Faculty Bibliography

At a time when drug safety is being questioned, and side effects of common drugs are often magnified, it is reasonable to question whether antidepressant medications are being properly utilized. Depression and anxiety are prevalent in an internist's practice, and in fact generalists diagnose and treat most of these conditions. The art of medicine is helping a patient distinguish between a sad mood and a clinical depression requiring medication. And with depression, the effects of the illness are often more severe than the side effects of the drug being considered

Campylobacter fetus is a gram-negative bacterial pathogen of both humans and animals. Two subspecies have been identified, Campylobacter fetus subsp. fetus and Campylobacter fetus subsp. venerealis, and there are two serotypes, A and B. To further investigate the genetic diversity among C. fetus strains of different origins, subspecies, and serotypes, we performed multiple genetic analyses by utilizing random amplification of polymorphic DNA (RAPD), pulsed-field gel electrophoresis (PFGE), and DNA-DNA hybridization. All 10 primers used for the RAPD analyses can distinguish C. fetus strains of reptile and mammal origin, five can differentiate between C. fetus subsp. fetus and C. fetus subsp. venerealis strains, and four showed differences between type A and type B isolates from mammals. PFGE with SmaI and SalI digestion showed varied genome patterns among different C. fetus strains, but for mammalian C. fetus isolates, genome size was well conserved (mean, 1.52 +/- 0.06 Mb for SmaI and 1.52 +/- 0.05 Mb for SalI). DNA-DNA hybridization demonstrated substantial genomic-homology differences between strains of mammal and reptile origin. In total, these data suggest that C. fetus subsp fetus strains of reptile and mammal origin have genetic divergence more extensive than that between the two subspecies and that between the type A and type B strains. Combining these studies with sequence data, we conclude that there has been substantial genetic divergence between Campylobacter fetus of reptile and mammal origin. Diagnostic tools have been developed to differentiate among C. fetus isolates for taxonomic and epidemiologic uses

BACKGROUND: Previous studies have shown that alcohol consumption is associated with decreased medication adherence, but this association may be confounded by characteristics common among those who drink heavily and those who fail to adhere (e.g., illicit drug use). Our objective was to determine whether there are temporal and dose-response relationships between alcohol consumption and poor adherence. METHODS: We administered telephone interview surveys to participants in the Veterans Aging Cohort Study, an eight-site observational study of HIV+ and matched HIV- veterans in care, to determine whether alcohol consumption on a particular day was associated with nonadherence to prescribed medications on that same day. We used the Time Line Follow Back to measure alcohol consumption and the Time Line Follow Back Modified for Adherence to measure adherence. Individuals were categorized as abstainers (no alcohol in past 30 days), nonbinge drinkers (alcohol in past 30 days but < or =four standard drinks on each day), or binge drinkers (> or =five standard drinks on at least one day). RESULTS: Among 2702 respondents, 1582 (56.6%) were abstainers, 931 (34.5%) were nonbinge drinkers, and 239 (8.9%) were binge drinkers. Abstainers missed medication doses on 2.4% of surveyed days. Nonbinge drinkers missed doses on 3.5% of drinking days, 3.1% of postdrinking days, and 2.1% of nondrinking days (p < 0.001 for trend), and this trend was more pronounced among HIV+ individuals than HIV- individuals. Binge drinkers missed doses on 11.0% of drinking days, 7.0% of postdrinking days, and 4.1% of nondrinking days (p < 0.001 for trend), and this trend was comparably strong for HIV+ and HIV- individuals. CONCLUSIONS: Among veterans in care, self-reported alcohol consumption demonstrates a temporal and dose-response relationship to poor adherence. HIV+ individuals may be particularly sensitive to alcohol consumption

[Jeanna Giese] told her pediatrician, Dr. Howard Dhonau, about the bat shortly before she left Fond du Lac, Dr. [Rodney E. Willoughby Jr.] said. Dr. Dhonau passed on the information to Children's Hospital, where Dr. Willoughby initially was skeptical about the possibility that she had rabies, a viral disease, largely because it is so rare in the United States. From his search of scientific articles and telephone discussions with the diseases centers, Dr. Willoughby said he learned that only five patients had recovered from rabies and that all had received rabies shots. No one who had not been immunized, as was Jeanna's case, had survived. Dr. Willoughby learned that laboratory researchers at the Pasteur Institute in Paris had shown that an anesthetic, ketamine, was active against the bullet-shaped rabies virus. So Dr. Willoughby proposed giving Jeanna ketamine to induce a deep coma and midazolam, a sedative, to prevent hallucinations

Early detection centers focus on women who may be at high genetic risk for ovarian cancer -- women like Cara Kealy, a 36-year-old mother of two from Mount Vernon, N.Y. After Kealy developed breast cancer at age 30, she was found to have a BRCA-1 gene mutation, which is associated with a high risk of ovarian cancer. [David Fishman] was thus able to tell her, based on established pathological testing of ovaries removed from other patients, that her ovaries have a 20 percent chance of having premalignant changes. This was enough to make Kealy decide to have her ovaries removed once she no longer wants the option of becoming pregnant again. 'I know I'll have them out. It won't be this year, but it will be soon,' she said. The spirit of international cooperation that Fishman envisions for the acceptance of his protein test doesn't yet exist. Critics of his spectrometric blood analysis haven't been able to reproduce his findings of almost 100 percent specificity, which were published in 2000. Fishman says improvements in technology -- he can now look at millions of protein fragments at once -- make his results far more reliable and reproducible. But a group of researchers at Yale remain unconvinced. They also say the state-of-the-art computer required for Fishman's method is too costly to be practical for broad use in a clinical setting. Led by Gil Mor and David Ward, the Yale group published a study in the May 10 issue of the Proceedings of the National Academy of Sciences, identifying four proteins -- leptin, prolactin, osteopontin and insulin-like growth factor-II -- that all tend to be abnormal in ovarian cancer more than 95 percent of the time. True, the abnormalities aren't unique to ovarian cancer, acknowledges Mor, director of the Reproductive Immunology Unit at Yale University School of Medicine, but identifying abnormalities in four complete proteins -- not just protein fragments -- is 'a good start,' he says; he intends to end up with 12 or more in an assay, or blood analysis, that will cost $10 to $20 to run -- instead of thousands of dollars

Remarkably, I found that she was also much less confused. A lung doctor who had treated Pearl for many years for occasional bronchitis came to visit her in the hospital, and she cheerfully complimented the doctor on her new hairstyle. The lung doctor remarked to me that she thought Pearl was very observant -- and grumbled that her own husband hadn't noticed her hairstyle change. At first, the neurologist didn't agree. Ultimately, when Pearl resumed doing crossword puzzles and knowing the details of others' lives, even the neurologist -- though still not convinced -- admitted that the sodium aberration had been the more likely culprit. Because 4 million Americans suffer from Alzheimer's disease, including almost half of people older than 85 (Pearl was close at 83), it was understandable that the neurologist had considered this disease. Alzheimer's has a devastating outcome attached, and because there are many other conditions that can cause similar memory loss and confusion (depression, infection, metabolic disturbances of all kinds), rushing to give a stigmatizing diagnosis such as Alzheimer's is unwise unless a doctor is almost certain. Without absolute tests at this point, and because Alzheimer's disease evolves, diagnosing it properly means observing a trend, not making a pronouncement on one day's observations