Prevalence of MRSA colonization in peripartum mothers and their newborn infants

Methicillin-resistant Staphylococcus aureus (MRSA) cultures were obtained from 288 mother-infant pairs. A questionnaire given to mothers and medical record review assessed risk factors for colonization. Only 2.1% of mothers and 0.7% of infants carried MRSA. There were no identical MRSA mother-newborn pairs. MRSA colonization by expectant mothers is uncommon and transmission to newborns from vaginal delivery did not occur.     

Prevalence and clinical predictors of Pneumocystis colonization among HIV-infected men

BACKGROUND: The epidemiology and transmission of Pneumocystis are poorly understood. The incidence of colonization, or detection of organisms without signs of disease, has been debated, and risk factors for colonization are largely unknown. OBJECTIVE: To determine the rate of Pneumocystis colonization among HIV-infected patients at autopsy and analyze associated clinical variables. METHODS: Subjects were selected from the Multicenter AIDS Cohort Study. Subjects who died from causes other than Pneumocystis pneumonia and consented to autopsy were included in analysis. DNA was extracted from lung tissue, and nested PCR was performed to detect the presence of Pneumocystis. Clinical data were obtained from the Multicenter AIDS Cohort database. Univariate and multivariate analyses were performed to determine predictors of Pneumocystis colonization. RESULTS: Pneumocystis DNA was detected in 42 of 91 (46%) subjects by nested PCR. Clinical variables such as CD4 cell count, use of Pneumocystis prophylaxis or antiretroviral drugs, and history of previous Pneumocystis pneumonia were not related to risk of colonization. Multivariate analysis demonstrated that cigarette smoking was related to an increased risk of colonization [odds ratio (OR), 4.5; 95% confidence interval (CI), 1.27-15.6; P = 0.02] and risk also varied by city of residence (OR, 0.12; 95% CI, 0.03-0.45; P = 0.002 for living in Los Angeles). CONCLUSIONS: This study found a high rate of Pneumocystis colonization among HIV-infected patients. We also identified cigarette smoking and city of residence as novel, independent risk factors for colonization. The role of subclinical colonization in disease transmission and the effects of Pneumocystis colonization on the lung require further study.     

Prevalence and predictors of osteoporosis in an urban Sri Lankan population

Aim: To determine the prevalence of osteoporosis in both women and men and to determine the association between osteoporosis and selected risk factors among a sample of urban Sri Lankan adults. Methods: The population aged 35–64 years residing in 22 Grama Niladhari divisions, the smallest administrative units in the country, of the Medical Officer of Health area Ragama, Sri Lanka, was identified using the electoral list and stratified into three age groups (n = 3012). A random sample was obtained from each stratum and selected individuals were invited to participate in the study (n = 1100). A structured, interviewer‐administered questionnaire was used to collect information on demographic data and details of risk factors. Bone mineral density (BMD) was measured using a peripheral dual‐energy X‐ray absorptiometry (DEXA) scan in 700 subjects (64%). A BMD < ?2.5 was considered as osteoporosis. Although peripheral DEXA is less sensitive and specific compared to central DEXA it was used in this study as it is less costly and easily transportable. Results: Of the 700 subjects who consented to participate in the study, 60% (n = 421) were females. In subjects < 50 years, 9% of women and 3% of men had osteoporosis. In subjects ≥ 50 years, 27% of women and 7% of men had osteoporosis. Female sex (odds ratio [OR] 12.0), smoking (OR 5.5), age > 50 years (OR 3.1), low BMI (OR 3.1) and low level of education (OR 1.7) were positively associated with osteoporosis. Conclusions: Female sex, age, BMI, smoking and level of education were significant predictors of osteoporosis. The prevalence of osteoporosis increased in both women and men after 50 years.     

IBD1 and IBD3 determine location of Crohn's disease in the Spanish population

BACKGROUND: Crohn's disease is a heterogeneous disease from both genetic and clinical points of view. AIMS: To look for associations between distinct genetic polymorphisms and clinical subgroups of the disease. SUBJECTS: A total of 210 patients and 343 healthy control subjects, all adult, unrelated, white, Spanish individuals. METHODS: DNA was purified from peripheral blood samples and was typed by sequence-specific oligonucleotide polymerase chain reaction (PCR) method for human leukocyte antigen (HLA)-DRB1 alleles (IBD3) and by allele-specific PCR for NOD2/CARD15 (IBD1) polymorphisms. RESULTS: NOD2/CARD15 mutations and HLA-DRB1*07 confer susceptibility only to the ileal location of the disease, whereas HLA-DRB1*0103 is associated only with the colonic location of the disease. The IBD3 effect was overshadowed by IBD1 mutations when present. CONCLUSION: The studied genetic polymorphisms of Crohn's disease basically determine the location of the disease and, only secondarily, the clinical form of the disease. This appears to be true for both inflammatory bowel diseases as HLA-DRB1*0103 is associated both with colonic Crohn's disease and ulcerative colitis.     

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

International Guidelines recommend ambulatory blood pressure monitoring (ABPM) for the management of hypertension. ABPM phenotypes predict outcomes independent of office blood pressure (BP). The authors explored the prevalence and clinical correlates of ABPM phenotypes and relationship with office BP in Saudi patients (n = 428, mean age 53.5 ± 14.6, 55% male) referred to a Specialist Hypertension clinic in Riyadh, Saudi Arabia. ABPM phenotypes included sustained normotension (27%), masked hypertension, MHT(32%), sustained hypertension, SHT(52%), and white coat hypertension(2.6%). MHT was more prevalent using asleep than 24‐hours (26.4% vs 12.9%, P < .01) or awake BP (26.4% vs 8.5%, P < .001) and observed in 85% of pre‐hypertensive patients. Isolated nocturnal hypertension was more prevalent in MHT vs SHT (70% vs 30%, P < .001). Office BP overestimated control rates compared with ABPM (48% vs 12.9%, P < .001). Our study shows that one in three Saudi patients will be managed inappropriately if office BP alone was relied upon for management of hypertension.     

Prevalence and predictors of undiagnosed chronic obstructive pulmonary disease in a Norwegian adult general population

Objectives: To determine the prevalence and predictors of undiagnosed chronic obstructive pulmonary disease (COPD) in Norway. Methods: An age and gender stratified random sample of all adults aged 47–48 and 71–73 years in Bergen, Norway, were invited. The 3506 participants filled in questionnaires including symptoms of COPD, smoking, socio‐economic status, self‐rated health and cardiac co‐morbidity. Spirometry was performed before and after inhalation of 400 µg of salbutamol. COPD was defined as post‐bronchodilator forced expiratory volume in 1 s (FEV1) / forced vital capacity (FVC) < 0.7 whereas diagnosed COPD was defined as having received treatment for obstructive lung disease the last year. Results: Three hundred‐three persons (9%) were classified as having COPD, and the undiagnosed fraction was 66%. In multiple logistic regression analysis, including multiple imputation, predictors of undiagnosed COPD were absence of COPD symptoms [odds ratio (OR) 6.92, P = 0.001], and self‐report of being in good/excellent health (OR 2.39, P = 0.005). When post‐bronchodilator FEV1 was added to the analysis, undiagnosed disease was predicted by pack years [OR 1.21 (1.01–1.47) per 10 pack‐year increase, P = 0.043], and close to normal lung function [OR 1.48 (1.22–1.80) per 10% increase in post‐bronchodilator FEV1 % predicted, P < 0.001]. Anthropometrical variables, socio‐economic status and cardiac co‐morbidity were not associated with having undiagnosed COPD. Conclusion: Two out of three COPD patients in Norway are undiagnosed. Risk factors for being undiagnosed are moderate reduction in lung function, absence of COPD symptoms and self‐report of being in good health. Please cite this paper as: Hvidsten SC, Storesund L, Wentzel‐Larsen T, Gulsvik A and Lehmann S. Prevalence and predictors of undiagnosed chronic obstructive pulmonary disease in a Norwegian adult general population. The Clinical Respiratory Journal 2009; DOI:10.1111/j.1752‐699X.2009.00137.x.     

Isolated systolic hypertension in an elderly Danish population. Prevalence and daytime ambulatory blood pressure

Isolated systolic hypertension (ISH) is a major risk factor for cardiovascular complications. Nevertheless, data on the prevalence in a representative population do not seem to be available. The prevalence of ISH and the white coat effect was thus studied in a cross-sectional survey of 2806 inhabitants aged 70-80 years. In untreated subjects, the prevalence of ISH was 17.4% (95% CI 14.9-20.2) in women and 13.5% (95% CI 11.3-15.9) in men using clinic blood pressure at first visit. The prevalence increased significantly with age. The prevalence was reduced to 10.4% when using the average of all-visits clinic blood pressures. By a simulation model, it was demonstrated that his reduction mainly resulted from a regression towards the mean. Average all-visits clinic blood pressure was 172.6 ±10.4/81.1±6.0 mmHg. Less than one-third of those with all-visit ISH had sustained ISH. Identifying subjects with sustained ISH requires measurements in more than three visits.     

Low prevalence of VRE gastrointestinal colonization of hospitalized patients in Manitoba tertiary care and community hospitals

OBJECTIVE:

To determine the prevalence of vancomycin-resistant enterococci (VRE) bowel colonization in hospitalized patients in Manitoba who had stool specimens collected for Clostridium difficile toxin and/or culture testing.

DESIGN:

Two tertiary care and five community hospitals in Winnipeg and three rural Manitoba community hospitals participated in this study. From January 1 to December 31, 1997 stool specimens, one per patient, submitted to hospital microbiology laboratories for C difficile toxin and/or culture testing were screened for VRE on colistin-nalidixic acid-vancomycin (6 μg/mL) (CNAV) agar plates. The study was divided into six, eight-week intervals. Stool specimens received in the first two weeks of each eight week interval were screened for VRE.

MAIN RESULTS:

A total of 1408 stool specimens were submitted over the 48-week study period. Sixty-seven (4.8%) patients with VRE colonization of their lower gastrointestinal tract were identified. Three of the 67 (4.5%) VRE isolates were Enterococcus faecium, with the remaining 64 (95.5%) were Enterococcus gallinarum. The three vancomycin-resistant E faecium -VREF- (from two different Winnipeg hospitals) demonstrated the vanA genotype, and were resistant to vancomycin, teicoplanin and ampicillin. All three VREF isolates also demonstrated high level resistance to both gentamicin and streptomycin but were susceptible to quinuprisitin/dalfopristin and {"type":"entrez-nucleotide","attrs":{"text":"LY333328","term_id":"1257359838"}}LY333328.

CONCLUSION:

VRE colonization in hospitalized patients in Manitoba is infrequent and most commonly due to E gallinarum. The prevalence of VREF colonization in the patients studied was 0.2% (three of 1408).Key Words: Manitoba, Prevalence, Vancomycin-resistant enterococciVancomycin-resistant Enterococcus faecium (VREF) accounts for up to 65% of E faecium isolates in hospitalized patients across the United States and is endemic in many North American tertiary care institutions (1,2). The management of these infections presents a significant clinical challenge because species of the genus Enterococcus, and in particular E faecium, are frequently resistant to several antimicrobial agents (3). High level penicillin resistance, high level aminoglycoside resistance and most recently vancomycin resistance are emerging as significant concerns in the treatment of enterococcal infections. This has prompted the development and evaluation of new antimicrobial agents such as quinupristin/dalfopristin and {"type":"entrez-nucleotide","attrs":{"text":"LY333328","term_id":"1257359838"}}LY333328, a glycopeptide, which may offer activity against enterococci resistant to conventional therapy (2).VREF is not endemic in Manitoba hospitals, and infection with VREF is extremely rare (4). However, the prevalence of VREF lower gastrointestinal tract (GIT) carriage, which frequently precedes infection (5,6), is presently unknown for patients hospitalized in Manitoba. To determine whether the lack of VREF endemnicity correlated with an absence of lower GIT colonization, we assessed lower GIT carriage of VREF for patients hospitalized in 10 Manitoba hospitals from January 1 to December 31, 1997. Our study was consistent with Centers for Disease Control and Prevention guidelines (Atlanta, Georgia) that suggest surveillance programs for vancomycin-resistant enterococci (VRE) be undertaken on an intermittent basis in areas where VRE is not known to be endemic (6). Isolates of VREF identified were phenotypically and genotypically characterized, and tested for their susceptibilities against a panel of antimicrobial agents.     

Prevalence and predictors of unsupervised walking and physical activity in a community population of women with fibromyalgia

Physical exercise is recognized as a component of the evidence-based guidelines for treatment of fibromyalgia. Walking is a low–moderate intensity exercise easily adaptable to a fibromyalgia patient’s situation. The present study aims to estimate the prevalence of unsupervised walking for exercise in women with fibromyalgia, to describe their level of physical activity and to identify their predictors among socio-demographic, symptom perception and medical advice to walk. A cross-sectional survey with 920 women (all members of fibromyalgia associations) completed the International Physical Activity Questionnaire-Short Form and self-reported scales to assess symptom perception, walking, medical advice to walk and physical comorbidity. The prevalence of reported walking regularly as physical exercise was 30.8 % and it was predicted by medical advice (odds ratio, OR 1.876), age (OR 1.021) and fatigue intensity (OR 0.912). The prevalence of physical activity was 16 % for high-intensity activity, 40 % for moderate activity and 44 % for low activity. Predictors of low versus moderate and high physical activity were pain intensity (OR 1.171) and fatigue impact perception (OR 1.076). Evidence shows a low percentage of women with fibromyalgia walking regularly for physical exercise. Most reported low or moderate physical activity. The results indicate the importance of doctors’ advice in promoting walking. Symptom perception and socio-demographic characteristics were weak predictors. Further work is required to examine other determinants of these low levels.     

Low prevalence of VRE gastrointestinal colonization of hospitalized patients in Manitoba tertiary care and community hospitals.

OBJECTIVE: To determine the prevalence of vancomycin-resistant enterococci (VRE) bowel colonization in hospitalized patients in Manitoba who had stool specimens collected for Clostridium difficile toxin and/or culture testing. DESIGN: Two tertiary care and five community hospitals in Winnipeg and three rural Manitoba community hospitals participated in this study. From January 1 to December 31, 1997 stool specimens, one per patient, submitted to hospital microbiology laboratories for C difficile toxin and/or culture testing were screened for VRE on colistin-nalidixic acid-vancomycin (6 mug/mL) (CNAV) agar plates. The study was divided into six, eight-week intervals. Stool specimens received in the first two weeks of each eight week interval were screened for VRE. MAIN RESULTS: A total of 1408 stool specimens were submitted over the 48-week study period. Sixty-seven (4.8%) patients with VRE colonization of their lower gastrointestinal tract were identified. Three of the 67 (4.5%) VRE isolates were Enterococcus faecium, with the remaining 64 (95.5%) were Enterococcus gallinarum. The three vancomycin-resistant E faecium -VREF- (from two different Winnipeg hospitals) demonstrated the vanA genotype, and were resistant to vancomycin, teicoplanin and ampicillin. All three VREF isolates also demonstrated high level resistance to both gentamicin and streptomycin but were susceptible to quinuprisitin/dalfopristin and LY333328. CONCLUSION: VRE colonization in hospitalized patients in Manitoba is infrequent and most commonly due to E gallinarum. The prevalence of VREF colonization in the patients studied was 0.2% (three of 1408).     

Prevalence and predictors of hyperprolactinemia in subclinical hypothyroidism

Background and aimsHyperprolactinemia has been reported in 0–57% of primary hypothyroidism. Data on hyperprolactinemia in subclinical hypothyroidism (ScH) is scant and inconsistent. This study aimed to determine the prevalence and predictors of hyperprolactinemia in ScH.MethodsConsecutive patients diagnosed to have normal thyroid function, ScH or overt primary hypothyroidism underwent serum prolactin, gonadotropins, testosterone and estradiol estimation. Patients with pregnancy, pituitary adenomas, secondary hypothyroidism, hyperthyroidism, comorbid states and drug-induced hyperprolactinemia were excluded.ResultsFrom initially screened 4950 patients, hormonal data from 2848 individuals who fulfilled all criteria were analyzed. The occurrence of hyperprolactinemia (females:males) was highest in primary hypothyroidism (42.95%:39.53%) (n = 192), followed by ScH (35.65%:31.61%) (n = 770) and euthyroid individuals (2.32%:2.02%) (n = 1886) (P < 0.001). Hyperprolactinemia in ScH with TSH 5–7.5, 7.5–10 and > 10 mIU/L (females: males) was 25.56%:20.73%, 49.07%:50% and 61.43%:35.71% respectively (P < 0.001). Significant positive correlation between TSH and prolactin was noted in ScH and primary hypothyroidism. In females, testosterone was lowest in patients with primary hypothyroidism. In males, serum estradiol was significantly higher, and testosterone significantly lower in men with ScH and primary hypothyroidism. Regression analysis revealed serum TSH followed by free T₄, to be best predictors of serum prolactin in both sexes.ConclusionHyperprolactinemia is common in ScH, especially in those with TSH > 7.5 mIU/L. ROC analysis confirmed that TSH ≥ 7.51 mIU/L in females and ≥ 8.33 mIU/L in males had a sensitivity of ≈ 50% with a very high specificity of > 90% in detecting hyperprolactinemia. Prolactin screening may be warranted in ScH with TSH > 7.5mIU/L, and may form an indication for treating ScH.