ASM LabCap's contributions to disease surveillance and the International Health Regulations (2005).

The revised International Health Regulations [IHR(2005)], which requires the Member States of the World Health Organization (WHO) to develop core capacities to detect, assess, report, and respond to public health threats, is bringing new challenges for national and international surveillance systems. As more countries move toward implementation and/or strengthening of their infectious disease surveillance programs, the strengthening of clinical microbiology laboratories becomes increasingly important because they serve as the first line responders to detect new and emerging microbial threats, re-emerging infectious diseases, the spread of antibiotic resistance, and the possibility of bioterrorism. In fact, IHR(2005) Core Capacity #8, "Laboratory", requires that laboratory services be a part of every phase of alert and response.Public health laboratories in many resource-constrained countries require financial and technical assistance to build their capacity. In recognition of this, in 2006, the American Society for Microbiology (ASM) established an International Laboratory Capacity Building Program, LabCap, housed under the ASM International Board. ASM LabCap utilizes ASM's vast resources and its membership's expertise-40,000 microbiologists worldwide-to strengthen clinical and public health laboratory systems in low and low-middle income countries. ASM LabCap's program activities align with HR(2005) by building the capability of resource-constrained countries to develop quality-assured, laboratory-based information which is critical to disease surveillance and the rapid detection of disease outbreaks, whether they stem from natural, deliberate or accidental causes.ASM LabCap helps build laboratory capacity under a cooperative agreement with the U.S. Centers for Disease Control and Prevention (CDC) and under a sub-contract with the Program for Appropriate Technology in Health (PATH) funded by the United States Agency for International Development (USAID). Successful activities of ASM LabCap have occurred throughout Africa, Asia, Central America and the Caribbean. In addition, ASM LabCap coordinates efforts with international agencies such as the WHO in order to maximize resources and ensure a unified response, with the intended goal to help build integrated disease surveillance and response capabilities worldwide in compliance with HR(2005)'s requirements.

Molecular assessment of the potential combination therapy of cytokines with biphalin and AZT for Friend leukemia virus infection in vitro.

Biphalin, a dimeric enkephalin analog, is under investigation as a potential, long-lasting medication of pain associated with chronic diseases, like cancer or AIDS. The role of cytokines, and splenocytes in anti-Friend leukemia virus (FLV) activity of biphalin, a synthetic opioid, and AZT was investigated in vitro. Mouse splenocytes inhibited FLV replication in Mus dunni (Dunni) cells when they were added to the cell culture. This inhibitory effect of splenocytes also was evident when cells were combined with biphalin and AZT as measured using a focus-forming assay. Under cell-free conditions, recombinant interferon gamma (IFNgamma), interleukin 2 (IL-2) and IL-4 directly inhibited the FLV reverse transcriptase (RT) activity by 27% to 36%. IFNgamma at 0.005 pg to 500 ng inhibited FLVRT activity by 61% to 80%. Acombination of 250 ng IFNgamma and 50 mug biphalin resulted in a 94% reduction of FLVRT activity, as compared with 61% inhibition by IFNgamma alone. The combination of AZT and IFNgamma, IL-2 or IL-4 also induced a stronger suppression of FLV RT activity than either cytokine or AZT used alone. In addition, cloned RT from Moloney murine leukemia virus (MMLV) was directly sensitive to inhibition by biphalin. Thus, the anti-FLV effects of splenocytes in combination with biphalin and AZT in cell culture are likely mediated to a large degree by the direct effect of cytokines. This antiviral activity of splenocytes or cytokines combined with chemotherapy, biphalin, and/or AZT, could be used as a complementary therapy to current approaches for retroviral infection and benefit acquired immunodeficiency syndrome (AIDS) patients. In conclusion, biphalin applied primarily as a new medicine for chronic pain treatment in AIDS patients may play a significant beneficial role as a component of antiviral HIV multidrug therapies.

Is medical student choice of a primary care residency influenced by debt?

CONTEXT: The average medical student accumulates more than $120,000 in debt upon graduation. OBJECTIVE: The purpose of this study was to investigate whether medical student debt affects residency choice. DESIGN: This was a cross-sectional research study. SETTING: This study was a 5-year analysis of student debt and residency choice for 2001-2005 graduates from 3 US medical schools (n = 2022): Tulane University School of Medicine, New Orleans, Louisiana; University of South Florida College of Medicine, Tampa, Florida; and Louisiana State University School of Medicine in New Orleans. MAIN OUTCOME MEASURES: Individual student data were collected from offices of financial aid for debt prior to and during medical school to determine total debt at graduation. Total debt (adjusted for inflation) was compared with residency match results coded according to specialties listed in the Graduate Medical Education Directory 2005-2006. Graduates were coded into either primary care (PC) or nonprimary care (NPC) specialty categories. Logistic regression for the choice of a PC residency was used with 4 predictors: (1) total debt, (2) medical school, (3) year of graduation, and (4) number of years of training required for a residency program. RESULTS: Mean total debt for the study population was $89,807 (SD = 54,925). Graduates entering PC did not have significantly less total debt than those entering NPC ($87,206 vs $91,430; P = .09). Further, total debt was not a predictor of a PC residency after adjusting for medical school, year of graduation, and years of training in residency (P = .64). CONCLUSION: There is no association between PC residency choice and debt. We conclude that medical students make residency decisions on the basis of a complex set of factors.

Gold Humanism Honor Society Election and Academic Outcomes: A 10-Institution Study.

BACKGROUND AND OBJECTIVES: This study examines relationships among election to the Gold Humanism Honor Society (GHHS) and election to Alpha Omega Alpha (AOA), class rank, and residency selection to determine if GHHS members are more likely to select primary care residencies than students not elected to GHHS membership. METHODS: We evaluated five graduating classes (2006--2010) at 10 medical schools (n=5,481 students). Residency selections were grouped into primary care (family medicine, internal medicine, pediatrics, OB-GYN), surgery (including surgical specialties), or E-ROAD and other (including lifestyle practices-emergency medicine, radiology, ophthalmology, anesthesiology, and dermatology plus all other specialties, eg, neurology, pathology). RESULTS: A higher proportion of GHHS members were attracted to primary care compared to non-GHHS members (54.3% versus 44.5%). Additional comparisons between GHHS and non-GHHS members demonstrated that 33.1% of GHHS members matched into E-ROAD and other residencies, while 40.9% of non-GHHS went into one of these specialties. Fewer GHHS members chose general surgery or a surgical sub-specialty (12.6% versus 14.6%). More GHHS members were elected into AOA (30.3% versus 14.0%). Further, a far greater proportion of dual AOA/GHHS members elect family medicine residency versus AOA members not elected to GHHS. In addition, GHHS members had slightly higher mean scores on USMLE Step 1 and 2 CK (Clinical Knowledge) and mean class rank. CONCLUSIONS: This study demonstrates that students elected into the GHHS as an aggregate group tend to be academically higher achieving when compared to their non-GHHS peers and gravitate to a higher degree toward primary care and specifically to family medicine.

Blood levels of TT virus following immune stimulation with influenza or hepatitis B vaccine.

Torque Teno virus (TTV) has been demonstrated to be present persistently in the blood of healthy individuals without evidence that it causes any disease process. The levels of TTV vary in patients co-infected with other viruses and there has been considerable speculation as to whether TTV contributes to pathogenesis by other viruses or if the varying levels might be related to immune activation in the host. In the present study, the load of TTV was examined in plasma and peripheral blood mononuclear cells (PBMCs) following immunization of subjects with either influenza (a recall antigen) or hepatitis B virus (HBV) (a new antigenic exposure). The results overall did not indicate a significant change in TTV titers over a 90 day observation period; however, when TTV genogroup was taken into consideration there was an increase in viral load in plasma at some time points for subjects persistently infected with genogroup 3. While this was observed in both influenza and HBV immunized subjects, the effect was more profound in HBV vaccination. Thus, it appears that exposure to a new antigen rather than a recall antigen may stimulate TTV replication more effectively. The data further suggest that investigating the interactions between TTV and its host might require to examine specifically each TTV genogroup separately in order to determine if certain TTV types have any role in disease pathogenesis.

Human metapneumovirus associated with respiratory tract infections in a 3-year study of nasal swabs from infants in Italy.

The newly described human metapneumovirus (hMPV) is reported here to be more commonly associated with lower respiratory tract disease. The present study examined nasal swab specimens from 90 infants with acute respiratory tract infections in Pisa, Italy, over a period of three respiratory virus seasons. The incidence of infection varied in each of the 3 years, with the rates of positivity for hMPV being 7% in 2001 but 37 and 43% in 2000 and 2002, respectively. hMPV was noted to occur seasonally in a pattern typical of the frequency of occurrence of respiratory syncytial virus. More than one-half (14 of 23) of the infants infected with hMPV had bronchopneumonia. One-third (9 of 23) of the hMPV-infected patients were also infected with another respiratory virus, a relationship that has not previously been reported. Mixed infections did not account for a higher percentage of cases of bronchopneumonia than hMPV infection alone did. Furthermore, 7 of 17 infants whose plasma was also tested for hMPV RNA were demonstrated to have virus in both nasal swab and blood specimens. The study indicates that hMPV is seen as commonly as other respiratory viruses, may be associated with severe respiratory disease in infants, can establish mixed infections with other respiratory viruses, and has a seasonal occurrence.

Relationship of TT virus and Helicobacter pylori infections in gastric tissues of patients with gastritis.

Blood and gastric tissue biopsies of 34 patients with gastritis were tested for the presence of TT virus (TTV), a ubiquitous virus found in the blood of most humans. Thirty-one of these patients were TTV positive, and 27 patients had virus in both tissues. In addition, 13 of the patients who had TTV in gastric tissue were Helicobacter pylori positive. There was an association of higher TTV titers in gastric tissues of patients who were H. pylori positive than in those in whom the bacterium could not be detected. Furthermore, this association was stronger in H. pylori-positive patients with the presence of the cagA protein. Of 10 specimens in which genogroup determination was carried out in the gastric corpus, 5/5 that were H. pylori positive showed the presence of TTV genogroup 3, while for those that were H. pylori negative, 5/5 showed the presence of genogroup 1t. By contrast, genogroup 1 was found in the corpus of only one H. pylori-positive patient, and genogroup 3 in only one H. pylori-negative patient. The histological severity of gastritis did correlate significantly with loads in the gastric tissues. There was no significant difference in TTV titer in blood of patients regardless of H. pylori infection status. These findings pique interest in clarifying the role of TTV, alone or in association with H. pylori infection, in the pathogenesis of gastritis.