Prevalence of cervical cancer and associated mortality in Grenada, 2000-2010

Objective To assess cervical cancer prevalence and associated mortality in Grenada, West Indies during 2000-2010. Methods Records of visits to hospital and clinical facilities were obtained from the histopathology laboratory of the Grenada General Hospital. Records were de-identified and electronically compiled. Cervical cancer prevalence was assessed via cross-sectional analysis of this secondary data. Of a total 12 012 records, 2 527 were selected for analysis using sampling without replacement. Cases were matched to corresponding patient data from death registries, where possible, and used to calculate associated mortality rates. Results The observed prevalence of cervical cancer was 52.4 per 100 000 women (ages 15 and above). The highest rates of cervical cancer occurred in the 35-44 age group, with the second highest among 45-64-year-olds. A total of 65 deaths were attributable to cervical cancer during 2000-2010, more than 50% of which were among women > 65 years old. The observed mortality rate was 16.7 per 100 000, almost twice the rate estimated by WHO for the region. Conclusions This study demonstrates the need for a comprehensive cervical cancer-screening program in Grenada. Results should contribute to informing future studies on how to appropriately generate and execute public health policy for education, screening, prevention, and control of cervical cancer in Grenada.

Abstract P2-06-04: Impact of genomic testing on chemotherapy utilization

Genomic testing for breast cancer has become a common practice. The two main tests at our institution are Oncotype DX® and MammaPrint®. Each test has unique features and criteria. We sought to compare the practice pattern between these tests and compare them to patients who did not undergo any genomic testing.

Methods: This is a retrospective review of all breast cancer patients between May 2008 and August 2011. Data was primarily thorough our tumor registry database. In some cases individual charts were also reviewed. Results: We analyzed 1093 breast cancers in 1064 patients. The average age was 62. The stage at diagnosis was 19% DCIS, 41% stage I, 24% stage II, 11% stage III and 5% stage IV. Of the 1093 cancers, 70 (6%) had an Oncotype test performed, 180 (16%) had a MammaPrint test done, 4 (0.4%) had both test, and 839 (77%) had no genomic test performed. Patients with an Oncotype test were more likely to be stage I than those with a MammaPrint (66% vs 48%). Additionally, patients who had a MammaPrint test more often received chemotherapy when compared to either the Oncotype test or no genomic testing.

Rotary ultrasonic machining of CFRP composites: a study on power consumption

Carbon fiber reinforced plastic (CFRP) composites are very difficult to machine. A large number of holes need to be drilled in CFRP for many applications. Therefore, it is important to develop cost-effective drilling processes. CFRP has been drilled by rotary ultrasonic machining (RUM) successfully. The literature has reports about the effects of input variables on output variables (including cutting force, torque, surface roughness, tool wear, and workpiece delamination) in RUM of CFRP. However, there are no reports on power consumption in RUM of CFRP. This paper reports the first study on power consumption in RUM of CFRP. It reports an experimental investigation on effects of input variables (ultrasonic power, tool rotation speed, feedrate, and type of CFRP) on power consumption of each component (including ultrasonic power supply, spindle motor, coolant pump, and air compressor) and the entire RUM system.

Protective factors relating to decreased risks of adolescent suicidal behaviour

BACKGROUND

Suicide has been identified as one of the three leading causes of death in adolescents and young adults. No previous study in China has tested the association between protective factors and urban adolescents' suicidal behaviours. In this study we tested the hypothesis that suicidal behaviours would be associated with multiple protective factors.

METHODS

A stratified random of 9015 students from 100 junior middle schools in Beijing, Hangzhou, Wuhan and Urumqi completed the Chinese version of Global School-Based Student Health Survey.

RESULTS

Overall, 17.4% of students had seriously considered attempting suicide, and 8.1% had made a specific plan to attempt suicide during the 12 months preceding the survey. The students in Wuhan (18.7%) and Urumqi (20.8%) cities were significantly more likely than students in Beijing (14.4%) and Hangzhou (14.4%) to have suicidal ideation (chi2 = 45.9, P < 0.001). Female students were significantly more likely than male students to have suicidal ideation and have made suicide attempts [odds ratio (OR) = 1.4, P < 0.001]. Results indicated that the rates of suicidal ideation and suicide attempts increased with age (OR = 1.44, P < 0.001). Multivariate logistic regression models showed that suicide risk tended to decrease significantly when 'days of missed classes or school without permission were less than one', and when students thought students in their school were kind and helpful most of the time or always', 'parents or guardians checked to see if homework was done most of the time or always', 'parents or guardians understood their problems and worries most of the time or always' and 'parents or guardians really know what they are doing with their free time most of the time or always'.

CONCLUSIONS

Adolescent suicide behaviour should be a serious problem. Measures can be taken to prevent suicide by observing the factors significantly linked to suicidal behaviour. Steps can then be taken to identify adolescents who have serious suicidal ideation so that intervention can be taken to reduce the suicidal rate.

Antimicrobial resistance of Escherichia coli strains causing community-acquired urinary tract infections among insured and uninsured populations in a large urban center

We assessed the susceptibility of Escherichia coli strains causing communityacquired urinary tract infection (UTI) in a large urban center in Brazil, comparing two different populations (patients with health insurance vs. uninsured). 581 nonduplicate strains of E. coli were isolated. The prevalence of antimicrobial resistance was greater than 20% for ampicillin (51%), trimethoprim-sulfamethoxazole (43%), tetracycline (41%) and chloramphenicol (22%). Overall, 12% of the E. coli isolates were resistant to ciprofloxacin. Resistance prevalences to most antimicrobials were similar in the two study populations. Our data provide much needed information on the prevalence of antimicrobial resistance among E. coli causing communityacquired UTI in Brazil. Antimicrobial resistance among strains of E. coli causing community-acquired UTIs was relatively high, particularly resistance to ciprofloxacin.

Prevalence of vaginal colonization by drug-resistant Candida species in college-age women with previous exposure to over-the-counter azole antifungals

We enrolled 382 college-age women in a cross-sectional survey to investigate the relationship between use of over-the-counter (OTC) azole-based antifungal drugs and vaginal colonization by drug-resistant Candida. This study showed no correlation (P=.506) between previous OTC exposure and colonization of drug-resistant Candida in vaginal flora. However, a small number of resistant Candida species isolates were obtained from women with a history of multiple exposures to OTC antifungals; given the widespread use of these products, this may be an emerging concern.

Variation in water relations characteristics of terminal shoots of Port-Orford-cedar (Chamaecyparis lawsoniana) seedlings

We measured water relations attributes of the terminal shoots of 3-year-old Port-Orford-cedar (Chamaecyparis lawsoniana (A. Murr.) Parl.) seedlings that represented its geographic range. Pressure-volume curves were developed and osmotic potentials at full (psi(sf)) and zero turgor (psi(sz)), relative water content at zero turgor, and an index of tissue elasticity (IE) were calculated for 38 families during early, mid- and late summer at an inland nursery, and for 12 of these families during mid- and late summer at a coastal nursery. Compared with other conifer species, psi(sz) was high (-1.4 to -1.5 MPa) and declined in seedlings at both nurseries as the season progressed. Both IE and osmotic amplitude (psi(sf)-psi(sz)) increased during the season. Osmotic potential at zero turgor was lower and osmotic amplitude greater in seedlings at the inland nursery than at the coastal nursery. Correlations of water relations attributes with geographic location of the seed sources were weak and usually not significant. High elevation southern sources exhibited smaller differences in psi(sz) between nurseries than low elevation northern sources. The small differences in water relations attributes among sources and between nurseries suggest that some may be of marginal physiological importance; however, sources that produced larger seedlings appeared to be less desiccation tolerant. We conclude that, when moving genotypes during reforestation, decisions based on patterns in tree size and timing of growth will account for these small differences in water relations.

Molecular epidemiology: focus on infection

Molecular biology techniques have become increasingly integrated into the practice of infectious disease epidemiology. The term "molecular epidemiology" routinely appears in the titles of articles that use molecular strain-typing ("fingerprinting") techniques-regardless of whether there is any epidemiologic application. What distinguishes molecular epidemiology is both the "molecular," the use of the techniques of molecular biology, and the "epidemiology," the study of the distribution and determinants of disease occurrence in human populations. The authors review various definitions of molecular epidemiology. They then comment on the range of molecular techniques available and present some examples of the benefits and challenges of applying these techniques to infectious agents and their affected host using tuberculosis and urinary tract infection as examples. They close with some thoughts about training future epidemiologists to best take advantage of the new opportunities that arise from integrating epidemiologic methods with modern molecular biology.

Long-term outcomes of stereotactic breast biopsies

Stereotactic core needle biopsies (SCNBs) are accurate and relatively convenient for the patient; however, the long-term follow-up of benign results has not been reported. All patients between 1993 and 1998 undergoing SCNB at a community-based hospital were entered into a registry. Follow-up was obtained by a retrospective analysis of the charts. Biopsies were performed on 865 lesions. One hundred thirty-one (15%) were malignant, 42 (5%) were suspicious for malignancy, 687 (79%) were benign, and five (1%) were lobular carcinoma in situ. Of the 42 patients with suspicious findings 38 underwent biopsy. Ten were malignant and 28 benign. Of the 687 patients with benign pathology, 377 had follow-up available with a mean length of 1.7 years. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SCNB for benign lesions in our study are all 100 per cent. Eight lesions were worrisome and await final analysis. Of 687 patients with benign lesions 310 were lost to follow-up. This study suggests that patients with a benign diagnosis should be returned to routine mammography. These data also extend the reported follow-up to 1.7 years and establish an acceptable level of accuracy for SCNB. The lost patients remind us that follow-up is essential despite a benign diagnosis.

Cross-sensitivity reaction between tacrolimus and macrolide antibiotics

A patient with an allergy to a macrolide antibiotic was given tacrolimus and developed a sudden cutaneous reaction.

A parallel intraphagosomal survival strategy shared by mycobacterium tuberculosis and Salmonella enterica

Mycobacterium tuberculosis and Salmonella enterica cause very different diseases and are only distantly related. However, growth within macrophages is crucial for virulence in both of these intracellular pathogens. Here, we demonstrate that in spite of the phylogenetic distance, M. tuberculosis and Salmonella employ a parallel survival strategy for growth within macrophage phagosomes. Previous studies established that the Salmonella mgtC gene is required for growth within macrophages and for virulence in vivo. M. tuberculosis contains an open reading frame exhibiting 38% amino acid identity with the Salmonella MgtC protein. Upon inactivation of mgtC, the resulting M. tuberculosis mutant was attenuated for virulence in cultured human macrophages and impaired for growth in the lungs and spleens of mice. Replication of the mgtC mutant was inhibited in vitro by a combination of low magnesium and mildly acidic pH suggesting that the M. tuberculosis-containing phagosome has these characteristics. The similar phenotypes displayed by the mgtC mutants of M. tuberculosis and Salmonella suggest that the ability to acquire magnesium is essential for virulence in intracellular pathogens that proliferate within macrophage phagosomes.

Tobacco use by youth: a surveillance report from the Global Youth Tobacco Survey project

The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire. The GYTS is school based and employs a two-stage sample design to produce representative data on smoking among students aged 13-15 years. The first stage consists of a probabilistic selection of schools, and the second consists of a random selection of classes from the participating schools. All students in the selected classes are eligible for the survey. In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries. This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland, the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela, and Zimbabwe. The findings show that tobacco use in the surveyed age group ranged from a high of 33% to a low of 10%. While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme. In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare. The majority of young people reported being taught in school about the dangers of smoking. Environmental tobacco smoke exposure was very high in all countries. These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes.

noxR3, a novel gene from Mycobacterium tuberculosis, protects Salmonella typhimurium from nitrosative and oxidative stress

Reactive oxygen intermediates (ROI) and reactive nitrogen intermediates (RNI) produced by activated macrophages participate in host defense against the facultative intracellular pathogens Mycobacterium tuberculosis and Salmonella typhimurium. To survive within macrophages, such pathogens may have evolved ROI and RNI resistance mechanisms. ROI resistance pathways have been intensively studied. Much less is known about the mechanisms of resistance to RNI. To identify possible RNI resistance genes in M. tuberculosis, a mycobacterial library was expressed in S. typhimurium and subjected to selection by exposure to the NO donor S-nitrosoglutathione (GSNO) in concentrations sufficient to kill the vast majority of nontransformed salmonellae. Among the rare surviving recombinants was a clone expressing noxR3, a novel and previously anonymous M. tuberculosis gene predicted to encode a small, basic protein. Expression of noxR3 protected S. typhimurium not only from GSNO and acidified nitrite but also from H2O2. noxR3 is the third gene cloned from M. tuberculosis that has been shown to protect heterologous cells from both RNI and ROI. This suggests diversity in the repertoire of mechanisms that help pathogens resist the oxidative and nitrosative defenses of the host.

Clinical presentation of tuberculosis in culture-positive children. Pediatric Tuberculosis Consortium

BACKGROUND

Because tuberculosis (TB) in children implies recent infection, children serve as sentinels for disease transmission within a community. Despite the significance of diagnosing tuberculosis in children, most cases are diagnosed on clinical evidence rather than laboratory findings.

METHODS

We analyzed the demographic and clinical presentation of 156 children with culture proven tuberculosis using Epi-Info Version 6.

RESULTS

Although the clinical characteristics of this population were generally consistent with those seen in previous studies, several unexpected results were observed. Boys were overrepresented in the group of very young children (72% < 1 year). Many of the children had coexisting diseases not known to predispose to TB (37%). Cavitation, usually observed in older children, was seen in four children < or = 1 year of age. Few children were homeless or HIV-infected, but many (42%) lived in female-headed households. Of the adult contacts at risk for TB, many (49%) were recent immigrants to the US. Overall 34% of the population was either foreign born or the children of recent immigrants.

CONCLUSIONS

This series of 156 culture-positive children provides an understanding of the risk factors and clinical presentation of pediatric tuberculosis. The data emphasize the impact of the child's environment on the risk for tuberculosis.