School of Medicine

Wayne State University School of Medicine
Spring concert set for April 24 in Margherio Conference Center
In Headlines on April 17, 2013
The sounds of spring will ring out on the School of Medicine campus next week when the UltraSounds and Music in Medicine perform as part of the “Arts in the Atrium” program.

The performance, titled “A Cappella Through the Ages,” will take place April 24 from noon to 1 p.m. in the Margherio Family Conference Center.

The Ultra Sounds is an a capella group of medical students who perform in school functions, hospitals and nursing homes. Members of the student organization Music in Medicine volunteer at hospitals, playing instruments or singing to provide music in lobbies. Volunteers perform solo or as part of an ensemble.

The Shiffman Medical library and the School of Medicine sponsor the “Arts in the Atrium” program for the enjoyment of students, staff, faculty and the community. The series of programs is designed to highlight the artistic talents of students, staff and faculty of both the library and the School of Medicine with seasonal performances scheduled at lunch time in the atrium of the Mazurek Medical Education Commons.
Dr. Omar Khan appointed chair of Department of Neurology
In Headlines on April 17, 2013
Omar Khan, M.D.

Omar Khan, M.D.

Omar Khan, M.D., Wayne State University School of Medicine professor of Neurology, has been appointed chair of the Department of Neurology.

Valerie M. Parisi, M.D., M.P.H., M.B.A., announced the appointment April 17. Dr. Khan’s appointment is effective April 22.

“His devotion to education and the clinical treatment of patients, combined with his passion for collaborative research, make Dr. Khan the ideal person to lead the department into its next chapter,” Dean Parisi said. “A widely published and internationally respected neurologist and clinical researcher, Dr. Khan is the ideal leader to maintain the high quality research and sought-after patient care for which the department has become known.”

Dr. Khan, a resident of West Bloomfield, Mich., has served as interim chair of the department for the last year while the school conducted an extensive national search and interviewed candidates.

“I am honored and humbled by the opportunity to lead a prestigious department nationally known for its excellence in teaching, clinical care and research,” said Dr. Khan, the director of the Wayne State University Multiple Sclerosis Center and the Sastry Foundation Advanced Imaging Laboratory. “I am looking forward to working with my colleagues and leading the department.”

Dr. Khan, who joined the Department of Neurology in 1998, also serves as neurologist-in-chief for the Detroit Medical Center and associate chief medical officer for the Wayne State University Physician Group.

He received his medical degree in 1987 from the Allama Iqbal Medical College, University of the Punjab in Lahore, Pakistan. Following initial residency training in Pakistan, he performed an internship in Internal Medicine at the Jewish Hospital of Cincinnati from 1990 to 1991. He then completed a Neurology residency at the Medical College of Virginia and dual fellowships in Neuroimmunology and Neuroimaging at the University of Maryland and the Veterans Affairs Medical Center in Baltimore, Md. He served on the University of Maryland Department of Neurology faculty from 1996 to 1998, before joining Wayne State University in 1998.

Since joining WSU, Dr. Khan has secured more than $10 million in research funding. He has served as principal investigator in more than 60 studies and is the principal investigator in more than 15 clinical trials, investigator-initiated and National Institute of Neurological Disorders and Stroke-funded studies. He directs the Wayne State University Multiple Sclerosis Center, one of the top five MS centers in the country, with a patient population exceeding 4,500. He is internationally recognized in the field of therapeutic development, genotype-phenotype MR mapping in multiple sclerosis. Dr. Khan has established the largest African-American Multiple Sclerosis Clinic in the United States and is the founding member of the African-American Initiative in Multiple Sclerosis, a Detroit community-based endeavor. His MRI Analysis Laboratory, supported by a generous gift from the Sastry Foundation, focuses on developing biomarkers and investigations into mechanisms of tissue injury and repair in neurodegenerative disorders, including Parkinson’s disease, amyotrophic lateral sclerosis, Alzheimer’s disease and multiple sclerosis.

“We will be undertaking several initiatives exploring new partnerships as well strengthening existing ones,” Dr. Khan said of his immediate plans. “On the clinical side, our hospital partners provide several opportunities to collaborate and create services that benefit teaching, clinical care and even research. Research is critical to the success of teaching and clinical missions of the department, the school and the university. While federal funding of research remains challenging, amidst these challenges also lay opportunities. Collaborative and translational studies in neurosciences will continue to be favorably viewed as evident from President Obama’s recent neurosciences-related initiative. In this context, we will soon start active discussions to undertake such collaborative projects.”

He said he also looks forward to recruiting “top-notch faculty with a view to carry our mission in the years to come.” He also wants to expand residency and fellowship programs. “Last, but certainly not least, will be our renewed effort on philanthropy, which will be critical to the research undertakings in the department, both in clinical and basic sciences,” he said.

Dr. Khan serves on the Translational Research Committee of the National Multiple Sclerosis Society and is a member of the society’s National Medical Advisory Board. He is one of the few neurologists in the United States serving on the prestigious European Charcot Foundation for Multiple Sclerosis Research. He also has served on study sections of the National Institutes of Health, the Department of Defense, the Canadian Institute of Health Research and the Multiple Sclerosis Society of Canada. He has served on the U.S. Food and Drug Administration CNS & PNS Advisory Committee. He is a member of the American Academy of Neurology, International Society of Magnetic Resonance in Medicine, the International Genetic Consortium in Multiple Sclerosis, and is a fellow of the American Neurological Association.
WSU study examines relationship between 1991 Gulf War exposure, birth outcomes
In Headlines on April 16, 2013
Bengt Arnetz, M.D., Ph.D.

Bengt Arnetz, M.D., Ph.D.

Hikmet Jamil, M.D. Ph.D.

Hikmet Jamil, M.D. Ph.D.

Robert Sokol, M.D.

Robert Sokol, M.D.

Data collected and analyzed at the Wayne State University School of Medicine in Detroit has resulted in what could be the first published work to examine the relationship between wartime environmental exposures and birth outcomes for children of men and women living in Iraq before and after the 1991 Gulf War.

“The key finding is that exposures to that war seem to be associated with an increase in adverse pregnancy outcomes,” said reproductive health expert Robert Sokol, M.D., the WSU distinguished professor of Obstetrics and Gynecology and the John M. Malone Jr., M.D., Endowed chair and director of the C.S. Mott Center for Human Growth and Development in Detroit.

The study also revealed a dose-response relationship between war-related environmental exposures and total number of adverse birth outcomes, especially for certain chemical exposures, and suggests primary care doctors in particular consider reproductive risks in pregnant mothers with a history of exposure to war.

“There’s very little data like this in the whole world. Most of the work involves veterans, not civilian populations,” Dr. Sokol added.

Adverse birth outcomes were defined as congenital anomalies, stillbirth, low birth weight and preterm delivery.

The study stresses the need to design better studies of reproductive health risks from war and conflicts, including those that consider the interaction between chemical and psychosocial stressors.

“You’ll collect, hopefully, better data the next time,” Dr. Sokol said. “It will be very helpful to know these kinds of things.”

Using data from interviews with 307 Iraqi families who immigrated to the United States, the WSU team compared mothers giving birth in Iraq before and after being exposed to the Gulf War, to those giving birth in the U.S. before or after the first Gulf War.

“1991 Gulf War Exposures and Adverse Birth Outcomes” is published in the April-June issue of the United States Army Medical Department Journal. While previous studies about the 1991 Gulf War implied potential exposure to psychological trauma and environmental stressors such as smoke from oil-burning fires, diesel or gas fumes and skin contact, burning trash, burning feces, nerve gas, mustard gas, contaminated water, depleted uranium and pesticides on clothing or bedding, little was known about how the war might affect an unborn child.

“There is generally a lack of good studies of the reproductive hazards of war in which there are both data on exposures as well as outcomes,” said Bengt Arnetz, M.D., Ph.D., WSU professor of Family Medicine and Public Health Sciences and the study’s principal investigator.

After adjusting for other risk factors, psychosocial stress/trauma did not relate significantly to adverse birth outcomes, Dr. Arnetz said.

Co-author Hikmet Jamil, M.D., Ph.D., WSU professor of Occupational and Environmental Health, lived in Iraq from 1991 to 1997, and in 1998 began voluntarily collecting the self-reported data from Iraqi immigrants living in Michigan. The Detroit area’s Iraqi population is estimated at more than 46,000, per the U.S. Census, making it the largest concentration in the country.

“In the literature review, we don’t see, until now, such type of impact of the environment on health,” Dr. Jamil said.

“We were surprised to see the high levels of adverse birth outcomes following the Gulf War. However, there are independent and smaller local studies in Iraq, and a few from Kuwait, suggesting adverse effects on the fetus from the war,” Dr. Arnetz said.

The study does not lend support to the popular, but so far unproved notion, that psychosocial stress per se induces adverse birth outcomes, he added.

Study participants lived both in and away from the war zone, and were also asked about socioeconomics and lifestyle. “We found that the mean number of adverse birth outcome per women increased from a pre-Gulf War prevalence of 3.43 to 4.63 in those that had experienced the Gulf War. There were no differences before the Gulf War in adverse birth outcome whether the birth had occurred in Iraq or the United States. This supports the notion that something associated with the Gulf War contributed to the findings,” Dr. Arnetz said.

The mean stress exposure increased by 2,300 percent from before to after the Gulf War, on the study scale. The mean environmental exposure increased by 1,900 percent.

“It might be that there are residual effects from the Gulf War exposures that affect reproductive health many years later. A weakness in our study is that we do not know the timing of birth, only whether they gave birth before or after the 1991 Gulf War,” Dr. Arnetz said. “We also need to develop better exposure measures of civilians’ exposures during war and conflict and how it might affect reproductive health.”

Study co-authors include statistician Michael Kruger and School of Medicine graduate Alexis Drutchas, M.D., Class of 2012.

Drs. Arnetz and Jamil’s work was funded by R01MH085793 from the National Institute of Mental Health, National Institutes of Health. The study was also funded by an unrestricted grant from Pfizer Inc.

Resident contributes skills to medical mission trip to Dominican Republic
In Headlines on April 16, 2013
Pierre Rojas, D.O.

Pierre Rojas, D.O.

Drs. Claudia and Pierre Rojas are flanked by two other members of the recent medical mission trip.

Drs. Claudia and Pierre Rojas are flanked by two other members of the recent medical mission trip.

The Wayne State University School of Medicine and its Department of Physical Medicine and Rehabilitation - Oakwood are known for physicians who excel in bringing health and healing to patients. The residency program staff includes the example of one such generous physician, found in the gifts and skills of Pierre Rojas, D.O., a first-year resident who spent his winter break with his wife, Claudia Rojas, an Obstetrics and Gynecology resident, on a volunteer medical mission trip to San Pedro de Macoris, Dominican Republic.

Dr. Rojas joined a team of 15 health care provides based in of Toledo, Ohio, who packed medical supplies and pharmaceuticals, and then traveled to the Caribbean nation to provide vital medical care to those in need.

The physicians who volunteer their skills began conducting mission trips to Latin America in 1979. Based out of the Mercy Health Care system in Toledo, Ohio, the Midwest Regional Mission Team spends a week each winter in Santo Domingo providing the poor with surgical and medical treatments not readily available in the region. The team included a gynecologist, a general surgeon, an anesthesiologist, an obstetrics and gynecology resident, a nurse anesthetist, a student nurse anesthetist, a physician assistant, two scrub nurses, two recovery nurses, three circulators, a Spanish-expert volunteer and Dr. Rojas.

The Midwest Regional Mission Team traveled to the Dominican Republic the week of Feb. 15- 23, and performed 40 surgeries, mostly hysterectomies, cystectomies, cholecystectomies and hernia repairs. Patients were triaged for their medical procedures when the mission physician group arrived at the state hospital, Dr. Antonio Musa Regional Hospital, a 150-bed hospital with four operating rooms.

Members of the team who travel on medical missions enhance their clinical skills in ways they do not often get to experience in the United States. One of those is the art of communication in the doctor-patient relationship. Being a first-generation Colombian-American, Dr. Rojas’ first language was Spanish, so he was a valuable asset in communicating with patients during the trip.

Dr. Rojas said he learned significantly from his patients while in the Dominican Republic. “I had been there twice before, I knew the country pretty well and I identified a lot with the people,” he said. “My family had to go through a similar life before coming to the States.”

When asked why he used his vacation time on a volunteer medical mission trip, Dr. Rojas said, “I wanted to give back to a population and culture that means so much to me and that I love. It was like being home away from home.”

Dr. Rojas recommends that every resident have the opportunity during clinical training to join a medical mission trip. The mission allowed him to experience a broader world in the field of medicine, which he described as, “You step back and see how other people live, how health care is different in other countries. It makes you a better person, a better physician. It helps you not take things for granted.”

Dr. Rojas’ reflection upon his experience included a deeper appreciation for the medical resources available in the U.S. “As physicians and patients, we have all of this technology, labs, imaging and medicine,” he said. “Not everyone in the world has that luxury. You become better clinically. You think about the patient more because the care is simplified.”

Dr. Rojas described the difference in medical care as “more human” because of the limited medical resources available. This nurtures another level of human interaction with the patient. The communication between doctor and patient is more intimate.

“For the most part, patients in Latin America are incredibly grateful and appreciative of the care they are being provided,” he said. “They may view you as an extension of their family and may express their appreciation with hugs, homemade food or blessings, for example. And while they may not have much, the efforts are genuine.”

Dr. Rojas is considering another trip -- this time in the field of physiatry -- after he hones and perfects a new skill set as a Physical Medicine and Rehabilitation resident. He has his heart set on making a return to another country he knows well, Costa Rica, and offering services to a pediatric orphanage.
Discovery could improve life for congestive heart failure patients
In Headlines on April 12, 2013
Donal O'Leary, Ph.D.

Donal O'Leary, Ph.D.

New research from a study on chronic heart failure has the potential to dramatically improve quality of life for congestive heart failure patients fatigued by daily activities such as walking across a room.

Donal O’Leary, Ph.D., Wayne State University School of Medicine professor and director of Cardiovascular Research in the Department of Physiology, is the senior author of a paper that provides insight on how ventricular function could be improved during exercise by relieving vasoconstriction, the narrowing of blood vessels due to exaggerated sympathetic activity to the coronary arteries.

 “When we can relieve the vasoconstriction, we see a marked increase in the function of the heart. This could be used as a treatment for heart failure patients, especially if the blockage of nerves can be directed to the heart itself,” Dr. O’Leary said. “If we could get a significant improvement, going out and gardening could be possible. You could improve their heart function to where that doesn’t totally tire them out.”

“Muscle Metaboreflex-Induced Coronary Vasoconstriction Limits Ventricular Congratility During Dynamic Exercise in Heart Failure” is the featured article in the American Journal of Physiology: Heart and Circulatory Physiology’s April 1 edition. Associate Editor Fabio Recchia interviewed Dr. O’Leary for the journal’s accompanying podcast.

“I was really honored,” said Dr. O’Leary, a member of WSU’s Cardiovascular Research Institute. “There is usually only one article selected each month. This is the third we’ve had selected.”

Vasoconstriction occurs because of excessive activation of sympathetic nerves to the heart itself, he said, citing the spike in deaths during snow shoveling after a heavy snow fall as one example of the condition.

The latest publication from his group represents the culmination of more than 20 years of work, bringing together ventricular function and coronary blood flow control in one experiment. “It’s a great big project that we’re getting better and better at refining how we’re going to investigate these phenomena,” he said.

While previous studies showed that systemic therapies with nerve blockers could improve ventricular function during exercise, there are side effects, he said. “We need to find a way to directly target to the coronary vascular. With nanobiotechnology, we can absolutely see this within the clinical lives of our current students and residents,” he said.

He expects the answer is in a specialized delivery process.

The research and results, collected over two years served as the doctoral dissertation for WSU graduate Matt Coutsos, Ph.D., and is the second paper to be published from his work. The initial paper looked at the same phenomena in normal, healthy subjects, and another section of the study focuses on those with hypertension.

Dr. O’Leary is the principal investigator of the National Institutes of Health’s award R01HL055473-16, a $1.56 million four-year competing grant used to fund the ongoing study “Blood Pressure Control During Exercise in Heart Failure.”

“These experiments require a team. They’re highly complex. It has been through the great fortune I have had of having outstanding postdoctorates, students and technicians, that we’ve been able to do this work,” Dr. O’Leary said. “Each study builds on the next.”

The grant, in its 15th year, was renewed earlier this month by the National Heart, Lung and Blood Institute.

WSU computer science students' open source software benefits School of Medicine mission trips
In Headlines on April 11, 2013
A volunteer uses the EasyEMR software in Haiti.

A volunteer uses the EasyEMR software in Haiti.

A screenshot of EasyEMR shows the software's pharmacy component.

A screenshot of EasyEMR shows the software's pharmacy component.

The work of Wayne State University College of Engineering students is having an impact on underserved patients being cared for by WSU School of Medicine students thousands of miles from Detroit.

On a December 2012 trip to Haiti, the School of Medicine’s World Health Student Organization was the first group to test the EasyEMR program, an open source electronic medical record software designed as a class project by a group of Computer Science seniors.

School of Medicine student Erik Brown and recent WSU Biology graduate Sarah Draugelis initiated the creation of EasyEMR after experiencing the challenges of pop-up clinics set up on mission trips by organizations like WHSO. Both have volunteered on medical mission trips, including those organized by the WHSO and Africans in Medicine, another School of Medicine student organization.

“What we lacked is the ability to easily record, retain and access any data about the people we see when we visit these places,” said Brown, a sixth-year M.D./Ph.D. student completing his dissertation in Translational Neuroscience before beginning his third year of medical school in July. “Currently, we often use paper forms that help us on the day of the clinic but, at the end of the day they get discarded because we often have no effective method to organize them. If we could do this electronically, organization would be massively simplified.”

 “The two things that our patient population really needs are preventative care and continuity between visits, both of which are pretty much nonexistent,” Draugelis said. “We see close to 1,000 patients in under a week. Often, the people on the medical team are working together for the first time, which can be a hurdle in itself. The EMR system needs to be as error free as possible to keep the clinic running smoothly.”

The initial software was designed by students in a Fall 2012 senior project and computer ethics course taught by WSU College of Engineering Associate Professor of Computer Science Andrian Marcus, Ph.D. Additional testing and debugging will continue each class semester to improve essential functionality.

“My goal is to expose students to an environment where they can learn by doing, rather than by listening,” Dr. Marcus said. “In addition to the learning outcomes, and equally important, I want the students to work on real projects that are useful to organizations and companies from the Detroit area and beyond. It is one way for us to give back to the community.”

Building the software was a challenge, and came with plenty of specs from the medical students who would use it. It had to be easy and fast to use. Only the bare essentials were needed: vitals; history of present illness; a brief medical, social and family history; and past and present medication. Everything needed to be on one easy-to-use screen with as few clicks as possible. The system also needed to fit into the chaotic flow of the transient medical clinics, where hundreds of patients line up, often early in the morning.

Brown and Draugelis initially sought donations for existing EMR software more than a year ago, but “quickly realized that this system didn't exist and needed to be built from the ground up,” Brown said.

For December’s pilot trip to Haiti, the computer science students who designed the software were available nearly 24/7 for virtual troubleshooting. They included WSU Computer Science senior Tom Hickman, the student team representative, who remotely signed in to make modifications on the fly.

"Our first impression of this project was very bittersweet,” Hickman said. “On the face of it, it appeared to be a set of very daunting requirements, but would give us the ability and experience of helping real people with the potential of saving lives. It seemed like a lot of pressure as well as being a great opportunity.”

The biggest challenge, he said, was deploying the software to computers with poor system configurations and old hardware. The new class goal is to restructure the system to a central database on a server, so all computers remain in sync from the creation of each patient record, update of patient information and update of user information, Hickman said.

“We were very impressed with the students' ability to take on a very difficult project with limited resources,” Brown said. “They were a force. Indeed, in the final week, the night before the medical students were to leave for Haiti, we discovered that only one of the eight (donated) computers was working. Several of the (computer) students worked very late into the night and got three more computers up and running just in time to make the flight.  The medical team left with four laptops running the software.”

Their hard work was appreciated, said Samantha Bruni, a second-year medical student and the Haiti trip’s lead organizer. “I think that having the ability to look back on the patient population that we saw and being able to evaluate the prescriptions that we filled is invaluable for WHSO. Bringing EMR on a trip is a huge step toward the future of WHSO providing more sustainable medical care,” Bruni said. “On future trips, the patients will receive better care, as we have records of their previous treatments and past medical history. Also, the EMR can be used for research purposes, as we have the ability to analyze our past care, which can enable us to provide better care on future trips.”

The system served its initial purpose: collecting basic medical data on patients in Haiti that can be later retrieved and utilized to improve continuity of care between the transient clinics, Brown said.

“I appreciate everyone who thought it was a cool idea and wanted to try it,” Brown said.

He hopes to secure new laptops, netbooks or tablets with longer-lasting batteries, a must because electrical outlets aren’t always available in the remote clinics. “Clearly, this costs money. We are looking into grants and searching for donors to help fund the purchase of the necessary hardware,” Brown said. “As long as it has a web browser, it will work.”

If interested in supporting the project, contact Brown at ecbrown@med.wayne.edu.

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