Anorectal swabs as a marker of male-to-male sexual exposure in STI surveillance systems.

Identification of priority populations such as men who have sex with men (MSM) is important in surveillance systems to monitor trends of sexually transmitted infections (STIs). We explored using routinely collected non-behavioural data as a means to establish MSM status in surveillance by assessing anorectal swab as a marker of male-to-male sexual exposure. We used chlamydia testing data from a sexual health clinic, 2007-2012. Men reporting any male sexual partner(s) in the previous 12 months were considered MSM. The dataset was split into development and validation samples to develop a univariate predictive model and assess the model fit. The dataset included 30 358 individual men and 48 554 episodes of STI testing; 45% were among reported MSM and an anorectal swab was performed in 40% of testing episodes. Anorectal swabbing had good diagnostic performance as a marker for MSM status (sensitivity = 87%, specificity = 99%, positive predictive value = 98·6%, negative predictive value = 90·3%). The model showed good fit against the internal validation sample (area under the curve = 0·93). Anorectal swabs are a valid marker of MSM behaviour in surveillance data from sexual health clinics, and they are likely to be particularly useful for monitoring STI trends among MSM with higher risk behaviour.

HIV and Sexual Risk Among Men Who Have Sex With Men and Women in Asia: A Systematic Review and Meta-Analysis.

We performed a systematic review to estimate the proportion of men who have sex with men (MSM) in Asia who are bisexual and compare prevalence of HIV and sexual risk between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). Forty-eight articles based on 55 unique samples were identified from nine countries in Asia. Bisexual behaviour was common among MSM (pooled prevalence 32.8 %). Prevalence of HIV (pooled OR 0.90; 95 % CI 0.77-1.05), recent syphilis infection (pooled OR 0.99; 95 % CI 0.93-1.06) and unprotected anal intercourse (pooled OR 0.80; 95 % CI 0.57-1.11) were similar between MSMW and MSMO, but heterogeneity was high. MSMW had lower odds of reporting a prior HIV test than MSMO (OR 0.82; 95 % CI 0.70-0.95; p = 0.01, I(2) = 0 %). Targeted interventions are needed to increase uptake of HIV testing among MSMW. Increased reporting of disaggregated data in surveillance and research will help improve understanding of risk in MSMW and inform targeted interventions.

Comparing short versions of the Alcohol Use Disorders Identification Test (AUDIT) in a military cohort.

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) is widely used for monitoring harmful alcohol consumption among high-risk populations. A number of short versions of AUDIT have been developed for use in time-constrained settings. In military populations, a range of AUDIT variations have been used, but the optimal combination of AUDIT items has not been determined. METHODS: A total of 952 participants (80% male), recruited as part of a wider study, completed the AUDIT-10. We systematically assessed all possible combinations of three or four AUDIT items and established AUDIT variations using the following statistics: Cronbach's alpha (internal consistency), variance explained (R2) and Pearson's correlation coefficient (concurrent validity). RESULTS: Median AUDIT-10 score was 7 for males and 6 for females, and 380 (40%) participants were classified as having a score indicative of harmful or hazardous alcohol use (≥8) according to WHO classifications.A novel four-item AUDIT variation (3, 4, 8 and 9) performed consistently higher than established variations across statistical measures; it explained 85% of variance in AUDIT-10, had a Pearson's correlation of 0.92 and Cronbach's alpha was 0.63. The FAST, an established shortened AUDIT variant, together with several other four-item novel variants of AUDIT-10 performed similarly. The AUDIT-C performed consistently low on all measures, but with a satisfactory level of internal consistency (75%). CONCLUSION: Shortened AUDIT variations may be suitable alternatives to the full AUDIT for screening hazardous alcohol consumption in military populations. Four-item AUDIT variations focused on short-term risky drinking and its consequences performed better than three item versions. TRIAL REGISTRATION NUMBER: ACTRN12614001332617.

Giant hemangioma of the arm associated with cardiac failure and the Kasabach-Merritt syndrome in a neonate.

We report a neonate who presented within hours of birth with severe congenital cardiac failure, thrombocytopenia, and consumption coagulopathy, caused by a massive hemangioma of the left arm. Initial treatment with glucocorticoids, platelet and clotting factor replacements, and cardiovascular support failed to control these hemangioma effects and amputation was avoided only when axillary artery ligation and an intermittent pneumatic compression device, manufactured in this hospital, achieved control of this lesion and hastened its subsequent resolution. The treatment of such lesions is reviewed, emphasizing individualized treatment protocols, and stressing that such lesions and their effects, cannot be regarded as variants of a single disease entity when planning management.

Prophylactic colectomy in Ehlers-Danlos syndrome with colonic ectasia.

An adolescent boy with clinical features of Ehlers-Danlos syndrome developed ectasia of the colon leading to intractable constipation and clinically imminent colonic perforation. Total colectomy with ileorectal anastomosis in two stages was performed eliminating not only his intractable constipation but also the risk of potentially lethal perforation. This case illustrates an approach that may reduce the high mortality rate reported in patients with Ehlers-Danlos syndrome and colonic perforation.

The treatment of napkin dermatitis: a double-blind comparison of two steroid-antibiotic combinations.

A double-blind trial was carried out in 62 infants with moderate to severe napkin dermatitis to assess the effectiveness and acceptability of topical treatment with a miconazole/hydrocortisone preparation compared with that of a nystatin/benzalkonium chloride/dimethicone/hydrocortisone preparation. Patients were allocated at random to one or other treatment and the creams were applied to the affected area 3-times daily for 7 days. At the initial visit, a swab was taken for microbiological investigation. Clinical assessments were made of the signs and symptoms of erythema, weeping, tissue maceration and the more general symptom irritability, before and after 7-days' treatment. Parents were asked to note the time taken to significant improvement of their infant's condition and to comment on ease of application and staining properties of the preparation used. Both treatments produced a high and similar overall cure rate (80% and 84%, respectively), with a significant improvement within 48 hours in the majority of cases. Staining of napkins was reported in significantly fewer cases with the miconazole/hydrocortisone cream.