Faculty Bibliography

Dr. Peter Piot, who directs the United Nations AIDS program, said: ''The epidemic has yet to display a natural saturation point. In Swaziland, the country most affected by AIDS in the world, adult prevalence continues to climb; 42.6 percent of pregnant women there tested positive for H.I.V. in 2004. ''In East Africa, for example, in every big city'' there had been declines in the rates for young people, ''and particularly among women and girls,'' Dr. Piot said in an interview. He cited Addis Ababa, Kigali, Lusaka and Nairobi -- the capitals of Ethiopia, Rwanda, Zambia and Kenya -- largely because they are the places with the most extensive AIDS education and prevention programs, particularly for young people. For the first time, truly comprehensive responses to AIDS, including prevention and treatment, are emerging, Dr. Piot said. ''Iran has one of the best AIDS programs,'' he added, citing in particular its needle-exchange efforts

Surgeons can generally learn the on-pump operation faster than the off-pump technique because it is technically less demanding. Also, the report said, surgeons can generally perform more grafts, if necessary, in an on-pump bypass, and the grafts may stay open longer. A controversy has developed over some evidence that a small but significant number of on-pump bypass patients suffer a degree of cognitive impairment like memory and attention deficits and language problems. Such problems tended to occur less among patients whose bypasses were performed with the beating-heart technique compared with the stopped-heart technique, the team said. The extent of the decrease was not detailed. The most conclusive benefit of off-pump over on-pump operations was for patients who had deposits of calcium in their aortas, the body's main artery. When surgeons clamp the aorta in the on-pump technique, small pieces can break off to cause disabling and fatal strokes

The scientists analyzed the genetic makeup of patients taking warfarin in clinics at the University of Washington in Seattle and Washington University in St. Louis and found that they fell into three dosing groups -- low, intermediate and high. The genetic variations identified in the study correlated with the grouping, suggesting the findings hold promise for simplifying warfarin therapy, the scientists reported in The New England Journal of Medicine. The scientists identified genetic variations, matched them to the doses warfarin patients were taking, and found that patients with a particular variation of the gene usually took similar doses of warfarin. The VKORC1 gene accounted for 25 percent of the overall variation in warfarin doses in the studies -- what Dr. [Mark J. Rieder] said he believes is the largest genetic variation affecting warfarin

A novel series of selective ligands for the human glucocorticoid receptor is described. Structure-activity studies focused on variation of B-ring size, ketal ring size, and ketal substitution. These analogs were found to be potent and selective ligands for GR and have partial agonist profiles in functional assays for transactivation (TAT, GS) and transrepression (IL-6). Of these compounds, 27, 28, and 35 were evaluated further in a mouse LPS-induced TNF-alpha secretion model. Compound 28 had an ED(50) of 14.1 mg/kg compared with 0.5 mg/kg for prednisolone in the same assay.

SETTING/METHODS:Large urban tuberculosis control program. OBJECTIVES/OBJECTIVE:To determine the frequency and characteristics of treatment interruptions, and the factors associated with the different types of treatment interruptions. DESIGN/METHODS:This was a case-control study using culture-positive tuberculosis (TB) patients verified in 1998-1999. Case patients included those in whom any of the following mutually exclusive categories of treatment interruption: default with return to therapy, directly observed therapy nonadherence, default without return to therapy, or multiple types of interruptions. Controls were selected randomly from the cohort. RESULTS:Overall, 6.0 percent of patients had treatment interruptions. All types of treatment interruption were associated with prolonged treatment course and decreased treatment completion rates. The median number of months to treatment interruption was 4.0 (range, 0.5-28.9 months). Two factors were significantly associated with every type of interruption: homelessness and lack of awareness of the severity of TB disease. In multivariate analysis, only lack of awareness of the severity of disease remained independently associated with all interruption types. CONCLUSION/CONCLUSIONS:Efforts to improve patients' understanding of TB disease and related treatment issues may be an important TB control program strategy and should be emphasized at the initiation of therapy and at intervals throughout the treatment course to minimize treatment interruption.

SETTING: Since 1992, tuberculosis (TB) control measures have reduced incidence rates in New York City and elsewhere. Nevertheless, trends have not been uniform in all demographic groups. OBJECTIVE: To characterize the epidemiology of human immunodeficiency virus (HIV) associated TB in New York during the 1990s, we analyzed social, demographic and clinical characteristics and genetic data on Mycobacterium tuberculosis isolates among persons with known HIV-status. DESIGN: A retrospective case-control study to compare patients with HIV-associated TB and patients with TB alone. RESULTS: Of 546 patients (70.5%) in the Department of Health Tuberculosis Control Registry treated for TB, 385 also had documented HIV status; 198 were HIV-infected (51%) and 187 (49%) were not. Genotype analysis of the 385 M. tuberculosis isolates identified 200 (52%) clustered strains, representing recent transmission. Although the overall percentage of TB cases associated with restriction fragment length polymorphism (RFLP) clustering fell over the period studied, HIV-associated cases were still much more likely to be associated with clustering than non-HIV-associated cases. CONCLUSIONS: Continued attention is required to contain the spread of TB in this vulnerable population

OBJECTIVE: Study objectives were to assess the accuracy of a food record delivered on a personal digital assistant (PDA) and to examine sources of error from the PDA-based food record. METHODS: Thirty-nine adults recruited with a newspaper advertisement were trained to record food intake using DietMatePro, a dietary assessment program delivered on a PDA. After 3 d of use, subjects returned for a follow-up visit in which a 24-h recall was conducted. Subjects also were timed while recording an observed, weighed lunch. Recalled and actual food intakes were compared with estimates recorded by the subjects when using the PDA. Paired sample t tests and Pearson's correlations assessed means and measurements of association between DietMatePro data compared with the 24-h recall data and observed meal data. Bland-Altman plots were used to assess bias in food recording. Sources of error were quantified by using calories as the unit for comparison. RESULTS: There were no significant differences in daily totals for calories and macronutrients between DietMatePro data and comparison measurements. Pearson's correlations of associations between DietMatePro data and the comparison measurement ranged from 0.505 to 0.797 (P < 0.005, n = 28) for the 24-h recall and from 0.419 to 0.786 (P < 0.005, n = 33) for the observed lunch, depending on the nutrient measured. The largest source of absolute error in caloric estimation was attributable to portion size estimation error (49%). CONCLUSIONS: DietMatePro, a PDA-based dietary assessment program, provides a method of assessing energy and macronutrient intakes comparable to the 24-h recall in samples lacking dietary restrictions.