She provided care in Ghana

 

Nurse practitioner Brandy Baillargeon and a baby girl she provided care for in Ghana, West Africa.

Brandy Baillargeon of Watertown, a family psychiatric mental health nurse practitioner, traveled to Ghana through Upstate nurse Lauri Rupracht’s Americans Serving Abroad Project. She was touched by the gratitude of those she helped in several villages during the eight-day medical mission, including a baby girl who has problems with her feet. Baillargeon helped fashion some braces for her, using tongue depressors and high-top sneakers, and made arrangements for her to be seen at a hospital a few hours from her village. Baillargeon is a student in Upstate’s doctor of nursing practice program.

This article appears in the summer 2017 issue of Upstate Health magazine. To hear more about the Americans Serving Abroad Project in Ghana and how you might participate or help out, listen to this podcast/radio interview with Rupracht and fellow Upstate nurse Caitlin Phalen on Upstate’s “HealthLink on Air.”

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Posted in community, health care, HealthLink on Air, international health care, public health, volunteers | Tagged , , , ,

Science is art: Preserving fatherhood

Sperm cells, which can be stored for future use by men who, because of cancer or other reasons, might not otherwise be able to father children.

Kazim Chohan, PhD (right), leads Upstate’s Male Fertility Preservation Program, which came about through the efforts of Chohan and colleagues including pediatric oncologist Jody Sima, MD (left); urologist JC Trussell, MD; oncologist Rahul Seth, DO; and pathology chair Robert Corona Jr., DO. (PHOTO BY ROBERT MESCAVAGE)

The andrology department at Upstate helps men preserve their ability to become fathers by offering:

— sperm banking, where semen is collected and frozen in liquid nitrogen;

— testicular sperm extraction, a surgical procedure for men with no sperm in their semen, in which sperm are extracted directly from testicles, and then frozen;

— testicular tissue freezing, an experimental process that involves surgically removing and freezing tissue from the testicles of boys who are not old enough to produce sperm. The tissue could potentially be used later to restore fertility or produce sperm.

These techniques help men with a cancer diagnosis or temporary or permanent infertility issue. Learn more about fertility preservation by calling Upstate’s andrology department at 315-464-6550.

This article appears in the summer 2017 issue of Upstate Health magazine.  Hear a “HealthLink on Air” podcast/radio interview with Chohan and Sima where they discuss fertility preservation and the patients it can help.

 

 

Posted in health care, HealthLink on Air, men's health, research, sexuality, technology

Limiting Lyme disease: How you can protect yourself and your family

Long sleeves and pant legs tucked into boots can help prevent ticks from biting. (PHOTO BY DAN CAMERON)

Sixteen of every 100,000 New Yorkers were infected with Lyme disease in 2015, the latest year for which statistics are available. In 2015, 95 percent of Lyme diagnoses came from 14 states, including New York.

Lyme disease is caused by bacteria that are transmitted to humans through the bite of an infected tick, called Ixodes scapularis but better known as a deer tick because of its habit of parasitizing the white-tailed deer. Ticks acquire Lyme disease microbes by feeding on infected mice and other small rodents. They may also spread other organisms.

Prevention advice

  1. Ticks do not jump or fly or drop from trees. They start from the ground and crawl upward until they find a place to attach. Tuck pants legs into socks, to keep ticks on the outside, where they may be seen or brushed off.
  2. Use repellents on your skin (that contain DEET) and your clothes (that contain permethrin.) Be sure to spray shoes and the insides of pants and shorts, too.
  3. Ticks may live where yards border wooded areas. They like shady areas and leaves with high humidity. Keeping leaves raked and shrubs and low branches trimmed can ruin their habitat. You may also consider pesticide treatment along the yard’s perimeter.
  4. Check for ticks daily – especially the scalp, ears, underarms, belly button, waist and back, behind knees and the pelvic area – and remove any promptly (See “The right way to remove a tick,” below.)) The smallest deer ticks may resemble poppy seeds.
  5. Throw clothing in a hot dryer for 10 minutes to kill ticks. Washing clothes even in hot water does not kill ticks.

 The right way to remove a tick

An adult tick on a blade of grass.

“Take tweezers and grab the tick at the very bottom, close to the skin, and gently pull up,” says Jana Shaw, MD, an associate professor of pediatrics and public health and preventive medicine at Upstate.

She says not to try choking or burning the ticks, or other home remedies, because they are not effective — and stressing a tick can make it expel bacteria into your skin.

“Just a gentle pull with the tweezers — and cleaning the skin with alcohol afterwards — is ll that is needed.”

Dispose of a live tick by submerging it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape or flushing it down the toilet. Never crush a tick with your fingers.

— Sources: Centers for Disease Control and Prevention, Cornell Cooperative Extension, Tick Encounter Resource Center from the University of Rhode Island and Upstate Medical University

What happens when Lyme attacks the heart

BY AMBER SMITH

Every time he stood, he would feel dizzy.

Hamza Murtaza, 25, is a fourth-year medical student at Upstate Medical University who wrote about his personal experience with a complication of Lyme disease. (PHOTO BY ROBERT MESCAVAGE)

But since he was fasting for Ramadan in the summer of 2015, Upstate medical student Hamza Murtaza figured he was just lightheaded from not eating.

He was also tired, and he had abdominal pain. When he felt his pulse, it was an abnormally slow 30 to 40 beats per minute.

“It got to the point where I walked from my apartment to the library, and I had to stop two or three times,” Murtaza says. “I wasn’t winded or short of breath. I was just tired.”

Murtaza, 25, took a detour to the student health center at Upstate. Among the tests he submitted to was an electrocardiogram, which showed the electrical functioning of his heart.

Murtaza had complete heart block. The impulses from his heartbeat were not working properly. That’s why his heart rate was so low and why he was getting dizzy.

He was promptly admitted to Upstate University Hospital. A temporary pacemaker was installed. As doctors set about trying to determine what caused Murtaza’s heart problems, Murtaza started thinking.

He’d been married early that summer, and for a quick honeymoon, he and his wife traveled to Maine for a long weekend at Acadia National Park. One morning, he awoke with joint pain and shoulder pain. He thought he had pulled a muscle or slept wrong. The pain went away, and he forgot about it. Then his right elbow started hurting. Then his left thumb started to hurt.

Looking back, Murtaza realized he had “migratory arthritis,” something that is sometimes seen in Lyme disease. He never noticed a rash. Nevertheless, the heart block he developed was blamed on a rare complication of Lyme called Lyme carditis.

Doctors put him on antibiotics for seven days in the intensive care unit, and he continued taking the medicine for two weeks after he was discharged. He eventually recovered.

Murtaza wrote about his experience in a poster presentation for this year’s Charles R. Ross Student Research Day at Upstate. “Of the 30,000 Lyme cases reported each year, only 1 percent present with meningitis or Lyme carditis,” says his poster. “My case elucidates the value of a complete history and demonstrates that a lack of the hallmark rash can often lead to the underestimation of symptoms.”

This happened between Murtaza’s first and second year of medical school. When classes resumed, he attended an infectious diseases lecture – and the professor discussed an interesting case of Lyme disease. Murtaza volunteered that he was the patient, providing a perspective not usually available in a medical class lecture.

This article appears in the summer 2017 issue of Upstate Health magazine.

Posted in arthritis, health care, heart/cardiovascular, infectious disease, medical student, patient story, public health | Tagged , , , ,

Resident physician sees increasing awareness of a common mental disorder

Nicole Cifra, MD, shown in an Upstate cafeteria, is concerned with how may young women have unhealthy eating practices. (PHOTO BY WILLIAM MUELLER)

BY JIM HOWE

Upstate graduate Nicole Cifra, MD, trained with a mentor who told her of his early years as a doctor, some 35 years prior. When he heard a patient had anorexia, he had no idea what that was because he had never heard of the eating disorder in medical school or during residency training.

These days, people are more aware of eating disorders, and professionals no longer blame families or exclude loved ones when treating a young patient, Cifra says. She earned her medical and master of public health degrees at Upstate and is now a pediatric resident physician at the University of Rochester.

About one in 20 young women has an eating disorder, and “everybody knows somebody” who has had one, Cifra notes. Between 4 percent and 20 percent of young women practice unhealthy patterns of dieting, purging and/or binge eating.

At a recent talk at Upstate, Cifra explained that researchers are looking for the cause of anorexia and other eating disorders. Current thinking suggests a brain-based genetic illness.

She also spoke of challenges in diagnosing and treating patients, who may try to hide the disorder out of shame or guilt or whose obsessions with weight and food can seem commonplace. Since many health insurers do not cover the cost of treatment for eating disorders at the same level as for other mental disorders, families are liable to face high out-of-pocket costs. Finding appropriate care can be difficult, too.

Still, Cifra sees progress.

A medical care standards guide for eating disorders, which Cifra helped develop as a member of the Academy for Eating Disorders, offers information to care providers if no treatment is available nearby. Parents also use the guide to advocate for their children.

This article appears in the summer 2017 issue of Upstate Health magazine. For a 2016 essay Cifra wrote about eating disorders, click here. For  more information on eating disorders, visit the Academy for  Eating Disorders website.

Posted in adolescents, diet/nutrition, health care, medical student, mental health/emotional health, psychology/psychiatry, weight loss | Tagged , , ,

Geocaching booklet shows one way people with disabilities can enjoy nature

Real-life scavenger hunts using GPS assistance can involve people with developmental disabilities.

A booklet called “Accessible Geocaching” explains how to find accessible nature areas and instructions for novice geocachers. It’s an effort to promote inclusion of young adults with developmental disabilities in community-based wellness programs.

“Accessible Geocaching” is part of the New York State Developmental Disabilities Planning Council’s Inclusive Fitness Initiative. Upstate pediatrician Nienke Dosa, MD, assembled the booklet with help from several students and collaboration from the City of Syracuse Department of Parks, Recreation and Youth Programs, Syracuse University, SUNY Cortland department of therapeutic recreation and physical education, and the state Department of Environmental Conservation.

Click here to download a copy of the booklet.

This article appears in the summer 2017 issue of Upstate Health magazine. Click here for a podcast/radio interview in which Dosa talks about the Fitness Inclusion Network and ways that the outdoors can be made more accessible to people with disabilities.

Posted in disability, health care, sustainability/environment, technology | Tagged , , , , ,

Sticking to it: Kali Club offers enjoyable route to self-defense skills

A Kali Club practice session at Upstate’s Institute for Human Performance. From left, Alan Blayney, MD/PhD student; John Sprey, master of nursing student; Karen Cyndari, MD/PhD student and the club’s founder; and Breanna Felidin, medical student. (PHOTO BY SUSAN KAHN)

BY JIM HOWE

About two dozen people battle each other with wooden sticks every week on the Upstate campus, displaying skills that look like a mix of a fencing class, a pirate raid and a street brawl.

But no one gets hurt.

These Upstate employees and students are only tapping their sticks lightly, not hitting each other, as they go through their moves.

They are learning a martial art called kali, which is increasingly popular in the United States. Also called arnis or eskrima, the fighting style developed in the Philippines as natives learned to take whatever weapons were available – sticks, knives or bare hands – to defend themselves from foreign invaders or each other.

Karen Cyndari, who is in the sixth year of her MD/PhD program, studied kali for eight years before starting the SUNY Upstate Kali Club this year. Club practice sessions are free and usually held twice a week. She loans wooden or rattan sticks to members who don’t have their own.

Cyndari, 30, who met her future husband a few years ago in a kali class, teaches at a beginner level and emphasizes kali’s skills and strategies, such as how to move when attacking or being attacked, and its camaraderie and fun. She does not want a hard-core fight atmosphere where people just “bang sticks,” get hurt or feel intimidated, she said.

The club is open to any adult at Upstate.

“I like kali because it is surprisingly difficult. For me, the challenge is in learning the moves. Moving around while swinging sticks with precision and coordination is not something I’m used to doing,” says Marten Peterson, 27, a second-year medical student.

Another second-year med student, John Frandina, 26, said, “I like how much strategy is involved in kali. There are moves and countermoves, kind of like playing chess, only you’re attacking each other with wooden sticks.”

“I always thought a fighting style that involved weapons would be very primal; however, kali is strategic and methodical,” he noted.

Marleny Acosta, 29, also in her second year of medical school, says the idea of learning self-defense appealed to her. “I thought this would be a great way to learn how to best defend myself from an attacker. What I like most is knowing that I am learning something that is not only ‘cool’ but also beneficial.”

Club members learn the basic moves – the types of strikes, plus footwork – fairly quickly, and then they practice, practice, practice while adding new moves. Although kali club sessions involve a lot of movement, they’re not designed to help people get fit. “There’s boot camp or Zumba for that,” Cyndari said. “My classes are calm and focused.”

This article appears in the summer 2017 issue of Upstate Health magazine.

Posted in entertainment, fitness, health care | Tagged , , , , , , ,

Mystery at the lake: Researchers uncover deadly potential of obscure, long-buried chemicals

Chemical compounds found in mud near Onondaga Lake’s southern end, above, likely came from the former Allied Corp., which dumped wastes in or near the lake for years. The compounds, related to the banned pesticide DDT, are extremely toxic at low levels and would like accumulate in the lake’s fish, making them dangerous to eat, researchers say. (PHOTO BY WILSON SUMMER/NEWYORKPHOTOGRAPHY.US)

BY JIM HOWE

Among the industrial wastes that have polluted Syracuse’s Onondaga Lake for decades are two “mystery compounds” related to – and apparently more toxic than – the banned pesticide DDT.

Scientists from Upstate Medical University, Syracuse University and the SUNY College of Environmental Science and Forestry have collaborated to study the chemicals, termed diphenylethanes, and whether they might cause seizures, developmental defects, brain damage or early death.

John Hassett, PhD, a professor of chemistry at ESF, has studied the lake for years and discovered these chemicals in a mud sample he took near the southern end of the lake.

He recognized the DDT-like structure of the two chemical compounds, which have no common names because they were never used commercially.

“It was a eureka moment for me when I realized how these two compounds came to be,” Hassett said. He had researched chemical processes going back to the 1880s and theorized that the lake’s chief industrial polluter, the defunct Allied Corp., produced the two chemicals as chance byproducts of refining oil produced from coking coal. The oily, thick compounds, officially designated as PTE (1-Phenyl-1-(p-Tolyl)-Ethane) and PXE (1-Phenyl-1-(2,4-Xylyl)-Ethane), had not been identified by industrial chemists, had no commercial use and were dumped in tar pits near the lake and possibly into the lake itself, he said.

Hassett and his team analyzed the newly found lake chemicals, which matched the material in the tar pits.

“When we looked at the structure, it has the same chemical backbone as DDT, so we wondered if this stuff might have biological consequences,” Hassett said.

Hassett has found the chemicals in the water all through the lake, apparently coming from very contaminated sediments near shore. “If it’s buried in the mud and not disturbed, it should stay there. If you go down about a meter into the mud in the middle of the lake, I think there is a layer through the whole sediment of the lake. It comes up to the surface in that shallow part in the southern end; in deeper parts, it is buried. We’re going to see what’s still out there,” Hassett said.

Dredging and capping of the lake bottom, completed this spring as part of a decades-long lake cleanup, probably stirred up some of the sediment, although any tar should remain buried in deeper sections, Hassett said. Since the tar is not very soluble in water, it probably is not much of a groundwater threat, he said. It is likely accumulated by lake fish, which health officials warn people not to eat. Some refugees and possibly other people, however, have been known to ignore warnings and eat fish from the lake.

To study the compounds’ possible toxic effects, Hassett partnered with James Hewett, PhD, and Katharine Lewis, PhD, associate professors of biology at SU. Lewis conducted studies on young zebrafish, while Hewett studied mice, both of which are often used as test models for humans.

“Because it looked like DDT, which has effects in development and is neurotoxic — DDT is linked to tremors and other neurological problems — we thought we’d test the neurotoxic potential of these compounds at the earliest stages of life,” Hewett said. “DDT is linked to tremors and other neurological problems.”

“My field of research is epilepsy. There is considerable interest now in how early life environment influences disease susceptibility later in life.”

Hewett exposed pregnant female mice to PTE and found their offspring seemed normal until adulthood, when testing showed they were more susceptible to seizures, such as happens with epilepsy. While it is difficult to mimic precisely how human exposure to these chemicals might take place, the mouse study provides a model for future testing, Hewett said.

Lewis found the chemicals to be extremely toxic at very low levels, hundreds of times lower than DDT. The lowest levels that they tested were similar to the levels Hassett found in Onondaga Lake in 1994. These levels cause heart defects and increased death rates in young zebrafish, and slightly higher levels caused increased susceptibility to convulsion behaviors that are similar to human seizures.

“I would be very surprised if the effects these chemicals have on zebrafish are fundamentally different than those on humans, but there may be subtle differences,” Lewis said. “It’s highly likely that the same effects would also occur in humans, but you can never say for sure.”

Also participating in the research, now in its third year and paid for by a grant from the Hill Collaboration on Environmental Medicine, is Frank Middleton, PhD, an associate professor of neuroscience and physiology and director of the SUNY Molecular Analysis Core at Upstate. Middleton assessed changes in gene expression – the process by which genetic information is made into a product, such as a protein — in the brains of the exposed mice offspring and zebrafish embryos. He was seeking clues that might help explain the altered seizure susceptibility and birth defects using a high-powered approach referred to as next generation sequencing (NGS).

“The NGS data are very compelling and indicate disruption of very specific genes and cellular signaling pathways is occurring as a result of the PTE and PXE exposures,” said Middleton.

The researchers all hope to continue studies based on this work.

“I would like to test other chemicals and see which genes might be turned on or off because of these chemicals. That could teach more about what can cause seizure or early development toxicity and might give more potential targets for therapy,” Lewis noted.

What is DDT?

DDT was a commonly used pesticide until it was banned in the U.S. in 1972 because it persists in the environment, accumulates in fatty tissues and can cause adverse health effects on wildlife, becoming more toxic as it moves up the food chain.

The two chemical compounds found in the Onondaga Lake mud — PTE and PXE — are related to DDT and appear to be more toxic. They have no known commercial value and have never been studied extensively before.

This article appears in the summer 2017 issue of Upstate Health magazine.

Posted in health care, public health, research, sustainability/environment | Tagged , , , , , , , , , , , , , ,

Upstate stroke neurologists care for patients in remote areas

Mary Green, shown with her husband, Marshall, was airlifted to Syracuse from Alexandria Bay for stroke treatment after a consultation through the Upstate Telestroke network. (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

This is a story about two women, living in different parts of rural Central New York.

Each suffered a stroke.

Each had a loved one who summoned help.

Each saw a stroke neurologist from Upstate University Hospital long before arriving at the academic medical center in Syracuse.

Upstate’s Telestroke partnership – which allows Upstate neurologists to provide clinical care from a distance — helped save the lives of both Amanda Peer of Watertown and Mary Green of Clayton.

A headache that wouldn’t stop

Green, 49, is a licensed practical nurse who has worked for 30 years at River Hospital in Alexandria Bay. She was supposed to work there Oct. 25, but at 5:15 a.m. she remained sound asleep, snoring. Her husband, Marshall Green, tried to wake her up, twice.

Elwaleed El Nour, MD

When he realized she was unresponsive, he called for their son, Dustin to help while they waited for the ambulance. They thought Mary Green might have overdosed on her medication.

The day before, Green had a headache that wouldn’t stop. She remembers going to bed early. That’s all she remembers. “I don’t remember anything for about 38 days. I kind of lost a month of my life.”

Her husband kept notes for her. At River Hospital, the doctors consulted with Upstate neurologist Elwaleed El Nour, MD, via Telestroke. His assessment allowed for a quick decision that Green needed prompt transport by helicopter for expert care in Syracuse.

At Upstate, Green immediately underwent an angiogram, showing the blood flow – and the blockages – in the vessels of her brain. She had what is called a bilateral occipital stroke, affecting the lower back part of her brain. This region that controls vision, coordination and balance, among other essential functions.

Carmen Martinez, MD

Green spent 38 days in Upstate’s specialized neuroscience intensive care unit for patients with neurological problems. Medications helped her recover from her stroke. After she was  stabilized, she was transferred to Upstate’s physical medicine and rehabilitation unit.

She went home Dec. 13. She continues to see neurologist Carmen Martinez, MD, who is trying to determine why Green had a stroke – although the reasons remain unknown for some stroke patients.

Green is not back to work yet. She can’t drive, but she can walk, and she’s hopeful her vision will continue to improve. She considers herself “a very fortunate, lucky lady.”

Debra Ezell and her daughter, Amanda Peer. After she suffered a stroke, Peer’s doctors in Watertown conferred remotely with the director of Upstate’s Comprehensive Stroke Center before deciding to transfer her to Syracuse. (PHOTO BY SUSAN KAHN)

A hand that went numb

Amanda Peer, 33, lay in her hospital bed Sunday, March 12, the day after her stroke. She watched doctors walk by her room. Then she saw him. “Mom! That’s the guy who was in the car.”

That guy was neurologist Gene Latorre, MD, medical director of Upstate’s Comprehensive Stroke Center.

Gene LaTorre, MD

The car he was in was his own. Thanks to telestroke technology, Latorre was in the back seat on his laptop computer, with his wife at the wheel, conferring by video with Peer’s  doctors at Samaritan Medical Center in Watertown.

Shortly before, Peer had been talking on the phone with her mother, Debra Ezell, who lives next door. She placed fish sticks in the oven, and her right hand went numb. She collapsed onto a fold-out bed in the adjacent room. Ezell came running when she got no response over the phone.

“My words weren’t coming to me,” Peer recalls. “I couldn’t think of the words I was trying to say.”

Hesham Masoud, MD

She was in and out of awareness. She remembers seeing Latorre on a monitor doing an assessment. Peer thought she lifted both feet when he asked, although only the left one moved. One minute she heard people talking about transferring her to Syracuse. The next, she was in Syracuse, and family members were pouring into her room.

Peer wound up receiving a dose of clot-busting medication called tPA before she arrived at Upstate. A scan revealed six clots in her brain. Upstate’s neurointerventionalist and stroke neurologist Hesham Masoud, MD, used a specialized clot retrieval device to remove the largest ones. The small ones were treated with medication.

Within 12 hours, Peer says she had her speech back. Four days later, she was well enough to go home. She credits God with helping the doctors help her recover.

Telestroke network hospitals

The Upstate Telestroke network includes nine outlying hospitals:

— Carthage Area Hospital

— Canton-Potsdam Hospital

— Claxton-Hepburn Medical Center in Ogdensburg

— Clifton-Fine Hospital in Star Lake

— Cortland Regional Medical Center

— Gouverneur Hospital

— Lewis County General Hospital in Lowville

— River Hospital in Alexandria Bay

— Samaritan Medical Center in Watertown.

This article appears in the summer 2017 issue of Upstate Health magazine. Click here to hear more about how to deal with a stroke if you suspect one is occurring, and also about Upstate’s outreach efforts in stroke care.

 

 

Posted in brain/neurology, brain/spine/neurosurgery, emergency medicine/trauma, health care, patient story, stroke, technology

Are you age 52 to 72? Three health conditions to check

 

A state campaign aims to spread awareness among baby boomers about prediabetes, hepatitis C and high blood pressure, three conditions that can go unnoticed for years.

BY JIM HOWE 

Baby boomers can save their health, their lives and lots of money and trouble by getting themselves checked for three major but often neglected health problems, says New York State Health Commissioner Howard Zucker, MD.

The conditions – high blood pressure, prediabetes and hepatitis C – are the focus of a statewide campaign to encourage those born from 1945 to 1965, who are prime candidates for all three, to be screened and, if needed, treated.

The diseases often go undiagnosed because they may not have obvious symptoms, says Zucker, who toured the state this spring with other physicians for a series of talks to increase awareness. He suggests baby boomers ask their doctors about:

Prediabetes

Prediabetes involves a high blood sugar level. It’s possible to change diet and exercise routines to delay or prevent full-blown Type II diabetes, Zucker said at Upstate Medical University, which hosted one of the talks.

State Health Commissioner Howard Zucker, MD, hopes to raise awareness among baby boomers about major health issues they should have checked. (PHOTO BY JIM HOWE)

Diabetes can lead to numerous complications, including heart disease, blindness, kidney failure and lower-limb amputations.

More than a third of U.S. adults have prediabetes, and most don’t know it. More than half of Type II diabetes cases are preventable, according to the U.S. Centers for Disease Control and Prevention.

High blood pressure (hypertension)

Known as the “silent killer,” high blood pressure might go unnoticed for years if a person does not get regular checkups. About half of baby boomers have high blood pressure – defined as two consecutive readings of 140/90 or greater — and only about a half of them have it under control, Zucker said.

Medicines are available to control high blood pressure, which, if untreated, can lead to a stroke, heart attack or kidney problems.

Hepatitis C

Hepatitis C is the most common chronic viral disease in the United States. It is estimated that three out of four baby boomers are infected with the hepatitis C virus and that most don’t know it.

Spread through blood, this common infection might have been contracted years before from injecting illegal drugs, even once, or from people who received blood transfusions before 1992, when strict screening methods started.

The virus can destroy the liver but is curable through medications, noted David Bernstein, MD, a hepatitis C specialist who spoke at the Upstate event.

This article appears in the summer 2017 issue of Upstate Health magazine. Click here to hear an interview with Zucker in which he discusses the above-mentioned health issues as well as loneliness.

 

 

 

 

 

 

 

 

Posted in aging/geriatrics, diabetes/endocrine/metabolism, health care, HealthLink on Air, heart/cardiovascular, infectious disease, liver/ gallbladder/ pancreas, prevention/preventive medicine, public health, stroke | Tagged , , , , ,

Open wide and say ‘aha!’: Urologist looks to patient’s mouths for help repairing urethral strictures

Dmitriy Nikolavsky, MD, is director of reconstructive urology at Upstate University Hospital. He has completed more than 250 urethral reconstructions over the past four years. He is shown with his wife, Daniela Nikolavsky, who works in the urology laboratory. (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

Only an innovative scientist with expertise in reconstructive urology would look at the inside lining of the cheek and wonder how those cells would behave if transplanted into the urethra, the tube that carries urine from the bladder.

Dmitriy Nikolavsky, MD, is that urologic scientist.

As director of reconstructive urology at Upstate University Hospital, Nikolavsky has completed more than 250 urethral reconstructions over the past four years. Many of the reconstructions were necessary because of patients with urethral strictures, a narrowing of the urethra with a variety of causes, including inflammation, infection, injury and previous surgeries or catheterizations.

He’s on a quest to find solutions for these patients. He earned a “Young Investigator” grant this year from the northeastern section of the American Urologic Association. And in May the Journal of Urology chose his research paper as best paper in investigative urology in 2016. (For a video presentation of that paper, in which Nikolavsky wrote on liquid grafts with several co-authors from Upstate), click here.

A normal cross-section of a urethra. (FROM THE LAB OF DMITRIY NIKOLAVSKY, MD)

Spray paint or wallpaper?

Among the traditional treatments for urethral stricture are a urethral dilation meant to stretch scar tissue without injuring the lining of the urethra, or an endoscopic procedure that involves internal cutting to widen the urethra, called a urethrotomy. These procedures often do not provide lasting relief.

An open surgery called urethroplasty has a better success rate, but not many urologists have the proficiency to offer it as an option to patients.

Nikolavsky says the success of urethroplasty can be improved with the use of a buccal mucosa graft, which many reconstructive urologists have used for several decades. That’s where the surgeon cuts a section of tissue from the patient’s inner cheek and transplants it like wallpaper onto the inside of the urethra.

Tissue from inside the mouth is a natural substitute for urethral tissue because both are from wet, hairless environments, and because surgeons can easily access the inside of the mouth. Also, the inside of the cheek typically heals quickly, similar to the way a pizza burn wound heal.

Unfortunately, transplanting tissue directly from the mouth and onto the urethral defect requires an open surgery that is technically difficult and not widely available from all urologists.

So, Nikolavsky is experimenting with a couple of ways to complete a two-step process that he hopes will become a feasible alternative option. Instead of a surgeon “wallpapering” the damaged area of the urethra with buccal mucosa in an open surgery, Nikolavsky wants to be able to “spray-paint” a buccal mucosa solution through an endoscope, a tubular instrument.

A buccal mucosa engraftment. (FROM THE LAB OF DMITRIY NIKOLAVSKY, MD)

Here’s how it might work:

In one version, the tissue could be removed from the patient’s mouth and immediately processed into a liquid. Then, the urologist could place a catheter (tube) in the urethra, and the liquid buccal mucosa would be injected around the catheter. The catheter would stay in place for a week, until the urethra heals.

Another method Nikolavsky is exploring would remove the tissue from the patient’s mouth and send it to a laboratory. Fragments of the buccal mucosa would become part of a liquid solution containing a fibrin glue, designed to help the solution adhere to the damaged area of the urethra. The patient would return another day for the second step, in which the liquid graft would be added to the urethra through an endoscope.

“Buccal mucosal cells have increased metabolism and contain numerous fibroblast and epithelial progenitor cells with stem cell properties,” which means they are ideal to help with wound-healing, Nikolavsky and colleagues describe in the Journal of Urology in 2016.

Urologists are not the only ones excited about the potential of buccal mucosa grafts. Scientists studying regenerative medicine are looking at such grafts for use in reconstruction of the cornea, esophageal (food pipe) strictures and skin burns.

This article appears in the summer 2017 issue of Upstate Health magazine. To hear a “HealthLink on Air” interview in which Nikolavsky and fellow Upstate urologist Jonathan Riddell, MD, discuss innovations in minimally invasive surgery, click here

Posted in health care, HealthLink on Air, research, surgery, urology | Tagged , , , , , ,