Elmhurst Hospital Center

Introduction: Thyroid storm is a life-threatening form of hyperthyroidism that can lead to multiorgan failure. Severe hyperthyroidism can be precipitated by trauma, infection, surgery, acute iodine load or non adherence with antithyroid drugs. The exact mechanism of why some patients develop thyroid storm instead of uncomplicated thyrotoxicosis is not fully understood. Here we present a case of a young man with cardiogenic shock secondary to thyroid storm. Description: A 37-year-old undomiciled man with unknown past medical history presented after a syncopal episode. He reported sore throat, dizziness, edema, weight loss, and a petechial rash for 1 month, and cough for 2 days. Vitals: BP 152/87, HR 148, Temp 103°F, SpO2 93%. He appeared cachectic with diffuse purpura. ECG showed sinus tachycardia, biatrial enlargement, and LV hypertrophy. Chest CT revealed right heart dilation with hepatic vein reflux, and multifocal pneumonia. Abdominal CT showed anasarca, mesenteric edema, and ascites. Echo revealed EF 10%, global hypokinesis, and RV dilation. Labs: TSH < 0.01, free T4 1.13, T3 76.5, TSI 72.3, TPO 239, Na 124, K 5.1, Cr 0.7. He was started on propranolol, PTU, and Lugol’s iodine for suspected thyroid storm. He developed hemodynamic collapse with PEA arrest, was intubated, and transferred to the ICU. Despite vasopressors, inotropes, corticosteroids, and methylene blue, he suffered a second arrest. He was transferred for VA-ECMO, but progressed to DIC and died despite maximal support. Discussion: Thyroid storm is a rare, life-threatening endocrine crisis that can mimic sepsis or cardiogenic shock, often delaying diagnosis. Fewer than 1% of patients develop severe cardiomyopathy. In this case, misleadingly low T3/T4 levels likely reflected nonthyroidal illness syndrome (NTIS), masking underlying Graves disease. While BWPS helped support early treatment, it has limited value in the ICU due to physiologic overlap with sepsis. Imaging findings and thyroid antibody testing ultimately supported the diagnosis. This case highlights the importance of clinical judgment, multimodal workup, and early recognition, even when labs are inconclusive. ECMO may offer benefit in refractory cases

Our study investigates disparities in receipt of palliative-intent care among broad racial/ethnic and disaggregated Hispanic subgroups with stage IV liver cancer. This retrospective cohort study included patients with stage IV liver cancer diagnosed between 2004 and 2021 from the National Cancer Database. The primary outcome was the receipt of palliative-intent intervention. Multivariate regressions controlling for age group, country of origin, year group, sex, insurance status, 2016 median income quartiles, facility type, Charlson-Deyo comorbidity index score, stage group, and facility location quantified disparities in palliative-intent intervention. Further difference-in-differences analyses were conducted. Among 37,987 patients with stage IV liver cancer, 6573 (17.30%) received palliative-intent treatment. Compared to non-Hispanic White (NHW) patients, disaggregated analyses revealed significantly lower odds of receiving palliative-intent interventions for Black patients (AOR=0.93, 95% CI: 0.86-1.00, P=0.050) and patients of Hispanic descent (AOR=0.76, CI: 0.69-0.84, P<0.001). Furthermore, patients with stage IV liver cancer of Mexican and Cuban descent had lower odds of obtaining palliative-intent treatment compared with NHW patients (AOR=0.70, 95% CI: 0.54-0.90, P=0.006; AOR=0.44, 95% CI: 0.19-1.02, P=0.056). Difference-in-differences analyses revealed a significant association between palliative-intent intervention and 2014 to 2021, suggesting potential temporal differences in the primary outcome. Our study highlights the significant disparities in receipt of palliative-intent care among Hispanic subgroups upon disaggregation, underscoring the need for continued disaggregated research and targeted community- and patient-level solutions to close care gaps.

Introduction: Current stroke guidelines emphasize risk reduction through lifestyle changes, diabetes and hypertension management, and smoking cessation. The AHA recommends assessing ASCVD risk in individuals aged 40–75, with statin therapy advised for those at borderline or intermediate risk to achieve LDL levels under 100 mg/dL, aiming to reduce cardiovascular morbidity and mortality. For patients with prior cardiovascular events, the target LDL is under 70 mg/dL. This study examines stroke patients with baseline LDL &lt;70 mg/dL to evaluate the impact of statins on post-stroke disability outcomes. Methods: Our Stroke center maintains a registry of acute ischemic stroke patients with an admission LDL &lt;70mg/dl who are longitudinally followed for any vascular outcomes over 5 years. Patients baseline characteristics including NIHSS on admission, therapeutics and mRS/mortality are collected. Data was analyzed using R studio. We present the preliminary baseline observations and analysis of impact of prior statins on stroke severity and post stroke disability. Results: We analyzed 243 stroke patients (Jan 2021–June 2024) with LDL &lt;70 mg/dL; 42% had prior statin use. The cohort had a mean age of 68.7 years (SD 13.6), was 50% female, 60% Hispanic, and 33% African American. Common comorbidities included HTN (85%), DM (56%), CAD (23%), and COPD/asthma (19%); 21% had prior stroke/TIA, and 18% had substance use. Median hospital stay was 5 days (IQR 3–10), and median NIHSS was 4 (IQR 1–11). Stroke types were thrombotic (63%), TIA (23%), and ICH (14%), with a discharge median mRS of 3 (IQR 1–4) and 5% in-hospital mortality. No association was found between prior statin use and stroke type or severity using a multinomial regression model. However, CAD was linked to higher odds of thrombotic stroke (OR 4.96) and TIA (OR 5.40) vs. ICH. Age was associated with increased odds of TIA (OR 1.04), while HTN was linked to lower odds of TIA (OR 0.14). Prior statin use did not correlate with stroke severity (NIHSS) or disability (mRS) after adjusting for key covariates. Conclusion: Our data indicates that prior statin use in patients with acute stroke and LDL &lt;70 mg/dL is not associated with stroke severity or disability at discharge, contrary to our initial hypothesis. This finding highlights the need to explore other contributing factors or interventions that may enhance outcomes and lower the risk of future cardiovascular events, especially in individuals with a history of such events.

Despite the existence of evidence-based guidelines from the Centers for Disease Control and Prevention, studies have demonstrated the need for improvement in the evaluation and treatment of adolescents and young adults with a possible sexually transmitted infection (STI) presenting for care in pediatric emergency departments (PEDs) and general emergency departments (EDs) in the United States. We created an implementation strategy plan for our PED designed to improve STI care for patients. Using the Tailored Implementation in Chronic Diseases (TICD) determinants framework, we identified, prioritized, and investigated determinants of implementation success of our initiative. We then conducted stakeholder interviews to refine and design an implementation strategy plan that addressed identified barriers and facilitators. The resulting implementation strategy included: (1) a standardized STI care protocol; (2) electronic health record (EHR) enhancements, including smart phrases and tailored order sets; (3) staff training materials and academic detailing sessions for physicians and nurses; (4) an adolescent-friendly discharge instruction handout; (5) an EHR-based referral system to an adolescent health clinic; (6) visual aids to support accurate STI sample collection' and (7) an evaluation plan to assess protocol uptake, documentation quality, treatment accuracy, and follow-up linkage. This TICD-informed, stakeholder-driven approach may serve as a model for EDs aiming to enhance STI care delivery for adolescent and young adult patients.

ObjectiveSignificant global health disparities persist in cervical cancer, with over 85% of cases and deaths occurring in low- and middle-income countries (LMICs). In many settings, access to screening, vaccination and treatment is limited. Despite cervical cancer being largely preventable through human papillomavirus (HPV) vaccination and early detection, many women around the world face inadequate healthcare infrastructure, lack of awareness, cultural stigma and gender barriers to seeking care. Therefore, we evaluated global health system metrics that may inform efforts to improve equity in access to cervical cancer care globally.Methods and analysisWe derived estimates of age-standardised mortality-to-incidence ratios (MIRs) for female patients with cervical cancer of all ages from the Global Cancer Observatory (GLOBOCAN 2022 database), with complete data available for 121 of 185 countries in the database. We selected the following health system metrics: health spending as a per cent of gross domestic product (GDP), physicians/1000 population, nurses and midwives/1000 population, surgical workforce/1000 population, GDP per capita, Universal Health Coverage Service Coverage Index (UHC index), availability of pathology services, Human Development Index (HDI), Gender Inequality Index (GII) (a combined metric of health, empowerment and economic agency), radiotherapy centres/1000 population, out-of-pocket expenditure as percentage of current health expenditure, availability of cervical cancer screening, and HPV coverage.We evaluated the association between MIR and each metric using univariable linear regressions. To account for multiple comparisons, a Bonferroni correction using a p<0.0045 was applied. Metrics meeting this threshold were included in multivariable models. Variation inflation factor (VIF) allowed exclusion of variables with significant multicollinearity. R2 defined goodness of fit.Subgroup analysis was done by country income level using 2025 World Bank classifications. Separate regression models were then done for high-income and low-middle-income countries.ResultsOn univariable analysis, 12 of the 13 metrics were significantly associated with MIR of cancer (p<0.001 for all). HPV coverage was not significantly associated with MIR (β=–0.0007, p=0.290). After including metrics that were significant on univariable analysis, HDI demonstrated significant collinearity (VIF=19). Therefore, after correcting for multicollinearity, the final multivariable model with 11 variables had R2 of 0.81.On multivariable analysis, the following variables were independently associated with lower (improved) MIR for cancer: (1) nurses/midwives per 1000 population (β=–0.0072, p=0.029) and (2) UHC index (β=–0.0022, p=0.026). In addition, greater gender inequality was associated with greater (worse) MIR (β=0.30, p=0.003). Further subgroup analysis by income classification showed that GII remained significantly associated with lower MIRs among HICs (β=–0.526, p=0.033), and only UHC index was significantly associated among LMICs (β=–0.0023, p=0.047)ConclusionThis comprehensive and global analysis of health system metrics suggests promoting progress towards UHC and strengthening the nursing/midwifery workforce may be independently associated with improved cervical cancer MIR. Furthermore, greater gender inequality was associated with worse MIR. These findings may inform efforts to improve global cervical cancer care and underscore the importance of reducing gender inequality to improve global cervical cancer outcomes.