Smith S.W.,New York University |
Smith S.W.,New York City Poison Control Center |
Smith S.W.,Bellevue Hospital Center
Journal of Medical Toxicology | Year: 2013
These proceedings will review the role of chelation in five metals-aluminum, cadmium, chromium, cobalt, and uranium-in order to illustrate various chelation concepts. The process of "chelation" can often be oversimplified, leading to incorrect assumptions and risking patient harm. For chelation to be effective, two critical assumptions must be fulfilled: the presumed "metal toxicity" must correlate with a given body or a particular compartment burden, and reducing this compartmental or the body burden (through chelation) attenuates toxicity. Fulfilling these assumptions requires an established dose-response relationship, a validated, reproducible means of toxicity assessment (clinical, biochemical, or radiographical), and an appropriate assessment mechanisms of body or compartment burden. While a metal might "technically" be capable of chelation (and readily demonstrable in urine or feces), this is an insufficient endpoint. Clinical relevance must be affirmed. Deferoxamine is an accepted chelator for appropriately documented aluminum toxicity. There is a very minimal treatment window in order to address chelation in cadmium toxicity. In acute toxicity, while no definitive chelation benefit is described, succimer (DMSA), diethylenetriaminepentaacetate (DTPA), and potentially ethylenediaminetetraacetic acid (EDTA) have been considered. In chronic toxicity, chelation is unsupported. There is little evidence to suggest that currently available chromium chelators are efficacious. Similarly, scant human evidence exists with which to provide recommendation for cobalt chelation. DTPA has been recommended for cobalt radionuclide chelation, although DMSA, EDTA, and N-acetylcysteine have also been suggested. DTPA is unsupported for uranium chelation. Sodium bicarbonate is currently recommended, although animal evidence is conflicting. © 2013 American College of Medical Toxicology.
Ross S.,Bellevue Hospital Center |
Ross S.,New York University |
Peselow E.,New York University
Clinical Neuropharmacology | Year: 2012
Psychosis and substance abuse are intimately related. Psychotic spectrum illnesses commonly co-occur with substance use disorders (SUDs), and many substances of abuse can cause or exacerbate psychotic symptoms along a temporal spectrum from acute to chronic presentations. Despite the common co-occurrence between psychotic spectrum illnesses and SUDs, they are often under-recognized and undertreated, leading to poor treatment outcomes. Accurate detection and diagnosis of individuals with psychotic illness co-occurring with addictive disorders is key to properly treat such disorders. This article will review the nature of the relationship between psychosis and substance abuse by examining prevalence rates of each disorder alone and their rates of co-occurrence, the neurobiological basis for substance abuse comorbidity in schizophrenia spectrum disorders, key and salient aspects related to accurate diagnosis along a continuum from acute to subacute to chronic conditions, and pitfalls associated with diagnostic dilemmas. A case example will be used to highlight key points related to diagnostic challenges Copyright © 2012 by Lippincott Williams & Wilkins.
Shannon E.J.,Louisiana State University |
Sanchez M.R.,New York University |
Levis W.R.,Bellevue Hospital Center
Journal of Drugs in Dermatology | Year: 2010
Thalidomide and analogues are a class of immunomodulatory drugs or IMiDS. Thalidomide was initially approved by the U.S. Food and Drug Administation for treatment of erythema nodosum in leprosy and is now approved for multiple myeloma as well. A second generation IMiD, lenalidomide, is also approved for multiple myeloma and refractory myelodysplastic syndrome. Discovery of this class of drugs has been serendipitous and empirical, as the drug targets have been unknown. In this review, the authors integrate recent identification of drug targets of IMiDS, which include the inducible form of nitric oxide synthase (iNOS), Rho GTPase and caspase-1, with the developments in the understanding of the molecular biology of human inflammatory, infectious and neoplastic skin disorders. Because thalidomide reemerged through leprosy, the original disease classified by the T cell, the authors have also emphasized advances in the understanding of T-cell subsets in human skin disorders. Copyright © 2010 Journal of Drugs in Dermatology.
Coughlin F.X.,Bellevue Hospital Center
Social Medicine | Year: 2014
This paper describes the creation and implementation of a global health service-learning elective based on the ideals of social medicine. The elective was supported by the Brown Alpert Medical School and Rhode Island Hospital. It was designed for fourth-year medical students and internal medicine residents during the winter of 2012, based in Santiago, Dominican Republic. The aim of the course was to create a structured global health elective with principles based in social medicine and social justice. Following a service-learning paradigm, one half of the course was a clinical experience, centered in a large, urban teaching hospital, a primary care clinic, and a rural health promotion program. The other half of the course was a structured compilation of assigned readings, lectures, films, field visits, and reflection sessions that placed the clinical experiences into a national and international context. The course analyzed systemic causes of poverty as well as the role of structural violence in creating poor health. Finally, using Rudolf Virchow’s call for physicians to be the “natural attorneys of the poor” as a foundation, we explored the role of the physician- advocate in terms of social justice and solidarity with the poor. © 2014 Albert Einstein College of Medicine. All rights reserved.
Aggarwal N.K.,New York State Psychiatric Institute |
Aggarwal N.K.,Columbia University |
Ford E.,Bellevue Hospital Center
Behavioral Sciences and the Law | Year: 2013
Neuroethics and neurolaw are fields of study that involve the interface of neuroscience with clinical and legal decision-making. The past two decades have seen increasing attention being paid to both fields, in large part because of the advances in neuroimaging techniques and improved ability to visualize and measure brain structure and function. Traumatic brain injury (TBI), along with its acute and chronic sequelae, has emerged as a focus of neuroethical issues, such as informed consent for treatment and research, diagnostic and prognostic uncertainties, and the subjectivity of interpretation of data. The law has also more frequently considered TBI in criminal settings for exculpation, mitigation and sentencing purposes and in tort and administrative law for personal injury, disability and worker's compensation cases. This article provides an overview of these topics with an emphasis on the current challenges that the neuroscience of TBI faces in the medicolegal arena. © 2013 John Wiley & Sons, Ltd.