A SUSTAINABLE APPROACH TO THE CONTROL OF PATHOGENS: THE FATE OF STREPTOCOCCI IN EQUINE COMPOST.

Streptococcus equi subspecies equi (S. equi), causes the potentially fatal respiratory disease called “strangles” in horses, while the closely related Streptococcus equi subspecies zooepidemicus (S. zooepidemicus) causes potentially fatal infections in humans. A study was undertaken to determine the survival of these two organisms in equine compost. Compost piles of equine bedding and feed waste were inoculated with 10 x 1010 c.f.u. of S. zooepidemicus and samples taken at 48, 96, 168 and 336 hours relative to samples placed in the pile at 0 hours. No Streptococci were isolated at 48 hours or subsequent time-points. Next, S. equi was similarly inoculated into equine compost, with samples taken at 2, 4, 8, 12, 24, 48, 168 and 336 hours later. No Streptococci were isolated at any time-point. To rule out killing of S. equi by microflora in equine waste, samples of soiled bedding, both autoclaved and un-autoclaved (with water added to match autoclaved moisture) were inoculated with 10 x 1010 c.f.u. of S. zooepidemicus and sampled at 0, 6, 12, 24, 48, 72, 120, 168 and 264 hours. In autoclaved bedding, S. zooepidemicus was isolated from 0 – 120 hours, but replaced by other flora at 264 hours. In un-autoclaved samples, Streptococci were not present after 48 hours. A repeated trial with S. equi yielded similar results. This data suggest that microbial activity of equine waste bedding may eliminate streptococci within 24 - 48 hours, indicating that normal microflora may provide sustainable methods for the control of human and animal pathogens

Measuring human rights violations in a conflict-affected country: results from a nationwide cluster survey in Central African Republic

<p>Abstract</p> <p>Background</p> <p>Measuring human rights violations is particularly challenging during or after armed conflict. A recent nationwide survey in the Central African Republic produced estimates of rates of grave violations against children and adults affected by armed conflict, using an approach known as the "Neighborhood Method".</p> <p>Methods</p> <p>In June and July, 2009, a random household survey was conducted based on population estimates from the 2003 national census. Clusters were assigned systematically proportional to population size. Respondents in randomly selected households were interviewed regarding incidents of killing, intentional injury, recruitment into armed groups, abduction, sexual abuse and rape between January 1, 2008 and the date of interview, occurring in their homes' and those of their three closest neighbors.</p> <p>Results</p> <p>Sixty of the selected 69 clusters were surveyed. In total, 599 women were interviewed about events in 2,370 households representing 13,669 persons. Estimates of annual rates of each violation occurring per 1000 people in each of two strata are provided for children between the ages of five and 17, adults 18 years of age and older and the entire population five years and older, along with a combined and weighted national rate. The national rates for children age five to 17 were estimated to be 0.98/1000/year (95% CI: 0.18 - 1.78) for recruitment, 2.56/1000/year (95% CI: 1.50 - 3.62) for abduction, 1.13/1000/year (95% CI: 0.33 - 1.93) for intentional injury, 10.72/1000 girls/year (95% CI: 7.40 - 14.04) for rape, and 4.80/1000 girls/year (95% CI: 2.61 - 6.00) for sexual abuse. No reports of any violation against a person under the age of five were recorded and there were no reports of rape or sexual abuse of males. No children were reported to have been killed during the recall period. Rape and abduction were the most frequently reported events.</p> <p>Conclusions</p> <p>The population-based figures greatly augment existing information on human rights violations in CAR, and represent a step forward in quantifying the protection needs of Central Africans. Government, donors, and international organizations should make use of this data to better inform advocacy, prevention, and response programs, to assist in fundraising, and to develop surveillance activities to monitor child protection concerns.</p

Risks for Acquisition of Bacterial Vaginosis Among Women Who Report Sex with Women: A Cohort Study

Bacterial vaginosis (BV) is common in women who have sex with women. While cross-sectional data support a role for sexual transmission, risks for incident BV have not been prospectively studied in this group. at enrollment conferred reduced risk for subsequent BV (HR 0.18 (0.08–0.4)). Detailed analysis of behavioral data suggested a direct dose-response relationship with increasing number of episodes of receptive oral-vulvovaginal sex (HR 1.02 (95% CI, 1.00–1.04).Vaginal detection of several BVAB in BV-negative women predicted subsequent BV, suggesting that changes in vaginal microbiota precede BV by weeks or months. BV acquisition was associated with report of new partner with BV; associations with sexual practices – specifically, receptive oral sex – require further investigation

An Outbreak of Dengue Fever in St. Croix (US Virgin Islands), 2005

BACKGROUND: Periodic outbreaks of dengue fever occur in the United States Virgin Islands. In June 2005, an outbreak of dengue virus (DENV) serotype-2 with cases of dengue hemorrhagic fever (DHF) was detected in St. Croix, US Virgin Islands. The objective of this report is to describe this outbreak of DENV-2 and the findings of a case-control study examining risk factors for DHF. METHODOLOGY/PRINCIPAL FINDINGS: This is the largest dengue outbreak ever recorded in St. Croix, with 331 suspected dengue cases reported island-wide during 2005 (62.2 cases/10,000 population); 54% were hospitalized, 21% had at least one hemorrhagic manifestation, 28% had thrombocytopenia, 5% had DHF and 1 patient died. Eighty-nine laboratory-positive hospitalized patients were identified. Of these, there were 15 (17%) who met the WHO criteria for DHF (cases) and 74 (83%) who did not (controls). The only variable significantly associated with DHF on bivariate or multivariable analysis was age, with an adjusted odds ratio (95% confidence interval) of 1.033 (1.003,1.064). CONCLUSIONS/SIGNIFICANCE: During this outbreak of DENV-2, a high proportion of cases developed DHF and increasing age was significantly associated with DHF

Interactive “Video Doctor” Counseling Reduces Drug and Sexual Risk Behaviors among HIV-Positive Patients in Diverse Outpatient Settings

, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors.We conducted a parallel groups randomized controlled trial (December 2003–September 2006) at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults) completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476) were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a “Video Doctor” via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months) and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months). Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months) than did controls, and had fewer casual sex partners at (−2.3 vs. −1.4, p = 0.461, at 3 months; and −2.7 vs. −0.6, p = 0.042, at 6 months)., including Video Doctor counseling, is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient settings, and holds promise as a public health HIV intervention

The Healing Potential of Stable Juvenile Osteochondritis Dissecans Knee Lesions

Background: The purpose of the present study was to determine if patient age, lesion size, lesion location, presenting knee symptoms, and sex predict the healing status after six months of a standard protocol of nonoperative treatment for stable juvenile osteochondritis dissecans of the knee

Lower birth weight-for-age and length-for-age z-scores in infants with in-utero HIV and ART exposure : a prospective study in Cape Town, South Africa

CITATION: Nyemba, D, C., et al. 2021. Lower birth weight-for-age and length-for-age z-scores in infants with in-utero HIV and ART exposure : a prospective study in Cape Town, South Africa. BMC Pregnancy and Childbirth, 21:354, doi:10.1186/s12884-021-03836-z.The original publication is available at https://bmcpregnancychildbirth.biomedcentral.comBackground: Successful scale-up of antiretroviral therapy (ART) during pregnancy has minimized infant HIV acquisition, and over 1 million infants are born HIV-exposed but uninfected (HEU), with an increasing proportion also exposed in utero to maternal ART. While benefits of ART in pregnancy outweigh risks, some studies have reported associations between in utero ART exposure and impaired fetal growth, highlighting the need to identify the safest ART regimens for use in pregnancy. Methods: We compared birth anthropometrics of infants who were HEU with those HIV-unexposed (HU) in Cape Town, South Africa. Pregnant women had gestational age assessed by ultrasound at enrolment. Women living with HIV were on ART (predominately tenofovir-emtricitabine-efavirenz) either prior to conception or initiated during pregnancy. Birth weights and lengths were converted to weight-for-age (WAZ) and length-for-age (LAZ) z-scores using Intergrowth-21st software. Linear regression was used to compare mean z-scores adjusting for maternal and pregnancy characteristics. Results: Among 888 infants, 49% (n = 431) were HEU and 51% (n = 457) HU. Of 431 HEU infants, 62% (n = 268) were exposed to HIV and antiretrovirals (ARVs) from conception and 38% (n = 163) were exposed to ARVs during gestation but after conception (median fetal ARV exposure of 21 weeks [IQR; 17–26]). In univariable analysis, infants who were HEU had lower mean WAZ compared with HU [β = − 0.15 (95% Confidence Interval (CI): − 0.28, − 0.020)]. After adjustment for maternal age, gravidity, alcohol use, marital and employment status the effect remained [adjusted β − 0.14 (95%CI: − 0.28, − 0.01]. Similar differences were noted for mean LAZ in univariable [β − 0.20 (95%CI: − 0.42, − 0.01] but not multivariable analyses [adjusted β − 0.18 (95%CI: − 0.41, + 0.04] after adjusting for the same variables. Mean WAZ and LAZ did not vary by in utero ARV exposure duration among infants who were HEU. Conclusion: In a cohort with high prevalence of ART exposure in pregnancy, infants who were HEU had lower birth WAZ compared with those HU. Studies designed to identify the mechanisms and clinical significance of these disparities, and to establish the safest ART for use in pregnancy are urgently needed.https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03836-zPublisher's versio

Point-of-Care CD4 Testing to Inform Selection of Antiretroviral Medications in South African Antenatal Clinics: A Cost-Effectiveness Analysis

Background: Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. Methods: We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99$26). We modeled South African PMTCT guidelines during the study period (WHO “Option A”): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). Results: In the base case, laboratory led to projected MTCT risks of 5.7$1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs:$23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs. Conclusions: In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection

Selected model input parameters for the base-case analysis (See S1 Table for complete list and ranges evaluated in sensitivity analyses).

<p><b>SD</b>: Standard deviation; <b>ART</b>: antiretroviral therapy; <b>PMTCT</b>: prevention of mother-to-child HIV transmission; <b>AZT</b>: azidothymidine (zidovudine); <b>ARV</b>: antiretroviral; <b>NVP</b>: nevirapine; <b>ABC</b>: abacavir; <b>3TC</b>: lamivudine; <b>LPV/r</b>: lopinavir/ritonavir; <b>TDF</b>: tenofovir; <b>FTC</b>: emtricitabine; <b>EFV</b>: efavirenz; <b>WHO</b>: World Health Organization</p><p><b>a</b>. Sensitivity and specificity were modeled with regard to true CD4 value of ≤350/μL (sensitivity: assay reports CD4 ≤350/μL when true CD4 is ≤350/μL; specificity: assay reports CD4 >350/μL when true CD4 is >350/μL). To be conservative with regard to the benefit of POC, we assumed in the base case that <i>laboratory</i> CD4 had 100% sensitivity and specificity to detect true CD4 ≤350/μL.</p><p><b>b</b>. In the base-case analysis, 13 weeks of antentatal AZT for non-ART eligible women are assumed in both strategies, based on median gestational age at booking in South Africa of 26 weeks. For ART-eligible women, 13 weeks of ART are assumed in the <i>POC</i> strategy and 3 weeks of AZT and 10 weeks of ART are assumed in the <i>laboratory</i> strategy.</p><p><b>c</b>. Please see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0117751#pone.0117751.s004" target="_blank">S1 Table</a> for description of assumptions of outpatient healthcare resource utilization.</p><p>Selected model input parameters for the base-case analysis (See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0117751#pone.0117751.s004" target="_blank">S1 Table</a> for complete list and ranges evaluated in sensitivity analyses).</p