Assessment of the prognostic value of horner syndrome in perinatal brachial plexus palsy

The aim of this study was to evaluate the prognostic value of Horner syndrome as an indicator of preganglionic injuries of the lower part of the brachial plexus. The study investigated 18 cases of children with perinatal brachial plexus injury and coexistent Horner syndrome. The following data sets were analyzed: the degree of severity of the brachial plexus injury, the results of imaging examinations, the intraoperative view, the kind of operative treatment and the resultant hand function. On the basis of a clinical material analysis, it was established that Horner syndrome accompanying upper and upper-middle brachial plexus injuries has no prognostic importance. In total injuries the presence of this syndrome is not a definite proof of preganglionic injury to the C8-Th1 roots of the spinal nerves.

[Cardiosurgical procedures in patients refusing blood transfusions: IKEM outcomes]

INTRODUCTION

Jehovah's Witnesses who require cardiac operation represent a specific challenge to the physicians. Members of this faith will not accept blood or blood products under any circumstances on the basis of religious grounds. Nevertheless cardiac operations belong to surgical interventions with potential severe bleeding and necessity of blood transfusions.

THE AIM OF THE STUDY

The aim of this retrospective study was to analyze clinical data, operative and postoperative courses of patients operated at IKEM who refused blood transfusions.

METHODS AND RESULTS

From January 1995 to August 2010, 73 Jehovah's Witnesses ranging in age from 19 to 82 years underwent cardiac surgery at our institute. Aortocoronary bypass were performed in 34 patients, valve surgery in 25 patients, 6 patients underwent concomitant aortocoronary bypass and valve surgery, 2 patients underwent aortocoronary bypass and resection of the left ventricle aneurysm and 2 patients underwent atrial septal defect repair and tricuspid valve anuloplasty. Ventricular septal sefect repair, atrial septal defect repair, Cor Cap device implantation and left ventricular epicardial electrodes implantation were performed in the other patients. Early 30-days mortality was 2.8 % (2 patients).

CONCLUSION

We can conclude that cardiac surgery in Jehovah's Witnesses can be performed safety without blood transfusion and belongs to standard operating procedures at our institution.

[Outcomes of combined mitral valve repair surgery and aortic valve replacement in IKEM Praha]

AIM OF THE STUDY

We retrospectively analyzed long-term outcome of concomitant mitral valve repair and aortic valve replacement.

METHODS

From 1996 to 2009 we performed mitral valve plasty with aortic valve replacement in 50 patients. Clinical and echocardiographic data were obtained from computer database and hospital records. Missing data were obtained through mailed questionnaire. We evaluated hospital mortality, long-term survival, thromboembolic and hemorrhagic complications and TR of 3+ on follow up echocardiography.

RESULTS

Four patients who had previously undergone aortic valve surgery were excluded from the study. Aortic valve pathology was stenosis in 21 patients, regurgitation in 20 and 4 patients presented with mixed aortic disease. The etiology of mitral regurgitation was rheumatic in 6, non-rheumatic in 31 and infective in 6 patients. Aortic valve was replaced with mechanical prosthesis in 22 (mean age 59) and tissue prosthesis in 24 (mean age 71) patients. Additional surgical procedure was performed in 26 patients. Follow-up was 94% complete, with a mean duration of 51 months. Hospital mortality was 13%. Two and five year survival was 79% and 64% respectively. We noted one case of retroperitoneal hemorrhage and one stroke. We recorded 9 (19.6%) patients with residual TR of more than 3+ grade on follow up echocardiography. Out of 9 patients with residual TR, 3 were operated for rheumatic and 6 for non-rheumatic mitral valve disease. One patients underwent successful mitral valve replacement with mechanical prosthesis, 3 died and 5 are treated expectantly.

CONCLUSION

We conclude that concomitant mitral valve repair with aortic valve replacement has high hospital mortality, excellent long-term survival and low complication rate. The durability of mitral valve repair in patients with rheumatic mitral valve disease is limited and replacement, rather that repair should be considered in this patient group.

Incorporation of the fluorescent ribonucleotide analogue tCTP by T7 RNA polymerase

Fluorescent RNA is an important analytical tool in medical diagnostics, RNA cytochemistry, and RNA aptamer development. We have synthesized the fluorescent ribonucleotide analogue 1,3-diaza-2-oxophenothiazine-ribose-5'-triphosphate (tCTP) and tested it as substrate for T7 RNA polymerase in transcription reactions, a convenient route for generating RNA in vitro. When transcribing a guanine, T7 RNA polymerase incorporates tCTP with 2-fold higher catalytic efficiency than CTP and efficiently polymerizes additional NTPs onto the tC. Remarkably, T7 RNA polymerase does not incorporate tCTP with the same ambivalence opposite guanine and adenine with which DNA polymerases incorporate the analogous dtCTP. While several DNA polymerases discriminated against a d(tC-A) base pair only by factors <10, T7 RNA polymerase discriminates against tC-A base pair formation by factors of 40 and 300 when operating in the elongation and initiation mode, respectively. These catalytic properties make T7 RNA polymerase an ideal tool for synthesizing large fluorescent RNA, as we demonstrated by generating a approximately 800 nucleotide RNA in which every cytosine was replaced with tC.

Disturbances in some gene expression in T regulatory cells separated from children with metabolic syndrome

The metabolic syndrome (MS) is defined as a cluster of risk factors, including abdominal obesity, dyslipidaemia, glucose intolerance and hypertension, which increase the risk for coronary heart disease. The immunological aspects of obesity and MS, including the role of T regulatory cells, have been intensively investigated. The aim of this study was to determine whether there is any disturbance in T regulatory cells number and/or function in children with MS. The percentages of T regulatory cells in the peripheral blood of children fulfilling the International Diabetes Federation criteria of the disease (n = 47) were assessed. Treg cells were also separated for further analysis of multiple genes important in their function with the use of real-time RT-PCR. We did not observe any difference in Treg percentages between study and control group but there was lower expression of some molecules including transforming growth factor-beta and interleukin-12 family members in Treg cells separated from children with MS compared to the healthy subjects. Our study is the first to report significant disturbances in some gene expression in T regulatory cells separated from children with MS. The results should be useful for further research in this field, including immunotherapeutic interventions.

[Assessment of routine surveillance of patients after primary treatment for cervical cancer in stage I. and II.: retrospective analysis]

OBJECTIVE

Evaluate the monitoring and diagnosis of recurrence after primary treatment for cervical cancer.

DESIGN

Retrospective analysis.

SETTING

Department of Obstetrics and Gynecology Faculty Hospital and Constantine the Philosopher University Nitra.

METHODS

We retrospectively analyzed 199 patients who have undergone surgical treatment for cervical cancer between 2000 and 2008 at the Faculty Hospital Nitra and they received chemoradioterapy after evaluation of risk factors. Monitoring after primary treatment consisted of general physical examination, gynecological examination, vaginal and abdominal ultrasonography, chest X-ray and determining the level of SCCA. The examinations were performed by gynecologist and clinical oncologist. We compared the survival of patients with symptomatic and asymptomatic recurrences.

RESULTS

The recurrence after 6 months post primary therapy were identified in 17 cases. At the time recurrence diagnosis 3 patients were asymptomatic and 14 were symptomatic. Recurrences all 3 asymptomatic patients were detected during regular examinations. Asymptomatic and symptomatic patients had similar survival.

CONCLUSION

Regular monitoring of patients after primary treatment of cervical cancer in the rigid intervals and diagnosis of recurrence in the asymptomatic stage does not improve survival compared with symptomatic patients. It is necessary to re-evaluate the algorithm of follow-up not only in terms of survival but also in terms of economic consequences.

Measurement of the depth of maximum of extensive air showers above 10{18} eV

We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.

Mechanisms by which human DNA primase chooses to polymerize a nucleoside triphosphate

Human DNA primase synthesizes short RNA primers that DNA polymerase alpha then elongates during the initiation of all new DNA strands. Even though primase misincorporates NTPs at a relatively high frequency, this likely does not impact the final DNA product since the RNA primer is replaced with DNA. We used an extensive series of purine and pyrimidine analogues to provide further insights into the mechanism by which primase chooses whether or not to polymerize a NTP. Primase readily polymerized a size-expanded cytosine analogue, 1,3-diaza-2-oxophenothiazine NTP, across from a templating G but not across from A. The enzyme did not efficiently polymerize NTPs incapable of forming two Watson-Crick hydrogen bonds with the templating base with the exception of UTP opposite purine deoxyribonucleoside. Likewise, primase did not generate base pairs between two nucleotides with altered Watson-Crick hydrogen-bonding patterns. Examining the mechanism of NTP polymerization revealed that human primase can misincorporate NTPs via both template misreading and a primer-template slippage mechanism. Together, these data demonstrate that human primase strongly depends on Watson-Crick hydrogen bonds for efficient nucleotide polymerization, much more so than the mechanistically related herpes primase, and provide insights into the potential roles of primer-template stability and base tautomerization during misincorporation.

[Low-grade renal trauma (part I): diagnostic validity of haematuria]

PURPOSE OF THE STUDY

The aim of the study was to evaluate the diagnostic validity of haematuria findings in patients with low-grade renal trauma.

MATERIAL AND METHODS

The group studied comprised the patients hospitalised between 1994 and 2008 in the University Hospital Královské Vinohrady, Prague, for blunt renal trauma, classified as grade I or grade II according to the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma, in whom trauma to the lower urinary tract (urinary bladder and urethra) was excluded because of the mechanism of injury (direct blow to the kidney region) or by clinical examination or imaging methods. It included 116 patients (72 men and 44 women) at the age between 17 and 86 years (average, 38 years). The urine was examined for the presence of blood by clinical and laboratory methods and, based on the results, the patients were allocated to three groups with macroscopic haematuria, microscopic haematuria and negative findings, respectively. The results in each group were then related to those of the imaging methods (computed tomography /CT/ and ultrasonography /US/) and, using Epi Info Version 6 CZ software, the statistical significance was evaluated by the Chi-square test with the level of significance set at 0.5 %.

RESULTS

Haematuria, either macroscopic or microscopic, was confirmed in 102 (88 %) patients. No blood in the urine was detected in 14 (12 %) patients. Positive CT or US findings were recorded in 76 (66 %) patients with subcapsular haematoma, renal contusion or perirenal haematoma. In the patients with haematuria, the confirmation of their diagnosis by imaging methods was not significant (p=0.076). The sensitivity of macrohaematuria was 53 ;% and that of microhaematuria was 21 % the specificity was 21 % and 13 %, respectively. The sensitivity of imaging methods was 62 % and their specificity was 38 %.

DISCUSSION

A consistent exclusion of all patients diagnosed with injury to the lower urinary tract allowed us to relate haematuria in our group only to renal parenchymal trauma. The authors consider this an important part of the study method. However, although this method of patient selection was strictly observed, haematuria failed to be detected in all patients diagnosed with low grade renal trauma. The CT or US findings of renal trauma in the patients with no haematuria can be explained by the fact that the lesion occurred in the superficial renal cortex with bleeding detected as a subcapsular haematoma or perirenal collection without blood leaking into the renal tubular system. The statistical evaluation of the results confirmed the randomness of both the clinical manifestation of a trauma and the diagnostic method presentation of a renal trauma. The changes in tissues and their manifestations are highly variable including a potential negative finding without causality. Even though the group under study fails to be exactly evaluated by statistical methods, it is obvious that the validity of a diagnosis of low grade renal trauma is higher if haematuria is present together with positive CT or US findings.

CONCLUSIONS

The finding of haematuria is a valuable piece of information in low grade renal trauma. Particularly, if imaging methods fail to detect an injury, haematuria is a sign indicating renal trauma following a typical blunt force mechanism, even though our results of its evaluation were not statistically significant. The absence of macroscopic or microscopic haematuria did not exclude the existence of renal trauma in our group, and it is therefore necessary to pay increased attention to the evaluation of findings obtained by imaging methods in patients involved in a typical blunt force accident.

High density labeling of polymerase chain reaction products with the fluorescent base analogue tCo

Fluorescent DNA of high molecular weight is an important tool for studying the physical properties of DNA and DNA-protein interactions, and it plays a key role in modern biotechnology for DNA sequencing and detection. While several DNA polymerases can incorporate large numbers of dye-linked nucleotides into primed DNA templates, the amplification of the resulting densely labeled DNA strands by polymerase chain reaction (PCR) is problematic. Here, we report a method for high density labeling of DNA in PCR reactions employing the 5'-triphosphate of 1,3-diaza-2-oxo-phenoxazine (tCo) and Deep Vent DNA polymerase. tCo is a fluorescent cytosine analogue that absorbs and emits light at 365 and 460 nm, respectively. We obtained PCR products that were fluorescent enough to directly visualize them in a gel by excitation with long UV light, thus eliminating the need for staining with ethidium bromide. Reactions with Taq polymerase failed to produce PCR products in the presence of only small amounts of dtCoTP. A comparative kinetic study of Taq and Deep Vent polymerase revealed that Taq polymerase, although it inserts dtCoTP with high efficiency opposite G, is prone to forming mutagenic tCo-A base pairs and does not efficiently extend base pairs containing tCo. These kinetics features explain the poor outcome of the PCR reactions with Taq polymerase. Since tCo substitutes structurally for cytosine, the presented labeling method is believed to be less invasive than labeling with dye-linked nucleotides and, therefore, produces DNA that is ideally suited for biophysical studies.

Herpes simplex virus-1 DNA primase: a remarkably inaccurate yet selective polymerase

Herpes simplex virus-1 primase misincorporates the natural NTPs at frequencies of around one error per 30 NTPs polymerized, making it one of the least accurate polymerases known. We used a series of nucleotide analogues to further test the hypothesis that primase requires Watson-Crick hydrogen bond formation to efficiently polymerize a NTP. Primase could not generate base pairs containing a complete set of hydrogen bonds in an altered arrangement (isoguanine.isocytosine) and did not efficiently polymerize dNTPs completely incapable of forming Watson-Crick hydrogen bonds opposite templating bases incapable of forming Watson-Crick hydrogen bonds. Similarly, primase did not incorporate most NTPs containing hydrophobic bases incapable of Watson-Crick hydrogen bonding opposite natural template bases. However, 2-pyridone NTP and 4-methyl-2-pyridone NTP provided striking exceptions to this rule. The effects of removing single Watson-Crick hydrogen bonding groups from either the NTP or templating bases varied from almost no effect to completely blocking polymerization depending both on the parental base pair (G.C vs A.T/U) and which base pair of the growing primer (second, third, or fourth) was examined. Thus, primase does not absolutely need to form Watson-Crick hydrogen bonds to efficiently polymerize a NTP. Additionally, we found that herpes primase can misincorporate nucleotides both by misreading the template and by a primer-template slippage mechanism. The mechanistic and biological implications of these results are discussed.

[Management of deep device related infection in patient implanted with mechanical cardiac support device using V.A.C. system]

Infection remains the most significant cause of morbidity and mortality in pacients implanted with mechanical circulatory support devices (MCSD), reaching prevalence of 40-60% according various authors. Successful treatment of the whole spectrum of infectious complications is the basic determinant in archieving good results in MCSD patients. The treatment involves standard surgical procedures, as well as the use of vacuum assisted closure (V.A.C.) therapy in the last few years. We demonstrate successful management of deep device related infection using V.A.C therapy in a patient with MCSD, giving him the opportunity to heart transplantation, and thereafter successful treatment of poststernotomy mediastinitis in this imunosupressed pacient after heart transplantation.

Herpes simplex virus-1 helicase-primase: roles of each subunit in DNA binding and phosphodiester bond formation

The helicase-primase complex from herpes simplex virus-1 contains three subunits, UL5, UL52, and UL8. We generated each of the potential two-subunit complexes, UL5-UL52, UL5-UL8, and UL52-UL8, and used a series of kinetic and photo-cross-linking studies to provide further insights into the roles of each subunit in DNA binding and primer synthesis. UL8 increases the rate of primer synthesis by UL5-UL52 by increasing the rate of primer initiation (two NTPs --> pppNpN), the rate-limiting step in primer synthesis. The UL5-UL8 complex lacked any detectable catalytic activity (DNA-dependent ATPase, primase, or RNA polymerase using a RNA primer-template and NTPs as substrates) but could still bind DNA, indicating that UL52 must provide some key amino acids needed for helicase function. The UL52-UL8 complex lacked detectable DNA-dependent ATPase activity and could not synthesize primers on single-stranded DNA. However, it exhibited robust RNA polymerase activity using a RNA primer-template and NTPs as substrates. Thus, UL52 must contain the entire primase active site needed for phosphodiester bond formation, while UL5 minimally contributes amino acids needed for the initiation of primer synthesis. Photo-cross-linking experiments using single-stranded templates containing 5-iodouracil either before, in, or after the canonical 3'-GPyPy (Py is T or C) initiation site for primer synthesis showed that only UL5 cross-linked to the DNA. This occurred for the UL5-UL52, UL5-UL52-UL8, and UL5-UL8 complexes and whether the reaction mixtures contained NTPs. Photo-cross-linking of a RNA primer-template, the product of primer synthesis, containing 5-iodouracil in the template generated the same apparent cross-linked species.

Ambivalent incorporation of the fluorescent cytosine analogues tC and tCo by human DNA polymerase alpha and Klenow fragment

We studied the incorporation of the fluorescent cytidine analogues 1,3-diaza-2-oxophenothiazine (tC) and 1,3-diaza-2-oxophenoxazine (tCo) by human DNA polymerase alpha and Klenow fragment of DNA polymerase I (Escherichia coli). These tricyclic nucleobases possess the regular hydrogen bonding interface of cytosine but are significantly expanded in size toward the major groove. Despite the size alteration, both DNA polymerases insert dtCTP and dtCoTP with remarkable catalytic efficiency. Polymerization opposite guanine is comparable to the insertion of dCTP, while the insertion opposite adenine is only approximately 4-11 times less efficient than the formation of a T-A base pair. Both enzymes readily extend the formed tC(o)-G and tC(o)-A base pairs and can incorporate at least four consecutive nucleotide analogues. Consistent with these results, both DNA polymerases efficiently polymerize dGTP and dATP when tC and tCo are in the template strand. Klenow fragment inserts dGTP with a 4-9-fold higher probability than dATP, while polymerase alpha favors dGTP over dATP by a factor of 30-65. Overall, the properties of tC(o) as a templating base and as an incoming nucleotide are surprisingly symmetrical and may be universal for A and B family DNA polymerases. This finding suggests that the aptitude for ambivalent base pairing is a consequence of the electronic properties of tC(o).

Interaction of human DNA polymerase alpha and DNA polymerase I from Bacillus stearothermophilus with hypoxanthine and 8-oxoguanine nucleotides

To better understand how DNA polymerases interact with mutagenic bases, we examined how human DNA polymerase alpha (pol alpha), a B family enzyme, and DNA polymerase from Bacillus stearothermophilus (BF), an A family enzyme, generate adenine:hypoxanthine and adenine:8-oxo-7,8-dihydroguanine (8-oxoG) base pairs. Pol alpha strongly discriminated against polymerizing dATP opposite 8-oxoG, and removing N1, N(6), or N7 further inhibited incorporation, whereas removing N3 from dATP dramatically increased incorporation (32-fold). Eliminating N(6) from 3-deaza-dATP now greatly reduced incorporation, suggesting that incorporation of dATP (analogues) opposite 8-oxoguanine proceeds via a Hoogsteen base pair and that pol alpha uses N3 of a purine dNTP to block this incorporation. Pol alpha also polymerized 8-oxo-dGTP across from a templating A, and removing N(6) from the template adenine inhibited incorporation of 8-oxoG. The effects of N1, N(6), and N7 demonstrated a strong interdependence during formation of adenine:hypoxanthine base pairs by pol alpha, and N3 of dATP again helps prevent polymerization opposite a templating hypoxanthine. BF very efficiently polymerized 8-oxo-dGTP opposite adenine, and N1 and N7 of adenine appear to play important roles. BF incorporates dATP opposite 8-oxoG less efficiently, and modifying N1, N(6), or N7 greatly inhibits incorporation. N(6) and, to a lesser extent, N1 help drive hypoxanthine:adenine base-pair formation by BF. The mechanistic implications of these results showing that different polymerases interact very differently with base lesions are discussed.

[Transmyocardial laser revascularization]

AIM OF THE STUDY

The study looked at our results with transmyocardial laser revascularization. We also tried to ascertain the role of TMLR in current cardiothoracic surgical practice.

METHODS

Twenty patients underwent TMLR at IKEM Praha in a period from 1999 to 2007. Patients were categorized into two separate groups. The first included patients who had TMLR as a single procedure. Second group comprised patients who underwent combined TMLR and direct bypass revascularization. Outcome measures were reduction of angina, improvements in exercise tolerance and left ventricular systolic function.

RESULTS

Improvement in CCS classification of two and more classes has been achieved in almost half the patients who underwent TMLR combined with CABG, but only in 20% of patients after isolated TMLR. There was no change in left ventricular systolic function either in group of patients after TMLR or in group with hybrid procedure. There was also no change detected in myocardial perfusion in thallium scintigraphy studies.

CONCLUSION

The study confirmed that TMLR has minimal perioperative complication rate and is safe. On the other hand our results failed to demonstrate any significant improvement in quality of life following TMLR. In our opinion TMLR should be reserved for symptomatic patients in CCS IV class when all other conventional treatment options have been exhausted.

Discrimination between right and wrong purine dNTPs by DNA polymerase I from Bacillus stearothermophilus

We used a series of dATP and dGTP analogues to determine how DNA polymerase I from Bacillus stearothermophilus (BF), a prototypical A family polymerase, uses N-1, N(2), N-3, and N(6) of purine dNTPs to differentiate between right and wrong nucleotide incorporation. Altering any of these nitrogens had two effects. First, it decreased the efficiency of correct incorporation of the resulting dNTP analogue, with the loss of N-1 and N-3 having the most severe effects. Second, it dramatically increased the rate of misincorporation of the resulting dNTP analogues, with alterations in either N-1 or N(6) having the most severe impacts. Adding N(2) to dNTPs containing the bases adenine and purine increased the degree of polymerization opposite T but also tremendously increased the degree of misincorporation opposite A, C, and G. Thus, BF uses N-1, N(2), N-3, and N(6) of purine dNTPs both as negative selectors to prevent misincorporation and as positive selectors to enhance correct incorporation. Comparing how BF discriminates between right and wrong dNTPs with both B family polymerases and low-fidelity polymerases indicates that BF has chosen a unique solution vis-a-vis these other enzymes and, therefore, that nature has evolved at least three mechanistically distinct solutions.

Identifying the features of purine dNTPs that allow accurate and efficient DNA replication by herpes simplex virus I DNA polymerase

To accurately replicate its viral genome, the Herpes Simplex Virus 1 (HSV-1) DNA polymerase usually polymerizes the correct natural 2'-deoxy-5'-triphosphate (dNTP) opposite the template base being replicated. We employed a series of purine-dNTP analogues to determine the chemical features of the base necessary for the herpes polymerase to avoid polymerizing incorrect dNTPs. The enzyme uses N-3 to prevent misincorporation of purine dNTPs but does not require N-3 for correct polymerization. A free pair of electrons on N-1 also helps prevent misincorporation opposite A, C, and G and strongly drives polymerization opposite T. N6 contributes a small amount both for preventing misincorporation and for correct polymerization. Within the context of guanine in either the incoming dNTP or the template base being replicated, N2 prevents misincorporation opposite adenine but plays at most a minor role for incorporation opposite C. In contrast, adding N2 to the dNTPs of either adenine, purine, 6-chloropurine, or 1-deazapurine greatly enhances incorporation opposite C, likely via the formation of a hydrogen bond between N2 of the purine and O2 of the pyrimidine. Herpes polymerase is very sensitive to the structure of the base pair at the primer 3'-terminus since eliminating N-1, N-3, or N6 from a purine nucleotide at the primer 3'-terminus interfered with polymerization of the next two dNTPs. The biological and evolutionary implications of these data are discussed.

Sexual partner concurrency among STI clinic patients with a steady partner: correlates and associations with condom use

OBJECTIVES

Partner concurrency facilitates the transmission of HIV and other sexually transmitted infections (STIs). In this study, we sought to (1) determine the correlates of concurrency among patients with a steady partner, and (2) identify correlates of condom use among patients reporting concurrent steady and non-steady partners.

METHODS

Patients recruited from an STI clinic (n = 973; 48% female; 68% African-American) completed a survey that assessed demographic characteristics, substance use, sexual partnerships and sexual behaviour, including condom use. Patients reporting a steady sexual partner for 3 months or longer were included in the analyses. Those who also reported a non-steady partner in the past 3 months, in addition to a steady partner, were considered to have engaged in concurrency.

RESULTS

Nearly two-thirds (64%) of patients reported both steady and non-steady partners in the past 3 months. Steady/non-steady concurrency was associated with being male, not cohabitating with a partner, use of alcohol and other drugs, and thinking their steady partner was monogamous. Patients with steady and non-steady partners reported that they seldom used condoms consistently with steady (5%) or non-steady (24%) partners. Compared to patients who did not report concurrency, patients who reported steady/non-steady concurrency reported more episodes of unprotected sex in the past 3 months. Among patients reporting concurrency, consistent condom use with non-steady partners was more likely among individuals who (a) used less alcohol and (b) thought that their steady partner was non-monogamous.

CONCLUSIONS

To reduce risk for HIV and other STIs, behavioural interventions need to address partner concurrency and its correlates, including alcohol and other drug use.