Internal Medicine - Pediatrics
My clinical practice at the Linwood Avenue Internal Medicine-Pediatrics office provides healthcare services to an underserved area of Buffalo. I provide primary care for both adult and pediatric patients with a wide variety of medical issues. In addition, I provide specialized care for patients with chronic pain issues through osteopathic manipulation including Cranial Osteopathy. Lastly, I provide specialized and primary care services for adult patients with Sickle Cell disease. As the Director of the Adult Sickle Cell Transitional Care program, I have a formalized transitional program with providers in the Sickle Cell & Hemoglobinopathy Center of Western New York at Women and Children’s Hospital of Buffalo. Directing such a program not only educates the faculty, staff, and residents in the Linwood Avenue clinic and Internal Medicine and Pediatrics residency, but also all healthcare providers around the Buffalo area who care for these patients. This program leads to better patient-centered care for those suffering with Sickle Cell disease throughout Western New York. Currently, my research is focused on a quality improvement project: Increasing Cancer Screening through Academic Detailing and Practice Facilitation. The grant is funded through Health Research, Inc. and the New York State Department of Health. The primary focus of the project is to determine if educational and quality improvement support provided will improve screening rates among primary care practices. In cooperation with other project leaders and sites around the state, the Linwood Avenue primary care office is using these resources to improve screening rates for breast, cervical, and colorectal cancer among our patients As a teacher, I supervise Med-Peds residents at the Linwood Avenue office, as well as Internal Medicine residents on the inpatient service at Buffalo General Medical Center four weeks per year. I also teach pediatric residents when I am on call for pediatric patients and Newborn Nursery, which occurs on a rotating basis throughout the year. Both my weeks on service and on call also include the teaching of University at Buffalo medical students. In addition, I help run the osteopathic medical student elective during which we are able to introduce students outside of UB to our Internal Medicine and Pediatrics residency program. Lastly, I give a number of lectures each year at the monthly Med-Peds conferences as well as educate residents and students across specialties about Sickle Cell Disease and the standards of care for patients of all ages and in a variety of settings. As an Associate Program Director for the Combined Internal Medicine-Pediatrics Residency Program, I ensure that the goals and objectives of the program continue to match the goals and philosophies of both osteopathic and allopathic medicine. Furthermore, I focus on maintaining a core principle of Osteopathy, that being the care of the whole patient. As a group, we feel education is a core principle in our role as UB professors. As our program continues to increase the number of Med-Peds medical providers and educate an increasing number of medical students, was are able to aide in the care of the growing transitional patient population in the US.
Autoimmunity; Immunology; Neurobiology
My research is aimed at understanding the roles of the innate and adaptive immune systems in health and disease. The organs of my interest are the two specialized filtration units, glomeruli and blood-brain barrier, of the kidney and brain respectively. Recently, our understanding of the immune system has undergone a substantial paradigm shift: researchers now recognize that the innate immune system, the body’s first line of defense, assesses the level of danger of a particular event and initiates an adaptive immune response that subsequently confers protection. My studies focus on the role of an important arm of the innate immune system, the complement cascade in inflammatory conditions such as glomerulonephritis and lupus. For both disease conditions, the perfect therapy remains an enigma. Using a gamut of techniques, we are attempting to define the molecular mechanisms involved and the resulting behavioral aberrations. Once molecular targets are identified, therapeutic strategies will be defined. I teach in UB’s Discovery Seminar Program, which is geared for first- and second-year undergraduates. The seminars are taught in a small-class environment to students who share common goals and similar interests, in ways that enhance their academic, civic and personal growth. I teach “The Yin-Yang of Biology” and “Brain: Day and Night,” and I teach as well in UB’s Honors College. I also mentor students through the CLIMB-PRO program. One of my recent students conducted research that resulted in a publication in the journal Kidney International.
Internal Medicine; Infectious Disease
I am an attending physician on the Infectious Diseases service at Roswell Park Cancer Institute (RPCI). My clinical duties include inpatient and outpatient consultations at RPCI and on-call duties at Buffalo General Medical Center. In addition to providing clinical care, I teach medical students, residents and fellows in daily rounds and through formal didactic lectures. My primary research interest focuses on the epidemiology, pathogenesis, prevention and treatment of opportunistic infections in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation. In addition, I study the epidemiology, pathogenesis and transmission of colonization and infection by vancomycin resistant Enterococcus in patients with hematologic malignancies. My long-term goal is to define strategies to prevent transmission, determine virulence and decrease the mortality associated with these infections. Finally, I participate as a site principal investigator in several multicenter clinical trials.
Rheumatology; Immunology; Autoimmunity
My research revolves around IL-14 and its role in immunological memory. Studies delve into 3 areas - vaccination, autoimmunity and lymphoid malignancies. The majority of my current work involves studies examining early events in Sjogren‘s syndrome. We have identified new autoantibodies that occur early in the course of the disease. We are examining mediators involved in the early injury to the salivary and lacrimal glands. We are studying events that result in the transition from the autoimmune disease to lymphoma.
My main research interests are in the areas of health economics and strategies to improve clinical reasoning skills among medical trainees. I am designing a study comparing strategies that improve cost consciousness among medical residents. I am also partnering with the School Management in using Information Technology to improve the ‘test ordering’ behavior by residents in the ambulatory care clinic. My other interests include techniques to improve clinical reasoning among students and residents.
Children and Adults; Internal Medicine - Pediatrics
Born and raised in Western New York, I graduated from UB medical school and trained in the Combined Internal Medicine-Pediatrics Residency Program at University at Buffalo. I have now been a faculty member for two decades, working in primary care of both adults and children at the Elmwood Health Center. I became the Program Director for the Med-Peds Residency in 2006 and the Division Chief for Med-Peds in 2008. At my primary care clinical practice at the Elmwood Health Center, I care for patients in an underserved community of Buffalo with a variety of backgrounds and socioeconomic statuses. The center specializes in caring for individuals with developmental disabilities and I see many patients with complex social and medical issues. I have an interest in transitional health care for pediatric patients with chronic diseases, whom this practice allows me to continue caring for into adulthood. My research focus recently has been on Med-Peds medical education. I worked with other Med-Peds program directors across the country to research the support provided to Med-Peds programs since being recognized as separate categorical residencies by the ACGME in 2006. I also supervise and mentor Med-Peds residents on their individual research projects. In addition, I earned my Masters of Epidemiology in 2005 with a thesis on the knowledge, attitudes, and beliefs about influenza vaccine administration. Much of my role as a faculty member and program director is focused on teaching and medical education is of particular interest to me. I supervise Med-Peds residents at both the Elmwood Health Center and the Linwood Med-Peds site. I teach Medicine and Pediatric residents and medical students on the inpatient wards at Buffalo General Medical Center and Women and Children’s Hospital of Buffalo while on service several weeks throughout the year. I lecture several times a year at the monthly Med-Peds conferences and have given evidence-based medicine lectures to pediatric residents in the past. In the larger Department of the Medicine, I lead the Internal Medicine Teaching Interest Group which focuses on faculty development of teaching skills. I also recently formed the Transitional Care Interest Group in cooperation with both adult and pediatric physicians throughout Jacobs School of Medicine and Biomedical Sciences. Together, we work to improve transitional care for patients in Western New York through development of clinical protocols, research, education, and administrative support.
Internal Medicine; Nephrology
I am the acting chief of nephrology services at the Buffalo VA Medical Center (VAMC). My clinical work includes caring for both inpatients and outpatients diagnosed with a variety of kidney diseases. I have expertise in caring for patients with chronic kidney disease (CKD) and acute kidney injury. I also direct dialysis services at the VAMC. In this role, I care for dialysis patients and oversee quality improvement activities to ensure the best possible care for our VAMC dialysis patients. I have a broad background in nephrology and specific training and expertise in key research areas such as CKD and acute kidney injury. My main research interest is to determine reversible factors to prevent acute kidney injury. I am also studying preventable causes of CKD and have expanded my research to include the care of elderly patients who have been diagnosed with CKD. I am committed to education, and I teach medical students, residents and fellows, primarily at the VAMC. I am one of the key faculty in the “renal module” for first-year medical students: I give four lectures and participate in six small-group sessions each year. During my inpatient consult service, I teach residents and fellows.
Internal Medicine; Pediatrics; Internal Medicine - General; Internal Medicine - Pediatrics
Francis W Peabody said: “… the secret of the care of the patient is in caring for the patient” I am a primary care physician to adults and children, forging long-term relationships with my patients and their families, as their doctor from birth to death. I am board-certified in internal medicine and pediatrics. My mission in medicine is four-fold: to provide empathetic and expert patient care, to teach and train the next generation of physicians, research and global health. I practice in UBMD’s Division of Internal Medicine at Conventus-- part of the Buffalo Niagara medical campus. I therefore offer easy access primary care to all staff and students in the medical campus, and their families. I have a Ph.D. in biochemistry and worked for a decade as a scientist and professor. I therefore have an interest in genetic and metabolic disorders. I led adult cystic fibrosis care for five years at the Marshfield Clinic in Wisconsin. I continue to provide care to patients with these congenital diseases. I have a decade of experience in training different learners in the outpatient setting, on international medical mission trips and in the hospital. My research is on bacteriophages -- their role in the microbiome of the respiratory tract and in genomic predictors of pathogenicity in bacteria. I also do research on problems I have seen in my patient population – suicidal ideation and risk in high school students and obesity in children. I believe a good history and physical exam can reduce needless testing in the search for a diagnosis. My skills have been honed by practice in Africa and Latin America. I was a short-term Ebola Clinician in Sierra Leone during the 2014-2015 outbreak and remain committed to delivering healthcare internationally. I offer primary care support to specialty services and welcome learners and collaborators in our mission to provide excellent healthcare to populations locally and globally.
I am a UB faculty member and one of the few advanced endoscopists in the Buffalo-Niagara region. I serve as the chief of endoscopy and director of advanced endoscopic services at Roswell Park Cancer Institute. My clinical interests are in the field of endoscopic oncology, and the medical conditions I treat include cancers and polyps of the gastrointestinal tract, Barrett’s esophagus, bile duct strictures and pancreatic cysts. I perform endoscopic procedures that diagnose, stage, treat and palliate malignant and pre-malignant conditions of the gastrointestinal tract such as endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, cholangioscopy, endoscopic mucosal resection, enteral stenting, ablation of Barrett’s esophagus and double-balloon enteroscopy. I am widely regarded throughout the Western New York physician community for my excellence in patient care, especially as it relates to advanced endoscopic procedures. I teach and train gastroenterology fellows and supervise fellows and residents in clinical research. My research interests include the optimal management of submucosal masses of the gastrointestinal tract and the effectiveness of enteral stents for malignant bowel obstruction. I am also interested in health services research as it relates to providing patients with advanced endoscopic procedures, and I am investigating the effect of an interventional endoscopist on surgical volumes. My team is also analyzing the effectiveness of combined endoscopic ultrasound with fine needle aspiration and endoscopic retrograde cholangiopancreatography (ERCP) vs. ERCP alone as an initial step in diagnosing patients with pancreatic cancer and symptoms related to the biliary tract. I have also contributed instructional videos on gastric hyperplastic polyps and pancreatic lymphoepithelial cysts to the Digital Atlas of Video Education (the DAVE Project) so that professionals in the field have access to information on optimally managing these disorders. One of my roles is to help develop the Buffalo Niagara Medical Campus (BNMC) as a destination for patients needing complex, high-end endoscopic procedures not currently offered in this region. Toward that goal, I seek to expand training opportunities for fellows in advanced endoscopic procedures at the BNMC.
Internal Medicine; Internal Medicine - General
I provide outpatient primary care service at Erie County Medical Center. I treat patients with multiple chronic medical problems such as diabetes, hypertension, obesity and high cholesterol, providing proactive, preventative and compassionate care for these complex cases. My practice emphasizes coordinating care across interdisciplinary teams and helping patients make therapeutic lifestyle changes through diet, exercise and weight loss. I take great pleasure in working with diverse, underserved patients, including patients with mental illnesses, helping them understand their disease, overcome barriers to treatment and address the causes of noncompliance. As a medical director of the Internal Medicine Clinic, I am actively engaged in several ongoing quality improvement projects to improve patient safety and the quality of care we provide. I have led initiatives to design and optimize clinical workflows and to implement Allscript Enterprise Electronic Health Records (EHR) in all outpatient clinics at ECMC, building a framework to provide consistent care throughout our health care system. Through benchmarking evidence-based national quality standards and providing physician leadership in using EHR and Patient-Centered Medical Home (PCMH) programs, I hope to lay the groundwork for a twenty-first century health care system. I am passionate about teaching and education. I provide mentoring, teaching and supervision for medical students and the 33 residents at our clinic. Our quality improvements projects have been presented at various national annual conferences, including American College Of Physicians( ACP) and Society of General Internal Medicine. We have published QI projects in BMJ open quality journal. My goal is to create great leaders and excellent physicians for the future.
Cardiology; Cardiovascular Disease; Internal Medicine
As director of the Division of Cardiology at the Buffalo VA Medical Center (Buffalo VAMC), I oversee cardiac care, education and research. My division is one of the most efficient across similar VA facilities: it provides the full spectrum of cardiovascular diagnostic and therapeutic services while maintaining outcomes that meet or exceed all nationally mandated standards. I see outpatients in my own clinic, and I see inpatients as well, including those admitted to the Intensive Care Unit (ICU). My practice focuses on coronary artery disease (CAD), congestive heart failure, atrial fibrillation and valvular abnormalities. I approach my patients by practicing both the art and science of medicine and spend ample time getting to know my patients and the social structures that surround them. I believe that the care of a patient is much more effective when the patient is treated as a person rather than a diagnosis. I truly enjoy my clinical sessions at the Buffalo VAMC where I meet new and returning veterans who share their stories with me. It is a privilege to care for each of these amazing individuals. The abundance of complex cases at the Buffalo VAMC, along with extensive longitudinal electronic health data, allows us to conduct clinical research to improve patient care. We physician-scientists at the Buffalo VAMC are increasing our focus on clinical research to complement the bench research performed at UB. My current research is studying the role of post-traumatic stress disorder (PTSD) in heart disease. While longitudinal studies indicate a role of PTSD on CAD prevalence and outcomes, its causative mechanism has been debated. My colleagues and I are looking at mental stress-induced myocardial ischemia (MSIMI) and how this differs in patients with PTSD. I am passionate about teaching and feel a strong responsibility to mentor the next generation of physicians. I trained as a Royal College of Physicians educator in order to become a better medical educator. To me, mentorship involves more than just teaching the facts of medicine. I emphasize interpersonal and communication skills with the fellows I train, in addition to traditional bedside teaching, because these patient-centered abilities are essential to being a good physician. I also help trainees navigate increasingly complex hospital and health care environments. The knowledge I share with them about the systems that are part of modern health care is also key to providing the best care to patients.
Cardiology; Clinical Cardiac Electrophysiology
I am a clinical cardiac electrophysiologist and my focus and passion are in evaluating and managing cardiac arrhythmias and their associated symptoms such as palpitations and syncope. I treat patients with bradycardia, heart block, supraventricular tachycardia (SVT) including atrial tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT), atrial fibrillation (AF) and ventricular tachycardia. My main clinical responsibilities include diagnostic and therapeutic procedures for arrhythmias such as electrophysiologic studies and ablation of arrhythmias such as atrial flutter, AF, SVT and ventricular tachycardia. I perform implantation and extraction of cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter defibrillators (ICDs) and biventricular pacemakers and ICDs for the treatment of certain patients with heart failure. I also perform laser lead extraction in patients with malfunctioning or infected pacemaker and ICD leads. I believe in extensive pre- and post-procedural care and provide in-depth consultation and close communication with my patients, referring physicians and staff. I closely monitor my post-implant patients through the use of remote monitoring systems and I am a strong advocate for appropriate reprogramming to accommodate the needs of patients with CIEDs. I evaluate and treat inpatients with cardiovascular disease and other cardiac disorders at Buffalo General Medical Center (BGMC) as part of the Cardiac Critical Care Unit and the cardiology consult service and at the Buffalo VA Medical Center (Buffalo VAMC). I also see outpatients at various sites, including the BGMC Heart and Lung Center, UBMD Internal Medicine Electrophysiology Clinic and the Buffalo VAMC Electrophysiology Clinic. I am involved in the RE-CIRCUIT clinical trial. It evaluates treatment using the drug Pradaxa in patients with paroxysmal or persistent nonvalvular atrial fibrillation (NVAF) who are scheduled to undergo a first ablation procedure. I also have a research interest in using imaging techniques to delineate patients with infection who might require extraction of CIEDs. By the innovative use of PET scan techniques, physicians can differentiate pacemaker lead infection versus fibrosis. The goal of this research is to help physicians decide whether patients really need laser lead extraction or if the procedure could be avoided. I enjoy teaching. I lecture on arrhythmias in various forums, including continuing medical education classes, and to a variety of trainees, including medical students, residents and fellows as well as other health professionals in internal medicine and emergency medicine. I supervise cardiology fellows during their clinics, inpatient consultation and electrophysiology rotations at BGMC and the Buffalo VAMC.
As the new Associate Program Director and Site Director at Buffalo General Hospital, I look forward to strengthening our residency program and enhancing the patient experience. My clinical practice focuses on the comprehensive care of seriously ill, adults admitted to an inpatient, acute care facility. My academic interests include medical resident and student education, with a specific focus on consult medicine, the physical exam, as well as reducing preventable readmissions. I have previously practiced medicine in Rochester, NY and New York City. I am very fortunate to now practice in my hometown. My husband and I have greatly enjoyed all the cultural activities which Buffalo has to offer and look forward to raising a family here.
Immunology; Infectious Disease
My patient care and teaching responsibilities are centered at the Veterans Administration hospital where I care for hospitalized patients and maintain an active outpatient clinic. I enjoy teaching medical students and residents in both lecture and small group settings. In addition, my laboratory is open to interested undergraduate, graduate and medical students and residents seeking to gain a research experience. Research interests of my laboratory focus on two key areas of the function of specialized immune cells called macrophages. Our first area of interest concentrates on the immunologic roles of mammalian macrophage gangliosides. Gangliosides are unique molecules that hold diverse regulatory roles as receptors and as mediators of cell differentiation in cells of most species. Our studies encompass ganglioside regulation of macrophage inflammatory responses, ganglioside-associated alterations of the architecture of macrophage cell membranes in HIV-infected individuals, and the function of macrophage gangliosides as receptors for bacterial pathogens and toxins. This work will lead to a better understanding of mechanisms of macrophage activation, to permit manipulation of host immune responses. Our second area of interest centers on the regulation of inflammatory responses of human alveolar macrophages by respiratory bacterial pathogens and bacterial antigens that contribute to the pathogenesis of chronic obstructive pulmonary disease (COPD). Studies encompass defining the repertoire of inflammatory mediators of human alveolar and blood-derived macrophages regulated by bacterial pathogens and characterizing bacteria-regulated immunologic properties of macrophages, in patients with COPD. These investigations into fundamental mechanisms of dysfunctional immune responses of macrophages underlying the progression of COPD are providing the basis for designing novel and more effective therapies.
Internal Medicine - Pediatrics
I was born and raised in southern Pennsylvania and after attending medical school at Penn State University, I relocated to Buffalo for residency in Combined Internal Medicine and Pediatrics. After graduation, I remained in academics at UB. I have interests in transitional care medicine, particularly in medical management of behavioral issues in patients with developmental disabilities. I also have interests in resident and student education, especially in developing simulation curriculum. Helping to take care of underserved populations is also important to me. I volunteer regularly with the Lighthouse Free Clinic, which is run by UB medical students. Outside of medicine, I enjoy travel, making wine as well as enjoying good wine, and spending time with friends and families.
My goal is to provide high quality clinical care to patients with a broad range of gastroenterological disorders. I have a particular interest in the elderly: I completed a geriatrics fellowship, I have extensive experience treating and managing the care of elderly patients and I am dedicated to providing the best possible care for this growing, often vulnerable segment of our population. I view elderly patients first as individuals, and I work with them in ways that respect their autonomy. I also work with them in the context of their family, assessing the best ways to ensure successful disease and health management. I assess my elderly patients in a holistic way as well, taking into account their overall health status and myriad clinical problems instead of focusing solely on whatever gastroenterological problem they present. I work as a UBMD providing clinical services at the hospitals affiliated with UB’s division of gastroenterology: the Buffalo VA Medical Center, Erie County Medical Center and Buffalo General Medical Center, and Roswell Park Cancer Institute. I perform upper endoscopy including radio frequency ablation, colonoscopy and paracentesis. I have experience in performing endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, endoscopic stent placements and high resolution motility studies along with pH and manometry studies. I am conducting a multi-site research study in collaboration with the VA hospitals in Albany and Syracuse studying the effects of continuing vs. stopping clopidogrel during colonoscopies. This is an especially important study given the large number of patients taking this medication. I teach students, residents and fellows during patient rounds and via lectures to the house staff. My lectures concentrate on a variety of gastrointestinal topics ranging from the management of foreign bodies in the gastrointestinal system to biliary tract diseases and pancreatitis.
Allergy and Immunology
I am specialist in the field of Allergy and Immunology. I provide care at the UBMD office in Amherst, UBMD at Conventus, Buffalo General Medical Center and WNY Veterans Administration Hospital. My clinical interests include allergic rhinitis, allergic conjunctivitis, sinus disease, asthma, chronic cough, drug allergy, food allergy, eosinophilic esophagitis, urticaria (hives), angioedema (swelling), atopic dermatitis, contact dermatitis, stinging insect allergy, anaphylaxis and immune system deficiencies. I have a strong interest in medical education and am the associate program director for the Allergy/Immunology fellowship program.
I chose the field of gastroenterology as my medical subspecialty because of my long-standing interest in cellular absorptive processes and the role of immunity in preventing and causing diseases. I have made the transition from basic scientist to full-time academic physician and find clinical practice in gastroenterology challenging, fast-paced and immensely satisfying. I see patients as a UBMD physician at Erie County Medical Center in both inpatient and outpatient capacities, and I see patients at the UBMD Internal Medicine on Youngs Road in Amherst, NY as well. I manage the care of adult patients of all ages and backgrounds in clinical situations that range from basic gastroenterology and liver disease to specialized hepatobiliary and pancreatic problems. I am comfortable with office-based consultation and all routine endoscopic procedures as well as complicated emergent and advanced endoscopic procedures. One of the most rewarding aspects of my career is the variety of clinical problems I evaluate on a daily basis. I also love the teaching aspect of being an academic physician, and I have been teaching and supervising medical students, residents and fellows for over 25 years. I consider academic physicians to be lifelong learners — i.e., health care practitioners who keep pace with medical advances in order to teach those who follow in our footsteps. Our constant review of the latest medical breakthroughs and the continuous and open exchange of thoughts and ideas we foster with our students allow us to stay up to date on medical knowledge and this, in turn, enhances our ability to deliver the highest quality patient care. I also mentor clinical research projects with medical residents and review manuscripts for publication in the medical literature.
Cardiology; Cardiovascular Disease; Clinical Cardiac Electrophysiology; Internal Medicine
An internationally recognized cardiovascular physician-scientist, Dr. Cain is a specialist in abnormal heart rhythms. He is board-certified in internal medicine, cardiovascular diseases and clinical cardiac electrophysiology and pacing. He is a fellow of the American College of Cardiology, the American Heart Association and the Heart Rhythm Society. A former associate editor of Circulation, Cain is a member of the editorial boards of the American Journal of Cardiology, the Journal of Cardiovascular Electrophysiology, Nature Clinical Practice Cardiovascular Medicine and Heart Rhythm. His NIH-supported research has focused on determining the mechanisms of life-threatening heart rhythm abnormalities that occur in heart attacks and other conditions that damage heart muscle cells. This information is being used to better characterize and more accurately localize the abnormal heart tissue responsible for these abnormal heart rhythms and to improve the identification of patients at increased risk for sudden cardiac death.
Cardiology; Cardiovascular Disease; Apoptosis and cell death; Cardiac pharmacology; Gene therapy; Genomics and proteomics; Molecular Basis of Disease; Stem Cells
As a SUNY Distinguished Professor, I am involved in the clinical, teaching and research programs is the Division of Cardiovascular Medicine at the University at Buffalo. I care for patients at the Gates Vascular Institute (GVI) of Buffalo General Medical Center (BGMC), the Buffalo VA Medical Center (VAMC) and I am a member of the UBMD clinical practice. My clinical areas of expertise are in diagnosing and caring for patients with coronary artery disease and heart failure. My research group conducts bench to bedside translational studies directed at advancing our mechanistic understanding of cardiac pathophysiology as well as developing new diagnostic and therapeutic approaches for the management of patients with chronic ischemic heart disease. Our ongoing areas of preclinical investigation apply proteomic approaches to identify intrinsic adaptive responses of the heart to ischemia and studies examining the ability of intracoronary stem cell therapies to stimulate endogenous cardiomyocyte proliferation and improve heart function. We are particularly interested in understanding how elevations in heart filling pressures and reversible ischemia lead to cardiomyocyte cell death and heart dysfunction. We also conduct basic and patient-oriented research to understand how chronic ischemia modifies the cellular composition and sympathetic innervation of the heart to help develop new approaches to identify patients at risk of sudden cardiac arrest from ventricular fibrillation using positron emission tomography in the UB Center for Biomedical Imaging. Our overall goal is to use advanced cardiac imaging to translate new applications between the bench and bedside in order to identify new imaging biomarkers of pathophysiological processes such as chronic myocardial ischemia and cardiac arrhythmogenesis. In addition to my laboratory investigation, I serve as the deputy director of the UB Clinical and Translational Science Institute (CTSI) and the director of the UB Translational Imaging Center. I am engaged in the cardiology profession at national and international levels, including study sections of the National Heart Lung and Blood Institute, professional guidelines committees and served as former president of the Association of Professors of Cardiology.
Internal Medicine - General
I am working as Women‘s Health Medical director at VA hospital and Associate program director for department of Internal Medicine. I trained and was board certified as a surgeon from New Delhi, India. I then did training and was board certified in obstetrics and gynecology from Royal College of obstetrics and gynecology in London, UK. After working many years as an obstetrician gynecologist in Ireland I came to United States to do residency internal medicine.I did my residency from Buffalo in 1999 and recertified in 2009. I worked for 9 years in Buffalo General Hospital, as an attending in internal medicine with academic medicine. I have been with the hospital for last 4 years working in women‘s health. I am very interested in teaching.
Internal Medicine; Nephrology
I am trained as a general nephrologist and as an epidemiologist. I have interest in kidney stones prevention and in dialysis in general. I did extra training in hemodialysis prior to working as a community nephrologist for 14 years. I have significant experience in caring for dialysis patients including in acute and chronic renal failure and in various settings comprising intensive care unit, emergency department, chronic outpatient and home dialysis (this includes both hemodialysis and peritoneal dialysis). I care for patients in my general nephrology clinics twice a week. In that clinic I see patients with acute kidney injury, chronic kidney disease (hereditary or acquired), complications of chronic kidney disease, hypertension, electrolytes anomalies, glomerulonephritis or kidney stones. I am an attending for the nephrology service provided at Erie County Medical Center and at Roswell Park Comprehensive Cancer Center. I oversee care for chronic outpatient hemodialysis individuals. I also provide care for patients on home hemodialysis and peritoneal dialysis both at Erie County Medical Center and Clevehill Dialysis Unit (DaVita). I am currently the medical director for the home dialysis program at Erie County Medical Center. My research interests are with infection prevention in dialysis patients including vaccination, kidney stone prevention, interventions to delay end stage renal disease in chronic kidney disease population. I am involved with clinical teaching while on inpatients rotation. Teaching is provided to medical students, residents and fellows. I participate also in the renal fellows’ longitudinal clinic.
Internal Medicine; Nephrology; Bioinformatics; Molecular Basis of Disease; Cardiac pharmacology
I have a passion for challenge and an allergy to routine. This has driven my interest for research and clinical medicine, mainly internal medicine. I am currently a nephrologist at UBMD and a Faculty at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. In my clinical practice, I manage all aspects of kidney disease, renal replacement therapies including dialytic therapies and kidney transplant, hypertension, as well as disorders of fluid and electrolytes. With my group, I also provide nephrology consultations at the Roswell Park Cancer Institute. I particularly favor this part of my clinical activity, considering the very specific and challenging nephrological problems arising in cancer patients. I have a passion for education and never say no for opportunities to teach or learn. At the expense of longer days, I always take opportunities to teach fellows, residents and students. I strongly believe in problem-based learning, in the sense that what is learned is best remembered as a solution to a problem. So far, my research has focused on cardiovascular disease, mainly cardiac and vascular mechanics. In this phase of my career in nephrology, I am moving towards issues interfacing the cardiovascular system and the kidneys.
Cardiology; Cardiovascular Disease; Critical Care Medicine; Cardiopulmonary physiology; Cardiac pharmacology
I care for patients with diagnoses across the spectrum of heart disease at the UBMD Internal Medicine practice group in Amherst NY, the Buffalo General Medical Center Heart and Lung Clinic, and the Cardiac Care Unit in the Buffalo General Medical Center (BGMC). My specialty is the diagnosis and treatment of congestive heart failure: I integrate information from multiple cardiac diagnostic studies to coordinate treatment for my patients with interventional cardiologists, heart rhythm specialists and heart surgeons. I am trained as an Advanced Heart Failure specialist and I am experienced in the treatment of patients with cardiac transplants and ventricular assist devices. In the Cardiac Care Unit I oversee patients with acute congestive heart failure, most often after myocardial infarction. In the outpatient clinics I manage medical and device therapy for heart failure and perform cardiopulmonary stress testing to identify patients who need advanced heart failure therapies including left ventricular assist devices or cardiac transplantation. I am involved in multi-center clinical trials in treatment of heart failure. I study the role of hematopoietic system and inflammation in repair of heart attacks and the failing heart via my own independent research, and in collaboration with pharmaceutical firms. I am a peer reviewer for several leading global journals in Cardiology, and review research grant applications for the NIH and American Heart Association. I teach and supervise Internal Medicine residents and Cardiology Fellows in all facets of my clinical practice: during inpatient hospital care in the Cardiac Care Unit, while interpreting cardiac imaging studies, and in my outpatient practice. I also teach and mentor young scientists involved in research.
I provide inpatient infectious disease consultation services at both Erie County Medical Center (ECMC) and Buffalo General Medical Center (BGMC). In addition, I collaborate with the ECMC renal and pancreas transplant team to evaluate and treat infectious complications associated with solid organ transplantation. I feel honored to serve patients who receive a lifesaving organ in order to help live a normal life. Lastly, I see outpatients with various infectious disease problems at the immunodeficiency clinic at ECMC. I enjoy teaching medical students, residents and infectious diseases fellows the principles and practice of infectious diseases. The majority of my teaching is at clinical sites at ECMC and BGMC. However, I also give didactic lectures during specialty conferences and grand rounds. Although the majority of my time is centered on patient care and teaching, I am also involved with clinical research. My role is to identify and recruit patients for a variety of clinical trials designed to assess new modalities for the prevention or treatment of infectious diseases.
As an adult and pediatric physician practicing at both the Buffalo General Medical Center (BGMC) and the John R. Oishei Children's Hospital, I care exclusively for hospitalized adults and children. I oversee every aspect of my patients’ care, from their admission to the hospital to their discharge. My particular expertise is caring for hospitalized adults who have congenital or chronic health conditions that originated in childhood. My research focus is quality improvement. I completed advanced training in the science of improvement and in the care of adults with congenital or complex health care needs who are admitted to pediatric hospitals. I present nationally on these topics. My work includes improving communication between patients and their physicians, knowing that when communication improves, the quality of medical care increases and better patient education takes place. My research interests also involve improving hospital efficiency with an eye toward improved patient care. My overall goal is to identify and help implement the interpersonal and institutional factors that lead to the best possible medical care for hospitalized patients. Teaching and mentoring in the hospital setting is a large part of my day. I am actively involved in resident and medical student education and clinical training, focusing on evidence-based medicine and systems-based practice. I also regularly participate in morning report and case-based teaching, lecturing at both internal medicine conferences and the monthly conferences of the Division of Medicine-Pediatrics. I work at BGMC on the teaching services, supervising residents and medical students; I also supervise trainees at the John R. Oishei Children's Hospital.
Cardiology; Cardiovascular Disease; Interventional Cardiology
I am an interventional and clinical cardiologist at the Buffalo VA Medical Center (Buffalo VAMC) after having been in private practice for over 25 years. The focus of my practice is the cardiac catheterization laboratory, though I also see outpatients in the cardiology clinic and perform inpatient clinical consultations in the hospital. I care for individuals with a spectrum of cardiovascular disease, including patients with stable coronary disease, acute coronary syndromes, valvular diseases and cardiomyopathies. I participated as a site investigator in over 100 multicenter clinical research trials. My particular research interests are in studies of lipid management and preventive cardiology, intravascular ultrasound and plaque regression, critical care pathway development and application and outcomes research in the treatment of acute coronary syndromes. My current research involvement includes studies on lipid therapy, novel congestive heart pharmacologic therapy and atrial fibrillation in cancer patients. I am also involved in a supportive role with a study of antibiotic therapy and the management of peripheral arterial disease. I enjoy teaching and have taught throughout my private practice career and continue at the VA. I teach cardiology fellows in the cardiac catheterization laboratory and in the cardiology clinic during initial cardiology consultations and follow-up outpatient care. I also teach fellows, medical residents and medical students during consultative rounds in the hospital.
Infectious Disease; Infectious Disease; Microbial Pathogenesis; Vitamins and Trace Nutrient
I care for patients who are hospitalized at Erie County Medical Center where I also serve as the hospital epidemiologist addressing infection control. I teach medical students, residents, and fellows in both hospital and classroom settings. In UB’s schools of medicine and dentistry, I teach a variety of topics including microbiology, pharmacology and toxicology, oral biology, and gastrointestinal systems, host defenses, and global health. I also conduct laboratory research on diarrhea-producing strains of E. coli bacteria. My lab focuses on enteropathogenic Escherichia coli (EPEC), Shiga-toxigenic E. coli (STEC, aka EHEC) and enterotoxigenic E. coli (ETEC). We are working on the role of intestinal host defenses such as nitric oxide and on the immune modulatory effects of adenosine. We have discovered that zinc can directly inhibit the virulence of pathogenic bacteria, and we are working on turning these laboratory findings into treatments. In our work on zinc we collaborate with Michael Duffey, PhD, in the Department of Physiology and Biophysics. Recently we have discovered that zinc can inhibit the development of resistance to antibiotics in Escherichia coli and other bacteria. Zinc does this by its ability to inhibit the SOS response, a bacterial stress response triggered by damage to the bacterial DNA. We are collaborating with Dr. Mark Sutton of Biochemistry to better determine the mechanism of zinc in this regard. I am interested in international medicine and global health and participate in an annual medical mission trip to Honduras, a trip in which student volunteers are encouraged to participate. Closer to home, I am a volunteer physician at Good Neighbors Health Center, a free clinic for the underserved on Jefferson Avenue in Buffalo. Resident physicians are encouraged to volunteer, and students may also be able to arrange clinical experiences. I am Co-Medical Director, with Dr. Ryosuke Osawa, of the Erie County TB Clinic. Learning experiences in my laboratory, in infection prevention and hospital epidemiology, or in international health, may be available for motivated students, residents, and fellows.
Cardiology; Clinical Cardiac Electrophysiology
As a clinician actively involved in patient care, I see patients in my office at 1020 Youngs Road, suite 110 in suburban Amherst, as well as in the Conventus Medical Office Building on the downtown Buffalo Niagara Medical Campus. My specialty is clinical cardiac electrophysiology, which is the field of cardiology that deals with arrhythmias and implantable devices, such as pacemakers and defibrillators. We have assembled a team of cardiac electrophysiologists who work closely together, so that patients who are evaluated for cardiac arrhythmias in our practice have access to state-of-the-art procedures such as catheter ablation and implantable cardiac electrical devices. I was personally involved in the development of national guidelines for patient care in the treatment of atrial fibrillation from 2004 to 2011, and I am on the writing committee for the upcoming national guideline on ventricular arrhythmias and sudden cardiac death. As the chair of the Department of Medicine at the University at Buffalo, I am involved in the education of residents and fellows as well as clinical research, in addition to my administrative responsibilities. My research focus is electrophysiology and pacing, including implantable device therapy and clinical trials in atrial fibrillation. I am the principal investigator on a study of heart failure patients with atrioventricular block entitled the Block HF Trial, the results of which have recently been published in the New England Journal of Medicine. I have been involved in clinical trials for over 25 years which have led to close to 300 publications. I am a member of a number of prominent professional organizations, and I am the current President of the Association of University Cardiologists. On a national level, I have held numerous national leadership roles, including serving as president of the Heart Rhythm Society. I have also chaired the American College of Cardiology’s Clinical Electrophysiology Committee and the Food and Drug Administration’s Circulatory System Devices Panel. I currently serve as an associate editor of one of the key journals in the field of cardiology, the Journal of the American College of Cardiology.
Endocrinology, Diabetes and Metabolism
Vascular cell reactivity encompassing platelet function, endothelial function, monocyte/macrophage function and the interactions between them (adhesion molecules viz lCAM, VCAM, P-selectin, L-selectin, E-selectin, etc.). Reactive Oxygen Species (ROS) in diabetes, atherosclerosis, hypertension, aging, infection, etc. and a consequential damage to lipids, proteins and DNA. Regulation of aromatase, the effect of estrogen on estrogen receptor, androgen receptor and glucocortico receptor (elucidationi of pre- and post-receptor mechanisms in menopause, etc.). Venous reactivity with measurements of venous diameter and flow velocity and the effect of various drugs in NIDDM, IDDM, and IGT. Genetic regulation of aromatase and estrogen receptor. The role of nitric oxide in vascular reactivity, vis-a-vis various complications of diabetes and other factors involved with vascular reactivity. Effects of endotoxin on adhesion molecules, PAF, platelets, ROS and procalcitonin.
Internal Medicine; Public Health and General Preventive Medicine
I am a primary care physician specialized in both internal medicine and preventive medicine. As a member of the UBMD Internal Medicine primary care team, I see patients at the Hertel-Elmwood Internal Medicine Center. My clinical work focuses on providing high value care for patients with acute and complex chronic conditions, including diabetes, heart failure, asthma, chronic obstructive pulmonary disease (COPD) and hypertension. I have worked as a physician in both Peru and the United States, and my ability to speak English and Spanish fluently—in addition to my multicultural background--allows me to relate to, and care effectively for a broad patient population. My ability to reach across cultural divides helps build trust in my patients, an essential component in rendering individualized, compassionate care. I have a special interest in translating evidence-based innovations, using quality improvement tools, to enhance the care of patients with multiple chronic diseases. I am interested in research that strives to understand the social determinants of health, i.e., how socioeconomic circumstances, neighborhood environments and psychosocial factors affect the prevention and treatment of chronic conditions. I am specifically interested in how social determinants affect the treatment of patients with Type 2 diabetes. My goal in this research is to understand the multiple factors affecting health and wellness in order to help ameliorate the disparities found in the health care of vulnerable populations. I train medical students and residents as they rotate in the Hertel-Elmwood Internal Medicine Center. I emphasize to trainees that building a healing longitudinal relationship with patients is as important as mastering the science of medicine in delivering effective and compassionate patient care. Furthermore, I encourage trainees to look not only “downstream” for the causes of diseases but “upstream” as well in order to offer holistic approaches for the prevention and treatment of diseases that affect our Buffalo and Western New York community.
Internal Medicine - Pediatrics
As a physician trained in Internal Medicine-Pediatrics, I treat both children and adults. I am also fortunate enough to be able to see patients in the both the hospital and clinic setting at Buffalo General Hospital, Women’s and Children’s Hospital, and the Elmwood Health Center, respectively. As a Clinical Assistant Professor, I work directly with residents and medical students in teaching and clinical education. Although I am not originally from Buffalo, having trained here for four years, I have grown to love the city and the people who call it home. I look forward to continuing to develop my clinic practice and treating adult and pediatric patients who are in need of hospital-based care for years to come.
As an Infectious Disease specialist, I see and evaluate adult patients as part of the Infectious Disease inpatient consultation service at both Buffalo General Medical Center (BGMC) and Erie County Medical Center (ECMC). I enjoy teaching medical students, residents and fellows the principles of Infectious Disease at both ECMC and BGMC. The practice of infectious disease crosses a large variety of specialties from Surgery to Internal Medicine and I believe exposure to this field in training is very important. I appreciate the interdisciplinary aspect of Infectious Diseases and its intersection with global health, microbiology, and epidemiology. The face of the infectious processes seen in Buffalo will continue to change due to the effects of globalization and climate change and I find this especially fascinating.
Pulmonary & Critical Care Medicine; Sleep Medicine
I hold clinical appointment at the VA WNY Healthcare System. Aside of my administrative duties, I attend and supervise the sleep clinic at the VA My research focuses on the association between sleep apnea and cardiovascular diseases. My laboratory examines the burden of oxidative stress on endothelial function and the link to endothelial apoptosis. As part of a VA merit review grant, we are engaged in determining the impact of obstructive sleep apnea on the manifestations of post-traumatic stress disorder (PTSD) in veterans and whether treatment of sleep apnea alleviates the debilitating symptoms of PTSD. Toward that goal, we have adopted a patented screening tool to identify patients with sleep apnea. My research in the critical care arena involves the epidemiology and risk factors of Pseudomonas infections with the type III secretory system. The goal is to develop a rapid diagnostic tool to identify these organisms early in the course of infection. My other projects include studying the role of adjuvant treatment with corticosteroids in the management of severe community acquired pneumonia, such as nursing home acquired pneumonia, the management of morbidly obese critically ill patients and the long-term outcomes of elderly patients after treatment from a critical care ailment.
Cardiology; Cardiovascular Disease; Regulation of metabolism
My clinical activities as a noninvasive cardiologist primarily take place at the Buffalo VA Medical Center (VAMC). My responsibilities include attending on the inpatient cardiology consultation service and interpreting echocardiograms, stress tests and electrocardiograms (EKGs). My research career initially focused on translational research using porcine models to investigate physiologic and metabolic adaptations that result from acute and chronic myocardial ischemia (chronically stunned and hibernating myocardium). These preclinical investigations have led to clinical research, including the recent completion of an NIH-sponsored clinical trial. This trial, on which I am the co-principal investigator with John M. Canty, Jr., MD, proved that the presence of sympathetically denervated myocardium quantified by positron emission tomography can predict the risk of sudden death in patients with ischemic cardiomyopathy. I am in the process of extending these findings to the clinical management of patients with implantable cardiac defibrillators. My work as a physician-scientist has included serving on numerous research-related oversight committees and as a peer reviewer for multiple national, regional and local committees. I have been funded by the National Institutes of Health (NIH), the Department of Veterans Affairs and the American Heart Association to conduct a variety of investigator-initiated research projects. Medical education is a critical component of my professional life. Nearly all of my clinical and research activities are performed in conjunction with the education of fellows in cardiovascular diseases, residents in internal medicine and medical students. I facilitate small group sessions for second-year medical students in Cardiovascular Physiology for which I have earned several commendations for teaching excellence; I am gratified to have participated in the education of hundreds of young physicians. I have also published dozens of abstracts and manuscripts with various levels of trainees, giving them the opportunity to grow as physician-scientists while at the same time advancing medical knowledge.
Internal Medicine; Nephrology
My breadth of clinical practice is broad; I care for patients with a wide range of both acute and chronic renal diseases. This includes patients with electrolyte abnormalities, autoimmune and/or secondary glomerulonephritides and polycystic kidney disease as well as those who have undergone kidney transplantation. My training at the Weill Cornell Hypertension Center has provided me with focused training in the management of refractory, secondary and perinatal hypertension. Therefore, I also see patients with refractory or difficult-to-control hypertension even though they may not have kidney dysfunction. As medical director of the Erie County Medical Center (ECMC) Living Donor Kidney Transplant Program, I see many prospective living donor kidney candidates during their donor evaluation process, and I follow them in the post-operative period. I see patients in a variety of inpatient and outpatient settings. I serve as the nephrology attending physician on the inpatient Renal Medicine and Renal Consultation services at ECMC as well as the Renal Consult service at the Buffalo Niagara Medical Campus (BNMC). My outpatient clinics include my weekly general UBMD Nephrology and Transplant clinics at ECMC and my weekly general UBMD Nephrology clinic at the Niagara Falls Renal Office. I care for both in-center and home hemodialysis as well as peritoneal dialysis (PD) patients receiving services at numerous dialysis centers located throughout Erie and Niagara Counties. I work with national and global kidney care groups such as Fresenius and DaVita to provide care for my patients, and I serve as medical director for several of their Western New York dialysis centers. My clinical research interests are also wide-ranging. I have particular interests in medication, chemotherapy and toxin-induced kidney injury. I have worked on a project that investigated the long-term renal impacts of the chemotherapy agent ifosfamide in adult cancer patients. I also have a research interest in autosomal dominant adult polycystic kidney disease (AD-PKD). I am involved in a multicenter clinical trial to compare the efficacy and safety of the drug Tolvaptan to determine if it can help to slow, or even halt the progression of renal cysts and thereby delay or prevent progression of end-stage kidney disease in people with AD-PKD. I supervise and teach physicians at all stages of their training, including interns and residents from UB’s internal medicine residency program as well as fellows in UB’s nephrology training program. I supervise trainees on both the inpatient Renal Medicine and Renal Consult services and in the outpatient Renal and Hypertension Clinic and the outpatient Transplant Clinic. In addition to bedside teaching, I sometimes teach small group nephrology seminars for third-and fourth-year medical students rotating on their medicine clerkships. I also provide lectures for the internal medicine resident teaching program and for the nephrology fellowship teaching program.
Cardiology; Cardiovascular Disease
My clinical practice focuses on all aspects of general cardiology. I work in areas from preventive cardiology, such as treatment of patients with resistant hypertension or high-risk complex dyslipidemia, to inpatient care of critically ill patients with acute coronary syndrome,congestive heart failure exacerbation or advanced valvular disorders. I have particular expertise in noninvasive imaging techniques and use multimodality cardiac imaging to aid the diagnosis and treatment of patients with complex cardiovascular diseases. I am involved in the structural heart program at the Gates Vascular Institute (GVI) and am well-versed in ultrasound-based imaging modality. This includes interpretation of basic transthoracic and transesophageal echocardiograms as well as “interventional echocardiography,” which provides intraprocedural transesophageal imaging support for transcatheter aortic valve replacement (TAVR), MitraClip valve repair and left atrial appendage occluder deployment. I also perform and interpret 12-lead electrocardiograms, 24-hour Holter monitors, event monitors, 24-hour ambulatory blood pressure monitors, cardiac nuclear stress testing, stress echocardiograms and cardiac computed tomography (CT) angiography. My expertise in the range of cardiac imaging modalities allows me to provide guidance to medical practitioners from different specialties in the appropriate use and application of each modality. My research focus spans both translational and clinical applications. Using a porcine model of ischemic heart disease, our team investigates cardiac autonomic regulation and remodeling, employing in-vitro protein analysis and whole animal PET imaging to identify sympathetic denervation and subsequent neuronal sprouting. This area of study has important implications in our understanding of the myocardial substrate that promotes vulnerability to electrical instability and sudden cardiac death. I am also conducting several clinical trials, including a Phase III PCSK9 inhibitor study to evaluate the clinical benefits of Evolucomab in high-risk populations (FOURIER trial, Amgen). I am also involved in a clinical trial using the repositionable Lotus valve system for transcatheter aortic valve replacement (REPRISE study, Boston Scientific). As a faculty member in the Division of Cardiovascular Medicine, I teach medical students, internal medicine residents and cardiology fellows. I facilitate small group discussions for second-year medical students as part of the cardiovascular physiology curriculum, and I serve as a clinic preceptor for third-year medical students in the outpatient cardiology clinic. I also conduct inpatient rounds with residents and fellows. In addition, I teach cardiology fellows in the performance and proper interpretation of cardiac imaging modalities such as echocardiograms and stress testing.
Pulmonary & Critical Care Medicine
My clinical practice focuses on management of general pulmonary disease with a specialized interest in cystic fibrosis (CF) and bronchiectasis. As a physician-consultant for the inpatient UBMD pulmonary consult services at Buffalo General Medical Center (BGMC) and at Roswell Park Cancer Institute, I attend to the needs of hospitalized patients with pulmonary problems in conjunction with the UBMD pulmonary team. This talented inpatient consult team of fellows, residents and medical students works under my supervision, and through my mentoring and teaching of them I hope to share my expertise and give back to medical education by training future healthcare professionals. I see patients to evaluate and treat pulmonary disorders such as shortness of breath, lung masses, abnormal chest imaging, abnormal pulmonary function tests, chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease and bronchiectasis. My outpatient office locations are the Heart and Lung Center at BGMC and the UBMD Specialty Clinic on Youngs Rd in Williamsville. As the Adult Director of the Cystic Fibrosis Center in Buffalo, the only care facility in Western New York accredited by the national Cystic Fibrosis Foundation, I provide comprehensive care for individuals with cystic fibrosis with a specially devoted multidisciplinary team. I also provide local care for patients who have received lung transplants for cystic fibrosis, coordinating and collaborating on their care with the transplant physicians and health care providers. In addition to these responsibilities as a pulmonologist, I attend to hospitalized patients at BGMC and WCHOB who are patients of the UBMD Internal Medicine and Pediatric practices to provide continuity of care for those physicians and their patients. I am actively engaged in clinical research through many international clinical trials, and through this work strive for improved therapies and a cure for individuals with cystic fibrosis. I am excited to see the major advances made recently with genetic mutation specific therapy being delivered to individuals with CF. Research will continue to progress as a result of successful clinical trials made possible by generous patients and the concerted efforts our highly productive local research team and the Cystic Fibrosis Foundation.
Geriatric Medicine; Palliative Medicine
I am a general internist by training, and I practice primary care at a UBMD/Kaleida Health ambulatory center in North Buffalo. I am also a member of the ECMC Geriatrics Consultation Service. I provide medical care to a diverse population of adults, and I specialize in caring for chronically ill and frail elders. I strive to integrate my patients’ values, circumstances and preferences with evidence from high-quality medical research in order to make the best possible care decisions for my patients—a decision-making process that often includes quality-of-life discussions with my patients and their families. My main research and teaching areas are biomedical ethics (particularly in regard to incapacitated patients), research ethics and palliative medicine. I am also interested in the study of medical decision making, decision analysis and evidence-based medicine. I was responsible for research ethics at the UB Clinical and Translational Research Center (CTRC) from its inception until 2014, where I founded and still chair the monthly Clinical and Research Ethics Seminar. My teaching centers on ethics and palliative medicine. I teach medical students communication skills in the preclinical years. I am the course director for the required medical student ethics course, a leadership role I have filled since 1990. I organized the first palliative medicine elective for medical students in 1999 and continue to serve as course director. I also designed an innovative standardized patient exercise that forms a central part of the elective. I supervise internal medicine trainees, and my focus includes general internal medicine as well as evidence-based medicine.
Internal Medicine; Internal Medicine - General
I graduated from the University of Buffalo School of Medicine and completed a residency in Internal Medicine at UB as well. I was a Chief Resident in 1990 and subsequently joined the Department of Medicine as a faculty member in the Division of General Internal Medicine. I served as an Associate Program Director for the Internal Medicine resident training program until 2008. From 2002 until 2008 I became involved in hospital administration and served as the Chief Medical Officer for the Erie County Medical Center. From 2008 until 2011 I served as the Chief Medical Officer for the Seneca Nation Health Department. During that time I completed a Masters of Public Health at the Mailman School of Public Health at Columbia University. In 2011 I returned full time to the Department of Medicine as Division Chief of General Internal Medicine and to ECMCC as an Associate Medical Director. Throughout my career I have been very interested in medical education, quality improvement and patient safety. In my role at ECMC I have been charged with improving the patient experience and have focused on patient and physician communication. We are currently assessing barriers to effective communication and developing interventions to improve the quality of physician and patient interactions.
I am primarily involved in clinical and teaching activities related to the care of patients with pulmonary disease and the critically ill. My practice is located at Buffalo General Hospital, Roswell Park Cancer Institute, and the VA Hospital in Buffalo. I am currently the assistant program director of the Pulmonary and Critical Care Fellowship program at the University of Buffalo. Additionally, I teach interns, residents, and medical students both at the bedside and in the classroom. Education and Training -Fellowship: Pulmonary and Critical Care Medicine, National Capital Consortium (2012) -Residency: Internal Medicine, National Naval Medical Center (2009) -Internship: Internal Medicine, National Naval Medical Center (2007) -MD, Dartmouth Medical School, 2006 -BS, University of Connecticut, 2002
As the Clerkship Director for 3rd and 4th year required Medicine Clerkships, my main interest is student education. My goal is for every student, regardless of their future career goals, to acquire the knowledge, skills and attitudes to provide basic medical care to their patients. For the 3rd year students, I have developed a practical examination to assess interpretation of commonly encountered problems on chest radiographs, ECGs, hematologic smears, microbiologic samples and electrolyte disorders. The 4th year in-house exam requires students to manage 2 patients initial presentation to discharge in a step wise manner. As a management attending on the inpatient teaching service at Buffalo General Medical Center, my focus is to serve as a role model for providing effective and empathetic care to all patients.
Pulmonary & Critical Care Medicine
My clinical expertise focuses on comprehensive management of general pulmonary problems such as evaluation and treatment of shortness of breath and chronic cough, asthma, chronic obstructive pulmonary disease (COPD), emphysema, pulmonary fibrosis, pleural effusions. My special clinical interest is the evaluation and management of patients with suspected or proven pulmonary arterial hypertension (PAH). There are less than a dozen pulmonary hypertension care physician-consultants in upstate New York (north and west of Poughkeepsie). In conjunction with UBMD’s pulmonary and cardiology consultants and other health care staff, I attend to the very specialized needs of patients with PAH at the UBMD dedicated pulmonary clinic at UBMD Internal Medicine at Amherst and at the outpatient Heart and Lung Center at Buffalo General Medical Center (BGMC). In my role at UBMD’s dedicated pulmonary clinic at UBMD Internal Medicine at Amherst, I evaluate and treat patients with the pulmonary conditions mentioned above. I also provide local care for patients who have received lung transplants elsewhere, coordinating and collaborating on their care with the physicians and health care providers from the lung transplant center where they received the transplant. As a physician-consultant for the inpatient UBMD pulmonary consult services at BGMC and Roswell Park Cancer Institute, and in conjunction with my UBMD pulmonary team, I attend to the needs of hospitalized patients with pulmonary problems. I actively participate in clinical research to find new and better ways to help manage and treat patients with PAH. A constant of my career has been to help supervise and educate future pulmonologists in both the hospital and outpatient settings so that they can improve their pulmonary medical knowledge base and procedural skills. I mentor fellows through UB’s pulmonary and critical care medicine fellowship program by clinically supervising their patient interactions in offices and hospitals, teaching them certain testing and procedural skills and emphasizing a respectful, attentive and compassionate approach to patients.
I am the new Director of Hematology and Medical Oncology for Great Lakes Cancer Care. I am also the Associate Chief of Hematology and Medical Oncology for the University of Buffalo, and a Clinical Associate Professor of Internal Medicine. I obtained my double major in biochemistry and genetics/cell biology at the University of Minnesota-Twin Cities. Thereafter, I completed my MD and PhD degrees at the Mayo Clinic in Rochester, MN. I did my internal medicine residency at The George Washington University in Washington, DC, where I completed four months of training at the National Institutes of Health in Bethesda, Maryland. Subsequently, I completed my clinical fellowship in Hematology and Medical Oncology, and post-doctoral fellowship in biochemistry at Stanford University in Palo Alto, CA. I was the youngest cancer center director in the country when I took over as the leader of the St. Luke’s Regional Cancer Center in Duluth, MN, in October of 2012. Thereafter, I was the Director of Hematology and Medical Oncology of seven cancer centers for Covenant Health/Thompson Oncology Group in Knoxville, TN, prior to coming to Buffalo. I am a strong proponent of clinical trials, experimental therapeutics, and precision oncology. I have published in numerous journals, including The New England Journal of Medicine, on several occasions. My primary interests are precision genomics/oncology, the inhibition of intracellular trafficking of proteins as it relates to the development of new therapeutics, and clinical trials involving novel agents.
I see patients primarily at the Erie County Medical Center (ECMC), caring predominantly for inpatients. I care for patients who have acute kidney disease and for patients who have received kidney transplants. I serve as the attending physician on the inpatient renal medicine and renal consultation services at ECMC. I also take care of patients with end-stage renal disease on chronic dialysis who have been admitted to the hospital with other medical problems. My research interest is acute kidney injury and chronic kidney disease (CKD). I supervise interns, residents and fellows during their inpatient rotations. I am also involved in teaching medical students.
Cardiology; Cardiovascular Disease
I am a cardiologist with a subspecialty interest in heart failure and general cardiology. I am based at Buffalo General Medical Center (BGMC) and the Gates Vascular Institute (GVI), and I care for inpatients admitted to Cardiology Critical Care, Inpatient Cardiology and Inpatient Consultation. I have administrative duties that focus on the care of the cardiac patient at Kaleida Health: I help lead the collaborative efforts of over 50 cardiologists to improve the quality of patient care and patient outcomes. My research responsibility has included serving as a local principal investigator in multicenter clinical trials, and our site has contributed to a number of cardiology research programs over the past 25 years. Our current focus is in systolic and diastolic heart failure, as a collaborative effort with colleagues in internal medicine and cardiology. I am part of the teaching faculty in the Division of Cardiovascular Medicine, and I am the lead physician for the BGMC training site. In this role, I work with another attending cardiologist to provide oversight and guidance to a team of five cardiology fellows, residents and fourth-year medical students at the BGMC continuity clinic. I also help organize and lead annual continuing medical education conferences through the medical school’s Department of Medicine and through Kaleida Health.
As Director of the Clinical Research and Consulting Lab (CRCL), the primary focus of my work is assisting residents, fellows, and junior faculty within the Department of Medline (DOM) in conducting and disseminating high quality, impactful research projects. My background and training in research methodology and statistics helps to fill the gap that many early career researchers face when trying to get a project from concept to completion. Given the nature of my responsibilities at CRCL, I do not have one specific research are of interest. I have, however, had the opportunity to work with researchers within many divisions of the DOM, and have had research published and presented at national and international conferences in the areas of behavioral medicine, nephrology, cardiology, and internal medicine, to name a few. In addition, I also provide workshops and training (e.g., research design, statistical analysis) to assist DOM members in becoming better producers and consumers of research. We are currently developing a ‘portable’ research curriculum at CRCL that we hope will be useful research tool for all of the members within the DOM.
I am a palliative care physician at Roswell Park Comprehensive Cancer Center (Roswell Park). I care for patients who have advanced cancer, helping to manage their pain and other symptoms and providing psychosocial support. I have expertise in managing refractory cancer pain, neuropathy, nausea, fatigue, dyspnea, mood disorders and the other symptoms patients with advanced cancer experience. I see patients in the Roswell Park outpatient palliative care clinic, and I conduct inpatient consults for patients admitted to Roswell Park. An important part of my care is helping patients identify their treatment options and preferences throughout the stages of their cancer treatment. I help my patients weigh the risks and benefits of further chemotherapy and invasive procedures, for example, to decide the best tailored approach to their care. In addition, I help patients plan their care in the event their health worsens. These conversations help ensure that medical teams understand and respect my patients’ choices. I am an active researcher. Immune checkpoint inhibitors have provided an exciting breakthrough for patients with advanced cancer, but they can come with serious toxicities. I focus my research on evaluating better ways to screen and diagnose these toxicities earlier and identifying risk factors which may predispose some patients to developing these immune-related toxicities. Many patients also experience serious neuropathic pain as a result of their treatments, which can be challenging to care for; I am working to identify new treatments for this condition. I am in the beginning stages of investigating advanced-care planning in patients who are often at risk of poor communication with their medical teams. These patients receive less information, and in turn ask fewer questions of their physicians, than other patients. As a result, they may not receive the care that is truly consistent with their wishes. My goal is to educate medical teams to recognize high-risk patients and ensure that these patients receive the information they need. I teach medical students and residents. I lead small group discussions for third- and fourth-year students on advanced-care planning strategies. I also provide lectures and board review to the internal medicine residents.
Internal Medicine - General
I am a primary care doctor specialized in Internal Medicine and currently practice at Hertel-Elmwood Internal Medicine center. I am passionate about developing long-standing and trusting relationships with my patients. It is important to establish a candid relationship and open communication with my patients in order to properly treat their disease. My professional goal is to reach out to the underserved and minor population in the WNY community, by allowing my patients to feel empowered and knowledgeable about their health.
Cardiology; Interventional Cardiology
I am an interventional cardiologist specializing in structural heart interventions. My clinical practice includes general cardiology, interventional cardiology and complex valvular heart diseases. I see patients at the UBMD cardiology offices--and at Buffalo General Medical Center (BGMC), where I direct the complex valve clinic. I also direct structural heart interventions at the Gates Vascular Institute (GVI) and BGMC, and in that capacity I perform transcatheter aortic valve replacements, mitral clip procedures, left atrial appendage occlusion, atrial and ventricular septal defect closure and percutaneous paravalvular leak closures. I also care for patients by performing routine diagnostic coronary angiograms and percutaneous coronary interventions (PCI)/angioplasty. I believe that in this era of technologically advanced, modern medicine it is the physician’s responsibility to educate patients in a straightforward and open manner about the different treatment modalities. I spend time with my patients to ensure that they are comfortable with the treatment options they choose and that they have a clear understanding of the alternatives, benefits and risks. My research interests are in new devices for aortic and mitral valve replacement, novel therapeutics in the form of stem cells and newer therapies for acute coronary syndromes. I also collaborate with the Toshiba Stroke Research Center to develop advanced imaging modalities in the cardiac catheterization laboratory. I am investigating the use of robotic PCI to improve precision in stent placement and reduce radiation dosage in the catheterization laboratory, and I serve as the local principal investigator for a number of multicenter clinical trials in these areas. For example, I am: evaluating the LOTUS transcatheter valve to CoreValve in high-risk patients (Reprise III, Boston Scientific); investigating the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with severe, symptomatic aortic stenosis (AS) at intermediate surgical risk by randomizing patients to either surgical aortic valve replacement (SAVR) or TAVI (SURTAVI, Medtronic); and determining the efficacy of cardiac stem cells in patients with recent myocardial infarction and ischemic cardiomyopathy (ALLSTAR, Capricor. I train residents and cardiology fellows through didactic and bedside teaching, and I mentor their research projects. I also oversee cardiology fellows in outpatient settings. Additionally, I collaborate with the departments of Anesthesiology and Pediatrics and the Division of Pulmonary, Critical Care and Sleep Medicine to train their residents and fellows.
Cardiovascular Disease; Internal Medicine; Nephrology; Pathophysiology; Vascular and Interventional Radiology; Cardiac pharmacology
(1) Role of the sympathoadrenal system in hypertension, postural adaptation, and long-term cardiovascular adaptation (2) Control of regional and systemic blood flow during acute stress responses (3) Mechanisms of stress responses and vasoreactivity, both in vivo and in vitro, including metabolic interactions (4) Cardiovascular drug effects (5) Outcomes of drug therapies
Critical Care Medicine; Internal Medicine - General; Pulmonary; Pulmonary & Critical Care Medicine; Sleep Medicine
I provide intensive care to patients admitted to the intensive care unit (ICU) at the Veterans Administration Medical Center (VAMC), I care for adult patients with pulmonary diseases such as chronic obstructive pulmonary disease (COPD)/emphysema, asthma, sarcoidosis, cough, lung nodules, pneumonitis and bronchitis, and patients with sleep disorders such as sleep apnea, narcolepsy, insomnia and restless legs syndrome. I have a special interest in the value of good physician-patient communication, and its effect on outcomes. Explaining disease process to patients, listening to their concerns and involving them in their medical decisions may have a positive effect on the results of treatment and interventions, and on their outcomes. I emphasize the importance of physician-patient communication with the students, residents and fellows I teach, train and mentor. I teach medical students in small group sessions in their first and second years, including courses in respiratory pathophysiology. Third- and fourth-year students rotate with me in the ICU and on the pulmonary service. I also supervise residents in the ICU and on the pulmonary consult service, and I mentor pulmonary, critical care and sleep medicine fellows in all aspects of their training. My sleep medicine research interest is focused on the pathophysiology of cardiovascular disease in patients with sleep breathing disorders, and on the interplay between PTSD and sleep disorders. My pulmonary and Critical Care Medicine research focuses on the relation between PTSD and Critical illness, and on pneumonia. Fellows are welcome to work with me on research projects.
Pulmonary & Critical Care Medicine
My clinical responsibilities include care of inpatient and outpatient veterans at the Buffalo VA Medical Center. My clinical interests include diagnosis and management of a broad range of pulmonary and sleep disorders including hemoptysis, chronic cough, dyspnea, chronic obstructive pulmonary disease, lung cancer, interstitial lung disease, pulmonary hypertension, sleep apnea, insomnia, restless leg syndrome and narcolepsy. I serve as the section chief of pulmonary, critical care and sleep medicine and as the director of the pulmonary function laboratory at the Buffalo VA Medical Center where I perform pulmonary function tests (PFTs) to evaluate a patient‘s respiratory status. I am a pioneer in the use of telemedicine and use electronic communications to evaluate patients with sleep disorders. I am in the process of expanding the use of this technology in the care of pulmonary patients — particularly those patients with suspected lung cancer.
I am Professor of Medicine and Chief of the Division of Behavioral Medicine whose clinical, research, and educational activities focus on the interplay of health and behavior. Since its founding in 1994, the division’s clinical arm provide brief, state-of-the-art treatment for patients with painful medical disorders. These disorders include irritable bowel syndrome (IBS), low back pain, pelvic pain, arthritis, fibromyalgia, non-cardiac chest pain, temporomandibular disorder (TMD) and benign headaches such as migraine and tension headaches. A unique feature of our clinical services is the use of evidence-based treatment protocols that help patients gain control of symptoms that have not adequately responded to standard medical therapies. Because our clinicians are active researchers, patients receive cutting-edge treatments often times before they are more broadly disseminated. Our clinical work emphasizes a collaborative approach that recognizes that each patient is unique and presents with specific problems and not simply a diagnosis or set of symptoms. My research focuses on developing and testing novel and safe treatments for chronic pain disorders, understanding their “active ingredients”, identifying patients for whom they are most effective, and their real world value. With NIH support since 1999, my research has influenced clinical practice guidelines and established me as an internationally recognized authority in the behavioral treatment of chronic pain disorders particularly IBS. Division research provides valuable scholarly experiences for trainees in the UB medical school, school of public health, and the College of Arts and Sciences. We are pleased to offer these educational opportunities to qualified students at other local and international educational institutions as well. Trainees learn to design, write, conduct and analyze quality research projects with the goal of co-authoring at least one empirical study for publication. The academic skills students learn during research rotation support their professional development whether they progress to careers as independent researchers or academically-oriented clinicians who depend on critical thinking and a scholarly approach to healthcare delivery. As part of the division’s Clinical Research Consulting Lab, I routinely assist faculty and mentor residents and fellows in research design and methods and consult with industry partners seeking ways to harness the science of behavior change to gain a competitive edge for product development, strategy, and evaluation. I lecture in several UB departments such as internal medicine, family medicine, psychiatry, orthopedic surgery, neurosurgery and psychology with the aim of familiarizing trainees with the psychosocial aspects of chronic diseases and behavioral change strategies critical for managing their day-to-day burden.
Cardiology; Cardiovascular Disease; Cell growth, differentiation and development; Gene Expression; Molecular and Cellular Biology; Signal Transduction; Stem Cells
As a general cardiologist, I diagnose and treat a wide range of problems that affect the heart and blood vessels, including but not limited to coronary artery disease, valvular heart disease, heart failure, diseases of the myocardium and pericardium, cardiac arrhythmias, conduction disorders and syncope. I care for patients at Buffalo General Medical Center (BGMC), the Gates Vascular Institute (GVI), the Buffalo VA Medical Center (VAMC) and am a member of the UBMD clinical practice. In addition to treating pre-existing cardiac conditions, I also believe in strong preventive care and addressing modifiable risk factors for coronary disease. I take time to get to know my patients, and I talk with them about measures they can take to reduce their risk for cardiovascular disease and improve their health. As a clinician-scientist, I have a special interest in developing new stem cell based treatments for heart disease. My research is focused on understanding what stem cell secreted factors are responsible for improved heart function, what their targets are and how these can be modulated to develop new cell-free therapies that can help patients with a wide spectrum of coronary disease and heart failure. I welcome medical students, graduate students, residents and fellows to conduct research with me in my lab. As a native Buffalonian, I am honored to partner with the patients in our community to help improve their heart health and cardiac knowledge base. I am equally excited to be involved in shaping the next generation of physicians through the teaching I conduct at the medical student, resident and fellow level.
Infectious Disease; Bioinformatics; Microbial Pathogenesis
My clinical interest work focuses on infectious diseases, particularly those caused by Staphylococcus aureus. I practice medicine at the VA Western New York Healthcare System, where I am Chief of the Infectious Disease Section. The service here treats veterans with a wide variety of infectious diseases, including HIV and hepatitis C. I follow both inpatients and outpatients on this clinical service. Medical students, residents, and fellows evaluate and follow infectious disease consultations with me on the inpatient service. I teach extensively in the Medical School, and serve as Vice Chair for Education in the Department of Medicine. I enjoy working with students throughout the full spectrum of medical education, from first-year medical students to senior fellows in Infectious Disease. My research interests dovetail with my clinical work. I study Staphylococcal infections, particularly complications related to S. aureus bloodstream infections. My laboratory uses advanced molecular biology techniques to identify bacterial virulence factors. In collaboration with Steve Gill at the University of Rochester, we are analyzing three years of clinical data on S. aureus bacteremia in the Buffalo area and sequencing hundreds of bacteremia isolates of S. aureus to identify the genomic architectures associated with more severe complications and those associated with poor clinical outcomes. This work makes use of bioinformatics and database design, techniques that support my ongoing collaborations with other investigators on bioinformatics problems, particularly with Moraxella catarrhalis and Haemophilus influenzae. Prior to my studies in S. aureus, I conducted research on a fascinating pathogen, H. influenzae bio group aegyptius and Brazilian Purpuric Fever. Over that 10-year period my laboratory identified a unique epitope on a surface proteins associated with the disease. We were able to create the only isogenic mutant so far described with this pathogen that is highly refractory to genetic manipulation.
I work primarily at the Buffalo VA Medical Center (VAMC) where I served as the chief of nephrology for many years. I care for patients with a variety of kidney diseases, including acute and chronic kidney disease, end-stage renal disease, glomerulonephritis, polycystic disease and hypertension. I have a particular interest in the treatment of patients with resistant hypertension. I also care for patients with advanced chronic kidney disease. Together with a team of other health care professionals at the VAMC, I help patients to decide the optimal modality of dialysis for themselves and, when warranted, to consider the possibility of renal transplantation. I care for inpatients as a consultant on the nephrology consultation services. I see patients at outpatient clinics at the VAMC, and I follow patients in the VAMC outpatient dialysis unit. I participate in clinical trials related to treatment of diabetic kidney disease, treatment of anemia in chronic kidney disease and hypertension. My past research focused on understanding the response of cells to conditions of hypo- and hyperosmolality. I have published on hyponatremia and hypernatremia, and continue to have a clinical interest in these areas. I am the program director for the nephrology fellowship program and have served in this role since 1997. I oversee the nephrology fellowship training experience at the multiple clinical sites of UB’s Division of Nephrology, and I contribute to the development of the curriculum. I also serve as the coordinator of the four-week, organ-based “renal module” for first-year medical students: I plan the curriculum, identify speakers, organize the case-based small group sessions and write test questions. I also give 12 lectures and participate in four small-group sessions each year. I am committed to teaching and devote significant time in the medical school teaching medical students. In addition, I hold an adjunct appointment in the Department of Pharmacology and Toxicology, and I give lectures on renal pharmacology, hypertension and adverse drug reactions each year to students in that department. I also teach pharmacology and toxicology students in a recitation session focused on discussion of a clinical research paper.
Pulmonary & Critical Care Medicine; Sleep Medicine
My patient care responsibilities are centered at the Veterans Administration Western New York Healthcare System (VA) where I care for hospitalized patients with pulmonary problems as well as maintain two active outpatient clinics in the VA system: the pulmonary clinic and the sleep medicine clinic. I also supervise the continuity clinics at the VA. My research interests dovetail with my clinical work. I conduct research on skeletal muscle function in patients with chronic obstructive pulmonary disease (COPD) and those patients in pulmonary rehabilitation. I investigate predictors of the response to pulmonary rehabilitation, and I am also interested in sleep apnea research, comparing the occurrence of complications (postoperative and others) between patients with sleep apnea and those without. I examine sleep apnea treatment options and their success rate in special patient populations, such as patients with psychiatric disease or those on chronic opioid therapy. I run multicenter trials in patients with COPD, and I am presently involved in two NIH-sponsored studies: one examining the effects of long-term oxygen therapy in patients with mild hypoxemia and one examining whether administration of a statin can reduce the exacerbation rate in optimally-treated patients with COPD. I teach medical students primarily in the respiratory physiology course. I enjoy working with students throughout the full spectrum of medical education from first-year medical students to senior fellows in pulmonary critical care or sleep medicine. As the fellowship director for pulmonary critical care medicine I am responsible for the educational curricula for the fellowship.
Apoptosis and cell death; Bioinformatics; Endocrinology; Gene Expression; Gene therapy; Genomics and proteomics; Immunology; Molecular Basis of Disease; Molecular and Cellular Biology; Neurobiology; RNA; Viral Pathogenesis
Dr. Mahajan has established herself as an investigator in the area of neuropathogenesis of HIV-1 in the context of drug abuse. She has established 2D and 3D Blood Brain Barrier (BBB) models, that allow studying mechanisms of BBB pathophysiology, examine BBB integrity and evaluate permeability of neurotherapeutics across the BBB. She investigates the role of a unique key signaling molecule in the dopaminergic pathway called DARPP-32, that impacts drug addiction, depression and other neurological disorders. Her focus has always been on collaborative, interdisciplinary partnerships between various Departments within UB that include the Institute of Lasers, Photonics and Biophotonics, Research Institute of Addiction, Dept of Computer Science and Engineering, Dept of Pharmaceutical sciences, Dept of Oral Biology and the Department of Bioengineering and also multiinstitutional collaborations with University of Rochester Medical Center and SUNY Albany. This inclusive strategy has facilitated the emergence of a robust, innovative clinical translational research program that continues to grow steadily. Dr Mahajan has obtained independent research funding from NIDA, NSF iCorp, Pharmaceuticals like Pfizer, Shire, Global- CRDF, US- Fulbright and other Private Foundations such as Dr. Louis Skalrow Memorial trust. Dr. Mahajan is Director of Research of the Division of Allergy, Immunology & Rheumatology. She supervises the research training of the Allergy fellows, Medical residents, graduate and undergraduate students. Dr. Mahajan has presented her research work at National and International conferences and was an invited speaker at several seminars and colloquiums. She has authored over 108 publications in several top quality peer reviewed journals and has thus demonstrated a high level of scholarly productivity. She is a reviewer and an adhoc member of the editorial board of several journals in her field. The following is a brief synopsis of her research interests. HIV neuropathogenesis in the context of drug abuse: We proposed that Opiates act as co-factors in the pathogenesis of HIV-1 infections by directly suppressing immune functions of the host through interactions with mu-opioid receptors on lymphocytes. Exacerbation of HIV encephalopathy (HIVE) is observed with opiate abuse. The mechanisms underlying HIVE are currently undetermined however, they likely to include the generation of endogenous neurotoxins combined, perhaps synergistically, with bioreactive HIV-1 envelope proteins. We believe that these proposed mechanisms may work through a common signal transduction mechanism activating dopamine D1 receptors in the nucleus accumbens of the brain. Opiate abuse by HIV-1 infected subjects may exacerbate the progression of HIVE as a consequence of the combined effects of HIV-1 induced neurotoxins plus opiate induced increases in the D1 receptor activation. We hypothesize that the dopaminergic signaling pathway is the central molecular mechanism that integrates the neuropathogenic activities of both HIV-1 infections and the abuse of opiate drugs. In this context our investigation is focused on the DARPP-32 signalling pathway. Addictive drugs act on the dopaminergic system of the brain and perturb the function of the dopamine- and cyclic-AMP-regulated phosphoprotein of molecular weight 32 kD (DARPP-32). DARPP-32 is critical to the pathogenesis of drug addiction by modulating both transcriptional and post-translational events in different regions of the brain. DARPP-32 is localized within neurons containing dopamine receptors and is a potent inhibitor of another key molecule in the dopaminergic signaling pathway, protein phosphatase 1 (PP-1). We propose that the sustained silencing of DARPP-32 gene expression using specific siRNA delivered to the brain is an innovative approach for the treatment of drug addiction. The specific challenge of the proposed project is the non-invasive delivery of biologically stable, therapeutic siRNA molecules to target cells within the brain. We are developing biocompatible nanoparticles to both protect DARPP-32 specific siRNA against degradation and deliver it from the systemic circulation across the BBB to specific dopaminergic neurons in the brain of patients with opiate addictions. BBB Research: While examining neuropathogenesis of HIV, we became interested in the role of the blood-brain barrier (BBB) in HIV neuropathogenesis with the objective of developing therapeutic interventions to prevent and limit the progression of HIV associated neurological disease. The blood-brain barrier is an intricate cellular system composed of vascular endothelial cells and perivascular astrocytes that restrict the passage of molecules between the blood stream and the brain parenchyma. The in-vitro BBB models allow examining permeability of virus, effects of drugs of abuse on BBB permeability, mechanisms of BBB transport, and tight junction modulation. Our goal remains to determine the impact of current and potential CNS antiretrovirals, psychopharmacologic, and other medications on the integrity of the BBB in HIV associated neurological disorder and other neurodegenerative diseases. Additionally, we also investigate mechanisms that underlie drugs of abuse induced neuronal apoptosis. Systems biology approach: We expanded our investigation to include functional genomic/proteomic NGS analyses that allowed characterization of gene/ protein modulation in response to a drug stimulus or under a specific disease condition. We developed an expertise in these large-scale genomic and proteomic studies and the genomic studies helped identify key genes that underlie molecular mechanisms in drug addiction, HIV diseases progression, and allowed examination of the interplay of genes and environmental factors. The proteomic studies confirmed the presence of specific proteins that regulate key biological processes in drug addiction and HIV diseases progression. Recently, We have expanded my research program to include microbiome analyses and incorporated the utility of the computational drug discovery platform (CANDO) model that allows studying interaction between protein structures from microbiome genomes and determine the interactions that occur between them and small molecules (drugs and human/bacterial metabolites that are already a part of or continue to be added to the CANDO library. Using the CANDO Platform we are able to do the hierarchical fragment-based docking with dynamics between those compounds/drugs and the microbiome proteins/proteomes to determine which ones of the drugs and metabolites will work most efficaciously in patients using specific drugs. NanoMedicine: We have developed a strong program in nanomedicine and have initiated several interdisciplinary clinical translational research focused collaborations that include 1) Nanotechnology based delivery systems to examine antitretroviral transport across the BBB; 2) Nanotherapeutics using siRNA/Plasmid delivery to specific regions in the brain to target various genes of interest specifically those pertaining to the dopaminergic pathway that result in the modulation of behavioral response which we observed in animal models of addiction/depression; 3) Biodistribution studies of various nanotherapeutic formulations using PET small animal imaging. Additionally, We are also focused on exploring epigenetic mechanisms that under drug addiction and mechanisms that underlie oxidative stress in neurodegenerative diseases.
My clinical focus is providing excellent clinical care to patients with a broad range of gastroenterological disorders--particularly those with liver diseases such as hepatitis, alcoholic and non-alcoholic liver disease, cirrhosis, ascites and portosystemic encephalopathy. I work exclusively at the Buffalo VA Medical Center where I serve as chief of gastroenterology. I perform upper endoscopy, colonoscopy and paracentesis on inpatients and outpatients at that facility. My patient-care efforts include digital outreach: I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” Since the Buffalo VA Medical Center serves veterans from a broad geographic area, I also provide telehealth—i.e, telephone and secure messaging consultation and follow up to patients in need of this type of long-distance care. This provides more accessible health care to patients who reside a distance from Buffalo, saving them the time and expense of traveling, or to patients for whom travel is inconvenient. I teach the medical students at the University at Buffalo in the classroom, on the wards and in the clinic, how to diagnose and treat liver disease. I have been recognized for my educational skills and have received several awards for teaching. My current research focuses on the delivery of care to patients with liver disease who have limited access to specialists. I conduct studies evaluating tele-gastroenterology, tele-hepatology, telephone medicine and palliative care in patients with advanced liver disease, and I routinely involve and mentor UB fellows, internal medicine residents and medical students in these ongoing studies. The aim of this research is to help provide more accessible health care to patients with physical challenges, those patients who have trouble traveling and those patients whose remote geographic location prevents them from otherwise receiving high-quality health care.
Pulmonary & Critical Care Medicine
I am engaged in clinical, teaching and research responsibilities related to the evaluation and treatment of patients with pulmonary disease or patients who are critically ill. My inpatient practice situated at the medical intensive care unit (MICU) at the Buffalo General Medical Center (BGMC) positions me to provide ongoing medical care to patients who are critically ill and require significant life support therapies to sustain life or vital bodily functioning. I am specifically interested in asthma, COPD, interstitial lung disease, pleural disease, pulmonary hypertension and lung cancer, but deal with a variety of lung disease. I evaluate patients with pulmonary disorders including shortness of breath, lung masses, abnormal chest imaging, abnormal pulmonary function tests, chronic obstructive pulmonary disease (COPD), asthma, pleural disease, interstitial lung disease, pulmonary hypertension, and lung cancer, at the UBMD practice location at Conventus. As a member of the UBMD pulmonary division, I provide inpatient pulmonary consultation at both BGMC and Roswell Park Cancer Institute. Currently, I am focusing on the analysis of Big Data in the medical/healthcare fields. I am mainly focused on the application of drug repurposing in translation and clinic research. Additionally, I am engaged in the study of the human airways microbiome and metagenome. The human microbiome is the collection of all the microbial organisms in a human body, and the corresponding metagenome is the collection of the genes, and gene products of the microbes. Due to the potential impact of the microbiome on human health and disease, I am interested in studying the putative effects the interaction with human hosts, specifically innate immunity interaction with the metagenome in lung disease. My collaborators include the Division of Allergy and Immunology. We endeavor to elucidate immune cell function in airway diseases such as asthma and COPD. Our research focuses on the development of therapeutics aimed at novel targets identified as necessary in the molecular basis of pulmonary disease; efficacious laboratory results will generate more effective treatment plans for patients. I am actively involved in teaching medical students, residents, and fellows about the appropriate care of the patient with either pulmonary disease and critical illness.
Addictions; Gastroenterology; Internal Medicine; Liver (Hepatology); Infectious Disease
I care for patients with liver disease and addiction disorders, including opiate dependency, viral hepatitis, alcoholic and fatty liver disease, in an outpatient setting at Erie County Medical Center where I am the medical director of hepatology. In collaboration with the division of infectious diseases, I also evaluate and treat patients with hepatitis C virus (HCV) and HIV co-infection. I also treat veterans with opiate dependency at the Buffalo VA Medical Center, in the addiction medicine unit. My patient-care efforts include digital outreach: I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” My research involves improving hepatitis C treatments in populations disproportionately affected by HCV but with limited access to health care (including many American veterans, ethnic minority groups, injection drug users, and patients with psychological disorders) as well as developing novel modalities to deliver care. The goal of my research is to expand HCV treatment services to a wide-ranging group of patients, especially those without immediate access to care, in an effort to reduce global disease burden. This may include training primary care or other providers to treat HCV and using telemedicine and co-localization as a way to increase treatment uptake in areas such as rural primary care clinics and methadone clinics. My team is also investigating barriers to hepatitis C screening and treatment. Using the data we collect (e.g., patients’ knowledge of the disease, their perceptions regarding treatment, their willingness to be treated), we can design initiatives to improve patient-based HCV education and work toward the goal of increasing treatment uptake. This component of my research also looks at the same issues on the provider side: provider HCV knowledge and screening, referral and treatment practices. These data will help us understand what the provider-level barriers are to disease control, and we can design provider-based HCV educational initiatives to improve screening and referral for care. I am also a co-investigator on numerous clinical trials related to new therapeutic agents for hepatitis C and fatty liver disease, including a study funded by the Centers for Disease Control and Prevention (CDC) to evaluate the use of telemedicine to treat HCV in methadone maintenance clinics. I present and lecture nationally about hepatitis C with an emphasis on opiate dependence and special populations. I am a member of the New York State Hepatitis C Demonstration Project expert panel. I teach medical students in small group settings in the area of gastroenterology and hepatology. I also precept internal medicine residents and gastroenterology fellows in the outpatient clinics.
Cardiology; Cardiovascular Disease
I am a cardiologist with more than 30 years’ experience. The primary focus of my patient care is the diagnosis, treatment and prevention of coronary artery disease, arrhythmias, valvular heart disease, lipid abnormalities, heart failure and hypertension. My goal is to improve my patients’ quality of life. The UBMD cardiology practice allows me to provide my patients the full spectrum of cardiovascular services representing state-of-the-art therapy. In addition, I am able to take advantage of a wide range of clinical research studies conducted within UBMD Cardiology, which may prove to be unique options for my patients. Having these complete services and research studies available to me allows my patients to receive a level of care unparalleled in our community. I am intimately involved in educating the next generation of physicians through my teaching of medical students, residents and fellows. In 2015, the family medicine residents at Millard Fillmore Suburban Hospital recognized my commitment to medical education with an award for my specialty teaching.
Jennifer Meka, PhD is the Assistant Dean for Medical Education and Director of the Medical Education and Educational Research Institute (MEERI) at the Jacobs School of Medicine at the State University of New York SUNY at Buffalo (UB). She earned her PhD from UB in Elementary Education and her master’s in Teacher Education from Canisius College. Prior to joining UB, Jennifer served as the Director of the Woodward Center for Excellence in Health Sciences Education at the Penn State College of Medicine providing support for faculty and other teaching health professionals seeking skills development and mentorship in their roles as educators. Her current research areas focus on the impact of participation in peer observation of clinical teaching on observer teaching self-efficacy and clinical teaching practice; developing co-teaching partnerships — between clinician-educators and learning specialists — to enhance student learning; and using evidence-based educational principles for assessment of student learning.
I primarily provide consultations for inpatients at Buffalo General Medical Center (BGMC) and Gates Vascular Institute (GVI). I also provide consultation services at Roswell Park Cancer Institute during on-call weekends. In my clinic at BGMC, I evaluate and treat patients with a variety of infections primarily as a follow-up from recent hospitalization. This allows for continuity of care, a service that is highly appreciated by the medical and surgical services at BGMC and GVI. I enjoy teaching medical students, residents, and fellows on inpatient consultation service at BGMC and GVI; consultations may be called by a medical or a surgical service. Medical services include general internal medicine or one of the medical specialties (cardiology, pulmonary, nephrology, oncology, etc.), neurology, family medicine and rehab medicine. Surgical services include general surgery, colorectal surgery, bariatric surgery, cardiothoracic surgery, orthopedic and hand surgery, vascular surgery, plastic surgery and urology. This spectrum of consultations allows for a broad variety of patients, which provides fellows and residents a diverse intellectual experience during their rotation. I see patients with residents and fellows and discuss cases with them. Also, I provide didactic morning reports to the internal medicine residency program. During my off-service months, I enjoy writing case reports with the medicine residents. I am also the director of the Anti-microbial Stewardship (AMS) program at BGMC and GVI. In this role, and in collaboration with the pharmacy department, I am responsible for providing an overview to the antimicrobial use at these institutions. The aim of the AMS program is to help provide to the different specialties a better understanding of appropriate use of antibiotics and to adjust or de-escalate antibiotics whenever it is deemed appropriate. Our goals are to reduce nosocomial infections like Clostridium difficile, reduce colonization/infection with multi-drug resistant organisms and decrease the length of hospital stay whenever possible.
I am a primary care physician, board-certified in internal medicine. I see patients at the UBMD Internal Medicine office on Youngs Road in Williamsville. I take a holistic approach to my patients and am part of a “medical home” model of patient care. This means I work as part of a team: I collaborate with other physicians and health care professionals to provide comprehensive and continuous medical care to my patients, with the goal of obtaining the best possible health outcomes. I focus, too, on preventive care and believe that it is important to help patients lead a lifestyle that will maximize their health. I also teach medical students. My goal is to teach students to become compassionate physicians who care for patients holistically and in the context of their families, their cultures and their communities. I have been recognized with numerous teaching awards throughout my career. I serve as well as the senior associate dean for student and academic affairs. As such, I am responsible for medical admissions, multicultural affairs, student services, registrar services, student disciplinary matters and the school’s Clinical Competency Center and simulation centers. I am also the program director for STEP (Science and Technology Entry Program) and director of the post-baccalaureate program. My overall goals are to support strong pipeline programs that help ensure a diverse student body, attract academically talented students who show the potential to become compassionate physicians, provide our students with a variety of hands-on opportunities in research, training and innovative learning experiences--and help our students succeed at every stage in their medical education. My office is structured to support our students throughout the four years of medical school, both with academic advising and personal counselling services.
Critical Care Medicine; Pulmonary & Critical Care Medicine; Internal Medicine; Pulmonary; Sleep Medicine
My clinical responsibilities include serving as an intensivist to patients requiring critical care and participating in the care of hospitalized patients with pulmonary problems at the Buffalo VA Medical Center (Buffalo VAMC). I also diagnose and manage outpatients with sleep problems at the Buffalo VAMC. My clinical research interests include asthma in the elderly and the impact of passive smoke on respiratory health. I also have been exploring novel appreciative assessment approaches to raise resilience and prevent burnout in faculty and medical trainees. In addition, I have a keen interest in working on strategies to enhance faculty mentoring skills. In addition to my clinical and research responsibility, I am passionate about educating future generations of health care professionals, and I help train and mentor medical students from the first to final year of medical school. I am one of the seminar leaders for the Clinical Practice of Medicine course. As such, I help train first-year students in clinical skills. I also play an active role in mentoring medical students, helping them to develop into compassionate and well-rounded physicians who have sound clinical skills as well as the humanistic qualities that are exhibited in the best medical care. As a member of the steering committee for the medical school’s Center for Medical Humanities, I am involved in designing a humanistic curriculum to prepare the next generation of physicians. I facilitate sessions with second- and third-year medical students, with the goal of supporting and fostering humanism. I teach students how to develop their ability to use self-awareness of knowledge, skill and emotional limitations in order to engage in appropriate help-seeking behaviors. As the associate clerkship director in internal medicine, I run “brain teasers” sessions to excite and activate my students as they embark on their clerkship journey into medicine. I conduct lectures and small group sessions in pulmonary and critical care medicine, on topics such as asthma, chest x-ray interpretation, pulmonary function testing and shock--and on topics diverse from my subspecialty such as rheumatology, infectious disease and hematology. In addition, I teach medicine residents and the pulmonary, critical care and sleep medicine fellowship trainees who rotate with me on the inpatient and outpatient services. As a preceptor and member of the Resident Clinical Competency Committee, I provide support and career advice to residents during their training. I believe the ability to think creatively is essential in the medical field, and I strive to help students and physicians-in-training overcome creative barriers. I develop methods to guide students to think “out of the box” and to be inquisitive, and I encourage them to apply these skills to help recognize problems, solve medical cases and design research and clinical treatment.
I am an attending physician on the Infectious Diseases service at Roswell Park Cancer Institute (RPCI). In addition to my clinical duties of inpatient infectious disease consultations, I am the medical director of the Antimicrobial Stewardship Program and the director of Infection Control and Prevention at RPCI. I also enjoy teaching medical students, residents and fellows in daily rounds and through formal didactic lectures. My primary research interest focuses on appropriate use of antimicrobials in "special populations" including oncology patients and other immunosuppressed patients, especially as it relates to antimicrobial and diagnostic stewardship.
Research in my laboratory focuses on nontypeable Haemophilus influenzae and Moraxella catarrhalis, important pathogens in otitis media and lower respiratory tract infections in adults with chronic obstructive pulmonary disease (COPD). A goal of work is to develop vaccine to prevent these infections. To that end, outer membrane proteins have been identified and are being evaluated as potential vaccine antigens. A COPD Study Clinic supported by a grant from the Department of Veteran Affairs has been running continuously since 1994. This prospective study follows adults with COPD during monthly clinic visits during which sputum and serum samples are collected. Bacterial isolates are recovered from sputum and are subjected to molecular typing. These studies are elucidating the dynamics of respiratory tract bacterial colonization. In addition, serum and sputum samples are being studied to learn about systemic and mucosal immune responses to bacterial pathogens.
My clinical activities are focused on caring for patients with chronic kidney disease (CKD) and those with end-stage renal disease undergoing renal replacement therapy. I am the Chief Medical Officer of Erie County Medical Center (ECMC); as such, I am responsible for ensuring that the hospital has a high-quality, safe and efficient environment in which our health care professionals can render the best possible care for all patients. I also serve as the liaison between physicians and hospital administration, helping the latter to develop hospital policy and its strategic vision. My research is focused on addressing population health management. With the use of bioinformatics, my goal is to develop methods that will permit earlier detection of kidney disease and improved models for delivering extended care management for patients with CKD. My past research has included study of the diagnosis and treatment of viral diseases in transplant patients, vascular access problems in hemodialysis patients and the early identification and treatment of CKD.
Pulmonary & Critical Care Medicine
As a faculty member in the division of pulmonary, critical care and sleep medicine, I split my time among the medical intensive care unit (MICU), the outpatient pulmonary clinic and the inpatient pulmonary consult services at Buffalo General Medical Center (BGMC) and Roswell Park Cancer Institute. In the MICU we are responsible for the care of critically ill patients from within the Kaleida Health system and, as a tertiary care center, routinely accept transfers from surrounding hospitals. On pulmonary service, I am consulted for a wide range of disorders, including chronic obstructive pulmonary disease (COPD), asthma, pulmonary arterial hypertension, lung masses and interstitial lung disease. I also provide pre-operative assessments and ventilator management for our non-medical critical care services. Together with other faculty from the division, I oversee the training of residents, interns, medical students and pulmonary critical fellows who rotate through the MICU and pulmonary services. As a division, we are actively involved in didactic teaching sessions as well as day-to-day bedside teaching. In addition, I teach at UB’s School of Medicine and Biomedical Sciences and provide core lectures for students rotating through internal medicine at BGMC.
I was the first chief of gastroenterology at the Buffalo VA Medical Center, and I have been an attending physician and have cared for patients there for more than 30 years. I am also an attending physician at Erie County Medical Center (ECMC), and I see patients at UBMD Internal Medicine at Amherst as part of the UBMD practice plan. I am a board certified gastroenterologist, and my specialty interest in clinical care is treating patients with inflammatory bowel disease (IBD), specifically patients with Crohn’s disease and ulcerative colitis. I focus my practice exclusively on individuals with these disorders. My primary interest in IBD is treating the disease and understanding and treating its complications. I am also interested in identifying and understanding genetic predispositions to the disease, i.e., why the disease runs in some families, and why IBD may sometimes occur or get worse after a patient sustains an infection. I follow more than 100 patients with IBD, including many in families that have multiple generations affected by the disease. I take a holistic, multidisciplinary approach to the care of my IBD patients, and their welfare and recovery are my primary concern. In treating them, I work in close collaboration with surgeons and nutritionists whose skills and knowledge are frequently needed to help treat and support patients with IBD. I enjoy teaching medical students residents and gastroenterology fellows and contribute to the division’s teaching activities through several case studies that are used to demonstrate important principles in clinical gastroenterology and hepatology. I lecture extensively on IBD, its complications and its manifestations.
Adolescent Medicine; Children and Adults; Internal Medicine; Pediatrics
As a specialist in adult and pediatric care, I practice general primary care for both children and adults. I also provide specialized care for adolescents and young adults who have a wide range of health and psychosocial conditions and concerns, including eating disorders, gynecologic issues, sexual health concerns and complex chronic disease. My academic interests focus on adolescent resiliency, i.e., a teenager’s ability to overcome adversity. Those with more resiliency tend to cope better with chronic disease or negative experiences and are less likely to engage in risk-taking behaviors. I am particularly interested in the role resiliency plays in my patients’ quality of life in the face of their chronic health conditions. I am also interested in its role in preventing risk-taking behaviors—specifically, high-risk sexual behaviors that lead to teenage pregnancy. My resident research project focused on the relationship between resiliency and perceived quality of life in adolescent mothers, a research area that I continue to explore. My goal with these research foci is to develop ways to improve resiliency among adolescents in our community, through coursework in our high schools, perhaps, or through after-school programs. As a faculty member in internal medicine and pediatrics, I am involved in resident and medical student education. I teach evidence-based medicine and its clinical application, keeping current with journal articles and reviews, using data to modify my clinical practice, when indicated--and encouraging these practices in residents and medical students. I participate as well in introducing both first- and second-year medical students into the clinical setting via the Clinical Practice of Medicine (CPM) course they are required to take. Students come to my primary care office to shadow me and to practice their history-taking and physical-exam skills. I also lecture at the monthly medicine-pediatrics conferences; recent topics have included contraception and proteinuria in pediatric patients.
Cardiology; Cardiovascular Disease
As a general cardiologist, I care for patients with a spectrum of cardiovascular diseases, including acute and chronic manifestations of coronary artery disease, congestive heart failure, cardiomyopathies, valvular disorders, arrhythmias and aortic and pericardial diseases. I have expertise in the role of echocardiography and nuclear cardiac imaging for the evaluation of cardiac disorders, including transesophageal echocardiography (TEE), nuclear stress testing (myocardial perfusion imaging), viability imaging and multiple-gated acquisition scan (MUGA) studies for evaluation of cardiac function. I also perform stress testing, electrical cardioversions to manage arrhythmias and interpret electrocardiograms (EKGs). I care for inpatients in the critical care and cardiac monitoring units (telemetry) at the Buffalo General Medical Center (BGMC) and the Gates Vascular Institute (GVI), and I provide consultative services there as well. I continue to provide care for patients after they are discharged from the hospital, and I also provide outpatient consultations at the UBMD Internal Medicine office in Amherst. I care for patients with chronic cardiac conditions, evaluate patients with chest pain or shortness of breath and provide preventative cardiology services for patients with hypertension and hyperlipidemia. I am also part of a multidisciplinary team that cares for patients with sarcoidosis, an inflammatory condition that can affect the heart. My research interests are focused on clinical cardiac imaging. They include using single photon emission computed tomography (SPECT) to evaluate patients with mildly elevated biomarkers of cardiac injury and elucidate mechanisms of transient ischemic dilation of the left ventricle in patients without significant coronary artery disease. I also help supervise positron emission tomography (PET) studies at the UB Clinical and Translational Research Center (CTRC) in patients with ischemic heart disease, to better identify patients at risk of sudden cardiac death from ventricular arrhythmias. As program director for the fellowship in cardiovascular disease, I organize the fellowship didactic curriculum and case discussions. I mentor the fellows and coordinate their training to help them achieve their specific career goals, including their preparation for subspeciality training in interventional cardiology, electrophysiology, heart failure or advanced cardiac imaging. I also teach medical students and residents. I teach in the second-year medical student cardiovascular curriculum, and I coordinate and lead small-group case discussions for third- and fourth-year medical students. I also provide didactic teaching to residents.
I am the medical director of the hemodialysis program at Erie County Medical Center (ECMC). In this role, I am involved in all aspects of patient care, safety and quality. I also have an active outpatient practice and care for patients with chronic kidney disease (CKD), glomerulonephritis, hypertension, polycystic kidney disease, electrolyte abnormalities, anemia, secondary hyperparathyroidism and end-stage renal disease (ESRD). My clinical research is in two main areas: mechanisms of, and treatment options for anemia; and acid base disturbances in ESRD hemodialysis patients. In collaboration with UB’s Department of Pharmaceutical Sciences, I am involved in translational research investigating the mechanisms, risk factors and pathophysiology of erythropoietin dosing and resistance in ESRD patients. I am interested as well in understanding the development of metabolic alkalosis in patients with ESRD and the condition’s correlation to the risk of sudden cardiac death. I am conducting a clinical study investigating changes in bicarbonate levels post-hemodialysis using various concentrations of Fresenius’ Naturalyte bicarbonate/acetate dialysate and the effects on arrhythmias and cardiovascular hemodynamics. My involvement in clinical informatics includes serving as an adjunct faculty member and site program director for UB’s ACGME-accredited clinical informatics fellowship program. In this role, I provide medical leadership by assisting physicians in the delivery of patient care, medical education and research, and advancing clinical quality and safety initiatives through the use of clinical information systems. I am currently involved in projects studying methods to increase interoperability of electronic health records across hospital systems, optimizing dialysis-specific electronic health records and developing methods and procedures to reduce copying and pasting in medical documentation. I supervise nephrology fellows and internal medicine residents during their rotations in the inpatient nephrology consultation services at ECMC.
Internal Medicine; Pulmonary Disease; Infectious Disease
My area of expertise is in infectious diseases in adults and I evaluate and treat adults with all infections, without restriction to a special area, and see patients within the Veterans Affairs hospital system. I act as a consultant for other physicians treating patients who have, or are suspected to have, infectious diseases in hospital settings or outside the hospital. Prior to becoming an infectious disease specialist, I had training and work experience in surgery as well as internal medicine. This exposure has helped me in my current clinical practice since infections occur in patients after surgical procedures. Having a firsthand understanding of what surgeons do allows me to understand the patient’s overall situation better. I teach first- and second-year medical students, primarily in pulmonary, in small group sessions. My research is focused on bacterial infections in patients with chronic obstructive pulmonary disease (emphysema and chronic bronchitis, known also as COPD). I am especially interested in how the host (the human body) reacts to the pathogen (the bacteria), and how differences in the host determine the outcome of the encounter between host and pathogen. Recently, we found that airway epithelial cells from patients with COPD respond to pathogenic bacteria in a manner that is different from healthy, non-COPD people. My goal is to further characterize and understand the cellular mechanisms underlying this aberrant behavior in COPD. I expect this research to open new avenues of therapy specially tailored to intervene in the host-pathogen interaction. Students and fellows have the opportunity to conduct research with me. I collaborate with Sanjay Sethi, MD and Charles Berenson, MD from the department of medicine.
Pulmonary & Critical Care Medicine; Immunology; Membrane Transport (Ion Transport)
My clinical responsibilities include working as one of five Intensive Care Unit physicians at the Buffalo VA Medical Center (Buffalo VAMC). I also have a pulmonary medicine outpatient clinic at the UBMD multispecialty practice in Williamsville. My outpatient clinic accepts all patients, with a focus on interstitial lung disease (associated with collagen vascular disorders such as systemic lupus erythematousus [SLE]), scleroderma, rheumatoid arthritis, Sarcoidosis, the idiopathic pulmonary pneumonitis syndromes (IPF/UIP) and advanced chronic obstructive pulmonary disease (COPD). We are one of the founding sites of the Greater New York Sarcoidosis Consortium and work closely with our neurology colleagues in managing patients with respiratory complications of neuromuscular disorders such as ALS, Duchenne‘s Muscular Dystrophy and others. I focus my research on understanding the impaired immune response to infection that occurs in patients with COPD. This impaired immune response leads to more frequent disease exacerbations and more rapid disease progression. My lab has optimized a noninvasive macrophage model (monocyte-derived macrophage) to study how to restore the immune function of alveolar macrophages in patients with COPD. Using this model, we study cell surface receptor expression, cytokine responses and intracellular signaling using flow cytometry, bead arrays and molecular biology techniques. My research team collaborates with Dr. Sanjay Sethi and other researchers in the areas of pulmonary, sleep medicine, critical care, infectious disease and microbiology. Undergraduates, medical students, residents and fellows are welcome in my lab. I am committed to teaching the next generation of physicians. I teach medical students in years two through four; in addition, I teach the residents and the pulmonary and critical care medicine fellowship trainees who rotate with me on the inpatient and outpatient services. I also teach the internal medicine and anesthesia residents and provide grand rounds lectures for the Buffalo VAMC, Buffalo General Medical Center and Erie County Medical Center. I serve on the Resident Clinical Competency Committee and as a formal resident advisor, shepherding my mentees through residency and helping them launch their professional careers. My door is always open to any trainee at any level.
I am a physician board-certified in internal medicine and medical oncology. I care exclusively for adult patients diagnosed with acute leukemias, myelodysplastic syndromes, chronic myeloid leukemia, chronic myeloproliferative disorders and other bone marrow disorders. I care for people diagnosed with these illnesses who are hospitalized at Roswell Park Cancer Institute or who come to the leukemia service at Roswell Park for outpatient care. I have an active translational research program. My research interest is focused on understanding more about the role of the immune microenvironment in facilitating persistent disease in acute myeloid leukemia. My goal is also to develop novel immunotherapeutic strategies for this disease. I invite interested students to my lab to collaborate with me in conducting research. I am responsible for supervising, teaching and mentoring medical students, internal medicine residents and hematology/oncology fellows at Roswell Park. I lecture to the hematology/oncology fellows as part of their curriculum and to residents rotating on the leukemia service. My focus during these lectures is mainly myeloid malignancies. I also teach and train at the bedside with the fellows, residents and students who are on service with me, and I teach and train in clinic settings as well. Given my expertise, I am able to provide trainees with comprehensive knowledge about how to render the best possible care for individuals diagnosed with bone marrow disorders, a medically complex patient population.
Over the past 30 years, my outpatient focus has been the care and management of patients with complex glomerular and autoimmune diseases. I serve as attending physician on the renal consult services for UBMD Nephrology at Buffalo General Medical Center, Roswell Park Cancer Institute and Erie County Medical Center (ECMC). I am also an attending physician on the inpatient Medicine A (General Medicine) and D (Renal Medicine) services at ECMC. My research concentrates on understanding mechanisms that underlie kidney disease, including the role of the complement system, a major factor in the body‘s immune response. My lab has developed and studied animal models of systemic lupus erythematosus, diabetic nephropathy, glomerulonephritis, obstructive nephropathy and acute renal failure. In addition to modeling disease in animals, we also have performed clinical studies both for promising new therapies and for those that focus on examining gene profiles from diseased renal tissue. To answer questions that arise in the course of our research, our work spans a number of disciplines and utilizes state-of-the-art approaches such as mouse kidney transplantation, 15-color flow cytometry and magnetic resonance imaging. My original degree is in mathematics, which remains a passion of mine. I also am interested in computational biology and founded the Computation Biology Core Facility at the University of Chicago. The core strength and emphasis of UB in the area of clinical informatics was a key factor in my decision to accept a position here so that I can continue to contribute to projects related to this field. In collaboration with leadership from other disciplines at UB, I helped establish one of the first clinical informatics fellowship programs in the United States. As a result, we accepted in 2014 the first joint nephrology/clinical informatics trainee in the country. As an educator, I am committed to the career development of the students, trainees and faculty working with me in my lab, in clinical research areas, in clinical informatics and in the clinical arena. Over the course of my career, I have mentored many outstanding students, fellows and faculty. Under my leadership and guidance, a number have received nationally competitive awards, and many have gone on to become academic leaders--including one who became a medical school dean. I serve on the Kidney, Urologic and Hematologic Diseases Subcommittee of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which critically evaluates training in nephrology. Through this commitment, I help ensure continued quality improvement in nephrology training, both nationally and at UB.
Addictions; Public Health and General Preventive Medicine; Behavioral Medicine
I was trained as an experimental social psychologist but my research has involved the use of multiple methodologies including laboratory studies, longitudinal survey studies, and daily diary studies. My primary research interests are in the area of behavioral health, in particular (1) the relationship of substance use and misuse to aggression, relationship conflict, and social functioning and (2) psychological and social variables that influence quality of life among people with chronic medical disorders (IBS, cardiac arrhythmia etc).
I am a fellowship-trained health psychologist and director of the Pilot Studies Program in the Division of Behavioral Medicine at the University at Buffalo. My program develops and tests self-management programs for persistent pain disorders. I also develop and refine treatment manuals designed to help clinicians test and disseminate standardized interventions in order to consistently administer effective treatments. My research goals are twofold: to better understand the predictors of treatment response, including co-morbid psychiatric disorders, personality variables, coping strategies, social environment, family factors; and to eventually identify the neurobiological underpinnings of treatment response to clarify how cognitive behavioral therapy CBT exerts its effects. In addition to my clinical research program, I have more than 10 years of clinical experience assessing and treating patients struggling with chronic pain. I provide clinical care through UBMD internal medicine at the UB Behavioral Medicine Clinic. My practice provides behavioral treatments for medical patients with chronic illnesses ranging from traumatic brain injury, migraines, low back pain and multiple sclerosis to irritable bowel syndrome. I believe that the goal of behavioral counseling for chronic pain is less about lowering pain levels on a scale and more about helping patients develop strategies and skills that improve their quality of life. This process varies for every patient, but most often involves patients becoming involved in goal-directed activities with family, friends, recreational activities, and hobbies. For many patients, the goal is to reduce dependence on medications by learning more adaptive self-management skills.
I care for patients with a variety of renal diseases, including acute kidney injury, chronic kidney disease, and end-stage renal disease, that require renal replacement therapy and renal transplantation. My clinical interests include various glomerular diseases, hereditary kidney diseases, renal stone and various electrolyte and acid-base disorders. I also have a passion for taking care of patients with resistant hypertension and secondary hypertension, with a focus on renovascular hypertension. My clinical responsibilities are exclusively at the Buffalo VA Medical Center (Buffalo VAMC) where I take care of both outpatient and inpatient renal patients. The Buffalo VAMC is the medical destination for veterans in Western New York in need of renal services, including patients from Batavia, Rochester, Canandaigua and Bath, NY and Erie, PA. I see outpatients in the renal clinic and dialysis unit at the Buffalo VAMC and serve as the director of the renal clinic. I also provide electronic consultation to primary care physicians who need specialized counsel in managing the care of patients with renal conditions. I am involved in pretransplant testing, screening and consultation for prospective transplant recipients. I participate in pharmacy-sponsored clinical trials studying the efficacy of various drugs in kidney diseases. One of the multicenter studies for which I am the primary investigator is looking at the effects of canagliflozin. The goal is to assess whether canagliflozin has a renal and vascular protective effect in reducing the progression of renal impairment in patients with Type 2 diabetes mellitus. I also am the co-investigator studying the use of darbopetin alpha, a long-acting erythropetin stimulating agent, to avoid blood transfusion and its associated risks in patients with chronic kidney disease. As the resident program director of the Nephrology Fellowship Program at the Buffalo VAMC, I am responsible for supervising and providing guidance to the fellows in renal medicine when they are rotating at the medical center. I am also actively involved in lectures and small group sessions of the nephrology module for first-year medical students. I also participate in educating and training medical students, residents and renal fellows during their inpatient nephrology rotations.
Gene therapy; Genomics and proteomics; Immunology; Infectious Disease; Neurobiology; Neuropharmacology; Viral Pathogenesis; Virology
As a postdoctoral fellowship in the Division of Allergy, Immunology & Rheumatology at University at Buffalo I received a NIDA funded National Research Service Award (NRSA) F32 to study the mechanisms of cocaine-induced HIV-1 infection in astrocytes. This was a two year fellowship award ($99,224). I received several Young Investigator Travel Awards to attend and present my research at national conferences including the Society for NeuroImmune Pharmacology, the College on Problems of Drug Dependence and the International Society for NeuroVirology. I was the first to demonstrate that cocaine enhances the replication of HIV in astrocytes, specialized glial cells in the central nervous system. During this time I was first author on 3 publications and contributed as a co-author on 6 publications in internationally recognized, peer reviewed journals including the Journal of Immunology, Brain Research and Biochimica et Biophysica Acta. As a Research Assistant Professor in the Division of Immunology I was funded through a NIDA Mentored Research Scientist Development Award (K01) award to investigate targeted nanoparticles for gene silencing in the context of HIV and drug abuse. This K01, was a five year award, $785000 that allowed for advanced training in nanotechnology and immunology. I applied this new expertise in nanotechnology to the development of innovative methods to control HIV-1 infections, particularly those associated with methamphetamine abuse. I was an invited panel speaker at the International Symposium on NeuroVirology and the American College of Neuropsychopharmacology. During this time, I published approximately 30 peer-reviewed publications in internationally recognized, peer-reviewed journals, including journals such as the Journal of Immunology, Brain Research, and the Journal of Pharmacology Experimental Therapeutics. Six as first author, 1 as senior author and 23 as a co-author. Presently, I am a Associate Professor and Proposal Development Officer in the Department of Medicine at University at Buffalo where I continue to develop my research in drug delivery methods. I am currently investigating exosomes as potential delivery vehicles. Exosomes are one of several types of membrane vesicles known to be secreted by cells including microvesicles, apoptotic bodies, or exosome-like vesicles. Exosomes, unlike synthetic nanoparticles, are released from host cells and have the potential to be novel nanoparticle therapeutic carriers I have recently been invited to be a panel speaker at the American Society of Nanomedicine and the American Society of Gene & Cell Therapy conferences. I have been a principal investigator and co-instigator on NIH funded projects studying multimodal nanoparticles for targeted drug delivery and immunotherapy in Tuberculosis and HIV and a co-investigator on a NYS Empire Clinical Research Investigator Program (ECRIP) to develop a Center for Nanomedicine at UB and Kaleida Health. I have had over eight years of NIH supported funding.
I am a board-certified gastroenterologist with deep clinical experience. Having been a leader in interventional endoscopy in the gulf region in the U.S. for nearly a decade, I now care for patients at Buffalo General Medical Center (BGMC), Roswell Park Cancer Institute (RPCI) and Erie County Medical Center (ECMC). I also care for patients at the UBMD Internal Medicine office at 1020 Youngs Rd. in Amherst. Patient-focused care is a hallmark of my medical practice; I often collaborate with other gastroenterologists and primary care physicians to help ensure the best possible coordinated care for my patients. I have advanced training in therapeutic endoscopic procedures, and I have vast experience in all aspects of therapeutic endoscopy. This includes endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasounds (EUS), endoscopic mucosal resection (EMR), radio frequency ablation (RFA), cryoablation, balloon-assisted ERCP in postsurgical anatomy, cholangioscopy, biliary and pancreatic EUS rendezvous, post-liver-transplant ERCP in deceased and live-donor anatomy and minimally invasive hybrid endoscopic surgery. My research interests span the field of interventional endoscopy, with a special focus on genetic and environmental risk factors of pancreas disease as well as interventional endoscopic ultrasound (EUS). I am active in training and mentoring the next generation of physicians. I believe it’s critical that trainees understand the disease process. I encourage them to question the intricacies of each case in order to foster their knowledge and growth as clinicians. I believe that expecting trainees to conceptualize each case in this manner is more valuable than simply memorizing the data. When approaching disease from this perspective, novel questions inherently arise and this, in turn, drives research questions that will fill a void in the extant literature. I teach from the perspective that while I am an expert in this field, I continue to be a student, following the literature and incorporating best practices as they arise.
Infectious Disease; Infectious Disease; Microbial Pathogenesis
I am an expert in infectious diseases, and I care for hospitalized patients at the Buffalo VA Medical Center (Buffalo VAMC). I have an active, nationally funded translational research program. My research focuses on Gram-negative bacilli (GNB), including Escherichia coli, Acinetobacter baumannii and a new hypervirulent variant of Klebsiella pneumoniae. These GNB cause infection in nearly every nonintestinal site in the body. The hypervirulent variant of K. pneumoniae is both fascinating and worrisome. Unlike its predecessors, it is capable of causing infection in young, healthy hosts and spreading nearly anywhere in the body from the initial infected site, including the eyes and brain. GNB-caused infections result in the loss of billions of health care dollars, millions of work days and hundreds of thousands of lives each year. GNB are becoming increasingly resistant to antibiotics, including strains that have become resistant to all available antibiotics. Unfortunately, there are virtually no new antimicrobial agents active against highly resistant GNB in the pharmaceutical “pipeline.” To address this formidable clinical challenge, my collaborators and I have increased our understanding of the bacterial factors that are critical for these GNB to cause infection. We use this information to develop vaccines that will prevent infection and antibodies that can be used to treat infection. My UB collaborators include Dr. Campagnari (microbiology), Dr. Gulick (structural biology) and Drs. Elkin and Zola (biomedical informatics). My research also involves identifying potential bacterial drug targets; this information will be used to develop new classes of antibiotics. I intermittently have students in my lab, and I participate in a grant designed to encourage medical students to become physician-scientists. I welcome interested students to contact me about conducting research with me. The Buffalo VAMC is the site of my clinical teaching. I teach first- and second-year medical students in lecture settings and small group sessions, including courses in lung respiration, musculoskeletal, renal and microbiology-immunology. Residents attend my grand rounds; I also teach fellows in all aspects of their training and mentor those who perform their research projects in my lab.
I am a PhD exercise physiologist with expertise in kinesiology, quantitative research methods, and translational research with the aim of promoting successful aging. My research program is focused developing innovative and effective methods of translating non-invasive therapies to improve cognitive and motor function among older adults in under-served, minority communities. Through an ongoing partnership with a local community organization dedicated to supporting older adults, I have developed and am disseminating a dual-task ("thinking while moving") physical activity-based intervention for older adults managing mild cognitive impairment. I am interested in examining not only the most effective lifestyle and behavior-based therapies to improve cognitive and motor function, but also methods by which to deliver these novel therapies into community settings with unique strengths and challenges. Acquiring a more complete understanding of our older adult community members' perspectives surrounding the appeal and usability of proposed therapeutic strategies is central to my work. I am also a co-investigator on a Veterans Affairs Small Projects in Rehabilitation Research (SPiRE) grant to study the impact of high intensity interval exercise training (HIIT) on physical performance, muscle strength and quality, frailty, and muscle blood flow among older adult veterans. This important work will help to inform future, larger-scale intervention strategies that employ HIIT to promote successful aging in various clinical contexts. In addition, through an ongoing collaboration with the Health Foundation for Western and Central New York I am Project Director on a mixed methods assessment focused on better understand primary care providers‘ perspectives, attitudes, and practices regarding screening for fall risk and depression among older patients. The results of our assessment are directly informing development of novel community and primary-care based intervention programs in the Western and Central New York region. Over the past 4 years I have worked extensively in medical education, striving to improve the research training that primary care providers receive at ever level of their medical education. I work closely with medical students, residents, and faculty members in primary care to inspire the physician-scientist to embrace evidence-based medicine, develop their critical thinking skills, and apply rigor to their practice.
Infectious Disease; Oncology
I care for hospitalized patients and outpatients at Roswell Park Cancer Institute (RPCI), where I am head of Infectious Diseases. My area of clinical expertise relates to infections in patients with cancer and stem cell transplant recipients, and I have served on several national panels that establish guidelines for preventing, diagnosing, and managing infections in these patients. I also have a specific interest in patients with primary phagocytic disorders (e.g., chronic granulomatous disease). RPCI is the site of my clinical teaching. I also teach medical students in lecture settings and in small group sessions in their first and second years, including courses in lung pathophysiology and microbiology-immunology. We intermittently have students in our lab and participate in a grant designed to encourage medical students to become physician-scientists. I mentor residents in their clinical training and in research. I also teach fellows in all aspects of their training and mentor those who perform their research projects in my lab. I have an active, nationally funded translational research program. The major focus of our lab is studying NADPH oxidase as a critical regulator of inflammation and host defense. NADPH oxidase is an emergency host defense pathway that is rapidly activated in response to certain microbial products, and converts molecular oxygen to superoxide anion and downstream reactive oxidant intermediates (ROIs). Chronic granulomatous disease is an inherited disorder of the NADPH oxidase characterized by severe bacterial and fungal infections (e.g., invasive aspergillosis) and by excessive inflammation. In addition to its critical host defense role, our lab, in collaboration with colleagues, found that NADPH oxidase also functions to restrain inflammation by modulating redox-sensitive innate immune pathways. NADPH oxidase also affects T-cell responses, including the balance between Tn17 and regulatory T-cells. We have an NIH grant to further elucidate mechanisms by which NADPH oxidase regulates inflammation. We believe that our work has broad relevance to human diseases associated with inflammation, such as inflammation-induced injury and tumor immunology. Indeed, several of the pathways that NADPH oxidase regulates are important in tumorigenesis and the tumor microenvironment (e.g., NF-kB, Nrf2, IL-17, Tregs), and are potential therapeutic targets. In collaboration with colleagues, we are examining how NADPH oxidase influences tumor immunity.
Geriatric Medicine; Nutrition; Bioinformatics; Gene Expression; Molecular and Cellular Biology; Molecular genetics; Protein Folding; Protein Function and Structure; RNA; Regulation of metabolism; Stem Cells; Vitamins and Trace Nutrient
Infectious Disease; Infectious Disease
My primary patient care activites involve hospitalized patients at the Department of Veterans Affairs Medical Center (VA) in Buffalo. I also have an outpatient clinic at UB’s Student Health Center on the South Campus where I see students for general ambulatory infectious diseases such as skin infections, positive tuberculosis skin tests, etc. I also see students before they travel internationally for care such as immunizations and risk avoidance education and, if needed, for post-travel care and follow-up. I teach first- and second-year medical students in lectures and small group sessions, primarily in the microbiology, respiration, musculoskeletal and reproductive modules. I also teach third- and fourth-year medical students, residents, and fellows on the infectious diseases and internal medicine services at the VA. In addition to patient care and teaching, I have significant roles related to infection prevention and antimicrobial stewardship at two of Buffalo’s major health care systems, and I serve as Hospital Epidemiologist for both. My work includes pandemic and bioterrorism planning activities for these hospital systems as well as the University at Buffalo. These responsibilities require that I collaborate with hospital infection control teams, pharmacists, microbiologists and administrators (particularly the offices of quality management, risk management and patient safety) and with UB’s Student Affairs team. I also interact frequently with local health department staff. Our infection control efforts have been based on the epidemiologic paradigm of hypothesis development, data collection and critical interpretation of the data followed by a rational and directed action plan. This is done for routine infection prevention, outbreak and cluster investigation, healthcare worker safety and antimicrobial stewardship.
Pulmonary & Critical Care Medicine
As chief of the division of pulmonary, critical care and sleep medicine, I oversee clinical, teaching, research and administrative tasks related to the evaluation and treatment of adult patients with lung diseases and sleep disorders as well as critically ill patients. My outpatient practice is at UBMD Internal Medicine clinics at Conventus in the Downtown Medical Campus and at Youngs road in Amherst. My inpatient practice is primarily located at the VA Medical Center (VA) in Buffalo. Members of my division provide care at sites throughout Buffalo, including the UBMD clinics, UBMD Sleep Center and other UB-affiliated hospitals. I also conduct research on one of the most common lung diseases: chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, and lung infections such as bronchitis and pneumonia. Interestingly, patients with COPD become more prone to lung infection, and understanding why and how this happens is my main research interest. In addition to bench research in this field, I am also working to develop better ways to prevent and treat these infections by leading and participating in several clinical research studies in this field that are open to both veterans and the general public. I lead a multidisciplinary research team based at UB and the VA that includes pulmonary and infectious disease physicians, post-doctoral scientists, nurse coordinators and research assistants. Through mentored research programs, our laboratories train undergraduate and graduate students, residents and fellows. I am active in several professional organizations and have served as a consultant on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.
Endocrinology, Diabetes and Metabolism
I am a board-certified endocrinologist with a special interest in diabetes and thyroid- and cancer-associated endocrinological issues. My clinical expertise is in diabetes, thyroid nodules and the endocrine side effects of cancer drugs. I work in tandem with a team of nurses, certified diabetes educators (CDEs) and physicians to provide the best possible care to my endocrine patients. I see patients at UBMD Internal Medicine at the Conventus Center for Collaborative Medicine located on Main St. in Buffalo. I have a simple approach toward my patients: I want them to see me as a true friend for whom their health is a top priority. I get to know my patients by asking about their hobbies, travel plans and daily chores. I avoid medical terminologies so that we can communicate without confusion and develop as equal partners in their care. I believe that the relationships I develop with my patients, along with aggressive care, help prevent long-term complications and facilitate excellent diabetes-related outcomes--in many instances avoiding amputations or stopping diabetes from progressing to chronic kidney disease (CKD). My current research interests include checkpoint inhibitors (as a new cancer therapy), related endocrine dysfunction and the methods to recognize and manage these toxicities. I encourage residents and fellows to work with me on small research projects and present them at national meetings. I teach medical students and residents on topics related to endocrine issues in adult patients. I also lecture to residents and fellows on diabetes, thyroid disorders and endocrine-related cancers. I emphasize with all my trainees that patients benefit maximally if health care professionals work as a team: team work minimizes errors, and it also elicits new ideas.
Cardiology; Cardiovascular Disease; Internal Medicine; Radiology; Cardiopulmonary physiology; Autoimmunity; Cardiac pharmacology; Gene Expression; Immunology; Stem Cells
I am a cardiologist with specialized training in advanced cardiac imaging. I see outpatients at the Heart and Lung Center of Buffalo General Medicine Center (BGMC), and I care for inpatients through the cardiology consult and inpatient services at BGMC. As an advanced imaging cardiologist, I am responsible for developing and advancing the cardiac computed tomography (CT) and magnetic resonance imaging (MRI) programs at the Gates Vascular Institute (GVI) and providing these services to patients. These advanced, noninvasive imaging techniques allow physicians to perform in-depth, 3-D evaluation of the coronary tree, myocardium, heart valves, pericardium and great vessels. These imaging tools allow for the best possible diagnoses and care of patients. My research spans basic science, translational and clinical fields and combines the cross-discipline expertise on magnetic resonance (MR) technology with molecular biology. My overall goal is to study the consequences of ischemia-induced myocardial injury, with a focus on their therapeutic reversal. My research laboratory at UB’s Clinical and Translational Research Center (CTRC) is devoted to the development of novel time-and-tissue-targeted MRI methods for integrative understanding of cardiovascular pathophysiology in preclinical models. We have several interesting research projects, e.g., we have recently discovered that the presence of high-risk plaques in the carotid arteries predict future incidence of myocardial infarction and stroke. The results emphasize that the nature of atherosclerosis and the use of comprehensive non-invasive computed tomography angiography (CTA) will help identify patients who are at higher risk of developing ischemic stroke. These research results will help physicians employ early therapeutic strategies for these high-risk patients. I mentor medical students, residents and fellows both in clinical and research settings, and I precept cardiology fellows at the Heart and Lung Center at BGMC. In addition, I am deeply engaged in furthering the research and clinical education of our house staff. Our trainees have published their research in highly esteemed peer-reviewed journals, and many have routinely presented their work at national and international scientific conferences. I am committed to facilitating the career goals of my mentees while I continue to advance my own career as a clinician, researcher and mentor.
Infectious Disease; Internal Medicine - General
I provide infectious diseases consultations for hospitalized patients at the Erie County Medical Center (ECMC). In addition to my inpatient duties, I care for HIV infected patients at the Evergreen Health. HIV infection has become a chronic illness with antiretroviral therapy, and patients with HIV need primary care as well as HIV care. The Evergreen Health offers comprehensive care to these patients and gives me the opportunity to practice primary care for HIV infected patients in addition to my infectious disease practice. I also participate in antiretroviral therapy clinical trials. These studies are crucial in evaluating the effectiveness and safety of new medications and new combination regimens. Patients are screened for eligibility for ongoing trials during their visit, and eligible candidates are enrolled. I enjoy teaching medical students, residents, and fellows, supervising them on crucial skills in infectious diseases: recognizing important physical findings, developing differential diagnosis and selecting appropriate antibiotic treatment. I feel fortunate to be part of their medical training.
I am Clinical Faculty in the Division of General Internal Medicine. I see patients and supervise residents in Internal Medicine and medical students at the Primary Medicine Center at Buffalo General Hospital. I am interested in scholarship relating to medical education, quality of care, and helping patients adopt healthy behaviors.
Gastroenterology; Liver (Hepatology); Infectious Disease
I am a leading expert in liver disease. My work through UBMD at Erie County Medical Center’s liver clinic has tripled the clinic’s capacity to treat patients with viral hepatitis and other forms of liver disease. Colleagues and I also have established comprehensive liver clinics at Buffalo General Medical Center to evaluate patients with liver disease referred from throughout Western New York. In addition, we provide clinical support to the Buffalo VA Medical Center in order to deliver uniformly excellent clinical care to patients with liver disease cared for at hospitals and clinics affiliated with UB’s medical school. We offer trial therapies to patients with viral hepatitis and other forms of liver disease if they meet the protocol criteria of our clinical trials. Our patient-care efforts include digital outreach: my colleagues and I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” My lab has received multi-year funding for its research programs in translational and clinical research. During the course of our translational research, members of my lab and I developed techniques for animal and human liver sampling that will enable sorting of liver cells in order to understand drug distribution in the liver during treatment and to develop ways to measure liver drug concentration. These translational research techniques will enable physicians to base drug dosing on the data gathered from the site of antiviral action in the liver instead of measuring the plasma concentration that is more reflective of systemic exposure. This may be an important breakthrough because of the fine line between drug efficacy and toxicity: the techniques will help physicians pinpoint the precise amount of drug needed for maximum benefit to the patient. In the area of clinical research, we are studying care models for viral hepatitis. We are conducting a study sponsored by the Centers for Disease Control and Prevention (CDC) Foundation to assess telemedicine to treat hepatitis C (HCV) in patients who are in treatment for substance use. By creating processes that simplify testing and improve provider and patient awareness and by expanding recommendations for HCV screening, patients can receive more timely care and treatment. I teach GI fellows, residents and students in outpatient and inpatient settings. I also teach first- and second-year medical students in small groups and research seminars with pharmacology graduate students. I am very interested in mentoring, and I supervise residents and fellows in clinical research as well as in my laboratory. The enriching experience my trainees receive affords them excellent placement opportunities once their training is complete. A number of my former trainees so valued their work with my lab that they joined our division as faculty members.
As one of the few sleep physicians certified in behavioral sleep medicine (CBSM) in New York State, I am engaged in the full-time practice of sleep medicine. I have clinics in the main UBMD Sleep Center as well as satellite facilities. While sleep apnea is the most common issue of our patients, we evaluate a broad range of sleep disturbances in our UB affiliated clinics. Cognitive Behavioral Therapy for insomnia (CBT-I) methods are used in our insomnia practice. Having been instrumental in establishing the sleep fellowship program remains a source of great satisfaction, and besides patient care, the most rewarding aspect of my professional life is mentoring fellows in sleep medicine. In my dual roles as the chief of sleep medicine and the sleep medicine fellowship director, I understand the challenges and opportunities that face this growing, multidisciplinary field. We strive to ensure that all dimensions of the sleep program are vibrant and that the breadth of clinical and research experience is available to our sleep fellows. In addition to mentoring fellows in a clinical setting, I devote time to providing instruction in the proper evaluation and interpretation of diagnostic sleep testing. In conjunction with the fellows, I assist with the coordination of monthly sleep medicine grand rounds and selection of cases to present to the faculty. I organize these conferences to highlight sleep medicine’s multidisciplinary nature. Discussion topics vary; recent conferences have included the dental aspects of sleep medicine and the unique needs of pediatric patients with sleep disorders, for example. We have also featured presentations by faculty with pulmonary expertise on sleep apnea and on the neurological aspects of the discipline, such as the cause of neurochemical sleep mechanisms. The carefully selected discussion topics attract faculty, fellows, residents and advanced students from UB’s schools of nursing, dentistry and medicine to take part. I also teach elective classes for both medical students and residents who demonstrate an early interest in this growing and rapidly evolving discipline.
Allergy and Immunology; Oncology
-Studies in this laboratory have established that trophoblast cells have developed two novel mechanisms of silencing MHC class II genes: an upstream negative-regulatory element controlled by two trophoblast specific DNA binding proteins, and repression of transcription of the class II transactivator (CIITA). Recently, some human tumor cells have been shown to have a trophoblast phenotype, in that CIITA and class II are not inducible with g-IFN or other cytokines. In collaboration with A. Latif Kazim and Carleton Stewart, RPCI, we have shown that tumor cell lines that are not responsive to g-IFN despite an intact g-IFN receptor and Jak-Stat signaling pathway, can be induced to express mRNA and cell surface class II with agents that acetylate histones and remodel chromatin structure. Unexpectedly, we found that class II induction by inhibitors of histone deacetylase occurred in the apparent absence of transcription of CIITA. Recent studies with mutant cell lines defective in established class II regulatory genes suggest the existence of a pathway independent of CIITA, the presumed master regulator of MHC class II. During these experiments, we also showed that the expression of two other molecules of immunological importance MHC class I and CD40 also were activated by histone deace-tylase inhibitors. Dr. William Magner has joined my laboratory recently and, together with Dr. Elizabeth Repasky, we extended these studies to different mouse tumor cell lines, and demonstrated by flow analysis the induction of MHC class I and II genes as well as the costimulator molecule CD40. We are exploring the spectrum of antigens expressed on tumor cells treated with histone deacetylase inhibitors including TGF-b receptors and tumor associated antigens. We are determining whether treated tumor cells administered in vivo show enhanced immunity and decreased tumorigenicity to subsequent challenge with wild type cells. In this regard, as first shown by Ostrand-Rosenberg, et al., mouse sarcoma I cells, when transfected with MHC class II, produce solid and long-lasting immunity to inoculation with wild type cells. Thus, these findings have significance in tumor escape mechanisms and the development of vaccines. We have explored the possibility that repressors of CIITA transcription exist in trophoblast and tumor cells, thus inhibiting class II expression and its induction by g-IFN. TGF-b1 and IL-10 are produced by all of the tumor cell lines we examined that were deficient in class II expression. Since these cytokines repress class II transcription by inhibiting CIITA transcription, the possibility of autocrine inhibition is suggested. The mechanisms of TGF-b repression may involve recruitment of deacetylase enzymes to the class II promoter site by CREB-CBP-CIITA complexes. This possibility will be explored using chromatin immunoprecipitation techniques. Studies have been initiated on the role of transcriptional cofactors with histone acetyltransferase activity, as well as the role of ATP-dependent multiprotein chromatin remodeling complexes in regulating MHC gene expression. Our work also has demonstrated that TGF-b can bind to receptors on dendritic cells and inhibit antigen presentation. Moreover, serum TGF-b1 levels are elevated in AIDS and DC cells derived from the blood of HIV patients who have high levels of cell surface TGF-b1. Treatment with anti-TGF-b, or anti-type III TGF-b receptor antibodies, or the addition of GM-CSF reverses the defect in antigen presentation in AIDS-PBL in vitro. Prelimin-ary clinical studies in patients with advanced AIDS, in collaboration with the Department of Medicine, have shown that GM-CSF reverses the antigen presentation defect and significantly raises CD4 cell numbers in many, but not all, AIDS patients. To test the hypothesis frequently quoted in the literature that aberrant expression of class II antigens on fetal trophoblast cells is responsible for most spontaneous abortions, transgenic animals are being prepared that will express class II on placental trophoblast cells at a specific time during gestation. We have cloned 300 bp of the proximal promoter of a trophoblast specific gene, 4311, and placed this in an expression plasmid upstream of the full-length CIITA gene. This construct was shown to be active when transfected into freshly isolated mouse spongiotrophoblast cells. Thus, mice bearing this transgene should begin to transcribe CIITA at day 6 of gestation when the 4311 gene is first expressed. If the hypothesis is correct, then MHC class II should be expressed by day 7-8, and abortion would occur. A dominant negative of CIITA has been produced by deletion of part of the activation domain of CIITA, and this could potentially be expressed in trophoblast cells of strains with high abortion rates. If as postulated by others, fetal loss in these abortogenic strains is due to aberrant expression of CIITA and subsequently class II, the dominant negative should inhibit abortions in these mice.
As an assistant professor and licensed psychologist in the Department of Medicine, Division of Behavioral Medicine at the University at Buffalo, my work involves a combination of patient care, research, and outreach and education. I am a fellowship trained health psychologist specializing in chronic pain, my patient care focuses on utilizing psychosocial interventions to help patients better manage pain and improve their quality of life. Through this treatment, patients learn a variety of skills and tools to approach managing pain from a biopsychosocial perspective. While many of the skills and tools are similar across patients, each is applied in an individualized manner to help patients achieve their treatment goals. Another facet of my work involves research to better understand the biobehavioral development and treatment of chronic pain. My research explores psychosocial factors associated with chronic pain and opioid risk, how to effectively educate medical students on chronic pain and physician-patient communication skills, and the efficacy of a community-based chronic pain self-management program. These topics allow me to generate a deeper understanding of chronic pain, while also improving patient care and guiding emerging providers in making pain management decisions for their patients. Lastly, it is important to me to disseminate research through education and outreach. As such, I work within the community to assist healthcare professionals in better understanding and treating the psychosocial aspects of chronic pain and other conditions. Additionally, I am passionate about improving medical education on the biopsychosocial treatment of chronic pain, and have developed curriculum to address this need. I have presented at regional, national, and international conferences on the topics of chronic pain and overlapping opioid use/abuse, and will continue to work toward providing affordable and accessible evidence-based treatment for patients with chronic pain.
Internal Medicine; Nephrology; Renal Transplantation
My main goal is extending and improving native kidney and renal transplant function. Over the last 15 years, I have focused my efforts on transplant renal management and acute kidney injury. I completed my nephrology and transplant training at Harvard in Massachusetts, and have been part of a busy group at The Ohio State University Transplant Center for the last 13 years as an attending and clinical researcher. I recently assumed the Medical Director of Transplant and Renal Services as part of the Erie County Medical Center/University at Buffalo, NY. Hot areas of clinical research concentrate on antibody-mediated rejection, new immune suppression and recurrent diseases post kidney transplant, and prevention and management of acute kidney injury and delayed transplant renal function. Through studies of immune suppression effects and impact on renal function and disease recurrence, we are hoping to improve early graft function and prevent disease recurrence. I have also been participating in novel pharmaceutical studies for management of transplant related injury and infections as well as artificial organ devices for bridge therapies including stem cells and pre-determined precursor kidney cells. My original PhD studies were in Neuroscience, at the University of Maryland Medical System, where I worked on growth factors for central nervous system (brain and spine) regeneration. Unfortunately, CNS injury repair continues to be under developed. The immune system plays a crucial role in the normal competition between true tissue repair and scarring. This recognition and the large population with renal diseases and transplant led me to transition in to kidney diseases and injury repair and transplant. While treatment and recovery from stroke have languished, chronic kidney disease and dialysis therapy have blossomed during the last 50 years, and renal transplant has become the gold standard for renal replacement therapy and live kidney donation has the best results. My research experience and publications span the fields of renal disease, transplant, and recovery. I contribute to national and international transplant meetings and educational efforts in transplant and nephrology in the American Society for Transplantation and the American Society of Nephrology for the development of new therapies and policies for better renal outcomes. Promoting renal transplant through education, clinical research and outreach are prime targets for transplant success. As an educator, I support nephrology and immunology lectures and conferences in medical school, graduate students and specialty fellowship training; working to develop the leaders of tomorrow in this field. Volunteerism and philanthropy are also important, passionate causes in raising awareness and funding for clinical studies, patient support and organ donation.
My clinical responsibilities include caring for patients coping with a wide variety of renal diseases, including but not limited to acute kidney injury (AKI), chronic kidney disease (CKD), glomerulonephritis and polycystic kidney disease. I also manage the care of patients who have resistant hypertension. I see patients at the bedside in Buffalo General Medical Center (BGMC) and in BGMC’s renal clinics. My research focuses on finding modifiable factors to reverse or halt the progression of CKD, through modifying the contents of gut bacteria (microbiota) and studying their correlation to disease states. Studies have demonstrated that gut microbiota can influence numerous aspects of human biology, and alterations in their function and composition (dysbiosis) suggest they play a role in the pathogenesis of diverse human illnesses such as chronic inflammation, diabetes mellitus, obesity, cardiovascular diseases and recently, CKD. I use both human and animal studies to explore the effects of gut microbiota dysbiosis on renal diseases. I have conducted clinical trials evaluating the diversities and population of gut bacteria in patients with different degrees of renal insufficiencies. I also have evaluated the role of diet on gut bacteria and inflammation, in patients with end-stage renal disease (ESRD) who are on dialysis. To confirm the findings and further explore the importance of gut microbiota on renal diseases and conditions, I am conducting animal experiments using different murine models of advanced and acute-reversible renal diseases. In addition to my research activities, I supervise and teach renal fellows, medicine residents and medical students in the renal inpatient rotation and in the renal outpatient clinic.
Cardiology; Cardiovascular Disease; Interventional Cardiology
As an interventional cardiologist, I perform a variety of invasive diagnostic and interventional cardiac catheterization procedures. My primary interests are in the diagnosis and treatment of acute coronary syndromes and interventional treatment of complex coronary lesions such as unprotected left main coronary artery interventions, bifurcating lesions and chronic total occlusions. Although my focus and passion have been interventional cardiology, I maintain an active interest and involvement in general cardiology and internal medicine and treat a variety of cardiovascular diseases, including congestive heart failure, valvular heart disease, arrhythmias and dyslipidemias. I practice at the Buffalo VA Medical Center (Buffalo VAMC) where I have been the chief of the cardiac catheterization laboratory since 1999. In addition to my responsibilities in the laboratory, my duties include attending on the cardiology consult service, covering the inpatient acute medicine service and interpreting a variety of non-invasive studies (e.g., stress tests, Holter and event monitor studies and EKGs). I enjoy teaching and working with medical students, residents and fellows as they progress through their hospital rotations on cardiology consults and weekend medicine service coverage. I also mentor, supervise and teach fellows in the cardiac catheterization laboratory and outpatient cardiology clinic.
Children and Adults; Internal Medicine - Pediatrics
I provide adult and pediatric health care with a primary focus on caring for individuals with developmental disabilities. My clinical expertise draws from over a decade of primary care practice at the Elmwood Health Center, a clinic located in an underserved area of Buffalo. The center specializes in caring for individuals with developmental disabilities and providing primary care to residents in the surrounding city neighborhoods and adjacent suburbs. I see children and adults from a wide variety of backgrounds, many with complex social as well as medical issues. I care for patients from an increasingly diverse population due to the growth of immigrants in the Buffalo area; this gives me the rich experience of treating and communicating with patients from different cultural backgrounds. I am committed to health care equity, and I strive to understand the needs of all my patients. My research is dedicated to increasing advanced directives in the medical charts of developmentally disabled adults. I serve frequently as a consultant to hospital health care providers in assessing the decision-making ability of intellectually impaired adults. I teach in a number of settings: I present endocrine topics to medical students during inpatient rotations at the Buffalo General Medical Center (BGMC) and the Women and Children’s Hospital of Buffalo (WCHOB), and I give endocrinology lectures to our Medicine-Pediatrics residents. I oversee inpatient and outpatient clinical training of medical students and residents in internal medicine and pediatrics at Elmwood Health and at the inpatient services at BGMC and WCHOB. I also teach the second-year Clinical Practice of Medicine course as a preceptor at the Elmwood Health Center. Additionally, I have served as the quality improvement officer within our academic division, and I organized a Web-based residency curriculum for our training program. I periodically advise residents on quality improvement projects.
Cardiology; Cardiovascular Disease; Interventional Cardiology; Endovascular Medicine; Vascular Medicine
I am an interventional cardiologist with UBMD Cardiovascular Medicine, with specialized training in echocardiography, nuclear cardiology and noninvasive vascular interpretation (RPVI). I see outpatients through the UBMD ambulatory practice at the Amherst Clinic, and I care for patients admitted to the Buffalo General Medical Center (BGMC) consultative service and BGMC’s Cardiac Care Unit (CCU). My interventional practice involves evaluating and caring for patients with coronary and structural heart diseases. I perform diagnostic coronary angiography, percutaneous coronary intervention (PCI), coronary atherectomy, percutaneous mechanical hemodynamic support, cardiac biopsy, patent foramen ovale (PFO)/atrial spetal defect (ASD) closure and transaortic valve replacement (TAVR). I also have a specialized focus on evaluating and managing patients with peripheral vascular disease, including noninvasive vascular testing and endovascular interventions. I see patients at the Gates Vascular Institute (GVI) where I perform diagnostic peripheral and carotid angiography and interventions for peripheral arterial diseases. These procedures include lower extremity arterial atherectomy, angioplasty and stenting, renal and mesenteric artery revascularization and subclavian intervention. I am active in research at the GVI by participating in a number clinical trials. One aims at protecting patients from renal damage during PCI (CARIN, Ischemix). Another involves an alternative procedure to perform TAVR for intermediate-risk patients with symptomatic aortic stenosis (SURTAVI, Medtronic). A third clinical trial addresses using intracoronary delivery of stem cells in patients postanterior myocardial infarction with ischemic left ventricular dysfunction (ALLSTAR, Capricor). As a faculty member at the University at Buffalo, I teach and mentor residents and fellows during their hospital rotations.