Evaluating patterns in retention,continuation, gaps,and re-engagement in HIV care in a Medicaid-insured population, 2006–2012, United States

We used the US-based MarketScan^® Medicaid Multi-state Databases to determine the un-weighted proportion of publically insured persons with HIV that were retained, continued, and re-engaged in care. Persons were followed for up to 84 months. Cox proportional hazards models were conducted to determine factors associated with gaps in care. Of the 6463 HIV cases identified in 2006, 61% were retained during the first 24 months, and 53% continued in care through 78 months. Between 8% and 30% experienced a gap in care, and 59% of persons who experienced a gap in care later re-engaged in care. Persons with one or more Charlson co-morbidities (HR 0.72, 95% CI 0.64–0.81), ages 40–59 (0.79, 0.71–0.88), mental illness diagnosis (0.79, 0.72–0.87), hepatitis C co-infection (0.83, 0.75–0.93), and female sex (0.86, 0.78–0.94) were less likely to experience a gap in care. Between 27% and 38% of those not retained in care continued to receive HIV-related laboratory services. This Medicaid claims database combines features of both clinic visits-based and surveillance lab-based surrogate measures to give a more complete picture of engagement in care than single-facility-based studies.     

Prevalence of constipation in adolescents enrolled in São José dos Campos, SP, Brazil, school's and in their parents

BACKGROUND: There is few information concerning constipation in adolescence. AIMS: To evaluate the prevalence of constipation in adolescents enrolled in schools settled down in the city of S?o José dos Campos, state of S?o Paulo, Brazil, and in their biological parents. PATIENTS AND METHODS: A transversal study was carried out by analyzing a convenience sample which included adolescents between 9 years and 9 months and 18 years and 7 months old and their parents in five schools situated in S?o José dos Campos, SP. Data was obtained from an individual and personal questionnaire filled by the father, the mother and the adolescent. Three hundred and seventy two adolescents were studied. Constipation was defined as the elimination of hard stools and the presence of at least one of the following: painful or difficult defecation, soiling or bloody stools. Scybalous feces or dry cracked stools or the defecation frequency equal or minor than two per week were considered criteria for characterization of constipation. Rome II criteria was used for evaluate the prevalence of constipation in the parents. RESULTS: The prevalence of constipation in adolescents was 22.3%, being it more frequent in female (27.4%) than in male (14.9%). Among the fathers, the prevalence of constipation (7.3%; 20/274) was lower than in the mothers. Kappa's coefficient showed a slight concordance in the concomitance of constipation in the adolescent and his/her mother (kappa = 0.12) and in the adolescent and his/her father (kappa = 0.05). CONCLUSIONS: Intestinal constipation is a prevalent disturbance in the studied group of adolescents. However, it was not found relevant concordance between constipation in the adolescents and their parents.     

Toxoplasma gondii in fresh pork sausage and seroprevalence in butchers from factories in Londrina, Paraná State, Brazil

The aims of this study were to verify the presence of Toxoplasma gondii cysts in fresh pork sausage and the presence of antibodies against T. gondii in serum of workers from factories with Municipal Inspection Service, in Londrina, PR, Brazil. 149 samples of sausage were collected from eight factories and blood samples from 47 workers. We also took information about the practices that were adopted in the factories and the workers' habits that could influence the prevalence of toxoplasmosis. After bioassay in mice, 13 (8.7%) sausage samples were positive, in one of them T. gondii was isolated and in the other 12 the mice seroconverted. Of 47 workers, 36 (76.6%) worked in sausage production and 11 (23.4%) were involved in other functions; 59.5% (28/47), 55.5% (20/36) and 72.7% (8/11), respectively, had T. gondii antibodies. There were no significant differences in the variables of industries' practices and workers' habits related to T. gondii infection. We concluded that fresh pork sausage could be important in the transmission of toxoplasmosis.     

Pancreatitis in pregnancy：etiology,diagnosis, treatment,and outcomes

BACKGROUND: Acute pancreatitis in pregnancy is a rare and dangerous disease. This study aimed to examine the etiology, treatment, and outcomes of pancreatitis in pregnancy.
METHOD: A total of 25 pregnant patients diagnosed with pancreatitis during the period of 1994 and 2014 was analyzed retrospectively.
RESULTS: The pregnant patients were diagnosed with pancre-atitis during a period of 21 years. Most (60%) of the patients were diagnosed with pancreatitis in the third trimester. The mean age of the patients at presentation was 25.7 years, with a mean gestational age of 24.4 weeks. Abdominal pain occurred in most patients and vomiting in one patient was associated hyperemesis gravidarum. The common cause of the disease was gallstone-related (56%), followed by alcohol-related (16%), post-ERCP (4%), hereditary (4%) and undetermined condi-tions (20%). The level of triglycerides was minimally high in three patients. ERCP and wire-guided sphincterotomy were performed in 6 (43%) of 14 patients with gallstone-related pancreatitis and elevated liver enzymes with no complications. Most (84%) of the patients underwent a full-term, vaginal delivery. There was no difference in either maternal or fetal outcomes after ERCP.
CONCLUSIONS: Acute pancreatitis is rare in pregnancy, oc-curring most commonly in the third trimester, and gallstones are the most common cause. When laparoscopic cholecystec-tomy is not feasible and a common bile duct stone is highly suspected on imaging, endoscopic sphincterotomy or stenting may help to prevent recurrence and postpone cholecystectomy until after delivery.     

Congenital toxoplasmosis in dizygotic twins, Paraná, Brazil

This is the first report of congenital toxoplasmosis in dizygotic twins in Brazil. We emphasize the need for early diagnosis of the mother and follow-up of children with suspected or confirmed infection from birth to adolescence, in order to avoid the hazard and damage from congenital toxoplasmosis.     

Novel serum tumor marker, RCASl, in pancreatic diseases

AIM: As tumor markers for pancreatic carcinoma, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 have been used, but the sensitivity and specificity are not enough for the diagnosis of pancreatic carcinoma. METHODS: A novel serum tumor marker, RCAS1, was compared with two conventional serum tumor markers, CEA (highly specific for pancreatic cancer) and CA 19-9 (highly sensitive for pancreatic cancer), in 48 patients with pancreatic exocrine tumors. RESULTS: When the diagnosis of benign or malignant conditions was examined by one tumor marker, the sensitivity of RCAS1 alone (55%) was higher than that of CEA alone (27%) and the specificity of RCAS1 alone (92%) was greater than that of CA19-9 alone (78%). When examined by a combination of two markers, the sensitivity of a combination of RCAS1 and CA19-9 (95%) was superior to those of CA19-9 alone (78%), RCAS1 alone (55%, P = 0.002), CEA alone (27%) (P<0.001), RCAS1 and CEA (59%) and CA19-9 and CEA (82%). CONCLUSION: These results suggest that the combination of RCAS1 and CA19-9 is highly sensitive for pancreatic carcinoma.     

Trends in survival of patients with ovarian cancer in Saarland, Germany, 1976–1995

Purpose: We aimed to monitor recent progress in survival of patients with ovarian cancer. Methods: We assessed trends in survival in 1976–1995 among patients notified to the population-based cancer registry of Saarland, Germany, with a first diagnosis of ovarian cancer below the age of 80 years. A new statistical methodology was applied that allows the most timely detection of changes in survival rates. Results: There was a dramatic, ongoing increase in 5-year relative survival rates from 36.6% in 1976–1980 to 60.1% in 1991–1995 among patients whose cancer was detected below the age of 55 years, and from 23.7% to 42.9% in patients aged 55–64 years at the time of diagnosis. No such improvement was seen among older patients, who continued to have a very poor prognosis. Therefore, the variation of prognosis with age was strongly increasing over time. Conclusions: Improvement of prognosis in younger patients most likely reflects the benefits of more aggressive surgery and chemotherapy in these age groups. Efforts should be made to overcome obstacles to more successful therapy for older patients. Received: 3 August 1998 / Accepted: 16 November 1998     

Cancer mortality in young adults in Switzerland, 1951–1989

Summary Trends in mortality from all neoplasms and major cancer sites in Switzerland among populations aged between 20 and 44 years are presented. In men total cancer mortality was approximately constant around 270/10⁶ between 1951 and 1965, but declined appreciably thereafter to 217 per million in 1980–1989. The overall fall was 20%. The pattern of trends was similar for women, although a modest decline was already apparent in the earlier calendar period, and the overall fall was 29% (from 303 to 215/10⁶). These favourable trends reflect therapeutic advancements for Hodgkin's disease, leukaemias, testis and (chiefly non-epithelial) ovarian cancer, better control of cervical cancer, the long-term decline in gastric cancer, but also the downward trends in cancer of the intestines and a few less common sites, such as gallbladder and thyroid neoplasms for reasons that are not yet clear. Appreciable rises were observed for lung and other tobacco-related sites in women, for the oral cavity in men and (in earlier calendar periods) cutaneous melanoma in both sexes. Although restricted to a selected number of sites, these rises are discouraging, since the causes of these neoplasms have long been recognized. Somewhat discouraging also is the absence of decline in male lung cancer. These problems notwithstanding, the overall pattern of trends in cancer mortality in young Swiss adults over the last few decades is still reassuring, particularly in comparison with those observed in other European countries, and in the more general frame-work of the debate on the perspectives of progress in cancer control. Although restricted to a small proportion of all cancer deaths, in fact, trends in young adults offer useful indications on the likely future trends in the same generations in the near future, since they reflect more recent changes in the pattern of exposure. The size of the changes, however, will probably differ, since the prevalent cancers in middle age are different from those in the young.     

Snakebites by Crotalus durissus ssp in children in Campinas,São Paulo,Brazil

From January, 1984 to March, 1999, 31 children under 15 y old (ages 1-14 y, median 8 y) were admitted after being bitten by rattlesnakes (Crotalus durissus ssp). One patient was classified as "dry-bite", 3 as mild envenoming, 9 as moderate envenoming and 18 as severe envenoming. Most patients had neuromuscular manifestations, such as palpebral ptosis (27/31), myalgia (23/31) and weakness (20/31). Laboratory tests suggesting rhabdomyolysis included an increase in total blood creatine kinase (CK, 28/29) and lactate dehydrogenase (LDH, 25/25) levels and myoglobinuria (14/15). The main local signs and symptoms were slight edema (20/31) and erythema (19/31). Before antivenom (AV) administration, blood coagulation disorders were observed in 20/25 children that received AV only at our hospital (incoagulable blood in 17/25). AV early reactions were observed in 20 of these 25 cases (9/9 patients not pretreated and 11/16 patients pretreated with hydrocortisone and histamine H1 and H2 antagonists). There were no significant differences in the frequency of patients with AV early reactions between the groups that were and were not pretreated (Fisher's exact test, p = 0.12). Patients admitted less than and more than 6 h after the bite showed the same risk of developing severe envenoming (Fisher's exact test, p = 1). No children of the first group (< 6 h) showed severe complications whereas 3/6 children admitted more than 6 h post-bite developed acute renal failure. Patients bitten in the legs had a higher risk of developing severe envenoming (Fisher's exact test, p = 0.04). There was a significant association between both total CK and LDH blood enzyme levels and severity (p < 0.001 for CK and p < 0.001 for LDH; Mann-Whitney U test). No deaths were recorded.     

Controversies in liver biopsy: Who,where, when,how, why?

Liver biopsy continues to have a central role in the evaluation of patients with suspected liver disease. The procedure is often indicated to evaluate otherwise unexplained liver biochemical test abnormalities, but the precise degree of serum aminotransferase elevations that should prompt a liver biopsy is controversial, as is the need for liver biopsy in all patients with suspected nonalcoholic fatty liver disease and chronic hepatitis C. Standard liver biopsy is contraindicated in patients with severe coagulopathy and ascites, although the degree of coagulopathy that contraindicates a liver biopsy is controversial. A transjugular approach is an alternative in patients with coagulopathy or ascites. Controversy surrounds all the technical aspects of liver biopsy, particularly the choice of needle (cutting vs suction) and the use of ultrasound to mark or guide the biopsy site. Bleeding is the major complication of liver biopsy, with a risk of 0.3%; cutting needles are more likely to cause hemorrhage than are suction needles. Traditionally, liver biopsy has been the province of the hepatologist/ gastroenterologist. However, an increasing number of liver biopsies are performed by radiologists. The implications of this trend with respect to patient outcome, safety, and training of fellows is unclear.     

Lead levels in high-risk populations and the surrounding environment in San Ignacio, Fresnillo, Zacatecas, México

OBJECTIVE: To determine the lead concentration in the blood of children and nursing or pregnant women from San Ignacio, Fresnillo, in Zacatecas, Mexico as well as in soil, plants, ash and lead-glazed pottery, in order to determine exposure due to a metal-recycling facility. MATERIAL AND METHODS: The study was carried out from December 2004 to April 2005. Lead in blood was measured with anodic stripping voltammetry, while dispersive energy X-ray fluorescence was used in the other matrices. RESULTS: Based upon the criteria outlined in the Official Mexican Standards, 90% of the children was identified as category 1, 5% as category II and another 5% as category III. The soil in the land near the facility contained from 73 to 84,238 microg/g, with an average of 4940 microg/g. Larger lead concentrations were found on sites located closer to the facility. San Ignacio's soil contained, on average, 109 microg/g. High lead levels were found in glazed pottery and the concentration in agricultural crops was greater than 300 microg/g. CONCLUSIONS: Although the majority of children in San Ignacio have blood lead concentrations considered to be acceptable according to the Official Mexican Standards, several studies indicate that deleterious effects on children's health exist even at low concentrations.The land around the metal recycling facility is contaminated with lead, and to that extent, the crops that are produced there, once ingested, are a source of contamination, which is compounded by the use of glazed pottery.     

Correlates of Adherence to Antiretroviral Therapy in HIV-Infected Children in Lomé, Togo, West Africa

We assessed pediatric adherence to antiretroviral therapy (ART) and examined associated factors among children in Togo, West Africa. Structured interviews of caregivers of consecutively enrolled HIV-infected children receiving ART in three HIV/AIDS care centers in Lome, Togo were conducted. Child perfect adherence reflected caregivers’ report of no antiretroviral drug doses missed neither in the past 4 days nor in the month before the interview. A total of 74 ART-treated children were included (median age 6 years). Of these, 42% of caregivers declared perfect adherence. In univariate analyses, the major factors relating to child non-adherence were: being female, living in an individual setting (vs. compound with enlarged family), receiving other ART than an NNRT-based regimen, drug regimens with six pills/spoons or more per day, caregiver other than biological parent, caregiver not declaring HIV-status, not participating to support groups and having perceived difficulty of antiretroviral (ARV) administration. In multivariate analysis, female gender, living in an individual setting, receiving other than NNRTI-based regimen and caregivers’ perceived difficulty of ARV administration remained independently associated with the reported child’s non-adherence. These data show low rates of perfect adherence to ART in children in West Africa, influenced by child and caregiver characteristics and suggest a need for counseling and education interventions as well as continuous psychological and social support.     

Acute bacterial meningitis among children, in Manhiça, a rural area in Southern Mozambique

INTRODUCTION: Acute bacterial meningitis (ABM) is one of the most severe diseases in Sub-Saharan Africa. Although data for the continent is very limited, more than one million cases are estimated per year, with mortality and life-long sequelae occurring in 50% of these cases. METHODS: As part of the clinical management of children admitted to the Manhi?a District Hospital, information on cases of ABM was recorded. We analysed data from June 1998 to November 2003. RESULTS: During the study period, 475 cerebrospinal-fluid (CSF) samples were collected from 20,173 children <15 years of age admitted to hospital. Culture results confirmed 71 (15%) cases of ABM. The most prevalent bacterial aetiologies were Streptotoccus pneumoniae (pneumococcus, n=31), Haemophilus influenzae (n=13) and Neisseria meningitis (n=8). Other important bacteria were Streptococcus sp. (n=7), Salmonella sp. (n=4) and Staphylococcus aureus (n=3). Crude incidence rates of ABM and pneumococcal meningitis were 20/100,000 and 10/100,000 children-year-at-risk, respectively. Incidences were more than three times higher in the <1 year age group. Overall case fatality rate was 36%, and was highest for H. influenzae and pneumococcal meningitis (55% and 45%, respectively, p=0.044). Pneumococcal susceptibility was 81% for oxacillin and 93% for chloramphenicol. For H. influenzae isolates, susceptibility was 54% for ampicillin and 62% for chloramphenicol. CONCLUSIONS: S. pneumoniae and H. influenzae are the main aetiologies responsible for the high burden of morbidity and mortality associated with ABM in rural Mozambique. These findings are important to evaluate treatment guidelines and potential impact of control measures.