), p=0.001 -1856 (-2540- -1170), p<0.001

Length of hospital 5.27 4.16 stay (days) Total cost of 12,800 10,580 hospitalization (dollars) Table 2. In-hospital outcomes of UGIB patients with and without AF

126

ABSTRACT #74 CLINICAL RESEARCH GASTROENTEROLOGY ENDOSCOPY FOR HOSPITALIZED PATIENTS WITH ATRIAL FIBRILLATION IS SAFE: ANALYSIS FROM THE 2016 NATIONAL INPATIENT SAMPLE Bing Chen1, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Patients with atrial fibrillation (AF) are predisposed to gastrointestinal bleeding (GIB) due to anticoagulation use. Evaluation frequently requires endoscopy to make a diagnosis and, in some cases, provide treatment. This study aimed to investigate the safety of endoscopy in hospitalized patients with atrial fibrillation.

METHODS: The 2016 National Inpatient Sample database was analyzed using ICD-10 codes to identify all hospitalizations with a primary or secondary diagnosis of AF. Those patients were subdivided based on whether any endoscopic procedure was performed, as evidenced by listing of a concurrent procedure code. Subgroup analysis for three presumed indications (upper GIB, lower GIB, and anemia) was performed. Multivariate regression was used to adjust for age, gender, incomes, insurance, hospital characteristics, Charlson comorbidity index, and presumed indications. The primary outcome was in-hospital all-cause mortality. STATA 15 (College Station, TX) was used for analysis.

RESULTS: A total of 3,656,792 patients were admitted to a hospital in 2016 with a diagnosis of AF, of which 219,539 (6.00%) underwent endoscopy (Table 1). Patients in the endoscopy group had a slightly higher Charlson comorbidity index compared to the non-endoscopy group. The three most common presumed indications for endoscopy were upper GIB (32.62%), lower GIB (27.22%), and anemia (14.29%). In comparison to the nonendoscopy group, the endoscopy group had significantly lower overall mortality (3.65% versus 5.27%), with an adjusted odds ratio of 0.42 (p<0.001, Table 2). In the subgroup analysis, patients who had an endoscopy had significantly lower mortality in all three subgroups: upper GIB (4.04% versus 11.03%), lower GIB (2.58% versus 12.64%), and anemia (3.27% versus 5.74%) (all p<0.001).

CONCLUSION: In hospitalized AF patients, performing endoscopy was associated with significantly lower mortality. This study suggests that AF should not be a deterrent to endoscopy when it is indicated. However, the study is limited in that we cannot say how many patients could not safely have an endoscopy even when it was a potentially life-saving measure. Lower mortality could therefore reflect a bias toward selecting only healthier patients for endoscopy, even though the Charlson index was higher in the cohort undergoing endoscopy.

Prospective studies are needed to validate these findings.

127

Table 1. Characteristics of AF patients having endoscopy versus no endoscopy

Table 2. Subgroup analysis of mortality in AF patients having endoscopy versus no endoscopy 128

ABSTRACT #75 CLINICAL RESEARCH GASTROENTEROLOGY MICROSCOPIC COLITIS IS ASSOCIATED WITH A SIGNIFICANTLY INCREASED RISK INFLAMMATORY BOWEL DISEASE IN THE U.S. POPULATION: A NATIONAL COHORT STUDY Bing Chen1, Maan El Halabi1, Omar Mahmoud1, Frank Nelson1

OF

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Although the pathogenesis of microscopic colitis is unclear, the disease appears to have shared pathophysiology with inflammatory bowel disease (IBD). A recent population-based study from Sweden found a significant increase in the risk of incident IBD among patients with microscopic colitis. To date, there is no similar large population study from North America. We aimed to investigate the association of microscopic colitis and IBD in a United States-based national database.

METHODS: In this retrospective cohort study, the 2016-2017 National Inpatient Sample database was analyzed by using ICD-10 Code for hospitalizations with a primary or secondary diagnosis as microscopic colitis (MC), Crohn’s disease, and ulcerative colitis. Patients were divided into the MC group and the non -MC group. The outcome of interest was the prevalence of Crohn’s disease and ulcerative colitis in both MC and non-MC group. Multivariate regression was used to adjust for age and gender to investigate the impact of MC on the rate of Crohn’s disease and ulcerative colitis. STATA 14 (College Station, TX) was used for analysis.

RESULTS: We identified 12,805 patients with MC hospitalized from 2016 to 2017, which was about 0.018% of all hospitalizations. The mean age was 70.9 years and the percentage of females was 78.2%. There were 190 cases of CD (190/12,805, 1.48%; 95% CI, 1.08%–2.03%) in the MC group compared to 411,225 cases of Crohn’s disease (411,225/71,461,430, 0.58%; 95% CI, 0.57%–0.59%) in the non-MC group. MC was found to be associated with a significantly higher rate of Crohn’s disease with an adjusted odds ratio of 2.50 (95% CI, 1.82–3.43; p<0.001). There were 250 cases of ulcerative colitis (250/12,805, 1.95%; 95% CI, 1.48%–2.57%) in the MC group compared to 245,585 cases of ulcerative colitis (245,585/71,461,430, 0.34%; 95% CI, 0.34%– 0.35%) in the non-MC group. MC was found to be associated with a significantly higher rate of ulcerative colitis with an adjusted odds ratio of 5.11 (95% CI, 3.85–6.79; p<0.001).

CONCLUSION: In this large population study based in the United States, microscopic colitis was found to be associated with a significantly increased risk of IBD. Clinicians should be attentive to this association, as it aids in appropriate timely evaluations particularly in atypical gastrointestinal symptoms. Further studies are needed to investigate the underlying mechanism of this association.

Table 1. Microscopic Colitis risk of Crohn’s disease and ulcerative colitis

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ABSTRACT #76 CLINICAL RESEARCH GASTROENTEROLOGY THE BURDEN OF CONCURRENT AUTOIMMUNE DISEASES IN HOSPITALIZED PATIENTS WITH CELIAC DISEASE: A NATIONAL COHORT STUDY Bing Chen1, Maan El Halabi1, Omar Mahmoud1, Frank Nelson1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Celiac disease (CD) is an autoimmune disorder known to be associated with multiple other autoimmune conditions. In this study, we aimed to quantify the association between the CD and some most common autoimmune conditions systematically and further investigate the impact of concurrent gastrointestinal (GI) autoimmune diseases on its in-hospital outcomes.

METHODS: In this retrospective cohort study, the 2014 National Inpatient Sample database was analyzed by using ICD-9 Code for hospitalizations with a primary or secondary diagnosis as celiac disease. The primary outcome of interest was the prevalence of concurrent autoimmune diseases. The secondary outcomes were the impact of the concurrent GI autoimmune conditions on its in-hospital outcomes including mortality, length of stay, and total charge. Multivariate regression was used to adjust for age, gender, and race to calculate the odds ratio (OR) of concurrent autoimmune diseases and further adjust for the Charlson comorbidity index for in-hospital outcomes. STATA 14 (College Station, TX) was used for analysis.

RESULTS: There was a total of 39,215 patients with celiac disease who were hospitalized in 2014, which was about 0.11% of all hospitalizations. In comparison to patients without celiac diseases, those patients were older and more likely to be female and white. In comparison to the control group, patients with celiac disease had a significantly higher rate of having concurrent autoimmune conditions (19.56% vs 4.96%; OR, 4.16; 95% CI, 3.89–4.43). Celiac disease was also associated with a higher rate of coexisting GI autoimmune diseases compared to the control group (4.53% vs 1.00%; OR, 4.34; 95% CI, 3.85–4.89). In patients hospitalized with celiac disease, concurrent GI autoimmune disease was associated with a significantly longer length of stay (coefficient, 0.56; 95% CI, 0.09–1.03; p<0.05). The impact on its in-hospital all-cause mortality (OR, 1.40; 95% CI, 0.50–3.97; p=0.52) and total charge (coefficient, $4663; 95% CI, −$2619 to $11946; p=0.21) was not statistically significant.

CONCLUSION: Celiac disease was associated with a significantly higher burden of concurrent autoimmune conditions including other autoimmune diseases of the GI system. This association highlights the possible shared pathogenic mechanism and the need for optimal strategies to diagnose other autoimmune conditions in patients with celiac disease.

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Table 1. Comparison of demographics and concurrent autoimmune conditions in hospitalized patients with celiac disease vs without celiac disease

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ABSTRACT #77 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY EVALUATING THE ROLE OF AROMATASE INHIBITORS IN THE TREATMENT OF ENDOMETRIAL STROMAL SARCOMAS Fionnuala Crowley1, Karen Anne Cadoo2, Sarah Chiang2, Jennifer Jean Mueller2, Martee Leigh Hensley2, Roisin Eilish O'Cearbhaill2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Memorial Sloan Kettering Cancer Center, New York, NY, United States

2

To be presented at the American Society of Clinical Oncology (ASCO) Annual Meeting that will be held virtually from June 4-8, 2021.

BACKGROUND/INTRODUCTION: Endometrial stromal sarcomas (ESS) account for < 20% of uterine sarcomas. They usually express estrogen and progesterone receptors (ER/PR) and are considered hormone sensitive. Due to the rarity of these tumors, large clinical trials studying optimal treatment have not been possible. This study represents the largest retrospective study of ESS treated with aromatase inhibitors.

METHODS: The clinicopathological variables and outcomes of patients with pathologically confirmed low grade ESS treated with aromatase inhibitors at our institution between 1998-2020 were recorded.

RESULTS: 48 patients with ESS treated with aromatase inhibitors were identified. They had a median age of 54 years (range 23-84) and BMI of 27 (range 20-50). 79% were White. 6 (12%), 9 (19%), 14 (29%) and 19 patients (40%) had stage 1,2,3,4 ESS, respectively. 37 (77%) were ER+/PR+; 2 (4%) ER+/PR- and 9 patients (19%) had unknown ER/PR status. All patients were postmenopausal at aromatase inhibitor initiation. 12 patients (25%) had a synchronous cancer (5 of these had breast cancer; 3 of the 5 presented post tamoxifen).

23 patients (48%) received megestrol acetate and 25 (52%) an aromatase inhibitor as first line hormonal manipulation. During their disease course, 35 patients (73%) received letrozole, 21 (44%) anastrozole and 19 (39.6%) exemestane. 22 patients (46%) were treated with more than one aromatase inhibitor. 28 patients (58%) reported side-effects; arthralgia (33%) being the most common. 10 patients (21%) discontinued aromatase inhibitor due to toxicity; 12 patients (25%) switched aromatase inhibitor for toxicity (with improved tolerance in 67% of these patients). Among the 24 patients (50%) with measurable disease there were 2 partial responses (objective response rate of 8.3%). 1-year disease control rate (DCR) was (79%) for all patients and 58% in stage 4 disease. Median PFS for 1st line aromatase inhibitor was 161.6 months (95% CI, 48.5 months to 274.7 months).

CONCLUSION: This study represents the largest study of aromatase inhibitor use in ESS to date. We found the ORR to be more modest than previously reported. The majority of patients had prolonged stable disease with a DCR of 58% even in stage 4 disease. Patients who progress on one aromatase inhibitor may benefit from trial of a 2nd aromatase inhibitor. A phase 2 study of interruption versus maintenance AI in locally advanced/metastatic ESS is currently underway (NCT03624244).

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ABSTRACT #78 CLINICAL RESEARCH CARDIOVASCULAR DISEASE ACCURACY OF EXERCISE INDUCED ST ELEVATIONS IN LEAD AVR IN THE DIAGNOSIS OF SIGNIFICANT LEFT MAIN OR PROXIMAL LEFT ANTERIOR DESCENDING ARTERY STENOSIS: A SYSTEMATIC REVIEW Vardhmaan Jain1, Subrat Das2, Kirtipal Bhatia2, Devika Aggarwal3, Agam Bansal1, Bharat Narasimhan2, Nirupama Krishnamurthi2, Lily Martin2, Aditya Joshi2, Arman Qamar4, Samir Kapadia1, Nina Kukar2 1 Cleveland Clinic, Cleveland, OH, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Beaumont Hospital, Royal Oak, MI, United States; 4Northshore University Hospital, Chicago, IL, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020. Published in the American Journal of Cardiology, 2021. PMID: 33453173 BACKGROUND/INTRODUCTION: ST segment changes during exercise stress testing are diagnostic of myocardial ischemia in patients with suspected coronary artery disease (CAD). However, lead aVR is traditionally overlooked during analysis of ST changes during stress testing. Recent studies have suggested an association between exercise induced ST elevation in aVR and significant stenosis of left main (LM) and proximal Left anterior descending artery (pLAD). Given that revascularization strategy in addition to optimal medical therapy is recommended for patients with significant LM and pLAD, early risk stratification of these patients is necessary. We performed a systematic review of published literature to investigate the diagnostic accuracy of exercise induced ST elevation in lead aVR. METHODS: Comprehensive literature search of electronic databases including Embase, Medline, and Web of Science using MeSH terms and keywords for “exercise stress test”, “lead aVR,” and “CAD” from inception through December 2019. Two reviewers independently screened all results in two stages: title/abstract followed by full-text, using the Covidence software. Studies were included if they included adult patients who underwent exercise stress testing and reported diagnostic performance of ST elevation > 1 mm in lead aVR for identifying significant LM or pLAD disease. Significant disease was defined as luminal narrowing of LM by greater than 50 percent and greater than 70 percent for pLAD by coronary angiography. Pooled sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratios were calculated using a bivariate model, and a summary receiver operator curve (SROC) was constructed.

RESULTS: Across 6 studies (1128 patients), the pooled sensitivity was 0.80 (95% CI, 0.36-0.97) with heterogeneity (I2=94.7) and a pooled specificity of 0.78 (95% CI, 0.56-0.90) with heterogeneity (I2=97.8) (Figure 1). Likelihood ratio syntheses gave an overall positive LR of 3.56 (95% CI, 2.34-5.4) and negative LR of 0.26 (95% CI, 0.07-1.01). The pooled diagnostic odds ratio was 13.5 (95% CI, 4.8-38.5). Hierarchical SROC curve indicates that the area under the curve was 0.84 (95% CI, 0.81-0.87) (Figure 2).

CONCLUSION: Our meta-analysis showed moderate sensitivity and specificity of exercise induced aVR ST elevation for diagnosing hemodynamically significant LM or pLAD disease. The heterogeneity among studies was extremely high, likely stemming from multifactorial causes including differences in baseline characteristics of patient population and patient selection. In conclusion, while presence of aVR during exercise stress test increases the likelihood of having LM or pLAD disease, further large multicenter studies are needed to further substantiate the diagnostic accuracy of this finding.

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Figure 1. Pooled sensitivity and specificity of exercise induced ST elevations in lead aVR for predicting significant left main or proximal left anterior descending artery stenosis

Figure 2. Hierarchical SROC derived from pooled analysis using the bivariate model. Area under the curve was 0.84

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ABSTRACT #79 CLINICAL RESEARCH CARDIOVASCULAR DISEASE CREATION AND VALIDATION OF A NOVEL SEX-SPECIFIC MORTALITY RISK SCORE IN LVAD PATIENTS Aditi Nayak1, Yingtian Hu1, Yi-An Ko1, Rebecca Steinberg1, Subrat Das2, Anurag Mehta1, Chang Liu1, John Pennington3, Rongbing Xie3, James K. Kirklin3, Robert L. Kormos4, Jennifer Cowger5, Marc A. Simon4, Alanna A. Morris1 1

Emory University, Atlanta, GA, United States; 2Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3University of Alabama, Birmingham, AL, United States; 4University of Pittsburgh Medical Center, Pittsburgh, PA, United States; 5Henry Ford Health System, Detroit, MI, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held virtually from November 13-17, 2020.

BACKGROUND/INTRODUCTION: Prior studies have shown that females have worse 3-month survival postLVAD. Currently used prognostic scores including the Heartmate II Risk Score (HMRS), were developed in >75% male cohorts, and may not account for the increased residual risk in females.

METHODS: Adult CF-LVAD patients from the ISHLT Mechanically Assisted Circulatory Support (IMACS) registry (Implant years: January, 2013 to September, 2017, age: 56 ± 13 years, 21% female, 36% centrifugal pumps) were randomly divided into derivation (DC, n=9113, 21% female) and validation cohorts (VC, n=6074, 21% female). Primary outcome of interest was 3-month mortality. IMACS risk score (IMACS-RS) was developed in the DC, from pre-operative candidate predictors selected using Akaike Information Criterion, or significant sex*variable interaction.

RESULTS: There were 1,466 deaths (9.7%) within 3 months after implant. In the DC, age, cardiogenic shock at implant, body mass index, blood urea nitrogen, bilirubin, hemoglobin, albumin, platelet count, LV end diastolic diameter, tricuspid regurgitation, dialysis, and major infection pre-implant were retained as significant predictors of 3-month mortality. There was a significant ischemic HF*sex and platelet count*sex interaction. For each quartile increase in IMACS-RS, females had 93% increased odds (p<0.0001), and males had 86% increased odds (p<0.0001) of 3-month mortality. IMACS-RS represented a significant improvement over HMRS (p<0.01 for improvement in AUC) and provided excellent risk calibration in both sexes (no significant difference between observed and predicted risk). Removal of sex-specific interaction terms resulted in significant loss of model fit.

CONCLUSION: A sex-specific risk score provides excellent risk prediction in LVAD patients. Future prognostic studies in advanced HF should present sex-specific secondary outcomes.

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Predictors in IMACS-RS*

Female

Male

Intercept

-2.64

-2.64

Age, years

0.04

0.04

BMI

0.02

0.02

Cardiogenic shock at implant (INTERMACS 1 or 2)

0.34

0.34

Dialysis, pre-implant

0.75

0.75

Major infection during index hospitalization, pre-implant

0.35

0.35

LVEDD, cm

-1.10

-1.10

Moderate to Severe TR

0.18

0.18

BUN, mg/dl

0.40

0.40

Total Bilirubin, mg/dl

0.57

0.57

Hemoglobin, g/dl

-0.31

-0.31

Albumin, g/dl

-0.33

-0.33

Female sex

1.28

0

Ischemic HF etiology

0.35

-0.11

Platelet count, x 103/uL

-0.40

-0.05

Table 1: Weights for IMACS-RS predictors in males versus females * Calculation of IMACS-RS: (-2.64 + (0.04 * [Age in years]) + (0.02 * [BMI in kg/m 2]) + 0.34 (if cardiogenic shock at implant) + 0.75 ( if dialysis pre-implant) + 0.35 ( if major infection pre-implant) – (1.10 * [Log(LVEDD in cm)]) + 0.18 ( if moderate to severe TR) + (0.40 * [Log(BUN in mg/dl)]) + (0.57 * [Log(Total Bilirubin in mg/dl + 1)]) - (0.31 * [Log (Hemoglobin in gm/dl)]) - (0.33* [Albumin in gm/dl]) – 0.11 (if Ischemic HF etiology) -(0.05 * [Log(Platelet count, x 103/uL]) + 1.28 (if female) + 0.46 (if Ischemic HF etiology, if female) – (0.35 * (Log[Platelet count, x 103/ul]), if female)) * 100

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ABSTRACT #80 MEDICAL EDUCATION GENERAL INTERNAL MEDICINE EFFECTIVE SCIENTIFIC COMMUNICATION: NEEDS ASSESSMENT SURVEY Subrat Das1, Nicole Littman1, Georgina Osorio1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medicine Education, Icahn School of Medicine’s 18th Annual Education Research Day that was held virtually on April 27, 2021.

BACKGROUND/INTRODUCTION: Effective scientific communication is as important as conducting good research. Good scientific writing entails an important skill set that needs to be nurtured and developed, but an appropriate curriculum for the same is lacking in medical school and residency training. While there are a few online resources to this end, none is tailored to the specific needs of a medical professional in training. As we implement a formal curriculum in scientific writing for our Internal Medicine Residency Program, we conducted this needs assessment survey.

METHODS: A questionnaire-based needs assessment survey was administered across all residents in our Internal Medicine Residency Program. Google forms with QR code and hyperlink-based access was utilized to ensure high response rate. Questions were broadly divided into demographics (limited to year of training), previous research experience, comfort with manuscript preparation and any suggestions (free text). No identifying data was collected.

RESULTS: A total of 50 responses were received, with 56% coming from 1st year residents. Only 4 had previous formal training in conducting research (MPH or PhD). 80% wanted to pursue sub-specialty fellowship, and close to 60% were involved in research either at the program or previously. Only 8% have ever taken a course in scientific writing and half of the respondents are not aware of the use of reference managers in manuscript preparation. There was a heterogenous response to the best learning approach regarding the delivery of the course.

CONCLUSION: The survey responses solidified our work to improve the knowledge gap and develop a curriculum delivery method adapted to the heterogenous learning preferences of the residents in the program.

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ABSTRACT #81 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GASTROENTEROLOGY/INFECTIOUS DISEASES CYTOMEGALOVIRUS ILEITIS: A RARE CAUSE OF SUB-ACUTE DIARRHEA Maan El Halabi1, Oluwasayo Adeyemo1,2, Nebras Zeizafoun1, Michael Smith1 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Cytomegalovirus (CMV) enteritis is a common infection in immunocompromised patients. In the gastrointestinal tract, CMV infections are often seen in the esophagus and colon; only rarely do they involve the small bowel. We present a case of acute CMV pan-ileitis confirmed on histopathology.

CASE PRESENTATION: A 77-year-old man with previous history of high-grade muscle-invasive urothelial carcinoma treated with resection, biweekly chemotherapy, and radiation presented with sub-acute non-bloody watery diarrhea up to 10 times per day. Laboratory values are shown below:

CT scan of the abdomen and pelvis revealed pan-ileitis. Initial clinical management focused on possible infectious ileitis, empirically treated for bacterial enteritis with antibiotics without improvement. Colonoscopy then was performed and showed erythema, edema, and ulceration at the TI (Figure 1). Pathology showed fibrin-inflammatory exudates and lympho-plasmocytic infiltrates in the lamina propria, with mild architectural distortion. Viral immunostains demonstrated CMV inclusion bodies (Figure 2). Subsequent serum immunoglobulin test results confirmed elevated levels of both CMV IgM and IgG. CONCLUSION: Arriving at this diagnosis of CMV enteritis can be challenging, especially in the absence of immunosuppression or pathognomonic punched-out ulcerations.

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ABSTRACT #82 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GASTROENTEROLOGY DIAGNOSIS OF A GRAVE DISEASE IN A SEEMINGLY ASYMPTOMATIC WOMAN: BUDD CHIARI WITH PORTAL VEIN THROMBOSIS IN SETTING OF POLYCYTHEMIA VERA Maan El Halabi1, Jack Husney1,2; Bing Chen1, Jose Concepcion1, Gil Ascunce1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Portal vein thrombosis (PVT) and vascular disorder of the liver are rare in the general population with increased prevalence in patients with cirrhosis and myeloproliferative disorders (MPD). Up to 50% of patients with Budd Chiari syndrome (BCS) have an associated MPD while 10-15% are classified as idiopathic. Coincidence of BCS and PVT has been reported in 10-15% cases.

CASE PRESENTATION: A 35-year-old female with a history of migraines and spontaneous miscarriage presented with 1 week of epigastric pain, abdominal distention, and early satiety. On physical examination, she had marked hepatosplenomegaly and abdominal distention with dull percussion note throughout the abdomen including Traub’s space and shifting dullness. The liver was palpable 4 cm below the right costal margin. Labs showed ALT 810, AST 499, total bilirubin/direct bilirubin: 9.4/7.1, alkaline phosphatase 272, INR 2.6, albumin 2.9, and Hgb/Hct 14.3/42. CT-abdomen showed hepatomegaly, markedly enlarged left lobe of the liver, findings suggestive of PVT, splenomegaly, diffuse ascites, and focal wall thickening of colon and small bowel segments (Figure 1). The hospital course was complicated by worsening of symptoms and repeat imaging two days afterwards showed extension of the clot to involve the hepatic vein and SMV thrombosis and extending into the IVC with concerns for early signs of bowel necrosis. The patient underwent an emergent successful extended TIPS, IVC stent, and thrombectomy/thrombolysis of SMV and portal vein (Figure 1 and 2). Further work-up showed positive hypercoagulability workup for Janus kinase 2 (JAK2) 21%, no further mutations detected.

CONCLUSION: Young patients with no previous liver disease who present with hepatomegaly and abnormal LFTs need to be evaluated for vascular disease of liver; especially when there is a portal vein thrombosis and hepatomegaly in the setting of myeloproliferative disorders.

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ABSTRACT #83 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GASTROENETOLOGY IT’S SO MUCH MORE THAN JUST CARCINOID: CASE OF MIXED GASTRIC NEUROENDOCRINE CARCINOMA Maan El Halabi1, Neelesh Rastogi1,2, Jack Husney1,2, Sun A. Kim1, Edward Lung1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Mixed adeno-neuroendocrine carcinoma is a rare neoplasm composed of both exocrine and endocrine carcinomas, each comprising at least 30% of the tumor. The first description of mixed adeno-neuroendocrine caricinoma dates to a report published by Cordier in 1924, with further case reports published until 2010, when the WHO recognized this rare neoplasm as a distinct entity.

CASE PRESENTATION: A 52-year-old generally healthy female presented for a surveillance endoscopic evaluation of a gastric NET that had previously been endoscopically resected. Four months prior to her presentation, the patient had an EGD for workup of chronic anemia that was notable for a submucosal nodule at the greater curvature of the stomach. Subsequent EUS confirmed a 10 x 12 mm, umbilicated submucosal nodule originating from the submucosa. EMR was successfully performed. Biopsy, including synaptophysin and chromogranin stains, returned positive for well-differentiated neuroendocrine tumor. For surveillance of her lesion, the patient underwent an octreotide scan which revealed faint activity in the stomach. Repeat endoscopy to evaluate for residual tumor showed a 5 mm submucosal papule at the greater curvature, while EUS showed a hyperechoic lesion originating from the superficial mucosa involving the submucosa (Figure 1).

Pathology this time revealed intermingled components of invasive well-differentiated adenocarcinoma and NET, positive for SYN and Chromogranin (Figure 2). A diagnosis of mixed adeno-neuroendocrine carcinoma was confirmed and patient ultimately underwent a laparoscopic partial gastrectomy.

CONCLUSION: The diagnosis of mixed adeno-neuroendocrine carcinoma is based on tumor architecture and immuno-histochemical identification, as imaging and tumor markers are typically normal. Further studies are needed to increase awareness of this rare diagnosis and formulate more thorough diagnostic criteria and guidelines for management.

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ABSTRACT #84 CLINICAL RESEARCH GASTROENTEROLOGY LOWER ESOPHAGEAL SPHINCTER PRESSURES ARE SIGNIFICANTLY REDUCED IN PATIENTS WITH A HIATAL HERNIA BUT NO MAJOR ABNORMALITY ON ESOPHAGEAL MANOMETRY Maan El Halabi1, Xiaocen Zhang1, Elijah Verheyen1,2, Justin Field1,2, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: A hiatal hernia (HH) eliminates the normal alignment of the lower esophageal sphincter (LES) and crural diaphragm, separating the two components of the esophago-gastric junction high pressure zone. This separation may affect parameters measured during high resolution esophageal manometry (HREM), including measurements of resting lower esophageal sphincter (LES) pressure. The effect of a HH on LES relaxation, as measured by integrated relaxation pressure, is less well studied. The aim of this study was to determine how a HH affects HREM parameters.

METHODS: HREM performed at a large referral-based motility center between 2013 and 2019 were reviewed.

Patients with any major/minor peristaltic disorder based on Chicago Classification version 3.0 (CC3), or where the catheter did not traverse the LES, were excluded. Key manometric parameters including LES resting pressure and IRP, distal contractile integral, contractile front velocity, distal latency, and esophageal length were collected. Patients were further subdivided into 3 groups according to HH size on HREM for analysis: no HH, HH 0.1–1.9cm, and HH ≥ 2 cm.

RESULTS: A total of 1,330 HREM reports were reviewed, with 479 studies not showing a CC3 abnormality.

These patients had no HH (189, 39.5%), HH 0.1–1.9 cm (172, 35.9%), and HH ≥ 2 cm (118, 24.6%) (Figure 1 and Table 1). Analysis demonstrated that the presence of a hiatal hernia was associated with a significantly lower mean LES resting pressure, integrated relaxation pressure, and distal contractile integral (all pvalues<0.02, Table 2). Esophageal length was consistently shorter in hiatal hernia patients (p<0.01). For all three parameters, values decreased as hiatal hernia size increased. There was no statistical difference between groups with respect to contractile font velocity or distal latency.

CONCLUSION: In patients without a CC3 peristaltic abnormality, hiatal hernia patients show significant decreases in LES resting pressure, integrated relaxation pressure, and esophageal length. Separating the crural diaphragm from the esophago-gastric junction high pressure zone may be partially responsible for the drop in pressures. However, HREM analysis software is supposed to isolate the LES from any crural diaphragm contribution. Additional investigation is necessary to determine whether and what hiatal herniarelated changes to the LES itself are contributing to this significant difference, and if they affect related conditions such as gastro-esophageal reflux. Shorter esophageal length may impact the success of a hiatal hernia repair. Further studies exploring the outcomes of different surgical approaches in varying esophageal lengths are warranted.

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Figure 1. Study flow diagram

Table 1. Baseline demographic characteristics

Table 2. High resolution esophageal manometry findings 142

ABSTRACT #85 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY METASTATIC GASTRIC CARCINOMA MASQUERADING AS A PEDUNCULATED BLEEDING GASTRIC POLYP Maan El Halabi1, Heath Ward2, Elijah Verheyen1,2, Ilan Weisberg2, Gabriel Levi2 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: The majority of gastric polyps are found incidentally and are benign hyperplastic or fundic gland polyps with low malignant potential. Up to 10% can be adenomas which possess a higher neoplastic potential. Appropriate management of gastric polyps is vital as some may harbor underlying malignancy or cause complications, e.g. bleeding. We present a case of an elderly patient with acute upper GI bleeding from a metastatic gastric adenocarcinoma masquerading as a typical fundic gland polyp.

CASE PRESENTATION: A 77-year-old woman presented with 2 days of loose foul-smelling black stools and fatigue, was hemodynamically stable with a benign abdominal exam, and had a hemoglobin of 7.1 g/dL. EGD revealed a 3.5 × 2.0 × 1.8 cm pedunculated polyp on the lesser curvature of the stomach with large adherent clot, which was removed and hemostasis achieved (Figures A and B). Histopathology showed a gastric tubular adenoma with intra-mucosal carcinoma and invasion into the lamina propria. Staging scans revealed peritoneal implants consistent with disseminated stage IV disease. Due to age, a palliative treatment approach was taken with radiotherapy.

CONCLUSION: Gastric polyps can be seen in incidentally on 6% of endoscopies with gastric adenomas representing only 6–10%. While all classes of gastric polyps are usually incidental findings on EGD, gastric adenomas are more likely than all other classes to cause complications. The neoplastic potential of two other commonly encountered polyps - hyperplastic and fundic gland polyps - are generally quite low at 1% and virtually nonexistent outside of familial polyposis syndromes, respectively. On the contrary, gastric adenomatous polyps are associated with concurrent gastric carcinoma in 8–59% of cases. Isolated polyps that are pedunculated with normal surrounding mucosal tissue, as seen here, conventionally have a low suspicion for malignancy. Furthermore, is it uncommon to encounter a purely pedunculated gastric adenoma, as the majority of these lesions are sessile. Often, signs of upper GI bleeds can be the initial presentation of gastric carcinomas. As older populations are more prone to gastric polyps, many may also have comorbidities such as chronic anemia or on medications preventing hemostasis, which has potential to be detrimental. In conclusion, here we highlight a unique presentation of metastatic gastric carcinoma and stress vigilant assessment of all gastric polyps and discuss potential complications as even benign appearing lesions could harbor malignancy.

Figure 1. 3.5 x 2 x 1.8 cm pedunculated polyp seen on retro-flexion on the lesser curvature of the gastric body with an adherent clot with normal appearing surrounding gastric mucosa.

Figure 2. Site after local epinephrine injection and hot-snare polypectomy, prior to hemostatic clip placement.

143

ABSTRACT #86 CLINICAL RESEARCH GASTROENTEROLOGY OUTCOMES OF ENDOSCOPY VERSUS SURGERY FOR AMPULLARY ADENOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS Maan El Halabi1, Angad Uberoi1, Gaurav Kakked1, Gassan Kassim1, Samantha Walsh1, Christopher J. DiMaio2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Ampullary adenomas (AA) form an uncommon group of gastrointestinal neoplasms that are can be incidentally discovered on a routine upper GI endoscopy. These lesions have traditionally necessitated a pancreatoduodenectomy or a transduodenal surgical ampullectomy (SA), which entail considerable morbidity. In recent years, endoscopic ampullectomy (EA) has surged as an alternative in periampullary neoplasms, however, data about rates of successful resection, complication and long-term recurrence rates is sparse.

METHODS: We searched Medline and Embase databases up to May 30, 2020, to identify RCTs and observational studies evaluating the efficacy and safety of endoscopic vs surgical approach for patients with AA. The outcomes of interest were complete primary resection, primary success, recurrence, complications, length of stay and mortality. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. Meta-analysis was performed using the Random effects model in Revman 5.3.

RESULTS: Ten retrospective cohort studies were selected (728 patients). Majority of studies had complete primary resection and primary success data available, which showed a difference that slightly favored surgical treatment [(OR, 0.15; 95% CI, 0.05–0.45; I2=46%) and (OR, 0.14; 95% CI, 0.05–0.40; I2=24%), respectively] (Figure 1). Recurrence data indicated a statically significant odds ratio of having recurrence with endoscopy (OR, 3.22; 95% CI, 1.65–6.28; I2=1%). Median follow-up period was variable ranging from 8 to 38 months for EA group vs 15 to 48 months for SA group. Postoperative complications were less common after EA versus SA (OR, 0.35; 95% CI, 0.16 to 0.75; I2=59%), mainly hemorrhage and pancreatitis in both groups, and wound dehiscence/infection and leak in the SA group (Figure 2). Only five studies included data about length of stay of patients with ranges between 0 and 8.5 days for EA versus 9.5–20 days for SA, however no reported SD thus analysis was not feasible. Only 3 studies (314 patients) compared mortality rates (1 patient in EA versus 3 patients in SA).

CONCLUSION: Endoscopic ampullectomy is a less invasive technique associated with lower morbidity and improved LOS compared to conventional surgery, however, has a higher chance of recurrence and lower successful papillectomy rates. With the presence of high heterogeneity among studies and the lack of a randomized trials, further studies are required to evaluate long-term outcomes with endoscopic ampullectomy and the need for post endoscopy surveillance to assess for recurrence.

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Figure 1. A. complete primary resection; B. primary success

Figure 2. C: Recurrence; D. Complications

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ABSTRACT #87 CLINICAL RESEARCH CARDIOVASCULAR DISEASE WHOLE EXOME SEQUENCING OF 3 PATIENTS WITH BRUGADA SYNDROME IN THE MIDDLE EAST: NOVEL VARIANTS IN KNOWN GENES IN RELATION TO A RANGE OF PHENOTYPES Athar Khalil1*, Farah Abdulhai2*, Joseph Elias2,3, Mohammad Sabra2,4, Jad Ballout2,5, Patrick Zakka6, Khalid Al Muti7, Maurice Khoury2, Bernard Abi-Saleh2, George Nemer1*, Marwan M. Refaat1,2* 1

American University of Beirut, Beirut, Lebanon; 2American University of Beirut, Beirut, Lebanon; 3Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Indiana University, Indianapolis, IN, United States; 5University of Kentucky, Lexington, KY, United States; 6Emory University, Atlanta, GA; 7Cleveland Clinic, Abu Dhabi, United Arab Emirates

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021. *These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Brugada syndrome is estimated to be responsible for 4% of all sudden deaths and 20% of sudden deaths among patients with structurally normal hearts. The genetic basis of this syndrome relies on those encoding for the subunits of cardiac sodium channels, potassium channels, and calcium channels, or genes involved in the trafficking or regulation of these channels.

METHODS: We used whole exome sequencing (WES) to unravel the genetic basis of idiopathic cases of Brugada syndromes.

RESULTS: WES revealed the presence of three novel mutations in three different genes encoding sodium channels (SCN5A, SCN4A and SCN10A) to be implicated in a range of phenotypes. SCN4A (Gln413*), a heterozygous non-synonymous nonsense mutation resulted in a stop codon, was detected in an asymptomatic patient with a family history of sudden cardiac death in his brother. Second novel mutation was found in SCN10A (Ile1159Val) resulting in a missense mutation that resulted in the patient with sudden cardiac arrest with ventricular fibrillation complicated with anoxic brain injury. Finally, a heterozygous mutation in SCN5A (Ala 672Thr) resulted in a missense mutation in a patient with Brugada syndrome (Figure A) and a presentation of syncope with ventricular fibrillation (Figure B) requiring implantable cardioverter defibrillator implantation.

CONCLUSION: These variants help in filling the gap in our knowledge on the genetic basis of Brugada syndrome in the Middle East.

Figure A. Brugada syndrome and Figure B. Ventricular Fibrillation 146

ABSTRACT #88 CLINICAL RESEARCH CARDIOVASCULAR DISEASE BIFURCATION PCI TECHNIQUE IN THE ERA OF NEWER-GENERATION DRUG-ELUTING STENTS: INSIGHTS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS Tomohiro Fujisaki1*, Toshiki Kuno2*, Yohei Numasawa3, Hisato Takagi4, Sripal Bangalore5 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan; 4Shizuoka Medical Center, Shizuoka, Japan; 5New York University Grossman School of Medicine, New York, NY, United States 2

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021. *These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: In patients with bifurcating coronary lesions, a provisional stent technique is recommended when compared with a routine 2-stent strategy. However, much of this data is from trials involving 1st generation drug eluting stents (DES).

METHODS: PubMed and EMBASE were searched through December 2020 for randomized control trials (RCT) investigating bifurcation percutaneous coronary intervention (PCI) techniques using newer generation DES. The primary endpoint was trial defined major adverse cardiovascular event (MACE).

RESULTS: Our research identified 12 RCTs with a total of 3,574 patients undergoing PCI with newer generation DES. Two-stent technique significantly decreased MACE (HR, 0.70; 95% CI, 0.54-0.92) (Figure 1A) and target vessel revascularization (TVR) (HR, 0.58; 95% CI, 0.39-0.85) (Figure 1B) when compared with provisional technique. There were no significant differences in all-cause mortality (HR, 0.82; 95% CI, 0.411.64), cardiovascular mortality (HR, 0.82; 95% CI, 0.46-1.48), myocardial infarction (HR, 0.95; 95% CI, 0.631.44), and stent thrombosis (HR, 0.79; 95% CI, 0.36-1.72) between the two groups. DK crush technique significantly decreased TVR when compared to other 2-stent techniques.

CONCLUSION: In this era of newer-generation DES, contrary to popular perception, a 2-stent approach is superior to provisional stenting technique for bifurcation lesion with significant reduction in MACE and TVR.

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ABSTRACT #89 CLINICAL RESEARCH CARDIOVASCULAR DISEASE/INFECTIOUS DISEASES EFFECT OF HEPATITIS C VIRUS INFECTION AMONG RECIPIENTS ON HEART TRANSPLANTS IN THE CURRENT ERA Tomohiro Fujisaki1*, Takahisa Mikami2*, Toshiki Kuno2, Noah Moss3, Sripal Bangalore4 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine, New York, NY, United States; 4New York University Grossman School of Medicine, New York, NY, United States 2

Presented at the Society General Internal Medicine (SGIM) Mid-Atlantic Meeting that was held virtually on November 13, 2020.** *These authors contributed equally to this work. **Recipient of the SGIM Mid-Atlantic Meeting Award for Scientific Abstract Poster Presentation BACKGROUND/INTRODUCTION: Heart transplants have become the gold standard of treatment for advanced heart failure. Hepatitis C virus (HCV) infection in recipients has been considered a relative contraindication, and heart transplants were often declined for those patients. However, the introduction of direct-acting antiviral agents (DAAs) in 2011 has fundamentally changed the treatment of HCV infection. The effect of HCV infection in recipients on heart transplants is less known in the current era after the introduction of DAAs. METHODS: Using the United Network for Organ Sharing registry, 25,581 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV infected recipients and the transplant outcomes were investigated in the past era versus the current era separated by 2011. HCV seropositivity was defined as positive HCV antibody. The primary outcome was all-cause mortality. Secondary outcomes included liver failure.

RESULTS: 8,779 (34%) patients underwent heart transplantation in the past era with a prevalence of HCV antibody positive recipients at 2.1% (n=184), and 16,802 (66%) patients in the current era with a similar prevalence at 2.1% (n=348). Regardless of the era, the patient demographics were similar between HCV antibody positive and negative recipients including the key prognostic factors such as age, gender, functional status, hemodynamics, renal function, liver function, donor age, donor gender, and ischemic. However, HCV antibody positive recipients were likely to have hepatitis B infection, ventricular assist device support at transplantation, and receive allografts from HCV infected donors. In the past era, recipient HCV antibody positive status was associated with an increased risk of liver failure (OR, 8.51; 95% CI, 2.73–21.7; p<0.001). In the current era, the recipient HCV antibody status was no longer associated with liver failure (OR, 0.98; 95% CI, 0.05–5.06; p=0.99).

CONCLUSION: Our study has several important limitations. The treatment regimens for HCV infection were not available, thus direct cause effect relationship between DAA introduction and survival could not be inferred.

In addition, HCV NAT status at the time of transplantation in recipients was not available, therefore the viral load of the recipients could not be adjusted for. In the current era, positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes. The compromised post-heart transplant survival in HCV antibody positive recipients observed in the past was not confirmed in the current era, supporting the candidacy of appropriately selected patients with history of HCV infection.

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ABSTRACT #90 CLINICAL RESEARCH CARDIOVASCULAR DISEASE POTENT P2Y12 INHIBITORS VS. CLOPIDOGREL IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME: INSIGHTS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS Tomohiro Fujisaki1*, Toshiki Kuno2*, Tomo Ando3, Alexandros Briasoulis4, Hisato Takagi5, Sripal Bangalore6 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Kawasaki Saiwai Hospital, Kawasaki, Japan; 4University of Iowa Hospitals and Clinics, Iowa City, IA, United States; 5Shizuoka Medical Center, Shizuoka, Japan; 6New York University Grossman School of Medicine, New York, NY, United States 2

Presented at the Society General Internal Medicine (SGIM) Mid-Atlantic Meeting that was virtually held on November 13, 2020. Published in American Heart Journal, 2021. PMID: 33737060 *These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Potent P2Y12 inhibitors (prasugrel or ticagrelor) reduce cardiovascular events but increase bleeding in patients presenting with acute coronary syndrome (ACS). Elderly patients are at increased risk of bleeding, and whether the benefit-risk ratio of potent P2Y12 inhibitors remains favorable is not known.

METHODS: PubMed and EMBASE were searched through July 2020 for randomized control trials (RCTs) or subgroup analyses of RCTs investigating potent P2Y12 inhibitors or clopidogrel in elderly (age ≥65 years) patients with ACS. The primary endpoint was trial defined major adverse cardiovascular events defined as a composite of cardiovascular death, myocardial infarction, and stroke. The secondary endpoints were all-cause mortality, cardiovascular death, myocardial infarction, stroke, stent thrombosis, and trial defined major bleeding.

RESULTS: Our study identified 9 eligible RCTs (1-9) including a total of 10,792 elderly. The median age ranged from 77 to 80 years. No significant differences were observed for major adverse cardiovascular events between potent P2Y12 inhibitors versus clopidogrel. Potent P2Y12 inhibitors, compared to clopidogrel, were associated with reduced risk of cardiovascular death, and ticagrelor was associated with lower risks of allcause mortality and cardiovascular death compared to clopidogrel. Potent P2Y12 inhibitors were associated with the higher major bleeding. risk in comparison with clopidogrel.

CONCLUSION: The finding elucidated in this study would help clinicians to use the best clinical judgement when selecting the P2Y12 inhibitors for elderly patients at high bleeding risk.

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ABSTRACT #91 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW CARDIOVASCULAR DISEASE/GENERAL INTERNAL MEDICINE IMPACTS OF SOCIAL DETERMINANTS OF HEALTH ON DUAL ANTIPLATELET THERAPY FOR ACUTE CORONARY SYNDROME Christopher Gold1, Dipal Patel1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held virtually from April 20-23, 2021.

CASE PRESENTATION: A 69-year-old female with unknown past medical history was brought into the Emergency Department after being found unconscious. ECG showed ST elevations in leads II, III, and aVF, reflecting myocardial infarction (MI). After intubation for acute respiratory failure, she was loaded with ticagrelor and aspirin and rushed to emergent coronary angiogram and PCI of the RCA. Mechanical thrombectomy was performed, along with placement of a drug-eluting stent. After an extensive stay in the Cardiac Care Unit, she was discharged with prescriptions for aspirin, ticagrelor, lisinopril, atorvastatin, and metoprolol, along with a limited supply of ticagrelor. One week after discharge, the family contacted the hospital about medication costs. The patient was only taking ticagrelor. During a cardiology follow up, she was given medication coupons. At her primary care follow up, she reported being unable to afford ticagrelor despite the coupons that reduced the out-of-pocket monthly cost of $1,200 to $600. She had yet to start her other medications. After discussion with her cardiologist, the regimen was changed to clopidogrel, available at the local 340B pharmacy for $30 per month.

DISCUSSION: This clinical vignette illustrates a complex but common example of MI requiring PCI and dual antiplatelet therapy (DAPT). In the inpatient setting, evidence-based treatment was followed. According to the American Heart Association and American College of Cardiology, ticagrelor is a reasonably preferred antiplatelet agent to be administered with aspirin for acute coronary syndrome. However, when transitioning to an outpatient setting, other factors need to be considered. This patient had limited insurance coverage of her medications. Although this was somewhat addressed with the coupons, her socioeconomic status was not taken into consideration. Coupons reduced the cost of ticagrelor by half, but as this medication is needed at least 12 months, this was not a solution. Additionally, the other medications could not be obtained. Like ticagrelor, clopidogrel is effective in improving outcomes and reducing cardiovascular events. Moreover, it is available as a generic formulation with a much cheaper price. Although one can argue preference for ticagrelor, in situations where the more expensive drug cannot be obtained, clopidogrel is a practical alternative.

CONCLUSION: For STEMI treated with stent, DAPT with aspirin and a P2Y12 inhibitor (eg, ticagrelor, clopidogrel) should be administered for at least 12 months. While ticagrelor has been shown to result in fewer cardiovascular events and death, clopidogrel is an effective and cheaper option. It is imperative to assess social determinants of health when prescribing treatment options.

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ABSTRACT #92 CLINICAL RESEARCH PULMONARY/CRITICAL CARE DISMANTLING THE OBESITY PARADOX IN ACUTE PULMONARY EMBOLISM Kam S. Ho1, Shabnam Nasserifar1, Paaras Kohli1, Joseph Poon1, Yasmin Herrera1, Archana Pattupara1, Andre Sotelo2, Raymonde Jean1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Hackensack Meridian Health Hackensack University Medical Center, Hackensack, NJ, United States

2

Presented at the European Respiratory Society (ERS) Annual Meeting that was held virtually from September 7-9, 2020.

BACKGROUND/INTRODUCTION: The “obesity paradox” has been a controversial topic in health outcome research. Age has been a significant cofounder and a new study is needed. To determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with acute pulmonary embolism (PE).

METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Adults (≥ 18 years) with a principal diagnosis of acute PE and a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature. The primary outcome was in-hospital mortality.

Secondary outcomes were length of hospital stay (LOS), and total hospitalization costs. Propensity score using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders.

RESULTS: In total, 171,233 hospital admissions with a primary diagnosis of acute PE were identified, of which 16.4% were obese. The index in-hospital mortalities were not statistically different between obese and nonobese patients (1.9 versus 7.1%, p=0.24). The 30-day readmission rate among were similar between the obese and non-obese patients (p=0.14). The most common reason for readmission was DVT (12%). Obesity and non-obese patients have similar LOS (p=0.46) and total hospital cost (p=0.52).

CONCLUSION: In this study, the mortality difference between obese and non-obese patients was not statistically significant. This clarifies that among acute pulmonary embolism patient, obesity paradox may not hold true.

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ABSTRACT #93 CLINICAL RESEARCH PULMONARY/CRITICAL CARE GO EASY WITH THE FLUIDS? INCREASED MORTALITY IN ACUTE RESPIRATORY DISTRESS SYNDROME WITH HYPERVOLEMIA Kam S. Ho1, Paaras Kohli1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Shabnam Nasserifar1, Andre Sotelo2, Raymonde Jean1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Hackensack Meridian Health Hackensack University Medical Center, Hackensack, NJ, United States

2

Presented at the European Respiratory Society (ERS) Annual Meeting that was virtually held from September 7-9, 2020.

BACKGROUND/INTRODUCTION: Sepsis is a leading cause of acute respiratory distress syndrome (ARDS).

The Surviving Sepsis guideline recommends the generous use of fluids, but hypervolemia is also associated with increased lung injury. To determine the relationship between hypervolemia and mortality and health care resource utilization in patients admitted to the hospital in the United States with ARDS on mechanical ventilation.

METHODS: A retrospective study was conducted using the AHRQ-HCUP National Readmission Database for the year 2014. Adults (≥ 18 years) with a principal diagnosis of ARDS on mechanical ventilation and a secondary diagnosis of hypervolemia were identified using ICD-9 codes as described in the literature. The primary outcome was in-hospital mortality. Secondary outcomes were length of hospital stay (LOS), and total hospitalization costs. Propensity score using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders.

RESULTS: In total, 92,438 hospital admissions with a primary diagnosis of ARDS on mechanical ventilation were identified, of which 7.76% were hypervolemic. In-hospital morality (33.62%) was higher among the hypervolemic group in comparison to the euvolemic group (25.54%, p<0.001). The 30-day readmission rate among were similar between the two group (p=0.06). The most common reason for readmission was unspecified acute respiratory failure (9.7%). Hypervolemia was associated with longer LOS (p<0.003) and a higher total hospitalization cost (p<0.001).

CONCLUSION: Excessive use of fluids during resuscitation for sepsis has an impact on lung and distal organ injury in ARDS.

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ABSTRACT #94 CLINICAL RESEARCH PULMONARY/CRITICAL CARE HYDROXYCHLOROQUINE AND COVID-19: A META-ANALYSIS Kam Sing Ho1, Yasmin Herrera1, Archana Pattupara1, Joseph Poon1, Bharat Narasimhan1, Justin Poon1,2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

BACKGROUND/INTRODUCTION: The use of anticoagulation was associated with a reduction in mortality in patients with COVID-19. To investigates the association between the use of anticoagulation and mortality among hospitalized patients with COVID-19 in order to provide clinical insights.

METHODS: An electronic search was conducted in PubMed, Scopus, and Medrxiv (preprint articles), using the search strategy included all MeSH terms and free keywords found for “coronavirus 2019” OR “COVID-19” OR “2019-nCoV” or “SARS-CoV-2”, AND “anticoagulation” OR “heparin” OR “enoxaparin” OR “apixaban” OR “rivaroxaban” between 2019 and present time without language restriction. The title, abstract, and full text of all documents captured with these search criteria were scrutinized, and those reporting the rate of anticoagulation in COVID-19 patients were included in this meta-analysis. The reference list of these identified studies was also analyzed (forward and backward citation tracking) for detection for other potential eligible articles. A metaanalysis was performed with Comprehensive Meta-Analysis software (version 3.3.070) in accordance with the PRISMA guidelines.

RESULTS: Overall, 286 documents could be initially identified based on our search criteria and from the reference list, 283 of which were excluded after title, abstract, or full text reading, since they were reviewed articles, commentaries, or other editorial materials, or they did not provide the information on mortality associated with the use of anticoagulation. Therefore, 3 studies could finally be included in our meta -analysis, for a total of 5297 patients, 2969 of which received anticoagulation. In summary, the odds ratio of mortality was 0.85 (random effect; 95% CI, 0.41-0.99; p<0.05), indicating that on an average, patients receiving anticoagulation had a 15% less likelihood of dying compared to those without anticoagulation. The variation in effect size was assessed by Q-value (8.36, df=2), I² (76.1%), and T² (0.11). Based on the Q-value, we rejected the null hypothesis that the true effect size is identified in all studies. Based on the I², 76.1% of the variance in observed effects reflects variance in true effects rather than sampling error. Publication bias, a concern where studies included in the analysis could be a non-random subset of all studies, were assessed by the Begg’s (p=0.60) and Egger’s test (p=0.07), which demonstrated no significant publication bias.

CONCLUSION: In conclusion, the results of this preliminary meta-analysis suggested that anticoagulation to be associated with a reduction in mortality in patients with COVID-19. Our study is not without limitations.

Given the novelty of the COVID-19 pandemic, many clinical trial studies were not available at the time of analysis and we had to rely on observational studies, which were less reliable, to evaluate the risk of death.

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ABSTRACT #95 CLINICAL RESEARCH PULMONARY/CRITICAL CARE IS THERE AN OPTIMAL DOOR-TO-TREATMENT TIME FOR ACUTE PULMONARY EMBOLISM? A NATIONAL PROPENSITY MATCH ANALYSIS Kam S. Ho1, Paaras Kohli1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Shabnam Nasserifar1, Andre Sotelo2, Raymonde Jean1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, United States

2

Presented at the European Respiratory Society (ERS) Annual Meeting that was held virtually from September 7-9, 2020 BACKGROUND/INTRODUCTION: Currently, there is limited data on the optimal door-to-treatment time for acute pulmonary embolism (PE).

METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Adults (≥18 years) with a principal diagnosis of acute PE and a procedural of systemic thrombolysis were identified using ICD-9 codes as described in the literature. The primary outcome was in-hospital mortality.

Secondary outcomes were length of hospital stay, total hospitalization costs, and 30-day readmission rates.

Propensity score using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders.

RESULTS: In total, 156,293 hospital admissions with a primary diagnosis of acute PE, 2.6% had systemic thrombolysis within 24 hours of admission. In-hospital morality is similar between early and late ST (p=0.97).

However, 30-day readmission rate was significantly lower for early ST compared to late ST (7.05 versus 19.5%, p<0.02). The index length of hospital stay was significantly longer for early ST group versus late ST (6.7 versus 5.1 days, p<0.01). Similarly, the total hospital cost was also more expensive for early ST group versus late group (p<0.001). Early ST was an independent predictor for lower 30-day readmission (OR, 0.291; p<0.001).

CONCLUSION: Early use of ST was associated with a lower 30-day readmission rate, higher length of hospital stay, and higher total hospital cost.

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ABSTRACT #96 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW PULMONARY/CRITICAL CARE SEIZURES AS THE INITIAL PRESENTATION OF COVID-19: A NOVEL CASE OF SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE Kam Sing Ho1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Bharat Narasimhan1, James Salonia1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

BACKGROUND/INTRODUCTION: The rapid and unprecedented spread of severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) has significantly limited our understanding of this disease. As the pandemic continues to evolve, cardio-pulmonary symptoms predominate, however, new atypical manifestation of COVID are increasingly recognized.

CASE PRESENTATION: A previously healthy 70-year-old man presented with a witnessed episode of newonset seizures. Per family accounts, the episode lasted three minutes with tonic-clonic movements of all extremities, followed by a period of confusion. He had endorsed worsening fatigue and headaches with a declining appetite over the preceding two weeks. There was no history of cough, respiratory symptoms, sick contacts, or prior similar episodes. Travel history was significant for a trip to California two weeks prior. He denied any medication, health supplement, or illicit substance use. Past medical, surgical, and family histories were unremarkable. On examination, the patient was obtunded and afebrile (37.3°C). He appeared visibly dyspneic, with an SpO2 of 85% on room air and RR of 34/minute, but remained hemodynamically stable. Lung auscultation revealed scattered bilateral crackles, while the neurological exam was non-focal. Clinically the patient appeared euvolemic. Computed tomography of the brain was unrevealing with no additional explanation for his prolonged altered mentation. Chest-radiography revealed bilateral air-space opacities. Labs indicated mild leukocytopenia (3.2 x10 9/L) with lymphopenia (0.6 x10 9/L) and a profound hyponatremia of 104 mEq/L. Renal and liver parameters were normal. Workup of his hyponatremia revealed a serum and urine osmolality of 230 mOsm/kg and 693 mOsm/Kg respectively with a urine sodium of 58 mmol/L. TSH and cortisol levels were normal. Inflammatory markers were significantly elevated. Influenza PCR, respiratory viral PCR panel, legionella urine antigen, and blood cultures were all negative; however, the COVID-19 PCR assay was subsequently found to be positive. Based on the patient’s clinical and biochemical data, he was diagnosed with severe symptomatic hyponatremia secondary to SIADH in the setting of COVID-19 pneumonia.

DISCUSSION: SIADH in the setting of pneumonia has been extensively studied and reported. A number of potential mechanisms have been postulated including extensive cytokine release, hypoxemia, nausea, and stress. Additionally, inflammation (IL-6 in particular) itself has been reported to directly impair osmoregulation leading to hyponatremia. We hypothesize that milder forms of hypercytokinemia and hyperinflammation could result in a number of less dramatic atypical presentations including SIADH. CONCLUSION: A high index of suspicion and awareness of this association is essential to mitigate SIADH related complications as cases of COVID-19 continue to rise.

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ABSTRACT #97 CLINICAL RESEARCH PULMONARY/CRITICAL CARE THE MOUNT SINAI COVID-19 EXPERIENCE: 4,300 HOSPITALIZED PATIENTS IN NEW YORK CITY Kam Sing Ho1, Archana Pattupara1, Yasmin Herrera1, Joseph Poon1, Justin Poon1,2, David Steiger1,2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

BACKGROUND/INTRODUCTION: To understand the characteristics, comorbid conditions, and clinical outcome of patients hospitalized with coronavirus disease 2019 (COVID-19) in the United States.

METHODS: This analysis included data from 7 acute care hospitals in the Mount Sinai Health System, which serves approximately 3.5 million patients in the New York metropolitan area. We included all consecutively hospitalized adults between March 1, 2020 to May 10, 2020, who had a positive polymerase-chain-reaction testing (RT-PCR) for SARS-CoV-2 infection by nasopharyngeal or oropharyngeal swab and who had a completed hospital course (discharged alive or died) at time of analysis, May 15, 2020. Initial testing for SARSCoV-2 was conducted by the New York State Department of Health until March 15, 2020, when internal testing was available at the Mount Sinai laboratory. Patients who died or who were transferred to another facility within 24 hours after hospital admission were excluded from the analysis. The study used de-identified data from the Mount Sinai Data Warehouse (MSDW) ‒ “COVID-19 Project”. The Mount Sinai COVID-19 Clinical Research Protocol Review Committee approved this study and the Institutional Review Board of the Icahn School of Medicine at Mount Sinai exempted the research project from approval as it is a retrospective review of already collected, de-identified data.

RESULTS: A total of 4,903 consecutive admissions with RT-PCR confirmed COVID-19 were admitted to seven Mount Sinai Hospitals between March 1, 2020 to May 10, 2020. Among these 4313 patients, 1270 died during their hospitalization while 3043 were successfully discharged. The mean age of the study population was 65.08 ± 16.8 years, with a male predominance (56.6%). Hypertension, diabetes, chronic kidney disease, smokers, a history of chronic obstructive pulmonary disease, and a history of smoking were significantly more common among non-survivors (all p<0.05). Inflammatory biomarkers were examined in patients on admission.

Survivors were more likely to have a lower mean level of CRP, D-dimer, and procalcitonin.

CONCLUSION: In this case series, we described our early clinical experience with COVID-19. We illustrated the characteristics, comorbid conditions, and clinical outcome of sequentially hospitalized patients with confirmed COVID-19 in New York City.

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ABSTRACT #98 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY SUSPICIOUS FOR SOMETHING PERNICIOUS Krystle Hernandez1, Kirtipal Bhatia1, Jonathan Albert Jamito1, Ana Arevalo1, Shivani Handa1, Yasmin Herrera1, David Weininger Cohen1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held virtually from July 20-24, 2020.

CASE PRESENTATION: A 52-year-old African American male with a past medical history of gastric ulcer presented to the emergency department with progressively worsening exertional dyspnea and fatigue over the past two months. Physical examination was significant for a heart rate of 105 bpm and icteric sclera. Initial laboratory analysis revealed a hemoglobin of 3.9 g/dl, platelet count of 54 X 10 3/ml, and white blood cell count of 5.8 X 103/ml, with a mean corpuscular volume of 110 fL. Peripheral smear revealed schistocytosis, teardrop cells, and anisopoikilocytosis. No hypersegmented neutrophils were seen. PT/INR and aPTT were normal.

Total bilirubin was 2.8 mg/dl with a direct component of 0.9 mg/dl, lactate dehydrogenase (LDH) was 6,975 IU/L and haptoglobin levels (<8 mg/dl) were undetectable. Abdominal ultrasound showed no hepatosplenomegaly and normal biliary ducts. Additional labs revealed a corrected reticulocyte count of 0.4 %, and direct coombs was negative. D-dimer, fibrinogen levels, ADAMTS13 levels, hemoglobin electrophoresis, and serum Immuno-electrophoresis were normal. However, vitamin B12 level was low (<150 pg/ml) with elevated methylmalonic acid levels of 3853 mmol/L (MMA) and normal folate levels. The anti-intrinsic factor antibody was positive, and the diagnosis of pernicious anemia was made. The patient was transfused three units of pack red blood cells and started on 1000 mcg of intramuscular B12 injection daily. LDH, haptoglobin, hemoglobin, platelet count, and reticulocyte count all improved with high dose vitamin B12 therapy.

DISCUSSION: Our patient presented with symptomatic anemia, thrombocytopenia, schistocytes, elevated LDH, low haptoglobin, and indirect hyperbilirubinemia concerning for microangiopathic hemolytic anemia (MAHA). However, ADAMTS13 levels, coagulation profile, and fibrinogen levels were normal, ruling out disseminated intravascular coagulopathy (DIC) and thrombotic thrombocytopenic purpura (TTP). The patient’s inadequate bone marrow response, signified by a low reticulocyte count, along with the low vitamin B12 levels and elevated MMA, confirmed vitamin B12 deficiency as the cause for his anemia. Intramedullary hemolysis resulting in pseudo-thrombotic microangiopathy may occur in 2.5 percent of patients with severe vitamin B12 deficiency and can mimic TTP. Pernicious anemia is the most common cause of severe B12 deficiency. It occurs due to an autoimmune response against the gastric mucosa, resulting in the formation of autoantibodies to intrinsic factor secreted by parietal cells. Lifelong treatment with parenteral or oral B12 supplementation is indicated, and initiation of treatment results in a marked improvement in markers of hemolysis and cell counts.

CONCLUSION: Intramedullary hemolysis is an uncommon presentation of severe vitamin B12 deficiency. Due to the starkly differing management strategies, differentiation between MAHA and vitamin B12 deficiency is of utmost importance. Therefore, physicians should always include B12 deficiency as a differential for a patient presenting with features of MAHA and an inadequate bone marrow response.

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ABSTRACT #99 CLINICAL RESEARCH GASTROENTEROLOGY APPLICATION OF FECAL MICROBIOTA TRANSPLANTATION BEYOND THE FIELD GASTROENTEROLOGY Gassan Kassim1, Ryan Ungaro2, Ari Grinspan2, David Sachar2, Jean-Frederic Colombel2, Eyal Klang3

OF

1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel 2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: First described in 1958 as a possible treatment modality for pseudomembranous enterocolitis, now decades later fecal microbiota transplantation (FMT) has become part of the treatment guidelines for recurrent Clostridium difficile infections. With increasing understanding of the microbiome’s role in various diseases, application of FMT beyond Clostridium difficile colitis and other gastrointestinal (GI) conditions is being explored. This study aimed to investigate registered clinical trials dealing with FMT and various non-GI conditions.

METHODS: We analyzed the freely available ClinicalTrials.gov registry. ClinicalTrials.gov is a Web-based resource maintained by the National Library of Medicine (NLM) at the National Institutes of Health (NIH) for registering clinical trials. Data retrieval was performed on 5/25/2020. We searched for all trials including the terms microbiome or microbiota. The database was downloaded and analyzed. Trials dealing with FMT were collected. Official title, summary, detailed description, and primary outcome of every trial were reviewed. Trials were then stratified by the discipline and by disease or condition.

RESULTS: We retrieved 258 FMT clinical trials. Of those, 171/258 (66.3%) were related to GI conditions.

87/258 (33.7%) were related to other conditions outside gastroenterology. In GI, the most studied condition was Clostridium difficile colitis with 68/184 trials (40.0%). Inflammatory bowel disease (IBD) had 47/184 trials (25.5%), Irritable bowel syndrome (IBS) had 14/184 trials (7.6%), as well as other GI conditions. In the non -GI group, we identified 12 different disciplines (Figure 1) with oncology being the most common (24 trials). Table 1 details the conditions studied in each discipline. The most studied condition is multidrug resistant organisms such carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococcus (VRE) (17 trials) and how FMT can decontaminate these organisms from the host microbiome.

CONCLUSION: Not surprisingly, most FMT clinical trials are dealing with Clostridium difficile colitis. Outside GI, multiple disciplines are starting to explore the role FMT may play in modifying outcome or response to therapy. Oncology is the discipline that has the highest number of trials, while decontamination of multidrug resistant organisms is the most studied condition.

159

Figure 1: FMT Clinical trials in various non-GI disciplines

160

Medical Discipline

Conditions

Oncology (24 trials)

•

Infectious disease (19 trials)

• • • • • • • •

Endocrinology (11 Trials)

Psychiatry (8 Trials)

Neurology (8 Trials)

Dermatology (5 Trials) Rheumatology (4 Trials)

Urology (2 trials) Transplant medicine (2 trials) Nephrology (2 trials) Immunology (1 trial) Critical Care (1 trial)

• • • • • • • • • • • • • • • • • • • • •

13 trials about hematopoietic stem cell transplant and gastrointestinal graft vs Host disease, 2 trials about Acute myelogenous leukemia, 3 trials about cancer directed immunotherapy 1 trial about radiotherapy 2 trials about melanoma, 1 trial about renal cell carcinoma 1 trial about genitourinary cancer 1 trial about prostate Cancer 17 trials about multidrug resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococcus (VRE) 2 trials about HIV 7 trials about obesity 3 trials about diabetes type 2 1 trial about diabetes type 1 2 trials about Depression 1 trial about Bipolar 2 trials about autism 2 trials about chronic fatigue syndrome 1 trial about anxiety 4 trials about multiple sclerosis 2 trials about Parkinson’s disease 1 trial about epilepsy 1 trial about Alzheimer’s disease 4 trials about atopic dermatitis 1 trial about alopecia areata 1 trial about Rheumatoid Arthritis 1 trial about Psoriatic arthritis 1 trial about Systemic Sclerosis 1 trial about Ankylosing spondylitis 2 trials about recurrent urinary tract infections 2 trials about renal transplant

• • • •

1 trial about chronic kidney disease 1 trial about IgA nephropathy 1 trial about peanut allergy 1 trial about sepsis

Table 1: Detailed description of FMT clinical trials stratified by medical disciplines and conditions

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ABSTRACT #100 CLINICAL RESEARCH GASTROENTEROLOGY TIME TRENDS IN GUT MICROBIOME CLINICAL TRIALS IN GASTROENTEROLOGY Gassan Kassim1, Ryan Ungaro2, David Sachar2, Jean-Frederic Colombel2, Eyal Klang3 1

Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel 2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Over the past few 2 decades many studies have deepened our understanding of the gut microbiome’s role in health and various conditions/diseases. There is great interest in exploring the microbiome as a therapeutic target in many gastrointestinal (GI) conditions. We aimed to analyze the trends in clinical trials that investigate gut microbiome-based interventions in GI conditions.

METHODS: We analyzed the freely available database on ClinicalTrials.gov which is a web-based resource maintained by the National Library of Medicine (NLM) at the National Institutes of Health (NIH) for registering clinical trials. The registry was accessed on 5/25/2020. We searched for trials including the terms microbiome or microbiota. The database was downloaded and analyzed. All trials dealing with the microbiome were collected.

Official title, summary, detailed description, funding, start date, and primary outcome for each trial were reviewed.

Trials were then stratified by discipline and by investigated disease/condition and divided into GI vs non GI conditions.

RESULTS: Overall, 2048 microbiome clinical trials were retrieved. Of these trials, 491/2048 (24.0%) investigated GI diseases and conditions and 1557/2048 (76%) were non-GI conditions. Table 1 details various GI conditions and the number of trials respectively. When looking at specific GI conditions, the most investigated group was inflammatory bowel disease (IBD) (124/491,25.3%), followed by GI infections (94/491, 19.1%), irritable bowel syndrome (IBS) and motility disorders (92/491, 18.7%). The annual rate of clinical trials started to rise in 2005 for both GI and non-GI conditions. While for non-GI conditions the annual rate is still exponentially rising, for GI conditions the annual rate has plateaued at a rate of about 70 trials per year since 2016 (Figure1). Sub-analysis of the trends for the respective GI conditions is presented in Figure 2. Most GI trials were funded by individuals, universities, and organizations (listed as Others) (412/491, 83.9%). 49/491(10.0%) were funded by industry and 32/491 (6.5%) were funded by the National Institutes of Health (NIH) or other U.S. Federal agencies.

CONCLUSION: Overall, clinical trials in microbiome continue to increase although in the GI field the rate is plateauing. The role of microbiome interventions in various GI conditions is being explored with the most commonly investigated condition being IBD.

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Gastrointestinal condition groups IBD

Number of Clinical Trials 124

Gastrointestinal infections IBS

94

GI cancer

56

NAFLD

29

Cirrhosis

24

GI Procedures

23

Malabsorption Reflux disease

15 14

Pancreatico-biliary system Hepatitis

10

92

10

Detailed conditions included Inflammatory Bowel Disease (IBD), Crohn's Disease, Ulcerative Colitis, Pouchitis, Collagenous Colitis, Microscopic Colitis Clostridium difficile, Helicobacter pylori, Gastroenteritis, Gut infections Irritable Bowel Syndrome (IBS), Motility disorders, Chronic Constipation, Diarrhea, Chronic Intestinal Pseudo-Obstruction, Diverticulosis Barrett’s Esophagus, Colorectal Cancer, Gastric Cancer, Pancreatic Cancer, Anal Cancer Nonalcoholic Fatty Liver Disease (NAFLD), Non-alcoholic steatohepatitis (NASH), NASH Cirrhosis Cirrhosis, Hepatic Encephalopathy, Liver Transplant, Hepatocellular Carcinoma Esophagogastroduodenoscopy (EGD), Colonoscopy, Endoscopic retrograde cholangiopancreatography (ERCP), Fecal Microbiota Transplant (FMT), bariatric endoscopy Malnutrition, Celiac Disease Gastroesophageal Reflux Disease (GERD), Dyspepsia, Proton Pump Inhibitors (PPI) Acute Pancreatitis, Primary Sclerosing Cholangitis, Biliary atresia Alcoholic Hepatitis, Alcoholic Liver Disease, Hepatitis B, Hepatitis C, Acute liver Failure

Table 1: Detailed description and grouping of various GI conditions and the number of trials respectively.

Figure 1: Trends in microbiome clinical trials over the past 2 decades stratified by trials regarding GI conditions versus trials regarding non-GI conditions.

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ABSTRACT #101 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW CARDIOVASCULAR DISEASE INFECTIVE ENDOCARDITIS DUE TO GROUP B STREPTOCOCCUS IN A TRANSGENDER FEMALE Persio Lopez Loyo1, Chandrashekar Bohra1, Adrian Nugent1, Yeraz Khachatoorian1, Edgar Argulian1, Vaani Garg1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

BACKGROUND/INTRODUCTION: Infective endocarditis (IE) can affect structurally normal valves due to patient-specific factors in the transgender community.

CASE PRESENTATION: A 20-year-old trans female presented with fever, dyspnea, and myalgia for a week.

Medical history included hormonal gender transition and sickle cell trait. She had recently completed a course of ciprofloxacin for acute cystitis. Social history was unremarkable. On exam, she was febrile, tachycardic, and had a 3/6 apical holosystolic murmur. Labs revealed leukocytosis and mild troponin elevation, and ECG showed nonspecific T wave inversions. Due to subacute fever and a new murmur, empiric therapy for IE was initiated.

CONCLUSION: Transthoracic echocardiography (TTE) revealed a large vegetation on the mitral valve with moderate-severe regurgitation. Transesophageal echocardiogram showed P1 mitral valve leaflet perforation and a 1.5-cm vegetation involving the lateral commissure and subvalvular apparatus (Figure 1). Blood cultures identified Group B streptococcus (S. agalactiae). The patient later described daily use of compression underwear to hide male genitalia, possibly leading to an atypical, complicated cystitis with a gastrointestinal commensal.

Follow-up TTE showed resolution of the vegetation but persistent severe mitral regurgitation. She awaits mitral valve repair due to progressive dyspnea. IE due to atypical organisms may complicate gender adjustment measures in transgender individuals.

Figure 1. Transesophageal echocardiogram showed P1 mitral valve leaflet perforation and a 1.5-cm vegetation involving the lateral commissure and subvalvular apparatus

164

ABSTRACT #102 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW CARDIOVASCULAR DISEASE SEVERE METHEMOGLOBINEMIA CLINICALLY PRESENTING AS ACUTE CORONARY SYNDROME Arsalan Rehmani1, Yeraz Khachatoorian1, Angel De La Cruz Tejada1,2, Nassim Krim1,2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY, United States

2

To be presented at the American College of Cardiology (ACC) Annual Meeting that will be held virtually from May 15-17, 2021.

BACKGROUND/INTRODUCTION: Methemoglobinemia is a rare disorder presenting with various degrees of end organ ischemia.

CASE PRESENTATION: Methylene blue was given intravenously causing dramatic recovery. SaO2 normalized and EKG changes resolved (Fig. 1B). Echocardiogram was normal and stress testing showed no signs of ischemia. Methemoglobin contains iron atoms in the ferric (Fe 3+) state instead of the ferrous (Fe 2+), losing their ability to reversibly bind oxygen. The patient accidentally ingested a “popper” containing isobutyl nitrite. Nitrites are commonly implicated in the pathogenesis of methemoglobinemia due to their oxidizing property. At levels over 60% severe symptoms occur. Transient hypoxia likely caused cardiac ischemia, imitating ACS. Methylene blue non-enzymatically reduces methemoglobin to hemoglobin (Fig. 1C). It is contraindicated in glucose 6-phosphate dehydrogenase deficiency. An interesting yet harmless effect is its propensity to turn urine blue due to renal elimination (Fig. 1D).

CONCLUSION: Non-coronary conditions can mimic ACS due myocardial hypoxia. Timely recognition prevents unnecessary testing and potentially fatal delay in management.

165

ABSTRACT #103 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW PULMONARY/CRITICAL CARE AN UNCOMMON CAUSE OF ACUTE KIDNEY INJURY AFTER PROLONGED SEIZURE Archana Pattupara1, Maria Athena Riego1, Paaras Kohli1, H.S. Gupta1, James Salonia1, Susannah Kurtz1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

BACKGROUND/INTRODUCTION: Acute urate nephropathy seen after prolonged seizures is an uncommon phenomenon and diagnosis is often missed or delayed. Most of the literature describes the condition in the setting of chemotherapy or tumor lysis syndrome. With timely diagnosis and intervention, kidney damage is reversible and might prevent the need for renal replacement therapy.

CASE PRESENTATION: We describe a case of a 28-year-old gentleman with a medical history of seizures, non-compliance with antiepileptics, occasional alcohol and marijuana use who presented with generalized tonic-clonic seizures. The patient was intubated for airway protection, started on a continuous infusion of benzodiazepines and admitted to the medical ICU. Neurology was consulted and he was treated with levetiracetam and monitored on a continuous electroencephalogram. CT-head revealed no acute pathology. A basic metabolic panel (BMP) was significant for a sodium of 151 mmol/L, potassium of 3.8 mmol/L, creatinine of 1.29 mg/dL, BUN 11 mg/dL and creatinine phosphokinase (CPK) of 500 U/L. A BMP obtained six hours later was significant for a new acute kidney injury (AKI) with creatinine of 2.18 mg/dL. Urinalysis was significant for blood with 11 RBC’s. Given concern for developing rhabdomyolysis he was treated with three liters of saline, followed by additional maintenance IV fluids. Despite aggressive fluid resuscitation, the patient developed progressive oliguria and creatinine increased to 4 mg/dL. Further work up revealed a modestly elevated CPK of 857 U/L, an elevated serum uric acid of 15 mg/dL, and an extremely high amount of uric acid in his urine (513 mg/L). Classic uric acid crystals were visualized on urine microscopy. A diagnosis of acute urate nephropathy was made. Intravenous Rasburicase was administered within 12 hours of AKI onset. Subsequently, the uric acid level decreased to 4 mg/dL and urine output increased to 80 mL/hr. The patient clinically improved and was extubated. Unfortunately, at this point the patient left the ICU against medical advice and was lost to follow up.

CONCLUSION: Acute oliguric urate nephropathy can develop without dramatic increase in CPK as seen in rhabdomyolysis. A serum uric acid level may be considered as part of a post ictal evaluation in patients with prolonged seizures. Evaluation of urine is quick and helps with diagnosis. This case emphasizes the significance of a timely diagnosis of an uncommon phenomenon and the importance of early interventions and administration of Rasburicase to prevent irreversible kidney damage and progression to renal replacement therapy.

166

ABSTRACT #104 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW PULMONARY/CRITICAL CARE AN UNUSUAL CASE OF LOWER EXTREMITY WEAKNESS AND SHOCK IN A YOUNG WOMAN FROM THYMIC CARCINOMA Archana Pattupara1, Maria Athena Riego1, Jon Stoever,1,2 J.T. Guerra1, Kusum S. Mathews3 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

BACKGROUND/INTRODUCTION: Thymic carcinoma is an aggressive and rare cancer from thymic epithelial cells. It frequently occurs in adults from 40 to 60 years old and is associated with very poor prognosis. This neoplasm is usually diagnosed in advanced stages with symptoms of upper airway obstruction, chest pain, or dyspnea due to the burden of the disease required to cause symptoms. Here, we describe a 24-year-old female who presented with bilateral lower extremity numbness found to have rapidly aggressive thymic carcinoma.

CASE PRESENTATION: We report a 24-year-old female with medical history of intermittent asthma who presented to the emergency department with a two-week history of progressive bilateral lower extremity numbness. Imaging of the spine revealed no spinal cord abnormalities but a mediastinal mass and left sided pleural effusion. On further review, she reported exertional dyspnea and history of pericardiocentesis one -year prior for unclear reasons but was lost to follow up. CT-chest revealed a large mediastinal mass with mass effect, encasing and partially compressing the great vessels, main pulmonary arteries, left pulmonary vein, and left mainstem bronchus, along with a filling defect consistent with left atrial thrombus on contrast enhancement.

Further CT angiogram of abdomen and pelvis showed emboli in distal common femoral arteries, explaining her presenting symptoms. Pathology of CT-guided biopsy revealed a poorly differentiated high-grade epithelial neoplasm consistent with thymic carcinoma. In this short duration, she decompensated hemodynamically, likely from obstructive shock in the setting of compression of great vessels, requiring intubation and vasopressors. Given her hemodynamic instability, she was not a candidate for surgical intervention and was started on neoadjuvant chemotherapy with cisplatin after multidisciplinary discussion. She however did not tolerate the treatment, suffered from cardiac arrest from worsening shock and eventually succumbed to her illness on day 16 of hospital admission.

CONCLUSION: This case report emphasizes an atypical presentation in a young woman with a rare diagnosis of thymic carcinoma, leading to rapid progression of the disease and death. TNM (tumor/node/metastasis) and pathology-based staging are used for thymic cancer which is imperative in deciding treatment options including surgical resection and if unresectable, chemotherapy or radiotherapy for palliation. As noted in earlier studies, tumor invasion of vessels and inoperability of the tumor are known to be negative prognostication indicators. It is challenging but vital for critical care physicians to have high suspicion for rapidly progressing malignant disease and consider early surgical intervention if possible in these conditions.

167

ABSTRACT #105 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW PULMONARY/CRITICAL CARE PERICARDIAL EFFUSION ASSOCIATED WITH CRYPTOCOCCAL TRANSPLANT PATIENT Christopher Perez Lizardo1, Avinash Singh1,2, Jennifer Fung1 1 2

MENINGITIS

IN

A

RENAL

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

BACKGROUND/INTRODUCTION: Immunosuppressed individuals such as those with HIV/AIDS infection, solid organ or hematologic transplants, hematologic neoplasm, and immunodeficiency are at increased risk of fungal infections. Although the central nervous and respiratory systems are the most common involved organs, other locations have been described, including the pericardium.

CASE PRESENTATION: A 59-year-old male with a past medical history of renal transplant 9 years prior, on tacrolimus, mycophenolate, and prednisone, presented with confusion, new onset hearing loss, and fever for the past month. Upon arrival patient had a temperature of 102.1F, White Blood Cell Count was 13,500/mm3.

Imaging revealed a large pericardial effusion. Cryptococcus antigen was positive in cerebrospinal fluid and serum but was not identified in the pericardial fluid. Nevertheless, no re-accumulation of fluid noted after starting antifungal therapy and drainage. Over 2,000 ml of serous fluid were drained through the pericardial window in a span of 12 days. Hospital course was complicated by embolic strokes and new onset atrial flutter.

CONCLUSION: Cryptococcus neoformans is the third most common fungal infection found in solid transplant patients. Disease occurs through inhalation of the yeast to the respiratory tract, followed by hematogenous dissemination. The central nervous system is the most common site of infection, followed by the lungs.

Pericardial disease is rare and there have been few case reports of fungal associated pericarditis. Despite no recent increases in the dose of immunosuppressants, this patient was already at high risk of opportunistic infections given a previous history of infection with BK virus three years prior.

168

ABSTRACT #106 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW PULMONARY/CRITICAL CARE MISDIAGNOSIS OF ASTHMA IN A PATIENT WITH HYPEREOSINOPHILIC SYNDROME WITH CARDIAC INVOLVEMENT Maria Athena Riego1, Justin Poon1,2, Roshni Naik1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

BACKGROUND/INTRODUCTION: Misdiagnosis of asthma can lead to delays in treatment of underlying respiratory condition and lead to adverse outcomes to patient. Spirometry is crucial in the diagnosis of asthma as history and physical exam alone is not reliable. In severe asthma, biomarkers such as blood eosinophil level may be checked to determine asthma endotype; however, blood eosinophil alone is not useful in asthma diagnosis. We present a case of a patient with severe asthma-like symptoms with normal spirometry and a very elevated eosinophil count, later diagnosed with hypereosinophilic syndrome (HES) complicated with cardiac involvement.

CASE PRESENTATION: A 25 year-old-male with no pertinent past medical history was initially diagnosed with asthma for episodic dyspnea and wheeze for 3 months. Initial spirometry was normal. Complete blood count with differential showed absolute eosinophil count (AEC) of 1,700 cells/uL. Serum immunoglobulin E level was 210 IU/mL and allergy panel was grossly negative to aeroallergens. The patient took high dose inhaled steroidlong-acting inhaled beta2-agonist and multiple courses of systemic steroid with clinical improvement over a period of 6 months, but symptoms returned whenever steroid was discontinued. Trigger included alcohol, and patient was suspected to have sulfite sensitivity. Thus, the patient was referred to Allergy and Immunology, who noted eosinophilia in setting of normal spirometry. Blood eosinophil was rechecked and was found to be 4,400 cells/uL. Patient was urgently referred to hematology as HES was suspected. Initial work up for HES showed elevated troponin 10.04 ng/mL which prompted for urgent hospitalization. Cardiac MRI showed myopericarditis with cardiomyopathy suspected due to hypereosinophilia. Patient was started on high dose steroid therapy, anticoagulation therapy, anti-hypertensive therapy, and later with anti-IL5 therapy Mepolizumab with clinical improvement of symptoms.

DISCUSSION: This case highlights the importance of evaluation of alternative diagnosis of asthma, and timely diagnosis of HES can result in early relief of symptom burden and decrease in morbidity. Patients with HES often have normal spirometry. Although eosinophilia may be seen in severe asthma, AEC count of above 1500 cells/uL should prompt evaluate for hypereosinophilic syndrome.

CONCLUSION: It is important to recognize HES as an alternative differential diagnosis in patients with uncontrolled asthmatic symptoms, sustained hypereosinophilia, and normal spirometry. Early diagnosis can potentially improve clinical outcomes.

169

ABSTRACT #107 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW PULMONARY/CRITICAL CARE IMMUNOTHERAPY INDUCED PNEUMONITIS Dishant J. Shah1, Christian M. Lo Cascio1,2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

To be presented at the American Thoracic Society (ATS) International Conference Annual Meeting that will be held virtually from May 14-19, 2021.

BACKGROUND/INTRODUCTION: Pneumonitis is focal or diffuse inflammation of lung parenchyma. With recent advancements in oncology, immunotherapy is an emerging cause of pneumonitis. Atezolizumab is an immune checkpoint inhibitor (ICI) that targets PD-L1 to prevent the interaction with receptors PD-1 and B7-1, thus reversing T-cell suppression and can cause pneumonitis due to the inflammatory response. It has an incidence of up to 10%. Symptoms can include dyspnea (53%), cough (35%), fever (12%), and chest pain (7%).

CASE PRESENTATION: An 81-year-old male with unresectable hepatocellular carcinoma (HCC) on Atezolizumab-Bevacizumab, intra-lesional hematoma, and portal vein thrombosis presented with one day of dyspnea. In the emergency department, he was found to be hypoxic to 80% on room air. The examination was unremarkable except for bilateral crackles on auscultation. Laboratory tests including complete blood count, electrolytes, liver function tests, kidney function tests, and arterial blood gas were within normal limits. CT chest revealed bilateral multifocal airspace opacities. Due to the acute hypoxemic respiratory failure, he was transferred to the ICU for care. Blood cultures were sent. Antibiotic therapy with vancomycin, cefepime, and azithromycin was initiated for presumed community-acquired pneumonia. The patient continued to worsen clinically. All initial infectious workup was negative including blood cultures, tuberculosis and fungal workup, and respiratory viral pathogen PCR. COVID-19 and influenza PCR was negative thrice. Of note, the patient completed his second cycle of immunotherapy with Atezolizumab-Bevacizumab, four days prior to admission.

He was started on methylprednisolone 2 mg/kg/d on hospital day (HD) 5 for likely ICl-induced pneumonitis.

Despite steroid therapy, no clinical improvement was noted. He was additionally given a single dose of infliximab 5 mg/kg to which he improved clinically initially. However, he later grew Aspergillus in his bronchoalveolar lavage and passed away from multi-organ failure on HD 22.

CONCLUSION: We describe a case of HCC with hematoma. Given the risk of bleeding with first-line therapy (Sorafenib), a combination of Atezolizumab-Bevacizumab was used instead. ICl-induced pneumonitis is a diagnosis of exclusion with no specific clinical picture or radiologic findings. Anti-VEGF antibodies like Bevacizumab are more likely to cause pulmonary hemorrhage than pneumonitis. ICl-induced pneumonitis is divided into 4 grades. This patient was categorized as Grade 3. The patient received infliximab as he did no t respond to initial therapy consisting of empirical antibiotics and IV methylprednisolone. In patients on ICI, who present with respiratory symptoms, clinicians should have a high degree of suspicion for pneumonitis. Early diagnosis and treatment could potentially reduce mortality.

170

ABSTRACT #108 CLINICAL RESEARCH GERIATRICS PERCUTANEOUS ENDOSCOPIC GASTROSTOMY PLACEMENT INCREASES 30-DAY HOSPITAL READMISSION RATES IN PATIENTS WITH ADVANCED DEMENTIA Jacqueline Sheehan1, Kam Sing Ho1, Jennifer Fung1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Annual Assembly of Hospice and Palliative Care Annual Meeting that was held virtually from February 17-19, 2021.

BACKGROUND/INTRODUCTION: The American Geriatrics Society opposes the use of feeding tube for patients with advanced dementia due to the increase risk of agitation and subsequent use of restraints.

However, percutaneous endoscopic gastrostomy tube continues to be an option for patients with difficulty with mastication and swallowing.

METHODS: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (≥ 18 years) with a primary and secondary diagnosis of Alzheimer’s disease, with an in-hospital procedure of percutaneous endoscopic gastrostomy tube were included. The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders. Independent risk factors for readmission were identified using a Cox proportional hazards model.

RESULTS: In total, 394,963 hospital admissions among adults with a primary diagnosis of Alzheimer’s dementia were identified, of which 1.82% (7,213) received a PEG tube during the same admission. 1:1 PS matching was performed based on demographic (age, gender, hospital status, etc.) and clinical characteristics (Charlson comorbidity score). The 30-day rate of readmission advanced dementia with and without PEG tube were 14.87% versus 9.36%, p<0.001. The most common readmission for both groups was unspecified sepsis (13.1%). During the index admission for Alzheimer’s dementia, the length of stay (LOS) among PEG patients was significantly longer than non-PEG patients (p<0.001). Similarly, total hospital cost for the PEG patients was also longer than non-PEG patients (p<0.001). The in-hospital mortality rates during their index admission were similar between the 2 cohorts (p=0.51). Among those readmitted, the LOS was longer for advanced dementia patients with PEG tube (p<0.001) and their total hospital cost was also more expensive (p<0.001).

However, mortality rates were similar to non-PEG patients (p=0.55).

CONCLUSION: In this study, Alzheimer’s dementia patients who received PEG tube placement during their index had a higher 30 days of readmission rate and total hospital cost relative to those who did not undergo PEG tube placement.

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ABSTRACT #109 CLINICAL RESEARCH PULMONARY/CRITICAL CARE IMPACT OF COVID-19 PANDEMIC ON HOUSE-STAFF Patrick Tobin-Schnittger1, Georgina Osorio1, Raymonde Jean1, Katherine Mark1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held virtually from October 18-21, 2020.

BACKGROUND/INTRODUCTION: On April 7, 2020, 597 people died from COVID-19 in NYC. That was the peak of a pandemic which has caused nearly twenty-thousand confirmed deaths in the city since March 11, 2020. Internal Medicine residents took care of these patients. Traditionally communication skills and nuances necessary for breaking bad news and complex goals of care discussions are refined over years of practice, not weeks. Poor coping skills with patient death in large numbers can lead to burnout and compassion fatigue.

This study aims to examine the impact that the COVID-19 pandemic has had on house-staff, their communication skills and perceived abilities to cope with patient death.

METHODS: An IRB approved (#20-03637) anonymous REDCap survey was shared by email to all Mount Sinai Morningside and West Internal Medicine house-staff who had worked from March to June 2020.

Respondents answered open and closed ended questions plus Bugen’s "Coping with Death Survey" (CDS) which uses Likert-scale questions to produce scores from 30 to 210. Scores below 105 indicate inadequate coping and scores above 157 suggest optimal coping.

RESULTS: There was a total of forty-eight respondents (n=94 surveyed) of whom thirty-two answered every question. Their mean age was 29.5 (n=48, SD 2.53). 47.9% (n=23) had worked as doctors for three yea rs, 47.9% (n=23) had worked as doctors outside of the U.S., and 56.3% (n=27) were interns. Before the pandemic, house-staff discussed goals of care, broke bad news, and encountered patient death “less than once a week” (44.2%, n=19), (58.1%, n=25), (93%, n=40) respectively. During the pandemic they discussed goals of care “every day” (48.8%, n=21). They broke bad news and encountered patient death “every other day” (46.5%, n=20) and (39.5%, n=17) respectively. Levels of comfort and fluency with these conversations improved from before (Mean=52.05, SD 24.01) and during (Mean=76.7, SD 14.89) the pandemic (t=6.7301, p=0.0001, n=40). 92.3% (n=36) of respondents feel more comfortable treating dying patients but 51.3% (n=20) of them remember a “particularly bad experience at work”. Three people (7.7%) have changed their career plans. Respondents’ (n=32) overall CDS score mean was 131.5 (SD 20.07). Those with less than two years’ experience working as doctors (n=16, Mean=124.44, SD 18.20) compared to those with more experience (n=16, Mean=138.56, SD 19.88) had a significantly lower mean CDS score (t=2.0965, p=0.0446).

CONCLUSION: More than half of residents remember traumatic encounters during this period of high patient death. While their levels of comfort caring for and communicating with these patients improved during this time, their ability to cope with death remains suboptimal, particularly amongst the junior house-staff.

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ABSTRACT #110 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GASTROENTEROLOGY RARE TERMINAL ILEUM MIGRATION OF LUMEN-APPOSING METAL STENT USED FOR PANCREATIC PSEUDOCYST DRAINAGE Sanjana Luther1,2, Angad Uberoi1, Frank Nelson1 1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Pancreatic fluid collections, including pseudocysts, can occur as complications of pancreatitis. Endoscopic ultrasound-guided transluminal drainage with a lumen-apposing metal stent (LAMS) is the standard of care for symptomatic pseudocysts. Migration of these stents can occur into the cyst cavity or GI tract. Here we describe a case of LAMS migration into the terminal ileum which was successfully removed during colonoscopy.

CASE PRESENTATION: A 51 year-old-male presented with right lower quadrant (RLQ) pain for one week. No other symptoms or changes in bowel habits were reported. His prior history includes polysubstance use disorder, alcohol-induced pancreatitis (multiple episodes), chronic kidney disease, diabetes, hypertension, and hyperlipidemia. His most recent episode of pancreatitis, complicated by pseudocyst formation required an endoscopic cystogastrostomy and LAMS placement for drainage of a large, symptomatic pseudocyst. On initial examination, the patient was well appearing, but had tenderness to palpation in the RLQ without rebound or guarding. Laboratory tests were notable for a normocytic anemia and a mild AKI. Liver tests, lipase, and electrolytes were unremarkable. CT imaging showed an Axios stent within the terminal ileum with adjacent inflammation, but no obstruction (Figure 1). The patient was evaluated by both Gastroenterology and Surgery.

An endoscopic approach was preferred and a colonoscopy was completed after bowel prep. The terminal ileum was reached and the migrated stent was visualized just proximal to the ileocecal valve (Figure 2). The stent was successfully removed utilizing a 2.4 mm raptor grasping device (manufacturer-US Endoscopy) (Figure 3). The terminal ileum was inspected post removal and was healthy-appearing with some residual congestion. The patient’s symptoms improved and he was discharged.

CONCLUSION: Estimates regarding rates of stent migration have been varied across different reports, ranging from 1% to 19%. The cumulative rate of migration over a period of two years has been estimated to be as high as 31.4%. Previously reported migration of LAMS has been within the esophagus, small bowel, and colon. We report a case of migration of a LAMS in the terminal ileum and subsequent retrieval. Removal of these stents via endoscopic intervention can be difficult and requires adequate surgical support should endoscopic removal be unsuccessful. In our case, the stent was successfully removed during colonoscopy, preventing the morbidity and cost associated with surgical intervention.

Figure 1. CT imaging with LAMS in the terminal ileum

Figure 2. LAMS in the terminal ileum, proximal extent

Figure 3. LAMS retrieved and raptor grasping device used

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ABSTRACT #111 CLINICAL RESEARCH GASTROENTEROLOGY STATINS FOR THE PREVENTION OF POST-ERCP PANCREATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS Angad Uberoi1, Maan El Halabi1, Gaurav Kakked1, Sanjana Luther1,2, Kirtipal Bhatia1, Christopher DiMaio3 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Acute pancreatitis is one of the most common complications after ERCP. There is no definite consensus on chemoprophylaxis for the prevention of post-ERCP pancreatitis. Recently, there has been interest in the role of statins in the prevention of post-ERCP pancreatitis. Our study aims to perform a systematic review and meta-analysis on the use of statins for the prevention of post-ERCP pancreatitis.

METHODS: We performed a comprehensive literature search of Embase, Medline and SCOPUS using MeSH terms and keywords for statins, ERCP and pancreatitis from inception through June 2020. Two reviewers independently screened all results in two stages: title/abstract followed by full-text review. We included full articles as well as meeting abstracts in our search. Only studies with multivariate analysis were included. The primary outcome of interest was incidence of post-ERCP pancreatitis. For the present analysis, adjusted odds ratio and 95% confidence intervals (CI) reported by individual studies were utilized. For pooled analysis, a random-effects model was used, and weights were assigned for each study based on the inverse of variance.

Heterogeneity among studies was assessed using the Higgins I 2 value. Publication bias was assessed visually with funnel plots. All p-values were two-tailed with statistical significance specified at 0.05 and CI reported at 95% level.

RESULTS: A total of 7 studies were included in the final analysis with a pooled sample size (n) of 8,873. Only 6 studies reported the proportion of patients in the statin and non-statin groups (2,479 in statin group; 5,744 in non-statin group). Out of the 7 studies, 2 were conference abstracts and 5 were full articles. The pooled adjusted Odds Ratio (OR) was 0.63 (95% CI, 0.38-1.03; p-value=0.064; Figure 1). There was significant heterogeneity with I2 of 76.4%. There is also publication bias on visual inspection of the funnel plot (Figure 2).

CONCLUSION: The use of statins is not associated with a decrease in post-ERCP pancreatitis as per the results of our meta-analysis, albeit with significant heterogeneity of data. Given the ubiquity of statin use and favorable side effect profile, larger randomized studies are warranted before we make definitive conclusions.

Figure 1. Forest plot

Figure 2. Funnel plot

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ABSTRACT #112 CLINICAL RESEARCH GASTROENTEROLOGY ENDOSCOPIC THERAPY VERSUS SURGICAL INTERVENTION IN MANAGING T1AN0M0 AND T1BN0M0 ESOPHAGEAL CANCER: A MORTALITY ANALYSIS Mengdan Xie1, Michael S. Smith1 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Digestive Disease Week (DDW) that will be held virtually from May 21-23, 2021.

BACKGROUND: Endoscopic therapy is gaining more acceptance as a preferred intervention for superficial node-negative esophageal cancer, avoiding the morbidity and mortality of esophagectomy. Since 2010, guidelines have subdivided these neoplasms into T1a (mucosal only involvement) and T1b (submucosal involvement), with corresponding differences in treatment guidance. The aim of this study was to compare long-term survival in patients with T1a/T1b esophageal cancer managed with either endoscopic therapy or surgery.

METHODS: The Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2017 was searched to identify patients with T1aN0M0 or T1bN0M0 esophageal cancer who underwent either endoscopic therapy or surgery. Those with unknown TNM stage or no/unknown intervention performed were excluded.

Clinicopathological information including age, gender, race, cancer site, histology, and grade were compared between the endoscopic and surgery cohorts. All-cause mortality and esophageal cancer-specific mortality were analyzed. Multivariate regression was used to adjust for possible confounders. Kaplan-Meier and Cox proportional hazard modeling were used for survival analysis.

RESULTS: Data was available for analysis in 2,460 patients, among which there were 1,643 T1a lesions and 817 T1b cancers. For both tumor stages, the endoscopic therapy group was older (p<0.05) and had a higher tumor grade level (p<0.05) than the surgery group. With a median of survival time 35 months, all-cause mortality rates for T1a and T1b tumors were 20.2% and 31.2%, respectively. There were no significant differences in all-cause mortality between the endoscopic therapy and surgery groups for either T1a or T1b cancer. For T1a lesions, patients undergoing surgery had a significantly higher esophageal cancer-specific mortality rate (HR, 2.15; p<0.01) and decreased cancer-free survival compared to the endoscopic therapy group. This difference in cancer-specific mortality was not found for T1b tumors (HR, 1.34; p=0.259), though the non-esophageal cancer-related mortality rate was significantly higher in the endoscopic therapy group compared to the surgery group (19.66% versus 12.76%, p<0.05).

CONCLUSION: These results suggested a greater mortality benefit for endoscopic therapy over surgery in T1aN0M0 esophageal cancers. As for T1bN0M0 cancer, the SEER data did not show a clear mortality benefit of endoscopic therapy. However, as included patients were relatively older and more likely to die from other diseases, endoscopic therapy may have been underused for at least some of these patients. If this were the case, a similar mortality benefit may have been found for these more invasive tumors.

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ABSTRACT #113 CASE REPORT/CLINICAL VIGNETTE/CLINICAL REVIEW GASTROENTEROLOGY KLEBSIELLA PNEUMONIAE LIVER ABSCESS ASSOCIATED WITH CHRONIC KETAMINE ABUSE Mengdan Xie1, Rita Jammal1,2, George McKinley1, David Frager1

1 2

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held virtually from October 23-28, 2020.

BACKGROUND/INTRODUCTION: Chronic ketamine abuse is known to cause hepatobiliary abnormality and urinary bladder dysfunction. We present a case of a young man with chronic ketamine abuse who developed Klebsiella pneumoniae liver abscess (KLA) and urinary bladder cystitis.

CASE PRESENTATION: A 21-year-old Asian male with 7-year abuse of intranasal ketamine presented with acute onset of fever, RUQ abdominal pain, and jaundice. Symptoms also associated with chronic intermittent dysuria. Initial labs significant for WBC 12.4 × 109/L, ALT 51 IU/L, total bilirubin 2.4 mg/dl, direct bilirubin 1.4 mg/dl, and alkaline phosphatase 194 IU/L. Abdominal CT imaging revealed multiple hypodense hepatic lesions concerning for abscesses (Figure 1). Bladder asymmetry was also noted (Figure 2). He underwent CT guided abscess drainage which revealed purulent fluid. The patient was started on IV ceftriaxone and metronidazole and fluid cultures grew susceptible Klebsiella pneumoniae. Patient clinically improved and as the remaining workup was non-revealing, the patient was transitioned to high dose oral ciprofloxacin and metronidazole.

Repeat CT imaging after 4 weeks showed size-reduction, but persistent multiple liver abscesses. Treatment course was extended to 8 weeks which coincided with improved resolution of the lesions on imaging.

CONCLUSION: Klebsiella pneumoniae is a rare causative organism of liver abscess. Patients at risk for developing KLA are those with hepatobiliary disease, of East-Asian descent, and uncontrolled diabetes mellitus. Considering higher risk of developing extrahepatic metastatic abscess in KLA patients, early recognition and intervention are fatal in minimizing complications. The mechanism by which chronic ketamine use leads to abnormal hepatobiliary function likely due to either actions on the biliary smooth muscles or direct hepatotoxicity. Considering the increasing ketamine abusers in the United States, it’s worthwhile to suspect ketamine misuse as a potential cause of cholestatic LFTs and risk factor for KLA.

Figure 1. Multiple abscesses in the right lobe of the liver

Figure 2. Bladder asymmetry

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ABSTRACT #114 CLINICAL RESEARCH GASTROENTEROLOGY OUTCOMES OF ATRIAL FIBRILLATION/FLUTTER PATIENTS HOSPITALIZED GASTROINTESTINAL BLEEDING: RESULTS OF A NATIONAL COHORT Mengdan Xie1, Bing Chen1 1

FOR

LOWER

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Digestive Disease Week (DDW) that will be held virtually from May 21-23, 2021.

BACKGROUND: Anticoagulant use in patients diagnosed with atrial fibrillation (AFIB) and atrial flutter (AFL) increased their risk of lower gastrointestinal bleeding (LGIB). In this specific population, the risk of ongoing bleeding, risk of thromboembolic events, and risk of colonoscopy need to be better evaluated and balanced.

This study aimed to investigate the effects of concurrent AFIB/AFL in hospitalized LGIB patients.

METHODS: A retrospective cohort study based on the 2016 Nationwide Inpatient Sample (NIS) database was performed. ICD-10 codes were utilized to identify the diagnosis. All patients >=18 years old with a primary or secondary diagnosis of LGIB were included. Patients were divided into two groups according to the concurrence of AFIB/AFL. The primary outcome was the in-hospital all-cause mortality. Secondary outcomes included length of stay (LOS), the total cost of the hospital admission, and colonoscopy rate. Multivariate regression was used to adjust for possible confounders, including age, gender, race, incomes, insurance, hospital characteristics, and comorbidities. STATA 15 (College Station, TX) was used for analysis.

RESULTS: A total of 501,445 patients were diagnosed of LGIB from NIS, among which 135,410 (27%) had concurrent diagnosis of AFIB or AFL. Compared to LGIB patients without AFIB/AFL, patients with AFIB/AFL had higher Charlson comorbidity Index (3.25 versus 2.62, p<0.01) and older age (77 versus 62, p<0.01). Other significant comorbidities concurred with AFIB/AFL included congestive heart failure, diabetes, renal failure, and stroke. Patients with AFIB/AFL had more angiodysplasia bleeding (5.2% versus 3.1%, p<0.001), less diverticular bleeding (16.7% versus 17.4%, p<0.05), and less hemorrhage of rectum and anus (13.9% versus 17.5%, p<0.001). After adjusted for confounders, LGIB patients with AFIB/AFL had significant higher inhospital mortality rate (8.0% versus 6.2%; OR,1.2, p<0.001), longer LOS (7.1 days versus 5.9 days, p<0.001), higher cost ($18,106 versus $15,617, p<0.05), and higher rate of colonoscopy (30.8% versus 30.0%; OR, 1.08, p<0.01).

CONCLUSION: This study revealed that in hospital-mortality of LGIB was higher in AFIB/AFL patients, despite of higher rate of colonoscopy. Also, discontinuing anticoagulant during acute bleeding may explain the higher stroke rate in AFIB/AFL patients. A multidisciplinary and comprehensive approach with collaboration among Cardiology, Neurology, and Gastroenterology should be adopted to ensure better management of patients admitted for LGIB with concurrent AFIB/AFL.

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ABSTRACT #115 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY DURATION OF POST-AUTOLOGOUS HEMATOPOIETIC CELL TRANSPLANT ANEMIA AND THROMBOCYTOPENIA ARE ASSOCIATED WITH PROLONGED HOSPITAL LENGTH-OF-STAY FOR MULTIPLE MYELOMA PATIENTS Binbin Zheng-Lin1, Nirupama Krishnamurthi1, Benjamin Diamond2, Kylee H. Maclachlan 2, Francesco Maura2, Ola Landgren2, David J. Chung2 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Memorial Sloan Kettering Cancer Center, New York, NY, United States

2

Presented at the American Society of Hematology (ASH) Annual Meeting that was held virtually from December 5-8, 2020.

BACKGROUND/INTRODUCTION: Anemia, neutropenia, and thrombocytopenia are expected complications of autologous hematopoietic cell transplant (AHCT) for multiple myeloma (MM). However, prolonged cytopenias may predispose patients to other infectious, cardiovascular, and/or hematological toxicities. Various factors have been implicated in the length of post-AHCT cytopenias including stem cell dose, marrow microenvironment, and clonal hematopoiesis. We hypothesize that the length of post-transplant anemia, neutropenia, and thrombocytopenia may negatively impact hospital length-of-stay (LOS) and in-hospital complications.

METHODS: This is a single-center observational study of MM patients who underwent AHCT. Patients were part of a larger cohort with detailed single nucleotide polymorphism (SNP) array cytogenetic data. Exclusion criteria were concurrent amyloidosis and tandem transplant. Demographic data, comorbidities, cytogenetic features (presence of TP53 deletion, and translocation status of MMSET, CCDN3, CCDN1, MAF, and MAFB), therapy line, peri-transplant laboratory values, and clinical outcome were collected retrospectively. LOS was calculated from transplant day -2 to hospital discharge. Predictive factors for LOS were calculated with multiple linear regression. Multiple logistic regression was then used to calculate associating factors for in-hospital complications. Grade III and IV post-transplant cardiovascular, infectious, and hematological complications were collected following the Common Terminology Criteria for Adverse Events (CTCAE). Post-transplant anemia was defined as sustained hemoglobin (Hb) <8 g/dL despite transfusions. The cutoffs for neutropenia and thrombocytopenia were absolute neutrophil count (ANC) <1.5 K/uL, and platelet (PLT) count <50 K/uL, respectively.

RESULTS: 158 AHCT cases of MM patients were identified. 95 patients received AHCT as frontline treatment, 35 patients were transplanted in the salvage setting, and 14 patients received both frontline and subsequentline transplant. The most commonly used conditioning regimen was melphalan 200 mg/m2 in 123 cases, followed by melphalan 140 mg/m2 in 23 patients. 50.6% (80/158) developed grade III anemia with a median onset of 9 days after transplant (IQR 5-11 days) and median length of 2 days (IQR 1-6 days). Neutropenia had higher incidence of 96.8% (153/158) with an earlier onset of 5 days (IQR 5-6 days) and median length of 5 days (IQR 2-7 days). Grade III thrombocytopenia occurred in 98.1% (155/158), with median onset of 7 days (IQR 5-7 days) and a median duration of 8 days (IQR 6-10 days). When comparing patients who received frontline transplant vs subsequent line transplants, no statistical significance was observed between onset or length of cytopenias (p=0.40). Median LOS was 16 days (IQR 15-19 days). The most frequent post-AHCT complications in our cohort were neutropenic fever (n=27), followed by engraftment syndrome (n=12), pneumonia (n=4), urinary tract infection (n=2), cellulitis (n=2), and bacteremia (n=1). Cardiovascular events were uncommon (n=3) and included pericarditis, new onset atrial fibrillation, and new onset supraventricular tachycardia. Pulmonary embolism (n=1) and deep vein thrombosis (n=3) were recorded. No major bleeding was observed. Longer LOS was independently associated with post-AHCT anemia (p=0.03) and thrombocytopenia (p=0.0005). Notably, LOS and in-hospital complication rates were not significantly associated with demographic data, pre-existing comorbidities, pre-transplant cytopenias, or cytogenetic abnormalities.

CONCLUSION: In our cohort, longer duration of post-transplant anemia and thrombocytopenia were statistically associated with longer hospital LOS, but not with post-transplant complications. Prospective validation in an independent cohort is warranted.

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ABSTRACT #116 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY NEUTROPHIL-TO-LYMPHOCYTE RATIO AND PLATELET-TO-LYMPHOCYTE RATIO AT ADMISSION ARE PREDICTORS FOR WORSE FUNCTIONAL OUTCOME IN CEREBRAL VENOUS SINUS THROMBOSIS Binbin Zheng-Lin1, Qian Wang2, Biyue Dai3, Cynthia Zevallos3, Darko Quispe Orozco3, Mudassir Farooqui3, Jorge Ares Morcuende4, Santiago Ortega-Gutierrez3 1

Mount Sinai Morningside/West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Carver College of Medicine, University of Iowa, IA, United States; University of Alcalá, Alcalá de Henares, Madrid, Spain 2

Presented at the American Society of Hematology (ASH) Annual Meeting that was held virtually from December 5-8, 2020.

BACKGROUND/INTRODUCTION: Cerebral Venous Sinus Thrombosis (CVST) primarily affects children and young adults, especially young women of child-bearing age. Despite overall favorable outcome with systemic anticoagulation, it is still associated with up to 15% mortality and a high incidence of morbidity, resulting in a significant loss of productive life. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are inflammatory and immunologic serum biomarkers that have been described to be predictive of outcome in arterial and venous thromboembolism events including pulmonary embolism and ischemic stroke. Nonetheless, the relationship between these ratios and outcome in CVST has never been reported.

METHODS: This is a single-center, observational and retrospective study that included patients diagnosed with CVST from January, 2004 to December, 2016 in University of Iowa Hospitals and Clinics. Patients with age older than 18 years were included. Exclusion criteria were incomplete clinical or laboratory data and patients with active malignancy receiving chemotherapy at the time of CVST diagnosis. Patients’ complete blood count obtained at admission was used for ratio calculation. Receiver Operating Characteristic (ROC) curve was used to determine cutoff value for the ratios. Predictive utility of each ratio was evaluated in separate multivariate logistic regression models, conditioned on variables that were already shown to have strong association with mRS outcome in univariate analyses. An Akaike information criterion (AIC)-based backward stepwise selection scheme was used for model selection. Functional outcome was assessed by using modified Rankin score (mRS) which was into good outcome (mRS score of 0 to 2) and poor outcome (mRS score of 3 to 6). A two-sided p-value of 0.05 was considered statistically significant.

RESULTS: 134 patients were included; median age was 42 years (IQR = 26.75 years) and 90 (67%) were female. The overall mortality was 9% (n=13). After adjusting by demographic characteristics, presenting symptoms and comorbidities, NLR>6.24 (OR, 4.57; 95% CI, 1.85-11.29; p=0.001) and PLR>144 (OR, 4.80; 95% CI, 1.95-11.82; p=0.001) were statistically associated with poor mRS (mRS 3-6) at hospital discharge.

Altered mental status on presentation was independently correlated with poor neurologic outcome and inhospital mortality. While altered motor function and concomitant infection correlated with higher mRS and higher mortality, respectively. The present study did not observe significant prediction between ratios and inhospital mortality, being NLR marginally significant (OR, 4.67; 95% CI, 0.85-25.67; p=0.077).

CONCLUSION: To the best of our knowledge, this is the first study that describes a statistically significant association between increased NLR and PLR at admission and poor functional outcome among CVST patients at discharge. Their predictive value could be potentially used in the early identification of high-risk patients who may benefit from more aggressive therapeutic approaches, such as endovascular treatment.

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181

Publications Publications2020-2021 2020-2021

182

182

LIST OF PUBLICATIONS 2020-2021*

1

Kirtipal Bhatia, Guneesh Uberoi, Navkaranbir S. Bajaj, Vardhmaan Jain, Sameer Arora, Alfonso Tafur, Sripal Bangalore, Jeffrey W .Olin, Gregory Piazza, Samuel Z .Goldhaber, Muthiah Vaduganathan, Arman Qamar. “Meta-Analysis Comparing Direct Oral Anticoagulants to Low Molecular Weight Heparin for Treatment of Venous Thromboembolism in Patients With Cancer.” American Journal of Cardiology, 2020.

PMID: 32807386

2

Chayakrit Krittanawong, Anirudh Kumar, Zhen Wang, Bharat Narasimhan, Hani Jneid, Salim S. Virani, Glenn N. Levine. “Meditation and Cardiovascular Health in the United States.” American Journal of Cardiology, 2020. PMID: 32758360

3

Vardhmaan Jain, Adham Karim, Agam Bansal, Kirtipal Bhatia, Ann Gage, Muhammad Siyab Panhwar, W. H. Wilson Tang, Ankur Kalra. “Relation of Malnutrition to Outcome Following Orthotopic Heart Transplantation.” American Journal of Cardiology, 2021. PMID: 33383009

4

Chayakrit Krittanawong, Anirudh Kumar, Zhen Wang, Bharat Narasimhan, Dhruv Mahtta, Hani Jneid, Usman Baber, Roxana Mehran, Wilson Tang, Christie M Ballantyne, Salim S. Virani. “Coronary artery disease in the young in the United States populationbased cohort.” American Journal of Cardiovascular Disease, 2020. PMID: 32923100

5

Chayakrit Krittanawong, Ameesh Isath, Joshua Hahn, Zhen Wang, Sonya E. Fogg, Dhrubajyoti Bandyopadhyay, Hani Jneid, Salim S. Virani, W. H. Wilson Tang. “Mushroom Consumption and Cardiovascular Health: A Systematic Review.” American Journal of Medicine, 2020. PMID: 33309597

6

Chayakrit Krittanawong, Bharat Narasimhan, Hafeez Ul Hassan Virk, Harish Narasimhan, Joshua Hahn, Zhen Wang, W. H. Wilson Tang. “Misinformation Dissemination in Twitter in the COVID-19 Era.” American Journal of Medicine, 2020.

PMID: 32805227

7

Chayakrit Krittanawong, Ameesh Isath, Joshua Hahn, Zhen Wang, Bharat Narasimhan, Scott L. Kaplin, Hani Jneid, Salim S. Virani, W. H. Wilson Tang. “Fish Consumption and Cardiovascular Health: A Systematic Review.” American Journal of Medicine, 2021.

PMID: 33444594

8

Kam Sing Ho, Daniel Howell, Linda Rogers, Bharat Narasimhan, Hannah Verma, David Steiger. “The relationship between asthma, eosinophilia, and outcomes in coronavirus disease 2019 infection.” Annuals of Allergy, Asthma, and Immunology, 2021.

PMID: 33647451

*Updated on March 31, 2021.

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LIST OF PUBLICATIONS 2020-2021*

9

Uroosa Ibrahim, Giulia Eva Maria Petrone, John Mascarenhas, Alla Keyzner.

“Peritransplantation Use of Ruxolitinib in Myelofibrosis.” Biology of Blood and Marrow Transplantation, 2020. PMID: 32818555

10

Douglas Tremblay, Maaike van Gerwen, Mathilda Alsen, Santiago Thibaud, Alaina Kessler, Sangeetha Venugopal, Iman Makki, Qian Qin, Sirish Dharmapuri, Tomi Jun, Sheena Bhalla, Shana Berwick, Jonathan Feld, John Mascarenhas, Kevin Troy, Caroline Cromwell, Andrew Dunn, William K. Oh, Leonard Naymagon. “Impact of anticoagulation prior to COVID-19 infection: A propensity score-matched cohort study.”

Blood, 2020. PMID: 32462179

11

Renee Pekmezaris, Myia S. Williams, Briana Pascarelli, Kayla D. Finuf, Yael T. Harris, Alyson K. Myers Tonya Taylor, Myriam Kline, Vidhi H. Patel, Lawrence M. Murray, Samy I. McFarlane, Karalyn Pappas, Martin L. Lesser, Amgad N. Makaryus, Sabrina Martinez, Andrjez Kozikowski, Jennifer Polo, Josephine Guzman, Roman Zeltser, Jose Marino, Maria Pena, Ralph J. DiClemente, Dilcia Granville. “Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes: An acceptability and feasibility study.” BMC Medical Informatics and Decision Making, 2020. PMID: 33287815

12

Jeeyune Bahk, Wanding Yang, Jonathan Fishman. “Bilateral vocal cord paralysis in Miller Fisher syndrome/Guillain-Barre overlap syndrome and review of previous case series.”

BMJ Case Reports, 2021. PMID: 33504540

13

Li-Jun Chang, Chun-Jen Hsiao, Bing Chen, Tzu-Yu Liu, Julia Ding, Wan-Ting Hsu, Victor Su-Ortiz, Szu-Ta Chen, Ke-Ying Su, Han-Ping Wu, Chien-Chang Lee. “Accuracy and comparison of two rapid multiplex PCR tests for gastroenteritis pathogens: A systematic review and meta-analysis.” BMJ Open Gastroenterology, 2021.

PMID: 33648983

14

Kam Sing Ho, Bharat Narasimhan, Larry Difabrizio Linda Rogers, Sonali Bose, Li Li, Roger Chen, Jacqueline Sheehan, Maan Ajwad El-Halabi, Kimberly Sarosky, Zichen Wang, Elliot Eisenberg, Charles Powell, David Steiger. “Impact of corticosteroids in hospitalized COVID-19 patients.” BMJ Open Respiratory Research, 2021.

PMID: 33811098

15

Jacqueline Sheehan, Kam Sing Ho, Joseph Poon, Kimberly Sarosky, Jennifer Y. Fung.

“Palliative care in critically ill COVID-19 patients: The early New York City experience.”

BMJ Supportive and Palliative Care, 2020. PMID: 33268477

*Updated on March 31, 2021.

184

LIST OF PUBLICATIONS 2020-2021*

16

Toshiki Kuno, Hisato Takagi, Tomo Ando, Hiroki Ueyama, Tomohiro Fujisaki, Masaki Kodaira, Yohei Numasawa, Alexandros Briasoulis, Kentaro Hayashida. “Shortand Long-term Outcomes in Dialysis Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis.” Canadian Journal of Cardiology, 2020. PMID: 32562656

17

Michele Stanchina, Deborah Soong, Binbin Zheng-Lin, Justin M. Watts, Justin Taylor.

“Advances in Acute Myeloid Leukemia: Recently Approved Therapies and Drugs in Development.” Cancers (Basel), 2020. PMID: 33139625

18

Takayuki Yamada, Mako Wakabayashi, Abhinav Bhalla, Nitin Chopra, Hirotaka Miyashita, Takahisa Mikami, Hiroki Ueyama, Tomohiro Fujisaki, Yusuke Saigusa, Takahiro Yamaji, Kengo Azushima, Shingo Urate, Toru Suzuki, Eriko Abe, Hiromichi Wakui, Kouichi Tamura. “Cardiovascular and renal outcomes with SGLT-2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes mellitus and chronic kidney disease: A systematic review and network meta-analysis.” Cardiovascular Diabetology, 2021. PMID: 33413348

19

Ana B. Arevalo, Rawann Nassar, Satyam Krishan, Priyanka Lakshmanan, Maria Salgado, Priya Chokshi. “Lupus Never Fails to Deceive US: A Case of Rowell's Syndrome.” Case Reports in Rheumatology, 2020. PMID: 33029442

20

Rushil Shah, Fabrizio Assis, Bharat Narasimhan, Vahe Khachadourian, Shijie Zhou, Harikrishna Tandri, Nauman Tariq. “Trans-nasal high-flow dehumidified air in acute migraine headaches: A randomized controlled trial.” Cephalalgia, 2021. PMID: 33631965

21

Imane El Dika, Iman Makki, Ghassan K Abou-Alfa. “Hepatocellular carcinoma, novel therapies on the horizon.” Chinese Clinical Oncology, 2021. PMID: 32527116

22

Florence X. Doo, Gassan Kassim, Daniel R. Lefton, Shanna Patterson, Hien Pham, Puneet Belani. “Rare presentations of COVID-19: PRES-like leukoencephalopathy and carotid thrombosis.” Clinical Imaging, 2021. PMID: 32707411

23

Anup Kasi, Shivani Handa, Sajjad Bhatti, Shahid Umar, Ajay Bansal, Weijing Sun. “Molecular Pathogenesis and Classification of Colorectal Carcinoma.” Current Colorectal Cancer Reports, 2020. PMID: 32905465

24

Subrat Das, Jordan McCreary, Shariq Shamim, Tro Kalayjian. “Reversal of severe hypertriglyceridemia with intermittent fasting and a very-low-carbohydrate ketogenic diet: A case series.” Current Opinion Endocrinology, Diabetes, and Obesity, 2020.

PMID: 32740049

*Updated on March 31, 2021.

185

LIST OF PUBLICATIONS 2020-2021*

25

Dhruv Mehta, Aparna Saha, Lavneet Chawla, Mohamed Tausif Siddiqui, Supreet Kaur, Dishita Pandya, Priti Poojary, Shanti Patel, Virendra Tewari, Edward Lebovics. “National Landscape of Unplanned 30-Day Readmission Rates for Acute Non-hemorrhagic Diverticulitis: Insight from National Readmission Database.” Digestive Diseases and Science, 2021. PMID: 32358707

26

Karan Sud, Kirtipal Singh Bhatia, Birgit Vogel, Chandrashekar Bohra, Edgar Argulian.

“Prognostic significance of exercise-induced diastolic dysfunction: A systematic review.”

Echocardiography, 2020. PMID: 32892393

27

Chayakrit Krittanawong, Bharat Narasimhan, Zhen Wang, Joshua Hahn, Hafeez Ul Hassan Virk, Ann M. Farrell, HongJu Zhang, Wh Wilson Tang. “Association between chocolate consumption and risk of coronary artery disease: A systematic review and meta-analysis.” European Journal of Preventative Cardiology, 2020. PMID: 32697925

28

Kirtipal Bhatia, Bharat Narasimhan, Gaurav Aggarwal, Adrija Hajra, Soumya Itagi, Shathish Kumar, Sandipan Chakraborty, Neelkumar Patel, Vardhmaan Jain, Dhrubajyoti Bandyopadhyay, Birendra Amgai, Wilbert S. Aronow . “Perioperative pharmacotherapy to prevent cardiac complications in patients undergoing noncardiac surgery.” Expert Opinion on Pharmacotherapy, 2020. PMID: 33350868

29

Bharat Narasimhan, R. Aravinthkumar, Ashish Correa, Wilbert S. Aronow.

“Pharmacotherapeutic principles of fluid management in heart failure.” Expert Opinion on Pharmacotherapy, 2021. PMID: 33560159

30

Denisa Muraru, Karima Addetia, Andrada C. Guta, Roberto C. Ochoa-Jimenez, Davide Genovese, Federico Veronesi, Cristina Basso, Sabino Iliceto, Luigi P. Badano, Roberto M. Lang. “Right atrial volume is a major determinant of tricuspid annulus area in functional tricuspid regurgitation: A three-dimensional echocardiographic study.” European Heart Journal of Cardiovascular Imaging, 2020. PMID: 33387441

31

Kirtipal Bhatia, Vardhmaan Jain, Kartik Gupta, Agam Bansal, Arieh Fox, Arman Qamar, Kevin Damman, Muthiah Vaduganathan. “Prevention of heart failure events with sodiumglucose co-transporter 2 inhibitors across a spectrum of cardio-renal-metabolic risk.”

European Journal of Heart Failure, 2021. PMID: 33609071

32

Kia Vosoughi, Yervant Ichkhanian, Petros Benias, Larry Miller, A. Aziz Aadam, Joseph R. Triggs, Ryan Law, William Hasler, Nicole Bowers, Dalton Chaves, Alberto M. Ponte-Neto, Peter Draganov,, Dennis Yang, Maan El Halabi, Omid Sanaei, Olaya Isabella Brewer Gutierrez, Robert Stephen Bulat, John Pandolfino, Mouen Khashab. “Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: Results from an international prospective trial.” Gut, 2021. PMID: 33741641

*Updated on March 31, 2021.

186

LIST OF PUBLICATIONS 2020-2021*

33

Taoran Li, Diane Donegan, W. Michael Hooten, Irina Bancos “Clinical Presentation and Outcomes of Opioid-Induced Adrenal Insufficiency.” Endocrine Practice, 2020.

PMID: 33471659

34

Subrat Das, Gregory P. Siroky, Shawn Lee, Davendra Mehta, Ranjit Suri. “Cybersecurity: The need for data and patient safety with cardiac implantable electronic devices.” Heart Rhythm, 2021. PMID: 33059076

35

Ben L. Da, Tatyana Kushner, Maan El Halabi, Pavan Paka, Mian Khalid, Angad Uberoi, Brian T. Lee, Ponni V. Perumalswami, Stephanie M. Rutledge, Thomas D. Schiano, Scott Friedman, Behnam Saberi. “Liver Injury in Hospitalized Patients with COVID-19 Correlates with Hyper Inflammatory Response and Elevated IL-6.” Hepatology Communications, 2020. PMID: 33230491

36

Fouzia Siraj, Jeewendra Dulal, Shruti Sharma, Pooja Gupta, Pawan Vasudeva, Akanksha Malik. “Benign Mimickers of Urinary Bladder Cancer: A Case Series.” Indian Journal of Surgical Oncology, 2020. PMID: 33364688

37

Sandipan Chakraborty, Birendra Amgai, Dhrubajyoti Bandyopadhyay, Neelkumar Patel, Adrija Hajra, Bharat Narasimhan, Devesh Rai, Gaurav Aggarwal, Raktim K. Ghosh, Srikanth Yandrapalli, Wilbert S. Aronow, Gregg C. Fonarow, Srihari S. Naidu. “Acute myocardial infarction in the young with diabetes mellitus: National Inpatient Sample (NIS) study with sex-based difference in outcomes.” International Journal of Cardiology, 2021.

PMID: 32781013

38

Chayakrit Krittanawong, Yiming Liu, Dhruv Mahtta, Bharat Narasimhan, Zhen Wang, Hani Jneid, Jacqueline E. Tamis-Holland, Mahboob Alam, Usman Baber, Roxana Mehran, W. H. Wilson Tang, Christie M. Ballantyne, Salim S. Virani. “Non-traditional risk factors and the risk of myocardial infarction in the young in the US population-based cohort.”

International Journal of Cardiology, Heart, and Vasculature, 2020. PMID: 32995474

39

Gregory P. Siroky, Hieu Huynh, Devendra Bisht, Ameesh M. Isath, Davendra Mehta.

“Incessant palpitations in a young male.” Journal of Arrhythmia, 2020. PMID: 33024476

40

Tomohiro Fujisaki, Frida Kassim, Gassan Kassim, Dhrubajyoti Bandyopadhyay, Vasundhara Singh, Bette Kim. “Biventricular Takotsubo Syndrome with COVID-19 in an Asian Male.” Journal of Cardiology Cases, 2020. PMID: 33262862

*Updated on March 31, 2021.

187

LIST OF PUBLICATIONS 2020-2021*

41

Deepak Padmanabhan, Danesh Kella, Ameesh Isath, Nidhi Tandon, Siva Mulpuru, Abhishek Deshmukh, Suraj Kapa, Ramila Mehta, Connie Dalzell, Nora Olson, Joel Felmlee, Mary L. Jondal, Samuel J. Asirvatham, Robert E. Watson Jr., Yong M. Cha, Paul Friedman. “Prospective evaluation of the utility of magnetic resonance imaging in patients with non-MRI-conditional pacemakers and defibrillators.” Journal of Cardiovascular Electrophysiology, 2020. PMID: 32757438

42

Lingling Wu, Bharat Narasimhan, Kam S. Ho, Yingying Zheng, Arti N. Shah, Bharat K. Kantharia. “Safety and complications of catheter ablation for atrial fibrillation: Predictors of complications from an updated analysis the National Inpatient Database.” Journal of Cardiovascular Electrophysiology, 2021. PMID: 33650749

43

Taoran Li, Julie L Cunningham, Wesley P. Gilliam, Larissa Loukianova, Diane M. Donegan, Irina Bancos. “Prevalence of Opioid-Induced Adrenal Insufficiency in Patients Taking Chronic Opioids.” Journal of Clinical Endocrinology and Metabolism, 2020.

PMID: 32866966

44

Ameesh Isath, Deepak Padmanabhan, Syed Waqas Haider, Gregory Siroky, Stuthi Perimbeti, Ashish Correa, C. Anwar A. Chahal, Jayaprakash Shenthar, Samuel Asirvatham, Davendra Mehta. “Does the use of intracardiac echocardiography during atrial fibrillation catheter ablation improve outcomes and cost? A nationwide 14year analysis from 2001 to 2014.” Journal of Interventional Cardiac Electrophysiology, 2020. PMID: 32743700

45

Kam Sing Ho, Bharat Narasimhan, Jacqueline Sheehan, Lingling Wu, Jennifer Y. Fung. “Controversy over smoking in COVID-19-A real world experience in New York City.” Journal of Medical Virology, 2020. PMID: 33325049

46

Douglas Tremblay, Rafael Madero-Marroquin, Guido Lancman, Alexander Coltoff, Jonathan Feld, Jessica Caro, Emily Sherlock, Alla Keyzner, Shyamala Navada, Lewis R. Silverman, Erin Moshier, Nicole Zubizarreta, John Mascarenhas. “An Opportunity for Hospice Referral in Acute Myeloid Leukemia: Prognostic Significance of Hospitalization Status at Time of Second Cycle of Hypomethylating Agents for Patients Ineligible for Intensive Induction Chemotherapy.” Journal of Palliative Medicine, 2020. PMID: 33174777

47

Katerina Svigos, Lu Yin, Katherina Shaw, Daniel Gutierrez, Erik Peterson, Kristen Lo Sicoo, Jerry Shapiro. “Response to Variables affecting the potential efficacy of plateletrich plasma in dermatology.” Journal of the American Academy of Dermatology, 2021.

PMID: 32858079

*Updated on March 31, 2021.

188

LIST OF PUBLICATIONS 2020-2021*

48

Joshua Berookhim, Ashish Correa, Jacqueline E Tamis-Holland. “Notes from the Eye of the Storm: Trainees at the Frontlines of the COVID-19 Pandemic.” Journal of the American College of Cardiology, 2020. PMID: 32422181

49

Vardhmaan Jain, Ankur Kalra, Muhammad Siyab Panhwar, Agam Bansal, Amy Nowacki, Kirtipal Bhatia, Tanush Gupta, Nichole L. Ineman, Safi U. Khan, Amar Krishnaswamy, Grant W. Reed, Rishi Puri, Samir R. Kapadia, Lars G. Svensson, Anmar Kanaa'N, Joseph A. Lahorra. “Outcomes of transcatheter aortic valve replacement in patients with cognitive dysfunction.” Journal of the American Geriatrics Society, 2021. PMID: 33570174

50

Vaani P. Garg, Ameesh Isath, Edgar Argulian, Stamatios Lerakis, Jagat Narula. “Impact of COVID-19 Pandemic on the Role of Cardiac Sonographers.” Journal of the American Society of Echocardiography, 2021. PMID: 33161067

51

Andreas Ebbehoj, Dingfeng Li, Ravinder J. Kaur, Catherine Zhang, Sumitabh Singh, Taoran Li, Elizabeth Atkinson, Sara Achenbach, Sundeep Khosla, Wiebke Arlt, William F. Young, Walter A. Rocca, Irina Bancos. “Epidemiology of adrenal tumours in Olmsted County, Minnesota, USA: A population-based cohort study.” Lancet Diabetes and Endocrinology, 2020. PMID: 33065059

52

Bharat Narasimhan, Scott Kaplin, Zhen Wang, Chayakrit Krittanawong, “Impact of a High-Shrimp Diet on Cardiovascular Risk: An NHANES Analysis.” Mayo Clinic Proceedings, 2021. PMID: 33549272

53

Horacio Medina DE Chazal, Ignacio Seropian, Francisco Romeo, Juan G. Chiabrando, Juan Valle Raleigh, Daniel H. Berrocal, Carla Agatiello. “Balloon aortic valvuloplasty through the novel transradial technique.” Minerva Cardiology and Angiology, 2021.

PMID: 33703866

54

Paulino Tallón de Lara, Héctor Castañón, Marijne Vermeer, Nicolás Núñez, Karina Silina, Bettina Sobottka, Joaquín Urdinez, Virginia Cecconi, Hideo Yagita, Farkhondeh Movahedian Attar, Stefanie Hiltbrunner, Isabelle Glarner Holger Moch, Sònia Tugues, Burkhard Becher, Maries van den Broek. “CD39 + PD-1 + CD8 + T cells mediate metastatic dormancy in breast cancer.” Nature Communications, 2021. PMID: 33536445

55

Tomohiro Fujisaki, Satoshi Miyashita. “The role of advance care planning and palliative care in New York City during COVID-19 pandemic.” Nihon Ronen Igakkai Zasshi, 2021.

PMID: 33627559

*Updated on March 31, 2021.

189

LIST OF PUBLICATIONS 2020-2021*

56

Eyal Klang, Gassan Kassim, Shelly Soffer, Robert Freeman, Matthew A. Levin, David L. Reich. “Severe Obesity as an Independent Risk Factor for COVID-19 Mortality in Hospitalized Patients Younger than 50.” Obesity, 2020. PMID: 32445512

57

Chayakrit Krittanawong, Dhruv Mahtta, Bharat Narasimhan, Zhen Wang, Dhrubajyoti Bandyopadhyay, Bashir Hanif, Zainab Samad, Takeshi Kitai, Mahboob Alam, Samin K. Sharma, Hani Jneid, Salim S. Virani. “Clinical characteristics and mortality after acute myocardial infarction-related hospitalization among Asians from a national populationbased cohort study.” Progress in Cardiovascular Diseases, 2021. PMID: 33545205

58

Chayakrit Krittanawong, Hafeez Ul Hassan Virk, Sripal Bangalore, Zhen Wang, Kipp W. Johnson, Rachel Pinotti, HongJu Zhang, Scott Kaplin, Bharat Narasimhan, Takeshi Kitai, Usman Baber, Jonathan L. Halperin, W. H. Wilson Tang. “Machine learning prediction in cardiovascular diseases: A meta-analysis.” Scientific Reports, 2020. PMID: 32994452

59

Binbin Zheng-Lin, Eileen M. O’Reilly. “Pancreatic ductal adenocarcinoma in the era of precision medicine.” Seminars in Oncology, 2021. PMID: 33637355

60

Shivani Handa, Bandhul Hans, Shokhi Goel, Hafis O. Bashorun, Zach Dovey, Ashutosh Tewari. “Immunotherapy in prostate cancer: Current state and future perspectives.” Therapeutic Advances in Urology, 2020. PMID: 32952615

61

Leonard Naymagon, Nicole Zubizarreta, Jonathan Feld, Maaike van Gerwen, Mathilda Alsen, Santiago Thibaud, Alaina Kessler, Sangeetha Venugopal, Iman Makki, Qian Qin, Sirish Dharmapuri, Tomi Jun, Sheena Bhalla, Shana Berwick, Krina Christian, John Mascarenhas, Francine Dembitzer, Erin Moshier, Douglas Tremblay. “Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19.” Thrombosis Research, 2020. PMID: 32853982

62

Vardhmaan Jain, Kartik Gupta, Kirtipal Bhatia, Agam Bansal, Sameer Arora, Akshay K. Khandelwal, Jonathan R. Rosenberg, Justin P. Levisay, Carl L. Tommaso, Mark J. Ricciardi, Arman Qamar. “Management of STEMI during the COVID-19 pandemic: Lessons learned in 2020 to prepare for 2021.” Trends in Cardiovascular Medicine, 2021.

PMID: 33338636

*Updated on March 31, 2021.

190

Index Posters Index of Virtual Posters

191

RESIDENT NAME

POSTER CATEGORY

POSTER

Abed, Robert

Clinical Research

1

Aguilar Gallardo, Jose

Case Report/Clinical Vignette/Clinical Review

2

Anand, Shruti

Quality Improvement

3

Arreaza, Javier

Clinical Research

4

Bachoo, Nikhil

Case Report/Clinical Vignette/Clinical Review

5

Berookhim, Joshua

Quality Improvement

6

Bhatia, Kirtipal

Clinical Research

7

Botero, Lauren

Case Report/Clinical Vignette/Clinical Review

8

Chen, Bing

Clinical Research

9

Crowley, Fionnuala

Basic Science

10

Danso, Lady

Case Report/Clinical Vignette/Clinical Review

11

Das, Subrat

Clinical Research

12

Derman, Abraham

Case Report/Clinical Vignette/Clinical Review

13

Dulal, Jeewendra

Case Report/Clinical Vignette/Clinical Review

14

El Halabi, Maan

Clinical Research

15

El Tomb, Paul

Clinical Research

16

Fujisaki, Tomohiro

Clinical Research

17

Gotzev, Simeon

Case Report/Clinical Vignette/Clinical Review

18

Gutierrez, Angelica

Case Report/Clinical Vignette/Clinical Review

19

192

RESIDENT NAME

POSTER CATEGORY

POSTER

Handa, Shivani

Clinical Research

20

Herrera, Yasmin

Clinical Research

21

Ho, Kam

Clinical Research

22

Horowitz, Maxwell

Clinical Research

23

Huang Lucas, Claire

Clinical Research

24

Isath, Ameesh

Clinical Research

25

Kahen, Michael

Quality Improvement

26

Karr, Matthew

Case Report/Clinical Vignette/Clinical Review

27

Kassim, Frida

Case Report/Clinical Vignette/Clinical Review

28

Kassim, Gassan

Clinical Research

29

Khachatoorian, Yeraz

Basic Science

30

Kim, Andrew

Case Report/Clinical Vignette/Clinical Review

31

Kohli, Paraas

Case Report/Clinical Vignette/Clinical Review

32

Lao, Shu Min

Case Report/Clinical Vignette/Clinical Review

33

Lopes, Jan

Clinical Research

34

Lorente Ros, Marta

Clinical Research

35

Madero-Marroquin, Rafael

Clinical Research

36

Mahmoud, Omar

Clinical Research

37

Makki, Iman

Case Report/Clinical Vignette/Clinical Review

38 193

RESIDENT NAME

POSTER CATEGORY

POSTER

McKinnell, Zoe

Quality Improvement

39

Moctezuma, Sananda

Clinical Research

40

Narasimhan, Bharat

Clinical Research

41

Nassar, Rawann

Clinical Research

42

Nasserifar, Shabnam

Clinical Research

43

Nunna, Pratyusha

Clinical Research

44

Ochoa Jimenez, Roberto

Clinical Research

45

Patel, Ramya

Clinical Research

46

Pattupara, Archana

Case Report/Clinical Vignette/Clinical Review

47

Perez Lizardo, Christopher

Case Report/Clinical Vignette/Clinical Review

48

Petrone, Giulia

Clinical Research

49

Poojary, Priti

Clinical Research

50

Poon, Joseph

Clinical Research

51

Prince, James

Case Report/Clinical Vignette/Clinical Review

52

Rabinovitz, Itay

Case Report/Clinical Vignette/Clinical Review

53

Robin, Edith

Clinical Research

54

Robles Aponte, Ines

Quality Improvement

55

Romeo, Francisco

Clinical Research

56

Sacchi de Camargo Correia, Guilherme

Clinical Research

57 194

RESIDENT NAME

POSTER CATEGORY

POSTER

Santillan, Yeriko

Quality Improvement

58

Shah, Suraj

Case Report/Clinical Vignette/Clinical Review

59

Sheehan, Jacqueline

Quality Improvement

60

Shenoy, Shabari

Case Report/Clinical Vignette/Clinical Review

61

Skaf, Michel

Quality Improvement

62

Sterpi, Michelle

Clinical Research

63

Sy, Hendrik

Case Report/Clinical Vignette/Clinical Review

64

Twomey Brenner, Ciaran

Quality Improvement

65

Uberoi, Angad

Clinical Research

66

Wu, Lingling

Clinical Research

67

Xie, Mengdan

Clinical Research

68

Yang, Zhuoran

Clinical Research

69

Yassin Jioussy, Heba

Clinical Research

70

Zheng, Binbin

Medical Education

71

195

Index ofofAuthors Index Authors

196

196

INDEX OF RESIDENT AUTHORS Abed, Robert: 23, 51, 72 Aguilar Gallardo, Jose: 24 Anand, Shruti: 25, 87 Arreaza, Javier: 24, 26, 39, 59 Bachoo, Nikhil: 27, 72 Bahk, Jeeyune: 184 Bernal, Gabriela: 28, 53 Berookhim, Joshua: 28, 53, 70, 189 Bhatia, Kirtipal: 29-31, 77, 93, 94, 133-134, 158, 174, 183, 186, 189, 190 Botero, Lauren: 32, 54, 68-69 Chen, Bing: 33, 76, 123-124, 125-126, 127-128, 129, 130-131, 139, 177, 184 Crowley, Fionnuala: 35, 132 Danso, Lady: 36 Das, Subrat: 28, 37, 53, 94, 133134, 135-136, 137, 185, 187 Derman, Abraham: 38 Dulal, Jeewendra: 26, 39, 59, 187 El Halabi, Maan: 40-41, 129, 130131, 138, 139, 140, 141-142, 143, 144-145, 174, 184, 186, 187 El Tomb, Paul: 42 Elias, Joseph: 146 Fujisaki, Tomohiro: 43-44, 148149, 150, 185, 187, 189 Gold, Christopher: 151 Gotzev, Simon: 45 Gutierrez, Angelica: 46 Handa, Shivani: 47, 95, 158, 185, 190 Herrera, Yasmin: 48, 49, 77, 8183, 152, 153, 154, 155, 156, 157, 158 Ho, Kam: 48, 49, 73, 77, 81-83, 92, 101, 103-106, 152, 153, 154, 155, 156, 157, 171, 183, 184, 188

Horowitz, Maxwell: 50 Hoskote, Abhinav: 95 Huang Lucas, Claire: 51, 62, 70, 72, 94 Isath, Ameesh: 51, 52, 183, 187, 188, 189 Jamito, Jonathan: 55, 158 Kahen, Michael: 28, 53 Karr, Matthew: 32, 54 Kassim, Frida: 55, 187 Kassim, Gassan: 56-57, 144-145, 159-161, 162-163, 185, 187, 190 Khachatoorian, Yeraz: 58, 63, 164, 165 Kim, Andrew: 26, 39, 59 Kim, Ga Hee: 26, 39, 59 Kohli, Paaras: 49, 60, 152, 153, 155, 166 Krishnamurthi, Nirupama: 133134, 178-179 Lakshmanan, Priyanka: 185 Lao, Shu Min: 61 Li, Taoran: 187, 188, 189 Lopes, Jan: 51, 62, 94 Lorente Ros, Marta: 63 Madero-Marroquin, Rafael: 64-65, 188 Mahmoud, Omar: 33-34, 66, 123124, 129, 130-131 Makki, Iman: 67, 108-110, 190 McKinnell, Zoe: 68-69 Moctezuma, Sananda: 70, 87 Narasimhan, Bharat: 64, 72, 101, 103-106, 133-134, 154, 156, 183, 184, 185, 186, 187, 188, 189, 190 Nassar, Rawann: 23, 72, 185 Nasserifar, Shabnam: 73, 152, 153, 155 Nunna, Pratyusha: 74, 87 Ochoa Jimenez, Roberto: 75, 186

197

INDEX OF RESIDENT AUTHORS Paka, Pavan: 187 Patel, Ramya: 76 Pattupara, Archana: 48, 49, 78, 152, 153, 154, 155, 156, 157, 166, 167 Pena, Maria: 184 Perez Lizardo, Christopher: 78, 168 Peterson, Erik: 188 Petrone, Giulia: 79, 184 Poojary, Priti: 80, 186 Poon, Joseph: 48, 49, 81-83, 152, 153, 154, 155, 156, 157, 184 Prince, James: 84 Rabinovitz, Itay: 85 Reigo, Maria Athena: 166, 167, 169 Robin, Edith: 86 Robles Aponte, Ines: 25, 87 Romeo, Francisco: 88, 189 Sacchi de Camargo Correia, Guilherme: 89 Santillan, Yeriko: 90 Shah, Dishant: 170 Shah, Suraj: 91 Sheehan, Jacqueline: 92, 171, 184, 188 Shenoy, Shabari: 93 Skaf, Michel: 94 Sterpi, Michelle: 93, 95 Sy, Hendrik: 96 Tallón de Lara, Paulino: 189 Tobin-Schnittger, Patrick: 172 Tracey, Matthew: 27 Twomey Brenner, Ciaran: 97 Uberoi, Angad: 98-100, 144-145, 173, 174, 187 Wu, Lingling: 51, 63, 70, 94, 101, 103-106, 186, 188 Xie, Mengdan: 102, 175, 176, 177

Yang, Zhuoran: 103-106 Yassin Jioussy, Heba: 107 Zalcgendler, Sara: 96 Zheng, Binbin: 67, 108-110, 178179, 180-181, 185, 190

198

Second Annual Icahn School of Medicine at Mount Sinai Morningside/West Internal Medicine Residency Virtual Research Week

Research Day Judges May 12, 2021

Ana Belen Arevalo Molina

Fernando Carnavali

Peter Goulden

Forough Hakimzada

Erna Kojic

Theresa Mack

Brian Markoff

Joseph Mathew

Ira Meisels

Argelis Rivera

Adam Rothman

Ashwin Sawant

Samuel Seward

Janet Shapiro

Sarah Shihadeh

Priya Simoes

Michael Smith

Christine Stavropoulos

David Steiger

Jacqueline Tamis-Holland

Melissa Wiener

David Weininger

Kevin Yan

Sanaa Zafar

199

200

Thank you for attending the Mount Sinai Morningside/West Internal Medicine Residency Second Annual Virtual Research Week!

Residency Leadership John A. Andrilli, MD, FACP

Georgina Osorio, MD, MPH

Lillian Galindo

Nicole Littman

Mariah Soria

Residency Contact Information Email: slrmedresinfo@mountsinai.org Website: icahn.mssm.edu/education/residenciesfellowships/list/msslw-internal-medicineresidency Twitter: @MSM_MSW

200

201

Official Official Publication of of Publication Second Annual Second Annual Mount Sinai Mount Sinai Morningside/ Morningside/ West Internal West Internal Medicine Medicine Residency Residency Research Week Research Week

Editors Georgina Osorio Nicole Littman Lillian Galindo

Associate Editors David Weininger Ana Arevalo Mariah Soria

Editorial Board John Andrilli Caroline Dooley Deborah Edelman Tamara Goldberg Shane Murray Alejandro Prigollini Bert Salguero Geeta Varghese Vasundhara Singh Heather Viola 21

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