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Biomedical subjects

L Slutsker

Publications and source records attributed to L Slutsker.

67 records · Page 4Linked to original sources
PubMed1992

Risks associated with cocaine use during pregnancy.

Prenatal cocaine use has become an increasingly important public health problem in the last decade. Interpretation of epidemiologic studies designed to assess the association between cocaine use and adverse pregnancy outcomes is limited by inaccurate measurement of cocaine use, misclassification of users as non-users, confounding by socioeconomic factors, and reporting bias. Studies have consistently documented placental abruption as a maternal reproductive risk associated with cocaine use. Although suggested, less evidence is available to link cocaine use with premature rupture of membranes, spontaneous abortion, pregnancy-induced hypertension, precipitate delivery, or fetal death. Infant outcomes consistently associated with prenatal cocaine use include decreased birth weight, prematurity, and decreased fetal growth. Data on the relationship between prenatal cocaine use and congenital anomalies are limited, but one large retrospective study has documented an association between maternal cocaine use and congenital abnormalities of the urinary tract. Evidence linking prenatal cocaine use and an increased incidence of perinatal cerebral infarction or sudden infant death syndrome is lacking. Future studies should focus on the effect of maternal cocaine use on pregnancy outcome in diverse socioeconomic groups, longitudinal follow-up of exposed children, and the relationship between cocaine use and maternal behaviors that may affect access to prenatal care.

Cocaine↗
PubMed1990

Eosinophilia-myalgia syndrome associated with exposure to tryptophan from a single manufacturer.

Although eosinophilia-myalgia syndrome has been linked to use of tryptophan, it has been unclear whether tryptophan itself or a contaminant causes illness. In Oregon, we compared the brand and source of tryptophan used by 58 patients with eosinophilia-myalgia syndrome with the brand and source of tryptophan used by 30 asymptomatic controls identified through a random telephone survey and 63 asymptomatic controls who contacted the Oregon Health Division voluntarily. Although a single brand/retail lot of tryptophan was statistically associated with the development of eosinophilia-myalgia syndrome, there was no common importer, wholesaler, tablet maker, encapsulator, or distributor. However, 45 (98%) of 46 cases had taken a product made by one manufacturer, compared with three (30%) of 10 telephone survey controls and 15 (48%) of 31 volunteer controls. Retail lots of tryptophan from this manufacturer that were associated with cases were significantly more likely to have been produced from January through June 1989 than lots from this manufacturer that were taken by controls. These findings indicate that the recent epidemic of eosinophilia-myalgia syndrome was caused by a contaminant or an alteration in a subset of tryptophan manufactured by a single company in Japan shortly before the outbreak began.

Adult↗
PubMedDate not supplied

A multistate outbreak of Escherichia coli O157:H7 infections associated with consumption of mesclun lettuce.

BACKGROUND: An outbreak of Escherichia coli O157:H7 infections in Connecticut and Illinois during May 28 to June 27, 1996, was investigated to determine the source of infections. METHODS: Independent case-control studies were performed in both states. Pulsed-field gel electrophoresis (PFGE) was performed on E. coli O157:H7 isolates. A case-patient was defined as a Connecticut or northern Illinois resident with diarrhea whose stool culture yielded E. coli O157:H7 of the outbreak-associated PFGE subtype. Controls were town-, age-, and sex-matched to case-patients. We traced implicated lettuce to the farm level and performed environmental investigations to identify unsafe lettuce production practices. RESULTS: In Connecticut and Illinois, infection was associated with consumption of mesclun lettuce (Connecticut matched odds ratio [MOR], undefined; 95% confidence interval [CI], 3.4 to infinity; and Illinois MOR, undefined; 95% CI, 1.4 to infinity). We traced implicated lettuce to a single grower-processor. Cattle, a known E. coli O157:H7 reservoir, were found near the lettuce fields. Escherichia coli (an indicator of fecal contamination) was cultured from wash water and finished lettuce. A trace-forward investigation identified 3 additional states that received implicated lettuce; E. coli O157:H7 isolates from patients in 1 of these states matched the outbreak-associated PFGE subtype. CONCLUSIONS: This multistate outbreak of E. coli O157:H7 infections was associated with consumption of mesclun lettuce from a single producer. Molecular subtyping facilitated the epidemiological investigation. This investigation increased the knowledge about current production practices that may contribute to the contamination of lettuce by microbial pathogens. Lettuce production practices should be monitored for microbiological safety.

Adolescent↗
PubMedDate not supplied

In-hospital morbidity and mortality due to malaria-associated severe anaemia in two areas of Malawi with different patterns of malaria infection.

We examined the relative contribution of malaria-associated severe anaemia (parasitaemia and haematocrit < or = 15%) to malaria-related morbidity and mortality among children admitted at 2 hospitals in areas with different seasonal patterns of malaria infection in Malawi. The prevalence of malaria-associated severe anaemia was 8.5% among admissions at the hospital in an area with sustained, year-round infection (Mangochi District Hospital [MDH]), compared to 5.2% at the hospital in an area with a fluctuating pattern of infection (Queen Elizabeth Central Hospital [QECH]). Infants at MDH were nearly twice as likely to have malaria-associated severe anaemia as were those at QECH. Parasite density on admission was not related to the risk of severe anaemia at MDH, but it was at QECH. A similar proportion of all deaths was attributed to malaria at MDH (17.5%) and QECH (20.4%). However, malaria-associated severe anaemia accounted for 54% of malaria-related deaths at MDH compared to only 32% at QECH. Malaria-associated severe anaemia contributed significantly to morbidity and mortality at both sites, but its impact was more marked in the area with a sustained pattern of infection. These findings suggest that seasonal fluctuations in malaria infection may contribute to differences in patterns of malaria disease.

Age Factors↗
PubMedDate not supplied

Haplotype analysis of CYP11B2.

Polymorphisms affecting the synthesis of aldosterone or its regulation may have effects on blood pressure. For example, an autosomal dominant form of human hypertension, glucocorticoid suppressible hyperaldosteronism, is caused by recombination between the genes for aldosterone synthase (CYP11B2) and steroid 11 beta-hydroxylase (CYP11B1), creating a chimeric gene in which the CYP11B1 promoter and CYP11B2-specific coding sequences are juxtaposed. Thus, aldosterone synthesis is improperly regulated. We have begun an analysis of the human CYP11B2 and CYP11B1 genes to see if frequent polymorphisms exist and if they are correlated with differences in blood pressure. We have found frequent polymorphisms in CYP11B2. One in the promoter influences binding of the transcriptional regulatory protein, SF-1. Another is a gene conversion in intron 2 so that most of the intron has a sequence corresponding to CYP11B1. These polymorphisms are in linkage disequilibrium, defining 3 haplotypes. Blacks and whites differ significantly (p < 0.001) in the frequency with which these haplotypes occur. Further studies are required to determine if the observed differences between blacks and whites in blood pressure and in aldosterone levels can be explained in part by these allelic differences in CYP11B2 or by other polymorphisms in linkage disequilibrium on these haplotypes.

Alleles↗
PubMedDate not supplied

Clinical, biochemical and genetic features of five extended kindred's with glucocorticoid-suppressible hyperaldosteronism.

Glucocorticoid-suppressible hyperaldosteronism (GSH) is an uncommon form of dominantly inherited hypertension caused by the inheritence of a chimaeric 11 beta-hydroxylase/aldosterone synthase gene. Affected individuals appear to have an increased risk of premature morbidity and mortality from stroke, but treatment with low doses of dexamethasone can completely reverse the biochemical and clinical features. We assessed the clinical and genetic features of 5 British kindreds with GSH, the largest collection outwith the United States, and determined the location of the crossover regions in the chimaeric gene of all 5 kindreds. All of the kindreds were of celtic origin, another feature peculiar to GSH. In total 19 out of 60 individuals screened by genotyping were found to possess the chimaeric gene and sequencing of the chimaeric gene revealed that all the crossover regions were within the exon 3- exon 4 region of, in keeping with previous studies, and three kindreds possessed indistinguishable chimaeric genes.

Chimera↗
PubMedDate not supplied

Using laboratory-based surveillance data for prevention: an algorithm for detecting Salmonella outbreaks.

By applying cumulative sums (CUSUM), a quality control method commonly used in manufacturing, we constructed a process for detecting unusual clusters among reported laboratory isolates of disease-causing organisms. We developed a computer algorithm based on minimal adjustments to the CUSUM method, which cumulates sums of the differences between frequencies of isolates and their expected means; we used the algorithm to identify outbreaks of Salmonella Enteritidis isolates reported in 1993. By comparing these detected outbreaks with known reported outbreaks, we estimated the sensitivity, specificity, and false-positive rate of the method. Sensitivity by state in which the outbreak was reported was 0%(0/1) to 100%. Specificity was 64% to 100%, and the false-positive rate was 0 to 1.

Algorithms↗
PubMedDate not supplied

Food-related illness and death in the United States.

To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.

Acute Disease↗
PubMedDate not supplied

Infections associated with eating seed sprouts: an international concern.

Recent outbreaks of Salmonella and Escherichia coli O157:H7 infections associated with raw seed sprouts have occurred in several countries. Subjective evaluations indicate that pathogens can exceed 107 per gram of sprouts produced from inoculated seeds during sprout production without adversely affecting appearance. Treating seeds and sprouts with chlorinated water or other disinfectants fails to eliminate the pathogens. A comprehensive approach based on good manufacturing practices and principles of hazard analysis and critical control points can reduce the risk of sprout-associated disease. Until effective measures to prevent sprout-associated illness are identified, persons who wish to reduce their risk of foodborne illness from raw sprouts are advised not to eat them; in particular, persons at high risk for severe complications of infections with Salmonella or E. coli O157:H7, such as the elderly, children, and those with compromised immune systems, should not eat raw sprouts.

Aged↗
PubMedDate not supplied

A multistate outbreak of Escherichia coli O157:H7 infections linked to alfalfa sprouts grown from contaminated seeds.

A multistate outbreak of Escherichia coli O157:H7 infections occurred in the United States in June and July 1997. Two concurrent outbreaks were investigated through independent case-control studies in Michigan and Virginia and by subtyping isolates with pulsed-field gel electrophoresis (PFGE). Isolates from 85 persons were indistinguishable by PFGE. Alfalfa sprouts were the only exposure associated with E. coli O157:H7 infection in both Michigan and Virginia. Seeds used for sprouting were traced back to one common lot harvested in Idaho. New subtyping tools such as PFGE used in this investigation are essential to link isolated infections to a single outbreak.

Adolescent↗
PubMedDate not supplied

A multistate outbreak of Salmonella enterica serotype Baildon associated with domestic raw tomatoes.

Salmonella enterica serotype Baildon, a rare serotype, was recovered from 86 persons in eight states; 87% of illnesses began during a 3-week period ending January 9, 1999. Raw restaurant-prepared tomatoes were implicated in multiple case-control studies. Contamination likely occurred on the farm or during packing; more effective disinfection and prevention strategies are needed.

Adolescent↗