SAS grad: Don’t miss out on “the entire experience” at SGU

2020 graduate Dominic Gaspard has used his degree to earn a teaching position at Anglican High School in St. George’s.

From his time as a student at St. George’s University, Dominic Gaspard values the people he met and the adventures he went on as much as foundation it provided for his career

“If you come to SGU with the mindset of obtaining a degree as fast as possible, you would have missed the entire experience,” said the 2020 School of Arts and Sciences alum who earned degrees in international business as well as accounting and finance.

Currently a teacher at the Anglican High School in Grenada, Mr. Gaspard is also a full-time entrepreneur involved in two business ventures, one of which started as a project for the SAS Principles of Marketing course in which they were tasked with creating a marketing plan for a new product. Their product of choice: insect repellent candles.

SAS grad Dominic Gaspard encourages students to take advantage of the “entire experience” at SGU

After receiving positive reviews, he encouraged his classmates to join him in pursuing the concept further. They later took the idea to the Grenada Industrial Development Corporation’s Young Innovators Challenge where similar sentiments were echoed.

“Most of my time at SGU was actually spent with the SGU community and forming relationships. I’ve learned so much more outside the classroom thanks to the network I’ve built,” said Mr. Gaspard. “The level of student support and student engagement greatly enhanced my studies, especially given the additional responsibilities at home with my mom.”

The highlight of his time was the opportunity to participate in the 2018 Global X-Culture Conference and Symposium held at the University of Macerata in Italy. There he competed among 140 students from 29 countries, and he and his team captured one of only four company challenge trophies. In addition, the international experience provided him with the opportunity to learn about various cultures, interact with different nationalities and understand the importance of global perspectives.

“To SGU, I would say thank you—it’s the most enlightening experience I have ever had is my university experience,” he said. “That slogan ‘Think Beyond’ is something that has been branded into me and I don’t see the world the same way as I used to. I’m always looking at the bigger picture.”

It was not only a reward for him and his colleagues, but when he was faced with personal challenges leading up the Symposium—prompting him to second-guess his participation—he was instead buoyed by the enormous outpouring of support from his fellow classmates, as well as faculty and staff alike.

“I have been involved with another universities, and when I assess the level of student support systems SGU has in place, I can tell there is a conscious effort to take care of both students and staff,” he said.

During his time at SGU, Mr. Gaspard was also named president of the Business Students Association and served as a key member of the orientation team.  For those who aspire to pursue any number of careers locally, regionally, or around the world, he would implore them weigh all their options but also to know that “being a product of St. George’s University, including the quality of the education, the level of student support, and the extensive ability to network, prepares you for life.”

– Tornia Charles

Then a student, Dominic Gaspard (left), aided by his team of international students, was presented with one of the four company challenge trophies at the 2018 Global X-Culture Conference and Symposium held in Italy.

PhD grad: COVID-19 spread resembles prior dengue pandemics

The daughter of a Grenadian, Karin Schiøler, PhD ’06, frequented the Spice Isle as a child, visiting her Grandfather and family in La Digue, St. Andrew’s. Yet there was a period of 18 years where her life and studies brought her elsewhere. She didn’t return until the early 2000s when, while living in Martinique, she first realized that a curious mosquito-borne disease was posing a serious public health threat to the Caribbean and other tropical regions.

Dr. Schiøler seized the opportunity to undertake a research project on dengue in Grenada and simultaneously earned her PhD from St. George’s University, the second such degree to be awarded by SGU’s School of Graduate Studies. She has gone on to study mosquito-borne diseases primarily in Sub-Saharan Africa, and is currently an associate professor in the Global Health section at the University of Copenhagen in Denmark.

SGU News reached out to Dr. Schiøler to learn more about the research she has done, specifically on dengue, and how it applies to the current healthcare situation surrounding coronavirus (COVID-19).

St. George’s University: According to the CDC, up to 400 million people worldwide get infected with dengue each year. Why is the disease such a challenge to control?

Dr. Schiøler: The disease is difficult to control because it is transmitted by a mosquito that is extremely well adapted to the domestic environment of most tropical areas. In other words, it lives in and around our houses. We provide the water containers for its larvae and the blood for its egg production—a rather smart setup, at least for the mosquito. Eliminating the mosquito in an environmentally safe way has proven very difficult. At the same time, vaccine development has taken decades, and although a dengue vaccine was recently marketed in some countries, its wider use is limited as it is deemed safe only for those who have already had dengue at least once.

SGU: What parallels can you draw between dengue and what’s taking place with COVID-19?

Dr. Schiøler: Dengue epidemics are acute in the sense that they erupt more or less unexpectedly, rage through the population and then disappear again after weeks or months. The real problem is not as much the experience of the disease, but when all of a sudden a large proportion of the society has it and are home sick or hospitalized, then you have to worry not just for the individual but for society at large in terms of social and economic consequences. What we are currently experiencing with COVID-19 at a global level, many countries have experienced previously due to dengue. That is a healthcare system under siege and the disease taking hold of the entire society, often triggering a health emergency or even a state of emergency declaration.

About a third of those who are infected by dengue virus experience symptoms, and a fraction of those people die from dengue. In between, dengue may cause a range of different symptoms and severities, just like COVID-19. So another parallel that can be drawn is that of human behavior—risk understanding and risk perceptions. How do people perceive COVID-19 and the risk of infection, and how does that affect their behavior? How much can you control this behavior if people don’t feel at risk? In a way, I think COVID was due to happen one way or the other. It’s a large-scale version of what we see with national or regional epidemics, like dengue, where efforts to control the disease by targeting the mosquito often falls short as risk perception is relatively low among homeowners compared to the efforts required to keep the mosquito out of our houses and lives.

“What we are currently experiencing with COVID-19 at a global level, many countries have experienced previously due to dengue.”

 

SGU: How have you addressed the persistence and spread of dengue?

Dr. Schiøler: My colleagues and I focus on understanding the dengue mosquito and its habitat, from the household to a wider community level including institutions and specific commercial settings. I believe that this understanding remains the key to dengue control. One of the projects that I’m directly involved with in Zanzibar, Tanzania, is an effort to integrate dengue control into primary school curriculum so that children can learn and execute mosquito control adapted to the realities of their household and wider community. It’s a mixed-methods study where we aim to determine how the children perceive dengue and other mosquito-borne diseases, what they can and can’t do as children in terms of control activities, and what’s actually accepted in that particular society. In another study, also on Zanzibar, we are working in collaboration with the tourism sector to replace the heavy reliance on chemical insecticides with environmentally sustainable mosquito control measures at hotels.

SGU: How would you describe your experience studying dengue in the Caribbean?

Dr. Schiøler: My thesis focused around understanding who the main risk groups are when an arbovirus like dengue is transmitted in the population. I studied how it spread and how a local active surveillance system worked to address it. In collaboration with both public and private health care providers, I actively went out and pursued cases and set up a system with rapid diagnostic turnover and response to the health authorities.  The aim was to predict outbreaks by picking up on the early cases, and then activate vector control and public dissemination before epidemic onset. My study showed that, after diagnosing the index case, there was a seven to eight week lull before a full-blown epidemic. We learned how to react to the risk of a new virus and how it is likely to spread through a small-island population. This experience was groundbreaking for me in that it gave me the first experience of working across disciplines and with different institutions and actors from the nurses and doctors forming the frontline of Grenada’s health care system and officials at the Grenada Ministry of Health to researchers at the CDC in Puerto Rico, who helped me set up advanced diagnostic techniques in Grenada.

SGU: What led you down the path to becoming an infectious disease researcher?

Dr. Schiøler: For me, research has always been about curiosity. Why is dengue even a public health problem? Why has nobody solved this problem already? Of course, the reason is that dengue is a complex disease—it’s not that easy to solve. You may get a few answers to the problem, but that will create new questions, and you keep seeking new answers for these questions. It’s perhaps frustrating at times, yet very rewarding. I started out fairly narrowly in terms of an immunological interest in dengue symptoms, but that interest lead me in into new directions, where today my primary focus is more on the entomological aspects of disease transmission and the inclusion of the community and other stakeholders in finding sustainable solutions to mosquito control. It’s the prospect of change that makes it exciting, and the realization that there isn’t necessarily a simple biomedical answer to diseases such as dengue. One can argue the same in the case of COVID-19.

– Brett Mauser

 

SGU graduate Karin Schiøler, PhD, with Dean of Graduate Studies Dr. Calum Macpherson.

Showcasing SGU Doctors: University’s New Marketing Campaign Features Real-Life Graduate Success Stories to Prospective Students

For more than four decades, St. George’s University continues to educate highly qualified physicians who are helping to alleviate the physician shortage in the US and around the world.

Recently, 13 School of Medicine graduates including emergency medicine doctors, anesthesiologists, vascular surgeons, cardiologists, pediatricians, and others, participated in a two-day photo and video shoot in New York City that will allow SGU to showcase alumni success in its upcoming digital marketing campaign. Candidates were asked to share their career paths and SGU experiences in video.

“SGU-educated physicians are well positioned to make a positive influence on the global healthcare system—particularly during the COVID pandemic,” said Nadav Levinton, who led this marketing initiative for St. George’s University. “There is no better way to celebrate our impressive graduates than by stepping up to tell their stories in the same way they would: without hesitation, with a primary concern for the well-being of others, and with well-planned teamwork.”

Robert Alig, vice president of alumni affairs for SGU, said: “We thank all of the alumni who participated in the photoshoots. With busy schedules both personally and professionally, we greatly appreciate their time and candor. Hearing about the wonderful work they’ve done, and the paths taken to get where they are in their careers, is truly inspiring. We know these testimonials will inspire those individuals who are eyeing a career in medicine themselves.”

SGU is cognizant of the precarious and difficult situations that healthcare workers everywhere are facing as a result of COVID. As a result, the University took strong precautions to keep both the subjects and the crew safe while completing the photo/video shoot. Such precautions before, during, and after the photoshoots included:

  • Each subject and crew member was required to have a negative COVID test result prior to filming.
  • The production crew was kept to a minimum to lower the number of people interacting with each other. All were required to wear masks, sterile suits, hair nets, and booties provided by the clinic where filming commenced. Crew members were provided eye protection as well.
  • The medical clinic received a special cleaning the night before and again after SGU completed the filming.
  • SGU had a COVID compliance coordinator on site taking temperatures and asking questions before anyone entered the location.
  • Subjects were required to wear N95 masks for the majority of the time on location. Photographers only shot a few takes with masks off.

 

Using the tagline “Are You In?” the images and interviews will be on display starting in mid-December through various digital ads as well as on SGU’s website and social media pages. SGU News will highlight the final assets in the December issue of the SOM alumni newsletter.

SGU is hoping to schedule additional photo shoots in the US and Canada in 2021. Details will be forthcoming on how alumni can participate. In the meantime, visit SGU’s Alumni Association website to learn other ways that SGU graduates are invited to get involved.

 

–  Laurie Chartorynsky

 

 

Working in underserved communities “resonates with the soul”

Jeremiah Madedor, MD ’20

From up close, and from a young age, Jeremiah Madedor, MD ’20, has gained intimate knowledge of the disadvantages that stem from a lack of healthcare access. His mother, who immigrated to the United States from Nigeria, pushed him to volunteer at the local veterans affairs hospital and homeless shelter, and he also went on mission trips with the family’s church. Then as a medical student at St. George’s University, he got hands-on experience working with the homeless population in New York City, as well as those who struggled to make ends meet.

“Those things really resonate with the soul and need to be addressed,” said Dr. Madedor. “I feel that, as a physician, I can do that.”

Now a first-year internal medicine resident at Spectrum Health in Grand Rapids, MI, Dr. Madedor sat down with SGU News to discuss ongoing healthcare issues in underserved communities, as well as his experience entering medicine in an especially challenging time.

St. George’s University: What are the most significant problems facing healthcare in underserved communities?

Dr. Jeremiah Madedor: Means and access. Patients usually fall into those two categories. In terms of means, we’re talking about money, resources, insurance, and connections to get to a primary care provider or the medical help you need. For financial reasons, a lot of patients don’t see physicians. An emergency department visit can cost thousands of dollars even without surgery, and with surgery, you can be looking six or seven figures for the cost.

Access is just as bad as means, because people may have the money or insurance, but if they don’t have the time to go for care, then nothing will be done. Several patients I see in the clinic skip appointments because they don’t have a babysitter or they work long workdays, and the list could go on.

SGU: What was it like entering medicine in the thick of a coronavirus pandemic? How would you describe the hospital and the community in Grand Rapids?

Dr. Madedor: My hospital has been preparing for COVID spikes since March, and has handled it as well as you can. Residents are educated on cases with didactics, and MICU/pulmonary attendings have been instrumental in learning managements of COVID. During my clinic, I have been tasked with seeing COVID patients with virtual visits, and while on the intensive care unit I have been seeing patients firsthand and managing them with the guidance of pulmonary attendings. It’s definitely been a life-changing experience seeing the complications firsthand of this new disease.

SGU: How has the recent social justice movement energized or changed you personally and/or professionally?

Dr. Madedor: I don’t believe it has energized or changed me personally because I have always fought for those disenfranchised or less fortunate. As an African American, I live this fight every day, so with my patients, I can empathize with them. I relate to them on a personal and ethnic level. A lot of people say ‘hi’ to me on the hospital floors or in the clinic and are happy to have their skin color represented by the physician they see.

“SGU took a student who was a potential diamond in the mine and refined him.”

 

SGU: Is there a case or experience that you can point to that brought your career path into focus?

Dr. Madedor: When I worked at Brooklyn Hospital as a medical student, there are incidents I can always lean on that fueled my fire. Working with Dr. Mansur and Dr. Bakshi is something I will always cherish. They taught me not see a patient as a pit stop but, as a physician, you become their conduit who will guide them to their next destination. So with that in mind, I did my best to learn their cases better and do thorough chart reviews so I could prevent potential oversights. Then in the rooms, I treated them like human beings, because patients are more than stats, and sometimes we forget that with a busy schedule.

SGU: How would you describe your experience at SGU, and how has it prepared you for your career?

Dr. Madedor: SGU was one of the most challenging and exhausting journeys of my life. I wouldn’t change that for the world because it prepared for me the roadblocks ahead. Now, as I sit here in the ICU, we had two patients code, two admissions, and I had to follow up on multiple patients throughout the night. Without the tools and guidance I received at SGU, I don’t think I would be capable of this feat. SGU took a student who was a potential diamond in the mine and refined him. Now he is a resident living out his dreams amongst the elite in his craft. From the days of eight- to 10-hour study dates, student support sessions, and rounding as a medical student, SGU provided the necessary environment for me to grow. With great resources, teaching, and great hospitals to rotate at, my experience couldn’t have been any better.

– Brett Mauser

On Match Day 2020, Dr. Madedor shared the news that he was headed to Grand Rapids, MI, for an internal medicine residency with Spectrum Health.

The Surprising Impact of COVID on Small Animal Veterinarians

Dr. Heather Douglas, DVM ’06

It’s not just human healthcare that has been dramatically impacted as a result of the COVID pandemic—animal medicine had its own challenges and some surprising opportunities for small animal veterinarians.

Dr. Heather Douglas, DVM ’06, owns and operates Douglas Animal Hospital in Osseo, MN. Douglas Animal Hospital treats a wide variety of animals from cats and dogs to geckos, snakes, potbellied pigs, and hamsters. She is also heavily involved in community services—both in the states as well as Grenada. Dr. Douglas founded the non-profit veterinary service, GrenVet, which provides free care to animals in Grenada.

Last month, Dr. Douglas presented a continuing education webinar to SVM alumni titled, “The Surprising Impact of the Pandemic on Veterinary Care.” She recently spoke with SGU News to explain how COVID is changing the way that veterinarians treat patients and interact with pet owners.

St. George’s University: What are the top concerns of pet owners about their pets in this environment?

Dr. Douglas: There has been an increase in cases of pets with behavioral changes which is most likely a result of the increased amount of time the owner is spending at home. This can escalate when owners return to work and patients have decreased contact time with them.

SGU: How have you had to adapt your clinical skills during the pandemic to care for your patients?

Dr. Douglas: I’ve had to become more efficient and spend more time communicating with owners. With new owners, it is harder to establish trust, so we gained their trust during what were essentially “curbside services,” by talking to clients on the phone when they can physically see you or performing physical exams in exam rooms with windows so clients can observe and support their pet.

SGU: Has the pandemic presented opportunity to small animal veterinarians? In what way?

Dr. Douglas: Yes, in the most surprising way. Initially, businesses like my own were slow when lockdowns were in place. We, along with other veterinary practices across the US affected by the downturn, received funding via the Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL) to help keep us going. Then in mid- to late-April the floodgates opened. Some veterinary practices became so busy they were put in a tough position of choosing not to accept new clients or referrals. This influx was due to clients waiting to bring their pets in during lockdown, clients paying more attention to their pets while at home for extended periods so that illnesses were being detected much sooner, and people adopting new pets to decrease loneliness and feelings of isolation at home.

“I’ve had to become more efficient and spend more time communicating with owners.”

 

SGU: What are some additional ways the pandemic has affected veterinarians?

Dr. Douglas: Veterinarians are working longer hours to be there for our patients. But we’ve learned to value our emotional well-being and spend more time caring for our mental and physical health. Many veterinarians are hiring more staff to handle the increased number of patients, which is an unusual response considering the national unemployment rate.

SGU: How have technology and mobile care played an increased role in vet care, especially as a result of the pandemic?

Dr. Douglas: Telemedicine has been a valuable piece of technology to allow us to see our patients without a physical point of contact. This is especially important for those clients who are at higher risk of COVID-19 and complications.

SGU: What lessons can vet students take away from the global epidemic and how it affects them as future veterinarians?

Dr. Douglas: Vet students should learn to be adaptable. Going forward, there will be more opportunities in the veterinary field with increased hiring rates as well as opportunities in public health. Students will also have the upper hand compared to older veterinarians when it comes to technology and innovation.

– Laurie Chartorynsky

SGU grad takes to skies to save lives in Florida

It was the fall of 2012 when Larissa Dudley, MD ’13, then an SGU medical student on an emergency medicine/EMS clinical rotation at Newark Beth Israel Medical Center, accompanied helicopter crew on an airlift. It not only left an impression; it changed the course of her life.

“I happened to fly very shortly after Hurricane Sandy, and I was amazed by not only the view but by the amazing responsibility that these flight nurses and medics had,” she said. “Those in the aircraft risk their health and wellbeing to be available 24/7 to triage, stabilize, and safely deliver the most critical patients to their destinations, whether it be an emergency department, trauma center, or to the catheterization lab or operating room for definitive care.”

Dr. Dudley, now an emergency medicine physician in Florida, also serves as the assistant medical director of Health First’s First Flight, a helicopter program that makes approximately 700 flights per year covering the state’s Space Coast. First Flight is called for pre-hospital transports, often for severely injured trauma patients where the crew performs life-saving procedures and stabilization, as well as inter-facility transports. Dr. Dudley’s leadership role means that she is teaching and reviewing cases and best practices, updating and adjusting protocols, and maintaining relationships with local cities and towns to help coordinate seamless care.

“My heart is in EMS—all facets of EMS,” Dr. Dudley said. “As a physician, the oversight is nothing short of imperative, and the responsibility to maintain the crew’s education, clinical competencies, and best practices is humbling.”

– Brett Mauser

Simulation labs critical to emergency room efficiency

Traci Thoureen, MD ’98, in the Duke University Hospital Emergency Department. Photos courtesy Shawn Rocco/Duke Health

Before emergency medicine physicians face the myriad of cases that may come through the door on any given day, they will have practiced—over and over—the techniques and procedures needed to provide quality care with great efficiency. Some of the training occurs in a simulation lab, where practice can save critical minutes and even seconds when they’re needed most.

SGU News caught up with Traci Thoureen, MD ’98, the director of simulation and associate professor in the Division of Emergency Medicine at Duke University Medical Center in North Carolina, to learn more about the role that simulation plays at Duke, and how it was especially important at the onset of the COVID-19 pandemic.

St. George’s University: What is simulation and how important has it become in the training of emergency medicine residents?

Dr. Traci Thoureen: Simulation is one technique that we use in educating our medical school students and residents, as well as to provide context for attending physicians. It’s become paramount to add this live training to our department—such as procedural training, seeing rare cases, and also for team training and leadership. The sim lab allows us to have a safe learning environment that is incredible for practice and evaluation.

SGU: In addition to practical training, what intangible skills can be taught in the simulation lab?

Dr. Thoureen: In the emergency department, most of our day is spent working as a team—with nursing, techs, consultant residents, and/or attendings. We work in teams certainly for our trauma activations, as well as our sick medical patients and resuscitations. This is a skill starting from the first year that our residents are learning, and simulation allows them to practice their roles and the techniques that work well in those roles. Communication is a skill that we don’t often get to take a look at and with simulated scenarios, we really slice and dice it out to improve it.

“Simulation is one of the few ways that we can teach in a safe way yet get a visceral reaction.”

 

SGU: How and why did simulation become your career path, and what do you enjoy most about it?

Dr. Thoureen: I’ve been doing academic emergency medicine since I finished residency, and I’ve been lucky enough to have great mentors. I was able to learn from some of the best in simulation at Harvard’s Center for Medical Simulation in 2004 and that started my interest and passion for it. I really enjoy being creative in developing new cases and thinking about all the ways to make it more real. Simulation is one of the few ways that we can teach in a safe way yet get a visceral reaction. Also, I really enjoy trying out other educational technologies and seeing how they could fit into curriculum.

SGU: In what ways did simulation scenarios assist with addressing the COVID-19 pandemic?

Dr. Thoureen: We were able to set up a simulated airway area within our emergency department. We first got the attending staff onboarded with the equipment that we were going to be using for addressing intubations with COVID patients. Because of the success and safety we had with that, we extended that to our second- and third-year residents. We were able to see the ins and outs of the equipment on a manikin before having to use it on an actual patient.

SGU: How did the department adjust for online education in the early stages of the pandemic?

Dr. Thoureen: I teach a course to our first-year medical students, “Body and Disease.” It covers pathophysiology, immunology, and pharmacology, and we do four cases over three months. With COVID, I had to rethink and rework how to do simulation patient activity without a simulator. It was an abrupt change, but we were able to creatively mirror the experience virtually. Through Laerdal, one of the main manufacturers of human patient high-fidelity simulators, we could pipe in software and display a patient monitor that could show the effect of vital sign changes, and incorporate other aspects of the case with other instructors who would represent the patient, a nurse, or a family member. In our residency, we transitioned to Zoom conference. It became a wonderful way to incorporate national speakers and alumni to our education, as well as to do creative activities like using Zoom breakout rooms for gamification activities.

SGU: You co-authored the book Emergency Medicine Simulation Workbook: A Tool for Bringing the Curriculum to Life. The second edition comes out next year. What can readers expect to see in the book?

Dr. Thoureen: One of the frustrations that people have with new technology is that they feel like they don’t even know where to start. This is meant to be a catch-all book for novices and seasoned educators alike when it comes to simulation, specifically EM simulation. It can appeal to not only physician groups but nursing groups, RTs, and EMS. It’s broken down from nuts and bolts, to educational objectives, to all the things that you need to run a case. There’s also an online component, with images and labs for each case so that you have everything you need to run a case or a whole EM simulation curriculum.

SGU: How would you describe your St. George’s University experience?

Dr. Thoureen: I have really fond memories of my time at St. George’s. I made great friendships and bonds, and I felt like it was the time where I got to really try my best and move everything forward in my career. Medical school was a period where there were a lot of transitions, but they have served me well in my residency training and going forth in my now 18 years in practice in academic medicine. It’s been really fun for me to read about the expansion of education at SGU and to see SGU residents along the way join academic medicine and emergency medicine.

– Brett Mauser

What Is Multisystem Inflammatory Syndrome in Children (MIS-C)? Q&A with SGU Grads Featured in New England Journal of Medicine Article (UPDATED)

This article has been updated from its original publication date of September 29, 2020, to name additional SGU graduates who contributed to the New England Journal of Medicine article.

As the novel coronavirus (COVID-19) continues to affect persons young and old, and increasingly in children, the New England Journal of Medicine recently published an article titled “Multisystem Inflammatory Syndrome in U.S. Children and Adolescents.”

Among the nearly 50 contributing physicians, five were St. George’s University graduates:

  • Steven Horwitz, MD ’08, a lead author on the paper who is a pediatric critical care specialist and assistant professor of pediatrics at Rutgers University School of Medicine;
  • Michael Keenaghan, MD ’06, the associate chief academic officer at New York City Health+Hospitals/Kings County;
  • Hussam Alharash, MD ’11, a pediatric intensivist and informatics liaison at New York City Health+Hospitals/Kings County;
  • Shira Gertz, MD ’01, FAAP, an attending physician in pediatric critical care at Saint Barnabas Medical Center in Livingston, NJ, and clinical associate professor in the Department of Pediatrics at Rutgers New Jersey Medical School; and
  • Stacy Ramsingh, MD ’15, a third-year pediatric ICU fellow at Advocate Children’s Hospital in Park Ridge, IL.

 

SGU spoke with three of the SGU-educated doctors to get their take on the article’s findings, and why the research was an important contribution to the expansion of medical knowledge of COVID-19.

St. George’s University: As COVID continues to affect adults and children, what is MIS-C and why is it an important disease to understand?

Drs. Horwitz, Keenaghan, and Alharash: Multisystem inflammatory syndrome in children (MIS-C) is a newly identified inflammatory syndrome affecting children, that is associated with SARS-CoV-2019 infection. The pathophysiology is not clear at this point, and there is much we do not yet know about the long-term prognosis. Some of the children who present with this syndrome are very sick and require ICU-level care, while others have very mild symptoms.

There are several reasons why it is important to understand this disease: Because MIS-C in some ways mimics the presentation of Kawasaki disease, pediatricians are concerned that some of the same sequelae and complications of Kawasaki may develop in children who are diagnosed with MIS-C. We know that some of the children who present with MIS-C are very sick, and since it is unlikely that COVID-19 will disappear in the immediate future, there is a lot of interest in better understanding it and its long-term complications.

SGU: What was the research intending to prove?

Drs. Horwitz, Keenaghan, and Alharash: The study we were involved in aimed to describe the presentation and inpatient course of MIS-C. By looking at a series of patients and characterizing some of the disease’s features, the paper should give clinicians who have not yet seen patients of MIS-C an idea of what to look for and what to expect. It will also help to characterize and pin down the definition of the syndrome, which will help in ongoing research that looks at MISC.

SGU: What were the key findings? Why were the results significant?

Drs. Horwitz, Keenaghan, and Alharash: The study confirmed what many of us suspected. MIS-C was causing cardiovascular symptoms, gastrointestinal symptoms, hematologic abnormalities, and was associated with markedly elevated signs of inflammation.

It also reassured us in some ways because it demonstrated that while a good number of the patients with MIS-C required cardiovascular support in the form of vasopressors and in a few rare occasions extracorporeal membrane oxygenation (ECMO), the vast majority of these kids got better and went home.

SGU: What exactly was your part in the research efforts?

Drs. Horwitz, Keenaghan, and Alharash: As the pandemic took hold in the United States, the Northeast and New York City, in particular, were the epicenter of the new cases of COVID and eventually of MIS-C cases as well. Our contribution to this project was to review the patients at our hospitals who presented with features of what would eventually come to be called MIS-C and prepare detailed case reports about the presentation and hospital course for each of the patients. This data was later included in the multicenter analysis that resulted in the publication in the New England Journal of Medicine.

SGU: What practical advice would you give to medical students who want to get research published?

Drs. Horwitz, Keenaghan, and Alharash: Be curious and follow through. There is much we do not know in medicine—being curious will make it more likely that you will become familiar with the questions that are waiting to be answered. Of course, coming up with the question is just the start. Research can be a very long and drawn-out process with many setbacks. Perseverance and follow-through in the face of adversity will be required to keep going.

 

— Laurie Chartorynsky

VIDEO: From MMA to MD

Dr. Anthony McDonald, a 2013 graduate of St. George’s University School of Medicine, turned in his mixed martial arts championship belt to pursue his dream of becoming a physician. He is now the director of cardiopulmonary medicine at San Angelo Community Medical Center in San Angelo, TX.

“What I used to do with fighting and training, it really ingrained in me the discipline that I needed and the structure that I needed to know what I needed to do to be successful,” Dr. McDonald said. “The contrast is very different, but I feel that the idea is still the same. It’s about not giving up. Medical school is challenging. There’s no two ways about it. And I was very fortunate to be able to do it at St. George’s University, where I felt that the entire island was set up to make you succeed.”

World Alzheimer’s Month brings focus to mysterious disease

Michael Reinhardt, MD ’09

World Alzheimer’s Month, launched in 2012 by nonprofit organization Alzheimer’s Disease International, cast a light on the growing and persistent issue surrounding a condition that affects more than five million Americans, with one in three seniors passing away with the disease’s pathology in his or her brain.

Michael Reinhardt, MD ’09, the associate director of the Center of Excellence for Alzheimer’s Disease at SUNY Downstate Health Sciences University and director of its geriatric psychiatry fellowship program, explained what makes the disease so mysterious and so challenging, and the steps that doctors are taking to treat patients suffering from the affliction. 

St. George’s University: What is Alzheimer’s disease, and what causes it?

Michael Reinhardt: Alzheimer’s disease is the most common form of dementia, making up 60 to 80 percent of all cases. It is neurogenerative, meaning it causes a decline in brain cell health and function, and eventually it results in brain cell death. We haven’t put our finger on exactly what causes Alzheimer’s disease yet, but the most common explanation is that it’s a buildup of what’s called amyloid plaque in the brain. Once you’ve triggered enough amyloid buildup in the brain, there’s this irreversible cascade that happens that leads to progressive decline in brain cell function and healthy brain cells.

SGU: How prevalent is Alzheimer’s in the US? Is the situation getting better or worse?

MR: Unfortunately, it’s getting worse. Between 2000 and 2018, there’s been about an 8 percent decrease in cardiovascular-related deaths, but there’s been a 146 percent increase in Alzheimer’s-related deaths. In 2020, the projection is that Alzheimer’s-related care will cost around $305 billion. By 2050, the costs are going to be around $1 trillion annually. (can we link to a study or report?)

“We’re looking to 2021 as a possible timeframe in which medication may become available and provide us hope of not only slowing down the illness, but stopping it in its tracks.”

 

SGU: A recent study by University of California, Berkeley suggests that Alzheimer’s may be a byproduct of poor sleep habits. Have you seen such links between sleep and the disease?

MR: This is absolutely in the literature and it’s been a growing area of study over the last several years. We ourselves aren’t doing research on the link between sleep disorders and Alzheimer’s disease, but we do see it clinically. Our patients with more disrupted sleep cycles tend to have a more rapidly progressive course of illness. Knowing what we know about basic physiology, neurophysiology, and the growing knowledge base surrounding the actual functions of sleep and allowing the brain to recuperate—to clear its waste products on a nightly basis—it makes only good sense that if your sleep cycle is disrupted, you’re not going to have that rhythmic cleaning of your central nervous system that’s required for optimal brain health.

SGU: What treatments are used for patients who suffer from Alzheimer’s?

MR: The current treatments comes with limits. We have a couple of approved classes of medication that modestly slow the progress of the illness while you’re taking them, and perhaps have some benefits to the behavioral problems that come with Alzheimer’s disease and related dementias. But they’re not disease-modifying treatments. We’re very hopeful about some compounds that are going through clinical trials. We’re looking to 2021 as a possible timeframe in which that medication may become available and provide us hope of not only slowing down the illness, but stopping it in its tracks.

SGU: At the Center of Excellence for Alzheimer’s Disease, what goals are you aiming for with your patients?

MR: Some of the other treatments that many times prove more meaningful and more useful involve connecting families to the support services and social services they need to maintain their loved one in the home and really improve their outcomes through social connectedness and meaningful preventive programming. Music programming, art therapy, all of the different multimodal social therapies that don’t involve medications, are of utmost importance, both to patients and their caregivers.

– Brett Mauser