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2010-11 Research conducted by Residents and Fellows in the Department of Medicine

Department of Medicine residents and fellows have been involved in several important areas of research this past year. Many of these projects have led to abstract or poster presentation at national meetings. Below is a summation of recent studies and presentations.


FELLOWS

Arash Babaei, MD – PGY VI Fellow in the Division of Gastroenterology and Hepatology
Preceptor – Reza Shaker, MD, Professor and Division Chief, Gastroenterology and Hepatology
Title – Reliability and Reproducibility of fMRI Activity in the Cortical Swallowing Network

Dr. Babaei will presenting his research in several abstracts at Digestive Disease Week in Chicago in May 2011. The research will also be presented at the Neurogastroenterology and Motility Joint International Meeting in Boston in September 2011. He describes his research as "mainly focused on brain processing of visceral sensory and motor functions such as during swallow, nutritive oral stimulation or esophageal acidification using functional magnetic resonance imaging. We have previously shown that cortical swallowing activity is enhanced by physiologic nutritive stimulation and pathophysiological esophageal acidification. Current studies now have led us to the exciting identification of a "Deglutition Connectome", a network of distinct cortical regions,that are connected with each other even at rest and in concert coordinate volitional and non-volitional swallowing."

Brian Jubeck, MD – PGY IV Fellow in the Division of Rheumatology
Preceptor – Ann Rosenthal, MD, Professor and Interim Division Chief, Rheumatology
Title – Matrix vesicles promote monosodium urate crystal formation

Dr. Jubeck was recently awarded a trip to Amsterdam, The Netherlands at the European Workshop for Rheumatology Research to present this poster summarizing the relationship between osteoarthritis and the formation of monosodium urate (gout) and calcium pyrophosphate crystals. He has identified small particles in synovial fluids from patients with osteoarthritis that promote monosodium urate crystal formation.

Gagan Kumar, MD, PGY IV Fellow in the Division of Pulmonary, Critical Care and Sleep Medicine
Preceptor – Rahul Nanchal, Assistant Professor, Pulmonary, Critical Care and Sleep Medicine
Title - Outcomes of Severe Sepsis in Uninsured Patients

Dr. Kumar presented this research at the 40th Critical Care Congress in San Diego in January 2011. He states “we used Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) which is the largest all-payer inpatient care database publicly available in the United States for our study. Using ICD-9 CM codes, we identified about 2 million adult patients admitted with severe sepsis in United States between years 2000 and 2008. Our primary outcomes were all cause in-hospital mortality, length of hospital stay, hospital charges and discharge dispositions. We hypothesize that uninsured patients will have worse clinical outcomes when compared to those with health insurance.”

Nicole Lohr, MD, PhD – PGY V Fellow in the Division of Cardiology
Preceptor – David C. Warltier, MD, PhD, Professor and Chairman, Department of Anesthesiology.
Title – Collateral Development in the Hindlimb Stimulated by Far Red/Near Infrared Light is
Mediated via Nitric Oxide

Dr. Lohr presented her research in poster format at the Scientific Sessions of the annual American Heart Association meeting in Chicago in November of 2010. She explains the project as “understanding the role of nitric oxide in collateral vessel development in the coronary and peripheral circulations. I discovered the application of far red/near infrared light can release nitric oxide from hemoglobin and myoglobin, which utilize in vivo storage pools of nitrite. This is exciting because we can use light and nitrite to provide patients nitric oxide which is cardioprotective to the heart and can stimulate angiogenesis.” Her research was a continuation of original work in which she uncovered the mechanism by which light can increase nitric oxide. This was previously published in August of 2009 in the Journal of Molecular and Cellular Cardiology.

Tulika Singh, MD – PGY V Fellow in the Division of Infectious Diseases
Preceptor – Mark Beilke, MD, Professor and Division Chief, Infectious Diseases
Title – Selective Effects of Human T Lymphotropic Virus Type 2 Tax Protein on CC chemokine Expression in T Cell Subsets

Dr. Singh has applied to exhibit her research in poster format at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago in September 2011. The aims of her study are as follows: 1) determine if T cell subsets secrete CC-Chemokines and if yes, do they do it differently; 2) determine if HTLV Tax-2 protein play a role in innate immunity; 3) determine if HTLV Tax-2 protein assists in viability of T cell subsets. Previous work showed that Recombinant Tax 1 and 2 proteins induced CC-Chemokines in PBMC (peripheral blood mononuclear cells). However the cell type responsible was not identified.

Kevin Tucker, MD – PGY V Fellow in the Division of Nephrology
Preceptors – Jeff Wesson, MD, PhD, Associate Professor and Jack Kleinman, MD, Professor and
Chief in the Division of Nephrology
Title – Net charge assay: A promising new test for kidney stone risk?" summarize

Dr. Tucker’s research was recently presented at the Midwest Nephrology Fellows research symposium, where it received a third place nomination, and has been accepted for presentation at the National Kidney Foundation’s spring clinical meeting in Las Vegas, in April 2011. His focus of the study is comparing “the net charge of urine samples obtained from those who are stone formers to samples obtained from normal individuals. While data collection is ongoing, preliminary data show a significant relationship between stone former status and a decreased urinary net charge. This suggests that assessment of the urinary net charge may hold promise as a novel assessment of stone formation risk and potential therapeutic intervention.”


RESIDENTS

Poonam Beniwal, MD – PGY II Resident in Internal Medicine
Preceptor – Kia Saeian, MD, Associate Professor, Gastroenterology
Title – Barriers to and Facilitators of Diagnosis and Treatment of Hepatitis C (HCV)

Dr. Beniwal will be presenting her research in abstract form at Digestive Disease Week in Chicago in May 2011. She summarizes her research as “The aims of this study were to identify, from the patient’s perspective, barriers and facilitators to diagnosis, management and treatment of HCV in a high risk urban population already diagnosed with either isolated HCV infection or HIV-HCV co-infection. This study concluded that, from the perspective of patients with isolated HCV or HIV-HCV co-infection, there is a lack of: 1. Adequate education about staging and means of prevention of HCV and 2. Consistent and effective discussion of prognosis and management options.”


Tara Kroll, MD – PGY II Resident in Internal Medicine
Preceptor – Christopher Bredeson, MD,
Title – Outcomes of Non-myeloablative Transplants Performed on an IRB Approved Clinical
Research Trial Compared to those Performed as Standard of Care


Drs. Bredeson and Kroll have completed the IRB trial and are currently working to publish a manuscript on the study. “We reviewed all non-myeloablative allogeneic transplants performed at MCW from 2000-present and compared them to patients transplanted as "standard of care" during the same time period,” Dr. Kroll states.

Reema Lamba, MD – PGY III Resident in Internal Medicine
Preceptors - Ivan Lang PhD, and Reza Shaker MD, Professor and Chief, Division of Gastroenterology and
Hepatology
Title – Characterization and quantification of a new esophago-LES reflex

Dr. Lamba will present this study as an abstract at Digestive Disease Week in Chicago in May 2011. She states “The aim of this study was to determine whether distension of the proximal esophagus effects LES tone and whether this response is centrally or peripherally mediated. Cat studies were done in the animal physiology lab to evaluate esophageal responses to different stimuli. Our conclusion was that an esophago-LES relaxation reflex (ELRR) of the proximal esophagus exists, but it is less sensitive than that of the lower esophagus. The ELRR of the proximal esophagus is centrally and vagally mediated, but the ELRR of the distal esophagus is not. However, the vagus nerves provide increased sensitivity of the ELRR of the distal esophagus.”

Marc Sala, MD – PGY II Resident in Internal Medicine
Preceptors – Parameswaran Hari, MD, Associate Professor and Ayman Saad, MD, Assistant
Professor in the Division of Hematology and Oncology
Research has currently not been presented

Dr. Sala, along with Dr. Niravkumar Naik, PGY V Fellow, are researching the association between the outcome of autologous stem cell transplants for multiple myeloma and the patients' pre-transplant comorbidities.

Shannon Schmidt, MD – PGY II Resident in Internal Medicine
Preceptor – Ehab Atallah, MD, Assistant Professor, Division of Hematology and Oncology
Research has currently not been presented

Dr. Schmidt states “my research project addresses hyperglycemia in acute leukemia patients during induction chemotherapy. There has been evidence in AML, ALL and transplant patients that improved glycemic control leads to reduced infection rates as well as possibly improved complete remission duration and mortality. The theory is that hyperglycemia may lead to altered metabolism supporting the proliferation of leukemic cells. I am retrospectively gathering data on 100 acute leukemia patients to investigate the benefits of improved glycemic control in this population. End-points will include infection, length of neutropenia, complete remission achievement, complete remission duration, and mortality.”

Tisha Suboc, MD – PGY II Resident in Internal Medicine
Preceptor – Nicholas Choong, MD, Assistant Professor, Division of Hematology and Oncology
Title – Incidence and Impact Syndrome of Inappropriate Anti-Diuretic Hormone hypersecretion
(SIADH) in Small Cell Lung Cancer (SCLC)

This abstract will be presented at the World Conference on Lung Cancer in Amsterdam in July 2011. The focus of the study “was a comparative analysis of the overall survival in patients with extensive stage small cell lung cancer who reached disease stabilization following chemotherapy and subsequently received mediastinal consolidative radiation versus those who did not. This is a retrospective study involving patients from both Froedtert and the Milwaukee VAMC.

Selamawit Tarekegn, MD – PGY II Resident in Internal Medicine
Preceptor – Lilani Perera, MD, Assistant Professor, Division of Gastroenterology
Title – Biologics are superior to immunomodulators in prevention of post-operative recurrence of
Crohn's disease

Dr. Tarekegn will present this as a poster for Digestive Disease Week in Chicago in May 2011. She sums up the project as “a retrospective study of 238 patients with Crohn's disease who have had surgery. The goal of the project is to compare recurrence rates of post-operative Crohn's patients who have been treated with biologics (B), combination of biologics and immunomodulators (B+I), immunomodulators (I) and No treatment (NT). Crohn's pts treated with biologics have a lower recurrence rates compared to pts on immunomodulators or no therapy. African Americans have a higher recurrence rate. Smokers have worse scores overall and appear to have more to gain from the use of biologics. Treatment with biologics is superior in prevention of post operative recurrence rates in Crohn's.”

 

Article written by Kathy A. Rafel, Medical Education Coordinator
 

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