Rapid changes in key ruminal microbial populations during the induction of and recovery from diet-induced milk fat depression in dairy cows.

The ruminant provides a powerful model for understanding the temporal dynamics of gastrointestinal microbial communities. Diet-induced milk fat depression (MFD) in the dairy cow is caused by rumen-derived bioactive fatty acids, and is commonly attributed to the changes in the microbial population. The aim of the present study was to determine the changes occurring in nine ruminal bacterial taxa with well-characterised functions, and abundance of total fungi, ciliate protozoa and bacteria during the induction of and recovery from MFD. Interactions between treatment and time were observed for ten of the twelve populations. The total number of both fungi and ciliate protozoa decreased rapidly (days 4 and 8, respectively) by more than 90% during the induction period and increased during the recovery period. The abundance of Streptococcus bovis (amylolytic) peaked at 350% of control levels on day 4 of induction and rapidly decreased during the recovery period. The abundance of Prevotella bryantii (amylolytic) decreased by 66% from day 8 to 20 of the induction period and increased to the control levels on day 12 of the recovery period. The abundance of Megasphaera elsdenii and Selenomonas ruminantium (lactate-utilising bacteria) increased progressively until day 12 of induction (>170%) and decreased during the recovery period. The abundance of Fibrobacter succinogenes (fibrolytic) decreased by 97% on day 4 of induction and increased progressively to an equal extent during the recovery period, although smaller changes were observed for other fibrolytic bacteria. The abundance of the Butyrivibrio fibrisolvens/Pseudobutyrivibrio group decreased progressively during the induction period and increased during the recovery period, whereas the abundance of Butyrivibrio hungatei was not affected by treatment. Responsive taxa were modified rapidly, with the majority of changes occurring within 8 d and their time course was similar to the time course of the induction of MFD, demonstrating a strong correlation between changes in ruminal microbial populations and MFD.

Pelvic inflammatory disease in adolescents between the time of testing and treatment and after treatment for gonorrhoeal and chlamydial infection.

In incarcerated adolescents, 13% developed pelvic inflammatory disease (PID) between the time of testing and treatment for chlamydial and gonorrhoeal infection, and 13% developed PID in the 30 days following single-dose treatment for one or both of these infections.

Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women.

US blacks carry a disproportionate risk of heterosexually transmitted HIV. This study aimed to evaluate the association between self-reported heterosexual anal intercourse and HIV. Using respondent-driven sampling (RDS), we recruited and interviewed 909 blacks from areas of high poverty and HIV prevalence in Houston, Texas, and who reported heterosexual sex in the last year. All individuals were tested for HIV. Weighted prevalence values were calculated to account for non-random recruitment associated with RDS. The weighted population prevalence of HIV infection was 2.4% and 2.5% among men and women, respectively. Education, employment status, income and crack cocaine use were not associated with HIV infection. Lifetime injection drug use (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.31-8.33%) and heterosexual anal intercourse (OR 2.41, 95% CI 1.02-5.73%) were associated with HIV infection. Individuals who reported both injection drug use and heterosexual anal intercourse had 6.21 increased odds of HIV (95% CI 2.47-15.61%). Our results suggest that heterosexual anal sex may be a vector for HIV transmission, especially in the context of injection drug use. Prevention strategies directed at curbing the HIV epidemic among black heterosexuals require that we correctly identify the risks so that appropriate interventions can be developed.

Purulent vaginal and cervical discharge in the diagnosis of pelvic inflammatory disease.

In this structured review, we evaluated purulent vaginal and cervical discharge as diagnostic tests for pelvic inflammatory disease (PID). Using a pretest probability of PID (diagnosed clinically) of 50%, we used the odds-likelihood formulation of Bayes' theorem to calculate post-test probabilities of PID (proven by laparoscopy or endometrial biopsy). If abnormal discharge was present, the post-test probabilities of PID ranged from 50% to 73%, with a mean value of 57%. If abnormal discharge was absent, the post-test probabilities ranged from 24% to 52%, with a mean value of 39%. Therefore, the presence or absence of excess white blood cells in vaginal or cervical discharge was not particularly helpful in confirming or excluding PID in patients in whom the diagnosis was suspected from the clinical examination.

Condom use among high-risk heterosexual women with concurrent sexual partnerships, Houston, Texas, USA.

Concurrent sexual partnerships allow for enhanced transmission of sexually transmitted infections (STIs). Condom use dynamics in this context may be an important factor for transmission of HIV. We conducted a cross-sectional study to describe the frequency of concurrency among high-risk heterosexual women in Houston, Texas and determine the factors associated with condom use. A total of 553 participants were recruited using respondent-driven sampling and completed an anonymous questionnaire; 256 (49%) were identified as having a concurrent partnership. The prevalence of condom use at last sexual encounter was 26%. Women were significantly more likely to use condoms if their sexual encounter was with a casual partner and if alcohol and/or drugs were not used. The high prevalence of concurrent partnerships suggests the presence of a dense sexual network which may enable the rapid spread of STIs and HIV. The risk of transmission may be additionally increased due to the low prevalence of condom use.

The incidence of pelvic inflammatory disease in untreated women infected with Chlamydia trachomatis: a structured review.

Because of the long-term consequences of pelvic inflammatory disease (PID), the cost-effectiveness of Chlamydia trachomatis screening depends in part on the incidence of PID in untreated, chlamydia-infected women. The aim of this study was to evaluate the original research assessing the incidence of PID following C. trachomatis infection. We conducted a thorough search of the literature and selected all available prospective cohort studies. Six studies had original data: the incidence of PID varied from 0% (97.5% confidence interval [CI] 0-12%) during one year of follow-up of 30 women to 30% (95% CI 12-54%) during 50 days of follow-up of 20 women. Studies that included asymptomatic women in other settings reported a lower incidence than those that evaluated women in sexually transmitted disease clinics. In conclusion, no study was of a size or quality to answer our research question definitively. Investigators and clinicians planning chlamydia-screening programmes need to be cognizant of the inconclusive incidence data.

Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease.

PURPOSE: We determined the incidence of Fitz-Hugh-Curtis syndrome (FHCS) in adolescents who had mild to moderately severe pelvic inflammatory disease (PID). DESIGN: Prospective cohort study. SETTING: Harris County Juvenile Detention Center, April 2000-April 2006. PARTICIPANTS: Incarcerated female adolescents. INTERVENTION: In patients who met accepted criteria for the diagnosis of PID, we determined the proportion that had right upper quadrant pain that responded to therapy for PID. They were diagnosed as having FHCS. RESULTS: The 117 subjects' mean age (SD) was 15.6 (1.8) years; 37% were Hispanic, 34% black, and 26% white. 5/117 (4.3%, 95% confidence interval 1.4-9.7%) had symptomatic FHCS. Fifteen (13%) of all subjects, including 1 with FHCS, had fever and/or nausea and vomiting (moderately severe PID): none had generalized peritonitis or tubo-ovarian abscess (severe PID). Thirty-four had chlamydial, 4 gonorrheal, and 9 combined infections. All improved with standard outpatient PID therapy. CONCLUSION: FHCS was uncommon (4%) in adolescents who had mild to moderate PID and chlamydia as the most common pathogen.

The prevalence of suicidal behaviours in a group of HIV-positive men.

We studied a convenience sample of 54 HIV-positive men, recruited from HIV/AIDS community based service organizations. Data were collected on HIV risk factors and suicidal behaviours. Fifty-nine percent of the sample reported ever thinking about suicide, and 50% of those individuals reported attempting suicide at some point in their lives. Suicide ideation and attempts were more common among white participants. Suicidal behaviours were prevalent in this sample suggesting a need for mental health and suicide interventions targeted for this population.

The prevalence of partner violence in a group of HIV-infected men.

There is a paucity of literature regarding partner violence among males that identifies the sex and relationship of their partner(s). We studied a convenience sample of 54 HIV-infected men, recruited from HIV/AIDS service organizations. Using a standard questionnaire, we collected data on HIV risk behaviours and self-reports of acts of partner violence and forced sex. Physical violence perpetrated by a primary or a casual partner was reported by 39% and 17% of the sample, respectively. Life-time forced sex by a primary or casual partner was reported by 32% and 15% of the sample, respectively. Forced sex was more commonly reported by participants who were non-white and reported a higher number of primary partners in the previous 12 months. We recommend that health care providers be aware of the high rates of intimate partner violence among men infected or at risk of infection with HIV.

Ischemic stroke subtypes among Mexican Americans and non-Hispanic whites: the BASIC Project.

Ischemic stroke subtype distribution was compared between Mexican Americans (MAs) and non-Hispanic whites (NHWs) in a community-based stroke surveillance study in Nueces County, TX. There was no difference in the distribution of stroke subtype by ethnicity (p = 0.19). There was a similar proportion of small-vessel and large-artery strokes between the two ethnic groups (p = 0.32). Differences in stroke rates among MAs and NHWs are not explained by the distribution of ischemic stroke subtypes.

A population-based study of acute stroke and TIA diagnosis.

BACKGROUND: Acute stroke therapy is heavily dependent on the diagnostic acumen of the physician in the emergency department (ED). OBJECTIVE: To determine this diagnostic accuracy in a population-based multiethnic stroke study. METHODS: The Brain Attack Surveillance in Corpus Christi (BASIC) Project prospectively ascertained all acute stroke or TIA cases in an urban Texas county of 313,645 residents without an academic medical center. Cases were validated by board-certified neurologists using source documentation. Case validation was used as the gold standard to compare the diagnosis given by the ED physician. RESULTS: From January 2000 to August 2002, a total of 13,015 patients were screened. Of these, 1,800 were validated as stroke/TIA. Overall sensitivity of the emergency physician for the BASIC-validated diagnosis was 92%, and positive predictive value was 89%. Of the cases that the emergency physician thought were stroke, 11% were validated as no stroke. In multivariable modeling, motor symptoms was an independent predictor of protection from false-negative ED diagnosis of stroke/TIA (odds ratio [OR] = 0.61; 95% CI 0.41 to 0.89). Protection from false-positive stroke/TIA diagnosis was predicted by sensory symptoms (OR = 0.43; 95% CI 0.28 to 0.66), motor symptoms (OR = 0.44; 95% CI 0.32 to 0.62), and severe neurologic deficit (OR = 0.33; 95% CI 0.14 to 0.78). History of stroke/TIA predicted false-positive stroke diagnosis (OR = 1.72; 95% CI 1.23 to 2.40). The majority of disagreements occurred in patients with generalized neurologic or acute medical, nonneurologic syndromes. CONCLUSIONS: Physicians practicing in the ED are sensitive for stroke/TIA diagnosis. The modest positive predictive value argues for a systems approach with neurology support so that proper decisions regarding acute stroke therapy can be made.

Impact of new diagnostic criteria on the prevalence and incidence of pelvic inflammatory disease.

STUDY OBJECTIVE: The Centers for Disease Control and Prevention (CDC) recently changed the recommended criteria for the clinical diagnosis of pelvic inflammatory disease (PID). The purpose of this study was to assess the impact of this change on the frequency with which we made a diagnosis of PID. DESIGN: prospective cohort study. SETTING: juvenile detention center. PARTICIPANTS: adolescent females. INTERVENTIONS: We used the new diagnostic criteria to determine the prevalence and incidence of PID. We then compared these values to those in a previous study of a similar cohort of youth who were evaluated with the CDC's old, more stringent clinical criteria. MAIN OUTCOME MEASURES: Prevalence and incidence of PID. INCIDENCE MEASURES: Incidence density and cumulative incidence, using the Kaplan-Meier method. Results between studies were compared using prevalence and incidence ratios. RESULTS: In sexually active adolescents (N=315), the prevalence of PID (95% confidence interval) at admission was 8.6% (5.7-12.2%). During the first 31 days of incarceration, the cumulative incidence was 7.9% (5.0-12.3%) and the incidence density was 11.1 cases/100 person-months (6.5-16.4). Comparison of these results with those of our previous study that used old diagnostic criteria yielded a prevalence ratio of 2.0 (1.0-4.2), a risk ratio (comparing cumulative incidence) of 3.6, and a rate ratio (comparing incidence density) of 3.4 (1.2-11.2). All differences were statistically significant (P<0.05). CONCLUSION: The new diagnostic criteria for PID doubled the prevalence and more than tripled the incidence of this disease in this high risk population of incarcerated adolescents.

Implementation of a screening program for chlamydial infection in incarcerated adolescents.

BACKGROUND: In collaboration with the Houston Department of Health and Human Services, the authors implemented and evaluated a urine-based chlamydia screening program in incarcerated youth in Harris County, Texas, and assessed predictor variables for infection. GOAL: To implement and evaluate chlamydia screening in incarcerated youth. STUDY DESIGN: The authors determined prevalence of chlamydial infection, treatment rates, and predictor variables in 589 youth and repeated the measures 6 months later in 975 additional youth. RESULTS: Initially, the prevalence of infection was 9.6% in males and 28.1% in females; 88% of infected youth were treated while incarcerated. White males had a significantly lower prevalence of chlamydial infection; however, consistent condom use was not associated with a lower prevalence of chlamydia. In the 6-month assessment of chlamydia prevalence in 975 youth, prevalence and treatment rates remained high and predictor variables were similar. CONCLUSION: The authors instituted a screening program for chlamydial infection in incarcerated youth that was performing well at reassessment 6 months later.

Weight change in adolescents who used hormonal contraception.

PURPOSE: (a) To compare weight change at 1 year between adolescents 13-19 years old who were using either depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OC), and (b) to determine if age, baseline body mass index (BMI), race/ethnicity, or weight gain at 3 months predicted which subjects would gain excessive weight. METHOD: The setting was a Planned Parenthood Teen Clinic with chart review of variables of interest. Excessive weight was defined as weight gain > 10%. RESULTS: Baseline variables were similar in the two groups, except that DMPA users (n = 44) had a greater mean BMI (t test, p = .05) than OC users (n = 86). Mean (standard deviation) and median weight gains at 1 year were 3.0 (4.5) and 2.4 kg in the DMPA users and 1.3 (3.9) and 1.5 kg in the OC users (difference in medians not significant, Wilcoxon rank sum test, p = .10). Fifty-six percent of DMPA and 70% of OC users lost weight or gained < 5% of their baseline weight (p = .17, Fisher exact test); 25% of DMPA users and 7% of OC users gained > 10% of their baseline weight (p = .006). Age, baseline BMI, or race/ethnicity did not affect the likelihood that either group would gain > 5% or > 10% of their baseline weight. Of adolescents who gained > 5% of baseline weight at 3 months, 13 of 14 (93%) gained even more weight at 12 months. CONCLUSIONS: The majority of adolescents who used hormonal contraception for 1 year lost weight or gained < 5% of baseline weight. DMPA users were more likely than OC users to gain > 10%. Subjects who gained > 5% of baseline weight at 3 months were at high risk (93%) of gaining even more weight by 1 year.

PIP: This study aims to compare weight change after 1 year between adolescents aged 13-19 years who were using either depot medroxyprogesterone acetate (DMPA) or an oral contraceptive (OC). It also seeks to determine whether age, baseline body mass index (BMI), race/ethnicity, or weight gain at 3 months predicted which subjects would gain excessive weight (defined as weight gain 10%). A total of 2883 charts were reviewed for all clients attending the Planned Parenthood Teen Clinic in Texas. In the results, 56% of DMPA and 70% of OC users lost weight or gained 5% of their baseline weight; whereas 25% of DMPA users and 7% of OC users gained 10% of their baseline weight. Furthermore, age, baseline BMI, or race/ethnicity did not affect the likelihood of weight gain in both groups. The findings indicated that most adolescents who used hormonal contraception for 1 year lost weight or gained 5% of their baseline weight. DMPA users were more likely to gain 10% of their baseline weight compared to OC users. Subjects who gained 5% of baseline weight at 3 months were at high risk (93%) of gaining even more weight by 1 year.

The epidemiology of syphilis in the waning years of an epidemic: Houston, Texas, 1991-1997.

BACKGROUND: National and local syphilis rates have fallen since 1990. Accurate epidemiologic information about the distribution of syphilis during the waning years of an epidemic are important to health care organizations so that they can specifically target screening and intervention programs. GOALS: To describe the epidemiology of syphilis in Houston, Texas, from 1991 through 1997. STUDY DESIGN: Descriptive evaluation of morbidity surveillance data from the Houston Department of Health and Human Services. RESULTS: Between 1991 and 1997, rates for syphilis fell 61%. Rates for primary and secondary syphilis fell 90% among men and women in all race/ethnicity groups; early latent rates fell 81% among blacks, 57% among Hispanics, and 50% among whites. Late latent rates were stable among blacks and whites and increased among Hispanics. The proportion of total cases identified as late latent disease increased from 16% in 1991 to 63% in 1997. Congenital syphilis rates have remained at approximately 2 per 1,000 live births since 1993. CONCLUSION: Syphilis continues to be a problem in Houston. The medical community and HIV/STD prevention programs need to be vigilant in actively screening high-risk individuals to identify syphilis at earlier stages of the disease and to prevent congenital syphilis.

A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished HIV-infected patients.

OBJECTIVE: To evaluate the effects of nutrition counseling with or without oral supplementation in malnourished patients infected with the human immunodeficiency virus (HIV). DESIGN: Randomized controlled trial. SUBJECTS: HIV-infected men (n=118) who were less than 90% of usual weight for height or who had lost more than 10% of body weight. INTERVENTION: Nutrition counseling alone (control group) vs nutrition counseling plus enteral supplementation (supplement group) for 6 weeks. All patients were instructed to consume a diet that exceeded estimated total energy expenditure by 960 kcal/day. MAIN OUTCOME MEASURES: Weight, skinfold thickness, fat-free mass, grip strength, quality of life, and cognitive function (Buschke test). STATISTICAL ANALYSES: Differences in baseline variables and outcomes were evaluated using analysis of variance or the Wilcoxon rank sum test. RESULTS: Ninety-nine men completed at least 4 weeks of treatment, 49 in the supplement group and 50 in the control group. Half the patients in each treatment group achieved at least 80% of their energy target. No differences in weight, skinfold thickness measurements, or quality of life were observed. Compared with the control group, the supplement group had larger increases in fat-free mass and grip strength, although the differences did not reach statistical significance. APPLICATIONS: In the short term, nutrition counseling with or without oral supplementation can achieve a substantial increase in energy intake in about 50% of malnourished HIV-infected patients. Although further study is needed to evaluate long-term effects, these findings suggest that nutrition counseling has an important role in the management of malnourished HIV-infected patients.

SKF 38393 enhances odor detection performance.

The purpose of this study was to determine the influence of the D1-selective partial agonist SKF 38393 on the odor detection performance of rats using high precision olfactometry and a go/no-go operant task. Previous studies have found that the D2 receptor partial agonist quinpirole decreases such performance, but the influences of D1 receptor activation are unknown. In experiment 1, such detection performance to the odorant ethyl acetate was enhanced by SKF 38393, relative to saline, in male rats at 7.5 and 10.0 mg/kg i.p. dose levels, but not at the lower doses of 1.0, 2.5, and 5.0 mg/kg. In experiment 2, this enhancement was replicated at the 7.5 and 10.0 mg/kg doses and was shown to occur at the 12.5 mg/kg dose as well. In experiment 3, similar enhancement was shown for the odorant eugenol in female rats at the 7.5, 10.0 and 12.5 mg/kg doses, suggesting this effect is neither sex-specific nor confined to the odorant ethyl acetate. In experiment 4, a 0.025 mg/kg dose of the D1 receptor antagonist SCH 23390 depressed the enhancement produced to ethyl acetate by 7.5 mg/kg SKF 38393 to control levels. Overall, these data demonstrate that, in contrast to quinpirole, SKF 38393 improves odor detection performance in the rat and that this phenomenon can be attenuated by the D1 receptor blocker SCH 23390.

Problems in physician's classification and reporting of congenital syphilis.

The diagnosis of congenital syphilis (CS) in newborns can only be made through a review of the mothers' testing and treatment history and through the infants' clinical and laboratory findings. We describe difficulties in the classification of CS by physicians and the health department during a recent syphilis epidemic. The records of infants identified as potential cases of CS by laboratory testing, discharge diagnosis, or health department records were reviewed by epidemiologists. The reasons for concordance and discordance in classification between the physician and the epidemiologist were determined. Congenital syphilis was identified in 126 infants. Seventeen cases were discordant and 12 cases concordant but the physician's classification was for incorrect reasons. Misclassification occurred because physicians lacked data known to the health department (n=7), health departments lacked data known to the physician (n=1), and physicians misinterpreted the case definition for CS (n=21). Suggestions for improving the diagnosis and reporting of CS are included.

Uncertain clinical significance of duodenal mucosal abnormalities in HIV-infected individuals. Results of a case-control study.

Previous research has described abnormalities of duodenal mucosal morphology in human immunodeficiency virus (HIV)-infected individuals. We wanted to determine the frequency of disturbed villus architecture and investigate its relationship to HIV-related chronic diarrhea. We conducted a case-control study of 120 HIV-infected men, 63 with and 57 without chronic diarrhea. Stools were cultured for bacteria and examined for ova and parasites; esophagogastroduodenoscopy and flexible sigmoidoscopy with mucosal biopsies were performed. Biopsy tissue was examined using light and electron microscopy to detect enteric pathogens and to evaluate mucosal morphology. The mean CD4+ cell count was 143/min3, and enteric pathogens were detected in 56 of 120 men (47%). In approximately half the study sample (57%), duodenal villus architecture was normal; complete villus flattening was not observed. We detected no association between chronic diarrhea and altered villus architecture. Although further study is needed to clarify the pathogenesis of altered duodenal mucosal morphology, our results suggest that the clinical significance of the abnormalities may be small.

Odor detection performance in hypothyroid and euthyroid rats.

The influence of hypothyroidism on the odor detection ability of male Long-Evans rats was determined using high-precision olfactometry and a go/no-go operant task. Nonparametric signal detection measures of sensitivity and responsitivity, as well as measures of S+ response latency, the number of aborted trials, and session time were obtained in daily 200-trial test sessions prior to, during, and after 50 days of maintenance on 0.1% propylthiouracil (PTU). Similar determinations were made in control animals. Neither odor detection nor associated nonsensory performance measures were influenced by hypothyroidism. These results suggest that PTU-induced hypothyroidism does not affect the odor detection performance of rats.