Low rates of active hepatitis B and C infections among adults and children living with HIV and taking antiretroviral therapy: A multicenter screening study in Lesotho

Lesotho presents the second-highest adult human immunodeficiency virus (HIV) prevalence globally. Among people living with HIV, data on hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfection are limited. We report HBV and HCV coinfection data from a multicentre cross-sectional study among adult and pediatric patients taking antiretroviral therapy in 10 health facilities in Lesotho. Among 1318 adults screened (68% female; median age, 44 years), 262 (20%) had immunologically controlled HBV infection, 99 (7.6%) tested anti-HBs positive and anti-HBc negative, indicating vaccination, and 57 (4.3%) had chronic HBV infection. Among the patients with chronic HBV infection, 15 tested hepatitis B envelope antigen (HBeAg) positive and eight had detectable HBV viremia (median, 2 477 400 copies/mL; interquartile range, 205-34 400 000) with a mean aspartate aminotransferase-to-platelet ratio index of 0.48 (SD, 0.40). Prevalence of HCV coinfection was 1.7% (22 of 1318), and only one patient had detectable HCV viremia. Among 162 pediatric patients screened, three (1.9%) had chronic HBV infection, whereby two also tested HBeAg-positive, and one had detectable HBV viral load (210 copies/mL). Six of 162 (3.7%) had anti-HCV antibodies, all with undetectable HCV viral loads. Overall prevalence of chronic HBV/HIV and HCV/HIV coinfection among adults and children was relatively low, comparable to earlier reports from the same region. But prevalence of immunologically controlled HBV infection among adults was high. Of those patients with chronic HBV infection, a minority had detectable HBV-DNA.     

Risk Estimates of Dengue in Travelers to Dengue Endemic Areas Using Mathematical Models

Background.  Dengue has emerged as a frequent problem in international travelers. The risk depends on destination, duration, and season of travel. However, data to quantify the true risk for travelers to acquire dengue are lacking.
Methods.  We used mathematical models to estimate the risk of nonimmune persons to acquire dengue when traveling to Singapore. From the force of infection, we calculated the risk of dengue dependent on duration of stay and season of arrival.
Results.  Our data highlight that the risk for nonimmune travelers to acquire dengue in Singapore is substantial but varies greatly with seasons and epidemic cycles. For instance, for a traveler who stays in Singapore for 1 week during the high dengue season in 2005, the risk of acquiring dengue was 0.17%, but it was only 0.00423% during the low season in a nonepidemic year such as 2002.
Discussion.  Risk estimates based on mathematical modeling will help the travel medicine provider give better evidence-based advice for travelers to dengue endemic countries.     

A cost minimization analysis of olive oil vs. hyperoxygenated fatty acid treatment for the prevention of pressure ulcers in primary healthcare: A randomized controlled trial

Pressure ulcers represent a major current health problem and cause an important economic impact on the healthcare system. Most studies on the prevention of pressure ulcers have been carried out in hospital contexts, with respect to the use of hyperoxygenated fatty acids (HOFA), and to date no studies have specifically examined the use of olive oil‐based treatments. Aim: To evaluate the cost of using extra virgin olive oil, rather than HOFA, in the prevention of pressure ulcers among persons with impaired mobility and receiving home care. Study Design: Cost minimization analysis of the results obtained from a noninferiority, triple‐blind, parallel, multicenter, randomized clinical trial. Population attending primary healthcare centers in Andalusia (Spain). Study sample: 831 immobilized patients at risk of suffering pressure ulcers. These persons were included in the study and randomly assigned as follows: 437 to the olive oil group and 394 to the HOFA group. At the end of the follow‐up period, the results obtained by the olive oil group were not inferior to those of the HOFA group, and did not exceed the 10% delta limit. The total treatment cost for 16 weeks was €19,758 with HOFAs and €9,566 with olive oil. Overall, the olive oil treatment was €10,192 less costly. It has been concluded the noninferiority of olive oil makes this product an effective alternative for the prevention of pressure ulcers in patients who are immobilized and in a domestic environment. This treatment enables considerable savings in direct costs. Trial registration: Clinicaltrials.gov Identifier: NCT01595347. Date: 2011‐2013     

Diabetic retinopathy and the major causes of vision loss in Aboriginals from remote Western Australia

Purpose: To report on diabetic retinopathy (DR) and the major causes of vision loss and blindness in Aboriginals in the Eastern Goldfields region of Western Australia between 1995 and 2007. Methods: Aboriginals (>16 years old) diagnosed with diabetes or eye problems from 11 communities in the Eastern Goldfields region of Western Australia were examined annually from 1995 to 2007. Data collected from prospective clinical examination included; visual acuity (VA), causes of vision loss, and whether DR was present. Severity of DR was graded according to the Early Treatment of Diabetic Retinopathy Study modified Airlie House grading system. Results: A total of 920 Aboriginals underwent 1331 examinations over the study period. There were 246 eyes with vision loss (best‐corrected VA < 6/12) in 159 Aboriginals, of whom five were bilaterally blind. The four major known causes of vision loss were cataract (n = 53, 30.1%), DR (n = 44, 25.0%), uncorrected refractive error (n = 31, 17.6%) and trauma (n = 19, 10.8%). Aboriginals who had diabetes were far more likely to have vision loss (odds ratio = 8.5, 95% confidence interval 5.7–12.6, P < 0.0001). Of the 329 Aboriginals with diabetes, 82 (24.9%) had DR, and 32 (9.7%) had vision‐threatening retinopathy. Of those with diabetes, 94 (42.5%) returned for follow‐up examination on an average of 3.2 visits with a median time between visits of 2 years. Conclusion: The four major causes of vision loss in Aboriginals from the Eastern Goldfields are largely preventable and/or readily treated. DR and other diabetes‐related eye conditions are a major cause of vision loss in Aboriginals, representing a significant health challenge for health services and clinicians into the future.     

Recurrent Implantable Cardioverter‐Defibrillator Replacement Is Associated with an Increasing Risk of Pocket‐Related Complications

Background: Despite beneficial effects of implantable cardioverter‐defibrillator (ICD) therapy, limited service life results in replacement within the majority of patients. Data concerning the effect of replacement procedures on the occurrence of pocket‐related adverse events are scarce. In this study, the requirement for pocket‐related surgical re‐interventions following ICD treatment and the effect of device replacement were evaluated. Methods: From 1992 to 2008, 2,415 patients receiving an ICD at the Leiden University Medical Center were analyzed. Pocket‐related complications requiring surgical re‐intervention following ICD implantation or replacement were noted. Elective device replacement, lead failure, and device malfunction were not considered pocket‐related complications. Results: A total of 3,161 ICDs were included in the analysis. In total, 145 surgical re‐interventions were required in 122 (3.9%) ICDs implanted in 114 (4.7%) unique patients. Three‐year cumulative incidence for first surgical re‐intervention in all ICDs was 4.7% (95% confidence interval [CI] 3.9–5.5%). Replacement ICDs exhibited a doubled requirement for surgical re‐intervention (rate ratio 2.2, 95% CI 1.5–3.0). Compared to first implanted ICDs, the occurrence of surgical re‐intervention in replacements was 2.5 (95% CI 1.6–3.7) times higher for infectious and 1.7 (95% CI 0.9–3.0) for noninfectious causes. Subdivision by the number of ICD replacements showed an increase in the annual risk for surgical re‐intervention, ranging from 1.5% (95% CI 1.2–1.9%) for the first, to 8.1% (95% CI 1.7–18.3%) for the fourth implanted ICD. Conclusions: ICD replacement is associated with a doubled risk for pocket‐related surgical re‐interventions. Furthermore, the need for re‐intervention increases with every consecutive replacement. (PACE 2010; 1013–1019)