Human immunodeficiency virus (HIV) infection is a significant health concern in the United States, affecting 38 million Americans. Despite a recent decline in prevalence, social determinants of health remain an important factor driving infections, particularly among minority populations. However, the relationship between community-level economic deprivation indices and HIV infection among hospital admissions has been understudied in the literature. ObjectivesThis study investigated the association between community-level economic deprivation, measured by the Distressed Community Index (DCI), and HIV infection among hospital admissions in Washington, District of Columbia (DC). MethodsWe utilized data from the State Inpatient Database (SID) for Washington, DC, between 2016 and 2019, identifying all admissions with a history of HIV. The multivariate analysis determined the association between DCI quintiles and HIV infection among hospital admissions. Also included in the multivariate analysis were patients' age, sex, race/ethnicity, insurance type, smoking status, obesity, sexually transmitted infections (STIs), hepatitis B infections, and mental health conditions.

Introduction: Fetal macrosomia is defined as a fetal weight of more than 4kg or 4.5 kg irrespective of gestational age at delivery. The mode of delivery is usually left to the surgeon's discretion, but fetal macrosomia increases the risk of cesarean delivery among women worldwide. In addition, the role of social determinants of health such as maternal race, educational level, and insurance in managing fetal macrosomia cannot be overemphasized.Aim: To determine the interaction between maternal race, insurance, and education level and how this affects the management of fetal macrosomia in the United States.

Acute transverse myelitis (ATM) is an inflammatory disease of the spinal cord, characterized by rapid onset of bilateral neurological symptoms. The term myelitis refers to inflammation of the spinal cord, which often leads to demyelination. The clinical finding of a pattern of altered sensation is often a horizontal band-like sensation at the dermatomal level of the lesion, with sensory changes below. The symptoms usually develop over hours to days; they typically present as muscle weakness, ascending paralysis, and autonomic dysfunction. Recovery is variable, but often prolonged over many months, and can lead to a wide range of deficits. 1 Our report reviews a unique case of transverse myelitis in a patient with Lyme disease. A 27 year old male presented to the emergency department with past medical history of diabetes mellitus and hyperlipidemia with a week long history of fever to 102℉, non-productive cough, nausea, and decreased motor function and sensation in the bilateral lower extremities. Strength was intact in bilateral biceps, triceps, and wrists, but diminished in bilateral hips, knees, and ankles. Sensation to light touch was diminished from the level of T8 and below, fine touch sensation diminished from the level of T10 and below, and there was diminished proprioception in bilateral toes. There was intact pain sensation in all extremities and hyperreflexia in bilateral upper extremities. An MRI was obtrained which demonstrated cervical syrinx with expansion of the spinal cord and resultant cervical stenosis with cord compression indicating need for surgical intervention. A posterior cervical decompressive laminectomy at levels C4-C7 and posterior thoracic decompressive laminectomy at level T1 were scheduled, with a subsequent lumbar puncture. Serum findings were significant for elevated Lyme disease antibody titer (7.89) and antibody reaction to 8 borrelial proteins. After detection of Lyme disease, the patient was started on antibiotics. Over the course of the hospital stay, motor function continually improved with the aid of physical therapy. Sensation also significantly improved. Lyme disease may not always be identifiable with CSF collection from lumbar puncture, and as a result the etiology of ATM may go unknown. Guillain-Barre syndrome is a common differential which has a similar presentation. However, the treatment consists of plasmapheresis and immunoglobulin. This is an important distinction in order to to provide the appropriate treatment modalities to the patient.

INTRODUCTION: Use of electronic patient health portals (EMR-PHP) was stressed during the first year of the COVID-19 pandemic as an important vehicle for equitable access to healthcare information. Disparate use of the EMR-PHP according to race, age, ethnicity, and insurance status has been reported. Less is known about disparities associated with EMR-PHP use in pregnancy. Further, the effect of the COVID-19 pandemic on EMR-PHP utilization according to race/ ethnicity is unclear.METHODS: Institutional review board approval was obtained through Vanderbilt University Medical Center. A retrospective cohort study of patients who delivered and received prenatal care between 2018 and October 2021 was performed. Demographic and EMR-PHP activation/use data were stratified by race, ethnicity, and language. Differences in EMR-PHP registration/use in 2019 and in 2020, during the first year of the COVID-19 pandemic, were determined according to race, ethnicity, and primary language. RESULTS: In 2019-2020, an average of 4,400 patients delivered and selfidentified as: White (54%), Black (17%), Hispanic (17%), English language (EL) (80%), and Spanish language (SL) (20%). EMR-PHP registration/use increased in 2020 for all patients. EMR-PHP registration increased more in Hispanic (44% increase 2020 vs 2019) and SL (54% increase 2020 vs 2019) patients compared to White and EL patients (P,.05). Despite significant gains in 2020, Hispanic and SL patients were less likely to register/use the EMR-PHP compared to White and EL patients at the time of delivery (P,.01).CONCLUSION: Significant disparities in EMR-PHP registration and use were identified in pregnancy. The patient, provider, and digital health access factors underlying low rates of EMR-PHP use in underserved populations require further investigation.

Objectives: To determine if race/ethnicity is an independent predictor of adverse outcomes following diagnosis of primary ovarian cancer. Design: Retrospective study Setting: We utilized data from the Surveillance, Epidemiology, and End Results Program (SEER) database for this study. Population: We studied women with a primary diagnosis of Ovarian Cancer in the SEER database between January 1998 and December 2018. Method: We utilized the nearest neighbor propensity-score matching without replacement in a 1:1 ratio to compare mortality and overall survival following primary ovarian cancer diagnosis between Non-Hispanic Black (NHB) women and a control group of Non-Hispanic White (NHW) women. These women were matched for age, treatment modalities (surgery/irradiation/chemotherapy), laterality, and stage of cancer at presentation. Main Outcomes: The primary outcomes of interest were differences in mortality and survival (in months) among NHB and NHW women Results: We compared 6,801 NHB women with 27, 204 NHW women with primary ovarian cancer. Prior to propensity-score matching, NHB women had a higher mortality rate (56.7%vs.53.5%, p<0.001) and lower survival rate (40.1 vs. 48.9 months<0.001). Following propensity-score matching, there was no difference in the mortality rate between the two groups. (56.7% vs 55.7% p=0.13). However, NHB women had significantly lower survival rates (40.1vs.49.6 months, p < 0.001). Conclusion: Racial disparities in survival following treatment for ovarian cancer persist despite adjusting for age, stage of cancer, and treatment modalities. Further research is warranted to explore patient and systemic factors such as appropriate level of care and follow-up after treatment that might account for these differences.