Prediction of Chronic Disease-Related Inpatient Prolonged Length of Stay Using Machine Learning Algorithms / 대한의료정보학회지

Comparative Performance of the Reverse Algorithm Using Architect Syphilis TP Versus the Traditional Algorithm Using Rapid Plasma Reagin in Florida's Public Health Testing Population

In Florida, where syphilis is a reportable disease, the number of primary and secondary (P&S) syphilis cases has increased from 3,266 in 2008–2010 to 5,340 in 2013–2015, a 63% increase. The objective of this study was to compare the performance and sensitivity of the syphilis reverse algorithm with the traditional algorithm for detecting P&S (infectious) syphilis cases. Clinical specimens from individuals who self-referred for syphilis testing at public health clinics were processed using the traditional algorithm (non-treponemal rapid plasma reagin (RPR) test followed by a confirmatory treponemal (EIA) test) and then further tested with the Architect Syphilis TP (ASTP) immunoassay (Abbott Diagnostics, Chicago, IL, USA) or by RPR confirmation, if needed (reverse algorithm). Of 1,079 specimens, 59 were positive for syphilis. The sensitivity of the reverse algorithm was 98.3% (58/59) and of the traditional algorithm was 72.9% (43/59). Based on clinical evidence, of the 16 traditional algorithm-negative but reverse algorithm-positive cases, 68.8% (11/16) were classified as missed P&S infections (treatment naïve) and 31.2% (5/16) were classified as missed past syphilis (latent or infections with documented linkage to care). The reverse algorithm enables the detection of additional P&S syphilis cases missed by our current traditional algorithm.

The “Warm Zone” Cases: Environmental Monitoring Immediately Outside the Fire Incident Response Arena by Firefighters

Hazardous work zones (i.e., hot, warm, and cold) are typically established by emergency response teams during hazardous materials (HAZMAT) callsbut less consistently for fire responses to segment personnel and response activities in the immediate geographic area around the fire. Despite national guidelines, studies have documented the inconsistent use of respiratory protective equipment by firefighters at the fire scene. In this case-series report, we describe warm zone gas levels using multigas detectors across five independent fire incident responses all occurring in a large South Florida fire department. Multigas detector data collected at each fire response indicate the presence of sustained levels of volatile organic compounds in the “warm zone” of each fire event. These cases suggest that firefighters should not only implement strategies for multigas detector use within the warm zone but also include respiratory protection to provide adequate safety from toxic exposures in the warm zone.

Intrahepatic, Perihilar and Distal Cholangiocarcinoma: Management and Outcomes

Abstract: Introduction and aims. Cholangiocarcinomas are a heterogeneous group of tumors that can be classified into three clinically distinct types of cancers, intrahepatic, perihilar and distal cholangiocarcinoma. The inconsistent use of nomenclature for these cancers has obscured a true knowledge of the epidemiology, natural history and response to therapy of these cancers. Our aims were to define demographic characteristics, management and outcomes of these three distinct cancer types. Materials and methods. A retrospective study of patients enrolled in an institutional cancer registry from 1992 to 2010. Median survival was compared between different treatment modalities over three time periods for the three types of cholangiocarcinoma at different stages of the disease using Kaplan Meyer analysis. Results. 242 patients were identified. All cases were reviewed and classified into intrahepatic (90 patients), distal (48 patients) or perihilar (104 patients) cholangiocarcinomas. These cancers differed in median age of onset, gender distribution, median survival and stage. 13.8% of patients presented with stage I, 5.8% with stage II, 9.6% with stage III, 28% with stage IV, with 41.8% having unknown stage. The overall median survival was 15.8 months, and was 23, 25, 14, and 4.5 months for stages I, II, III, and IV respectively. Surgery improved survival in both early and advanced stages. Multimodality therapies further improved outcomes, particularly for perihilar cholangiocarcinoma. Conclusion. Perihilar, distal and intrahepatic cholangiocarcinoma vary in their presentation, natural history and therapeutic approach to management. A consistently applied classification is essential for meaningful interpretation of studies of these cancers.

Safety and Efficacy of Permacol Injection in the Treatment of Fecal Incontinence

PURPOSE: Permacol has been gaining popularity in recent times for the treatment of fecal incontinence (FI). This study aims to evaluate the safety and efficacy of anal submucosal Permacol injection in the treatment of FI. METHODS: All consecutive patients who underwent Permacol injection for FI over a 3-year period were included. Patients' data relating to obstetric history, anorectal/pelvic operations, type of FI, preoperative anorectal physiology results and follow-up details for outcome measures were collected. Preoperative and postoperative Cleveland Clinic Florida Incontinence Scores (CCFISs) were noted. Patients were surveyed by using a telephone questionnaire to assess the quality of life and other outcome measures. Data were analysed using SPSS ver.19.0. RESULTS: Thirty patients (28 females and 2 males) with a median age of 67 years were included in the study. Of those patients, 37%, 50%, and 13% were noted to have passive, mixed and urge FI, respectively. Six of the patients (20%) had repeat Permacol injections, 5 of whom had sustained responses to the first Permacol injection for a mean of 11 months. There was a significant improvement in the CCFIS from a baseline median of 12.5, mean 12.8 interquartile range [IQR], 6-20), to a median of 3.5, mean 4.8 (IQR, 0-20), P < 0.001. Of the patients surveyed by telephone 89% were satisfied with their overall experience and the improvement in their symptoms following Permacol injections. CONCLUSION: This study has demonstrated that Permacol injection for the treatment of FI is safe and effective and has no associated major complications. However, the results are not permanent; consequently, a significant proportion of the patients with an initial response may require repeat injections.

2014 Annual Meeting of the American Urological Association: early screening and molecular markers of prostate cancer / 中华男科学杂志

The 109th Annual Meeting of the American Urological Association was held in Orlando, Florida, USA in May 2014, which received more than 1,000 abstracts on prostate cancer (PCa), covering new epidemiological data about PCa, new theories of early screening, novel molecular markers, new surgical methods, new ideas of diagnosis and treatment of castration-resistant PCa, and progress in basic researches. This paper focuses on the new theories of early screening and novel molecular markers of PCa, including the risk factors of PCa, a revolutionary understanding of the relationship between testosterone and PCa, and new application of PSA, new imaging techniques and molecular markers in the early diagnosis of PCa.

Blended Infant MassageeParenting Enhancement Program on Recovering Substance-Abusing Mothers' Parenting Stress, Self-Esteem, Depression, Maternal Attachment, and Mother-Infant Interaction

PURPOSE: This study aimed to determine whether a blended Infant MassageeParenting Enhancement Program (IMPEP) improved maternal psychosocial health outcomes (parenting stress, depressive symptoms, self-esteem, maternal attachment) and maternal-infant interaction among substanceaddicted mothers (SAMs) actively engaged in outpatient rehabilitation. METHODS: Designed as a randomized, three-group controlled trial testing two levels of psychoeducational intervention (IMPEP vs. PEP) and a control group (standard care parenting resources), the studywas conducted in two substance abuse centers in southeast Florida on a convenience sample of 138 recovering SAM-infant pairs. IMPEP or PEP classes were held weekly onWeeks 2e5, with data collected at baseline (Week 1),Week 6, andWeek 12 via structured interviews, observation (Observation Checklist onMaternal-Infant Interaction), and self-administered questionnaires (Abidin Parenting Stress Index, Beck Depression Inventory, Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory), analyzed descriptively and inferentially using Kruskall-Wallis analysis of variance and post hoc Wilcoxon rank sum and Mann-Whitney U tests. RESULTS: Both IMPEP and PEP groups had significantly increased Parenting Stress Index scores (decreased parenting stress) and decreased Beck Depression Inventory scores (decreased depressive symptoms) compared to controls at Week 12, whereas there were no clinically meaningful differences among study groups in Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory, or Observation Checklist on Maternal-Infant Interaction scores. Only the IMPEP group showed significant improvements in both psychological and physical (waist-hip ratio) measures of parenting stress over time. CONCLUSIONS: The findings suggest that infant massage blended into a structured parenting program has value-added effects in decreasing parenting stress and maternal depressive symptoms, but not on SAM's self-esteem, attachment, or maternal-infant interaction.

Does Pain Mediate or Moderate the Effect of Cognitive Impairment on Aggression in Nursing Home Residents with Dementia?

PURPOSE: The purpose of this study was to investigate if pain mediates or moderates the relationship between cognitive impairment and aggressive behaviors in nursing home residents with dementia based on the Need-driven Dementia-compromised Behavior model. METHODS: This was a secondary analysis of the Minimum Data Set assessment data on long-term care from the state of Florida during calendar year 2009. The data used in this study was the first comprehensive assessment data from residents with dementia (N = 56,577) in Medicare-certified or Medicaid-certified nursing homes. Path analysis using a series of hierarchical regression analyses and two-way analysis of variance was used to evaluate the mediating and moderating effect of pain on the relationship between the level of cognitive impairment and aggression. RESULTS: Results indicated that pain did not mediate the relationship between cognition and aggressive behaviors, but there was evidence of a significant moderating effect of pain only for residents with severe cognitive impairment. Only among the residents with severe cognitive impairment, those with pain had significantly more frequent aggressive behaviors than those without pain. CONCLUSION: A change in the frequency of aggressive behaviors in severely cognitively impaired residents should signal the possibility that the person is experiencing pain. Accurate but simple pain assessment in this population including these behavioral changes should be developed further, and pain should be well controlled to reduce these problematic behaviors.

Florida Sleeve Repair for Aortic Root Aneurysm

A 74-year-old man was diagnosed with aortic root aneurysm and two-vessel coronary disease. Echocardiographic assessment revealed an enlarged sinus of Valsalva 60 mm in diameter with mild aortic regurgitation. Florida sleeve repair was performed using a vascular graft combined with coronary artery bypass grafting. The postoperative course was uncomplicated and follow-up echocardiographic evaluations showed an aortic root diameter of 38 mm without aortic insufficiency up to 1 year after surgery.

Coral recruitment to two vessel grounding sites off southeast Florida, USA / Reclutamiento de coral en dos sitios de encallamiento de embarcaciones frente al sureste de Florida, EE. UU

Over the last two decades, more than 10 major vessel groundings have occurred on coral reefs offshore southeast Florida. Lack of any published information on coral settlement, post-settlement survival, and juvenile coral growth in the southeast Florida region inhibits efforts to determine if coral populations will be able to effectively re-establish themselves. The goal of this study was to examine these processes to obtain background data needed to determine the potential for natural recovery. Over a three year period annual coral recruitment, juvenile growth, and mortality rates were measured in 20 permanent quadrats at each of two ship grounding and two control sites. The density of new recruits was generally low, ranging from 0.2±0.1 (SE) to 7.1±1.0 recruits m-2. Although the density of coral recruits was generally higher at the grounding sites, mortality rates were high at all sites during the study period. Growth rates of individual colonies were highly variable, and many of the colonies shrank in size due to partial mortality. Results indicate that corals are able to recruit to the damaged reefs but that slow growth rates and high mortality rates may keep these areas in a perpetual cycle of settlement and mortality with little or extremely slow growth to larger size classes, thus inhibiting recovery.

En las dos últimas décadas, más de10 grandes encallamientos de embarcaciones se han producido en los arrecifes de coral mar afuera en el sureste de Florida. La falta de información publicada sobre el asentamiento de corales y sobrevivencia post-asentamiento y de los corales juveniles que crecen en la región, limita los esfuerzos para determinar si las poblaciones de coral serán capaces de restablecerse por ellas mismas. El objetivo de este estudio fue examinar estos procesos para obtener la información necesaria para determinar el potencial de recuperación natural. Se midió el reclutamiento anual de coral joven, el crecimiento y las tasas de mortalidad por un período de tres años, mediante 20 cuadrantes permanentes en cada uno de los dos encallamientos de barcos y dos sitios de control. La densidad de nuevos reclutamientos fue generalmente baja, de 0.2±0.1 a 7.1±1.0 reclutamientos m-2. Aunque la densidad del reclutamiento fue generalmente más alta en los sitios de encallamiento también hubo mayor mortalidad de corales juveniles en esos sitios durante el período de estudio. Las tasas de crecimiento de las colonias individuales fueron altamente variables, y muchas de las colonias se redujeron en tallas debido a mortalidad parcial. Los resultados indican que los corales presentan una disposición a reclutarse en arrecifes dañados, pero las lentas tasas de crecimiento y la alta mortalidad pueden mantener esas áreas en un perpetuo ciclo de asentamiento y mortalidad con poco o extremadamente lento crecimiento hacia las clases de tallas largas, por lo tanto inhibiendo la recuperación.

The characteristics of stress cardiomyopathy in an ethnically heterogeneous population

OBJECTIVES: Stress cardiomyopathy is a cardiac syndrome that is characterized by transient left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Its epidemiology has been described in homogeneous Asian, Caucasian and Black populations, but its characteristics in heterogeneous populations are poorly understood. Our aim was to assess the characteristics of stress cardiomyopathy in a heterogeneous population that included a large percentage of Hispanics. METHODS: We reviewed 59 consecutive cases of stress cardiomyopathy that were confirmed by coronary angiography and were in agreement with the Mayo Clinic diagnostic criteria. RESULTS: The mean age of the patients was 74 years (range, 39-91 years), and 37 patients were female (62.7 percent). Twenty-nine patients (49.2 percent) were Latino/Hispanic, 26 (44 percent) were Caucasian, 3 (5 percent) were Asian, and 1 patient (1.7 percent) was Black. The most common chief symptom was dyspnea, followed by chest pain and an absence of symptoms in 54.2, 28.8, and 18.6 percent of the patients, respectively. The primary EKG abnormalities consisted of a T wave inversion, an ST segment elevation, and ST segment depression in 69.5 percent, 25.4 percent, and 15.3 percent of the patients, respectively. The stressor event was identified in 90 percent of the cases. In 32 cases (54 percent), the stressor event was physical stress or a medical illness, and in 21 cases (35.6 percent), the stressor event was emotional stress. The in-hospital mortality rate was 8.5 percent. CONCLUSIONS: In our heterogeneous study population, stress cardiomyopathy presented with a 3:2 female-to-male ratio, and dyspnea was the most common chief complaint. Stress cardiomyopathy exhibited a T wave inversion as the primary EKG abnormality. These findings differ from previous cases that have been reported, and further studies are needed.

Resorption of labial bone in maxillary anterior implant

PURPOSE: The purpose of this study was to evaluate the amount of resorption and thickness of labial bone in anterior maxillary implant using cone beam computed tomography with Hitachi CB Mercuray (Hitachi, Medico, Tokyo, Japan). MATERIALS AND METHODS: Twenty-one patients with 26 implants were followed-up and checked with CBCT. 21 OSSEOTITE NT(R) (3i/implant Innovations, Florida, USA) and 5 OSSEOTITE(R) implants (3i/implant Innovations, Florida, USA) were placed at anterior region and they were positioned vertically at the same level of bony scallop of adjacent teeth. Whenever there was no lesion or labial bone was intact, immediate placement was tried as possible as it could be. Generated bone regeneration was done in the patients with the deficiency of hard tissue using Bio-Oss(R) (Geistlich, Wolhusen, Switzerland) and Bio-Gide(R) (Geistlich, Wolhusen, Switzerland). Second surgery was done in 6 months after implant placement and provisionalization was done for 3 months. Definite abutment was made of titanium abutment with porcelain, gold and zirconia, and was attached after provisionalization. Two-dimensional slices were created to produce sagittal, coronal, axial and 3D by using OnDemand3D (Cybermed, Seoul, Korea). RESULTS: The mean value of bone resorption (distance from top of implant to labial bone) was 1.32 +/- 0.86 mm and the mean thickness of labial bone was 1.91 +/- 0.45 mm. CONCLUSION: It is suggested that the thickness more than 1.91 mm could reduce the amount and incidence of resorption of labial bone in maxillary anterior implant.

Restoration and monitoring of a vessel grounding on a shallow reef in the Florida Keys

This paper summarizes the results of a monitoring event designed to track the recovery of a repaired coral reef injured by the M/V Alec Owen Maitland vessel grounding incident of October 25, 1989. This grounding occurred within the Florida Keys National Marine Sanctuary. Pursuant to the National Marine Sanctuaries Act, NOAA recovers money for injury to Sanctuary resources, and uses it to restore those resources. A monitoring program tracks patterns of recovery, in order to determine the success of restoration measures. To evaluate success, reference habitats adjacent to the restoration site are concurrently monitored to compare the condition of restored areas with natural areas. Restoration of this site was completed in September 1995 by means of cement and limestone rock, and the monitoring results from summer 2007 are presented. Monitoring consisted of omparison of the biological conditions in the restored area with the reference area. Monitored corals are divided into the Orders: Gorgonians, Milleporans, and Scleractinians. Densities at the restored and reference areas are compared, and are shown to be greater in the restored. Size-class frequency distributions for the most abundant Scleractinians are examined, and reveal that the restoration is converging on the reference area. Also, for the Scleractinians, number and percentage of colonies by species, as well as several common biodiversity indices are provided; measures for the restored area approximate the reference area. A quantitative comparison of colony substrate settlement preference in the restored area is provided for all Orders, and for Scleractinians is further broken down for the two most frequent Genera. Rev. Biol. Trop. 58 (Suppl. 3): 151-161. Epub 2010 October 01.

Este artículo sintetiza los resultados del seguimiento diseñado para medir la recuperación de un arrecife restaurado que fue impactado por el encallamiento del M/V Alec Owen Maitland el 25 de octubre de 1989. Este encallamiento ocurrió en el área que comprende el Santuario Marino Nacional de los Cayos de Florida. De acuerdo con la Ley de los Santuarios Marinos Nacionales, la NOAA cobra dinero por daños a los recursos del Santuario y los usa para restaurar dichos recursos. Un programa de seguimiento o monitoreo mide los patrones de recuperación para determinar el éxito de las medidas de restauración. Para evaluar el éxito, hábitats de referencia adyacentes al sitio de restauración son examinados para comparar las condiciones de las áreas restauradas con las naturales. La restauración de este lugar se completó en septiembre de 1995 utilizando roca de cemento y caliza y los resultados del seguimiento desde el verano del 2007 son presentados. Se compararon las condiciones biológicas entre el área restaurada y la de referencia. Los corales evaluados se dividieron en tres Órdenes: Gorgonios, Milleporinos y Escleractinios. Se compararon las densidades en las áreas de restauración y de referencia, siendo la densidad más grande en las áreas restauradas. Se examinaron las distribuciones de frecuencia de tamaño y clase para los Escleractinios más abundantes, lo que mostró que las áreas restauradas están convergiendo con las de referencia. Para los Escleractinios, también se presentan números y porcentajes de colonias por especie al igual que varios índices comunes de biodiversidad. Las medidas para el área restaurada se aproximan al área de referencia. Una comparación cuantitativa del sustrato preferido para el asentamiento de las colonias en el área de restauración se presenta para todos los Órdenes; para el caso de Escleractinios se presenta más detalle de los dos géneros más frecuentes.

Distribution and abundance of natural parasitoid (Hymenoptera: Pteromalidae) populations of house flies and stable flies (Diptera: Muscidae) at the University of Florida Dairy Research Unit

From September 2001 through September 2002, house fly and stable fly pupae were collected weekly from three fly habitats at the University of Florida Research dairy in northcentral Florida and evaluated for parasitism. Varying parasitism percentages were observed throughout the study but they were not affected by temperature, precipitation or fly abundance. Of the 6,222 house fly pupae and 1,660 stable fly pupae that produced either a host fly or a parasitoid, 26.9 percent and 26.7 percent were parasitized, respectively. Ten parasitoid species were recovered, with the genus Spalangia accounting for 85.7 percent of the total; the most common parasitoids attacking house fly and stable fly pupae were Spalangia endius Walker (33.9 percent and 27.3 percent), S. cameroni Perkins (27.9 percent and 40.6 percent), and S. nigroaenea Curtis (21.0 percent and 24.8 percent), respectively. Other parasitoids included one specimen of S. erythromera Fõrster and four specimens of Phygadeuon fumator Gravenhõrst (Ichneumonidae). The percentage parasitism of pupae collected from bunker silos was higher than that of pupae from calf pens and open pastures. Spalangia cameroni was consistently recovered through the entire year. Spalangia nigroaenea was predominant in July, August, and September. Spalangia endius was most active from October to May with a peak of relative abundance in January.

Two Year Experiences of the International Elective Clerkship for Medical Students / 영남의대학술지

BACKGROUND: The aims of medical education have recently been changing in Korea, which has been accompanied by efforts to modify the rotating clerkship courses, improve the quality of clinical education, and make global doctors. We report the experiences of medical students going through an international elective clerkship for during past two years. MATERIALS AND METHODS: Third year medical students could apply to the international elective clerkship course during a 4 week period after their third-year rotating clerkship at a university hospital. This was done twice-in 2008 and in 2009. Applicant students were allowed to select hospitals anywhere in the world. We analyzed their choices including data on nation, state or city, hospital or institute, contacted hospitals by medical college, differences of two years, etc. RESULTS: Twelve students (10.9%) of a total of 75 third-year students applied to 3 nations and 4 hospitals in 2008. Nine students applied to the Tampa General Hospital at the University of South Florida (USF) in the USA, which was arranged by their medical college. In 2009, a total of five (4.2%) of 77 students applied to 2 nations and 3 hospitals, including three at the University of South Florida, one in another city in the USA, and one in another nation because of the increased financial burden due to a higher exchange rate. CONCLUSION: Medical students started their first international elective clerkship courses during the past two years. Experiences were interesting and meaningful to the students and the medical college. Greater effort and support to developing a new paradigm and to enlarge the scope of the program for making global doctors are required in the future.

Comparative Effects of Oyster Mushrooms on Lipid Profile, Liver and Kidney Function in Hypercholesterolemic Rats

Comparative effects of oyster mushrooms on plasma and fecal lipid profiles and on liver and kidney function were evaluated in hyper and normocholesterolemic rats. Feeding of hypercholesterolemic rats a 5% powder of oyster mushrooms (Pleurotus ostreatus, P. sajor-caju and P. florida) reduced the plasma total cholesterol level by 37%, 21% and 16%, respectively and reduced the triglyceride level by 45%, 24% and 14%, respectively. LDL/HDL ratio decreased by 64%, 45% and 41% for P. sajor-caju, P. ostreatus and P. florida fed rats, respectively. Mushroom feeding also reduced body weight in hypercholesterolemic rats. However, it had no adverse effect on plasma bilirubin, creatinin and urea nitrogen level. Mushroom feeding also increased the total lipid and cholesterol excretion in the feces. The present study reveals that feeding of 5% oyster mushroom powder does not have detrimental effects on the liver and kidneys rather may provide health benefits for the cardiovascular-related complication by decreasing the atherogenic lipid profiles.

Human Papillomavirus infection in men residing in Brazil, Mexico, and the USA / Infección por Virus de Papiloma Humano en hombres de Brasil, México y EUA

OBJECTIVE: To assess Human Papillomavirus (HPV) type distribution among men ages 18 years and older recruited from three different countries utilizing a common protocol for sampling HPV detection, and to evaluate whether HPV detection differs by age and country. MATERIAL AD METHODS: The study protocol includes a pre-enrollment run-in visit, a baseline (enrollment) visit, and nine additional visits after enrollment scheduled six months apart. For this analysis, the first 1160 men who completed both the run-in and baseline visit were included. To maximize sampling and prevent fraying of applicators, three different applicators were utilized to sample the external genitalia of participants among different anatomic sites. These samples were later combined to form a single sample for the detection of HPV using polymerase chain reaction (PCR) for amplification of a fragment of the HPV L1 gene. RESULTS: Among 1160 men from Brazil, Mexico, and the United States (U.S.), overall HPV prevalence was 65.2 percent; with 12.0 percent oncogenic types only, 20.7 percent non-oncogenic types only, 17.8 percent both oncogenic and non-oncogenic, and 14.7 percent unclassified infections. Multiple HPV types were detected in 25.7 percent of study participants. HPV prevalence was higher in Brazil (72.3 percent) than in the U.S. (61.3 percent) and Mexico (61.9 percent). HPV 16 (6.5 percent), 51 (6.5 percent), and 59 (5.3 percent) were the most commonly detected oncogenic infections, and HPV 84 (7.7 percent), 62 (7.3 percent), and 6 (6.6 percent) were the most commonly detected non-oncogenic infections. Overall HPV prevalence was not associated with age. However, significant associations with age were observed when specific categories of oncogenic, non-oncogenic, and unclassified HPV infections were considered. CONCLUSIONS: Studies of HPV type distribution among a broad age range of men from multiple countries is needed to fill the information gap internationally ...

OBJETIVO: Evaluar la distribución tipo específica de infección por Virus del Papiloma Humano (VPH) entre hombres de 18 años o más de tres países con un protocolo común para el muestreo de la detección de VPH, y evaluar si la detección de VPH varía de acuerdo con la edad y el país. MATERIAL Y MÉTODOS: El estudio incluye diversas etapas que inician con la identificación de hombres susceptibles, una medición basal (visita de enrolamiento) y nueve visitas adicionales programadas cada seis meses. En este artículo, se presenta el análisis de los primeros 1160 hombres que fueron incluídos en el estudio. Para maximizar la posibilidad de detección de VPH se utilizó un cepillo de dacrón que muestreó en forma combinada diferentes sitios anatómicos. Para la determinación de ADN de VPH se utilizó ión en cadena de polimerasa (PCR) por amplificación de un fragmento del gen de VPH L1. RESULTADOS: Entre 1160 hombres de Brasil, México y EUA, la prevalencia global de VPH fue de 65.2 por ciento, con solamente 12 por ciento de tipos oncogénicos, 20.7 por ciento de tipos de VPH no oncogénicos, 17.8 por ciento de muestras positivas a tipos oncogénicos y no oncogénicos; y finalmente 14.7 por ciento de infecciones no clasificadas. Múltiples tipos de VPH fueron detectados en 25.7 por ciento de los participantes en el estudio. La prevalencia de VPH fue más alta en Brasil (72.3 por ciento), comparada con la observada en EUA (61.3 por ciento) y México (61.9 por ciento). Los tipos de VPH 16 (6.5 por ciento), 51 (6.5 por ciento) y 59 (5.3 por ciento) fueron los más comúnmente observados con poder oncogénico. El VPH 84 (7.7 por ciento), 62 (7.3 por ciento) y 6 (6.6 por ciento) fueron las infecciones no oncogénicas más comunes. CONCLUSIONES: Son necesarios estudios de la distribución de VPH en un amplio margen de edad entre hombres de múltiples países, para establecer con mayor precisión, el conocimiento de la historia natural de la infección por VPH en hombres.

HIV risk behaviors of Latin American and Caribbean men who have sex with men in Miami, Florida, USA / Comportamientos de riesgo de infección por el VIH en hombres latinoamericanos y caribeños que tienen sexo con hombres en Miami, Florida, EUA

OBJECTIVE: The goal of this study is to describe the sexual practices, drug use behaviors, psychosocial factors, and predictors of unprotected anal intercourse (UAI) in a sample of Hispanic men who have sex with men (MSM) born in Latin American and Caribbean (LAC) countries who currently reside in Miami-Dade County, Florida. METHODS: Hispanic MSM (N = 566) recruited from community and Internet venues completed a computer-assisted self-interview assessing sociodemographic factors, drug use, sexual behaviors, and psychosocial factors. We focused on the 470 men who were born in LAC countries, including Puerto Rico. We first examined separately, by country of origin, the sexual practices, drug use behaviors, and psychosocial factors of the sample. We then collapsed the groups and examined the factors associated with UAI in the previous 6 months for the entire sample of Hispanic MSM from LAC countries. RESULTS: In the previous 6 months, 44 percent of the sample engaged in UAI, and 41 percent used club drugs. At the multivariate level, psychological distress, higher number of sexual partners, club drug use, HIV-positive status at the time of immigration, and greater orientation to American culture were significantly associated with UAI in the previous 6 months. CONCLUSIONS: Many MSM born in LAC countries engage in HIV-related risk behaviors in the AIDS epicenter of Miami-Dade County, Florida. Culturally appropriate interventions should address these risk behaviors in this underserved population.

OBJETIVO: Describir las prácticas sexuales, el consumo de drogas y los factores psicosociales y de predicción del coito anal sin protección (CASP), en una muestra de hombres nacidos en América Latina y el Caribe (ALC) residentes actualmente en el Condado de Miami-Dade, Florida, que tienen sexo con hombres. MÉTODOS: En total, 566 hispanos que tienen sexo con hombres (HSH), captados en la comunidad y sitios de Internet, completaron una encuesta autoaplicada por computadora que abordaba los factores socioeconómicos, el consumo de drogas, el comportamiento sexual y los factores psicológicos. El estudio se centró en 470 hombres nacidos en ALC, incluido Puerto Rico. La muestra se analizó por país de origen, prácticas sexuales, consumo de drogas y factores psicológicos. Luego se unieron los grupos y se analizaron los factores asociados con el CASP en los 6 meses previos en toda la muestra. RESULTADOS: En los 6 meses previos, 44 por ciento de la muestra tuvo CASP y 41 por ciento consumió drogas de las llamadas recreativas. Según el análisis multifactorial, los factores asociados significativamente con el CASP en los 6 meses previos fueron: los problemas psicológicos, el mayor número de parejas sexuales, el consumo de drogas recreacionales, la positividad al VIH en el momento en que inmigró y el mayor grado de orientación hacia la cultura estadounidense. CONCLUSIONES: Muchos HSH nacidos en ALC incurren en comportamientos de riesgo de infección por el VIH en el epicentro de sida del Condado de Miami-Dade, Florida. Se deben aplicar intervenciones culturalmente apropiadas para combatir estos comportamientos de riesgo en la población marginada estudiada.

Nutritional Analysis of Cultivated Mushrooms in Bangladesh - Pleurotus ostreatus, Pleurotus sajor-caju, Pleurotus florida and Calocybe indica

Mushroom cultivation has been started recently in Bangladesh. Awareness of the nutritional and medicinal importance of mushrooms is not extensive. In this study, the nutritional values of dietary mushrooms- Pleurotus ostreatus, Pleurotus sajorcaju, Pleurotus florida and Calocybe indica that are very popular among the cultivated mushrooms in Bangladesh have been determined. These mushrooms were rich in proteins (20~25%) and fibers (13~24% in dry samples) and contained a lower amount of lipid (4 to 5%). The carbohydrate contents ranged from 37 to 48% (on the basis of dry weight). These were also rich in mineral contents (total ash content is 8~13%). The pileus and gills were protein and lipid rich and stripe was carbohydrate and fiber-rich. The moisture content of mushrooms ranged from 86 to 87.5%. Data of this study suggest that mushrooms are rich in nutritional value.

The Role of Rectoanal Inhibitory Reflex in the Anal Continence Function

PURPOSE: The rectoanal inhibitory reflex (RAIR) aids the anal continence function by a sampling process. On the other hand, it might impair the anal continence function because the internal anal sphincter is relaxed during the reflex. We assessed the parameters of RAIR in incontinent patients with or without a sphincter defect and compared them with healthy control subjects to clarify the exact role of that reflex in the anal continence function. METHODS: The recovery time, slope, amplitude, and area under the reflex curve of the RAIR were measured for 31 normal controls without any history of anorectal surgery (group A), 32 incontinent patients with a sphincter defect (group B), and 49 incontinent patients without a sphincter defect (group C). Incontinence was defined as bowel accidents of more than 3 by the Cleveland Clinic Florida score. A sphincteric defect was defined endoanal sonographically. The mean ages of group A, B, and C were 57.9+/-14.3, 54.5+/-13.6, and 61.8+/-15.4 years, respectively. RESULTS: When group A and group B+C were compared, the recovery times (seconds) were 17.5+/-3.5 and 14.8+/-5.5 (P=.003), the slopes (mmHg/second) were 0.67+/-3.04 and 3.27+/-2.44 (P<.001), the amplitudes (%) were 7.0+/-16.5 and 53.3+/-19.4 (P=.352), and the area under the reflex curve (mmHg*seconds) were 230.2+/-102.15 and 173.0+/-140.8 (P=.020). When group B and group C were compared, the recovery times were 15.0+/-5.8 and 14.7+/-5.3 (P=.828), the slopes were 3.6+/-2.8 and 3.1+/-2.2 (P= .388), the amplitudes were 54.2+/-22.4 and 52.7+/-17.4 (P=.737), and the area under the reflex curve were 188.0+/-151.1 and 163.2+/-134.3 (P=.443). All parameters of the RAIR, except the amplitude were significantly diminished in incontinent patients whether they had a sphincter defect or not. CONSLUSIONS: Although the RAIR functions against continence in normal conditions by inhibiting sphincteric tone, it behaves suitably for keeping continence in the presence of incontinence, whatever the cause is, by attenuating the degree of inhibition.