Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study

BackgroundMen who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied.ObjectiveWe aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males.MethodsWe included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status.ResultsThe median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7% (95% CI 38.8%-56.7%; 61/128), a specificity of 85.9% (95% CI 75.0%-93.4%; 55/64), a positive predictive value of 87.1% (95% CI 77.0%-93.9%; 61/70), and a negative predictive value of 45.1% (95% CI 36.1%-54.3%; 55/122).ConclusionsSelf-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes.     

Medical treatment of hepatic amebic abscess: rare need for percutaneous drainage

Although amebic liver abscess can virtually always be successfully treated medically, percutaneous drainage has been advocated recently. In 96 recently treated patients, therapeutic aspiration and percutaneous drainage were rarely needed. Most cases were correctly diagnosed by means of clinical, laboratory, and sonographic findings. Abscesses in only 13 (13.5%) patients were diagnostically aspirated. An abscess in one patient was therapeutically aspirated because the patient was responding slowly to medical therapy. No patient required catheter drainage. The key to successful amebic abscess management is medical therapy. Therapeutic drainage is rarely needed. Successfully treated patients occasionally respond slowly to medical therapy, and successfully treated amebic abscesses may enlarge or become bizarre-appearing on sonograms. This should not prompt therapeutic drainage. Diagnostic aspiration is appropriate when amebic and pyogenic abscesses are indistinguishable using clinical and imaging findings. Rare indications for therapeutic aspiration or drainage include pyogenic superinfection and large, juxtacardiac abscesses (potential intrapericardial rupture).     

RESTORATION OF NITRIC OXIDE FUNCTION IN HUMAN HYPERLIPIDAEMIA, CONGESTIVE HEART FAILURE AND LIVER CIRRHOSIS

1. There is accumulating evidence for a range of abnormalities in the nitric oxide (NO) signalling cascade in human cardiovascular disorders. 2. In the present review we assess the literature detailing such evidence in early (hyperlipidaemia) and end-stage (heart failure) disease, with emphasis on the mechanisms by which the disturbances are thought to occur. 3. Strategies for the correction of disturbed NO signalling in these states are reviewed and include both prescribed pharmacological interventions, such as lipid-lowering therapy and novel uses of angiotensin-converting enzyme inhibitors, as well as non-pharmacological interventions, such as exercise and dietary supplementation with l -arginine and n-3 polyunsaturated fatty acids. 4. In addition to a decreased production/function of NO, the possible detrimental effects of a chronic elevation in NO production in patients with liver cirrhosis, together with a novel use of antibiotics to correct this perturbation, is outlined.