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The cognitive reserve theory in the setting of pediatric-onset multiple sclerosis. - Multiple sclerosis (Houndmills, Basingstoke, England)
The study of cognitive reserve (CR) in relationship with cognitive impairment (CI) in pediatric-onset multiple sclerosis (POMS) may provide cues to identifying subjects at higher risk of impairment and scope for therapeutic strategies.To assess the potential impact of CR on cognition in a cohort of POMS patients.In all, 48 POMS patients were followed up for 4.7â€‰Â±â€‰0.4â€‰years. CI was defined as the failure of â©¾3 tests on an extensive neuropsychological battery. Change of neuropsychological performance was assessed through the Reliable Change Index (RCI) method. At baseline, CR was estimated by measuring the intelligence quotient (IQ). The relationships were assessed through multivariable regression analyses.At baseline, CI was detected in 14/48 (29.2%) patients. Two out of 57 healthy control (HC; 3.5%) met the same criteria of CI (pâ€‰<â€‰0.001). A deteriorating cognitive performance using the RCI method was observed in 18/48 patients (37.6%). Among the 34 cases who were cognitively preserved at baseline, a higher reserve predicted stable/improving performance (odds ratio (OR)â€‰=â€‰1.11; 95% confidence interval (CI): 1.03-1.20; pâ€‰=â€‰0.006).Our results suggest that higher CR in POMS patients may protect from CI, particularly in subjects with initial cognitive preservation, providing relevant implications for counseling and rehabilitation strategies.Â© The Author(s), 2016.
Sharps injuries among emergency department nurses in one tertiary care hospital in Ghana. - International emergency nursing
Exposure to bloodborne pathogens is the most serious occupational health risk encountered within the healthcare profession worldwide. The World Health Organization estimates that 3 million healthcare workers experience percutaneous injuries each year. The objectives of this study were to: (1) examine the frequency of sharps injuries, and (2) assess the adequacy, understanding, and use of post-exposure protocols within a sample of the nursing staff at a busy tertiary care emergency department in the Ashanti Region of Ghana. A mixed-methods descriptive study design was used including key informant interviews to develop the survey, a structured survey of emergency department nursing staff, and document review. Overall, the emergency department staff was well informed regarding the risks of sharps injury and the immediate steps to take in the event of a sharps injury. However, few staff could list essential post-exposure follow-up steps. Over one-quarter (28.9%) of emergency nurses reported a sharps injury during a one-year period according to hospital records. The high incidence of sharps injuries indicates an urgent and pressing need for policy and educational interventions to address the infectious disease risk to this group of emergency department staff.Copyright Â© 2015 Elsevier Ltd. All rights reserved.
Psychometric Validation and Comparison of the Self-Reporting Questionnaire-20 and Self-Reporting Questionnaire-Suicidal Ideation and Behavior Among Congolese Refugee Women. - Journal of nursing measurement
The Self-Reporting Questionnaire (SRQ) has long been used among refugee populations to detect common mental health disorders.Our purpose was to compare findings from psychometric validation of the 20-item SRQ with a modified version, the SRQ-SIB (suicidal ideation and behavior).Factor analysis of both scales was performed in a sample of Congolese refugee women as well as predictive validity, contrast validity, and internal consistency.Both scales exhibited a reliability of .911. The SRQ-SIB exhibited a three-factor solution; somatic, psychological, and SIB. The SIB was highly predictive for having experienced sexual violence. Analyses validate the use of both, but the SIB is useful for differentiating more severe cases of common mental disorder (CMD).The SRQ-SIB may be an important tool for the nursing assessment of suicide among refugee women.
DICER1 and microRNA regulation in post-traumatic stress disorder with comorbid depression. - Nature communications
DICER1 is an enzyme that generates mature microRNAs (miRNAs), which regulate gene expression post-transcriptionally in brain and other tissues and is involved in synaptic maturation and plasticity. Here, through genome-wide differential gene expression survey of post-traumatic stress disorder (PTSD) with comorbid depression (PTSD&Dep), we find that blood DICER1 expression is significantly reduced in cases versus controls, and replicate this in two independent cohorts. Our follow-up studies find that lower blood DICER1 expression is significantly associated with increased amygdala activation to fearful stimuli, a neural correlate for PTSD. Additionally, a genetic variant in the 3' un-translated region of DICER1, rs10144436, is significantly associated with DICER1 expression and with PTSD&Dep, and the latter is replicated in an independent cohort. Furthermore, genome-wide differential expression survey of miRNAs in blood in PTSD&Dep reveals miRNAs to be significantly downregulated in cases versus controls. Together, our novel data suggest DICER1 plays a role in molecular mechanisms of PTSD&Dep through the DICER1 and the miRNA regulation pathway.
What makes a likely abortion provider? Evidence from a nationwide survey of final-year students at Ghana's public midwifery training colleges. - Contraception
Even in countries where the abortion law is technically liberal, the full application of the law has been delayed due to resistance on the part of providers to offer services. Ghana has a liberal law, allowing abortions for a wide range of indications. The current study sought to investigate factors associated with midwifery students' reported likelihood to provide abortion services.Final-year students at 15 public midwifery training colleges participated in a computer-based survey. Demographic and attitudinal variables were tested against the outcome variable, likely to provide comprehensive abortion care (CAC) services, and those variables found to have a significant association in bivariate analysis were entered into a multivariate model. Marginal effects were assessed after the final logistic regression was conducted.A total of 853 out of 929 eligible students enrolled in the 15 public midwifery schools took the survey, for a response rate of 91.8%. In multivariate regression analysis, the factors significantly associated with reported likeliness to provide CAC services were having had an unplanned pregnancy, currently using contraception, feeling adequately prepared, agreeing it is a good thing women can get a legal abortion and having been exposed to multiple forms of education around surgical abortion.Midwifery students at Ghana's public midwifery training colleges report that they are likely to provide CAC. Ensuring that midwives-in-training are well trained in abortion services, as well as encouraging empathy in these students, may increase the number of providers of safe abortion care in Ghana.Copyright Â© 2016 Elsevier Inc. All rights reserved.
FHL1 activates myostatin signalling in skeletal muscle and promotes atrophy. - FEBS open bio
Myostatin is a TGFÎ² family ligand that reduces muscle mass. In cancer cells, TGFÎ² signalling is increased by the protein FHL1. Consequently, FHL1 may promote signalling by myostatin. We therefore tested the ability of FHL1 to regulate myostatin function. FHL1 increased the myostatin activity on a SMAD reporter and increased myostatin dependent myotube wasting. In mice, independent expression of myostatin reduced fibre diameter whereas FHL1 increased fibre diameter, both consistent with previously identified effects of these proteins. However, co-expression of FHL1 and myostatin reduced fibre diameter to a greater extent than myostatin alone. Together, these data suggest that the expression of FHL1 may exacerbate muscle wasting under the appropriate conditions.
A case series study on the effect of Ebola on facility-based deliveries in rural Liberia. - BMC pregnancy and childbirth
As communities' fears of Ebola virus disease (EVD) in West Africa exacerbate and their trust in healthcare providers diminishes, EVD has the potential to reverse the recent progress made in promoting facility-based delivery. Using retrospective data from a study focused on maternal and newborn health, this analysis examined the influence of EVD on the use of facility-based maternity care in Bong Country, Liberia, which shares a boarder with Sierra Leone - near the epicenter of the outbreak.Using a case series design, retrospective data from logbooks were collected at 12 study sites in one county. These data were then analyzed to determine women's use of facility-based maternity care between January 2012 and October 2014. The primary outcome was the number of facility-based deliveries over time. The first suspected case of EVD in Bong County was reported on June 30, 2014. Heat maps were generated and the number of deliveries was normalized to the average number of deliveries during the full 12 months before the EVD outbreak (March 2013 - February 2014).Prior to the EVD outbreak, facility-based deliveries steadily increased in Bong County reaching an all-time high of over 500 per month at study sites in the first half of 2014 - indicating Liberia was making inroads in normalizing institutional maternal healthcare. However, as reports of EVD escalated, facility-based deliveries decreased to a low of 113 in August 2014.Ebola virus disease has negatively impacted the use of facility-based maternity services, placing childbearing women at increased risk for morbidity and death.
Tubal ectopic pregnancy: our experience from 2000 to 2013. - Acta bio-medica : Atenei Parmensis
In this paper we summarize our experience in diagnosis and treatment of 402 retrospectively collected tubal EP and review the most recent topics from the literature. Systemic Methotrexate (MTX) was effective in 56 out of 65 patients (failure rate 13.8%), in whom hCG level was significantly lower when compared to the failure group (p<0,05); we performed 299 salpingectomies, 297 of whom through laparoscopic approach. MTX single-dose is safe and effective in eligible patients; surgery represents the treatment of most of the EPs, mainly through laparoscopic approach.
Histological validation of high-resolution DTI in human post mortem tissue. - Frontiers in neuroanatomy
Diffusion tensor imaging (DTI) is amongst the simplest mathematical models available for diffusion magnetic resonance imaging, yet still by far the most used one. Despite the success of DTI as an imaging tool for white matter fibers, its anatomical underpinnings on a microstructural basis remain unclear. In this study, we used 65 myelin-stained sections of human premotor cortex to validate modeled fiber orientations and oft used microstructure-sensitive scalar measures of DTI on the level of individual voxels. We performed this validation on high spatial resolution diffusion MRI acquisitions investigating both white and gray matter. We found a very good agreement between DTI and myelin orientations with the majority of voxels showing angular differences less than 10Â°. The agreement was strongest in white matter, particularly in unidirectional fiber pathways. In gray matter, the agreement was good in the deeper layers highlighting radial fiber directions even at lower fractional anisotropy (FA) compared to white matter. This result has potentially important implications for tractography algorithms applied to high resolution diffusion MRI data if the aim is to move across the gray/white matter boundary. We found strong relationships between myelin microstructure and DTI-based microstructure-sensitive measures. High FA values were linked to high myelin density and a sharply tuned histological orientation profile. Conversely, high values of mean diffusivity (MD) were linked to bimodal or diffuse orientation distributions and low myelin density. At high spatial resolution, DTI-based measures can be highly sensitive to white and gray matter microstructure despite being relatively unspecific to concrete microarchitectural aspects.
A common oxytocin receptor gene (OXTR) polymorphism modulates intranasal oxytocin effects on the neural response to social cooperation in humans. - Genes, brain, and behavior
Intranasal oxytocin (OT) can modulate social-emotional functioning and related brain activity in humans. Consequently, OT has been discussed as a potential treatment for psychiatric disorders involving social behavioral deficits. However, OT effects are often heterogeneous across individuals. Here we explore individual differences in OT effects on the neural response to social cooperation as a function of the rs53576 polymorphism of the oxytocin receptor gene (OXTR). Previously, we conducted a double-blind, placebo-controlled study in which healthy men and women were randomized to treatment with intranasal OT or placebo. Afterwards, they were imaged with functional magnetic resonance imaging while playing an iterated Prisoner's Dilemma Game with same-sex partners. Within the left ventral caudate nucleus, intranasal OT treatment increased activation to reciprocated cooperation in men, but tended to decrease activation in women. Here, we show that these sex differences in OT effects are specific to individuals with the rs53576 GG genotype, and are not found for other genotypes (rs53576 AA/AG). Thus, OT may increase the reward or salience of positive social interactions for male GG homozygotes, while decreasing those processes for female GG homozygotes. These results suggest that rs53576 genotype is an important variable to consider in future investigations of the clinical efficacy of intranasal OT treatment.Â© 2015 John Wiley & Sons Ltd and International Behavioural and Neural Genetics Society.
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