1.  Peer Reviewed Title: Diarrhoeagenic Escherichia coli are not a significant cause of diarrhoea in hospitalised children in Kuwait. Author: Albert MJ; Rotimi VO; Dhar R; Silpikurian S; Pacsa AS; Molla AM; Szucs G Source: BMC Microbiology. 2009;9:62. Abstract: BACKGROUND: The importance of diarrhoeagenic Escherichia coli (DEC) infections in the Arabian Gulf including Kuwait is not known. The prevalence of DEC (enterotoxigenic [ETEC], enteropathogenic [EPEC], enteroinvasive [EIEC], enterohemorrhagic [EHEC] and enteroaggregative [EAEC]) was studied in 537 children < or = 5 years old hospitalised with acute diarrhoea and 113 matched controls from two hospitals during 2005-07 by PCR assays using E. coli colony pools. RESULTS: The prevalence of DEC varied from 0.75% for EHEC to 8.4% for EPEC (mostly atypical variety) in diarrhoeal children with no significant differences compared to that in control children (P values 0.15 to 1.00). Twenty-seven EPEC isolates studied mostly belonged to non-traditional serotypes and possessed beta and theta intimin subtypes. A total of 54 DEC isolates from diarrhoeal children and 4 from controls studied for antimicrobial susceptibility showed resistance for older antimicrobials, ampicillin (0 to 100%), tetracycline (33 to 100%) and trimethoprim (22.2 to 100%); 43.1% of the isolates were multidrug-resistant (resistant to 3 or more agents). Six (10.4%) DEC isolates produced extended spectrum beta-lactamases and possessed genetic elements (blaCTX-M, blaTEM and ISEcp1) associated with them. CONCLUSION: We speculate that the lack of significant association of DEC with diarrhoea in children in Kuwait compared to countries surrounding the Arabian Gulf Region may be attributable to high environmental and food hygiene due to high disposable income in Kuwait. Language: English Keywords: KUWAIT | RESEARCH REPORT | CONTROL GROUPS | CHILDREN | BACTERIAL AND FUNGAL DISEASES | DIARRHEA | DIARRHEA, INFANTILE | PREVALENCE | ANTIBIOTICS | DRUG RESISTANCE | Middle East | Developed Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Measurement | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341689 |
| 2. Title: Combined oral contraceptive pills for treatment of acne. Author: Arowojolu AO; Gallo MF; Lopez LM; Grimes DA; Garner SE Source: Cochrane Database of Systematic Reviews. 2009;(3):CD004425. Abstract: BACKGROUND: Acne is a common skin disorder among women. Although no uniform approach to the management of acne exists, combination oral contraceptives (COCs), which contain an estrogen and a progestin, often are prescribed for women. OBJECTIVES: To determine the effectiveness of combined oral contraceptives (COCs) for the treatment of facial acne compared to placebo or other active therapies. SEARCH STRATEGY: We searched for randomized controlled trials of COCs and acne in the computerized databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, and LILACS. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We wrote to authors of identified trials to seek any unpublished or published trials that we might have missed. SELECTION CRITERIA: All randomized controlled trials reported in any language that compared the effectiveness of a COC containing an estrogen and a progestin to placeboor another active therapy for acne in women were eligible. DATA COLLECTION AND ANALYSIS: We extracted data on total and specific (i.e., open or closed comedones, papules, pustules and nodules) facial lesion counts; acne severity grades; global assessments by the clinician or the participant and discontinuation due to adverse events. Data were entered and analyzed in RevMan. MAIN RESULTS: The search yielded 25 trials: 7 placebo-controlled trials made 4 different comparisons, 17 trials made 13 comparisons between 2 different COC regimens, and 1 additional trial compared a COC to an antibiotic. COCs reduced acne lesion counts, severity grades and self-assessed acne compared to placebo. Differences in the comparative effectiveness of COCs containing varying progestin types and dosages, though, were less clear. COCs that contained chlormadinone acetate or cyproterone acetate improved acne better than levonorgestrel, although this apparent advantage was based on limited data. A COC with cyproterone acetate might result in better acne outcomes than one with desogestrel; however, the three studies comparing these COCs produced conflicting results. Likewise, levonorgestrel showed a slight improvement over desogestrel in acne outcomes in one trial, but a second trial found the COC groups were similar. AUTHORS' CONCLUSIONS: The four COCs evaluated in placebo-controlled trials are effective in reducing inflammatory and non-inflammatory facial acne lesions. Few important differences were found between COC types in their effectiveness for treating acne. How COCs compare to alternative acne treatments is unknown since limited data were available regarding this question. Language: English Keywords: GLOBAL | LITERATURE REVIEW | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN | ACNE | TREATMENT | ORAL CONTRACEPTIVES, COMBINED | ADMINISTRATION AND DOSAGE | ANTIBIOTICS | HORMONES | Clinical Research | Research Methodology | Studies | Demographic Factors | Population | Dermatitis | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Drugs | Endocrine System | Physiology | Biology Document Number: 341912 |
| 3. Peer Reviewed Title: Prevalence of tuberculosis, HIV and respiratory symptoms in two Zambian communities: implications for tuberculosis control in the era of HIV. Author: Ayles H; Schaap A; Nota A; Sismanidis C; Tembwe R; De Haas P; Muyoyeta M; Beyers N Author: Peter Godfrey-Faussett for the ZAMSTAR Study Team Source: PloS One. 2009;4(5):e5602. Abstract: BACKGROUND: The Stop TB Partnership target for tuberculosis is to have reduced the prevalence of tuberculosis by 50% comparing 2015 to 1990. This target is challenging as few prevalence surveys have been conducted, especially in high burden tuberculosis and HIV countries. Current tuberculosis control strategies in high HIV prevalent settings are therefore based on limited epidemiological evidence and more evidence is needed from community-based surveys to inform improved policy formulation. METHODS AND FINDINGS: 8044 adults were sampled from 2 sub-districts (wards) in Lusaka province, Zambia. Questionnaires were used to screen for symptoms, respiratory samples were obtained for culture and oral secretions collected for HIV testing. 79 individuals were found to have Mycobacterium tuberculosis in their sputum, giving an adjusted overall prevalence of tuberculosis of 870/100,000 (95% CI 570-1160/100,000). The adjusted overall prevalence of HIV was 28.61% (95% CI 26.04-31.19). HIV- infection was significantly associated with prevalent tuberculosis (Adj OR 2.3, 95% CI 1.42-3.74) and the population attributable fraction of HIV for prevalent tuberculosis was 36%. Symptoms such as prolonged cough (adj OR 12.72, 95% CI 7.05-22.94) and fever (Adj OR 2.04, 95%CI 1.23-3.39), were associated with prevalent tuberculosis, but 8 (10%) individuals with prevalent tuberculosis denied having any symptoms at all and only 34 (43%) would have been classified as a TB suspect by current guidelines. CONCLUSIONS: Undiagnosed tuberculosis is a challenge for tuberculosis control and new approaches are needed if we are to reach international targets. Epidemiological studies can inform screening algorithms for both detection and prevention of active tuberculosis. Language: English Keywords: ZAMBIA | RESEARCH REPORT | SAMPLING STUDIES | ADULTS | TUBERCULOSIS | HIV INFECTIONS | RESPIRATORY INSUFFICIENCY | PREVALENCE | SCREENING | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | PREVENTION AND CONTROL | ANTIBIOTICS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Viral Diseases | Pulmonary Effects | Physiology | Biology | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment Document Number: 342445 |
| 4. Title: Daily trimethoprim-sulfamethoxazole prophylaxis rapidly induces corresponding resistance among intestinal Escherichia coli of HIV-infected adults in Kenya. Author: Chiller TM; Polyak CS; Brooks JT; Williamson J; Ochieng B; Shi YP; Ouma P; Greene C; Hamel M; Vulule J; Bopp C; Slutsker L; Mintz E Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):165-9. Abstract: BACKGROUND: Trimethoprim-sulfamethoxazole (TMP-SMZ) has been recommended by World Health Organization (WHO) as daily prophylaxis for Africans with AIDS to prevent opportunistic infections. Daily TMP-SMZ may reduce its susceptibility to commensal intestinal Escherichia coli (E coli), increasing the burden of TMP-SMZ-resistant pathogens. METHODS: Participants received either daily TMP-SMZ (CD4 <350 cells/mm(3)) or daily multivitamins (MVIs; CD4 > or =350 cells/mm(3)) for 6 months. Stool was collected at baseline, 2 weeks, 2 months, and 6 months. A random E coli was tested for susceptibility. RESULTS: Baseline prevalence of TMP-SMZ resistance ranged from 71% to 81% and was not different across CD4 strata. At 2 weeks, prevalence of TMP-SMZ-resistant E coli increased significantly from 78% to 98% (P < .001) among persons taking daily TMP-SMZ and did not change among persons taking MVIs. CONCLUSIONS: Daily prophylaxis with TMP-SMZ induced in vivo resistance to the drug after 2 weeks. Empiric therapy for diarrhea with agents other than TMP-SMZ should be considered for HIV-infected persons receiving daily TMP-SMZ prophylaxis. Language: English Keywords: KENYA | RESEARCH REPORT | STATISTICAL STUDIES | PERSONS LIVING WITH HIV/AIDS | ADULTS | BACTERIAL AND FUNGAL DISEASES | ANTIBIOTICS | DRUG RESISTANCE | PREVALENCE | DIARRHEA | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement Document Number: 342456 |
| 5. Title: Frequency of Mycobacterium bovis as an etiologic agent in extrapulmonary tuberculosis in HIV-positive and -negative Mexican patients. Author: Cicero R; Olivera H; Hernandez-Solis A; Ramirez-Casanova E; Escobar-Gutierrez A Source: European Journal of Clinical Microbiology and Infectious Diseases. 2009 May;28(5):455-60. Abstract: Mycobacterium bovis can be an important etiological agent for extrapulmonary (EP) manifestations of tuberculosis, especially in HIV-infected persons. From January 2000 to December 2003, M. bovis as a cause of EP tuberculosis was investigated at the Pneumonology Service, Hospital General de Mexico, Mexico City. Eighty HIV-positive (HIV+) patients and 83 HIV-negative (HIV-) with EP involvement (ganglionar, genitourinary, meningeal, cutaneous, peritoneal, and pericardial) were analyzed using clinical, immunological, bacteriological, histopathological, and molecular biology methods. Mycobacterium species were identified by hsp65-RFLP analysis and species of M. tuberculosis complex isolates by spoligotyping. M. bovis was present in 6 HIV- cases (7.2%; 3 with lymphadenitis and 3 genitourinary) vs 11 in HIV+ cases (13.75%; 7 with lymphadenitis, 3 genitourinary, and 1 meningeal). Favorable response to retroviral and specific M. bovis chemotherapy was observed. Spoligotyping showed a unique profile in each isolate, 16 belonging to BOV1 lineage and 1 to BOV2 lineage. M. bovis is an significant re-emerging cause of EPTB in Mexico. Consumption of unpasteurized dairy products is the most likely source of transmission. Successful treatment depends on the adequate and opportune identification of the agent responsible. Language: English Keywords: MEXICO | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | ADULTS | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | BACTERIAL AND FUNGAL DISEASES | ANTIBIOTICS | ADMINISTRATION AND DOSAGE | DRUG RESISTANCE | North America | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Infections | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341794 |
| 6. Peer Reviewed Title: Group a Streptococcus causing necrotizing fasciitis and toxic shock syndrome after medical termination of pregnancy. Author: Daif JL; Levie M; Chudnoff S; Kaiser B; Shahabi S Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 2):504-6. Abstract: BACKGROUND: Group A Streptococcus is an aerobic gram-positive bacteria known to cause cutaneous infections. Invasive infections can lead to toxic shock syndrome with multiorgan failure and mortality rates of 25-48%. CASE: A healthy, young woman developed necrotizing fasciitis, myonecrosis, and toxic shock syndrome after an elective medical termination of pregnancy. This patient had confirmed group A Streptococcus on blood cultures and underwent surgical debridement. After aggressive surgical treatment, below-the-knee amputation, and antibiotic therapy, the patient survived. CONCLUSION: This case demonstrates the need for prompt recognition and treatment of necrotizing fasciitis/toxic shock syndrome. Language: English Keywords: NEW YORK | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | HISPANICS | WOMEN | BACTERIAL AND FUNGAL DISEASES | DERMATITIS | TOXIC SHOCK SYNDROME | ABORTION | GYNECOLOGIC SURGERY | SURGERY | ANTIBIOTICS | Developed Countries | United States of America | North America | Americas | Research Methodology | Studies | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Fertility Control, Postconception | Family Planning | Urogenital Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs Document Number: 330358 Notification |
| 7. Peer Reviewed Title: High early mortality in patients with chronic acquired immunodeficiency syndrome diarrhea initiating antiretroviral therapy in Haiti: a case-control study. Author: Dillingham RA; Pinkerton R; Leger P; Severe P; Guerrant RL; Pape JW; Fitzgerald DW Source: American Journal of Tropical Medicine and Hygiene. 2009 Jun;80(6):1060-4. Abstract: This case-control study examines whether chronic diarrhea at initiation of antiretroviral therapy (ART) affects survival of human immunodefiency virus-infected patients. Cases (288) were treatment-naive, non-pregnant, adults with self report of frequent loose stool for > 3 weeks at the time ART was initiated. One-third of patients had an enteric pathogen identified including Cryptosporidium spp., Giardia spp., Isospora belli, Cyclospora cayetanensis, and Entamoeba histolytica. Control patients (400) did not have diarrhea when initiating ART. At six weeks, mortality was 10% in the patients with diarrhea and 5% in the patients without diarrhea (P = 0.009). Chronic diarrhea in patients requesting ART in Haiti is associated with increased early mortality. Language: English Keywords: HAITI | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | ADULTS | PERSONS LIVING WITH HIV/AIDS | AIDS | ANTIRETROVIRAL THERAPY | DIARRHEA | GASTROINTESTINAL EFFECTS | ANTIBIOTICS | MORTALITY | Developing Countries | Caribbean | Americas | Research Methodology | Program Activities | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics Document Number: 341760 |
| 8. Peer Reviewed Title: Rates of serious infection after changes in regimens for medical abortion. Author: Fjerstad M; Trussell J; Sivin I; Lichtenberg ES; Cullins V Source: New England Journal of Medicine. 2009 Jul 9;361(2):145-51. Abstract: BACKGROUND: From 2001 through March 2006, Planned Parenthood health centers throughout the United States provided medical abortion (abortion by means of medication) principally by a regimen of oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In response to concern about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration from vaginal to buccal and required either routine provision of antibiotics or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine treatment with antibiotics for all medical abortions. METHODS: We performed a retrospective analysis assessing the rates of serious infection after medical abortion during a time when misoprostol was administered vaginally (through March 2006), as compared with rates after a change to buccal administration of misoprostol and after initiation of additional infection-reduction measures. RESULTS: Rates of serious infection dropped significantly after the joint change to buccal misoprostol from vaginal misoprostol and to either testing for sexually transmitted infection or routine provision of antibiotics as part of the medical abortion regimen. The rate declined 73%, from 0.93 per 1000 abortions to 0.25 per 1000 (absolute reduction, 0.67 per 1000; 95% confidence interval [CI], 0.44 to 0.94; P<0.001). The subsequent change to routine provision of antibiotics led to a further significant reduction in the rate of serious infection - a 76% decline, from 0.25 per 1000 abortions to 0.06 per 1000 (absolute reduction, 0.19 per 1000; 95% CI, 0.02 to 0.34; P=0.03). CONCLUSIONS: The rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with routine administration of antibiotics. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | STATISTICAL STUDIES | ABORTION | RU-486 | MISOPROSTOL | ADMINISTRATION AND DOSAGE | STANDARDS | INFECTION PREVENTION | ANTIBIOTICS | MONITORING | Developed Countries | North America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Evaluation Document Number: 342147 Notification |
| 9. Peer Reviewed Title: Provision of contraception services and advice for women with cystic fibrosis. Author: Gatiss S; Mansour D; Doe S; Bourke S Source: Journal of Family Planning and Reproductive Health Care. 2009 Jul;35(3):157-60. Abstract: BACKGROUND AND METHODOLOGY: As the prognosis of patients with cystic fibrosis (CF) improves, issues of sexual health, fertility, pregnancy and contraception are increasingly important. In order to plan the provision of a contraception and sexual health service for women with CF we studied their sexual and reproductive history, their current usage of contraception, the sources and quality of advice they had received, and their particular needs using a confidential questionnaire sent to all women over 16 years of age attending a regional CF centre. RESULTS: Of 55 women (mean age 29.7 years) surveyed, 42 (76%) responded. Thirty-three women (79%) were sexually active and 13 (31%) had experienced 19 pregnancies, five (26%) of which were unplanned. Only half of the women who responded were using contraception. No woman used female sterilisation, the progestogen implant, intrauterine system (IUS) or copper-bearing intrauterine device (IUD) for contraception. Twenty-six (62%) women reported not having received contraceptive advice specific to CF and 24 (57%) said that they had not been warned about the potential interaction between broad-spectrum antibiotics and the combined pill. DISCUSSION: Women with CF have a relatively high rate of unplanned pregnancy and do not receive optimal advice or use the full range of contraceptive methods. CF teams lack training in contraception and contraceptive services may not have a detailed knowledge of CF and its complications. New strategies are needed to focus the knowledge and skills of both teams in providing better services for women with CF. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | WOMEN | CLIENTS | HEREDITARY DISEASES | COMPLICATIONS | CONTRACEPTIVE USAGE | FERTILITY | PREGNANCY | QUESTIONNAIRES | ANTIBIOTICS | GENETIC COUNSELING | Developed Countries | Europe, Western | Europe | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Diseases | Contraception | Family Planning | Population Dynamics | Reproduction | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Counseling | Clinic Activities Document Number: 342139 |
| 10. Peer Reviewed Title: Self-medication prevalence for sexually transmitted diseases: meta-analysis and meta-regression of population level determinants. Author: Gomez GB; Garnett GP; Ward H Source: Sexually Transmitted Diseases. 2009 Feb;36(2):112-9. Abstract: BACKGROUND: Estimated prevalence of self-medication for sexually transmitted diseases (STDs) in observational studies differs between studies and it may vary according to population characteristics. METHODS: We investigated the extent of self-medication use for STD and explored population and study level factors correlated to the variability observed between populations. Medical databases were systematically searched for published studies. Crude prevalence data were extracted. Pooled estimates were calculated using random effects models. Univariate and multivariate meta-regression models with categorical population level covariates were constructed. RESULTS: Of the 35 studies that met the inclusion criteria for all self-medication use, 20 were also included in the analysis of antibiotic only use. There was significant heterogeneity present across prevalence estimates for all self-medication, Q = 3954.82, P <0.001; and among antibiotic only self-medication, Q = 3797.94, P <0.001. In meta-regression analyses, publication year seemed to explain 22.5% of variation among studies of self-medication with antibiotic only. No other significant associations with population or study characteristics were found. CONCLUSIONS: No population level factors leading to high levels of self-medication use for STD were identified. Publications before year 2000 seem to present a higher prevalence of antibiotic use for self-medication. Greater risk awareness of antibiotic misuse and improved control of antibiotic availability at population level might explain this result. An analysis of individual level characteristics should indicate which are influential and whether their local prevalence can explain the observed heterogeneity better. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | KAP SURVEYS | EPIDEMIOLOGIC METHODS | STATISTICAL REGRESSION | MULTIVARIATE ANALYSIS | TARGET POPULATION | SEXUALLY TRANSMITTED DISEASES | PREVALENCE | SELF CARE | ANTIBIOTICS | DEMOGRAPHIC FACTORS | Developed Countries | North America | Americas | Research Methodology | Theoretical Models | Surveys | Sampling Studies | Studies | Data Analysis | Program Design | Programs | Organization and Administration | Reproductive Tract Infections | Infections | Diseases | Measurement | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Population Document Number: 330365 |
| 11. Peer Reviewed Title: Intrapartum antibiotic exposure and early neonatal, morbidity, and mortality in Africa. Author: Kafulafula G; Mwatha A; Chen YQ; Aboud S; Martinson F; Hoffman I; Fawzi W; Read JS; Valentine M; Mwinga K; Goldenberg R; Taha TE Source: Pediatrics. 2009 Jul;124(1):e137-44. Abstract: BACKGROUND: Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants. OBJECTIVE: Our goal was to determine the association of maternal intrapartum antibiotics and early neonatal morbidity and mortality. METHODS: We performed secondary analysis of data from a multisite randomized, placebo-controlled clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV-1 and preterm birth in sub-Saharan Africa. Early neonatal morbidity and mortality were analyzed. In an intention-to-treat (ITT) analysis, infants born to women randomly assigned to antibiotics or placebo were compared. In addition, non-ITT analysis was performed because some women received nonstudy antibiotics for various clinical indications. RESULTS: Overall, 2659 pregnant women were randomly assigned. Of these, 2466 HIV-1-infected and HIV-1-uninfected women delivered 2413 live born and 84 stillborn infants. In the ITT analysis, there were no significant associations between exposure to antibiotics and early neonatal outcomes. Non-ITT analyses showed more illness at birth (11.2% vs 8.6%, P = .03) and more admissions to the special care infant unit (12.6% vs 9.8%, P = .04) among infants exposed to maternal intrapartum antibiotics than among unexposed infants. Additional analyses revealed greater early neonatal morbidity and mortality among infants of mothers who received nonstudy antibiotics than of mothers who received study antibiotics. CONCLUSIONS: There is no association between intrapartum exposure to antibiotics and early neonatal morbidity or mortality. The associations observed in non-ITT analyses are most likely the result of women with peripartum illnesses being more likely to receive nonstudy antibiotics. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | DATA ANALYSIS | CLINICAL TRIALS | PREGNANT WOMEN | PREMATURE BIRTH | NEONATAL DISEASES AND ABNORMALITIES | ANTIBIOTICS | MORBIDITY | NEONATAL MORTALITY | Africa | Developing Countries | Research Methodology | Clinical Research | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Mortality | Mortality | Population Dynamics Document Number: 342887 |
| 12. Peer Reviewed Title: Probiotics and prebiotics for severe acute malnutrition (PRONUT study): a double-blind efficacy randomised controlled trial in Malawi. Author: Kerac M; Bunn J; Seal A; Thindwa M; Tomkins A; Sadler K; Bahwere P; Collins S Source: Lancet. 2009 Jul 11;374(9684):136-44. Abstract: BACKGROUND: Severe acute malnutrition affects 13 million children worldwide and causes 1-2 million deaths every year. Our aim was to assess the clinical and nutritional efficacy of a probiotic and prebiotic functional food for the treatment of severe acute malnutrition in a HIV-prevalent setting. METHODS: We recruited 795 Malawian children (age range 5 to 168 months [median 22, IQR 15 to 32]) from July 12, 2006, to March 7, 2007, into a double-blind, randomised, placebo-controlled efficacy trial. For generalisability, all admissions for severe acute malnutrition treatment were eligible for recruitment. After stabilisation with milk feeds, children were randomly assigned to ready-to-use therapeutic food either with (n=399) or without (n=396) Synbiotic2000 Forte. Average prescribed Synbiotic dose was 10(10) colony-forming units or more of lactic acid bacteria per day for the duration of treatment (median 33 days). Primary outcome was nutritional cure (weight-for-height >80% of National Center for Health Statistics median on two consecutive outpatient visits). Secondary outcomes included death, weight gain, time to cure, and prevalence of clinical symptoms (diarrhoea, fever, and respiratory problems). Analysis was on an intention-to-treat basis. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN19364765. FINDINGS: Nutritional cure was similar in both Synbiotic and control groups (53.9% [215 of 399] and 51.3% [203 of 396]; p=0.40). Secondary outcomes were also similar between groups. HIV seropositivity was associated with worse outcomes overall, but did not modify or confound the negative results. Subgroup analyses showed possible trends towards reduced outpatient mortality in the Synbiotic group (p=0.06). INTERPRETATION: In Malawi, Synbiotic2000 Forte did not improve severe acute malnutrition outcomes. The observation of reduced outpatient mortality might be caused by bias, confounding, or chance, but is biologically plausible, has potential for public health impact, and should be explored in future studies. FUNDING: Department for International Development (DfID). Language: English Keywords: MALAWI | RESEARCH REPORT | DOUBLE-BLIND STUDIES | CHILDREN | MALNUTRITION | NUTRITION PROGRAMS | FOOD AND BEVERAGE | ANTHROPOMETRY | HIV INFECTIONS | ANTIBIOTICS | INFECTIONS | MORTALITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Nutrition | Measurement | Viral Diseases | Drugs | Treatment | Medical Procedures | Medicine | Population Dynamics Document Number: 342331 |
| 13. Title: Ventilator-associated pneumonia in a paediatric intensive care unit in a developing country with high HIV prevalence. Author: Morrow BM; Argent AC Source: Journal of Paediatrics and Child Health. 2009 Mar;45(3):104-11. Abstract: AIM: To obtain preliminary prevalence, aetiological and outcome data on South African paediatric patients with ventilator-associated pneumonia (VAP). METHODS: Non-bronchoscopic bronchoalveolar lavage (BAL) specimens taken between January 2004 and September 2005 were prospectively recorded and related clinical data were retrospectively reviewed. VAP was defined as a new isolate on BAL and a modified Clinical Pulmonary Infection Score > or =5. RESULTS: A total of 230 patients aged 3.9 (2.2-9.1) months (median interquartile range (IQR) ) underwent 309 BALs during 244 paediatric intensive care unit (PICU) admissions. Most patients (84%) were admitted with acute infectious diseases, with a 70% incidence of comorbidity. Thirty-three patients (14.3%) were HIV-exposed but uninfected and 58 (25.2%) were HIV-infected. Of 172 BALs taken > or =48 h after intubation, 63 specimens from 55 patients fulfilled VAP criteria. Acinetobacter baumannii was the most common VAP pathogen, followed by Klebsiella pneumoniae, viruses, yeasts and Staphylococcus aureus. Patients who developed VAP had a higher proportion of comorbid conditions (76% vs. 55%, P= 0.01) and reintubations (39% vs. 12%, P < 0.0001) when compared with non-VAP patients. Median (IQR) length of PICU stay was 12.5 (5-21) days versus 8 (5-14) days (P= 0.03); and the risk adjusted PICU mortality was 1.38 versus 0.79 (P= 0.002) in VAP versus non-VAP patients, respectively. CONCLUSIONS: VAP is associated with significant morbidity and mortality and may relate to the high incidence of comorbid conditions in this population. Primary VAP pathogens differ from developed countries. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLIENTS | INFANT | PNEUMONIA | SIGNS AND SYMPTOMS | HOSPITALS | ANTIBIOTICS | MORBIDITY | INFANT MORTALITY | HIV INFECTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Pulmonary Effects | Physiology | Biology | Diseases | Health Facilities | Delivery of Health Care | Health | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Mortality | Population Dynamics | Viral Diseases Document Number: 341838 |
| 14. Title: Trends in HIV/TB coinfection in Trinidad and Tobago for the period 1998-2007. Author: Mungrue K; Beharry A; Kalloo J; Mahabir S; Maraj T; Ramoutar R; Ramsaroop K; Solomon V Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):170-5. Abstract: OBJECTIVES: The aim of this study was to extend the description of the epidemiologic pattern of human immunodeficiency virus (HIV)/tuberculosis (TB) coinfection from 1998 to 2007 in a high HIV/AIDS prevalence country. DESIGN AND METHODS: This study utilized registry data to determine yearly TB incidence and HIV coinfection. Mortality rates for coinfected patients were calculated and compared with patients receiving highly active antiretroviral therapy (HAART). RESULTS: From a TB population of 2010 registered patients, data was collected on the 466 patients with HIV/TB coinfection. The coinfection rate was found to be 23.6% for the study period. Patients on HAART were twice as likely to survive. DISCUSSION AND CONCLUSIONS: The incidence of TB and HIV/TB coinfection rates continues to be major challenges in the developing world. Demographic, socioeconomic trends as well as risk factors remain unchanged. Increased HIV screening and HAART coverage offers hope for the future. Language: English Keywords: TRINIDAD AND TOBAGO | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | HIV INFECTIONS | TUBERCULOSIS | INCIDENCE | PREVALENCE | ANTIRETROVIRAL THERAPY | ANTIBIOTICS | CASE FATALITY RATE | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | Measurement | HIV | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Death Rate | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 342459 |
| 15. Title: Enteric bacterial pathogens in HIV-infected children with acute diarrhea in Mulago referral and teaching hospital, Kampala, Uganda. Author: Musiime V; Kalyesubula I; Kaddu-Mulindwa D; Byarugaba J Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):185-90. Abstract: OBJECTIVE: HIV-infected children develop severe bacterial infections. We set out to determine the enteric bacterial pathogens in HIV-infected children and HIV-negative controls with acute diarrhea and their antimicrobial sensitivities. METHODS: Children below 5 years of age with acute diarrhea were screened for HIV and their stools were analyzed by culture and use of antisera and the sensitivities of the pathogens were determined using the Kirby Bauer disc diffusion method. RESULTS: Of the 190 children, 47 were HIV positive. The prevalence rates of the pathogens in HIV-infected and -uninfected children were 19% (9/47) and 27% (38/143), respectively; odds ratio = 0.64 (95% confidence interval 0.20-1.97), P value .396. The pathogens in HIV-infected and -uninfected children were Escherichia coli, Salmonella, and Shigella species. Most isolates were resistant to cotrimoxazole. CONCLUSIONS: Escherichia coli, Salmonella, and Shigella species significantly cause acute diarrhea in HIV-infected and -uninfected children and they are highly resistant to cotrimoxazole. Language: English Keywords: UGANDA | RESEARCH REPORT | CONTROL GROUPS | PERSONS LIVING WITH HIV/AIDS | CHILDREN | DIARRHEA | BACTERIAL AND FUNGAL DISEASES | HIV INFECTIONS | PREVALENCE | ANTIBIOTICS | LABORATORY PROCEDURES | DRUG RESISTANCE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Measurement | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses Document Number: 342454 |
| 16. Peer Reviewed Title: Reproductive tract infections in northern Vietnam: health providers' diagnostic dilemmas. Author: Nguyen MH; Gammeltoft T; Christoffersen SV; Tran TT; Rasch V Source: Women and Health. 2009 Mar-May;49(2-3):229-45. Abstract: Research was conducted on reproductive tract infections among women obtaining induced abortions at Ph[image omitted]-[image omitted] hospital in Haiphong City, a major maternity hospital in northern Vietnam. The research aimed to explore how clinicians and lab-technicians diagnose reproductive tract infections and the difficulties they experience in establishing exact diagnoses. A combination of both quantitative and qualitative research methodologies was employed. The quantitative research involved 748 abortion-seeking women; the qualitative research was conducted with 10 doctors and 10 lab-technicians providing reproductive health services. A marked tendency was observed among both clinicians and lab-technicians to overdiagnose reproductive tract infections and to prescribe antibiotics routinely. Social, cultural, and clinical factors associated with the tendency to overdiagnose reproductive tract infections included: inadequate training of health staff, lack of equipment, and cultural assumptions regarding the overwhelming prevalence of reproductive tract infections in Vietnamese women, especially among those who receive abortion services. Misconceptions of reproductive tract infections led to substantial over-diagnosis and unnecessary treatment of reproductive tract infections in this hospital. To enhance reproductive tract infection care, providers need to be sensitized to the social and medical consequences of their own cultural perceptions and to increase their awareness of the risks associated with overuse of antibiotics. Language: English Keywords: VIETNAM | RESEARCH REPORT | CLINICAL RESEARCH | FOCUS GROUPS | ABORTION | PROVIDERS WITH CLIENTS | REPRODUCTIVE TRACT INFECTIONS | PREVALENCE | PHYSICAL EXAMINATIONS AND DIAGNOSES | LABORATORY EXAMINATIONS AND DIAGNOSES | ANTIBIOTICS | INTERVIEWS | PERCEPTION | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Data Collection | Fertility Control, Postconception | Family Planning | Health Services | Delivery of Health Care | Health | Infections | Diseases | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Drugs | Treatment | Psychological Factors | Behavior Document Number: 342405 Notification |
| 17. Peer Reviewed Title: Reproductive tract infections in women seeking abortion in Vietnam. Author: Nguyen MH; Kurtzhals J; Do TT; Rasch V Source: BMC Women's Health. 2009;9:1. Abstract: BACKGROUND: Women requesting abortion are at increased risk of developing RTI complications. However, RTI control in many resource-poor countries including Vietnam have been faced with logistical and methodological problems due to lack of standardized definitions of RTIs, lack of well-validated diagnostic criteria, lack of accurate laboratory tests, and lack of diagnostic equipment and skills. This article investigates the prevalence of RTIs among Vietnamese abortion-seeking women, to evaluate the available diagnostic techniques, and to assess antibiotic resistance among aetiological agents of RTI. METHOD: The study was conducted in Phu-San hospital (PSH) from December 2003 through April 2004 among 748 abortion clients. A structured questionnaire was used to collect data on socio-economic and reproductive characteristics. Specimens were collected for laboratory analyses of chlamydia, gonorrhoea, trichomoniasis, vaginal candidiasis (VC), bacterial vaginosis (BV) and syphilis. To assess the validity of the obtained results, the study was repeated among 100 women and the duplicate samples were analysed at PSH and Copenhagen University Hospital (CUH). RESULTS: In all 54% of the women were diagnosed as having an RTI, including 3.3% with sexually transmitted infections. Endogenous infections were most prevalent (VC 34% and BV 12%) followed by chlamydia (1.3%) and trichomoniasis (0.7%). The sensitivity of culture for VC and BV was 30% and 88%, respectively, when tests in PSH were measured against tests in CUH. Antibiotic resistance was common among bacterial isolates. CONCLUSION: RTIs are common among women seeking abortion. The presence of RTIs is associated with an increased risk of developing iatrogenic infections, routine administration of prophylactic antibiotic to all women undergoing abortion should be considered. However, the choice of routine prophylactic antibiotics should be based on relevant surveillance data of antibiotic resistance. Moreover, since the accuracy of diagnosis is doubtful and to address the problem of under-diagnosed and treated RTIs new investment in diagnostic facilities with simple performed microscopy or improved rapid tests should also be taken into consideration. Language: English Keywords: VIETNAM | RESEARCH REPORT | QUESTIONNAIRES | WOMEN | ABORTION | REPRODUCTIVE TRACT INFECTIONS | SCREENING | LABORATORY EXAMINATIONS AND DIAGNOSES | ANTIBIOTICS | TREATMENT | Asia, Southeastern | Asia | Developing Countries | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs Document Number: 341239 Notification |
| 18. Title: Improved early results for patients with extensively drug-resistant tuberculosis and HIV in South Africa. Author: O'Donnell MR; Padayatchi N; Master I; Osburn G; Horsburgh CR Source: International Journal of Tuberculosis and Lung Disease. 2009 Jul;13(7):855-61. Abstract: SETTING: A public tuberculosis (TB) referral hospital in KwaZulu-Natal, South Africa. OBJECTIVE: To present treatment outcomes of patients with extensively drug-resistant tuberculosis (XDR-TB) patients and human immunodeficiency virus (HIV) coinfection with and without highly active antiretroviral therapy. METHODS: Retrospective cohort study. Eligible patients had drug susceptibility testing that met a consensus definition for XDR-TB, and agreed to treatment. Therapy was based on drug susceptibilities, available medications and patient tolerance. RESULTS: Overall, 60 XDR-TB patients initiated therapy with a median number of 5.5 drugs. Of these, 43 (72%) were HIV-positive, and 21 (49%) were on antiretroviral therapy; 29 HIV-infected patients (67%) had available CD4 counts, with a median CD4 count of 200.5 cells/mm(3) (standard deviation 127.4 cells/mm(3)). Of 60 patients, 31 (52%) had adverse events (AEs), and 17/60 patients (28%) had severe AEs. During follow-up, 12/60 (20%) experienced sputum culture conversion, while 25/60 (42%) patients died. None of the following was significantly associated with mortality: HIV status, previous MDR diagnosis or severe AEs. DISCUSSION: In this study, it was possible to treat HIV-XDR-TB coinfected patients and prolong survival in a resource-limited setting. We highlight the challenges in treatment, including high frequencies of AEs and death. Expanded identification of cases, prompt referral for treatment, and attention to management of comorbidities may facilitate successful treatment of XDR-TB in HIV-infected patients. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | HIV INFECTIONS | TUBERCULOSIS | DRUG RESISTANCE | ANTIRETROVIRAL THERAPY | IMMUNOLOGICAL EFFECTS | ANTIBIOTICS | SIDE EFFECTS | ELECTROLYTE BALANCE | CASE FATALITY RATE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Immunity | Immune System | Physiology | Biology | Drugs | Homeostasis | Death Rate | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 342822 |
| 19. Title: Pelvic actinomycosis: a malignant appearing mass. A case report. Author: Pirenne Y; Bouckaert W; Vangertruyden G Source: Acta Chirurgica Belgica. 2009 Mar-Apr;109(2):250-2. Abstract: Pelvic actinomycosis is a rare complication of a long-term intrauterine contraceptive device. Early diagnosis is important, as clinical and radiological imaging may mimic a malignant pathology and lead to radical and unnecessary surgery. We report a case of pelvic actinomycosis in a woman who had used an intrauterine contraceptive device for the last 13 years. The actinomycosis appeared as a malignant pelvic mass with invasion into the sigmoid and left ureter, with high-grade stenosis of these structures. Because of its rapidly developing obstructive character, an urgent Hartmann procedure with resection of the uterus and both ovaries was performed. Histology revealed actinomycosis. With this case we want to illustrate that for a woman presenting with an intrauterine contraceptive device and a malignant appearing mass in the pelvis, pelvic actinomycosis must be considered in the list of differential diagnosis, so that appropriate diagnostic work out and treatment can be made. Language: English Keywords: BELGIUM | SUMMARY REPORT | CASE STUDIES | CLIENTS | IUD COMPLICATIONS | BACTERIAL AND FUNGAL DISEASES | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | HISTOLOGY | ULTRASONICS | ANTIBIOTICS | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Drugs | Treatment Document Number: 342597 |
| 20. Peer Reviewed Title: Doxycycline serum levels at the time of dilation and evacuation with two dosing regimens. Author: Reeves MF; Lohr PA; Hayes JL; Harwood BJ; Creinin MD Source: Contraception. 2009 Feb;79(2):129-33. Abstract: BACKGROUND: Doxycycline is commonly used for antibiotic prophylaxis before dilation and evacuation (D&E) but frequently causes nausea and emesis which may affect absorption and effectiveness. Taking doxycycline the night prior to surgery may result in adequate absorption with better tolerance. STUDY DESIGN: We enrolled 40 women into a double-blind randomized comparison of doxycycline 200 mg given 4 h before D&E (Group 1) vs. the night prior to D&E with dinner (Group 2). D&E procedures were scheduled after 11 a.m. and subjects were nil per os on the morning of the procedure. Subjects completed symptom diaries from dilator placement until the D&E. Serum for doxycycline assays was obtained before the D&E. RESULTS: Mean gestational age was 19.4 weeks (range 15.8-22.0 weeks) and did not differ by group. Serum was collected at 3.2 h (range 1.9-4.8 h) and 16.3 h (range 13.8-19.1 h) after ingestion of doxycycline in Groups 1 and 2, respectively. Median serum doxycycline levels (milligrams per liter) were 2.7 and 1.8 for Groups 1 and 2, respectively (p=.04). Emesis was experienced by 50% and 15% of women in Groups 1 and 2, respectively (p=.04). Nausea ratings were worse after doxycycline in the morning compared to doxycycline with dinner and compared to placebo at either time (all p<.01). Emesis following doxycycline consumption was not associated with lower doxycycline levels (p>.2). CONCLUSION: When given with food on the night prior to D&E, doxycycline results in less emesis and nausea, but results in lower serum levels at the time of D&E. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLIENTS | WOMEN | ABORTION | PREOPERATIVE PROCEDURES | ANTIBIOTICS | INFECTION PREVENTION | PROGRAM EVALUATION | Developed Countries | North America | Americas | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Infections | Diseases Document Number: 331059 Notification |
| 21. Title: Sonographic and multiplanar computed tomographic findings of large uterine perforation 2 weeks after first-trimester pregnancy termination. Author: Sherer DM; Novac S; Dalloul M; Salame G; Zinn H; Farnaz S; Abulafia O Source: Journal of Ultrasound In Medicine. 2009 May;28(5):699-701. Abstract: This case report illustrates the importance of maintaining a high index of suspicion of iatrogenic injury to the uterus subsequent to termination of pregnancy. It also stresses the importance of substantial contribution of sonography and computed tomography in the imaging diagnosis of uterine perforation remote from the procedure. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | CASE HISTORIES | CLIENTS | UTERINE PERFORATION | PREGNANCY, FIRST TRIMESTER | ABORTION | CURETTAGE | ULTRASONICS | LAPAROTOMY | MYOMETRIAL EFFECTS | ANTIBIOTICS | ADMINISTRATION AND DOSAGE | Developed Countries | North America | Americas | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Perforations | Diseases | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Myometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Drugs Document Number: 341997 Notification |
| 22. Peer Reviewed Title: Pregnancy outcomes after laminaria placement and second-trimester removal. Author: Siedhoff M; Cremer ML Source: Obstetrics and Gynecology. 2009 Aug;114(2 Pt 2):456-8. Abstract: BACKGROUND:: Even after comprehensive counseling, patients change their mind about the decision to terminate a pregnancy. There are few data about the effect of laminaria placement and removal on subsequent pregnancy outcome. CASE:: We describe four cases of laminaria removal at 12-17 weeks of gestation with varying outcomes. Two of the four cases developed cervical dilation and delivered early with documented acute chorioamnionitis. CONCLUSION:: Patients should be counseled that pregnancy termination begins with laminaria placement and that their removal could result in premature delivery. Language: English Keywords: UNITED STATES OF AMERICA | NEW YORK | SUMMARY REPORT | CASE HISTORIES | CLIENTS | LAMINARIA TENTS | PREGNANCY OUTCOMES | FETAL MEMBRANES | SEXUALLY TRANSMITTED DISEASES | ANTIBIOTICS | PREMATURE BIRTH | PREMATURE LABOR | Developed Countries | North America | Americas | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Cervical Dilatation | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Fetus | Reproductive Tract Infections | Infections | Diseases | Drugs Document Number: 342274 |
| 23. Peer Reviewed Title: Migration of levonorgestrel IUS in a patient with complex medical problems: what should be done? Author: Soleymani Majd H; El Hamamy E; Chandrasekar R; Ismail L Source: Archives of Gynecology and Obstetrics. 2009 Mar;279(3):385-6. Abstract: Patients with complex medical problems should be counselled about the need for highly effective contraception. As failure resulting in pregnancy, could cause significant morbidity and mortality. The LNG-IUS has gained great popularity and generally has a low side effect profile; however, perforation of the uterus and migration of the device is a potentially serious complication known to be associated with its use. The current accepted management is removal of the device from the abdominal cavity in order to prevent further morbidity. However this is not always a simple matter in patients who have complex medical problems and who are deemed unfit for surgery. Each time the patient comes for renewal of the contraceptive method, clinicians need to reassess the risks and benefits. This is particularly relevant in patients who have complex medical problems where special attention needs to be given, not only to immediate risks but also to long-term ones. Careful individualised counselling and consideration are paramount and perhaps it would have been prudent to discuss vasectomy with this patient and her husband (as the first line of contraception), as this may have avoided the ensuing complications arising from the chosen method. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN | IUD MIGRATION | LEVONORGESTREL | IUD, HORMONE RELEASING | OBESITY | SIGNS AND SYMPTOMS | IUD COMPLICATIONS | ANTIBIOTICS | PHYSICAL EXAMINATIONS AND DIAGNOSES | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Body Weight | Physiology | Biology | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses Document Number: 331038 |
| 24. Title: Contraception and pregnancy in cystic fibrosis. Author: Thorpe-Beeston JG Source: Journal of the Royal Society of Medicine. 2009 Jul;102 Suppl 1:3-10. Abstract: This journal article is based on cystic fibrosis (CF) and its connection to fertility, contraception, and pregnancy. It explains that advancements in the management of CF has made parenthood more realistic for many women and increasingly affected men. It also touches on the complications that could result from a pregnancy when affected by CF as well as the need for prepregnancy counseling for young CF patients. Language: English Keywords: UNITED KINGDOM | LITERATURE REVIEW | RECOMMENDATIONS | CLIENTS | HEREDITARY DISEASES | COMPLICATIONS | PULMONARY EFFECTS | CONTRACEPTIVE USAGE | FERTILITY | PREGNANCY OUTCOMES | DIABETES | ANTIBIOTICS | GENETIC COUNSELING | Developed Countries | Europe, Western | Europe | Program Activities | Programs | Organization and Administration | Diseases | Physiology | Biology | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Pregnancy | Reproduction | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Counseling | Clinic Activities Document Number: 342141 |
| 25. Peer Reviewed Title: Trends observed during a decade of paediatric sick visits to peripheral health facilities in rural western Kenya, 1997-2006. Author: Van Hemelrijck MJ; Lindblade KA; Kubaje A; Hamel MJ; Odhiambo F; Phillips-Howard PA; Laserson KF; Slutsker L; Feikin DR Source: Tropical Medicine and International Health. 2009 Jan;14(1):62-9. Abstract: OBJECTIVES: To assess whether longitudinal surveillance in peripheral health facilities could document trends in disease burden, healthcare practice and utilization resulting from large-scale public health interventions made in the decade 1997-2006. METHODS: Data were collected from sick child visits (SCVs) among children <5 years attending 14 outpatient facilities in Asembo, rural western Kenya, during 1997-2006. Changes in proportions, and counts and rates were evaluated using chi-square and Poisson regression respectively. RESULTS: During the decade, 64 394 SCVs were made, yielding an average rate of 0.70 SCVs per child-year. The annual number of SCVs stayed constant during 1997-2003, then increased by 74% between 2003 and 2006 (P < 0.01). The time between symptom onset and SCV shortened from 5.6 days in 1997 to 4.4 days in 2006 (P < 0.01). Malaria and upper respiratory tract infection (URTI) were most commonly diagnosed (69% and 36% of SCVs respectively). Between 2003 and 2006, the proportion of SCVs with a malaria diagnosis fell from 77% to 48%, although the rate of malaria SCVs did not. URTI visits increased in 2004-2006. The most frequently prescribed antimalarials changed three times, lagging 1-2 years behind changes in national policy. Treatment of pneumonia with antibiotics varied by year, ranging from 19% to 89%. CONCLUSION: Surveillance of paediatric SCVs at peripheral health facilities was useful in documenting the timing and penetration of changes in national policies and clinical patterns of drug use for common infections. The surveillance data suggested that improved access to care, rather than disease burden changes, likely led to greater healthcare utilization after 2003. Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | STATISTICAL REGRESSION | EPIDEMIOLOGIC METHODS | CHILDREN | RURAL POPULATION | CLINIC VISITS | PNEUMONIA | MALARIA | RESPIRATORY INFECTIONS | PREVALENCE | ANTIMALARIAL DRUGS | ANTIBIOTICS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Service Statistics | Program Activities | Programs | Organization and Administration | Pulmonary Effects | Physiology | Biology | Parasitic Diseases | Diseases | Infections | Measurement | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330262 |
| 26. Peer Reviewed Title: HIV care and treatment factors associated with improved survival during TB treatment in Thailand: an observational study. Author: Varma JK; Nateniyom S; Akksilp S; Mankatittham W; Sirinak C; Sattayawuthipong W; Burapat C; Kittikraisak W; Monkongdee P; Cain KP; Wells CD; Tappero JW Source: BMC Infectious Diseases. 2009;9:42. Abstract: BACKGROUND: In Southeast Asia, HIV-infected patients frequently die during TB treatment. Many physicians are reluctant to treat HIV-infected TB patients with anti-retroviral therapy (ART) and have questions about the added value of opportunistic infection prophylaxis to ART, the optimum ART regimen, and the benefit of initiating ART early during TB treatment. METHODS: We conducted a multi-center observational study of HIV-infected patients newly diagnosed with TB in Thailand. Clinical data was collected from the beginning to the end of TB treatment. We conducted multivariable proportional hazards analysis to identify factors associated with death. RESULTS: Of 667 HIV-infected TB patients enrolled, 450 (68%) were smear and/or culture positive. Death during TB treatment occurred in 112 (17%). In proportional hazards analysis, factors strongly associated with reduced risk of death were ART use (Hazard Ratio [HR] 0.16; 95% confidence interval [CI] 0.07-0.36), fluconazole use (HR 0.34; CI 0.18-0.64), and co-trimoxazole use (HR 0.41; CI 0.20-0.83). Among 126 patients that initiated ART after TB diagnosis, the risk of death increased the longer that ART was delayed during TB treatment. Efavirenz- and nevirapine-containing ART regimens were associated with similar rates of adverse events and death. CONCLUSION: Among HIV-infected patients living in Thailand, the single most important determinant of survival during TB treatment was use of ART. Controlled clinical trials are needed to confirm our findings that early ART initiation improves survival and that the choice of non-nucleoside reverse transcriptase inhibitor does not. Language: English Keywords: THAILAND | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | TUBERCULOSIS | COMPLICATIONS | DEATH RATE | ANTIRETROVIRAL THERAPY | ANTIBIOTICS | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Data Analysis | Viral Diseases | Diseases | Infections | Mortality | Population Dynamics | Demographic Factors | Population | HIV | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 331243 |
| 27. Peer Reviewed Title: Adherence to both cotrimoxazole and placebo is associated with improved survival among HIV-infected Zambian children. Author: Walker AS; Ford D; Mulenga V; Thomason MJ; Nunn A; Chintu C; Gibb DM; Bangsberg DR Source: AIDS and Behavior. 2009 Feb;13(1):33-41. Abstract: In the CHAP randomized placebo-controlled trial of cotrimoxazole prophylaxis in HIV-infected Zambian children conducted between 2001 and 2003, cotrimoxazole was associated with significant mortality reductions. In a secondary analysis we used Cox regression models to estimate the association between adherence measured by bottle weights and caregiver report and subsequent mortality in children surviving >28 days (n = 496, 153 deaths). Adherence was high and similar in both cotrimoxazole and placebo groups; adherence from bottle weights was 100% at 71% of visits, while caregivers reported 100% adherence at 79% of visits. Every 10% lower adherence to cotrimoxazole or placebo measured by bottle weights was associated with a 10-11% increase in mortality risk. Effects remained after adjustment for baseline predictors of survival and for current and recent change in primary caregiver. Caregiver-reported adherence was not associated with survival. The association between bottle-weight adherence to placebo and survival is likely capturing unmeasured caregiver effects, whose identification will be essential for quantifying the impact of antiretroviral therapy (ART) adherence on clinical outcomes in children. Language: English Keywords: ZAMBIA | RESEARCH REPORT | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | ANTIBIOTICS | ANTIRETROVIRAL DRUGS | USER COMPLIANCE | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Drugs | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior Document Number: 330157 |
| 28. Peer Reviewed Title: A randomized controlled trial of treatment options for troublesome uterine bleeding in Implanon users. Author: Weisberg E; Hickey M; Palmer D; O'Connor V; Salamonsen LA; Findlay JK; Fraser IS Source: Human Reproduction. 2009 Aug;24(8):1852-61. Abstract: BACKGROUND: Pilot data have indicated that both doxycycline alone and mifepristone combined with ethinyl estradiol (EE) are effective in stopping episodes of bleeding in Implanon users with troublesome bleeding. We compared four treatments against a placebo in Implanon users and tested whether repeated treatment improved subsequent bleeding patterns. METHOD: Implanon users aged 18-45 years were randomized to treatment with (i) mifepristone 25 mg given twice on day 1 followed by 4 days of EE 20 microg; (ii) doxycycline 100 mg twice daily for 5 days; (iii) mifepristone 25 mg given twice on day 1 plus doxycycline 100 mg twice daily for 5 days; (iv) doxycycline 100 mg twice daily with EE 20 microg daily; and (v) placebo twice daily for 5 days. The primary end-point was the number of days of bleeding/spotting immediately following initiation of the first 5-day course of each therapy, compared with placebo. RESULTS: There were 204 women assigned to treatment. Mifepristone in combination with either EE or doxycycline was significantly more effective in stopping an episode of bleeding (mean 4.0 days (CI 3.5-4.6) and 4.4 days (CI 3.8-5.2), respectively) than doxycycline alone or in combination with EE, or placebo (6.4 days (CI 4.4-9.2), 6.4 days (CI 4.8-8.6) and 6.4 days (CL 5.1-8.0), respectively). CONCLUSION: Mifepristone combined with either EE or doxycycline was significantly more effective than placebo in terminating an episode of bleeding in Implanon users. However there was no improvement in subsequent bleeding patterns. Trial registration number: ACTR # 012605000206628. Language: English Keywords: AUSTRALIA | RESEARCH REPORT | CONTROL GROUPS | CONTRACEPTIVE IMPLANTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | MENSTRUATION DISORDERS | TREATMENT | RU-486 | ETHINYL ESTRADIOL | ANTIBIOTICS | ENDOMETRIAL EFFECTS | Oceania | Developed Countries | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Drugs | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System Document Number: 342798 |
| 29. Title: Progress in introduction of pneumococcal conjugate vaccine- |