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Staten Island, NY, United States

Naboush A.,Staten Island University Hospital | Hamdy O.,Harvard University
Endocrine Practice | Year: 2013

Objective: To review how visceral and hepatic fat are measured in clinical practice and clinical research.Methods: We examine different methods employed to assess visceral and hepatic fat in the literature.Results: Fat in the human body is located in 2 main compartments: subcutaneous and visceral, which also includes liver fat. Visceral and liver fats are associated with the metabolic complications of obesity like hypertension, diabetes, and atherosclerosis. Therefore, there is a need to detect those fats early in life before the development of cardiometabolic syndrome (CMS). Many modalities have been proposed to measure visceral and liver fat. Indirect measurements can be done through waist circumference (WC), dual-energy X-ray absorptiometry (DEXA), ultrasound, and bioelectric impedance, whereas direct methods include computed tomography (CT) and magnetic resonance imaging (MRI). An ideal measurement method should be noninvasive, reliable, suitable for all body sizes, widely available, cost and time effective, show low variability, and have no or limited radiation exposure.Conclusion: Measuring visceral and liver fat is not a straightforward procedure in clinical practice or research; several variables may affect measure accuracy and validity. © 2013 AACE.

BACKGROUND: After spontaneous conception, the rate of miscarriage is more common in multiple rather than singleton pregnancies. However, the incidence of miscarriage is lower in in-vitro fertilization twin versus singleton pregnancies. Most patients have little understanding of pregnancy outcomes once they achieve a positive pregnancy test. This study investigated the relationship between multiple pregnancy and miscarriage in women with infertility after fresh and frozen embryo transfer.METHODS: Retrospective local cohort study of all consecutive patients undergoing in-vitro fertilization at our institution (n = 1130), fresh or frozen embryo transfer, between January 1, 2008 and December 31, 2012. Patient characteristics (age, body mass index, initial hCG, maximum follicle stimulating hormone levels) and in-vitro fertilization parameters (estradiol levels, eggs retrieved, and endometrial thickness) were collected and statistically analyzed using T-test and Chi-square test (Stata version 10). Linear and logistic regression were used when appropriate.RESULTS: Overall, live birth rate for all cycles was 30.44% and total pregnancy loss was 6.55% - similar for fresh and frozen cycles despite a higher rate of biochemical pregnancies for frozen cycles. Among all pregnant patients, 62.48% had a live birth. Although clinical pregnancy rate was higher for fresh cycles, live birth rates were similar. In pregnancies where multiple sacs were demonstrated on ultrasound, live birth rates were higher despite 31% of patients losing at least one sac. This finding was comparable between fresh and frozen cycles. However, in patients under age 35 and using donor egg, no live birth advantage was seen in patients with multiple sacs. In fact, transferring more than one embryo did not increase live birth rate either.CONCLUSIONS: Despite the many maternal and fetal risks of multiple pregnancies, patients who achieve a positive pregnancy test with fresh and frozen in-vitro fertilization and who have more than one pregnancy sac are more likely ultimately to deliver at least one baby. This finding is true of both fresh and frozen embryo transfer cycles. This pregnancy advantage is not seen in young patients and in patients using donor egg, and single embryo transfer maximizes birth outcomes.

Bourjeily G.,Pulmonary and Critical Care Medicine | Chalhoub M.,Staten Island University Hospital | Miller M.A.,Women and Infants Hospital of Rhode Island
European Respiratory Journal | Year: 2010

The physiological changes of pregnancy may predispose females to develop sleep-disordered breathing (SDB) or protect against it. Studies evaluating outcomes of SDB symptoms in pregnancy are scarce. The goal of this study was to evaluate the prevalence of SDB symptoms in pregnancy and their relationship with pregnancy and neonatal outcomes. A cross-sectional survey of randomly selected immediate postpartum females was performed using the multivariable apnoea prediction index. Record review, including demographics and medical history, was performed. Main outcome measures included pregnancy and neonatal outcomes. 1,000 subjects were recruited. Mean±SD age was 29.1±6.1 yrs. Factors used in the regression analysis included age, body mass index, diabetes, chronic hypertension, multifetal gestations, smoking and renal disease. Snoring was present in 35.1% of subjects. Symptoms of SDB were associated with a higher likelihood of pregnancy-induced hypertension and pre-eclampsia (adjusted OR 2.3, 95% CI 1.4-4.0), gestational diabetes (adjusted OR 2.1, 95% CI 1.3-3.4) and unplanned Caesarean deliveries (adjusted OR 2.1, 95% CI 1.4-3.2) after multivariable regression analysis. Gasping may have been associated with a higher likelihood of preterm delivery, after adjusting for age and multifetal pregnancies (adjusted OR 1.8, 95% CI 1.1-3.2) but this association appeared to be mediated by pre-eclampsia. Symptoms of SDB are common in pregnancy and associated with a higher likelihood of gestational hypertensive disorders, gestational diabetes and unplanned Caesarean deliveries. Copyright©ERS 2010.

Tirgan M.H.,Keloid Research Foundation | Shutty C.M.,Staten Island University Hospital | Park T.H.,Sungkyunkwan University
Pediatrics | Year: 2013

Keloid disorder (KD) is a fibroproliferative ailment of the cutaneous connective tissue secondary to dysregulation in various skin repair and healing processes. This disorder is characterized by excess collagen and/or glycoprotein depositions in the dermis. Age of onset of KD is not well documented. Based on clinical observations, various authors have reported the onset of KD to be between the ages of 10 and 30 years. We report on an African American female who developed bilateral auricular keloids at the age of 9 months. To our knowledge, this is the youngest age at which a patient has been documented to have developed KD. Copyright © 2013 by the American Academy of Pediatrics.

Aycock R.D.,Staten Island University Hospital | Kass D.A.,Staten Island University Hospital
Southern Medical Journal | Year: 2012

A change in urine color can be distressing for patients and physicians alike. Many of the causes of abnormal urine color are benign effects of medications and foods; however, a change in urine color may be a sign of an underlying pathological condition. The good news is that in many cases the diagnosis can be determined from a thorough history and urinalysis. This article presents many of the conditions physicians may encounter and will help them form a narrow differential diagnosis and treatment plan. Copyright © 2011 The Southern Medical Association.

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