Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men

OBJECTIVES: Few data are available on the prevalence of sexually transmitted diseases (STDs) in men who have sex with men (MSM), making it difficult to develop STD screening guidelines for this population. The objective of the study was to determine the prevalence of urethral infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae within a large, community based population of MSM, and to assess the feasibility of rectal screening in this population. METHODS: This was a cross sectional study of 566 MSM, who were predominantly middle aged, white, asymptomatic, and engaged in sex with multiple partners. All provided a urine sample to screen for chlamydial and gonorrhoea infections using a PCR assay; rectal screening was performed on 48 participants. RESULTS: Urethral C. trachomatis infections were detected in 1/566 participants (prevalence 0.2%, 95% CI 0.004% to 1.0%), and rectal C. trachomatis infections were detected in 2/48 men (prevalence 4.2%, 95% CI 0.5% to 14.2%). No gonorrhoea infections were detected, and none of the 117 HIV positive men had either infection. CONCLUSIONS: Chlamydial and gonorrhoea infections were uncommon in this sample of MSM, even among those with multiple sexual partners or HIV infection. These data call into question recommendations to screen all MSM based on their individual sexual behaviours or HIV. Additional data are needed on the prevalence of these infections in MSM from different settings.     

Neck treatment and shoulder morbidity: still a challenge

Shoulder complaints and functional impairment are common sequelae of neck dissection. This is often attributed to injury of the spinal accessory nerve by dissection or direct trauma. Nevertheless, shoulder morbidity may also occur in cases in which the spinal accessory nerve has been preserved. In this article, the physiology and pathophysiology of the shoulder are discussed, followed by a consideration of the impact of neck dissection on shoulder complaints, functional impairment, and quality of life. Finally, rehabilitation will be considered.     

Postoperative hypothermia and patient outcomes after elective cardiac surgery

Hypothermia after elective cardiac surgery is an important physiological abnormality and is associated with increased morbidity and mortality. The Australian and New Zealand intensive care adult patient database was studied to obtain the lowest and highest temperature in the first 24 h after surgery. Hypothermia was defined as core temperature < 36 °C; transient hypothermia as temperature < 36 °C that was corrected within 24 h; and persistent hypothermia as hypothermia that was not corrected within 24 h. Hypothermia occurred in 28,587 out of a total of 43,158 consecutive patients (66%) and was persistent in 111 (0.3%). Transient hypothermia was not independently associated with increased hospital mortality (OR = 0.9, 95% CI 0.8-1.1), whereas persistent hypothermia was associated with markedly increased risk of death (OR = 6.3, 95% CI = 3.3-12.0). Hypothermia is common in postoperative cardiac surgery patients during the first 24 h after ICU admission but, if transient, is not independently associated with an increased risk of death.     

Routine drainage after thyroid surgery--a meta-analysis

Thyroidectomy is a common surgical procedure. The results of some clinical trials suggest that routine drainage does not offer advantages, but the evidence is not strong either in favor of or against this intervention. The effect of routine drainage compared to no drainage in patients subject to thyroidectomy was measured using a meta-analysis. After an extensive literature review, suitable randomized clinical trials were selected for analysis. Outcome measures included the comparative incidence of neck hematoma or seroma and length of hospital stay. Eleven randomized clinical trials were included. There were no statistically significant differences in the incidence of neck hematoma/seroma (OR 1.03, 95% CI 0.59-1.81) between the groups. The mean length of hospital stay was 1.53 days longer for the drainage group (95% CI 1.39-1.68). There was no difference found between routine drainage and no drainage with regard to the frequency of postoperative hematoma/seroma in patients following thyroidectomy. In addition, the mean length of hospital stay was longer in the routine drainage group.