Michael Poles - Academia.edu (original) (raw)

Papers by Michael Poles

Research paper thumbnail of Isolation and cytokine analysis of lamina propria lymphocytes from mucosal biopsies of the human colon

Journal of immunological methods, Jan 10, 2015

Much of our understanding of gut-microbial interactions has come from mouse models. Intestinal im... more Much of our understanding of gut-microbial interactions has come from mouse models. Intestinal immunity is complex and a combination of host genetics and environmental factors play a significant role in regulating intestinal immunity. Due to this complexity, no mouse model to date gives a complete and accurate representation of human intestinal diseases, such as inflammatory bowel diseases. However, intestinal tissue from patients undergoing bowel resection reflects a condition of severe disease that has failed treatment; hence a more dynamic perspective of varying inflammatory states in IBD could be obtained through the analyses of pinch biopsy material. Here we describe our protocol for analyzing mucosal pinch biopsies collected predominantly during colonoscopies. We have optimized flow cytometry panels to analyze up to 8 cytokines produced by CD4+ and CD8+ cells, as well as for characterizing nuclear proteins and transcription factors such as Ki67 and Foxp3. Furthermore, we have ...

Research paper thumbnail of Assessing cultural competency skills in gastroenterology fellowship training

World journal of gastroenterology : WJG, Jan 14, 2015

To assess and teach cultural competency skills at the fellowship training level through the use o... more To assess and teach cultural competency skills at the fellowship training level through the use of objective structured clinical examinations (OSCEs). We revised four scenarios to infuse a specific focus on cross-cultural care, and to render them appropriate for gastroenterology fellows. Three are discussed here: (1) Poor Health Literacy; (2) Disclosing/Apologizing for a Complication to a Patient Who Mistrusts the Healthcare System; and (3) Breaking Bad News to a Fatalistic Patient. A fourth case emphasizing shared decision-making will be described elsewhere. Four stations were completed by fellows and observed live by four faculty members, and the fellows' performance was assessed. Eleven fellows from four programs participated in the four OSCE. In the "Poor Health Literacy" case, 18% (2/11) of participants recognized that the standardized patient (SP) had below-basic health literacy. None successfully evaluated the SP's reading skills in a culturally-sensitive ma...

Research paper thumbnail of Treatment of gastrointestinal cytomegalovirus infection with twice-daily foscarnet: a pilot study of safety, efficacy, and pharmacokinetics in patients with AIDS

Antimicrobial agents and chemotherapy, 1997

Ten patients with AIDS and cytomegalovirus (CMV) gastrointestinal infection were included in an o... more Ten patients with AIDS and cytomegalovirus (CMV) gastrointestinal infection were included in an open-label study to evaluate the safety, efficacy, and pharmacokinetics of 90 mg of intravenous foscarnet/kg of body weight twice daily accompanied by (pre)hydration of 500 to 750 ml. Efficacy was documented endoscopically, while safety was evaluated clinically by patient reports and physical and laboratory observation. The pharmacokinetics of foscarnet was evaluated after the first dose and following approximately 20 days of therapy. Nine patients (90%) responded histopathologically, nine (90%) responded endoscopically, and nine (90%) responded symptomatically to foscarnet therapy. Adverse events resulted in discontinuance of medication in the case of one patient. The mean maximal concentration was 621 microM following the first dose and 687 microM at steady state (P = 0.11). The apparent elimination rate constant and elimination half-life were not different between dose 1 and steady sta...

Research paper thumbnail of HIV and hepatitis virus infection

Current Hepatitis Reports, 2002

Research paper thumbnail of Teaching the Competencies: Using Observed Structured Clinical Examinations for Faculty Development

The American Journal of Gastroenterology, 2010

Gastroenterology (GI) training programs must develop the teaching skills of their faculty and pro... more Gastroenterology (GI) training programs must develop the teaching skills of their faculty and provide feedback to their fellows. Many faculty feel uncomfortable offering feedback or identifying specific areas for improvement to the fellows. We developed an Observed Structured Clinical Exam (OSCE) to assess fellows' skills and provided faculty with specific criteria to rate the fellows' performance. We propose that OSCEs can serve as tools for faculty development in delivering effective feedback. Faculty completed a Web-based training module and received written guidelines on giving feedback. Four OSCE stations were completed by each fellow with faculty using standardized checklists to assess the fellows' skills. Afterwards, faculty rated each program component and assessed their comfort level with feedback. Eight faculty members and 10 fellows from 5 GI training programs in NYC participated. 100% of the faculty agreed that feedback is an important learning tool, should include the learner's self-assessment, and that feedback skills could improve with practice. Compared to faculty skills prior to the program, 87.5% of the faculty agreed that they focused more on specific behaviors and 75% agreed that giving negative feedback was now easier. OSCEs can serve as practicums for faculty development in giving constructive feedback.

Research paper thumbnail of Design Aspects of a Case-Control Clinical Investigation of the Effect of HIV on Oral and Gastrointestinal Soluble Innate Factors and Microbes

PLoS ONE, 2014

The impaired host defense system in HIV infection impacts the oral and gastrointestinal microbiot... more The impaired host defense system in HIV infection impacts the oral and gastrointestinal microbiota and associated opportunistic infections. Antiretroviral treatment is predicted to partially restore host defenses and decrease the oral manifestation of HIV/AIDS. Well-designed longitudinal studies are needed to better understand the interactions of soluble host defense proteins with bacteria and virus in HIV/AIDS. ''Crosstalk'' was designed as a longitudinal study of host responses along the gastrointestinal (GI) tract and interactions between defense molecules and bacteria in HIV infection and subsequent therapy.

Research paper thumbnail of HIV-related diarrhea is multifactorial and fat malabsorption is commonly present, independent of HAART

The American Journal of Gastroenterology, 2001

Research paper thumbnail of Informed Consent in the Older Adult: OSCEs for Assessing Fellows’ ACGME and Geriatric Gastroenterology Competencies

The American Journal of Gastroenterology, 2011

The American Gastroenterological Association fellowship curriculum identifies geriatric component... more The American Gastroenterological Association fellowship curriculum identifies geriatric components for gastroenterology (GI) training; however, few tools are available for this purpose. Using an objective structured clinical examination (OSCE), we aimed to assess ACGME competencies of communication, professionalism, and geriatric-specific patient care among GI fellows. We developed an informed-consent case involving a geriatric patient who needs surveillance colonoscopy. We used a validated faculty skills checklist to rate fellows across three competency domains. Fifteen fellows from four GI training programs participated. Although the fellows excelled at communication and professionalism, only 51% excelled at geriatric-specific patient-care skills. Fellows were least likely to demonstrate collaboration with the patient, to assess patient understanding, and to explain the limits of the test. Communication and geriatric-specific skills were correlated. OSCEs are a feasible method for assessing geriatric-related ACGME competencies for fellows. The results highlight the need for curriculum development.

Research paper thumbnail of Can You Hear Me Now? Using OSCES to Assess Telephone Management Skills

Research paper thumbnail of TH17, TH22 and TReg Cells Are Enriched in the Healthy Human Cecum

PLoS ONE, 2012

There is increasing evidence that dysregulation of CD4(+) T cell populations leads to intestinal ... more There is increasing evidence that dysregulation of CD4(+) T cell populations leads to intestinal inflammation, but the regional distribution of these populations throughout the intestinal tract in healthy individuals remains unclear. Here, we show that T(H)17, T(H)22 and T(Reg) cells are enriched in the healthy human cecum compared to the terminal ileum and sigmoid colon, whereas T(H)1 and T(H)2 cells do not significantly vary by location. Transcriptional profiling analysis of paired pinch biopsies from different regions of the intestine identified significant differences in the metabolic state of the terminal ileum, cecum, and sigmoid colon. An increased proportion of T(H)17 cells was positively associated with expression of resistin (RETN) and negatively associated with expression of trefoil factor 1 (TFF1). These results suggest that CD4(+) T helper cells that are important in maintaining mucosal barrier function may be enriched in the cecum as a result of metabolic differences of the surrounding microenvironment.

Research paper thumbnail of Lack of Decay of HIV-1 in Gut-Associated Lymphoid Tissue Reservoirs in Maximally Suppressed Individuals

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2006

Although peripheral blood mononuclear cells (PBMCs) and lymph nodes represent a principal reservo... more Although peripheral blood mononuclear cells (PBMCs) and lymph nodes represent a principal reservoir, the contribution of gut-associated lymphoid tissue (GALT) has not been evaluated. In 15 HIV-1Yinfected subjects with maximal suppression of HIV replication by highly active antiretroviral therapy, we quantified HIV-1 DNA and RNA in mucosal biopsy specimens, PBMCs, and plasma with ultrasensitive assays. We also calculated compartmental burdens of HIV-1 DNAYpositive cells and characterized the temporal decay of these reservoirs in a period of 1 year (with projections to 950 years). HIV-1 RNA was detected in 20% of the subjects' mucosal biopsy specimens and in 80% of the PBMC samples. Mucosal HIV-1 DNA was detected in 80% of the subjects and in 100% of the PBMC samples. Calculated numbers of lymphoid cells containing Bpotentially replication-competent^HIV-1 DNA showed that the PBMC compartment contained approximately 70,000 such cells, and GALT contained approximately 160,000 cells. Rates of decay slopes for all 15 subjects in both compartments were not statistically significantly different when compared with each other or with zero slope. Our data indicate that GALT is a quantitatively important reservoir of potentially replicative cells containing HIV-1 DNA, harboring at least as many or more of such cells as the PBMC compartment. In well-suppressed patients on highly active antiretroviral therapy, the GALT compartment showed no clear pattern of HIV-1 decay, similar to that in the PBMCs. *BV^as part of confidence interval, indicates that the upper point of the 95% confidence interval for slope was positive (can be read as B950 years^). †BV^as the estimated number, indicates that the subject's trajectory was increasing, showing a positive slope or no clearance (can be read as B950 years^). CI indicates confidence interval.

Research paper thumbnail of Increased HIV-1 Mucosal Replication Is Associated With Generalized Mucosal Cytokine Activation

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2004

The purpose of this study was to characterize intestinal mucosal cytokine profiles in subjects wi... more The purpose of this study was to characterize intestinal mucosal cytokine profiles in subjects with HIV-1 infection and their relation to mucosal viral load (MVL). Intestinal mucosal cytokine mRNA (interleukin [IL]-2, interferon [IFN]-gamma, IL-12, IL-10, IL-1beta, tumor necrosis factor [TNF]-alpha, IL-6, and regulated upon activation, normal T-cell expressed and secreted [RANTES]) and HIV-1 RNA were quantified using real-time polymerase chain reaction (PCR). On the basis of MVL quantification, the HIV-1-infected subjects were divided into 3 groups: undetectable MVL (<50 copies/microg of tissue total RNA), low MVL (>50 but <5000 copies/microg of tissue total RNA), and high MVL (>5000 copies/microg of tissue total RNA). Compared with the control group, significant reductions in RANTES, IL-2, and IFNgamma expression were seen in the undetectable MVL group (P < 0.005). IL-6 was significantly increased in all the HIV groups (P < 0.005), and RANTES, IL-10, and IFNgamma were increased in the high MVL group (P < 0.005). Subjects with high MVL have generalized immune activation with increases in T helper (Th)1, Th2, and proinflammatory cytokines, whereas subjects with undetectable MVL have reduced expression of multiple cytokines. The pathologic basis for these observations is unclear but may relate to the success or failure of antiretroviral therapy in controlling mucosal viral replication.

Research paper thumbnail of Observing handoffs and telephone management in GI fellowship training

The American journal of gastroenterology, 2011

Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication... more Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication and professionalism as basic competencies. We sought to assess important skill sets used by our fellows but not formally observed or measured: handoffs, telephone management, and note writing. We designed an Observed Standardized Clinical Examination (OSCE) form and provided the faculty with checklists to rate fellows' performance on specific criteria.

Research paper thumbnail of Human microbiome and HIV/AIDS

Current HIV/AIDS reports, 2012

Understanding of the human microbiome continues to grow rapidly; however, reports on changes in t... more Understanding of the human microbiome continues to grow rapidly; however, reports on changes in the microbiome after HIV infection are still limited. This review surveys the progress made in methodology associated with microbiome studies and highlights the remaining challenges to this field. Studies have shown that commensal oral, gut, vaginal, and penile bacteria are vital to the health of the human immune system. Our studies on crosstalk among oral and gastrointestinal soluble innate factors, HIV, and microbes indicated that the oral and gut microbiome was altered in the HIV-positive samples compared to the negative controls. The importance of understanding the bacterial component of HIV/AIDS, and likelihood of "crosstalk" between viral and bacterial pathogens, will help in understanding the role of the microbiome in HIV-infected individuals and facilitate identification of novel antiretroviral factors for use as novel diagnostics, microbicides, or therapeutics against H...

Research paper thumbnail of DIAGNOSIS AND TREATMENT OF HEPATIC DISEASE IN PATIENTS WITH HIV

Gastroenterology Clinics of North America, 1997

Liver involvement with opportunistic infections and neoplasms is a well-recognized component of A... more Liver involvement with opportunistic infections and neoplasms is a well-recognized component of AIDS, affecting most patients. The cause of hepatic disease in these patients may be divided into hepatitis, granulomatous disease, mass lesions, vascular lesions, hepatotoxic drugs, and nonspecific findings. With a rational approach, most patients with AIDS and liver disease can be diagnosed and treated in a cost-effective manner with low morbidity.

Research paper thumbnail of DIARRHEAL DISEASES ASSOCIATED WITH HIV INFECTION

Gastroenterology Clinics of North America, 1997

Diarrhea is a major complication of HIV infection and adversely impacts health care costs, qualit... more Diarrhea is a major complication of HIV infection and adversely impacts health care costs, quality of life, and even survival of patients. There is a wide variety of potential causes of diarrhea in HIV-infected patients, and the number of pathogens found continues to increase with time. In addition, there is some controversy concerning the role of some organisms in the pathogenesis of diarrhea and the appropriate diagnostic evaluation of affected patients. This article reviews our current understanding of these pathogens and some of the diagnostic and therapeutic approaches for diarrhea associated with HIV infection.

Research paper thumbnail of 1064 Teaching the Competencies: Using Observed Standardized Clinical Encounters (OSCES) for Faculty Development

Gastroenterology, 2009

to assess improvement. Results: 9 full-time faculty and 8 fellows were surveyed. Hand-offs were g... more to assess improvement. Results: 9 full-time faculty and 8 fellows were surveyed. Hand-offs were graded from 1 (poor) to 5 (excellent). Fellow overall hand-offs were rated at 4, which remained constant at the follow up satisfaction survey. Attendings viewed the hand-offs at 3 during the initial survey and this improved to 4 in the follow up survey. Fellows rated their hand-offs from clinic fellow to procedure fellow at 1 at the start of the program and post-procedure between endoscopy and consult fellows as a 2; these both improved to 4s. We have incorporated a number of changes including routine hand-off of the service between attendings, the use of standardized spreadsheets in the hand-off of the service between fellows and altered conference schedule to facilitate uninterrupted patient care and bedside teaching. Conclusion: Identification of factors that lead to suboptimal patient hand-offs and development of methods to improve hand-offs can lead to better communication between physicians and ultimately safer patient care. The success of our program served as a model and was shared with the other subspecialty training programs at our institution to help them improve hand-off communication.

Research paper thumbnail of S1039 Teaching the Competencies: Educational Performance Improvement Using OSCEs for Gastroenterology Fellows

Gastroenterology, 2008

Gastroenterology, Volume 134, Issue 4, Pages A-164, April 2008, Authors:Bani Chander; Robert Kule... more Gastroenterology, Volume 134, Issue 4, Pages A-164, April 2008, Authors:Bani Chander; Robert Kule; Peter J. Baiocco; Sita S. Chokhavatia; Donald P. Kotler; Michael Poles; Sondra Zabar; Elizabeth H. Weinshel. Gastroenterology ...

Research paper thumbnail of 895 Informed Consent in the Older Adult – Can OSCES Assess Fellows' Competencies in Caring for the Geriatric Gastroenterology Patient?

Gastroenterology, 2010

Gastroenterology, Volume 138, Issue 5, Pages S-126, May 2010, Authors:Roy Miler; Brijen Shah; Mic... more Gastroenterology, Volume 138, Issue 5, Pages S-126, May 2010, Authors:Roy Miler; Brijen Shah; Michael Poles; Sondra Zabar; Colleen C. Gillespie; Elizabeth H. Weinshel; Sita S. Chokhavatia.

Research paper thumbnail of T1034 Observing Hand-Offs and Telephone Management in GI Fellowship Training

Gastroenterology, 2010

Gastroenterology, Volume 138, Issue 5, Pages S-473, May 2010, Authors:Roy Miler; Brijen Shah; Ren... more Gastroenterology, Volume 138, Issue 5, Pages S-473, May 2010, Authors:Roy Miler; Brijen Shah; Renee Williams; Sita S. Chokhavatia; Michael A. Poles; Sondra Zabar; Colleen C. Gillespie; Elizabeth H. Weinshel.

Research paper thumbnail of Isolation and cytokine analysis of lamina propria lymphocytes from mucosal biopsies of the human colon

Journal of immunological methods, Jan 10, 2015

Much of our understanding of gut-microbial interactions has come from mouse models. Intestinal im... more Much of our understanding of gut-microbial interactions has come from mouse models. Intestinal immunity is complex and a combination of host genetics and environmental factors play a significant role in regulating intestinal immunity. Due to this complexity, no mouse model to date gives a complete and accurate representation of human intestinal diseases, such as inflammatory bowel diseases. However, intestinal tissue from patients undergoing bowel resection reflects a condition of severe disease that has failed treatment; hence a more dynamic perspective of varying inflammatory states in IBD could be obtained through the analyses of pinch biopsy material. Here we describe our protocol for analyzing mucosal pinch biopsies collected predominantly during colonoscopies. We have optimized flow cytometry panels to analyze up to 8 cytokines produced by CD4+ and CD8+ cells, as well as for characterizing nuclear proteins and transcription factors such as Ki67 and Foxp3. Furthermore, we have ...

Research paper thumbnail of Assessing cultural competency skills in gastroenterology fellowship training

World journal of gastroenterology : WJG, Jan 14, 2015

To assess and teach cultural competency skills at the fellowship training level through the use o... more To assess and teach cultural competency skills at the fellowship training level through the use of objective structured clinical examinations (OSCEs). We revised four scenarios to infuse a specific focus on cross-cultural care, and to render them appropriate for gastroenterology fellows. Three are discussed here: (1) Poor Health Literacy; (2) Disclosing/Apologizing for a Complication to a Patient Who Mistrusts the Healthcare System; and (3) Breaking Bad News to a Fatalistic Patient. A fourth case emphasizing shared decision-making will be described elsewhere. Four stations were completed by fellows and observed live by four faculty members, and the fellows' performance was assessed. Eleven fellows from four programs participated in the four OSCE. In the "Poor Health Literacy" case, 18% (2/11) of participants recognized that the standardized patient (SP) had below-basic health literacy. None successfully evaluated the SP's reading skills in a culturally-sensitive ma...

Research paper thumbnail of Treatment of gastrointestinal cytomegalovirus infection with twice-daily foscarnet: a pilot study of safety, efficacy, and pharmacokinetics in patients with AIDS

Antimicrobial agents and chemotherapy, 1997

Ten patients with AIDS and cytomegalovirus (CMV) gastrointestinal infection were included in an o... more Ten patients with AIDS and cytomegalovirus (CMV) gastrointestinal infection were included in an open-label study to evaluate the safety, efficacy, and pharmacokinetics of 90 mg of intravenous foscarnet/kg of body weight twice daily accompanied by (pre)hydration of 500 to 750 ml. Efficacy was documented endoscopically, while safety was evaluated clinically by patient reports and physical and laboratory observation. The pharmacokinetics of foscarnet was evaluated after the first dose and following approximately 20 days of therapy. Nine patients (90%) responded histopathologically, nine (90%) responded endoscopically, and nine (90%) responded symptomatically to foscarnet therapy. Adverse events resulted in discontinuance of medication in the case of one patient. The mean maximal concentration was 621 microM following the first dose and 687 microM at steady state (P = 0.11). The apparent elimination rate constant and elimination half-life were not different between dose 1 and steady sta...

Research paper thumbnail of HIV and hepatitis virus infection

Current Hepatitis Reports, 2002

Research paper thumbnail of Teaching the Competencies: Using Observed Structured Clinical Examinations for Faculty Development

The American Journal of Gastroenterology, 2010

Gastroenterology (GI) training programs must develop the teaching skills of their faculty and pro... more Gastroenterology (GI) training programs must develop the teaching skills of their faculty and provide feedback to their fellows. Many faculty feel uncomfortable offering feedback or identifying specific areas for improvement to the fellows. We developed an Observed Structured Clinical Exam (OSCE) to assess fellows' skills and provided faculty with specific criteria to rate the fellows' performance. We propose that OSCEs can serve as tools for faculty development in delivering effective feedback. Faculty completed a Web-based training module and received written guidelines on giving feedback. Four OSCE stations were completed by each fellow with faculty using standardized checklists to assess the fellows' skills. Afterwards, faculty rated each program component and assessed their comfort level with feedback. Eight faculty members and 10 fellows from 5 GI training programs in NYC participated. 100% of the faculty agreed that feedback is an important learning tool, should include the learner's self-assessment, and that feedback skills could improve with practice. Compared to faculty skills prior to the program, 87.5% of the faculty agreed that they focused more on specific behaviors and 75% agreed that giving negative feedback was now easier. OSCEs can serve as practicums for faculty development in giving constructive feedback.

Research paper thumbnail of Design Aspects of a Case-Control Clinical Investigation of the Effect of HIV on Oral and Gastrointestinal Soluble Innate Factors and Microbes

PLoS ONE, 2014

The impaired host defense system in HIV infection impacts the oral and gastrointestinal microbiot... more The impaired host defense system in HIV infection impacts the oral and gastrointestinal microbiota and associated opportunistic infections. Antiretroviral treatment is predicted to partially restore host defenses and decrease the oral manifestation of HIV/AIDS. Well-designed longitudinal studies are needed to better understand the interactions of soluble host defense proteins with bacteria and virus in HIV/AIDS. ''Crosstalk'' was designed as a longitudinal study of host responses along the gastrointestinal (GI) tract and interactions between defense molecules and bacteria in HIV infection and subsequent therapy.

Research paper thumbnail of HIV-related diarrhea is multifactorial and fat malabsorption is commonly present, independent of HAART

The American Journal of Gastroenterology, 2001

Research paper thumbnail of Informed Consent in the Older Adult: OSCEs for Assessing Fellows’ ACGME and Geriatric Gastroenterology Competencies

The American Journal of Gastroenterology, 2011

The American Gastroenterological Association fellowship curriculum identifies geriatric component... more The American Gastroenterological Association fellowship curriculum identifies geriatric components for gastroenterology (GI) training; however, few tools are available for this purpose. Using an objective structured clinical examination (OSCE), we aimed to assess ACGME competencies of communication, professionalism, and geriatric-specific patient care among GI fellows. We developed an informed-consent case involving a geriatric patient who needs surveillance colonoscopy. We used a validated faculty skills checklist to rate fellows across three competency domains. Fifteen fellows from four GI training programs participated. Although the fellows excelled at communication and professionalism, only 51% excelled at geriatric-specific patient-care skills. Fellows were least likely to demonstrate collaboration with the patient, to assess patient understanding, and to explain the limits of the test. Communication and geriatric-specific skills were correlated. OSCEs are a feasible method for assessing geriatric-related ACGME competencies for fellows. The results highlight the need for curriculum development.

Research paper thumbnail of Can You Hear Me Now? Using OSCES to Assess Telephone Management Skills

Research paper thumbnail of TH17, TH22 and TReg Cells Are Enriched in the Healthy Human Cecum

PLoS ONE, 2012

There is increasing evidence that dysregulation of CD4(+) T cell populations leads to intestinal ... more There is increasing evidence that dysregulation of CD4(+) T cell populations leads to intestinal inflammation, but the regional distribution of these populations throughout the intestinal tract in healthy individuals remains unclear. Here, we show that T(H)17, T(H)22 and T(Reg) cells are enriched in the healthy human cecum compared to the terminal ileum and sigmoid colon, whereas T(H)1 and T(H)2 cells do not significantly vary by location. Transcriptional profiling analysis of paired pinch biopsies from different regions of the intestine identified significant differences in the metabolic state of the terminal ileum, cecum, and sigmoid colon. An increased proportion of T(H)17 cells was positively associated with expression of resistin (RETN) and negatively associated with expression of trefoil factor 1 (TFF1). These results suggest that CD4(+) T helper cells that are important in maintaining mucosal barrier function may be enriched in the cecum as a result of metabolic differences of the surrounding microenvironment.

Research paper thumbnail of Lack of Decay of HIV-1 in Gut-Associated Lymphoid Tissue Reservoirs in Maximally Suppressed Individuals

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2006

Although peripheral blood mononuclear cells (PBMCs) and lymph nodes represent a principal reservo... more Although peripheral blood mononuclear cells (PBMCs) and lymph nodes represent a principal reservoir, the contribution of gut-associated lymphoid tissue (GALT) has not been evaluated. In 15 HIV-1Yinfected subjects with maximal suppression of HIV replication by highly active antiretroviral therapy, we quantified HIV-1 DNA and RNA in mucosal biopsy specimens, PBMCs, and plasma with ultrasensitive assays. We also calculated compartmental burdens of HIV-1 DNAYpositive cells and characterized the temporal decay of these reservoirs in a period of 1 year (with projections to 950 years). HIV-1 RNA was detected in 20% of the subjects' mucosal biopsy specimens and in 80% of the PBMC samples. Mucosal HIV-1 DNA was detected in 80% of the subjects and in 100% of the PBMC samples. Calculated numbers of lymphoid cells containing Bpotentially replication-competent^HIV-1 DNA showed that the PBMC compartment contained approximately 70,000 such cells, and GALT contained approximately 160,000 cells. Rates of decay slopes for all 15 subjects in both compartments were not statistically significantly different when compared with each other or with zero slope. Our data indicate that GALT is a quantitatively important reservoir of potentially replicative cells containing HIV-1 DNA, harboring at least as many or more of such cells as the PBMC compartment. In well-suppressed patients on highly active antiretroviral therapy, the GALT compartment showed no clear pattern of HIV-1 decay, similar to that in the PBMCs. *BV^as part of confidence interval, indicates that the upper point of the 95% confidence interval for slope was positive (can be read as B950 years^). †BV^as the estimated number, indicates that the subject's trajectory was increasing, showing a positive slope or no clearance (can be read as B950 years^). CI indicates confidence interval.

Research paper thumbnail of Increased HIV-1 Mucosal Replication Is Associated With Generalized Mucosal Cytokine Activation

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2004

The purpose of this study was to characterize intestinal mucosal cytokine profiles in subjects wi... more The purpose of this study was to characterize intestinal mucosal cytokine profiles in subjects with HIV-1 infection and their relation to mucosal viral load (MVL). Intestinal mucosal cytokine mRNA (interleukin [IL]-2, interferon [IFN]-gamma, IL-12, IL-10, IL-1beta, tumor necrosis factor [TNF]-alpha, IL-6, and regulated upon activation, normal T-cell expressed and secreted [RANTES]) and HIV-1 RNA were quantified using real-time polymerase chain reaction (PCR). On the basis of MVL quantification, the HIV-1-infected subjects were divided into 3 groups: undetectable MVL (<50 copies/microg of tissue total RNA), low MVL (>50 but <5000 copies/microg of tissue total RNA), and high MVL (>5000 copies/microg of tissue total RNA). Compared with the control group, significant reductions in RANTES, IL-2, and IFNgamma expression were seen in the undetectable MVL group (P < 0.005). IL-6 was significantly increased in all the HIV groups (P < 0.005), and RANTES, IL-10, and IFNgamma were increased in the high MVL group (P < 0.005). Subjects with high MVL have generalized immune activation with increases in T helper (Th)1, Th2, and proinflammatory cytokines, whereas subjects with undetectable MVL have reduced expression of multiple cytokines. The pathologic basis for these observations is unclear but may relate to the success or failure of antiretroviral therapy in controlling mucosal viral replication.

Research paper thumbnail of Observing handoffs and telephone management in GI fellowship training

The American journal of gastroenterology, 2011

Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication... more Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication and professionalism as basic competencies. We sought to assess important skill sets used by our fellows but not formally observed or measured: handoffs, telephone management, and note writing. We designed an Observed Standardized Clinical Examination (OSCE) form and provided the faculty with checklists to rate fellows' performance on specific criteria.

Research paper thumbnail of Human microbiome and HIV/AIDS

Current HIV/AIDS reports, 2012

Understanding of the human microbiome continues to grow rapidly; however, reports on changes in t... more Understanding of the human microbiome continues to grow rapidly; however, reports on changes in the microbiome after HIV infection are still limited. This review surveys the progress made in methodology associated with microbiome studies and highlights the remaining challenges to this field. Studies have shown that commensal oral, gut, vaginal, and penile bacteria are vital to the health of the human immune system. Our studies on crosstalk among oral and gastrointestinal soluble innate factors, HIV, and microbes indicated that the oral and gut microbiome was altered in the HIV-positive samples compared to the negative controls. The importance of understanding the bacterial component of HIV/AIDS, and likelihood of "crosstalk" between viral and bacterial pathogens, will help in understanding the role of the microbiome in HIV-infected individuals and facilitate identification of novel antiretroviral factors for use as novel diagnostics, microbicides, or therapeutics against H...

Research paper thumbnail of DIAGNOSIS AND TREATMENT OF HEPATIC DISEASE IN PATIENTS WITH HIV

Gastroenterology Clinics of North America, 1997

Liver involvement with opportunistic infections and neoplasms is a well-recognized component of A... more Liver involvement with opportunistic infections and neoplasms is a well-recognized component of AIDS, affecting most patients. The cause of hepatic disease in these patients may be divided into hepatitis, granulomatous disease, mass lesions, vascular lesions, hepatotoxic drugs, and nonspecific findings. With a rational approach, most patients with AIDS and liver disease can be diagnosed and treated in a cost-effective manner with low morbidity.

Research paper thumbnail of DIARRHEAL DISEASES ASSOCIATED WITH HIV INFECTION

Gastroenterology Clinics of North America, 1997

Diarrhea is a major complication of HIV infection and adversely impacts health care costs, qualit... more Diarrhea is a major complication of HIV infection and adversely impacts health care costs, quality of life, and even survival of patients. There is a wide variety of potential causes of diarrhea in HIV-infected patients, and the number of pathogens found continues to increase with time. In addition, there is some controversy concerning the role of some organisms in the pathogenesis of diarrhea and the appropriate diagnostic evaluation of affected patients. This article reviews our current understanding of these pathogens and some of the diagnostic and therapeutic approaches for diarrhea associated with HIV infection.

Research paper thumbnail of 1064 Teaching the Competencies: Using Observed Standardized Clinical Encounters (OSCES) for Faculty Development

Gastroenterology, 2009

to assess improvement. Results: 9 full-time faculty and 8 fellows were surveyed. Hand-offs were g... more to assess improvement. Results: 9 full-time faculty and 8 fellows were surveyed. Hand-offs were graded from 1 (poor) to 5 (excellent). Fellow overall hand-offs were rated at 4, which remained constant at the follow up satisfaction survey. Attendings viewed the hand-offs at 3 during the initial survey and this improved to 4 in the follow up survey. Fellows rated their hand-offs from clinic fellow to procedure fellow at 1 at the start of the program and post-procedure between endoscopy and consult fellows as a 2; these both improved to 4s. We have incorporated a number of changes including routine hand-off of the service between attendings, the use of standardized spreadsheets in the hand-off of the service between fellows and altered conference schedule to facilitate uninterrupted patient care and bedside teaching. Conclusion: Identification of factors that lead to suboptimal patient hand-offs and development of methods to improve hand-offs can lead to better communication between physicians and ultimately safer patient care. The success of our program served as a model and was shared with the other subspecialty training programs at our institution to help them improve hand-off communication.

Research paper thumbnail of S1039 Teaching the Competencies: Educational Performance Improvement Using OSCEs for Gastroenterology Fellows

Gastroenterology, 2008

Gastroenterology, Volume 134, Issue 4, Pages A-164, April 2008, Authors:Bani Chander; Robert Kule... more Gastroenterology, Volume 134, Issue 4, Pages A-164, April 2008, Authors:Bani Chander; Robert Kule; Peter J. Baiocco; Sita S. Chokhavatia; Donald P. Kotler; Michael Poles; Sondra Zabar; Elizabeth H. Weinshel. Gastroenterology ...

Research paper thumbnail of 895 Informed Consent in the Older Adult – Can OSCES Assess Fellows' Competencies in Caring for the Geriatric Gastroenterology Patient?

Gastroenterology, 2010

Gastroenterology, Volume 138, Issue 5, Pages S-126, May 2010, Authors:Roy Miler; Brijen Shah; Mic... more Gastroenterology, Volume 138, Issue 5, Pages S-126, May 2010, Authors:Roy Miler; Brijen Shah; Michael Poles; Sondra Zabar; Colleen C. Gillespie; Elizabeth H. Weinshel; Sita S. Chokhavatia.

Research paper thumbnail of T1034 Observing Hand-Offs and Telephone Management in GI Fellowship Training

Gastroenterology, 2010

Gastroenterology, Volume 138, Issue 5, Pages S-473, May 2010, Authors:Roy Miler; Brijen Shah; Ren... more Gastroenterology, Volume 138, Issue 5, Pages S-473, May 2010, Authors:Roy Miler; Brijen Shah; Renee Williams; Sita S. Chokhavatia; Michael A. Poles; Sondra Zabar; Colleen C. Gillespie; Elizabeth H. Weinshel.