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Blaser M.J.,New York University | Blaser M.J.,New York Harbor Medical Center
Science | Year: 2016

Anti-infectives, including antibiotics, are essentially different from all other drugs; they not only affect the individual to whom they are given but also the entire community, through selection for resistance to their own action. Thus, their use resides at the intersection of personal and public health. Antibiotics can be likened to a four-edged sword against bacteria. The first two edges of the antibiotic sword were identified immediately after their discovery and deployment in that they not only benefit an individual in treating their infection but also benefit the community in preventing the spread of that infectious agent. The third edge was already recognized by Alexander Fleming in 1945 in his Nobel acceptance speech, which warned about the cost to the community of antibiotic resistance that would inevitably evolve and be selected for during clinical practice. We have seen this cost mount up, as resistance curtails or precludes the activities of some of our most effective drugs for clinically important infections. But the fourth edge of the antibiotic sword remained unappreciated until recently, i.e., the cost that an antibiotic exerts on an individual's own health via the collateral damage of the drug on bacteria that normally live on or in healthy humans: our microbiota. These organisms, their genes, metabolites, and interactions with one another, as well as with their host collectively, represent our microbiome. Our relationship with these symbiotic bacteria is especially important during the early years of life, when the adult microbiome has not yet formed. Source


Leaf D.E.,Brigham and Womens Hospital | Bukberg P.R.,Beth Israel Deaconess Medical Center | Goldfarb D.S.,New York University | Goldfarb D.S.,New York Harbor Medical Center
American Journal of Kidney Diseases | Year: 2012

Kidney stones are listed among the complications of eating disorders; however, very few cases have been reported. We present an additional case of nephrolithiasis associated with laxative abuse, including detailed results of the patient's urine metabolic profiles, in a patient with idiopathic hypercalciuria. We review the literature and provide an explanation for the paucity of cases of nephrolithiasis associated with these disorders. Despite low urine volumes resulting from extracellular fluid volume depletion and hypocitraturia resulting from hypokalemia, both of which would tend to favor the formation of kidney stones, most patients with eating disorders are likely to be protected from stone formation by the hypocalciuric effect of extracellular fluid volume depletion and increased proximal tubular sodium reabsorption. However, patients with underlying idiopathic hypercalciuria who develop eating disorders may be at increased risk of stone formation in the setting of low urine volume and therefore high supersaturation of calcium oxalate and phosphate. © 2012 National Kidney Foundation, Inc. Source


Ohmann E.L.,New York University | Ohmann E.L.,New York Harbor Medical Center | Borofsky M.S.,New York Harbor Medical Center | Han J.S.,New York Harbor Medical Center | And 2 more authors.
Urology | Year: 2013

Ectopic ureters are rare congenital mesonephric duct malformations with a higher prevalence in women than men. In women, ectopic ureters are often associated with a duplicated collecting system, whereas in men, ectopic ureters usually drain a single system and are associated with renal dysplasia and obstruction. Presentation and diagnosis generally occurs in the pediatric age group. Herein, we present an unusual case of delayed diagnosis of ectopic insertion of the upper pole ureter in a completely duplicated left kidney causing massive hydroureteronephrosis in an adult man. © 2013 Elsevier Inc. All Rights Reserved. Source


Back E.E.,Ellis Hospital | Bachwani A.S.,Ellis Hospital | Strogatz D.S.,Bassett Research Institute | Sherman Z.M.V.,New York Harbor Medical Center
Ethnicity and Disease | Year: 2012

Objective: Prompted by anecdotal evidence of a higher rate of type 2 diabetes, we set out to investigate the prevalence of diabetes, its risk factors, and co-morbidities among immigrant Guyanese patients being treated in a family medicine health center in Schenectady, New York. Methods: Patients were ascertained from a registration database of all patients aged $ 30 years who were treated from 2004 to 2006. We then conducted a detailed retrospective chart review of all Guyanese, Caucasian, African American, and Hispanic patients with diabetes and randomly selected non-diabetic controls. Results: Of 222 Guyanese patients, 67 (30.2%) had a diagnosis of diabetes, compared with 47/219 (21.5%) of Hispanics, 132/777 (17.0%) of African Americans, and 442/2834 (15.6%) of Caucasians (P>.0001). Compared with the other racial and ethnic groups, the Guyanese diabetic patients were significantly leaner and more likely to be male. Conclusion: We found a very high prevalence of type 2 diabetes among the Guyanese patient population studied and found unique characteristics when compared with other ethnic and racial groups. These findings have alerted local clinicians to intensify diabetes screening among Guyanese patients. Furthermore, in response to these findings, a broad coalition including public health, clinical, and community groups has been established with the goal of developing culturally appropriate strategies to prevent and control diabetes among Guyanese residents. Source


Perez-Perez G.I.,New York University | Bowers A.L.,Vanderbilt University | Rautelin H.,University of Helsinki | Kosunen T.U.,University of Helsinki | And 2 more authors.
Journal of Infectious Diseases | Year: 2010

Because Helicobacter pylori persist for decades in the human stomach, the aim of this study was to examine the long-term course of H. pylori-specific serum immunoglobulin G (IgG) responses with respect to subclass and antigenic target. We studied paired serum samples obtained in 1973 and in 1994 in Vammala, Finland, from 64 healthy H. pylori-positive adults and from other healthy control subjects. H. pylori serum immunoglobulin A, IgG, and IgG subclass responses were determined by antigen-specific enzyme-linked immunosorbent assays. H. pylori-specific IgG1 and IgG4 subtype responses from 47 subjects were similar in 1973 and 1994, but not when compared with unrelated persons. H. pylori-specific IgG1:IgG4 ratios among the participants varied 11000-fold; however, 57 (89.1%) of 64 subjects had an IgG1:IgG4 ratio >1.0, consistent with a predominant IgG1 (Th1) response. Furthermore, ratios in individual hosts were stable over the 21- year period (r=0.56; P < .001). The immune response to heat shock protein HspA was unchanged in 49 (77%) of the 64 subjects tested; of the 15 whose serostatus changed, all seroconverted and were significantly younger than those whose status did not change. These findings indicate that H. pylori-specific antibody responses are host-specific with IgG1:IgG4 ratios stable over 21 years, IgG1 responses predominating, and HspA seroconversion with aging. © 2010 by the Infectious Diseases Society of America. All rights reserved. Source

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