Risk Factors for Invasive Cryptococcus neoformans Diseases: A Case-Control Study

Background: Cryptococcus neoformans is a ubiquitous environmental fungus that can cause life-threatening meningitis and fungemia, often in the presence of acquired immunodeficiency syndrome (AIDS), liver cirrhosis, diabetes mellitus, or other medical conditions. To distinguish risk factors from comorbidities, we performed a hospital-based, density-sampled, matched case-control study. Methods: All new-onset cryptococcal meningitis cases and cryptococcemia cases at a university hospital in Taiwan from 2002–2010 were retrospectively identified from the computerized inpatient registry and were included in this study. Controls were selected from those hospitalized patients not experiencing cryptococcal meningitis or cryptococcemia. Controls and cases were matched by admission date, age, and gender. Conditional logistic regression was used to analyze the risk factors. Results: A total of 101 patients with cryptococcal meningitis (266 controls) and 47 patients with cryptococcemia (188 controls), of whom 32 patients had both cryptococcal meningitis and cryptococcemia, were included in this study. Multivariate regression analysis showed that AIDS (adjusted odds ratio [aOR] = 181.4; p < 0.001), decompensated liver cirrhosis (aOR = 8.5; p = 0.008), and cell-mediated immunity (CMI)-suppressive regimens without calcineurin inhibitors (CAs) (aOR = 15.9; p < 0.001) were independent risk factors for cryptococcal meningitis. Moreover, AIDS (aOR = 216.3, p < 0.001), decompensated liver cirrhosis (aOR = 23.8; p < 0.001), CMI-suppressive regimens without CAs (aOR = 7.3; p = 0.034), and autoimmune diseases (aOR = 9.3; p = 0.038) were independent risk factors for developing cryptococcemia. On the other hand, diabetes mellitus and other medical conditions were not found to be risk factors for cryptococcal meningitis or cryptococcemia. Conclusions: The findings confirm AIDS, decompensated liver cirrhosis, CMI-suppressive regimens without CAs, and autoimmune diseases are risk factors for invasive C. neoformans diseases

HIV: Seek, test, treat, and retain

AbstractThe “HIV: Seek, Test, Treat, and Retain” session was chaired by Dr Jacques Normand, the director of AIDS Research at the US National Institute on Drug Abuse. Dr Yi-Ming Chen served as the discussant. The three presenters (and their presentation topics) were: Dr Julio Montaner (Treatment as Prevention–The Key to an AIDS-free Generation), Dr Chi-Tai Fang (Population-level Effect of Free Access to HAART on Reducing HIV Transmission in Taiwan), and Dr Zunyou Wu (Challenges in Promoting HIV Test and Treat Strategy in China)

Ubiquitous Sensor Networks and Its Application

Ubiquitous sensor networks and its application are emerging rapidly as an exciting new paradigm to provide reliable and comfortable life services. The ever-growing ubiquitous sensor networks and its application will provide an intelligent and ubiquitous communication and network technology for tomorrow. That is, the UCMA have emerged rapidly as an exciting new paradigm that includes ubiquitous, grid, and peer-to-peer computing to provide computing and communication services at anytime and anywhere. In order to realize the advantages of such services, it is important that intelligent systems be suitable for UCMA

Risk factors for Kaposi's sarcoma in human immunodeficiency virus patients after initiation of antiretroviral therapy: A nested case–control study in Kenya

AbstractBackground/PurposeThis study aimed to evaluate the association between highly active antiretroviral therapy (HAART) adherence and development of Kaposi's sarcoma (KS) in human immunodeficiency virus (HIV)/AIDS patients.MethodsWe conducted a retrospective nested case–control study of 165 participants (33 cases and 132 controls) receiving HAART care at Maseno Hospital, Kenya, from January 2005 to October 2013. Cases were HIV-positive adults with KS, who were matched with controls in a ratio of 1:4 based on age (±5 years of each case), sex, and KS diagnosis date. Perfect adherence to HAART was assessed on every clinic visit by patients' self-reporting and pill counts. Chi-square tests were performed to compare socioeconomic and clinical statuses between cases and controls. A conditional logistic regression was used to assess the effects of perfect adherence to HAART, the latest CD4 count, education level, distance to health-care facility, initial World Health Organization stage, and number of regular sexual partners on the development of KS.ResultsOnly 63.6% participants reported perfect adherence, and the control group had a significantly higher percentage of perfect adherence (75.0%) than did cases (18.2%). After adjustment for potential imbalances in the baseline and clinical characteristics, patients with imperfect HAART adherence had 20-times greater risk of developing KS than patients with perfect HAART adherence [hazard ratios: 21.0, 95% confidence interval: 4.2–105.1]. Patients with low latest CD4 count (≤350 cells/mm3) had a seven-times greater risk of developing KS than did their counterparts (HRs: 7.1, 95% CI: 1.4–36.2).ConclusionImperfect HAART adherence and low latest CD4 count are significantly associated with KS development

Staphylococcal Cassette Chromosome mec in MRSA, Taiwan

To determine the predominant staphylococcal cassette chromosome (SCC) mec element in methicillin-resistant Staphylococcus aureus, we typed 190 isolates from a hospital in Taiwan. We found a shift from type IV to type III SCCmec element during 1992–2003, perhaps caused by selective pressure from indiscriminate use of antimicrobial drugs