Digital Commons Network^™

Dilemma Of Thrombolysis In A Patient With High-Risk Pulmonary Embolism With Severe Thrombocytopenia: A Case Report, Phool Iqbal, Mhd Baraa Habib, Ahmed Hatim, Mohammed Alkhatib, Muhammad Abu Bakar, Sunil Hassan Koya, Awni Alshurafa, Habib Ur Rehman

NYMC Faculty Publications

BACKGROUND: Managing a high-risk pulmonary embolism (PE) in a critically ill patient with severe thrombocytopenia can present a challenging dilemma. There is a high risk of fatal bleeding due to anticoagulation in high-risk PE with thrombocytopenia; therefore, risks and benefits are balanced while dealing with such a critical scenario. CASE REPORT: We present a case of a female patient with thrombocytopenia who was admitted for management of lymphoma. Her hospital course was complicated by high-risk PE, leading to acute respiratory failure and hypotension, necessitating urgent transfer to the medical intensive care unit. She was intubated and placed on mechanical ventilation. …

Food-Borne Chemical Carcinogens And The Evidence For Human Cancer Risk, Tetyana Kobets, Benjamin P C Smith, Gary M Williams

NYMC Faculty Publications

Commonly consumed foods and beverages can contain chemicals with reported carcinogenic activity in rodent models. Moreover, exposures to some of these substances have been associated with increased cancer risks in humans. Food-borne carcinogens span a range of chemical classes and can arise from natural or anthropogenic sources, as well as form endogenously. Important considerations include the mechanism(s) of action (MoA), their relevance to human biology, and the level of exposure in diet. The MoAs of carcinogens have been classified as either DNA-reactive (genotoxic), involving covalent reaction with nuclear DNA, or epigenetic, involving molecular and cellular effects other than DNA reactivity. …

Acrylonitrile Induction Of Rodent Neoplasia: Potential Mechanism Of Action And Relevance To Humans, Tetyana Kobets, Michael J. Iatropoulos, Gary M. Williams

NYMC Faculty Publications

Acrylonitrile, an industrial chemical, is a multisite carcinogen in rats and mice, producing tumors in four tissues with barrier function, that is, brain, forestomach, Zymbal’s gland, and Harderian gland. To assess mechanism(s) of action (MoA) for induction of neoplasia and to evaluate whether the findings in rodents are indicative of human hazard, data on the potential key effects produced by acrylonitrile in the four rodent target tissues of carcinogenicity were evaluated. A notable finding was depletion of glutathione in various organs, including two target tissues, the brain, and forestomach, suggesting that this effect could be a critical initiating event. An …

Mind-Body Interventions To Reduce Coronavirus Pandemic Stress And Support Long-Term Recovery, Patricia L. Gerbarg, Richard P. Brown

NYMC Faculty Publications

The COVID-19 pandemic is causing global stress, trauma and mental illness that has already outpaced current healthcare resources. Inequalities in the burden of illness, death, and economic loss are exacerbated by inequalities in the provision of mental health care. Minority populations and indigenous peoples bear the brunt of both inequities. Ancient healing systems, such as Yoga, Qigong, and tribal practices, are a rich source of group healing methods that can be studied and optimized for prevention and recovery during current and future disasters. Modern research is shedding light on a myriad of mechanisms that underly the healing properties of voluntarily …

Bioethics And Covid-19: The Tension Of Quarantine And Civil Liberties, Jeffrey H. Dobken

NYMC Faculty Publications

The COVID-19 public health response is based on law and concepts developed to address an act of
bioterrorism. In the absence of a specific treatment or vaccine for an identified patient with COVID-19 this is fundamentally a statistical approach to preserve the general healthy population rather than address the needs of the individual patient.

A Core Genome Approach That Enables Prospective And Dynamic Monitoring Of Infectious Outbreaks, Helen Van Aggelen, John T. Fallon, Weihua Huang, Guiqing Wang, Brian D. Gross

NYMC Faculty Publications

Whole-genome sequencing is increasingly adopted in clinical settings to identify pathogen transmissions, though largely as a retrospective tool. Prospective monitoring, in which samples are continuously added and compared to previous samples, can generate more actionable information. To enable prospective pathogen comparison, genomic relatedness metrics based on single-nucleotide differences must be consistent across time, efficient to compute and reliable for a large variety of samples. The choice of genomic regions to compare, i.e., the core genome, is critical to obtain a good metric. We propose a novel core genome method that selects conserved sequences in the reference genome by comparing its …

Breath Practices For Survivor And Caregiver Stress, Depression, And Post- Traumatic Stress Disorder: Connection, Co-Regulation, Compassion, Patricia L. Gerbarg, Richard P. Brown, Chris C. Streeter, Martin Katzman, Monica Vermani

NYMC Faculty Publications

Does compassion itself benefit the healing process or does the activation of neurophysiological processes, from which the experience of compassion arises, trigger a cascade of physical and psychological changes that support health and well-being? Exploration of the neurological substrates of compassion reveals multiple healing pathways that can be activated by mind-body practices. Furthermore, these pathways affect physical health, emotion regulation, and how we perceive and relate to others.

Physiological states affect the capacity for empathy, compassion and understanding. A state of calm alertness based on sympatho-vagal balance may support such high-level prosocial functions. Evidence suggests that polyvagal-informed mind-body practices, particularly …

A New Guideline For Diagnosis And Treatment Of Syncope In Children And Adolescents That Stimulates Further Thought And Discussion, Julian M. Stewart

NYMC Faculty Publications

No abstract provided.

Recent Updates In Cancer Immunotherapy: A Comprehensive Review And Perspective Of The 2018 China Cancer Immunotherapy Workshop In Beijing, Zihai Li, Wenru Song, Mark Rubinstein, Delong Liu

NYMC Faculty Publications

The immune system is the hard-wired host defense mechanism against pathogens as well as cancer. Five years ago, we pondered the question if the era of cancer immunotherapy was upon us (Li et al., Exp Hem Oncol 2013). Exciting progresses have been made at all fronts since then, including (1) sweeping approval of six agents by the US Food and Drug Administration (FDA) to block the PD-1/PD-L1 pathway for treatment of 13 cancer types; (2) a paradigm shifting indication of PD-1 and CTLA4 blockers for the management of a broad class of cancers with DNA mismatch repair defect, the first-ever …

Physician-Assisted Suicide (Pas)/Physician-Assisted Death (Pad): The Rise Of Lifeboat Ethics, Jeffrey H. Dobken

NYMC Faculty Publications

No abstract provided.

Intraoperative Blood Loss During Induced Abortion: A Comparison Of Anesthetics, Camille A. Clare, Gabrielle E. Hatton, Neela Shrestha, Michael Girshin, Andre Broumas, Danielle Carmel, Mario A. Inchiosa Jr.

NYMC Faculty Publications

Objective: To determine whether there is a difference in intraoperative bleeding with inhalational versus noninhalational anesthetic agents for patients undergoing suction dilatation and curettage for first-trimester induced abortion. Methods: This is an IRB-approved retrospective chart review of the electronic medical records of patients undergoing induced abortion at gestational ages between 5 0/7 and 14 0/7 weeks of pregnancy at the New York City Health + Hospitals/Metropolitan. The records of 138 patients who underwent suction dilatation and curettage for induced abortion between June 2012 and June 2014 were reviewed for an association between anesthetic technique and intraoperative hemorrhage. Twenty patients received …

A 54-Year-Old Woman With Myelofibrosis And Massive Hemothorax Due To Primary Extramedullary Hematopoiesis Of The Pleura, Michael Karass, Katherine Linder, Anup Agarwal, Alexandra Budhai, Yasmin Yusuf, Oleg Epelbaum

NYMC Faculty Publications

No abstract provided.

Effects Of Novel Calpain Inhibitors In Transgenic Animal Model Of Parkinson's Disease/Dementia With Lewy Bodies, Getaw Hassen, Leo Kesner, Alfred Stracher, Abraham Shulman, Edward Rockenstein, Michael Mante, Eliezer Masliah

NYMC Faculty Publications

Parkinson's disease (PD) and dementia with Lewy bodies (DLB) are neurodegenerative disorders of the aging population characterized by the accumulation of alpha-synuclein (alpha-syn). The mechanisms triggering alpha-syn toxicity are not completely understood, however, c-terminus truncation of alpha-syn by proteases such as calpain may have a role. Therefore, inhibition of calpain may be of value. The main objective of this study was to evaluate the effects of systemically administered novel low molecular weight calpain inhibitors on alpha-syn pathology in a transgenic mouse model. For this purpose, non-tg and alpha-syn tg mice received the calpain inhibitors - Gabadur, Neurodur or a vehicle, …

Decreasing Mortality And Hospitalizations With Rising Costs Related To Gastric Cancer In The Usa: An Epidemiological Perspective, Delong Liu, Dhruv Mehta, Supreet Kaur, Arun Kumar, Kaushal Parikh, Lavneet Chawla, Aparna Saha

NYMC Faculty Publications

BACKGROUND: There is no convincing data on the trends of hospitalizations, mortality, cost, and demographic variations associated with inpatient admissions for gastric cancer in the USA. The aim of this study was to use a national database of US hospitals to evaluate the trends associated with gastric cancer. METHODS: We analyzed the National Inpatient Sample (NIS) database for all patients in whom gastric cancer (ICD-9 code: 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9) was the principal discharge diagnosis during the period, 2003-2014. The NIS is the largest publicly available all-payer inpatient care database in the US. It contains …

Controversies About Lyme Disease-Reply, Eugene D. Shapiro, Gary P. Wormser

NYMC Faculty Publications

No abstract provided.

Evolution And Mutations Predisposing To Daptomycin Resistance In Vancomycin-Resistant Enterococcus Faecium St736 Strains, Guiqing Wang, Weihua Huang, Abhay Dhand, Changhong Yin, Marisa Montecalvo, Nevenka Dimitrova, John T. Fallon

NYMC Faculty Publications

We recently identified a novel vancomycin-resistant Enterococcus faecium (VREfm) clone ST736 with reduced daptomycin susceptibility. The objectives of this study were to assess the population dynamics of local VREfm strains and genetic alterations predisposing to daptomycin resistance in VREfm ST736 strains. Multilocus sequence typing and single nucleotide variant data were derived from whole-genome sequencing of 250 E. faecium isolates from 1994-1995 (n = 43), 2009-2012 (n = 115) and 2013 (n = 92). A remarkable change was noticed in the clonality and antimicrobial resistance profiles of E. faecium strains between 1994-1995 and 2013. VREfm sequence type 17 (ST17), the prototype …

Regional Tissue Oxygen Extraction And Severity Of Anemia In Very Low Birth Weight Neonates: A Pilot Nirs Analysis, Jonathan Mintzer, Boriana Parvez, Edmund F. La Gamma

NYMC Faculty Publications

Objective: Anemia causes blood flow redistribution and altered tissue metabolic behavior to sustain homeostatic oxygen consumption. We hypothesized that anemia severity would correlate with increased regional fractional tissue oxygen extraction among premature neonates.

Study Design: Regional oxygen extraction was calculated using pulse oximetry and near-infrared spectroscopy data among neonates

Results: Twenty-seven neonates with gestational age 27 ± 2 weeks and birth weight 966 ± 181 g underwent 116 hematocrit determinations. Cerebral and flank oxygen extraction inversely correlated with hematocrit (cerebral r = −0.527, p = 0.005; flank r = −0.485, p = 0.01). Increased cerebral oxygen extraction was observed for …

Low Risk Monitoring In Neurocritical Care, Christian D. Becker, Christian Bowers, Dipak Chandy, Chad Cole, Meic H. Schmidt, Corey Scurlock

NYMC Faculty Publications

Background/Rationale: Patients are admitted to Intensive care units (ICUs) either because they need close monitoring despite a low risk of hospital mortality (LRM group) or to receive ICU specific active treatments (AT group). The characteristics and differential outcomes of LRM patients vs. AT patients in Neurocritical Care Units are poorly understood. Methods: We classified 1,702 patients admitted to our tertiary and quaternary care center Neuroscience-ICU in 2016 and 2017 into LRM vs. AT groups. We compared demographics, admission diagnosis, goal of care status, readmission rates and managing attending specialty extracted from the medical record between groups. Acute Physiology, Age and …

The Prevalence And Volumetry Of Pituitary Cysts In Children With Growth Hormone Deficiency And Idiopathic Short Stature, Nicholas Krasnow, Bradley Pogostin, James Haigney, Brittany Groh, Winston Weiler, Michael Tenner, Marion Kessler, Michael Frey, Richard A. Noto

NYMC Faculty Publications

Background

Pituitary cysts have been speculated to cause endocrinopathies. We sought to describe the prevalence and volumetry of pituitary cysts in patients with growth hormone deficiency (GHD) and idiopathic short stature (ISS).

Methods

Six hundred and eighteen children evaluated for growth failure at the Division of Pediatric Endocrinology at New York Medical College between the years 2002 and 2012, who underwent GH stimulation testing and had a brain magnetic resonance imaging (MRI) prior to initiating GH treatment were randomly selected to be a part of this study. High resolution MRI was used to evaluate the pituitary gland for size and …

Global, Regional, And National Disability-Adjusted Life-Years (Dalys) For 359 Diseases And Injuries And Healthy Life Expectancy (Hale) For 195 Countries And Territories, 1990–2017: A Systematic Analysis For The Global Burden Of Disease Study 2017, Hmwe Hmwe Kyu, Degu Abate, Kalkidan Hassen Abate, Solomon M. Abay, Cristiana Abbafati, Mohammad Tavakkoli, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Gbd 2017 Dalys And Hale Collaborators

NYMC Faculty Publications

BACKGROUND: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for …

The Basics Of Clinical Trial Centralized Monitoring, Adam Beauregard, Vadim Tantsyura, Fernand Labrie

NYMC Faculty Publications

No abstract provided.

Multistate Infestation With The Exotic Disease-Vector Tick Haemaphysalis Longicornis - United States, August 2017-September 2018, C. B. Beard, James Occi, Denise L. Bonilla, Andrea M. Egizi, Dina M. Fonseca, Gary P. Wormser, William Halperin

NYMC Faculty Publications

Haemaphysalis longicornis is a tick indigenous to eastern Asia and an important vector of human and animal disease agents, resulting in such outcomes as human hemorrhagic fever and reduction of production in dairy cattle by 25%. H. longicornis was discovered on a sheep in New Jersey in August 2017 (1). This was the first detection in the United States outside of quarantine. In the spring of 2018, the tick was again detected at the index site, and later, in other counties in New Jersey, in seven other states in the eastern United States, and in Arkansas. The hosts included six …

Concussion Knowledge Among Family Physicians In Croatia, Mark Herceg, Linda L. Kalcina, Ivo Lusic

NYMC Faculty Publications

Aim: The objective of this study was to administer and analyze results of a survey targeting knowledge about concussion symptoms, diagnosis, treatment and expected recovery among family medicine specialists in the Split-Dalmatia County of Croatia. Methods: An electronic survey questionnaire was developed utilizing concepts from previously published studies on concussion knowledge, attitudes and beliefs completed by physicians. The survey was intended to briefly and broadly assess concussion knowledge of Croatian healthcare providers. The first section of the survey included five questions clarifying professional practice, years of experience and experience with concussions; the second section included 15 questions about typical concussion …

Development Of A Return To Work Tool For Primary Care Providers For Patients With Low Back Pain: A Pilot Study, Lisanne Cruz, Hasanat A. Alamgir, Parag Sheth, Ismail Nabeel

NYMC Faculty Publications

Context: Low back pain (LBP) is a common cause of disability in adults and primary care physicians (PCPs) are commonly the first medical practitioners to assess these patients. Despite this, PCPs often feel unprepared to make return to work (RTW) recommendations. Aims: The purpose of our project was to develop RTW guidelines for patients with LBP in the form of an accessible and adaptable electronic medical records (EMR) integrated tool. Settings and Design: All licensed physicians and physician extenders who see patients over the age of 18 years, presenting with acute LBP who are currently employed were eligible for participation. …

A Reversible Carnitine Palmitoyltransferase (Cpt1) Inhibitor Offsets Chronic Lymphocytic Leukemia Cell Proliferation, Elena Gugiatti, Claudya Tenca, Silvia Ravera, Marina Fabbi, Fabio Ghiotto, Zbigniew Darzynkiewicz, Silvia Bruno

NYMC Faculty Publications

No abstract provided.

Zinc Enhances Hippocampal Long-Term Potentiation At Ca1 Synapses Through Nr2b Containing Nmda Receptors, John Sullivan, Xiao-Lei Zhang, Arthur P. Sullivan, Linnea R. Vose, Alexander A. Moghadam, Victor A. Fried, Patric K. Stanton

NYMC Faculty Publications

The role of zinc (Zn2+), a modulator of N-methyl-D-aspartate (NMDA) receptors, in regulating long-term synaptic plasticity at hippocampal CA1 synapses is poorly understood. The effects of exogenous application of Zn2+ and of chelation of endogenous Zn2+ were examined on long-term potentiation (LTP) of stimulus-evoked synaptic transmission at Schaffer collateral (SCH) synapses in field CA1 of mouse hippocampal slices using whole-cell patch clamp and field recordings. Low micromolar concentrations of exogenous Zn2+ enhanced the induction of LTP, and this effect required activation of NMDA receptors containing NR2B subunits. Zn2+ elicited a selective increase in NMDA/NR2B fEPSPs, and removal of endogenous Zn2+ …

Home Return Following Invasive Mechanical Ventilation For The Oldest-Old Patients In Medical Intensive Care Units From Two Us Hospitals, Puthiery Va, Parth Rali, Harshitha Kota, Vivian Keenan, Sobia Mujtaba, Win Naing, Reka Salgunan, Irene Galperin, Oleg Epelbaum

NYMC Faculty Publications

Background: The aging of the US population has been associated with an increase in intensive care unit (ICU) utilization and correspondingly, invasive mechanical ventilation (IMV) among the oldest-old (age >/=80 years). While previous studies have examined ICU and IMV outcomes in the elderly, very few have focused on patient-centered outcomes, specifically home return, in the oldest-old. We investigated the rate of immediate home return following IMV in the medical ICU in previously home-dwelling oldest-old patients relative to that of a comparison group of 50-70-year olds. Methods: Data were extracted retrospectively from patient records at Elmhurst Hospital Center in Elmhurst, NY, …

Nrh:Quinone Oxidoreductase 2 (Nqo2) And Glutaminase (Gls) Both Play A Role In Large Extracellular Vesicles (Lev) Formation In Preclinical Lncap-C4-2b Prostate Cancer Model Of Progressive Metastasis, Thambi Dorai, Ankeeta Shah, Faith Summers, Rajamma Mathew, Jing Huang, Tze-Chen Hsieh, Joseph M. Wu

NYMC Faculty Publications

In the course of studies aimed at the role of oxidative stress in the development of metastatic potential in the LNCaP-C4-2B prostate cancer progression model system, we found a relative decrease in the level of expression of the cytoplasmic nicotinamide riboside: quinone oxidoreductase (NQO2) and an increase in the oxidative stress in C4-2B cells compared to that in LNCaP or its derivatives C4 and C4-2. It was also found that C4-2B cells specifically shed large extracellular vesicles (LEVs) suggesting that these LEVs and their cargo could participate in the establishment of the osseous metastases. The level of expression of caveolin-1 …

Development And Utilization Of 3d Printed Material For Thoracotomy Simulation, Evan Yates, Roger Chirurgi, Frosso Adamakos, Rania Habal, Rajnish Jaiswal, Hossein Kalantari, Getaw W. Hassen

NYMC Faculty Publications

Medical simulation is a widely used training modality that is particularly useful for procedures that are technically difficult or rare. The use of simulations for educational purposes has increased dramatically over the years, with most emergency medicine (EM) programs primarily using mannequin-based simulations to teach medical students and residents. As an alternative to using mannequin, we built a 3D printed models for practicing invasive procedures. Repeated simulations may help further increase comfort levels in performing an emergency department (ED) thoracotomy in particular, and perhaps this can be extrapolated to all invasive procedures. Using this model, a simulation training conducted with …

Regeneration Of Neurotransmission Transcriptome In A Model Of Epileptic Encephalopathy After Antiinflammatory Treatment, Dumitru Iacobas, Libor Velisek

NYMC Faculty Publications

Inflammation is an established etiopathogenesis factor of infantile spasms (IS), a therapy-resistant epileptic syndrome of infancy. We investigated the IS-associated transcriptomic alterations of neurotransmission in rat hypothalamic arcuate nucleus, how they are corrected by antiinflamatory treatments and whether there are sex differences. IS was triggered by repeated intraperitoneal administration of N-methyl-D-aspartic acid following anti-inflammatory treatment (adreno-cortico-tropic-hormone (ACTH) or PMX53) or normal saline vehicle to prenatally exposed to betamethasone young rats. We found that treatments with both ACTH and PMX53 resulted in substantial recovery of the genomic fabrics of all types of synaptic transmission altered by IS. While ACTH represents the …