These are C. albicans cells growing invasively into tissue in a mouse model of an oral infection. The candida hyphae are stained black, and the tissue is stained a blue/green. Photo by James Konopka
A study that assesses the effects of hypochlorous acid (HOCI), commonly known as bleach, as it is generated during the immune response of a cell (phagocytosis) when fighting a common fungal pathogen, Candida albicans, reveals that HOCI is a potent killing agent. The laboratory finding, highlighted in a paper published in the coming issue of the American Society of Microbiology’s mBio, also uncovers some of HOCI’s mechanisms of actions in that killing process. The work could be a significant step toward using HOCI as a novel therapeutic strategy against C. albicans, and potentially other pathogens.
C albicans causes much infection worldwide. It is particularly virulent in immunocompromised patients and the cause of dangerous systemic infections in this population. There have been many effective treatments against the fungal pathogen, but for decades drug resistance has been problematic when treating infections cause by C. albicans.
Most studies looking at this immune response against the fungal pathogen have focused on hydrogen peroxide (H2O2), not HOCI. Phagocytes capture the fungal invader and in the process two oxidants are created – H202 and HOCI. Myeloperoxidase converts H2O2 created during the oxidative burst in the phagosome into HOCI, the more potent killing agent.
“We discovered that hypochlorous acid kills cells by targeting the plasma membrane and oxidizing cellular components in a very different way than hydrogen peroxide,” says James Konopka, PhD, lead author and Professor in the Department of Microbiology and Immunology in the Renaissance School of Medicine at Stony Brook University. “It disrupts the C. albicans plasma membrane, produces a very different transcriptional response than hydrogen peroxide, is more effective and disruptive to the plasma membrane, and therefore has a more distinct effect on killing these fungal cells.”
Konopka explains that neutrophils are the critical cell type for controlling infections by C. albicans and other fungal pathogens. They are distinct because they make high levels of myeloperoxidase compared to other phagocytes, such as macrophages. This study shows the important aspect of the neutrophil response, essential to the oxidative process that produces this fungal killing HOCI or bleach.
While the laboratory results will not have any immediate impact on new treatments against C. albicans infections, Konopka believes the findings provide a basis for designing new therapeutic strategies against this pathogen that causes infections worldwide.
The research was supported by a grant from the National Institutes of Health’s Institute of Allergies and Infectious Disease (grant number RO1AI047837), and in collaboration with researchers at Seoul National University in South Korea.
Chetan Potu poses to show his match to Stanford Health Care in California for a residency in Physical Medicine and Rehabilitation. Photo by Arthur Fredericks
A scene of jubilance with this group of Renaissance School of Medicine matching students – in total 121 graduating students matched to residency programs in New York State and around the nation. Photo by Arthur Fredericks
A scene of jubilance with this group of Renaissance School of Medicine matching students – in total 121 graduating students matched to residency programs in New York State and around the nation. Photo by Arthur Fredericks
Ashley Ferguson, center, with her family at Match Day, holds a sign showing her residency match to General Surgery at the University of Rochester/Strong Memorial. Photo by Arthur Fredericks
As the U.S. faces challenges with health care delivery systems and shortages of physicians will likely continue in the future, the Renaissance School of Medicine at Stony Brook University continues to produce new crops of physicians for the workforce each year. This year at its annual Match Day, 121 graduating students matched to residency programs around the country, from New York State to 19 other states and Washington, DC. More than one-quarter of these students (26%) matched to residency programs at Stony Brook Medicine.
Match Days are held nationwide each year, a celebratory event when students learn of their residency training assignments. Administered by the National Resident Matching Program, this year more than 40,000 positions were filled — a record for the NRMP’s 70-year history.
“Congratulations to all of you, and remember that things are going to work out regardless of where you have matched to,” said Dr. Peter Igarashi, dean of the RSOM, who waved his own residency notice letter that he received years ago from his Match Day, one which revealed a choice that he did not expect and was not his first choice. “You have accomplished this at a time when a worldwide pandemic was at the center of your medical school training, an impressive feat.”
A majority of the matching students will stay in New York State for their residency training — 59%. Of that portion, 55% will be employed on Long Island, and 45% at Stony Brook Medicine.
The top residency training programs matched to included Anesthesiology (21), Internal Medicine (16), Psychiatry (12), and Emergency Medicine (11). A solid portion of the students (21%) matched to primary care specialties, such as Medicine and Pediatrics. This is an important portion entering primary care fields, as the country faces primary care shortages ranging from 21,000 to 55,000 practitioners over the next decade, according to an Association of American Medical Colleges 2021 report.
In addition to students matching at Stony Brook and other hospitals across New York State such as Montefiore Medical Center, Memorial Sloan Kettering and University of Rochester, they also matched to residencies at nationally recognized institutions such as Tufts Medical Center in Massachusetts, the Mayo Clinic in Minnesota, and Johns Hopkins Hospital in Maryland.
Nivea Pereira de Sa Photo by Rodrigo Carvalho da Silva
By Daniel Dunaief
When people are immunocompromised, exposure to what might ordinarily be a harmless fungus can cause significant health problems.
Researchers in the laboratory of Maurizio del Poeta, Distinguished Professor in the Department of Microbiology and Immunology at the Renaissance School of Medicine at Stony Brook University, have been looking to create new treatments and develop vaccines against these fungi.
Working with a team of scientists at Stony Brook, research scientist Nivea Pereira de Sa, who joined del Poeta’s lab in 2018 as a postdoctoral researcher, recently published research in the journal mBio about potential anti-fungal drugs that target a key enzyme in the fungus Aspergillus fumigatus.
Without the enzyme, the fungus can’t cause disease and the host defenses have time to eliminate it even if the host is immunodeficient.
Working with Michael Airola, Assistant Professor in the Department of Biochemistry and Cell Biology at SBU, Pereira de Sa started out by trying to find the structure of sterylglucosidase, an enzyme that is a molecular key for the fungus during infection and that aids in its ability to adapt to environmental changes such as low oxygen levels and changes in pH.
Pereira de Sa learned how to do x-ray crystallography from Airola, a process that reveals the structure of compounds.
In an email, Airola described Pereira de Sa as an “expert” in the technique.
Airola called the research “one of the most exciting projects” he’s worked on and hopes the group can translate the results into the clinic. A talented biochemist, Pereira de Sa is also an “expert in so many different scientific areas,” Airola wrote, which he described as “rare.”
Pereira de Sa also determined the structure of the same enzyme for Cryptococcus, another invasive and potentially harmful fungus. The enzymes in both fungi have a high degree of similarity.
Pereira de Sa expressed satisfaction at the application of such work. “Every time I get a crystal structure, it’s so amazing,” she said. “I love doing that.”
Pereira de Sa started screening potential compounds to inhibit sterylglucosidase in Aspergillus,
Del Poeta’s lab coordinated the design and testing of these inhibitors with Iwao Ojima, Distinguished Professor in the Department of Chemistry and Director of the Institute of Chemical Biology and Drug Discovery at Stony Brook.
Refining potential drugs
Ojima’s group is synthesizing derivatives of the hits Pereira de Sa found and she will start tests outside a living organism, or in vitro, soon.
Ojima has synthesized several compounds using computer-assisted drug design. He is currently developing several inhibitors that scored high on his computational molecular docking analysis and will synthesize two to three dozen potential small molecules.
Ojima, who partnered with Pereira de Sa in this study, “greatly appreciates her and her seminal contributions to this project,” he wrote in an email. She made critical contributions to the study that ensured its success and Stony Brook is “very fortunate to have her as a leader in this project.”
Ojima plans to identify highly potent inhibitors individually for Aspergillus and Cryptococcus separately, and then will try to find and develop broad spectrum inhibitors based on those compounds.
The need for a treatment has increased dramatically as the number of immunocompromised patients has increased.
Invasive aspergillosis can have mortality rates above 90 percent. The World Health Organization last October released its first ever list of health threatening fungi, which includes Aspergillus.
Pereira de Sa suggested two possible uses for this inhibitor. It could work as a treatment, knocking down the virulence of the fungus or it could contribute to the development of a vaccine.
In strains with a mutated enzyme, a mouse model has full protection against infection.
Getting a vaccine approved through the Food and Drug Administration for immunocompromised individuals might be challenging, she said. Several studies would be needed to confirm its safety.
Del Poeta added that the vaccine his lab has developed is effective alone when heat killed, reducing the threat a live virus with a defective enzyme might pose to an immunocompromised patient. Del Poeta has been developing a vaccine for cryptococcus and aspergillus and is testing it for other fungal infections as well.
‘A beautiful cause’
Del Poeta described Pereira de Sa as a key contributor to his lab, who is methodical, systematic and hard working.
The program she is developing will take years to go to clinical trials, he added.
Del Poeta met Pereira de Sa in 2017, when he visited Brazil and spoke with her mentor, Daniel de Assis Santos, who gave her an enthusiastic reference.
After meeting with her for only five minutes, del Poeta offered her a job.
“I will never forget her face: surprised, joyful, excited and she could not hold back some tears,” del Poeta described.
Del Poeta is thrilled with his choice, as she has gone above and beyond his expectations.
Born and raised in Belo Horizonte, Brazil, Pereira de Sa lives in East Setauket with her husband Rodrigo Carvalho da Silva, who is an airplane mechanic.
She enjoys Long Island, particularly during the summer, when she goes hiking, visits parks, kayaks and goes paddle boarding.
Pereira de Sa is encouraged by the progress in her work and is hoping her research contributes to future treatments.
“We are developing tools to help people,” she said. “It’s a beautiful cause I’m fighting for.”
She said the mortality rate from these fungal infections is “very high,” especially because a fungus like Aspergillus is ubiquitous.
“The fungus is present everywhere,” she said. “We are inhaling the spores of it every day.”
The invasive fungal disease starts in the lungs and spreads to the rest of the body, including in the brain, which can cause seizures.
Pereira de Sa recognizes the urgency of developing an effective treatment.
“We need some solutions and we need it now,” she said. “We are not prepared to fight fungal infections” on a large scale.
Dr. Bettina Fries. Photo by Jeanne Neville/Stony Brook Medicine
Bettina Fries, MD, Chief of the Division of Infectious Diseases, Professor of Medicine, and Molecular Genetics and Microbiology in the Renaissance School of Medicine at Stony Brook University, has been named a 2022 fellow of the American Association for the Advancement of Science (AAAS).
The AAAS is dedicated to elevating the quality of science and technology across the world for the benefit of humankind, and its fellows represent members of the association who have made exceptional contributions to that mission.
Dr. Fries is a nationally recognized physician-scientist who specializes in mycology and also conducts research of antibodies in relation tovaccine development. Under her leadership, the Division of Infectious Diseases at Stony Brook has greatly expanded and rose to combat the COVID-19 Pandemic and lead clinical care and research throughout the pandemic and its changing circumstances.
From expanding clinical and basic research and improving patient care to allocating essential resources and protecting health care providers, Dr. Fries’ work in healthcare and infectious disease researchhas impacted both Stony Brook and other institutions.
In addition to her appointment as an AAAS fellow, the East Setauket resident is also a fellow of the Academy of Microbiology of America, a fellow of the Infectious Disease Society, and a fellow of the American College of Physicians. She has served as President of the Medical Mycological Society of the Americas, and the Infectious Diseases Society of New York.
Dr Fries’ work spans a wide range of disciplines, but her research chiefly investigates the pathogenesis of chronic fungal infections and the development of monoclonal antibodies against multidrug-resistant bacteria.
Editor’s Note: Dr. Bettina Fries was one of TBR News Media’s 2022 People of the Year.
Do the birds on the Galapagos Islands, with their unique coloration, differently shaped beaks and specific nesting places, have anything to do with the cancer cells that alter the course of human lives?
For Mehdi Damaghi, Assistant Professor in the Department of Pathology at the Renaissance School of Medicine at Stony Brook University, the answer is a resounding, “Yes.”
Damaghi uses the same principles of evolutionary biology to understand how cancer, which resides within human genes, works to adapt, as it tries to win the battle to survive.
“What we try to understand is the Darwinian principals of cancer,” said Damaghi. Cancer “adapts and reprograms themselves” to their environment to survive.
Damaghi, who arrived at Stony Brook four months ago from Moffitt Cancer Center, plans to address numerous questions related to cancer. He recently received a $4 million grant from the Physical Science in Oncology program (PSON) through the National Institutes of Health/ National Cancer Institute. Working with cancer biologists, clinicians, and computational scientists, he plans to define and understand cancer’s fitness.
“We are trying to study the core evolution of cancer cells and the normal stroma around them,” said Damaghi. “We are looking at the evolution of the tumor and some of the host cells.”
Cancer biologists are trying to build mathematical and theoretical models to explore the playbook cancer uses when confronted with threats, either in the form of a body’s natural defenses against it or from therapies against which it can, and often does, develop resistance.
Treating cancer could involve using adaptive therapy, which could enable people to control and live with cancer longer, Damaghi suggested.
In studying cancer’s phenotype, or the way the disease is expressed and survives, he hopes to understand factors in the microenvironment. Many cancers, he reasons, become more problematic as people age. Indeed, centuries ago, cancer wasn’t as prevalent as it is today in part because life expectancy was shorter.
Damaghi also has an evolutionary model to explore metastasis, in which cancer spreads from one organ or system to other parts of the body. He is looking at the earliest stages of breast cancer, to see what factors some of these cancers need or take from the environment that enables them not only to develop into breast cancer, but also to spread to other systems.
Through the microenvironment, he is looking for biomarkers that might signal a potential tumor development and metastasis long before a person shows signs of an aggressive form of the disease.
“We look at the tumor as a part of a whole ecosystem that can have different niches and habitats,” he said. “Some can be hypoxic and oxidative, and others can be like a desert on Earth, where not much grows and then cancer evolves.”
Damaghi challenges cells in a culture or organoids, which are miniature, three-dimensional live models of human cells, with different microenvironmental conditions to see how they respond. He exposes them to hormones, immune cells, and hypoxic conditions.
“We try to understand what is the adaptation mechanism of cancer to this new microenvironment and how can we push them back to the normal phenotype,” he said.
Like other scientists, Damaghi has demonstrated that many of these cancer cells use sugar. Removing sugar caused some of the cancer to die.
Increasing the survival for patients could involve knowing what kinds of micro-environments cancer uses and in what order. Deprived of sugars, some cancers might turn to amino acids, dairy or other sources of food and energy.
Damaghi thinks researchers and, eventually, doctors, will have to approach cancer as a system, which might have a patient-specific fingerprint that can indicate the resources the disease is using and the progression through its various diseased stages.
Choosing Stony Brook
Damaghi appreciates the depth of talent in cancer sciences at Stony Brook University. He cited the work of Laufer Center Director Ken Dill and Cancer Center Director Yusuf Hannun. He also suggested that the Pathology Department, headed by Ken Shroyer, was “very strong.”
For their part, leaders at Stony Brook were pleased to welcome, and collaborate with, Damaghi. Hannun suggested Stony Brook recruited Damaghi because his research “bridges what we do in breast cancer and informatics.”
Shroyer, meanwhile, has already started collaborating with Damaghi and wrote that his new colleague’s focus on breast cancer “overlaps with my focus on pancreatic cancer.”
To conduct his research, Damaghi plans to look at cells in combination by using digital pathology, which can help reveal tumor ecosystems and niches.
He also appreciated the work of Joel Saltz, the Founding Chair in the Department of Biomedical Informatics. “In the fight against cancer, we all need to unite against this nasty disease,” Damaghi said. “From looking at it at different angles, we can understand it first and then design a plan to defeat it.”
Originally from Tehran, Iran, Damaghi is the oldest of five brothers. He said his parents encouraged them to explore their curiosity.
Damaghi, whose wife Narges and two daughters Elissa and Emilia are still in Tampa and hope to join him before long, has hit the ground running at Stony Brook, where he has hired three postdoctoral researchers, a lab manager, four PhD students, two master’s candidates, and three undergraduates.
Damaghi is inspired to conduct cancer research in part because of losses in his family. Two grandparents died from cancer, his aunt has breast cancer, and his cousin, who had cancer when he was 16, fought through the disease and is a survivor for 20 years.
Damaghi bicycles and plays sports including soccer. He also enjoys cooking and said his guests appreciate his Persian kebobs.
As for his arrival in Stony Brook, he said it was “the best option for me. It’s a great package and has everything I need.”
Krisha Mehta celebrates her match to Stony Brook Medicine with her family. Photo by Arthur Fredericks
All smiles: matching fourth-year students hold up their signs indicating where their careers as physician will begin. Photo by Arthur Fredericks
Leslie Peralta celebrates her match – to Obstetrics/Gynecology at UNC Medical Center in North Carolina. Photo by Arthur Fredericks
Some of the 26 matching students who will stay at Stony Brook Medicine for their residency training. Photo by Arthur Fredericks
Dr. William Wertheim, Interim RSOM Dean, urged the students to recognize they are on the threshold of their careers where opportunities and enriching experiences await them. Photo by Arthur Fredericks
131 RSOM students match to residency programs; 20 percent to stay at Stony Brook Medicine
Taking a major step toward launching their careers, 131 Renaissance School of Medicine (RSOM) fourth-year students matched to residency training programs all over the country, New York State and at Stony Brook Medicine on March 18. Twenty percent of the students matched to training programs at Stony Brook, the highest percentage staying at Stony Brook since 2010 when the school began tracking this metric annually.
Match Days are held nationwide each year, a celebratory event when students learn of their residency training assignments. Administered by the National Resident Matching Program (NRMP), this year more than 39,000 positions were filled. See this NRMP news. The numbers of physicians continue to increase, in part because of a need for our nation’s growing population and increasing need for specialty services in medicine. The two-year international pandemic has also raised awareness of the importance of a strong physician pool going forward in the 21st Century.
“The role of the physician has never been more important,” said Hal Paz, MD, MS, Executive Vice President for Health Sciences at Stony Brook University, in a video message to the matching students. “You will soon be joining a network of over 4.500 physician alumni. The Renaissance School of Medicine gave you an opportunity to become a physician, but you did the hard work to fulfill your dreams.”
Collectively the students matched to programs in 18 states and Washington, DC. Approximately 43 percent of the students matched to programs in NYS, and 56 percent to programs in other states. The leading programs matched to included Internal Medicine (21 students), Emergency Medicine (15), Anesthesiology (12), and Pediatrics (11).
To view the celebration and some students’ matches see this video.
“You all stand on the threshold of your medical careers, a threshold can be the entrance to a new place, or it can be the beginning of some new chapter in our lives, or it can be the limit of a prior condition. For you it is all those things,” said William Wertheim, MD, Interim Dean of the RSOM.
Considering these challenging times in our society and in healthcare, Dr. Wertheim continued: “COVID has become, during your student years, a fact of life. Though it has posed disruptions for you all, it has also created opportunities — for you to witness the advances of science and how each of these advances is incorporated into practice, for the rapidity with which recognition of new conditions and new challenges are adopted into medical care. These are all good lessons to learn.”
Among the students matching include native Long Islanders Kristin Krumenacker and Justin Cheung. Krumenacker, a dual-degree student who will also earn a Master of Arts in Medical Humanities, Compassionate Care, and Bioethics in May, matched to a Radiology residency at Virginia Commonwealth University Health Systems. Cheung, who earned a BS in Chemical Engineering at Stony Brook University as an undergraduate, hopes to pursue a fellowship in hematology/oncology. He is one of four fourth-year students completing the BS to MD program at Stony Brook. Cheung matched to an Internal Medicine program at Massachusetts General Hospital.
Another student completing the BS to MD program at Stony Brook, Verdah Ahmad, matched to Rutgers Robert Wood Johnson University Hospital in New Jersey. A native of New Jersey, Ahmad was hoping to match to a school in the New York metro area. She is very happy to match to a program in her home state.
136 incoming students to the Renaissance School of Medicine took their Hippocratic Oath for the first time. Photo from Stony Brook Medicine
The Renaissance School of Medicine at Stony Brook University welcomed its incoming 2021 class at the annual White Coat Ceremony on Aug. 15. A total of 136 students for the first time donned their white coats and took the Hippocratic Oath at a ceremony in the Staller Center. They begin their medical training during a year that marks the 50th anniversary of the school.
First-year student Jessica Kwong. Photo from Stony Brook Medicine
Dr. William Wertheim, interim dean, cited the students as a unique and talented incoming class entering medicine at a challenging and changing time in the profession. He emphasized professionalism and compassion for patients as two of the leading areas they will need to develop and build on in their medical school training years.
A large portion of the class hails from New York State (69%), yet many students are from all over including 13 other U.S. states and five countries. They are among a select group, as the school received more than 5,800 applications for a position in the class.
“I feel like entering the medical field during these pandemic times will give my class a humbler perspective on medicine,” said student Jessica Kwong, who had majored in Psychology and Linguistics at Emory University. “I have no idea what I want to specialize in, but during the pandemic I worked with the elderly populations and organized a tele-volunteer initiative. I do plan on working with underserved populations, which is why I minored in Spanish so I can use it in my practice as a future physician.”
“This pandemic has shown me just how critical physicians are, and I am excited to see how myself and classmates can help in the Covid-19 crisis,” said Michelle Carfagno, who started to become very interested in medicine at age 12 when she had a knee injury. A Cornell University graduate who majored in Biological Sciences, Carfagno is very interested in the relationship between nutrition and disease and is considering a path in primary care or perhaps specializing in GI diseases at some point.
First-year student Michelle Carfagno. Photo from Stony Brook Medicine
Career-changer Carlos Ortiz worked in the area of supply chain management but was also a volunteer EMT. He found EMT work fulfilling. That service along with his interest in maintaining physical health and supporting others to do the same inspired him to pursue medicine. Ortiz also found himself on the front lines during the pandemic, which he says further helped prep him for medical school.
As the need for more physicians continues in the U.S. and worldwide due to aging populations, increased medical interventions, and a new lens on public health due to the pandemic, it’s fitting that the 2021 incoming class is one of the RSOM’s largest to date. Four members of the school’s first entering class of 1971 attended the ceremony to celebrate with the new students. That class included only 24 individuals, 16 men and eight women.
Three-year medical school grads Adam Bindelglass, Simrat Dhawilal, William Guo, Maxwell Moore, Justin Bell, Eliana Fine and Brant Lai. Photo from Stony Brook University
Behind every stethoscope is a story.
Chineze Nwebube during the Graduate Address. Photo from Stony Brook University
This year, the stories among the new doctors who recently graduated from the Renaissance School of Medicine at Stony Brook University developed against the backdrop of a pandemic and included numerous firsts for the school and for the families of graduates.
Seven of the 150 graduates, which is the largest medical school class to earn a medical degree from Stony Brook, completed their training in three years, joining a small but growing trend among medical schools that are encouraging more people to consider becoming physicians while reducing the potential debt that can accrue while earning their medical degree.
“This year is really going to stand out,” said Andrew Wackett, vice dean of Undergraduate Medical Education and the director of the Clinical Simulation Center. “This was a group of students that really went through an awful lot. They rose to the occasion. They didn’t complain. Rather than do that, they tried to figure out how to help. It’s a special group of physicians that will make a great impact.”
Indeed, amid the worst of the pandemic, which hit Suffolk County especially hard during the spring of 2020, medical school students performed a host of important tasks, just as so many other health care professionals took on additional responsibilities and put themselves in harm’s way to protect the public.
Students volunteered to help with research, assisted patients who needed to connect with clinicians through in-person or telehealth and did “a lot of work with following up to make sure [residents] were doing okay when they were discharged,” Wackett said. These students were “really important in organizing the vaccine strategy,” as a number of them trained and volunteered to give vaccines. “They doled out thousands of them.”
Wackett suggested that the adversity caused by the pandemic has enabled class members to become resilient.
“What they learned, more than anything, was that they could adapt to whatever the world threw at them,” Wackett said. “It made them a much tougher group of students.”
Wackett said he was moved by the story of Chineze Nwebube, who described in the Graduate Address how she took the MCAT several times and had moments when she thought about giving up.
With the support of her family, she persisted and was “an exceptional medical student and will be an incredible physician,” Wackett wrote in an email.
Wackett said the spotlight on social injustice amid the pandemic also affected the dialog and the didactic efforts at the medical school.
“Certain populations have disparate health care, and we need to be involved to make that better,” Wackett said. That includes an analysis not just of disease or pathology, but also a consideration of how social factors impact the course of illnesses.
“Courses that traditionally taught science [are also] looking at the social context,” he said. “Medicine and public health are way more interconnected than we even realized.”
The graduates are preparing to venture into a world in which new lessons learned in the classroom and the clinic will prove especially valuable. At the same time, they bring a passion, dedication and conviction to the communities they plan to serve.
In between graduating and taking the next steps in their medical careers, some of this year’s graduates shared their inspiring and inspired stories.
Former dean and senior vice president of health services Ken Kaushansky, center, with Jheison and Monica Giraldo, the first married couple to enter and graduate from medical school at Stony Brook together. Photo from Stony Brook University.
Here comes the married couple
Monica Lenis didn’t think Jheison Giraldo, the guy from another class who was making up a lab in undergraduate biology at Stony Brook University, was all that funny. That just made him try so much harder, prompting eye rolls from a tough audience.
“His jokes were not making me laugh,” Monica recalled about that fateful science class eight years ago. “Somehow, we hit it off. We started talking after that and got to know each other.”
Despite Monica’s initial resistance to his charms, the couple started spending considerable time together, where they realized how much they had in common.
For starters, they were born in Colombia, five hours apart by car. Their families had moved to Long Island, his to Brentwood and hers to Bethpage, when each of them was nine years old.
Once they started to get to know each other, they appreciated each other’s strengths.
Jheison, who describes himself as the more outgoing of the two, tried to compete with Monica academically. That didn’t work out too well.
On a test in Biochemistry 2, in which the average was around 40, he reached the high 90s. He confidently went over to Monica, figuring he had to have beaten her.
She scored a 102, getting all the questions right and adding the two extra points.
“If you can’t beat them, join them,” he said. “I knew being next to her, she’s going to push me to excel in every way I could. I would do the same for her.”
Monica appreciated Jheison’s pervasive and persistent positive attitude. She also appreciated how well he interacted with her parents and her family, enjoying the older brother role he took with Monica’s 15-year-old brother.
After they graduated from Stony Brook, they got married. Jheison had always known he wanted to be a physician, dressing up for Halloween close to a dozen times as a doctor. Monica had other interests, including in the law. In addition to falling in love with Jheison, she also developed a deep appreciation for science in college and eventually deciding that she didn’t want to conduct research.
They applied to 30 medical schools. When they decided to go to Stony Brook together, they became the first married couple to enter the medical school together.
“When we first started” meeting people in the class, some of their peers “thought of us as the grown-up couple,” Monica said. Each of them, however, established their own academic and social friend groups.
While in medical school, they supported each other, as they focused on becoming, as Jheison put it, “the best physicians we could.”
Now that he is planning to become a resident in internal medicine and pediatrics and she plans to focus on internal medicine and cardiology, the medical couple has decided to contribute to a community they feel could use their support.
“From day one, we wanted to go to a place where we could be faced with patients who need more equity and diverse doctors working with them,” Jheison said. “We always looked at strong minority areas or historically under-represented areas. Miami stood out for us.”
While Long Island has been her home since she arrived in the United States in 2002 and has a “special place in my heart,” Monica is excited for an opportunity for personal growth. She is also thrilled to get away from the snow and the cold.
As she prepares for the next chapter in her life, she is looking forward to continuing in her journey with Jheison, who is “very positive and very uplifting. He’s always been very supportive, which is really all you could ask for in a partner.”
Eliana Fine with her husband Mark Feld, their 4-year-old son Ezra and their 6-month-old daughter Sophia. Photo from Eliana Fine.
Dr. Mom
Like many of her friends in the Orthodox Jewish community, Eliana Fine got married soon after high school, at the age of 19. Within two years, she gave birth to her son Ezra and, six months ago, to her daughter Sophia.
She could have dedicated herself and her time to becoming a stay-at-home mom, enveloping herself in a culture that emphasizes family and community and that keeps many women incredibly busy taking care of their often numerous children.
Instead, with the valuable and necessary support of her husband Mark Feld, Eliana decided to go a different route, not only pursuing a career as a doctor but also earning her degree in three years.
“I come from a community where most of the women don’t work,” Fine said. “I honestly didn’t even know any other orthodox Jewish woman who was a physician or was a medical student or physician trainee.”
Fine, however, wanted to develop her own career, particularly in the field of obstetrics and gynecology, where she felt she could help women, particularly in her community.
She described how the women in her community often don’t have extensive knowledge about reproductive and sexual health education before they get married. Women often have a kallah teacher, who is usually the wife of a rabbi.
“Your education is really based on the knowledge of your teacher,” Fine said, and “what they feel comfortable teaching you.”
Fine wanted to give back to her community, educating women about medical and health issues that can help “empower them to make better health care decisions.”
As a physician, Fine hopes to help other orthodox Jewish women understand more about women’s health and fertility.
“If women are having difficulty conceiving, the peer pressure can be stressful,” she said. “All of your friends are having kids and you’re not moving forward with your family.”
She wanted to give back to a community that she loves and that provides the context and framework for her life.
“There’s a lot of misconceptions when it comes to contraception,” Fine said. “People think contraception causes infertility. People don’t necessarily utilize contraception because of various misconceptions about it.”
To get to this point in her career, Fine said she had to overcome some of the expectations of a culture that sometimes places a stronger emphasis on family, particularly for women, than it does on developing careers.
She appreciated and is grateful for the support of her husband and her grandfather, Dr. Richard Fine, who was a dean of Stony Brook Medical School. When she was younger, she knew he was a physician, but wasn’t aware of his extensive career beyond that. She appreciated his regular questions to her about what she wanted to do when grew up, which allowed her to think for herself about what motivates her and how to make a difference in the world.
Fine believes that her experience and background as a member of the Orthodox Jewish community will help her relate to and communicate with her patients.
“Women have these family purity laws and it’s really important to go to an OB/Gyn who is very familiar with these laws. To be a part of the culture and come from the same community, you understand how to provide care.”
Fine, like several of her colleagues in the inaugural three-year medical program, felt closer to the incoming class of 2018 than to the graduating class of 2021, with whom she interacted primarily in the last six months of her medical school training.
During graduation, Fine appreciated the opportunities she feels she had that others don’t always get.
“I want to make sure I do something great with the opportunity I was given and make a difference in the world,” Fine said.
As for her children, Fine would like them to see that they, too, can choose how they live their lives, regardless of any expectations that others place on them.
“I would like to show my kids, if I can do it, they can do it,” she said. “I want them to know they have choices in life and that I will support whatever they choose. They should know they have the wings to fly, in terms of having a career and going to college.”
Adam Bindelglass. Photo from Stony Brook University
Early challenges
When Adam Bindelglass was five years old, the car he was in slid across black ice into oncoming traffic, which took the life of his two-year-old sister Amy.
Bindelglass also sustained serious injuries, breaking both his arms, his left leg, collar bone, and fracturing his neck. During his recovery, he had to wear a halo on his head to keep his spine aligned until it healed. The halo and the injuries left numerous scars, which triggered questions from his classmates.
“I have a pretty long scar from the base of my skull down my neck,” Bindelglass said. “I was self-conscious about those scars.”
Additionally, he has scars on his right bicep, and he has a mark that used to stretch the entire length of the long bone on his leg.
Motivated by the desire to help other people, particularly in difficult medical situations, Bindelglass said that day, and the scars he now bears as a mark of his career commitment, brought him to this landmark career moment.
A recent medical school graduate, Bindelglass said his experiences early in life have come up several times when he interacts with patients in high-stress situations in the hospital.
He recalled one incident when he spoke with a patient who was about to undergo spinal surgery.
He described how he could “live a full, fulfilling life without complications from these operations,” Bindelglass said. “I hope to continue to bring that [empathy], especially since the patients I’ll be working with [could be] in an acute situation where I’m going to see them right before one of the potentially the biggest operations or procedures of their life.”
He hopes to bring comfort and peace of mind going into surgery.
A three-year graduate from medical school, Bindelglass plans to continue in a residency at Stony Brook in anesthesia. Bindelglass said the pandemic showed him the importance of managing patients’ airways.
Bindelglass said he thinks about his sister “all the time” and hopes she “would be proud” of his commitment to helping others with his career choice.
Simrat Dhaliwal. Photo from Stony Brook University
The magic of threes
Simrat Dhaliwal graduated from Northeastern with her bachelor’s degree in neuroscience in three years and repeated the pattern at Stony Brook’s Renaissance School of Medicine, where she recently earned her medical degree.
The pattern of moving through degree programs in one fewer year is a by-product of several factors.
Dhaliwal is “efficient with time,” she said. “Medicine is a very long route. I know the path I want to take.”
Dhaliwal, whose mother Tejwinder Dhaliwal is a nurse practitioner at Rochester Regional and served as a health care role model, wanted to be a doctor from the time she was in kindergarten. As she attended middle school and high school, she became fascinated with science. She majored in neuroscience at Boston University.
Comparing the accelerated pace of her undergraduate years to medical school, Dhaliwal said the medical education is considerably more rigorous.
“As an undergraduate, once you finish a course, you can forget [some of the material] and move on,” she said. In medical school, students build “on the foundation. If you never had that strong foundation, there’s no way to move on. You’ll be responsible for patients” someday and “you need to know as much as possible.”
Indeed, the pandemic reinforced Dhaliwal’s decision to become a doctor, showing her that doctors had to “fall back on that foundation to help patients in need,” she said. “This pandemic made me want to become a physician even more because it is [a combination of] public service and critical thinking at the same time. There is no greater service to the public than helping someone, especially when it is in such high demand.”
Dhaliwal, who is starting her residency in internal medicine at Stony Brook on July 1, said her parents are originally from a rural part of India.
In her travels to visit family in India, she has “seen the health care disparity that exists in a non-developed nation.” For people in rural India, the nearest hospital is a 45-minute drive, which can create a dangerous delay for people who are having a heart problem or a stroke, where minutes can make the difference in a prognosis.
One of the most important lessons she learned from medical school is to keep learning. The same holds true for her expectations of herself when she practices medicine. She hopes to help educate people about how “preventive medicine is as important as treatment.”
Stony Brook, NY; Stony Brook University: School of Medicine 2018 Convocation Photo by Arthur Fredericks
Stony Brook, NY; Stony Brook University Medical Center: The White Coat Ceremony in the Student Activities Center. (8/14/2016)
Stony Brook, NY; Stony Brook University MART & Children's Hospital Pavilion: MART ribbon cutting, November 1, 2018. Left to right: New York State Assemblyman Steve Englebright; SUNY Trustee and Stony Brook Foundation board member Cary Staller; Stony Brook University President Samuel L. Stanley Jr., MD; New York State Senator Kenneth P. LaValle; SUNY Chancellor Kristina Johnson; Jim and Marilyn Simons; New York State Senate Majority Leader John Flanagan; Kevin Law, President of the Long Island Association and Chair of the Stony Brook Council; Kenneth Kaushansky, MD, Senior Vice President for Health Sciences and Dean of the School of Medicine; Director of the Stony Brook University Cancer Center Yusuf Hannun, MD; representing Governor Andrew Cuomo, Marta Santiago-Jones, Consultant Nurse Hospital Services Administrator at the New York State Department of Health.
Stony Brook, NY; Stony Brook University Medical Center: Donors David and Cynthia Lippe and Dean, School of Medicine and Senior Vice President of Health Sciences Ken Kaushansky outside of the garden area of the MART/Hospital Pavilion
Stony Brook, NY; Stony Brook University Hospital: Stony Brook Medicine rolled out new Mobile Stroke Units on March 18, 2019, to treat people who are having a stroke.
Left to right: Kimberly Noel, MD, Director, Telehealth, Stony Brook Medicine, Michael Guido III, MD, Neurologist, Director, Stony Brook Neurology Stroke Program, Ken Kaushansky, MD, Dean, Renaissance School of Medicine at Stony Brook University, David Fiorella, MD, PhD, Neurointerventionalist, Director, Stony Brook Cerebrovascular Center, Trevor Marshall, MD and Eric Niegelberg, Associate Director, Operations, Emergency Services and Internal Medicine
Stony Brook, NY; Stony Brook University: Chancellor Jim Malatras and Stony Brook University President McInnis Announce Partnership with SUNY Upstate Medical University to Launch Pooled Surveillance Testing for COVID-19.
Stony Brook to Test 5200 Students Each Week. Testing Expansion Follows FDA Approval of Groundbreaking Saliva Swab Test Developed at Upstate Medical University
By Daniel Dunaief
Like so many others, Ken Kaushansky had to alter his plans when the pandemic hit last March. Kaushansky had expected to retire after over 10 years as Dean of the Renaissance School of Medicine at Stony Brook University and the Senior Vice President of Health Sciences, but the public health needs of the moment, particularly on Long Island which became an early epicenter for the disease, demanded his attention.
“Now that COVID hopefully is coming under control, it seems more logical” to retire this year, Kaushansky said in a wide-ranging interview about the pandemic, his career, and the medical school. In January, he stepped down as the dean, while he plans to retire as Senior Vice President of Health Sciences at the end of June.
Views on the Pandemic
Dr. Kenneth Kaushansky
Looking back at the immediate challenges in the first few months, Kaushansky said SBU did “extremely well” in caring for patients who were battling COVID-19 and was gratified by the school’s effort to catalog and understand the disease. “I’m very proud that we’ve been able to study this infection on all sorts of levels and make a real impact that has helped others,” he said.
Early on, as the medical team at Stony Brook met, Kaushansky urged the hospital to study COVID “to the hilt” and to “extract every little bit of data we can. We must keep all that data on all these patients.”
Indeed, Stony Brook has created a database that continues to grow of close to 10,000 people, which includes 3,000 inpatients, 4,000 who weren’t sick enough for hospital admission, and around 3,000 who thought they had the disease, but had other illnesses. “We’ve learned a ton from that, and it’s not just learning for learning’s sake,” Kaushansky said. The demand for the use of the database is so high that a steering committee is reviewing proposals.
Stony Brook had heard from doctors in Italy that COVID patients were having problems with blood clotting. This symptom was particularly meaningful to Kaushansky, who is a hematologist.
SBU studied the symptoms and “did a trial to see if aggressive anticoagulants would produce better outcomes” than the standard of care at the time, he said. “Our [intensive care unit] patients who were on this more aggressive anticoagulation protocols had half the mortality” of other patients, so the hospital “quickly adopted all of our care” to the more effective approach.
The hospital preemptively used biomarkers to determine who should and should not get aggressive anticoagulation. A subsequent study using the database confirmed the school’s early conclusion. Stony Brook published over 150 papers on the structure of the virus, clinical observations, sociological interventions, and a host of other areas, according to Kaushansky.
Carol Gomes, Chief Executive Officer of Stony Brook University Hospital, appreciated Kaushansky’s hands on approach, which included participating in daily calls as part of the hospital incident command center.
She likened Kaushansky to an orchestra leader, coordinating the research and patient care, making sure there was “no duplication of effort.”
Kaushansky believes federal research funding agencies and policy makers will recognize the importance of gathering information about this pandemic to treat future patients who might battle against variants and to provide a playbook for other health threats. “We really do need to prepare for the next one” as this is the third and deadliest of three coronaviruses, including SARS and MERS, he said.
Vaccines
As for vaccines, Kaushansky said Stony Brook was making it as “convenient as we can” to get a vaccination for health care workers. As of about a month ago, over 80 percent of Stony Brook’s health care workers had been vaccinated.
The black and brown communities have benefited from seeing leaders and role models receiving the vaccine. “This is beginning to erode the mistrust,” said Kaushansky, which developed as a byproduct of the infamous Tuskegee experiment, in which black men with syphilis did not receive penicillin despite its availability as an effective treatment.
Kaushansky added that a concern he’s heard from a range of people is that the vaccine was developed too quickly and that the side effects could be problematic. He cited the simultaneous steps doctors, pharmaceutical companies and others took to accelerate a process that didn’t leave out any of those steps.
Kaushansky participates in a group email interaction with prominent European hematologists. Looking at the data for the Astrazeneca vaccine, these researchers have calculated that anywhere from one in 500,000 to one in a million have developed blood clots.
“Not a single person on this mass email believes that they should stop the Astrazeneca vaccines for that kind of incident,” he said.
What He Helped Build
Kaushansky has been such a supporter of expanding the facilities and expertise at Stony Brook that he said the campus developed a joke about him.
“What’s the dean’s favorite bird?” he asked. “A crane.”
Fixtures on the campus for years, those cranes — the construction vehicles, not the birds — have changed the university, adding new teaching, research and clinical space on the campus.
That includes the Medical and Research Translational building and Bed Tower, which started in 2013 and opened in 2018, and the Hospital Pavilion, which has an additional 150 beds. Those extra beds were especially important a year after the pavilion opened, providing much-needed space for patients battling against COVID.
Gomes appreciated what Kaushansky built physically, as well as the interactive collaborations among different parts of the university. “An active collaboration and communication between researchers, clinicians and academics is a very different model” from the typical separation among those groups, she said. The work “reaped great rewards on the front end with the ability to collaborate to bring new ideas forward.”
As for the type of care patients received at Stony Brook, Kaushansky recalled a discussion over six years ago about central line infections. The data came from a 12 month period, starting six months prior to the meeting and going back to 18 months earlier.
“How are we going to know why all those central line infections occurred by looking at data” from so much earlier, Kaushansky recalled asking. The hospital created real time dashboards, which is an effort that has “paid huge dividends.”
Kaushansky cited the hospitals’ top 100 health grade for three years running. These grades assess whether patients survive a procedure, have complications or need to be readmitted.
“You’re going to get the best care possible when you come to Stony Brook,” Kaushansky said, as the top 100 rating puts Stony Brook in the top 2 percent of hospitals in the country.
Apart from the buildings Kaushansky helped develop, he’s proud of the program he helped build for medical school students.
About six years ago, Stony Brook instituted a new medical school curriculum that had translational pillars. The school starts students in the clinical realm considerably earlier than the classic program that involves two years of basic studies, followed by two years of clinical work.
Stony Brook provides basic science, followed by earlier exposure to the clinic, with a return to basic science after that
“It’s much more effective if you teach the basic science after the student has witnessed the clinical manifestation,” Kaushansky said. These approaches are part of translational pillars in areas such as cancer, physiology and infectious diseases.
As for what he’ll miss after he leaves, Kaushansky particularly appreciated the opportunity to speak with students. He used to hold a monthly breakfast with four or five students, where he learned about each student, their career goals and their medical journey.
A former colleague at the University of California at San Diego, John Carethers, who is the Chair in the Department of Internal Medicine at the University of Michigan, visited Kaushansky as a speaker twice at Stony Brook.
Carethers saw “first hand the wonderful impact he had on students — knowing their names, and providing wonderful advice,” he wrote in an email.
The Next Steps
For a decade, Kaushansky said he wanted to create a course about the future of medicine.
“There are a lot of great innovations in medicine that are fascinating from a scientific and clinical perspective,” Kaushansky said.
He will work on a course for use at Stony Brook in the main campus, the medical campus and for whichever program is interested in sharing these innovative medical and scientific steps in medicine.
He also plans to continue to be the lead editor of the primary textbook in hematology, called Williams Hematology. The textbook has gone through 10 editions.
Kaushansky and his wife Lauren, who is an author and education professor at Stony Brook, aren’t likely to remain on Long Island in the longer term. The couple has a getaway home in Santa Fe and may go there.
Kaushansky’s hobbies include wood working and running. He made a sofa when he was an undergraduate at UCLA, while his second significant work was a 16-foot sailboat he made as a second-year resident. He estimates he has made 40 pieces of furniture.
Kaushansky runs four miles a day four to six times a week. In 1990, he ran the Seattle Marathon which was the Goodwill Games Marathon, finishing in a time of around three hours and twenty-five minutes.
Culturally, Kaushansky hopes the school continues to embrace his focus on generosity.
“You’ve got to be generous with your time,” he said.
“No more can you say that you are too busy to talk. You have to be of a personality that takes pride and that gets the endorphins going from seeing the people you have brought, the people you have entrusted in leadership roles, succeed.”
Stony Brook University Hospital. Photo by Rita J. Egan
By Odeya Rosenband
Stony Brook University’s newest class of medical residents began their careers head first, graduating early to take on the fight with COVID-19.Renaissance School of Medicine at SBU led a virtual graduation ceremony that took place two months ahead of schedule, in early April.
SBU Vice Dean for Graduate Medical Education Dr. William Wertheim. Photo from SBUH
In line with other medical schools such as Hofstra University in Hempstead and New York University, SBU resolved to graduate their medical students in early spring in order to readily transition them into the workforce. This decision was “definitely a natural step,” said Dr. William Wertheim, vice dean for Graduate Medical Education at Renaissance School of Medicine at SBU. Gov. Andrew Cuomo (D) “took away a lot of roadblocks in helping us utilize the staff that were capable of doing this, so that was really helpful.”
Starting in April, 52 residents began volunteering at SBU Hospital and predominantly focused on emergency COVID-19 cases, rather than their specialties. While resident education typically consists of 80-hour work weeks, the Renaissance School adopted a shift schedule that included five days off following every five days working, given the heightened emotional difficulty residents were facing.
Beginning July, Stony Brook Medicine welcomed over 300 medical residents across SBU, Stony Brook Southampton and Stony Brook Eastern Long Island hospitals. This number included the residents who had been volunteering with COVID-19 patients.
“Residents are interesting in that they both are doctors taking care of patients, and they are learners in an educational program,” Wertheim said. Aside from in-person training in personal protective equipment, the residents learned other essential information such as employee benefits and payroll over virtual modules.
“Top to bottom it’s a different place than we were in one year ago,” the vice dean said.
The continued focus on education was also felt by the new residents. Dr. Kelly Ieong, a urology resident and 2020 graduate of the medical school, said, “Going into my residency, I had the expectation that I’m just going to work, not learn much, and just help out as much as possible. But all of the teams did carve out time for our education and we had virtual meetings over Zoom, even during lunch. I felt very safe during my entire shift, unlike my friends who worked in other hospitals.” Additionally, she said residents were each assigned a specific mentor who provided the residents with an extra layer of support.
After feeling helpless when some of her family were diagnosed with the virus earlier this year,Ieong knew she wanted to be a volunteer when given the opportunity.
“I definitely think volunteering was a helpful experience because a lot of the difficult conversations that I was having with my patients and their family members are something that you can’t learn in the books,” she said. “You don’t learn it in medical school, it’s something you have to learn through experience.”
Although Wertheim said “everything is a bit slower when you can only put two people in an elevator,” he added that SBU was quick to adapt and optimize their eager students. Online platforms such as Zoom and Microsoft Teams helped meet the demands for educational conferences, especially as residents may be on rotation at other hospitals. It’s clear that these platforms are here to stay, according to him.
“Medicine in general tends to adopt things slowly unless we have to… and we really had to,” he said.
In thinking about the possibility of a second surge in coronavirus cases, Wertheim noted, “now that we’ve been through this experience once, as hard as it was, it is going to be easier to swiftly redeploy all of those residents as well as all of the other doctors.” Regardless of the future of the coronavirus, there have been benefits for the medical residents, according to the vice dean.
“I think the fact that all of these residents from different specialties had to work together to the same end, even though it was an arduous task, gives them a sense of mission that you don’t always get when everyone’s doing their own thing,” Wertheim said. “And I think that that’s definitely a positive that comes out of all of this.”
