Enoch Chung - Academia.edu (original) (raw)

Papers by Enoch Chung

American Journal of Preventive Medicine

Indian Journal of Clinical Cardiology, 2021

A 31-year-old male was referred for a stress test due to worsening palpitations and chest pressur... more A 31-year-old male was referred for a stress test due to worsening palpitations and chest pressure. His clinic 12-lead electrocardiogram was normal. At the time of his stress test, his pre-exercise electrocardiogram revealed an intermittent short PR interval with a delta wave. This pattern resolved during exercise, but in recovery he experienced paroxysms of supraventricular tachycardia. Imaging revealed low left ventricular ejection fraction. Given the diagnosis of Wolff-Parkinson-White Syndrome, he underwent radiofrequency ablation. His cardiomyopathy was presumed to be secondary to his Wolff-Parkinson-White, and an echocardiogram a few months later showed normalization of his left ventricular ejection fraction.

American Journal of Gastroenterology, 2021

Introduction: During the COVID-19 pandemic, outpatient colonoscopies throughout the US were postp... more Introduction: During the COVID-19 pandemic, outpatient colonoscopies throughout the US were postponed, creating a significant backlog of procedures. We estimated the number of missed high- risk adenomas and colorectal cancers in 2020 at an urban, tertiary-care, safety-net teaching hospital in Boston, Massachusetts. Methods: This observational study evaluated the number of high-risk adenomas (defined as ≥3 adenomas, adenoma ≥10 mm in size, adenoma with tubulovillous or villous histological features, or adenoma with high-grade dysplasia) and colorectal cancers diagnosed by outpatient colonoscopy from January 2020 to November 2020, and compared it with those diagnosed from January 2017 to December 2019. Patients with a personal history of colorectal cancer or a colonoscopy indication of inflammatory bowel disease, therapeutic procedure (other than removal of large polyp), or diarrhea were excluded (10% of all colonoscopies). A Poisson regression model using colonoscopy data from 2017 to 2019-adjusted for age, sex, race/ethnicity and indication-was used to predict expected highrisk adenomas and colorectal cancers per month in 2020. Predicted values were compared to actual values to estimate missed diagnoses. Results: A total of 6597, 7136, and 6816 colonoscopies were performed in 2017, 2018 and 2019, respectively. There were 40% fewer colonoscopies performed in January to November 2020 (n = 3704) compared to the same period in 2019. In January to November 2020, 505 high-risk adenomas (Figure 1a) and 21 colorectal cancers (Figure 1b) were diagnosed. We estimate that 284 (36%) highrisk adenomas and 9 (30%) colorectal cancers were missed during this period. The rate of colorectal cancer detection was 6 per 1000 cases performed in 2017 to 2019. Assuming similar patient characteristics and indications, 1349 additional colonoscopies will be needed to diagnose 9 missed colorectal cancers. Conclusion: This study provides one of the first real world estimates of missed high-risk adenomas and colorectal cancers due to the cancellation of outpatient colonoscopies during the COVID-19 pandemic. The results have implications on planning strategies to schedule elective colonoscopies to increase the yield of detection of these high-risk lesions.

The European Educational Researcher, 2019

Since the mid-1990s, the US has seen a decline in research activities in medical education and ac... more Since the mid-1990s, the US has seen a decline in research activities in medical education and academic health care centers. Our goal was to offer a multidisciplinary experience for undergraduates to participate in a practical, hands-on research experience to increase the likelihood of entering STEM research careers. The authors structured a collaborative teaching environment to lead a group of over 25 undergraduate and graduate students in clinical research activities as part of the resident author's research program during psychiatry graduate training. A particularly innovative component of this work, making the timeline and technical analysis possible, was the partnership with an industry sponsor. Much of the teaching program's structure was inspired by the analogous program of the industry sponsor. This provided a structured clinical research experience for undergraduates, providing opportunities to participate in the study design, patient recruitment and enrollment, data collecti on and analysis phases of the project with more autonomy than typically available at this level of training. Students favored the experience with generally positive ratings of the program. Students gained skills and felt more comfortable in practical aspects of research and stated they were more likely to pursue a research career after this experience. This method may be a solution for other clinical trainees given their limited time and funding while serving to increase exposure to STEM research earlier in life to reverse the trend of declining research activity. This method can be used across other training institutions at different scales to achieve similar goals.

Annals of Geriatric Medicine and Research

Epidemiology and Pathophysiology of Alzheimer's Disease Alzheimer's disease (AD) is the most comm... more Epidemiology and Pathophysiology of Alzheimer's Disease Alzheimer's disease (AD) is the most common cause of dementia worldwide, affecting over 40 million people, primarily older adults. 1) The pathophysiology of AD is believed to result from the loss of cholinergic neurons, resulting in atrophy of cholinergic nuclei and reduced levels of the neurotransmitter acetylcholine in the brain. 2) Acetylcholine is involved in brain functions including attention, memory, motivation, and arousal, which are often affected in patients with the disease. The β-amyloid protein plaques found in the brains of patients with AD are also thought to negatively impact cholinergic synapses. 3) Acetylcholine is broken down into acetic acid and choline by acetylcholinesterase enzymes in the synaptic cleft, thereby ending signal transmission and postsynaptic receptor activation. Management of Alzheimer's Disease There are no well established disease-modifying treatments for AD; thus, prevention and behavioral interventions comprise the bedrocks of management. There has been a focus on improving

Journal of the Royal College of Physicians of Edinburgh

American Journal of Preventive Medicine

Indian Journal of Clinical Cardiology, 2021

A 31-year-old male was referred for a stress test due to worsening palpitations and chest pressur... more A 31-year-old male was referred for a stress test due to worsening palpitations and chest pressure. His clinic 12-lead electrocardiogram was normal. At the time of his stress test, his pre-exercise electrocardiogram revealed an intermittent short PR interval with a delta wave. This pattern resolved during exercise, but in recovery he experienced paroxysms of supraventricular tachycardia. Imaging revealed low left ventricular ejection fraction. Given the diagnosis of Wolff-Parkinson-White Syndrome, he underwent radiofrequency ablation. His cardiomyopathy was presumed to be secondary to his Wolff-Parkinson-White, and an echocardiogram a few months later showed normalization of his left ventricular ejection fraction.

American Journal of Gastroenterology, 2021

Introduction: During the COVID-19 pandemic, outpatient colonoscopies throughout the US were postp... more Introduction: During the COVID-19 pandemic, outpatient colonoscopies throughout the US were postponed, creating a significant backlog of procedures. We estimated the number of missed high- risk adenomas and colorectal cancers in 2020 at an urban, tertiary-care, safety-net teaching hospital in Boston, Massachusetts. Methods: This observational study evaluated the number of high-risk adenomas (defined as ≥3 adenomas, adenoma ≥10 mm in size, adenoma with tubulovillous or villous histological features, or adenoma with high-grade dysplasia) and colorectal cancers diagnosed by outpatient colonoscopy from January 2020 to November 2020, and compared it with those diagnosed from January 2017 to December 2019. Patients with a personal history of colorectal cancer or a colonoscopy indication of inflammatory bowel disease, therapeutic procedure (other than removal of large polyp), or diarrhea were excluded (10% of all colonoscopies). A Poisson regression model using colonoscopy data from 2017 to 2019-adjusted for age, sex, race/ethnicity and indication-was used to predict expected highrisk adenomas and colorectal cancers per month in 2020. Predicted values were compared to actual values to estimate missed diagnoses. Results: A total of 6597, 7136, and 6816 colonoscopies were performed in 2017, 2018 and 2019, respectively. There were 40% fewer colonoscopies performed in January to November 2020 (n = 3704) compared to the same period in 2019. In January to November 2020, 505 high-risk adenomas (Figure 1a) and 21 colorectal cancers (Figure 1b) were diagnosed. We estimate that 284 (36%) highrisk adenomas and 9 (30%) colorectal cancers were missed during this period. The rate of colorectal cancer detection was 6 per 1000 cases performed in 2017 to 2019. Assuming similar patient characteristics and indications, 1349 additional colonoscopies will be needed to diagnose 9 missed colorectal cancers. Conclusion: This study provides one of the first real world estimates of missed high-risk adenomas and colorectal cancers due to the cancellation of outpatient colonoscopies during the COVID-19 pandemic. The results have implications on planning strategies to schedule elective colonoscopies to increase the yield of detection of these high-risk lesions.

The European Educational Researcher, 2019

Since the mid-1990s, the US has seen a decline in research activities in medical education and ac... more Since the mid-1990s, the US has seen a decline in research activities in medical education and academic health care centers. Our goal was to offer a multidisciplinary experience for undergraduates to participate in a practical, hands-on research experience to increase the likelihood of entering STEM research careers. The authors structured a collaborative teaching environment to lead a group of over 25 undergraduate and graduate students in clinical research activities as part of the resident author's research program during psychiatry graduate training. A particularly innovative component of this work, making the timeline and technical analysis possible, was the partnership with an industry sponsor. Much of the teaching program's structure was inspired by the analogous program of the industry sponsor. This provided a structured clinical research experience for undergraduates, providing opportunities to participate in the study design, patient recruitment and enrollment, data collecti on and analysis phases of the project with more autonomy than typically available at this level of training. Students favored the experience with generally positive ratings of the program. Students gained skills and felt more comfortable in practical aspects of research and stated they were more likely to pursue a research career after this experience. This method may be a solution for other clinical trainees given their limited time and funding while serving to increase exposure to STEM research earlier in life to reverse the trend of declining research activity. This method can be used across other training institutions at different scales to achieve similar goals.

Annals of Geriatric Medicine and Research

Epidemiology and Pathophysiology of Alzheimer's Disease Alzheimer's disease (AD) is the most comm... more Epidemiology and Pathophysiology of Alzheimer's Disease Alzheimer's disease (AD) is the most common cause of dementia worldwide, affecting over 40 million people, primarily older adults. 1) The pathophysiology of AD is believed to result from the loss of cholinergic neurons, resulting in atrophy of cholinergic nuclei and reduced levels of the neurotransmitter acetylcholine in the brain. 2) Acetylcholine is involved in brain functions including attention, memory, motivation, and arousal, which are often affected in patients with the disease. The β-amyloid protein plaques found in the brains of patients with AD are also thought to negatively impact cholinergic synapses. 3) Acetylcholine is broken down into acetic acid and choline by acetylcholinesterase enzymes in the synaptic cleft, thereby ending signal transmission and postsynaptic receptor activation. Management of Alzheimer's Disease There are no well established disease-modifying treatments for AD; thus, prevention and behavioral interventions comprise the bedrocks of management. There has been a focus on improving

Journal of the Royal College of Physicians of Edinburgh