HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men--five U.S. cities, June 2004-April 2005

Well into the third decade of the human immunodeficiency virus (HIV) epidemic, rates of HIV infection remain high, especially among minority populations. Of newly diagnosed HIV infections in the United States during 2003, CDC estimated that approximately 63% were among men who were infected through sexual contact with other men, 50% were among blacks, 32% were among whites, and 16% were among Hispanics. Studies of HIV infection among young men who have sex with men (MSM) in the mid to late 1990s revealed high rates of HIV prevalence, incidence, and unrecognized infection, particularly among young black MSM. To reassess those findings and previous HIV testing behaviors among MSM, CDC analyzed data from five of 17 cities participating in the National HIV Behavioral Surveillance (NHBS) system. This report summarizes preliminary findings from the HIV-testing component of NHBS, which indicated that, of MSM surveyed, 25% were infected with HIV, and 48% of those infected were unaware of their infection. To decrease HIV transmission, MSM should be encouraged to receive an HIV test at least annually, and prevention programs should improve means of reaching persons unaware of their HIV status, especially those in populations disproportionately at risk.     

Epidemiologic assessment of the impact of four hurricanes--Florida, 2004

During August 13, 2004-September 25, 2004, Florida experienced four major hurricanes: Charley and Frances (both Category 4) and Ivan and Jeanne (both Category 3). An estimated 20% of homes throughout Florida were damaged by these hurricanes, and 124 persons died. In October 2004, the Florida Department of Health (FDOH) added 30 questions to the Behavioral Risk Factor Surveillance System (BRFSS) survey to assess the impact of the hurricanes on state residents. This report summarizes the results of that survey, which indicated that 48.7% of Florida residents had no evacuation plan before any of the hurricanes, portable generators were used in 17.5% of homes after electric power outages, and residents of counties not in the direct paths of the four hurricanes had consequences similar to those who lived in the direct paths of the hurricanes (e.g., physical injuries, barriers to medical treatment, and loss of work days). Public health officials should consider the needs of residents both in and not in the direct paths of hurricanes in their preparedness planning.     

Progress in measles control--Zambia, 1999-2004

Zambia, a southern African country with estimated population of 11.6 million in 2005, reported 1,698-23,518 measles cases annually during 1991-1999. During that period, measles was considered one of the five major causes of morbidity and mortality among children aged <5 years. During 1999-2004, the challenge of controlling measles led Zambia to try several strategies in succession. In addition to a single dose of measles vaccine offered at age 9 months through routine services, in 1999, measles supplemental immunization activities (SIAs) targeting children aged 9 months-4 years were held in four urban centers. Those activities were followed in 2000 by a subnational measles SIA targeting children aged 9 months-4 years in approximately half of the country's 72 districts. In 2003, Zambia adopted a strategy of accelerated measles control that included strengthening routine vaccination, providing a second opportunity for measles immunization for all children, and conducting case-based surveillance. As part of this strategy, a nationwide measles SIA targeting all children aged 6 months-14 years was conducted in 2003. This report summarizes progress in measles control in Zambia during 1999--2004, as measured through surveillance data, which demonstrates a marked reduction in measles transmission after the 2003 SIA.     

Biomarkers of inflammation and progression of chronic kidney disease

BACKGROUND: Chronic kidney disease is associated with higher levels of inflammatory biomarkers. Statins have anti-inflammatory properties and may attenuate loss of kidney function. Although inflammation may mediate progressive renal injury, the relation between statin use, markers of inflammation, and the rate of kidney function loss has not been elucidated. We examined the association between pravastatin use, levels of C-reactive protein (CRP), soluble tumor necrosis factor receptor II (sTNFrii), and the rate of kidney function loss. METHODS: We performed a post hoc analysis of data from a randomized placebo controlled trial of pravastatin 40 mg daily in people with previous myocardial infarction. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease Study (MDRD) GFR equation. We studied 687 subjects with chronic kidney disease (GFR < 60 mL/min/1.73 m(2)) who did not experience a cardiovascular event during follow-up. Multivariate linear regression was used to study the relation between baseline CRP and sTNFrii and the rate of kidney function loss in mL/min/1.73 m(2)/year. Cross-product interaction terms were used to determine if these relations varied with pravastatin use. RESULTS: Median baseline GFR was 54.5 mL/min/1.73 m(2) (interquartile range 49.7, 57.8) and median duration of follow-up was 58 months. Higher baseline CRP level was independently associated with more rapid kidney function loss (highest tertile 0.6 mL/min/1.73 m(2) per year faster than lowest tertile) (P= 0.001). A similar independent relation was observed between tertile of sTNFrii and rate of kidney function loss (highest tertile 0.5 mL/min/1.73 m(2) per year faster than lowest tertile) (P= 0.006). Subjects with both CRP and sTNFrii in the highest tertile ("inflamed" status) appeared to derive more renal benefit from pravastatin than those without (P for interaction 0.047). In these 108 subjects, renal function loss in pravastatin recipients was 0.8 mL/min/1.73 m(2)/year slower than placebo (95% CI 0 to 1.5 mL/min/1.73 m(2)/year slower) (P= 0.039). CONCLUSION: Higher CRP and sTNFrii are independently associated with faster rates of kidney function loss in chronic kidney disease. Pravastatin appears to prevent loss of kidney function to a greater extent in individuals with greater evidence of inflammation, although this was of borderline significance. These data suggest that inflammation may mediate the loss of kidney function among subjects with chronic kidney disease and concomitant coronary disease.     

Living donor renal transplantation in Catalonia: overall results and comparison of survival with cadaveric donor renal transplantation

OBJECTIVES: To describe the general characteristics of living-donor renal transplantation (LRT) in Catalonia, and to compare results with those of the cadaveric donor renal transplant (CRT). RESULTS: Four hundred seventy-three LRTs have been performed in Catalonia since 1965. Transplantations carried out between 1980 and 2003, according to the RMRC data, were reviewed. The most frequent degrees of kinship are parents-children (48%), spouses (22%), and siblings (18%). Around 68% of the donors were women. Around 56% of recipients were men. The transplant was advanced in approximately 30% of the cases. The mean cold ischemia was 2 hours. Seven percent showed delayed graft function (DGF). Forty-nine percent of the patients had glomerular filtration >60 mL/min after 1 year. Patient survival at 1, 5, 10, and 20 years were 99%, 97%, 93%, and 82% in LRT; and 96%, 90%, 80%, and 62% in CRT (P < .00001). Graft survivals over the same periods were 91%, 76%, 58%, and 32% in LRT, and 85%, 69%, 49%, and 23% in CRT (P = .00008). The graft mean life was 12 years (LRT) and 10 years (CRT). Graft survivals, censoring deaths over the same periods, were 93%, 79%, 62%, and 39% in LRT, and 89%, 77%, 62%, and 37% in CRT (P = .3). Mean life was 14 years in both cases. The recipients mean age was 31 (LRT), and 44 years (CRT), whereas the donor mean age was 51 (LRT), and 42 years (CRT). CONCLUSIONS: LRT results were excellent both regarding DGF and patient and graft survivals. They were not comparable to CRT due to the different characteristics of the recipients. LRT is a good solution to reduce waiting lists.     

Training trauma teams in the Nordic countries: an overview and present status

Background:  During the last decade there has been an increased interest in the organisation and quality of trauma care in the Nordic countries. Still, most patients are initially cared for at hospitals with low caseloads of severe trauma. More than 200 hospitals offer initial care to trauma patients. Training of trauma teams using simulators or simulated patients has evolved in the same period, as one important factor to overcome lack of practical training. This overview describes the present state of trauma team training in the Nordic countries.
Methods:  Members of a Nordic working group on the use of simulation in medicine reviewed present literature on training with simulation and described the present use of team training in their own countries during winter 2004.
Results:  There is an increasing amount of evidence indicating that training of teams with simulation reduces treatment errors and improves performance. The training activities do not need to be complex, but skilled debriefing seems necessary. Few Nordic hospitals train their trauma teams. The training activities vary considerably between and within countries.
Conclusion:  There is considerable evidence supporting an increased use of experience gained in other high-risk domains where training in communication, leadership and decision-making is the focus for safety and improvement efforts. There is a need for more widespread training of trauma teams. The different training activities actually undertaken should be scientifically evaluated.     

泰素周疗和三周疗法作为卵巢癌一线化疗的多中心对照研究

目的比较泰素周疗和铂尔定联合化疗与泰素3周疗法和铂尔定联合化疗作为卵巢癌一线化疗的效果,观察两种联合方案的毒性作用及两种联合方案对卵巢癌患者两年生存期的影响。方法采用多中心对照研究的方法,将手术后病理学诊断为晚期卵巢上皮癌的125例患者分为两组。（1）周疗组：51例患者,泰素60—80mg／m^2,每周给药1次,共6次。铂尔定（药释曲线=5．0）仅在第1周,第4周用完泰素后给药。8周为1个疗程,化疗6周,休息2周。2个疗程（16周）后评价疗效。（2）3周疗法组：74例,泰素175mg／m^2,3h静脉滴注。铂尔定：（药释曲线面积为5．0）,每疗程的第一天联合应用泰素＋铂尔定,3周为1个疗程,用药6个疗程（18周）后评价疗效。结果（1）CAl25下降情况：经手术和化疗后102例（81．6％）患者CAl25呈现满意的下降,其中3周疗法组为58例（78．4％）,周疗组为44例（86．3％）,两组比较差异无统计学意义（P〉0．05）。（2）病情复发和未控情况：①总的复发和／或未控病例有32例,占26．4％。3周疗法组复发和／或未控病例有22例（29．7％）,其中停化疗〉6个月的复发有8例,停化疗〈6月的复发有9例,肿瘤持续进展为5例。周疗组复发和／或未控病例有10例（19．6％）,其中停化疗〉6个月的复发有2例,停化疗〈6个月的复发有6例,肿瘤持续进展为2例,两组在病情复发和未控发生率上差异无显著意义（P〉0．05）。②肿瘤复发平均时间：3周疗法组平均复发时问为15．7个月,周疗组平均复发时问为13．6个月（P〉0．05）。③无瘤生存时问（progress—free survival,PFS）3周疗法组平均复发时间为16．5个月,周疗组平均复发时问为15．6个月（P〉0．05）。④生存情况：3周疗法组1年生存率为95．2％,2年生存率为78．7％;周疗组1年生存率为93．9％,2年生存率为85．3％,两组在1年和2年生存率上差异无统计学意义意义（P〉0．05）。（3）毒副反应的情况：在血液毒性方面：3周疗法组,有34例发生3—4度骨髓抑制,发生率为45．9％,周疗组有14例发生3—4度骨髓抑制,发生率为27．5％,两组差异有统计学意义（P〈0．05）。在神经毒性方面3周疗法的发生率略低于周疗组,但差异无统计学意义（P〉0．05）。其他的毒性反应,两组比较差异无统计学意义（P〉0．05）。结论（1）泰素的临床疗效周疗与3周疗法相同。（2）泰素周疗的骨髓抑制发生率明显低于3周疗法,其他的毒性作用与3周疗法比较差异无统计学意义。（3）泰素周疗的毒副反应较轻,更适用于年迈体弱的患者和门诊化疗。     

Tachon's syndrome (suracute back and/or thoracic pain following local injections of corticosteroids). A report of 318 French cases

OBJECTIVES: To assess the frequency, features, and outcome of excruciating lumbar, dorsal, and/or thoracic pain following injections of local corticosteroids in rare instances. METHODS: A questionnaire mailed to 500 French rheumatologists. RESULTS: Three hundred and eighteen cases were reported by 92 rheumatologists (one event per 8000 injections or 6.5 years of practice), following injections into lumbar epidural space (39%), an upper limb (30%), a lower limb (mostly the heel) (24%), or other locations (7%), of cortivazol (67%), hydrocortisone (25%), betamethasone (7%), or paramethasone (1%). Symptoms occurred 1-5 min (78%) or less than 1 min (22%) after injection, and highly acute axial pain usually lasted for less than 5 min (34%) or 5-15 min (51%). In addition to pain in lumbar (84%) and/or dorsal regions (25%) [often preceded or associated with thoracic pain (36%)], other signs were: anxiety (87%), shortness of breath (64%), facial flushing (64%), diffuse sweating (41%), agitation (29%), transient cough (23%), abdominal pain (20%), transient hypertension (15%), paleness (10%), hypotension (8%), diarrhoea (3%) and headache (3%). None of these patients was known to be allergic, and urticaria developed in only 2%. Outcome was favourable in all cases (even though 4/318 patients were transiently hospitalised) with an overall duration of 25 +/- 71 min. Another injection was performed later in 146/318 cases (46%), but Tachon's syndrome recurred in only 20 of these 146 patients (14%). CONCLUSION: The outcome of this impressive syndrome seems excellent. Tachon's syndrome might be the venous counterpart of Nicolau's syndrome (injection of corticosteroids in an artery).