Intestinal parasitic infections and risk factors for infection in Kenyan children with and without HIV infection

It has been reported that HIV infection is not a risk factor for Entamoeba species infection but is for Giardia intestinalis assemblage B in children living in Western Kenya. This study aimed to investigate the prevalence of and the risk factors for Entamoeba spp. and G. intestinalis infection in children living in Nairobi, Kenya. This cross-sectional study included 87 children with HIV [HIV(+)] and 85 without HIV [HIV(−)]. Stool and blood samples were collected for the detection of the parasites by PCR and immunological analyses using flow cytometry. Sociobehavioral and hygienic data were collected using questionnaires and analyzed statistically. The prevalence of Entamoeba spp. infection was significantly lower in the HIV(+) than in the HIV(−) children (63.2% vs. 78.8%, P = 0.024), whereas the prevalence of G. intestinalis infection was not (27.6% vs. 32.9%, P = 0.445). “Not boiling drinking water” (adjusted odds ratio [aOR]: 3.8, P = 0.044) and “helping in nursery care” (aOR: 2.8, P = 0.009) were related to G. intestinalis assemblage B infection, and “CD4/CD8 ratio ≥1” was related to Entamoeba spp. infection (aOR: 3.3, P = 0.005). In stratified regression analyses, HIV infection was negatively associated with G. intestinalis assemblage B infection in females (aOR: 0.3, P = 0.022), but positively associated in males (aOR 3.8, P = 0.04). These results suggest that G. intestinalis assemblage B infection is related to hygienic conditions, while Entamoeba spp. infection is an indicator of better immunological status, and that the role of HIV infection in Giardia infection may differ between Kenyan boys and girls.     

Prevalence of risk factors associated with human papillomavirus infection in women living with HIV

BACKGROUND: Concurrent infection with HIV and human papillomavirus (HPV) in women is associated with increased rates of cervical dysplasia and shorter survival following the development of cervical cancer. The authors examined risk factors for HPV infection at study entry in HIV-positive women enrolled in the Canadian Women''s HIV Study, a prospective open cohort study. METHODS: Subjects eligible for this analysis included the 375 HIV-positive women in the Canadian Women''s HIV Study for whom HPV test results were available. Questionnaires on behavioural and clinical information, Pap smears, cervicovaginal lavage specimens and vaginal tampon specimens for HPV detection and typing by polymerase chain reaction were obtained at study entry. RESULTS: Overall, 67.2% (252/375) of the women were HPV-positive; the global prevalence of intermediate- and high-risk oncogenic HPV types was 49.1% (184/375). Women with squamous cell dysplasia (32/294) were more likely to have HPV infection than those without dysplasia (90.6% v. 62.6%; p = 0.002). Multivariate logistic regression analysis, with adjustment for number of lifetime partners and history of STD, revealed that the following risk factors were independently associated with HPV infection: CD4 count of less than 0.20 x 10(9)/L (adjusted odds ratio [OR] 1.99 [95% confidence interval (Cl) 1.17-3.37 (p = 0.011)]), non-white race (adjusted OR 2.00 [95% Cl 1.17-3.42 (p = 0.011)]), inconsistent condom use in the 6 months before study entry (adjusted OR 2.02 [95% Cl 1.16-3.50 (p = 0.013)]), and lower age, with women age 30-39 years (adjusted OR 0.51 [95% Cl 0.30-0.87 (p = 0.013)]) and age 40 years or older (adjusted OR 0.52 [95% Cl 0.26-1.01 (p = 0.052)]) compared with women less than 30 years of age. INTERPRETATION: Close monitoring for HPV-related effects is warranted in all HIV-positive women, particularly younger, non-white women who do not always use condoms. Counselling for women living with HIV, particularly younger women, should emphasize the importance of regular cytological screening, with increasing frequency as the CD4 count falls.     

HIV infection and risk behaviours among young gay and bisexual men in Vancouver

BACKGROUND: Young gay and bisexual men may perceive that the consequences of HIV infection have dramatically improved with the availability of highly active antiretroviral therapy. We therefore sought to identify trends in HIV infection rates and associated risk behaviours among young gay and bisexual men in Vancouver. METHODS: Prospective cohort study involving gay and bisexual men aged 18-30 years who had not previously tested HIV positive. Subjects were recruited through physicians, clinics and community outreach in Vancouver. Annually participants were tested for HIV antibodies and asked to complete a self-administered questionnaire pertaining to sociodemographic characteristics, sexual behaviours and substance use. Prevalence of HIV infection and risk behaviours were determined for eligible participants who completed a baseline questionnaire and HIV testing as of May 1998. The primary outcome was the proportion of men who reported having protected sex during the year before enrollment and who reported any episode of unprotected sex by the time of the first follow-up visit. RESULTS: A total of 681 men completed a baseline questionnaire and HIV testing as of May 1998. The median duration between baseline and the first follow-up visit was 14 months. The median age was 25 years. Most of the subjects were white and of high socioeconomic status. The majority (549 [80.6%]) reported having sex only with men; 81 (11.9%) reported bisexual activity. Of the 503 men who had one or more regular male partners, 245 (48.7%) reported at least one episode of unprotected anal sex in the year before enrollment; the corresponding number among the 537 who had one or more casual male partners was 140 (26.1%). The prevalence and incidence of HIV seropositivity were 1.8% (95% confidence interval [CI] 0.8%-2.8%) and 1.7 per 100 person-years [95% CI 0.7-2.7], respectively. Fifty-two (26.5%) of the 196 and 55 (29.7%) of the 185 men with regular partners who reported having practiced protected insertive and receptive anal sex in the year before the baseline visit reported engaging in these activities without a condom at the follow-up visit; the corresponding numbers among the 232 and 242 men with causal partners who had practiced protected insertive and receptive anal sex before the baseline visit were 43 (15.5%) and 26 (9.4%) respectively at follow-up. INTERPRETATION: The incidence of HIV infection is unacceptably high among this cohort of young gay and bisexual men. Preliminary results suggest a disturbing trend toward increasing levels of unprotected anal intercourse.     

老年吸入性肺炎患者病原菌感染特点及相关危险因素分析

目的分析老年吸入性肺炎患者病原菌感染特点及其相关危险因素,为临床有效防治老年吸入性肺炎提供依据。方法纳入2013年1月-2015年12月期间本院收治的需行机械通气治疗的老年患者120例,根据治疗过程中患者是否发生吸入性肺炎分为吸入性肺炎组(47例)和无吸入性肺炎组(73例)。分析吸入性肺炎组患者的病原菌分布情况及构成比;单因素分析吸入性肺炎的可能相关因素在两组间的差异,对单因素分析中存在显著差异的因素进行多元Logistic回归分析。结果 (1)47例吸入性肺炎患者中共检出病原菌96株,其中革兰阴性菌65株(67.7%)、革兰阳性菌20株(20.8%)、真菌11株(11.5%)。(2)单因素分析结果显示,两组间年龄、咳嗽反射障碍、意识障碍、长期卧床、吞咽障碍、胃食管反流、鼻饲饮食、低白蛋白血症、高血压、糖尿病、冠心病、口腔疾病等因素存在明显差异(P0.05)。(3)多元Logistic回归分析结果显示,年龄≥70岁、咳嗽反射障碍、意识障碍、长期卧床、吞咽障碍、胃食管反流、鼻饲饮食、低白蛋白血症、高血压、冠心病均是吸入性肺炎的危险因素(P0.05)。结论老年吸入性肺炎感染的病原菌主要以革兰阴性菌为主;年龄≥70岁、存在咳嗽反射障碍、意识障碍、长期卧床、吞咽障碍、胃食管反流、鼻饲饮食以及合并低白蛋白血症、高血压、冠心病等基础病的老年患者更易发生吸入性肺炎。     

胆道肠球菌感染患者炎症因子水平和病原菌分布及危险因素分析

目的 讨论肠球菌感染患者炎症因子水平、病原菌分布及相关危险因素。 方法 选择2017年1月至2019年1月于咸宁市中心医院就诊的120例胆道肠球菌感染患者作为观察组,另选取同期120例未感染的健康体检者为对照组。对比两组对象血清炎症因子水平,分析观察组患者肠球菌种类分布及其耐药性,并分析胆道肠球菌感染的危险因素。 结果 观察组患者血清IL6、IL17、TNFα水平明显高于对照组(P结论 胆道肠球菌感染患者会出现炎症因子水平升高的现象,其病原菌以屎肠球菌、粪肠球菌、鸟肠球菌为主,其中屎肠球菌对多种抗菌药物具有较高耐药率,应针对相关危险因素采用合理治疗方案,以尽可能降低患者感染率。     

Trends in sexual behaviour and risk factors for HIV infection among homosexual men, 1984-7.

To assess whether the spread of infection with HIV can be reduced by changes in behaviour among groups most at risk because of their sexual practices sexual behaviour was monitored among 1050 homosexual men tested for HIV infection at a genitourinary medicine clinic in west London from November 1984 to September 1987. Four cohorts, defined by date of presentation, were studied by questionnaire at their presentation, and blood samples were analysed. Between the first and last cohorts there was a considerable fall in the proportion reporting casual relationships (291/329 (88%) v 107/213 (50%] and high risk activities, such as anoreceptive intercourse with casual partners (262/291 (90%) v 74/106 (70%], with the greatest changes occurring before the government information campaign began in 1986. Nevertheless, half of the men in the last cohort studied reported having casual partners. Multiple logistic regression showed that behavioural risk factors for HIV infection most closely resembled those for hepatitis B and that previous sexually transmitted diseases (syphilis, hepatitis B, and anogenital herpes) were themselves independent risk factors. A history of syphilis ranked above anoreceptive intercourse as the strongest predictor of HIV infection. Actively bisexual men showed a much lower prevalence of HIV infection (3/57, 5%) than exclusively homosexual men (113/375, 30%). Sexual behaviour among homosexual men changed during the period studied, and the incidence of HIV infection fell, although more education programmes directed at homosexual men are needed to re-emphasise the dangers of infection.     

Clinical outcome and risk factors related to extended-spectrum beta-lactamase-producing Klebsiella spp. infection among hospitalized patients

Over the past two decades, nosocomial infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. have become a major problem all around the world. This situation is of concern because there are limited antimicrobial options to treat patients infected with these pathogens, and also because this kind of resistance can spread to a wide variety of Gram-negative bacilli. Our objectives were to evaluate among in-patients at a public university tertiary-care hospital with documented infection due to Klebsiella spp., which were the risk factors (cross-sectional analysis) and the clinical impact (prospective cohort) associated with an ESBL-producing strain. Study subjects were all patients admitted at the study hospital between April 2002 and October 2003, with a clinically and microbiologically confirmed infection caused by Klebsiella spp. at any body site, except infections restricted to the urinary tract. Of the 104 patients studied, 47 were infected with an ESBL-producing strain and 57 with a non-ESBL-producing strain. Independent risk factors associated with infection with an ESBL-producing strain were young age, exposure to mechanical ventilation, central venous catheter, use of any antimicrobial agent, and particularly use of a 4th generation cephalosporin or a quinolone. Length of stay was significant longer for patients infected with ESBL-producing strains than for those infected with non-ESBL-producing strains, although fatality rate was not significantly affected by ESBL-production in this cohort. In fact, mechanical ventilation and bacteremia were the only variables within dependent association with death detected in this investigation.     

Study of coronary risk factors related to physical activity in 15 171 men.

Physical activity, both at work and during leisure, was assessed in 15 171 men aged 25-74 years. Heavy leisure activity was associated with lower mean serum cholesterol levels and blood pressure. In men under 60 years the same negative association was also noted between leisure activity and relative weight and cigarette smoking. Different degrees of physical activity at work were not associated with any differences in these risk factors, nor did the level of exercise at work seem to influence the negative association between leisure activity and risk factors. Heavy leisure activity in young and middle-aged men is associated with lower levels of certain coronary risk factors and, therefore, a lower risk of coronary heart disease. The often-reported reduction in coronary morbidity and mortality with physical exercise may not be the direct effect of the exercise itself.     

羊膜腔内感染微生物分布及相关影响因素分析

研究剖宫产术中产妇的感染症状、羊水微生物分布情况及相关影响因素,为该类患者的治疗提供帮助。

采集本院2020年6月至2023年2月于剖宫产术中提取的羊水498份进行细菌培养,根据羊水微生物分布情况和相关因素,综合分析产妇临床感染症状。

498份送检羊水标本中有147份标本检出微生物,总检出率为29.5%（147/498）。498例产妇中有100例术前出现感染症状,检出微生物78株;51例术后出现感染症状,检出微生物34株;8例术后切口感染,检出微生物7株。339例没有临床感染症状的产妇检出微生物28株。羊水微生物的检出率与胎膜早破或试产后人工破膜、产妇自身阴道菌群分布、术前出现感染症状呈显著相关（均P＜0.05）。

对胎膜早破、阴道菌群失调等高危产妇及时送检标本查找病原体,对羊膜腔内感染的早期预防和针对性治疗具有显著意义。

     

Cardiovascular risk factors in subjects with Helicobacter pylori infection

Background. It has been proposed that Helicobacter pylori infection is related to cardiovascular disease, although this has not been fully investigated. The aim of this study was to investigate whether H. pylori in‐fection is associated with cardiovascular risk factors. Subjects and Methods. One thousand six hundred and fifty people undergoing annual medical checks at Shimane Institute of Health Science between September 1998 and August 1999 were enrolled. Gender, age, body mass index, habitual smoking and drinking, systolic and diastolic blood pressure, serum level of total cholesterol, triglyceride, high‐density lipoprotein cholesterol (HDLC), blood glucose, leukocyte count and hemoglobin were compared between H. pylori seropositive and seronegative cases. Results. In H. pylori seropositive individuals, HDLC was significantly lower than that in seronegative individuals. After adjustment for possible confounding factors (gender, age, BMI, smoking and drinking habits), mean HDLC in H. pylori‐seropositive and seronegative individuals were 56.1 and 58.2 mg/dl, respectively (p < .005). The percentage of the elderly (over 50 years old) individuals with HDLC < 35 mg/dl in H. pylori seropositive and seronegative groups were 7.4% and 4.7%, respectively (p < .001). In addition, the lower HDLC level was accompanied by an increased leukocyte count. Conclusion. Long‐term infection with H. pylori may have an important role in decreasing the serum HDLC concentration.     

Heart muscle disease related to HIV infection: prognostic implications.

OBJECTIVES--To determine the natural course of heart muscle disease in patients infected with HIV. DESIGN--Prospective echocardiographic survey and observational study over four years. SETTING--Edinburgh. SUBJECTS--296 adults infected with HIV (mean age 32.7 years (range 21.5 to 67.6) drawn from all the major groups at risk of HIV infection in Britain. MAIN OUTCOME MEASURES--Detection of myocardial dysfunction and time to death from index echocardiogram in serial echocardiography. RESULTS--Cardiac dysfunction was identified in 44 subjects (dilated cardiomyopathy, 13; isolated right ventricular dysfunction, 12; borderline left ventricular dysfunction, 19). Dilated cardiomyopathy was strongly associated with a CD4 cell count of < 100 x 10(6)/l, in contrast with the other forms of cardiac dysfunction. During the study 12/13 (92%) subjects with dilated cardiomyopathy, 5/12 (42%) with right ventricular dysfunction, and 8/19 (42%) with borderline left ventricular function died of conditions related to AIDS. Survival was significantly reduced in the subjects with dilated cardiomyopathy compared with those with normal hearts (P < 0.001). The median survival from the index echocardiogram was 101 days (95% confidence interval 42 to 146) for the subjects with cardiomyopathy compared with 472 days (383 to 560) for those with normal hearts and a CD4 cell count of < 20 x 10(6)/l. No significant difference existed in survival for subjects with borderline left or isolated right ventricular dysfunction. CONCLUSION--Even after adjustment for the significantly reduced CD4 cell count with which dilated cardiomyopathy is associated, the outlook for patients with HIV infection and dilated cardiomyopathy is poor. Isolated right and borderline left ventricular dysfunction are not associated with reduced CD4 cells counts and do not carry adverse prognostic implications.