Medicine and Health Sciences Commons^™

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.

It's Getting Hot In Here: A Rare Case Of Heat Stroke In A Young Male., Oriana Ramirez, Yury Malyshev, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Heat stroke is a severe acute illness characterized by a core temperature greater than 40°C (104°F) and central nervous system manifestations, such as delirium, convulsions, or coma, resulting from exposure to environmental heat or strenuous physical activity. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications, such as cardiac arrest, rhabdomyolysis and acute renal failure, are essential to reduce morbidity and mortality. Herein we describe a case of heat stroke in a 23-year-old male who suffered cardiac arrest in which prompt initiation of cooling measures prevented permanent neurological sequelae, provided swift neurological recovery and resolution of …

Impact Of Individual Traits, Saturated Fat, And Protein Source On The Gut Microbiome., Jennifer M Lang, Calvin Pan, Rita M Cantor, W H Wilson Tang, Jose Carlos Garcia-Garcia, Ira Kurtz, Stanley L Hazen, Nathalie Bergeron, Ronald M Krauss, Aldons J Lusis

Faculty Publications & Research of the TUC College of Pharmacy

Interindividual variation in the composition of the human gut microbiome was examined in relation to demographic and anthropometric traits, and to changes in dietary saturated fat intake and protein source. One hundred nine healthy men and women aged 21 to 65, with BMIs of 18 to 36, were randomized, after a two-week baseline diet, to high (15% total energy [E])- or low (7%E)-saturated-fat groups and randomly received three diets (four weeks each) in which the protein source (25%E) was mainly red meat (beef, pork) (12%E), white meat (chicken, turkey) (12%E), and nonmeat sources (nuts, beans, soy) (16%E). Taxonomic characterization using …

Change In Brain Volume And Cortical Thickness After Behavioral And Surgical Weight Loss Intervention, Cara Bohon, Allan Geliebter

Lander College of Arts and Sciences Publications and Research

Obesity is associated with reduced cortical thickness and brain volume, which may be related to poor nutrition. Given that brain atrophy in anorexia nervosa recovers with nutritional improvements and weight gain, it is worth examining how brain structure changes at the other end of the weight spectrum with weight loss. Thus, this study aimed to examine change in cortical thickness and brain volume in 47 patients with severe obesity who participated in no treatment, behavioral weight loss, or bariatric surgery. T1-weighted MRI scans were conducted pre-treatment and approximately four months later. Measures of cortical thickness, gray matter volume, and white …

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.

"Planting The Seed": Perceived Benefits Of And Strategies For Discussing Long-Term Prognosis With Older Adults, Jayaji More, Sean Lang-Brown, Rafael D. Romo, Sei J. Lee, Rebecca Sudore, Alexander K. Smith

NYMC Student Publications

OBJECTIVES: To characterize the goals and approaches of clinicians with experience discussing long-term prognostic information with older adults. DESIGN: We used a semistructured interview guide containing 2 domains of perceived benefits and strategies to explore why and how clinicians choose to discuss long-term prognosis, defined as life expectancy on the scale of years, with patients. SETTING: Clinicians from home-based primary care practices, community-based clinics, and academic medical centers across San Francisco. PARTICIPANTS: Fourteen physicians, including 11 geriatricians and 1 geriatric nurse practitioner, with a mean age of 40 and a mean 9 years in practice. MEASUREMENTS: Clinician responses were analyzed …

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 …

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 …

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, …

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 …

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.

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

NYMC Faculty Publications

No abstract provided.

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 …

Financial Incentives For Smoking Treatment: Protocol Of The Fiesta Trial And Fiesta Oral Microbiome Substudy, Katherine M French, Sasha Z Gonzalez, Scott E Sherman, Alissa R Link, Sadozai Zoe Malik, Chi-Hong Tseng, Saahil A Jumkhawala, Briesny Tejada, Andrew White, Joseph A Ladapo

NYMC Student Publications

BACKGROUND: Smoking is the leading preventable cause of death in the United States, but evidence-based smoking cessation therapy is underutilized. Financial incentive strategies represent an innovative approach for increasing the use of counseling and pharmacotherapy. If effective, they could supplement or supplant resource-intensive policy options, particularly in populations for whom smoking has substantial societal costs. FIESTA (Financial IncEntives for Smoking TreAtment) will randomize hospitalized smokers to receive usual smoking cessation care alone or usual smoking care augmented with financial incentives. We aim to compare the impact of these two strategies on 1) smoking abstinence, 2) use of counseling and nicotine …

The Phylogenetic Signal In Tooth Wear: What Does It Mean?, Larisa Desantis, Mikael Fortelius, Frederick E Grine, Christine Janis, Thomas M Kaiser, Gildas Merceron, Mark A Purnell, Ellen Schulz-Kornas, Juha Saarinen, Mark F. Teaford, Peter S Ungar, Indrė Žliobaitė

Faculty Publications & Research of the TUC College of Osteopathic Medicine

A new study by Fraser et al (2018) urges the use of phylogenetic comparative methods, whenever possible, in analyses of mammalian tooth wear. We are concerned about this for two reasons. First, this recommendation may mislead the research community into thinking that phylogenetic signal is an artifact of some sort rather than a fundamental outcome of the evolutionary process. Secondly, this recommendation may set a precedent for editors and reviewers to enforce phylogenetic adjustment where it may unnecessarily weaken or even directionally alter the results, shifting the emphasis of analysis from common patterns manifested by large clades to rare cases.

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+ …

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 …

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. …

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 …

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.

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 …

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, …

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 …

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 …

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 …

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

NYMC Faculty Publications

No abstract provided.

Characteristics Of Adolescents Living With Hiv Receiving Care And Treatment Services In Antiretroviral Therapy Clinics In Cambodia: Descriptive Findings From A Cross-Sectional Study., Siyan Yi, Sovannary Tuot, Khuondyla Pal, Vohith Khol, Say Sok, Pheak Chhoun, Laura Ferguson, Gitau Mburu

BACKGROUND: Adolescents living with HIV experience worse HIV care outcomes compared to adults, especially during transition from pediatric to adult care. However, data regarding adolescents are limited. This paper describes and compares characteristics of male and female adolescents living with HIV preparing for transition from pediatric to adult care in Cambodia.

METHODS: This cross-sectional study was conducted in August 2016 among 328 adolescents aged 15-17, randomly selected from 11 antiretroviral therapy (ART) clinics. Data were collected using a structured questionnaire, and descriptive analyses were conducted to compare characteristics of male and female adolescents.

RESULTS: Of total, 55.2% were male, and …

Association Of Non-Alcoholic Fatty Liver Disease With Cardiovascular Disease And Subclinical Atherosclerosis, Rahul Sao, Wilbert S. Aronow

NYMC Faculty Publications

Non-alcoholic fatty liver disease (NAFLD) refers to fatty infiltration of liver in the absence of significant alcohol intake, use of steatogenic medication, or hereditary disorders. It is a common cause of chronic liver disease with a worldwide estimated prevalence ranging from 6.3% to 33%. The NAFLD is considered a hepatic manifestation of the metabolic syndrome. Insulin resistance and increased oxidative stress are central to pathogenesis of NAFLD, and risk factors include metabolic syndrome, diabetes mellitus, obesity, lack of physical activity, smoking, and high fat diet. NAFLD is associated with higher mortality as compared to the general population with cardiovascular disease …