Screening for hepatitis B in the Bronx West African community with a blood pressure cuff: a cohort study.

Background: Hepatitis B (HBV) and hypertension (HTN) are prevalent in West Africa (WA). Inadequate control is common, and evaluation and management are challenging among immigrants due to unfamiliarity with the United States (US) healthcare system. While HBV is stigmatised, HTN is recognised as an important condition. We describe how a HTN screening program can facilitate HBV screening in the Bronx WA community. Methods: Thirty-minute HTN educational programs were delivered in collaboration with faith-based organisations, and 5-min presentations were presented upon request at community gatherings. Arrangements were made for those interested in a clinic visit where a questionnaire was completed, blood pressure (BP) measured, a free BP cuff provided, HBV testing performed, and referrals made. For those without ongoing care, insurance was arranged, and linkage to care provided. Findings: Seven 30-min and five 5-min presentations were conducted. After the 30-min presentation, 204 of 445 attendees (45.8%) requested a visit, and 68 (33.3%) attended the visit. After the 5-min presentation, 80 requested a visit and 51 (63.8%) attended the visit. A BP >140/90 mmHg was present in 122 individuals (48.4%), including 43 (17.1%) without a history of HTN and 39 (15.5%) with BP >160/90 mmHg. All except two who reported previous testing agreed to HBV testing. 19 (7.5%) were hepatitis B surface antigen positive. Transition into ongoing care was provided for 60 (33.9%) with HTN who were not integrated into the US healthcare system. Interpretation: HTN screening with a free BP cuff promotes HBV screening and US healthcare integration. Funding: No funding.

Eliminating hepatitis B vaccination disparities for West African immigrants.

BACKGROUND: Hepatitis B virus (HBV) infection is endemic in West Africa. There has been a significant increase in the Bronx West African (WA) community. To achieve HBV elimination, vaccination of non-immune individuals is important. Unfortunately, vaccine uptake in immigrant populations is at this time very limited. METHODS: An educational program was conducted by medical providers of WA origin in collaboration with local faith-based organizations, after which free HBV screening was offered. Non-immune individuals were initially recommended to contact their medical provider or referred to the Department of Health for vaccination. Beginning in 2021, the program offered vaccination. A questionnaire including reasons for vaccination in the program was offered. FINDINGS: Among the first500 individuals screened,34.6 % required vaccination. Among those screened before program vaccine availability, 72.2 % initiated the vaccination series,with38.2 % obtainingit at an outside setting and34 % returning when available through the program.Among patients screened after program vaccineavailability, 92.1 % initiated the series.Of those receiving vaccination in the program and completing the questionnaire,70.7 % had access to care but chose vaccination by the program because of the trust instilled by WA personnel. INTERPRETATION: Our findings demonstrate the effectiveness of integrating vaccination into an HBV screening program for an immigrant population. It emphasizes the importance of timeliness and cultural sensitivity.

Analyzing the Effects of Demographic Differences on Patient Outcomes Following Non-pyogenic Intracranial Venous Thrombosis.

OBJECTIVE: To investigate the effect of racial and demographic differences on the short-term outcome of patients following a non-pyogenic cerebral venous thrombosis. METHODS: Data from the National Inpatient Sample were gathered from the years 2013 to 2016. Patients who had a non-pyogenic cerebral venous thrombosis were identified. Admissions of patients between different racial groups were compared. Outcome measures included inpatient mortality, length of stay (LOS), all patients refined diagnosis-related group (APR-DRG) severity and mortality risk scores, non-routine discharges, total charges, sepsis, and urinary tract infections (UTIs). RESULTS: We identified 973 patients who were admitted with a non-pyogenic cerebral venous thrombosis between 2013 and 2016. Of those, 65.7% were classified as White, 15.6% as Black, 14.1% as Hispanic, and 4.6% as Asian or Pacific Islander. Compared to White patients, Black patients were found to have a higher severity score upon admission (2.94 ± 0.818 vs 2.77 ± 0.839; p = 0.025) as well as a longer adjusted LOS (8.085 ± 5.917 vs 6.503 ± 5.552; p = 0.004) and log LOS (0.934 ± 0.507 vs 0.773 ± 0.521; p = 0.001). On initial analysis, we found that older age, elevated WBC count, income group, anemia, and an expected primary payer of Medicare/Medicaid were significantly associated with Black race and also worse outcomes. When controlling for these variables using multivariate regression, older age, lower income group, and elevated WBC count were not significantly associated with any measures of outcome. The race was no longer associated with a higher APR-DRG severity score but was still significant for adjusted LOS (p = 0.001) and adjusted log LOS (p = 0.004). Lastly, we noted that anemia and the expected primary payer of Medicare/Medicaid were both independently and significantly associated with APR-DRG severity score (p = 0.003; p = 0.010) and the adjusted log LOS (p = 0.019; p = 0.035). CONCLUSIONS: Black patients admitted with a non-pyogenic intracranial venous thrombosis have significantly longer LOS compared to White patients. Anemia and Medicare/Medicaid as the primary expected payer also seem to play a role in longer LOS, as well as the severity of the case.

Gram-Negative Ventriculostomy-Associated Infections Predict Shunt Dependency in Stroke Diagnoses and Other Brain Injuries.

BACKGROUND: Several predictors have been studied for shunt dependency after stroke and other brain injuries. However, little is known about the association between ventriculostomy-associated infections (VAIs) and impaired cerebrospinal fluid (CSF) outflow. Moreover, gram-negative (GN) VAIs induce a potent neuroinflammatory process and are clinically challenging to treat. OBJECTIVE: To assess if GN-VAIs predict ventriculoperitoneal shunt (VPS) dependency. METHODS: Retrospective analysis of postprocedure infection rates was performed in 586 patients with external ventricle drainage (EVD) placed on site between 2012 and 2018. We collected sex, age, stroke and nonstroke related, location of EVD placement, type of hospital, EVD duration, and EVD exchange. RESULTS: Among 586 patients requiring an EVD, 55 developed a VAI. Most were caused by gram-positive (GP) pathogens (61.8%). A total of 120 patients required a conversion from EVD to VPS. Patients with VAIs had higher rates of VPS placement (49.09% vs 17.65%, P < .001), whereas patients with GN-VAIs had significantly higher rates of EVD conversion to VPS (77.78% vs 35.29%, P = .012) compared with GP-VAIs. The multivariate analysis showed that GN-VAIs were an independent predictor for shunt dependency (odds ratio = 12.896; 95% CI 3.407-48.82, P < .001). In receiver operating characteristics analysis, those less than 44.5 yr of age and more than 12 d of EVD duration were identified as the best cutoff values to discriminate the development of GN-VAI. CONCLUSION: Patients who experience a GN VAI are in greater risk of impaired CSF outflow, thus requiring VPS placement.

Impact of hospital-acquired complications in long-term clinical outcomes after subarachnoid hemorrhage.

OBJECTIVE: Patients with subarachnoid hemorrhage (SAH) usually have prolonged hospitalizations due to the need to closely monitor their neurological status. Therefore, these patients have higher risk of experiencing hospital-acquired complications (HACs), which can complicate their clinical course and recovery. However, there is no evidence on the impact of HACs of long-term clinical outcomes. We aimed to identify if HACs are independent risk factors for poor clinical outcomes at 12-18 months of follow-up. PATIENTS AND METHODS: Retrospective analysis of 323 patients with SAH diagnosis from 2013 until June 2018. We collected patient-related factors (age, sex, body mass index (BMI), ethnicity), comorbidities (hypertension, smoke status, diabetes, coronary heart diseases, prothrombotic diseases and hypercholesterolemia), clinical variables (Hunt-Hess grade, modified Fisher grade, treatment, delayed cerebral ischemia), aneurysm characteristics (location, size) and HACs (pneumonia, deep vein thrombosis (DVT), urinary tract infection (UTI), external ventricular drainage (EVD) infections, sepsis, hyponatremia and acute respiratory distress syndrome). Poor outcomes were defined as mRS ≥ 3. RESULTS: 204 patients were included in the primary analysis. 82 (40.2%) experienced one or more HACs during their hospital course. Patients that developed HACs have significantly increased ICU (12.1 ±â€¯6.6 vs 24.3 ±â€¯23.6, p < .001) and hospital (18.7 ±â€¯14.2 vs 35.3 ±â€¯26.3, p < .001) length of stays. Moreover, patients with HACs had significant higher rates of delayed cerebral ischemia, non-routine discharge and poor outcomes at 90 days. 177 patients had complete follow-ups at 12-18 months, HACs were independent risk factors for poor functional outcomes at 12-18 months after adjusting for demographic, comorbidities and clinical variables [OR = 3.205, 95% CI 1.231-8.347, p < 0.001]. CONCLUSIONS: HACs are an independent risk factor of sustaining poor clinical outcomes 12-18 months after a SAH. Furthermore, HACs are significantly related with the occurrence of DCI, with non-routine discharge and 90-day poor functional outcomes.

Peripheral Monocytosis at Admission to Predict Cerebral Infarct and Poor Functional Outcomes in Subarachnoid Hemorrhage Patients.

OBJECTIVE: Increasing evidence points monocytes' role to be larger than thought in developing cerebral infarction (CI) after subarachnoid hemorrhage (SAH). However, there is no clinical evidence of the relationship between peripheral monocytes and CI and clinical outcomes. Therefore we determine whether an increase in monocytes in the acute phase is useful to predict CI and functional outcomes in SAH patients. METHODS: We included 204 patients with an SAH diagnosis. We collected patient-related factors, comorbidities, Hunt-Hess grade, modified Fisher grade, treatment, delayed cerebral ischemia, CI, aneurysm characteristics, and peripheral monocytes from vein blood at admission. Poor outcomes were defined as modified Rankin Scale score ≥3. RESULTS: Fifty (24.5%) patients had CI before discharge. In a multivariate model, increased monocytes at admission were significantly associated with CI after adjusting for IV-V Hunt-Hess grade and delayed cerebral ischemia (odds ratio: 3.193, 95% confidence interval: 1.069-9.532, P = 0.037). In receiver operating characteristic curve analysis, a monocyte count of 0.60 was identified as the best cutoff value to discriminate the development of CI (area under the curve = 0.622, P = 0.010; CI for monocytes <0.60 17.4% vs. CI for monocytes ≥0.60 29.1% P = 0.046). Admission monocytes ≥0.60 predicted poor functional outcomes at discharge (monocytes <0.60 52% vs. monocytes ≥0.60 64.7%) and at 12 months (monocytes <0.60 29.4% vs. monocytes ≥0.60 70.6%). CONCLUSIONS: Increased peripheral monocytes at admission is a risk factor for developing CI after SAH. Moreover, short- and long-term poor clinical outcomes were associated with higher monocyte count. Therefore monocytes could be a convenient biomarker for prognosis unfavorable outcomes and a possible target for new therapeutic strategies.