Faculty Bibliography

At the same time, the prevalence of H.I.V., the virus that causes AIDS, among young people has declined in eight countries in Africa, showing that prevention efforts can work, United Nations officials said. The officials said they were encouraged by new data showing declines in H.I.V. prevalence among young people from 2000 to 2005 in eight African countries: Botswana, Burundi, Ivory Coast, Kenya, Malawi, Rwanda, Tanzania and Zimbabwe. In Portugal, new H.I.V. infections among injecting drug users declined after the introduction of special prevention programs focused on H.I.V. and drug use

House [Television Program] -- [Allison Cameron] keeps [George Hagel] from being discharged from the hospital by slipping him the antiseizure drug phenytoin, which causes him to stagger and crash through a glass wall. When cerebrospinal fluid is needed, Dr. Eric Foreman decides that the patient is too obese for a routine lumbar puncture, so he takes Hagel to the operating room and inserts a needle into the back of his brain. When he does this, Hagel goes blind. Finally, House notices that Hagel's fingers are deformed (known as 'clubbing'), and orders X-rays, which confirm a paraneoplastic syndrome that House believes is associated with small cell cancer of the lung -- which would explain the coma and blindness. The diagnosis is confirmed by bronchoscopy. Hagel will be treated with radiation but is only expected to live a few months. The reality: A morbidly obese patient presents a series of unique diagnostic problems. Scanners have weight limits -- 450 pounds in many cases -- limiting imaging options. Because of Hagel's mass of fatty tissue, it would also be extremely difficult to place a spinal needle into his lumbar canal, the optimal place to draw fluid in a spinal tap. Ultimately, a neurosurgeon might be needed to place the needle in the back or the neck. But the needle would not generally be placed in the brain, and blindness as a direct result of this rare procedure is unlikely

Dr. Chan would take office in early January, filling a vacancy left by the death of Dr. Lee Jong-wook, a South Korean, from a stroke on May 22. Her term would run to June 2012. The agency's 34-member executive board nominated Dr. Chan, 59, most recently the W.H.O.'s top official on communicable disease, in secret balloting. As Hong Kong's health director, Dr. Chan led its response to two major disease outbreaks that threatened the world's health and economy. In 1997, she ordered 1.4 million chickens and ducks slaughtered to control the first cases of the A(H5N1) strain of avian influenza. In 2003, she led the investigation of SARS after the new virus, which had emerged in mainland China, had spread to Hong Kong. In 2005, she became the W.H.O.'s top official for communicable diseases

The premise: Geralyn Lucas is just beginning a job when she's diagnosed with breast cancer at the age of 27. The non-invasive cancer has an extensive intraductal component involving three separate areas of her breast. After debating whether to have a lumpectomy or a mastectomy, she chooses the latter, with adjuvant chemotherapy. Despite frequent episodes of nausea and vomiting, Lucas (played by Sarah Chalke) continues to work, buoyed by her friends. She also bolsters her mood and self-image by dressing well, getting a tattoo -- and wearing lipstick. Although at first worried that her husband will leave her, especially when she spies him speaking privately with a nurse, he ultimately proves to be very supportive. Lucas goes on to become pregnant and deliver a healthy child

PURPOSE: To explore the relationship of HIV, hepatitis C (HCV), and alcohol abuse/dependence to risk for hepatocellular carcinoma and non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Male veterans (n = 14,018) with a first HIV diagnosis in the Veterans Affairs Healthcare System from October 1997 to September 2004; and 28,036 age-, race-, sex-, and location-matched HIV-negative veterans were identified. We examined the incidence of hepatocellular carcinoma and NHL and presence of HCV and alcohol abuse/dependence using International Classification of Diseases, ninth revision (ICD-9-CM) codes. HIV-positive to HIV-negative incident rate ratios (IRRs) and 95% CIs for the occurrence of hepatocellular carcinoma and NHL were calculated using Poisson regression models. RESULTS: HIV-positive veterans were at greater risk for hepatocellular carcinoma than HIV-negative veterans (IRR = 1.68; 95% CI, 1.02 to 2.77). After adjusting for HCV infection and alcohol abuse/dependence, HIV status was not independently associated with hepatocellular cancer (IRR = 0.96; 95% CI, 0.56 to 1.63). HIV-positive veterans had 9.71 times (95% CI, 6.99 to 13.49) greater risk of NHL than HIV-negative veterans. After adjusting for HCV and alcohol abuse/dependence, the IRR for NHL comparing HIV-positive with HIV-negative veterans is similar (IRR = 10.03, 95% CI, 7.19 to 13.97). CONCLUSION: HIV-positive veterans have a higher relative incidence of hepatocellular carcinoma and NHL than HIV-negative veterans. For hepatocellular carcinoma, this association appears to be largely explained by the higher prevalence of HCV and alcohol abuse/dependence. Efforts to decrease hepatocellular carcinoma among persons with HIV should focus primarily on detecting and treating HCV and reducing heavy alcohol use

We present a novel approach for analysis of Mycobacterium tuberculosis complex (MTC) strain genotyping data. Our work presents a first step in an ongoing project dedicated to the development of decision support tools for tuberculosis (TB) epidemiologists exploiting both genotyping and epidemiological data. We focus on spacer oligonucleotide typing (spoligotyping), a genotyping method based on analysis of a direct repeat (DR) locus. We use mixture models to identify strain families of MTC based on their spoligotyping patterns. Our algorithm, SPOTCLUST, incorporates biological information on spoligotype evolution, without attempting to derive the full phylogeny of MTC. We applied our algorithm to 535 different spoligotype patterns identified among 7166 MTC strains isolated between 1996 and 2004 from New York State TB patients. Two models were employed and validated: a 36-component model based on global spoligotype database SpolDB3, and a randomly initialized model (RIM) containing 48 components. Our analysis both confirmed previously expert-defined families of MTC strains and suggested certain new families. SPOTCLUST, which is available online, can be further improved by incorporating data obtained using additional strain genetic markers and epidemiological information. We demonstrate on New York City (NYC) patient data how the resulting models can potentially form the basis of TB control tools using genotyping

OBJECTIVE:Clinically non-functioning pituitary adenomas (NFPAs) can express functional dopamine D2 receptors. Therapy with dopamine (DA) agonists may result in a NFPA size reduction. However, DA agonist-sensitive and -resistant NFPAs are clinically indistinguishable. We have studied the correlation between in vivo imaging of D2 receptors using (123)I-epidepride and the radiological response of NFPA to DA in 18 patients. METHODS:Patients were treated with either cabergoline (1-2 mg/week) or quinagolide (150-300 mug/day) for a mean period of 89.7 months (range, 34-187 months). RESULTS:Pituitary uptake of (123)I-epidepride varied from slight uptake classified as grade 0 to very high classified as grade 3. Grade 0 uptake was found in four patients; grade 1 in three; grade 2 in ten, and grade 3 in one. NFPA stabilization or shrinkage with DA agonist therapy showed no significant difference between grade 0, 1, and 2 tumors (mean tumor stabilization or shrinkage: 31, 30, and 36% respectively). However, when we considered a decrease in tumor size ranging from 0 to 20% as tumor stabilization and >20% decrease in tumor size as true shrinkage, one out of four NFPAs with grade 1 uptake, two out of three with grade 1 uptake, and eight out of ten with grade 2 uptake showed tumor shrinkage. CONCLUSION/CONCLUSIONS:In conclusion, there is limited clinical usefulness of dopamine D2 receptor imaging for predicting the clinical efficacy of DA agonist in selected patients with NFPAs. DA agonist therapy in NFPAs can result in tumor stabilization and shrinkage.

BACKGROUND: Prior studies have found fluoroquinolone exposure to be a risk factor for infection with fluoroquinolone-resistant gram-negative rods in the acute care setting. However, risk factors may be different in the long-term care setting. METHODS: A case-control study design was used to determine whether fluoroquinolone exposure is a risk factor for fluoroquinolone-resistant Escherichia coli urinary tract infections in a long-term care center. Cases had fluoroquinolone-resistant E. coli urinary tract infections; 4 controls were selected for each case. RESULTS: Thirty-three case patients were eligible; 132 controls were then selected. In the multivariable analysis, fluoroquinolone-resistant E. coli urinary tract infection was more common with prior fluoroquinolone use (odds ratio 21.8, 95% confidence interval, 3.7-127.1). CONCLUSIONS: Prior fluoroquinolone use is a strong risk factor for fluoroquinolone-resistant E. coli urinary tract infection in the long-term care setting. Further studies are needed to examine the effect of interventions to decrease fluoroquinolone-resistant infections in the long-term care setting, including studying the effect of decreasing fluoroquinolone use.