Pathways to Excellence URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
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VOL 5 | ISSUE 2 | OCTOBER 2018
“This is Literally the Place that Saved My Life” By Jim Mandelaro J. ADAM FENSTER
Befikadu Mekonnen ’22 is 7,000 miles from home and hasn’t seen his family in two years. But the Ethiopia native feels at peace at the University of Rochester, where he is a biomedical engineering major. “I believe fate brought me here,” he says. “This is literally the place that saved my life.” Mekonnen was in his first year of high school in 2013 when he began experiencing constant headaches, throbbing in his right eye, and swelling in his face. “Eventually, I couldn’t breathe through my right nostril,” he says. “I couldn’t sleep.” His anxious parents took him to five hospitals in Ethiopia, but doctors couldn’t diagnose the problem. One doctor told him “‘We’ll take out your eye and do some tests’,” Mekonnen recalls. “My dad was like ‘No, you’re not going to do that.’’ Then they were referred to Rick Hodes, M.D. ’82M, an American doctor who serves as medical director of the American Jewish Joint Distribution Committee. Hodes first visited Ethiopia as a relief worker during the 1984 famine, returned on a Fulbright
Fellowship to teach internal medicine, and in 1990 was hired by the Joint Distribution Committee as medical adviser for the country. He’s been there ever since. “Here’s this man who has saved thousands of lives in Ethiopia,” Mekonnen says, “and he looks at me and says, ‘We will find out what’s wrong with you.’’ Hodes discovered a mass behind Mekonnen’s right eye and was concerned he had a fatal disease. He sent a biopsy to the University of Rochester Medical Center, where years before he had forged an altruistic relationship with Daniel Ryan, the chair of the Department of Pathology & Laboratory Medicine. “I introduced myself and explained that I needed free analysis of path specimens from some of the poorest people on the planet,” Hodes says. “He agreed, and since then, I’ve sent over 100 specimens.” The work has saved lives. Medical Center pathologists diagnosed Mekonnen with an aggressive form of cancer called embryonal rhabdomyosarcoma of the orbit. He underwent chemotherapy in Ethiopia, then moved
IN THIS ISSUE From the Chair.................................................................. 2
Friends of Strong Gifts...................................................... 4
Graduate Program Update................................................ 3
Arnot Ogden Partnership.................................................. 5
Summer Students.............................................................. 4
Focus on Faculty: Dr. Nicole Pecora................................... 6
CHAIR’S COLUMN
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Bruce Smoller, M.D.
“Our faculty and staff are doing an amazing job of maintaining high quality work with superb turnaround times...”
am sitting here and writing this on a hot, steamy, rainy day, right after Labor Day, thinking back on a productive and busy summer and looking forward to a busy and hopefully productive autumn. We welcomed many new members to our faculty, along with a group of new fellows, residents, graduate and medical students and medical technology students. As is always the case, the enthusiasm is running high as each of these folks step into their new roles. We were most fortunate in being able to keep 100 percent of our initial class of medical technology students within our department as new members to the team. In the upcoming weeks, NAACLS (the accreditation board) is scheduled to come by for final evaluation of the Medical Technology Program and we have full confidence that we will pass with flying colors. This summer was also marked by our first year of participating in the Explorations in Pathology program for high school students. Approximately ten students chosen from applicants all over the country spent several weeks within our department, ultimately producing slide presentations and written accountings of topics into which they chose to dig deeply. Students were offered a selection of faculty members with whom to work and met with these tutors several times over the course of the program. Dr. Jennifer Findeis-Hosey, with the help of Dr. Abberly Lott-Limbach, oversaw the program, which by all accounts was a great success. I personally found this one of the most rewarding experiences of my recent years on faculty – what enthusiasm! The move to Bailey Road continues to make progress, with many of the laboratories working diligently on validation processes and the logistics of the move. We still anticipate the move occurring during the winter months and a full opening for the late spring. Meanwhile, planning has begun for backfilling the lab spaces that will be vacated when these labs move to Bailey Road. In addition, plans have begun for a marked expansion of the Emergency Room into the spaces currently occupied by the Blood Bank and the Automated Chemistry and Hematology Labs here at Strong. Thus, another group of labs will be designing new spaces and developing equipment move and validation processes. The hospital is hoping to have the new ER space opened by the end of 2019, so we will have to have our laboratories up and running in new spaces before then. Obviously, we have a lot to work on in a short period of time. As if this were not enough, we are continuing to expand at a rapid pace, fueled mainly by the affiliation agreements with our affiliated hospital partners who participate in the UR Medicine Labs. Our faculty and staff are doing an amazing job of maintaining high quality work with superb turnaround times, despite all of the pulls on their time. As I look ahead to the shorter days rapidly approaching, I am hopeful that with the end of the winter doldrums, we will emerge onto a bright landscape consisting of new labs, new equipment and an enthusiastic group of faculty and staff members who will be proud of what they have and are accomplishing for the good of our patients in Western New York.
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“THIS IS LITERALLY THE PLACE THAT SAVED MY LIFE” (CONT.) to Michigan for several months of radiation therapy, staying with a host family until his treatment was completed. He lost vision in his right eye, but his cancer went into remission. Mekonnen returned to Ethiopia and was living with his aunt to complete his chemotherapy treatments. One day, his aunt asked him to leave immediately because she was getting married. Hodes, who has adopted five former Ethiopian patients, asked Mekonnen to live with him, and the teenager began doing volunteer work for the doctor. Mekonnen’s host mother was Lynn Farash, a Rochester woman whose family has funded Hodes’s work in Ethiopia through the Farash Foundation. Mekonnen told Farash about his desire to study in the United States, and she offered to take him in and enroll him at the Harley School, a college preparatory school in Rochester. During his two years there, he twice interned at Pathology & Laboratory Medicine, the place where his cancer was diagnosed. “That experience made me feel very connected to the University,” he says. “If it weren’t for that lab, nobody would have known I even had cancer. I knew I wanted to go here for school.” Mekonnen plans to join the University’s club soccer team and student organizations focused on volunteer work. “Although I lost vision in my eye, I’ve seen a lot through my journey over the past five years,” he says. “I was lucky to find Dr. Hodes, and my life was saved because a lot of generous people worked to help me. A lot of kids don’t get that chance.”
From left, Drs. Rick Hodes, Philip Katzman, and Bruce Smoller visited with patients, Tilahun (front) and Befikadu in early 2016. Bef plans to enroll in medical school after college and hopes to one day return to Ethiopia.
MCMURRAY TAKES HELM OF GRADUATE PROGRAM AS LIBBY MOVES UP After two years leading the department’s graduate program, Dr. Rick Libby is passing the torch to Helene McMurray, Ph.D. in order to accept a promotion within the medical school. Libby has been named the Senior Associate Dean for Graduate Medical Education, replacing Edith Lord who is stepping down after more than a decade in the Dean’s office. Libby, whose primary appointment is in Ophthalmology, took over for longtime graduate program director, Robert Mooney in 2016. Dr. McMurray was named the associate director of the Cell Biology of Disease (Pathology) Graduate Program in March, taking over from Dr. Lianping Zhang who previously served in this capacity. Helene officially took on the role of program director Sept. 1. She serves as the Director-in-Training in the Tissue Typing/ Histocompatibility Laboratory at Strong Memorial Hospital. Her research focuses on identification of vulnerabilities in cancer cells, in collaboration with colleagues in Biomedical Genetics. Her clinical and research work utilize approaches in genomics, bioinformatics, biostatistics, and genetics. As an educator, Dr. McMurray works to introduce students to these modern techniques in biomedicine. She is looking at the new position as an opportunity to help inspire and guide students in their own academic pursuits.
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“Mentors and advisors have helped me imagine new possibilities in my science and in my career,” said McMurray. “I wouldn’t be who or where I am today without guidance from others. I am excited to take on this new role in the Cell Biology of Disease Graduate Program to try to share what I have learned with the next generation of scientists.”
HIGH SCHOOLERS ENGAGE WITH PATHOLOGY AT SUMMER PROGRAM In July, a group of 10 high school students from across the U.S. participated in the Explorations in Pathology (EIP) Pre-College Program at the University of Rochester. The three week program facilitated by Pathology and Lab Medicine faculty, residents, staff, as well as medical students. It included didactic and hands-on activities that demonstrated how pathology fits into patient care. Students toured laboratories and participated in “wet labs” in which they could examine gross specimens including lungs, hearts, and eyeballs, to name a few. They were introduced to microscopic examination and the ways in which pathologists provide diagnoses based on what they see. The students also completed group projects, with help from faculty mentors, which they presented at a poster session. “What I liked most about my time here were the opportunities I got to have and the mentors I got to work with,” said Hanora Chapman, a rising senior from New Jersey whose group project explored Lynch Syndrome in colonic adenocarcinoma. “This program has opened me up to a different area of medicine,” she said. The EIP program is led by Jennifer Findeis-Hosey, M.D., a GI pathologist and instructor for the School of Medicine. For the past several years, Pathology has hosted a summer program for both high school and college students. This is the first year the department has partnered with the University’s existing Pre-College programs. “Through the intensive 3 week program, we are able to immerse students in all facets of Pathology, not only teaching them
High school students participated in an ocular dissection lab as part of the EIP summer program. ‘what’ of pathology, but also the ‘how’ and the ‘why,’” she said. During their stay, the students had the chance to meet and learn from residents, as well as medical technologists, pathologists’ assistants, and others. “I learned that there’s more than being a doctor,” said Maggie Hoare, a junior from Honeoye Falls, NY. “I had a great time and loved how we got the perspective of a ton of people who are in pathology.”
FRIENDS OF STRONG CONTINUES TO PROVIDE SUPPORT Each year, our department benefits from charitable donations provided by the Friends of Strong (FOS). For 2018 we are happy to be receiving over $142,300 in lab instruments and supplies for our clinical laboratories. FOS is a volunteer based organization that raises funds through its gift shop, Finger Lakes Coffee Roasters and other events throughout the year. In its more than four decades of operation, it has given more than $16 million to programs at Strong Memorial Hospital. Among the notable items being gifted to us are three types of centrifuges, microtomes, a microscope, analyzer, and other lab instrumentation and equipment. There are a dozen lab areas receiving gifts including Specimen
Management, Hematology/Chemistry, Cytogenetics, Blood Bank, Flow Cytometry, Molecular Diagnostics, Histology, Microarray, IHC, Toxicology, and Phlebotomy. Loralee McMahon, supervisor of Immunohistochemistry, is getting an IHC microtome for the lab which will help the lab cut more specimens that come through the lab. “We use these (microtomes) all day every day,” said McMahon, adding, “We currently have two microtomes and some days we need three just to keep up.” This is the third gift from the FOS organization to come to her lab, and she says it was a relief to learn it was approved. Visit www.fos.urmc.edu for more information on Friends of Strong and how you can support its initiatives.
THANK YOU FOR GIVING BACK We are grateful for philanthropic support that allows us to maintain and accelerate clinical, educational, and research initiatives. To make a tax-deductible gift today or as part of your estate plans, please visit www.pathology.urmc.edu and click the “Make a Gift” button, or contact Matt Haag at (585) 276-3638 or matthew.haag@rochester.edu. 4
PARTNERSHIP HELPS PATIENTS IN SOUTHERN TIER While not formally affiliated, over the last year, Pathology & Laboratory Medicine at URMC and Arnot Ogden Hospital in Elmira have developed a partnership that has served to help that institution support and diagnose their patients with greater confidence. More than 100 miles separate Strong Memorial Hospital and Arnot, a 256-bed facility. URMC first started providing consult support for anatomic pathology cases in December 2016 but has become gradually more involved with both AP and CP testing. URMC has reached out to many regional hospitals to provide expertise and access so patients in outlying communities can have the same care as those in Rochester. In addition to doing consults and AP sendout tests, URMC took on clinical reference lab testing for Arnot. Pathology has also worked alongside Wilmot Cancer Institute to give patients at Falck Center, access to molecular testing for lung cancer. This past summer, URMC also provided a pathologists’ assistant to provide backup over the summer while one of Arnot’s grossing assistants was on medical leave. This duty was shared among three PA’s, which was very helpful, according to Arnot’s Pathology Supervisor, Danielle Correll. Like many staff in smaller hospitals, Correll also wears the hat of both Blood Bank and Blood Gas supervisor. She said hosting the visiting PA’s has helped expose her team to new learning. “With a facility with a surgical program as vast as yours (at URMC), you see some of the bigger cases and a lot more of them,” said Correll. “I think we would benefit from that relationship especially – we’ve benefited already.” Terry Lenhardt, M.D., director of Pathology at Arnot, said this is just one example of how the partnership has helped provide staffing relief. Having access to URMC’s subspecialists has helped in this respect, especially with challenging cases, said Lenhardt. “Across the board, folks have been great and extremely helpful,” he said. “It’s been very collegial.” The relationship between the departments is about more than helping Arnot “stay afloat,” Lenhardt explained. He mentioned Drs. Bruce Smoller, Chair, and Victoria Zhang, Vice Chair for Clinical Enterprise, as faculty who are making extra effort to make the arrangement successful. “I think they’re devoted to this concept of trying to help at the end of the day,” he said, “And that makes for a better and stronger system.”
OUT AT THE
Department employees and their families enjoyed a complimentary day at Frontier Field on Sunday, Aug. 12, as the Rochester Red Wings took home a win.
SHARING THE LOAD: BY THE NUMBERS
677
AP cases analyzed analyzed by URMC since January 2017
300
AP consult cases since 2016
3,400
Pap smears and HPV tests since June 2017
Top: Dr. Linda Schiffhauer, far right, (Surgical Pathology) with her family at “The Nest” pavilion. Middle: Greg Indovina (Cytogenetics) and his family watch the game from the stands. Bottom: Lisa Musial (Outreach) with husband Scott, and daughter, Avery. 5
Department of Pathology and Laboratory Medicine University of Rochester Medical Center 601 Elmwood Avenue, Box 626 Rochester, NY 14642
FOCUS ON FACULTY: NICOLE PECORA, M.D., PH.D. It’s an exciting time to be a clinical microbiologist, according to Dr. Nicole Pecora. She is the associate director and fellowship director for Clinical Microbiology. Pecora joined the faculty in 2016 after finishing a residency in Clinical Pathology and a fellowship in Medical Microbiology at Brigham and Women’s Hospital. Prior to that, she earned her M.D., Ph.D. at Case Western Reserve University. It was there that her research projects on host-pathogen interactions (quorum sensing among the Enterobacteriaceae and modulation of the immune response by Mycobacterium tuberculosis) got her interested in infectious diseases and diagnostic microbiology. Today, Pecora’s translational research goals are to bring genomic sequencing into routine use in the clinical lab setting to improve patient safety. Through her collaborations with her fellows, Infectious Prevention, and Infectious Disease clinicians she is using molecular methods to map the genetic fingerprint of aggressive, drug resistant bacteria that turn up within the hospital. It’s no secret that hospital acquired infections are a huge public health concern. They can not only be fatal but are very costly and can hurt the hospital’s reputation. By documenting the exact composition of these harmful bacteria via routine surveillance of each hospital unit, data can clearly indicate whether the appearance of certain isolates is evidence of an outbreak, or just a bad coincidence. This will equip clinical labs with the tools to detect signs of a potential outbreak before it’s already a problem.
“We wish to make a local map of our in-house strains,” she explains. “You’ve heard of a microbiome of person – it’s sort of like a microbiome of the hospital.” This use of genomic molecular methods is cutting-edge for a clinical microbiology lab, but, Pecora says, “Microbiology is really in a very dynamic moment in terms of adoption of new technologies.” Introducing new automation at the lab at Bailey Road is part of this shift. Pecora said the new automation line will not only allow for higher volume but cut down the time required to deliver identifications and susceptibilities to patients. As part of Pecora’s teaching regimen, she is a course instructor for the medical technology program, which brought five new technical staff to the lab after its first year. Her experience in research and clinical work is part of what motivates her to make new discoveries. “I wouldn’t want a job where I didn’t have the opportunity to work on research projects,” she said. “It’s also good to help trainees develop past what they’re learning in books and in the clinical practice, but to be able to dive deeper into questions.” Pecora grew up in the Hudson Valley and has had a lifelong love for science. Interestingly, she was a history and biology double major with a minor Greek and Latin classic literature when she was an undergraduate at Case Western. While doing her Ph.D. in microbiology, she met her future husband, Michael Drage when both were working in the same research lab. Both finished their training and went on to couples-match at both Brigham and Women’s – for fellowships – and as new faculty at URMC, where he is a GI pathologist. They live in Brighton with their two daughters (ages 8 and 7) and son (age 4).
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