Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 +/- 2.5 years); unprotected sexual intercourse (only 4% used condoms consistently); multiple sexual partners (mean 3.8 +/- 2.4 and 1.8 +/- 1.2 for boys and girls, respectively) were found. Marijuana, used by 60% of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95% CI, 1.6-3.4). Repeated episodes of STD (33%), coinfection with HIV (1.2%), syphilis (1.2%) and teenage pregnancy (13%) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.     

545例性病门诊女性就诊者性传播感染的临床调查

目的探讨性传播感染的流行病学特点,为合理防治女性性传播感染提供依据。方法对性病门诊女性就诊者进行临床流行病学调查和实验室检查。结果545例就诊者中,支原体、梅毒和尖锐湿疣（CA）的感染率分别为66.42％、25.69％和20.18％;≥40岁者和＜40岁者、初中及以下学历者和高中及以上学历者的梅毒感染率分别为33.50％、21.16％、33.01％和15.88％。仅5.00％的梅毒患者出现皮损。结论性病门诊女性就诊者的支原体、梅毒和CA的感染率较高,其中梅毒以隐性感染为主。≥40岁者、低学历者的梅毒感染率明显高于＜40岁者、学历相对高者。     

Antibiotic susceptibility of Clostridium difficile isolates from adult patients at two Jamaican hospitals. Clinical and epidemiological implications

The susceptibility of 39 toxin producing Clostridium difficile isolates from stools of hospitalized patients was determined, by disc diffusion, to six antibiotics. All but one isolate (toxin A negative) produced toxin A and toxin B. A wide variation in susceptibility to clindamycin, tetracycline and chloramphenicol was noted. Erythromycin and cotrimoxazole showed a clear-cut discrimination in resistance and susceptibility, while all isolates were sensitive to vancomycin. Erythromycin sensitive isolates demonstrated a significant association with diarrhoea (60.9%, 14/23, p < 0.001). These strains were predominantly found at the University Hospital of the West Indies (UHWI, 94.1%, 16/17). Strains resistant to erythromycin and clindamycin together were commonly found at the National Chest Hospital (NCH, 68.2%, 15/22). All erythromycin sensitive strains found at the NCH were from patients transferred to that hospital. These findings suggest that there is a common strain of C difficile (erythromycin resistant) at the NCH different from that found at the UHWI; the resistant pattern seen with isolates from the NCH was typical of toxigenic serogroup C strain and could be typed by the the disc diffusion method. Patients at the NCH who were colonized with either of the two strains of C difficile were likely to get diarrhoea, once there was suppression of the normal microflora by antibiotics and colonic overgrowth with C difficile.     

初诊变应性鼻炎患者临床变应原分析

目的分析初诊为变应性鼻炎患者的变应原检查结果,区别变应性鼻炎(allergic rhinitis,AR)和非变应性鼻炎(non-allergic rhinitis,NAR),指导临床诊断和治疗。方法对门诊2010年1月～2012年3月期间临床症状及体征符合变应性鼻炎的患者833例给予抽血做变应原检查,记录病人性别、年龄、总IgE(total-IgE)、血清特异性IgE(sIgE)、屋尘螨,粉尘螨(HX2)检测结果及吸入性变应原筛查(phadiatop),并对检测结果进行分析。结果初诊833例患者有555例总IgE在参考值以上(>60ku/L),HX2和(或)phadiatop阳性,同时伴有临床症状,可确诊为变应性鼻炎;278例患者总IgE在参考值以内,HX2和(或)phadiatop阴性,但有AR相关临床症状,故诊断为非变应性鼻炎。结论临床有部分变应性鼻炎相关症状的病人(约33.4%)检测相关变应原阴性,故并不能确诊为变应性鼻炎,在临床上应重视行变应原检查,为正确诊断和治疗提供指导。     

新诊断的早发2型糖尿病的临床特征分析

目的研究新诊断的早发2型糖尿病（T2DM）患者的临床代谢特点。方法将150例新诊断为T2DM的患者按年龄分为早发组（≤40岁,n=68）和晚发组（〉40岁,n=82）,比较2组在体重指数（BMI）、血清尿酸、血糖、血压、血脂、空腹C肽、胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）等方面的差别。结果早发组的BMI、血清尿酸比晚发组高（P〈0.05）,而收缩压、高血压患病率及HOMA-β低于晚发组（P〈0.05或P〈0.01）。经相关分析,早发组的HOMA-IR与HbA1c呈正相关（r=0.499,P=0.049）,与HDL-C呈负相关（r=-0.643,P=0.008）,HOMA-β与TC呈负相关（r=-0.519,P=0.027）。晚发组的HOMA-β与BMI呈正相关（r=0.555,P=0.012）,与HbA1c呈负相关（r=-0.481,P=0.011）。结论新诊断的早发T2DM患者表现为肥胖与胰岛β细胞功能降低。     

Poverty, folate deficiency, human immunodeficiency virus and ulcerated vulval sexually transmitted diseases in Jamaica

Sexually transmitted genital ulcerative conditions are declining in Jamaica. The rates at present are far lower than that seen in the 1950s-1960s. Review of the records of the national Comprehensive Clinic has revealed that all of the major sexually transmitted conditions (Syphilis, Lymphogranuloma Venereum (LGV), Chancroid, Granuloma Inguinale and Herpes Simplex) have declined but have had three peaks between 1958 and 2000. Closer review seems to suggest that the peaks were associated firstly with poverty in the 1960s and 1970s and to the HIV epidemic in the 1980s and early 1990s. There are also smaller spikes which appear to be associated with periods of environmental disasters, with a possible association with folate deficiency. This is apparent for the bacterial and chlamydial conditions as well as viral conditions such as Herpes simplex.     

女性青少年的安全套使用情况、性行为以及患性传播性疾病与生殖器人乳头状瘤病毒感染持续时间的关系

目的:调查女性青少年中潜在的可改变因素如安全套使用、性行为和并发的性传播性疾病与生殖器人乳头状瘤病毒(H PV)感染持续时间的关系。设计:纵向观察研究。机构:在印第安纳州的印第安纳波利斯的3所诊所进行的研究。入选者:49名H PV阳性青少年对H PV感染进行经常性测试并提供性行为日记。主要调查内容:安全套使用情况、性行为、性伴侣人数和伴发的淋病奈瑟菌、沙眼衣原体和阴道毛滴虫感染。主要观察指标:对特定类型H PV感染从发生到清除的时间应用比例风险模型进行分析,应用校正后的危险比(AH Rs)来评价危险因素对H PV感染时程的影…     

性病患者临床心理分析与治疗效果

目的探索STD患者心理因素与治疗效果的关系，从而提高性病治愈率。方法根据患者对性病的心态，分成恐惧忧郁型、愤怒伤感型、玩世不恭型三种类型，采用正规治疗，辅以心理治疗的方法观察治疗效果。结果472例正规治疗辅以心理治疗的患者治愈443例，治愈率为93．86％。而未辅以心理治疗的患者治愈率为70．93％（61／86）。二者差异有统计学意义（X^2=43．74，P〈0．01）。三型病人中以愤怒伤感型治愈率最高为96．94％（95／98），其次为恐惧忧郁型为95．54％（150／157）。结论采用正规治疗，辅以心理治疗的方法，可提高STD治愈率。     

Health seeking and sexual behaviour among patients with sexually transmitted infections - the importance of traditional healers

We aimed to describe health seeking and sexual behaviour including condom use among patients presenting with sexually transmitted infections (STI) and, to identify socio-demographic and behavioural risk factors associated with “no condom use” during the symptomatic period. A cross-sectional study of consecutive new STI cases presenting at the district STI clinic in Thyolo were interviewed by STI counsellors after obtaining informed consent. All patients were treated according to National guidelines. Of 498 new STI clients, 53% had taken some form of medication before coming to the STI clinic, the most frequent alternative source being the traditional healer (37%). 46% of all clients reported sex during the symptomatic period (median=14 days), the majority (74%) not using condoms. 90% of all those who had not used condoms resided in villages and had seen only the traditional healer. Significant risk factors associated with “no condom use” included: visiting a traditional healer; being female; having less than 8 years of school education; and being resident in villages. Genital ulcer disease (GUD) was the most common STI in males (49%) while in females this comprised 27% of STIs. These findings, especially the extremely high GUD prevalence is of particular concern, considering the high national HIV prevalence in Malawi (9%) and the implications for STI and HIV transmission. There is an urgent need to integrate traditional healers in control activities, encourage their role in promoting safer sexual behaviour, and to reorient or even change existing strategies on condom promotion and STI control.     

常见性病患者中的巨细胞病毒感染

以往对人巨细胞病毒 (ＨＣＭＶ)传播途径多着眼于围产期感染。近年来大量流行病学资料证实 ,性传播是其主要的传播途径之一。本研究应用ＥＬＩＳＡ法检测了 46 1例常见性病患者特异性巨细胞病毒ＩｇＭ (ＣＭＶ -ＩｇＭ) ,以了解性病患者中ＣＭＶ感染情况 ,探讨其性传播的可能性。1　对象与方法1.1　病例　在杭州市第六人民医院就医的性病患者共 46 1例 ,男性 2 44例、女性 2 17例 ;年龄 18～ 6 5岁 ,平均31± 8.8岁。 46 1例均经临床及实验室检查确诊 ,其中梅毒 5 8例 ,淋病 10 0例 ,非淋菌性尿道炎 10 3例 ,非淋菌性宫颈炎 97例 ,尖锐湿疣 …     

Epidemiological investigation of human papillomavirus infection in men attending a sexually transmitted disease clinic in Hangzhou area

Objective To investigate the epidemiological characteristics of human papillomavirus （HPV） infection in men attending a sexually transmitted diseases （STD） clinic in Hangzhou area. Methods Male subjects （n=375） aged 18-70 years, attending the STD clinic were recruited. Urethral swabs were assessed for HPV DNA using polymerase chain reaction （PCR） with the consensus primers MY09/11. HPV genotypes of positive PCR products were determined by restriction fragment length polymorphisms and direct sequence analysis. Results Of the 375 swabs collected, 305 （81.3%） yielded sufficient DNA for the subsequent HPV analysis. Among the 305 subjects, the prevalence of HPV was 13.8%. Nononcogenic HPV types were found in 8.5% （26/305） of subjects, oncogenic types in 4.3% （13/305）, and multiple types in 1.0% （3/305）. The prevalence of HPV infection was higher in subjects from urban area than in those from rural area （P〈0.05）. The prevalence was also higher in those who received fewer years of education （P〈0.05） and those who had more sex partners （P〈0.05）. Conclusions HPV infection among men at high risk is not uncommon. The detection rate of HPV DNA is significantly related to some sociodemographic factors, such as residence, educational level and the number of sex partners.     

初诊2型糖尿病患者短期胰岛素强化治疗的临床疗效

目的探讨初诊2型糖尿病患者短期胰岛素强化治疗的临床疗效。方法选择初次诊断为2型糖尿病患者40例,给予持续性皮下胰岛素强化治疗2周,比较治疗前后血糖、糖化血红蛋白、空腹胰岛素、B细胞功能等相关指标。结果治疗后空腹血糖（FPG）、餐后2h血糖（2hPG）及Homa-IR下降明显,而Homa-β与治疗前比较差异显著（P〈0．05或0．01）。结论短期持续胰岛素输注强化治疗初诊2型糖尿病,能够有效控制空腹血糖和餐后血糖,并且能够显著改善β细胞的功能,值得临床推广使用。     

新诊断酮症起病超重或肥胖糖尿病患者的临床分析

目的探讨新诊断酮症起病超重或肥胖糖尿病患者的临床特征和初步分型。方法根据体质指数(BMI)将86例新诊断酮症起病糖尿病患者分为三组:低体重组(A组,BMI≤18.5 kg/m2,16例)、正常体重组(B组,BMI为18.6~23.9 kg/m2,45例)及超重或肥胖组(C组,BMI≥24.0 kg/m2,25例)。52例非酮症起病超重或肥胖2型糖尿病患者为D组。分别比较A组、B组和C组的临床资料及C组和D组的临床资料。结果①C组及B组的发病年龄明显高于A组(均P<0.01),谷氨酸脱羧酶抗体/蛋白酪氨酸磷酸酶抗体阳性率、随机血糖及血β羟丁酸水平均明显低于A组(P<0.01或P<0.05)。C组伴代谢综合征比例、二氧化碳结合力、空腹C肽及餐后2 h C肽水平均明显高于A组及B组(P<0.01或P<0.05),血压及餐后C肽增加值水平明显高于A组(P<0.01或P<0.05)。②C组随机血糖及糖化血红蛋白水平明显高于D组(均P<0.01),空腹C肽、餐后2 h C肽及餐后C肽增加值水平均明显低于D组(均P<0.01)。两组在发病年龄、病程、糖尿病家族史、伴代谢综合征比例、BMI、腰围、体重下降程度、血压、血脂水平间的比较差异均无统计学意义(均P>0.05)。结论新诊断酮症起病超重或肥胖糖尿病患者更倾向于2型糖尿病。     

Plantar verrucae in patients with human immunodeficiency virus. Clinical presentation and treatment response

Several previous studies have yielded data showing that plantar and other cutaneous verrucae follow a more aggressive course in patients infected with human immunodeficiency virus (HIV) than in uninfected individuals. A pilot study was undertaken to identify trends in a sample population that would support this characterization of plantar verrucae in HIV+ patients and to determine whether there are differences in treatment response between HIV+ and HIV- patients. The results show that the HIV+ patients in the study presented with a significantly greater number and total area of lesions than did the HIV- patients. Furthermore, the HIV+ patients experienced a greater frequency of recurrence of their lesions following treatment with surgical curettage. These findings should provide the foundation for other extensive, multicenter studies to further characterize the treatment response of these lesions in HIV+ patients and to develop effective guidelines for their management.     

成人社区获得性肺炎临床特征研究

目的:探讨本院成人患者社区获得性肺炎(CAP)的临床特点,为制定该地区CAP防治策略提供依据。方法:选取我院诊治的320例成人CAP患者作为研究对象,进行病原学检测,所得数据采用SPSS 17.0进行统计学分析。结果:老年和青年患者为CAP高发人群,与中年组和青年组相比,老年组肺炎临床表现、发生部位、病原学分布差异具有统计学意义。结论:关于成人CAP流行病学研究较少,病原学检测对CAP的正确诊断和合理治疗具有十分重要的临床意义。治疗中应综合考虑年龄、临床表现、体征、基础疾病情况等多种因素。