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Clarkson, NY, United States

SUNY Downstate Medical Center, located in central Brooklyn, New York, is the only academic medical center for health education, research, and patient care serving Brooklyn’s 2.5 million residents. As of Fall 2011, it had a total student body of 1,738 and approximately 8,000 faculty and staff.Downstate Medical Center comprises a College of Medicine, Colleges of Nursing and Health Related Professions, Schools of Graduate Studies and Public Health, and University Hospital of Brooklyn. It also includes a major research complex and biotechnology facilities.SUNY Downstate ranks eighth nationally in the number of alumni who are on the faculty of American medical schools. More physicians practicing in New York City graduated from Downstate than from any other medical school. With 1,040 residents , Downstate's residency program is the 16th largest in the country.SUNY Downstate Medical Center is the fourth largest employer in Brooklyn. Eighty-six percent of its employees are New York City residents; 68 percent live in Brooklyn. The medical center's total direct, indirect, and induced economic impact on New York State is in excess of $2 billion. SUNY Downstate Medical Center attracted close to $60 million in external research funding in 2011, which includes $26 million from federal sources. It ranks fourth among SUNY campuses in grant expenditures, and second among SUNY's academic health centers. Wikipedia.


Bodis-Wollner I.,SUNY Downstate Medical Center
Parkinsonism and Related Disorders | Year: 2013

Purpose: The article aims to review foveal involvement in Parkinson's disease. Scope: Clinical observations as well as electrophysiological and anatomical studies in animal models provide evidence that Parkinson's disease (PD) affects vision. The retina is the most distal locus of visual dysfunction in PD as shown by electroretinographic (ERG) and optical coherence tomographic (OCT) studies. Thinning of the retinal nerve fibre layer (RNFL) and the fovea has been reported in PD. This review summarises retinal physiology and foveal visual dysfunction in PD and quantification of retinal thinning as reported in different studies and using different instruments. At this point due to methodological diversity and relatively low number of subjects studied, a meta-analysis is not yet possible. Results obtained on one equipment are not yet transferable to another. The author also briefly alludes to some links of visual processing deficits beyond visual detection, such as visual discrimination, visual categorisation and visuospatial orientation in PD. Conclusions: There are some promising results suggesting the potential applicability of ST-Oct as a biomarker in PD. Furthermore, these data raise some interesting neurobiological questions. However, there are identifiable pitfalls before OCT quantification may be used as a biomarker in PD. Analysis standardisation is needed on a larger than existing healthy and patient population. Furthermore, longitudinal studies are needed. The exact relationship between retinal foveal deficits and visuo-cognitive impairment in PD remains a challenging research question. © 2012 Elsevier Ltd.


Meister L.,SUNY Downstate Medical Center
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine | Year: 2013

Emergency physicians often encounter females presenting with symptoms suggestive of urinary tract infections (UTIs). The diagnostic accuracy of history, physical examination, and bedside laboratory tests for female UTIs in emergency departments (EDs) have not been quantitatively described. This was a systematic review to determine the utility of history and physical examination (H&P) and urinalysis in diagnosing uncomplicated female UTI in the ED. The medical literature was searched from January 1965 through October 2012 in PUBMED and EMBASE using the following criteria: Patients were females greater than 18 years of age in the ED suspected of having UTIs. Interventions were H&P and urinalysis used to diagnose a UTI. The comparator was UTI confirmed by a positive urine culture. The outcome was operating characteristics of the interventions in diagnosing a UTI. Study quality was assessed using Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Sensitivity, specificity, and likelihood ratios (LRs) were calculated using Meta-DiSc. Four studies (pooled n = 948) were included with UTI prevalence ranging from 40% to 60%. H&P variables all had positive LRs (+LR, range = 0.8 to 2.2) and negative LRs (-LR, range = 0.7 to 1.0) that are insufficient to significantly alter pretest probability of UTI. Only a positive nitrite reaction (+LR = 7.5 to 24.5) was useful to rule in a UTI. To rule out UTI, only a negative leukocyte esterase (LE; -LR = 0.2) or blood reaction on urine dipstick (-LR = 0.2) were significantly accurate. Increasing pyuria directly correlated with +LR, and moderate pyuria (urine white blood cells [uWBC] > 50 colony-forming units [CFUs]/ml) and moderate bacteruria were good predictors of UTI (+LR = 6.4 and 15.0, respectively). No single H&P finding can accurately rule in or rule out UTI in symptomatic women. Urinalysis with a positive nitrite or moderate pyuria and/or bacteruria are accurate predictors of a UTI. If the pretest probability of UTI is sufficiently low, a negative urinalysis can accurately rule out the diagnosis. © 2013 by the Society for Academic Emergency Medicine.


Minkoff H.,SUNY Downstate Medical Center
American Journal of Obstetrics and Gynecology | Year: 2014

Respect for autonomy is a key ethical principle. However, in some cultures other moral domains such as community (emphasizing the importance of family roles) and sanctity (emphasizing the sacred and the spiritual side of human nature) hold equal value. Thus, an American physician may sometimes perceive a conflict between the desire to practice ethically and the wish to be sensitive to the mores of other cultures. For example, a woman may appear to be making what the physician thinks is a bad clinical choice because her spouse is speaking on her behalf. That physician may find it difficult to reconcile the sense that the patient had not exercised freely her autonomy with the desire to be culturally sensitive. In this article, the means by which a physician can reconcile respect for other cultures with respect for autonomy is explored. The question of whether physicians must always defer to patients' requests solely because they are couched in the language of cultural sensitivity is also addressed. © 2014 Mosby, Inc. All rights reserved.


Smith S.S.,SUNY Downstate Medical Center
Frontiers in Neural Circuits | Year: 2013

The onset of puberty is associated with alterations in mood as well as changes in cognitive function, which can be more pronounced in females. Puberty onset in female mice is associated with increased expression of α4βδ γ-amino-butyric acid-A (GABAA) receptors (GABARs) in CA1 hippocampus. These receptors, which normally have low expression in this central nervous system (CNS) site, emerge along the apical dendrites as well as on the dendritic spines of pyramidal neurons, adjacent to excitatory synapses where they underlie a tonic inhibition that shunts excitatory current and impairs activation of N-methyl-D-aspartate (NMDA) receptors, the trigger for synaptic plasticity. As would be expected, α4βδ expression at puberty also prevents long-term potentiation (LTP), an in vitro model of learning which is a function of network activity, induced by theta burst stimulation of the Schaffer collaterals to the CA1 hippocampus. The expression of these receptors also impairs spatial learning in a hippocampal-dependent task. These impairments are not seen in δ knock-out (-/-) mice, implicating α4βδ GABARs. α4βδ GABARs are also a sensitive target for steroids such as THP ([allo]pregnanolone or 3α-OH-5α[β]-pregnan-20-one), which are dependent upon the polarity of GABAergic current. It is well-known that THP can increase depolarizing current gated by α4βδ GABARs, but more recent data suggest that THP can reduce hyperpolarizing current by accelerating receptor desensitization. At puberty, THP reduces the hyperpolarizing GABAergic current, which removes the shunting inhibition that impairs synaptic plasticity and learning at this time. However, THP, a stress steroid, also increases anxiety, via its action at α4βδ GABARs because it is not seen in δ-/- mice. These findings will be discussed as well as their relevance to changes in mood and cognition at puberty, which can be a critical period for certain types of learning and when anxiety disorders and mood swings can emerge. © 2013 Smith.


Lang E.K.,SUNY Downstate Medical Center
Journal of endourology / Endourological Society | Year: 2013

We present our experience with the use of metallic stents (Wallstents®) in the management of malignant ureteral obstruction to maintain renal function, thereby permitting the use of chemotherapeutic agents to treat the underlying malignancy. We retrospectively reviewed the records of 24 patients with ureteral obstruction secondary to advanced cervical carcinoma, stage T3b (n=10) and T4 (n=14), that was relieved by Wallstents. Nineteen patients needed bilateral and 5 needed unilateral Wallstents to relieve the obstruction. Fifty-six additional endourologic interventions were necessary to assure continued patency. Holmium laser ablation was used 14 times to manage tumor proliferation and ingrowth at the distal end of the stent. Thirty-two endostents, 4 extension, and 6 replacement stents were used to maintain patency of the ureter. Nineteen of our 24 patients received between one and five chemotherapeutic cycles over 18 to 140 months. In five patients, placement of Wallstents did not achieve adequate decrease of the creatinine levels to allow treatment with chemotherapy. Thirteen of 24 Wallstents remained patent over 18 months, yielding a primary patency rate of 54%. Technical success rate of Wallstent placement was 100%. The overall mean primary and secondary patency rates of the stent were 16.5 and 52 months, respectively. For T3b and T4 patients, the mean primary patency rates were 20.6 and 13.6 months, respectively. Secondary patency for T3b patients was 73.9 months vs 36.4 months for T4 patients. There were no serious complications associated with Wallstent placement. Wallstents offer a salutary solution to the problem of maintaining prolonged patency of ureters compromised by encasing neoplasms.

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