Clinical characteristics and management of 106 patients with pyogenic liver abscess in a traditional Chinese hospital.

This is a retrospective study of clinical data from 106 patients with pyogenic liver abscess (PLA) treated in a traditional Chinese hospital during the eight years preceding this publication. We aimed to provide evidence to improve the diagnosis accuracy and the treatment strategies for PLAs. We collected records of patients treated at the Guangxing Hospital, which is affiliated to the Zhejiang Traditional Chinese University in Hangzhou, and we collected their general background information, laboratory and imaging features, and clinical manifestations and outcomes to perform a retrospective analysis. Diabetes mellitus (45.3%, 48/106), biliary calculi (36.8%, 39/106), and history of abdominal surgery (15.1%, 16/106) were the three most common PLA risk factors present in our cohort. Fever and chills (95.3%, 101/106), right upper quadrant pain/epigastric discomfort (68.9%, 73/106), nausea and vomiting (38.8%, 41/106), and cough and sputum (14.2%, 15/106) were the most common clinical manifestations of PLA. Most patients had the abscesses in the right liver lobe, and the most commonly found bacteria were Klebsiella pneumoniae (54.8%, 42/76), Escherichia coli (35.1%, 27/76), and Streptococcus pneumoniae (3.9%, 3/76). Liver Doppler ultrasound is a conventional and effective method to identify liver abscesses. Most patients were treated using a percutaneous puncture under B-ultrasound guidance. Most patients (n = 104 or 98.1%) were cured, one patient (0.9%) died, and one was discharged with multiple abscesses post treatment.

Accuracy of breath test for diabetes mellitus diagnosis: a systematic review and meta-analysis.

The review aimed to investigate the accuracy of breath tests in the diagnosis of diabetes mellitus, identify exhaled volatile organic compounds with the most evidence as potential biomarkers, and summarize prospects and challenges in diabetic breath tests. Databases including Medline, PubMed, EMBASE, Cochrane Library and Science Citation Index Expanded were searched. Human studies describing diabetic breath analysis with more than 10 subjects as controls and patients were included. Population demographics, breath test conditions, biomarkers, analytical techniques and diagnostic accuracy were extracted. Quality assessment was performed with the Standards for Reporting Diagnostic Accuracy and a modified QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). Forty-four research with 2699 patients with diabetes were included for qualitative data analysis and 14 eligible studies were used for meta-analysis. Pooled analysis of type 2 diabetes breath test exhibited sensitivity of 91.8% (95% CI 83.6% to 96.1%), specificity of 92.1% (95% CI 88.4% to 94.7%) and area under the curve (AUC) of 0.96 (95% CI 0.94 to 0.97). Isotopic carbon dioxide (CO2) showed the best diagnostic accuracy with pooled sensitivity of 0.949 (95% CI 0.870 to 0.981), specificity of 0.946 (95% CI 0.891 to 0.975) and AUC of 0.98 (95% CI 0.97 to 0.99). As the most widely reported biomarker, acetone showed moderate diagnostic accuracy with pooled sensitivity of 0.638 (95% CI 0.511 to 0.748), specificity of 0.801 (95% CI 0.691 to 0.878) and AUC of 0.79 (95% CI 0.75 to 0.82). Our results indicate that breath test is a promising approach with acceptable diagnostic accuracy for diabetes mellitus and isotopic CO2 is the optimal breath biomarker. Even so, further validation and standardization in subject control, breath sampling and analysis are still required.

Geographical variations in risk factors associated with HIV infection among drug users in a prefecture in Southwest China.

BACKGROUND: Previous studies have shown inconsistent or even contradictory results for some risk factors associated with HIV infection among drug users, and these may be partially explained by geographical variations. METHODS: Data were collected from 11 methadone clinics in the Liangshan Yi Autonomous Prefecture from 2004 to 2012. A non-spatial logistical regression model and a geographically weighted logistic regression model were fitted to analyze the association between HIV infection and specific factors at the individual level. RESULTS: This study enrolled 6,458 patients. The prevalence of HIV infection was 25.1 %. The non-spatial model indicated that being divorced was positively associated with HIV infection. The spatial model also showed that being divorced was positively associated with HIV infection, but only for 49.4 % of individuals residing in some northern counties. The non-spatial model suggested that service sector work was negatively associated with HIV infection. However, the spatial model indicated that service work was associated with HIV infection, but only for 23.0 % of patients living in some western counties. The non-spatial model did not show that being married was associated with HIV infection in our study field, but the spatial model indicated that being married was negatively associated with HIV infection for 12.0 % of individuals living in some western counties. For other factors, the non-spatial and spatial models showed similar results. CONCLUSION: The spatial model may be useful for improving understanding of geographical heterogeneity in the relationship between HIV infection and individual factors. Spatial heterogeneity may be useful for tailoring intervention strategies for local regions, which can consequently result in a more efficient allocation of limited resources toward the control of HIV transmission.

[A cross-sectional and factor analysis study on HIV, HBV and HIV/HBV infection in a Yi Prefecture, southwest China].

OBJECTIVE: To understand the epidemiological characteristics and related risk factors on HIV, HBV infection of people from the southwest province of China and to provide basic data for the development of related strategies. METHODS: According to the information on current HIV epidemics, one township from the area was selected as the study field and all the adult population were surveyed using a questionnaire to collect social demographic data and information on infection-related factors. RESULTS: A total of 2 290 adults were investigated and data showed as follows:the average HIV infection rate as 7.9% , the average HBV infection rate as 3.1%, and the average HIV/HBV co-infection rate as 1.2%. As for HIV infection, people whose yearly family gross income between 1 000 and 3 000 Yuan (OR = 0.28) or more than 5 000 Yuan (OR = 0.14) were less likely to be infected with HIV than those people whose annual family gross income less than 1 000 Yuan. People with educational level of primary school and above were more likely to carry HIV than those who were illiterate (OR = 3.28). People who had the history of migration were less likely to carry HIV than those who had not (OR = 0.33). People who had the history of being drug abusers were more likely to infect HIV than those who had not (OR = 46.32). People whose spouses had the history of using drugs were more likely to infect HIV than those who had not (OR = 3.52). People whose spouses had been infected with HIV were more likely to infect HIV than those who had not (OR = 9.56). As for HBV infection, people who had the history of migration were more likely to infect HBV(OR = 2.48). As for HIV/HBV co-infection, people whose spouses had the history of HIV infection were more likely to infect HIV/HBV co-infection than others who did not have the history (OR = 6.04). CONCLUSION: There had been a serious HIV/AIDS epidemic in our study field. Other than taking measures as detection and vaccination on HBV, health education should be strengthened, together with measurements as needle exchange and methadone substitution therapy, to control the spread of AIDS.

HIV-, HCV-, and co-infections and associated risk factors among drug users in southwestern China: a township-level ecological study incorporating spatial regression.

BACKGROUND: The human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are major public health problems. Many studies have been performed to investigate the association between demographic and behavioral factors and HIV or HCV infection. However, some of the results of these studies have been in conflict. METHODOLOGY/PRINCIPAL FINDINGS: The data of all entrants in the 11 national methadone clinics in the Yi Autonomous Prefecture from March 2004 to December 2012 were collected from the national database. Several spatial regression models were used to analyze specific community characteristics associated with the prevalence of HIV and HCV infection at the township level. The study enrolled 6,417 adult patients. The prevalence of HIV infection, HCV infection and co-infection was 25.4%, 30.9%, and 11.0%, respectively. Prevalence exhibited stark geographical variations in the area studied. The four regression models showed Yi ethnicity to be associated with both the prevalence of HIV and of HIV/HCV co-infection. The male drug users in some northwestern counties had greater odds of being infected with HIV than female drug users, but the opposite was observed in some eastern counties. The 'being in drug rehabilitation variable was found to be positively associated with prevalence of HCV infection in some southern townships, however, it was found to be negatively associated with it in some northern townships. CONCLUSIONS/SIGNIFICANCE: The spatial modeling creates better representations of data such that public health interventions must focus on areas with high frequency of HIV/HCV to prevent further transmission of both HIV and HCV.

The geographic distribution patterns of HIV-, HCV- and co-infections among drug users in a national methadone maintenance treatment program in Southwest China.

BACKGROUND: HIV-, HCV- and HIV/HCV co-infections among drug users have become a rapidly emerging global public health problem. In order to constrain the dual epidemics of HIV/AIDS and drug use, China has adopted a methadone maintenance treatment program (MMTP) since 2004. Studies of the geographic heterogeneity of HIV and HCV infections at a local scale are sparse, which has critical implications for future MMTP implementation and health policies covering both HIV and HCV prevention among drug users in China. This study aimed to characterize geographic patterns of HIV and HCV prevalence at the township level among drug users in a Yi Autonomous Prefecture, Southwest of China. METHODS: Data on demographic and clinical characteristics of all clients in the 11 MMTP clinics of the Yi Autonomous Prefecture from March 2004 to December 2012 were collected. A GIS-based geographic analysis involving geographic autocorrelation analysis and geographic scan statistics were employed to identify the geographic distribution pattern of HIV-, HCV- and co-infections among drug users. RESULTS: A total of 6690 MMTP clients was analyzed. The prevalence of HIV-, HCV- and co-infections were 25.2%, 30.8%, and 10.9% respectively. There were significant global and local geographic autocorrelations for HIV-, HCV-, and co-infection. The Moran's I was 0.3015, 0.3449, and 0.3155, respectively (P < 0.0001). Both the geographic autocorrelation analysis and the geographic scan statistical analysis showed that HIV-, HCV-, and co-infections in the prefecture exhibited significant geographic clustering at the township level. The geographic distribution pattern of each infection group was different. CONCLUSION: HIV-, HCV-, and co-infections among drug users in the Yi Autonomous Prefecture all exhibited substantial geographic heterogeneity at the township level. The geographic distribution patterns of the three groups were different. These findings imply that it may be necessary to inform or invent site-specific intervention strategies to better devote currently limited resource to combat these two viruses.