Raghu Loganathan

“Looking out for each other”: a qualitative study on the role of social network interactions in asthma management among adult Latino patients presenting to an emergency department

Abstract Objective: The objective of this study was to identify the types of interactions between asthma patients and their social networks such as close family and friends that influence the management of asthma. Methods: Participants were Latino adults presenting for a repeat visit to the emergency department for asthma treatment. Qualitative interviews were conducted with 76 participants. They were asked to describe the experiences of their social networks that have asthma and how interactions with these individuals influenced their own asthma management. Responses were transcribed and analyzed using Grounded Theory as a qualitative analytic approach. Responses were assigned codes; similar codes were grouped into concepts and then categorized to form overarching themes. Results: Four themes emerged: (1) Perceptions of severity of asthma may be based on the experiences of social networks; (2) Economic factors may contribute to the sharing and borrowing of asthma medications between patients and their social networks; (3) Economic factors may contribute to using home remedies instead of prescribed medications; (4) Social network members may be unaware of the factors that trigger asthma and therefore, contribute to asthma exacerbations. Conclusion: This study identified important social network interactions that may impact asthma management in Latino adults. These results can be used to broaden the current focus of asthma self-management programs to incorporate discussions on the role of social networks. A focus on social network interactions addresses the social epidemiology of asthma and advances our understanding of root causes that may underlie the high prevalence of asthma in many Latino communities.

Characteristics of asthmatic patients with and without repeat emergency department visits at an inner city hospital.

Abstract Objective: The objective of this study was to document the frequency and clinical characteristics associated with repeat emergency department (ED) visits for asthma in an inner city population with a high burden of asthma. Methods: During an ED visit for asthma in an inner city hospital (‘index visit’), patients completed a valid survey addressing disease and behavioral factors. Hospital records were reviewed for information about ED visits and hospitalizations for asthma during the 12 months before and the 90 days after the index visit. Results: One hundred and ninety-two patients were enrolled; the mean age was 42 years, 69% were women, 36% were black, 54% were Latino, 69% had Medicaid, and 17% were uninsured. 100 patients (52%) were treated and released from the ED, 88 patients (46%) were hospitalized, and 4 patients (2%) left against medical advice. During the subsequent 90 days, 64 patients (33%) had at least one repeat ED visit for asthma and 27 (14%) were hospitalized for asthma. In a multivariate model, more past ED visits (OR 1.7, 95% CI 1.4, 2.1; p < 0.0001) and male gender (OR 2.5, 95% CI 1.2, 5.4; p = 0.02) remained associated with having a repeat ED visit. Most patients had the first repeat ED visit within 30 days and 18 returned within only 7 days. Among all patients with a repeat visit, those who were not hospitalized for the index visit were more likely to have a repeat visit within 7 days (37%) compared to those who were hospitalized (17%) (p = 0.05 in multivariate analysis). Conclusions: Repeat ED visits were prevalent among inner city asthma patients and most occurred shortly after the index visit. The strongest predictors of repeat visits were male gender and more ED visits in the 12 months before the index visit.

Complications of Small Bore Enteral Feeding Tubes in an Inner-City Community Teaching Hospital

Octavio Chavez Herbas* Beatriz Garcia-Prieto Evan Siau Natoushka Trenard Edward Telzak and Raghu Loganathan SBH Health System, Bronx, NY C A T IO N , R E S E A R C H , A N D Q U A L IT Y IM P R O V E M E N T PURPOSE: Narrow bore feeding tubes have largely replaced large bore tubes for enteral nutrition over the past decade. Serious tracheal-esophageal complications following large bore tube placement have been reported and include pneumothoraces, esophageal perforations and bronchial injuries.There is however scant data on complications following insertion of small bore enteral feeding tubes. A higher likelihood of malposition was observed in small case series, and was attributed to the high degree of flexibility of the tubes, especially among neurologically impaired patients. We report the incidence and associated risk factors for complications among a large series of patients following small bore feeding tubes placement.

Unusual Case of Necrotizing Pneumonia

Coccidioidomycosis is caused by inhalation of Coccidoides spores which is endemic in south western parts of USA and an uncommon cause of pneumonia in non-endemic areas. We report a young Hispanic man who lives in New York presenting with diabetic ketoacidosis and severe pulmonary Coccidioidomycosis. Through this case report and review we want to familiarize clinicians from non-endemic area to this unusual cause for necrotizing pneumonia, its association with diabetes mellitus, other risk factors for dissemination and the management strategy.

An Unusual Case of Toxic Shock Syndrome: A Case Report and Review of Viral Etiologic Agents

Toxic shock syndrome is a multisystemic illness most often associated with toxins produced by Staphylococcus aureus and group A Streptococcus. An extensive review of available literature revealed many other microbial agents including viruses to be associated with toxic shock syndrome. Parvovirus B-19 is usually a self-limiting illness. There has been only 1 case report of acute Parvovirus B-19 infection in association with severe sepsis. We report the first case of acute Parvovirus B-19 infection that fulfilled the CDC criteria for the diagnosis of Toxic Shock Syndrome in an immunocompetent host.

CHARACTERISTICS ASSOCIATED WITH MORTALITY IN GASTROINTESTINAL BLEEDING IN AN INNER CITY MINORITY POPULATION ADMITTED TO A UNIVERSITY-AFFILIATED MEDICAL ICU

Purpose: GI bleeding(GIB) is a major cause of morbidity and deaths in ICUs. However there is scant literature related to this condition among Hispanics and African Americans. In addition, illicit drug use, smoking and alcoholism are common social factors in this population that are suspected to affect outcomes with GIB. Previously published studies have shown that APACHE-II scores overestimate mortality among GIB patients. We proposed to study the predictors of survival among patients with GIB in our MICU.