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1.  Right ventricular free wall dyskinesis in the setting of left ventricular non compaction: a case report 
BMC Research Notes  2014;7(1):787.
Left ventricular non compaction is a relatively rare congenital disorder characterized by prominent trabeculations and intertrabecular recesses with the potential for thromboembolism, arrhythmias, and sudden cardiac death as adverse effects. Echocardiography has traditionally been employed as the primary mode of imaging; however, with the advent of cardiac magnetic resonance as a more precise imaging technique, the disorder known as left ventricle non compaction is becoming more broadly defined with increasing recognition of right ventricle (RV) involvement.
Case presentation
This report describes a 52-year-old Caucasian female with new onset atrial fibrillation with an unusual finding of left ventricular non compaction and right ventricular dysfunction on transthoracic echocardiogram with preserved left ventricular ejection fraction. Cardiac magnetic resonance imaging demonstrated a disproportionately affected right ventricle, with apical free wall dyskinesis.
This case illustrates the unique occurrence of left ventricular non compaction with preserved ejection fraction alongside RV free wall dyskinesis and RV systolic dysfunction. The significance of this is yet unknown given the paucity of existing literature. This report serves to highlight the vast heterogeneity within left ventricular non compaction as we are better able to delineate this disorder using increasingly sophisticated imaging techniques.
PMCID: PMC4233058  PMID: 25374312
Left ventricular non compaction; Multi-modality cardiac imaging
2.  Efficacy, User Acceptability, Tolerability, and Cycle Control of a Combined Contraceptive Vaginal Ring: The Indian Perspective 
To assess the contraceptive efficacy, user acceptability, cycle control, and tolerability of a combined contraceptive vaginal ring for up to 13 cycles.
Materials and Methods
Healthy women coming to the OPD for contraceptive advice were enrolled in this one-year study. Each ring was used for three weeks followed by a one-week ring-free period.
A total of 184 women started treatment forming the intent to treat population. Subjects were followed for 13 cycles. Compliance was good with 99 % of cycles in full compliance with specified criteria. In the intent to treat population, no pregnancies occurred giving a Pearl Index of 0. The mean incidence of withdrawal bleeding was 99 % in all cycles. There was 0.16 % incidence of intermenstrual bleeding and 2 % incidence of early withdrawal bleeding. The ring was well tolerated with a low incidence of adverse events.
The ring is an effective contraceptive that is convenient, well tolerated with excellent cycle control, and highly acceptable to users.
PMCID: PMC3798445  PMID: 24431671
Combined vaginal contraceptive ring; Efficacy; Cycle control
3.  Health Care Expenditures for Adults With Multiple Treated Chronic Conditions: Estimates From the Medical Expenditure Panel Survey, 2009 
The objective of this article is to illustrate the usefulness of Medical Expenditure Panel Survey (MEPS) data for examining variations in medical expenditures for people with multiple chronic conditions (MCC). We analyzed 2009 MEPS data to produce estimates of treated prevalence for MCC and associated medical expenditures for adults in the US civilian noninstitutionalized population (sample = 24,870). We also identified the most common dyad and triad combinations of treated conditions. Approximately one-quarter of civilian US adults were treated for MCCs in 2009; 18.3% were treated for 2 to 3 conditions and 7% were treated for 4 or more conditions. The proportion of adults treated for MCC increased with age. White non-Hispanic adults were most likely and Hispanic and Asian adults were least likely to be treated for MCC. Health care expenditures increased as the number of chronic conditions treated increased. Regardless of age or sex, hypertension and hyperlipidemia was the most common dyad among adults treated for MCC; diabetes in conjunction with these 2 conditions was a common triad. MEPS has the capacity to produce national estimates of health care expenditures associated with MCC. MEPS data in conjunction with data from other US Department of Health and Human Services sources provide information that can inform policies addressing the complex issue of MCC.
PMCID: PMC3652712  PMID: 23618543
4.  Vanishing left ventricular thrombus in a woman with peripartum cardiomyopathy: a case report 
BMC Research Notes  2012;5:544.
Peripartum cardiomyopathy (PPCM) is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other identifiable causes of cardiac failure. The combination of left ventricular (LV) systolic dysfunction and hypercoaguability can cause thromboembolic complications including intra-cardiac thrombi.
Case presentation
A 25-year-old Caucasian female with PPCM demonstrated multiple thrombi in the LV on transthoracic echocardiography. Following anticoagulation with parenteral heparin, a cardiac MRI four days later demonstrated near resolution of the thrombi.
We review the presentation, diagnosis and management of LV thrombi in the clinical setting of PPCM.
PMCID: PMC3551696  PMID: 23031314
Peripartum cardiomyopathy; Multimodality cardiac imaging; Thrombus
6.  Colorectal Tumors Within an Urban Minority Population in New York City 
Data on gender- and age-specific predisposition to colorectal tumors and colorectal tumor location and stage among the urban minority population in Northeastern United States is limited.
To study the age and gender distribution of colorectal tumor type, location, and stage of colorectal tumors among urban minorities.
Retrospective analysis of a database of 4,043 consecutive colonoscopies performed over a 2-year period.
Of study participants, 99% were Hispanic or African American and two-thirds were women. Age, gender, colonoscopy findings, and biopsy results were analyzed in all study subjects. Outcome measures are expressed as odds ratios (OR) with 95% confidence intervals (CI).
Colonoscopies, 2,394 (63.4%), were performed for cancer screening. Women had higher visit volume adjusted odds to undergo colonoscopy (OR 1.35; CI 1.26–1.44, P < .001). Individuals, 960 (23.7%), had adenomas, and 82 (2.0%) had colorectal cancer. Although cancers were outnumbered by adenomas in the colon proximal to splenic flexure (OR 0.48; CI 0.29–0.80 P = .002), 51% of all abnormalities and 35.4% of cancers were found in this region. Of cancers, 75% belonged to AJCC stage 0 to 2. Men had higher odds for both adenomas and cancers (OR 2.38, CI 2.0–2.82, P < .001). More polyps occurred at a younger age. Of the cancers, 38% were noted among the 50- to 59-year-old subjects. However, the odds of colorectal cancers were higher at age greater than 70 years (OR 1.91; CI 1.09–3.27, P < .05), specifically among men (OR 2.27, 95% CI 1.07–4.65, P < .05).
Our study of colonoscopies demonstrates lower odds of colonoscopy after adjusting for visit volume and greater predilection for colorectal cancer among urban minority men. Although older individuals were more likely to have colorectal cancer, a high percentage of colorectal tumors were noted at a younger age. These findings emphasize the vital need for preventive health education and improving early access to colorectal screening among urban minority men. A large proportion of colorectal tumors were found proximal to splenic flexure, which supports colonoscopy as the preferred method for colorectal cancer screening in the urban minority population in New York City.
PMCID: PMC2219849  PMID: 17370031
colonoscopy; minority; Hispanic; colorectal cancer; adenoma
8.  The research rotation: competency-based structured and novel approach to research training of internal medicine residents 
In the United States, the Accreditation Council of graduate medical education (ACGME) requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM) residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents.
We would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation".
Since the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine.
Internal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program.
PMCID: PMC1630691  PMID: 17044924
9.  Letter to the editor 
Critical Care  2005;9(4):414-416.
PMCID: PMC1269425  PMID: 16137393

Results 1-9 (9)