Faculty Bibliography

The countries in Africa are Mozambique, Rwanda, South Africa and Tanzania, which have about one-third of all AIDS cases there. The Caribbean nations are the Bahamas, Dominican Republic, Haiti and the Organization of Eastern Caribbean States, which includes Antigua and Barbuda; Dominica, Grenada; Saint Kitts and Nevis; St. Lucia; Saint Vincent and the Grenadines; Montserrat, Anguilla and the British Virgin Islands. More than 90 percent of Caribbean AIDS patients live in those places

All countries should conduct inventories at their laboratories to determine where the SARS virus is being kept and what strains of the virus are being stored, [John MacKenzie] said Tuesday. Also, MacKenzie said, the WHO, an agency of the United Nations, and member countries needed to develop procedures to control which laboratories can hold and work with the virus, which apparently is confined to laboratories now. The committee came up with a list of high-priority research questions for researchers, but did not release the list. In the Singapore case, a 27-year-old doctoral student accidentally became infected with SARS while working on the West Nile virus. The student did not know he had been exposed to the SARS virus

If a major outbreak of SARS, or severe acute respiratory syndrome, occurred, then the system of sending specimens for independent confirmation would become less critical, said Dr. Malik Peiris of the Queen Mary Hospital in Hong Kong. W.H.O. credits Dr. Peiris with discovering the SARS coronavirus. During the epidemic, some individuals whose serums were rich with SARS antibodies had donated blood as an experimental treatment known as passive immunization for very ill SARS patients. Such donations are relatively easy to obtain because they are altruistic. But, Dr. Peiris said, ''when you talk about donating blood for diagnostic tests it seems a bit more remote.'' SARS is one of many viruses that can cause a lung condition known as atypical pneumonia, and many doctors would be likely to suspect SARS because of the epidemic earlier this year. But, Dr. [John MacKenzie] said, ''we don't want to test everyone who has atypical pneumonia unless there is a cluster of cases for which there is no other alternative diagnosis and for which antibiotics do not work.''

The W.H.O. invited 45 international experts in public health, SARS, virologists, social sciences, laboratory science and other disciplines to meet for the first time to identify the most important gaps in knowledge about SARS, or severe acute respiratory syndrome. The committee came up with a list of the highest priority research questions for researchers, but did not specify what the issues were. In the case this summer, a 27-year-old doctoral student accidentally became infected with SARS while working on the West Nile virus in a laboratory in Singapore. The student did not know he had been exposed to the SARS virus. Dr. Jong Wook Lee, the director general of the World Health Organization, assured the committee that the agency would devote more money for SARS, if needed. But, Dr. [Angus Nicoll] said, ''we are wary'' about the the agency's ability to deal with SARS and other epidemics of new and old diseases

Influenza affects up to 20% of the U.S. population in a given year, with 114,000 people hospitalized on average. While roughly 70 million Americans receive the flu vaccine every year, another 70 million should get it but don't. Health care workers, older people, those with respiratory or chronic illnesses, pregnant women and anyone who may come in close contact with the flu all should be vaccinated. In fact, it may not be long before the vaccine is recommended for everyone. WHO also has done a good job of not spreading panic by connecting the flu to the media megaphone the way SARS was. During the past century, three influenza pandemics -- diseases spreading over a large region -- caused millions of deaths worldwide, social disruption and profound economic losses. The scourge of 1918 wiped out 33,000 people just in New York City. Luckily, no one is hyping this history. This year has been a bad flu season in Australia and Chile, which might be a harbinger for a bad flu season here. In addition, since we have just experienced two mild flu seasons, some experts say that a severe one is due. But such speculation is about as sure as predicting the stock market. We are better off preparing, not predicting

Doctors have long linked one known as the antinuclear auto-antibody with a number of diseases, including lupus. But while many people who have the antinuclear auto-antibody later develop lupus, many more do not. There has been no reliable way to predict which people with the antinuclear antibody will develop lupus, in part because scientists have not conducted extensive studies to explore the development of such antibodies in the disease. Some auto-antibodies develop years before lupus, others just before the onset of the disease. The auto-antibodies that seemed to correlate with the onset of lupus are known as the anti-nuclear ribonucleoprotein and anti-Sm antibodies. Dr. [John B. Harley] said his team believed that Epstein-Barr virus infection was necessary to start the lupus process but required other factors because while the overwhelming majority of Americans are infected with that virus, only a small percentage get lupus

Disparities in breast cancer survival have been observed between African American and white women. There are also known differences in mean baseline white blood cell (WBC) count among racial and ethnic groups. If the WBC count falls below conventionally defined treatment thresholds for patients undergoing adjuvant chemotherapy, reduced doses or treatment delays may occur, which could lead to race-based differences in treatment duration. We used the tumor registry at Columbia-Presbyterian Medical Center to identify 1178 women with newly diagnosed stage I and II breast cancer from whom we collected base-line information for 73 African American women and 126 age- and tumor stage-matched white women. Of these women, 43 African American and 93 white women underwent adjuvant chemotherapy. African American women had statistically significantly lower WBC counts than white women at diagnosis (6.2 x 10(9)/L for African American women versus 7.4 x 10(9)/L for white women, difference = 1.2, 95% confidence interval [CI] = 0.2 to 1.2; P =.02) and after treatment (5.3 x 10(9)/L for African American women versus 6.4 x 10(9)/L for white women, difference = 1.1, 95% CI = 0.2 to 2.5; P =.03). Overall, African American women required a statistically significantly longer duration of treatment than white women (19 weeks versus 15 weeks, respectively, difference = 4 weeks, 95% CI = 0.5 to 7.2 weeks; P =.03). The lower baseline WBC counts and longer duration of treatment for early-stage breast cancer in African American women compared with those in white women result in lower dose intensity of treatment for African American women, possibly contributing to observed racial differences in breast cancer survival