Migratory Gaddi sheep and goats as potential carriers of Theileria infection: a molecular survey.

Theileriosis caused by parasites of the genus Theileria, is a vector-borne haemoprotozoan parasitic disease of critical concern in small ruminants. This study aimed to explore the infection status of migratory Gaddi sheep and goats with parasites from the Theileria genus in concurrence with ectoparasite infestations using molecular methods. Seventy three apparently healthy animals were randomly sampled from different flocks of migratory Gaddi sheep and goats and were systematically screened for ectoparasitic infestations. Molecular investigation for theileriosis was conducted using the genus wide polymerase chain reaction (PCR) technique. Out of 56 (76.71%) animals positive for the genus Theileria, 2 randomly selected amplicons were sequenced and subjected to BLAST analysis and were showing 99.71% identity with Theileria luwenshuni, a pathogenic Theileria species of small ruminants. To confirm the presence of T. luwenshuni, species-specific PCR was attempted to identify that 38 (52.05%) animals were infected by T. luwenshuni. On analysing the molecular prevalence data of Theileria to the ectoparasitism, it was evident that the infection existed in the animals irrespective of the type of ectoparasitic infestation and even T. luwenshuni was found in non-infested animals also. This is the first report of subclinical infections of T. luwenshuni in sheep and goats of Northern India and its potential carrier status. The asymptomatic carrier status of these nomadic animals is a matter possessing serious implications on the disease transmission rates and the production economics of small ruminant production in this region.

Ethnicity and sexual risk in heterosexual people attending sexual health clinics in England: a cross-sectional, self-administered questionnaire study.

OBJECTIVES: In the UK, people of black ethnicity experience a disproportionate burden of HIV and STI. We aimed to assess the association of ethnicity with sexual behaviour and sexual health among women and heterosexual men attending genitourinary medicine (GUM) clinics in England. METHODS: The Attitudes to and Understanding of Risk of Acquisition of HIV is a cross-sectional, self-administered questionnaire study of HIV negative people recruited from 20 GUM clinics in England, 2013-2014. Modified Poisson regression with robust SEs was used to calculate adjusted prevalence ratios (aPR) for the association between ethnicity and various sexual risk behaviours, adjusted for age, study region, education and relationship status. RESULTS: Questionnaires were completed by 1146 individuals, 676 women and 470 heterosexual men. Ethnicity was recorded for 1131 (98.8%) participants: 550 (48.6%) black/mixed African, 168 (14.9%) black/mixed Caribbean, 308 (27.2%) white ethnic groups, 105 (9.3%) other ethnicity. Compared with women from white ethnic groups, black/mixed African women were less likely to report condomless sex with a non-regular partner (aPR (95% CI) 0.67 (0.51 to 0.88)), black/mixed African and black/mixed Caribbean women were less likely to report two or more new partners (0.42 (0.32 to 0.55) and 0.44 (0.29 to 0.65), respectively), and black/mixed Caribbean women were more likely to report an STI diagnosis (1.56 (1.00 to 2.42)). Compared with men from white ethnic groups, black/mixed Caribbean men were more likely to report an STI diagnosis (1.91 (1.20 to 3.04)), but did not report risk behaviours more frequently. Men and women of black/mixed Caribbean ethnicity remained more likely to report STI history after adjustment for sexual risk behaviours. DISCUSSION: Risk behaviours were reported less frequently by women of black ethnicity; however, history of STI was more prevalent among black/mixed Caribbean women. In black/mixed Caribbean men, higher STI history was not explained by ethnic variation in reported risk behaviours. The association between STI and black/mixed Caribbean ethnicity remained after adjustment for risk behaviours.

How and why do South Asians attend GUM clinics? Evidence from contrasting GUM clinics across England.

BACKGROUND: Improving access to sexual healthcare is a priority in the UK, especially for ethnic minorities. Though South Asians in the UK report low levels of sexual ill health, few data exist regarding their use of genitourinary medicine (GUM) services. OBJECTIVES: To describe reasons for attendance at GUM clinics among individuals of South Asian origin relative to patients of other ethnicities. METHODS: 4600 new attendees (5% South Asian; n=226) at seven sociodemographically and geographically contrasting GUM clinics across England completed a questionnaire between October 2004 and March 2005, which were linked to routine clinical data. RESULTS: South Asians were more likely than other groups to be signposted to the GUM clinic by another health service-for example, in women 14% versus 8% respectively (p=0.005) reported doing so from a family planning clinic. These women also reported that they would be less likely to go to the clinic if their symptoms resolved spontaneously compared with other women (51% vs 31%, p=0.024). However, relative to other clinic attendees, no differences in the proportions of South Asians who had acute STI(s) diagnosed at clinic were noted. Furthermore, South Asian men were more likely to report as their reason for attendance that they wanted an HIV test (23.4% vs 14.8%, p=0.005). CONCLUSION: Despite having similar STI care needs to attendees from other ethnic groups, South Asians, especially women, may be reluctant to seek care from GUM clinics, especially if their symptoms resolve. Sexual health services need to develop locally-delivered and culturally-appropriate initiatives to improve care pathways.

Cervical surveillance in HIV-positive women: a genitourinary medicine clinic experience.

BACKGROUND: The prevalence of cervical intraepithelial neoplasia (CIN) is increased in HIV infection. The UK National Health Service Cervical Screening Programme (NHSCSP) guidelines therefore provide specific recommendations for HIV-positive women. An audit of cervical surveillance in HIV-positive women who attend the genitourinary medicine (GUM) department at the Leicester Royal Infirmary, Leicester, UK was conducted. The objectives were to assess adherence to UK and local screening guidelines, prevalence of cervical pathology and appropriate referral for colposcopy. METHODS: A retrospective case note review of 130 HIV-infected women attending the GUM department between January 2000 and December 2005 was undertaken. RESULTS: Results showed that 76.2% of patients had cervical cytology within a year of HIV diagnosis and 42.4% of patients had abnormal cytology. All patients with dyskaryosis were referred for colposcopy according to local and national guidelines. Cytology results were consistent with histological findings and the prevalence of CIN was 15.2%. CD4 counts at presentation were significantly lower in those with dyskaryosis compared with those without dyskaryosis (p = 0.038). Twenty-two patients were lost to follow-up after initial cytology. DISCUSSION AND CONCLUSIONS: A designated health advisor in the GUM department co-ordinates cervical surveillance in HIV-positive women. This, together with an increasingly integrated service with family planning services, may contribute to relatively successful surveillance. Overall, patients are carefully monitored to ensure that surveillance is adequate. Extra vigilance is, however, required and further cost-effective measures in future may include more active involvement of general practitioners.

Antioxidative activity and protein profile of skim milk of Gaddi goats and hill cattle of North West Himalayan region.

AIM: This study was aimed at evaluation of antioxidative activity, protein profile, and vitamins content of milk of Gaddi goats, local non-Gaddi goats, hill cattle, and Jersey crossbred cattle. MATERIALS AND METHODS: Total phenol, antioxidant activity measured as 2, 2-diphenyl- 1-picrylhydrazyl radical scavenging capacity, total protein, and vitamins were estimated in milk samples by spectrophotometric methods. Milk protein profiles were studied by sulfate-polyacrylamide gel electrophoresis. RESULTS: Total phenol, antioxidant activity, and total protein were higher in indigenous hill cattle skim milk. Average protein content in raw skimmed milk was 1.33±0.01, 1.03±0.02, 0.76±0.05, and 0.81±0.01%, in indigenous hill cattle, Jersey crossbred cattle, non -Gaddi goat, and Gaddi goat, respectively. Three proteins of 19.01, 22.08, and 32.96 kDa were observed in Gaddi goat, but not in non -Gaddi goat skim milk. Furthermore, the above proteins were absent in cattle skim milk. Two proteins of 15.56 and 25.06 kDa were found in local hill and crossbred cattle skimmed milk, but were absent in goat skimmed milk. Vitamin C content was the lowest in Gaddi goat milk and the highest in Jersey crossbred cattle milk. CONCLUSION: It is envisaged that bioactive metabolites in the milk of Gaddi goats and hill cattle might offer anti-aging and beneficial health effects.

UK National Audit of chlamydial infection management in sexual health clinics. case notes audit: information-giving, partner notification and follow-up.

Verbal information-giving is good, but only half of cases were reportedly given written information on chlamydia. Follow-up by 'phoning or texting (43%) was as common as follow-up in clinics (39%). About one-fourth of cases did not have follow up, with no recall for around 60% of these cases. Advice about partner notification (PN) was provided by a health adviser or other suitably trained health professional to 91% of cases, and the method of PN was documented for 92% of these cases. PN outcome was not documented for about 25% of these cases. There was no information on the chlamydial status of sexual contacts of about half of cases, and no information about the treatment status of sexual contacts of about 40% of cases. The average number of contacts screened per index was 0.52 outside London and 0.29 for the London Regions, levels below those suggested in the National Guideline.

UK National Audit of chlamydial infection management in sexual health clinics. clinic policies audit.

There was a wide range of activity and chlamydial diagnoses between the 177 clinics that responded. Most (92%) clinics have nucleic acid tests for chlamydial diagnosis. Different practitioners largely share roles in providing advice to patients about partner notification, treatment adherence, safer sex advice and abstinence. Most (97%) clinics have information leaflets about chlamydia, although about 30% of clinics lack leaflets containing information about antibiotics and hormonal contraception. About two-third clinics follow the National Guideline recommended interval for providing a test of cure where this is indicated. Only 18% of clinics routinely ask patients to reattend, with 40% having a policy of no routine follow-up and 62% using telephone or text follow-up. These categories were not mutually exclusive. Most (86%) of the 146 English clinics had a local Chlamydia Screening Programme coordinator for their Primary Care Trust area, although cooperation varies, with cooperation over treatment of 70% and Programme policy of 62%.

UK National Audit of chlamydial infection management in sexual health clinics. case notes audit: demography, diagnosis and treatment.

The case notes of cases of genital chlamydial infection were audited against the UK National Guideline. This was the first web-based and the largest national audit to date, with 193 clinics in all UK Regions contributing data. About half of all cases had no symptoms, with about one-third attending for routine or asymptomatic screens; suggesting significant provision of screening by clinics that might be managed differently to reduce workload. Nucleic acid amplification tests (NAATs) are now well established for chlamydial detection in UK clinics, with 93% of cases having genital NAATs. Azithromycin is now more commonly used than doxycycline (54% vs. 37%). Of 26 pregnant women, 20 were treated with azithromycin, suggesting that most prescribers treating pregnant women consider that erythromycin is not an adequate alternative to azithromycin. Most women had NAATs obtained from sites recommended by the Guideline, with 93% of women who had genital NAATs having these from the cervix or vulvovaginal area.

A Cross-Sectional Study on Attitudes to and Understanding of Risk of Acquisition of HIV: Design, Methods and Participant Characteristics.

BACKGROUND: The annual number of new human immunodeficiency virus (HIV) infections in the United Kingdom among men who have sex with men (MSM) has risen, and remains high among heterosexuals. Increasing HIV transmission among MSM is consistent with evidence of ongoing sexual risk behavior in this group, and targeted prevention strategies are needed for those at risk of acquiring HIV. OBJECTIVE: The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study was designed to collect information on HIV negative adults at risk of HIV infection in the United Kingdom, based on the following parameters: physical and mental health, lifestyle, patterns of sexual behaviour, and attitudes to sexual risk. METHODS: Cross-sectional questionnaire study of HIV negative or undiagnosed sexual health clinic attendees in the United Kingdom from 2013-2014. RESULTS: Of 2630 participants in the AURAH study, 2064 (78%) were in the key subgroups of interest; 580 were black Africans (325 females and 255 males) and 1484 were MSM, with 27 participants belonging to both categories. CONCLUSIONS: The results from AURAH will be a significant resource to understand the attitudes and sexual behaviour of those at risk of acquiring HIV within the United Kingdom. AURAH will inform future prevention efforts and targeted health promotion initiatives in the HIV negative population.

A randomized comparative trial of continued abacavir/lamivudine plus efavirenz or replacement with efavirenz/emtricitabine/tenofovir DF in hypercholesterolemic HIV-1 infected individuals.

BACKGROUND: Drug choice and metabolic changes with antiretroviral therapy contribute to cardiovascular risk in persons with HIV-1 infection. METHODS: A randomized, 12 week, open-label, comparative study of the impact on lipids of continuation of abacavir/lamivudine (ABC/3TC) plus efavirenz (EFV) or replacement with the single tablet regimen of EFV/emtricitabine/tenofovir DF (EFV/FTC/TDF) in hypercholesterolaemic subjects on successful antiretroviral therapy, with a 12-week extension with all subjects on EFV/FTC/TDF. RESULTS: 157 subjects received study drug, 79 switched to EFV/FTC/TDF and 78 subjects continued ABC/3TC+EFV. At Week 12, 73 subjects on ABC/3TC+EFV switched to EFV/FTC/TDF. The switch was well tolerated and no subject experienced viral rebound. Median baseline fasting total cholesterol was 6.32 mmol/L. 12 weeks following switch, the difference in the means (LSM) between treatment groups (EFV/FTC/TDF minus ABC/3TC+EFV) in total cholesterol change from baseline was -0.74 mmol/l (95% CI -1.00, -0.47, p < 0.001). The median change from baseline in total cholesterol following switch in the EFV/FTC/TDF arm was -0.86 mmol/l (p < 0.001) compared with +0.01 mmol/l (p = 0.45) in the continuation arm at Week 12. Significant (p < 0.001) differences between treatment groups following switch were seen for all lipid fractions from baseline to Week 12: LDL cholesterol (-0.47 mmol/L [-0.70, -0.25]), HDL cholesterol (-0.15 mmol/L [-0.21, -0.08]), triglycerides (-0.43 mmol/L [-0.75, -0.11]), and non HDL cholesterol (-0.56 mmol/L [-0.80, -0.31]). In the extension phase, similar declines in total cholesterol were observed with a median change from Week 12 to Week 24 of -0.73 mmol/L (p < 0.001). CONCLUSIONS: Switching from ABC/3TC+EFV to EFV/FTC/TDF in persons with hypercholesterolemia maintains virological control and significantly improves key lipid parameters. TRIAL REGISTRATION: ClinicalTrials.gov NCT00615810.

New hopane triterpenes and antioxidant constituents from Potentilla fulgens.

Phytochemical investigation of the aerial parts of Potentilla fulgens L. led to the isolation of two new triterpenes, potentene A (1) and potentene B (2). In addition, three known compounds afzelchin-4alpha --> 8"-catechin (3), epiafzelchin (4) and rutin (5) were isolated. The structures of all these compounds were elucidated by extensive spectroscopic and chemical evidence. Compounds 3, 4, and 5 exhibited significant 1,1,diphenyl-2-picrylhydrazyl radical scavenging activity, with IC50 values of 1.21, 2.88 and 5.20 mg/mL, respectively; the known standard antioxidant, vitamin C, had a value of 0.44 mg/mL.

How much do delayed healthcare seeking, delayed care provision, and diversion from primary care contribute to the transmission of STIs?

OBJECTIVES: To quantify the contribution of patient delay, provider delay, and diversion between services to delayed access to genitourinary medicine (GUM) clinics. To describe the factors associated with delay, and their contribution to STI transmission. METHODS: Cross-sectional survey of 3184 consecutive new patients attending four GUM clinics purposively selected from across England to represent different types of population. Patients completed a short written questionnaire that collected data on sociodemographics, access, and health-seeking behaviour. Questionnaires were then linked to routinely collected individual-level demographic and diagnostic data. RESULTS: Patient delay is a median of 7 days, and does not vary by demographic or social characteristics, or by clinic. However, attendance at a walk-in appointment was associated with a marked reduction in patient delay and provider delay. Among symptomatics, 44.8% of men and 58.0% of women continued to have sex while awaiting treatment, with 7.0% reporting sex with >1 partner; 4.2% of symptomatic patients reported sex without using condoms with new partner(s) since their symptoms had begun. Approximately 25% of all patients had already sought or received care in general practice, and these patients experienced greater provider delay. CONCLUSIONS: Walk-in services are associated with a reduction in patient and provider delay, and should be available to all populations. Patients attending primary care require clear care pathways when referred on to GUM clinics. Health promotion should encourage symptomatic patients to seek care quickly, and to avoid sexual contact before treatment.