Faculty Bibliography

The current study evaluated Mycobacterium tuberculosis isolates from Rio de Janeiro, Brazil, for genomic deletions. One locus in our panel of PCR targets failed to amplify in approximately 30% of strains. A single novel long sequence polymorphism (>26.3 kb) was characterized and designated RD(Rio). Homologous recombination between two similar protein-coding genes is proposed as the mechanism for deleting or modifying 10 genes, including two potentially immunogenic PPE proteins. The flanking regions of the RD(Rio) locus were identical in all strains bearing the deletion. Genetic testing by principal genetic group, spoligotyping, variable-number tandem repeats of mycobacterial interspersed repetitive units (MIRU-VNTR), and IS6110-based restriction fragment length polymorphism analysis cumulatively support the idea that RD(Rio) strains are derived from a common ancestor belonging solely to the Latin American-Mediterranean spoligotype family. The RD(Rio) lineage is therefore the predominant clade causing tuberculosis (TB) in Rio de Janeiro and, as indicated by genotypic clustering in MIRU-VNTR analysis, the most significant source of recent transmission. Limited retrospective reviews of bacteriological and patient records showed a lack of association with multidrug resistance or specific risk factors for TB. However, trends in the data did suggest that RD(Rio) strains may cause a form of TB with a distinct clinical presentation. Overall, the high prevalence of this genotype may be related to enhanced virulence, transmissibility, and/or specific adaptation to a Euro-Latin American host population. The identification of RD(Rio) strains outside of Brazil points to the ongoing intercontinental dissemination of this important genotype. Further studies are needed to determine the differential strain-specific features, pathobiology, and worldwide prevalence of RD(Rio) M. tuberculosis

BACKGROUND:Physicians' communication skills, which are linked to important patient outcomes, are rarely explicitly taught during the clinical years of medical school. This paper describes the development, implementation, and evaluation of a communication skills curriculum during the third-year Internal Medicine Clerkship. METHODS:In four two-hour structured bedside rounds with trained Internal Medicine faculty facilitators, students learned core communication skills in the context of common challenging clinical situations. In an end-of-clerkship survey students evaluated the curriculum's educational effectiveness. RESULTS:Over the course of a year, 160 third-year students and 15 faculty participated. Of the 75/160 (47%) of students who completed the post-clerkship survey, almost all reported improvement in their communication skills and their ability to deal with specific communication challenges. CONCLUSIONS:The curriculum appears to be a successful way to reinforce core communication skills and practice common challenging situations students encounter during the Internal Medicine Clerkship.

Even after their reconciliation last month, Dr. [Michael E. DeBakey] said that Dr. [Denton A. Cooley] had ''disappointed me with his ethics'' and ''poor judgment'' in doing the implant, which was ''a little childish.'' After the reconciliation, he said in an interview that ''there was no reason to consider him an enemy'' and ''we have never had any bad words,'' although ''we haven't had very much in the way of communication.'' In the reconciliation meeting, Dr. Cooley told Dr. DeBakey he regretted that they had become so distant and hoped that the ''temporary truce or cease-fire'' they had reached in their ''rivalry'' and ''small battle'' would become permanent

Mr. [John Edwards], in a plan released in September, promises to ''strengthen'' financing for such research. Mr. [Barack Obama], who put out parts of his plan at different times this year, said he would ''expand'' such financing. According to a paper outlining the [Hillary Rodham Clinton] plan, which her campaign provided, Mrs. Clinton supports giving young people ''age-appropriate information about H.I.V./AIDS and how to protect themselves against it.'' She also backs federal financing for needle exchange programs, as do Mr. Edwards and Mr. Obama. Mr. Edwards has said his strategy would include holding his administration's health and human services secretary ''accountable'' for issuing an annual H.I.V./AIDS report that shows progress on Mr. Edwards's goals. He also has said he would appoint a ''strong'' director of the White House Office of National AIDS Policy

Unit: Five Brothers [Television Program] -- The clinical diagnosis of a 'dropped lung' can be made without a stethoscope, by observing distended veins in the neck, difficulty breathing and absence of the movement of breathing on one side of the chest, says Cmdr. D. J. Green, an assistant professor of trauma surgery at Keck School of Medicine of USC and Naval Trauma Training Center.

Chlamydia and gonorrhea are the two most common diseases among those doctors must report in the United States. And the 1,030,911 cases of chlamydia in 2006 are the highest ever recorded for any nationally reported disease in any year, the officials said in releasing their annual report on sexually transmitted diseases. They said that because of underreporting, a more accurate estimate is 2.8 million new chlamydia cases annually. ''Chlamydia is now the most common S.T.D. ever reported,'' Dr. [John M. Douglas Jr.] said, but not by much. The next most common is gonorrhea, with just over one million cases reported each year from 1976 to 1980. The peak for gonorrhea was 1,013,00. Gonorrhea cases then declined steadily. African-Americans account for 69 percent of all gonorrhea in this country. ''The biggest increase in gonorrhea regionally has been in the South, and we do not have a ready explanation for that,'' Dr. Douglas said

The increased risk was principally among a group of people who had pre-existing levels of immunity to a common cold virus known as adenovirus type 5, which was modified to become a critical part of the vaccine. Researchers emphasized that the vaccine itself could not cause AIDS, but one theory is that the cold virus may have activated the immune system in some way to make certain recipients more susceptible to becoming HIV-infected when exposed to the AIDS virus. The vaccine was being tested among 3,000 volunteers at high risk of developing AIDS in nine countries, including those at immunization centers organized by the National Institutes of Health in the United States. Merck's was seen as one of the most promising experimental AIDS vaccines to have been tested on people. Many scientists and AIDS advocates have called the failure of the experimental vaccine a major setback

''The new analyses are both disappointing and puzzling'' because they offer no explanation for the vaccine's failure, said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, a partner in the vaccine trial. The findings raise questions about whether adenovirus can ever be used as a crucial ingredient in an AIDS vaccine and whether new tacks will be needed. Use of a modified virus as a vector to deliver H.I.V. genes is a new and evolving way to make an AIDS vaccine. The Merck vaccine included three synthetic H.I.V. genes. ''We did a beautiful experiment, but it definitely was a disappointment,'' Dr. Larry Corey of the University of Washington, who led the investigators, said in an interview. ''One lesson is that scientists will have to look at vector-based immunity more thoroughly than we have in the past.''

The new reports create even more scientific confusion about how to develop a vaccine to stop the global HIV pandemic, which has infected an estimated 39 million people and killed 25 million more. The findings raise questions about whether adenovirus can ever be used as a crucial ingredient in an AIDS vaccine and whether new tacks will be needed. Use of a modified virus as a vector to deliver HIV genes is a new and evolving way to make an AIDS vaccine. The Merck vaccine included three synthetic HIV genes