Archive for November, 2013

Dr. Joshi receives high honor from Indian government

by Elizabeth Kumru, UNMC public relations

Ashish Joshi, M.D., Ph.D. 

Ashish Joshi, M.D., Ph.D., assistant professor in the Department of Health Services Research and Administration, and the Center for Global Health and Development in the UNMC College of Public Health, was awarded the 2013 Mahatma Gandhi Pravasi Samman Award by the government of India and the Non-Resident Indians (NRI) Welfare Society of India.

He received the award last week from the Honorable Baroness Sandip Verma, junior minister of Energy and Climate Change in the United Kingdom, at the House of Lords in London in the presence of dignitaries during a function of the Global Achievers Conclave.

The Mahatma Gandhi Pravasi Samman Gold Medal recognizes people of Indian origin for their significant contributions in various fields in the country of their residence and in the service of the wider global community. Pravasi Bharatiya Divas is celebrated in India each year on Jan. 9 to mark the contribution of the overseas Indian community to the development of India. The day commemorates the return of Mahatma Gandhi from South Africa to Bombay on Jan. 9, 1915.

Dr. Joshi was chosen as one of 30 awardees from around the world for the outstanding services, achievements and contributions in the field of innovative use of information and communication technology in public health research in diverse global settings.

“I’m extremely honored and humbled to have received this award,” Dr. Joshi said.
Dr. Joshi has designed and developed innovative, accessible and affordable heath technologies to improve access, alleviate health illiteracy, reduce health disparities and enhance population outcomes among individuals living in diverse global settings.

Lifestyle diseases like obesity, diabetes and hypertension are an increasing burden worldwide. He uses such information and communication technologies as Internet, cell phone and electronic health kiosks to prevent and manage the increasing disease burden among individuals living in urban and resource-poor settings.

“I combine interactive media such as audio, video, images and animations with public health evidence to develop informatics tools that can effectively communicate risk to an individual in an easy-to-understand format so that appropriate recommendations can be given,” he said.

Dr. Silva: Investigate options for breast cancer treatment

by Kalani Simpson, UNMC public relations


VIDEO: Edibaldo Silva, M.D., Ph.D., discusses breast cancer fears
The fear of breast cancer hangs over many women like a dark cloud.


Edibaldo Silva, M.D., Ph.D., professor of surgical oncology, understands why some take immediate, even drastic, action in order to achieve peace of mind.
But Dr. Silva, who specializes in the research and treatment of breast cancer, counsels his patients to sit down with their team of health care providers first.
A week or two or three of gathering information won’t hurt your long-term prognosis, he said.

“What you see in the U.S. now is women have a lump in the breast and they find it’s cancer, and the next day they are having bilateral double mastectomy,” Dr. Silva said. “No consideration of counseling, genetic testing, none of that.”

In fact, Dr. Silva said, on average among women who have a double mastectomy in the U.S., only 29 percent ever even discuss the subject with a genetic counselor to see if they carry mutated BRCA genes which cause breast and incurable ovarian cancer.

Studies by the University of Michigan, the Mayo Clinic and others show most women are doing it out of fear.

Dr. Silva said it’s important to remember that only 5 percent of women who contract breast cancer have “bad genes.” The rest simply had “bad luck,” likely a one-time occurrence.

And their cancer is often best treated with lumpectomies and radiation, the effectiveness of which “we know is equivalent to mastectomy,” Dr. Silva said.
A possible option for many women diagnosed with breast cancer could be to start chemotherapy while simultaneously taking the time to gather information, Dr. Silva said.

First, it is actively fighting the cancer. Second, if surgery is necessary, it makes the surgery more effective and easier to complete. Third, in some cases, the cancer may be gone by the end of the chemo treatment.

“And by gone, I mean you can’t find it,” Dr. Silva said.

If you are worried that you carry the BRCA gene mutation, draw up your family tree, Dr. Silva said, and visit with a genetic counselor to see if you should get further testing.

“The odds are overwhelmingly in your favor that you are not a gene carrier,” Dr. Silva said.

But if you are among the statistically select few, it is serious.

The gene causes a 20 percent to 40 percent risk of developing incurable ovarian cancer, Dr. Silva said, and double mastectomy and eventual removal of ovaries are recommended.


Islet Cell Transplant Gives Patient Her Life Back

Facing No Other Option, Linda Elonich Agrees to Life-Changing Surgery

For seven years, Linda Elonich lived with the excruciating pain of pancreatitis attacks. The Omaha woman says it started suddenly in her sleep – pain so severe she couldn’t speak. She thought she was dying. She underwent several surgeries over the next several years, but continued attacks meant she could no longer work, travel or spend much time away from home. Her doctors brought up the idea of removing her pancreas and performing an islet cell transplant. They were cautious, but Elonich was ready.

“I said, ‘Let’s do it.’ I hurt so bad at that point, I had no fear of it. It was a chance for relief,” she recalls.

Her husband and her doctors urged caution, but a serious and extremely painful attack led them all to believe the time was right.

“The islet cell transplant is the second part of a procedure for patients who have their pancreas taken out,” explains Brian Boerner, MD, endocrinologist. “Those are patients who have no other option for treatment. As part of that, we can remove the islets, the insulin-producing cells from the pancreas and put them back into the person’s liver where they function and prevent serious diabetes.”

After a successful transplant, the liver essentially performs the function of the pancreas.

Though not the first islet cell transplant performed here, Elonich’s operation was the first done as part of the medical center’s Pancreas and Biliary Disorders Clinic.

“It went off without a hitch and went according to plan,” says Luciano Vargas, MD, the transplant surgeon who performed Elonich’s procedure.

Transplant surgeon Luciano Vargas, MD, looks on as Linda Elonich’s islet cells are infused into her liver.

The operation took most of the day. In the first part of the surgery, Dr. Vargas removed the pancreas and sent it to our Biologics Production Facility (BPF). Scientists there spent four to six hours isolating the islet cells and prepare them for re-infusion into the patient’s liver.

“The expertise at the lab is phenomenal,” Dr. Vargas says. “You can tell by how Linda is doing.”

When the cells are ready to be infused into the liver, BPF staff brings the bags of cells to the OR where the surgical team is waiting.

Elonich says she could tell a difference as soon as she woke up from surgery. After a recent check up with both Drs. Boerner and Vargas, Elonich says she has a new outlook on life.

“It’s nice to wake up in the morning. Every day is a beautiful day,” she says. She recently traveled to Arkansas to visit her 93-year-old grandmother; something that would have been impossible before the surgery.

Elonich has praise not only for the expertise at the medical center, but for the caring personalities of everyone she’s met from the clinics to the hospital.

“These people for me are life savers. Most people going to the doctor, they dread it. It’s not like that for me. They’re like family to me now; we’ve been through something so personal and life-changing together.”

Watch more of Linda’s story.


UNMC team finds early heart disease warning with simple blood test

by Charlie Litton, UNeMed

thieleGeoff Thiele, Ph.D. 

It’s a virtual certainty that everyone over 50 – more than 98 million Americans -has coronary artery disease. So do 70 percent of 40-year-olds. About half of people in their 20s and 30s probably have it too.
Yet heart disease doesn’t kill everybody.

Understanding why has been a confounding riddle for modern medicine.

An team of researchers at UNMC believe they’ve made a potentially groundbreaking discovery — a test that determines whether a patient is harboring the dangerous type of heart disease that kills one in four Americans every year.

Michael Duryee 

Unfortunately, that heart attack is too often the first indication that a patient has the lethal form of coronary artery disease. But UNMC’s new test could change that.

Geoff Thiele, Ph.D. a professor of internal medicine, and Michael Duryee, a research coordinator for the division of rheumatology and immunology, made the initial discovery. While looking for clues to help understand inflammatory conditions such as arthritis, they focused on a molecule that is a strong indicator of inflammation.

Known as MAA or malondialdehyde-acetaldehyde, the molecule also appeared to indicate the presence of coronary artery disease.

Dr. Thiele and Duryee brought in Dan Anderson, M.D., Ph.D., an assistant professor in cardiology. He has a frontline view of the battle against the world’s most prolific killer. 

Dan Anderson, M.D., Ph.D. 

“In the current realm of understanding disease, we know that inflammation is important in cardiovascular disease,” Dr. Anderson said. “But we really don’t understand a lot about why or how.”

By current measures, Anderson said, about 30 percent of people with heart disease slip through the cracks. For those people, the first indication of trouble may be a killer heart attack.

But others with the disease suffer few, if any, ill-effects. Predicting which patients will develop the more deadly form of heart disease is little more than a guess.
Then Dr. Thiele and Duryee knocked on the door.

“From a clinical diagnostic perspective, this becomes invaluable to help understand those different groups of patients,” Dr. Anderson said.

The research team and UNMC’s technology transfer office, UNeMed Corporation, are currently in preliminary discussions with several companies on how to translate the results into products that can better factor in a patient’s risk of heart attack.

The next rounds of testing will be critical to understand how accurate the test can be, particularly studies that follow individual patients over the course of five or 10 years, Duryee said.