Faculty Bibliography

Most published recommendations for treatment of pediatric nerve agent poisoning are based on standard resuscitation doses for these agents. However, certain medical and operational concerns suggest that an alternative approach may be warranted for treatment of children by emergency medical personnel after mass chemical events. (1) There is evidence both that suprapharmacological doses may be warranted and that side effects from antidote overdosage can be tolerated. (2) There is concern that many emergency medical personnel will have difficulty determining both the age of the child and the severity of the symptoms. Therefore, the Regional Emergency Medical Advisory Committee of New York City and the Fire Department, City of New York, Bureau of Emergency Medical Services, in collaboration with the Center for Pediatric Emergency Medicine of the New York University School of Medicine and the Bellevue Hospital Center, have developed a pediatric nerve agent antidote dosing schedule that addresses these considerations. These doses are comparable to those being administered to adults with severe symptoms and within limits deemed tolerable after inadvertent nerve agent overdose in children. We conclude that the above approach is likely a safe and effective alternative to weight-based dosing of children, which will be nearly impossible to attain under field conditions

Dr David Katz, director of the Yale prevention research center, recently published a book, The Flavor Point Diet, in which he explores the idea that being stimulated by too many flavors stimulates more hunger. But many patients lack the discipline and do not manage to achieve a healthier lifestyle, no matter what the road map. So it is necessary to consider dietary aides. Without a perfect diet drug, many are looking with interest at Acomplia (rimonabant), a promising drug in late-stage clinical trials that works directly by blocking appetite (endocannabinoid) receptors in the brain

GOALS/BACKGROUND: Reports of segmental colitis with diverticula regard this entity as a local disease. Our goal was to reexamine the association of diverticula to colitis and question the relationship of colonic diverticulosis with generalized inflammatory bowel disease (IBD). STUDY: A retrospective database review of more than 1,600 patients matched 100 cases with IBD and colonic diverticulosis with a control group of 100 patients with IBD without diverticulosis. Patients were matched by gender, IBD diagnosis, and date of birth. Variables examined included disease distribution, strictures, fistulae, extraintestinal manifestations (EIMs), family history, and age at IBD diagnosis. RESULTS: For all IBD diagnoses, more sigmoid inflammation occurred in cases with diverticular disease: 82% versus 65% for controls (P = 0.005), and in the rectum: 85% versus 69% for controls (P = 0.005). In the Crohn's disease with diverticulosis subset, sigmoid inflammation was more common: 70% versus 42% for controls (P = 0.007), and in the rectum: 70% versus 46% for controls (P = 0.02). Disease distribution was otherwise similar throughout the colon, ileum, and jejunum. The incidence of strictures (P = 0.99) and fistulae (P = 0.69) was similar. EIMs were more frequent in cases with diverticulosis: 28% versus 16% (P = 0.05). Family history of IBD was similar: 26% for cases and 16% for controls (P = 0.12). Age at IBD diagnosis was significantly greater in diverticulosis cases compared with controls: 51.5 years (+/-17.6) versus 42.8 years (+/- 17.5) (P < 0.001), respectively. CONCLUSIONS: We observed an increased frequency of sigmoid and rectal inflammation, EIMs, and an older age of IBD onset in cases with diverticulosis. This suggests a role for diverticula in IBD beyond that of a mere coincidental finding

Overactive bladder (OAB) is a syndrome characterized by symptoms of urinary urgency with or without urgency urinary incontinence (UUI), usually with frequency and nocturia. OAB affects approximately 17% of women in the United States and Europe. The causes of OAB, as with many bladder disorders, are multifactorial and are not completely understood. The primary functions of the lower urinary tract (bladder and bladder outlet mechanism) are storage and evacuation of urine. The bladder and the micturition cycle are under complex neural control involving both the sympathetic and parasympathetic nervous systems. Micturition may occur in response to the activation of receptors in the bladder muscle and detection of chemical stimuli by receptors within the bladder lining. Neurogenic or myogenic bladder dysfunction can lead to the symptoms of urgency, frequency, and UUI that characterize OAB. The consequences of this condition are far-reaching and include direct medical consequences and coping strategies that adversely affect quality of life. Although the prevalence of OAB increases with age, it is not a normal consequence of aging. Antimuscarinic agents (e.g., oxybutynin, tolterodine, trospium, solifenacin, and darifenacin) have demonstrated efficacy for the treatment of OAB symptoms in multiple clinical trials. This review explores the physiological basis for OAB, the effects of OAB on health-related quality of life, and the pharmacotherapies that may provide relief to patients with this distressing condition

The Scale of Ethnic Experience (SEE) is a new self-report instrument designed to measure multiple ethnicity-related cognitive constructs across ethnic groups. We present the development and psychometric properties here. We generated and refined an item pool using expert consultants and culturally diverse focus groups. We derived a final 32-item version of the SEE based on separate factor analyses of data from college students in 4 ethnic groups: African Americans, Caucasian Americans, Filipino Americans, and Mexican Americans. Four factors were consistent across the ethnic groups: Ethnic Identity, Perceived Discrimination, Mainstream Comfort, and Social Affiliation. We found evidence of test-retest reliability, internal consistency, and criterion and construct validity for all groups. Finally, we cross-validated the factor structure of the SEE in a culturally diverse sample. Results support the reliability and validity of the SEE as a multidimensional measure of ethnicity-related cognitive constructs that can be used across American ethnic groups

Many health officials have predicted major increases in H.I.V. in India, which has the world's second highest number of infected people, after South Africa. But new infections among young adults declined by more than a third from 2000 through 2004, according to a statistical study by Dr. Rajesh Kumar and a team of researchers reported in the journal Lancet. A second is that routine monitoring of H.I.V. and other sexually transmitted diseases are powerful and cost-effective ways to control AIDS in India. But experts urged constant vigilance for signs of a reversal of the favorable trend. The prevalence of H.I.V. among women aged 15 to 24 in the southern states fell to 1.1 percent from 1.7 percent during the period of study. But H.I.V. prevalence did not fall significantly among women aged 25 to 34

According to a significant study published in the prestigious British journal Nature recently, the H5N1 bird flu virus is at least two large mutations and two small mutations away from being the next human pandemic virus. This virus attaches deep in the lungs of birds but cannot adhere to the upper respiratory tract of humans. Since we can't transmit the virus to one another, it poses little immediate threat to us. Fear causes the public to blur the distinction between birds and people, and so, as the H5N1 virus infects flocks of birds in Pakistan and Israel, nightly news watchers track the path to the United States. The poultry industry cringes as migratory birds that might be carrying H5N1 make their way closer to the northern shores of North America. If H5N1 spreads in pigs (a soup of viruses) and exchanges genetic material with another human flu virus before passing to humans, the result is likely to be far less deadly. The swine flu fiasco of 1976 is an example of the damage that can be done by fear of a mutated virus that never quite lives up to 1918 expectations. About 1,000 cases of ascending paralysis occurred from a rushed vaccine given to more than 40 million people in response to a feared pandemic that never arrived

The dilemma often concerns the influenza virus because it continually mutates, leading to human pandemics that predictably occur unpredictably. Although scientists lack the knowledge to predict when and what strain will cause the next influenza pandemic, they say they are convinced that another one is inevitable and so preparation must start as soon as a threat is detected. That kind of immediate action occurred in 1976 after four cases of swine influenza were detected at Fort Dix, a military base in New Jersey. Fearing that the cases represented an early warning of an impending pandemic of influenza, Public Health Service officials rushed President Gerald R. Ford, who was running for re-election, into recommending a swine influenza shot for every American. Warnings about A(H5N1) avian influenza began in 1997, when scientists in Hong Kong discovered that that strain of virus had jumped directly to cause disease in humans without first mixing in pigs, which had been the pattern until then. With the spread of the virus among birds, officials have warned that it could mutate, combine with a human influenza virus and create a new one to cause a human pandemic