Mar 10, 2020 | COVID-19, Featured, Research
Patients in China with COVID-19 showed distinct patterns in their lungs that became more defined within a few of days of disease onset, according to two cardiothoracic radiologists at the Mount Sinai Health System, who were the first in the nation to examine the CT scans of Chinese patients with the coronavirus.
The radiologists, Michael S. Chung, MD, and Adam Bernheim, MD, from the Icahn School of Medicine at Mount Sinai, say the distinct markings of these 121 patients offer objective evidence that could help doctors diagnose COVID-19 within minutes. The CT scans would support the health care community’s work in determining who has the disease and its ability to quickly isolate and treat patients. The test swabs being used to confirm the disease in patients can take up to 12 hours to process.
In a study that appeared in the February issue of Radiology, Drs. Chung and Bernheim described the disease characteristics of patients at four hospitals located in four different provinces in China. The patients were between the ages of 18 and 80, and their cases ranged from mild to severe. Of the patients who were scanned within two days after reporting symptoms, more than half showed no evidence of lung disease. Patients who were scanned three to five days after reporting symptoms showed distinctive patterns in their lungs.
Dr. Chung, the study’s senior author, is an Assistant Professor of Diagnostic, Molecular and Interventional Radiology, and Medicine (Cardiology). Dr. Bernheim, the first author, is an Assistant Professor of Diagnostic, Molecular and Interventional Radiology. According to the authors, “Prompt recognition of the disease is invaluable to ensure timely treatment, and from a public health perspective, rapid patient isolation is crucial to containment of this communicable disease.”
The doctors say CT imaging is an efficient tool that is generally available throughout the world, even in places with more limited resources. The established imaging patterns of COVID-19 will provide doctors with the evidence they need to look for when making a diagnosis.
Early in the disease phase, the radiologists described a look of “ground-glass abnormality,” in the lungs. As the disease progressed, it was followed by what they called a look of “crazy paving,” which was followed by “increasing consolidation.” This imaging road map, they say, will help physicians predict disease progression and the development of complications.
For physicians, the most critical element in the severity of COVID-19 is the degree to which the lungs fill with fluid, with the worst outcome being the patient succumbing to pneumonia.
“The normal lung is black because it’s composed of air,” says Dr. Chung. “But in a patient with COVID-19 or another severe pneumonia, those areas become filled with cells, debris, pus, and fluid, and become white. That is a diseased lung that is not aerating, not exchanging oxygen and carbon dioxide. If it’s extensive enough and severe enough, and the body’s inflammatory response and immune system’s response can also cause downstream complications at the cellular level, that would make it difficult to oxygenate and could become fatal.”
Why some patients have more severe cases of the disease than others is still unknown, says Dr. Bernheim. He says that even though COVID-19 is in the same viral family as the SARS and MERS coronaviruses and “probably affects the lungs the same way, we are treating this as a new entity. We will have to see how it changes, progresses, and resolves, and treat it as a new area of research as opposed to just comparing it to SARS and MERS.”
Drs. Chung and Bernheim worked with Zahi Fayad, PhD, and his team at the Icahn School of Medicine at Mount Sinai’s newly renamed BioMedical Imaging and Engineering Institute, which creates novel imaging programs and medical technology. Dr. Fayad is the Institute’s Director.
Mar 10, 2020 | Featured, Research
Jason C. Kovacic, MD, PhD; back row center, and Jeffrey W. Olin, DO, second from right; with team members, from left, Daniella Kadian-Dodov, MD; Annette King, NP; Bhargavi Vonguru, MSc; and Valentina d’Escamard, PhD.
A Mount Sinai team has gained valuable insights into fibromuscular dysplasia (FMD), a disorder of the arteries that is typically diagnosed in otherwise healthy women at midlife and sometimes causes aneurysms or serious heart disease. The findings could open the door to new strategies for the diagnosis, treatment, and management of FMD, including a blood test that could lead to earlier diagnosis.
“A lot of work remains, but we have proved that a reliable, blood-based test for this disease is eminently possible,” says Jason C. Kovacic, MD, PhD, Professor of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, and corresponding author of a study published in August 2019 in Cardiovascular Research. “Such a test could have an enormous impact on the management of FMD. It could pave the way for screening and counseling of family members, and for tailoring clinical care to patients who, in many cases, remain undiagnosed until they suffer a major event.”
The team compared blood samples from 90 women with FMD and 100 women without it, evaluating nearly 1,000 proteins and 31 lipid subclasses. Eventually, researchers identified and validated 37 proteins and 10 lipid sub-classes that make up a unique FMD disease signature. Then, machine learning was used to develop a prototype blood test for FMD.
Fibromuscular dysplasia (FMD) can affect arteries throughout the body. Arteries to the kidney of a patient with FMD, left, have a “string of beads” appearance, compared with normal arteries, right. A team at Mount Sinai is in the early stages of developing a blood test for the disease, which can cause aneurysms, heart attacks, or stroke.
“This is preliminary, but it is the first meaningful, mechanistic research that has been done in this disease,” says Jeffrey W. Olin, DO, Professor of Medicine (Cardiology), Icahn School of Medicine, and a co-author of the study. Developing an accurate test is crucial, says Dr. Olin, a leader in the treatment of FMD. “It’s not uncommon for a patient to have high blood pressure related to FMD that started when she was 30, and not have FMD diagnosed until she is 50,” he says.
FMD is a genetic disease that predominantly affects women and can strike at any age, although the average age of patients at diagnosis is 52. Abnormal cells form in the arteries, which take on a characteristic “string of beads” appearance, causing narrowing, tearing, or bulging of the vessels.
“FMD can affect the arteries of the kidney, causing high blood pressure. It can affect the arteries to the brain, which can cause stroke, or it can affect the arteries in the heart, in which you can develop a heart attack,” Dr. Olin explains. The prevalence of the disease is hard to gauge, because most patients with FMD have no symptoms for many years, and it is often found in a scan for another clinical purpose. For example, “FMD is discovered in approximately 4 percent of potential kidney donors, but this may be a serious underestimation of its prevalence,” he says.
Mount Sinai is in the forefront of efforts to unravel the genetics of FMD, due to the work of Dr. Kovacic and Dr. Olin, who is principal investigator for the United States Registry for Fibromuscular Dysplasia, and Director of the Mount Sinai Heart Center for Fibromuscular Dysplasia Care and Research. The team also includes Daniella Kadian-Dodov, MD, Assistant Professor of Medicine (Cardiology); Valentina d’Escamard, PhD, a senior scientist in the Kovacic Lab; and Annette King, NP, study coordinator.
“We are looking for a genetic profile of this disease, and we do have some promising preliminary results,” Dr. Olin says. “But ultimately, we want to find the gene or genes that cause this disease, and develop a treatment that blocks the effects of those genes.”
Mar 10, 2020 | Community, Featured
U.S. Surgeon General Jerome M. Adams, MD, MPH, center, with David L. Reich, MD, President and Chief Operating Officer, The Mount Sinai Hospital, right, and Jonathan S. Gal, MD, Assistant Professor, Anesthesiology, Perioperative and Pain Medicine.
The Mount Sinai Hospital in February hosted a lecture by U.S. Surgeon General Jerome M. Adams, MD, MPH, who called upon the hospital’s medical community to embrace their role as “health advocates” while helping to guide the public in critical areas such as smoking cessation and the treatment and prevention of opioid abuse.
During a question-and-answer session in Hatch Auditorium that was led by Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System, Dr. Adams said, “We need more of you to use your voices.”
There is a lot of misinformation on the internet, said Dr. Adams, a board certified anesthesiologist. “It’s going to take a hands-on approach for us to communicate to people what it will take for them to be healthy.”
Dr. Adams discussed his priorities as Surgeon General. He said he was pleased that the United States has the lowest rate of cigarette smoking among adults and youth in history, but was also dismayed by a rise in e-cigarette smoking among high school and middle school students.
For the first time in 20 years, he said, national opioid-related deaths were decreasing, yet every 11 minutes someone still dies from opioid abuse. He also said the trend toward legalizing the use of marijuana in many states did not take into account the negative effects of its active ingredient, THC, on the developing brains of youngsters or on pregnant women.
Medical professionals in every specialty should help people understand the health consequences of their actions, he said, and be as well trained in handling drug abuse as they are in managing relatively commonplace complications, such as hypertension.
Updated on Jun 30, 2022 | COVID-19, Featured, Your Health
A newly identified coronavirus now known as COVID-19 was first recognized in Wuhan, China, in early December 2019 and is rapidly spreading throughout the world.
Bernard Camins, MD, MSc, Medical Director for Infection Prevention for the Mount Sinai Health System, offers some basic guidelines for understanding this latest health concern. You can also get up-to-date information from the Centers for Disease Control and Prevention (CDC).
Who is most at risk?
According to the CDC, those at the most risk include: people in places where ongoing community spread has been reported and people who have had close contact with those who have COVID-19. In addition, people who recently traveled to an area where cases of COVID-19 are occurring are most at risk, and they should consult their doctor or the CDC for the latest information. The CDC maintains a list of countries with significant COVID-19 cases.
What are the symptoms?
Symptoms have included mild to severe respiratory illness with fever, cough, and difficulty breathing. The symptoms usually begin within two to three days of exposure but could take as long as 14 days to develop. These symptoms are also typical of the flu and other seasonal viral illnesses, and if you have symptoms like these and you have not traveled to an area with COVID-19 cases or been in close contact with someone who has, you probably have a seasonal illness and not the novel coronavirus.
What if I recently traveled to an area with COVID-19 cases and now have symptoms of a respiratory illness and/or fever?
If you feel sick with fever, cough, or difficulty breathing within 14 days after you return to the United States, you should seek urgent medical care. However, before going to your doctor’s office, an urgent care center, or an emergency room, call ahead and alert the staff about your recent travel and symptoms.
Avoid contact with others. Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. Frequently wash your hands with soap and water for at least 20 seconds to avoid spreading the virus to others. Use an alcohol-based hand sanitizer if soap and water are not available. As soon as you arrive at the medical facility, let a staff member know about your symptoms and travel history. You should be provided with a mask and moved to an area away from other patients.
How is coronavirus spread?
There are many types of human coronaviruses, including those that cause the common cold. They typically spread from an infected person through the air in tiny droplets produced when coughing or sneezing. These droplets, when they come into contact with another person’s mucous membranes (e.g., mouth, nose, or eyes), can lead to infection. The virus can also be transmitted if you touch a person, an object, or a surface on which the virus has settled and then touch your mouth, nose, or eyes before washing your hands.
How can I protect myself?
As with other respiratory viruses, you can protect yourself from infection through frequent, proper hand hygiene, either with an alcohol-based hand sanitizer or with soap and water. Also, practice proper respiratory hygiene by covering your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
How is Mount Sinai prepared to treat infectious diseases?
For a long time, Mount Sinai has been developing procedures to make sure that people arriving for care at our facilities are quickly screened for infectious diseases. This includes questioning people about whether they have traveled abroad in the last three weeks or come into contact with people who are traveling abroad. Our procedures enable us to quickly isolate any possible cases of infectious disease.
Feb 25, 2020 | Featured, Global Health
Keynote speaker Karenna Gore with conference host Robert Wright, MD, MPH.
Global warming is having an increasingly profound effect upon human health, making it harder to breathe, giving rise to more infectious diseases, and even lowering nutritional levels in our food supply.
These were among the many consequences cited on Friday, January 24, when the Institute for Exposomic Research at the Icahn School of Medicine at Mount Sinai hosted its second annual Clinical Climate Change Conference at the New York Academy of Medicine. The event drew more than 150 clinicians and other members of the U.S. medical community.
“Health care professionals are on the front lines of this planetary health problem,” which is having a disproportionate effect on “the poor, the marginalized, the elderly and infirm, and nonhuman life,” said Karenna Gore, the Conference’s keynote speaker, and the founder and Director of the Center for Earth Ethics at Union Theological Seminary.
She told the audience, “This is no ordinary time and we are together in not knowing how it will turn out. We need you to warn, and we need you to heal.” Ms. Gore is the daughter of former U.S. Vice President Al Gore, who received the 2007 Nobel Peace Prize for his work on climate change.
Robert Wright, MD, MPH, the Ethel H. Wise Chair of the Department of Environmental Medicine and Public Health, Director of the Institute for Exposomic Research, and Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, said exposomics—a new field of science that uses technology to measure an individual’s total environmental exposures over their lifetime—could help physicians understand the effects of global warming.
Satellites, for example, are used to help measure a person’s external exposure to air pollution, whereas mass spectrometry is used to measure an individual’s internal chemical exposures. As the field matures, Dr. Wright said, exposomic data will be used more widely to determine cause and effect and monitor the success of interventions.
Dr. Wright shared information from the U.S. Centers for Disease Control and Prevention (CDC), which highlighted the negative impact of extreme heat and air pollution on cardiovascular health and asthma and showed that warmer weather would lead to an increase in tick-and-mosquito-borne illnesses such as Lyme disease and the Zika virus, since insects could live and breed in more places.
Conference attendees gathered at the New York Academy of Medicine in New York City.
As a point of reference, Dr. Wright cited the European heat wave of 2003, which led to tens of thousands of deaths. France, he said, had the highest temperatures and the most deaths. Another example, he said, was chronic kidney disease of unknown origin, a progressive loss of kidney function that has killed more than 20,000 people in Central America over the past 10 years, most of whom were agricultural workers.
“The leading theory of the cause,” he said, “is a combination of dehydration and pesticide exposure. With climate change and higher temperatures, workers may be dehydrated for longer periods of time.”
Lewis Ziska, PhD, Associate Professor of Environmental Health Sciences at the Columbia University Mailman School of Public Health, and a former plant physiologist at the U.S. Agricultural Service, said increasing levels of carbon dioxide in the atmosphere were creating an imbalance in many plant species that people consume. Rice, wheat, potatoes, and barley, he said, were all showing a decline in protein, nitrogen, sulfur, zinc, and iron. Extreme weather-related events that take place in one part of the continent also affect the health of people living thousands of miles away.
Allan C. Just, PhD, Assistant Professor of Environmental Medicine and Public Health at the Icahn School of Medicine, discussed the unprecedented Canadian wildfires of 2015, which followed a hot, dry spring. The forest fires burned millions of acres and displaced thousands of people, mainly in Saskatchewan. Airborne particles from the fires spread to the Eastern United States, he said, and led to unsafe levels of air pollution in cities as far away as Baltimore.
In her closing remarks, Ms. Gore reminded the audience of the earth’s interconnectedness. “The climate crisis is a force that will ultimately spare no one,” she said. “Solving it should be a unifying cause.”
Updated on Feb 26, 2020 | Cardiology, Community, Featured
Health fairs were held throughout the Mount Sinai Health System to raise awareness of women’s risk for disease. Above, the fair at The Mount Sinai Hospital.
Eat healthy, get plenty of exercise, manage stress, and know your numbers. This was some of the crucial advice dispensed at health fairs held throughout the Mount Sinai Health System in honor of Go Red for Women Day® on Friday, February 7. The fairs, which were spearheaded by the nurses of Mount Sinai Heart, also provided nutritious snacks and free health screenings. Go Red is an initiative of the American Heart Association with the goal of increasing the awareness that heart disease is the No. 1 cause of death for women. Says Beth Oliver, DNP, RN, Senior Vice President, Cardiac Services, Mount Sinai Health System: “We want all women to understand the importance of knowing their numbers—their cholesterol levels, weight, blood sugar, and blood pressure—and to understand the risks of stress, smoking, and a sedentary lifestyle.”
