Effectiveness of a pilot partner notification program for new HIV cases in Barcelona, Spain

BACKGROUND

An estimated 30% of HIV cases in the European Union are not aware of their serological status. This study aimed to assess the effectiveness of a pilot HIV partner notification program.

METHODS

HIV cases diagnosed between January 2012 and June 2013 at two healthcare settings in Barcelona were invited to participate in a prospective survey. We identified process and outcome measures to evaluate this partner notification program, including the number of partners identified per interviewed index case, the proportion of partners tested for HIV as a result of the partner notification, and the proportion of new HIV diagnoses among their sex or needle-sharing partners.

RESULTS

Of the 125 index cases contacted, 108 (86.4%) agreed to provide information about partners. A total of 199 sexual partners were identified (1.8 partners per interviewed index case). HIV outcome was already known for 58 partners (70.7% were known to be HIV-positive), 141 partners were tested as result of partner notification, and 26 were newly diagnosed with HIV. The case-finding effectiveness of the program was 18.4%.

CONCLUSION

This pilot program provides evidence of the effectiveness of a partner notification program implemented in healthcare settings. This active partner notification program was feasible, acceptable to the user, and identified a high proportion of HIV-infected patients previously unaware of their status.

Outcomes of modified Dega acetabuloplasty in acetabular dysplasia related to developmental dislocation of the hip

Developmental dislocation of the hip (DDH) is frequently, even after reduction, associated with residual acetabular dysplasia. Various surgical techniques are used to correct this, one of which is Dega acetabuloplasty. This osteotomy technique has, however, rarely been assessed in this particular indication. The present study therefore sought to describe the technical details, report clinical and radiological results, and present limitations.

HYPOTHESIS

Unlike reorientation osteotomy in children, Dega acetabuloplasty does not lead to a high rate of acetabular retroversion at the end of growth.

PATIENTS AND METHODS

Sixteen Dega acetabuloplasties in 15 patients were assessed on joint range of motion, limp, lower limb length discrepancy and impaired everyday activity, pre-operatively and at end of follow-up. Hips were classified following Wicart et al. (2003). Radiologic assessment comprised Wiberg angle and acetabular index, pre- and post-operatively and at follow-up. Acetabular retroversion was analyzed by crossover sign, and hips were classified following Severin.

RESULTS

Median age at surgery was 3 years (range, 1.1-12.2 years) and 10 years (6.4-17.8) at end of follow-up. At end of follow-up, all hips were pain-free and classified as Wicart A, and all activities were allowed. Radiologically, hips were classified as Severin I, II or IV, in 11 (68.5%), 4 (25%) and 1 (6.5%) cases respectively. Wiberg angle rose from a mean 3.3° (-30° to 30°) to 23° (10° to 38°) and acetabular index fell from a mean 31° (25° to 45°) to 20° (5° to 30°) with surgery, and both continued to improve over follow-up: 26° (12-45°) and 13° (3-24°) respectively (P<0.05). Acetabular retroversion was found in 2 of the 10 hips with Y cartilage fusion.

DISCUSSION

Modified Dega acetabuloplasty was effective in correcting acetabular dysplasia in DDH. Functional and radiological results were good, with a low rate of acetabular retroversion (2/10), unlike with other techniques.

LEVEL OF EVIDENCE

Level IV. Therapeutic study.

Sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV-1 infections in two at-risk populations in Barcelona: female street prostitutes and STI clinic attendees

OBJECTIVE

To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and HIV-1 infections in female street prostitutes and STI clinic attendees in Barcelona.

DESIGN

This was a prospective study carried out in two four-month periods over two years. Urine specimens were tested for CT and NG using a PCR pooling algorithm. Among street prostitutes HIV-1 testing in urine was also carried out.

RESULTS

The prevalences of CT, NG, and HIV-1 in female street prostitutes (n=301) were 4.7%, 3.7%, and 1.0%, respectively. Women from Eastern Europe had the highest prevalence of CT (p=0.01). Prevalences of CT, NG, and HIV-1 among all clinic attendees (n=536) were 4.3%, 4.5%, and 4.4%, respectively. Prevalence of HIV-1 infection among homosexual men was higher compared with heterosexual men and women (p<0.001).

CONCLUSIONS

Overall CT prevalence is currently lower than in other European countries, although it could increase as a result of immigration. Rates of HIV-1 and of NG are higher among homosexual than among heterosexual men.

Gene polimorphisms and biological factors as possible predictors for patients with pleural metastatic breast cancer

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Background: Pronosis of breast cancer varies widely in patients with similar clinical features. Therefore, we investigated other factors with possible prognostic value. The CYP17 gene has a polimorphism related to a increased susceptibility to breast cancer (single T; A1 allele to C; A2 allele). ( Mitrunen et al. Cancer Epidemiol Biomarkers Prev 2000,9;12;1343–8). On the other hand, it has been found in the MTHFR gene a common C-T substitution at nucleotide 677 that is associated with reduced enzyme activity and increased risk of breast cancer (Capmbell et al., Breast Cancer Research 2002;4,6:R14). Other genes such as GSTT1 and GSTM1 variant genotypes have a controversial association to breast cancer. We have analyzed the genotype and biological factors in a group of patients with pleural metastatic cancer of the breast and compared it to a control group of women with no cancer. Methods: Forty-six patients with breast cancer and forty women as controls were includes in the study. Age at diagnosis of the primary tumor, TNM staging, interval free of disease, estrogen and progesteron receptors, Ki67, p53 and Her-2neu expression were recorded, as well as survival from the time of diagnosis and polimorphism of CYP17, MTHFR, GSTT1 and GSTM1 genes. Results: Mean survival differed significantly between patients having pleural effusion as the first site of relapse as compared to those with other sites of relapse (28’9 vs 11’9 months, p = 0’004). A high Ki67 expression correlated best with longer survival after talc pleurodesis. We detected a high frequency in the CYP17 A2 variant genotype in patients with metastatic breast cancer compared to the control group. As for MTFHR gene, we found a high frequency for the T/T genotypes variant in breast cancer group. No significant differences between control and cancer group were found in either GSTT1 and GSTM1 gene variations. Conclusions: Genotype and biological factors, such as factors investigated in this study, play an important role as predictors for patients with pleural metastatic breast cancer.

No significant financial relationships to disclose.

[HIV infection and other sexually-transmitted infections among immigrants in Barcelona]

BACKGROUND

Immigration is a recent phenomenon in Spain. Certain subgroups of the immigrant population may be vulnerable to acquiring sexually transmitted infections (STI).

MATERIAL AND METHODS

Descriptive study of the seroprevalenceof certain STI (HIV, hepatitis B and syphilis) and the general characteristicsn of persons tested for HIV infection in a specialized clinic in Barcelona during the year 2000.

RESULTS

Seroprevalence of HIV was similar in immigrants and native residents(1.8% vs. 1.7% respectively). However, the seroprevalences of hepatitis B virus (anti-HBc) (19.5% vs. 8.3%) and syphilis (RPR 1 TPHA) (3.2% vs. 1.1%), as well as other STI and the practice of prostitution, were higher in immigrants.

CONCLUSIONS

Several STI, including hepatitis B and syphilis, were found more frequently in immigrants than in the native population, whereas HIV seroprevalence was similar in the two groups.

Histomorphometry of the porcine scleral lamina cribrosa surface

The lamina cribrosa surface of the pig was examined using trypsin digestion, scanning electron microscopy, and computerized image analysis. Six normal eyes from healthy pigs were studied. The total intralaminar scan area, total number of laminar pores, median individual laminar pore areas, median individual pore form factors, and mean pore density were determined for the dorsal, ventral, nasal and temporal hemicircles, the dorsal-nasal, dorsal-temporal, ventral-nasal, and ventral-temporal quadrants, and their central and peripheral subdivisions. The mean (+/- SD) total intralaminar scan area was 8.29 +/- 1.54 mm2. The mean (+/- SD) total laminar pore count was 517 +/- 73 pores. The mean pore count was significantly larger in the ventral than the dorsal hemicircle (292 +/- 39 vs. 225 +/- 38 pores, respectively; P = 0.001), and significantly greater in the periphery compared to the center (388 +/- 58 vs. 129 +/- 27 pores, respectively; P = 0.0001). The overall mean (+/- SD) pore density was 67 +/- 7 pores mm-2. Mean pore density was significantly greater in the ventral than the dorsal hemicircle (70 +/- 8 vs. 64 +/- 6 pores mm-2, respectively; P = 0.019), and significantly greater in the center compared to the periphery (75 +/- 9 vs. 60 +/- 8 pores mm-2, respectively; P = 0.020). The mean (+/- SD) median individual pore area was 3752 +/- 572 &mgr;m2. The mean (+/- SD) median pore form factor was 0.680 +/- 0.035. No significant regional differences were found in mean median pore form factor or mean median individual pore areas. The intralaminar optic nerve of pigs is 55.1% non-neural connective and vascular tissue. A pigmented ventral fascial groove in the scleral lamina cribrosa appears unique to the porcine lamina cribrosa, and may be a vestige of the embryonic optic fissure.