Albert Einstein College of Medicine, Yeshiva University: Open Journal Systems
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Mineral and Bone Metabolism Disorders in Minority Incident ESRD Patients in an Inner-City Hemodialysis Unit
Get PDFBackground: Chronic kidney disease (CKD) predisposes patients to mineral and bone metabolism disorder (CKD- MBD), which is a well-known risk factor for increased mortality. Because Medical Evidence Form 2728 from the Centers for Medicare and Medicaid Services for incident end-stage renal disease (ESRD) patients does not require documentation of CKD-MBD markers, MBD status on incident patients remains unknown. Objective: Retrospective observational study to determine the prevalence of mineral and bone metabolism disorder in minority incident ESRD patients. Methods: We studied all incident ESRD patients in our hemodialysis unit between January 2000 and September 2008. Patients followed for less than three months were excluded. Target values for CKD stage 5 were defined as per 2003 Kidney Disease Outcome Quality Initiative guidelines. Results: One hundred seventy-four patients were stud- ied, with a mean age of 53.7±16.1 years, mean body mass index of 26.67±5.98 kg/m2, and mean estimated glomerular filtration rate of 6.7±4.03 mL/min/1.73m2. Mean lab values with one standard deviation were as follows: corrected calcium 8.5±1.3 mg/dL, serum albumin 3.05±0.77 g/dL, phosphorus 5.5±2.2 mg/dL, calcium-phosphorus product 46.7±18.5 mg2/dL2, and intact parathyroid hormone (iPTH) 440.9±397.8 pg/mL. Target values for cal- cium, phosphorus, calcium-phosphorus product, and iPTH were met in 34%, 42%, 72%, and 31% of the patients, respectively, while only 6% of the patients met all four target values. Conclusions: CKD-MBD is widely prevalent in minority incident dialysis patients at initiation of therapy. Its management continues to be a challenge and warrants early recognition and therapy in CKD patients.
Oral Cancer Screening in High-Risk Individuals: The Need for Awareness by the Primary Care Physician
Get PDFMedical Student Views of Healthcare Reform in the United States, 2009
Get PDFPurposeTo assess the opinions of Albert Einstein College of Medicine (Einstein) medical students about U.S. healthcare reformin the context of the 2008 U.S. presidential election through the use of an online survey. The study additionallyevaluates the influences on students’ healthcare opinions and whether there is sufficient instruction given to medicalstudents about healthcare systems.MethodDuring January and February 2009, first-year and second-year (classes of 2011 and 2012) Einstein medical students(n=362) were surveyed about U.S. healthcare using a web-based electronic survey. The survey included questionsabout students’ healthcare views and influences, political views, and education related to healthcare systems.ResultsWith a response rate of 56%, the survey showed that, among Einstein students, the most popular reform to the U.S.healthcare system would be a multipayer system (41%) in which all U.S. citizens would have access to healthcare paidfor by the U.S. government, but could also choose to obtain private insurance. More than 86% of the respondentsfelt that they had not received adequate education in medical school about the U.S. healthcare system. Seventy-fourpercent of respondents supported Barack Obama in the 2008 U.S. presidential election.ConclusionsEinstein students overwhelmingly recognize the need for reform in the U.S. healthcare system, and students are confidentthat, under Barack Obama’s leadership, the number of uninsured American citizens will decrease in the nextfour years. Survey findings also reveal the need for improved medical student education about the U.S. healthcaresystem
The Next Steps: Thoughts of a Medical Student-Watcher
Get PDFSpeech given at the Albert Einstein College of Medicine Class of 2011 Transition Ceremony, April 2, 2009
Role of Auxilin and Heat Shock Protein 70kDa in Clathrin Uncoating
Get PDFAn interaction between auxilin and heat shock protein 70kDa (Hsc70) was initially discovered in 1995. There exists a large amount of data supporting the basis for their interaction in vitro and their function in clathrin uncoating in vivo. This review examines the key experiments in elucidating this interaction and introduces a third protein that may connect constriction or fission with hsc70/auxilin mediated clathrin uncoating.
Drug Discovery over the Past Thirty Years: Why Aren’t There More New Drugs?
Get PDFThe rate of drug discovery has not kept pace with the exponential increase in biomedical knowledge. For the past 30 years, the number of new molecular enti- ties approved by the United States Food and Drug Administration has averaged 20 to 30 drugs per year, except for a peak in the mid-1990s that briefly doubled this rate. This modest productivity cannot be explained by lack of funding, as the research budgets of government and industry-funded programs have increased threefold to fivefold over the past three decades. Various arguments have been proposed to account for the relative lack of innovative new drugs, but little consideration has been given to the focus on hypothesis-driven translational research. In theory, the emphasis on translational research should have led to an increase in the number of new drugs. However, in considering the historical perspective of drug discovery and the role of serendipity, it can be argued that the emphasis on translational research diverts scientists from pursuing basic-science studies that give rise to fundamental discoveries. In many cases, retro-translational research (from clinic to basic science) is necessary before the disease process can be understood well enough for scientists to develop therapeutics. Ultimately, a balance of disease-oriented and basic-science research on fundamental processes is optimal
Psychiatric Underpinnings of Chronic Diabetic Neuropathic Pain
Get PDFThere is increasing evidence that psychosocial factors may be involved in the pathophysiology of chronic diabetic neuropathic pain. Individuals with diabetic polyneuropathy exhibit significantly higher rates of axis I psychiatric disorders, and worsening neuropathic symptoms correlate with worsened psychiatric illness. This association exists even when social-support and quality-of-life measures are controlled. Aberrant supraspinal structures and neuronal networks in diabetic neuropathy mimic those found in other psychiatric illnesses. Response to standard medications and therapeutic approaches remains unsatisfactory, and antidepressants continue to serve as first-line treatment for diabetic neuropathy. The exact interplay between neuropathic pain and psychiatric illness remains unclear and may have a common pathophysiological focus. This area of study needs to be revisited and psychological interventions must be explored as possible treatment options for diabetic neuropathy.