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Mehta J, MacLaughlin KL, Millstine DM, Faubion SS, Wallace MR, Shah AA, Fields HE, Ruddy BE, Bryan MJ, Patel BK, Buras MR, Golafshar MA, Kling JM. A Comparison of Perceived Lifetime Breast Cancer Risk to Calculated Lifetime Risk Using the Gail Risk Assessment Tool. J Womens Health (Larchmt) 2022; 31:356-361. [PMID: 35041492 DOI: 10.1089/jwh.2019.8231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding the accuracy of a woman's perceived breast cancer risk can enhance shared decision-making about breast cancer screening through provider and patient discussion. We aim to report and compare women's perceived lifetime breast cancer risk to calculated lifetime breast cancer risk. Methods: Women presenting to Mayo Clinic in Arizona and Minnesota in July 2016 completed a survey assessing their perceived breast cancer risk. Lifetime Gail risk scores were calculated from questions pertaining to health history and were then compared with perceived breast cancer risk. Results: A total of 550 predominantly white, married, and well-educated (≥college) women completed surveys. Using lifetime Gail risk scores, 5.6% were classified as high risk (>20% lifetime risk), 7.7% were classified as intermediate risk (15%-20%), and 86.6% were classified as average risk (<15%). Of the 27 women who were classified as high risk, 18 (66.7%) underestimated their risk and of the 37 women who were intermediate risk, 12 (32.4%) underestimated risk. Women more likely to underestimate their risk had a reported history of an abnormal mammogram and at least one or more relative with a history of breast cancer. Surveyed women tended to overestimate risk 4.3 (130/30) times as often as they underestimated risk. Conclusion: In a group of predominantly white, educated, and married cohort of women, there was a large portion of women in the elevated risk groups who underestimated risk. Specific aspects of medical history were associated with underestimation including a history of abnormal mammogram and family history of breast cancer. Overall, in our sample, more women overestimated than underestimated risk.
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Affiliation(s)
- Jaya Mehta
- Department of General Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Denise M Millstine
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Stephanie S Faubion
- Mayo Clinic, Jacksonville, Florida, USA.,Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark R Wallace
- Department of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Amit A Shah
- Department of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Heather E Fields
- Department of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Barbara E Ruddy
- Department of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Michael J Bryan
- Department of Family Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bhavika K Patel
- Department of Radiology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Matthew R Buras
- Division of Biostatistics and Bioinformatics, Department of Health Sciences Research, Scottsdale, Arizona, USA
| | - Michael A Golafshar
- Division of Biostatistics and Bioinformatics, Department of Health Sciences Research, Scottsdale, Arizona, USA
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA.,Mayo Clinic, Jacksonville, Florida, USA
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Shah AA, Wallace MR, Fields H. Shared Decision-Making for Administering PCV13 in Older Adults. Am Fam Physician 2020; 101:134-135. [PMID: 32003958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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3
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Wallace MR, Garavaglia JC. Response to: A Retrospective Forensic Review of Unexpected Infectious Deaths. Open Forum Infect Dis 2019; 6:ofz300. [PMID: 31341932 PMCID: PMC6641788 DOI: 10.1093/ofid/ofz300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/25/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mark R Wallace
- Infectious Disease Department, Skagit Valley Hospital, Mt Vernon, Washington
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Harris TH, Wallace MR, Huang H, Li H, Shaddox LM. Associations of P2RX7 Functional Diplotypes with Localized Aggressive Periodontitis. JDR Clin Trans Res 2019; 4:342-351. [PMID: 31319038 DOI: 10.1177/2380084419863789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM The purpose of this study was to test for the role of the P2X7 receptor in localized aggressive periodontitis (LAP). METHODS Peripheral blood was obtained from 95 subjects with LAP and 76 healthy unrelated controls (HUCs). Three P2RX7 single-nucleotide polymorphisms (rs1718119, rs2230911, and rs3751143) were genotyped from these subjects, and their peripheral blood samples were stimulated with lipopolysaccharide (LPS) from Escherichia coli and tested for inflammatory markers. The 3 P2RX7 single-nucleotide polymorphisms were in found to be in perfect linkage disequilibrium, and a total of 4 haplotypes and 9 diplotypes were identified among all subjects. For both subject populations, the 9 diplotypes were grouped into 4 functional groups and tested for association with subject inflammatory response. To specifically study the effects of extrinsic activation of the P2X7 receptor in LAP, peripheral blood samples from were stimulated under 3 treatments: LPS, LPS + ATP, and LPS +ATP+ P2X7 selective inhibitor. The effects of these treatments on P2X7 receptor activity were measured through Luminex protein assay. Last, to test whether receptor stimulation was related to P2RX7 expression, relative mRNA levels of P2RX7 were quantified with real-time quantitative polymerase chain reaction. RESULTS Several associations between the P2RX7 diplotypes and LPS-stimulated blood chemokine/cytokine levels were found between the LAP and HUC populations (P < 0.05). P2X7 activation resulted in statistically significant differences in IL-1β and IL-12p40 concentrations for both subject populations. The relative P2RX7 mRNA levels increased significantly after addition of its inhibitor for both LAP and HUC populations. CONCLUSIONS This study detected an association between P2RX7 functional diplotypes and in vitro immune response of whole blood from subjects with LAP. In addition, we found that inhibition of the activated P2X7 receptor leads to increased P2RX7 mRNA levels, suggesting a feedback loop ( ClinicalTrials.gov NCT01330719). KNOWLEDGE TRANSFER STATEMENT The results of this study suggest that P2RX7 functional diplotypes are associated with LAP and their in vitro immune response to bacteria. Ongoing studies to uncover the mechanistic link between P2RX7 and LAP phenotypes could lead to the development of preventive approaches for susceptible subjects.
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Affiliation(s)
- T H Harris
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA.,Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - M R Wallace
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL, USA.,University of Florida Genetics Institute, Gainesville, FL, USA
| | - H Huang
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - H Li
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - L M Shaddox
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA.,Current affiliation: Division of Periodontology, Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY, USA
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Mehta JM, MacLaughlin KL, Millstine DM, Faubion SS, Wallace MR, Shah AA, Fields HE, Ruddy BE, Bryan MJ, Patel B, Temkit MH, Buras MR, Golafshar MA, Kling JM. Breast Cancer Screening: Women's Attitudes and Beliefs in Light of Updated United States Preventive Services Task Force and American Cancer Society Guidelines. J Womens Health (Larchmt) 2019; 28:302-313. [DOI: 10.1089/jwh.2017.6885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jaya M. Mehta
- Department of Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Denise M. Millstine
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Stephanie S. Faubion
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic Rochester, Rochester, Minnesota
| | - Mark R. Wallace
- Division of Community Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Amit A. Shah
- Division of Community Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Heather E. Fields
- Division of Community Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Barbara E. Ruddy
- Division of Community Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Michael J. Bryan
- Department of Family Medicine and Mayo Clinic Arizona, Scottsdale, Arizona
| | - Bhavika Patel
- Department of Diagnostic Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - M' hamed Temkit
- Division of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Matthew R. Buras
- Division of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Juliana M. Kling
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
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Gonçalves PF, Harris TH, Elmariah T, Aukhil I, Wallace MR, Shaddox LM. Genetic polymorphisms and periodontal disease in populations of African descent: A review. J Periodontal Res 2017; 53:164-173. [PMID: 29105764 DOI: 10.1111/jre.12505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 01/22/2023]
Abstract
Aggressive periodontitis is a rare but rapidly progressing form of periodontal disease that usually affects otherwise systemically healthy individuals, at a young age. It usually affects first molars and incisors, which are usually lost if treatment is not properly and early rendered. Although of low prevalence, it affects individuals of African descent at a higher prevalence, and usually multiple members within the same family. Several studies have been performed in the attempt to evaluate specific single nucleotide polymorphisms (SNPs) that could be associated with this disease. To the best of our knowledge, the present article provides the first review of the literature focusing on studies that evaluated SNPs in patients of African descent with aggressive periodontitis. Several SNPs have been evaluated in different genes according to their role in the pathogenesis of the disease, with positive and negative associations (such as IL1, FCGR3B, FPR1, LTF, CYBA, GLT6D1, TLR4) with both the localized and generalized forms of aggressive periodontitis. Given the complexity of periodontitis, the difficulty in gathering large cohorts diagnosed with this rare form of disease, and the fact that candidate gene studies may only determine part of the genetic risk of a disease, the search for specific SNPs associated with aggressive periodontitis seems to be a long one, most likely to result in the combination of multiple SNPs, in multiple genes.
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Affiliation(s)
- P F Gonçalves
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA.,Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, MG, Brazil
| | - T H Harris
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - T Elmariah
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - I Aukhil
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - M R Wallace
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL, USA.,University of Florida Genetics Institute, University of Florida, Gainesville, FL, USA
| | - L M Shaddox
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
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Matthews MR, Stroebel RJ, Wallace MR, Bryan MJ, Swanson JA, Allen SV, Bunkers KS. Implementation of a Comprehensive Population Health Management Model. Popul Health Manag 2017; 20:337-339. [DOI: 10.1089/pop.2016.0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marc R. Matthews
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert J. Stroebel
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark R. Wallace
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | | | - Jill A. Swanson
- Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Summer V. Allen
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kari S. Bunkers
- Family Medicine, Mayo Clinic Health System in Owatonna, Owatonna, Minnesota
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Affiliation(s)
- Tara Nair
- Skagit Valley Hospital, Mt Vernon, WA, USA
| | | | - Bob Ly
- Skagit Valley Hospital, Mt Vernon, WA, USA
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9
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Wassef M, Luscan A, Battistella A, Le Corre S, Li H, Wallace MR, Vidaud M, Margueron R. Versatile and precise gene-targeting strategies for functional studies in mammalian cell lines. Methods 2017; 121-122:45-54. [PMID: 28499832 DOI: 10.1016/j.ymeth.2017.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 11/28/2022] Open
Abstract
The advent of programmable nucleases such as ZFNs, TALENs and CRISPR/Cas9 has brought the power of genetic manipulation to widely used model systems. In mammalian cells, nuclease-mediated DNA double strand break is mainly repaired through the error-prone non-homologous end-joining (NHEJ) repair pathway, eventually leading to accumulation of small deletions or insertions (indels) that can inactivate gene function. However, due to the variable size of the indels and the polyploid status of many cell lines (e.g., cancer-derived cells), obtaining a knockout usually requires lengthy screening and characterization procedures. Given the more precise type of modifications that can be introduced upon homology-directed repair (HDR), we have developed HDR-based gene-targeting strategies that greatly facilitate the process of knockout generation in cell lines. To generate reversible knockouts (R-KO), a selectable promoter-less STOP cassette is inserted in an intron, interrupting transcription. Loss-of-function can be validated by RT-qPCR and is removable, enabling subsequent restoration of gene function. A variant of the R-KO procedure can be used to introduce point mutations. To generate constitutive knockouts (C-KO), an exon is targeted, which makes use of HDR-based gene disruption together with NHEJ-induced indels on non-HDR targeted allele(s). Hence the C-KO procedure greatly facilitates simultaneous inactivation of multiple alleles. Overall these genome-editing tools offer superior precision and efficiency for functional genetic approaches. We provide detailed protocols guiding in the design of targeting vectors and in the analysis and validation of gene targeting experiments.
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Affiliation(s)
- M Wassef
- Institut Curie, PSL Research University, 75005 Paris, France; INSERM U934, Paris, France; CNRS UMR3215, Paris, France.
| | - A Luscan
- INSERM UMR_S745 et EA7331, Université Paris Descartes, Sorbonne Paris Cité, Facultée des Sciences Pharmaceutiques et Biologiques, 75006 Paris, France; Service de Biochimie et Génétique Moléculaire, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - A Battistella
- Institut Curie, PSL Research University, 75005 Paris, France; INSERM U934, Paris, France; CNRS UMR3215, Paris, France
| | - S Le Corre
- Institut Curie, PSL Research University, 75005 Paris, France; INSERM U934, Paris, France; CNRS UMR3215, Paris, France
| | - H Li
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - M R Wallace
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, FL, USA; University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA; University of Florida Genetics Institute, University of Florida, Gainesville, FL, USA
| | - M Vidaud
- INSERM UMR_S745 et EA7331, Université Paris Descartes, Sorbonne Paris Cité, Facultée des Sciences Pharmaceutiques et Biologiques, 75006 Paris, France; Service de Biochimie et Génétique Moléculaire, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - R Margueron
- Institut Curie, PSL Research University, 75005 Paris, France; INSERM U934, Paris, France; CNRS UMR3215, Paris, France
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Kling JM, Vegunta S, Al-Badri M, Faubion SS, Fields HE, Shah AA, Wallace MR, Ruddy BE, Bryan MJ, Temkit M, MacLaughlin KL. Routine pelvic examinations: A descriptive cross-sectional survey of women's attitudes and beliefs after new guidelines. Prev Med 2017; 94:60-64. [PMID: 27856341 DOI: 10.1016/j.ypmed.2016.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/11/2016] [Accepted: 11/12/2016] [Indexed: 11/16/2022]
Abstract
Routine pelvic examinations have been a fundamental part of the annual female examination. The 2014 American College of Physicians (ACP) guideline recommends against routine pelvic examinations in asymptomatic, nonpregnant, average-risk women. Our aim was to evaluate women's attitudes and beliefs about pelvic examinations and how knowledge of the new guidelines contributes to attitudes and beliefs. A descriptive cross-sectional study was performed using a self-administered written survey developed through literature review and pretested and revised on the basis of staff suggestions. Nonpregnant women age≥21years presenting to outpatient clinics at Mayo Clinic in Arizona or Mayo Clinic in Rochester, Minnesota, received the survey. After being asked about pelvic examination practices and beliefs, participants were informed of the ACP guideline, to determine effect on attitudes and beliefs. Demographic characteristics and pertinent medical history questions were collected from participants. In total, 671 women who were predominantly white, married, and educated completed surveys. Participants described pelvic examinations as reassuring, and a majority believed the examinations were useful in detecting ovarian cancer (74.6%), necessary for screening for sexually transmitted infections (STIs) (71.0%), or necessary before initiating contraception (67.0%). After reading the 2014 ACP guideline, significantly fewer women planned to continue yearly pelvic examinations (P<0.001). Despite evidence to the contrary, women believed pelvic examinations were necessary for STI screening, contraception initiation, and ovarian cancer detection. After education on the ACP screening guideline, fewer women planned to continue yearly pelvic examinations.
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Affiliation(s)
- Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States.
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Mina Al-Badri
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Heather E Fields
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Amit A Shah
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Mark R Wallace
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Barbara E Ruddy
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Michael J Bryan
- Department of Family Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - M'hamed Temkit
- Department of Biostatistics, Mayo Clinic, Scottsdale, AZ, United States
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12
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Jacobson S, Junco Noa L, Wallace MR, Bowman MC. Clinical outcomes using minocycline for Stenotrophomonas maltophilia infections. J Antimicrob Chemother 2016; 71:3620. [PMID: 27516472 DOI: 10.1093/jac/dkw327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shauna Jacobson
- Department of Pharmacy, Orlando Regional Medical Center/Orlando Health, 52 W. Underwood St., Orlando, FL 32806, USA
| | - Luis Junco Noa
- Division of Infectious Diseases, Orlando Regional Medical Center/Orlando Health, 52 W. Underwood St., Orlando, FL 32806, USA
| | - Mark R Wallace
- Division of Infectious Diseases, Orlando Regional Medical Center/Orlando Health, 52 W. Underwood St., Orlando, FL 32806, USA
| | - Mary Catherine Bowman
- Division of Infectious Diseases, Orlando Regional Medical Center/Orlando Health, 52 W. Underwood St., Orlando, FL 32806, USA
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Mehta P, Gulevich SJ, Thal LJ, Jin H, Olichney JM, McCutchan JA, Heaton RK, Kirson D, Kaplanski G, Nelson J, Atkinson JH, Wallace MR, Grant I, Group H. Neurological Symptoms, Not Signs,<br />Are Common in Early HIV Infection. ACTA ACUST UNITED AC 2016; 1:67-85. [PMID: 16873165 DOI: 10.1300/j128v01n02_05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Objective. To examine the cross-sectional prevalence of neurological symptoms and signs in a large cohort of human immunodeficiency virus (HIV)-seropositive men, and determine the relationship of the symptoms to disease stage, immunologic markers, and independent variables from neuropsychological (NP) testing and psychiatric interview. METHODS One hundred-nine controls and 386 HIV-infected volunteers enrolled in the HIV Neurobehavioral Research Center (HNRC) longitudinal study. The majority, without acquired immune deficiency syndrome (AIDS), were screened for alcohol/substance abuse; previous diagnosis of HIV-associated dementia; and HIV-unrelated developmental, neurological, medical, and neurobehavioral conditions which potentially impair cognition; and underwent a structured neurological interview and examination, standardized NP testing, and psychiatric interview as part of a more extensive battery. A large subset (N = 377) underwent lumbar puncture for cerebrospinal fluid (CFS) examination. We examined the relationship of sixteen select but independent variables, using stepwise multiple regressions, from demographic/staging, immunological, NP, and psychiatric domains to neurological symptoms in an effort to identify possible predictors of subclinical nervous systems involvement. Results. All categories of neurological symptoms were significantly more prevalent among medically asymptomatic (CDC stage A) subjects than controls, with a further rise in prevalence in those with more advanced stages of infection. The most marked rise was seen in cognitive and sensorimotor complaints. In contrast, significant findings on neurological examination were evident in only the sicker (stage C) subjects. Stage of illness, serum β2-microglobulin, psychiatric indices of depressed mood or anxiety, and NP "motor" performance were the most significant independent variables associated with the presence of neurological symptoms. CSF pleocytosis was seen early (CDC stage A), and may reflect the presence of HIV in the central nervous system (CNS) at the least stages of infection. We also confirmed the value of CSF β2m and neopterin as important markers of advancing disease stage. Whether they predict subclinical CNS involvement is to be determined by longitudinal observations. Conclusion. Neurological complains are common in medically asymptomatic HIV subjects whereas signs are not. The symptoms correlate with commonly determined independent measures of depression, anxiety, NP tests of fine motor speed and strength, as well as indices of disease worsening (CDC stage, serum β2m).
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Affiliation(s)
- P Mehta
- , Neurology Service (127), 3350 La Jolla Village Drive, San Diego, CA, 92161
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Fields H, Ruddy B, Wallace MR, Shah A, Millstine D, Marks L. How to Monitor and Advise Vegans to Ensure Adequate Nutrient Intake. J Osteopath Med 2016; 116:96-9. [DOI: 10.7556/jaoa.2016.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Infectious deaths accounted for 228 (3.4%) of all autopsied cases in a US Medical Examiner's office. Most infectious deaths were rapid (ill <1 week) and pulmonary sources predominated. Drug users and the homeless were at high risk. Many patients failed to recognize how ill they were and missed opportunities for care.
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Affiliation(s)
- Lynda Yu
- From the *University of Central Florida; †District Nine Medical Examiner's Office; and ‡Infectious Disease Department, Orlando Health, Orlando, FL
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Shah AA, Fields H, Wallace MR. Navigating the Changes in Pneumococcal Immunizations for Adults. Am Fam Physician 2015; 92:456-458. [PMID: 26371730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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17
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Wright SN, Gerry JS, Busowski MT, Klochko AY, McNulty SG, Brown SA, Sieger BE, Michaels PK, Wallace MR. Gordonia bronchialis Sternal Wound Infection in 3 Patients following Open Heart Surgery: Intraoperative Transmission from a Healthcare Worker. Infect Control Hosp Epidemiol 2015; 33:1238-41. [DOI: 10.1086/668441] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We describe an investigation of 3 postoperative Gordonia bronchialis sternal infections. A nurse anesthetist was identified as the source of the outbreak, her scrubs likely becoming contaminated by her home washing machine. The outbreak ended after disposal of the implicated washing machine. Domestic laundering of surgical scrubs may need reevaluation.
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Salazar D, Fries B, Wallace MR. 134Implement of a Mandatory Infectious Disease Consultation for Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2014. [PMCID: PMC5782310 DOI: 10.1093/ofid/ofu051.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Vaccines are critical components for protecting HIV-infected adults from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected persons persist, likely due to concerns regarding the safety and efficacy of vaccines, as well as the changing nature of vaccine guidelines. In addition, the optimal timing of vaccination among HIV-infected adults in regards to HIV stage and receipt of antiretroviral therapy remain important questions. This article provides a review of the current recommendations regarding vaccines among HIV-infected adults and a comprehensive summary of the evidence-based literature of the benefits and risks of vaccines among this vulnerable population.
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Affiliation(s)
- Nancy F. Crum-Cianflone
- Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, California
- Department of Infectious Disease, Scripps Mercy Hospital, San Diego, California
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Szczypinska E, Velazquez A, Salazar D, Deryke CA, Raczynski B, Wallace MR. The impact of initial antibiotic therapy (linezolid, vancomycin, daptomycin) on hospital length of stay for complicated skin and soft tissue infections. Springerplus 2014; 2:696. [PMID: 24422184 PMCID: PMC3884083 DOI: 10.1186/2193-1801-2-696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/18/2013] [Indexed: 11/17/2022]
Abstract
Background Empiric therapy of inpatient skin and soft tissue infections (SSTIs) generally require methicillin resistant Staphylococcus aureus (MRSA) coverage. Limited data are available to directly compare the effect of initial antibiotic choice on treatment outcomes and length of stay (LOS). Objective To assess potential differences in length of hospital stay when inpatients with complex skin and soft tissue infections (SSTIs) were initially treated with either vancomycin, linezolid, or daptomycin. Methods A retrospective review of 219 patients diagnosed with inpatient SSTI who received linezolid, vancomycin, or daptomycin for >48 hours was performed. Data collected included demographics, comorbidities, microbiologic/laboratory data, additional management (surgical, non-study antibiotics), hospital LOS, treatment outcome and morbidity/mortality. Results The three groups evaluated were linezolid (n = 45), vancomycin (n = 90) daptomycin (n = 84). There was no difference between the three groups with respect to gender, age, comorbidities, leukocytosis, fever, antibiotics prior to admission, site of infection culture results and surgical intervention. One death was recorded, not associated with diagnosis of SSTI. No significant difference in LOS was found (P = 0.525) between the 3 groups. The mean LOS in entire cohort was 4.5 days (SD ± 2.5); thirty patients had prolonged LOS for non-SSTI reasons; reanalyzing the data without these 30 patients did not produce any difference in the mean LOS between the 3 groups. Switching vancomycin just prior to discharge to facilitate outpatient therapy was common but did not impact LOS. Conclusions No difference was detected in hospital length of stay with respect to the initial choice of antibiotic (linezolid, vancomycin, or daptomycin) for SSTI. The three antibiotic regimens were equally effective in treating SSTIs as judged by LOS, irrespective of age, gender, comorbidities or baseline severity of SSTI. Given the large standard deviation in LOS, this result should be confirmed by larger studies.
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Affiliation(s)
- Ewa Szczypinska
- Department of Infectious Disease, Orlando Health, Orlando, FL USA
| | | | - Diana Salazar
- Department of Infectious Disease, Orlando Health, Orlando, FL USA
| | - C Andrew Deryke
- Department of Infectious Disease, Orlando Health, Orlando, FL USA
| | - Beata Raczynski
- Department of Infectious Disease, Orlando Health, Orlando, FL USA
| | - Mark R Wallace
- Department of Infectious Disease, Orlando Health, Orlando, FL USA ; 21 W Columbia St., Suite 102, Orlando, FL 32806 USA
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Velazquez A, DeRyke CA, Goering R, Hoover V, Wallace MR. Daptomycin non-susceptible Staphylococcus aureus at a US medical centre. Clin Microbiol Infect 2013; 19:1169-72. [PMID: 23480569 DOI: 10.1111/1469-0691.12171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 01/17/2013] [Accepted: 01/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A Velazquez
- Infectious Disease, Orlando Health, Orlando, FL, USA
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Fries BL, Licitra C, Crespo A, Akhter K, Busowski MT, Salazar D, Wallace MR. Infectious diseases consultation and the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 58:598-9. [PMID: 24200749 DOI: 10.1093/cid/cit730] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVES To describe the treatment and outcomes of patients with carbapenemase-producing Enterobacteriaceae and evaluate whether these cases represented active infection requiring antibiotic therapy or colonization. METHODS Adult inpatients with carbapenemase-producing Enterobacteriaceae were retrospectively evaluated. Cases were classified as colonization versus infection by 2 infectious diseases physicians. Multiple cultures that grew in the same patient within a 2-week period were evaluated as a single case. RESULTS A total of 42 cases among 35 patients were identified. The mean age of the cohort was 67.7 ± 13.7 y, mean APACHE II score was 17.9 ± 8.6, and 77% of patients were in the intensive care unit when the carbapenem-producing Enterobacteriaceae was isolated. Klebsiella pneumoniae (84%) was the predominant organism; urine (36%), tissue/wound/drainage (25%), and blood (20%) were the most common sites of collection. Though 43% of cases were classified as colonization, 56% of these cases were treated with antibiotics. Only 1 patient characterized as colonized subsequently developed infection, 29 days later. Among infected cases, colistin (55%), meropenem (41%), aminoglycosides (32%), and tigecycline (27%) were used for treatment, and combination antimicrobial therapy was common (55%). Clinical and microbiological success was higher in patients receiving combination therapy (83% vs 60%, p = 0.35). Colistin monotherapy was only successful in urinary infections. All-cause hospital mortality was 29%. CONCLUSIONS Nearly half of cases represented colonization, yet the majority were treated with broad-spectrum antibiotics. Determining infection versus colonization is a critical first step in managing patients with carbapenemase-producing Enterobacteriaceae. The risk of not treating apparent colonization appears low.
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Affiliation(s)
- Deba S Rihani
- Department of Pharmacy, Orlando Health, Orlando, Florida, USA.
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Crum-Cianflone NF, Wilkins K, Lee AW, Grosso A, Landrum ML, Weintrob A, Ganesan A, Maguire J, Klopfer S, Brandt C, Bradley WP, Wallace MR, Agan BK. Long-term durability of immune responses after hepatitis A vaccination among HIV-infected adults. J Infect Dis 2011; 203:1815-23. [PMID: 21606540 PMCID: PMC3100512 DOI: 10.1093/infdis/jir180] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 01/26/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vaccination provides long-term immunity to hepatitis A virus (HAV) among the general population, but there are no such data regarding vaccine durability among human immunodeficiency virus (HIV)-infected adults. METHODS We retrospectively studied HIV-infected adults who had received 2 doses of HAV vaccine. We analyzed blood specimens taken at 1 year, 3 years, and, when available, 6-10 years postvaccination. HAV immunoglobulin G (IgG) values of ≥10 mIU/mL were considered seropositive. RESULTS We evaluated specimens from 130 HIV-infected adults with a median age of 35 years and a median CD4 cell count of 461 cells/mm(3) at or before time of vaccination. Of these, 49% had an HIV RNA load <1000 copies/mL. Initial vaccine responses were achieved in 89% of HIV-infected adults (95% confidence interval [CI], 83%-94%), compared with 100% (95% CI, 99%-100%) of historical HIV-uninfected adults. Among initial HIV-infected responders with available specimens, 90% (104 of 116; 95% CI, 83%-95%) remained seropositive at 3 years and 85% (63 of 74; 95% CI, 75%-92%) at 6-10 years. Geometric mean concentrations (GMCs) among HIV-infected adults were 154, 111, and 64 mIU/mL at 1, 3, and 6-10 years, respectively, compared with 1734, 687, and 684 mIU/mL among HIV-uninfected persons. Higher GMCs over time among HIV-infected adults were associated with lower log(10) HIV RNA levels (β = -.12, P = .04). CONCLUSIONS Most adults with well-controlled HIV infections had durable seropositive responses up to 6-10 years after HAV vaccination. Suppressed HIV RNA levels are associated with durable HAV responses.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
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Abstract
We report the fourth case of group B streptococcal (GBS) necrotizing fasciitis and toxic shock-like syndrome. Since the mechanism of GBS toxic shock may be similar to Group A Streptococcus, intravenous immunoglobulin should be considered as an adjunct to clindamycin-based antibiotic therapy.
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Affiliation(s)
- Nancy F Crum
- Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA 92134-1005, USA.
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Abstract
Pain represents the major motivating factor for which individuals seek healthcare, and pain responses are characterized by substantial inter-individual differences. Increasing evidence suggests that genetic factors contribute significantly to individual differences in responses to both clinical and experimental pain. The purpose of this review article was to summarize the current literature regarding genetic contributions to pain, highlighting findings relevant to oral pain where available. A brief discussion of methodologic considerations is followed by a review of findings regarding genetic influences on clinical pain. Next, the literature examining genetic contributions to experimental pain responses is presented, emphasizing genetic associations that have been replicated in multiple cohorts. It is hoped that an enhanced understanding of genetic contributions to pain responses will ultimately improve diagnosis and treatment of clinical pain conditions.
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Affiliation(s)
- R B Fillingim
- College of Dentistry, University of Florida, Gainesville, FL 32608, USA.
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Crum-Cianflone N, Truett A, R. Wallace M. Cryptococcal meningitis manifesting as a large abdominal cyst in a HIV-infected patient with a CD4 count greater than 400 cells/mm(3). AIDS Patient Care STDS 2008; 22:359-63. [PMID: 18373418 DOI: 10.1089/apc.2007.0085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cryptococcal meningitis usually occurs among HIV-positive patients with CD4 counts less than 100 cells/mm(3) and manifests as headaches, fevers, and mental status changes. We present an unusual case of cryptococcal meningitis in a 34-year-old HIV-positive man presenting as a large abdominal cyst at the ventriculoperitoneal shunt site despite receiving highly active antiretroviral therapy (HAART) for more than 5 years and having a CD4 count more than 400 cells/mm(3).
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Affiliation(s)
- Nancy Crum-Cianflone
- Infectious Disease Clinic, Naval Medical Center, San Diego, California
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - April Truett
- Infectious Disease Clinic, Naval Medical Center, San Diego, California
- Tropical Medicine Division, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Mark R. Wallace
- Infectious Disease Clinic, Naval Medical Center, San Diego, California
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Crum-Cianflone NF, Bavaro M, Hale B, Amling C, Truett A, Brandt C, Pope B, Furtek K, Medina S, Wallace MR. Erectile dysfunction and hypogonadism among men with HIV. AIDS Patient Care STDS 2007; 21:9-19. [PMID: 17263654 DOI: 10.1089/apc.2006.0071] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Erectile dysfunction (ED) and hypogonadism are increasingly recognized conditions, however, the prevalence and etiologies of these conditions among HIV-infected men remain unclear. We studied 300 HIV-infected men who completed standardized questionnaires regarding sexual function and hypogonadal symptoms. An early morning testosterone test was performed; patients with a low serum testosterone level (defined by <300 ng/dL), underwent additional blood tests to determine the etiology of the hypogonadism. The participants' mean age was 39 years (range, 19-72); 61% were Caucasian; 24%, African American; 9%, Hispanic; and 5% other. Participants had been HIV-positive for a mean of 9 years (range, 0.5-20) with a mean CD4 count of 522 cells/mm(3) (range, 1-1531). Sixty percent were receiving antiretroviral therapy. ED was reported by 61.4%; of those with ED, 32% did not have a rigid enough erection for penetration, and 46% were unable to sustain an erection for the completion of intercourse. In the multivariate analysis, increasing age (odds ratio [OR] 1.4 for a 5-year increment, p < 0.001) and depression (OR 2.64, p < 0.0001) were associated with ED. A higher current CD4 count was protective (OR 0.80 for each 100 cells/mm(3), p = 0.004). Only 25% of patients with ED had utilized a phosphodiesterase-5-inhibitor for treatment. Seventeen percent of the 300 men were hypogonadal; there was no correlation between hypogonadism and ED. Increasing age and a higher body mass index (BMI) were positively associated with hypogonadism, while smoking was negatively associated (OR 0.44, p = 0.02). All patients with low testosterone had secondary hypogonadism. There was no association between ED or hypogonadism with the current, past, or cumulative use of HIV medications.
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Crum NF, Lee RU, Thornton SA, Stine OC, Wallace MR, Barrozo C, Keefer-Norris A, Judd S, Russell KL. Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. Am J Med 2006; 119:943-51. [PMID: 17071162 DOI: 10.1016/j.amjmed.2006.01.004] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 01/20/2006] [Accepted: 01/20/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE The study's purpose was to elucidate the evolutionary, microbiologic, and clinical characteristics of methicillin-resistant Staphylococcus aureus (MRSA) infections. METHODS MRSA cases from military medical facilities in San Diego, from 1990 to 2004, were evaluated and categorized as community-acquired or nosocomial. Sequence type, staphylococcal chromosomal cassette gene type, and Panton-Valentine leukocidin gene status were determined for a subset of isolates. RESULTS Over the 15-year period, 1888 cases of MRSA were identified; 65% were community acquired. The incidence (155 infections/100000 person-year in 2004) and household-associated cases rapidly increased since 2002. Among persons with community-acquired MRSA, 16% were hospitalized and only 17% were initially given an effective antibiotic. Community-acquired MRSA cases compared with nosocomial MRSA cases were more often soft-tissue and less often urinary, lung, or bloodstream infections (P<.001). Patients with community-acquired MRSA were younger (22 vs 64 years, P<.001) and less likely to have concurrent medical conditions (9% vs 98%, P<.001). Clindamycin resistance increased among community-acquired MRSA isolates during 2003 and 2004 compared with previous years (79% vs 13%, P<.001). Genetically, nosocomial MRSA isolates were significantly different than those acquired in the community. Although community-acquired MRSA isolates were initially diverse by 2004, one strain (staphylococcal chromosomal cassette type IV, sequence type 8, Panton-Valentine leukocidin gene positive) became the predominant isolate. CONCLUSIONS Community-acquired and intrafamilial MRSA infections have increased rapidly since 2002. Our 15 years of surveillance revealed the emergence of distinct community-acquired MRSA strains that were genetically unrelated to nosocomial MRSA isolates from the same community.
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Affiliation(s)
- Nancy F Crum
- Infectious Diseases Division, Naval Medical Center San Diego, San Diego, Calif 92134-1005, USA.
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Abstract
BACKGROUND In recent years, non-syndromic idiopathic cardiomyopathies have increasingly been characterised as autosomal dominant conditions caused by single gene mutations. Loci have been identified for hypertrophic and dilated cardiomyopathy, and in some cases the same loci are associated with restrictive cardiomyopathy (RCM). In a kindred with RCM that we previously reported, we ruled out the known cardiomyopathy loci and other candidate genes by linkage analysis and mutation screening. METHODS AND RESULTS Here we report a genome-wide analysis in this family that has resulted in linkage to a region on chromosome 10. CONCLUSIONS There are no genes in the interval that are known to cause idiopathic cardiomyopathy, and thus this linkage represents localisation of a new RCM locus.
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Abstract
Mutations in the NF1 tumor-suppressor gene underlie neurofibromatosis type 1 (NF1), in which patients are predisposed to certain tumors such as neurofibromas and may associate with vascular disorder. Plexiform neurofibromas are slow growing benign tumors that are highly vascular and can progress to malignancy. The development of neurofibromas requires loss of both Nf1 alleles in Schwann cells destined to become neoplastic and may be exacerbated by Nf1 heterozygosity in other non-neoplastic cells. This study tested the hypothesis that Nf1 heterozygosity exaggerates angiogenesis. We found that Nf1 heterozygous mice showed increased neovascularization in both the retina and cornea in response to hypoxia and bFGF, respectively, compared to their wild-type littermates. The increase in corneal neovascularization was associated with heightened endothelial cell proliferation and migration, and increased infiltration of inflammatory cells. In addition, Nf1 heterozygous endothelial cell cultures showed an exaggerated proliferative response to angiogenic factors, particularly to bFGF. These findings support the conclusion that Nf1 heterozygosity in endothelial cells and perhaps inflammatory cells augments angiogenesis, which may promote neurofibroma formation in NF1.
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Affiliation(s)
- M Wu
- Department of Pediatrics, Division of Neurology, University of Florida, Gainesville, FL 32610, USA.
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Mogil JS, Ritchie J, Smith SB, Strasburg K, Kaplan L, Wallace MR, Romberg RR, Bijl H, Sarton EY, Fillingim RB, Dahan A. Melanocortin-1 receptor gene variants affect pain and mu-opioid analgesia in mice and humans. J Med Genet 2006; 42:583-7. [PMID: 15994880 PMCID: PMC1736101 DOI: 10.1136/jmg.2004.027698] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A recent genetic study in mice and humans revealed the modulatory effect of MC1R (melanocortin-1 receptor) gene variants on kappa-opioid receptor mediated analgesia. It is unclear whether this gene affects basal pain sensitivity or the efficacy of analgesics acting at the more clinically relevant mu-opioid receptor. OBJECTIVE To characterise sensitivity to pain and mu-opioid analgesia in mice and humans with non-functional melanocortin-1 receptors. METHODS Comparisons of spontaneous mutant C57BL/6-Mc1r(e/e) mice to C57BL/6 wildtype mice, followed by a gene dosage study of pain and morphine-6-glucuronide (M6G) analgesia in humans with MC1R variants. RESULTS C57BL/6-Mc1r(e/e) mutant mice and human redheads--both with non-functional MC1Rs--display reduced sensitivity to noxious stimuli and increased analgesic responsiveness to the mu-opioid selective morphine metabolite, M6G. In both species the differential analgesia is likely due to pharmacodynamic factors, as plasma levels of M6G are similar across genotype. CONCLUSIONS Genotype at MC1R similarly affects pain sensitivity and M6G analgesia in mice and humans. These findings confirm the utility of cross species translational strategies in pharmacogenetics.
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Affiliation(s)
- J S Mogil
- Department of Psychology and Centre for Research on Pain, McGill University, Montreal, Canada.
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Abstract
Although vaccine-preventable diseases are common in HIV, concerns about vaccine safety and lack of efficacy in this patient population often lead to missed opportunities for vaccination. In this article, we review the literature regarding vaccine risks and benefits and offer recommendations regarding their use and timing in patients with HIV infection.
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Affiliation(s)
- Todd D Gleeson
- Department of Infectious Diseases, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
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Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, Armstrong AW, Fraser S, Wallace MR. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr 2006; 41:194-200. [PMID: 16394852 DOI: 10.1097/01.qai.0000179459.31562.16] [Citation(s) in RCA: 347] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
METHODS Comparisons of death-related variables during the 3 eras were performed. RESULTS The number of deaths declined over the study period, with 987 deaths in the pre-HAART era, 159 deaths in the early HAART era (1997-1999), and 78 deaths in the late HAART era (2000-2003) (P < 0.01). The annual death rate peaked in 1995 (10.3 per 100 patients) and then declined to <2 deaths per 100 persons in the late HAART era (P < 0.01). The proportion of deaths attributable to infection decreased, but infection remained the leading cause of death in our cohort, followed by cancer. Of those who died, there was an increasing proportion of non-HIV-related deaths (32% vs. 9%; P < 0.01), including cardiac disease (22% vs. 8%; P < 0.01) and trauma (8% vs. 2%; P = 0.01) in the post-HAART versus pre-HAART era. Despite the absence of intravenous drug use and the low prevalence of hepatitis C coinfection in our cohort, an increasing proportion of deaths in the HAART era were attributable to liver disease, although the numbers are small. CONCLUSIONS Despite increasing concerns regarding antiretroviral resistance, the death rate among HIV-infected persons in our cohort continues to decline. Our data show a lower death rate than that reported among many other US HIV-infected populations; this may be the result of open access to health care. A shift in the causes of death toward non-HIV-related causes suggests that a more comprehensive health care approach may be needed for optimal life expectancy; this may include enhanced screening for malignancy and heart disease as well as preventive measures for liver disease and accidents.
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Affiliation(s)
- Nancy F Crum
- Infectious Diseases Division, Clinical Investigation Department, Naval Medical Center San Diego, San Diego, CA 92134-1005, USA.
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Abstract
We provide a review of the medical care provided to human immunodeficiency virus (HIV)-positive service members in the U.S. Navy and Marine Corps. An overview of the history of HIV and its impact on the U.S. Navy is presented. We also explain the policies of mandatory HIV testing within the U.S. Navy and the evaluation process for those found to have HIV infection. We specifically describe the multidisciplinary HIV medical care provided at Naval Medical Center San Diego, which is one of three HIV specialty clinics within the U.S. Navy.
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Affiliation(s)
- Nancy F Crum
- Infectious Disease Division, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Crum NF, Furtek KJ, Olson PE, Amling CL, Wallace MR. A Review of Hypogonadism and Erectile Dysfunction Among HIV-Infected Men During the Pre- and Post-HAART Eras: Diagnosis, Pathogenesis, and Management. AIDS Patient Care STDS 2005. [DOI: 10.1089/apc.2005.19.869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Crum NF, Furtek KJ, Olson PE, Amling CL, Wallace MR. A review of hypogonadism and erectile dysfunction among HIV-infected men during the pre- and post-HAART eras: diagnosis, pathogenesis, and management. AIDS Patient Care STDS 2005; 19:655-71. [PMID: 16232050 DOI: 10.1089/apc.2005.19.655] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hypogonadism and erectile dysfunction (ED) appear to be more common among men infected with HIV compared to age-matched men within the general U.S. population. HIV providers should consider these conditions and utilize standardized evaluation and diagnostic criteria. Treatment of both hypogonadism and ED increases sexual function and quality of life; testosterone supplementation in the setting of hypogonadism may also improve lean body mass, mental status, and anemia. We review the epidemiology, diagnosis, pathogenesis, and treatment options of both hypogonadism and ED among HIV-infected men.
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Affiliation(s)
- Nancy F Crum
- Infectious Diseases Division, Naval Medical Center San Diego, San Diego, California 92134-1005, USA.
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Burgi A, Brodine S, Wegner S, Milazzo M, Wallace MR, Spooner K, Blazes DL, Agan BK, Armstrong A, Fraser S, Crum NF. Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals. Cancer 2005; 104:1505-11. [PMID: 16104038 DOI: 10.1002/cncr.21334] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The objective of this study was to determine the rates and predictors of non-AIDS-defining cancers (NADCs) among a cohort of human immunodeficiency virus (HIV)-infected individuals. METHODS The authors conducted a retrospective study of 4144 HIV-infected individuals who had 26,916 person-years of follow-up and who had open access to medical care at 1 of the United States military HIV clinics during the years 1988-2003. Cancer incidence rates were race specific and were adjusted for age; these were compared with national rates using logistic regression to assess predictors of NADC development. RESULTS One hundred thirty-three NADCs were diagnosed with a rate of 980 diagnoses per 100,000 person-years. The most frequent NADCs were skin carcinomas (basal cell and squamous cell), Hodgkin disease, and anal carcinoma. The results showed that there were higher rates of melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease among the HIV-infected cohort compared with age-adjusted rates for the general United States population. Predictors of NADCs included age older than 40 years (odds ratio [OR], 12.2; P < 0.001), Caucasian/non-Hispanic race (OR, 2.1; P < 0.001), longer duration of HIV infection (OR, 1.2; P < 0.001), and a history of opportunistic infection (OR, 2.5; P < 0.001). The use of highly active antiretroviral therapy (HAART) was associated with lower rates of NADCs (OR, 0.21; P < 0.001). A low CD4 nadir or CD4 count at diagnosis (< 200 cells/mL) was not predictive of NADCs. CONCLUSIONS The most frequent NADCs were primary skin malignancies. Melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease occurred at higher rates among HIV-infected individuals. The implementation of screening programs for these malignancies should be considered. Most risk factors for the development of NADCs are nonmodifiable; however, the use of HAART appeared to be beneficial in protecting against the development of malignant disease.
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Affiliation(s)
- Alina Burgi
- Graduate School of Public Health, San Diego State University, San Diego, California 92134, USA
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Abstract
Tumor necrosis factor (TNF)-alpha antagonists are promising therapeutic agents for patients with severe autoimmune and rheumatologic conditions. Unfortunately, their use has been associated with an increased rate of tuberculosis, endemic mycoses, and intracellular bacterial infections. Infliximab, 1 of 3 available drugs in this novel class, appears to be associated with the greatest risk of infection, likely because of its long half-life and induction of monocyte apoptosis. Prospective trials are necessary to determine the exact risk associated with these agents, particularly the newer TNF-alpha antagonists. More specific TNF-alpha blockers, which reduce inflammation while maintaining adequate immunity, are needed. In the meantime, a thorough work-up is mandatory for all febrile illness occurring in TNF-alpha blocker recipients. We present 4 patients who developed severe infections during TNF-alpha antagonist therapy, review the literature, and discuss current guidelines for surveillance and prophylaxis.
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Affiliation(s)
- Nancy F Crum
- From Infectious Diseases Division (NFC, MRW), Naval Medical Center San Diego, San Diego, California and United States Naval Medical Research Unit 2 (ERL), Jakarta, Indonesia
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Terra SG, McGorray SP, Wu R, McNamara DM, Cavallari LH, Walker JR, Wallace MR, Johnson BD, Bairey Merz CN, Sopko G, Pepine CJ, Johnson JA. Association between β-adrenergic receptor polymorphisms and their G-protein-coupled receptors with body mass index and obesity in women: a report from the NHLBI-sponsored WISE study. Int J Obes (Lond) 2005; 29:746-54. [PMID: 15917856 DOI: 10.1038/sj.ijo.0802978] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The beta-adrenergic receptor (betaAR) genes are candidate genes for obesity because of their roles in energy homeostasis and promotion of lipolysis in human adipose tissue. Objective is to determine the association between obesity and polymorphisms in genes of the beta(1)AR (ADRB1), beta(2)AR (ADRB2), beta(3)AR (ADRB3), Gs protein alpha (GNAS1), to which all three beta-receptors couple and the G protein beta3 subunit (GNB3), to which beta(3)ARs couple. DESIGN A case-control genetic association study. SUBJECTS A total of 643 black or white women enrolled in Women's Ischemia Syndrome Evaluation (WISE) study. MEASUREMENTS Genotypes were determined by PCR with single primer extension. Associations between genotype and body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, and obesity were made. RESULTS Polymorphisms in the three betaAR genes, GNAS1, and GNB3 were not associated with BMI, WHR, waist circumference, or obesity. Linear and logistic regression analyses found no contribution of either genotype or haplotype with anthropometric measurements or obesity. CONCLUSIONS Our study suggests that among American women with suspected coronary heart disease, polymorphisms in the betaARs and their G-protein-coupled receptors do not contribute to increased BMI, WHR, waist circumference, or obesity. Given that 50% of all women die from coronary heart disease, and a higher percentage have heart disease during their lifetime, our results are likely generalizable to many American women.
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Affiliation(s)
- S G Terra
- Department of Pharmacy Practice, University of Florida College of Pharmacy, Gainesville, FL 32610, USA
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Abstract
OBJECTIVE To determine the mode of inheritance of cataract formation in the Bichon Frise. MATERIALS Thirty-six closely related Bichon Frise dogs in a pedigree of 61 dogs were examined using slit-lamp biomicroscopy and indirect ophthalmoscopy over a period of 10 years. RESULTS Of the 61 related dogs, 36 were examined repeatedly. Twelve cataractous dogs were diagnosed (three males and nine females). Cataractous dogs resulted from matings between unaffected parents, and when one parent was cataractous and the other parent was unaffected. Age at onset of cataract formation ranged from 18 to 160 months. Available information suggests that the cataracts are inherited as an autosomal recessive trait. CONCLUSION Cataracts appear inherited in the Bichon Frise as an autosomal recessive trait. Additional cataract x cataract matings are necessary to confirm the autosomal recessive heredity.
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Affiliation(s)
- M R Wallace
- Department of Molecular Genetics, and Pediatric Genetics, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
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Crum NF, Russell KL, Kaplan EL, Wallace MR, Wu J, Ashtari P, Morris DJ, Hale BR. Pneumonia outbreak associated with group a Streptococcus species at a military training facility. Clin Infect Dis 2005; 40:511-8. [PMID: 15712072 DOI: 10.1086/427502] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Accepted: 09/17/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although group A streptococci (GAS) infections are a major cause of morbidity and mortality, outbreaks of associated pneumonia are rare. We report an outbreak of GAS pneumonia that occurred at a US military training camp. METHODS Standard epidemiologic and laboratory procedures were used to characterize the outbreak and causative organism(s). A case-control study and determination of the prevalence of GAS infection among camp personnel were also performed. RESULTS A total of 162 of 4500 Marine Corps personnel were hospitalized for respiratory symptoms during the period of 1 November and 20 December 2002, and 127 (78%) had radiographically confirmed pneumonia. The attack rate was 1.6 cases per 100 person-months. Thirty-four (27%) of 127 patients with pneumonitis had definite or probable GAS pneumonia; an additional 22 (17.3%) were coinfected with GAS and another pathogen. Pathogens, in addition to GAS, included Chlamydia pneumoniae (27 patients), Mycoplasma pneumoniae (19), adenovirus (5), and Streptococcus pneumoniae (2). A survey revealed that the pharyngeal carriage rate of GAS among camp personnel was 16%. Molecular characterization of the GAS isolates found emm type 3, multilocus sequence type 15. The epidemic ended after administration of additional prophylaxis with a single dose of intramuscular benzathine penicillin (1.2 million U) or azithromycin (1 g orally). Because the number of days from the last penicillin injection was correlated with a positive throat culture result and the occurrence of pneumonia, the dosing interval of benzathine penicillin was shortened from every 28-35 days to every 21 days. CONCLUSIONS This is the largest outbreak of GAS pneumonia reported in >30 years. This outbreak emphasizes the potential for GAS to cause epidemics of severe infection and demonstrates the need for surveillance and consideration of appropriate antibiotic prophylaxis among particularly high-risk populations.
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Affiliation(s)
- Nancy F Crum
- Infectious Diseases Division, Clinical Investigation Dept., Naval Medical Center San Diego, CA 92134-1005, USA.
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Crum NF, Wallace MR, Oldfield EC. New issues in infectious diarrhea. Rev Gastroenterol Disord 2005; 5 Suppl 3:S16-25. [PMID: 17713455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Infectious diarrhea remains a leading cause of both mortality and morbidity worldwide. Novel organisms recently have been described as causes of previously undiagnosed diarrhea. In addition, changes in epidemiologic trends of known pathogens, such as Clostridium difficile, are occurring, including multiple outbreaks of a newly recognized epidemic strain associated with increased severity of cases and poor response to current antibiotics. Given rising resistance rates, new antimicrobial agents are being studied. Rifaximin is a nonabsorbable, gut-selective antibiotic recently approved by the US Food and Drug Administration for the treatment of travelers' diarrhea caused by noninvasive Escherichia coli. This novel antibiotic has also shown promise in the prevention of travelers' diarrhea, as well as a host of other gastrointestinal disorders. Development of a vaccine against diarrheagenic organisms is of high global importance but has been a challenge, owing to the multiple causative serotypes of E. coli and other organisms.
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Affiliation(s)
- Nancy F Crum
- Infectious Diseases Division, Naval Medical Center San Diego, San Diego, California, USA
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Williams CA, Wallace MR, Drury KC, Kipersztok S, Edwards RK, Williams RS, Haller MJ, Schatz DA, Silverstein JH, Gray BA, Zori RT. Blood lymphocyte chimerism associated with IVF and monochorionic dizygous twinning: Case report. Hum Reprod 2004; 19:2816-21. [PMID: 15375077 DOI: 10.1093/humrep/deh533] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report on dizygotic (DZ) twins, conceived by IVF and ICSI with assisted hatching, who each had a mixture of 46,XX and 46,XY cells in blood lymphocytes. The female twin had mild genitalia abnormalities but further study revealed anatomically normal reproductive anatomy. Chromosome and fluorescence in situ hybridization studies of buccal, skin and ovarian tissue were normal, as were buccal tissue DNA studies. Fetal ultrasound and fetal membrane pathology were consistent with a monochorionic, diamniotic placenta (MCDAP). These twins thus have blood chimerism but are not chimeric in the other tissues studied. The mechanism for the chimerism could be due to either placental vascular anastamoses (after the development of the haematoblast stem cells) or due to an admixture of trophoblast cells during early blastocyst development. Such trophoblast cell admixtures would be restricted to the extraembryonic tissues so that general physical development in the fetus is normal and without somatic cell chimerism. This case in combination with others previously reported suggests that in IVF conceptions, the prevalence of blood chimerism associated with twinning, and the occurrence of DZ twinning associated with MCDAP, may be higher than previously thought.
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Affiliation(s)
- C A Williams
- The R.C.Philips Unit, Division of Genetics, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA.
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Wallace MR, Brandt CJ, Earhart KC, Kuter BJ, Grosso AD, Lakkis H, Tasker SA. Safety and immunogenicity of an inactivated hepatitis A vaccine among HIV-infected subjects. Clin Infect Dis 2004; 39:1207-13. [PMID: 15486846 DOI: 10.1086/424666] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 06/02/2004] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Hepatitis A is a major health risk for many human immunodeficiency virus (HIV)-infected individuals. Vaccination is a potentially attractive measure to reduce the incidence of hepatitis A among this population, but data on its safety and immunogenicity are incomplete. METHODS Ninety HIV-uninfected adults received an inactivated hepatitis A vaccine (VAQTA; Merck), and 90 HIV-infected subjects were randomized, in double-blind fashion, to receive either the vaccine or placebo. The HIV-infected subjects were stratified by CD4 cell count, with 45 subjects having CD4 cell counts of > or =300 cells/mm3 and 45 subjects having CD4 cell counts of <300 cells/mm3. Vaccine was given at weeks 0 and 24 of the study.Results. Seroconversion rates at week 28 of the study were 94% among the HIV-infected subjects and 100% among the HIV-uninfected control subjects. HIV-infected subjects with CD4 cell counts of <300 cells/mm3 had a seroconversion rate of 87%, and HIV-infected subjects with CD4 cell counts of > or =300 cells/mm3 had a seroconversion rate of 100%. The vaccine was generally well tolerated, and no adverse effect on either HIV load or CD4 cell count was found. CONCLUSION Hepatitis A vaccine was both immunogenic and safe among HIV-infected subjects.
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Affiliation(s)
- Mark R Wallace
- Clinical Investigation Dept., Naval Medical Center San Diego, San Diego, California 92134-1005, USA.
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Abstract
Throughout history, infectious diarrhea has been associated with crowding, poor sanitation, and war. Although descriptions of infectious diarrhea exist in the earliest records of civilization, effective measures for prevention were not widely or consistently used until the modern era of active public health promotion. Advances in the understanding of etiologies and therapies have revolutionized prognosis; however, constant vigilance against lapses in public health is necessary to prevent outbreaks of disease.
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Affiliation(s)
- Matthew L Lim
- Division of Infectious Diseases, Clinical Investigation Department (KCA), Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 5, San Diego, CA 92134-1005, USA.
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