Sexually transmitted infections and HIV in ophthalmology.

The ocular and periocular manifestations of sexually transmitted infections are heterogeneous in etiology, manifestations, and complications. Etiologic agents include bacteria, viruses, parasites, and protozoa, which are most frequently transmitted via direct ocular contact with an active lesion or infected bodily fluid, autoinoculation, or dissemination from a distant site. Vertical transmission most commonly occurs perinatally during vaginal delivery. The complications of ophthalmia neonatorum can be severe, with the potential for permanent blindness or life-threatening systemic involvement if untreated. Clinical features, diagnostic modalities, and therapeutic regimens vary based on etiology and are summarized in this review. Prompt diagnosis is imperative, given the severe sequelae that may result from ocular involvement in these infections, including permanent vision loss. A multidisciplinary approach, involving both ophthalmology and dermatology, to diagnosis and management is essential to mitigate the risk of morbidity associated with sexually transmitted infections resulting in eye disease.

Do Electronic Health Literacy and Online Health Information-Seeking Behavior Mediate the Effects of Socio-Demographic Factors on COVID-19- and Non-communicable Disease-Related Behaviors Among Myanmar Migrants in Southern Thailand?

Introduction Myanmar migrants in Thailand are vulnerable to COVID-19 and non-communicable disease (NCD) risk behaviors, influenced by socio-demographic factors. In the digital age, migrants can seek extensive health information online, and their ability to understand and use electronic health information, which is known as electronic health literacy (e-Health literacy), becomes critical in making decisions about their health behaviors. This study aims to investigate the potential mediating roles of online health information-seeking and e-Health literacy in the associations between socio-demographic factors and COVID-19- and NCD-related behaviors. Methods Our study was conducted in 2022, involving 1,050 Myanmar migrants in two southern Thai cities. Data on socio-demographic factors, e-Health literacy, online health information seeking, COVID-19-related behaviors (adherence to COVID-19 protective behavior (CPB), vaccination), and NCD risk behaviors (smoking, betel chewing, alcohol consumption, substance abuse) were collected. Structural equation modeling (SEM) was employed to analyze the hypothesized relationships. Results Nearly all migrants received the COVID-19 vaccination in two doses and above, with reasonable good adherence to CPB. Migrants exhibited risky NCD-related behaviors, including current smoking (26.8%), alcohol consumption (17.5%), and betel chewing (25.8%). Approximately three-quarters (73.4%) had a limited e-Health literacy level, and the vast majority did not search for online health information. Their COVID-19- and NCD-related behaviors were directly influenced by socio-demographic factors without the significant mediation roles of e-Health literacy and online health information seeking. Conclusions Myanmar migrant workers in Southern Thailand had reasonably good practices in COVID-19-related behaviors despite engaging in risky NCD-related behaviors. These outcome behaviors were directly influenced by their socio-demographic factors, without the significant mediation roles of e-Health literacy and online health information seeking. The findings suggest that diverse interventions beyond e-Health strategies for future pandemic mitigation and enhancement of their health behaviors are needed.

Topical treatments for Kaposi sarcoma: A systematic review.

Background: While treatment options exist for solitary or disseminated Kaposi sarcoma (KS) disease, there are currently no standardized clinical treatment guidelines for cutaneous KS. Objective: This systematic review seeks to identify safe and effective topical treatments for cutaneous KS lesions. Methods: We conducted a systematic review using peer-reviewed articles from January 1970 to September 2021 published in the PubMed/MEDLINE and EMBASE databases. Results: From the initial search that yielded 590 studies, 34 met the inclusion criteria and were selected. Of the 34 studies, seven were clinical trials, 26 were case reports/series and one was a multicentre study. A total of 634 patients were included in our review. The three most common topical treatments used for cutaneous KS were imiquimod, alitretinoin and timolol. Topical alitretinoin was used in three case reports and three clinical trials. Topical imiquimod was used in eight case reports, one prospective phase II cohort study and one comparative single-blinded non-controlled clinical study. Topical timolol was used in nine case reports/series. Our review also identified reports of less widely used topical treatments for cutaneous KS. These include topical diphencyprone (DPCP), all-trans-retinoic-acid, rapamycin and bleomycin-dimethylsulfoxide (BLM-DMSO) which achieved variable response rates but have not been widely studied. Conclusion: Topical alitretinoin, imiquimod and timolol demonstrated positive responses for cutaneous KS and the treatments were well tolerated. These three topical treatment modalities could be considered by clinicians when treating cutaneous KS.

Burden of trichomoniasis among older adults in the United States: a systematic review.

Despite being one of the most common sexually transmitted infections (STIs) in the United States, the epidemiology of trichomoniasis remains understudied. One population that has been historically overlooked regarding STIs is that of older adults, despite many individuals remaining sexually active well into their older years. We investigated the reported prevalence and incidence of trichomoniasis in adults aged ≥45years in the United States using a systematic literature review. Twelve articles were included in the review, all assessing prevalence of trichomoniasis in this age group. Notably, no included articles assessed trichomoniasis incidence. Data collected encompassed several decades, from 1993 to 2016. Estimates of infection prevalence varied widely and ranged from 0.2% to 21.4% in included populations, with the highest prevalence typically seen among individuals seeking diagnostic testing for STIs. Several studies found increased risk for trichomoniasis in older patients compared to younger age groups. This is the first review to examine the risk of trichomoniasis in older adults, and the surprisingly high prevalence suggests that older adults may merit increased screening for trichomoniasis and sexual health education.

Primary nasal Kaposi Sarcoma in well-controlled HIV-positive patient with normal CD4 count associated with long-term nasal steroid use.

Kaposi sarcoma (KS) is an angioproliferative disease that is caused by human herpesvirus 8. The epidemic form of KS is associated with acquired immunodeficiency syndrome (AIDS) and is common in HIV-positive patients with CD4 counts less than 200 cells/mm. We present the case of a 63-year-old man with well-controlled HIV and normal CD4 count developing atypical nasal KS associated with intranasal steroid use.

Serum Helicobacter pylori antibody reactivity in seven Asian countries using an automated latex aggregation turbidity assay.

BACKGROUND AND AIM: To determine the application range of diagnostic kits utilizing anti-Helicobacter pylori antibody, we tested a newly developed latex aggregation turbidity assay (latex) and a conventional enzyme-linked immunosorbent assay (E-plate), both containing Japanese H. pylori protein lysates as antigens, using sera from seven Asian countries. METHODS: Serum samples (1797) were obtained, and standard H. pylori infection status and atrophy status were determined by culture and histology (immunohistochemistry) using gastric biopsy samples from the same individuals. The two tests (enzyme-linked immunosorbent assay and latex) were applied, and receiver operating characteristics analysis was performed. RESULTS: Area under the curve (AUC) from the receiver operating characteristic of E-plate and latex curves were almost the same and the highest in Vietnam. The latex AUC was slightly lower than the E-plate AUC in other countries, and the difference became statistically significant in Myanmar and then Bangladesh as the lowest. To consider past infection cases, atrophy was additionally evaluated. Most of the AUCs decreased using this atrophy-evaluated status; however, the difference between the two kits was not significant in each country, but the latex AUC was better using all samples. Practical cut-off values were 3.0 U/mL in the E-test and 3.5 U/mL in the latex test, to avoid missing gastric cancer patients to the greatest extent possible. CONCLUSIONS: The kits were applicable in all countries, but new kits using regional H. pylori strains are recommended for Myanmar and Bangladesh. Use of a cut-off value lower than the best cut-off value is essential for screening gastric cancer patients.

Increasing trends in admissions due to non-communicable diseases over 2012 to 2017: findings from three large cities in Myanmar.

BACKGROUND: Globally, cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes are the four major non-communicable diseases (NCDs) contributing to more than 80% of mortality and morbidity due to NCDs. In Myanmar, the proportional mortality rate due to NCDs increased from 46.9% in 2000 to 68% in 2017. However, the trends and patterns of four major NCDs or their hospital admissions are not known. In this regard, we aimed to assess the trends and profile of admissions with four major NCDs using final diagnosis coded in International Classification of Diseases-2010 version (ICD-10) from medical record data of the large tertiary hospitals in different regions of Myanmar. RESULTS: Of the 774,970 total admissions in the study hospitals, the median and interquartile range (IQR) age was 39 (25-55) years and 51.6% were males. Over a 6-year period, there was not only 2.2-fold increase in the number of admissions due to any of four major NCDs but also their proportion increased significantly from 18.8% in 2012 to 25.4% in 2017 (chi-square for trend, p value < 0.001). The number of admissions due to cancers, cardiovascular diseases, and chronic respiratory diseases also showed linear increasing trends at the rate of 1741 (95% CI 766 to 2715), 1797 (95% CI 345 to 3249), and 597 (95% CI 530 to 612) per year, respectively. Though the admissions with diabetes increased over the years, the rate of increase of 284 (95% CI - 60 to 628) per year was not statistically significant. Among cancer admissions, colorectal (13.1%), breast (13.0%), and lung (11.0%) cancers were the commonest. Stroke (30.6%) and ischemic heart disease (21.9%) admissions were the highest among the cardiovascular diseases. Chronic obstructive pulmonary disease (35.5%) and type 2 diabetes (53.9%) were commonest among chronic respiratory diseases and diabetes, respectively. CONCLUSION: There was a disproportionate increase in NCD admissions which requires tertiary health facilities to increase their infrastructure and trained workforce to cater to such admissions. The primary health care facilities have to be strengthened for prevention, early detection, and efficient management of NCDs to prevent life-threatening complications requiring hospitalization.

Improving detection of tuberculosis among household contacts of index tuberculosis patients by an integrated approach in Myanmar: a cross-sectional study.

BACKGROUND: Contact tracing for tuberculosis (TB) is a recommended measure to improve the case detection rate; however, actual implementation in Myanmar is limited and low detection rates have been reported. Household contacts of a known index TB case are at high risk of infection, thus a more strategic action for contact tracing is required to achieve the goal of the World Health Organization End TB Strategy. This study aimed to assess TB case detection rates among household contacts by an integrated approach and identify risk factors for TB. METHODS: A cross-sectional study was conducted in Mandalay City, Myanmar. Household contacts of index TB cases who had been receiving treatment for at least 3 months were prospectively investigated by an integrated approach which included modification of screening methods and active facilitation of screening investigations as follows. Initial chest x-ray (CXR) was performed for all contacts at the responsible facilities followed by sputum specimen collection for those aged ≥15 years and gene Xpert MTB/RIF examination. Transportation of all household contacts to health facilities and transportation of sputum samples for smear and gene Xpert MTB/RIF examination at centers were arranged by the research team to ensure that all household contacts received all investigations. Risk factors for TB among household contacts were identified by multiple logistic regression models. RESULTS: Of 174 household contacts, 115 were ≥ 15 years and 59 were < 15 years. The percentage of TB cases detected among the household contacts was 13.8%. There were 14 (12.2%) positive TB cases among the 115 contacts aged ≥15 years while 10 (16.9%) of those aged < 15 years had clinical signs and symptoms of TB with an abnormal CXR. Risk factors among household contacts for TB were being a caretaker of an index case, active and passive smoking, and drinking alcohol. CONCLUSIONS: The integrated approach of TB contact tracing by special arrangement for CXR, sputum and gene Xpert MTB/RIF examination yielded a high TB detection rate in a high TB prevalence area. Logistic and financial administration is needed to strengthen contact tracing. Further research on high-risk household contacts should be considered for increasing TB detection rates.

Time to anti-retroviral therapy among people living with HIV enrolled into care in Myanmar: how prepared are we for 'test and treat'?

BACKGROUND: Among people living with HIV (PLHIV) enrolled into care, time to anti-retroviral therapy (ART) has not been studied in Myanmar. To inform progress, we conducted this operational research among treatment-naive PLHIV (≥18 years) enrolled during a period of three years (2014-2016) at Pyin Oo Lwin, Myanmar. OBJECTIVES: To determine (i) the time from HIV diagnosis to ART initiation (time to ART) and associated factors and (ii) the association between time to ART and attrition (loss to follow-up and death) from ART care. METHODS: This was a retrospective cohort study involving a record review of secondary programme data. The PLHIV were followed up to 5 December 2017 for ART initiation and up to 31 March 2018 (date of censoring) for attrition during ART. RESULTS: Of 543 enrolled, 373 (69%) were found to be eligible and initiated on ART. Of 373, 245 (67%) were initiated within 6 weeks of enrolment. The median enrolment delay (from diagnosis) was 4 (IQR: 1, 14) days and median ART initiation delay (from ART eligibility) was 20 (IQR: 13, 36) days. The median time to ART (excluding the time interval in pre-ART care) was 29 (IQR: 18, 55) days and was significantly long in those with prevalent TB and CD4 count ≥ 500/mm3 at enrolment. Among 373, the annual incidence density of attrition was 12.8% (0.95 CI: 10.2, 15.7). Attrition was common in first 100 days. Time to ART (after excluding time interval in pre-ART care) was not significantly associated with attrition. CONCLUSION: The programme appears to be on track to initiate ART as soon as possible in a 'test and treat' scenario (implemented since September 2017) subject to interventions to reduce ART initiation delay.