Long Island Community Hospital

Abstract Disclosure: S. Mark: None. M.H. Shanik: None. I.J. Romao: None. Ovarian stromal hyperplasia (OSH) is a rare cause of hyperandrogenism. It is a non-neoplastic proliferation of ovarian stromal cells that leads to the overproduction of testosterone. This case report highlights that OSH should be considered in patients who present with hyperandrogenism.A 49-year-old postmenopausal woman with a past medical history of polycystic ovary syndrome, type 2 diabetes and obesity complained of unwanted hair growth. On the physical exam her BMI was 51. She had an obese body habitus, hirsutism of her chin, chest and back and acanthosis nigricans on her neck. Blood work showed a total testosterone of 203 (2-45 ng/dL) and free testosterone 29 (0.1-6.pg/dL). FSH, LH, DHEAS, estradiol, SHBG and 17 hydroxyprogesterone (17 OHP) were in the normal range. She completed a 1 mg dexamethasone suppression test that was normal. She took spironolactone for hirsutism with minimal relief. Pelvic ultrasound was limited due to body habitus. CT of the abdomen and pelvis showed no adrenal or ovarian masses. The patient had a family history of pancreatic, ovarian, and breast cancer. Given her symptoms and her family history, the patient underwent genetic testing that was negative. She underwent bilateral salpingo-oophorectomy. Pathology revealed bilateral ovarian stromal hyperplasia. After surgery, her total testosterone normalized to 18 ng/dL and free testosterone was 1.6ng/dL with improvement in hair distribution. The patient continued to struggle with her weight and diabetes management.OSH is a non-malignant proliferation of ovarian stromal cells which leads to overproduction of testosterone. It occurs more in postmenopausal women and rarely in women of reproductive age. There is approximately 1 case of OSH in every 1000 cases of hirsutism. Clinical features include obesity, insulin resistance, acanthosis nigricans, acne, and hirsutism. Testosterone levels are usually greater than 150 ng/dL. Differential diagnosis includes PCOS, Cushing’s disease, adrenal or ovarian tumor and non-classic adrenal hyperplasia. Transvaginal ultrasound can be used to assess the ovaries for tumors or increase in size. If negative a pelvic MRI or CT can be done for further assessment. The gold standard for diagnosis would be histological evaluation following bilateral oophorectomy which is curative. Pathology usually shows stromal hyperplasia that is nodular or diffuse. Alternative treatment options include GNRH agonist therapy in patients who are not surgical candidates. Complications of this condition include insulin resistance, acanthosis nigricans and diabetes mellitus. After treatment hyperandrogenism skin changes improve. It is important that clinicians consider OSH as a cause of hyperandrogenism to ensure timely diagnosis and treatment. Presentation: 6/2/2024

Globally, the coronavirus disease 2019 (COVID-19) had a significant impact on everyone’s lives and put a tremendous strain on healthcare systems. Since the outbreak began, remdesivir has been investigated as a potential treatment for COVID-19 that may be both effective and safe. Remdesivir has had a huge impact on the disease’s progression, complications, and mortality. This review provides an updated assessment of the literature regarding remdesivir’s efficacy and safety for the treatment of patients with COVID-19. The search was performed through PubMed, Web of Science, Cochrane, and Scopus for articles published from 2019 to September 20, 2022. Studies that assessed remdesivir’s efficacy and safety were included in this review, with clinical improvements as the primary outcome measure. Seventeen studies were identified following the implementation of the search strategy. Among them, 11 corroborated remdesivir’s efficacy. Meanwhile, the remaining six studies did not observe a statistically significant difference in clinical improvement. Remdesivir is a potentially safe and effective antiviral that shows clinical improvement especially when used during the early course of the disease. However, current literature still questions its safety in patients who are afflicted with the complications of COVID-19, highlighting the need for studies on a large scale.

Planning for the nurse manager of the future.

Objective: Stony Brook University Renaissance Medical School and University Hospital [UH] is a tertiary care hospital in Sufflolk County, NY, an area covering 912 square miles [86 miles in length and maximum width of 26 miles] and serving a population of 1.5 million. UH coordinates STEMI calls of the 94 voluntary ambulance services covering the county. The county geography has made coverage for emergent interventional procedures challenging. UH, until relatively recently had one of two cath labs (now 7) and the only CT surgical program (now 3) in the county. Independent cath labs (and 2 CTS programs) have been set up at Community hospitals to provide 7 x 24 interventional service, changes that may modify the traditional "Hub with Spokes" referral pattern for STEMI. Opposing this centrifugal force has been the increasing consolidation of health care hospital networks. We examined the effects of these changes on STEMI referrals and overall volume at UH and a Cath capable community hospital between 2014- 2017. Procedure: We examined the effects of changes in emergency cath lab availability on STEMI referrals and overall volume at UH and a Cath capable community hospital [BMH] between 2014- 2017. Results: In 2014 of 167 STEMI calls 76 [45.5%] were referred to UH and 49 [29.3%] BMH. 2015 had 209 calls, 109 [52.2%] were referred to UH and 53 [25.4%] BMH. 2016 had 205 calls, 89 [43.4%] referred to UH and 53 [25.9%] BMH. 2017 had 247 calls, 101 [40.9%] referred to UH and 47 [19.0%] BMH. Ambulance company patterns of referral remained relatively stable despite an increase in local hospital availability. 34 ambulance companies brought patients to UH and 17 to BMH in 2014; 28 brought pts to UH and 19 to BMH in 2017. Ambulance companies continued to serve multiple hospitals throughout the monitored period. Total volume at UH remained little effected by changing practice guidelines or referral patterns: 2014: 2194 cath and 1329 PCI [total 3523]; 2015: 2371 cath and 1502 PCI [total 3873]; 2016: 2336 cath and 1578 PCI [total 3914]; 2017: 2367 cath and 1516 PCI [total 3883]. At UH, private [reflecting community hospital referrals] and staff physician utilization of the Cath lab also remained relatively unchanged in the studied period. Conclusions: Increased availability of 24 x 7 cath lab availability has resulted in a modest relative decline in referrals, more pronounced at the community hospital. Despite this, overall volume and therefore demand remains preserved. The increasing development of hospital networks and hospital based emergency ambulance services has not yet had a major impact on services, changing our "Hub with Spokes" to a "Castle and Moat", but will continue to be closely observed.

The aim of the present study is to describe how religiosity and spirituality affect the psychiatric morbidity of Muslim intensive care unit (ICU) patients. We conducted a prospective nationwide cross-sectional studyof ICU patients discharged from 45 medical centers spanning 31 proivinces in Iran. Adults (age ≥18years) admitted to the ICUand treated with invasive mechanical ventilationwere eligible. Nine validated survey tools were administered to detect direct and indirect associations between spiritual health (SH) and depression, anxiety, and post-traumatic disorder. The Hospital Anxiety and Depression Scale(HADS), Impact of Event Scale-Revised (IES-R),Post-Traumatic Stress Syndrome 14 question (PTSS-14) quality-of-life (QoL), and quality of patient tophysician or nurse communication (PP-QoC and PN-QoC) scales were modeled through two mediators by structural equation modeling(SEM). Sex, ICU type, LOS, and APACHE II score were added in the independent variable list. 338 eligible patients were discharged from the ICUs during the study period. 56 were excluded (clinical status), and 282 were administered the survey. 278 returned it, with 272 complete and 6 partial responses. SH displayed no direct or indirect association to QoL. SH was indirectly associated with decreased depression and anxiety (B=-0.081, p<0.05) via PP-QoC mediator. Both direct and indirect positive associations were observed between SH and IES-R (B=0.293, p<0.05; via PP-QoC) and PTSS-14 scores (B=0.267, p<0.001; via PP-QoC). Medical ICU location was associated with decreased PTSS-14 scores via the same mediator. In this survey of Muslim ICU patients treated with invasive mechanical ventilation, SH correlated with decreased depression and anxiety, but paradoxically increased post-traumatic stress. The most influential mediator was patient-physician quality-of-communication.

I wish to reply to the recent “Letter to the Editor” appearing in the September 2009 issue of LABMEDICINE (page 565, Vol. 40, No. 9). The contributor, Susan Hutcheson Tangye, MT(ASCP), describes challenging a nurse colleague when she withdrew blood clots from a tube containing a venipuncture sample which the nurse was to submit for a CBC and Chem 8. I want to underscore the importance of …

The world of poetry is a means of expression and source of comfort for many people who care for cancer patients. This periodic column spotlights poems written by oncologists, oncology nurses, oncology pharmacists, and other cancer caregivers. We welcome submissions—Please e-mail them to [email protected]Figure: Allison Berman, RNBosom Buddies Allison Berman, RN Twenty years old no cares in the world, Living each day, no end to occur. I am bright and beautiful, flying callously through life, Until the day I'm faced with a fright. A lump in the breast, growing so fast, No choice—a mastectomy, no hope, what sense. Along comes anonymous, silly name, no face, Nothing matters; she understands my pain. I confide my problems, fears, and dreams Any of it possible, not with cancer, you see. She breathes new life into a girl Who now realizes there's more to learn. Twenty years old, all cares in the world; Living each day, hoping no end will occur.

Brookhaven Memorial Hospital, Patchogue, New York and Human Performance Lab, Adelphi University, Garden City, NY.