An evaluation of p16(INK4a) expression in cervical intraepithelial neoplasia specimens, including women with HIV-1.

Although several studies have evaluated the role of p16(INK4a) as a diagnostic marker of cervical intraepithelial neoplasia (CIN) and its association with disease progression, studies regarding the role of p16(INK4a) in human immunodeficiency virus (HIV)-infected patients remain scarce. The present study was designed to determine the potential utility of p16(INK4a) as a diagnostic marker for CIN and invasive cervical cancer in HIV-positive and negative cervical specimens. An immunohistochemical analysis of p16(INK4a) was performed in 326 cervical tissue microarray specimens.

Klebsiella pneumoniae cervical necrotizing fasciitis originating as an abscess.

Cervical necrotizing fasciitis is a rapidly progressive and devastating infection that is usually caused by a polymicrobial infection including group A Streptococcus and anaerobes. We present a case of a newly diagnosed diabetic man who underwent transoral drainage of a Klebsiella pneumoniae paraglottic abscess, which, despite culture-directed antibiotics, progressed to cervical necrotizing fasciitis with descending mediastinitis. The patient required 12 surgical debridements and sternotomy, but survived and was discharged on hospital day 40.

Prior history of sexually transmitted diseases in women living with AIDS in São Paulo, Brazil.

Objectives: To describe the epidemiological profile, risk behaviors, and the prior history of sexually transmitted diseases (STDs) in women living with acquired immunodeficiency syndrome (AIDS).

Methods: Cross-sectional study, performed at the Centro de Referência e Treinamento em DST/AIDS of São Paulo. The social, demographic, behavioral, and clinical data such as age, schooling, marital status, age at first sexual intercourse, number of sexual partners, parity, use of drugs, time of HIV diagnosis, CD4 count, and viral load determination were abstracted from the medical records of women living with AIDS who had gynecological consultation scheduled in the period from June 2008 to May 2009.

Heterogeneity in tuberculosis transmission and the role of geographic hotspots in propagating epidemics.

The importance of high-incidence "hotspots" to population-level tuberculosis (TB) incidence remains poorly understood. TB incidence varies widely across countries, but within smaller geographic areas (e.g.

Time from symptom onset to the initiation of treatment of pulmonary tuberculosis in a city with a high incidence of the disease.

Objective: To estimate the time elapsed between the onset of symptoms and the initiation of treatment of pulmonary tuberculosis among treatment-naïve patients with positive results in sputum smear microscopy, and to evaluate the variables associated with delays in diagnosis and in treatment initiation.

Methods: This was a descriptive exploratory study involving 199 treatment-naïve tuberculosis patients > 12 years of age with AFB-positive sputum smear microscopy results between 2006 and 2008. At their first (treatment initiation) visit to a primary health care clinic in the city of Nova Iguaçu, Brazil, the patients were interviewed and their ancillary test results were reviewed.

Behavior assessment of women attending a sexually transmitted disease clinic in Vitória, Brazil.

Background: Studies about sexual risk behaviors can provide information to support design strategies to control the spread of HIV infection.

Objective: To assess sexual risk behaviors among women attending a sexually transmitted diseases clinic in Vitória, Brazil.

Methods: A cross-sectional study was performed among women attending an STD/AIDS reference center.

Evaluation of MCM-2 expression in TMA cervical specimens.

Background: Minichromosome maintenance proteins (MCM) are highly expressed in actively replicating cells. The need for biological markers for cervical carcinoma and its precursor lesions is emerging. Our main aim was to determine the immunohistochemical expression of MCM-2 in HIV-positive and -negative dysplastic cervical specimens.

Community-based targeted case finding for tuberculosis and HIV in household contacts of patients with tuberculosis in South Africa.

Rationale: South Africa has a high prevalence of tuberculosis (TB) and HIV-coinfected adults in whom TB is often diagnosed late in the course of disease.

Objectives: Improved case-finding approaches for TB and HIV are needed to reduce mortality and prevent transmission.

Methods: We identified newly diagnosed index TB cases in a rural district and enrolled their households in a TB-HIV contact-tracing study.

Spectral and temporal measures in hybrid cochlear implant users: on the mechanism of electroacoustic hearing benefits.

Objective: Compare auditory performance of Hybrid and standard cochlear implant users with psychoacoustic measures of spectral and temporal sensitivity and correlate with measures of clinical benefit.

Study Design: Cross-sectional study.

Setting: Tertiary academic medical center.

Inhibition of Notch activity promotes nonmitotic regeneration of hair cells in the adult mouse utricles.

The capacity of adult mammals to regenerate sensory hair cells is not well defined. To explore early steps in this process, we examined reactivation of a transiently expressed developmental gene, Atoh1, in adult mouse utricles after neomycin-induced hair cell death in culture. Using an adenoviral reporter for Atoh1 enhancer, we found that Atoh1 transcription is activated in some hair cell progenitors (supporting cells) 3 d after neomycin treatment.

Predictors of delayed culture conversion in patients treated for multidrug-resistant tuberculosis in Pakistan.

Culture conversion is an interim monitoring tool for treatment of multidrug-resistant tuberculosis (MDR-TB). We evaluated the time to and predictors of culture conversion in pulmonary MDR-TB patients enrolled in the community-based MDR-TB management program at the Indus Hospital in Karachi, Pakistan. Despite strict daily directly observed therapy, monthly food incentives and patient counseling, the median time to culture conversion was 196 days (range 32-471).

Cervical cytology and histopathologic abnormalities in women living with AIDS in São Paulo, Brazil.

Background: Women living with HIV/AIDS present with a higher prevalence of human papillomavirus (HPV) infection, higher rates of squamous intraepithelial lesions, and are more susceptible to invasive cervical carcinoma progression.

Objective: We assessed the frequency of precursory cervical lesions of cancer and its risk factors for women living with HIV/AIDS.

Methods: Sociodemographic, clinical, behavioral, and laboratory data were collected from medical records from 2008 to 2009 and analyzed using forward stepwise logistic regression.

Lower levels of interleukin-12 precede the development of tuberculosis among HIV-infected women.

Tuberculosis (TB) is the worldwide leading cause of death among HIV-infected individuals, accounting for more than half of AIDS-related deaths. A high risk of tuberculosis (TB) has been shown in early stages of the HIV disease, even in the presence of normal CD4(+) cell counts. Moreover, the factors that determine protective immunity vs.

Evaluation of oral antiseptic rinsing before sputum collection to reduce contamination of mycobacterial cultures.

To assess whether rinsing with oral antiseptics before sputum collection would reduce contamination of mycobacterial cultures, 120 patients with suspected tuberculosis were randomly assigned to rinse with chlorhexidine or cetylpyridinium mouthwash before collection. The culture contamination rate was significantly lower after rinsing with chlorhexidine before collection, especially for cultures grown in MGIT medium.

Physician adherence to guidelines for tuberculosis and HIV care in Rio de Janeiro, Brazil.

Background: Tuberculosis is the most common opportunistic infection among HIV-infected patients in Brazil. Brazil's national policy for HIV care recommends screening for latent tuberculosis (TB) and implementing isoniazid preventive therapy (IPT).

Objectives: We compared physician adherence to TB screening and other prevention and care policies among HIV primary care clinics in Rio de Janeiro City.

Cost-effectiveness of community health worker versus home-based guardians for directly observed treatment of tuberculosis in Vitória, Espírito Santo State, Brazil.

The objective of this study was to compare the costs and outcomes associated with guardian-supervised directly observed treatment relative to the standard of care Directly Observed Therapy, Short Course (DOTS) provided by community health workers (CHW). New cases of culture-positive pulmonary tuberculosis (TB) treated in Vitória, Espírito Santo State, Brazil, between January 2005 and December 2006 were interviewed and chose their preferred treatment strategy. Costs incurred by providers and patients (and patients' families) were estimated, and cost-effectiveness was assessed by comparing costs per successfully treated patient.

Impact of additional module training on the level of basic life support knowledge of first year students at the University of Maribor.

Aim: The aim of this study was to investigate the impact of additional (two versus one session) basic life support (BLS) training of university students on knowledge and attitude concerning the performance of cardiopulmonary resuscitation.

Methods: A total of 439 students in three separate groups were tested: those with no prior BLS training; BLS training in high school (part of the driver's education course); and BLS training in high school (in the driver's education course) and additional BLS training at the university.

Results: Our study showed the best results of BLS education in a group of university students who took an additional BLS module approximately half a year after the driver's education BLS course.

Fellowship and career path preferences in residents of otolaryngology-head and neck surgery.

Objectives/hypothesis: Assess fellowship and academic/private practice career track preferences in residents of otolaryngology-head and neck surgery.

Study Design: Cross-sectional survey.

Methods: A total of 1,364 U.

Epidemiological profile of adult patients with tuberculosis and AIDS in the state of Espírito Santo, Brazil: cross-referencing tuberculosis and AIDS databases.

Objective: To evaluate the epidemiological profile of patients with tuberculosis (TB) only and that of patients with TB/AIDS in the state of Espírito Santo, Brazil, between 2000 and 2006.

Methods: For the patients of interest, we collected demographic and clinical data from the Epidemiological Surveillance Center (TB database), Brazilian Case Registry Database, and Brazilian National Mortality Database, as well as the Brazilian National CD4+/CD8+ T Lymphocyte Count and Viral Load Network Laboratory Test Control System and the Logistic Medication Monitoring System (HIV/AIDS databases). All of the compiled data were cross-referenced.

Intention to quit smoking among human immunodeficiency virus infected adults in Johannesburg, South Africa.

Although smoking is common in human immunodeficiency virus (HIV) infected individuals, in resource-constrained, high HIV prevalence settings, information on smoking cessation intent and acceptability is limited. Of 150 self-reported current smokers surveyed in two South African HIV clinics, 62 (42%) reported intent to quit smoking in the next year, while 86 (58%) were not interested in quitting or had no plan to quit; 132 (82%) had attempted to quit at least once in the past. Respondents' preferred cessation strategies were counseling and nicotine replacement.

Prevalence of patients with respiratory symptoms through active case finding and diagnosis of pulmonary tuberculosis among prisoners and related predictors in a jail in the city of Carapicuíba, Brazil.

Background: Prisons offer a fertile setting for the transmission of tuberculosis due to the presence of many classic risk factors for both infection and disease: overcrowding, poor ventilation, and little sunlight. Prisoners are often malnourished and have poor hygiene and are more likely to have a background of alcohol and drug abuse.

Objectives: To determine the prevalence of prisoners with respiratory symptoms and pulmonary tuberculosis (PTB) through active case finding in a prisoner population of the county jail of Carapicuíba, and to study possible related variables.

The implementation of isoniazid preventive therapy in HIV clinics: the experience from the TB/HIV in Rio (THRio) study.

Objective: The TB/HIV in Rio (THRio) study was launched in September 2005 to assess the impact of integrated tuberculosis (TB) and HIV treatment strategies in 29 HIV clinics in Rio de Janeiro, Brazil.

Design: THRio is a cluster-randomized trial (CRT) to determine whether routine screening for and treatment of latent TB in HIV clinic patients with access to antiretroviral therapy will reduce TB incidence at the clinic level. THRio is part of the Consortium to Respond Effectively to AIDS/TB Epidemic that is implementing research studies to assess the impact of bold, new public health paradigms for controlling the AIDS/TB epidemic.

Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto: a prospective cohort.

Objective: To ascertain progression and regression of cervical dysplasia in HIV-infected women in Soweto.

Design: Prospective cohort.

Methods: Women attending an HIV wellness clinic were offered cervical smears as part of care; smears were assessed using the Bethesda system.

Professional burnout among microvascular and reconstructive free-flap head and neck surgeons in the United States.

Objectives: To determine the prevalence of professional burnout among microvascular free-flap (MVFF) head and neck surgeons and to identify modifiable risk factors with the intent to reduce MVFF surgeon burnout.

Design: A cross-sectional, observational study.

Setting: A questionnaire mailed to MVFF surgeons in the United States.