Screening for sexually transmitted infections at a DeAddictions service in South India

Objectives To estimate the lifetime prevalence of four sexually transmitted infections (STIs) and to identify correlates of these infections among patients seeking care for a substance use disorder at a specialized DeAddictions Unit in southern India. Methods Consecutive inpatients (n = 361; 98% male; M age = 36.7 years) admitted to DeAddictions Unit of the National Institute of Mental Health and Neuro Sciences in Bangalore, India, participated in a structured interview to obtain demographic, psychiatric, sexual behavior, and substance use data; each patient also provided a blood sample for serologic testing for HIV, chlamydia, syphilis, and hepatitis B. Results One-quarter of all patients tested positive for at least one STI. Lifetime seroprevalence rates were 12.9% for syphilis, 10.3% for chlamydia, 3.1% for hepatitis B, and 1.1% for HIV. Analyses did not reveal any consistent pattern of associations between STI status and sociodemographic, psychiatric, and sexual behavioral characteristics. Conclusions All patients should receive a comprehensive sexual assessment during standard care; for those patients who report risky sexual practices, we recommend voluntary counseling and testing for STIs. Although we do not recommend universal testing for STIs at this time, this should be revisited based upon national surveillance data

Correction: Impact of cardiovascular magnetic resonance on management and clinical decision-making in heart failure patients

Background: Cardiovascular magnetic resonance (CMR) can provide important diagnostic and prognostic information in patients with heart failure. However, in the current health care environment, use of a new imaging modality like CMR requires evidence for direct additive impact on clinical management. We sought to evaluate the impact of CMR on clinical management and diagnosis in patients with heart failure. Methods: We prospectively studied 150 consecutive patients with heart failure and an ejection fraction ≤50% referred for CMR. Definitions for “significant clinical impact” of CMR were pre-defined and collected directly from medical records and/or from patients. Categories of significant clinical impact included: new diagnosis, medication change, hospital admission/discharge, as well as performance or avoidance of invasive procedures (angiography, revascularization, device therapy or biopsy). Results: Overall, CMR had a significant clinical impact in 65% of patients. This included an entirely new diagnosis in 30% of cases and a change in management in 52%. CMR results directly led to angiography in 9% and to the performance of percutaneous coronary intervention in 7%. In a multivariable model that included clinical and imaging parameters, presence of late gadolinium enhancement (LGE) was the only independent predictor of “significant clinical impact” (OR 6.72, 95% CI 2.56-17.60, p=0.0001). Conclusions: CMR made a significant additive clinical impact on management, decision-making and diagnosis in 65% of heart failure patients. This additive impact was seen despite universal use of prior echocardiography in this patient group. The presence of LGE was the best independent predictor of significant clinical impact following CMR

Evaluation of two commercially available ELISAs for the diagnosis of Japanese encephalitis applied to field samples

To compare two commercially available kits, Japanese Encephalitis-Dengue IgM Combo ELISA (Panbio Diagnostics) and JEV-CheX IgM capture ELISA (XCyton Diagnostics Limited), to a reference standard (Universiti Malaysia Sarawak – Venture Technologies VT ELISA). Methods Samples were obtained from 172 ⁄ 192 children presenting to a site in rural India with acute encephalitis syndrome