New Rubidium Generator Improves Reliability and Reduces Time for Cardiac PET Testing

Mount Sinai Morningside recently installed a new rubidium generator to facilitate a reliable source of isotopes for cardiac positron emission tomography (PET) studies.

With this update, Mount Sinai will become the leading health system in New York City offering high-quality, timely, and easy access to the entire range of advanced cardiac PET imaging. Cardiac PET testing includes three common type of studies: cardiac stress imaging with PET; cardiac PET viability imaging; and cardiac PET infection and inflammation imaging.

Cardiac stress PET myocardial perfusion imaging is the most accurate non-invasive test to diagnose obstructive coronary artery disease as well as coronary microvascular dysfunction, which is a common cause of symptoms and morbidity among patients who have ischemia with non-obstructive coronary arteries (INOCA) with continued symptoms.

Other key advantages of cardiac PET include:

  • Significantly lower radiation dose to the patient—approximately 3 mSV, or millisieverts, a unit of radiation exposure, per study, equal to about the amount of radiation a person is exposed to from natural sources over the course of a year.
  • Superior imaging technology leading to excellent image quality even among patients with unfavorable bodily characteristics such as obesity or women with large breasts or breast implants.
  • Availability of coronary artery calcium score information to detect subclinical atherosclerosis.
  • Availability of absolute myocardial blood flow quantitation, which helps to accurately diagnose flow-obstructing CAD including high-risk, multi-vessel CAD, diffuse atherosclerosis, post-heart transplant vasculopathy, and microvascular dysfunction in INOCA.
  • Increased efficiency and significantly shorter study time—a rest and stress Rb-82 PET takes about 30 minutes.

Due to these advantages, recent American College of Cardiology and American Heart Association guidelines on chest pain evaluation endorse the preferred use of cardiac PET over other stress imaging modalities.

Common indications for cardiac PET stress testing are:

  • Symptomatic patients with suspected ischemia unable to exercise or complete exercise during a treadmill test.
  • Previous poor quality stress imaging: equivocal or inconclusive results, artifact on images, patients with discordant results on angiogram and stress study.
  • Body characteristics affecting image quality: large breasts, obesity, pleural effusions, chest wall deformities.
  • High-risk patients to avoid diagnostic errors: patients with history of chronic kidney disease, diabetes, suspected left main or multi-vessel disease, extensive known CAD, suspected transplant vasculopathy, known CAD prior to high-risk revascularization.
  • Young patients with established CAD requiring testing to avoid repeat radiation exposure.
  • Situations where myocardial flow quantitation is necessary for clinical decision-making, (e.g. microvascular dysfunction and/or suspected multi-vessel disease).

Cardiac PET viability testing is the gold standard for detecting hibernating myocardium among patients with suspected ischemic cardiomyopathy and heart failure with significant CAD. Cardiac PET guided management has been shown to reduce long-term adverse cardiac events among these patients.

Cardiac infection and inflammation PET imaging is critical for the diagnosis and management of patients with suspected or known cardiac sarcoidosis, suspected prosthetic valve endocarditis, left ventricular assist device (LVAD) infections, pocket, and other cardiac device infections.

To refer a patient for a cardiac PET scan, please contact the Cardiology Department at Mount Sinai Morningside 212-636-4809 or send an email to cardiacPet-scan@mountsinai.org.

Click here for more information on the PET CT program at Mount Sinai Morningside.

Mount Sinai Neuroscience Student Earns NIH Fellowship to Study Substance Use Disorders

Katherine Meckel

Can the bacteria in your gut influence addictive behavior? That is the question that Katherine Meckel is studying and trying to answer. Currently a fifth-year PhD candidate in neuroscience at the Icahn School of Medicine at Mount Sinai, Ms. Meckel is one of 31 young scientists from across the country to be honored with the National Institutes of Health (NIH) Blueprint Diversity Specialized Predoctoral to Postdoctoral Advancement in Neuroscience (D-SPAN) Award.

The award will provide Ms. Meckel with a six-year, $447,000 fellowship to fund the remaining two years of her PhD studies, as well as four years of postdoctoral research. The D-SPAN Award recognizes outstanding trainees from historically underrepresented communities in the sciences.

Working in the lab of Drew D. Kiraly, MD, PhD, Ms. Meckel is drawing upon her background in gastroenterology and neuropharmacology to study the effects of the gut microbiome on gene expression and behavior in a rodent model of cocaine use disorder.

“When we look at human patients and also animal models of substance use disorders, we see highly altered gene expression in response to cocaine and other drugs of abuse,” she explains. “This seems to emerge from long-term adaptations or ‘molecular scars’ which affect the ability of gene sequences in the DNA to be accessed and expressed. My work seeks to understand how gut bacteria and the metabolites they produce regulate the structure and accessibility of the DNA, influencing gene expression and ultimately drug-seeking behaviors.”

Dr. Kiraly, her dissertation advisor, praises her tenacity in establishing a new line of research within the field of neuroscience. “Katherine has generated a tremendous amount of exciting data, which provides insight into the mechanisms of gut-brain communication,” says Dr. Kiraly, Assistant Professor of Psychiatry, and Neuroscience, at Icahn Mount Sinai. “Her work holds potential to uncover novel pathways for drug development, which may one day lead to much-needed treatments for patients with substance use disorders.”

Trusting Her Gut Intuition

As an undergraduate, Ms. Meckel pursued a rigorous five-year dual degree program in Voice Performance and Biochemistry at Lawrence University in Appleton, Wisconsin. There, she conducted neuropharmacology research under Bruce Hetzler, PhD, studying the effects of methylphenidate (Ritalin) on rodent behavior and visual processing.

After graduating, she joined the Section of Gastroenterology at the University of Chicago, working under Joel Pekow, MD, and Marc Bissonnette, MD, to study the effects of diet and metabolism on inflammatory bowel disease and colorectal cancer.

Ms. Meckel credits her time in gastroenterology for encouraging a more integrative physiological approach, which now informs her studies. “Often times in neuroscience, we study the brain in isolation,” she says. “But it’s important to consider that the brain exists in communication with the other peripheral organs throughout the body, and they influence each other’s activity.”

Building Community for Students With Disabilities

Ms. Meckel has also emerged as a leader in disability rights since joining Icahn Mount Sinai. Together with classmates Jessica Pintado Silva and Marisa Goff, she co-founded Disability Rights, Education, and Awareness at Mount Sinai (DREAMS), which provides peer mentoring and support to graduate students with visible and invisible disabilities.

“As a queer, disabled individual, I often compare living with invisible chronic illness to ‘being in the closet.’ If you didn’t know me well, you probably wouldn’t realize I am disabled,” she says. “But much of my life outside of lab is characterized by managing chronic health flares.”

Ms. Meckel expressed gratitude to her advisors and the National Institute of Neurological Disorders and Stroke for supporting her training. “I hope that my experience inspires disabled and chronically ill trainees to continue in the sciences,” she says. “So we can share our unique perspectives and bring new innovation to STEM.”

 

Occupational Therapist Provides Inspiration and Expert Care

Lea Tsao, MS, CSRS

The Rehabilitation Department at Mount Sinai West would like to highlight Lea Tsao, MS, CSRS, an occupational therapist who works on our inpatient unit and on the acute medical floors.

When Lea started working with us, she was immediately dedicated to patients, willing to learn, and eager to help. She has a track record for going above and beyond for her patients, giving them not only excellent care but in difficult moments giving heartfelt words of encouragement that could inspire anyone else in the room listening.

Lea has been involved in several challenging cases, but we’d especially like to acknowledge her role in helping a patient who had a complex clinical presentation and a limited support system. Over several months, Lea remained an advocate for his functional progress and for the goal of getting him home.  She advocated for interdisciplinary communication, family involvement, and comprehensive care. Her consistency allowed for the continuity of care we strive for as health care providers to best meet the individual needs of our patients.

Without a doubt, this patient also benefitted from the care of numerous physical therapists, including Caitlin Counihan, Victor Rhee, and Erika Chason. Many of them worked to bring the patient’s mobility closer and closer toward functional independence.

We are very lucky to have a team of dedicated therapists and good human beings.

 

Ditch the Itch: Avoiding Skin Reactions to Halloween Costumes and Make Up

Halloween treats, costumes, and decorations are exciting for parents and children alike, but these holiday staples may be associated with unpleasant allergic reactions, such as contact dermatitis or urticaria (hives). As Halloween approaches and you are choosing your child’s costume, here are some helpful tips from Melissa Levoska, MD, Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai on how to protect your child’s skin.

Know the signs of a reaction

Your child may be experiencing an adverse skin reaction if redness, itching, dryness or blistering of the skin develops. If you notice these signs, immediately wash off any make-up/body paint and remove their costume and accessories. For some children, the rash may improve with removal of the offending agent, but others may require treatment topical corticosteroids or oral antihistamines. Contact your doctor if your child isn’t improving.

Do a spot check before applying face paint and makeup

Face paint and make-ups may contain preservatives such as methylchloroisothiazolinone/methylisothiazolinone, dyes, or fragrances that can be irritating to the skin. Be sure to test the face paint or makeup on a small area of your child’s skin, such as a spot on the arm, three to five days prior to full application on Halloween, to make sure your child does not develop a reaction.

Avoid false eyelashes and nails

Fake eyelashes are held in place with glues and acrylic nails, and contain potential contact allergens such as cyanoacrylates, latex, and formaldehyde. Furthermore, these products may damage your child’s nails and eyelashes over time.

Beware of hidden nickel  

Costume jewelry and accessories, such as belts, can also cause skin reactions as they commonly contain metals such as nickel, which is one of the most common causes of allergic contact dermatitis.

Opt for a natural, breathable fabric

When choosing a costume for your child, 100 percent cotton fabric is recommended. Other materials, such as wool and polyester, may be irritating to the skin. Irritation is especially likely if your child has a history of sensitive skin or eczema. Looser fitting, breathable fabrics also decreases the incidence of skin issues on the big day.

Most importantly, have fun and Happy Halloween! 

Melissa Levoska, MD, is an Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai and a board-certified dermatologist. Her patients are her top priority, and she strives to provide compassionate and patient-centered care.

Recognizing Our Colleagues: Rio Rivera at Mount Sinai Queens

“Rio Rivera, a phlebotomist at Mount Sinai Queens, is exceptional! She is excellent at prioritizing ‘stat’ labs to ensure that they arrive to the lab in a timely manner, improving patient outcomes. She is hard-working, kind to all patients and staff, professional, and efficient. I appreciate that she takes her time with hard sticks, accepts challenges, and really does her best to locate the best vein and minimize the number of times a patient is stuck with a needle—decreasing their pain and risk of infection. And very importantly, she is usually very successful at getting the specimen we need! She is a team player. We are so lucky to have her!”

Hoda Farghaly, BSN, RN, 3 East, Mount Sinai Queens

COVID-19: How Do I Know If My Workplace Is Safe?

COVID-19 has fundamentally changed the workplace. To reduce the spread of the virus, some organizations have allowed more people to work remotely and instituted daily health checks and staggered start and break times for those working in-office.

Even with social distancing signage and the presence of hand sanitization stations, those unable to work from home may still be concerned about office safety. In this Q & A, Dana S. Mazo, MD, MSc, an Assistant Professor of Medicine (Infectious Disease) at the Icahn School of Medicine at Mount Sinai and physician lead for Infection Prevention at Mount Sinai Queens, offers practical advice on how to protect yourself in the office.

How do I know that my office is safe?

The U.S. Occupational Safety and Health Administration (OSHA) has put out a set of guidelines for larger offices during the COVID-19 pandemic. You can check with the facilities department or your manager to see if the building is following these recommendations.

The rules start with conducting a thorough risk assessment to identify potential workplace hazards that could increase risks for COVID-19 transmission. Building owners and facilities managers should modify or adjust seats, furniture, and workstations so employees sit at least six feet apart. OSHA also recommends improving ventilation in the building by increasing total airflow as well as the percentage of outdoor air in the offices. And, housekeeping should clean and disinfect all surfaces that are frequently touched by many people on at least a daily basis.

How should I clean my office?

Start by cleaning the major high-touch surfaces—such as your desktop, keyboard, mouse, and the arms of your chair—with a sanitizing wipe. Hard surfaces, such as desks and chairs, are more likely to hang onto germs than porous materials, such as paper. If you’re not sure whether to clean, remember an extra swipe can’t hurt.

It is important to clean surfaces after someone else has touched them, since it is possible to transmit the virus by touching a contaminated surface with your hand and then touching your face, especially mouth, nose or eyes. If someone else used your work space within the past three days, make sure to clean before you start work.

Having a personal air purifier might be helpful in your immediate area. But what would be more useful would be if the entire building follows OSHA recommendations on air flow during this time.

Do I need to wear a face covering throughout the entire day?

If you have a closed office all to yourself, you don’t need to wear a face covering until someone wants to come into your space. If you share the office with someone, you’ll want to wear your face covering all day. This recommendation is especially important if desks are closer than six feet apart, but when people are sharing office space for an extended amount of time, six feet is not a hard boundary.

Open office plans are a different story as you may sit close to several people. Plus, there are those who walk by on their way to a meeting, the lunchroom, or the bathroom. The safest advice is to wear a face covering, even if co-workers are more than six feet apart. Throughout the Mount Sinai Health System, employees are required to wear face coverings at all times, unless in a closed office by themselves. But, even if it is safe to take your face covering off because there are no co-workers close by, keep it handy. If someone stops to chat, try to keep a distance of six feet and put your face covering on. You may be thinking that if your colleague seems fine, and it’s just the two of you, you don’t need to cover your face. But remember, your office mate could be infectious but not have any symptoms.  Also, sharing the air with that person means you are at risk for everyone that person has had contact with—on their way to work, in the supermarket, or at home.

How should I navigate elevators and communal office spaces?

Always wear a face covering in hallways, bathrooms, meeting spaces, kitchens, and any other communal spaces. You never know when someone is going to come around the corner.

When riding the elevator, keep your face covering on. Most buildings limit the number of people on each elevator car, often at 50 percent capacity. This means even before you get to the elevator, you must be careful as lobbies may be full of people waiting for their turn to ride up. If there are so many people that you cannot socially distance, you may want to wait outside the lobby for a few minutes until the area clears. Remember, outdoors is always safer than indoors because of the air circulation and often greater space for social distancing.

Inside the elevator, try to keep an arm’s length away from anyone else and limit conversation as talking forces respiratory droplets into the air. And, if you must push a button for your floor, don’t forget to wash your hands after.

How do I safely eat lunch at the office?

Lunchtime is often the time of greatest risk for transmission, because you have to take off your mask. Also, people let their guard down. You may not have seen your colleagues in months and want to catch up. But you still need to be on guard. It is important to keep at least six feet away from people during lunch when your face covering is off so that you can eat and drink.

Additionally, remember to wash your hands after using highly touched items like the office refrigerator, sink, microwave, or water cooler.

What about the bathroom?

The one place you cannot avoid during a day in the office—other than your desk—is the bathroom. Make sure to keep on your face covering and create as much social distancing as possible. Try not to stand next to someone; if there are multiple sinks or urinals, leave an empty spot between you and anyone else. There are a lot of commonly touched items in bathrooms, so the key here is hand washing. Wash your hands when entering and leaving the bathroom. And, before you flush, close the toilet lid—if possible.

When in doubt, maintain social distance, wear a face covering and wash your hands.

Now that we’re back in the office, are in-person meetings safe?

The best way to meet during a pandemic is virtually. But if the whole point of coming into the office was to be able to interact in person, then you’re going to need to be creative. Face coverings are a given, but you also need to think about ways to maintain social distance. One option, if possible, is to meet outdoors. If that isn’t an option, think about using a large auditorium, even for a group of a dozen people, as it’s easier to keep six feet apart if you have a few people in a large space.

Wherever you go, you should take the basic COVID-19 precautions: face coverings, hand sanitizer, and disinfecting wipes. Some people also wear gloves, but most experts recommend against it. Because gloves can lead to complacency and you could easily end up touching your face or not washing your hands sufficiently. If you do wear gloves, remain vigilant.

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