Comparing men who have sex with men only and men who have sex with men and women visiting a public STI clinic.

BACKGROUND: Men reporting same-sex behaviors are disproportionately impacted by sexually transmitted infections (STI). Differences in clinical characteristics and STIs in men who have sex with men only (MSMO), with men and women (MSMW), and with women only (MSW) are not well described. METHODS: First visits to two Baltimore City STI clinics 2011-2016 from MSMO and MSMW compared to an age-matched random sample of MSW were analyzed. Acute STI (aSTI) included chlamydia, gonorrhea, nongonococcal urethritis (NGU), and primary or secondary syphilis (PSS). Chi-squared tests and logistic regression examined associations. RESULTS: Among N = 1226 MSMO, N = 491 MSMW and N = 1717 MSW, most identified as Black/African American; mean age (29.8) was similar across groups. 73.5%, 67.2%, and 60.3% of MSMW, MSMO, and MSW reported ≥2 partners in last 6 months. "Always" condom use was reported by 20.4%, 17.4 % and 14.1% of MSMW, MSMO and MSW. Overall HIV prevalence was 13.8%. Among those tested, urogenital chlamydia prevalence was 21.7%, 8.3%, and 3.9% (p ≤ 0.01) in MSW, MSMW, and MSMO. Urogenital gonorrhea prevalence was 11.6%,7.7%, and 8.3% in MSMW, MSW, and MSMO respectively. Extragenital STI (range 2.7-21.9%), NGU (25.2%), and PSS (5.3-5.7%) positivity was similar in MSMW and MSMO. Older age was inversely associated with STI diagnosis in MSW and MSMO only, consistent condom use was protective against aSTI in MSW (aOR:0.60, p < 0.01) and MSMW (aOR:0.54 p = 0.03) only. CONCLUSION: Differences in behaviors and clinical characteristics associated with aSTI suggest that MSMO, MSMW and MSW have diverse sexual health needs and may require tailored interventions to improve sexual health outcomes.

Public health clinic-based hepatitis C testing and linkage to care in Baltimore.

Testing and linkage to care are important determinants of hepatitis C virus (HCV) treatment effectiveness. Public health clinics serve populations at high risk of HCV. We investigated their potential to serve as sites for HCV testing, initiation of and linkage to HCV care. Cross-sectional study of patients accessing sexually transmitted infection (STI) care at the Baltimore City Health Department (BCHD) STI clinics, from June 2013 through April 2014 was conducted. Logistic regression was used to assess factors associated with HCV infection and specialist linkage to care. Between 24 June 2013 and 15 April 2014, 2681 patients were screened for HCV infection. Overall, 189 (7%) were anti-HCV positive, of whom 185 (98%) received follow-up HCV RNA testing, with 155 (84%) testing RNA positive. Of 155 RNA-positive individuals, 138 (89%) returned to the STI clinic for HCV RNA results and initial HCV care including counselling regarding transmission and harm reduction in alcohol, and 132 (85%) were referred to a specialist for HCV care. With provision of patient navigation services, 81 (52%) attended an offsite HCV specialist appointment. Alcohol use and lack of insurance coverage were associated with lower rates of specialist linkage (OR 0.4 [95% CI 0.1-0.9] and OR 0.4 [95% CI 0.1-0.9], respectively). We identified a high prevalence of HCV infection in BCHD STI clinics. With availability of patient navigation services, a large proportion of HCV-infected patients linked to off-site specialist care.

The protective effects of fish oil and artichoke on hepatocellular carcinoma in rats.

BACKGROUND AND OBJECTIVES: The present study aimed to evaluate the effect of fish oil and Artichoke (Cynara scolymus I.) against diethylnitrosamine (DEN) induced hepatocellular carcinoma in rats. MATERIALS AND METHODS: Animals were divided into 8 groups. Group 1, control rats. Group 2: rats injected with single dose of DEN (100 mg/kg body weight). Groups 3-8 supplemented with different concentrations of either fish oil or artichoke for 25 days before DEN injection. RESULTS: DEN treatment revealed a significant decrease in tissue xanthine oxidase (XO), glutathione, glutathione-s-transferase (GST), and a marked increase in malondialdehyde (MDA) and nitric oxide (NO) levels. Vascular endothelial growth factor (VEGF), alpha-fetoprotein (AFP), and ferritin levels showed a significant increase. A significant increase in serum aspartate amino transferase (AST), alanine amino transferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and total bilirubin levels were found. A significant decrease in tissue total proteins and serum albumin was observed. The administration of DEN affected the liver cell through occurrence of hepatic cellular degeneration and necrosis. Treatment with fish oil (5%, 10%) or artichoke heads or leaves (0.5, 1 g) for 25 days led to significant amelioration of DEN-induced changes in the biochemical parameters. An almost normal histological architecture of the liver, in treated groups, was showed as compared to the controls. CONCLUSIONS: The results pointed that 10% fish oil and 1 g% leaves of artichoke succeeded to protect from hepatocellular carcinoma to a certain degree. In addition, they may be considered as protective foods against angiogenesis.

Risk of Chlamydia trachomatis infection during pregnancy: effectiveness of guidelines-based screening in identifying cases.

Our goal was to define the risk factors for Chlamydia trachomatis (CT) infection among pregnant women at a large urban medical centre. In a retrospective study, clinical records at a US maternity unit from July 2005 through February 2008 were reviewed. The study population included all pregnant women with a singleton newborn of at least 20 weeks gestation and antenatal care information. Logistic regression was used to analyse the association between a positive CT test and demographic, behavioural and prenatal care variables. A total of 2127 women were included in this analysis. The prevalence of CT infection was 4.7%. Cases were more likely to be younger, black and single. Other risk factors included tobacco use and Neisseria gonorrhoeae infection. Our findings suggest that factors other than age may impact upon the diagnosis of CT in pregnant women and that a more comprehensive testing strategy should be considered.

Chlamydia trachomatis infection during pregnancy and the risk of preterm birth: a case-control study.

Our goal was to define the risks of preterm birth associated with Chlamydia trachomatis (CT) and other sexually transmitted infections (STIs) among pregnant women. We accessed clinical records from July 2005 to February 2008. The study population included all pregnant women who gave birth to a singleton newborn of at least 20 weeks' gestation, and who had antenatal care information. We estimated the impact of CT and other STI on the odds of preterm birth using logistic regression. Overall, 2127 women were included in this analysis. The prevalence of CT infection was 4.7%. CT diagnosis was not associated with preterm birth. In conclusion, this study did not find an association between CT and preterm birth. The lack of an association may be explained by early treatment. Future studies evaluating the timing of screening for STIs may help clarify whether pregnant women would benefit more from earlier screening.

Fludarabine-based reduced intensity regimen for matched related donor hematopoietic stem cell transplantation in acquired severe aplastic anemia.

Different conditioning regimens have been evaluated in matched-related donor allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acquired severe aplastic anemia (SAA) with varying results. In this manuscript, we report our experience with fludarabine (120mg/m2), very low dose cyclophosphamide (1200mg/m2) and antithymocyte globulin (7.5mg/kg). Low dose total body irradiation (2Gy) was added to the conditioning regimen for patients older than 15 years. Nineteen patients (median age 23years) underwent transplant between 2008 and 2015. The majority (89%) were younger than 40 years. Stem cell source was BM (n=11) or PBSC (n=8). GvHD prophylaxis consisted of cyclosporine and either a short course of methotrexate (n=9) or mycophenolate mofetil (n=10). Eighteen (94.7%) patients achieved sustained engraftment. The median times to neutrophil and platelet engraftments were 19 (range: 14-34) and 17.1 (range: 12-25) days, respectively. The day-30 cumulative incidence of neutrophil and platelet engraftment was 89.4% and 94.7%, respectively. No secondary graft rejection was observed. The 1-year cumulative incidence of aGvHD (grade II-IV) and cGvHD was 11.7% and 0%, respectively. The 2-year GvHD-free survival rate was 78.6% (95% CI: 52.5-91.4%). Fludarabine-based reduced intensity regimen for MRD allo-HSCT in SAA compares favorably to other available regimens. This regimen deserves further investigations with larger cohort of patients.

Monitoring HPV type-specific prevalence over time through clinic-based surveillance: a perspective on vaccine effectiveness.

We investigated the feasibility of monitoring trends in prevalence of vaccine-preventable human papillomavirus (HPV) types in different clinic populations. We collected cervical specimens from women presenting to family planning, primary care, and sexually transmitted disease (STD) clinics for routine pap smears in five US cities during 2003-2005. We performed HPV genotyping and calculated annual type-specific prevalences; pre-vaccine era prevalence was highest for HPV 16 (6.0; 95% confidence interval [CI] 5.5-6.6%) and annual prevalences for vaccine-preventable types were stable, with few exceptions, after controlling for clinic type, age group, and city. With sufficient sample size and stable population characteristics, clinic-based surveillance systems can contribute to monitoring HPV vaccine impact in the cervical screening population.

A case control study of anovaginal distance and bacterial vaginosis.

We aimed to test the hypothesis that a short anovaginal distance may increase the risk of bacterial vaginosis (BV) due to faecal contamination and disruption of the vaginal microbiota. Women attending two sexually transmitted infection (STI) clinics in Baltimore, Maryland, USA, who complained of a vaginal discharge were asked to participate in a study to measure mucosal immune responses. In this pilot study of all enrolled women, a small plastic ruler was used to measure the anatomic distance from the posterior fourchette to the anus with the participant in the lithotomy position. Cases of BV, defined by Amsel's clinical criteria (n = 62), were compared with controls (n = 31) without BV. We used linear and logistic regression models to adjust for potential confounders. A total of 93 women were recruited (median age 28.6 years, 93% black, 4.4% gonorrhoea infection, 7.4% chlamydia infection, 8.6% trichomonas infection, 67% BV diagnosed). Mean anovaginal distance was 3.22 cm (SD: 0.74, range 1.8-5.2) for controls and 3.37 cm (SD: 0.76, range: 1.8-5.7) for cases (P = 0.38). There was no difference between cases and controls when comparing median values, quartiles and after adjusting for potential confounders. Among high-risk women with multiple co-infections, there was no association between anovaginal distance and clinical diagnosis of BV.

Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics.

BACKGROUND: HIV-positive patients treated for syphilis may be at increased risk for serological failure. OBJECTIVE: To compare follow-up serologies and serological responses to treatment between HIV-positive and HIV-negative patients attending two sexually transmitted disease (STD) clinics. STUDY DESIGN: Existing records were reviewed from HIV-positive patients who were diagnosed and treated for syphilis at the public STD clinics in Baltimore, Maryland, USA, between 1992 and 2000. Results of their serological follow-up were compared with those of HIV-negative clinic patients at the time of syphilis treatment. Failure was defined as lack of a fourfold drop in rapid plasma reagin (RPR) titre by 400 days after treatment or a fourfold increased titre between 30 and 400 days. RESULTS: Of the 450 HIV-positive patients with syphilis, 288 (64%) did not have documented follow-up serologies and 129 (28.5%) met the inclusion criteria; 168 (17%) of 1000 known HIV-negative patients were similarly eligible. There were 22 failures in the HIV-positive group and 5 in the HIV-negative group (p<0.001). The median times to successful serological responses in both groups were 278 (95% confidence interval (CI) 209 to 350) and 126 (95% CI 108 to 157) days, respectively (p<0.001). A multivariate Cox's proportional hazards model showed an increased risk of serological failure among the HIV-positive patients (hazards ratio 6.0, 95% CI 1.5 to 23.9; p = 0.01). CONCLUSION: HIV-positive patients treated for syphilis may be at higher risk of serological failure. Despite recommendations for more frequent serological follow-up, most patients did not have documentation of serological response after standard treatment for syphilis.

Audio computer assisted self interview and face to face interview modes in assessing response bias among STD clinic patients.

BACKGROUND: Audio computer assisted self interview (ACASI) may minimise social desirability bias in the ascertainment of sensitive behaviours. The aim of this study was to describe the difference in reporting risk behaviour in ACASI compared to a face to face interview (FFI) among public sexually transmitted diseases (STD) clinic attendees. STUDY DESIGN: Randomly selected patients attending a public STD clinic in Baltimore, Maryland, sequentially took an ACASI formatted risk behaviour assessment followed by an FFI conducted by a single clinician, with both interview modalities surveying sexual and drug use behaviours. Binary responses were compared using the sign test, and categorical responses were compared using the Wilcoxon signed rank test to account for repeated measures. RESULTS: 671 (52% men, mean age 30 years, 95% African American) of 795 clinic attendees screened consented to participate. Subjects affirmed sensitive sexual behaviours such as same sex contact (p = 0.012), receptive rectal sexual exposure (p < 0.001), orogenital contact (p < 0.001), and a greater number of sex partners in the past month (p < 0.001) more frequently with ACASI than with an FFI. However, there were no differences in participant responses to questions on use of illicit drugs or needle sharing. CONCLUSIONS: Among STD clinic patients, reporting of sensitive sexual risk behaviours to clinicians was much more susceptible to social desirability bias than was reporting of illegal drug use behaviours. In STD clinics where screening of sexual risk is an essential component of STD prevention, the use of ACASI may be a more reliable assessment method than traditional FFI.

Single cell protein production from beet pulp by mixed culture.

Different mixed cultures of Trichoderma reesei and a yeast were cultivated on beet pulp (BP)-containing medium. T. reesei and Kluyveromyces marxianus offered a combination that gave high SCP yields (51%) and efficiently converted BP into proteins (39.4%). The yeast extract in the basal medium could be substituted and the BP level multiplicated from 2 to 4% upon using mixed culture of T. reesei and K. marxianus. Under these conditions the protein yields reached to a maximum value of 54% and highest efficiency of BP conversion into proteins (41.8%). The obtained protein proved to contain all essential amino acids, which compared favourably with those of the FAO guideline and soy bean oil meal.

Some nutritional requirements of a mixed culture transforming Reichstein's compound S into prednisolone.

Reichstein's compound S was successfully converted to prednisolone in a single-step fermentation using a mixed culture of Curvularia lunata and Mycobacterium smegmatis. Introducing additional medium at the time of bacterial inoculation and increasing the M. smegmatis inoculum to 8% were necessary for maximal dehydrogenation of cortisol to prednisolone (86%). However, beef extract, corn-steep solids, and malt extract were inhibitory to the dehydrogenase activity and stimulatory to hydroxylase. Of the vitamins tested, nicotinic acid and riboflavin at 0.2 and 1.13 mg/L, respectively, resulted in maximum transformation of Reichstein's compound S (100%) and optimized prednisolone yields (92%) in the mixed culture. The trace elements present in the medium were sufficient for maximal transformation, and there was no need for an exogenous supply. Addition of ATP, sodium acetate, and NAD inhibited the dehydrogenation reaction.

Calcium bioavailability of selected Egyptian foods with emphasis on the impact of fermentation and germination.

The bioavailability of calcium (Ca) was assessed in 11 foodstuffs of plant or animal origin using rat feeding experiments and the criteria used for assessing the bioavailability were femur Ca and calcium efficiency. The bioavailability of Ca was found to be highest in fishes (Melouha) and cheeses (Mesh) fermented under local processing techniques. Germination of faba beans also enhanced the bioavailability of calcium to a mean value quite comparable to those of some dairy products, such as cottage cheese. The present study clearly demonstrates that the processes of fermentation and germination of selected foods are associated with an enhancement in the bioavailability of calcium. It is suggested that the breakdown of complex proteins under the fermentation or germination process is the underlying mechanism of action.

Riboflavin production by Aspergillus terreus from beet-molasses.

Aspergillus terreus was used for riboflavin (vitamin B2) production in a medium containing beet molasses as the sole carbon source. Growth and the vitamin production of the fungus were markedly affected by the composition of the culture medium. A maximum riboflavin yield was achieved at the late exponential growth phase (16 day-old cultures) in the presence of (g/l): centrifuged beet-molasses, 90; L-asparagine, 1; MgSO4.7H2O, 0.5; K2HPO4/kH2PO4 (1:1), 5; and the medium initially adjusted to pH 8.

Effect of nutrients on alginate synthesis in Azotobacter vinelandii and characterization of the produced alginate.

The role of nutrients on alginate production by Azotobacter vinelandii was studied in batch cultures. The largest amount of bacterial alginate was obtained in presence of: 0.3 g/l MgSO4.7H2O. 0.4 g/l NaCl, 42 mg/l CaCl2.2H2O,.4 mg/l KH2PO4, 16 mg/l K2HPO4, 2.5 mg/l FeSO4.7H2O, 2.9 mg/l H3BO3, 2 mg/l ZnSO4.7H2O, 2 mg/l Na2MoO4.2H2O, 0.3 mg/l CuSO4.5H2O, 0.2 mg/l MnCl2.4H2O. Alginate production was not enhanced by natural additives or inducing agents, except for acetate, which increased alginate yield. The pure alginate contained 0.36% ash and 0.4% protein. It is similar to algal alginate, but it has an extra acetyl group. It contains 69.5% M-M block, 27.5% M-G block and 3% G-G block.

Physiological study on riboflavin production by hydrocarbon-utilizing Candida guilliermondii Wickerham.

The production of riboflavin (vitamin B2) by Candida guilliermondii Wickerham cultivated on solar-containing medium was stimulated in the presence of corn oil (0.1 g%), arginine, phenylalanine (1 m mole/l) or CoSO4.7H2O (1000 micrograms/l). On the other hand, emulsifying agents strongly inhibited yeast growth and vitamin production. Similarly, FeSO4.7H2O and MnSO4.4H2O at 50 and 200 micrograms/l levels, respectively, also showed inhibitory effect. Among the tested purines, xanthine enhanced vitamin production.

Protein-enriched feedstuff from beet pulp.

Of five moulds that were cultivated in a medium containing beet pulp, Trichoderma reesel was superior in protein production (34%) and in conversion of pulp to proteins (18% w/w). Protein ylelds were improved by up to 49% by pre-treatment of the beet pulp, adjustment of the solld/llquid and liquld/solid ratios, the incubation period, nitrogen level and addition of some trace elements as well as with inoculum size. The protein obtained contained all essential amino acids and compared favourably with those of the FAO guldeline and of soy bean oll meal.

Amplification of the Escherichia coli lacZ gene in Bacillus subtilis and its expression on a by-product growth medium.

A Bacillus subtilis wild type strain and a kinA (spoIIJ) isogenic mutant were compared as hosts for the expression of the Escherichia coli beta-galactosidase gene, lacZ, driven by the B. subtilis aprE promoter in a chromosomal system. The 2 x SG sporulation formula, with some modifications, was used as a basal medium. The specific activity values recorded by the mutant strain at the stationary phase were markedly higher than those achieved by the wild type host. Exposure of the cells to increasing levels of chloramphenicol resulted in significant amplifications of the lacZ region. Gene copy numbers of 19 and 11 were estimated in the amplified wild type and kinA strains, respectively, with high segregational stability records. The magnitude of beta-galactosidase over-expression was dependent on, and roughly proportional to antibiotic resistance levels. Among five examined by-products, a 2.3-times diluted concentration of neutralized cheese whey was successfully used as a sole medium component for over-expression of the recombinant beta-galactosidase gene in B. subtilis.

Utilization of beet molasses for sterol production by some moulds.

Different moulds were cultivated in beet molasses (BM)-containing medium. Penicillium crustosum Thom was superior to the other moulds in total sterols production (4% on dry weight basis), efficiency of convertibility of the BM sugars to sterols (2%), total lipids (19.4%) and unsaponified lipids (13.4%). The treatment of BM with H2SO4- followed by centrifugation allowed maximum fermentation yields. The highest unsaponified lipids (16.5%) and total sterols level (7.4%) were obtained with a medium composed of (g/1): NaNO3, 3; K2HPO4, 3; MgSO4.7H2O, 1.5; K2SO4, 0.11; ZnSO4.7H2O, 0.05; FeCl3.6H2O, 0.16; H2SO4-treated BM, 60. Maximal sterol yields (8.4%) and high growth rate were achieved at the accelerated growth phase (8 days old cultures), when the initial pH value of the medium was adjusted to 7.0.