A5014408021- Cardiovascular Syncope and Autonomic Disorders
- Heart Rate Variability and Autonomic Control
- Urticaria and Related Conditions
- Psoriasis: Treatment and Pathogenesis
- Autoimmune and Inflammatory Disorders Research
- Vasculitis and related conditions
- Systemic Lupus Erythematosus Research
- Traumatic Brain Injury and Neurovascular Disturbances
- Long-Term Effects of COVID-19
- Neuroscience of respiration and sleep
- Non-Invasive Vital Sign Monitoring
- Immune Cell Function and Interaction
- COVID-19 and healthcare impacts
- COVID-19 Clinical Research Studies
- Thermoregulation and physiological responses
- Fibromyalgia and Chronic Fatigue Syndrome Research
- Cardiovascular Issues in Pregnancy
- Obstructive Sleep Apnea Research
- Rheumatoid Arthritis Research and Therapies
- Neurosurgical Procedures and Complications
- Adolescent and Pediatric Healthcare
- Drug-Induced Adverse Reactions
- Monoclonal and Polyclonal Antibodies Research
- SARS-CoV-2 and COVID-19 Research
- Pregnancy and Medication Impact
Unity Health System
2022-2024
University of Rochester
2024
University of Rochester Medical Center
2020-2024
Unity Hospital
2023
Rochester Institute of Technology
2023
Rochester General Hospital
2022-2023
ORCID
2022
Albany Medical Center Hospital
2017-2018
New York Medical College
2009-2013
Westchester Medical Center
2012
Chronic Fatigue Syndrome (CFS) is defined as greater than 6 months of persistent fatigue that experienced physically and cognitively. The cognitive symptoms are generally thought to be a mild impairment, but individuals with CFS subjectively describe them "brain fog." impairment not fully understood often described slow thinking, difficulty focusing, confusion, lack concentration, forgetfulness, or haziness in processes. Causes fog" have been investigated. Possible physiological correlates...
Objectives Rheumatoid arthritis (RA), along with glucocorticoid use, is associated cardiovascular disease. Cardiovascular safety of glucocorticoids in RA controversial and may be related to dose duration use. We determined if initiating steroid-naive patients would increase event (CVE) risk a duration-dependent manner over short-term intervals. Methods Patients enrolled CorEvitas (formerly Corrona) registry. Cox proportional-hazards models estimated adjusted HRs (aHR) for incident CVE who...
CFS (chronic fatigue syndrome) is commonly co-morbid with POTS (postural tachycardia syndrome). Individuals CFS/POTS experience unrelenting fatigue, during orthostatic stress and ill-defined neurocognitive impairment, often described as 'mental fog'. We hypothesized that causes impairment in related to decreased CBFV (cerebral blood flow velocity). A total of 16 20 control subjects underwent graded tilt table testing (at 0, 15, 30, 45, 60 75°) continuous cardiovascular, cerebrovascular,...
Postural tachycardia syndrome (POTS), a chronic form of orthostatic intolerance, has signs and symptoms lightheadedness, loss vision, headache, fatigue, neurocognitive deficits consistent with reductions in cerebrovascular perfusion. We hypothesized that young, normocapnic POTS patients exhibit abnormal cerebral autoregulation (CA) results decreased static dynamic blood flow (CBF) autoregulation. All subjects had continuous recordings mean arterial pressure (MAP) CBF velocity (CBFV) using...
Abstract Background and Aims Persons with rheumatoid arthritis (RA) have an increased risk of obstetric-associated complications, as well long-term cardiovascular (CV) risk. Hence, the aim was to evaluate association RA acute CV complications during delivery admissions. Methods Data from National Inpatient Sample (2004–2019) were queried utilizing ICD-9 or ICD-10 codes identify hospitalizations a diagnosis RA. Results A total 12 789 722 identified, which 0.1% among persons (n = 11 979)....
POTS (postural tachycardia syndrome) is a chronic form of OI (orthostatic intolerance). Neuropathic characterized by decreased adrenergic vasoconstriction, whereas hyperadrenergic exhibits increased vasoconstriction. We hypothesized that midodrine, an α1-adrenergic receptor agonist, would increase CVR (calf vascular resistance), decrease C(v) venous capacitance) and orthostatic in neuropathic POTS, but not alter haemodynamics POTS. A total 20 patients (12 eight hyperadrenergic), ages 12-20...
Neurocognition is impaired in chronic fatigue syndrome (CFS). We propose that the impairment relates to postural cerebral hemodynamics. Twenty-five CFS subjects and twenty control underwent incremental upright tilt at 0, 15, 30, 45, 60, 75° with continuous measurement of arterial blood pressure flow velocity (CBFV). used an n-back task n ranging from 0 4 (increased = increased difficulty) test working memory information processing. measured outcomes by number correct answers reaction time....
Although vaccination is the primary strategy against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), rheumatologic patients on B-cell depleting agent rituximab may have a suboptimal response. Tixagevimab and cilgavimab (Evusheld) could be administered under Food Drug Administration emergency use authorization as pre-exposure prophylaxis.A cohort study of therapy who received Evusheld was followed longitudinally. Adverse events were monitored.Forty-three Evusheld, with diagnoses...
Local cutaneous heating produces vasodilation that is largely nitric oxide (NO) dependent. We showed angiotensin II (ANG II) attenuates this by an ANG receptor, type 1 (AT1R)-dependent mechanism reversible with the antioxidant ascorbate, indicating oxidative stress. Reactive oxygen species (ROS) produced employ NADPH and xanthine oxidase pathways. To determine whether these mechanisms pertain to skin, we measured local 10 μM II, using apocynin inhibit allopurinol oxidase. also inhibited...
Postural tachycardia syndrome (POTS) is associated with increased plasma angiotensin II (Ang II). Ang administered in the presence of NO synthase inhibition nitro-L-arginine (NLA) and type 1 receptor blockade losartan produces vasodilation during local heating controls. We tested whether this angiotensin-mediated occurs POTS it related to angiotensin-converting enzyme 2 (ACE2) Ang-(1-7). used cutaneous 42 degrees C laser Doppler Flowmetry assess NO-dependent conductance at 4 calf sites 12...
Immunocompromised individuals with hematological malignancy have increased risk for poor outcomes and death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This special population may mount a suboptimal response to vaccination. We assessed the effectiveness of tixagevimab cilgavimab (Evusheld), monoclonal antibody combination against SARS-CoV-2, in conjunction standard preventative measures, at preventing symptomatic incident infection.Patients aged 18 years older...
Loss of the cardiovagal baroreflex (CVB), thoracic hypovolemia, and hyperpnea contribute to nonlinear time-dependent hemodynamic instability vasovagal syncope. We used a phase synchronization index (PhSI) describe extent coupling between cardiorespiratory parameters, systolic blood pressure (SBP) or arterial (AP), RR interval (RR), ventilation, directional (DI) measuring direction coupling. also examined differences directly. hypothesized that AP-RR PhSI would be normal during early upright...
Vasovagal syncope may be due to a transient cerebral hypoperfusion that accompanies frequency entrainment between arterial pressure (AP) and blood flow velocity (CBFV). We hypothesized autoregulation fails during fainting; phase synchronization index (PhSI) AP CBFV was used as nonlinear, nonstationary, time-dependent measurement of autoregulation. Twelve healthy control subjects twelve with history vasovagal underwent 10-min tilt table testing the continuous AP, CBFV, heart rate (HR),...
Increasing arterial blood pressure (AP) decreases ventilation, whereas decreasing AP increases ventilation in experimental animals. To determine whether a “ventilatory baroreflex” exists humans, we studied 12 healthy subjects aged 18–26 yr. Subjects underwent baroreflex unloading and reloading using intravenous bolus sodium nitroprusside (SNP) followed by phenylephrine (“Oxford maneuver”) during the following “gas conditions:” room air, hypoxia (10% oxygen)-eucapnia, 30% oxygen-hypercapnia...
While orthostatic tachycardia is the hallmark of postural syndrome (POTS), orthostasis also initiates increased minute ventilation (V̇e) and decreased end-tidal CO 2 in many patients. We hypothesized that chemoreflex sensitivity would be patients with POTS. therefore measured chemoreceptor 20 POTS (16 women 4 men) 14 healthy controls (10 men), 16–35 yr old by exposing them to eucapneic hyperoxia (30% O ), hypoxia (10% hypercapnic + 5% ) while supine during 70° head-upright tilt. Heart rate,...
Our prior studies indicated that postural fainting relates to thoracic hypovolemia. A supranormal increase in initial vascular resistance was sustained by increased peripheral until late during head-up tilt (HUT), whereas splanchnic resistance, cardiac output, and blood pressure (BP) decreased throughout HUT. aim the present study investigate alterations of baroreflex activity occur synchrony with beat-to-beat time-dependent changes heart rate (HR), BP, total (TPR). We proposed low-frequency...
Hemophagocytic lymphohistiocytosis (HLH) is a serious life-threatening disease if not recognised early. In patients with HIV/AIDS, this association has been reported following acute opportunistic infections, including histoplasmosis. However, optimal treatment known. We describe male aged 46 years AIDS who developed HLH disseminated Presenting symptoms included fever, hepatosplenomegaly and pancytopenia. Bone marrow biopsy confirmed HLH. Initially, he was refractory to the amphotericin B,...
Models of microgravity are linked to excessive constitutive nitric oxide (NO) synthase (NOS), splanchnic vasodilation, and orthostatic intolerance. Normal-flow postural tachycardia syndrome (POTS) is a form chronic intolerance associated with hyperemia. To test the hypothesis that there NOS in POTS, we determined whether cutaneous microvascular neuronal NO endothelial increased. We performed two sets experiments POTS control subjects aged 21.4 ± 2 yr. used laser-Doppler flowmetry measure...
Hypertrophic discoid lupus erythematosus is a rare variant of chronic cutaneous and often challenging to treat. A male in his early 60s presented with diffuse erythematous, crusty, pruritic plaques on upper lower extremities, face, back, dorsal aspect the hands chest. He also described prolonged morning stiffness, swelling fingers wrists, oral sores Raynaud’s phenomenon. was positive for antinuclear antibody anti-SSA had low C3 C4 proteins. The skin biopsy consistent hypertrophic...
Low flow postural tachycardia syndrome (LFP) is associated with vasoconstriction, reduced cardiac output, increased plasma angiotensin II, bioavailable nitric oxide (NO), and oxidative stress. We tested whether ascorbate would improve cutaneous NO reduce vasoconstriction when delivered systemically. used local heating to 42°C laser Doppler flowmetry assess NO-dependent conductance (%CVC(max)) sodium the systemic hemodynamic response ascorbic acid in 11 LFP patients 8 control subjects (aged...