Interventions and outcomes of COVID-19 patients in a community hospital-A single center study comparing the first and second waves.

BACKGROUND: We have had 3 coronavirus-related pandemics in the last two decades. Each has brought significant toll and with each case there was no cure. Even as vaccines have been developed for the current strain of the virus thereby increasing the prospects of bringing transmissions in communities to a minimum, lessons from this pandemic should be explored in preparation for future pandemics. Other studies have looked at differences in characteristics of patients and mortality rates between the first two waves. In our study we not only identify the differences in outcomes but also explore differences in hospital specific interventions that were implemented at Jersey City Medical Center, NJ, a community-based hospital. AIM: The aim of this study is to assess the differences between the first two waves of the COVID -19 pandemic in terms of management and outcomes to help identify any key lessons in the handling of future pandemics. We compared the population demographics, interventions and outcomes used during the first two waves of COVID-19 in a community-based hospital. METHODS: This is a retrospective single-center cross-sectional study including Laboratory confirmed COVID-19 patients requiring oxygen supplementation admitted at Jersey City Medical Center during the first wave (April 1 to June 30, 2020) and the second wave between (October 1, 2020, and January 1, 2021). The Chi-squared test was used to assess the relationship between categorical variables and the T- test for continuous variables. A Logistic regression model was built comparing the second to the first wave while accounting for important covariates. RESULTS: There was a combined total of 473 patients from both waves. Patients in the first wave were older (66.17 years vs 60.38 years, p <0.01), had more comorbidities (2.75 vs 2.29, p 0.003), had more severe disease (50% vs 38.78% p of 0.002), had a longer length of stay (14.18 days vs 8.77 days, p <0.001) and were more likely to be intubated (32.49% vs 21.9 4%, p 0.01). In the univariate model, the odds of mortality in the second wave compared to the first wave was 0.63 (CI, 0.41-0.96) and 1.73 (CI, 0.65-4.66) in the fully adjusted model. CONCLUSION: Overall, there was no statistically significant difference in mortality between the two waves. Interventions that were noted to be significantly different between the two waves were, increased likelihood of mechanical intubation in the first wave and increased use of steroids in the second wave compared to the first.

A Framework and Curriculum for Training Residents in Population Health.

There is increasing imperative to train residents in population health. The Accreditation Council for Graduate Medical Education (ACGME) enhanced its mission with revised Common Program Requirements (CPRs), which were fully implemented on July 1, 2020. The revised CPRs state ACGME's mission: "The development of physicians in GME focused on excellence in delivery of safe, equitable, affordable, quality care; and the health of the populations they serve." The new CPRs clearly articulate the need for graduate medical education (GME) trainees to develop and understand population health concepts during their GME experience, including social determinants of health and community impact. However, currently there is no standardized and widely available curriculum for GME to implement these revised CPRs. This paper proposes a curriculum in population health management for GME, which was developed in 1 institution, using a blend of didactic and experiential learning.

Cerebral mucormycosis in a diabetic man.

Cerebral mucormycosis without systemic foci of involvement is a rare life-threatening fungal infection that is reported to be more common in intravenous drug abusers. We present a case of isolated cerebral mucormycosis in a diabetic patient diagnosed through excision and biopsy and treated with combination of surgery and amphotericin with posaconazole.

Non-functioning pancreatic neuroendocrine tumors--a case report and review of literature.

PURPOSE: Neuroendocrine tumors of pancreas (PNET) are rare pancreatic neoplasms comprising 1-2% of all pancreatic tumors. The overall prognosis and long-term survival for PNET patients is far better than for patients with exocrine pancreatic cancer. PNETs are classified as functional or nonfunctional based on the presence or absence of a specific clinical syndrome associated with hormone oversecretion. METHODS: We present the case of a 36-year-old female with epigastric and right upper quadrant abdominal pain for 3 months associated with decreased appetite, early satiety and a 20-lb weight loss. On examination, she was cachectic with hepatomegaly. RESULTS: Laboratory assays showed elevated liver and pancreatic enzymes. On computed tomography (CT) scan of the abdomen and pelvis, there was a low-attenuation mass in the distal pancreatic tail measuring 4.7 × 2.4 cm with multiple liver masses, omental implants, left ovarian mass, and a small amount of ascites. CT-guided liver biopsy on pathology was consistent with a well-differentiated pancreatic neuroendocrine carcinoma with metastasis to the liver. Assays for biomarkers of pancreatic neuroendocrine tumors showed an elevated chromogranin A with normal to non-specific elevations of the rest. CONCLUSIONS: The patient and her family declined palliative chemoembolization of the liver lesions or palliative chemotherapy and desired home hospice. We describe here the presentation and course of the case as well as a literature review of PNET with particular emphasis on nonfunctioning PNETs.