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Monika Fischer, MD

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Gastroenterology

Assistant Professor of Clinical Medicine; Investigator in Gastroenterology and Hepatology

Academic Office

Regenstrief Health Center, Room 4100
1050 Wishard Blvd.
Indianapolis IN 46202-2859 Map

Contact Information

Phone: (317) 948-4198
Email:

Research Interests

Biomarkers in IBD

Clinical Interests

Inflammatory bowel diseases, small bowel endoscopy, clostridium difficile infection, management of women with chronic immune disorders (CID)

Education and Training

Chemical Tech./Technician Indiana University (Iupui)
Gastroenterology fellowship and Inflammatory Bowel disease fellowship Indiana University-Purdue University Indianapolis
Internal Medicine Residency Indiana University-Purdue University Indianapolis
Internal Medicine Residency Semmelweis University
Medicine (M.D.)

Board Certifications

Internal Medicine 2008
Gastroenterology 2010

Publications (16)¹

Narrow-band imaging versus white light for the detection of proximal colon serrated lesions: a randomized, controlled trial.
Journal: Gastrointestinal endoscopy
Authors: Rex DK; Clodfelter R; Rahmani F; Fatima H; James-Stevenson TN; Tang JC; Kim HN; McHenry L; Kahi CJ; Rogers NA; Helper DJ; Sagi SV; Kessler WR; Wo JM; Fischer M; Kwo PY;
Publication Date: 2015 May 5

Abstract

The value of narrow-band imaging (NBI) for detecting serrated lesions is unknown.
View details for PubMedID 25952085
Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility.
Journal: Canadian Urological Association journal = Journal de l'Association des urologues du Canada
Authors: Kovac JR; Fantus J; Lipshultz LI; Fischer MA; Klinghoffer Z;
Publication Date: 2014 Sep

Abstract

Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility.
View details for PubMedID 25295133
Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients.
Journal: The American journal of gastroenterology
Authors: Kelly CR; Ihunnah C; Fischer M; Khoruts A; Surawicz C; Afzali A; Aroniadis O; Barto A; Borody T; Giovanelli A; Gordon S; Gluck M; Hohmann EL; Kao D; Kao JY; McQuillen DP; Mellow M; Rank KM; Rao K; Ray A; Schwartz MA; Singh N; Stollman N; Suskind DL; Vindigni SM; Youngster I; Brandt L;
Publication Date: 2014 Jun 3

Abstract

Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients.
View details for PubMedID 24890442
Milestones of critical thinking: a developmental model for medicine and nursing.
Journal: Academic medicine : journal of the Association of American Medical Colleges
Authors: Papp KK; Huang GC; Lauzon Clabo LM; Delva D; Fischer M; Konopasek L; Schwartzstein RM; Gusic M;
Publication Date: 2014 May

Abstract

Critical thinking is essential to a health professional's competence to assess, diagnose, and care for patients. Defined as the ability to apply higher-order cognitive skills (conceptualization, analysis, evaluation) and the disposition to be deliberate about thinking (being open-minded or intellectually honest) that lead to action that is logical and appropriate, critical thinking represents a "meta-competency" that transcends other knowledge, skills, abilities, and behaviors required in health care professions. Despite its importance, the developmental stages of critical thinking have not been delineated for nurses and physicians. As part of a task force of educators who considered different developmental stage theories, the authors have iteratively refined and proposed milestones in critical thinking. The attributes associated with unreflective, beginning, practicing, advanced, accomplished, and challenged critical thinkers are conceived as independent of an individual's level of training. Depending on circumstances and environmental factors, even the most experienced clinician may demonstrate attributes associated with a challenged thinker. The authors use the illustrative case of a patient with abdominal pain to demonstrate how critical thinking may manifest in learners at different stages of development, analyzing how the learner at each stage applies information obtained in the patient interaction to arrive at a differential diagnosis and plan for evaluation. The authors share important considerations and provide this work as a foundation for the development of effective approaches to teaching and promoting critical thinking and to establishing expectations for learners in this essential meta-competency.
View details for PubMedID 24667504
The great masquerader: Behcet's disease.
Journal: BMJ case reports
Authors: Nordstrom E; Fischer M;
Publication Date: 2014 Apr 19

Abstract

This report describes the case of a 44-year-old Caucasian woman of Northern European descent with a medical history of pyoderma gangrenosum, chronic abdominal pain and erythema nodosum which required intermittent use of high-dose steroids that failed to improve her symptoms. The patient was initially diagnosed with Crohn's disease and most recently with sclerosing mesenteritis. She presented to the hospital with worsening abdominal pain. She was found to have recurrent painful aphthous oral, genital and perianal ulcers and a clinical diagnosis of Behçet's disease was made. Her hospitalisation was complicated by haemoptysis, and bronchoscopy revealed alveolar haemorrhage. Treatment was initiated with three days of pulse intravenous solumedrol 1 g/day and cyclophosphamide at 700 mg/m(2). The case had a favourable outcome despite the initial diagnostic challenges. This report emphasises that systemic diseases, including Behçet's disease, can have variable presentations and can be frequently misdiagnosed.
View details for PubMedID 24748137
Genomics and the origin of species.
Journal: Nature reviews. Genetics
Authors: Seehausen O; Butlin RK; Keller I; Wagner CE; Boughman JW; Hohenlohe PA; Peichel CL; Saetre GP; Bank C; Brännström A; Brelsford A; Clarkson CS; Eroukhmanoff F; Feder JL; Fischer MC; Foote AD; Franchini P; Jiggins CD; Jones FC; Lindholm AK; Lucek K; Maan ME; Marques DA; Martin SH; Matthews B; Meier JI; Möst M; Nachman MW; Nonaka E; Rennison DJ; Schwarzer J; Watson ET; Westram AM; Widmer A;
Publication Date: 2014 Mar

Abstract

Speciation is a fundamental evolutionary process, the knowledge of which is crucial for understanding the origins of biodiversity. Genomic approaches are an increasingly important aspect of this research field. We review current understanding of genome-wide effects of accumulating reproductive isolation and of genomic properties that influence the process of speciation. Building on this work, we identify emergent trends and gaps in our understanding, propose new approaches to more fully integrate genomics into speciation research, translate speciation theory into hypotheses that are testable using genomic tools and provide an integrative definition of the field of speciation genomics.
View details for PubMedID 24535286
Elimination of radiographic confirmation for small-bowel feeding tubes in critical care.
Journal: American journal of critical care : an official publication, American Association of Critical-Care Nurses
Authors: Powers J; Fischer MH; Ziemba-Davis M; Brown J; Phillips DM;
Publication Date: 2013 Nov

Abstract

A variety of techniques are used for placement of small-bowel feeding tubes. Standard practice at the study institution is for postpyloric placement using an electromagnetically guided placement device (EMPD). EMPD placement is performed by bedside nurses trained in the placement technique and may reduce radiograph exposures and time to initiation of enteral nutrition.
View details for PubMedID 24186824
A low-residue diet improved patient satisfaction with split-dose oral sulfate solution without impairing colonic preparation.
Journal: Gastrointestinal endoscopy
Authors: Sipe BW; Fischer M; Baluyut AR; Bishop RH; Born LJ; Daugherty DF; Lybik MJ; Shatara TJ; Scheidler MD; Wilson SA; Rex DK;
Publication Date: 2013 Mar 23

Abstract

Preprocedural dietary restrictions have been identified as a common reason potential candidates for colorectal cancer screening do not undergo colonoscopy as recommended.
View details for PubMedID 23531424
O-Nucleoside, S-nucleoside, and N-nucleoside probes of lumazine synthase and riboflavin synthase.
Journal: The Journal of organic chemistry
Authors: Talukdar A; Zhao Y; Lv W; Bacher A; Illarionov B; Fischer M; Cushman M;
Publication Date: 2012 Jul 10

Abstract

Lumazine synthase catalyzes the penultimate step in the biosynthesis of riboflavin, while riboflavin synthase catalyzes the last step. O-Nucleoside, S-nucleoside, and N-nucleoside analogues of hypothetical lumazine biosynthetic intermediates have been synthesized in order to obtain structure and mechanism probes of these two enzymes, as well as inhibitors of potential value as antibiotics. Methods were devised for the selective cleavage of benzyl protecting groups in the presence of other easily reduced functionality by controlled hydrogenolysis over Lindlar catalyst. The deprotection reaction was performed in the presence of other reactive functionality including nitro groups, alkenes, and halogens. The target compounds were tested as inhibitors of lumazine synthase and riboflavin synthase obtained from a variety of microorganisms. In general, the S-nucleosides and N-nucleosides were more potent than the corresponding O-nucleosides as lumazine synthase and riboflavin synthase inhibitors, while the C-nucleosides were the least potent. A series of molecular dynamics simulations followed by free energy calculations using the Poisson-Boltzmann/surface area (MM-PBSA) method were carried out in order to rationalize the results of ligand binding to lumazine synthase, and the results provide insight into the dynamics of ligand binding as well as the molecular forces stabilizing the intermediates in the enzyme-catalyzed reaction.
View details for PubMedID 22780198
Endoscopic retrograde cholangiopancreatography and manometry findings in 1,241 idiopathic pancreatitis patients.
Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
Authors: Fischer M; Hassan A; Sipe BW; Fogel EL; McHenry L; Sherman S; Watkins JL; Schmidt S; Lazzell-Pannell L; Lehman GA;
Publication Date: 2010 Aug 19

Abstract

10-30% of patients with pancreatitis are classified as idiopathic after the initial evaluation. Our aim was to assess the diagnostic yield of endoscopic retrograde cholangiopancreatography (ERCP) and sphincter of Oddi manometry in patients with idiopathic pancreatitis in a tertiary referral center.
View details for PubMedID 20720445
Discovery and development of a small molecule library with lumazine synthase inhibitory activity.
Journal: The Journal of organic chemistry
Authors: Talukdar A; Breen M; Bacher A; Illarionov B; Fischer M; Georg G; Ye QZ; Cushman M;
Publication Date: 2009 Aug 7

Abstract

(E)-5-Nitro-6-(2-hydroxystyryl)pyrimidine-2,4(1H,3H)-dione (9) was identified as a novel inhibitor of Schizosaccharomyces pombe lumazine synthase by high-throughput screening of a 100000 compound library. The K(i) of 9 vs Mycobacterium tuberculosis lumazine synthase was 95 microM. Compound 9 is a structural analogue of the lumazine synthase substrate 5-amino-6-(d-ribitylamino)-2,4-(1H,3H)pyrimidinedione (1). This indicates that the ribitylamino side chain of the substrate is not essential for binding to the enzyme. Optimization of the enzyme inhibitory activity through systematic structure modification of the lead compound 9 led to (E)-5-nitro-6-(4-nitrostyryl)pyrimidine-2,4(1H,3H)-dione (26), which has a K(i) of 3.7 microM vs M. tuberculosis lumazine synthase.
View details for PubMedID 19552377
Discovery and development of the covalent hydrates of trifluoromethylated pyrazoles as riboflavin synthase inhibitors with antibiotic activity against Mycobacterium tuberculosis.
Journal: The Journal of organic chemistry
Authors: Zhao Y; Bacher A; Illarionov B; Fischer M; Georg G; Ye QZ; Fanwick PE; Franzblau SG; Wan B; Cushman M;
Publication Date: 2009 Aug 7

Abstract

A high-throughput screening (HTS) hit compound displayed moderate inhibition of Mycobacterium tuberculosis and Escherichia coli riboflavin synthases. The structure of the hit compound provided by the commercial vendor was reassigned as [3-(4-chlorophenyl)-5-hydroxy-5-(trifluoromethyl)-4,5-dihydro-1H-pyrazol-1-yl](o-tolyl)methanone (18). The hit compound had a k(is) of 8.7 microM vs. M. tuberculosis riboflavin synthase and moderate antibiotic activity against both M. tuberculosis replicating phenotype and nonreplicating persistent phenotype. Molecular modeling studies suggest that two inhibitor molecules bind in the active site of the enzyme, and that the binding is stabilized by stacking between the benzene rings of two adjacent ligands. The most potent antibiotic in the series proved to be [5-(4-chlorophenyl)-5-hydroxy-3-(trifluoromethyl)-4,5-dihydro-1H-pyrazol-1-yl](m-tolyl)methanone (16), which displayed a minimum inhibitory concentration (MIC) of 36.6 microM vs. M. tuberculosis replicating phenotype and 48.9 microM vs. M. tuberculosis nonreplicating phenotype. The HTS hit compound and its analogues provide the first examples of riboflavin synthase inhibitors with antibiotic activity.
View details for PubMedID 19545132
High resolution fossil fuel combustion CO2 emission fluxes for the United States.
Journal: Environmental science & technology
Authors: Gurney KR; Mendoza DL; Zhou Y; Fischer ML; Miller CC; Geethakumar S; de la Rue du Can S;
Publication Date: 2009 Jul 15

Abstract

Quantification of fossil fuel CO2 emissions at fine space and time resolution is emerging as a critical need in carbon cycle and climate change research. As atmospheric CO2 measurements expand with the advent of a dedicated remote sensing platform and denser in situ measurements, the ability to close the carbon budget at spatial scales of approximately 100 km2 and daily time scales requires fossil fuel CO2 inventories at commensurate resolution. Additionally, the growing interest in U.S. climate change policy measures are best served by emissions that are tied to the driving processes in space and time. Here we introduce a high resolution data product (the "Vulcan" inventory: www.purdue.edu/eas/carbon/vulcan/) that has quantified fossil fuel CO2 emissions for the contiguous U.S. at spatial scales less than 100 km2 and temporal scales as small as hours. This data product completed for the year 2002, includes detail on combustion technology and 48 fuel types through all sectors of the U.S. economy. The Vulcan inventory is built from the decades of local/regional air pollution monitoring and complements these data with census, traffic, and digital road data sets. The Vulcan inventory shows excellent agreement with national-level Department of Energy inventories, despite the different approach taken by the DOE to quantify U.S. fossil fuel CO2 emissions. Comparison to the global 1degree x 1 degree fossil fuel CO2 inventory, used widely by the carbon cycle and climate change community prior to the construction of the Vulcan inventory, highlights the space/time biases inherent in the population-based approach.
View details for PubMedID 19708393
Association of the aldehyde dehydrogenase 2 promoter polymorphism with alcohol consumption and reactions in an American Jewish population.
Journal: Alcoholism, clinical and experimental research
Authors: Fischer M; Wetherill LF; Carr LG; You M; Crabb DW;
Publication Date: 2007 Oct

Abstract

Reduction in activity of the mitochondrial aldehyde dehydrogenase 2 (ALDH2) enzyme due to genetic deficiency causes reactions related to alcohol consumption and lowers the risk of alcoholism. ALDH2*2 is the only functionally significant polymorphism of the ALDH2 gene. An additional polymorphic locus in the promoter (G to A substitution approximately 360 bp from the translation start site) may influence ALDH2 activity through effects on transcriptional activity. The A allele is predicted to be less active transcriptionally than the G allele. Therefore, we hypothesized that individuals with 1 or 2 A alleles would have exaggerated reactions to alcohol.
View details for PubMedID 17850643
A novel lumazine synthase inhibitor derived from oxidation of 1,3,6,8-tetrahydroxy-2,7-naphthyridine to a tetraazaperylenehexaone derivative.
Journal: The Journal of organic chemistry
Authors: Zhang Y; Illarionov B; Bacher A; Fischer M; Georg GI; Ye QZ; Vander Velde D; Fanwick PE; Song Y; Cushman M;
Publication Date: 2007 Mar 10

Abstract

Air oxidation of 1,3,6,8-tetrahydroxy-2,7-naphthyridine afforded 2,5,8,11-tetraaza-5,11-dihydro-4,10-dihydroxyperylene-1,3,6,7,9,12-hexaone. X-ray crystallography of the product revealed that it exists in the meso form in the solid state. The mechanism of product formation most likely involves oxidative phenolic coupling and oxidation. The product proved to be a competitive inhibitor of Schizosaccharomyces pombe lumazine synthase with a Ki of 66+/-13 microM in Tris buffer and 22+/-4 microM in phosphate buffer. This is significantly more potent than the reactant (Ki 350+/-76 microM, competitive inhibition), which had previously been identified as a lumazine synthase inhibitor by high-throughput screening. Ab initio calculations indicate that the meso form is slightly less stable than the enantiomeric form, and that the two forms interconvert rapidly at room temperature.
View details for PubMedID 17348709
Design, synthesis, and biochemical evaluation of 1,5,6,7-tetrahydro-6,7-dioxo-9-D-ribitylaminolumazines bearing alkyl phosphate substituents as inhibitors of lumazine synthase and riboflavin synthase.
Journal: The Journal of organic chemistry
Authors: Cushman M; Jin G; Sambaiah T; Illarionov B; Fischer M; Ladenstein R; Bacher A;
Publication Date: 2005 Sep 30

Abstract

The last two steps in the biosynthesis of riboflavin, an essential metabolite that is involved in electron transport, are catalyzed by lumazine synthase and riboflavin synthase. To obtain structural probes and inhibitors of these two enzymes, two ribityllumazinediones bearing alkyl phosphate substituents were synthesized. The synthesis involved the generation of the ribityl side chain, the phosphate side chain, and the lumazine system in protected form, followed by the simultaneous removal of three different types of protecting groups. The products were designed as intermediate analogue inhibitors of lumazine synthase that would bind to its phosphate-binding site as well as its lumazine binding site. Both compounds were found to be effective inhibitors of Bacillus subtilislumazine synthase as well as Escherichia coli riboflavin synthase. Molecular modeling of the binding of one of the two compounds provided a structural explanation for how these compounds are able to effectively inhibit both enzymes. In phosphate-free buffer, the phosphate moieties of the inhibitors were found to contribute positively to their binding to Mycobacterium tuberculosis lumazine synthase, resulting in very potent inhibitors with Ki values in the low nanomolar range. The additional carbonyl in the dioxolumazine system versus the purinetrione system was found to make a positive contribution to its binding to E. coli riboflavin synthase.
View details for PubMedID 16277343