Brooklyn Historical Society

Introduction: Ulcerative colitis (UC) is a type of inflammatory bowel disease. Patients with UC often have other comorbidities, including diabetes mellitus (DM). However, there are very few studies on the effect of comorbid DM in patients with UC. This study aims to examine the clinical outcomes of hospitalized patients with UC and DM. Methods: We analyzed the National Inpatient sample from January 1, 2016, to December 31, 2020. We conducted a retrospective study in patients with primary and secondary diagnoses of UC using the International Classification of Diseases, Tenth Revision (ICD-10-CM) codes. We had a total sample size of 116,496 patients with UC. The study population was further categorized into patients with comorbid DM, 23,837 patients, and those without DM (non-DM), 92,659 patients. The primary study outcomes were in-hospital mortality, UC-related complications, UC-related surgery, septicemia, Clostridiodes difficile infection, and colorectal cancer (CRC). The survey weighted annual trends in national estimates of UC and subgroups (DM and non-DM), demographics, and in-hospital mortality. Propensity score matching (PSM) was performed to control confounding factors. Results: There was an increase in UC hospitalizations from 2016 to 2020, reflected among DM cohorts. After PSM, we obtained a well-balanced cohort of 23,628 DM matched to 23,628 non-DM groups, and the outcomes were compared. Patients in the DM group had an increased risk of sepsis/septicemia (17.2% vs. 14.3%, OR=1.24, CI: 1.18-1.31; P< 0.001) and depression (1.8% vs. 1.4%, OR=1.35, CI: 1.16-1.56; P< 0.001) than the non-DM groups. While the length of hospital stay was longer among the DM patients (3.7 (2.0 – 6.8) vs. 3.4 (1.8 – 6.3), OR=1.06, CI: 1.05-1.08; P < 0.01), the cost of hospitalization remained the same among the 2 cohorts. On the other hand, there was decreased risk of IBD-related complications among the DM patients (8.0% vs. 8.7%, OR=0.91, CI: 0.85-0.97; P< 0.004) compared to the non-DM cohorts. There was no difference in the risk of Clostridiodes difficile infection, CRC, and death among the two cohorts. Conclusion: Patients with Ulcerative colitis and diabetes have an increased rate of sepsis, septicemia, depression, and length of hospital stay, compared to patients with Ulcerative colitis without diabetes. The severity of Ulcerative colitis and diabetes was, however, not examined in this study. This study shows the extent to which diabetes affects the in-hospital outcomes of patients with Ulcerative colitis (Figure 1, Table 1).Figure 1.: Plots of the odds ratio and confidence intervals of outcomes of Ulcerative colitis and diabetes after propensity matching. Table 1. - Outcomes of Ulcerative colitis before and after propensity score matching Before Matching After Matching Diabetes Non-Diabetes P-value Diabetes Non-Diabetes P-value (N = 23,837) (N = 92,659) (N = 23,628) (N = 23,628) In-hospital Outcomes Major Adverse events 40.8 44.0 < .0001 40.8 40.0 0.0785 IBD-related complications 8.0 9.7 < .0001 8.0 8.7 0.0050 Surgery 27.0 37.0 < .0001 27.1 27.6 0.2983 Sepsis/Septicemia 17.2 12.8 < .0001 17.2 14.3 < .0001 C.difficile infections 6.5 6.4 0.7308 6.5 6.8 0.1108 Colorectal Cancer 1.3 1.4 0.1297 1.3 1.4 0.3173 Death 3.0 1.8 < .0001 3.0 2.8 0.1936 Depression 1.8 1.6 0.0143 1.8 1.4 < .0001 Anxiety 16.1 17.7 < .0001 16.1 16.8 0.0512 Length of stay (Median IQR) 3.6 (1.9 - 6.7) 3.1 (1.7 - 5.7) < .0001 3.7 (2.0 - 6.8) 3.4 (1.8 - 6.3) < .0001 Cost (Median IQR) 10320 (6172 - 18421) 9037 (5454 - 16328) < .0001 10295 (6167 - 18395) 10007 (5976 - 17755) 0.0716

Introduction: Classically, lumen-apposing metal stents (LAMS) are used for luminal drainage of pancreatic fluids. Given their unique barbell shape, the use of LAMS has grown to include many off-label indications, including pyloric stenosis. We present the first known case of pyloric stenosis managed with LAMS with subsequent unintended migration of stent into distal small bowel resulting in partial small bowel obstruction. Case Description/Methods: 58-year-old man with history of coronary artery disease, hypertension, dyslipidemia, mood disorder and nephrolithiasis presented with symptoms of early satiety, postprandial epigastric burning and fullness and unintentional weight loss ongoing for at least 1 year. The patient was previously assessed at an outside facility in June 2021 where upper endoscopy (EGD) demonstrated pyloric stenosis. An upper gastrointestinal study and gastric emptying study were unremarkable. Symptoms were managed with small portion meals and proton pump inhibitor therapy. In March 2022, symptoms worsened, and a repeat EGD with balloon dilation of pyloric stenosis to 15 mm was done with significant symptom improvement. Patient underwent repeat dilation up to 20 mm. In February 2023, patient had continued symptoms despite prior dilations, therefore repeat EGD was performed and showed moderate stenosis at pylorus and an AXIOS 15 mm x 10 mm LAMS was successfully placed. In March 2023, patient presented to the emergency room with complaints of cramping abdominal pain. Vitals were stable and initial labs significant for mild leukocytosis. Imaging with CT abdomen and pelvis suggestive of partial distal small bowel obstruction due to metal stent. No free air was seen. A colonoscopy was performed, and a metal stent was seen in the distal ileum (about 10 cm from ileocecal valve) with underlying mucosal ulceration. The stent retrieved. The patient's symptoms improved, and he was discharged the next day (Figure 1). Discussion: Self-expanding stents have been used off-label for pyloric stenosis refractory to balloon dilation. Complications associated with stent placement include stent migration or dysfunction, perforation, bleeding, abdominal pain, pancreatitis, and peritonitis. The risk for stent migration is thought to be reduced with LAMS due to its barbell shape, however as seen with this case, stent migration is still possible and can lead to further complications, such as small bowel obstruction. It is imperative that these complications are considered prior to stent placement.Figure 1.: 1. CT scan demonstrating metal stent in distal small bowel 2. Colonoscopy findings of stent in distal ileum.

In the U.S., Black men are disproportionately affected by HIV, with some of the highest HIV incidence rates and lowest rates of HIV testing. We examined correlates of HIV testing and knowledge among participants of the Barbershop Talk with Brothers (BTWB) project, an HIV prevention program targeting high-risk sexual behaviors amongBlack heterosexual men in Brooklyn, New York.Specifically, we examined differences between U.S. vs. foreign-born status and HIV testing rates, HIV knowledge, and socio-demographic factors. Of the 855 men included, the mean age was 33years and 35.0% were foreign-born. Lifetime HIV testing was reported at 84%, with greater proportion of U.S. vs foreign-born men reporting lifetime (88.6% vs. 75.0%) and recent testing (68.6% vs. 51.0%), p < 0.001. Among foreign-born men, recent HIV testing was associated with lower stigma and greater HIV transmission knowledge than those un-tested. The authors recommend tailored approaches to increasing HIV testing in Black communities, based on nativity and social factors.