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1.
J Clin Microbiol ; 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32611792

RESUMO

The coronavirus (COVID-19) pandemic has led many clinics to move from clinician-collected to self-collected oropharyngeal swabs for the detection of sexually transmitted infections (STIs). Before this change, however, self-collection was primarily used for genital and anorectal infections with only limited studies on the performance of self-collected oropharyngeal swabs for oropharyngeal STIs. Melbourne Sexual Health Centre (MSHC) changed from clinician-collected to self-collected oropharyngeal swabs for oropharyngeal gonorrhoea and chlamydia screening on March 16, 2020 to reduce healthcare worker risk during the COVID-19 pandemic. We compared the proportion of valid and positive samples for gonorrhoea and chlamydia among men who have sex with men (MSM) in two time periods; the clinician-collected period between January 20 and March 15, 2020; and the self-collected period between March 16 and May 8, 2020. A total of 4,097 oropharyngeal swabs were included. The proportion of oropharyngeal swabs with equivocal or invalid results for N. gonorrhoeae was higher in the self-collected period (1.6% [24/1,497]) compared to the clinician-collected period (0.9% [23/2,600]) (p=0.038) but did not differ for the detection of C. trachomatis The positivity of oropharyngeal N. gonorrhoeae (adjusted prevalence ratio (PR) 1.09; 95% CI: 0.87 to 1.37; p=0.435) and oropharyngeal C. trachomatis (adjusted PR 0.84; 95% CI: 0.51 to 1.39; p=0.504) did not differ between the two periods. Self-collected oropharyngeal swabs for detection of N. gonorrhoeae and C. trachomatis have acceptable performance characteristics and importantly reduce healthcare worker exposure to respiratory infection.

2.
J Invest Dermatol ; 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32615123

RESUMO

Mechanisms explaining the link between psoriasis, a pro-inflammatory condition, and cardiovascular disease (CVD) are not fully known. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is predominantly expressed in hepatocytes as a critical regulator of lipid metabolism and clinical trials targeting PCSK9 reduce CVD. Independent of its role in lipid metabolism, PCSK9 levels associate with endothelial dysfunction and predict CV events. We used two separate human psoriasis cohorts and the K14-Rac1V12-/+ murine model of psoriasis to investigate PCSK9 and CV risk in psoriasis. In both psoriasis cohorts, (n=88 and n=20), PCSK9 levels were 20% and 13% higher than age, sex, and cholesterol matched controls respectively (p<0.05 for each comparison), and correlated with psoriasis area severity index (r=0.43, p<0.05). Despite no difference in hepatocyte expression, K14-Rac1V12-/+ mice demonstrated skin-specific PCSK9 staining which was confirmed in human psoriatic lesional skin. In psoriasis patients, PCSK9 levels correlated with impaired endothelial vascular health (e.g. early atherosclerosis, ß=4.5, p<0.01) and coronary artery calcium score (ß=0.30, p=0.01) which remained significant after adjustment for Framingham risk, body mass index and active biologic use. Taken together, these findings suggest independent of cholesterol, an association between circulating PCSK9, and early and advanced stages of atherosclerosis in psoriasis.

4.
J Cardiovasc Magn Reson ; 22(1): 37, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32423456

RESUMO

BACKGROUND: There is a renewed interest in lower field magnetic resonance imaging (MRI) systems for cardiovascular magnetic resonance (CMR), due to their favorable physical properties, reduced costs, and increased accessibility to patients with implants. We sought to assess the diagnostic capabilities of high-performance low-field (0.55 T) CMR imaging for quantification of right and left ventricular volumes and systolic function in both healthy subjects and patients referred for clinical CMR. METHODS: Sixty-five subjects underwent paired exams at 1.5 T using a clinical CMR scanner and using an identical CMR system modified to operate at 0.55 T. Volumetric coverage of the right ventricle (RV) and left ventricles (LV) was obtained using either a breath-held cine balanced steady-state free-precession acquisition or a motion-corrected free-breathing re-binned cine acquisition. Bland-Altman analysis was used to compare LV and RV end-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF), and LV mass. Diagnostic confidence was scored on a Likert-type ordinal scale by blinded readers. RESULTS: There were no significant differences in LV and RV EDV between the two scanners (e.g., LVEDV: p = 0.77, bias = 0.40 mL, correlation coefficient = 0.99; RVEDV: p = 0.17, bias = - 1.6 mL, correlation coefficient = 0.98), and regional wall motion abnormality scoring was similar (kappa 0.99). Blood-myocardium contrast-to-noise ratio (CNR) at 0.55 T was 48 ± 7% of the 1.5 T CNR, and contrast was sufficient for endocardial segmentation in all cases. Diagnostic confidence of images was scored as "good" to "excellent" for the two field strengths in the majority of studies. CONCLUSION: A high-performance 0.55 T system offers good bSSFP CMR image quality, and quantification of biventricular volumes and systolic function that is comparable to 1.5 T in patients. TRIAL REGISTRATION: Clinicaltrials.gov NCT03331380, NCT03581318.

5.
Mol Genet Metab ; 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32466960

RESUMO

INTRODUCTION: Alkaptonuria (AKU) is a rare inherited disorder of tyrosine metabolism resulting in an accumulation of homogentisic acid oxidation products in the joints and cardiovascular system. Aortic distensibility may be a non-invasive indicator of cardiovascular complications. Descending thoracic aortic distensibility in alkaptonuria has not been studied. METHODS: Patients diagnosed with alkaptonuria underwent Magnetic Resonance Imaging (MRI) and gated non-contrast and contrast-enhanced cardiovascular computed tomography. Using MRI cine images, aortic distensibility of the descending thoracic aorta was determined. RESULTS: Seventy-six patients with alkaptonuria were imaged. When compared to literature normal values, aortic distensibility in AKU was impaired (5.2 vs 6.2 × 10-3, p < .001). Aortic distensibility was inversely related to age (r = -0.6, p = .0001). Hypertensive patients with alkaptonuria had impaired distensibility compared to normotensive patients with alkaptonuria (4.6 vs 5.6 × 10-3, p = .03), and hyperlipidemic patients with alkaptonuria had impaired distensibility compared to non-hyperlipidemic patients with alkaptonuria (4.1 vs 6.0 × 10-3, p = .001). Male hypertensive patients with alkaptonuria had greater distensibility than their female counterparts (5.3 vs 2.9 × 10-3, p = .02). Similarly, male hyperlipidemic patients with alkaptonuria had greater distensibility than their female counterparts (4.8 vs 2.5 × 10-3, p < .01). Of patients with alkaptonuria, those with a coronary artery calcium (CAC) score greater than 100 had more impaired distensibility than those with a CAC score less than 100 (3.5 vs 5.1 × 10-3, p = .01) and those with aortic calcium score greater than 100 had impaired distensibility compared to those with an aortic calcium score less than 100 (3.2 vs 4.9 × 10-3, p = .02). Univariate analysis revealed age, aortic calcification, and hyperlipidemia to be significant factors of distensibility, and multiple regression analysis showed age as the only significant risk factor of distensibility. CONCLUSIONS: Patients with alkaptonuria have impaired aortic distensibility, which is likely an early marker for reduced cardiovascular health. Variables such as age, hypertension, hyperlipidemia, and aortic and coronary calcification were associated with impaired distensibility.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32354625

RESUMO

BACKGROUND: To investigate the performance of a reconstruction algorithm, single-energy metal artifact reduction (SEMAR), against standard reconstruction in cardiac computed tomography (CT) studies of patients with implanted metal and in a defibrillator lead phantom. METHODS: From a retrospective, cross-sectional clinical study with institutional review board approval of 118 patients with implanted metal, 122 cardiac CT studies from November 2009 to August 2016 performed on a 320-detector row scanner with standard and SEMAR reconstructions were included. The maximum beam hardening artifact radius, artifact attenuation variation surrounding the implanted metal, and image quality on a 4-point scale (1-no/minimal artifact to 4-severe artifact) were assessed for each reconstruction. A defibrillator lead phantom study was performed at different tube potentials and currents with both reconstruction methods. Maximum beam hardening artifact radius and average artifact attenuation variation were measured. RESULTS: In the clinical study, SEMAR markedly reduced the maximum beam hardening artifact radius by 77% (standard: 14.8 mm [IQR 9.7-22.2] vs. SEMAR: 3.4 mm [IQR 2.2-7.1], p < 0.0001) and artifact attenuation variation by 51% (standard: 130.0 HU [IQR 75.9-184.4] vs. SEMAR: 64.3 HU [IQR 48.2-89.2], p < 0.0001). Image quality improved with SEMAR (standard: 3 [IQR 2-3.5] vs. SEMAR: 2 [IQR 1-2.5], p < 0.0001). The defibrillator lead phantom study confirmed these results across varying tube potentials and currents. CONCLUSIONS: SEMAR reconstruction achieved superior image quality and markedly reduced maximum beam hardening artifact radius and artifact attenuation variation compared to standard reconstruction in 122 clinical cardiac CT studies of patients with implanted metal and in a defibrillator lead phantom study.

7.
Artigo em Inglês | MEDLINE | ID: mdl-32367189

RESUMO

Clinical use of cardiac cine CT imaging is limited by high radiation dose and low temporal resolution. To evaluate a low radiation dose, high temporal resolution cardiac cine CT protocol in human cardiac CT and phantom scans. CT scans of a circulating iodine target were reconstructed using the conventional single heartbeat half-scan (HS, approx. 175 ms temporal resolution) and the 3-heartbeat multi-segment (MS, approx. 58 ms) algorithms. Motion artifacts were quantified by the root-mean-square error (RMSE). Low-dose cardiac cine CT scans were performed in 55 subjects at a tube potential of 80 kVp and current of 80 mA. Image quality of HS and MS scans was assessed by blinded reader quality assessment, left ventricular (LV) free wall motion, and LV ejection rate. Motion artifacts in phantom scans were higher in HS than in MS reconstructions (RSME 188 and 117 HU, respectively; p = 0.001). Median radiation dose in human scans was 1.2 mSv. LV late diastolic filling was observed more frequently in MS than in HS images (42 vs. 26 subjects, respectively; p < 0.001). LV free wall systolic motion was more physiologic and had less error in MS than in HS reconstructions (sum-of-squared errors 34 vs. 45 mm2, respectively; p < 0.001), and LV peak ejection rate was higher in MS than in HS reconstructions (166 vs. 152 mL/s, respectively; p < 0.001). Cardiac cine CT imaging is feasible at a low radiation dose of 1.2 mSv. MS reconstruction showed improved imaging of rapid motion in phantom studies and human cardiac CTs.

8.
Sex Transm Dis ; 47(6): 389-394, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32421299

RESUMO

BACKGROUND: The resumption of sexual activity shortly after commencing treatment for sexually transmitted infections (STIs) is poorly described despite contributing to onward transmission. With azithromycin remaining an option for rectal Chlamydia trachomatis, resuming sex too early after treatment may contribute to antimicrobial resistance because of exposure of newly acquired STIs to subinhibitory concentrations. METHODS: Clinical and sexual behavioral data were collected from men participating in a trial assessing treatment efficacy for rectal chlamydia. Data were collected at recruitment and weekly for 3 weeks after commencing treatment. Outcome measures were resumption of any sexual activity or condomless receptive anal sex within 1, 2, or 3 weeks after commencing treatment. Generalized linear regression was used to calculate adjusted risk ratios (aRR) to identify associated factors. RESULTS: Almost 1 in 10 men (9.5%; 95% confidence interval [CI], 7.2-12.1) resumed condomless receptive anal sex within 1 week of commencing treatment. This was associated with current preexposure prophylaxis use (aRR, 3.4; 95% CI, 2.5-4.8]) and having 9 or more sexual partners in the last 3 months (aRR, 3.2; 95% CI, 1.6-5.0). Most men (75.0%; 95% CI, 71.3-78.5) resumed any sexual activity within 3 weeks; this was associated with a greater number of sexual partners (4-8 partners; aRR, 1.2; 95% CI, 1.1-1.5; ≥9 partners; aRR, 1.5; 95% CI, 1.3-1.7). CONCLUSIONS: Resuming condomless receptive anal sex early after treatment may facilitate onward transmission and promote antimicrobial resistance for STIs. Although azithromycin remains a treatment option, this analysis highlights the need for new health promotion messages regarding early resumption of sex and continued surveillance for antimicrobial resistance.

9.
Artigo em Inglês | MEDLINE | ID: mdl-32273241

RESUMO

BACKGROUND: Multiple appropriate use criteria (AUC) exist for the evaluation of coronary artery disease (CAD), but there is little data on the agreement between AUC from different professional medical societies. The aim of this study is to compare the appropriateness of coronary computed tomography angiography (CCTA) exams assessed using multimodality AUC from the American College of Cardiology Foundation (ACCF) versus the American College of Radiology (ACR). METHODS: In a single-center prospective cohort study from June 2014 to 2016, 1005 consecutive subjects referred for evaluation of known or suspected CAD received a contrast-enhanced CCTA. The primary outcome was the agreement of appropriateness ratings using ACCF and ACR guidelines, measured by the kappa statistic. A secondary outcome was the rate of obstructive CAD by appropriateness rating. RESULTS: Among 1005 subjects, the median (5-95th percentile) age was 59 (37-76) years with 59.0% male. The ACCF criteria classified 39.6% (n = 398) appropriate, 24.2% (n = 243) maybe appropriate, and 36.2% (n = 364) rarely appropriate. The ACR guidelines classified 72.3% (n = 727) appropriate, 2.6% (n = 26) maybe appropriate, and 25.1% (n = 252) rarely appropriate. ACCF and ACR appropriateness ratings were in agreement for 55.0% (n = 553). Overall, there was poor agreement (kappa 0.27 [95% confidence interval 0.23-0.31]). By both AUC methods, a low rate of obstructive CAD was observed in the rarely appropriate exams (ACCF 7.1% [n = 26 of 364] and ACR 13.5% [n = 34 of 252]). CONCLUSIONS: Compared to ACCF criteria, the ACR guidelines of appropriateness were broader and classified significantly more CCTA exams as appropriate. The poor agreement between appropriateness ratings from the ACCF and ACR AUC guidelines evokes implications for reimbursement and future test utilization.

10.
PLoS One ; 15(4): e0231547, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298328

RESUMO

BACKGROUND: The Victorian legislation prohibits sex workers from working when they have visible anogenital herpes or warts. The aim of this study was to determine the proportion of asymptomatic female sex workers (FSW) diagnosed with anogenital herpes or warts by genital examination. METHODS: We analysed all computerised medical records of consultations with FSW at the Melbourne Sexual Health Centre (MSHC) in 2018. All asymptomatic sex workers were offered screening sexually transmitted infections (STIs) and a genital examination to identify visible anogenital herpes or warts at MSHC. FSW consultations were categorised into either 'asymptomatic' or 'symptomatic' based on the presence of symptoms reported by the FSW to the triage nurse. The proportion of asymptomatic FSW diagnosed with visible anogenital herpes or warts during a routine screening examination was calculated. RESULTS: In 2018, 4055 consultations were provided to 1979 FSW. 3406 of these consultations were asymptomatic and all were examined by an experienced clinician for signs of STIs. Of these 3406 asymptomatic consultations, seven FSW (0.21%, 95% CI: 0.08% to 0.42%) were diagnosed with visible anogenital herpes and/or warts following a genital examination. Four were diagnosed with warts (0.12%, 95% CI: 0.03% to 0.30%), two with herpes (0.06%, 95% CI: 0.01% to 0.21%) and one with both herpes and warts (0.03%, 95% CI: 0.001% to 0.16%). CONCLUSION: Based on these data, approximately 500 asymptomatic FSW would need to be examined to identify one case of anogenital herpes or warts. Genital examinations consume considerable clinical resources, increase the duration of consultations and provide essentially no significant benefit to the mandated testing for gonorrhoea, chlamydia, HIV and syphilis. Our clinic will use self-collected samples and no longer examine FSW who are asymptomatic.

11.
Sex Transm Infect ; 96(4): 265-270, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32169881

RESUMO

BACKGROUND: Outbreaks of hepatitis A are being reported more commonly among men who have sex with men (MSM) globally. Australia has also reported a sharp increase in the number of cases of hepatitis A in 2017. This study aimed to determine the level of immunity to hepatitis A among MSM attending a large urban sexual health clinic in Victoria in the lead up to recent outbreak. METHODS: This was a retrospective audit of serological testing data from first-time MSM attendees at Melbourne Sexual Health Centre (MSHC) in Australia from 1 January 2012 to 31 December 2018. We determined the proportion of MSM who were tested and who had serological detection of hepatitis A IgG, stratified by age and calendar year. We used univariable and multivariable logistic regression to investigate factors associated with testing for and detection of hepatitis A IgG. RESULTS: There were 16 609 first-time MSM attendees at MSHC over the 7-year period, of which 9718 (59%, 95% CI 58% to 60%) were tested for hepatitis A IgG. There was a 2% annual increase in the proportion of men tested (from 60% in 2012 to 69% in 2018; OR=1.02, 95% CI 1.00 to 1.03, p=0.025). Men born outside of Australia/New Zealand, and younger men <30 years had higher odds of being tested. Of those tested, 44% (n=4304, 95% CI 43% to 45%) had hepatitis A IgG detected at their first visit, with no change over time (OR=1.01, 95% CI 0.99 to 1.03, p=0.210). Detection of hepatitis A IgG was associated with being aged 30 years or older (adjusted OR=2.06, 95% CI 1.89 to 2.24, p<0.001) or being born overseas versus Australia/New Zealand (AOR=1.21, 95% CI 1.11 to 1.31, p<0.001). CONCLUSION: Hepatitis A immunity among MSM remains below the estimated 70% required to prevent outbreaks. Measures including increased testing and higher vaccination coverage are needed to prevent outbreaks and to limit the number of cases and deaths.


Assuntos
Anticorpos Anti-Hepatite A/sangue , Hepatite A/imunologia , Homossexualidade Masculina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estudos Soroepidemiológicos , Vitória , Adulto Jovem
12.
J Clin Microbiol ; 58(5)2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32132192

RESUMO

Screening for Chlamydia trachomatis and Neisseria gonorrhoeae at the pharyngeal, urogenital, and anorectal sites is recommended for men who have sex with men (MSM). Combining the three individual-site samples into a single pooled sample could result in significant cost savings, provided there is no significant sensitivity reduction. The aim of this study was to examine the sensitivity of pooled samples for detecting chlamydia and gonorrhea in asymptomatic MSM using a nucleic acid amplification test. Asymptomatic MSM who tested positive for chlamydia or gonorrhoea were invited to participate. Paired samples were obtained from participants prior to administration of treatment. To form the pooled sample, the anorectal swab was agitated in the urine specimen transport tube and then discarded. The pharyngeal swab and 2 ml of urine sample were then added to the tube. The difference in sensitivity between testing of pooled samples and individual-site testing was calculated against an expanded gold standard, where an individual is considered positive if either pooled-sample or individual-site testing returns a positive result. All samples were tested using the Aptima Combo 2 assay. A total of 162 MSM were enrolled in the study. Sensitivities of pooled-sample testing were 86% (94/109; 95% confidence interval [CI], 79 to 92%]) for chlamydia and 91% (73/80; 95% CI, 83 to 96%) for gonorrhea. The sensitivity reduction was significant for chlamydia (P = 0.02) but not for gonorrhea (P = 0.34). Pooling caused 22 infections (15 chlamydia and 7 gonorrhoea) to be missed, and the majority were single-site infections (19/22). Pooling urogenital and extragenital samples from asymptomatic MSM reduced the sensitivity of detection by approximately 10% for chlamydia but not for gonorrhea.

14.
J Acquir Immune Defic Syndr ; 83(2): 99-102, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31929399

RESUMO

BACKGROUND: Sexual mixing between HIV-positive, HIV-negative, and pre-exposure prophylaxis (PrEP) users among men who have sex with men (MSM) is an important determinant of the incidence of infection. There have been very limited studies examining the patterns of sexual mixing in relation to HIV status and PrEP use in the era of PrEP. SETTING: Melbourne Sexual Health Centre (MSHC), Australia. METHODS: We included all MSM partnerships attending MSHC on the same day between 2011 and 2018. A chi-square trend test was used to examine the changes in the annual proportion of partnerships by HIV serostatus in 2011-2018 and by PrEP use in 2016-2018. RESULTS: Of the 1765 MSM partnerships who attended MSHC between 2011 and 2018, 1.3% of the partnerships were concordant HIV-positive, 91.0% were concordant HIV-negative, and 7.6% were HIV-discordant. The proportion of HIV-discordant partnerships increased from 0% in 2011 to 12.5% in 2018 (ptrend < 0.001). In 2016-2018, only a small proportion (1.2%) of concordant HIV-negative partnerships involved both men taking PrEP, whereas 6.0% involved at least one man taking PrEP. Overall, 79.1% of concordant HIV-negative partnerships were not protected against HIV (ie, neither man taking PrEP), and this proportion declined significantly from 84.3% in 2016 to 74.0% in 2018 (ptrend = 0.001). CONCLUSIONS: The pattern of sexual mixing by HIV status and PrEP use among MSM partnerships has changed over time. PrEP use in both men within MSM partnerships is not common. About 79% of concordant HIV-negative partnerships were not protected against HIV as neither man taking PrEP.


Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Comportamento Sexual , Parceiros Sexuais , Minorias Sexuais e de Gênero , Adulto , Austrália , Estudos Transversais , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Incidência , Masculino , Profilaxia Pré-Exposição/estatística & dados numéricos , Sexo Seguro/estatística & dados numéricos
15.
Sex Transm Infect ; 96(4): 246-250, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31919276

RESUMO

OBJECTIVE: In 2017, there was an outbreak of invasive meningococcal disease (IMD) serogroup C among men who have sex with men (MSM) in Victoria, Australia. A government-funded free meningococcal (MenACWY) vaccination programme targeting all MSM living in Victoria was launched between December 2017 and December 2018. The aim of this study was to examine the vaccine uptake among MSM attending a sexual health clinic in Melbourne. METHODS: This was a retrospective clinical audit of MSM attending the Melbourne Sexual Health Centre (MSHC) during the vaccination programme. We calculated the proportion of MSM who received the meningococcal vaccine on their first visit and at any time during the programme. We performed univariable and multivariable logistic regression to identify the factors associated with the vaccine uptake on the first visit. RESULTS: Of the 10 370 MSM who attended MSHC, 55.5% received the vaccine on their first visit and 67.4% at any time during the programme. MSM had higher odds of receiving the vaccine on the first visit if they were aged 16-25 years (adjusted OR (aOR) 1.21; 95% CI 1.08 to 1.35) or 26-35 years (aOR 1.17; 95% CI 1.07 to 1.29) in comparison with MSM older than 35 years; were HIV-negative and not on pre-exposure prophylaxis (aOR 1.80; 95% CI 1.56 to 2.09); had more than four male partners in the last 12 months (aOR 1.16; 95% CI 1.06 to 1.27); had male partners only (aOR 2.24; 95% CI 1.96 to 2.55); or were born overseas (aOR 1.11; 95% CI 1.03 to 1.21). CONCLUSIONS: Two-thirds of the MSM attending a sexual health clinic received at least one dose of meningococcal vaccine. The vaccination programme coincided temporally with a dramatic reduction in the incidence of IMD. Vaccination should be further promoted among MSM and men who have sex with both men and women.


Assuntos
Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Homossexualidade Masculina , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Vitória/epidemiologia , Adulto Jovem
16.
Sex Health ; 17(1): 53-60, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31928612

RESUMO

Background Sexually transmissible infections (STIs) are rising among female sex workers (FSW) in Australia. The rise might be explained by changes in sexual practices; however, there is limited behavioural data available. This study aimed to explore the current sexual practices among FSW in Melbourne. METHODS: This cross-sectional study was conducted among FSW at Melbourne Sexual Health Centre between September 2017 and March 2018. Participants were asked about current sexual practices with male clients in an average working week. The frequency and proportion of each sexual practice was calculated. RESULTS: There were 180 questionnaires included in the analysis. The median age of the FSW was 28 years (interquartile range [IQR]: 25-34). Most FSW (80.6%) worked in brothels. In an average working week, FSW had a median of 10 (IQR: 7-20) male clients. The most common sexual practices included: vaginal sex (98.3%), fellatio (97.2%), cunnilingus (92.2%) and tongue-kissing (83.7%). FSW had a median number of 10 (IQR: 6-18) vaginal, 10 (IQR: 5-18) fellatio, 7 (IQR: 2-10) cunnilingus and 6 (IQR: 2-10) tongue-kissing clients. Consistent condom use with all clients was highest for vaginal sex (97.1%), followed by anal sex (92.3%), then fellatio (78.9%). Only 3.1% used dental dams consistently for cunnilingus. CONCLUSION: Consistent condom use with all clients was high among FSWs, especially for vaginal and anal sex. However, one-fifth of FSW had condomless fellatio during an average working week. Tongue-kissing was more common than previously published. Peer-led sexual health education on safe sex practice for FSW is of high importance.

17.
Acad Radiol ; 27(3): 371-380, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31155485

RESUMO

OBJECTIVES: Consistent levels of coronary artery enhancement are essential for quantitative analysis of coronary artery plaque. We studied three contrast injection protocols for coronary CT angiography (CCTA) and compared mean attenuation level and consistency of vascular contrast enhancement. We hypothesized that test bolus adjusted protocols will have a superior consistency of coronary attenuation compared to a weight-based protocol. MATERIALS AND METHODS: We prospectively evaluated a standard test bolus injection protocol (protocol 1, 32 subjects) and an optimized test bolus injection protocol (protocol 2, 59 subjects) in comparison to a body weight-based injection protocol (60 subjects). The test bolus was diluted contrast (20%-30% iopamidol 370 mixed with normal saline); peak aortic attenuation was measured and used to calculate a specific water/contrast mixture for the CCTA. The mean attenuation of the coronary lumen was measured on CCTA. Metrics of optimum arterial enhancement included the percentage of patients within a predetermined range for coronary attenuation (325-500 HU) and optimal timing with maximal ascending aortic attenuation. In addition, interpatient variation in coronary enhancement was quantified as percentage standard deviation of the attenuation. RESULTS: The mean attenuation of the coronary arteries was similar in all protocols (362, 364, and 375 HU for the weight-based, test bolus 1 and 2 protocols, respectively). The percentage standard deviations of the weight-based, test bolus 1 and 2 protocols for coronary attenuation were 25.3%, 27.1%, and 10.5%, respectively (p < 0.0001). Test optimized bolus protocol 2 yielded the highest percentage of scans within the preferred coronary attenuation range (88%, p = 0.002). In test bolus protocol 2, the contrast timing was optimal in 73% of cases compared to only 22% of cases in the body mass guided injection protocol (protocol 1, p < 0.0001). CONCLUSION: An optimized test bolus guided injection protocol resulted in a marked reduction in variation in coronary enhancement for CCTA compared to a body weight-based injection protocol.

18.
JACC Cardiovasc Imaging ; 13(2 Pt 1): 425-434, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31202772

RESUMO

OBJECTIVES: The aim of this study was to assess the use of low tube potentials for coronary computed tomography angiography (CCTA) in worldwide clinical practice and its influence on radiation exposure, contrast agent volume, and image quality. BACKGROUND: CCTA is frequently used in clinical practice. Lowering of tube potential is a potent method to reduce radiation exposure and to economize contrast agent volume. METHODS: CCTAs of 4,006 patients from 61 international study sites were analyzed regarding very-low (≤80 kVp), low (90 to 100 kVp), conventional (110 to 120 kVp), and high (≥130 kVp) tube potentials. The impact on dose-length product (DLP) and contrast agent volume was analyzed. Image quality was determined by evaluation of the diagnostic applicability and assessment of the objective image parameters signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR). RESULTS: When compared with conventional tube potentials, low tube potentials were used in 56% of CCTAs (≤80 kVp: 9%; 90 to 100 kVp: 47%), which varied among sites from 0% to 100%. Tube potential reduction was associated with low-cardiovascular risk profile, low body mass index (BMI), and new-generation scanners. Median radiation exposure was lowered by 68% or 50% and median contrast agent volume by 25% or 13% for tube potential protocols of ≤80 kVp or 90 to 100 kVp when compared with conventional tube potentials, respectively (all p < 0.001). With the use of lower tube potentials, the frequency of diagnostic scans was maintained (p = 0.41), whereas SNR and CNR significantly improved (both p < 0.001). Considering BMI eligibility criteria, 58% (n = 946) of conventionally scanned patients would have been suitable for low tube potential protocols, and 44% (n = 831) of patients scanned with 90 to 100 kVp would have been eligible for very-low tube potential CCTA imaging of ≤80 kVp. CONCLUSIONS: This large international registry confirms the feasibility of tube potential reduction in clinical practice leading to lower radiation exposure and lower contrast volumes. The current registry also demonstrates that this strategy is still underused in daily practice. (PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 [PROTECTION-VI]; NCT02996903).

20.
Clin Imaging ; 59(2): 119-125, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31816538

RESUMO

PURPOSE: To evaluate the accuracy of cyst score measurements by standard high-resolution helical volume chest CT (HRCT) in patients with lymphangioleiomyomatosis (LAM), using a short z-length ultra-high resolution re-scan (UH re-scan) as the reference. In cystic lung diseases, cyst score is derived from CT scans and defined as the percentage of the total lung parenchymal volume occupied by cysts, a biomarker which measures the severity of the disease. METHODS: In a prospective study of 73 LAM patients, each patient received the standard HRCT chest scan and a short z-length UH re-scan. Cyst scores were acquired from both scans using a standard FDA-approved scoring software on the CT scanner. RESULTS: The limited UH re-scan resolved small cysts that were not resolved in the HRCT. The HRCT-derived cyst scores were on average 59.6% of the reference values from the UH re-scan (p = 4.7e-25). The amount of under-estimation by HRCT varied from patient to patient, with an inter-quartile range of 29.8% and standard deviation of 20.7%. The overall trend was more pronounced underestimation for patients with lower cyst scores. For patients whose reference cyst scores were below 15 (n = 29), the HRCT cyst scores were 46.9 ± 21.6% of reference values (p = 7.4e-12), while for the rest of the patients (n = 44) the HRCT cyst scores were 68.0 ± 15.3% of reference values (p = 1.2E-19). Reconstructing the HRCT images to the resolution of the UH re-scan further widened the spread of the discrepancy between HRCT and reference values due to increased image noise, and did not provide accurate cyst scores. CONCLUSION: Cyst scores derived from standard high-resolution helical volume chest CT significantly underestimates the percentage lung volume occupied by cysts. This inaccuracy needs to be taken into consideration when cyst score is used as part of the CT assessment of the patient's condition.


Assuntos
Linfangioleiomiomatose/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Idoso , Cistos/diagnóstico por imagem , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
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