Mount Sinai Morningside, formerly known as Mount Sinai St. Luke's, is a teaching hospital located in the Morningside Heights neighborhood of Manhattan in New York City. It is affiliated with the Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System, a nonprofit hospital system formed by the merger of Continuum Health Partners and the Mount Sinai Medical Center in September 2013. It provides general medical and surgical facilities, ambulatory care, and a Level 2 Trauma Center, verified by the American College of Surgeons. From 1978 to 2020, it was affiliated with Mount Sinai West as part of St. Luke's–Roosevelt Hospital Center.Mount Sinai Morningside is the primary provider of health care serving the neighborhoods of the Upper West Side and western Harlem. It operates 21 clinics and as of 2020, is nationally ranked #23 for Diabetes and Endocrinology, and #25 for Nephrology by U.S. News & World Report. As of 2020, Arthur A. Gianelli, MBA, MPH, is President and Brian Radbill, MD, is Medical Officer and Senior Vice President of Medical Affairs.The structure was erected in 1896 as St. Luke's Hospital, and was designed by Ernest Flagg. Several additions were built in the early 20th century, and some of the original pavilions have been demolished. Parts of the facility have been designated as an official New York City landmark, and the remaining pavilions of the original hospital are listed on the National Register of Historic Places. Luke's–Roosevelt Hospital Center.
OBJECTIVE:Epilepsy duration is a modifiable risk factor in the outcome of definitive epilepsy surgery; however, an analogous effect in palliative procedures has not been shown. We reviewed the Pediatric Epilepsy Surgery Database data for an association between epilepsy duration and seizure reduction in palliative procedures. METHODS:Patients enrolled between January 2018 and April 2025 who underwent their first epilepsy surgery with palliative intent with 6 months of follow-up were included. Procedures included neuromodulation, corpus callosotomy, hemispherotomy, lesionectomy, and lobectomy where surgical intent was not seizure freedom. Outcomes of seizure freedom, 90% seizure reduction, and 50% seizure reduction were considered at 6-12 months and >12 months from surgery. Duration from epilepsy onset to surgery was compared for patients above and below each outcome threshold at each time point. Logistic regression analysis for the association between epilepsy duration and seizure reduction adjusted for potential confounders including procedure type, etiology, and other clinical factors. Logistic regression analysis was performed on the overall cohort and subgroups of patients with each procedure. RESULTS:A total of 588 patients were included. Initial univariate analysis suggested that epilepsy duration at time of surgery was significantly associated with seizure freedom and 90% seizure reduction at both 6-12 months and >12 months. After adjusting for confounders, only seizure freedom at >12 months was significantly associated with duration of epilepsy. When individual procedures were considered, only lobectomy was sensitive to duration of epilepsy in multivariate analysis, with significant impacts on >50% and >90% seizure reduction at >12 months. Lesional epilepsy predicted seizure freedom at >12 months. Neuromodulation and corpus callosotomy were less likely to achieve seizure reduction than other procedures. SIGNIFICANCE:We did not find an association between early epilepsy surgery and seizure reduction. This reflects the heterogeneity of our population, including different types of surgical procedures and lesional and nonlesional epilepsies.
Background: Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug, because of concern about teratogenicity and neonatal hypoglycemia. There is little information about the efficacy of these drugs in this group of women. Methods: We studied 404 women with singleton pregnancies and gestational diabetes that required treatment. The women were randomly assigned be- tween 11 and 33 weeks of gestation to receive gly- buride or insulin according to an intensified treatment protocol. The primary endpoint was achievement of the desired level of glycemic control. Secondary endpoints included maternal and neonatal complications. Results: The mean (±SD) pretreatment blood glucose concentration as measured at home for one week was 114±19 mg per deciliter (6.4±1.1 mmol per liter) in the glyburide group and 116±22 mg per deciliter (6.5±1.2 mmol per liter) in the insulin group (P=0.33). The mean concentrations during treatment were 105± 16 mg per deciliter (5.9±0.9 mmol per liter) in the glyburide group and 105±18 mg per deciliter (5.9±1.0 mmol per liter) in the insulin group (P=0.99). Eight women in the glyburide group (4 percent) required insulin therapy. There were no significant differences between the glyburide and insulin groups in the percentage of infants who were large for gestational age (12 percent and 13 percent, respectively); who had macrosomia, defined as a birth weight of 4000 g or more (7 percent and 4 percent); who had lung complications (8 percent and 6 percent); who had hypoglycemia (9 percent and 6 percent); who were admitted to a neonatal intensive care unit (6 percent and 7 percent); or who had fetal anomalies (2 percent and 2 percent). The cord-serum insulin concentrations were similar in the two groups, and glyburide was not detected in the cord serum of any infant in the glyburide group. Conclusion : In women with gestational diabetes, glyburide is a clinically effective alternative to insulin therapy
SMFM defines fetal growth restriction(FGR) by estimated fetal weight(EFW) or abdominal circumference(AC) < 10%. There is limited data on neonatal outcomes based on FGR diagnosed by EFW vs isolated AC. The SMFM algorithm for the diagnosis and management of FGR does not address managing patients with FGR based on AC. Our objective was to assess whether FGR based on EFW had worse outcomes and perinatal morbidity than those diagnosed solely on AC. This was a retrospective cohort study performed on singleton gestations from 03/2018-12/2022. All patients included, were admitted for induction of labor at term and had a pregnancy with a fetus defined as FGR at the last ultrasound prior to delivery. Group EFW was defined as FGR with overall EFW< 10%; Group AC was defined as FGR with an isolated AC< 10th% and overall EFW≥10%. The primary outcome was a neonatal composite outcome which was defined as: NICU Admission, APGAR < 5 at 5 minutes, neonatal hypoglycemia, and small for gestational age (SGA). Of the 529 patients eligible, 237(45%) were in the EFW Group and 292(55%) were in the AC Group. The demographic data was similar between the groups. There was a significant difference between the two groups in respect to: gestational age at delivery, neonatal birth percentile, weight & 5 minutes APGARS. The proportion of individuals who had abnormal Dopplers, chronic hypertension, SGA at birth, and NICU admission was significantly higher in EFW vs AC Group (p< 0.0001, See Table 1). Composite neonatal outcomes were significantly worse in the EFW group compared to AC Group (p< 0.0001). The odds of having an adverse outcome among individuals diagnosed as FGR via EFW is 3.88 times higher among neonates diagnosed as FGR via AC (95% CI:2.6–5.8). Our data suggests that neonates who were diagnosed with FGR based on EFW had worse neonatal outcomes when compared to FGR diagnosed by AC alone. These findings could be used to consult and reassure the patient that while an isolated AC< 10% gives a fetus the diagnosis of FGR, the outcomes appear to be better for these infants.
