Faculty Bibliography

The Food and Drug Administration has given a California company approval to conduct the world's first full-scale test of a vaccine to prevent infection by the virus that causes AIDS, the company announced on Wednesday. Florida will almost surely be chosen as one of the sites where the vaccine will be tested, VaxGen spokeswoman Nicole Lynch said. South Florida, with its diverse mix of AIDS patients, is a prime location, she said. The announcement brought expressions of cautious hope among health officials and advocates for people with AIDS. HIV, the virus that causes AIDS, has infected an estimated 30 million people in the world, and many experts say it will take a vaccine to stop the worsening epidemic

The Food and Drug Administration has given a California company approval to conduct the world's first full-scale test of a vaccine to prevent infection with the AIDS virus, the company announced Wednesday. The experiment is to involve 5,000 uninfected individuals in as many as 40 clinics in the United States and Canada and 2,500 volunteers in 16 clinics in Thailand during the next four years, VaxGen Inc. said. The South San Francisco company said it expects to receive approval from Thai health officials to begin testing in that country later this year. The VaxGen vaccine was safe in earlier tests involving 1,200 volunteers beginning in March 1992 and induced antibodies in more than 99 percent of the vaccinated participants, the company said. The question the new tests aim to answer is how effective the experimental vaccine will be among people who are exposed to HIV because of high-risk sexual practices or from injecting drugs

The Food and Drug Administration has given a California company approval to conduct the world's first full-scale test of a vaccine to prevent infection with the AIDS virus, the company announced Wednesday. The announcement brought expressions of cautious hope among health officials and advocates for people with AIDS. HIV, the AIDS virus, has infected an estimated 30 million people in the world, and many experts say it will take a vaccine to stop the worsening epidemic. But scientists are sharply divided over when and which experimental vaccines to approve for full-scale testing. No vaccine is 100 percent effective. Some experts favor testing any promising vaccine, even if it is likely to protect only a small proportion of recipients, arguing that something is better than nothing in a health emergency

The experiment is to involve 5,000 uninfected individuals in up to 40 clinics in the United States and Canada and 2,500 volunteers in 16 clinics in Thailand during the next four years, the company, VaxGen Inc. of South San Francisco, said. It said it expects to receive approval from Thai health officials to begin testing in that country later this year. The announcement brought expressions of cautious hope among health officials and advocates for people with AIDS. HIV, the AIDS virus, has infected an estimated 30 million people in the world, and many experts say it will take a vaccine to stop the worsening epidemic. But scientists are sharply divided over when and which experimental vaccines to approve for full-scale testing. No vaccine is 100 percent effective. Some experts favor testing any promising vaccine, even if it is likely to protect only a small proportion of recipients, arguing that something is better than nothing in a health emergency

OBJECTIVES: To update the WHO global and regional estimates of the prevalence and incidence of syphilis, gonorrhoea, chlamydia, and trichomoniasis. METHODS: Prevalence estimates for syphilis, gonorrhoea, chlamydia, and trichomoniasis were generated for each of the nine UN regions for males and females between the ages of 15 and 49 in 1995 based on an extensive review of the published and unpublished medical literature since 1985. Incidence estimates were based on the prevalence figures and adjusted to take into account the estimated average duration of infection for each disease in a particular region. The latter was assumed to depend upon a number of factors including the duration of infection in the absence of treatment, the proportion of individuals who develop symptoms, the proportion of individuals treated, and the appropriateness of treatment. RESULTS: In 1995 there were over 333 million cases of the four major curable STDs in adults between the ages of 15 and 49--12 million cases of syphilis, 62 million cases of gonorrhoea, 89 million cases of chlamydia, and 170 million cases of trichomoniasis. Geographically, the vast majority of these cases were in the developing world reflecting the global population distribution. CONCLUSIONS: STDs are among the most common causes of illness in the world. Estimates of the global prevalence and incidence of these infections are limited by quantity and quality of data available from the different regions of the world. Improving global STD estimates will require more well designed epidemiological studies on the prevalence and duration of infection.

Transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes has been shown to be useful in the diagnosis and staging of bronchogenic carcinoma. With the exception of sarcoidosis, the usefulness of TBNA has not been widely investigated in other clinical settings. We investigated the utility of TBNA with a 19-gauge histology needle in HIV-infected patients with mediastinal and hilar adenopathy at Bellevue Hospital Center. We performed 44 procedures in 41 patients. Adequate lymph node sampling was obtained in 35 of 44 (80%), and diagnostic material was obtained in 23 of 44 (52%) procedures. TBNA was the exclusive means of diagnosis in 13 of 41 (32%) patients. Of the 44 procedures, 23 (52%) were performed in patients with mycobacterial disease, with TBNA providing the diagnosis in 20 of 23 (87%). In these patients, positive TBNA specimens included smears of aspirated materials for acid-fast bacilli in 11, mycobacterial culture in 14, and histology in 15. In other diseases, TBNA diagnosed sarcoidosis with noncaseating granulomata in 2 of 4 patients and non-small cell lung cancer in 1 of 2 patients. TBNA was not helpful in other diseases including Pneumocystis carinii pneumonia, infection with Cryptococcus or Nocardia, bacterial pneumonia, viral pneumonia, and Kaposi's sarcoma. No pulmonary diagnosis was established in five patients. No complications of TBNA occurred. We conclude that TBNA through the flexible bronchoscope is safe and effective in the diagnosis of intrathoracic adenopathy in HIV-infected patients, and is particularly efficacious in the diagnosis of mycobacterial disease. Furthermore, TBNA may provide the only diagnostic specimen in almost one-third of HIV-infected patients, thereby sparing these patients more invasive procedures such as mediastinoscopy

Mouse erythroleukemia (MEL) cell erythroid differentiation induced by dimethyl sulfoxide or hexamethylene bisacetamide (HMBA) is accompanied by the production of hemoglobin, terminal cell division and decreases in lactate production and fructose 2,6-bisphosphate levels. A number of studies have suggested that decreases in the cellular level of protein phosphotyrosine content may play a role in MEL cell differentiation. In particular, it was shown that the expression of several protein tyrosine phosphatase genes accompany this process and that the transfection of one of these genes into MEL cells followed by its subsequent expression induced eythroid differentiation. However, none of the physiological substrates for these protein tyrosine phosphatases have been identified. It is shown here that MEL cell differentiation is accompanied by decreases in tyrosine phosphorylation of Vav and possibly of the erythropoietin receptor (EpoR). Immunoprecipitation of the EpoR and analysis of co-precipitated proteins, indicates that the EpoR associates with Vav, STAT5 and an unidentified 60 Kd protein, . HMBA-induced erythroid differentiation abrogates these associations. The phosphatase inhibitors, Na3VO4 and levamisole, inhibit HMBA-induced differentiation as well as the association of the EpoR with Vav, STAT5 and the 60 Kd protein. This is of interest since Na3VO4, at the concentrations used here, has been shown to be a potent inhibitor of the activity of protein tyrosine phosphatases. These results suggest that levamisole, at least indirectly, acts by a molecular mechanism similar to that of Na3VO4 and that the loss of the association of the EpoR with Vav, STAT5, and and/or the reduction in the level of tyrosine phosphorylation of these proteins may play a role in MEL cell differentiation

Background: Several molecular methods potentially useful in the detection of Mycobacterium tuberculosis mutations, specifically in rpoB and katG, were compared. Methods and Results: DNA from 24 M. tuberculosis clinical isolates, with mutations associated with resistance to rifampin and/or isoniazid, was analyzed. A 128 bp amplicon, spanning the 81 bp rpoB region containing most mutations leading to rifampin resistance, was analyzed by polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and a recently introduced mutation scanning method, cleavase fragment length polymorphism (CFLP) analysis. Also, a 350 bp amplicon encompassing that region was analyzed by the CFLP method. CFLP analysis of the 350 bp amplicon (23 isolates) identified 14 of 17 mutants; however, CFLP analysis of the 128 bp amplicon accurately identified all mutants as did PCR-SSCP with interpretative difficulty for two codon 513 mutations. CFLP and PCR-restriction fragment length polymorphism (RFLP) analyses of a 623 bp amplicon encompassing katG codons 315 and 463 showed that the CFLP method identified single and dinucleotide codon 315 substitutions with or without codon 463 (CGG-->CTG) changes, whereas PCR-RFLP (MspI) missed one codon 315 polymorphism (AGC-->ACA) in three isolates. Conclusion: Both PCR-SSCP and CFLP analyses were sensitive in identifying all mutations on short sequences in the rpoB mutants. CFLP appears to be more efficient than SSCP and RFLP for the detection of mutations in large amplicons

Lamm and Couzens discuss impotence and some of the new medication that can help with the problem. More and more, impotence is occurring in younger men due to stress

PURPOSE: Although medical students are expected to adopt and practice the ideals stated in the Hippocratic Oath, little is known about whether these values are actually taught during clinical training. The purpose of this study was to examine the "recommended curriculum" of medical values and compare it with values that are actually taught. SUBJECTS AND METHODS: The recommended curriculum was identified through content analysis of curriculum documents and interviews with individuals responsible for teaching. The taught curriculum of values was identified through naturalistic observations and audio taping of inpatient internal medicine teams at an academic medical center. RESULTS: The values most consistently recommended in the medical curriculum are honesty, accountability, compassion, the importance of public health, and self-policing. While accountability and caring were found frequently in the taught curriculum, self-policing and the importance of public health were emphasized less. Interprofessional respect and the importance of service were present in the recommended curriculum, but were taught as interprofessional disrespect and as the burden of service. The importance of industry (working hard) was not found in the recommended curriculum, but frequently identified in the taught curriculum. CONCLUSION: This study indicates that one reason medical students are not learning the intended norms of the profession may be that the teachers are not consistently teaching the recommended values of the profession. Future research should concentrate on confirming these findings in other settings and on understanding why these values are not consistently taught.