Faculty Bibliography

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

Last September, the giant drug company Merck announced that it was pulling its popular arthritis drug, Vioxx, off the market, even though it racked up $2.5 billion a year in sales. This happened on the heels of the publication of three separate books dealing with drugs and health care

In March 2004, a U.S.-born boy aged 15 months in New York City (NYC) died of peritoneal tuberculosis (TB) caused by Mycobacterium bovis infection. M. bovis, a bacterial species of the M. tuberculosis complex, is a pathogen that primarily infects cattle. However, humans also can become infected, most commonly through consumption of unpasteurized milk products from infected cows. In industrialized nations, human TB caused by M. bovis is rare because of milk pasteurization and culling of infected cattle herds. This report summarizes an ongoing, multiagency investigation that has identified 35 cases of human M. bovis infection in NYC. Preliminary findings indicate that fresh cheese (e.g., queso fresco) brought to NYC from Mexico was a likely source of infection. No evidence of human-to-human transmission has been found. Products from unpasteurized cow's milk have been associated with certain infectious diseases and carry the risk of transmitting M. bovis if imported from countries where the bacterium is common in cattle. All persons should avoid consuming products from unpasteurized cow's milk.

David Landry, a senior research associate at the Alan Guttmacher Institute in New York, criticized the Heritage team's reliance on self-reports of sexually transmitted diseases. 'The underreporting problem is so severe that it makes that data highly questionable,' Landry said

The authors of the new studies, Dr. Robert Rector, a senior research fellow in policy studies at the foundation, and Dr. Kirk A. Johnson, a senior policy analyst there, said their findings contradicted those published in March in The Journal of Adolescent Health by Dr. Peter Bearman, the chairman of the sociology department at Columbia University, and Hannah Bruckner of Yale University. The earlier study found that a majority of teenagers who took the pledge did not live up to their promises and developed sexually transmitted diseases about the same rate as adolescents who had not made such pledges. It also found that the promise did tend to delay the start of intercourse by 18 months. Dr. Bearman said: ''Our analyses showed that pledgers are less likely to get tested for S.T.D.'s, be diagnosed as having an S.T.D. and to see a doctor because they are worried about having an S.T.D. Most S.T.D. infections are asymptomatic, and therefore, people don't know that they have an S.T.D. unless they get tested. The use of self-report data for S.T.D.'s is therefore extremely problematic.''

The agency said that about one-quarter of those with H.I.V. did not know they were infected because they had not been tested, limiting the number of H.I.V.-positive Americans whose lives might be extended by the use of newer and more effective drugs. C.D.C. officials said that some prevention programs were substantially reducing sexual risk behavior among people with H.I.V. and those at risk for the infection. Also, H.I.V. diagnoses have steadily declined among adolescent and young adult women in all ethnic groups. Leaders of the AIDS Foundation of Chicago, the Community H.I.V./AIDS Mobilization Project and other groups advocating for people with AIDS blamed the government for the increase, citing long-term underfinancing for efforts to prevent and treat H.I.V

CONTEXT: The traditional teaching that pulmonary tuberculosis characterized by lymphadenopathy, effusions, and lower or mid lung zone infiltrates on chest radiography represents 'primary' disease from recently acquired infection, whereas upper lobe infiltrates and cavities represent secondary or reactivation disease acquired in the more distant past, is not based on well-established clinical evidence. Furthermore, it is not known whether the atypical radiograph common in human immunodeficiency virus (HIV)-associated tuberculosis is due to a preponderance of primary progressive disease or altered immunity. OBJECTIVE: To analyze the relationship between recently acquired and remotely acquired pulmonary tuberculosis, clinical and demographic variables, and radiographic features by using molecular fingerprinting and conventional epidemiology. DESIGN, SETTING, AND POPULATION: A retrospective, hospital-based series of 456 patients treated at a New York City medical center between 1990 and 1999. Eligible patients had to have had at least 1 positive respiratory culture for Mycobacterium tuberculosis and available radiographic data. MAIN OUTCOME MEASURES: Radiographic appearance as measured by the presence or absence of 6 features: upper lobe infiltrate, cavitary lesion, adenopathy, effusions, lower or mid lung zone infiltrate, and miliary pattern. Radiographs were considered typical if they had an upper lobe infiltrate or cavity whether or not other features were present. Atypical radiographs were those that had adenopathy, effusion, or mid lower lung zone infiltrates or had none of the above features. RESULTS: Human immunodeficiency virus infection was most commonly associated with an atypical radiographic appearance on chest radiograph with an odds ratio of 0.20 (95% confidence interval, 0.13-0.31). Although a clustered fingerprint, representing recently acquired disease, was associated with typical radiograph in univariate analysis (odds ratio, 0.68; 95% confidence interval, 0.47-0.99), the association was lost when adjusted for HIV status. CONCLUSIONS: Time from acquisition of infection to development of clinical disease does not reliably predict the radiographic appearance of tuberculosis. Human immunodeficiency virus status, a probable surrogate for the integrity of the host immune response, is the only independent predictor of radiographic appearance. The altered radiographic appearance of pulmonary tuberculosis in HIV is due to altered immunity rather than recent acquisition of infection and progression to active disease