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 Table of Contents  
CONFERENCE ABSTRACTS AND REPORTS
Year : 2022  |  Volume : 8  |  Issue : 4  |  Page : 321-348

The Seventh Annual Academic International Medicine Virtual Congress and Scientific Forum, June 9–12, 2022: Building a Stronger Future


The Academic International Medicine 2022 Congress and Scientific Forum Planning Committee, The American College of Academic International Medicine, Bethlehem, PA, USA

Date of Submission16-Nov-2022
Date of Acceptance21-Nov-2022
Date of Web Publication28-Dec-2022

Correspondence Address:
Dr. Stanislaw P Stawicki
St. Luke's University Health Network, Bethlehem, PA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijam.ijam_104_22

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  Abstract 


As the COVID-19 pandemic continued to fade, first glimpses of “post-pandemic normal” began to emerge in the late 2021 and early 2022. This new hope came with a positive new momentum – an opportunity to transform and reinvent. Yet given a high degree of uncertainty extending well into 2022, the American College of Academic International Medicine made a strategic decision in the late 2021 to move forward with Virtual 7th Annual Congress and Scientific Forum (AIM 2022). The theme of this year's meeting was “Building a Stronger Future” and reflected the early post-pandemic optimism. Primary organization of the meeting was facilitated by the Sarasota Memorial Health Care System, Sarasota, Florida, with substantial contributions provided by Northwell Health, Long Island, New York. The Scientific Forum once again took place virtually, enabling participants from around the globe to present their research. A summary of these efforts and outcomes is provided in this article.
The following core competencies are addressed in this article: Interpersonal and communication skills, Professionalism, Practice-based learning and improvement, Systems based practice.

Keywords: Academic International Medicine, American College of Academic International Medicine, annual meeting, scholarly output, scientific forum


How to cite this article:
Firstenberg MS, De Wulf A, Narayan M, Clark T, Miller A, Stawicki SP. The Seventh Annual Academic International Medicine Virtual Congress and Scientific Forum, June 9–12, 2022: Building a Stronger Future. Int J Acad Med 2022;8:321-48

How to cite this URL:
Firstenberg MS, De Wulf A, Narayan M, Clark T, Miller A, Stawicki SP. The Seventh Annual Academic International Medicine Virtual Congress and Scientific Forum, June 9–12, 2022: Building a Stronger Future. Int J Acad Med [serial online] 2022 [cited 2023 Feb 7];8:321-48. Available from: https://www.ijam-web.org/text.asp?2022/8/4/321/365552




  Introduction Top


Entering its 7th year of operations, the American College of Academic International Medicine (ACAIM) continued to navigate the challenging landscape of the coronavirus disease 2019 (COVID-19) pandemic. The current academic year was characterized by significantly more optimism and hope, but also by a persistent degree of uncertainty. Given the many waves of the pandemic, the emergence of new viral strains, and commonplace reports of in-person meetings in late 2021 being associated with high viral transmission rates, the Academic International Medicine (AIM) 2022 Conference Planning Committee decided to once again pursue a fully Virtual Congress and Scientific Forum. Corresponding action plan was implemented, with the event subsequently taking place on June 9–12, 2022. The scientific program featured more than 40 speakers and 50 scientific presentations. Because of the increasing magnitude of global refugee crises, inclusive of the immense human tragedy of the ongoing war in Ukraine, special emphasis was placed on refugee care, military medicine and related topics. In addition, a half-day Pre-Conference Workshop titled “Cyber Security for Healthcare Professionals” took place on June 9th, followed by a Consensus Session titled “Academic International Medicine: A Multi-Disciplinary Specialty” on Friday, June 10th. An overview of the pre-conference sessions, highlights from the main program, as well as published abstracts from the Scientific Forum will now follow.


  The Academic International Medicine 2021 Congress Theme Top


With the goal of providing high quality and up-to-date content for our membership, the ACAIM Conference Planning Committee (CPC) created a program relevant to both the emerging topic of refugee medicine as well as the post-pandemic future, focusing on novel implementations of technological advances related to the COVID-10 pandemic (and specifically highlighting ongoing post-pandemic, longer-term adoption). In alignment with the latter, the theme for the 2022 Congress was “Building a Stronger Future.” The overall diversity of topics, speakers, and sessions created an environment where there was truly “something for everyone” in the AIM 2022 program.


  Highlights of the Academic International Medicine 2022 Congress Program Top


June 9, 2022: Pre-conference

The 2021 AIM Congress included Pre-Conference Workshop titled, “Essential Cyber Security for Healthcare Professionals.” It is estimated that more than $12 billion is stolen each year by cyber criminals. Healthcare industry and healthcare professionals constitute a substantial and very attractive target for malicious actors. Types of harm include direct cyber theft, ransomware, data exfiltration, and identity appropriation, among other forms of illegal activity. As the risks of cybercrime increase around the globe, it is important to reinforce both the public awareness of the problem and the knowledge of simple yet powerful preventive steps. This comprehensive 4-hour session provided healthcare professionals with powerful tools and critical knowledge to reduce both individual and institutional vulnerabilities. Session faculty included Benjamin Wilson (Clevver & Logware, Inc.); Stanislaw P. Stawicki (ACAIM & EWMCI, LLC); Jason Zvaniga (GigaGeek Industries); and Jordan Kapper (St. Luke's University Health Network).

June 10, 2022: Pre-conference

Day two of AIM 2022 Pre-Conference included two back-to-back sessions. The morning Consensus Session, titled “Academic International Medicine as a Multidisciplinary Specialty,” was led by Dr. Victor Davila (The Ohio State University, Columbus, OH) and Dr. Manish Garg (Weill Cornell Medicine, New York, NY). In brief, the American College of Academic International Medicine was established as a platform for the development of a new, multi-disciplinary medical specialty - Academic International Medicine (AIM). The corresponding mission is to establish and promote both knowledge and skills that are unique to this emerging new area of academic and clinical expertise.

The afternoon Consensus Session focused on the ongoing development of accreditation standards for programs engaging in AIM. The session, chaired by Dr. Stanislaw P. Stawicki, was titled “ACIMP: Update on Accreditation Council for International Medical Programs.” Topics discussed included the mission and vision behind ACIMP, the incorporation of the 2017 ACAIM Comprehensive Framework for International Medical Programs into the credentialing system being developed, and the creation of a corresponding support system that will incorporate education, publications, and policy-making into its operating fabric.

June 11, 2022: Conference day #1

The main Conference event started with Dr. Michael S. Firstenberg, President of ACAIM, and Dr. Mayur Narayan, President-Elect of ACAIM, making joint Opening Remarks. After highlighting ACAIM's collective accomplishments from the concluding academic year, Dr. Firstenberg provided an overview of AIM 2022's program. This was followed by the introduction of the 2022 Keynote Speaker, Dr. Julie Mangino.

The Keynote Address, given by Dr. Julie Mangino, Professor of Internal Medicine and Infectious Diseases (The Ohio State University, Columbus, OH), was titled “Global Antibiotic Stewardship - Why and When to Say 'No More and Just Plain No'.” The crisis of antimicrobial resistance is a global public health problem requiring a global call to action, by all physicians and across all specialties. Antimicrobial stewardship consists of managing and protecting antibiotic use to optimize patient outcomes, while also decreasing unnecessary antibiotic exposure, thus reducing the overall incidence of antimicrobial resistance. Both high income nations and low and middle-income countries (LMICs) face the burdens of antimicrobial resistance; However, challenges faced by LMICs are further compounded by significant resource limitations.

The Past-President Keynote Address, titled “Do We Need to Decolonize Global Health?” was presented jointly by Dr. Susan B. Torrey (Baylor College of Medicine, Houston, TX) and Dr. Sari Soghoian (NYU Langone Health, New York, NY). Over the last few years, the global health literature has exploded with publications about decolonization. Discussions often focus on the influence of colonialism and racism on the practice of global health. The voices are overwhelmingly from academicians in North America. It is important to also discuss how are our African colleagues thinking and talking about decolonization. Only after conducting a meticulous, unbiased and comprehensive assessment of this topic area, including multilateral stakeholder input, can we develop suggestions for actionable next steps. This year's Past-President Keynote Speakers were introduced by ACAIM's Immediate Past-President, Dr. Annelies De Wulf.

Following the Keynotes, an expert panel titled “Evolving Use of Modern Technologies in Remote Didactics: How the Pandemic Forced Us to Change” took place. Moderated by Dr. Rafael Barrera (Northwell Health, Long Island, NY) the panel included Dr. John Q. Young (Northwell Health); Dr. Eric Cioe Pena (Northwell Health); and Dr. Maria Jose Jaramillo Cartwright (Minsterio de Salud Publica de Ecuador, Quito, Pichincha, Ecuador). In summary, the COVID-19 pandemic has resulted in significant disruption in medical school curricula across the world. Tens of thousands of medical students suddenly found themselves out of the classroom. As a result, medical education has changed dramatically, with the distinctive rise of web-enabled learning (e-learning), whereby teaching is undertaken remotely and on digital platforms. Research suggests that online learning may increase retention of information and be less time consuming. In practice, many of the changes attributable to COVID-19 pandemic may be here to stay. Some potentially deleterious aspects of this phenomenon, as well as certain important untapped opportunities, are also discussed.

The second panel session of the day, moderated by Dr. Manish Garg (Weill Cornell Medicine, New York, NY), focused on “Academic International Medicine and Global Health: Future Directions and Temporal Evolution.” The panel consisted of Dr. Victor Davila (The Ohio State University, Columbus, OH); Dr. Stanislaw P. Stawicki (St. Luke's University Health Network, Bethlehem, PA); Dr. Juan Carlos Zevallos (School of Health Sciences, Universidad Espiritu Santo, Ecuador); and Dr. Nathan A. Chrstopherson (Northwell Health). As deglobalization and emphasis on local self-sufficiency become defining forces across the world, a fundamental re-assessment of global health in its current form is required. This session provided a detailed analysis of the most current trends and developments related to various globalization and deglobalization forces, with emphasis on Academic International Medicine as the principal contributor to long-term global medical efforts.

The third panel session, moderated by Dr. Sagar C. Galwankar (Sarasota Memorial Hospital, Sarasota, FL) was titled “Trainee Participation in Academic International Medicine: Empowering Medical Students, Residents, and Fellows.” The panel consisted of Zachary Fowler (Northwell Health); Maria De Los Angeles Cardenas Sanchez (Northwell Health); Tambo Willians (Northwell Health); and Michaela S. Banks (Louisiana State University, New Orleans, Louisiana, USA). This session explored various ways in which medical students, residents, and fellows can become involved with Academic International Medicine. Unique to ACAIM's approach is the inclusion of diverse voices and the encouragement of active medical student, resident and fellow participation.

The subsequent session, titled “Focus on Wellness: Academic International Medicine and Provider Wellbeing” was presented by Dr. Dianne McCallister, Dr. Barbara Hernandez, and Dr. Nancy Markham Bugbee. Practicing physicians, residents and medical students are uniquely susceptible to moral injury and burnout. This session provided guidance and targeted solutions to support physician wellness and related strategies, including personalized learning on best practices for preventing physician burnout, rediscovering joy in medicine, creating a culture of team-based care and improving practice efficiency. In addition to a general overview of wellbeing in healthcare, the session also covered academic physician wellbeing, focusing on individual approaches to wellness.

The final session of the day, moderated by Dr. Maura Sammon (Temple University, Philadelphia, Pennsylvania, USA) was titled “Key Considerations and Preparations for Refugee Crises.” Panelists included Andrea Leiner, Mohanad Rashad, Mark MacDonald, and Brendan Tucker (all from Global Response Management, Yulee, Florida, USA); Dr. Thomas J. Papadimos (University of Toledo, Toledo, Ohio, USA); as well as Dr. William Novick (The Novick Cardiac Alliance, Memphis, TN, USA). More than 80 million people around the world have been forced to flee their homes. Among them are more than 26 million refugees, around half of whom are under the age of 18 years. There are also millions of stateless people, who have been denied a nationality and lack access to basic rights such as education, health care, employment and freedom of movement. At a time when 1 in every 95 people on earth has fled their home as a result of conflict, starvation, or persecution, this session focuses specifically on healthcare needs of refugees, including both acute and chronic conditions, with considerations given to both short- and long-term aspects.

June 12, 2022: Conference day #2

The second day of the Congress was primarily dedicated to the AIM 2022 Scientific Forum, with two sessions focused specifically on abstract presentations. Researchers, students, residents, fellows and attendings from more than 25 academic institutions around the world presented their abstracts, utilizing either short (e.g., 5 min presentation + 1 min questions) or long (e.g., 8 min presentation + 2 min questions) virtual formats. This year's forum was highly competitive, with awards given in two different categories, as follows:

  • Best 2022 Original Research Presentation: “A systematic review of behavioral economic-based interventions to improve HIV prevention, retention in care, and viral suppression for people at risk for or living with HIV/AIDS” by Neielle Saint-Cyr, et al. (University of South Florida, Tampa, Florida).
  • Second Place 2022 Original Research Presentation: “A study of the effect of Low molecular weight heparin on mucosal barrier of colon in septic peritonitis in a murine model” by Aakansha Giri, et al. (All India Institute of Medical Sciences, Rishikesh, India).
  • Best 2022 Case Report or Series: “Case cluster of neurotoxic shellfish poisoning following ingestion of clams collected from the Florida Gulf Coast” by Emily Wheeler, et al. (Florida State University Emergency Medicine Residency Program, Sarasota Memorial Hospital, Sarasota, Florida, USA).
  • Second Place 2022 Case Report or Series: “Medullary Sponge Kidney: A Case Study of Extreme Metabolic Derangements” by Dr. Michael Sun, et al. (Drexel University College of Medicine, Philadelphia, Pennsylvania, USA).


The final panel session of the 2nd day of the 2022 AIM Congress discussed “Warzone and Academic International Surgery: Helping in The Midst of The Unthinkable” and was chaired by Dr. Tamara Worlton (Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA). Panelists included Dr. Amila Ratnayake (Army Hospital, Colombo, Sri Lanka); Dr. Ghassan Al Swaiti (The Royal Medical Services of the Jordanian Armed Forces); and Dr. Mansoor Khan (University Hospitals Sussex & MK Consulting). Surgery in times of war ranges from battlefield and damage control interventions to elective or emergency procedures for the civilian population. War surgery is characterized by the inherent necessity of working with limited resources, under constant threat to the surgical team, and high-intensity, mass casualty environments where surgical decision-making offers little to no time or margin for error. This session specifically focused on key concepts and principles related to this very relevant, contemporary topic.


  Annual American College of Academic International Medicine Leadership Awards Top


This year, ACAIM continued the tradition of highly competitive Emerging Leader and Distinguished Leader Awards. Nomination cycle for the awards started several months before the Congress, with a dedicated Awards Committee convened to administer this process in an unbiased and confidential fashion. ACAIM is honored to present this year's awardees:

  • The 2022 ACAIM Emerging Leader Award: Dr. Taryn Clark, MD, FAWM, FAIM
  • The 2022 ACAIM Distinguished Leader Award: Dr. Harry L. Anderson III, MD, FACS, FICS, FCCM, FCCP, FAIM.



  Annual American College of Academic International Medicine Leadership Elections Top


In accordance with ACAIM Bylaws, the 2022 election cycle was initiated in January, with an open and transparent self-nomination process for prospective organizational leaders. The self-nomination process closed in April and was followed by leadership elections, with results announced ahead of our 7th Annual Virtual Congress and Scientific Forum. Dr. Mayur Narayan was installed as ACAIM President, with Dr. Michael S. Firstenberg becoming our Immediate Past-President. Dr. Rafael Barrera begins his tenure as President Elect. Dr. Ricardo Izurieta became Vice President. Dr. Victor Davila became ACAIM Treasurer. Finally, Dr. Alaa-Eldin A. Mira was elected to become ACAIM Executive Secretary. In addition, four actively contributing members were inducted as new Fellows of Academic International Medicine (FAIM, see https://www.acaim.org/fellowship for more information).


  Conclusions Top


The 2022 Clinical Congress of the American College of Academic International Medicine represented a successful transition to post-COVID-19 era. This was reflected across the diverse topics, panels, and Scientific Forum presentations featured in our program. In addition to its excellent sessions and a new leadership transition leading into the 2022-2023 academic year, the Congress truly represents a new foundation, consistent with its theme, “Building a Stronger Future.” As we approach 2023, we look forward to increasing our membership, to projecting our positive influence, and to organizing and hosting an exciting in-person Congress. We will strive to improve our educational outreach to low- and middle-income countries (LMICs) to assist in the continual improvement of undergraduate and graduate medical pedagogy through teaching, research, and administrative support, with focus on bidirectionality, quality, and sustainability. Abstracts of the Scientific Forum now follow.

Financial support and sponsorship

The Academic International Medicine 2022 Congress and Scientific Forum was supported by the following benefactors: JH Benefits, IntechOpen, LifeAire Systems, and EWMCI, LLC. Institutional Sponsors included Wayne State University, Northwell Health, and St. Luke's University Health Network.

Conflicts of interest

All authors of this report are members of ACAIM Executive Leadership / Governing Boards, and were actively involved in the planning of AIM 2022 Congress and Scientific Forum.

Ethical conduct of research

All of the abstracts and case reports listed below were required to follow applicable EQUATOR Network (http://www.equator-network.org/) guidelines prior to acceptance for presentation at the AIM 2022 Scientific Forum. This includes approval by Institutional Review Board / Ethics Committee and patient consent declaration for case reports or series. Verification of the above pre-requisites was performed by the AIM 2022 Conference Planning Committee.


  Abstract Number 1 Top


A Study of the Effect of Low Molecular Weight Heparin on Mucosal Barrier of Colon in Septic Peritonitis in a Murine Model

Aakansha Giri Goswami, Somprakas Basu

All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Introduction: The human gut, besides acting as the physiological portal for the entry of nutrients into the body, also acts as a barrier, limiting the systemic absorption of microbes and their toxins. This intestinal barrier is formed by a stratified system of defences, of which a tight junction between the epithelial cells is an important component. Claudin is an important family of tight junctions which establish paracellular barriers and control the flow in the intercellular space. Similarly, heat shock proteins (HSP) are cytoprotective agents whose expression is increased in response to stress and they play a pivotal role in protecting intestinal epithelial cells during gut inflammation. Low molecular weight heparin (LMWH), besides its anticoagulant activities, also has an anti-inflammatory action that can help protect cells from various damaging substances.

Through this study, we aim to find if the intestinal epithelial barrier is disrupted in sepsis and whether anti-inflammatory agents like LMWH are capable of reducing inflammation, and bacterial translocation thereby restoring the mucosal barrier functions.

Methods: Forty-five inbred Charles-Foster albino rats of 200-250 grams were randomly divided into sham, control and test groups, containing 15 rats each. These groups were further subdivided into 3 subgroups of 5 rats each, which were sacrificed at 24, 48 and 72 hours after the experiment respectively.

Operative Procedure: After an overnight fasting, general anaesthesia was given by the intraperitoneal injection of ketamine and the abdominal cavity was accessed by a 2 cm, anterior abdominal wall midline incision. Three puncture wounds were made on the cecum to produce faecal peritonitis and the abdomen was closed in layers by prolene 3-0. In the test group, injection of LMWH 150 IU/kg, subcutaneously was given 1 hour before laparotomy and then daily. Each subgroup was sacrificed by ketamine overdose at the aforementioned hours. The abdominal cavity was inspected grossly, the entire colon harvested, kept in 10% formalin and sent for histopathological examination and immunohistochemistry.

Assessment:

  1. Gross: ascetic fluid, bowel colour, adhesions, serosal and mucosal changes
  2. Histopathological: inflammatory cells, micro abscess, microvascular thrombosis, ulceration, necrosis
  3. Immunohistochemistry: expression of Claudin 4, HSP 70.


Statistical analysis was performed with the software SPSS (version 12, Illinois, Chicago). Results were recorded as mean ± SD. Comparison of means was done by ANOVA and post hoc Tukey tests. A P-value less than 0.05 was taken as significant.

Results:

Key quantitative results from the current study are presented in [Table 1] and [Table 2]. Additional results pertaining to the gross appearance, histopathology, and immunochemistry of tissue studies are provided, as follows:



  1. Gross appearance: In the control group, significant changes were found in mucosa, serosa and development of adhesions which were maximum at 72 hours. However, in the test group, only mucosal changes were found significantly which were maximum at 48 hours and improved at 72 hours due to LMWH. Insignificant morphological changes were appreciated in the sham group.
  2. Histopathology: No changes were found in the sham group whereas significant changes were found in the control group in form of mucosal necrosis, inflammatory infiltrates, serosal changes, adhesions and development of ascites which were maximum on day 3. In the test group, these changes were present but insignificant especially at 72 hours when compared to the test group, suggesting the protective role of LMWH in this group.
  3. Immunohistochemistry: Expression of Claudin 4 was significantly low in the control group in all the three subgroups in comparison to the sham and test group whereas its expression was comparable in between sham and test groups suggestive of the protective role of LMWH in the test group. HSP 70 expression was found maximally in the control group, especially on day 3, however, it was insignificant in comparison to other groups.


Conclusion: From the observation of the present study, it can be concluded that colonic mucosal injury occurs in sepsis disrupting the mucosal barrier mechanism and epithelial tight junction evidenced by decreased expression of Claudin 4. Although the expression of HSP 70 increased in mucosal epithelial cells during sepsis, the changes observed were insignificant. The use of LMWH decreased colonic mucosal injury evidenced by improved morphological and histopathological changes. Also increased expression of Claudin 4 and reduced expression of HSP 70 were observed in LMWH treated group. However, its effect was appreciated not before the second day of sepsis and was observed earliest by the expression of Claudin 4.


  Abstract Number 2 Top


Equity and Social Inclusion Model: Quota System of the Federal University of Rio Grande Do Sul - Porto Alegre/Brazil

Aline Zimmermann de Azambuja, Giordanna Andrioli, Flávia Beltrami, Maicon Chassot, Silvana Teixeira Dal Ponte

Hospital de Clínicas de Porto Alegre, Brazil

Introduction: Brazil is a large low income country (LIC). Due to the need for greater inclusion of individuals with low family income in universities, the Quota Law was established by the government in force at the time. This law provides that 50% of vacancies in universities and federal institutes are directed to people who studied in public schools. Of this total, half is intended for the population with a family income of up to 1.5 minimum wage per capita. The distribution of vacancies in the racial and disability quota is made according to the proportion of indigenous, black, brown and disabled people at local.

Methods: Experience-based, descriptive report.

Results: The UFRGS determines a reserve of, at, 50% of the vacancies for admission to the vacancy for candidates graduating from the Public High School (PHS) System [Figure 1]. And also allocated places for people with disabilities.Reserved places are strongholds in eight types of defined quotas, as below:



L1 – from the PHS System with gross monthly family income equal to or less than 1.5 national minimum wage per capita;

L2 – from the PHS System with gross monthly family income equal to or less than 1.5 minimum wage per capita self-declared black, brown or indigenous;

L3/L5 – from the PHS System regardless of family income;

L4/L6 – from the PHS System regardless of family income, self-declared black, brown or indigenous;

L9 – from the PHS System with gross monthly family income equal to or less than 1.5 national minimum wage per capita and Person with Disabilities;

L10 – from the PHS System with a gross monthly family modality equal to or less than 1.5 national minimum wage per capita self- declared black, brown or indigenous and Person with Disabilities;

L13 – from the PHS System regardless of family income and Person with Disabilities;

L14 – from the PHS System regardless of family income, black, brown or indigenous and with Disabilities.

Conclusion: The UFRGS Quota System is designed in accordance with Federal Law and allows access to higher education for people who do not have the purchasing power to pay for private education and/or people who experience poverty. The system is actively contributing to breaking the cycle of marginalization and encourages diversity, equity and inclusion.


  Abstract Number 3 Top


Assessing Clinical, Demographic, and Epidemiological Variables among the First 500 COVID-19 Patients in an Urban Emergency Department

Norris Isang Akpan, Mima Fondong, Ada Tusa, Peter DeBlieux, David Janz, Stacey Rhodes, Evrim Oral, Lisa Moreno-Walton

Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA

Introduction: As of May 8, 2022, there have been over 81 million confirmed cases of COVID-19 and more than 995,000 deaths in the United States. Given the ability of the virus to target multiple organ systems, many patients were hospitalized on average between 4-21 days. In addition, certain comorbidities predisposed patients to worse health outcomes when infected with COVID-19. It was vital that emergency medicine physicians considered these factors when determining whether to discharge or admit patients. Our study sought to characterize the first 500 COVID-19 patients seen in the emergency department of an urban hospital by analyzing dispositions, discharge statuses, patient demographics, O2 requirements, ventilatory interventions, and comorbidities. We hypothesized older patients with lower O2 saturations, increased need for ventilatory support, and certain comorbidities and demographics were more likely to be admitted to the hospital.

Methods: This study was a retrospective chart review of the first 500 COVID-19 patients who tested positive at an urban emergency department between March 9, 2020 – March 24, 2020. We queried the medical records for patients meeting qualifying criteria. Data was collected using REDCap including basic demographics, comorbidities, respiratory rates, initial O2 saturations, paO2, as well as respiratory interventions with final O2 saturations. All statistical analyses were carried out utilizing SAS 9.4. We used Fisher's exact or Pearson chi-square tests to assess the associations between categorical variables and disposition status. To compare admitted and discharged patients' continuous characteristics, we utilized two sample t-tests.

Results: Our study population consisted of 56% females. Regarding race demographics, 88.1% of total patients were black, 4.8% were white, and 0.6% were biracial. 5% of the patients identified as Hispanic. 0.4% were American Indian. The most common comorbidities were hypertension (50%), diabetes (28.8%), and obesity (56.6%). Most common chief complaints were flu-like symptoms (21.2%), fever (20.6%), cough (18.4%), and dyspnea (4%). The mean age for admitted patients was 56 years old, significantly higher than the mean age of discharged patients, which was 46 years old (p<0.0001). Data analysis indicated that 74.6% of the patients were discharged home after being seen in the ED, and 25.4% were admitted to the floor. 0.8% of patients died while in the ED. Of the patients who were admitted, 90% were black, and 2% were white. Of the patients who were discharged, 87% were black, and 6% were white. There was a statistically significant association between race and discharge status (p=0.0286). There was no statistically significant difference regarding the sex of patients who were admitted versus discharged. We observed statistically significant associations between hypertension (p<0.0001), diabetes (p<0.0001), chronic kidney disease (p<0.0001), obesity (p=0.0022), cardiac disease (p<0.0001), pulmonary disease (p<0.0001), neurological disease (p=0.0025), congestive heart failure (p=0.0105) and cancer (p=0.0421) and disposition status. Key study results are summarized in [Table 1] and [Figure 1].



Conclusion: Analysis of our data suggests that Black patients of older age fared worse health outcomes when infected with COVID-19, as they were the patients who were often admitted to the hospital as opposed to being discharged home. Additionally, there were statistically significant associations between all pre-existing conditions and disposition statuses except asthma. Further exploration is needed to better understand the results. Next steps will be to do additional investigation to analyze the relationships between patient demographics, respiratory measures and pulmonary function, and dispositions to see if there are any notable links.


  Abstract Number 4 Top


Clinical and Demographic Factors among Patients Suffering Cardiac Arrest with Field Termination in New Orleans during the COVID-19 Pandemic

Victoria Way, Stacey Rhodes, Lisa Moreno-Walton

LSU Health Sciences Center, New Orleans, Louisiana, USA

Introduction: Since the start of the COVID-19 pandemic, modified protocols for termination of resuscitation by EMS has impacted out-of-hospital cardiac arrest (OHCA) patient survival. Demographics and clinical presentation of these patients in the United States is variable. There is limited data in Louisiana regarding the number of OHCA deaths and the underlying comorbidities, demographics, and clinical presentations of these patients. This study aims to determine the number of cardiac arrests with field termination in New Orleans during the pandemic, discover associations between clinical and demographic factors and field termination, and measure the frequency of comorbidities among patients who experienced OHCA.

Methods: A retrospective analysis of patients ≥ 18 years of age who experienced a cardiac arrest with field termination eliciting EMS activation prior to and during the COVID-19 pandemic was performed. We queried NOLA EMS medical records for patients meeting study criteria and collected demographics, comorbidities, and details related to the code. Data was extrapolated to Redcap and analyzed using SAS 9.4. Correlations between variables were assessed utilizing Fisher's exact test. We also compared the number of DNR calls prior to and during the first six months of the pandemic.

Results: A preliminary data analysis showed that in the 2019 period, a statistically significant relationship exists between the disposition of the event and whether sustained return of spontaneous circulation (ROSC) was achieved by first responders. In the 2020 period, statistical significance was found for disposition and ROSC before and after EMS arrival. Of greatest interest, statistical significance was also found between disposition of the patient and the etiology of the arrest. Summary of study results provided in [Table 1] and [Figure 1].



Conclusion: Given the results of this preliminary data analysis, it can be concluded that achieving ROSC heavily impacted whether or not a cardiac arrest case was terminated in the field. Moving forward, we plan to determine if there are additional relationships between the demographics of the terminated cases, as well as postal code of the incident, hospital destinations, and health insurance of the patients.


  Abstract Number 5 Top


Disparities in Treatment of Hepatocellular Carcinoma in Hepatitis C Positive Patients

Jose P. DeCastro-Vazquez1, Stacy Rhodes2,

John Hutchings2, Evrim Oral2, Lisa Moreno-Walton2

1Ponce Health Sciences University, Puerto Rico, 2LSU Health New Orleans School of Medicine, New Orleans, Louisiana, USA

Introduction: Primary liver cancer is the sixth most diagnosed cancer and the third leading cause of cancer death worldwide in 2020, with approximately 906,000 new cases per year and 830,000 deaths per year. Hepatocellular Carcinoma (HCC) comprises 85-90% of primary liver cancers. Risk factors for HCC vary by region. According to recent data, Hepatitis C Virus (HCV) accounts for approximately one-third of HCC cases in the United States (US). Studies have shown HCC and HCV disproportionally impact racial/ethnic minorities in the US. This population is encouraged to seek screening in 6-months intervals to avoid delays in diagnosis and progression of the disease. Moreover, socioeconomic status (SES) and insurance status may limit preventive and surveillance measures.

Our study aims to identify disparities in HCC stage by age, race, ethnicity, gender, or SES at the time of diagnosis. Also, we seek to determine average duration from diagnosis to treatment and identify if one group carries a higher burden of disease.

Methods: This was a retrospective chart review of HCV+ patients diagnosed with HCC at University Medical Center New Orleans (UMCNO) from March 2013 to May 2021. The medical record was reviewed to collect basic demographics, staging at the time of diagnosis according to Barcelona Clinic Liver Cancer (BCLC, [Figure 1]), as well as duration to treatment. Data was analyzed using SAS 9.4. We looked at associations between demographics, delays in treatment, and stage.



Results: Our population consisted of 149 patients, 91% male, 61% black vs 33% white, 98% non-Hispanic. Of all patients, 6% had private insurance, 85% had Medicaid/Medicare, and 9% were uninsured. Median age at diagnosis was 61 years and 88% had either an early, intermediate, or advanced stage HCC (BCLC Stages A, B, and C, respectively), 32% Stage B.

While there were no statistically differences based on demographics, we observed a statistically significant relationship between HCC stage and delay in treatment (p<0.0001 where most delays occurred in stage 2 patients and no delays mostly occurred in stage 3. Of all patients, 83% received HCC treatment with a median time to treatment of 79.5 days, with 65% experiencing a delay in treatment. There was no association between treatment delay and age, race, SES, or gender. [Table 1] provides a summary of key study results.



Conclusion: While there was no significant relationship to demographic or SES, most patients did experience a delay in treatment. No group carried a higher burden of disease. Results emphasize the importance of screening for HCC in the HCV population given that only 30% of the population was diagnosed with stages 0/A according to BCLC.


  Abstract Number 6 Top


Evaluation of Rashes among Patients Testing Positive for COVID-19 in an Urban Emergency Department

Kyla L. Maupin, Norris Akpan, Stacey Rhodes, Heather Murphy-Lavoie, Evrim Oral, Lisa Moreno-Walton

Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA

Introduction: SARS-CoV-2 virus emerged in the United States in early 2020 causing a pandemic of respiratory illness. While respiratory and flu-like symptoms are well-known, other cutaneous findings such as maculopapular lesions, purpura, pruritic lesions, urticaria, acral lesions and chilblain are not. As a novel virus, it is important to document any COVID-related associations, as they may serve as a diagnostic, epidemiological, or prognostic markers of disease, and fill in gaps in our current understanding of COVID. We aim to identify the types of cutaneous manifestations among patients who tested positive for COVID in the ED and to identify which groups are more associated with these manifestations.

Methods: This was a retrospective chart review of the medical record to identify patients meeting the study criteria. We queried electronic medical records to identify patients testing positive COVID-19 between March 1, 2020, and May 31, 2021. We collected basic demographics including age, gender, race, and ethnicity. We also collected associated COVID symptoms and whether the patient was admitted to the hospital due to COVID-related symptoms. The medical records were reviewed to identify patients with a secondary diagnosis of rash. Data analysis was carried out using SAS 9.4.

Results: Our interim analysis of 3,261 charts yielded 8 patients meeting our study criteria of being COVID-19 positive and presenting with a secondary diagnosis of a rash. The sample demographics included 75% female, 62.50% non-Hispanic, with a mean age of 52. Rash descriptions included maculopapular, urticaria, purpura, pruritic, chilblain, dermatitis, bullous, and erythematous lesions. The most frequent rash types were urticaria and erythema. The Most frequent associated symptom was acute hypoxic respiratory failure. Summary of key study results is provided in [Table 1] and [Table 2].



Conclusion: While our sample size was small; we can make some observations. Non-Hispanic females were more impacted. A dual diagnosis of COVID-19 and rash was uncommon, as compared to literature. These findings may be due to decreased awareness of rash as a symptom of COVID-19 and lack of documentation of cutaneous findings when evaluating the patients in the ED. Data collection will be continued to increase the sample size and complete more statistical analyses.


  Abstract Number 7 Top


Development of Hepatocellular Carcinoma in HCV Patients

Aaliyah J Robinson, Stacey Rhodes, Jose DeCastro, John Hutchings, Evirm Oral, Lisa Moreno-Walton

Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA

Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and is a leading cause of cancer-related death worldwide. In the United States, HCC is the ninth leading cause of cancer deaths. Regardless of the etiology, development of cirrhosis remains the most important risk factor for development of HCC and commonly presents in advanced stages. Common risk factors associated with developing HCC are hepatitis B and C virus, both independent risk factors for HCC. Despite advances in prevention techniques, screening, and new technologies in both diagnosis and treatment, HCC incidence and mortality continue to rise. Our study aims to examine the relationship between HCV and HCC, as well as disparities associated with each disease.

Methods: This is a retrospective chart review of patients 18 years or older testing positive for HCV and HCC at the University Medical Center, New Orleans, LA; between January 2015, and April 2021. Patients were separated into two groups: HCV positive and HCC positive. We reviewed medical charts of HCV-positive patients to determine if they went on to develop HCC. Then we reviewed the medical records of HCC-positive patients for a prior diagnosis of HCV. We collected basic demographic data including age, gender, race, and ethnicity. Insurance types were collected to stratify their socioeconomic status. Data was analyzed utilizing SAS 9.4.

Results: This is an interim analysis of 121 patients, 53 HCV and 68 HCC patients; 67% African American, 30% White, and 3% other races. Of all patients, 88% were male, 93% were insured and 96% not homeless. Mean age at the time of HCC diagnosis was 61 years.

Regardless of group, 91% of all patients received treatment for HCC: 26% surgery, 41% interventional radiology, and 24% chemotherapy. Of all patients, 43% of HCV and 41% of HCC patients experienced a delay in treatment (≥ 51 days; p = 0.8062). Among both groups there was no correlation between treatment and demographics. Key study results are shown in [Figure 1] and [Figure 2].



Conclusion: In our population, those diagnosed HCC were more likely to be African American, male, age 60 years or older. Of all treatment options, interventional radiology was the most common. Surgery, a potentially curative modality, was utilized in only 26% of patients. While delay of treatment was not significant, almost half of patients in each group did experience a delay. Given delays ≥ 3 months are associated with worse prognosis in our study. There is a need to improve time to follow up for patients diagnosed with HCC.


  Abstract Number 8 Top


Creation of Projects and Innovative Solutions to Problems in Telemedicine

Karol E. Tipan1, Ivan Palacios2, Rafael Barrera2, Shari J. Jardine2

1Universidad San Francisco de Quito, Ecuador; 2Northwell Health, Long Island, NY, USA

Introduction: The global health partnership between Northwell Health (NWH) and Universidad San Francisco de Quito (USFQ) designed a telepsychiatry program (TP) to serve the urgent mental health needs with virtual access that is integrated into the primary care system of marginalized populations around Quito, Ecuador. Free programs reduce stigma, eliminates cost barriers, and improve patient wait time. As the world emerges from the COVID-19 pandemic, global comprehensive care models centered in dismantling inequity and addressing needs of patients must be inclusive of mental health services. Global health experiences (GHE) are an important mechanism to develop residents' commitments to health equity.

Methods: The implementation of the TP relies on the dynamic sustainability framework [Figure 1], operationalized through the following elements:



  1. Use of evidence-based, low-cost screening and technological interventions
  2. Cross training practitioners including psychiatry residents, medical students, and physicians
  3. Ongoing PDSA cycles
  4. Bi-lingual study protocols, data management systems, learning objectives, and transition guides. The referral pathway for the TP program is:


    • Screen patients using GAD-4 (psychologist)
    • Schedule telepsychiatry appointment over Zoom (UFSQ medical student)
    • Evaluate patients during 45-minute consultation (NWH psychiatry resident)
    • Provide recommendations to local team for follow-up (resident & medical student)
    • Coordinate medication management and/or psychiatric follow-up (medical student and psychologist).


Results: PDSA cycles are facilitated through weekly meetings by reviewing protocols, opportunity areas, and successes. Leadership from USFQ guide program objectives by convening monthly with the NWH team.

Seventy-two patients from six health centers (Quinche, Checa, Tumbaco, Cumbaya, Puembo and Pifo) were referred to the TP, producing a significant reduction in wait time and improving access to mental health services. Previously, patients waited over 90 days for psychiatric care and now receive a consultation within 10 days of referral [Figure 2]. This program is the basis of the creation of other pertinent, locally driven, mental health projects. One of the projects is a physician resiliency project, which utilizes psychologists and psychology trainees to provide Stress First Aid to physicians in 16 health centers and the bi-directional rotation of USFQ and NWH residents to build a family medicine sub-specialty program at USFQ.



Conclusion: As demonstrated through the dynamic sustainability framework, the TP leverages an existing partnership to address locally identified gaps in care and help in the development of other projects which are currently working.


  Abstract Number 9 Top


Global Medical Licensing: The American Model, Something Better, and an Emerging Opportunity for Blockchain Technology?

Cara A. Cama1, Michael S. Firstenberg2

1St. Luke's University Health Network, 2The American College of Academic International Medicine, Bethlehem, PA, USA

Introduction: Typically, a rate-limiting step to physicians being able to practice medicine in the United States, regardless of specialty and separate from institutional credentialing (although often a prerequisite), is a license in a given state / geographic jurisdiction. While the urgency of COVID-19 and ongoing physician shortages prompted revisions of existing policies and processes regarding obtaining a license to practice, if the US model is to be optimized and potentially adopted globally, then it is critical to understand its current advantages and limitations. While some physicians will only require a single license in their career to practice, others require multiple licenses, along with the need for professional mobility. Given these demands, the healthcare system might benefit from easier and more efficient opportunities to redistribute a workforce quickly – such as during a pandemic. Similar considerations apply to academic international medicine (AIM).

Methods: The Interstate Medical Licensure Compact (ILMCC: https://www.imlcc.org) was established to assist physicians, in selected states, who already have unrestricted medical licenses to obtain a 'compact' license that facilitates reciprocity in order to obtain a license in other participating states in a timely, efficient, and low-cost manner. However, not all US states participate, and while this system reflects a substantial improvement over historical systems, we aim to explore some of the barriers to obtaining a license to practice.

Results: Currently, 31 states participate, 10 states are actively working towards full participation, and 9 states remain isolated from the ILMCC, maintaining fully independent medical licensing boards. However, subjective challenges exist regarding transitioning a full medical license into a compact license that can serve as a basis for obtaining licensure in other participating states. Even within the IMLCC system, documentation requirements, while easier to meet given the evolution of digital technologies/advances and web-based systems, continue to be convoluted and somewhat difficult to navigate. Overall, substantial multi-factorial delays, often exceeding to months, can interfere with licensure regardless of the path. Various barriers emerged due to unintended consequences of measures, Initially implemented for public/patient safety, that incorporate redundant verification procedures and significant fees required for the facilitation of many aspects of the process, varying needs for regulatory requirements (i.e., fingerprinting for background checks), as well as source documentation verification. Medical Board staffing and resources to review and process applications in a timely manner, inclusive of communication tools required to ensure compliance and critical task completion, are also severely limited due to existing resource limitations. Such issues are only magnified when international physicians require timely licensure. Clearly, opportunities exist for improved efficiencies, better compliance systems, and the employment of emerging technologies, such as blockchain-based distributed databases. Such novel approaches and capabilities can be effectively leveraged to assist with licensing process optimization, both domestically and internationally. Key concepts related to the existing and proposed licensing frameworks are shown in [Figure 1] and [Figure 2].



Conclusion: Current medical licensing systems in the United States are evolving and their inefficiencies are being gradually addressed. However, there are still major areas for improvement, especially in terms of document verification/compliance, costs, potentially unnecessary process redundancies, and limitations of human resources. Unique opportunities exists to accelerate this progress, such as the use of distributed, decentralized databases (blockchains) to assist in the development of a global model designed around one primary overarching goal – facilitating safe, effective, and efficient process of bringing much needed clinical expertise to the bedside.


  Abstract Number 10 Top


Refugees and Infectious Disease Concerns: How Europe Can Learn from the Past to Help Ukrainians Now

Gabriel L. De Leon, Michael DeRogatis, Anna Ng Pellegrino

St. Luke's University Health Network, Bethlehem, Pennsylvania, USA

Introduction: Due to the Russian invasion of Ukraine, European nations are facing challenges related to the inflow of Ukrainian refugees -- over 5 million refugees were forced to flee Ukraine. Some challenges countries hosting refugees may face relate to infectious diseases beyond the SARS-CoV-2 virus. Specifically, concerns regarding the spread of measles, poliovirus, tuberculosis, and HIV. Consequently, it is imperative hosting countries be familiar with guidelines set out by global health entities, but also familiarize staff with experiences from countries such as Turkey, Lebanon, and Jordan, in handling the spread of diseases during the Syrian refugee crisis that began in 2011.

Methods: A detailed literature search was conducted using PubMed and Google™ Scholar, ranging from 2012 to 2022. We aggregated information on the status of Ukraine's infectious disease rates, specifically looking at data pertaining to COVID-19, measles, poliovirus, TB, and HIV, prior to the current invasion. Literature was also gathered on current recommendations of health entities such as the ECDC and WHO. These recommendations were compared to actions taken by Turkey, Lebanon and other host countries following the 2011 displacement of millions of Syrians. This was done with the aim of developing a set of recommendations for the countries hosting Ukrainian refugees.

Results: The ECDC and WHO highlighted infectious diseases of importance regarding Ukraine: COVID-19, measles, poliovirus, TB and HIV. The SARS-CoV-2 virus pre-invasion vaccination rate in Ukraine was low, with 2% of the population having received the 2-dose booster immunity against COVID-19. Recommendations suggest host countries determine vaccination status of all persons and consider lack of proof as non-vaccinated. Both entities recommend offering COVID-19 vaccination to all age-appropriate refugees. Pre-war polio vaccination rate in Ukraine was a sub-optimal 80%. Recommendations suggest all children >2 months of age receive the Inactivated Polio Vaccine (IPV), with a booster one month later. Pre-invasion, measles virus vaccination levels in Ukraine were low, and incidence was high. Recommendations suggest vaccinating all child refugees >9 months of age, and a booster after 12 months. Ukraine has high rates of Multi-drug Resistant Tuberculosis. ECDC recommends BCG vaccination for age-appropriate refugees entering the country. In 2021, Ukraine had over 15,000 new cases of HIV, and a below-average treatment rate (57%). Recommendations suggest that the most important action is maintaining Anti-Retroviral Therapy compliance in HIV-positive refugees. Other recommendations include access to clean water and sanitation, limiting entry of pets, and lastly, all countries should have effective disease surveillance and reporting systems. Summary of key findings and recommendations is provided in [Table 1].



Conclusion: Several recommendations were made by global entities on managing a mass displacement of Ukrainian refugees. Efforts were made to identify specific disease management opportunities in pre-war Ukraine. The diseases focused on were COVID-19, measles, poliovirus, TB and HIV. Many current recommendations offered were followed by countries that hosted Syrian refugees and were implemented with varying degrees of success. It is pivotal that the world recognizes key infectious disease concerns that come with mass displacement and understand how to handle them in a systematic way.


  Abstract Number 11 Top


Refugees and Non-Communicable Diseases: Focus on Management Priorities, Co-Morbidities, and Health Maintenance

Michael DeRogatis, Gabriel De Leon, Anna Ng Pellegrino

St. Luke's University Health Network, Bethlehem, Pennsylvania, USA

Introduction: Due to the Russian invasion of Ukraine, more than 5 million Ukrainians have become refugees. Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality in Ukraine, with five major NCDs (cardiovascular disease [CVD], diabetes, cancer, chronic respiratory disease (RD), and mental health conditions) accounting for 84% of all mortality. The ECDC and WHO have made recommendations on how to manage NCDs in displaced populations. Many of these same recommendations continue to be followed by countries hosting Syrian refugees. It is important that host countries not only heed current recommendations, but learn from past actions of Syrian host countries.

Methods: A detailed literature search was conducted using PubMed and Google™ Scholar, between January 2012 and March 2022. We sought to aggregate information on the status of Ukraine's pre-war NCD rates, as well as the current established recommendations/suggestions from the WHO and ECDC regarding the management of NCDs among Ukrainian war refugees. The search also included multiple literature sources on how Turkey, Jordan and Lebanon managed – and continue to manage – NCDs in Syrian refugee communities within those countries. The NCDs considered in the literature search were CVD, diabetes mellitus, chronic RD, malignancy, and mental health disorders.

Results: CVD was the leading cause of death in Ukraine in 2020. Pre-invasion data showed that 14% of Ukrainians suffered from some type of CVD. Furthermore, 85% of the patient population has poorly controlled HTN.

Pre-invasion, Diabetes prevalence in Ukraine was 7% -- an underestimated rate. The WHO estimates that 140 000 adult refugees and 26 000 children will require treatment for diabetes from their host country.

In 2020, the most common cancers in Ukraine were colorectal (13.5%), breast (11.2%), and lung (9.8%). The largest concern in refugees with cancer is the interruption of treatment modalities. The recommendations focused on improving health systems via standardization and innovative financial schemes.

Approximately 33% of the Ukrainian population are smokers, and 7% have a RD – an underestimated rate. In addition, 1.4% of the pediatric population are asthmatic. The WHO estimates that 200 000 adults and 28 000 children with a RD will migrate from Ukraine.

It is important to note the mental health toll associated with the simultaneous co-presence of and the COVID-19 pandemic can be significant. Anxiety, depression, and PTSD are among diagnoses of displaced peoples, and can be further amplified by pandemic-related factors. Given the undertreatment of anxiety and depression before Russian aggression, the number impacted by various mental health issues will likely rise with mass displacement.

Conclusion: The displacement of Ukrainians presents challenges in the acute and chronic period, as NCDs were already a cause of significant morbidity and mortality. Diabetes, CVD, RDs, cancer, and mental health conditions should be at the forefront of health entities within host countries. It is pivotal that host countries examine actions of Syrian host countries in managing NCDs in the Syrian refugees – particularly the differences in those countries' financial models for helping refugees. General recommendations for managing NCDs include identifying patients at the most immediate risk, expediting access to healthcare, providing access to translation services, and establishing a systematic triaging algorithm.


  Abstract Number 12 Top


Accuracy of Emergency Medicine Resident Performed Point-of-Care Ultrasound

Jeffery C. Anderson, Stacey Rhodes, Christine Butts, Lisa Moreno-Walton

Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA

Introduction: Point-of-Care Ultrasound (POCUS) has been shown to reduce lengths of hospital visits, decrease time to care, and increase cost- effectiveness. Emergency Medicine (EM) residents are required to demonstrate competency to complete their residency. Recent literature has shown POCUS teaching varies widely, competency prediction methods are inadequate, and EM residents use POCUS less often than attending EM physicians. These findings raise questions as to how residents develop proficiency in this field. The objective of this study is to uncover the accuracy and proficiency of EM residents at POCUS at a high-volume, urban, academic emergency department.

Methods: A retrospective chart review was conducted on patients over 18 years of age who received a POCUS performed by a EM resident from 12/1/2020 to 6/1/2021. Three POCUS modalities were examined including Focused Assessment with Sonography for Trauma (FAST), Cardiac, and Aorta. The resident's interpretation was compared to the results from the confirmatory study, and sensitivity and specificity were computed. Patients who did not receive a gold standard confirmatory study were excluded. The gold standard studies are listed in [Table 1]. Additionally, the abdominal component of the FAST exam was stratified by the Post Graduate Year (PGY) of the resident.



Results: [Table 1] shows sample size, sensitivity, and specificity for FAST, cardiac, and aorta. [Table 2] shows the abdominal component of the FAST exam stratified by PGY with sample size, sensitivity, and specificity.



Conclusion: In this study, residents performed POCUS with a sensitivity and specificity comparable to attending physicians for most of the modalities. Furthermore, residents obtained this competency early in their training. Discrepancies in detecting pericardial effusion on FAST exams and during cardiac exams can be attributed to a lack of patients presenting with such pathology, highlighting the importance of adequate training opportunities for residents. Resident directors should supplement the current minimum scan requirement with simulations where residents can practice interpreting images with these pathologies.


  Abstract Number 13 Top


Case Cluster of Neurotoxic Shellfish Poisoning Following Ingestion of Clams Collected from the Florida Gulf Coast

Emily A. Wheeler, Jeremy A. Lund, Brett Williams, Casey Cheney, Sagar Galwankar

Florida State University Emergency Medicine Residency Program, Sarasota Memorial Hospital, Sarasota, Florida, USA

Introduction: Harmful algal blooms (HAB) are an intermittent ecological hazard caused by the overgrowth of dinoflagellates in response to excessive nutrient water contamination. Commonly called 'red tide', Karenia brevis produces a heat-stable toxin that bioaccumulates in the flesh of filter feeders such as clams, mussels, and oysters. Symptoms from ingestion involve gastrointestinal distress and neurological abnormalities. Harvesting of contaminated shellfish is unusual due to noxious conditions of the water, respiratory irritation of brevetoxin-laden sea spray, and warning signs posted by the Florida Department of Agriculture. We describe the clinical course of five patients who ingested clams gathered from a local beach.

Methods: Patients were interviewed upon presentation and their symptoms were documented. Serum and urine samples collected on hospital day 2 from four patients were sent for quantitative brevetoxin assay to the Centers for Disease Control (CDC); results were reported 38 days later. The analytical method used was Brevetoxin in Human Plasma by ELISA. Although no clam flesh was available for analysis, Karenia brevis biomonitoring reports from the Florida Fish and Wildlife Conservation Commission indicate markedly elevated levels of K. brevis cells (>1,000,000 cells/L seawater) in the waters around the harvest site in the weeks prior to and after the incident.

Results: Five tourists collected clams from a beach known to be affected by red tide. The clams were soaked in salt water, microwaved for 3 minutes, and consumed. The index patient experienced seizure-like activity prompting the group to seek medical attention. Each patient reported eating a varying number of clams and presented with a wide variety of symptoms as presented in [Table 1]. More severe symptoms were observed in those who ingested a larger number of clams. The index patient (Patient 1) was the most severely affected and experienced diffuse muscle weakness and fasciculations. Two patients (Patients 1 and 2) were noted to have narrow QRS intervals (< 80 msec on ECG) without comparison ECGs available. Enhancement of sodium channel flow at cardiac myocytes via brevetoxin could theoretically narrow the QRS complex but is not well studied. None of the patients endorsed cutaneous dysesthesias such as cold-hot sensation reversal. Patient 1 was admitted to the ICU while the other four went to the general medical ward. All five patients were discharged the next day following resolution of their symptoms. Summary of brevetoxin-related toxicity is provided in [Table 1].



Conclusion: Harmful algal blooms continue to pose a threat to human and wildlife. Despite safeguards, human consumption of contaminated shellfish can occur. There are few documented cases demonstrating the dose-symptom correlation with brevetoxin ingestion, but this case cluster does show correlation between severity of symptoms and the number of brevetoxin-contaminated clams consumed. This cluster also illustrates that consumption of brevetoxin from the same source can cause variable clinical effects. Care providers must maintain an awareness of the hazards caused by local environmental conditions affecting food sources. Supportive care is likely adequate therapy. Resolution of symptoms should be expected within 24 hours.


  Abstract Number 14 Top


Evaluating Antibiotic Resistance in India through a Needs Assessment Model

Abhinay Tumati, Lynn Hydo, Charoo Piplani, Harjot Singh, Noah Rossen, Manjari Joshi, Phillip S. Barie, Mayur Narayan

New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA

Introduction: Antimicrobial resistance (AMR) continues to be one of the greatest public health threats worldwide. Disproportionately higher use of antibiotics has contributed to greater levels of resistance and complicated surgical infections in developing nations such as India. Gupta et al. have shown that the proportion of resistance to antibiotic classes (e.g. Carbapenems) is 20 times higher in the subcontinent when compared to the US. Improved management of health care delivery systems, both public and private, will mitigate the development of AMR. Therefore, it is imperative to prevent multidrug resistance (MDR) infections by changing how practitioners in India prescribe and utilize antibiotics. To counter the aforementioned problems in India, we will be implementing a pilot project to develop antibiotic prophylaxis guidelines as well as an education curriculum for each surgical service.

Methods: In order to evaluate these objectives, we will be conducting a needs assessment at five Indian academic medical centers. Our target audience will primarily include physicians, pharmacists, microbiologists, and nurses at these hospitals. We plan to share an electronic survey with each of the participating sites in order to I) understand the scope of the problem and patterns of surgical infections and AMR, II) gauge the centers' ability to collect and transmit data as a metric of their readiness to participate in prospective epidemiologic and infection control studies, and III) create a standardized Antimicrobial Stewardship Educational Program to address local culture, policy, and clinical practices.

Results: The current presentation represents a conceptual outline of our research protocol that is being implemented. Final study data will be collected, analyzed, and shared with the greater medical community in the upcoming months.

Conclusion: To our knowledge, this project spanning institutions encompassing the different regions of India will be the first of its kind to partner with a recognized international society in the study and management of infections. This project has the potential to reach thousands of providers who will then go on to train their members in a train-the-trainer model to curtail AMR in the medical and surgical fields.


  Abstract Number 15 Top


A Systematic Review of Behavioral Economic-Based Interventions to Improve HIV Prevention, Retention in Care, and Viral Suppression for People at Risk for or Living with HIV/AIDS

Miguel E. Reina Ortiz1, Alida Gertz2,

Neielle Saint-Cyr1, Miguel Vasquez2, Karen Wint2, Marie-Jose Francois2, Henian Chen2, Dinorah Martinez Tyson2, Stephanie Marhefka2, Harsha Thirumurhty2

1University of South Florida, Tampa, FL, 2University of Pennsylvania, Philadelphia, PA, USA

Introduction: The introduction of effective antiretroviral treatment (ART), the subsequent development of pre-exposure prophylaxis (PrEP), and the realization that undetectable = untransmissible (U=U), serve as a strong foundation for the achievement of UNAID's 95-95-95 Treatment Targets. It is extremely important to develop strategies effective at modifying behavior with an aim to achieve these targets. Here, we present the preliminary results of a systematic review of studies that have evaluated interventions based on principles of behavioral economics for improving prevention of HIV, retention in care and adherence to ART for people with HIV.

Methods: We searched PubMed, CINHAL, PsychInfo, and Embase for articles with titles including search terms combining HIV terms, behavioral economics terms, and outcomes terms. We included qualitative and quantitative studies that examined the efficacy of behavioral economics on HIV prevention, linkage to and retention in care, viral suppression, and/or medication adherence. We excluded studies that did not include an intervention, that did not report on outcomes listed above, and that did not focus on behavioral economics.

Results: The initial search resulted in 5288 peer-reviewed papers; 518 duplicates were excluded from the initial review. Two participants from the research team undertook independent title and abstract reviews, and full-text reviews. Fifty-nine peer-reviewed papers were included for full-text review [Figure 1]. Geographic distribution of included study reports is shown in [Figure 2]. Types of behavioral economic interventions described are presented in [Table 1].



Conclusion: In our research we discuss the implications of the use of behavioral economics to achieve UNAIDS 95-95-95 Treatment Targets. Many gaps in our knowledge of the effectiveness overall of economic incentives remain. Further research focusing on strategies that work in real-world diverse communities is clearly warranted, with sustainability as an important consideration.


  Abstract Number 16 Top


A Case of Triple Hit Lymphoma and Rapid Deterioration

Timothy Daly, Jasmit Walia, Kashyap Shah, Kunal Bhagatwala, Melissa Wilson

St. Luke's University Health Network, Easton, Pennsylvania, USA

Introduction: Triple hit lymphomas comprise a rare, heterogenous group of lymphomas and like many B-cell lymphomas, chromosomal translocations are biologic and diagnostic hallmarks of disease. Traditionally referred to as a subset of double hit lymphomas (DHL) in literature, THLs characteristically involve chromosomal rearrangements of c-MYC, BCL-2 and BCL-6 genes. Many case series of high grade B-cell lymphoma, especially MYC/BCL2 double hit lymphoma, have been described in the literature, but relatively few cases of triple hit lymphoma have been reported. Additionally, without chemotherapy, triple hit lymphomas are known to have a rapid clinical course and poor prognosis compared to double hit lymphomas.

Methods: We present a case of a 71-year-old male with past medical history of deep vein thrombosis of the lower extremity, who initially presented with right flank pain and was found to have right hydronephrosis with bulky intra-abdominal adenopathy. He underwent IR guided biopsy and was diagnosed with marginal B-cell lymphoma at stage IIA. After discharge he completed one course of rituximab and bendmustine. Three weeks post treatment, the patient had recurrent hydronephrosis requiring placement of stent, nephrostomy tube and foley catheter. He underwent TURP which revealed no overt bladder tumors, however preliminary pathology results were significant for high grade lymphoma.

Results: Hospital course was complicated by sudden onset confusion and word-finding difficulties. Computed tomography and magnetic resonance imaging of the brain were both unremarkable for acute intracranial abnormality. A video electroencephalography revealed left temporal delta activity suggesting an underlying area of neuronal dysfunction. The patient was started on Lacosamide and Levetiracetam. On day 11 of admission, the patient became febrile with a maximum temperature of 103.9° F. All infectious work up was negative; however he was started on broad-spectrum IV antibiotics for fever of unknown origin. Lumbar puncture was performed to investigate for CNS infiltration, but was ultimately inconclusive. CT abdomen revealed omental infiltration concerning for metastatic disease and a peripheral smear revealed rare blasts and immature myeloid cells. Prior to pursuing a bone marrow biopsy, the following day, the patient's TURP pathology results were finalized and were positive for triple hit lymphoma with MYC, BCL2, and BCL6 mutations. The patient's family decided to transition to comfort care at that time. He passed away on hospice approximately 2 ½ weeks after admission.

Conclusion: Despite early recognition and diagnosis of THL, prognosis is poor and overall survival without treatment is 0.2 to 1.5 years. The biological aggressiveness of this malignancy is exemplified by the high likelihood of bone marrow and CNS infiltration, and older age (> 60 years) and are associated with a worse prognosis. Controversies persistent over the choice of first-line treatment for THL and include R-CHOP, DA-R-EPOCH, R-ACVBP, R-COPADEM. But, even with treatment, studies have demonstrated a median overall survival of 18 months and there are high rates of early treatment failure and relapse of death. Overall, our case highlights a rare disease causing a rapid deterioration. The patient unfortunately only survived 1 month after his diagnosis. Despite initial chemotherapy treatment, his malignancy progressed at such a pace that could not facilitate any intervention.


  Abstract Number 17 Top


Exploring Barriers to Surgical Care Access: A Survey Study from Ghana

Emilie Soyeon Kim1,2, Monica Maloney1, Peter F. Johnston1, Vennila Padmanaban1, Ziad Sifri1

1Rutgers New Jersey Medical School, Newark, NJ, 2St. Luke's University Health Network, Bethlehem, PA, USA

E-mail: [email protected]/[email protected]

Introduction: In Ghana, there is a shortage of surgical care for elective surgeries. Though there are a limited number of studies on prevalence of such elective diseases, the few documentations report the prevalence of male inguinal hernia to be 3.2% to 7.7%with an annual incidence of 210 per 100,000. Surgical treatment for inguinal hernia is obtained only by 25 per 100,000 patients. Costs to repair all symptomatic hernias in Ghana looms over $53 million.The prevalence of other elective surgical disease, such as hydroceles, in Ghana is largely unstudied, often due to their non-emergent status. Though hydroceles are rarely fatal, untreated disease is still significant in terms of its impact on the physical and psychosocial aspects of patient life, such as sexual dysfunction and difficulty to find a spouse.Our goal was to improve current knowledge by assessing barriers to healthcare and surveying an inclusive list of burden of disease in elective medical conditions such as inguinal, ventral, and umbilical hernias, hydroceles, and soft tissue masses.

Methods: This study involved the analysis of survey results from pre-operative patients receiving medical care in Southern Ghana from an international surgical health initiative. A pre-operative questionnaire was designed from a previously validated survey method with input from local staff familiar with the social and medical context of the area. The survey included questions deemed important in the context of short term surgical mission trips. Topics included: impact of medical condition on activities of daily living (ADL), worst pain experienced due to condition, reasons for delaying treatment, and previous history of interactions with the medical community for their condition. The survey was administered in English by 1-2 trained nurses who spoke to patients in a pre-op triage setting. Patients were informed of the purpose of the survey and were assured that their participation and responses had no influence on their medical care. The analysis assigned patients who received surgeries for inguinal hernia, ventral hernia, umbilical hernia, and hydrocele to Group 1.

Patients who received surgeries for soft tissue masses and other were deemed Group 2. Any missing data on type of surgery performed were coded as 'Other'. Descriptive statistics were used to analyze the data. One-way ANOVA was conducted to compare the effect of disease condition on the worst pain experienced.

Results: Of 50 patients surveyed, three were excluded for non-response. The majority of the patients surveyed preoperatively had inguinal hernia 60% (28/47) [Table 1]. Prohibitive cost of surgical care was listed as the main barrier to obtaining surgical care in Group 1 (45%), while “other cause” (44%) and lack of surgeon/delay in surgery (44%) were tied as the main barriers to obtaining surgical care in Group 2. Across specific medical conditions, responders stated that routine physical activity such as sleeping 40% (95% CI: [28%,55%]) and daily physical activities 57% (95% CI: [43%,70%])were more negatively impacted than vigorous physical activity (95% CI: [1%,14%]). There were no statistically significant differences between group means as determined by one-way ANOVA (F(4,42) = 2.55, p = 0.053).



Conclusion: Untreated elective surgery cases continue to prevail in Ghana as depicted by the long-term patients who seek treatment at annual medical surgical missions. Our findings show there is need for accessibility of surgeons and affordability of surgical care in elective/non-emergent conditions in Southern Ghana. Implementations to address the lack of monetary and human resources must refer to medical testimonies of the local patients themselves to remediate the most important factors to change.


  Abstract Number 18 Top


The Development and Impact of the Good Samaritan Law in India

Charoo Piplani1, Piyush Tewari1, Mayur Narayan2

1Fortis Flt Lt Rajan Dhall Hospital, Vasant Kunj, New Delhi, India, 2Weill Cornell Medical Center, New York, New York, USA

Introduction: Road traffic accidents are one of the leading causes of death in India. According to a report by accidental deaths and suicides in India 2020, 3,54,796 road accidents caused 1,33,201 deaths and injuries to 3,35,050 persons. They are often considered an indicator of bottlenecks in the smooth flow of traffic. The first responders, who are the bystanders at the time of the accident, play a huge role in saving lives and determining the outcome of the situation by acting during the golden hour. They are considered the first in line, in the chain of survival. However, there is often a hindrance associated with the legal implications in these circumstances, especially the hit and run cases, which gave rise to the concept of a Good Samaritan.

Methods: Due to the need for creating a protective legal environment and safeguarding these Good Samaritans; i.e. the bystanders and passers- by who can render help in the immediate hour of need - the SaveLIFE foundation (SLF) on May 7, 2012 filed a Public Interest litigation (PIL) in the Supreme Court of India in order to introduce guidelines to protect them from being harassed and coerced. They propagated the Good Samaritan law that led to the Hon'ble Supreme Court passing its landmark judgment on 30th March 2016. By virtue of Article 144, the Hon'ble Court directed all authorities in the territory of India to act in aid of the Court by implementing the guidelines. The Government of India introduced the Motor Vehicles (Amendment) Act 2019 after a strong campaign led by SLF, which included written petitions from Members of Parliament to the Prime Minister. The Motor Vehicles (Amendment) Act of 2019 introduced Section 134 (A) to provide Good Samaritans with protection from civil and criminal liability.

Results: A survey has been conducted for all states of India to assess the implementation of the law. The guidelines that are assessed state that - the Good Samaritans will not be held for any civil or criminal liability; not be compelled to reveal his/ her personal details; cannot be detained or be forced to pay registration or admission costs at the hospitals; can choose to be an eyewitness and cannot be compelled.

Conclusion: The Act defines “Good Samaritan” for the first time in a Central Legislation, as a - “A person, who in good faith, voluntarily and without expectation of any reward or compensation renders emergency medical or non-medical care or assistance at the scene of an accident to the victim or transports such victim to the hospital.” Timely management of these victims could save thousands of lives each year. The SaveLIFE foundation - a non-profit organization is working to improve road safety and emergency care across India. With the help of evidence- based research and legal guidelines, the SaveLIFE foundation aims to ensure the effective enactment of the Law all across the country.


  Abstract Number 19 Top


Medullary Sponge Kidney: A Case Study of Extreme Metabolic Derangements

Michael L. Sun1, Crystal Joseph1, Ikechukwu Emengo1, Pallav Shah2, Mahesh Krishnamurthy1,2

1Drexel University College of Medicine, Philadelphia, 2St. Luke's University Hospital Network, Bethlehem, Pennsylvania, USA

Introduction: Medullary sponge kidney (MSK) is a disorder characterized by cystic dilation of distal collecting tubules, with complications including distal tubular acidosis, recurrent urinary tract infections, urolithiasis, and medullary nephrocalcinosis. Due to the rarity of MSK, its effects on the metabolite levels of patients are not widely noted and treatment guidelines for metabolic derangements due to MSK are limited. In this case report, we present an example of extreme metabolic derangements seen in an MSK patient due to her underlying disease.

Methods: The patient is a 42-year-old female with past medical history stage 4 chronic kidney disease secondary to medullary sponge kidney, recurrent urinary tract infection history and kidney stones, and chronic hypokalemia receiving biweekly potassium infusions who presented on admission with intractable nausea and vomiting and muscle weakness. She also experienced symptoms consistent with a urinary tract infection. On admission, her vitals were significant for tachycardia and hypotension, and her electrocardiogram showed QT prolongation. Her labs were significant hyponatremia, hypokalemia, hypochloremia, low bicarbonate, high anion gap, and high creatinine. Her venous blood gas showed significant acidosis. She has had frequent admissions in the past for acidosis and electrolyte disturbances. Her CT abdominal and pelvic scan showed multiple punctate calculi bilaterally which is consistent with medullary nephrocalcinosis from her history of medullary sponge kidney. The urinalysis showed moderate blood, leukocytes and bacteria, innumerable white blood cells, and trace protein.

Results: From her presentation, it was suspected she had a urinary tract infection which caused intractable nausea and vomiting, and she was appropriately managed. The nephrology team was consulted for further management of her severe electrolyte derangements, caused by her chronic kidney disease secondary to medullary sponge kidney [Figure 1], [Table 1]. Over the hospital admission, the hyponatremia and bicarbonate level improved, the anion gap closed, and the metabolic acidosis was resolved. Her creatinine improved. Her potassium level was consistent throughout the hospital course, which is found to be her baseline. Due to having medullary sponge kidney, she was consistently anemic. The patient symptomatically improved. Upon discharge, the plan was for her to have a repeat basic metabolic panel after a couple of days and to follow up with her outpatient nephrologist, hematologist and primary care provider. She continued to receive potassium supplementation given her chronic hypokalemia, and she was scheduled to have a catheter placed for dialysis access so she can begin outpatient dialysis.



Conclusion: Our case emphasizes the importance of continuous follow-up and management of patients with medullary sponge kidney, especially since they are at high risk for readmission. Providers should also be aware that patients with MSK can live with baseline significant metabolic abnormalities despite aggressive inpatient treatment, due to the chronicity of their electrolyte derangement. Patient and physician education on medullary sponge kidney is vital to prevent recurrent complications, provide appropriate management, and maintain continuity of care.


  Abstract Number 20 Top


Educating and Navigating: Managing Refugee Crisis, One Person at a Time

Erin Handspiker, Stanislaw P. Stawicki

St. Luke's University Health Network, Bethlehem, Pennsylvania, USA

Introduction: According to the United Nations High Commissioner for Refugees, Filippo Grandi, “Refugees face two journeys, one leading to hope, the other to despair. It is up to us to help them along the right path.” The unprovoked and unjustified war of aggression perpetrated by the Russian Federation on the country of Ukraine resulted in the largest – and most rapid – refugee crisis of the 21st Century. Here we will analyze scientifically established phases of refugee journey, focusing on ways to optimize favorable outcomes and successful integration within the destination country/community.

Methods: A comprehensive literature search was performed using PubMed and Google™ Scholar in order to assemble a definitive collection of sources regarding individual refugee post-arrival (RPA) responses to the cumulative shock of refugee transition combined with the arrival in destination country/community.

We then superimposed existing RPA models onto a unified grid, consisting of both descriptive and proscriptive elements, with specific intent of creating an easy-to-use guide for refugee management professionals.

Results: The four traditional RPA stages and sub-stages were superimposed on an alternative model of positive refugee response [Table 1]. In addition, different dimensions – from individual to society/environment [Table 2] – must be considered carefully within the context of the RPA stages outlined above.



Conclusion: Our research suggests that traditional RPA responses, combined with what we call “the positive model” as well as dimensional “individual-society” considerations, provide a valid platform for the development of more successful refugee crisis management frameworks, ultimately leading to more successful settlement.


  Abstract Number 21 Top


Emerging Health Consequences of Electronic Waste (E-Waste)

Nayer Jamshed

Department of Emergency Medicine, AIIMS, New Delhi, India

Introduction: Electronic waste (e-waste) is a serious and concerning issue globally and has created a major public health emergency. The mounting tsunami of e-waste has put the lives of millions of children and expectant mothers at risk. According to Global e-waste monitor (GEM) 2020 data, 53.6 million metric tons (Mt) of e-waste was produced globally in 2019, out of which only 17.4% was formally collected and recycled, fate of rest 82.6% of e-waste was uncertain. Informal cycling without protection and safety measures may lead to significant exposure of toxic chemicals and heavy metals which are extremely harmful to human and ecological health. These harmful chemicals can pollute air, groundwater and food chain causing significant morbidity and mortality in the long run. Informal dismantling and recycling is an industry of 57-62.5 billion US dollars, but unfortunately releases dangerous chemicals like brominated flame retardants, polyaromatic hydrocarbons, dioxins, hydrofluorocarbons, chlorofluorocarbons and metals like lead, mercury, cadmium, arsenic and chromium. These chemicals and metals may lead to significant long and short term effects on humans and ecosystem. DNA damage producing micro-nucleated or binucleated cells, telomere attrition, increased oxidative stress and decreased immune functions are the major mechanism of e-waste associated health hazard. This report presents the results of a comprehensive literature review on this important topic, focusing on deleterious health effects.

Methods: Descriptive literature review utilizing the search terms “electronic waste,” “e-waste,” “toxicity,” “hazardous chemicals,” “health effects,” “ecological health.” In addition, cross-referenced sources were also searched and potentially included for content relevant to the current research project.

Results: People working in e-waste recycling facilities or living in towns and cities where these facilities exist have reported abortion, still birth, premature birth and low birth weight babies in females of reproductive age group. Children are more susceptible to the adverse effects of e-waste, because of increased exposure through placenta, breast milk, hand to mouth behaviour, larger body surface area compared to their weight and decreased ability to clear them from the body. Decreased tidal volume and force vital capacity, asthma, Chronic obstructive pulmonary disease, increased incidence of lung cancer are the major respiratory effects of e-waste. Increased incidence of Attention deficit hyperactivity disorder, autism, cognitive decline and behavioural changes have been noted in children exposed to e-waste. Organ dysfunction and cancer of thyroid, kidney and liver along with Parkinsonism, Alzheimer disease have also been reported in excess, compared to general population.

Conclusion: E-waste will lead to devastating and heavy burden on health sector in the years to come, hence World Health Organization (WHO) has rightly emphasized the need of sensitizing and preparing the health sector. Health sector definitely can play a role by providing leadership, advocacy, engaging communities and conducting quality research. Global protocol for e-waste trade and recycling, stringent laws and their implementation for safe recycling, compliance to Basel convention and increased funding by the government and non-government organization to create more formal recycling units and doing research is the way forward to reduce the effect of e-waste in the future. WHO, United Nation and member countries should join hands and work in synergy to halt the tsunami of e-waste.






 

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