Binge drinking, HIV/HPV co-infection risk, and HIV testing: Factors associated with HPV vaccination among young adults in the United States.

Human papillomavirus (HPV) is a common sexually transmitted infection. Binge drinkers often engage in HIV/HPV co-infection high-risk behaviors. We examined the association between binge drinking, HIV/HPV co-infection risk, HIV testing and HPV vaccination among young adults. Data from the 2017 Behavioral Risk Factor Surveillance System survey were examined. Participants (N = 430/450,016; 0.11%) were HPV vaccine-eligible young adults ages 18-26 years. Multivariable logistic regression examined the association between binge drinking in the past 30 days, HIV/HPV co-infection high-risk risk behaviors, HIV testing, and HPV vaccination (initiated/completed, unvaccinated) among young adults. Respondents were primarily cisgender (99.8%), non-Hispanic White (41.4%), employed (46.2%) or student (35.4%), and insured (68.2%). Most did not binge drink (55.2%). The majority did not engage in HIV/HPV co-infection high-risk risk behaviors (78.2%). More than one-half had never been tested for HIV (59%) nor vaccinated against HPV (60.6%). Although binge drinkers (44.8%) were significantly more likely to engage in HIV/HPV co-infection high-risk behaviors (OR = 2.1; 95% CI: 1.0-4.5), binge drinking was not positively associated with HIV testing (OR = 0.98; 95% CI: 0.63-1.53). After adjusting for demographics and HIV/HPV co-infection high-risk behaviors, one (aOR = 2.71; 95% CI: 1.11-6.65) and two episodes (aOR = 3.05; 95% CI: 1.26-7.41) of binge drinking in the past 30 days were significantly associated with HPV vaccination uptake. Positive associations between HPV vaccination and participants having an HIV test in 2017 (aOR = 3.86; 95% CI: 1.42-10.55) and before 2017 (aOR = 2.62; 95% CI: 1.23-5.56) were also statistically significant. Because young adult binge drinkers are more likely to engage in HIV/HPV co-infection high-risk behaviors, promoting HPV vaccination and HIV testing are important public health objectives.

Inappropriate Intensive Care Unit admissions: Nigerian doctors' perception and attitude.

BACKGROUND: Nonclinical factors are said to influence decisions to admit patients into the Intensive Care Unit (ICU). We therefore assessed the perception and attitude of Nigerian doctors working in the ICU about inappropriate admissions and request for admission in the setting of a full ICU. METHODS: An anonymous, self-administered questionnaire survey was carried out among doctors working in the ICU of 17 University Teaching Hospitals, in Nigeria. A score of 0 (least usual reason) to 5 (most usual reason) was ascribed to some factors that can influence ICU admission. In addition, each of the 4 possible actions in the setting of a full ICU was graded from 0 (least likely) to 5 (most likely). The result was analyzed as appropriate. RESULTS: Sixty-four doctors participated in the survey. Inappropriate admissions were acknowledged by 96% of respondents. Perceived reasons included pressure from superiors (93.7%), referring clinicians (89.1%), and hospital management (87.5%). If confronted with request for admission in the setting of a full ICU, respondents will arrange for the discharge of fit ICU patients to the ward (95.3%), transfer patients not receiving acute care to high dependency unit or recovery room (70.3%), or create additional ICU beds (42.2%). Chi-square test showed a significant difference between single and married respondents with regard to clinical doubt (P = 0.01) and pressure from referring clinician (P = 0.02) as reasons for inappropriate admission. Respondents' gender, marital status, professional activity, and number of ICU admissions per year did not affect possible steps in the setting of a full ICU. CONCLUSION: Inappropriate ICU admissions were perceived as a common event and were mainly attributed to pressure from seniors, referring clinicians, and hospital management. Further work is necessary to determine the impact of such admissions on ICU efficiency.

Evaluation of pedestrian road traffic maxillofacial injuries in a Nigerian tertiary hospital.

UNLABELLED: Background: Walking is the most basic form of mobility and forms an important part of daily activities; however, walking could often be associated with risks. This is more so when pedestrians share a common space with motorized vehicles especially in developing countries. Despite the frequency of road traffic crashes (RTC) related pedestrian injuries in many developing countries, there is a dearth of documentation of maxillofacial injuries in victims of pedestrian road traffic crashes. The aim of this study was to determine the causes, frequency, pattern, severity, concomitant injuries and outcome of pedestrian maxillofacial injuries observed at a tertiary trauma centre in Nigeria. METHOD: Pedestrian victims of RTC were prospectively recruited from among all maxillofacial trauma patients seen at the Accident and Emergency department and the Department of Oral and Maxillofacial Surgery of the University College Hospital, Ibadan between April 2011 and November 2011. Ethical approval was obtained from the UI/UCH Joint Ethics Review Board before the commencement of the study and informed consent was obtained from participants. Patients' demography, the crash events, types of maxillofacial injuries, and concomitant injuries were recorded. Severity of maxillofacial injury was estimated based on the Maxillofacial Injury Severity Scale (MFISS). RESULTS: Forty-six participants (22.9% of all victims of road traffic crashes seen within the study period) were victims of pedestrian RTC. Pedestrian RTC occurred in all age groups with almost 40% of the victims in their 1st and 2nd decades of life. The most severe MFISS was observed in the 21 - 30 year age group while the least severe injury observed was in the 71 - 80 years age group. Thirty participants (65.2%) were hit by a car or minibus while fourteen (30.4%) were knocked down by a motorcycle. Two (4.4%) were hit by a truck. Soft tissue injury was the most common maxillofacial injury and head injury was the commonest concomitant injury observed. The median MFISS score of victims of motorcycle was 4.0 while the median scores for victims of car/minibus pedestrian RTC was 9.0. The most severe maxillofacial injury was seen in victim of car/minibus pedestrian crashes. Seventeen percent (8) of the victims had a fatal outcome. Conclusion: Pedestrian RTC resulting in maxillofacial injuries are common in the studied environment. It is particularly common among the 11 -20 year age group and victims are usually hit by cars/minibuses. These injuries are often severe and fatal outcome is not infrequent. Therefore, definitive preventive measures are imperative.

Incorporating point-of-care ultrasound into daily intensive care unit rounds: Another source of interruptions?

Point-of-care ultrasound (POCUS) is the use of bedside ultrasonography by the treating clinician, incorporating those images into direct clinical decisions. While there are a number of different techniques and training pathways in this relatively new modality, there has been little discussion around the logistics of integrating POCUS into the standard critical care "business day" of ward rounds, procedures and meetings. This article explores some of these aspects and presents data from an online survey of POCUS practitioners.

Phosphorylation of threonine 156 of the mu2 subunit of the AP2 complex is essential for endocytosis in vitro and in vivo.

The clathrin-coated pit is the major port of entry for many receptors and pathogens and is the paradigm for membrane-based sorting events in higher cells [1]. Recently, it has been possible to reconstitute in vitro the events leading to assembly, invagination, and budding off of clathrin-coated vesicles, allowing dissection of the machinery required for sequestration of receptors into these structures [2-6]. The AP2 adaptor complex is a key element of this machinery linking receptors to the coat lattice, and it has previously been reported that AP2 can be phosphorylated both in vitro and in vivo [7-10]. However, the physiological significance of this has never been established. Here, we show that phosphorylation of a single threonine residue (Thr156) of the mu2 subunit of the AP2 complex is essential for efficient endocytosis of transferrin both in an in vitro coated-pit budding assay and in living cells.

Curcumin and hydroxamate-derivative (PCI-34058) interfere with histone deacetylase I catalytic core Asp-His charge relay system: atomistic simulation studies.

Histone deacetylases (HDACs) are representative targets for the natural and synthetic chemicals used to transform cells to confer antitumor properties. In the current study, curcumin and hydroxamate-derivative PCI-34058-bound HDAC1 were subjected to atomistic simulation. The results support the view that fitting of curcumin and PCI-34058 within the HDAC1 pocket depends on extensive interactions between the aromatic moieties of the inhibitors and the extensive network of aromatic amino acid side chains lining the pocket of HDAC1. The interaction forces a local perturbation of the coiled structures connecting the pocket residues resulting in ligand-induced tightening of the pocket. In addition to the competitive occupancy of the histone-acetyl-lysine binding pocket by the inhibitors, interference with the in-pocket aspartate-histidine (ASP-HIS) charge relay system was also observed in inhibitor-bound HDAC1 systems. In conclusion, curcumin and PCI-34058-mediated ligand-dependent HDAC1 tunnel closure interferes negatively with the ASP-HIS charge relay system in HDAC1. Future design of HDAC inhibitors may benefit from optimizing competitive interaction with the ligand site and interference with the charge relay system.

Transfer of low level trimethoprim resistance in faecal isolates obtained from apparently healthy Nigerian students.

Twenty-four of 63 enteric Gram-negative organisms (38.1%) which were isolated from 35 apparently healthy Nigerian students were found to have low trimethoprim resistance (MIC less than 1000 mg/l). These isolates were also found to be resistant to several other antibiotics and trimethoprim resistance was found to be transferable from 15 (62.5%) of the trimethoprim resistant organisms into E. coli EC 1005. It is likely that the high percentage of trimethoprim resistance encountered in this study is related to the high rate of resistance transfer which was observed.

A long-term study of the nasal carriage of Staphylococcus aureus in healthy Nigerian students.

892 nasal swabs were collected from 50 pharmacy students (25 male and 25 female) over a period of 15 months. 323 (36.2%) contained Staphylococcus aureus and analysis of the results showed that 19 (38%) of the subjects were true nasal carriers of S. aureus, 23 (46%) were non-carriers, and the other 8 (16%) were sporadic non-carriers. 84% of the 162 isolates tested were resistant to penicillin and 58% were resistant to tetracycline.

Antibody prevalence against rubella among hospital personnel in Nigeria: implications for health care system and immunisation policy.

Among 385 sera from Nigerian hospital personnel aged 15-39 years, 289 (75%) had an antibody titer corresponding to immunity against rubella, compared with 346 (90%) of the sera from Swedish women of the same age group. The frequency of high immune level against rubella did not change with age among Nigerians compared with a decrease in immunity with increasing age in the Swedish individuals. This probably is due to the differences between the dynamics of the development of natural immunity and immunity acquired through vaccination. In Nigeria, socio-economic factors were related with the degree of immune responses while sex was not. The results highlight the importance of immunization among hospital personnel and eventual vaccination of the whole population in Nigeria and the continuous surveillance of rubella immunity and periodic re-evaluation of immunization policies.

Rotavirus as an aetiological agent of acute childhood diarrhoea in Ile-Ife, Nigeria.

Of the 456 urban children aged 14 days and 4 years examined for rotavirus in this study, 376 had diarrhoea while 80 were without diarrhoea and serve as control. Among the 376 diarrhoeic children, 57 (15.2%) had rotavirus while none of the 80 control children had the virus. Rotavirus was significantly higher (p less than 0.05) among the in-patients (19.8%) than in the out-patients (10.3%) and among children of 7-12 months compared with other aged groups. The majority of the children that had the rotavirus lived in areas without pipe-borne water and similarly belonged to the low-socio-economic level. It is therefore possible to deduce from this work that rotavirus is still a major aetiology of acute childhood diarrhoea in Nigeria and its incidence can be affected by hygienic practices, the environment and socio-economic level.

Occurrence of toxic shock syndrome toxin-1 producing Staphylococcus aureus and the anti TSST-1 serostatus of hospital personnel in Nigeria.

Of the 56 S. aureus strains tested, five (8.9%) isolates (four from asymptomatic nasal carriage and one from a non TSS staphylococcal disease) demonstrated TSST-1 production in vitro. Among the toxin positive strains the clinical isolate belonged to phage group I, 29/52 and the nasal carriage isolates were either non typable or ungroupable. Eighty-nine percent of isolates including all TSST-1 positive strains showed binding to crystal violet and were traced to S. aureus var. hominis (CV type C/D). A. aureus var. bovis (CV type A/B) were found only in nasal carriage group (10.7%) and did not bind crystal violet. During the sero-surveillance 101 out of 220 hospital personnel (48.1%) showed TSST-1 antibodies of IgG class at 1:1000 sera dilution. The four individuals with asymptomatic nasal carriage of TSST-1 positive staphylococci showed no antibody to the toxin. Anti TSST-1 levels persisted in 58 (57.4%) and 10 (9.9%) individuals at higher sera dilutions of 10(-4) and 10(-5) respectively.

Asymptomatic significant bacteriuria among pregnant and non-pregnant women in Sagam, Nigeria.

In a study carried out among 510 pregnant and 304 non-pregnant women at Ogun State University Teaching Hospital, Sagamu, 122 (23.9 pc) of the pregnant women and 37 (2.2 pc) of the non-pregnant women had significant bacteriuria. The rate amongst the pregnant women was significantly higher than in non-pregnant women (P < 0.001). There was a correlation between pyuria and significant bacteriuria in 45 (8.8 pc) of the pregnant women and in 11 (3.6 pc) of the non-pregnant women. Significant bacteriuria was closely associated with nulliparae. Most of the pregnant women with significant bacteriuria belonged to the low socio-economic group. Unlike in previous studies in this country, the most prevalent organism in this study was the Staphylococcus aureus.

Carriage of Staphylococcus aureus among hospital personnel in a Nigerian hospital environment.

Among the 395 hospital staff examined during this study, 35.2pc of them were found to carry S. aureus in their anterior nares. The carriage was slightly higher in females (35.8pc) compared with 34.4pc in males, although it was not statistically significant. When the different age groups and professions were considered, the carriage was highest among the age group of 21-30 years and with the Nursing staff, who incidentally, are closest to the patients and had the highest number among the staff members examined. The carrier rate was also significantly higher (P less than 0.05) among staff members who had worked in the hospital for 7-10 months compared with other staff. There was a good correlation (97pc) between coagulase positivity and mannitol fermentation, while Methicillin, Claforan and Gentamycin were found to be very effective against most of the isolates. On re-examination of those staff members who ar closely associated with the patients two years after the initial exercise in 1987, it was evident that a significant number (P less than 0.05) of those carriers of Staph aureus in our hospital are not persistent ones.

Childhood carriers of Salmonella and Shigella species in the rural area of Ile-Ife, Nigeria.

Four hundred and eight apparently healthy school children from rural primary schools in Ile-Ife were examined for the prevalence of Salmonella and Shigella species, which were found respectively in 2% and 3.2% of these children. The prevalence of the organisms decreased as the age of the children increased. Salmonella species were found only in specimens from boys while Shigella species occurred in both sexes and were more prevalent among females. No specimen contained both organisms. Only one of the 12 different sources of well and rain water used for domestic purposes in the rural areas where the children examined lived contained Salmonella species, and none contained any species of Shigella or faecal E. coli.

Biosocial factors in maternal mortality--a study from a Nigerian mission hospital.

A survey of deaths occurring in women in association with pregnancy and childbirth was carried out in a large mission hospital in Benin City, Nigeria, with a view to identifying the underlying biosocial factors that influence such deaths. Age, parity, booking status, level of educational attainment and socio-economic status were all found to be important variables statistically affecting maternal death risks. No significant association was found in the study between maternal death risks and other social variables such as marital status, distance of home from hospital and ethnic origin of pregnant women. Maternal deaths were shown to be an index of the socio-economic standards in any society, and measures to lower the present high rates of maternal mortality in Nigeria and other developing countries through a manipulation of these biosocial factors were highlighted.

Acute bacterial meningitis in children.

A retrospective study of 48 children with pyogenic meningitis who were admitted between January 1986 and December, 1987 at the Ogun State University Teaching Hospital, Sagamu has shown that childhood meningitis is an important health problem in the community as it accounted for 2.8% of 1,724 admissions into the paediatric ward. The ages of the patients ranged from three weeks to twelve years with a mean of 2 1/2 years. The commonest causative organism was Streptococcus pneumoniae which accounted for 67.5% of all isolates. The mortality rate was 26.1% while significant morbidity occurred in 23.5% of survivors. Important prognostic factors included the presence of coma or persistent convulsions, low CSF glucose and low serum sodium levels as well as the interval between symptoms and treatment.

Asymptomatic significant bacteriuria among pregnant and non-pregnant women in Sagamu, Nigeria.

In a study carried out among 510 pregnant and 304 non-pregnant women at Ogun State University Teaching Hospital, Sagamu, 122 (23.9%) of the pregnant women and 37 (12.2%) of the non-pregnant women had significant bacteriuria. The rate amongst the pregnant women was significantly higher than in non-pregnant women (P < 0.001). There was a correlation between pyuria and significant bacteriuria in 45 (8.8%) of the pregnant women and in 11 (3.6%) of the non-pregnant women. Significant bacteriuria was closely associated with nulliparae. Most of the pregnant women with significant bacteriuria belonged to the low socioeconomic group. Unlike in previous studies in this country, the most prevalent organism in this study was the Staphylococcus aureus. In view of the high incidence of the problem in this environment, it is important that routine screening of urine for significant bacteriuria should be part of our ante-natal clinic services at least on the first visit of pregnant women to ante-natal clinics.

Influence of mucin on serum and connective tissue protein binding to Staphylococcus aureus isolated from nasal carriage and clinical sources.

A total of 89 Staphylococcus aureus strains were tested for [125I]-labelled fibronectin (Fn), type I (Cn-I), type II (Cn-II), type IV (Cn-IV) collagens and laminin (Lm) binding, and nasal carriage isolates (54 strains) demonstrated higher degree of interaction than clinical isolates (35 strains). Strains belonging to nasal carriage group, after preincubation with mucin demonstrated a significant decline in binding to Fn (39.4%), Cn-I (44.7%), Cn-IV (42.0%) and Lm (43.5%) compared with inhibition of binding of clinical isolates to Fn (13.3%), Cn-I (8.0%), Cn-IV (9.8%) and Lm (11.2%). S. aureus strain Nig-6 demonstrated a mucin concentration (in the range 0.01 to 100 mg/ml) dependent decrease of [125I]-labelled serum and connective tissue protein binding. Mucin concentrations of 100, 150, 175 and 250 micrograms/ml when incubated with 10(9) cells, caused 50% displacement of [125I]-labelled Lm, Cn-I, Cn-IV and Fn uptake respectively. Mucin interaction with bacterial cells seems probably important in the pathomechanism of staphylococcal adhesion and colonization.