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Full text of "WTC UMD New Jersey Clinical Center"

World Trade Center Advisory Committee 

New Jersey Presentation 




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rofessor of Environmental & Occupational Medicin 

Medical Director of EOHSI Clinical Center 

Director of UMDNJ Employee Health Services 

November 9, 201 



i 




New Jersey Cohort: Final Report June 30, 
2011 

■ 4,01 1 monitoring exams performed 

■ More than 1 ,700 unique patients 

■ 80% of patients monitored in NJ offered 
physical or mental health treatment 

■ 90-95% of cohort have health insurance 
though many are uninsured 

■ Most common counties Middlesex, 
Monmouth, Richmond (SI) 



Demographics of NJ Cohort 

35% Law Enforcement (PAPD, NYPD, NJ State 
Police, county and municipal police departments) 

1 3% construction 

10% utilities 

7% firefighters (Elizabeth largest dept) 

Other large groups include NJUSAR, Hazardous 
waste workers, OSHA inspectors, volunteers 



Conditions Identified in NJ 
Treatment Programs 



85% Upper Airway 
51-58% G I 

24-38% Mental Health 
28-32% Lower Airway 



Frequency of WTC Diseases Requiring Prescription 

2009-2010 








200 400 600 800 

Number of Times Prescription Filled 



1000 



■ Mental Health 
u Gastrointestinal 
a Lower Airway 
u Upper Airway 



Top 15 Medication 2009-2010 



Most Used 



Nexium-Gastrointestinal 
2. Nasonex-Upper airway 
Advair -Lower airway 

4. Proair-Lower airway 

5. Fluticasone-Upper airway 
Singulair-Lower airway 

7. Lexapro-Mental health 
s. Prevacid-Gastrointestinal 
9. Cymbalta-Mental health 
Proventil-Lower airway 

11. Aciphex-Gastrointestinal 

12. Veramyst-Upper airway 

13. Omeprazole-Gastrointestinal 

14. Clonazepam-Mental health 
Fexofenadine-Upper airway 



Most Expensive 



Sumatriptan- Mental Health 

2. Gabapentin-Mental Health 

3. Provigil -Mental Health 

4. Seroquel-Mental Health 

5. Ability -Mental Health 

6. Effexor-Mental Health 

7. Catapres-Mental Health 
Advair- Lower airway 

9. Depakote-Mental Health 

io. Cymbalta-Mental Health 

11. Symbicort-Lower airway 

Spiriva-Lower Airway 

13. Aciphex-Gastrointestinal 

14. Carafate-Gastrointestinal 
Prevacid- Gastrointestional 




UMDNJ 

University of Medicine & 

Dentistry of New Jersey 



Emerging Illnesses / New Jersey 

Highlights 



Unique Features of Obstructive Sleep Apnea in 

World Trade Center Responders With 

Aerodigestive Disorders 

Sunderram, Jag MD; Udasin, Iris MD; Kelly-McNeil, Kathie BA; 

Ko, Susan BA; Cepeda, Clarimel BPH; Marroccoli, Barbara MD; 

Perret, Carol MS; Ohman-Strickland, Pamela PhD; Scardella, 

Anthony MD; Kipen, Howard MD 



Objectives: To compare obstructive sleep apnea (OSA) in World Trade Center (WTC) 
responders with aerodigestive disorders and snoring with non-WTC habitual snorers, and to 
distinguish features of OSA in a subset of responders with worsening of snoring after 9/11 
from responders with previous habitual snoring. 

Methods: Cross-sectional comparative study of 50 WTC Medical Monitoring and 
Treatment Program responders with aerodigestive disorders and snoring and 50 
nonresponders with snoring. Responders with worsening of snoring after 9/11 were 
compared with previous habitual snorers. 

Results: While there was a strong correlation between body mass index (BMI), weight, and 
Apnea + Hypopnea Index (r = 0.36, P = 0.001; r = 0.29, P = 0.044) in the nonresponders, 
no correlation between either BMI or weight and Apnea + Hypopnea Index was found in 
the responders. Responders with worsening of snoring after 9/11 had a significantly lower 
BMI than previous habitual snorers. 

Conclusion: Mechanisms other than obesity are important in the pathogenesis of OSA in 
WTC responders with aerodigestive disorders. 



Eosinophilic Esophagitis 



Condition is not well 
understood, but thought to 
be allergic, inflammatory, 
may be associated with 
food allergy 

Symptoms are swallowing 
difficulty, food impaction, 
and heartburn 

Dx by clinical pathology on 
endoscopy 

15 eosinophils/HPF, 
concentric rings 




Prevalence of Eosinophilic Esophagitis Among 

WTC Rescue Workers 

Karl Kwok, David Lee, Hazar Michael, Eric Shen, Carol Perret, Iris Udasin 



Abstract presented at Digestive Disease Week, 

May 2009 



EE: New Jersey Experience 



Retrospective review of 45 patients referred 
to Gl for refractory heartburn 

Average age 49, BMI 27.7 

20 patients on inhaled steroids 

27 patients had endoscopy 

3 had 



Since this review, we identified at least 5 
more patients in NJ cohort 



Cancer Cases Identified 
in New Jersey 



Hematopoietic Malignancies 



Multiple Myeloma 

4 cases 

Age at diagnosis : 58, 51 , 56, 68 

Non-Hodgkin's Lymphoma 

■ 5 cases 

■ Age at diagnosis: 35, 41 , 45, 64, 36 
4 are law enforcement 

CLL 

2 cases 

Age at diagnosis: 56, 51 

AML 

■ 1 case (age 37) 

Myelofibrosis 

1 case (age 45) 



Head and Neck Cancer 



5 cases in NJ, 4 are squamous cell 



Age at diagnosis: (39, 41 , 42, 41 , 40) 
1 - Construction worker 
2- Verizon / communications 
2- Law enforcement 



Other Cancers Seen in NJ 



Adenocarcinoma of lung (2 cases) 

Non small cell lung cancer (2 cases) 

Thyroid (2 cases) 

Epitheloid sarcoma first noted in hand, 
spread to lung 

Liposarcoma (2 cases) 

Gl cancers, prostate, Breast 



Questions 



Iris G. Udasin, MD 
udasin@eohsi.rutgers.edu