The Racial Divide: A Follow Up Study on Racial Disparity Amongst COVID-19 Survivors in an Urban Community.

Background: Studies have shown that COVID-19 has had a disproportionate effect on minority groups in both the clinical and social settings in America. We conducted a follow up study on patients previously diagnosed with COVID-19 one year ago in an urban community in New Jersey. The purpose of the study was to evaluate the socioeconomic impact of COVID-19 as well as assess for receptiveness towards COVID-19 vaccination amongst various ethnic groups. Methods: This was a prospective cohort study consisting of patients who had recovered from COVID-19 one year prior. The patients included in the study had a confirmed COVID-19 diagnosis in the months of March and April of 2020. This was a single institutional study conducted at St. Joseph's University Medical Center in Paterson, NJ from the months of March to April of 2021. Patients included in the study were either male or female aged 18 years or older. Patients who met criteria for inclusion were contacted by telephone to participate in a telephone survey. After informed consent was obtained, the patients completed a survey which obtained sociodemographic information pertaining to their diagnosis with COVID-19. Statistical analysis was performed using chi-square testing and multivariable logistic regression analysis. Results: Of the 170 patients enrolled in the study, the most common ethnicity was Hispanic (79/170 [46.47%]), followed by African American (46/170 [27.05%]). The gender distribution was 83 male (83/170 [48.82%]) and 87 female (87/170 [51.18%]) with a mean age of 51.5. Caucasians were the most willing to receive a COVID-19 vaccine (28/30 [93.3%]), followed by Asians (13/14 [92.8%]), Hispanics (63/78 [80.7%]) and African Americans (29/46 [63.0%]). Hispanics had the highest rate of job loss (31/79 [39.24%]), followed by of African Americans (16/46 [34.7%]). Hispanics were found to be in the most financial distress (31/79 [39.2%]), followed by African Americans (17/46 [36.9%]). Chi square analysis revealed Hispanics and African Americans were more likely to lose their jobs after being diagnosed with COVID-19 (p: 0.04). Hispanics and African Americans were also more likely to refuse vaccination with any of the available COVID-19 vaccines (p: 0.02). Multivariable Logistic regression analysis was then performed comparing both Hispanics and African Americans to Caucasians. Hispanics were more likely to lose their jobs compared to Caucasians (odds ratio, 4.456; 95% CI, 1.387 to 14.312; p: 0.0121). African Americans were also more likely to lose their jobs when compared to Caucasians (odds ratio, 4.465; 95% CI, 1.266 to 15.747; p: 0.0200). Discussion: Overall Hispanics reported the highest rates of financial distress after their diagnosis with COVID-19. Nearly 40% of the Hispanic lost their jobs following their diagnosis with COVID-19 which was the highest in our study group. African Americans were similarly affected with about 37% of all patients experiencing job loss and financial distress following diagnosis with COVID-19. Hispanics and african americans were the two ethnic groups who were least willing to receive COVID-19 vaccination. Only 63% of African Americans were willing to receive the vaccine, with 80.7% of Hispanics willing to become vaccinated. The most common reason for not receiving any of the COVID-19 vaccines was due to lack of trust in the vaccine. Both Hispanics and African Americans were more statistically likely to lose their jobs as well as refuse COVID-19 vaccination following diagnosis with COVID-19.

A Tumor Treated With Antibiotics: A Rare Case.

Pott's puffy tumor, a rare condition, is an osteomyelitis involving the frontal bone with accompanying subperiosteal abscess. Patients typically present with swelling of the scalp and forehead, headache, fever, tenderness of the frontal sinus, and nasal discharge. MRI is the modality of choice for diagnosis and assessment. The standard of care is incision and drainage with long-course antibiotics. The prognosis is excellent; however, complications from a hematogenous spread can lead to meningitis or epidural spaces if not treated properly.

Acute Pancreatitis-Induced Euglycemic Diabetic Ketoacidosis.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medications utilized for the treatment of diabetes mellitus by mechanisms promoting incretin release and insulin production. Although poorly understood, cases of acute pancreatitis have been observed in patients taking GLP-1 RAs. Sodium-glucose co-transporter-2 inhibitors (SGLT-2is) are another class of diabetic medications inhibiting renal glucose reabsorption which have been associated with rare cases of euglycemic ketoacidosis. Acute pancreatitis itself has been an observable cause of diabetic ketoacidosis, although typically in a hyperglycemia state. In this case report, we present a patient on SGLT-2is and GLP-1 RAs who developed acute pancreatitis, which may have precipitated euglycemic diabetic ketoacidosis (eu-DKA).

Acute Pancreatitis in the Transgender Population.

Hypertriglyceridemia (HTG) is an uncommon but well-established etiology of acute pancreatitis (AP) leading to significant morbidity and mortality. Hormone replacement therapy in the transgender population is an underrecognized cause of elevated triglyceride (TG) levels and may put this group at a higher risk for severe pancreatitis. We present a case of AP in a genetically male patient receiving hormone therapy for female gender transformation.A 51-year-old with a past medical history of type 2 diabetes mellitus presented with severe epigastric abdominal pain associated with nonbilious, nonbloody vomiting and anorexia for two days. The patient was diagnosed with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) in the setting of elevated lipase levels of 2,083 u/L and TGs of >5,000 mg/dL. In addition, a computerized tomography scan of the abdomen showed pancreatitis without evidence of necrosis. The patient was admitted to the medical intensive care unit for the management of AP in the setting of elevated TG levels. She was treated with intravenous fluids and an insulin drip. Her home medications including estradiol and Aldactone were held. Once the TG levels were reduced to <500 mg/dL, she was taken off the Insulin drip and transitioned to a subcutaneous insulin regimen along with gemfibrozil and omega-3 fatty acid over the next three days, and then discharged to home. HTG accounts for only about 7% of pancreatitis cases and increases in severity as TG levels increase. The clinical presentation of patients suffering from HTG-AP is similar to patients with AP from other etiologies and presents in a relatively younger population compared to AP from other causes. Treatment options for HTG-AP usually utilize insulin and heparin; however, plasma exchange and venovenous filtration may be used for severe cases of HTG-AP. The goal of treatment is to lower the TG levels. Physicians should be aware of such complications and should counsel patients while utilizing hormone replacement therapy, especially in patients with a prior family history of dyslipidemia.