United States

ABSTRACT
Purpose: Cytomegalovirus (HCMV) is a common viral infection that shapes lifelong immunity. A history of infection with HCMV has been associated with many chronic diseases, including cancer. In addition, prospective cohort studies have established that HCMV is associated with all-cause mortality. However, there are limited data regarding HCMV and cancer mortality.
Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) III study (1988 -1994): subjects aged 18 to 98, who had HCMV serology results, did not report having cancer at baseline, and were eligible for mortality follow up (N= 14,498). Mortality was ascertained until December 2011 using National Death Index (NDI) linkage.
Results: The unadjusted risk of all-cancer mortality was higher in HCMV seropositive individuals (HR=2.74, 95% CI 2.05 -3.64). This association was attenuated after adjusting for age (HR =1.39, 95% CI 1.02 - 1.92), and other covariates (age, sex, race/ethnicity, smoking status, BMI, education, and C-reactive protein (CRP); HR=1.28, 95% CI 0.91 - 1.81). There was a statistically significant interaction between HCMV and sex (p=0.01): HCMV seropositivity was associated with increased cancer mortality in men (HR = 1.65, 95% CI 0.99 - 2.73) but not in women (HR=0.95, 95% CI 0.59 - 1.54).
Conclusion(s): Consistent with prior reports, HCMV seropositivity may be associated with an increased risk of cancer-related mortality but the association is partially driven by socioeconomic status and other risk factors. Future research is needed to determine whether HCMV is a risk factor for cancer, as well as identify the specific cancer types where HCMV increases mortality.



AMA Research Challenge 2022

Cytomegalovirus and cancer-related mortality in the national health and nutritional examination survey

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Ricardo Correa, MD, EdD
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Jessica Li, MD/PhD Candidate
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Charles Lopresto, DO

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Welcome to the largest national, multi-specialty research event featuring research from 750 medical students, residents and fellows, and international medical graduates.


poster

Hospital MRSA and C. difficile rates drop with COVID-19 precautions

As the novel COVID-19 pandemic was on the rise, its impact on the healthcare system was devastating. Patients became more reluctant to present to the hospital and elective procedures were being postponed for patient safety. We wanted to assess the effects of the COVID-19 pandemic on the door-to-device time in our small community hospital in the heart of Trenton, New Jersey. We created a retrospective study that evaluated all STEMI cases that presented to our institute from January 2018 until the end of May 2021. Our primary outcome was the door-to-device time. Secondary outcomes were the length of hospital stay, ICU admission, length of ICU stay, cardiac arrest, and death during the hospitalization. We studied 114 patients that presented with STEMI to our emergency department, 77 of these patients presented pre-COVID-19, and 37 presented post-COVID-19 pandemic. Our median door-to-device for STEMI cases pre and post-COVID-19 pandemic were 70 minutes (IQR 84-57) and 70 minutes (IQR 88-59) respectively with no significant difference found (P-value 0.55, Mann Whitney Test). It is, however, interesting to note that the number of STEMI admissions significantly decreased during the post-pandemic era. There are limitations to our study, most noticeably the number of STEMI cases at our small community hospital which limits its generalizability. Moreover, we did not assess other comorbidities which might have confounded our outcomes and we were also unable to follow patients post-discharge to assess the long-term sequela of their STEMI admission. Therefore, more dedicated studies of this clinical conundrum are required to further assess and implement guidelines for the future.

Comparison of STEMI Door-to-Device Time during the COVID-19 crisis in a New Jersey Inner City Community Hospital

Difference in Severity of Heart Failure in Rurual Versus Urban Patients at Time of Referral for Advanced Therapies

Effect on Recurrent Emergency Room Visits and Hospitalizations in Atrial Fibrillation Patients in a Dedicated Nurse Practitioner Led Atrial Fibrillation Clinic 


Association of Cutaneous Manifestations with Admission Duration Among Dengue
Fever Patients in Rural, Underserved Philippines

Association of Cutaneous Manifestations with Admission Duration Among Dengue Fever Patients in Rural, Underserved Philippines

Background
Systemic isotretinoin is a highly effective treatment for severe and refractory acne but carries risk for serious adverse effects such as teratogenicity. The United States’ risk mitigation system, iPLEDGE, requires all patients on isotretinoin therapy to complete monthly tasks including follow-up visits with their prescriber, and patients with childbearing potential must additionally undergo monthly pregnancy testing. The onset of the COVID-19 pandemic presented an opportunity to reduce the isotretinoin gender gap, as updated regulations shifted to permit at-home pregnancy testing and telehealth visits for monthly follow-ups.

Methods
We performed a single-center analysis to determine whether gender differences in isotretinoin prescription changed at our institution during the initial months of the pandemic. Data was obtained from an institutional database. Inclusion criteria were dermatology encounters during which an adult patient (age>18) was prescribed isotretinoin or topical retinoids for acne. Gender identity originated from patient-reported demographics. Fisher’s exact tests with alpha set to 0.05 were used to compare odds of isotretinoin prescription for male and female patients, with control groups comprised of patients receiving topical retinoids for acne. Odds ratios were compared for the pandemic period (June 1, 2020 to January 22, 2021) versus the pre-pandemic period (June 1, 2019 to January 22, 2020). Odds ratios were also compared between telehealth visits and in-person visits during the pandemic period.

Results
We found that male predominance of isotretinoin prescriptions was greater during the pandemic compared to pre-pandemic (odds ratios: 4.13 vs. 2.86). Furthermore, male patients were more likely to utilize telehealth compared to in-person visits relative to female patients (odds ratios: 6.00 vs. 3.62).

Conclusion
Despite the newly introduced flexibilities of telehealth and remote pregnancy testing, gender inequity in receiving isotretinoin treatment persisted during the pandemic. Many factors may influence the relative decreased access to isotretinoin among female patients including patient and provider preference. Future work should examine factors influencing the prescription of isotretinoin to female patients, as well as identify opportunities to improve policies that promote safe isotretinoin use while minimizing gender inequity.

Differences in isotretinoin access by gender during the initial months of the COVID-19 pandemic

Extensive Risk Factor Evaluation and Long-Term Assessment of Actinic Keratosis

Abstract Title: Investigating and summarizing information resources for the clinical presentation and diagnosis of cutaneous manifestations of infectious diseases in patients with skin of color (SOC).

Background: Skin of color presents disease differently in many circumstances, yet we see a lack of information regarding the presentation and diagnosis of cutaneous manifestations, specifically of those with SOC who are experiencing infectious disease. Many studies have found that SOC is underrepresented in preclinical courses for medical students and may later lead to misdiagnosis of diseases in dark-skinned populations (Louie & Wilkes, 2018; Mangione-Smith et al., 2004; Martin et al., 2016; Tsai et al., 2016). Because SOC is less represented in medical textbooks, patients with diseases such as Lyme disease presenting with cutaneous manifestations such as Erythema migrans may experience a delay in diagnosis (Fix, 2000; Ly, 2021; Palmieri, 2019). 

Methods: The databases PubMed and ScienceDirect were used to acquire research and review articles. Only resources provided in English were considered in the literature search. Articles were reviewed if they addressed cutaneous manifestations of infectious diseases in patients with SOC as a key topic. Only articles after the year 1980 were included. For inclusion, articles needed to include information regarding cutaneous manifestations of infectious diseases, specifically in patients with SOC. Articles were excluded if they contained no information regarding both Infectious disease and SOC. Duplicates were also removed. 

Results: Overall, 17 articles were identified out of 2,565 results. Searches regarding the general phrase “skin manifestations of infectious disease in “dark skin” and “HIV in "pigmented skin" yielded the most results. Many articles contained only a few sentences regarding infectious disease manifestations in patients with SOC. HIV had the highest representation of infectious disease cutaneous manifestations in patients with SOC, with five of the seventeen articles pertaining to the discussion of HIV in patients with SOC. 1,5,6,11,14,15. The most recent article discussed a study looking at the use of Perceptual and Adaptive Learning Modules (PALMs) to increase skin assessment in patients with SOC

Conclusion: This review identified significant gaps in the literature regarding cutaneous manifestations of infectious disease in SOC, such as lack of visual examples and representations of common infectious diseases in Skin of Color. Healthcare disparities in both Infectious Disease and Dermatology are present and affect the care of patients with skin of color. Increased research is needed in both fields, as well as collaboration between fields to help alleviate the barriers patients with skin of color face when obtaining care.


Investigating and summarizing information resources for the clinical presentation and diagnosis of cutaneous manifestations of infectious diseases in patients with Skin of Color.

Racial and ethnic factors associated with differences in the receipt of treatments for patients with mycosis fungoides, a type of cutaneous T-cell lymphoma

Jessica B. Brown-Korsah, BS1, Larissa De Souza, BS1, Kevin D. Cooper, MD1,2

1Case Western Reserve University School of Medicine, Cleveland, OH, USA

2 Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA

Background: Previous studies have demonstrated an association between Black race and poorer overall survival for patients with mycosis fungoides (MF). As for Hispanic patients (HPs) with MF, little is known within the literature.1–4 Due to the impact treatment may have on overall survival, we identified racial and ethnic factors associated with the receipt of treatment for MF.

Methods: A retrospective analysis of 8257 eligible patients diagnosed with MF between 2004 – 2017 within the National Cancer Database (NCDB) was performed. Multivariate logistic regression was used to identify sociodemographic factors, clinical factors, and the receipt of treatment (immunotherapy, chemotherapy, radiation, or other treatments) associated with non-Hispanic Black patients (NHBPs) and Hispanic patients (HPs), compared to non-Hispanic White patients (NHWPs). Covariates included age, sex, stage, median household income, facility type, insurance status, metro/non-metro, and Charlson-Deyo score.

Results: NHBPs and HPs consisted of 20.2% and 6.4% of patients within the study, respectively. NHBPs were less likely to receive radiation compared to NHWPs, adjusting for sociodemographic and clinical factors (aOR 0.71; 95% CI: 0.58 – 0.86; P= <.001). NHBPs were more likely to receive other treatments such as psoralen and long-wave ultraviolet radiation (PUVA) (aOR 1.39, 95% CI: 1.22 – 1.60, P = <.001). HPs were more likely to be diagnosed with Stage 4 disease (aOR 2.67; 95% CI: 1.73 – 4.03; P= <.001). No differences were noted in the receipt of treatment due to Hispanic ethnicity. 

Conclusions: NHBPs with MF were 29% less likely to receive radiation compared to NHWPs. NHBPs were 39% more likely to receive other treatments like PUVA, after adjusting for sociodemographic and clinical factors. HPs were nearly 3 times more likely to be diagnosed with Stage 4 disease compared to NHWPs, after adjusting for sociodemographic characteristics and stage. These results underline possible difficulties in accessing equitable therapies for NHBPs with MF.

References
1. Su C, Nguyen KA, Bai HX, et al. Racial disparity in mycosis fungoides: An analysis of 4495 cases from the US National Cancer Database. J Am Acad Dermatol. 
2017;77(3):497-502.e2. doi:10.1016/j.jaad.2017.04.1137 
2. Nath SK, Yu JB, Wilson LD. Poorer prognosis of African-American patients with mycosis fungoides: An analysis of the SEER dataset, 1988 to 2008. Clin Lymphoma, Myeloma Leuk. 2014;14(5):419-423. doi:10.1016/j.clml.2013.12.018
3. Sun G, Berthelot C, Li Y, et al. Poor prognosis in non-Caucasian patients with early-onset mycosis fungoides. J Am Acad Dermatol. 2009;60(2):231-235. doi:10.1016/j.jaad.2008.09.063
4. Choi J, Sutaria N, Roh YS, et al. Racial and ethnic disparities in inpatient health care utilization for mycosis fungoides: A cross-sectional analysis of the 2012-2017 National Inpatient Sample. J Am Acad Dermatol. 2022;86(6):1408-1410. doi:10.1016/j.jaad.2021.06.00

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