Faculty Bibliography

Background/UNASSIGNED:Despite evidence that biological and genetic factors contribute strongly to obesity, many healthcare providers still attribute obesity more to controllable behavioral issues rather than factors outside a person's control. We evaluated whether medical school students' beliefs about obesity correlate with ability to effectively counsel patients with obesity. Methods/UNASSIGNED:Clerkship-year medical students at NYU School of Medicine completed an Objective Structured Clinical Experience (OSCE) that tests ability to effectively counsel standardized actor-patients with obesity. We surveyed these students to evaluate their beliefs about the causes of obesity and their attitudes towards people with obesity. We analyzed correlations between student beliefs, negative obesity attitudes, and OSCE performance. Results/UNASSIGNED: < 0.05). Conclusions/UNASSIGNED:Attribution of obesity to external factors correlated with greater ability to counsel patients with obesity, suggesting that educating providers on the biological causes of obesity could help reduce bias and improve provider care.

Background: There is growing evidence for the role of TRPC1 in regulating glucose & lipid metabolism. Secretion of insulin, leptin & adiponectin is sensitive to cell free Ca. TRPC1 may mediate the effects of leptin in anorexigenic hypothalamic neurons. TRPC1 iwas found low in diabetes & we recently found hyperglycemia in null mice. We tested if TRPC1 deficiency produces MetS & if 45% HFD x 3 mon aggravates it.
Method(s): In age-matched TRPC1 +/+. +/-, & -/-mice, we measured glucose & lipids using standard methods & insulin, leptin, & adiponectin by mouse ELISA. We did glucose tolerance test (GTT) by IP glucose (2 mg/kg) after 13 h fast.
Result(s): From 4-30 week, null mice ate & weighed more than +/-& wt. At 4 mon, HOMA-insulin resistance (IR) was up 60% & HOMA beta down 40%. By 12 mon, HOMAIR was up 8 fold. At 7 mon, by GTT, both TRPC1 +/-& -/-mice were diabetic. In null, adiponectin was down 11% but leptin up 77%. At 2 mon, total cholesterol was 85% hgher in null, their liver 36% heavier, & triglyceride content (TGC) 47% higher. Liver echogenicity was up by 50-150% at 7, 11, & 22 mon, confirmed by 140% higher liver TGC. At 12 mon, only null mice had hyperlipidemia (cholesterol up 30%, LDL up 60%, & TG up 200%). In +/-& wt, lipids, liver density at 12 & 19 mon, & liver TGC at 19 mon were all normal. Fasting glucose was high only in null from 1 through 16 mon). Thus on a normal fat diet (NFD), 1 wt allele prevented hyperphagia, obesity, MetS & hepatic steatosis. As expected, HFD vs NFD stimulated leptin & insulin, similarly in all 3 genotypes without altering adiponectin. Unlike NFD, HFD increased liver density in +/-& wt, but not in null. HFD induced the highest HOMA-IR in wt (3.1 vs 1.3 x in +/-) & the largest liver TGC hike in wt (3.3 vs 1.6 x in null). During GTT, AUC for glucose vs time was the highest in wt vs null.
Conclusion(s): 1. Diploid TRPC1 deletion produces hyperphagia, obesity & Met S, all resolvable by caloric restriction, implying hypothalamic resistance to leptin in null mice. 2. HFD raises the risks of dyslipidemia & hepatic steatosis, only in the presence of 1-2 wt alleles, as if deficiency would block the pathogenic Ca-CM-NFAT signaling pathway. 3. TRPC1 -/-is a good model to study MetS

We describe a case of immune reconstitution inflammatory syndrome (IRIS) secondary to reactivation of Mycobacterium tuberculosis in an HIV-infected patient with a high CD4+ cell count, who presented with a generalized seizure 6 weeks after starting antiretroviral therapy (ART). In our patient, the inflammatory response resulted in radiological features of neurological, pulmonary, and lymph node (LN) tuberculosis- (TB) IRIS, without the typical symptoms. Diagnosis was confirmed by LN biopsy and acid-fast bacilli (AFB) culture of LN and sputum. Treatment with isoniazid, rifabutin, ethambutol, and pyrazinamide was started in addition to continuation of ART. To our knowledge, we describe the first case of an atypical clinical presentation of an unmasking reaction of disseminated TB-IRIS in an HIV infected patient without acquired immune deficiency syndrome (AIDS), with restoring immunity during ART. Clinical and radiological predictors of TB-IRIS in co-infected patients starting ART are therefore essential in anticipating complications and facilitating expeditious management and prompt therapy.

Background: The growing opioid overdose epidemic has grappled the nation with the CDC now reporting that drug overdose deaths have become the most common cause of death for young people. Medical education has historically ignored substance use disorders, and though they generally require all medical students to learn basic life support, they have not taught how to respond to opioid overdoses. Further, medical education is moving towards modalities which utilize adult learning theory. One such modality are online modules. However, there are few studies comparing their outcomes with traditional lectures. Previously, the authors compared in-person and online training of medical students to respond to opioid overdoses using naloxone in a non-randomized controlled setting, which showed no meaningful differences in knowledge, attitudes, and preparedness outcomes for students. In this paper, the authors attempt to use a randomized controlled trial to compare the two educational modalities at a second urban medical school.
Objective(s): The author's primary objective was to demonstrate non-inferiority of online compared to in-person training for knowledge. Our secondary objective were to show non-inferiority of online compared to in-person training attitudes, and preparedness.
Method(s): Our study received IRB exemption as an education intervention. As a part of a transition to clinical clerkships curriculum used for second year medical students, second year medical students in an urban medical school were randomized into training sessions by the office of medical education without foreknowledge of the planned study. Students taking the online training were provided with a link to online modules with pre- and post-tests and video based lectures. Students randomized to the in-person training group took a pre-test just prior to receiving an oral lecture, and then immediately completed a post-test. Paired student's t-tests were used to compare measurements for each group in knowledge, attitudes, and preparedness, and Cohen's D was used to measure the effect size of the change. We calculated 99% confidence intervals for each measure and utilized a margin of non-inferiority of 5%.
Result(s): The in-person group demonstrated a statistically significant increase in knowledge, a non-statistically significant decrease in self-reported preparedness, and a small non-statistically significant increase in attitudes, see Table 1. The online group demonstrated a statistically significant increase in knowledge and self-reported preparedness, without a statistically significant change in attitudes, see Table 1. 99% CIs were [-0.20, 1.09] for knowledge, [6.51, 10.93] for preparedness, and [-2.32, 1.59] for attitudes, see Figure 1.
Conclusion(s): Online training for opioid overdose prevention training provided non-inferior outcomes for knowledge, preparedness, and attitudes. This study supports the use of online opioid overdose prevention training as a non-inferior alternative to in-person training