Prevalence of community-associated methicillin-resistant Staphylococcus aureus colonization in men who have sex with men

Summary

Outbreaks of skin and soft tissue infections mediated by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are being reported with increasing frequency among men who have sex with men (MSM). However, the potential role of asymptomatic colonization with this organism in perpetuating these infections is unclear. The purpose of this cross-sectional study was to determine the prevalence of colonization with CA-MRSA among a cohort of 500 MSM recruited from two inner city clinics in Toronto, Canada. Following the provision of informed consent, subjects completed a questionnaire capturing demographic and clinical variables, which may be associated with MRSA colonization. A nasal swab for MRSA was collected from each subject, and instructions were provided regarding the self-collection of a rectal swab. Cultured MRSA underwent pulsed-field gel electrophoresis and virulence testing for Panton-Valentine leukocidin gene expression. The prevalence of CA-MRSA colonization was 1.6% (95% CI: 0.5–2.6%).

A randomized control trial of an Ultra-Short zidovudine regimen in the prevention of perinatal HIV transmission in rural Zimbabwe

OBJECTIVE

To assess the practicality and effectiveness of an Ultra-Short zidovudine regimen for prevention of perinatal HIV transmission in rural Zimbabwe.

DESIGN

Double-blinded placebo-controlled randomized clinical trial.

SETTING

The Salvation Army Howard Hospital, a district hospital in rural Zimbabwe.

SUBJECTS

222 HIV positive pregnant women presenting for antenatal care prior to 36 weeks were randomized. Twenty nine women were lost to follow up.

INTERVENTION

In the Thai regimen, mothers received zidovudine (300 mg po bid) from 36 weeks gestation until labour, and zidovudine (300 mg po q3h) during labour, and the neonates received a placebo. In the Ultra-Short regimen, the mothers received a placebo from 36 weeks to labour, then zidovudine (300 mg po q3h) in labour. The neonates received zidovudine (2 mg/kg po qid) for the first three days of life.

MAIN OUTCOME MEASURE

Infant HIV RNA status at six weeks of life.

RESULTS

Results were available for 90 infants from the Thai group and 89 infants from the Ultra-Short group. Infant HIV seroconversion rates at six weeks of life were 18.9% (95%CI 10.8 to 27.0) with the Thai regimen, and 15.7% [95% Confidence Interval (CI) 8.1 to 23.4] with the Ultra-Short regimen. The upper bound of seroconversion in the Ultra-Short group was lower than the 25% seroconversion boundary that was specified to show equivalence.

CONCLUSIONS

Although the Ultra-Short regimen has equivalent efficacy to the Thai regimen, it also has many practical advantages. Ultra-Short is thus a preferable protocol.

The risk of myocardial infarction in HIV-infected patients receiving HAART: a case report

With the advent of highly active antiretroviral therapy (HAART), HIV-related morbidity and mortality has declined. Patients are surviving longer but with serious side effects, especially those receiving protease inhibitors (PIs). We report a case of a healthy young man receiving triple therapy with typical angina symptoms that were not recognized by physicians.

The effect of the sight of blood and use of decorative adhesive bandages on pain intensity ratings by preschool children

A total of 70 children between the ages of 3 and 6 years participated in two studies that tested the effect of (a) the sight of blood and (b) the application of a decorated adhesive bandage on pain intensity ratings following a fingerstick. In both studies, children were randomly assigned to one of four groups. These groups allowed for the combinations of testing blood or no blood and the application of a decorated adhesive bandage or plain adhesive bandage. The Oucher (Beyer, 1984) and the Poker Chip Tool (Hester, 1979) were used as self-report measures of pain intensity at the time of the fingerstick and immediately after the application of the adhesive bandage. The pilot study recruited 20 children from two day care centers and subjected them to sham fingersticks. Results indicated that there were no differences across the groups in pain intensity ratings. However, there was a trend for the sight of blood to increase the child's pain intensity rating. Age was a significant covariate across all groups, with younger children reporting higher levels of pain intensity. The second study took place in a pediatric test center of a metropolitan children's hospital. Fifty outpatient children who were receiving fingersticks for preoperative or diagnostic testing were enrolled. Results indicated that there were no differences across groups, and age was only significant on the Poker Chip Tool. These results suggest that simple interventions and distractions are not sufficient to decrease perceived pain intensity ratings in young children.