Bronx Psychiatric Center

Psychotic disorders are associated with negative symptoms such as apathy and amotivation, with greater loneliness, increased social isolation, 7 and comorbid

Culture-based studies have shown that acquisition of extended-spectrum β-lactamase-producing Enterobacterales is common during international travel; however, little is known about the role of the gut microbiome before and during travel, nor about acquisition of other antimicrobial-resistant organisms. We aimed to identify (1) whether the gut microbiome provided colonisation resistance against antimicrobial-resistant organism acquisition, (2) the effect of travel and travel behaviours on the gut microbiome, and (3) the scale and global heterogeneity of antimicrobial-resistant organism acquisition. In this metagenomic analysis, participants were recruited at three US travel clinics (Boston, MA; New York, NY; and Salt Lake City, UT) before international travel. Participants had to travel internationally between Dec 8, 2017, and April 30, 2019, and have DNA extractions for stool samples both before and after travel for inclusion. Participants were excluded if they had at least one low coverage sample (<1 million read pairs). Stool samples were collected at home before and after travel, sent to a clinical microbiology laboratory to be screened for three target antimicrobial-resistant organisms (extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, and mcr-mediated colistin-resistant Enterobacterales), and underwent DNA extraction and shotgun metagenomic sequencing. We profiled metagenomes for taxonomic composition, antibiotic-resistant gene content, and characterised the Escherichia coli population at the strain level. We analysed pre-travel samples to identify the gut microbiome risk factors associated with acquisition of the three targeted antimicrobial resistant organisms. Pre-travel and post-travel samples were compared to identify microbiome and resistome perturbation and E coli strain acquisition associated with travel. A total of 368 individuals travelled between the required dates, and 296 had DNA extractions available for both before and after travel. 29 travellers were excluded as they had at least one low coverage sample, leaving a final group of 267 participants. We observed a perturbation of the gut microbiota, characterised by a significant depletion of microbial diversity and enrichment of the Enterobacteriaceae family. Metagenomic strain tracking confirmed that 67% of travellers acquired new strains of E coli during travel that were phylogenetically distinct from their pre-travel strains. We observed widespread enrichment of antibiotic-resistant genes in the gut, with a median 15% (95% CI 10-20, p<1 × 10-10) increase in burden (reads per kilobase per million reads). This increase included antibiotic-resistant genes previously classified as threats to public health, which were 56% (95% CI 36-91, p=2 × 10-11) higher in abundance after travel than before. Fluoroquinolone antibiotic-resistant genes were aquired by 97 (54%) of 181 travellers with no detected pre-travel carriage. Although we found that visiting friends or relatives, travel to south Asia, and eating uncooked vegetables were risk factors for acquisition of the three targeted antimicrobial resistant organisms, we did not observe an association between the pre-travel microbiome structure and travel-related antimicrobial-resistant organism acquisition. This work highlights a scale of E coli and antimicrobial-resistant organism acquisition by US travellers not apparent from previous culture-based studies, and suggests that strategies to control antimicrobial-resistant organisms addressing international traveller behaviour, rather than modulating the gut microbiome, could be worthwhile. US Centers for Disease Control and Prevention and National Institute of Allergy and Infectious Diseases.

Introduction: Aortic dissection and aortic aneurysm represent significant health risk as they are associated with very high mortality. Incidence of aortic dissection is low and estimated to be 5-30/100,000 hospitalized patients. Similarly, aortic aneurysms have low incidence (depending upon location) and high mortality (over 80%). Combined mortality associated with aortic aneurysm or dissection and its contemporary trends in the U.S. are not well known. Methods: In this retrospective study death certificate data were retrieved from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database for 1999-2018. Mortality for aortic aneurysm and dissection ICD-10 code-I71 as an underlying cause of death were queried from 1999-2018. This duration was further stratified into five-year periods. WONDER database is publicly available de-identified data collected by CDC that reports the underlying cause of death across the United States. Crude mortality rate and age-adjusted mortality rate per 100,000 were calculated in four U.S census regions (CR1 Northeast, CR2 Midwest, CR3 South, CR4 West). Results: From 1999-2018 AAMR for aortic aneurysm and dissection showed a downward trajectory. Regional variations were observed and are illustrated in figure 1. For Northeast (CR-1) AAMR declined by 54%, for Midwest (CR-2) it declined by 48%; for South (CR-3) it declined by 53%, and for West (CR-4) it declined by 52%. (Table-1) Conclusions: Our study shows a downward trajectory of AAMR for aortic aneurysm and dissection. Which reinforces the continuation of guideline based screening.

Ovarian vein thrombosis is not well understood, and there is no consensus regarding treatment. It can present with subtle symptoms and is not usually high on the list of differentials. Traditionally, most cases are linked to pregnancy and postpartum state, but our case adds to the growing list of non-puerperal patients diagnosed with ovarian vein thrombosis after an outpatient procedure. In an era where there is a drive for minimally invasive procedures and shorter hospital stays, there is a need to have specific guidelines to direct the diagnosis and treatment of this rare form of thromboembolism.

Renal cell carcinoma (RCC) is a common cancer that affects a significant number of patients every year around the world. The presence of sarcomatoid features in these tumors is considered a poor prognostic feature. Patients with RCC with sarcomatoid features had significantly worse outcomes when treated with sunitinib, the previous first-line standard of care therapy when compared to patients without such features. Multiple immune checkpoint inhibitors have recently been approved for the treatment of RCC. In this article, we review the literature available on the outcomes of patients with sarcomatoid RCC treated with immune checkpoint inhibitors.

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. To the Editor: In 2013, Nielsen et al published an article, "Termination of Clozapine Treatment Due to Medical Reasons," with the objectives of identifying clozapine side effects leading to clozapine discontinuation and determining if some of these side effects could be managed without discontinuation or with a rechallenge. The article and accompanying charts, explicating discontinuation rules and management strategies, remain extremely useful in the clinical setting. The findings of their review were recently condensed into a summary table, Clozapine's Dangerous Side Effects and How to Manage Them, in Current Psychiatry for use by psychiatry residents and other clinicians.