Objective: To describe the distribution of abnormal uterine bleeding (AUB) type according to the polyp (AUB-P); adenomyosis (AUB-A); leiomyoma (AUB-L); malignancy and hyperplasia (AUB-M); coagulopathy (AUB-C); ovulatory dysfunction (AUB-O); endometrial (AUB-E); iatrogenic (AUB-I); and not yet classified International Federation of Gynecology and Obstetrics classification system in a medically underserved American inner-city population. Our secondary objective was to find an association between risk factors and type of AUB. Material and Methods: We conducted a descriptive cross-sectional analysis at our outpatient women’s health clinic located in the Bronx, New York City, from November 2016 to December 2019. Results: Among 390 patients, the most common AUB type was AUB-L (n=185, 47.4%), followed AUB-P (n=100, 25.6%), AUB-A (n=55, 14.1%), AUB-O (n=19, 4.9%), AUB-M (n=15, 3.8%), AUB-E (n=14, 3.6%) and AUB-I (n=2, 0.5%). Race was distributed as follows: Hispanic (68.2%), Black (25.9%), Caucasian (3.3%), and Asian (2.1%). Comorbidities included hypertension (36.4%), diabetes (15.6%), and thyroid disease (6.9%). The median age at diagnosis was significantly higher in AUB-M (59 years old, p<0.001), AUB-P (52.5 years old, p<0.001), AUB-E (51.5 years old, p=0.001) compared to AUB-L (46 years old). The median body mass index (BMI) was significantly higher in AUB-E (34.2 kg/m 2 , p=0.048) and AUB-O (32.6 kg/m 2 , p=0.038) compared to AUB-L (30 kg/m 2 ). Race was equally distributed among the AUB types. AUB-M (66.6%, p=0.002), AUB-E (57.1%, p=0.022), AUB-P (47%, p<0.001), and AUB-A (30.8%, p<0.001), had statistically significantly more cases of hypertension compared to AUB-L (28.1%). AUB-P (27%, p<0.001), AUB-M (26.6%, p=0.025), AUB-E (35.7%, p=0.001) and AUB-A (9%, p<0.001) had more patients with diabetes mellitus (DM) than AUB-L (3.3%). Conclusion: In an American population of medically underserved patients, the most common cause of AUB was leiomyoma and the most common race was Hispanic. Women with AUB-L were younger, with lower BMI, and with fewer cases of hypertension and DM when compared to other types of AUB.

Although the exact mechanism is unknown, incidence of drug-induced pancreatitis from corticosteroids is well established in the medical literature. Commonly reported in chronic steroid-dependent individuals who require large doses for a wide array of pathologies, the incidence of damage to the pancreas from low-doses have not been well described. We report a case of a 68-year-old woman who presented with severe abdominal pain, nausea and vomiting, 3 days after the initiation of low-dose methylprednisolone for osteoarthritis. Inpatient laboratory analysis revealed an elevated lipase of 1770 U/L and CT scan showing extensive necrotising pancreatitis involving the head, body and tail. Cessation of the causative medication and conservative treatment successfully led to resolution of symptoms. We present this case to inform clinicians of the precipitance of pancreatitis from modest strength corticosteroid management, so that more accurate and improved performance in pharmacological decisions can be made for patient care.

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The coronavirus disease 2019 (COVID-19) pandemic is a serious public health emergency with limited information to guide obstetrical management. As of April 22, 2020, New York City has documented 10,290 deaths, of which 2272 belong to the Bronx, the third largest borough affected. 1 It has disproportionately affected the high-risk patient population. The South Bronx is a vulnerable population area, composed mostly of Hispanics (57%) and African Americans (39%), with a median household income below the eighth percentile. 2 Lower socioeconomic status predisposes many to a plethora of comorbidities such as diabetes, hypertension, asthma, and obesity. In this research letter, we outline the clinical course of 33 pregnant patients from a South Bronx community hospital with symptomatic COVID-19 infection, 81.8% of which have underlying medical conditions.

West Nile Virus (WNV), an RNA arbovirus and member of the Japanese encephalitis virus antigenic complex, causes a wide range of clinical symptoms, from asymptomatic to encephalitis and meningitis. Nearly all human infections of WNV are due to mosquito bites with birds being the primary amplifying hosts. Advanced age is the most important risk factor for neurological disease leading most often to poor prognosis in those afflicted. We report a case of WNV meningoencephalitis in a 93-year-old Caucasian male who presented with fever of unknown origin (FUO) and nuchal rigidity that rapidly decompensated within 24 h to a persistent altered mental state during inpatient stay. The patient's ELISA antibody titers confirmed pathogenesis of disease by WNV; he given supportive measures and advanced to an excellent recovery. In regard to the approach of FUO, it is important to remain impartial yet insightful to all elements when determining pathogenesis in atypical presentation.

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