Robert S Holzman, M.D.

Virologic Outcome of Using Tenofovir/Emtricitabine to Treat Hepatitis B in HIV-Coinfected Patients
Engell, Christian A; Pham, Vinh Philip; Holzman, Robert S; Aberg, Judith A
2011 ;2011:405390-405390, ISRN gastroenterology
Goal. To study the effect of combination antiviral therapy with tenofovir and emtricitabine or lamivudine with and without prior monotherapy with lamivudine. Study. We reviewed charts of 31 HIV-/HBV-coinfected patients. Twelve 3TC-naive patients initially received tenofovir plus emtricitabine. Nineteen epivir experienced patients who had previously failed epivir were given tenofovir plus emtricitabine. Results. Baseline median HBV DNA was similar in the epivir-naive (5.8x10(7) copies/mL) and experienced group (7.3x10(7) copies/mL, P = .65). The median time to complete suppression of HBV was 466 days in the naive group and 877 days in the experienced (P = .001). After 12 months, 6/10 (60%) naive patients and 3/14 (21%) experienced patients had HBV DNA below the detectionlimit (P = .067). After 24 months, 5/5 (100%) naive patients and 4/13 (31%) experienced patients had an undetectable HBV DNA level (P = .015). Conclusions. The median time to suppression of HBV DNA was significantly shorter among treatment naive patients. There was a significantly greater proportion of naive patients with suppressed HBV DNA at 24 months. Our results support using initial dual therapy in those with HIV/HBV coinfection
— id: 138717, year: 2011, vol: 2011, page: 405390, stat: Journal Article,

Sex differences in the incidence of peripheral neuropathy among kenyans initiating antiretroviral therapy
Mehta, Sapna A; Ahmed, Aabid; Laverty, Maura; Holzman, Robert S; Valentine, Fred; Sivapalasingam, Sumathi
2011 Sep;53(5):490-496, Clinical infectious diseases
Background. Peripheral neuropathy (PN) is common among patients receiving antiretroviral therapy (ART) in resource-limited settings. We report the incidence of and risk factors for PN among human immunodeficiency virus (HIV)-infected Kenyan adults initiating ART. Methods. An inception cohort was formed of adults initiating ART. They were screened for PN at baseline and every 3 months for 1 year. We used the validated Brief Peripheral Neuropathy Screen (BPNS) that includes symptoms and signs (vibration perception and ankle reflexes) of PN. Results. Twenty-two (11%) of 199 patients had PN at baseline screening. One hundred fifty patients without evidence of PN at baseline were followed for a median of 366 days (interquartile range, 351-399). The incidence of PN was 11.9 per 100 person-years (95% confidence interval [CI], 6.9-19.1) and was higher in women than men (17.7 vs 1.9 per 100 person-years; rate ratio, 9.6; 95% CI, 1.27-72, P = .03). In stratified analyses, female sex remained statistically significant after adjustment for each of the following variables: age, CD4 cell count, body mass index, ART regimen, and tuberculosis treatment. Stratifying hemoglobin levels decreased the hazard ratio from 9.6 to 7.40 (P = .05), with higher levels corresponding to a lower risk of PN. Conclusions. HIV-infected Kenyan women were almost 10 times more likely than men to develop PN in the first year of ART. The risk decreased slightly at higher hemoglobin levels. Preventing or treating anemia in women before ART initiation and implementing BPNS during the first year of ART, the period of highest risk, could ameliorate the risk of PN
— id: 136612, year: 2011, vol: 53, page: 490, stat: Journal Article,

Awareness of post-exposure HIV prophylaxis in high-risk men who have sex with men in New York City
Mehta, Sapna A; Silvera, Richard; Bernstein, Kyle; Holzman, Robert S; Aberg, Judith A; Daskalakis, Demetre C
2011 Jun;87(4):344-348, Sexually transmitted infections
Objectives To understand the factors associated with knowledge of non-occupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP), bathhouse patrons in New York City (NYC) were surveyed. Methods 554 men who have sex with men (MSM) at two NYC bathhouses were given a standardised survey focused on nPEP and PrEP at the time of HIV testing. Results In the previous 90 days, 63% of respondents reported unprotected sex with a male partner and 7% reported any sex with a known HIV-positive male partner. Less than half reported having a primary provider (primary care practitioner) who was aware of their MSM behaviour. 201 men (36%) were aware of nPEP or PrEP. In univariate analyses, race/ethnicity, previous HIV testing, gay self-identification, higher education level, having a primary provider aware of MSM behaviour, reported interaction with the healthcare system, use of the internet for meeting sex partners, reporting unprotected sex in the previous 90 days, reporting any sex with an HIV-positive male partner in the previous 90 days and having a higher number of sex partners were each significantly associated with being aware of nPEP or PrEP. In multivariate analysis, having a higher number of sex partners was significantly associated (OR 5.10, p=0.02) with post-exposure prophylaxis (PEP)/PrEP knowledge and disclosure to a primary care provider was also associated, although less robustly (OR 2.10, p=0.06). Conclusions Knowledge of nPEP or PrEP among sexually active MSM in NYC is low and is associated with having a primary provider aware of their patient's same-sex behaviours. These findings show the need for improving education about nPEP among high-risk MSM in NYC and the role of providers in these efforts
— id: 132706, year: 2011, vol: 87, page: 344, stat: Journal Article,

Implementation of a validated peripheral neuropathy screening tool in patients receiving antiretroviral therapy in mombasa, kenya
Mehta, Sapna A; Ahmed, Aabid; Kariuki, Beatrice W; Said, Swaleh; Omasete, Fanuel; Mendillo, Megan; Laverty, Maura; Holzman, Robert; Valentine, Fred; Sivapalasingam, Sumathi
2010 Sep;83(3):565-570, American journal of tropical medicine & hygiene
Limited objective data are available for the prevalence of peripheral neuropathy (PN) among antiretroviral (ART)-treated human immunodeficiency virus (HIV)-infected patients in resource-limited settings. A validated neuropathy-screening tool was integrated into routine ART visits at an HIV clinic in Mombasa, Kenya. Diagnosis of PN required at least one symptom and either abnormal vibratory sensation or deep tendon reflex bilaterally. Among 102 consecutively screened patients, 63% were women, 62% were receiving ART for </= 1 year, and 86% were receiving a stavudine (D4T)-based regimen. Thirty-seven (36%) had PN. Univariate analysis showed that current D4T use was protective against PN (P = 0.03) and older age was a marginal risk factor (P = 0.05). Multivariate analysis showed that older age was a risk factor for neuropathy (P = 0.04). Peripheral neuropathy was common, particularly among older HIV-infected adults in Kenya. The protective association with current D4T use likely represents survivor effect bias. Longitudinal studies using this screen will help further characterize PN in resource-limited settings
— id: 112054, year: 2010, vol: 83, page: 565, stat: Journal Article,

Mutations in agr do not persist in natural populations of methicillin-resistant Staphylococcus aureus
Shopsin, Bo; Eaton, Christian; Wasserman, Gregory A; Mathema, Barun; Adhikari, Rajan P; Agolory, Simon; Altman, Deena R; Holzman, Robert S; Kreiswirth, Barry N; Novick, Richard P
2010 Nov 15;202(10):1593-1599, Journal of infectious diseases
Staphylococcus aureus organisms vary in the function of the staphylococcal virulence regulator gene agr. To test for a relationship between agr and transmission in S. aureus, we determined the prevalence and genetic basis of agr dysfunction among nosocomial methicillin-resistant S. aureus (MRSA) in an area of MRSA endemicity. Identical inactivating agr mutations were not detected in epidemiologically unlinked clones within or between hospitals. Additionally, most agr mutants had single mutations, indicating that they were short lived. Collectively, the results suggest that agr dysfunction is adaptive for survival in the infected host but that it may be counteradaptive outside infected host tissues
— id: 113948, year: 2010, vol: 202, page: 1593, stat: Journal Article,

Multidrug-resistant Acinetobacter baumannii in New York City - 10 years into the epidemic
Morgan, Daniel J; Weisenberg, Scott A; Augenbraun, Michael H; Calfee, David P; Currie, Brian P; Furuya, E Yoko; Holzman, Robert; Montecalvo, Marisa C; Phillips, Michael; Polsky, Bruce; Sepkowitz, Kent A
2009 Feb;30(2):196-197, Infection control & hospital epidemiology
— id: 133672, year: 2009, vol: 30, page: 196, stat: Journal Article,

Monitoring virologic responses to antiretroviral therapy in HIV-infected adults in Kenya: evaluation of a low-cost viral load assay
Sivapalasingam, Sumathi; Wangechi, Beatrice; Marshed, Fatuma; Laverty, Maura; Essajee, Shaffiq; Holzman, Robert S; Valentine, Fred
2009 ;4(8):e6828-e6828, PLoS ONE
BACKGROUND: A key advantage of monitoring HIV viral load (VL) in persons receiving antiretroviral therapy (ART) is the ability to detect virologic failure before clinical deterioration or resistance occurs. Detection of virologic failure will help clarify the need for enhanced adherence counseling or a change to second- line therapy. Low-cost, locally performable alternates to expensive VL assays are needed where resources are limited. METHODOLOGY/PRINCIPAL FINDINGS: We monitored the response to 48-week ART in 100 treatment-naive Kenyan adults using a low-cost VL measurement, the Cavidi reverse transcriptase (RT) assay and gold-standard assays, Roche RNA PCR and Bayer Versant HIV-1 RNA (bDNA) assays. In Altman-Bland plots, the mean difference in viral loads between the three assays was small (<0.5 log(10) copies/mL). However, the limits of agreement between the methods exceeded the biologically relevant change of 0.5 log copies/ml. Therefore, the RT assay cannot be used interchangeably with the other assays to monitor individual patients. The RT assay was 100% sensitive in detecting viral loads of > or =400 copies/ml compared to gold-standard assays. After 24 weeks of treatment, viral load measured by the RT assay was undetectable in 95% of 65 patients with undetectable RNA PCR VL (<400 copies/ml), 90% of 67 patients with undetectable bDNA VL, and 96% of 57 patients with undetectable VL in both RNA PCR and bDNA assays. The negative predictive value of the RT assay was 100% compared to either assay; the positive predictive value was 86% compared to RNA PCR and 70% compared to bDNA. CONCLUSION: The RT assay compared well with gold standard assays. Our study highlights the importance of not interchanging viral load assays when monitoring an individual patient. Furthermore, the RT assay may be limited by low positive predictive values when used in populations with low prevalence of virologic failure
— id: 101963, year: 2009, vol: 4, page: e6828, stat: Journal Article,

Differences in clinical presentation among persons with pulmonary tuberculosis: a comparison of documented and undocumented foreign-born versus US-born persons
Achkar, Jacqueline M; Sherpa, Tsering; Cohen, Hillel W; Holzman, Robert S
2008 Nov 15;47(10):1277-1283, Clinical infectious diseases
BACKGROUND: Most cases of tuberculosis (TB) in the United States are diagnosed in foreign-born persons, and undocumented foreign-born persons may face particular barriers to timely access to health care services. This study investigates whether differences in clinical presentations among persons with pulmonary TB are associated with foreign birth or documentation status. METHODS: In this cross-sectional study, we reviewed the medical records of patients who had received a diagnosis of microbiologically proven pulmonary TB at a New York City public hospital during the period April 1999 through March 2005. Three groups of patients with pulmonary TB (US-born persons, foreign-born persons with documents, and undocumented, foreign-born persons) were defined and compared at presentation. Odds ratios (ORs) for a symptom duration >or=8 weeks before hospital admission for each group were estimated using logistic regression. RESULTS: Among 194 subjects with newly diagnosed pulmonary TB, 61 (31%) were US born, 62 (32%) were documented foreign-born persons, and 71 (37%) were undocumented foreign-born persons. Undocumented foreign-born persons presented with significantly higher frequencies of cough (P = .020) and hemoptysis P = .012 and had a significantly longer median duration of symptoms, compared with US-born persons (8 vs. 4 weeks; P = .023). No statistically significant differences between documented foreign-born and US-born persons were observed. Multivariate analysis revealed that undocumented status (compared with being US born; adjusted OR, 4.1; 95% confidence interval, 1.7-10.2; P = .0002) and being unemployed (adjusted OR, 2.2; 95% CI, 1.1-4.5; P = .023) were independently associated with a prolonged symptom duration (i.e., >or=8 weeks). CONCLUSIONS: Undocumented status was associated with an increased frequency of cough and hemoptysis and a longer duration of symptoms before medical evaluation for pulmonary TB. Whether reducing barriers to health services for undocumented foreign-born persons could enhance TB control deserves additional study
— id: 96666, year: 2008, vol: 47, page: 1277, stat: Journal Article,

S-adenosylmethionine levels in the diagnosis of Pneumocystis carinii pneumonia in patients with HIV infection
Skelly, Michael J; Holzman, Robert S; Merali, Salim
2008 Feb 1;46(3):467-471, Clinical infectious diseases
BACKGROUND: S-adenosylmethionine (AdoMet) is a key molecule involved in methylation reactions and polyamine synthesis. Pneumocystis carinii are unable to synthesize this molecule and have been shown to scavenge this metabolic intermediate from the plasma of rats during active infection. A prior study involving humans strongly suggested that low levels of plasma AdoMet are sensitive and specific indicators of acute infection. METHODS: From March 2004 through January 2006, we collected plasma AdoMet levels from patients with human immunodeficiency virus (HIV) infection and either confirmed Pneumocystis carinii pneumonia (PCP), confirmed pulmonary tuberculosis, or confirmed bacterial pneumonia. We compared levels in patients with PCP with those in patients with other diseases and also monitored changes in levels during treatment of PCP. RESULTS: Initial AdoMet levels were significantly lower in patients with PCP, and there was no overlap between the groups. Among patients with PCP, levels of AdoMet increased with successful treatment. CONCLUSIONS: Measurement of plasma AdoMet levels in patients with HIV infection who have pulmonary infections can identify those with PCP
— id: 96667, year: 2008, vol: 46, page: 467, stat: Journal Article,

Risk factors associated with postcraniotomy meningitis
Kourbeti, Irene S; Jacobs, Anke V; Koslow, Maxim; Karabetsos, Dimitris; Holzman, Robert S
2007 Feb;60(2):317-325, Neurosurgery
OBJECTIVE: The authors conducted a retrospective cohort study to determine the incidence, bacteriological features, and risk factors for postcraniotomy meningitis. METHODS: Patients older than 18 years who underwent nonstereotactic craniotomies between January 1996 and March 2000 and who survived for more than 7 days were included. Operations for placement of burr holes and shunts were excluded. Records of the first 30 postoperative days were abstracted. Host factors, types of craniotomy, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS: Among 453 patients, there were 25 cases of meningitis. Eight out of 12 culture-positive cases were the result of gram-positive cocci. Four hundred twenty (92%) patients received antibiotic prophylaxis, most commonly a first-generation cephalosporin. In multivariate analysis, the risk of meningitis was increased by surgery that entered a sinus (odds ratio [OR], 4.49; P = 0.018), an increase in the American Society of Anesthesiologists score (OR, 1.72; P = 0.023), and increases in the number of days of external ventricular drainage (OR, 1.21; P = 0.049) and intracranial pressure monitoring (OR, 1.24; P = 0.002). CONCLUSION: Access of upper airway bacteria to the surgical wound, host factors as expressed by the American Society of Anesthesiologists score, and duration of device-related postoperative communication of the cerebrospinal fluid and the environment are major risk factors for postoperative meningitis after craniotomy
— id: 95742, year: 2007, vol: 60, page: 317, stat: Journal Article,

Mycobacterium tuberculosis malate synthase- and MPT51-based serodiagnostic assay as an adjunct to rapid identification of pulmonary tuberculosis
Achkar, Jacqueline M; Dong, Yuxin; Holzman, Robert S; Belisle, John; Kourbeti, Irene S; Sherpa, Tsering; Condos, Rany; Rom, William N; Laal, Suman
2006 Nov;13(11):1291-1293, Clinical & vaccine immunology
The 81-kDa malate synthase (MS; Rv 1837c) and the 27-kDa MPT51 (Rv 3803c) of Mycobacterium tuberculosis are immunodominant antigens recognized by serum antibodies from approximately 80% of human immunodeficiency virus-negative smear-positive tuberculosis patients from India. We now provide evidence that the use of the MS/MPT51-based serodiagnostic assay can serve as an adjunct to sputum microscopy in the rapid diagnosis of pulmonary tuberculosis
— id: 70310, year: 2006, vol: 13, page: 1291, stat: Journal Article,

Regional anesthesia for a parturient with venous sinus thrombosis and placental abruption undergoing fractional heparin therapy
Holzman, Robert S; Bessim, Sibel
2006 Aug;105(2):423-424, Anesthesiology
— id: 96668, year: 2006, vol: 105, page: 423, stat: Journal Article,

Air embolism during intraoperative endoscopic localization and surgical resection for blue rubber bleb nevus syndrome
Holzman, Robert S; Yoo, Lisa; Fox, Victor L; Fishman, Steven J
2005 Jun;102(6):1279-1280, Anesthesiology
— id: 96669, year: 2005, vol: 102, page: 1279, stat: Journal Article,

Seroprevalence of Helicobacter pylori in New York City populations originating in East Asia
Perez-Perez, Guillermo Ignacio; Olivares, Asalia Zuni; Foo, F Yeong; Foo, Sun; Neusy, Andre J; Ng, Christopher; Holzman, Robert S; Marmor, Michael; Blaser, Martin J
2005 Sep;82(3):510-516, Journal of urban health
Helicobacter pylori prevalence is higher in developing countries than in industrialized countries, and within the latter, higher among immigrants than among nativeborn residents. Using a point-prevalence survey, we sought to identify risk factors for H. pylori seropositivity in US urban East Asian-born populations. At a clinic in New York City, we consecutively enrolled 194 East Asian-born adults, who then responded to a survey and provided a blood sample. Assays were performed to detect IgG antibodies against whole cell (WC) and cytotoxin associated gene A (CagA) antigens of H. pylori. For this group (mean age 50.2+/-14.7 years), the mean period of residence in the United States was 11.9+/-7.7 years. The total H. pylori seroprevalence was 70.1%, with highest (81.4%) in Fujianese immigrants. Multiple logistic regression analysis indicated an independent association of H. pylori seropositivity with Fujianese origin [odds ratios (OR) =2.3, 95% confidence interval (95% CI) =1.05-5.0] and inverse associations with period in the United States (OR per year of residency in the United States =0.95, 95% CI =0.91-0.99) and with a history of dyspepsia (OR for a history of stomach pain =0.52, 95% CI =0.3-1.0). We conclude that H. pylori is highly prevalent among recent East Asian immigrants, especially among Fujianese. The protective effects of history of dyspepsia and duration in the United States suggest that these may be markers for antibiotic therapies.
— id: 58190, year: 2005, vol: 82, page: 510, stat: Journal Article,

Tuberculosis of the brain, mennges, and spinal cord
Henry M; Holzman RS
Tuberculosis Philadelphia : Lippincott Williams & Wilkins, 2004,
— id: 3970, year: 2004, vol: , page: 445, stat: Chapter,

Iatrogenic hyperthermia during cardiac magnetic resonance imaging
Kussman, Barry D; Mulkern, Robert V; Holzman, Robert S
2004 Oct;99(4):1053-5, table of contents, Anesthesia & analgesia
We report the occurrence of accidental hyperthermia in a young child undergoing anesthesia for cardiac magnetic resonance imaging. Although the tendency during anesthesia is to develop hypothermia, the absorbed radiofrequency energy from magnetic resonance scanning is added to metabolic energy and must be balanced by appropriate heat loss to maintain normothermia. In addition to stressing the clinical importance of temperature monitoring, this report suggests that the recommended specific absorption rates to prevent excessive patient heating may need to be revised for infants and young children
— id: 96670, year: 2004, vol: 99, page: 1053, stat: Journal Article,

Bioterrorism and children: unique concerns with infection control and vaccination
Leissner, Kay B; Holzman, Robert S; McCann, Mary Ellen
2004 Sep;22(3):563-77, viii, Anesthesiology clinics of North America
Treatment of child victims of a bioterrorism attack is complicated because they may be more vulnerable to the agents used and may suffer more complications from the treatment strategies. Isolation and other infection control measures can be psychologically harmful to young children and may require that they undergo sedation. Most of the recommended antibiotics and antiviral treatments for bioterror agents have not been approved for use in children, and children undergoing smallpox vaccination have a higher incidence of complications than adults. Pediatric anesthesiologists should expect to be part of the pediatric care team and must be careful to observe infection control procedures to limit the spread of disease caused by bioterror attack
— id: 96671, year: 2004, vol: 22, page: 563, stat: Journal Article,

Awake caudal anesthesia for inguinal surgery in one conjoined twin
Seefelder, Christian; Hill, David R; Shamberger, Robert C; Holzman, Robert S
2003 Feb;96(2):412-3, table of contents, Anesthesia & analgesia
— id: 96672, year: 2003, vol: 96, page: 412, stat: Journal Article,

S-adenosylmethionine concentrations in diagnosis of Pneumocystis carinii pneumonia
Skelly, Michael; Hoffman, Julie; Fabbri, Marilyn; Holzman, Robert S; Clarkson, Allen B Jr; Merali, Salim
2003 Apr 12;361(9365):1267-1268, Lancet
Pneumocystis carinii is unable to synthesise S-adenosylmethionine and thus scavenges this intermediate. We aimed to test whether measurement of concentrations of this metabolic intermediate in plasma could provide a new method for rapid diagnosis of Pneumocystis carinii pneumonia (PCP). We measured S-adenosylmethionine plasma concentrations in 12 healthy controls, 16 patients with confirmed or suspected PCP, and 36 patients with other infections. Median concentration in healthy controls was 106 nmol/L (range 86-128), but the protein was undetectable in eight patients with histologically proven and seven with suspected PCP, and was 8 nmol/L in another confirmed case (p<0.0001). In 36 patients with other infections, S-adenosylmethionine concentrations were much the same as in controls: 18 had bacterial pneumonia, two tuberculosis, five cryptococcal meningitis, three had other infections, and eight had asymptomatic HIV-1 infection. After treatment for PCP, S-adenosylmethionine concentrations rose rapidly in all but one patient who died of the disease. Measurement of plasma S-adenosylmethionine concentrations could prove useful for diagnosis of PCP and assessment of patients' response to treatment
— id: 34384, year: 2003, vol: 361, page: 1267, stat: Journal Article,

Uncertainty by choice: anesthesia and the children of night
Holzman, Robert S
2002 Feb;14(1):46-51, Journal of clinical anesthesia
Anesthesiologists sometimes have difficulty discussing uncertainties with patients. The widespread and deeply visceral uncertainty about sleep, dreams, and death--the daily terrain of the anesthesiologist--has its roots in the classical representations of these states as siblings, the children of the goddess Night. The symbolism of mythology can guide the practitioner by recognizing, through allegory, the range of our own and our patients' fears
— id: 96674, year: 2002, vol: 14, page: 46, stat: Journal Article,

Unilateral Horner's syndrome and brachial plexus anesthesia during lumbar epidural blockade
Holzman, Robert S
2002 Sep;14(6):464-466, Journal of clinical anesthesia
Horner's syndrome is a rare side effect of epidural analgesia. In association with ipsilateral brachial plexus block, it has only been reported once before, in French. Unilateral blockade has also been reported, although its etiology is unclear and may be multifactorial. The patient described here experienced an asymmetrical epidural blockade with a unilateral Horner's syndrome and ipsilateral brachial plexus block
— id: 96673, year: 2002, vol: 14, page: 464, stat: Journal Article,

Evolution and current use of the tuberculin test
Lee, Elsie; Holzman, Robert S
2002 Feb 1;34(3):365-370, Clinical infectious diseases
Since it was first introduced in the late 1800s, the tuberculin test has undergone continual refinement in its formulation, standardization, and dosage, as well as its interpretation and indications for use. New guidelines have replaced universal screening with targeted testing and rigid definitions of positivity with individualized criteria formulated from a Bayesian approach. This review summarizes the evolution of the test and provides information to help gauge its predictive value
— id: 39733, year: 2002, vol: 34, page: 365, stat: Journal Article,

Screening for infection and disease as a tuberculosis control measure among indigents in New York City, 1994-1997
Schluger NW; Huberman R; Holzman R; Rom WN; Cohen DI
1999 Apr;3(4):281-286, International journal of tuberculosis & lung disease
SETTING: Several social service agencies in New York City, and the Chest Clinic of Bellevue Hospital, a large public hospital. OBJECTIVE: To determine the utility of screening as a preventive and control measure among persons at risk for tuberculosis. DESIGN: Persons seeking social services at several private agencies in New York City were screened, and those with a positive skin test or symptoms suggestive of active tuberculosis were referred to the Chest Clinic for evaluation. RESULTS: Of 3828 persons evaluated, 20 had active tuberculosis, and 33% of the screened cohort were tuberculin skin test positive. Of 466 persons with tuberculosis infection who were evaluated, only 55 persons were given isoniazid (INH), and only 20 completed preventive therapy. Most patients who were not given INH had taken it previously, were older than 35 years, or had continuing alcohol use which made physicians reluctant to prescribe isoniazid. CONCLUSION: Screening for tuberculosis may detect a significant number of cases of active disease when the background prevalence of the disease is very high. However, screening for infection as a means to prevent future cases is unlikely to be effective unless rates of administration and completion of isoniazid preventive therapy are increased
— id: 6091, year: 1999, vol: 3, page: 281, stat: Journal Article,

Lymphocyte-proliferative responses to HIV antigens as a potential measure of immunological reconstitution in HIV disease
Valentine FT; Paolino A; Saito A; Holzman RS
1998 Jun;14 Suppl 2:S161-S166, AIDS research & human retroviruses
Lymphocyte-proliferative responses (LPRs) to HIV antigens are absent or of low magnitude in the majority of HIV-infected individuals, even early in the disease. However, lymphocytes from 2% to 3% of individuals proliferate very strongly to HIV Env or Gag antigens, and these individuals remain well clinically, without antiretroviral therapy. In established HIV infection, suppression of HIV-replication with potent antiretroviral therapy does not result in the development of strong LPRs to HIV antigens. Large LPRs to HIV antigens can be induced by HIV vaccines in patients with established infection, even though they were not formed in response to infection. Studies must be designed to determine whether large LPRs induced by vaccines administered in conjunction with potent antiretroviral therapy are associated with long-term control of HIV infection
— id: 7836, year: 1998, vol: 14 Suppl 2, page: S161, stat: Journal Article,

Tuberculosis infection and disease among persons seeking social services in New York City
Schluger NW; Huberman R; Wolinsky N; Dooley R; Rom WN; Holzman RS
1997 Feb;1(1):31-37, International journal of tuberculosis & lung disease
SETTING: A large public hospital in New York City. OBJECTIVE: To determine the prevalence of tuberculosis infection and disease in a cohort of indigent persons in New York. DESIGN: Persons seeking social services at any of five community-based organizations in New York City were screened for tuberculosis infection using tuberculin skin testing and a symptom questionnaire. Skin test or symptom positive persons were referred to the Bellevue Hospital Chest Clinic for a chest radiograph and medical evaluation. After this evaluation, patients were classified into a diagnostic category (e.g. tuberculosis infection, tuberculosis disease, no evidence of tuberculosis infection or disease). RESULTS: Of 651 persons screened, 591 (91%) completed the initial evaluation. The tuberculosis infection prevalence for the entire cohort was 41% (95% Confidence Interval [CI], 37% to 45%). Risk factors for infection included residence in a congregate setting, drug use, and birth outside the United States. Human immunodeficiency virus (HIV) infection was not a risk factor for infection. Eleven cases of active tuberculosis were also detected (disease prevalence of 1.7%, 95% CI, 0.85% to 3%). Most of the patients with active tuberculosis had documented HIV infection or clear risk factors for HIV. CONCLUSION: We conclude that tuberculosis infection and disease remain common in populations characterized by poor housing conditions, drug use, and HIV infection. Linking a major medical provider with community-based organizations is an effective means to provide highly targeted screening services to a population at serious risk for disease acquisition and transmission
— id: 12178, year: 1997, vol: 1, page: 31, stat: Journal Article,

Cryptococcal choroiditis in a patient with AIDS: case report and review
Gandhi SA; McMeeking AA; Friedberg D; Holzman RS
1996 Nov;23(5):1193-1194, Clinical infectious diseases
— id: 12495, year: 1996, vol: 23, page: 1193, stat: Journal Article,

Cutaneous tuberculous chest wall abscess as an AIDS-defining illness
Gandhi, SA; Holzman, RS; Gulick, R
1996 NOV ;5(8):504-505, Infectious diseases in clinical practice
— id: 52704, year: 1996, vol: 5, page: 504, stat: Journal Article,

Infection by M. avium-intracellulare complex in the Acquired Immunodeficiency Syndrome
Holzman, Robert S
Tuberculosis Boston : Little Brown, 1996,
— id: 4851, year: 1996, vol: , page: ?, stat: Chapter,

Suspected diphtheria in an Uzbek national: isolation of Corynebacterium pseudodiphtheriticum resulted in a false-positive presumptive diagnosis
Santos MR; Gandhi S; Vogler M; Hanna BA; Holzman RS
1996 Apr;22(4):735-735, Clinical infectious diseases
— id: 12630, year: 1996, vol: 22, page: 735, stat: Journal Article,

Evolution of phenotypic memory T cells in HIV-1 infected infants and children
Borkowsky W; Moore T; Krasinski K; Ajuang-Simbiri KO; Holzman R
1992 Jun;63(3):280-284, Clinical immunology & immunopathology
Infants are reported to be devoid of memory T cells at birth but acquired them with time. A cross-sectional study of peripheral blood mononuclear cells from HIV-infected and uninfected infants and children that bear the CD4R0 antigen was undertaken to describe the development of memory T cells. Linear regression lines derived from the data revealed increasing percentages of memory CD4 and CD8 cells in the uninfected children. Memory CD4 cells in the infected children were detected at a frequency equal to or greater than that seen in uninfected children until 6 months of age but subsequently declined with age. In contrast, memory CD8 cells were found to be significantly increased in HIV-infected children early in life with a rate of increase similar to that seen in the uninfected population. This increase in memory CD8 cells may facilitate the early diagnosis of HIV infection
— id: 13589, year: 1992, vol: 63, page: 280, stat: Journal Article,

Listeriosis in patients with HIV infection: clinical manifestations and response to therapy
Kales, C P; Holzman, R S
1990 ;3(2):139-143, Journal of acquired immune deficiency syndrome
Although listeriosis is an uncommon infection in patients with human immunodeficiency virus (HIV) infection, the frequency of listeriosis in New York City has increased because of the increase in the number of HIV-infected patients. The medical records of 30 patients admitted to three medical centers in New York City from 1981 to 1988 with infections due to Listeria monocytogenes were reviewed. Six patients had AIDS, one was seropositive and asymptomatic, and four had risk factors for HIV infection. While the annual number of cases of listeriosis in patients without risk factors for HIV infection was constant, 9 of the 11 patients with AIDS or with risk factors for HIV infection presented with listeriosis between 1985 and 1988, the last half of the survey period. These patients were male homosexuals or intravenous drug abusers, and all but one were black or Hispanic. Manifestations of listeriosis in patients with AIDS or with risk factors for HIV infection included bacteremia without apparent source in seven, meningitis in three, and endocarditis in one, syndromes that were similar to those in patients without risk factors for HIV infection. Ten of 11 patients were treated with penicillin or ampicillin, and 7 were also given an aminoglycoside. All patients responded well to therapy and no relapses were observed. Physicians should include antibiotics effective against L. monocytogenes when treating AIDS patients with meningitis of unknown origin and consider the diagnosis of listeriosis in patients with sepsis of unknown origin
— id: 135291, year: 1990, vol: 3, page: 139, stat: Journal Article,

Screening for respiratory syncytial virus and assignment to a cohort at admission to reduce nosocomial transmission
Krasinski K; LaCouture R; Holzman RS; Waithe E; Bonk S; Hanna B
1990 Jun;116(6):894-898, Journal of pediatrics
To limit nosocomial spread of respiratory syncytial virus (RSV) infection, a longitudinal intervention trial was instituted. Nasal secretions or washes were screened for RSV antigen by enzyme-linked immunosorbent assay, and patients were assigned to an RSV-infected or an RSV-uninfected cohort. The baseline (preintervention) rate of 7.17 nosocomial cases of RSV per 1000 patient-days of care was used for comparison. Despite continued infections in the community after screening was initiated, there were no cases of RSV infection in 1880 patient-days of care for 3 months (p = 0.039). During the fourth month, an RSV-infected child was erroneously assigned to the RSV-uninfected cohort, and three nosocomial cases occurred--5.33/1000 patient-days of care (p = 0.286). Overall, there were three nosocomial RSV infections in 2443 patient-days of care in the 1987 season after screening was introduced--1.23/1000 patient-days of care (p = 0.026). In the subsequent RSV season, there was one nosocomial case--0.461/1000 patient-days of care for 3 months (p = 0.0074). During the same period, nosocomial cases of RSV were observed in the pediatric and neonatal intensive care units, where assignment to a cohort was not possible. We conclude that entry into a cohort at the time of admission, on the basis of prospective RSV screening by enzyme-linked immunosorbent assay, effectively reduces nosocomial transmission of RSV
— id: 15069, year: 1990, vol: 116, page: 894, stat: Journal Article,

A controlled trial of bovine dialyzable leukocyte extract for cryptosporidiosis in patients with AIDS
McMeeking A; Borkowsky W; Klesius PH; Bonk S; Holzman RS; Lawrence HS
1990 Jan;161(1):108-112, Journal of infectious diseases
Cryptosporidial infection causes severe diarrheal disease in patients with AIDS. Fourteen patients with AIDS and symptomatic cryptosporidiosis were treated with a specific bovine dialyzable leukocyte extract (immune DLE) prepared from lymph node lymphocytes of calves immunized with cryptosporidia or a nonspecific (nonimmune) DLE prepared from nonimmunized calves. Six of 7 patients given immune DLE gained weight and had a decrease in bowel movement frequency, with eradication of oocysts from stool in 5 patients. Six of 7 patients given nonimmune DLE showed no decrease in bowel movement and 4, no clearing of oocytes from stool; 5 continued to lose weight. Subsequently, 5 of these 7 were treated with immune DLE; 4 had a decrease in bowel movement frequency and significant weight gain, with eradication of oocytes from stool in 2 patients. Immune DLE produces sustained symptomatic improvement in patients with AIDS and active cryptosporidiosis, but lack of an appropriate cryptosporidial antigen allows only postulation that an augmentation of cellular immunity to Cryptosporidium parvum induced by immune DLE resulted in the microbiologic and clinical improvement observed
— id: 14566, year: 1990, vol: 161, page: 108, stat: Journal Article,

Managing HIV
Ablow, Keith R.; Seidlin, Mindell.; Affoumado, Roma.; Ribble, Denise J.; Kelly, Janine S.; Holzman, Robert S.; Farthing, Charles F.; McGowan, James C.; Londino, Lawrence J.; Rosenberg, Conrad
[New York] : New York University Regional AIDS Education and Training Center, 1989,
Discusses the medical care and counseling of HIV infected/AIDS patients. Reviews treatment protocols in managing HIV/AIDS infections: treating the underlying infection; treating the opportunistic infections; providing prophylactic therapies to prevent opportunistic infections; referring patient to specialist when necessary
— id: 554, year: 1989, vol: , page: , stat: ,

Human immunodeficiency virus type 1 antigenemia in children
Borkowsky W; Krasinski K; Paul D; Holzman R; Moore T; Bebenroth D; Lawrence R; Chandwani S
1989 Jun;114(6):940-945, Journal of pediatrics
Human immunodeficiency virus type 1 (HIV-1) core antigen was assayed in the plasma of children at risk for infection with HIV to determine its usefulness in the diagnosis of infection and to correlate it with the clinical stage of disease. Antigen was detected in the plasma of all children less than 15 months of age with acquired immunodeficiency syndrome (AIDS). Two thirds of children with AIDS-related illnesses and half of children with asymptomatic infection had antigen. Although 53% of plasma specimens originating from HIV-infected children younger than 6 months of age contained antigen, only 25% of plasma specimens from children younger than 6 months who had no symptoms and none of the 10 specimens from HIV-infected newborn infants contained antigen. Half of the specimens containing core antigen also contained anticore antibody. Quantitative mean antigen levels were more likely to be elevated in children with AIDS (516 pg/ml) than in children with AIDS-related illnesses (295 pg/ml) or in those who had no symptoms (70 pg/ml). Antigen levels tended to increase over time in children with advancing clinical illness, but they tended to decrease over time after a diagnosis of AIDS was made. Antigen was detected in the plasma of 4 of 14 children without symptoms who subsequently reverted to an HIV seronegative state. We conclude that the detection of core antigen occurs with high frequency in children, even young infants, with symptomatic HIV infection. Plasma core antigen was less frequent in children without symptoms and was not detected in 10 infected children when they were tested at birth
— id: 10595, year: 1989, vol: 114, page: 940, stat: Journal Article,

The combined toxicity of azidothymidine and antimycobacterial agents. A retrospective study
Kavesh NG; Holzman RS; Seidlin M
1989 May;139(5):1094-1097, American review of respiratory disease
Eight patients being treated for tuberculosis prior to starting azidothymidine therapy (study group) were compared with 56 patients who were treated with azidothymidine but not with antimycobacterial agents (control group). Toxicity was assessed 12 wk after the initiation of treatment with azidothymidine. Study group patients were more likely than control subjects to be either black or Hispanic (75% versus 30%, p = 0.02). There were no other statistically significant demographic differences. Seven study patients, and 20 control subjects experienced a fall in leukocyte count greater than 10% (88% versus 36%, p = 0.01). Within each group, patients with acquired immune deficiency syndrome (AIDS) were more likely to experience this degree of hematologic toxicity than were patients with AIDS-related complex (p = 0.03). However, analysis of covariance showed no significant differences between the groups after 12 wk of azidothymidine with regard to mean leukocyte or platelet counts, hemoglobin levels, or values for tests of liver function. The groups were similar in transfusion requirements and frequency of changes in azidothymidine dosage. Although this study was limited in power by the number of patients and the nonrandomized, retrospective design, the data suggest that patients can tolerate concurrent therapy with azidothymidine and antimycobacterial agents without unacceptable toxicity
— id: 10637, year: 1989, vol: 139, page: 1094, stat: Journal Article,

Prognosis of human immunodeficiency virus infection in children and adolescents
Krasinski K; Borkowsky W; Holzman RS
1989 Apr;8(4):216-220, Pediatric infectious disease journal
The prognosis of 111 children and adolescents (from 2.5 months to 19.5 years of age) infected with human immunodeficiency virus (HIV) was assessed by survival analysis based on risk factors and clinical status. Risk factors included: maternal HIV infection 93; transfusion 12; both maternal HIV infection and transfusion 2; sexual abuse 1; and intravenous drug use and/or sexual activity 3. Children with perinatal infection survived from 2.5 months to 10.25 years (median, 1.87 years) and had inapparent infection from 6 weeks to 7.3 years (median, 0.75 years). Children who acquired HIV infection via transfusion had inapparent infection from 4 months to 5.7 years (median, 3.6 years). Actuarial survival following infection was not significantly different from maternally and transfusion-acquired infection; however, survival from infection was longer for children infected by transfusion beyond 2 years of age (mean, 7.5 years) than for children infected perinatally (mean, 5.6 years). The case-fatality ratio was 32%, with 25% of subjects succumbing within 1 year of developing an HIV-associated illness. Opportunistic infection was the most common acquired immunodeficiency syndrome-defining illness and the cause of death in 22 of the 35 children who died. Pneumocystis carinii and fungal pneumonias had the worst prognosis. Cryptosporidiosis and other opportunistic infections had a better prognosis. Because of difficulties in case finding, diagnosis of infection and variable survival of HIV-infected children, arge longitudinal studies and pooling of data among centers will be necessary to have an accurate understanding of the prognosis of individual clinical syndromes.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 10675, year: 1989, vol: 8, page: 216, stat: Journal Article,

The role of liver biopsies in psoriatic patients receiving long-term methotrexate treatment. Improvement in liver abnormalities after cessation of treatment
Newman M; Auerbach R; Feiner H; Holzman RS; Shupack J; Migdal P; Culubret M; Camuto P; Tobias H
1989 Sep;125(9):1218-1224, Archives of dermatology
Liver biopsy specimens from 168 patients who underwent a total of 364 biopsies were examined. Of 83 patients receiving biopsies before methotrexate treatment, 14 had one or more risk factors predictive of liver abnormality but they had normal pretreatment biopsy specimens. Among 17 patients with abnormal biopsy specimens before methotrexate treatment, only 1 had an identifiable risk factor and 5 had abnormal results of liver function tests. The probability of a normal biopsy specimen after methotrexate treatment dropped below 50% at a cumulative methotrexate dose of 3115 mg for the 31 patients with biopsy specimens from before and after methotrexate treatment and 5776 mg for those who had biopsies only after methotrexate treatment; this difference was statistically significant and is thought to be related to the fact that the patients who had biopsies before and after methotrexate treatment had received most of their medication by the parenteral rather than the oral route. A significant association existed between biopsy grade after methotrexate treatment and obesity. Other risk factors were not correlated with biopsy grade. Blood chemistry tests were not predictive of histopathologic findings. Eight of 11 patients with fibrosis or cirrhosis showed meaningful improvement in liver histologic findings after methotrexate treatment had been withdrawn for 6 months or more; none had progression of abnormalities
— id: 10501, year: 1989, vol: 125, page: 1218, stat: Journal Article,

The risk of zoster after varicella vaccination in children with leukemia
Lawrence R; Gershon AA; Holzman R; Steinberg SP
1988 Mar 3;318(9):543-548, New England journal of medicine
We examined the incidence of zoster in 346 children with underlying acute lymphoblastic leukemia who were immunized with live attenuated varicella vaccine while in remission. We also compared a subset of 84 of these children with a matched group of 84 children with leukemia who had had natural infection with varicella. Of the 346 vaccinated children, 5 (1.45 percent) became infected with zoster after 10,878 months of observation, for an incidence of 0.552 case per 100 person-years. Among the matched pairs of subjects, zoster occurred in 3 (3.6 percent) of the 84 vaccinated subjects during 2936 months of observation--an incidence of 1.23 cases per 100 person-years--and in 11 (13.1 percent) of the subjects with natural infection during 4245 months--an incidence of 3.11 cases of zoster per 100 person-years. Although the incidence of zoster was more than twice as high in the control children as in the vaccinated children (3.11 vs. 1.23 cases per 100 person-years), a Kaplan-Meier product-limit analysis revealed no significant differences in incidence between the two groups. Children from both groups in whom leukemia recurred were more likely to contract zoster than those who did not have a recurrence (7 of 35 vs. 7 of 133, P less than 0.025). Zoster was not a marker for impending relapse. No case of zoster was severe or disseminated. We conclude that the incidence of zoster following immunization with live attenuated varicella vaccine is no greater than that following natural varicella infection
— id: 11155, year: 1988, vol: 318, page: 543, stat: Journal Article,

Group G streptococcal bacteremia and parenteral drug abusers
McMeeking AA; Holzman RS
1988 Mar;157(3):612-613, Journal of infectious diseases
— id: 63329, year: 1988, vol: 157, page: 612, stat: Journal Article,

Risk for the acquired immunodeficiency syndrome among thrombocytopenic and nonthrombocytopenic homosexual men seropositive for the human immunodeficiency virus
Holzman RS; Walsh CM; Karpatkin S
1987 Mar;106(3):383-386, Annals of internal medicine
A group of 44 homosexual patients with immune thrombocytopenia and serologic evidence of infection with the human immunodeficiency virus (HIV) was observed for a total of 844 person-months. The risk of developing the acquired immunodeficiency syndrome (AIDS), an actuarial incidence of 36.5% in 37 months, was no different than that reported for seropositive homosexual men from New York who are nonthrombocytopenic and asymptomatic. A statistical analysis comparing the hazard function with a constant-risk model showed that the hazard of developing AIDS was not constant but increased with duration of seropositivity
— id: 14918, year: 1987, vol: 106, page: 383, stat: Journal Article,

Effect of changing needle disposal systems on needle puncture injuries
Krasinski K; LaCouture R; Holzman RS
1987 Feb;8(2):59-62, Infection control & hospital epidemiology
Accidental needle puncture injuries continue to pose a hazard to hospital workers. In order to reduce the number of such injuries in our hospital, needle disposal procedures were revised to discourage recapping and prevent bending or clipping of needles before discard. Collapsible cardboard boxes were replaced with impervious containers. An educational program accompanied these changes. We compared reports of needlestick injuries before and after the change of procedure, for three parallel 9-month periods. During the 27-month study, injuries occurred during administration of medication (22%), or recapping of used needles (16%), from needles protruding through (10%) or out of the 'mouth' (9%) of the container, from needles left in the patient's environment (10%), or those left on procedure trays (7%). Seven percent were the result of being stuck by someone else, usually in the operating room. The mechanism of injury for 19% was not described. Altering the disposal procedures did not change the number or anatomic site of injuries, nor the risk of injury among the various job categories. A reduction in the rate of sticks from needles protruding through the container (1.3 vs 0.3/mo, p less than or equal to 0.005) was the only difference observed. Changing the needle receptacle changed the type but not the overall number of injuries. The education program had little effect on the number and types of injuries. These data point to the need for developing innovative approaches for eliciting changes in behavior of health care personnel
— id: 15078, year: 1987, vol: 8, page: 59, stat: Journal Article,

Group B streptococcal osteomyelitis in an adult
McMeeking AA; Holzman R; Desiderio D; Hanna B
1987 Aug;87(8):466-467, New York state journal of medicine
— id: 63356, year: 1987, vol: 87, page: 466, stat: Journal Article,

Nonrandom development of immunologic abnormalities after infection with human immunodeficiency virus: implications for immunologic classification of the disease
Zolla-Pazner S; Des Jarlais DC; Friedman SR; Spira TJ; Marmor M; Holzman R; Mildvan D; Yancovitz S; Mathur-Wagh U; Garber J; et al
1987 Aug;84(15):5404-5408, Proceedings of the National Academy of Sciences of the United States of America
Blood specimens from 165 intravenous drug users who were seropositive for the human immunodeficiency virus (HIV), from 158 seropositive homosexual men with lymphadenopathy, and from 77 patients with acquired immunodeficiency syndrome (AIDS) were assessed immunologically. Immunologic parameters were analyzed by the Guttman scalogram technique to determine if immunologic abnormalities occurred in a nonrandom pattern. The following four patterns emerged: (i) seropositivity for HIV with no immunologic abnormalities; (ii) seropositivity for HIV with a depressed T4/T8 cell ratio; (iii) seropositivity with a depressed T4/T8 cell ratio and T4-cell depletion; and (iv) seropositivity with a depressed T4/T8 cell ratio, T4-cell depletion, and lymphopenia. Ninety-two to 100% of subjects in each of the three groups of patients were found \'to scale\' because the abnormalities occurred in the cumulative, ordered fashion described. This nonrandom occurrence of abnormalities indicates an ordered progression of immunologic abnormalities in individuals infected with HIV, a finding useful in the staging of both symptomatic and asymptomatic HIV-seropositive subjects.
— id: 9305, year: 1987, vol: 84, page: 5404, stat: Journal Article,

A stage model of HTLV-III LAV infection in intravenous drug users
Des Jarlais DC; Friedman SR; Spira TJ; Zolla-Pazner S; Marmor M; Holzman R; Mildvan D; Yancovitz S; Mathur-Wagh U; Garber J; et al
1986 ;67:328-334, NIDA research monograph series
— id: 9123, year: 1986, vol: 67, page: 328, stat: Journal Article,

Hospital experience with varicella-zoster virus
Krasinski K; Holzman RS; LaCouture R; Florman A
1986 Jun;7(6):312-316, Infection control & hospital epidemiology
Varicella-zoster virus (VZV), one of the most common highly communicable agents of disease, stimulates aggressive infection control measures. In a 1-year period, at one hospital, at least 93 inpatients (82 adult patients, 11 pediatric patients) and 2 hospital staff with active varicella-zoster infections served as potential sources of nosocomial infection. Six incidents of exposure to the virus that occurred without the protection of standard infection control precautions were investigated by the infection control surveillance team. One hundred fifty-six patients and 353 hospital staff were exposed. Fifty-one patients had no history of varicella-zoster infection, but only five were susceptible by serologic testing. One hundred one staff members had no history of varicella-zoster, but only 11 were susceptible by serologic testing. These exposures resulted in three secondary varicella-zoster infections, six courses of varicella-zoster immune globulin prophylaxis and furlough of 13 staff members. Epidemiologic investigation consumed approximately 356 hours of staff time, and management of exposed persons cost approximately $41,500. Prospective knowledge of the immune status of health care workers would vastly decrease the time and effort required to control hospital VZV exposures
— id: 15079, year: 1986, vol: 7, page: 312, stat: Journal Article,

Nosocomial fungal infection during hospital renovation
Krasinski K; Holzman RS; Hanna B; Greco MA; Graff M; Bhogal M
1985 Jul;6(7):278-282, Infection control & hospital epidemiology
Nosocomial fungal pulmonary infections (Zygomycetes, Aspergillus sp.) developed in two premature infants in a special care unit (SCU) adjacent to an area of renovation. Inspection showed that inadequate barriers permitted the passage of airborne particles between the two areas, and cultures confirmed a significantly higher (p less than or equal to 0.05) density of mold spores in the SCU (0.88 cfu per hour per settling plate) compared to a construction-free comparison area (0.22 cfu per hour per settling plate). The major source of mold was the dust above the hospital's false ceiling. In another construction area, imperious barriers were shown to effectively restrict the dispersal of mold. Our experience adds Rhizopus to Aspergillus as a possible cause of construction-related nosocomial infection. Sporadic episodes will continue to occur until the hazards of renovation are appreciated and effective preventive measures are routinely instituted
— id: 15081, year: 1985, vol: 6, page: 278, stat: Journal Article,

Cryptococcal pericarditis in an intravenous drug abuser
Schuster M; Valentine F; Holzman R
1985 Oct;152(4):842-842, Journal of infectious diseases
— id: 63235, year: 1985, vol: 152, page: 842, stat: Journal Article,

Acquired immune deficiency syndrome possibly related to transfusion in an adult without known disease-risk factors
Gordon SM; Valentine FT; Holzman RS; Holliday RA; Baggott B; Chinitz LA; Brick PD
1984 Jun;149(6):1030-1032, Journal of infectious diseases
— id: 15513, year: 1984, vol: 149, page: 1030, stat: Journal Article,

Mycobacterium avium-intracellulare: a cause of disseminated life-threatening infection in homosexuals and drug abusers
Greene JB; Sidhu GS; Lewin S; Levine JF; Masur H; Simberkoff MS; Nicholas P; Good RC; Zolla-Pazner SB; Pollock AA; Tapper ML; Holzman RS
1982 Oct;97(4):539-546, Annals of internal medicine
Five men developed disseminated infection with Mycobacterium avium-intracellulare. These patients all lived in the New York City area and presented with their illnesses between January 1981 and September 1981; four were homosexual and one was an intravenous drug abuser. Four patients died. All five patients had defects in the cell-mediated immune response. The infections were characterized histopathologically by poor or absent granulomatous tissue reaction. Clinical isolates of M. avium-intracellulare from all five patients agglutinated commonly used antimycobacterial drugs. The spectrum of opportunistic infections among populations of homosexuals and drug abusers should be expanded to include disseminated disease due to M. avium-intracellulare.
— id: 9319, year: 1982, vol: 97, page: 539, stat: Journal Article,

Salmonella enteritidis genitourinary tract infection in a homosexual man
Greene, J B; Adler, M; Holzman, R S
1982 Nov;128(5):1046-1048, Journal of urology
— id: 141806, year: 1982, vol: 128, page: 1046, stat: Journal Article,

Rickettsialpox: report of an outbreak and a contemporary review
Brettman LR; Lewin S; Holzman RS; Goldman WD; Marr JS; Kechijian P; Schinella R
1981 Sep;60(5):363-372, Medicine (Baltimore)
Rickettsialpox is a mild illness characterized by the appearance of a primary eschar at the site of a mite bite followed by fever, headache, and a papulovesicular rash. It can be confused with a variety of illnesses including several other rickettsial diseases and chickenpox. R. akari, the etiologic agent, is a rickettsia belonging to the spotted fever group (SFG) of rickettsial illnesses. In spite of significant serologic cross-reactivity with other SFG agents, there is no convincing evidence of cross-immunity to these agents after recovery from rickettsialpox. Tetracyclinie is the drug of choice in the treatment of this disease
— id: 16495, year: 1981, vol: 60, page: 363, stat: Journal Article,

An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction
Masur, H; Michelis, M A; Greene, J B; Onorato, I; Stouwe, R A; Holzman, R S; Wormser, G; Brettman, L; Lange, M; Murray, H W; Cunningham-Rundles, S
1981 Dec 10;305(24):1431-1438, New England journal of medicine
Eleven cases of community-acquired Pneumocystis carinii pneumonia occurred between 1979 and 1981 and prompted clinical and immunologic evaluation of the patients. Young men who were drug abusers (seven patients), homosexuals (six), or both (two) presented with pneumonia. Immunologic testing revealed that absolute lymphocyte counts, T-cell counts, and lymphocyte proliferation were depressed, and that humoral immunity was intact. Of the 11 patients, one was found to have Kaposi's sarcoma, and another had angioimmunoblastic lymphadenopathy. Eight patients died. In the remaining three, no diagnosis of an immunosuppressive disease was established, despite persistence of immune defects. These cases of pneumocystosis suggest the importance of cell-mediated immune function in the defense against P. carinii. The occurrence of this infection among drug abusers and homosexuals indicates that these groups may be at high risk for this infection
— id: 141804, year: 1981, vol: 305, page: 1431, stat: Journal Article,

Adjuvant-like effects of lithium on peripheral blood mononuclear cells
Borkowsky W; Shenkman L; Wadler S; Holzman RS; Shopsin B
1980 ;127:417-427, Advances in experimental medicine & biology
— id: 14593, year: 1980, vol: 127, page: 417, stat: Journal Article,

Enhancement of lymphocyte and macrophage function in vitro by lithium chloride
Shenkman L; Borkowsky W; Holzman RS; Shopsin B
1978 Jun;10(2):187-192, Clinical immunology & immunopathology
— id: 14601, year: 1978, vol: 10, page: 187, stat: Journal Article,

Leucocyte dialysates require precommitted, antigen-reactive cells to augment lymphocyte proliferation
Cohen L; Holzman RS; Valentine FT; Lawrence HS
Transfer factor: basic properties and clinical applications New York, Academic Press, 1976,
— id: 2535, year: 1976, vol: , page: 61, stat: Chapter,

Requirement of precommitted cells as targets for the augmentation of lymphocyte proliferation by leukocyte dialysates
Cohen L; Holzman RS; Valentine FT; Lawrence HS
1976 Apr 1;143(4):791-804, Journal of experimental medicine
After our initial report tha leukocyte dialysates containing transfer factor augment the thymidine incorporation of antigen-stimulated lymphocytes, we have adapted the system to microleukocyte cultures. This modification permits both (a) the simultaneous assay of a single dialysate on the cells of multiple individuals, and (b) the assay of multiple dialysates on the cells of a single individual. The data thus secured, demonstrate that dialysates from both skin-test-positive and -negative donors produced similar degrees of augmentation whether the data are expressed as an arithmetic difference or as a ratio. When expressed as an arithmetic difference, the amount of augmentation is increased in proportion to the level of thymidine incorporation of the assay cells when they were stimulated by antigen alone. When expressed as a ratio, however, the degree of augmentation is independent of the response of the assay cells. An analysis of the ability of dialysates to engage previously uncommitted lymphocytes and thus to augment thymidine incorporation, revealed that precommitted cells were required. In these experiments, antigen-reactive cells were deleted from populations of peripheral blood lymphocytes by incubation with purified protein derivative of tuberculin, diphtheria toxoid, or streptokinase-streptodornase in the presence of [3H]thymidine of high specific activity. This deletion depressed or abolished the effect of dialysate on the residual population when it was recultured with the same antigen, but the effect on the response of the remaining lymphocytes to other antigens was unaltered. In this study, leukocyte dialysate appeared to augment nonspecifically the thymidine incorporation of an antigen-specific precommitted clone of lymphocytes. The relationship of these adjuvant effects on peripheral blood lymphocytes in vitro to the specific and nonspecific activities of transfer factor in vivo remains to be elucidated
— id: 15515, year: 1976, vol: 143, page: 791, stat: Journal Article,

In vitro comparison of TF-DM obtained from skin test positive and negative individuals
Erickson AD; Holzman RS; Valentine FT; Lawrence HS
Transfer factor: basic properties and clinical applications New York, Academic Press, 1976,
— id: 2536, year: 1976, vol: , page: 23, stat: Chapter,

Aspergillus oryzae meningitis
Gordon MA; Holzman RS; Senter H; Lapa EW; Kupersmith MJ
1976 May 10;235(19):2122-2123, JAMA
In a patient with only meningitis, a septate hypha was seen in a Langhans giant cell, and the rarely pathogenic Aspergillus oryzae was cultured from the cerebrospinal fluid. Serologic results confirmed the diagnosis. The patient responded to therapy with amphotericin B and flucytosine
— id: 65726, year: 1976, vol: 235, page: 2122, stat: Journal Article,

LITHIUM-CHLORIDE, AN IMMUNOLOGICAL ADJUVANT
SHENKMAN, L; BORKOWSKY, W; HOLZMAN, RS; SHOPSIN, B
1976 ;24(5):A634-A634, Clinical research
— id: 98705, year: 1976, vol: 24, page: A634, stat: Journal Article,

Preparation and properties of cloning inhibitory factor. I. Inhibition of HeLa cell cloning by stimulated lymphocytes and their culture supernatants
Holzman RS; Lebowitz AS; Valentine FT; Lawrence HS
1973 Aug;8(2):249-258, Cellular immunology
— id: 15521, year: 1973, vol: 8, page: 249, stat: Journal Article,

Preparation and properties of cloning inhibitory factor. II. Factors affecting its production and assay
Holzman RS; Valentine FT; Lawrence HS
1973 Aug;8(2):259-269, Cellular immunology
— id: 15520, year: 1973, vol: 8, page: 259, stat: Journal Article,