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.
Infectious Diseases; 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.
Addictions; Gastroenterology; Internal Medicine; Liver (Hepatology); Infectious Diseases
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.
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.
My clinical expertise is in the management of infections in patients who have undergone solid organ transplant or hematopoietic stem cell transplant. These patients require a dedicated diagnostic and treatment approach, as they are severely immunocompromised due to medications they receive to prevent organ rejection and are susceptible to a large number of pathogens (bacteria, fungi, viruses) that should not cause infections in healthy individuals. I also treat infections in immunocompromised patients secondary to cancer, chemotherapy, and medications (steroids, biologics, etc). I provide consultation for inpatients in Buffalo General Medical Center (BGMC) and Roswell Park Cancer Institute, usually as a result of a referral from a primary care physician, but I also see patients referred from specialty services such as general surgery for surgical site infections, orthopedics for joint infections, cardiothoracic surgery for pacemaker infections, etc. In my clinic at BGMC, I evaluate and treat patients with a variety of infections, as follow-up from recent hospitalizations and a referral from a primary care physician. I also work at Erie County Department of Health Tuberculosis Clinic as Co-Medical Director. I enjoy teaching medical students, residents, and fellows in inpatient consultation service and lectures in BGMC and Roswell. I see patients with residents and fellows, and we discuss their cases.
Infectious Diseases; 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.
Infectious Diseases; 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.
Infectious Diseases; 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.
Infectious Diseases; Internal Medicine - General
I provide infectious diseases consultations for hospitalized patients at the Erie County Medical Center (ECMC). At the Immunodeficiency Clinic at ECMC, I care for HIV infected patients. HIV infection has become a chronic illness with antiretroviral therapy, and patients with HIV need primary care as well as HIV care. The Immunodeficiency Clinic 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 at the clinic. 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 at ECMC where I supervise 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.