Woodhull Medical Center

Brooklyn, NY, United States

Woodhull Medical Center

Brooklyn, NY, United States

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Antonopoulou M.,SUNY Downstate Medical Center | Bahtiyar G.,SUNY Downstate Medical Center | Bahtiyar G.,Woodhull Medical Center | Banerji M.A.,SUNY Downstate Medical Center | And 2 more authors.
Maturitas | Year: 2013

The increasing prevalence of diabetes especially type 2 diabetes worldwide is indisputable. Diabetics suffer increased morbidity and mortality, compared to their non-diabetic counterparts, not only because of vascular complications, but also because of an increased fracture incidence. Both types 1 and 2 diabetes and some medications used to treat it are associated with osteoporotic fractures. The responsible mechanisms remain incompletely elucidated. In this review, we evaluate the role of glycemic control in bone health, and the effect of anti-diabetic medications such as thiazolidinediones, sulfonylureas, DPP-4 inhibitors, and GLP-1 agonists. In addition, we examine the possible role of insulin and metformin as anabolic agents for bone. Lastly, we identify the current and future screening tools that help evaluate bone health in diabetics and their limitations. In this way we can offer individualized treatment, to the at-risk diabetic population. © 2013 Elsevier Ireland Ltd.


Non-classic adrenal hyperplasia (NCAH) has been associated with insulin resistance (IR). Therapies such as metformin, thiazolidinediones and lifestyle alterations improve IR and also ameliorate the biochemical and clinical abnormalities of NCAH, much as they do in polycystic ovarian syndrome (PCOS). More recently, bariatric surgery, such as Roux-en-Y gastric bypass (RYGBP), has also been associated with improvement in IR and amelioration of PCOS and may, therefore, be beneficial in NCAH. We report a case of a 39-year-old, deaf-mute, obese woman with NCAH due to 11-hydroxylase deficiency who underwent RYGBP followed by improvement of NCAH manifestations. She was initially treated with metformin and pioglitazone, which lowered serum 11-deoxycortisol from 198 ng/dl (<51) to 26 ng/dl. Five weeks after undergoing RYGBP her body mass index fell from 44.18 kg/m(2) to 39.54 kg/m(2) and, despite not taking metformin or pioglitazone, serum 11-deoxycortisol remained normal at <40 ng/dl. Concurrently and subsequently, her NCAH symptoms, for example, alopecia, hirsutism and irregular menses normalised as well. We conclude that RYGBP, like other interventions that reduce IR, may be another way of treating non-classic 11-hydroxylase deficiency in selected patients.


Butala A.,Woodhull Medical Center
BMJ case reports | Year: 2013

We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.


Kalani A.,Woodhull Medical Center
BMJ case reports | Year: 2012

Congenital adrenal hyperplasia (CAH) is a well-characterised family of disorders of the adrenal cortices, resulting in varying degrees of cortisol, aldosterone and androgen deficiency or androgen excess, depending on the enzyme(s) affected and the degree of quantitative or functional enzyme deficit. Withania somnifera (WS), commonly known as Ashwagandha, is a medicinal plant that has been employed for centuries in ayurvedic medicine. Preclinical studies have shown that WS increases circulating cortisol levels and improves insulin sensitivity. We report the case of a 57-year-old woman with non-classical adrenal hyperplasia due to both 3-β-ol dehydrogenase deficiency and aldosterone synthase deficiency who was self-treated with WS for 6 months. After 6 months of treatment her serum 18-OH-hydroxycorticoserone, 17-OH-pregnenolone, corticosterone and 11-deoxycortisol decreased by 31%, 66%, 69% and 55%, respectively. The biochemical improvement was accompanied by a noticeable reduction in scalp hair loss.


Joseph S.J.,St. George's University | Delcastilo E.,St. George's University | Osiro S.,St. George's University | Osiro S.,Woodhull Medical Center | Loukas M.,St. George's University
Medical Science Monitor | Year: 2014

Background: A Centenarian is a person who attains and lives beyond the age of 100. Four percent of centenarians die from cancer. It is therefore important to understand which cancers affect them in order to devise better methods to prevent and treat them. The aim of this study was to investigate the top cancers that affect centenarians. Material/Method: We identified 1385 cases with the Surveillance Epidemiology and End Result (SEER) database. Our study included centenarians age 100-115 years diagnosed with the 5 most common cancers between 1973 and 2007 in the United States. Observed survival (OS) was calculated for each cancer type. The Kaplan-Meier (KM) method was used to calculate OS at 1-month intervals for the first 40 months after diagnosis using SEER*Stat version 7.04. A log rank test was performed on KM survival output and a Cox roportional hazard model was used to calculate hazard ratios. All statistical analyses were performed with 95% confidence intervals with significance determined at P<0.05. Cox proportional hazard analysis was done using GraphPad Prism version 5.04. Results: There were 879 (63.47%) females and 506 (36.53%) males. There were 1118 (80.72%) whites, 159 (11.48%) blacks, and 108 (7.80%) other. The top cancers were 405 (29.24%) breast, 267 (19.28%) colorectal, 254 (18.34%) prostate, 247 (17.83%) lung and bronchus, and 212 (15.31%) urinary and kidney cancer cases. Conclusions: As the prevalence of centenarians increases, it is becoming increasingly important to become aware of the cancers that affect them in order to better manage them. © Med Sci Monit, 2014.


Patel M.,SUNY Downstate Medical Center | Sinha A.A.,Roswell Park Cancer Institute | Gilbert E.,SUNY Downstate Medical Center | Gilbert E.,Woodhull Medical Center
Journal of Drugs in Dermatology | Year: 2012

Background: Bullous pemphigoid (BP) is an acquired, autoimmune, sub-epidermal blistering disease. The incidence of both BP and internal malignancy increases with age, yet the relationship between BP and malignancy has been a matter of debate for many years. Numerous cases have been published that link BP with various internal malignancies. While some analyses of large sets of clinical data fail to show a statistically significant correlation between BP and internal malignancy, others imply that there is a measurable correlation. Observation: We report a case of a 71-year-old male with invasive squamous cell carcinoma of the left heel and renal cell carcinoma who presented with urticarial bullous pemphigoid. Conclusions: There are few case reports in the literature associating bullous pemphigoid and renal cell carcinoma or squamous cell carcinoma. To our knowledge, this is the first reported case of coincident renal cell carcinoma, squamous cell carcinoma and urticarial BP. This case further supports investigation for underlying malignancy in patients with BP, particularly in the elderly. Copyright © 2012 Journal of Drugs in Dermatology.


Soe K.,SUNY Downstate Medical Center | Sacerdote A.,Woodhull Medical Center | Sacerdote A.,SUNY Downstate Medical Center | Karam J.,Maimonides Medical Center | And 2 more authors.
Maturitas | Year: 2011

Aim: To provide evidence based recommendations for optimal care diabetes care in the elderly. Background: Diabetes affects approximately 25% of the population ≥65 years, and that percentage is increasing rapidly, particularly in minorities who represent an important fraction of the uninsured/ underinsured. Diabetes is an important cause of hospital admissions and a co-morbidity in as high as 50% of hospital inpatients. It impacts mortality and quality of life. While tools have become available to improve glycemic control, enthusiasm for their application must be tempered with the sober realization of the risks involved in intensification of glycemic control, chiefly hypoglycemia. Methods: Weighted review from PubMed and other literature search tools in descending order of randomized control trials, observational studies, pilot studies, published guidelines, the authors' clinical experience, and expert opinion. Results/conclusions: HbA 1c targets should be stratified according to the frailty of the elderly diabetic patient: <7.0% in the generally well elderly and < 8.0% in the frail elderly.Therapies are available that achieve glycemic goals, while minimizing the risk of hypoglycemia, taking into consideration such factors as cognitive function, renal and hepatic function, bone density, fall risk, and hypoglycemia unawareness.When insulin is used determir or glargine are safer choices than NPH.Ultra-short acting prandial insulins are safer than regular insulin.Pen devices for insulin delivery significantly reduce dosing errors and the risk of hypoglycemia.Sudden managed care formulary changes that disrupt patients' diabetes treatment should be prevented through national policy initiatives.Up to date home medication lists help prevent dangerous medication errors.Widespread adoption of telehealth approaches can significantly improve glycemic control and render it safer. © 2011 Elsevier Ireland Ltd. All rights reserved.


Sacerdote A.S.,Woodhull Medical Center
BMJ case reports | Year: 2012

The authors report a patient whose polycystic ovarian syndrome (PCOS) and increased calcitriol level were associated with neurocysticercosis (NCC), for which she refused standard therapy. Based upon a report on treatment with tamoxifen in murine cysticercosis,1 she was offered raloxifene. She began raloxifene 60 mg/day on 21 January 2010. On 17 March 2010 she was pregnant, and was terminated on 14 April 2010. MRI 26 April 2010 showed diminution in size, shrinkage and loss of viability in a number of the cysts. Total lesions fell from 37 to 33, 10 lesions shrunk, 5 resolved, 18 were unchanged, 4 enlarged and 1 new lesion developed. Concomitantly serum calcitriol fell from 81 to 41 pg/ml while 25-OH-vitamin D level fell from 34 to 30 ng/ml. Alteration of the hormonal milieu may reduce cestode burden in human NCC. The pregnancy on raloxifene, though unfortunate, supports the concept that NCC caused the PCOS. Serum calcitriol may be a useful biomarker for assessing disease activity in NCC.


Ghody P.,SUNY Downstate Medical Center | Shikha D.,SUNY Downstate Medical Center | Karam J.,Maimonides Medical Center | Bahtiyar G.,Woodhull Medical Center
Maturitas | Year: 2015

The rates of long-term diabetes related complications have declined substantially over the past decade. On the contrary, the growth in the incidence of prediabetes is note-worthy - especially in the population 60 years and above. As a result, the focus is now shifting toward early identification and prevention of diabetes. Prediabetes is a high risk state in the continuum of glycemic progression and beta cell dysfunction toward the development of diabetes mellitus. Observational studies have shown association of prediabetes with increased incidence of vascular complications. Long-term prospective randomized clinical trials across the globe have demonstrated a reduction in progression of prediabetes when lifestyle modifications are adopted and these effects can last up to 20 years beyond the period of intervention. While there has been recent interest in using pharmacotherapy for diabetes prevention, they have not been shown to be superior to lifestyle changes. This review hopes to provide a concise summary for the interested reader. © 2015 Elsevier Ireland Ltd.


A 37-year-old woman presented with a history of reactive hypoglycaemia, non-classic adrenal hyperplasia (NCAH), osteopenia and fibromyalgia. After several months of palpitations, postural orthostatic tachycardia syndrome (POTS) was diagnosed by tilt table studies. Her heart rate (HR) reached 191 bpm at 60 degrees from horizontal. Investigation suggested increase in epinephrine and norepinephrine levels in response to tilt table. Her 25(OH) vitamin D level measured by immunoextraction radioimmunoassay was 35 pg/ ml (normal 9-54 pg/ml) while her 1,25(OH)(2) vitamin D3 level was 24 pg/ml (normal 30-67 pg/ml). Accordingly, she was started on calcitriol 0.25 mcg orally daily. At her next visit after 5 months, she reported remarkable improvement in her palpitations and had been working full time for the past 4 months. HR both seated and upright was 72 bpm. After 3 months, her 1,25(OH)(2) vitamin D3 level on calcitriol was 40 pg/ml. The authors suggest that 1-α hydroxylation defects should be sought and treated, if present, with calcitriol in patients with POTS.

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