New York City, NY, United States
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Back E.E.,Ellis Hospital | Bachwani A.S.,Ellis Hospital | Strogatz D.S.,Bassett Research Institute | Sherman Z.M.V.,New York Harbor Medical Center
Ethnicity and Disease | Year: 2012

Objective: Prompted by anecdotal evidence of a higher rate of type 2 diabetes, we set out to investigate the prevalence of diabetes, its risk factors, and co-morbidities among immigrant Guyanese patients being treated in a family medicine health center in Schenectady, New York. Methods: Patients were ascertained from a registration database of all patients aged $ 30 years who were treated from 2004 to 2006. We then conducted a detailed retrospective chart review of all Guyanese, Caucasian, African American, and Hispanic patients with diabetes and randomly selected non-diabetic controls. Results: Of 222 Guyanese patients, 67 (30.2%) had a diagnosis of diabetes, compared with 47/219 (21.5%) of Hispanics, 132/777 (17.0%) of African Americans, and 442/2834 (15.6%) of Caucasians (P>.0001). Compared with the other racial and ethnic groups, the Guyanese diabetic patients were significantly leaner and more likely to be male. Conclusion: We found a very high prevalence of type 2 diabetes among the Guyanese patient population studied and found unique characteristics when compared with other ethnic and racial groups. These findings have alerted local clinicians to intensify diabetes screening among Guyanese patients. Furthermore, in response to these findings, a broad coalition including public health, clinical, and community groups has been established with the goal of developing culturally appropriate strategies to prevent and control diabetes among Guyanese residents.


Sarafraz-Yazdi E.,SUNY Downstate Medical Center | Pincus M.R.,SUNY Downstate Medical Center | Pincus M.R.,New York Harbor Medical Center | Michl J.,SUNY Downstate Medical Center
Current Medicinal Chemistry | Year: 2014

Since the introduction of chemotherapy in cancer therapy, development of resistance to every new therapeutic has been the universal experience. The growing understanding of cancer genomics, cancer-associated signal transduction pathways, and key protein drivers of cancer has enabled cancer biologists and medicinal chemists to develop targeted molecules to interfere with these pathways to tackle drug resistant cancers. However, to the dismay of oncologists, the clinical use of many of these tools has once again brought to the forefront the inevitable challenge of drug resistance. It is now understood that cancer resistance to different therapies involves multiple challenges that encompass the cancer cell itself as well as host physiology. This review presents small molecule inhibitors and peptides as two therapeutic approaches in anti-cancer drug development. Resistance to selected samples of these novel therapies is described in the context of cell autonomous resistance, the contributions of the tumor microenvironment, and germ line factors. For each approach, advantages and disadvantages are discussed on how to better overcome the inevitable challenge of resistance in cancer treatment. © 2014 Bentham Science Publishers.


PubMed | New York Harbor Medical Center and SUNY Downstate Medical Center
Type: Journal Article | Journal: Journal of clinical laboratory analysis | Year: 2016

The goal of this work was to determine if immediate versus postponed centrifugation of samples affects the levels of serum potassium.Twenty participants donated normal venous blood that was collected in four serum separator tubes per donor, each of which was analyzed at 0, 1, 2, or 4 hr on the Siemens Advia 1800 autoanalyzer.Coefficients of variation (CVs) for potassium levels ranged from 0% to 7.6% with a mean of 3 2%. ANOVA testing of the means for all 20 samples showed a P-value of 0.72 (>0.05) indicating that there was no statistically significant difference between the means of the samples at the four time points. Sixteen samples were found to have CVs that were 5%. Two samples showed increases of potassium from the reference range to levels higher than the upper reference limit, one of which had a 4-hr value that was within the reference or normal range (3.5-5 mEq/l). Overall, most samples were found to have reproducible levels of serum potassium.Serum potassium levels from stored whole blood collected in serum separator tubes are, for the most part, stable at room temperature for at least 4 hr prior to analysis. However, some samples can exhibit significant fluctuations of values.


PubMed | VA New York Harbor Healthcare System, New York Harbor Medical Center and SUNY Downstate Medical Center
Type: Journal Article | Journal: Journal of clinical laboratory analysis | Year: 2016

The goal of this work was to determine whether there are clinically significant fluctuations in the level of serum creatinine on serial determinations, especially in the borderline range (1.1-1.3 mg/dl), after specimen storage.Sixty-one serum samples were analyzed. They were divided into three categories based on the initial serum creatinine measurement: low (1.0 mg/dl), borderline (1.1-1.3 mg/dl), and high (1.4 mg/dl). The specimens were stored at 4C and run on the Siemens Advia 1800 chemistry analyzer on days 1, 3, and 11.Statistical comparisons of the three groups were made using the unpaired t-test, yielding a two-tailed P-value for each group comparison. The P-values ranged from 0.0829 to 0.3892, indicating no statistically significant difference between the standard deviations of each group.Mild-to-moderate fluctuations in precision occur in successive serum creatinine determinations. The overwhelming majority of these fluctuations should not affect clinical decision making.


Chillaron J.,University of Barcelona | Font-Llitjos M.,Lhospitalet Of Llobregat | Fort J.,Barcelona Institute for Research in Biomedicine | Zorzano A.,Barcelona Institute for Research in Biomedicine | And 3 more authors.
Nature Reviews Nephrology | Year: 2010

Cystinuria is a primary inherited aminoaciduria caused by mutations in the genes that encode the two subunits (neutral and basic amino acid transport protein rBAT and b(0,+)-type amino acid transporter 1) of the amino acid transport system b0,+. This autosomal recessive disorder (in which few cases show dominant inheritance) causes a failure in the reabsorption of filtered cystine and dibasic amino acids in the proximal tubule. The clinical symptoms of this disease are caused by the loss of poorly soluble cystine, which precipitates to form stones. Although rare, the prevalence of cystinuria is sufficiently high that the disease results in a substantial contribution to pediatric renal lithiasis. A thorough understanding of cystine transport processes over the past 15 years and the genetic abnormalities responsible for the disease has led to a new classification of cystinuria and recognition that some cases result from an autosomal dominant etiology with incomplete penetrance. This Review examines the molecular and mechanistic effects of some of the mutations that cause cystinuria based on our current understanding of the structural and cellular biology of system b0,+. This Review also describes the current treatments to prevent recurrent cystine lithiasis. © 2010 Macmillan Publishers Limited. All rights reserved.


Leaf D.E.,Brigham and Women's Hospital | Bukberg P.R.,Beth Israel Deaconess Medical Center | Goldfarb D.S.,New York University | Goldfarb D.S.,New York Harbor Medical Center
American Journal of Kidney Diseases | Year: 2012

Kidney stones are listed among the complications of eating disorders; however, very few cases have been reported. We present an additional case of nephrolithiasis associated with laxative abuse, including detailed results of the patient's urine metabolic profiles, in a patient with idiopathic hypercalciuria. We review the literature and provide an explanation for the paucity of cases of nephrolithiasis associated with these disorders. Despite low urine volumes resulting from extracellular fluid volume depletion and hypocitraturia resulting from hypokalemia, both of which would tend to favor the formation of kidney stones, most patients with eating disorders are likely to be protected from stone formation by the hypocalciuric effect of extracellular fluid volume depletion and increased proximal tubular sodium reabsorption. However, patients with underlying idiopathic hypercalciuria who develop eating disorders may be at increased risk of stone formation in the setting of low urine volume and therefore high supersaturation of calcium oxalate and phosphate. © 2012 National Kidney Foundation, Inc.


Blaser M.J.,New York University | Blaser M.J.,New York Harbor Medical Center
Science | Year: 2016

Anti-infectives, including antibiotics, are essentially different from all other drugs; they not only affect the individual to whom they are given but also the entire community, through selection for resistance to their own action. Thus, their use resides at the intersection of personal and public health. Antibiotics can be likened to a four-edged sword against bacteria. The first two edges of the antibiotic sword were identified immediately after their discovery and deployment in that they not only benefit an individual in treating their infection but also benefit the community in preventing the spread of that infectious agent. The third edge was already recognized by Alexander Fleming in 1945 in his Nobel acceptance speech, which warned about the cost to the community of antibiotic resistance that would inevitably evolve and be selected for during clinical practice. We have seen this cost mount up, as resistance curtails or precludes the activities of some of our most effective drugs for clinically important infections. But the fourth edge of the antibiotic sword remained unappreciated until recently, i.e., the cost that an antibiotic exerts on an individual's own health via the collateral damage of the drug on bacteria that normally live on or in healthy humans: our microbiota. These organisms, their genes, metabolites, and interactions with one another, as well as with their host collectively, represent our microbiome. Our relationship with these symbiotic bacteria is especially important during the early years of life, when the adult microbiome has not yet formed.


Sarafraz-Yazdi E.,New York University | Bowne W.B.,New York University | Adler V.,New York Harbor Medical Center | Sookraj K.A.,New York University | And 10 more authors.
Proceedings of the National Academy of Sciences of the United States of America | Year: 2010

The anticancer peptide PNC-27, which contains an HDM-2-binding domain corresponding to residues 12-26 of p53 and a transmembrane-penetrating domain, has been found to kill cancer cells (but not normal cells) by inducing membranolysis. We find that our previously determined 3D structure of the p53 residues of PNC-27 is directly superimposable on the structure for the same residues bound to HDM-2, suggesting that the peptide may target HDM-2 in the membranes of cancer cells. We now find significant levels of HDM-2 in the membranes of a variety of cancer cells but not in the membranes of several untransformed cell lines. In colocalization experiments, we find that PNC-27 binds to cell membrane-bound HDM-2. We further transfected a plasmid expressing full-length HDM-2 with a membrane-localization signal into untransformed MCF-10-2A cells not susceptible to PNC-27 and found that these cells expressing full-length HDM-2 on their cell surface became susceptible to PNC-27. We conclude that PNC-27 targets HDM-2 in the membranes of cancer cells, allowing it to induce membranolysis of these cells selectively. HDM-2 binding membranolysis three-dimensional structure transfection.


Dominguez-Bello M.G.,New York University | Blaser M.J.,New York University | Blaser M.J.,New York Harbor Medical Center
Science Translational Medicine | Year: 2015

Early microbiome composition can predict asthma risk, and asthma development can be subverted when missing protective microbes are restored (Arrieta et al., this issue).


Puri S.,New York Harbor Medical Center | Puri S.,New York University | Modersitzki F.,New York University | Goldfarb D.S.,New York Harbor Medical Center | Goldfarb D.S.,New York University
Hemodialysis International | Year: 2014

Accurate assessment of blood volume (BV) may be helpful for prescribing hemodialysis (HD) and for reducing complications related to hypovolemia and volume overload. Monitoring changes in relative BV (RBV) using hematocrit, e.g., Crit-Line Monitor (CLM-III), an indirect method, cannot be used to determine absolute BV. We report the first study of BV measurement for assessing volume status in HD patients using the indicator dilutional method. Ten adult HD patients were enrolled in this prospective observational study. BV measurement was performed before and after HD using BV analysis (BVA)-100 (Daxor Corporation, New York, NY, USA). BVA-100 calculates BV using radiolabeled albumin (Iodine-131) followed by serial measures of the radioisotope. Fluid loss from the extravascular space was calculated by subtracting the change in BV from total weight loss. Intradialytic changes in RBV were measured by CLM-III. Eight out of 10 cases had significant hypervolemia, two cases were normovolemic. The range of BV variation from predicted normal was 156 to 1990mL. Significant inter-individual differences in extravascular space fluid loss ranged from 54% to 99% of total weight loss. Spearman correlation showed a good correlation in the measurement of RBV by BVA-100 and CLM-III in 8 out of 10 patients (r2=0.64). BV measurement using BVA-100 is useful to determine absolute BV as well as changes in BV and correlates reasonably well with CLM-III measurements. Individual refilling ability can be determined as well. This may prove useful in prescribing and monitoring ultrafiltration rates, establishment of optimal BV in HD patients and reducing morbidity and mortality associated with chronic HD. © 2013 International Society for Hemodialysis.

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