New York Methodist Hospital

About: New York Methodist Hospital is a healthcare organization based out in Brooklyn, New York, United States. It is known for research contribution in the topics: Myocardial infarction & Percutaneous coronary intervention. The organization has 948 authors who have published 936 publications receiving 29954 citations.

Repetitive Monomorphic Ventricular Tachycardia Associated with Exercise A Case Report

Abstract: The case of a 45-year-old man suffering from a catecholamine-sensitive ventricular tachycardia originating from the right ventricular outflow tract is reported. The authors describe a novel noninvasive treatment strategy for the management of this patient.

COGNITIVE DYSFUNCTION AND OTHER COMORBIDITIES | Attention Deficit Disorder and Epilepsy in Children

Abstract: Cognitive and behavioral problems of all types are extremely common in association with childhood epilepsy, even in the so-called ‘benign’ epilepsy syndromes. Behavioral disorders highly contribute to the morbidity of epilepsy. Timely diagnosis and intervention may prevent permanent developmental impairments, although this type of positive result must be evaluated further. The purely inattentive subtype of attention deficit disorder is more common in children with epilepsy than in the general population and appears specific to epilepsy; in contrast, general behavioral problems are more likely to be related to chronic illness and family dynamics. Attention deficit disorder (ADHD) in children with epilepsy is most likely due to a complex interaction between biological and psychosocial factors. Biological factors may be permanent or state-dependent, and can potentially be reversed with treatment. Anticonvulsant toxicity may contribute to attentional and behavioral dysfunction in children with epilepsy, but may also have a positive effect owing to suppression of seizures and interictal epileptiform activity. Children with epilepsy and attentional problems require a stepwise diagnostic approach, including evaluation of seizure control, interictal spiking, and anticonvulsant side-effects, as well as psychosocial and educational factors. Although treatment guidelines for ADHD do not exist in this population, large numbers of case studies have shown that treatment with stimulant medications such as methylphenidate is safe and effective and should be utilized, given the high morbidity associated with untreated attentional problems.

Sequential Posture Change Fastens Gastric Emptying of Large Volume Bolus Intake of Normal Saline: A Pilot Study

Abstract: The physiology of gastric emptying (GE) is complex and incompletely understood due to the interplay of several factors such as age, sex, volume, pH, temperature, osmolality, ion and energy content, gravity, posture, physical activity, and food consistency [1–6]. It is well known that posture and gravity affect GE mainly via changes in gastric configuration, which changes the intra-gastric distribution and ultimately the pressure gradient (pressure pump mechanism of GE) across the gastroduodenal segment [7]. Postural changes are also associated with changes in gastric motility (peristaltic pump mechanism of GE) and intragastric distribution of liquid meals [7, 8]. The pattern of GE is known to vary among individuals, but remain consistent within individuals [9]. The post-gastrografin pictures of the author (V.A.) (Fig. 1) illustrate the actual changes in gastric configuration accomplished by the sequential posture changes (SPC) described in the present study. The SPC include mindful relaxation, deep breathing, arm elevation, stretching of the body, and tilting of the upper torso. Deep breathing stimulates the parasympathetic nervous system via the vagus nerve, which is known to increase the gastrointestinal motility [10, 11]. The SPC (‘‘Appendix’’) can be labeled as ‘‘specific’’ to enhance GE for several reasons. Arm elevation in normal subjects increases end-inspiratory gastric and trans-diaphragmatic pressure [12]. All postures are associated with auditory–vestibular stimulation, which is known to affect GE [13]. The SPC used in this study are mild to moderate intensity exercises (MET: 3–5) which also enhances GE [14, 15] as opposed to strenuous exercises which is known to delay GE [16]. Vagotomy is known to delay gastric emptying of both liquids and solids [17]. Shudh colon cleanse (SCC) is a meditation-based bowel prep, which uses lukewarm normal saline (average 2–3 L) consumed orally in large volume boluses alternating with SPC condition for colon prep [18, 19]. This method was as efficacious as NuLytely, and the bowel prep time was less than 2 h. Similar to the pharmacokinetics of an orally ingested medicine, bowel prep outcomes for colonoscopy can vary and depend on the GE of the solution ingested. The role of manipulating the GE via changing gastric configuration was never studied in conjunction with bowel preps. Normal saline (NS) is a non-nutrient liquid and follows first-order kinetics of GE. We propose that faster GE plays a major role in the rapid action of SCC. We conducted this study to see the effect of SPC on GE of 480 mL of NS consumed as single bolus. In experimental studies, real-time ultrasonography has been used for the measurement of liquid GE [20, 21]. It is the least invasive, and it is not associated with any radiation exposure as in nuclear scintigraphic studies of GE. The gastric antrum is the most dependent part of the stomach with no gas interference. Therefore, the measurement of the antral surface area provides more accurate information on GE than the measurement of the entire muscular sac (Bolondi method) [21]. The ultrasonography method also shows good V. Arya (&) A. Valluri Wyckoff Heights Medical Center, Brooklyn, NY, USA e-mail: varyamd@yahoo.com