Steve Blum

Multidrug-Resistant Tuberculosis in Patients without HIV Infection

BACKGROUNDnInvestigations of outbreaks of multidrug-resistant tuberculosis have found low rates of treatment response and very high mortality, and they have mainly involved patients with advanced human immunodeficiency virus (HIV) infection. For patients without HIV infection, one study reported an overall rate of response to treatment of 56 percent, and the mortality from tuberculosis was 22 percent. We investigated treatment response and mortality rates in 26 HIV-negative patients in New York with multidrug-resistant tuberculosis.nnnMETHODSnWe obtained detailed data from seven teaching hospitals in New York City on patients with multidrug-resistant tuberculosis--defined as tuberculosis resistant at least to isoniazid and rifampin--who were HIV-negative on serologic testing. Lengths of times from diagnosis to the initiation of appropriate therapy and from the initiation of appropriate therapy to conversion to negative cultures were assessed. Therapeutic responses were evaluated by both microbiologic and clinical criteria.nnnRESULTSnBetween March 1991 and September 1994, 26 HIV-negative patients were identified and treated. Of the 25 patients for whom adequate data were available for analysis, 24 (96 percent) had clinical responses; all 17 patients for whom data on microbiologic response were available had such a response. The median times from diagnosis to the initiation of appropriate therapy and from the initiation of therapy to culture conversion were 44 days (range, 0 to 181) and 69 days (range, 2 to 705), respectively. Side effects requiring the discontinuation of medication occurred in 4 of 23 patients (17 percent) who were treated with second-line antituberculosis medications. The median follow-up for the 23 patients who responded and who received appropriate therapy was 91 weeks (range, 41 to 225).nnnCONCLUSIONSnIn this report from New York City, HIV-negative patients with multidrug-resistant tuberculosis, contrary to previous reports, responded well to appropriate chemotherapy, both clinically and microbiologically.

Risk Behavior for Transmission of Human Immunodeficiency Virus (HIV) among HIV-Seropositive Individuals in an Urban Setting

We conducted interviews with 256 human immunodeficiency virus (HIV)-infected patients who attended an HIV clinic in New York City to assess ongoing risk behaviors for HIV transmission. After learning that the result of an HIV test was positive, 106 subjects (41%) had unprotected sex, 63 (25%) had a new sexually transmitted disease diagnosis, and 38 (15%) used injection drugs. Unprotected sex was reported by 50% of women, 29% of heterosexual men (P=.006, compared with women), and 42% of men who have sex with men, and it was reported more often by persons with a history of trading sex for money or drugs (P<.001). In multivariate analysis, unprotected sex was associated with a history of trading sex for money or drugs (adjusted odds ratio [AOR], 4.0; 95% confidence interval [CI], 2.2-7.0) and use of highly active antiretroviral therapy (AOR, 1.8; 95% CI, 1.1-3.1). Ongoing risk-reduction counseling and substance abuse treatment for HIV-infected persons are needed to reduce behaviors associated with HIV transmission.

Positive Vasodilator Stress ECG With Normal Myocardial Perfusion Imaging and Its Correlation With Coronary Angiographic Findings in African Americans and Hispanics

Ischemic electrocardiographic (ECG) changes during vasodilator stress testing (VST) in the presence of abnormal myocardial perfusion imaging (MPI) are uncommon and are associated with presence of multivessel coronary artery disease (CAD). However, there is a paucity of data regarding the significance of ischemic ECG changes during VST with normal MPI in general, and especially among African Americans and Hispanics.

Significance of Bowel Wall Thickening on Computed Tomography Scan: Higher Risk of Pathology Among African Americans Compared to Hispanics

PURPOSEnThe aims of our study were to examine the role of colonoscopy as further workup for bowel wall thickening reported on computed tomography (CT) scans and to investigate whether there were significant differences in pathology found among the racial groups in our study population.nnnMETHODSnThis is a retrospective study from March 2005 and January 2007 of all patients who have undergone colonoscopy for bowel wall thickening found on CT scans of the abdomen.nnnRESULTSnOf 94 patients with bowel wall thickening on CT scans, 7 (8%) had adenocarcinoma, 5 (5%) had large adenomas, 3 (3%) had infectious colitis, 2 (2%) ischemic colitis, 1 (1%) had inflammatory bowel disease, and 1 (1%) had a benign stricture. Bowel wall thickening on CT scan predicted clinical pathology in 34% of African Americans, as compared to 14% of Hispanics. Patients with significant pathology were more likely to have anemia and lower albumin levels.nnnCONCLUSIONnPatients with bowel wall thickening found on CT scans should be referred for colonoscopy, given that significant pathology is found in 20% of the cases. African Americans were 2.5 times more likely to have clinically significant pathology as compared to Hispanics.

Comparison of the yield of transthoracic needle aspiration and core biopsy between pulmonologist and radiologist in a community practice.

Vol XV N.o 1 Janeiro/Fevereiro 2009 Resumo A puncao aspirativa transtoracica (PATT) e biopsia transtoracica por agulha sao realizadas por pneumologistas e por radiologistas de intervencao. Actualmente, muito poucos internatos de pneumologia obrigam ao treino desta tecnica. Os autores decidiram comparar a rentabilidade e as complicacoes da tecnica quando realizadas por pneumologistas e por radiologistas de intervencao. Realizaram uma analise retrospectiva entre 2003 e 2007 de todos os exames realizados por internos de pneumologia supervisionados e por pneumologistas, comparando com os exames realizados por radiologistas de intervencao. Foram incluidos no estudo 35 doentes, 19 no grupo dos pneumologistas e 16 no grupo dos radiologistas de intervencao. Nao houve diferencas no campo das complicacoes entre os dois grupos; quanto a rentabilidade diagnostica, no grupo dos pneumologistas foi de 63% e no grupo dos radiologistas de intervencao de 69%. As doencas malignas foram o diagnostico mais frequente (70%). A biopsia transtoracica por agulha foi usada em 21% dos casos no grupo dos pneumologistas e em 50% dos casos do grupo dos radiologistas de intervencao. A rentabilidade diagnostica aumentou quando as duas tecnicas foram combinadas (75% para 61%, respectivamente). A presenca do patologista so se verificou no grupo dos exames realizados pelos pneumologistas. Neste grupo, os autores concluiram que as complicacoes eram sobreponiveis nos dois grupos de trabalho e que a combinacao das duas tecnicas aumentava a rentabilidade. A biopsia transtoracica por agulha foi considerada uma tecnica da maior importância porque aumenta o campo de diagnostico, evitando outros meios mais invasivos e com maior risco. Os autores propoem que o treino destas tecnicas continue ou seja reactivado em todos os internatos de pneumologia, desenvolvendo programas para manter a capacidade dos pneumologistas que a realizam a treinar os novos pneumologistas na realizacao das mesmas. Comparacao entre a puncao aspirativa transtoracica e a biopsia transtoracica realizada por pneumologistas e por radiologistas na pratica clinica

Comparação entre a punção aspirativa transtorácica e a biópsia transtorácica realizada por pneumologistas e por radiologistas na prática clínica

Resumo A puncao aspirativa transtoracica (PATT) e biopsia transtoracica por agulha sao realizadas por pneumologistas e por radiologistas de intervencao. Actualmente, muito poucos internatos de pneumologia obrigam ao treino desta tecnica. Os autores decidiram comparar a rentabilidade e as complicacoes da tecnica quando realizadas por pneumologistas e por radiologistas de intervencao. Realizaram uma analise retrospectiva entre 2003 e 2007 de todos os exames realizados por internos de pneumologia supervisionados e por pneumologistas, comparando com os exames realizados por radiologistas de intervencao. Foram incluidos no estudo 35 doentes, 19 no grupo dos pneumologistas e 16 no grupo dos radiologistas de intervencao. Nao houve diferencas no campo das complicacoes entre os dois grupos; quanto a rentabilidade diagnostica, no grupo dos pneumologistas foi de 63% e no grupo dos radiologistas de intervencao de 69%. As doencas malignas foram o diagnostico mais frequente (70%). A biopsia transtoracica por agulha foi usada em 21% dos casos no grupo dos pneumologistas e em 50% dos casos do grupo dos radiologistas de intervencao. A rentabilidade diagnostica aumentou quando as duas tecnicas foram combinadas (75% para 61%, respectivamente). A presenca do patologista so se verificou no grupo dos exames realizados pelos pneumologistas. Neste grupo, os autores concluiram que as complicacoes eram sobreponiveis nos dois grupos de trabalho e que a combinacao das duas tecnicas aumentava a rentabilidade. A biopsia transtoracica por agulha foi considerada uma tecnica da maior importância porque aumenta o campo de diagnostico, evitando outros meios mais invasivos e com maior risco. Os autores propoem que o treino destas tecnicas continue ou seja reactivado em todos os internatos de pneumologia, desenvolvendo programas para manter a capacidade dos pneumologistas que a realizam a treinar os novos pneumologistas na realizacao das mesmas.