Clinical research in the lay press: irresponsible journalism raises a huge dose of doubt.
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Antifungal Agents↗
Biomedical subjects
Robert Rubin
Publications and source records attributed to Robert Rubin.
Reducing bioaerosol dispersion from wastewater treatment and its land application: a review and analysis.
Wastewater treatment systems and spray irrigation of treated water may spread microorganisms such as bacteria and viruses through dispersion of aerosol particles. A recent review (Brooks, Josephson, Gerba, & Pepper, 2004) identifies appropriate reports. Teltsch and co-authors report findings that suggest effective management controls involve providing buffer zones, irrigating in the daytime and in times of low humidity, reducing microorganism levels in water used for spraying, and testing for multiple types of viruses and bacteria (Teltsch & Katzenelson, 1978; Teltsch, Shuval, & Tadmor, 1980; Teltsch, Kedmi, Bonnet, Borenzstajn-Rotem, & Katzenelson, 1980). Camann, Moore, Harding, and Sorber support these findings. They also note that fecal streptococci are hardier than fecal coliform and appear frequently in background samples, suggesting that this bacterium is a better indicator of background and downwind conditions than are fecal coliform bacteria. In their study, storage prior to spray irrigation reduced microorganism concentrations by 99 percent. Downwind concentrations of sprayed reservoir water were often comparable to background values (Camann, Moore, Harding, & Sorber, 1988). Italian researchers (Brandi, Sisti, & Amagliani, 2000; Carducci, Gemelli, Cantiani, Casini, & Rovini, 1999; Carducci et al., 2000) confirm variable die-away rates of microorganisms, observe a positive association between fecal streptococci and the presence of viruses, and recommend consideration of submerged aeration for sludge digestion at sewage treatment plants. No reports are available that measure dispersion of bioaerosols from wastewater consistently treated to meet contemporary disinfection standards.
Aerosols↗
Cytomegalovirus in hematopoietic stem cell transplant recipients: Current status, known challenges, and future strategies.
Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after hematopoietic stem cell transplantation. Significant progress has been made in the prevention of CMV disease over the past decade, but prevention of late CMV disease continues to be a challenge in selected high-risk populations. The pretransplantation CMV serostatus of the donor and/or recipient remains an important risk factor for posttransplantation outcome despite the use of antiviral prophylaxis and preemptive therapy; CMV-seropositive recipients of T cell-depleted grafts in particular continue to have a survival disadvantage compared with seronegative recipients with seronegative donors. The risk of developing antiviral drug resistance remains low in most patients; however, in a setting of intense immunosuppression (eg, after transplantation from a haploidentical donor), the incidence may be as high as 8%. Primary CMV infection via blood transfusion can be reduced by the provision of seronegative or leukocyte-depleted blood products; however, a small risk of 1% to 2% of CMV disease remains. Surveillance and preemptive therapy are effective in preventing the sequelae of transfusion-related CMV infection. Indirect immunomodulatory effects of CMV are increasingly recognized in hematopoietic stem cell transplant recipients. Strategies currently being investigated include long-term suppression of CMV with valganciclovir for the prevention of late CMV infection and disease, adoptive transfer of CMV-specific T cells, and donor and recipient vaccination strategies.
Acyclovir↗
The burden of selected digestive diseases in the United States.
BACKGROUND & AIMS: Gastrointestinal (GI) and liver diseases inflict a heavy economic burden. Although the burden is considerable, current and accessible information on the prevalence, morbidity, and cost is sparse. This study was undertaken to estimate the economic burden of GI and liver disease in the United States for use by policy makers, health care providers, and the public. METHODS: Data were extracted from a number of publicly available and proprietary national databases to determine the prevalence, direct costs, and indirect costs for 17 selected GI and liver diseases. Indirect cost calculations were purposefully very conservative. These costs were compared with National Institutes of Health (NIH) research expenditures for selected GI and liver diseases. RESULTS: The most prevalent diseases were non-food-borne gastroenteritis (135 million cases/year), food-borne illness (76 million), gastroesophageal reflux disease (GERD; 19 million), and irritable bowel syndrome (IBS; 15 million). The disease with the highest annual direct costs in the United States was GERD ($9.3 billion), followed by gallbladder disease ($5.8 billion), colorectal cancer ($4.8 billion), and peptic ulcer disease ($3.1 billion). The estimated direct costs for these 17 diseases in 1998 dollars were $36.0 billion, with estimated indirect costs of $22.8 billion. The estimated direct costs for all digestive diseases were $85.5 billion. Total NIH research expenditures were $676 million in 2000. CONCLUSIONS: GI and liver diseases exact heavy economic and social costs in the United States. Understanding the prevalence and costs of these diseases is important to help set priorities to reduce the burden of illness.
Cost of Illness↗