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New York City, NY, United States

Touro College is a sponsored independent institution of higher and professional education, in New York City, New York, United States. Founded by Bernard Lander, the College was established primarily to enrich the Jewish heritage, and to serve the larger American community. Approximately 19,000 students are currently enrolled in the various schools and divisions that comprise the Touro College and University System.The system includes Touro College and New York Medical College, accredited by the Middle States Commission on Higher Education, as well as Touro University California and Touro University Nevada, both of which are accredited by the Western Association of Schools and Colleges. The non-profit online university, Touro University Worldwide , is also part of the Touro College and University Systems. Wikipedia.

Goldberger J.J.,Northwestern University | Subacius H.,Northwestern University | Patel T.,Northwestern University | Cunnane R.,University of Chicago | Kadish A.H.,Touro College
Journal of the American College of Cardiology | Year: 2014

Objectives The purpose of this study was to provide a meta-analysis to estimate the performance of 12 commonly reported risk stratification tests as predictors of arrhythmic events in patients with nonischemic dilated cardiomyopathy. Background Multiple techniques have been assessed as predictors of death due to ventricular tachyarrhythmias/sudden death in patients with nonischemic dilated cardiomyopathy. Methods Forty-five studies enrolling 6,088 patients evaluating the association between arrhythmic events and predictive tests (baroreflex sensitivity, heart rate turbulence, heart rate variability, left ventricular end-diastolic dimension, left ventricular ejection fraction, electrophysiology study, nonsustained ventricular tachycardia, left bundle branch block, signal-averaged electrocardiogram, fragmented QRS, QRS-T angle, and T-wave alternans) were included. Raw event rates were extracted, and meta-analysis was performed using mixed effects methodology. We also used the trim-and-fill method to estimate the influence of missing studies on the results. Results Patients were 52.8 ± 14.5 years of age, and 77% were male. Left ventricular ejection fraction was 30.6 ± 11.4%. Test sensitivities ranged from 28.8% to 91.0%, specificities from 36.2% to 87.1%, and odds ratios from 1.5 to 6.7. Odds ratio was highest for fragmented QRS and TWA (odds ratios: 6.73 and 4.66, 95% confidence intervals: 3.85 to 11.76 and 2.55 to 8.53, respectively) and lowest for QRS duration (odds ratio: 1.51, 95% confidence interval: 1.13 to 2.01). None of the autonomic tests (heart rate variability, heart rate turbulence, baroreflex sensitivity) were significant predictors of arrhythmic outcomes. Accounting for publication bias reduced the odds ratios for the various predictors but did not eliminate the predictive association. Conclusions Techniques incorporating functional parameters, depolarization abnormalities, repolarization abnormalities, and arrhythmic markers provide only modest risk stratification for sudden cardiac death in patients with nonischemic dilated cardiomyopathy. It is likely that combinations of tests will be required to optimize risk stratification in this population. © 2014 by the American College of Cardiology Foundation.

Rehfield P.,Touro College
Current atherosclerosis reports | Year: 2013

CHD morbidity and mortality rates have more than halved since their peak in the 1960s and 1970s. This trend is a result of many factors; however, primary prevention provides the bulk of this benefit. Despite this tremendous progress, cardiovascular disease remains the major cause of death and this trend is projected to persist given the continuous growth in those aged 65 years or greater. Although statin therapy has been a main contributor to a primary prevention strategy, there is still controversy about exposing a large healthy population to long-term statin therapy. Advocates contend the mortality benefits from an aggressive statin approach would remove heart disease from its perch as the greatest killer of Americans and stroke mortality would drop from third to fifth place. Those advocating a much more conservative approach contend the data are not available to expose a healthy population to lifelong statin therapy given limited data on mortality, potential adverse events, and considerable costs. Given these opposing views, this summary of the evolution of statin therapy for the primary prevention of cardiovascular disease will review the major factors fueling this debate.

Del Rosso J.Q.,Valley Hospital Medical Center Las Vegas | Del Rosso J.Q.,Touro College
Journal of the American Academy of Dermatology | Year: 2013

Several more recent advances have led to a better understanding of the pathophysiologic mechanisms involved in rosacea and therapeutic modalities used for treatment. Although the clinical features may vary among patients, there are some unifying mechanisms that appear to relate to the more common presentations of rosacea. Both neurovascular dysregulation and augmented immune detection and response appear to play central roles that lead to many of the signs and symptoms of rosacea. Diffuse central facial erythema is a very common finding that intensifies during flares and persists to varying degrees between flares. This background of facial redness occurs secondary to vasodilation and fixed vascular changes that develop over time. Physical modalities are commonly used to treat the erythema that persists as a result of fixed changes in superficial cutaneous vasculature that do not remit after treatment with agents whose mechanisms are active primarily against some of the inflammatory processes operative in rosacea (ie metronidazole, azelaic acid, tetracyclines). As enlarged superficial cutaneous vessels that contribute to the fixed background facial redness of rosacea remain vasoactive to sympathetic nervous system innervation, topical α-adrenergic receptor agonists, namely brimonidine and oxymetazoline, are currently under evaluation for the treatment of facial erythema of rosacea. This article focuses on the clinical differentiation of facial erythema of rosacea and its management. © 2013 by the American Academy of Dermatology, Inc.

Troll J.G.,Touro College
Current Atherosclerosis Reports | Year: 2011

There is a significant prevalence (20%-80% depending on the population and the study) of lipid disorders and other cardiovascular risk factors in people living with HIV infection. This review focuses on HIV and HIV treatment-associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascular risk and other problems associated with these syndromes are discussed. Screening for cardiovascular risk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed. © 2010 The Author(s).

Ita K.B.,Touro College
Journal of Drug Delivery Science and Technology | Year: 2014

There are a number of advantages associated with transdermal drug delivery. With this route of administration, it is possible to avoid pain and presystemic metabolism. In addition, pharmacokinetic profile of the drug is more uniform with fewer peaks and troughs. However, the outermost layer of the skin - the stratum corneum - constitutes a strong barrier making it difficult for permeants to cross the skin at clinically relevant rates. This review examines progress made over the last 4 decades and challenges ahead. Over this period, about 35 transdermal products have been approved by regulatory authorities. About 19 drugs have been formulated into transdermal patches and approved by the Food and Drug Administration. The main challenge lies with the formulation of macromolecules- proteins, small interfering RNA and other products of biotechnology into transdermal delivery systems. This challenge is being met with approaches such as microneedles, iontophoresis, sonophoresis and electroporation.

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