Faculty Bibliography

While there might have been a large, prospective, double-blind, placebo-controlled study of healthy, uninsured, mildly diabetic, previously febrile but currently afebrile, Pakistani men in the diagnosis and treatment of presumptive community-acquired pneumonia, I wasn't aware of it, and for sure didn't have the time to go hunting on Medline with eight other patients waiting to see me. Yes, there has been enough written about diabetes to sink a galleon, but there is no invariant law that will predict exactly what will transpire in my patient with his unique constellation of glucose control, pulmonary pathology, drug absorption, cultural expectations, financial constraints, and personality quirks

BACKGROUND: The Direct Repeat locus of the Mycobacterium tuberculosis complex (MTC) is a member of the CRISPR (Clustered regularly interspaced short palindromic repeats) sequences family. Spoligotyping is the widely used PCR-based reverse-hybridization blotting technique that assays the genetic diversity of this locus and is useful both for clinical laboratory, molecular epidemiology, evolutionary and population genetics. It is easy, robust, cheap, and produces highly diverse portable numerical results, as the result of the combination of (1) Unique Events Polymorphism (UEP) (2) Insertion-Sequence-mediated genetic recombination. Genetic convergence, although rare, was also previously demonstrated. Three previous international spoligotype databases had partly revealed the global and local geographical structures of MTC bacilli populations, however, there was a need for the release of a new, more representative and extended, international spoligotyping database. RESULTS: The fourth international spoligotyping database, SpolDB4, describes 1939 shared-types (STs) representative of a total of 39,295 strains from 122 countries, which are tentatively classified into 62 clades/lineages using a mixed expert-based and bioinformatical approach. The SpolDB4 update adds 26 new potentially phylogeographically-specific MTC genotype families. It provides a clearer picture of the current MTC genomes diversity as well as on the relationships between the genetic attributes investigated (spoligotypes) and the infra-species classification and evolutionary history of the species. Indeed, an independent Naive-Bayes mixture-model analysis has validated main of the previous supervised SpolDB3 classification results, confirming the usefulness of both supervised and unsupervised models as an approach to understand MTC population structure. Updated results on the epidemiological status of spoligotypes, as well as genetic prevalence maps on six main lineages are also shown. Our results suggests the existence of fine geographical genetic clines within MTC populations, that could mirror the passed and present Homo sapiens sapiens demographical and mycobacterial co-evolutionary history whose structure could be further reconstructed and modelled, thereby providing a large-scale conceptual framework of the global TB Epidemiologic Network. CONCLUSION: Our results broaden the knowledge of the global phylogeography of the MTC complex. SpolDB4 should be a very useful tool to better define the identity of a given MTC clinical isolate, and to better analyze the links between its current spreading and previous evolutionary history. The building and mining of extended MTC polymorphic genetic databases is in progress

Mr. [George E. Pataki], 60, said he had taken a number of telephone calls in his hospital room from well-wishers. His spokesman, David Catalfamo, said that Mr. Pataki had spoken with former President Bill Clinton and Gov. Ernie Fletcher of Kentucky. Mr. Catalfamo said that one of the reasons Mr. Pataki appeared at the news conference was to reassure his mother, Margaret, who was concerned about news reports about his medical condition. On Tuesday, Mr. Pataki's doctors revealed that his ruptured appendix left him more seriously ill than his staff and doctors had previously acknowledged. For the first week that Mr. Pataki was at NewYork-Presbyterian/Columbia hospital, his doctors and staff gave little information about his medical condition, not fully explaining the need for his second operation or revealing the peritonitis and abscesses. Yesterday, Mr. Catalfamo defended the staff's handling of the information about Mr. Pataki's illness, saying, ''We are doing our best to provide the public with as much information as we understand.''

They used the word ''peritonitis'' -- the name of a potentially fatal inflammation of the abdominal lining -- only after being pressed repeatedly by reporters. They also described abscesses but declined to use that word, and declined to say how high a fever Mr. [George E. Pataki] had. And although they said that his bowel function was impaired but improving, they would not elaborate despite repeated questioning. Dr. Dennis L. Fowler said yesterday that the adhesions were new and probably caused by the ruptured appendix and the first operation. Dr. [Spencer E. Amory] said that after examining Mr. Pataki and reviewing his records, ''I thought the governor received excellent care at Hudson Valley.'' When asked whether Mr. Pataki had peritonitis, Dr. Amory said there was ''a spread of infection within the abdomen.'' He was asked again, and gave a similar answer. When asked a third time, he said the condition he described ''is defined as peritonitis.''

While a growing literature has addressed the psychological consequences of torture and refugee trauma, most studies have focused on homogeneous samples drawn from a single region. Thus, relatively little research has attempted to identify demographic or experiential factors that might help explain different levels of distress in these individuals. We measured depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in a convenience sample of refugees and survivors of torture seeking treatment in a torture treatment program (N = 325). We found 81.1% of patients had clinically significant anxiety, 84.5% had clinically significant depressive symptoms, and 45.7% had significant PTSD symptoms. Regression analyses revealed that anxiety and depressive symptom were significant higher among women (beta = .08, p = 0.02 and beta = .22, p = 0.0001 for anxiety and depression respectively) and those who reported death threats as part of their traumatic experiences (beta = .10, p = 0.033 and beta = .12, p = 0.036 respectively). Symptoms of PTSD were also predicted by death threats (beta = .22, p = 0.03), but were also influenced by the experience of rape (beta = .33, p < 0.001), family torture experiences (beta = .23, p = 0.022), religion (beta = .21, p = 0.03), and age (beta = -.18, p = 0.004). The clinical implications of these results are discussed

PURPOSE: Therapeutic drug monitoring (TDM) is the practice of managing plasma drug concentrations. This intervention can potentially improve inadequate antiretroviral dosing in the treatment of HIV infection. Our objective was to review the evidence regarding TDM in HIV management. METHOD: We searched MEDLINE using the following key words: therapeutic drug monitoring, HIV infection, pharmacokinetics, antiretroviral therapy, protease inhibitors, antiretroviral-naive, antiretroviral-experienced, and salvage therapy. inclusion criteria required definition of optimal concentration thresholds and measures of treatment effectiveness at these targets. RESULTS: Our search yielded 39 studies. 11 studies met inclusion criteria. 4 studies compared efficacy of TDM to standard of care (SOC) interventions via randomized clinical trials and were grouped as "interventional." 7 studies retrospectively defined thresholds from observed differences in outcome and were grouped as "observational." 3 interventional studies targeted similar indinavir concentrations (Cmin = 0.10-0.15 mg/L). 2 of these studies increased achievement of target serum levels and percentages of undetectable viral load (23%-41%, p < or = .009) with TDM implementation. CONCLUSION: TDM can effectively target antiretroviral threshold concentrations and improve virologic suppression in some cases. Further work is needed to define plasma thresholds and assess the value of TDM in HIV management.

Physicians in residency training will be the referring physicians of tomorrow. We sought to determine the current surgical and medical trainees' perception of vascular surgery's endovascular qualifications and capabilities. An anonymous survey was sent to all general surgery and internal medicine residents at a single academic institution. Respondents answered the question 'Which specialty is the most qualified to perform (1) inferior vena cava (IVC) filter insertion; (2) angiograms, angioplasty, and stenting of the carotid arteries; (3) renal arteries; (4) aorta; and (5) lower extremity arteries?' For each question, respondents chose one response, either vascular surgery, interventional radiology, interventional cardiology, or do not know. One hundred respondents completed the survey (general surgery, n=50; internal medicine, n=50). There was a significant difference in the attitudes of surgery and medicine residents when choosing the most qualified endovascular specialist (p<0.05). Surgery residents chose vascular surgery as the most qualified specialty for each listed procedure: carotid (80%, n=40), IVC (56%, n=28), aorta (100%, n=50), extremity (86%, n=43), renal (78%, n=39). Medicine residents chose vascular surgery as the most qualified specialty less frequently: carotid (66%, n=33), IVC (6%, n=3), aorta (88%, n=44), extremity (72%, n=36), renal (16%, n=8). There was no significant difference in specialty selection based on postgraduate year. There is a large discrepancy between surgical and medical trainees' perception of vascular surgery's endovascular abilities, particularly regarding IVC placement and renal artery interventions. If our own institution mirrors the nation, each passing year a significant portion of the 21,722 graduating internal medicine residents go into practice viewing vascular surgeons as second-tier endovascular providers. A concerted campaign should be undertaken to educate medical residents regarding the skills and capabilities of vascular surgeons

Many, if not most, of the author's New York City patients suffer from acid reflux disease. The introduction of proton pump inhibitors (PPIs) in the late 1980s changed everything. PPIs stand as a triumph of pharmaceutical research, and it seems that it has been underreported just how good they are. Overall, PPIs are a wonderful arrow to have in the medical quiver and have changed the course of esophageal, stomach and duodenal disease