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NEW YORK, May 03, 2017 (GLOBE NEWSWIRE) -- The American Health Council has chosen Dr. Amanda D. Maynard, Internist at Ohio Health, as one of the "Best Doctor's in America" for 2017. Recognized for her knowledge and expertise in Internal Medicine, Adult Medicine, Pulmonary Medicine and Osteopathic Manipulation, Dr. Maynard has been awarded the "Leaders in Medicine" award among Ohio doctors. Selection for the American Health Council’s “Leaders in Medicine” award is reserved for those individuals who have exhibited exemplary conduct in their field. These doctors and medical educators serve as the guiding light for advancement from the classroom to the consultation room to the operating room. Only those who master the key roles that drive patient care — advocate, collaborator, communicator, decision maker, expert, manager, scholar — are deserving to be named the “Best Doctors in America.” With experience in the field of Internal Medicine, Dr. Maynard offers valuable insight in her role as Internist at Ohio Health. Established in Ohio in 1891, Ohio Health is a non-for-profit, faith-based hospitals and healthcare organization. Focused on the improvement of the community through the delivery of quality, convenient, and timely healthcare, Ohio Health was named to the 2013 Top Hospital list from the Leapfrog Group. Board Certified by the American Osteopathic Board of Internal Medicine, Dr. Maynard’s day-to-day responsibilities include chronic acute care for patients age 16 and up tackling hypertension, diabetes, asthma/chronic obstructive pulmonary disease and osteopathic medicine. Maintaining consecutive recognition as the Best Doctors in America for 2015 and 2016, Dr. Maynard has completed a fellowship with the American College of Physicians, and has served as a Clinical Assistant Professor at Ohio University of Osteopathic Medicine. Following graduation with her medical degree from West Virginia School of Osteopathic Medicine in 2007, Dr. Maynard completed an internship in 2008 and residency in Internal Medicine at Doctors Hospital in 2010. Dr. Maynard maintains membership with the American College of Physicians, The American Osteopathic Association, The Ohio Osteopathic Association, The American College of Osteopathic Internists, and The American Board of Osteopathic Internal Medicine. Looking back, Dr. Maynard attributes her success to her dedication, strong work ethic, and the support from her parents who helped her to be involved in the medical field at a young age. Dr. Maynard chose the field of Internal Medicine after working at the front desk of a hospital in high school and later becoming an ER technician. In her free time, Dr. Maynard enjoys running marathons, horseback riding, paddle boarding, boating and spending time with her husband and two English Bulldogs (Gus and Lula). Considering the future, Dr. Maynard hopes to do administrative work for Ohio Health, to help to make changes to the VA hospitals, and to provide better healthcare and access to veterans. The American Health Council is the nation’s only organization with a constituency representative of all sectors of the healthcare industry. From the coasts to the heartland, the American Health Council has drawn Affiliates from major metropolitan hubs and small communities. These Affiliates span generations and have reached different stages of their careers — from recent graduates to retirees. More information about the American Health Council and its mission can be found at: http://americanhealthcouncil.org Additionally, the American Health Council strives to provide recognition and support for those individuals making the difference in patients’ lives day in and day out. Throughout 2017, the AHC is honoring America’s Best Doctors and Nurses. The American Health Council’s “Best in Medicine” and “Best in Nursing” awards programs honor the individuals and institutions that have contributed significantly to medicine and nursing, as well as the training and education of physicians and nurses. The most current selections for these honors may be viewed here: http://bestinmedicine.org and http://bestinnursing.org.


NEW YORK, May 03, 2017 (GLOBE NEWSWIRE) -- The American Health Council has chosen Dr. Amanda D. Maynard, Internist at Ohio Health, as one of the "Best Doctor's in America" for 2017. Recognized for her knowledge and expertise in Internal Medicine, Adult Medicine, Pulmonary Medicine and Osteopathic Manipulation, Dr. Maynard has been awarded the "Leaders in Medicine" award among Ohio doctors. Selection for the American Health Council’s “Leaders in Medicine” award is reserved for those individuals who have exhibited exemplary conduct in their field. These doctors and medical educators serve as the guiding light for advancement from the classroom to the consultation room to the operating room. Only those who master the key roles that drive patient care — advocate, collaborator, communicator, decision maker, expert, manager, scholar — are deserving to be named the “Best Doctors in America.” With experience in the field of Internal Medicine, Dr. Maynard offers valuable insight in her role as Internist at Ohio Health. Established in Ohio in 1891, Ohio Health is a non-for-profit, faith-based hospitals and healthcare organization. Focused on the improvement of the community through the delivery of quality, convenient, and timely healthcare, Ohio Health was named to the 2013 Top Hospital list from the Leapfrog Group. Board Certified by the American Osteopathic Board of Internal Medicine, Dr. Maynard’s day-to-day responsibilities include chronic acute care for patients age 16 and up tackling hypertension, diabetes, asthma/chronic obstructive pulmonary disease and osteopathic medicine. Maintaining consecutive recognition as the Best Doctors in America for 2015 and 2016, Dr. Maynard has completed a fellowship with the American College of Physicians, and has served as a Clinical Assistant Professor at Ohio University of Osteopathic Medicine. Following graduation with her medical degree from West Virginia School of Osteopathic Medicine in 2007, Dr. Maynard completed an internship in 2008 and residency in Internal Medicine at Doctors Hospital in 2010. Dr. Maynard maintains membership with the American College of Physicians, The American Osteopathic Association, The Ohio Osteopathic Association, The American College of Osteopathic Internists, and The American Board of Osteopathic Internal Medicine. Looking back, Dr. Maynard attributes her success to her dedication, strong work ethic, and the support from her parents who helped her to be involved in the medical field at a young age. Dr. Maynard chose the field of Internal Medicine after working at the front desk of a hospital in high school and later becoming an ER technician. In her free time, Dr. Maynard enjoys running marathons, horseback riding, paddle boarding, boating and spending time with her husband and two English Bulldogs (Gus and Lula). Considering the future, Dr. Maynard hopes to do administrative work for Ohio Health, to help to make changes to the VA hospitals, and to provide better healthcare and access to veterans. The American Health Council is the nation’s only organization with a constituency representative of all sectors of the healthcare industry. From the coasts to the heartland, the American Health Council has drawn Affiliates from major metropolitan hubs and small communities. These Affiliates span generations and have reached different stages of their careers — from recent graduates to retirees. More information about the American Health Council and its mission can be found at: http://americanhealthcouncil.org Additionally, the American Health Council strives to provide recognition and support for those individuals making the difference in patients’ lives day in and day out. Throughout 2017, the AHC is honoring America’s Best Doctors and Nurses. The American Health Council’s “Best in Medicine” and “Best in Nursing” awards programs honor the individuals and institutions that have contributed significantly to medicine and nursing, as well as the training and education of physicians and nurses. The most current selections for these honors may be viewed here: http://bestinmedicine.org and http://bestinnursing.org.


NEW YORK, May 03, 2017 (GLOBE NEWSWIRE) -- The American Health Council has chosen Dr. Amanda D. Maynard, Internist at Ohio Health, as one of the "Best Doctor's in America" for 2017. Recognized for her knowledge and expertise in Internal Medicine, Adult Medicine, Pulmonary Medicine and Osteopathic Manipulation, Dr. Maynard has been awarded the "Leaders in Medicine" award among Ohio doctors. Selection for the American Health Council’s “Leaders in Medicine” award is reserved for those individuals who have exhibited exemplary conduct in their field. These doctors and medical educators serve as the guiding light for advancement from the classroom to the consultation room to the operating room. Only those who master the key roles that drive patient care — advocate, collaborator, communicator, decision maker, expert, manager, scholar — are deserving to be named the “Best Doctors in America.” With experience in the field of Internal Medicine, Dr. Maynard offers valuable insight in her role as Internist at Ohio Health. Established in Ohio in 1891, Ohio Health is a non-for-profit, faith-based hospitals and healthcare organization. Focused on the improvement of the community through the delivery of quality, convenient, and timely healthcare, Ohio Health was named to the 2013 Top Hospital list from the Leapfrog Group. Board Certified by the American Osteopathic Board of Internal Medicine, Dr. Maynard’s day-to-day responsibilities include chronic acute care for patients age 16 and up tackling hypertension, diabetes, asthma/chronic obstructive pulmonary disease and osteopathic medicine. Maintaining consecutive recognition as the Best Doctors in America for 2015 and 2016, Dr. Maynard has completed a fellowship with the American College of Physicians, and has served as a Clinical Assistant Professor at Ohio University of Osteopathic Medicine. Following graduation with her medical degree from West Virginia School of Osteopathic Medicine in 2007, Dr. Maynard completed an internship in 2008 and residency in Internal Medicine at Doctors Hospital in 2010. Dr. Maynard maintains membership with the American College of Physicians, The American Osteopathic Association, The Ohio Osteopathic Association, The American College of Osteopathic Internists, and The American Board of Osteopathic Internal Medicine. Looking back, Dr. Maynard attributes her success to her dedication, strong work ethic, and the support from her parents who helped her to be involved in the medical field at a young age. Dr. Maynard chose the field of Internal Medicine after working at the front desk of a hospital in high school and later becoming an ER technician. In her free time, Dr. Maynard enjoys running marathons, horseback riding, paddle boarding, boating and spending time with her husband and two English Bulldogs (Gus and Lula). Considering the future, Dr. Maynard hopes to do administrative work for Ohio Health, to help to make changes to the VA hospitals, and to provide better healthcare and access to veterans. The American Health Council is the nation’s only organization with a constituency representative of all sectors of the healthcare industry. From the coasts to the heartland, the American Health Council has drawn Affiliates from major metropolitan hubs and small communities. These Affiliates span generations and have reached different stages of their careers — from recent graduates to retirees. More information about the American Health Council and its mission can be found at: http://americanhealthcouncil.org Additionally, the American Health Council strives to provide recognition and support for those individuals making the difference in patients’ lives day in and day out. Throughout 2017, the AHC is honoring America’s Best Doctors and Nurses. The American Health Council’s “Best in Medicine” and “Best in Nursing” awards programs honor the individuals and institutions that have contributed significantly to medicine and nursing, as well as the training and education of physicians and nurses. The most current selections for these honors may be viewed here: http://bestinmedicine.org and http://bestinnursing.org.


NEW YORK, May 03, 2017 (GLOBE NEWSWIRE) -- The American Health Council has chosen Dr. Amanda D. Maynard, Internist at Ohio Health, as one of the "Best Doctor's in America" for 2017. Recognized for her knowledge and expertise in Internal Medicine, Adult Medicine, Pulmonary Medicine and Osteopathic Manipulation, Dr. Maynard has been awarded the "Leaders in Medicine" award among Ohio doctors. Selection for the American Health Council’s “Leaders in Medicine” award is reserved for those individuals who have exhibited exemplary conduct in their field. These doctors and medical educators serve as the guiding light for advancement from the classroom to the consultation room to the operating room. Only those who master the key roles that drive patient care — advocate, collaborator, communicator, decision maker, expert, manager, scholar — are deserving to be named the “Best Doctors in America.” With experience in the field of Internal Medicine, Dr. Maynard offers valuable insight in her role as Internist at Ohio Health. Established in Ohio in 1891, Ohio Health is a non-for-profit, faith-based hospitals and healthcare organization. Focused on the improvement of the community through the delivery of quality, convenient, and timely healthcare, Ohio Health was named to the 2013 Top Hospital list from the Leapfrog Group. Board Certified by the American Osteopathic Board of Internal Medicine, Dr. Maynard’s day-to-day responsibilities include chronic acute care for patients age 16 and up tackling hypertension, diabetes, asthma/chronic obstructive pulmonary disease and osteopathic medicine. Maintaining consecutive recognition as the Best Doctors in America for 2015 and 2016, Dr. Maynard has completed a fellowship with the American College of Physicians, and has served as a Clinical Assistant Professor at Ohio University of Osteopathic Medicine. Following graduation with her medical degree from West Virginia School of Osteopathic Medicine in 2007, Dr. Maynard completed an internship in 2008 and residency in Internal Medicine at Doctors Hospital in 2010. Dr. Maynard maintains membership with the American College of Physicians, The American Osteopathic Association, The Ohio Osteopathic Association, The American College of Osteopathic Internists, and The American Board of Osteopathic Internal Medicine. Looking back, Dr. Maynard attributes her success to her dedication, strong work ethic, and the support from her parents who helped her to be involved in the medical field at a young age. Dr. Maynard chose the field of Internal Medicine after working at the front desk of a hospital in high school and later becoming an ER technician. In her free time, Dr. Maynard enjoys running marathons, horseback riding, paddle boarding, boating and spending time with her husband and two English Bulldogs (Gus and Lula). Considering the future, Dr. Maynard hopes to do administrative work for Ohio Health, to help to make changes to the VA hospitals, and to provide better healthcare and access to veterans. The American Health Council is the nation’s only organization with a constituency representative of all sectors of the healthcare industry. From the coasts to the heartland, the American Health Council has drawn Affiliates from major metropolitan hubs and small communities. These Affiliates span generations and have reached different stages of their careers — from recent graduates to retirees. More information about the American Health Council and its mission can be found at: http://americanhealthcouncil.org Additionally, the American Health Council strives to provide recognition and support for those individuals making the difference in patients’ lives day in and day out. Throughout 2017, the AHC is honoring America’s Best Doctors and Nurses. The American Health Council’s “Best in Medicine” and “Best in Nursing” awards programs honor the individuals and institutions that have contributed significantly to medicine and nursing, as well as the training and education of physicians and nurses. The most current selections for these honors may be viewed here: http://bestinmedicine.org and http://bestinnursing.org.


South Nassau Communities Hospital Names, Dedicates Medical Library in Honor of Former Medical Staff President Dr. Singh joined South Nassau in 1977, and from that year onward he was a dependable, wise source of leadership, demonstrating a zeal for medical innovation centered on patient-centered care. Oceanside, NY, February 17, 2017 --( So it was appropriate that on Friday, February 10 at South Nassau Communities Hospital in Oceanside, NY, family, friends, physicians, hospital staff and board members joined together to celebrate the naming and dedication of the hospital's medical library in honor of Harbhajan Singh, MD. While patients remember Dr. Singh, a pulmonologist, for his compassionate, expert medical care, his peers and staff who worked side-by-side with him at South Nassau for more than half of his 52-year career in medicine, attest that they were inspired by his steadfast pursuit to learn more and to understand more and to put that knowledge to work to raise the quality and standard of medical care that he provided his patients. "When we look at the history and growth of South Nassau Communities Hospital, they are indelibly marked with Dr. Singh's passion for patient-centered medicine and devotion to the hospital's mission and vision," said Richard J. Murphy, President & CEO. "On behalf of South Nassau physicians, staff and board members past, present and future, I salute Dr. Singh for his exemplary career in medicine. It is our honor that we now call this the Harbhajan Singh, MD, Medical Library. " Dr. Singh joined South Nassau in 1977, and from that year onward he was a dependable, wise source of leadership, demonstrating a zeal for medical innovation centered on patient-centered care. During his more than 30 years at South Nassau, Dr. Singh held staff appointments as President of the Medical Staff, Chief of Pulmonary Medicine, Director of the Respiratory Therapy Department, and Chairman of the Respiratory Therapy Committee, among many others. Through those appointments Dr. Singh mentored numerous staff physicians and served as a catalyst behind South Nassau's growth and expansion, which continues today. During his tenure as medical staff president, South Nassau completed an expansion of its Ambulatory Surgery Unit (ASU) to include 10 private patient suites and an enlarged holding area; established an Outpatient Dialysis Center with 18 patient suites; introduced advancements in medical technology including the multislice CT scanner; a 3-D diagnostic imaging system to locate and cure rapid heartbeats; and MicroEndoscopic Discectomy, a minimally invasive surgical procedure used to correct disabling spinal disc problems. A native of India, Dr. Singh began his distinguished career in medicine upon graduating from Amristar Medical College in 1963, (working as an internist in New Delhi). In 1968, he migrated to the United States, with his wife Naginder and they settled in Rockville Centre. While she raised their sons, Charnjit (C.J.) and Sarbjit, Dr. Singh completed residency training in internal medicine and a fellowship in pulmonary medicine, soon thereafter he opened a medical office on Merrick Rd. and then Hempstead Ave. in Lynbrook, providing specialized care in pulmonary and internal medicine. He was board certified in Internal Medicine, Pulmonary Medicine, Critical Care Medicine and Sleep Medicine. Inspired by his father's love for medicine and the compassionate care that he provided his patients, son C.J. chose a career in medicine as well. He has been an attending physician at South Nassau specializing in gastroenterology for almost 2 decades. Sarbjit is a tenured professor at Farmingdale State College in Sports Business. Naginder has worked in an array of volunteer capacities for South Nassau. "The naming and dedication of the medical library in Dr. Singh's honor will serve as a constant reminder of his commitment to lifelong learning and of his leadership to build on the hospital's tradition of excellence in health care," said Adhi Sharma, MD, chief medical officer. The Harbhajan Singh, MD Medical Library offers a collection of books, journals (both print and online), and access to clinical databases. The library's mission is to meet the ongoing information needs of physicians and other clinical staff in support of patient care, teaching, learning, and research. Oceanside, NY, February 17, 2017 --( PR.com )-- A library is a reflection of the passion for lifelong learning, the search for answers and when either or both are attained, the reward of knowledge, understanding and discernment that is to the benefit of the individual as well as those served by the individual.So it was appropriate that on Friday, February 10 at South Nassau Communities Hospital in Oceanside, NY, family, friends, physicians, hospital staff and board members joined together to celebrate the naming and dedication of the hospital's medical library in honor of Harbhajan Singh, MD.While patients remember Dr. Singh, a pulmonologist, for his compassionate, expert medical care, his peers and staff who worked side-by-side with him at South Nassau for more than half of his 52-year career in medicine, attest that they were inspired by his steadfast pursuit to learn more and to understand more and to put that knowledge to work to raise the quality and standard of medical care that he provided his patients."When we look at the history and growth of South Nassau Communities Hospital, they are indelibly marked with Dr. Singh's passion for patient-centered medicine and devotion to the hospital's mission and vision," said Richard J. Murphy, President & CEO. "On behalf of South Nassau physicians, staff and board members past, present and future, I salute Dr. Singh for his exemplary career in medicine. It is our honor that we now call this the Harbhajan Singh, MD, Medical Library. "Dr. Singh joined South Nassau in 1977, and from that year onward he was a dependable, wise source of leadership, demonstrating a zeal for medical innovation centered on patient-centered care. During his more than 30 years at South Nassau, Dr. Singh held staff appointments as President of the Medical Staff, Chief of Pulmonary Medicine, Director of the Respiratory Therapy Department, and Chairman of the Respiratory Therapy Committee, among many others. Through those appointments Dr. Singh mentored numerous staff physicians and served as a catalyst behind South Nassau's growth and expansion, which continues today.During his tenure as medical staff president, South Nassau completed an expansion of its Ambulatory Surgery Unit (ASU) to include 10 private patient suites and an enlarged holding area; established an Outpatient Dialysis Center with 18 patient suites; introduced advancements in medical technology including the multislice CT scanner; a 3-D diagnostic imaging system to locate and cure rapid heartbeats; and MicroEndoscopic Discectomy, a minimally invasive surgical procedure used to correct disabling spinal disc problems.A native of India, Dr. Singh began his distinguished career in medicine upon graduating from Amristar Medical College in 1963, (working as an internist in New Delhi). In 1968, he migrated to the United States, with his wife Naginder and they settled in Rockville Centre. While she raised their sons, Charnjit (C.J.) and Sarbjit, Dr. Singh completed residency training in internal medicine and a fellowship in pulmonary medicine, soon thereafter he opened a medical office on Merrick Rd. and then Hempstead Ave. in Lynbrook, providing specialized care in pulmonary and internal medicine. He was board certified in Internal Medicine, Pulmonary Medicine, Critical Care Medicine and Sleep Medicine.Inspired by his father's love for medicine and the compassionate care that he provided his patients, son C.J. chose a career in medicine as well. He has been an attending physician at South Nassau specializing in gastroenterology for almost 2 decades. Sarbjit is a tenured professor at Farmingdale State College in Sports Business. Naginder has worked in an array of volunteer capacities for South Nassau."The naming and dedication of the medical library in Dr. Singh's honor will serve as a constant reminder of his commitment to lifelong learning and of his leadership to build on the hospital's tradition of excellence in health care," said Adhi Sharma, MD, chief medical officer.The Harbhajan Singh, MD Medical Library offers a collection of books, journals (both print and online), and access to clinical databases. The library's mission is to meet the ongoing information needs of physicians and other clinical staff in support of patient care, teaching, learning, and research. Click here to view the list of recent Press Releases from South Nassau Communities Hospital


The International Association of HealthCare Professionals is pleased to welcome Charlene E. McEvoy, MD, MPH, Pulmonologist and Sleep Medicine Specialist, to their prestigious organization with her upcoming publication in The Leading Physicians of the World. Dr. McEvoy is a highly trained and qualified pulmonologist and sleep medicine specialist with a vast expertise in all facets of her work. Dr. McEvoy has been in practice for over 18 years and is currently serving patients at her private practice Dr. Charlene E. McEvoy, MD in St. Paul, Minnesota and is also affiliated with Regions Hospital, and Hudson Hospital & Clinic. Dr. McEvoy attended the University of Minnesota School of Medicine where she received her Medical Degree in 1986. In addition, Dr. McEvoy completed her Master in Public Health Degree with a focus on epidemiology at the University of Minnesota. She then completed her Internal Medicine residency at the University of Minnesota, her Internal Medicine residency at Regions Hospital, and her Pulmonary Medicine fellowship at the University of Minnesota. Dr. McEvoy is board certified in Internal Medicine and Pulmonary Disease by the American Board of Internal Medicine, and in Sleep Medicine by the American Board of Sleep Medicine. To keep up to date with the latest advances in her field, Dr. McEvoy maintains a professional membership with the American Thoracic Society, the American College of Chest Physicians, the American Academy of Sleep Medicine, and is also the recipient of many awards and honors. She attributes her great success to caring, her hard work, treating her patients as family, and sticking to her values. When she is not assisting patients, Dr. McEvoy likes to relax by working out. Learn more about Dr. McEvoy here: https://www.regionshospital.com/rh/provider-search/practitionerdetail/8643/show.html and read her upcoming publication in the Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics.  Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review.  FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews, and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  For more information about FindaTopDoc, visit:http://www.findatopdoc.com


Vece T.J.,Baylor College of Medicine | Vece T.J.,Texas Childrens Hospital | Young L.R.,Pulmonary Medicine | Young L.R.,Vanderbilt University
Chest | Year: 2016

Diffuse lung diseases in children, also called children's interstitial lung disease, are a diverse group of rare disorders that cause disturbances of gas exchange in the lungs. Although individually rare, there are many different forms of diffuse lung disease in children, and collectively these disorders are associated with significant morbidity and mortality, as well as health-care resource utilization. Over the past several years, there have been many significant advances in the field, including genetic discoveries and the development of clinical practice guidelines. This review summarizes recent advances in the understanding, diagnosis, and treatment of diffuse lung diseases in children. © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.


Bradshaw M.,Mayo Medical School | Mansfield A.,Mayo Medical School | Peikert T.,Pulmonary Medicine
Current Oncology Reports | Year: 2013

Malignant pleural effusions (MPEs) are a significant source of cancer-related morbidity. Over 150,000 patients in the United States suffer from breathlessness and diminished quality of life due to MPE each year. Current management strategies are of mostly palliative value and focus on symptom control; they do not address the pathobiology of the effusion, nor do they improve survival. Further elucidation of the pathophysiological mechanisms, coupled with the development of novel treatments such as intrapleural chemotherapeutics targeting this process, has the potential to greatly improve the efficacy of our current management options. Vascular endothelial growth factor-A (VEGF-A) has been implicated as a critical cytokine in the formation of malignant pleural effusions. Elevated levels of VEGF produced by tumor cells, mesothelial cells, and infiltrating immune cells result in increased vascular permeability, cancer cell transmigration, and angiogenesis. Therefore antiangiogenic therapies such as Bevacizumab, a monoclonal antibody targeting VEGF-A, may have a potential role in the management of malignant pleural effusions. Herein we review the pathogenesis and potential treatment strategies of malignant pleural effusions, with a focus on angiogenesis and antiangiogenic therapeutics. © 2013 Springer Science+Business Media New York.


Cribbs S.K.,Pulmonary Medicine | Cribbs S.K.,Emory University | Tse C.,Legacy Meridian Park Medical Center | Andrews J.,Emory University | And 2 more authors.
Critical Care Medicine | Year: 2015

Objectives: Although highly active antiretroviral therapy has led to improved survival in HIV-infected individuals, outcomes for HIVinfected patients with sepsis in the post-highly active antiretroviral therapy era are conflicting. Access to highly active antiretroviral therapy and healthcare disparities continue to affect outcomes. We hypothesized that HIV-infected patients with severe sepsis would have worse outcomes compared with their HIV-uninfected counterparts in a large safety-net hospital where access to healthcare is low and delivery of critical care is delayed. Design: Secondary analysis of an ongoing prospective observational study between 2006 and 2010. Setting: Three adult ICUs (medical ICU, surgical ICU, and neurologic ICU) at Grady Memorial Hospital, Atlanta, GA. Patients: Adult patients with severe sepsis in the ICU. Interventions: Baseline patient characteristics and clinical outcomes were collected. HIV-infected and HIV-uninfected patients with sepsis were compared using t tests, chi-square tests, and logistic regression; p values less than 0.05 indicated significance. Measurements and Main Results: Of 1,095 patients with severe sepsis enrolled, 165 (15%) were positive for HIV, with a median CD4 count of 41 (8-167). Twenty-two percent of HIV-infected patients were on highly active antiretroviral therapy prior to admission, and 80% had a CD4 count less than 200. HIV-infected patients had a greater hospital mortality (50% vs 38%; p < 0.01). HIV infection (odds ratio = 1.78; p = 0.005) was an independent predictor of mortality by multivariate regression modeling after adjusting for age, history of pneumonia, history of hospitalacquired infection, and history of sepsis. Conclusions: HIV-infected patients with severe sepsis continue to suffer worse outcomes compared with HIV-uninfected patients in a large urban safety-net hospital caring for patients with limited access to medical care. Further studies need to be done to investigate the effect of socioeconomic status and mitigate healthcare disparities among critically ill HIV-infected patients. © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.


Mehta A.J.,Pulmonary Medicine | Yeligar S.M.,Pulmonary Medicine | Yeligar S.M.,Emory University | Elon L.,Emory University | And 2 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2013

Rationale: Alcohol use disorders cause oxidative stress in the lower airways and increase susceptibility to pneumonia and lung injury. Currently, no therapeutic options exist to mitigate the pulmonary consequences of alcoholism. Objectives: We recently determined in an animal model that alcohol ingestion impairs pulmonary zinc metabolism and causes alveolar macrophage immune dysfunction. The objective of this research is to determine the effects of alcoholism on zinc bioavailability and alveolar macrophage function in human subjects. Methods: We recruited otherwise healthy alcoholics (n = 17) and matched control subjects (n = 17) who underwent bronchoscopy for isolation of alveolar macrophages, which were analyzed for intracellular zinc, phagocytic function, and surface expression of granulocyte-macrophage colony-stimulating factor receptor; all three of these indices are decreased in experimental models. Measurements and Main Results: Alcoholic subjects had normal serum zinc, but significantly decreased alveolar macrophage intracellular zinc levels (adjusted means [SE], 718 [41] vs. 948 [25] RFU/cell; P, 0.0001); bacterial phagocytosis (adjusted means [SE], 1,027 [48] vs. 1,509 [76] RFU/cell; P, 0.0001); and expression of granulocytemacrophage colony-stimulating factor receptor b subunit (adjusted means [SE], 1,471 [42] vs. 2,114 [35] RFU/cell; P < 0.0001]. Treating alveolar macrophages with zinc acetate and glutathione in vitro increased intracellular zinc levels and improved their phagocytic function. Conclusions: These novel clinical findings provide evidence that alcohol abuse is associated with significant zinc deficiency and immune dysfunction within the alveolar space and suggest that dietary supplementation with zinc and glutathione precursors could enhance airway innate immunity and decrease the risk for pneumonia or lung injury in these vulnerable individuals. Copyright © 2013 by the American Thoracic Society.

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