Faculty Bibliography

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.

BACKGROUND: One of the less well-defined complications of familial dysautonomia (FD) is chronic kidney disease (CKD). The goal of this report is to better define the prevalence and severity of kidney disease in this population and identify associated risk factors. METHODS: We conducted a retrospective analysis of the database of the Dysautonomia Treatment and Evaluation Center at New York University School of Medicine for patients with FD who were seen at ages 15, 20, 25, 30, 35, and 40 years. Estimated glomerular filtration rate (GFR) was compared with that of the general population. Changes in mean blood pressure from supine to erect at ages 15 and 20 years were analyzed for patients who eventually required dialysis therapy and compared with those of the other patients with FD. Percentage of patients requiring dialysis and duration of treatment also were analyzed. RESULTS: Mean estimated GFR of each predefined age group was considerably less than that of the general population starting at age 15 years (P < 0.001). Patients with FD were more likely to develop stage 3, 4, or 5 CKD than the general population. Of patients who remained alive at age 25 years, 19% eventually required dialysis. Those who required dialysis therapy were less likely to have had a feeding gastrostomy tube placed (P < 0.001) and had much more pronounced postural changes in blood pressure (P < 0.0001) by age 15 years. For those requiring dialysis therapy, average duration of treatment was 9 months. CONCLUSION: Patients with FD are far more likely than the general population to develop CKD. Patients with FD who eventually required dialysis showed a greater degree of orthostatic hypotension and were significantly less likely to have had a feeding gastrostomy tube placed for hydration before the age of 15 years. Dialysis therapy is not well tolerated in this population

The discovery of protease inhibitors was a revolutionary accomplishment in the world of virology that has changed the course of clinical disease for HIV patients. Here is how these drugs work: When the protease enzymes is blocked, HIV makes copies of itself that can no longer infect new cells. Studies have shown that these drugs reduce the amount of circulating virus in the blood and improve the body's immunological response to viruses. At a time when drug companies are routinely criticized for drug safety violations, it is good to recall the life-saving effects of the HIV drugs

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

CSI: Miami [Television Program] -- Victims suffocate from respiratory depression or sustain lethal heart arrhythmias as the cyanide interferes with hemoglobin metabolism (depriving the body's tissues of oxygen). The initial treatment is to administer pure oxygen. Common cyanide antidotes are nitrites and sodium thiosulfate, which work together to restore the hemoglobin. These aren't often completely effective, however, in part because the cyanide may have already done a lot of damage by the time the antidotes are administered

The 80-year-old was in the hospital after a failed balloon attempt to open the main artery that supplied blood and oxygen to his right kidney. His kidney function was deteriorating, and dialysis seemed likely, but he was now refusing all treatment and had fired his kidney doctor. My friend had contacted a new kidney expert, but he too was suggesting dialysis, and the father-in-law was on the verge of firing him as well. The father-in-law was a thin, tall man with a quick handshake, and his wife -- who immediately smiled when she saw me -- was sitting faithfully by his side. 'We've heard so much about you,' she said. 'We're so glad you're here.' The father-in-law smiled too. I knew better than to discuss dialysis, but in looking over the medical record, I saw that he had a fever and that his white blood count was elevated. My friend had warned me not to offer new treatments, but I feared a kidney infection and -- gambling on our seeming instant rapport -- suggested an antibiotic. The couple nodded and told me they would consider it. Just this month he has finally agreed -- in a state of near delirium from his kidney poisons -- to dialysis. When I had tried to break through his well-established macho structure to help him before he reached such a desperate point, it only created more anxiety and distance. He was afraid of becoming frail and dependent because this would negate his established role as his family's protector. In the end, there was little I could do beyond remaining cordial. This kind of pride and so-called male strength, when a man sets himself up as a quiet unemotional rock who doesn't need anyone's help and can't admit weakness, can be very destructive when it comes to his health

One million newcomers arrive in the United States every year; 11.7% of the total U.S. population is foreign-born. Immigrants face cancer care and research access barriers, including economic, immigration status, cultural, and linguistic. In 2000, the Center for Immigrant Health, NYU School of Medicine, launched the Cancer Awareness Network for Immigrant Minority Populations (CANIMP), a network comprising community- and faith-based organizations, local and national government health institutions, clinical service providers, researchers, and immigrant-service and advocacy organizations. This community-based participatory program chose as its priorities high- incidence cancer sites in the overall immigrant community (colorectal, lung, breast, cervical, prostate), as well as sites with strikingly high incidence in specific immigrant groups (gastric, liver, oral). CANIMP has developed successful outreach, education, screening, survivorship, training, and research programs to decrease cancer disparities. Over 2500 at-risk community members have been reached, 25 junior minority researchers trained, 60 minority interns mentored, numerous cancer disparities research projects funded and conducted, and vital partnerships to improve cancer data developed. These initiatives serve as models to address community, systems, physician, and cancer research gaps in immigrant communities. Cancer 2006. (c) 2006 American Cancer Society

AIM: To evaluate the prevalence of abnormalities of the uterine cervix in women with inflammatory bowel disease (IBD) when compared to healthy controls. METHODS: One hundred and sixteen patients with IBD [64 with Crohn's disease (CD) and 52 with ulcerative colitis (UC)] were matched to 116 healthy controls by age (+/- 2 years) at the time of most recent papanicolaou (Pap) smear. Data collected consisted of age, race, marital status, number of pregnancies, abortions/miscarriages, duration and severity of IBD, Pap smear results within five years of enrollment, and treatment with immunosuppressive drugs. Pap smear results were categorized as normal or abnormal including atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LGSIL), and high-grade squamous intraepithelial lesion (HGSIL). RESULTS: The median age at the time of Pap smear was 46 (range: 17-74) years for the IBD group and matched controls (range: 19-72 years). There were more Caucasian subjects than other ethnicities in the IBD patient group (P = 0.025), as well as fewer abortions (P = 0.008), but there was no significant difference regarding marital status. Eighteen percent of IBD patients had abnormal Pap smears compared to 5% of controls (P = 0.004). Subgroup analysis of the IBD patients revealed no significant differences between CD and UC patients in age, ethnicity, marital status, number of abortions, disease severity, family history of IBD, or disease duration. No significant difference was observed in the number of abnormal Pap smears or the use of immunosuppressive medications between CD and UC patients (P = 0.793). No definitive observation could be made regarding HPV status, as this was not routinely investigated during the timeframe of our study. CONCLUSION: Diagnosis of IBD in women is related to an increased risk of abnormal Pap smear, while type of IBD and exposure to immunosuppressive medications are not. This has significant implications for women with IBD in that Pap smear screening protocols should be conscientiously followed, with appropriate investigation of abnormal results

'It's the first formal way to track HIV/AIDS treatments and outcomes on a broad, comprehensive scale and in real time,' said Dr. Michael Saag, the principal investigator of the project, which is based at the University of Alabama at Birmingham. Extrapolating findings from clinical trials to individual patients can be difficult. One reason is that there are restrictions on the kinds of other ailments that participants in the trials can have. A second is that such trials usually are conducted on a short- term basis -- weeks or months. Doctors say that while short-term information is crucial for starting therapy, they need more data about the long-term benefits and dangers of such treatments. The seven current centers had pre-existing databases that tracked the clinical outcomes of their individual patients but lacked a collaborative, interactive information-sharing network. The centers were selected in part because they had shown the reliability of their data. be06 0078 061011 N S 0000000000 00002863