Bronx Lebanon Hospital
Bronx Lebanon Hospital
Garlich F.M.,Poison and Drug Information Service |
Garlich F.M.,University of Calgary |
Balakrishnan K.,Bronx Lebanon Hospital |
Shah S.K.,University of Rochester |
And 4 more authors.
Clinical Toxicology | Year: 2014
Context. Donepezil is a centrally-acting, reversible acetylcholinesterase inhibitor that is used in the treatment of Alzheimer disease. Altered mental status, nausea, vomiting, and bradycardia have been reported in therapeutic and supratherapeutic ingestions of donepezil, though pediatric exposures have not been well-described. We report a case of prolonged altered mental status and recurrent bradycardia in a child with a single-pill ingestion of donepezil. Case details. A 14-month-old boy was brought to the Emergency Department 3 hours after ingesting one of his grandfather's donepezil tablets (10mg). Upon arrival, he was somnolent and drooling, with multiple episodes of vomiting and diarrhea. Pupils were normal. Initial vitals: temperature, 36.8°C; blood pressure, 103/56 mmHg; heart rate, 140/min; respiratory rate, 36/min; oxygen saturation, 97%. His drooling, vomiting, and diarrhea resolved, but he remained intermittently agitated. Over the course of the following four days, he had intermittent, episodes of asymptomatic bradycardia to a low of 55/min, primarily when sleeping. A transient episode of junctional rhythm was observed. Serum donepezil level 97 hours post-ingestion was 10 ng/ml. He did not require atropine treatment, and was discharged in stable condition on hospital day 5. Discussion. Donepezil has a prolonged elimination of half-life in adults of approximately 70 hours. Despite its relative specificity for central AChEs, peripheral cholinergic symptoms have been described. We report a case of a symptomatic ingestion of donepezil in a child. Conclusions. Even after a single-tablet ingestion, donepezil may cause prolonged altered mental status and bradycardia in young children. © 2014 Informa Healthcare USA, Inc.
Cohen O.,Sheba Medical Center |
Filetti S.,University of Rome La Sapienza |
Castaneda J.,Medtronic |
Maranghi M.,University of Rome La Sapienza |
And 2 more authors.
Diabetes Care | Year: 2016
Treatment with insulin, alone or with oral or injectable hypoglycemic agents, is becoming increasingly common in patients with type 2 diabetes. However, approximately 40% of patients fail to reach their glycemic targets with the initially prescribed regimen and require intensification of insulin therapy, which increases the risks of weight gain and hypoglycemia. Many of these patients eventually reach a state in which further increases in the insulin dosage fail to improve glycemic control while increasing the risks of weight gain and hypoglycemia. The recently completed OpT2mise clinical trial showed that continuous subcutaneous insulin infusion (CSII) is more effective in reducing glycated hemoglobin (HbA1c) than intensification of multiple daily injection (MDi) insulin therapy in patients with type 2 diabetes who do not respond to intensive insulin therapy. CSII therapy may also be useful in patients who do not reach glycemic targets despite multidrug therapy with basal-bolus insulin and other agents, including glucagon-like peptide (GLP)-1 receptor agonists; current guidelines offer no recommendations for the treatment of such patients. Importantly, insulin and GLP-1 receptor agonists have complementary effects on glycemia and, hence, can be used either sequentially or in combination in the initial management of diabetes. Patients who have not previously failed GLP-1 receptor agonist therapy may show reduction in weight and insulin dose, in addition to moderate improvement in HbA1c, when GLP-1 receptor agonist therapy is added to MDi regimens. In subjects with long-standing type 2 diabetes who do not respond to intensive insulin therapies, switching fromMDi to CSII and/or the addition of GLP-1 receptor agonists toMDi have the potential to improve glycemic control without increasing the risk of adverse events.
Kaza P.L.,Bronx Lebanon Hospital Center |
Moulton T.,Bronx Lebanon Hospital
Journal of Pediatric Hematology/Oncology | Year: 2014
Purpose: Vitamin D is essential for the normal absorption of calcium and to maintain calcium homeostasis. Vitamin D deficiency results in rickets, osteomalacia, and bony changes in the spine. Sickle cell disease patients are at an increased risk of vitamin D deficiency. Case Presentation: We describe a case of severe vitamin D deficiency and response to vitamin D supplementation in a patient with sickle cell disease. Conclusions: Currently, there are no recommendations for calcium and vitamin D supplementation in sickle cell patients. Vitamin D deficiency in these patients may be due to poor absorption. Copyright © 2013 by Lippincott Williams & Wilkins.
Potter J.,Adolescent Medicine Fellow at Columbia |
Rubin S.E.,Yeshiva University |
Sherman P.,Bronx Lebanon Hospital
Contraception | Year: 2014
Objective The intrauterine contraceptive device (IUD) is one of the most effective contraceptive methods, but it remains underutilized, especially among adolescents. Little is known about how adolescents perceive IUDs. The objective of this study is to explore urban, minority female adolescents' attitudes and beliefs about IUDs and to identify barriers to IUD use. Study design Qualitative semistructured interviews were conducted with 21 adolescents aged 14 to 21 years who had heard about the IUD but never used one personally. Participants were recruited from two urban school-based health clinics and one community health center. Individual interviews were audiotaped and transcribed. Themes were identified by two independent researchers through line-by-line analysis of interview transcripts. Results Fear of the IUD predominated. Respondents related fears about pain, expulsion, foreign body and the potential for physical harm. Common themes in support of the IUD included the IUD's superior efficacy compared to other contraceptive methods and the ability to use this method long term. Despite identifying IUD benefits, most respondents did not appear to think the method would be well suited for them. Conclusion Though the IUD is safe and effective for adolescents, we found that urban female adolescents have many device-related concerns which must be addressed to make this method more acceptable. Implications Understanding urban, minority adolescents' perspective on IUDs and their specific concerns about IUD method use can help clinicians provide targeted and relevant contraceptive counseling. © 2014 Elsevier Inc.
Aggarwal V.,Jacobi Medical Center |
Rajpathak S.,Yeshiva University |
Singh M.,Bronx Lebanon Hospital |
Romick B.,Montefiore Medical Center |
Srinivas V.S.,Montefiore Medical Center
EuroIntervention | Year: 2012
Aims: Most studies investigating completeness of revascularisation and outcomes for multivessel disease (MVD) patients are limited by small sample size. Methods and results: We searched PUBMED, Cochrane and EMBASE for studies comparing outcomes of MVD patients with complete revascularisation (CR) vs. incomplete revascularisation (IR) in the stent era. We identified nine studies that met our selection criteria. Compared to IR, patients undergoing CR had significantly lower risk of mortality (relative risk (RR): 0.82; 95% confidence interval (CI): 0.68-0.99; p=0.05), non-fatal myocardial infarction (MI) (RR: 0.67; 95% CI: 0.53-0.84; p <0.01) and subsequent coronary artery bypass graft surgery (CABG) (RR: 0.70; 95% CI: 0.52-0.95; p=0.02) whereas no difference was noted in the incidence of repeat percutaneous coronary intervention (PCI) (RR: 0.87; 95% CI: 0.69-1.11; p=0.28). Average weighted follow up was approximately 29 months for mortality, subsequent CABG and Repeat PCI whereas it was 19 months for non-fatal MI. The results were similar after excluding the only RCT or the one study restricted to diabetics or the study restricted to drug-eluting stent use. Conclusions: In patients with multivessel coronary disease, complete revascularisation with PCI may be associated with better outcomes than incomplete revascularisation. © Europa Edition 2012. All rights reserved.
Glandt M.,Bronx Lebanon Hospital |
Raz I.,Hadassah University Hospital
Journal of Diabetes Science and Technology | Year: 2011
In an article in this issue of Journal of Diabetes Science and Technology, Peoples and colleagues address the issue that, while continuous glucose sensors have been shown to improve hemoglobin A1c, they are still fraught with concerns regarding accuracy and flexibility in sensor placement. Their study aimed to evaluate whether NexSensor, an improved version of the already commercially available Sof-Sensor, can be used for 6 days instead of the 3 days approved for Sof-Sensor in the United States. Also, the article aims to compare the accuracy of wearing the sensor in the abdomen versus the buttocks, given that this offers more flexibility than the approved labeling for Sof-Sensor, which is only in the abdomen. The study demonstrated that NexSensor is both safe and accurate for 6 days at both insertion sites. There was no statistically significant difference between the sites. As far as improved accuracy, the authors find evidence in favor of NexSensor as compared to Sof-Sensor, although this evidence is preliminary and is not backed by statistical significance measures. © Diabetes Technology Society.
PubMed | Maimonides Medical Center, Bronx Lebanon Hospital, Mount Sinai Hospital, Hospitals Insurance Company and 3 more.
Type: | Journal: Journal of obesity | Year: 2016
Objective. To determine if there is an association between BMI and 3rd- or 4th-degree perineal lacerations in normal spontaneous and operative vaginal deliveries. Study Design. We performed a retrospective case control study using a large obstetric quality improvement database over a six-year period. Cases were identified as singleton gestations with third- and fourth-degree lacerations. Controls were obtained randomly from the database of patients without third- or fourth-degree lacerations in a 1:1 ratio. Univariate and multivariate logistic regression analyses were performed. Results. Of 32,607 deliveries, 22,011 (67.5%) charts with BMI documented were identified. Third- or fourth-degree lacerations occurred in 2.74% (n = 605) of patients. 37% (n = 223) were identified in operative vaginal deliveries. In the univariate analysis, obesity, older maternal age, non-Asian race, and birth weight <4000g were all protective against 3rd- and 4th-degree lacerations. After controlling for age, race, mode of vaginal delivery, and birth weight, obesity remained significant. Conclusion. Being obese may protect against third- and fourth-degree lacerations independent of parity, race, birth weight, and mode of delivery.
Findley S.,Columbia University |
Matos S.,Community Health Worker Network of NYC |
Hicks A.,True North Consulting LLC |
Chang J.,New York University |
Reich D.,Bronx Lebanon Hospital
Journal of Ambulatory Care Management | Year: 2014
Community health workers are ideally suited to the care coordination niche within the patient-centered medical home (PCMH) team, but there are few case studies detailing how to accomplish this integration. This qualitative study documents how community health workers (CHWs) were integrated into a PCMH in South Bronx, New York. Results show that integration was linked to clear definition of their care coordination role within the care team, meticulous recruitment, training and supervision by a senior CHW, shared leadership of the care management team, and documented value for money. By helping the team understand patientsÊ backgrounds, constraints, and preferences, they helped everyone genuinely focus on the patient. Copyright © 2014 Wolters Kluwer Health Lippincott Williams and Wilkins.
Udgiri N.,Bronx Lebanon Hospital |
Curras E.,Bronx Lebanon Hospital |
Kella V.K.,Bronx Lebanon Hospital |
Nagpal K.,Bronx Lebanon Hospital |
Cosgrove J.,Bronx Lebanon Hospital
American Surgeon | Year: 2011
Prompt appendectomy has always been a standard of care because of the risk of progression in pathology. This time honored practice has been recently challenged by studies, suggesting that appendicitis can be operated on electively. The aim of this study is to examine whether delayed intervention in acute appendicitis is safe by correlating the interval from presentation to operation with the operative and postoperative complications. Retrospective review of patients who underwent appendectomy for acute appendicitis in 2009 was done. The following parameters were recorded: demographics, duration from presentation to evaluation by emergency room attending, performing CTscan, surgical consult, and operation. The pathology, post operative complications, and length of stay were also recorded. Patients were divided into two groups: incision time < 10 hours (early group) and incision time > 10 hours (delayed group). The end points chosen for comparison were: 1) laparoscopic to open conversion rate, 2) complications, 3) readmissions, and 4) length of stay. Number of cases totaled 201, with 76 in the < 10 hours group and 125 in the > 10 hours group. The male to female ratio for the < 10 hours group was 54:22 and for the > 10 hours group was 59:66 (P < 0.001). Length of stay for the early group was 75.52 hours and for the delayed group, 89.15 hours (P = 0.04). There was one intra-abdominal abscess in the early group and 10 in the delayed group (P = 0.04). The early group had 0.2 (2.6%) open conversions, and the delayed group had five (4.1%) conversions (P = 0.58). There were six (4.8%) readmissions in the delayed group and none in the early group (P = 0.05). Our study reveals that the complication rate, length of stay, and readmissions are more in the delayed group. Conversion rate was more in the delayed group, but the difference was not significant. We conclude that early surgical intervention is beneficial in acute appendicitis.
Fay C.M.,Bronx Lebanon Hospital
American journal of orthopedics (Belle Mead, N.J.) | Year: 2011
Fixation devices used during anterior cruciate ligament (ACL) reconstruction are of numerous designs and materials. Untoward events following the use of these devices are not common. However, if unrecognized, they can lead to serious complications. This article summarizes some of the reported complications with ACL fixation devices. There are complications common to all devices but others are unique to the implant itself or to the material of which it is made. Surgeons must be aware of the potential adverse events that can occur with the particular device being used.