Kings County Hospital Center

Objectives Afro-Caribbean patients are underrepresented in acute myeloid leukemia (AML) outcomes research, and the impact of socioeconomic and structural barriers on survival in this population remains poorly defined. We aimed to characterize clinicopathologic features, treatment utilization, and outcomes among Afro-Caribbean adults with AML treated at an urban safety-net hospital. Methods We conducted a retrospective cohort study of adults diagnosed with AML and treated at a large urban safety-net hospital in Brooklyn, New York, between 2012 and 2022. Demographic, clinical, and treatment variables were abstracted from electronic medical records. Outcomes were summarized descriptively, including treatment intensity, transplant eligibility and receipt, and survival. Results Among 47 patients (median age 66 years), 85% identified as Afro-Caribbean. At presentation, 38% were uninsured. Ten patients (21%) received supportive care only. Among treated patients (n = 37), 78% received intensive anthracycline+cytarabine–based induction chemotherapy. Twenty-seven patients (57%) were considered appropriate candidates for allogeneic transplantation based on disease risk and performance status; however, only 3 (11%) ultimately underwent the procedure. Complete remission was achieved in 51%, with 58% subsequently relapsing. Median progression-free survival was 8 months, and median overall survival was 9 months. Three-year progression-free and overall survival were 12.8% and 17.0%, respectively. Conclusions In this single-center safety-net cohort, long-term survival was limited and receipt of allogeneic transplantation was low despite documented eligibility in more than half of the patients. These findings provide descriptive insight into post-remission therapy patterns in an understudied population and identify areas for further investigation.

Abstract Background: Latin American (LA) women are more likely to be diagnosed with aggressive early-stage breast cancer (EBC) compared to Non-Hispanic White (NHW) women, yet population-specific tumor biology remains underexplored. Previously, we reported elevated immune gene expression in BluePrint® (BP) Luminal B tumors in LA patients (pts) with EBC and obesity compared to Black and NHW cohorts. Here, we present updated clinical comparisons between LA, NHW and Black pts with EBC and whole transcriptome analysis (WTA) between BP Luminal B and Basal BC in pts with obesity. Methods: Clinical and WT data were analyzed from 15,577 EBC pts self-identified as LA, Black, or NHW enrolled in FLEX (NCT03053193), a prospective observational study with MammaPrint® risk of recurrence and BP molecular subtyping assays, and WT profiles. ImPrint, 53-gene immune signature, results (+/-) were generated for pts with hormone receptor positive (HR+) EBC. Chi-square and t-tests were conducted on clinical groups using arsenal R package. For WT comparisons, 215 obese LA pts with BP Luminal B and 77 with BP Basal EBC were matched to corresponding NHW and Black pts by age, T and N status. Differentially expressed genes (DEGs) were evaluated using limma, and pathway enrichment was performed using gene set enrichment analysis with Hallmark gene sets. Significant results were reported with adjusted p < 0.05. Results: Compared to Black and NHW pts, LA pts were younger and more often premenopausal (Table). Both LA and Black pts had statistically significantly higher rates of obesity compared to NHW pts. Significantly higher rates of MP High Risk 2, BP Basal and ImPrint+ tumors were observed in LA and Black pts vs NHW. WT comparisons among the obese subpopulations revealed that metabolic pathways, including adipogenesis, angiogenesis, epithelial-mesenchymal transition, and oxidative phosphorylation were significantly downregulated in EBC in LA pts vs NHW and Black cohorts. Conversely, immune-related pathways such as allograft rejection and interferon gamma response were enriched among LA pts with Basal cancers compared to NHW and Black groups. These coordinated pathway alterations suggest unique metabolic and immune profiles in LA EBC subtypes with a median absolute fold change of 1.3 among DEGs. Conclusion: The data suggest that signals from metabolic pathway alterations from modest immune-related gene upregulation may contribute to more aggressive tumor behavior in obese LA pts with EBC. Clinical and transcriptomic analyses demonstrated differences in Luminal B and Basal EBC biology among self-identified LA pts compared to NHW and Black cohorts, consistent with prior research. With further research, these findings may offer treatment targets which may enhance outcomes and reflect the importance of including racially and ethnically diverse pts in clinical trials to characterize population-specific differences in EBC outcomes. Citation Format: M. Mazo Canola, A. Santillan, J. Alberty-Oller, E. Dias, V. Kaklamani, A. Elkhanany, K. Hoskins, M. Habibi, R. Hampton, J. L. Barone, N. M. Johnson, N. Gordon, N. Sookhan, T. Bah, P. John, E. Aponte, S. Diab, V. Klimberg, N. Stivers, C. Page, S. Uygun, W. Audeh, J. O'Shaughnessy. Distinct Immune and Metabolic profiles in Latin American breast cancer patients with obesity enrolled in FLEX [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-09.

Emergency Medical Services (EMS) providers, capable of rapidly delivering life-prolonging interventions, are often first to respond to acute health concerns for older adults in the United States. Prior work has shown a preference among many people with dementia for comfort-focused care near end-of-life. People with dementia frequently use EMS; however, little is known about communication surrounding treatment preferences during EMS response for this group. We conducted a qualitative content analysis of EMS incident reports for older adults with dementia transported to two urban academic hospitals (2011-2021). We identified eligible patients in the hospital electronic health record applying the following criteria: age ≥ 65, diagnosis code indicating dementia, assessment by EMS, hospitalization between 2011 and 2021, and National Early Warning Score ≥ 7 indicating critical illness. We characterized the frequency and content of documented patient treatment preferences in EMS incident reports and identified barriers and facilitators to communication about treatment preferences or goal-concordant care. We reviewed incident reports for 171 patients with a median age of 82 (IQR 12) years. About half (51%) of the patients were residing in nursing homes. A minority (23%) of the patients were described as able to communicate needs, and only 24% had a family member or friend present at the time of EMS assessment. Treatment preferences were mentioned in 27% of the reports. EMS providers documented barriers to communication or delivery of goal-concordant care in nursing home settings that included difficulty obtaining information from professional caregivers, receiving secondhand information, and variable role expectations. Goal-concordant care was facilitated in these settings when EMS providers spoke directly with patients' family members by telephone. EMS providers treating critically ill older adults with dementia face challenges that may hinder their ability to elicit treatment preferences, in particular when responding to calls from professional caregivers. Direct communication with surrogate decision-makers may facilitate goal-concordant care.

Abstract Background Strongyloidiasis affects over 600 million people globally and can persist asymptomatically for decades. Increasing global migration, particularly from endemic areas, has heightened the burden of neglected infections in the U.S. Since 2022, over 233,000 asylum seekers have arrived in New York City, straining public health systems, and coinciding with surges in communicable diseases such as tuberculosis. However, routine screening for parasitic infections like Strongyloides remains inconsistent. Methods We conducted a retrospective analysis of Strongyloides serologic testing from January 2020 to December 2024 across 11 NYC Health + Hospitals facilities. For seropositive patients at four hospitals (that had increases in testing volume and positivity rates), chart reviews were performed to extract demographic data, immigration history, testing indications, and treatment information. Statistical analyses included t-tests and Chi square analyses. Results Of 11,361 patients tested from 2020-2024 across the 11 hospital system, 1,914 (16.8%) were seropositive. Seropositive patients more likely to be older (57.0 vs. 53.2 years, P< .001), male (60.3% vs. 50.4%, P< .0001), and Spanish-speaking (48.6% vs. 35.7%, P< .0001) than seronegative patients. A marked increase in testing occurred at four hospitals. Testing rates at these four hospitals increased from 5.5 to 16.7 per 100000 hospital encounters (P< .0001), as did the number of seropositive cases (3.8 to 4.6 per 100000 encounters, P< .0001). A large number of migrant shelters were located near these four hospitals. Most patients originated from South America, Central America, or the Caribbean. Among 874 patients reviewed, eosinophilia (63.0%) and routine migrant screening (18.0%) were the most common testing reasons. Overall 13% did not receive therapy, highlighting treatment gaps. Conclusion The surge in Strongyloides seropositivity, especially at hospitals near shelters, reflects the evolving impact of migration on public health. Targeted screening and presumptive treatment strategies are urgently needed. Allocating additional resources to disproportionately affected facilities is critical to managing the growing infectious disease burden among migrant populations. Disclosures All Authors: No reported disclosures

Pediatric stroke is a rare entity but has high mortality and morbidity. This case report describes the presentation of acute ischemic stroke in a 7-year-old boy with a large cerebral arteriovenous malformation. The case emphasizes the early diagnosis of stroke, and dissects the mechanisms and presentation of possible stroke etiologies with multiple risk factors.

Introduction: Spontaneous coronary artery dissection (SCAD) is a significant cause of acute coronary syndrome in young women. Fibromuscular dysplasia (FMD) is frequently associated with SCAD, but its impact on clinical outcomes remains unclear. Hypothesis: We hypothesized that SCAD patients with concurrent FMD would have different clinical outcomes compared to those without FMD, potentially reflecting distinct pathophysiological mechanisms. Methods: Using the TriNetX Global Collaborative Network across 129 healthcare organizations, we performed a retrospective propensity-matched cohort study. SCAD patients (ICD-10: I25.42) with FMD (ICD-10: I77.3) were compared to those without FMD. After 1:1 propensity matching based on demographics and comorbidities, 857 patients per group were analyzed. Primary outcome was all-cause mortality; secondary outcomes included heart failure, cardiogenic shock, arrhythmias, and acute kidney injury over five years. Analysis included risk ratios (RR), odds ratios, and hazard ratios (HR) with 95% confidence intervals. Results: SCAD patients with FMD had significantly lower all-cause mortality (1.3% vs 6.5%; RR 0.199, 95% CI 0.105-0.377; p<0.001), heart failure (4.7% vs 13.4%; RR 0.349, 95% CI 0.239-0.512; p<0.001), and acute kidney injury (1.2% vs 4.7%; RR 0.257, 95% CI 0.128-0.514; p<0.001). No significant differences were observed for cardiogenic shock, ventricular tachycardia, or atrial fibrillation. Conclusions: FMD is associated with markedly improved outcomes in SCAD patients, suggesting it represents a distinct, more favorable pathophysiological subtype. These findings support comprehensive FMD screening in SCAD patients for enhanced risk stratification and personalized management strategies.

Background: Proton pump inhibitors (PPIs) are commonly prescribed for acid-related conditions, especially in patients with cardiovascular risk factors. Although widely considered safe, emerging evidence suggests potential associations with adverse vascular outcomes. The impact of chronic PPI use on clinical outcomes among patients undergoing coronary artery calcium (CAC) imaging is not well characterized. Objective: To assess whether chronic PPI use is associated with adverse cardiovascular outcomes in adults undergoing CAC imaging. Methods: We conducted a retrospective cohort study using the TriNetX Research Network. Adults ≥18 years with ≥2 CAC-related cardiac CT scans (CPT 75571–75574) were included. Patients with prior coronary artery disease, MI, coronary revascularization, chronic kidney disease stage ≥4, malignancy, or H2 receptor antagonist use were excluded. Two cohorts were defined: chronic PPI users and non-users. After 1:1 propensity score matching on age, sex, hypertension, diabetes, obesity, smoking, and hyperlipidemia, each cohort included 4,346 patients. Outcomes included ischemic stroke, MI, and all-cause mortality. Survival analyses were conducted using Kaplan-Meier curves and Cox proportional hazards models. Results: Following matching, baseline characteristics were balanced. Over a median follow-up of approximately 1.4 years, all-cause mortality was significantly higher among PPI users (3.0%) compared to non-users (0.9%) (hazard ratio [HR] 0.329, 95% CI: 0.232–0.468, p<0.001). Ischemic stroke was also more frequent in the PPI group (3.3% vs. 1.6%; HR 0.513, 95% CI: 0.385–0.682, p<0.001). MI incidence did not differ significantly (3.6% vs. 3.2%, p=0.408). No coronary revascularization events were reported in either cohort. Conclusion: In patients undergoing CAC imaging, chronic PPI use was associated with increased risk of all-cause mortality and ischemic stroke, but not MI. These findings suggest potential long-term cardiovascular risks of PPI therapy in at-risk populations and support the need for further prospective evaluation. Relevance to Cardiology: PPIs are often co-prescribed in cardiology, especially in patients on antiplatelet therapy. This study raises concern about their long-term cardiovascular safety and underscores the importance of judicious PPI use in preventive cardiology.

BACKGROUND AND OBJECTIVES Social media and digital device use are increasingly common among children, and there is growing concern over their impact on health and development. Although parental awareness is vital for safe media habits, little is known about discrepancies in parent-child reporting among younger children. This study aimed to examine these discrepancies and assess how parent demographics influence digital awareness. METHODS We conducted a cross-sectional survey of 221 parent-child dyads (children aged 8–12 years) at a large urban pediatric clinic. The inclusion criteria were children aged 8–12 years presenting for routine care with a consenting parent or guardian. Parents and children completed parallel questionnaires assessing device ownership, screen time, nighttime use, and social media behaviors. Discrepancy analyses were performed using McNemar and paired t tests. Logistic regression evaluated predictors of parent-child agreement. RESULTS Significant discrepancies emerged in reports of social media account ownership (74.5% child vs 44.3% parent, P < .001) and nighttime device use (61.5% vs 32.1%, P < .001). Higher parental education and income were associated with greater awareness. Agreement on digital behaviors was lowest among 11-year-olds and varied significantly by parent education and income. CONCLUSIONS Large gaps in parental awareness of digital behaviors exist even among preadolescent children aged 8–12 years. This younger age group is underrepresented in digital media research. Pediatric primary care offers a critical opportunity to improve parental digital literacy and guide safe media use, particularly for families with lower education and income levels.

Cryptococcal meningitis (CM) is an invasive fungal disease that poses a global health threat, particularly in immunocompromised individuals. CM mainly occurs in HIV-positive patients and other immunocompromised patients and is rare in immunocompetent persons. The clinical presentation and disease course of CM in an immunocompetent patient remain poorly understood due to limited data. We present the case of a 60-year-old woman with multiple comorbidities, including hypertension, burnt-out diabetes mellitus, chronic kidney disease on hemodialysis, heart failure with preserved ejection fraction, who was brought to the emergency department with a change in her mentation. Initial evaluation suggested a differential of uremic encephalopathy, cerebrovascular accident, or hypertensive emergency. Despite hemodialysis and supportive care, the patient’s lethargy and confusion did not improve. Neuroimaging revealed leptomeningeal enhancement, and lumbar puncture confirmed the diagnosis of cryptococcal meningitis through positive cerebrospinal fluid (CSF) PCR and cryptococcal antigen testing. Notably, the patient had no obvious immunosuppressive conditions, highlighting an atypical presentation of CM in an apparently immunocompetent host. This case underscores the importance of considering CM in the differential diagnosis of altered mental status, even in patients without overt immunosuppression. Understanding such atypical presentations is crucial for timely diagnosis, guiding effective treatment strategies, and improving outcomes in immunocompetent individuals affected by CM.