Brookwood Baptist Health is a network of hospitals, outpatient centers and clinics headquartered in Birmingham, Alabama. It is owned by Dallas-based Tenet Healthcare. The system is the result of a merger between Brookwood Medical Center and Baptist Health System.
Introduction: Diabetes mellitus significantly increases the risk and worsens outcomes for cerebrovascular diseases, making the comorbidity of stroke and diabetes a critical public health concern. This study aims to assess age-adjusted mortality trends among U.S. adults with concurrent stroke and diabetes, identifying disparities across demographic and urbanization strata. Methods: Multiple causes of death data were extracted from the CDC’s WONDER database, encompassing ICD-10 codes for cerebrovascular diseases (I60-I69) and diabetes mellitus (E10-E14) for individuals from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. Standard Population. Data were stratified by year, urbanization levels, race/ethnicity, and sex. Results: Overall, AAMRs for stroke in diabetic patients showed a general decline, from 7.08 per 100,000 in 1999 to 4.90 per 100,000 in 2020. However, significant disparities persisted. Black or African American individuals consistently had higher AAMRs compared to other racial groups. For example, in large central metropolitan areas in 1999, Black or African American females had an AAMR of 8.5 per 100,000, compared to 3.7 per 100,000 for White females. This disparity persisted into 2020, with rates of 4.7 for Black or African American females and 2.6 for White females in the same region. Furthermore, sex-based differences in mortality also varied by race and urbanization. Black or African American females occasionally had higher mortality rates than their male counterparts in certain urban settings. The AAMR for Black females was 8.5 in large central metro areas in 1999, compared to 7.4 for Black males. Conclusion: From 1999 to 2020, AAMRs for stroke in diabetic patients declined nationally. However, persistent and significant disparities were observed, with Black or African American individuals and residents of less urbanized areas bearing a disproportionately higher mortality burden. The consistent data limitations for American Indian or Alaska Native and Asian or Pacific Islander populations highlight a critical gap in health surveillance. These findings underscore the urgent need for targeted public health interventions that address systemic inequities and improve healthcare access and quality in underserved communities.
Abstract Background Acute pulmonary embolism leads to pulmonary infarction in only about 8% of the cases, 5% of which can be complicated by the development of pneumonia. The parenchymal necrosis caused by the pulmonary infarction can lead to a cavitary necrotizing pneumonia, a dreaded complication with extremely high mortality rate. Here we present a case of an elderly male with no known risk factors who presented with pulmonary embolism complicated by resistant necrotizing pneumonia. Case Description 85-year-old male with no reported past medical history presented to the hospital complaining of worsening dyspnea on exertion, fatigue, and generalized malaise for two weeks. On presentation, he was febrile with temperature 101.7oF, heart rate 110 beats per minutes, and hypoxic - oxygen saturation of 85% on room air. CT scan of the chest was indicative of a thromboembolus within the distal right main pulmonary artery with extension into the secondary and tertiary branches. Given his advanced age sand lack of right heart strain, the patient was not a candidate for thrombectomy or catheter directed thrombolysis. Therefore, intravenous heparin was initiated. The CT scan also showed a developing right lower lobe pneumonia, warranting initiation of Vancomycin and Cefepime. Unfortunately, the patient’s respiratory status worsened significantly, ultimately requiring intubation and mechanical ventilation. Despite appropriate treatment, his oxygen requirements did not improve, so a repeat CT scan was obtained, which revealed a large cavitary lesion with internal septation, along with moderate volume pleural effusion. Samples from bronchoalveolar lavage grew pseudomonas aeruginosa resistant to cefepime, so Meropenem was initiated. Despite 14 days of treatment, patient’s respiratory status did not improve. Ultimately, family opted for compassionate extubation with comfort measures only. The patient passed away shortly afterward. Discussion This case illustrates the importance of prompt recognition and treatment of acute pulmonary thromboembolism and its complications. The differential diagnosis for a cavitary lung lesion is very broad, including primary lung malignancy, sarcoidosis, granulomatosis with polyangiitis, tuberculosis, bacterial and fungal infections. In our case, there was no cavitation on the initial Chest X-Ray or CT scan. Therefore, our leading explanation is that the infarction caused by the pulmonary embolism led to a cavitation and provided the milieu for a necrotizing infection with pseudomonas. Our patient did not have any discernible risk factors except for his advanced age, which made him more susceptible to developing a complication and less likely to survive it despite aggressive treatment. This abstract is funded by: None
Objectives Kidney stone disease, or nephrolithiasis, is a condition that is prevalent amongst the population in the United States. The state of Kentucky is part of the "Kidney Stone Belt", which has the highest prevalence of kidney stones in the United States. Although kidney stone formation is multifactorial, efforts must be made by urologists in the Kidney Stone Belt to provide consistent care that is in accordance with American Urological Association (AUA) guidelines. To implement quality improvement measures in nephrolithiasis care, our study first aims to reveal inadequacies of our approach to care today. Methods We completed retrospective chart reviews of patients with nephrolithiasis from 13 urologists affiliated with two academic medical institutions. Individual data points were collected for each patient and stored in a database. The data was analyzed and tested for statistical significance using the Chi-squared test and stratified by race. Results Upon analysis of our data, we noted statistically significant racial differences in the following areas of nephrolithiasis care: post-lithotripsy stone analysis, orders for 24-hour urine tests, and dietary histories. Although not statistically significant, our population, regardless of race, had little to no documentation of physician-led counseling for kidney stone prevention. Conclusions Our analysis identifies several areas where patients could benefit from quality improvement measures in nephrolithiasis care. We recommend adherence to AUA guidelines for the medical management of nephrolithiasis care to prevent compromise of the quality of care provided to racial minority patients. Additionally, social determinants of health may have a role to play in disparities noted in this study.
