Faculty Bibliography

We studied genetic relationships among 5069 Mycobacterium tuberculosis strains recovered from patients enrolled in 4 population-based studies in the United States and Europe, by analysis of 36 synonymous single-nucleotide polymorphisms (SNPs). All strains were assigned to 1 of 9 major genetic clusters based on sSNP profile. The same 9 genetic clusters were revealed by analysis of 227 nonsynonymous SNPs, 121 intergenic SNPs, and concatenated profiles of 578 SNPs available for a subset of 48 representative strains. IS6110 profiles, spoligotypes, and mycobacterial interspersed repetitive unit patterns were nonrandomly associated with SNP-based phylogenetic lineages, together indicating a strongly clonal population structure. Isolates of the 9 genetic clusters were not distributed with equal frequency in all localities, reflecting geographic subdivision. The SNP-based phylogenetic framework provides new insight into the worldwide evolution of M. tuberculosis and a gateway for investigating genotype-disease phenotype relationships in large samples of strains

BACKGROUND.: It is unclear whether the coronary heart disease (CHD) mortality risk associated with obesity is mediated only through traditional CHD risk factors. This analysis evaluated the independent CHD mortality risk due to obesity and determined its population attributable risk (PAR). METHODS.: Using the NHANES I Epidemiologic Follow-up Study (1971-1992, n = 10,582), a diabetes-body mass index (BMI) variable was constructed. The hazard ratios (HR) for fatal CHD in the diabetes-BMI categories (adjusting for age, sex, race, exercise, education level, smoking, hypertension, cholesterol, and alcohol use) were determined and the PARs subsequently estimated. RESULTS.: Compared to lean non-diabetics, the HR (95% CI) for fatal CHD is 0.8 (0.7, 1.1) in overweight non-diabetics, 1.4 (1.3, 2.0) in obese non-diabetics, 2.2 (1.2, 4.0) in lean diabetics, 2.3 (1.4, 3.9) in overweight diabetics, and 3.3 (1.9, 8.9) in obese diabetics. The PAR% is -6.8 (-15.7, 1.8) in overweight non-diabetics, 6.1 (1.7, 11.1) in obese non-diabetics, 2.0 (0.3, 4.0) in lean diabetics, 2.2 (0.6, 4.3) in overweight diabetics, and 2.2 (0.8, 3.8) in obese diabetics. CONCLUSIONS.: Obesity is an independent risk factor for CHD mortality even after controlling for traditional CHD risk factors. The PAR for CHD death in obese non-diabetics is significant. Obesity should be aggressively treated in those without traditional CHD risk factors

To evaluate nurses' priorities for health system reconstruction and professional development in Iraq, a survey of 744 Iraqi nurses was conducted, with the research process managed via the Internet. Seven definite priorities emerged along with significant differences in priorities related to years of experience, age, speciality area of nursing practice, gender, level of education, and geographic location of practice. Results indicate that nurses should be included in health system reconstruction processes and that support for the development of the nursing profession should be included in the plan for overall reconstruction.

The authors review the current literature on the complementary and alternative medicines most frequently utilized by prostate cancer patients and those at risk for the disease. Products covered are vitamin E, vitamin A, selenium, zinc, soy, lycopene, pomegranate juice, green tea and omega-3 fatty acids. There is no definitive proof that any of the nutritional supplements discussed can impact the course of prostate cancer or its development. The authors believe that simply taking a standard daily multivitamin should be sufficient to ensure that patients have the appropriate levels of vitamins and minerals without risking the over utilization of vitamins, minerals, and supplements which can lead to numerous negative side effects.

Quinolones are great drugs, but like all great drugs, they should be used judiciously. All drugs have side effects, and this family of antibiotics is no exception, causing occasional diarrhea, insomnia, tremors and restlessness. Quinolones have traditionally established themselves as gram-negative drugs for the urinary tract. But further quinolones were developed, including Levaquin and Avelox, that not only treated atypical lung infections but also showed better activity against garden-variety pneumococcus. Criticism against quinolones has obscured a safe, versatile and extremely useful category of drugs

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) reduces the co-morbidities of obesity. Patients with super-super obesity (BMI>or=60) present additional technical and medical challenges. This study compares the results in super-super-obese patients with patients with a BMI of <60 over a 5.5-year period. METHODS: Retrospective analysis was performed of the 504 patients who underwent open RYGBP from January 1999 through June 2004. Patients were divided into 2 groups: Group A (444 patients) had a BMI <60, and Group B (60 patients) had a BMI>or=60, and also had a greater percentage of males. The groups were otherwise similar in demographics and co-morbidities. RESULTS: Concomitant ventral herniorrhaphy was performed in 23 patients (5%) in Group A and in 3 patients (5%) in Group B. Concomitant cholecystectomy was done in 11.2% in Group A and 10% in Group B. Group A patients had an incidence of leaks of 1.3%, and there were no leaks in Group B. Wound infection rate for Group A was 5% vs 1.7 % in Group B (NS). Mortality for both groups was similar. The stricture rate for Group A was 0.9% compared with 1.7 % for Group B. After 1 year, excess weight lost was 41.7% in Group A and 38.3% in Group B. The development of anemia was not statistically different (8.3% vs 11.0 %). Incidence of postoperative gallbladder disease and incisional hernia was similar. CONCLUSIONS: Super-super-obese patients should not be excluded from RYGBP because of a perceived increased risk based upon BMI

The role of tumor necrosis factor-alpha (TNF-alpha) in controlling growth of Mycobacterium tuberculosis in murine peritoneal macrophages infected in vitro was studied. TNF-alpha was shown to be required but not sufficient, and the amount of TNF-alpha produced by the infected cells did not correlate with the extent of growth control. In this system, TNF-alpha-dependent control of growth of the avirulent strain H37Ra was independent of inducible nitric oxide synthase (iNOS) and interferon-gamma (IFN-gamma), as shown by the infection of macrophages from selected gene-disrupted mice. TNF-alpha-mediated bacteriostasis of H37Ra in the infected macrophages was associated with increased expression of selected Th1-type cytokines and chemokines. In contrast, growth of the virulent strain H37Rv in macrophages involved upregulation by infected cells of Th2-type cytokines, including interleukin-5 (IL-5), IL-10, and IL-13. Taken together, these results suggest that the particular nature of macrophage activation and the cytokine and chemokine response to infection with different M. tuberculosis strains determine the ability of the cells to control the growth of the intracellular bacilli

BACKGROUND AND OBJECTIVES: Our objective was to assess medical students' ability to care for lesbian, gay, bisexual, and transgender (LGBT) patients and to identify potential deficiencies in medical school curricula pertaining to this care. METHODS: Between March 1 and April 15, 2004, third- and fourth-year medical students at a metropolitan medical school were sent an e-mail requesting participation in a confidential on-line survey of 64 quantitative questions designed to assess their ability to care for LGBT patients. RESULTS: A total of 248 of 320 (77.5%) students responded. Medical students with greater clinical exposure to LGBT patients reported more frequent sexual history taking with LGBT patients, had more positive attitude scores, and possessed higher knowledge scores than students with little or no clinical exposure. Overall, on the 13-item attitude survey, the mean was 4.15 (5 = most positive, SD = .55, range 1.86-5.00), indicating a desire and willingness to provide health care to LGBT patients. The mean score on the 14-item knowledge test was 60% (SD = .12) correct. CONCLUSIONS: Medical students with increased clinical exposure to LGBT patients tended to perform more comprehensive histories, hold more positive attitudes toward LGBT patients, and possess greater knowledge of LGBT health care concerns than students with little or no clinical exposure

BACKGROUND:Coronary heart disease (CHD) is the leading cause of death among American women. Currently, global risk assessment derived by Framingham risk equation (FRE) is used to identify women at increased risk for CHD. Electron-beam computed tomography (EBCT) derived coronary artery calcium (CAC) scores are validated markers for future CHD events among asymptomatic individuals. However, the adequacy of FRE for identifying asymptomatic women with CAC is unknown. METHODS AND RESULTS/RESULTS:We studied 2447 consecutive non-diabetic asymptomatic females (55 +/- 10 years). Based upon FRE, 90% were classified as low-risk (FRE < or = 9% 10-year risk of hard CHD events), 10% intermediate-risk (10-20%), and none were considered as high-risk (> 20%). Coronary artery calcium was present in 33%, whereas CAC > or = 100 and CAC > or = 400 were seen in 10 and 3% of women, respectively. Overall, 20% of women had age-gender derived > or = 75th percentile CAC. According to FRE, the majority (84%) of women with significant CAC > or = 75th percentile were classified as low-risk. Approximately half (45%) of low-risk women with > or = 2 CHD risk factors and a family history of premature CHD had significant CAC. CONCLUSION/CONCLUSIONS:Framingham risk equation frequently classifies women as being low-risk, even in the presence of significant CAC. Determination of CAC may provide incremental value to FRE in identifying asymptomatic women who will benefit from targeted preventative measures.