Icahn School of Medicine at Mount Sinai

About: Icahn School of Medicine at Mount Sinai is a education organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 37488 authors who have published 76057 publications receiving 3704104 citations. The organization is also known as: Mount Sinai School of Medicine.

Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment.

Abstract: OBJECTIVE: Novel antipsychotic medications have been reported to have beneficial effects on cognitive functioning in patients with schizophrenia. However, these effects have been assessed in studies with considerable variation in methodology. A large number of investigator-initiated and industry-sponsored clinical trials are currently underway to determine the effect of various novel antipsychotics on cognitive deficits in patients with schizophrenia. The ability to discriminate between high- and low-quality studies will be required to understand the true implications of these studies and their relevance to clinical practice. METHOD: This article addresses several aspects of research on cognitive enhancement in schizophrenia, emphasizing how the assessment of cognitive function in clinical trials requires certain standards of study design to lead to interpretable results. RESULTS: Novel antipsychotic medications appear to have preliminary promise for the enhancement of cognitive functioning. However, the ...

Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest.

Abstract: The patient was a 58-yr-old, 82-kg, 170-cm male who presented for arthroscopic repair of a torn rotator cuff in the right shoulder His medical history was significant for coronary artery bypass graft surgery at age 43 yr He gave a history of angina upon exertion and occasionally at rest He declined further preoperative cardiac workup but was considered by his cardiologist to be stable on medical therapy This included nitroglycerine as needed, lisinopril, atenolol isosorbide mononitrate, and clopidogrel and enteric-coated aspirin, both of which had been discontinued 1 week previously His preoperative electrocardiogram revealed a right bundle-branch block, a left anterior hemiblock, and evidence of an old anterior wall myocardial infarction The patient arrived at the operating room holding area, where standard monitors were applied Blood pressure was 120/80 mmHg, room air oxygen saturation measured by pulse oximetry was 98%, and heart rate was 60 beats/min Supplemental oxygen was delivered at 3 l/min via a nasal cannula A 20-gauge intravenous catheter was placed in the dorsum of his left hand, through which 2 mg midazolam and 50 g fentanyl were administered A 50-mm, 22-gauge Stimuplex insulated needle was connected to a Stimuplex-DIG nerve stimulator (both B Braun, Inc, Bethlehem, PA), and the interscalene groove was identified at the level of C6 The brachial plexus was identified by eliciting biceps stimulation (01-ms duration, 2 Hz) at 034 mA, following which 40 ml local anesthetic solution (20 ml bupivacaine, 05%, and 20 ml mepivacaine, 15%) were injected slowly (over approximately 25 min) in 5-ml increments with gentle aspiration between doses The patient was awake and conversant during the performance of the block At no time was any blood aspirated, nor did he report pain or paresthesias Approximately 30 s after removal of the block needle, the patient became incoherent and then developed a tonic–clonic seizure Oxygen was delivered by a facemask attached to a self-inflating resuscitation bag while 50 mg propofol was injected intravenously The seizure stopped, and spontaneous respirations resumed Approximately 90 s later, the patient began to seize again; this time, 100 mg intravenous propofol was administered The electrocardiogram showed asystole, and no pulse, by carotid or femoral palpation, or blood pressure was detectable Advanced cardiac life support was immediately started The trachea was intubated, and end-tidal carbon dioxide was detected with an EasyCapII (Nellcor Inc, Hayward, CA) Tube position was confirmed by auscultation, after which chest compressions were immediately resumed During the first 20 min of advanced cardiac life support, a total of 3 mg epinephrine, given in divided doses, 2 mg atropine, 300 mg amiodarone, and 40 U arginine vasopressin were administered In addition, monophasic defibrillation was used at escalating energy levels—200, 300, 360, and 360 J, according to the advanced cardiac life support protocol Cardiac rhythms included ventricular tachycardia with a pulse, pulseless ventricular tachycardia that momentarily became ventricular fibrillation, and eventually asystole The arrhythmias observed during most of the resuscitation period were pulseless ventricular tachycardia and asystole After 20 min, at which time plans were being made to institute cardiopulmonary bypass, the administration of a lipid emulsion was suggested, and 100 ml of 20% Intralipid (for Baxter Pharmaceuticals by Fresenius Kabi, Uppsala, Sweden) was given through the peripheral intravenous catheter Cardiac compressions continued, and a defibrillation shock at 360 J was given Within seconds, a single sinus beat appeared on the electrocardiogram, and 1 mg atropine and 1 mg epinephrine were administered Within 15 s, while external chest compressions were continued, the cardiac rhythm returned to sinus at a rate of 90 beats/min The blood pressure and pulse became detectable An infusion of lipid emulsion was started and continued at 05 ml · kg 1 · min 1 over the following 2 h and then discontinued The patient remained in sinus rhythm He was weaned from mechanical ventilation, and his trachea was extubated, approximately 25 h later He was awake and responsive, and had right upper extremity weakness consistent with a brachial plexus block No neurologic sequelae were sustained, and he was subsequently transferred to a monitored setting for overnight observation There was no evidence of complications secondary to the administration of intralipid (ie, pancreatitis) during the following 2 weeks Because the patient had a cardiac arrest after which he had increased levels of cardiac enzymes, he agreed to undergo cardiac catheterization This revealed total occlusion of the right coronary artery and a left ventricular ejection fraction of 32% As a consequence, an automatic implantable cardiac defibrillator was inserted without any complications, and the patient was discharged home

Phase 3 Studies Comparing Brodalumab with Ustekinumab in Psoriasis

Abstract: BackgroundEarly clinical studies suggested that the anti–interleukin-17 receptor A monoclonal antibody brodalumab has efficacy in the treatment of psoriasis. MethodsIn two phase 3 studies (AMAGINE-2 and AMAGINE-3), patients with moderate-to-severe psoriasis were randomly assigned to receive brodalumab (210 mg or 140 mg every 2 weeks), ustekinumab (45 mg for patients with a body weight ≤100 kg and 90 mg for patients >100 kg), or placebo. At week 12, patients receiving brodalumab were randomly assigned again to receive a brodalumab maintenance dose of 210 mg every 2 weeks or 140 mg every 2 weeks, every 4 weeks, or every 8 weeks; patients receiving ustekinumab continued to receive ustekinumab every 12 weeks, and patients receiving placebo received 210 mg of brodalumab every 2 weeks. The primary aims were to evaluate the superiority of brodalumab over placebo at week 12 with respect to at least a 75% reduction in the psoriasis area-and-severity index score (PASI 75) and a static physician’s global assessment ...

Clinical practice guideline: Management of thyroid dysfunction during pregnancy and postpartum: An endocrine society clinical practice guideline

Abstract: Objective: The objective is to provide clinical guidelines for the management of thyroid problems present during pregnancy and in the postpartum. Participants: The Chair was selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society. The Chair requested participation by the Latin American Thyroid Society, the Asia and Oceania Thyroid Society, the American Thyroid Association, the European Thyroid Association, and the American Association of Clinical Endocrinologists, and each organization appointed a member to the task force. Two members of The Endocrine Society were also asked to participate. The group worked on the guidelines for 2 yr and held two meetings. There was no corporate funding, and no members received remuneration. Evidence: Applicable published and peer-reviewed literature of the last two decades was reviewed, with a concentration on original investigations. The grading of evidence was done using the United States Preventive Services Task Force system and, where possible, the GRADE system. Consensus Process: Consensus was achieved through conference calls, two group meetings, and exchange of many drafts by E-mail. The manuscript was reviewed concurrently by the Society’s CGS, Clinical Affairs Committee, members of The Endocrine Society, and members of each of the collaborating societies. Many valuable suggestions were received and incorporated into the final document. Each of the societies endorsed the guidelines. Conclusions: Management of thyroid diseases during pregnancy requires special considerations because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse effects on the pregnancy and the fetus. Care requires coordination among several healthcare professionals. Avoiding maternal (and fetal) hypothyroidism is of major importance because of potential damage to fetal neural development, an increased incidence of miscarriage, and preterm delivery. Maternal hyperthyroidism and its treatment may be accompanied by coincident problems in fetal thyroid function. Autoimmune thyroid disease is associated with both increased rates of miscarriage, for which the appropriate medical response is uncertain at this time, and postpartum thyroiditis. Fine-needle aspiration cytology should be performed for dominant thyroid nodules discovered in pregnancy. Radioactive isotopes must be avoided during pregnancy and lactation. Universal screening of pregnant women for thyroid disease is not yet supported by adequate studies, but case finding targeted to specific groups of patients who are at increased risk is strongly supported. (J Clin Endocrinol Metab 92: S1–S47, 2007)

Marginal zone B cells: virtues of innate-like antibody-producing lymphocytes

Abstract: Protective responses to microorganisms involve the nonspecific but rapid defence mechanisms of the innate immune system, followed by the specific but slow defence mechanisms of the adaptive immune system. Located as sentinels at the interface between the circulation and lymphoid tissue, splenic marginal zone B cells rapidly respond to blood-borne antigens by adopting 'crossover' defensive strategies that blur the conventional boundaries of innate and adaptive immunity. This Review discusses how marginal zone B cells function as innate-like lymphocytes that mount rapid antibody responses to both T cell-dependent and T cell-independent antigens. These responses require the integration of activation signals from germline-encoded and somatically recombined receptors for microorganisms with helper signals from effector cells of the innate and adaptive immune systems.