Faculty Bibliography

While some experts supported the extraordinary treatments that were used to try to save Mr. [Ariel Sharon]'s life, and others opposed them, all agreed that Mr. Sharon's Israeli doctors were working at the very edges of medicine's lifesaving capacities, with little experience and few studies to guide them. Mr. Sharon's second stroke occurred on the eve of a scheduled procedure to close a hole in the wall separating the upper chambers of his heart. Doctors suspected that the clot that caused his first stroke arose from his legs or elsewhere to pass through the hole and ultimately lodge in an artery in the brain. When doctors examined him on Wednesday night, Mr. Sharon complained of chest pain that could have resulted if part of a clot traveled to his lungs and another piece went through the hole to his brain. Or, if he had suffered a heart attack, a clot within the heart might have broken off to lodge in a brain artery. In either case, the anticoagulant therapy could have converted the clot into a hemorrhagic stroke

Last year a study in the journal Cancer Epidemiology, Biomarkers & Prevention looked at 7,000 current and former smokers and found a marked reduction in cancer occurrence and mortality in those who exercised regularly and vigorously, even among current smokers. For example, there was a 25 percent reduction in cancer deaths in the 54- to 62-year-old smokers who followed a workout program compared to those who did not exercise. The study is among several that shows exercise has a positive effect even in heavy smokers. The study looked at 43,000 people from the 1970s through 2002 and found that those who smoked very little (one to four cigarettes daily) had poor health outcomes. These light smokers were three times more likely to die of heart disease than nonsmokers; heavy smokers were four times more likely. Light smokers also had significantly higher death rates over the 30 year period -- 1.5 times higher generally -- than those who had never smoked. Going from zero to four cigarettes per day showed by far the greatest correlation in the study between smoking and associated death rates. In fact, it wasn't until cigarette consumption increased to 25 cigarettes per day that the corresponding death rate from all causes reached three times normal. Certainly, a subset of patients has been so devastated by smoking that any exertion may present a strain too great for a severely damaged heart or lungs. Any smokers considering beginning an exercise program must consult with their physicians first. But for most smokers it seems clear that regular exercise initiates a healthy cycle that is likely to improve, and perhaps extend, their lives

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: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.

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.

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