Lactobacillus dominates the lower genital tract microbiota of many women, producing a low vaginal pH, and is important for healthy pregnancy outcomes and protection against several sexually ...transmitted pathogens. Yet, factors that promote Lactobacillus remain poorly understood. We hypothesized that the amount of free glycogen in the lumen of the lower genital tract is an important determinant of Lactobacillus colonization and a low vaginal pH.
Free glycogen in lavage samples was quantified. Pyrosequencing of the 16S rRNA gene was used to identify microbiota from 21 African American women collected over 8-11 years.
Free glycogen levels varied greatly between women and even in the same woman. Samples with the highest free glycogen had a corresponding median genital pH that was significantly lower (pH 4.4) than those with low glycogen (pH 5.8; p<0.001). The fraction of the microbiota consisting of Lactobacillus was highest in samples with high glycogen versus those with low glycogen (median = 0.97 vs. 0.05, p<0.001). In multivariable analysis, having 1 vs. 0 male sexual partner in the past 6 months was negatively associated, while BMI ≥30 was positively associated with glycogen. High concentrations of glycogen corresponded to higher levels of L. crispatus and L. jensenii, but not L. iners.
These findings show that free glycogen in genital fluid is associated with a genital microbiota dominated by Lactobacillus, suggesting glycogen is important for maintaining genital health. Treatments aimed at increasing genital free glycogen might impact Lactobacillus colonization.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Soluble Urokinase Receptor and Chronic Kidney Disease Hayek, Salim S; Sever, Sanja; Ko, Yi-An ...
New England journal of medicine/The New England journal of medicine,
11/2015, Letnik:
373, Številka:
20
Journal Article
Recenzirano
Odprti dostop
This study examined plasma levels of soluble urokinase-type plasminogen activator receptor (suPAR) and the estimated glomerular filtration rate at baseline and incident CKD. Higher suPAR levels ...predicted incident CKD and an accelerated decline in the eGFR.
Chronic kidney disease and progressive loss of kidney function constitute a major public health problem affecting 11% of the U.S. population.
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Patients with chronic kidney disease are at high risk for cardiovascular disease and death.
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It is thus important to identify patients at high risk for chronic kidney disease and to treat underlying disease processes that drive kidney injury.
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In clinical practice, methods of screening for kidney disease are limited to measurement of urinary protein excretion and calculation of the estimated glomerular filtration rate (eGFR). Proteinuria and a decline in the eGFR are relatively insensitive indexes of early injury and . . .
Colonization of the female lower genital tract with Lactobacillus provides protection against STIs and adverse pregnancy outcomes. Growth of genital Lactobacillus is postulated to depend on ...epithelial cell-produced glycogen. However, the amount of cell-free glycogen in genital fluid available for utilization by Lactobacillus is not known.
Eighty-five genital fluid samples from 7 pre-menopausal women taken over 4-6 weeks were obtained using the Instead SoftCup® (EvoFem, Inc., San Diego, CA, USA) by consented donors. Cell-free glycogen and glucose in genital fluids and estrogen and progesterone in blood were quantified.
Glycogen ranged from 0.1-32 μg/μl. There were significant differences between women in glycogen over the observation period. There was a strong negative correlation between glycogen and vaginal pH (r = -0.542, p<0.0001). In multivariable analysis, free glycogen levels were significantly negatively associated with both vaginal pH and progesterone (p < 0.001 and p = 0.004, respectively). Estrogen, glucose, age, sexual intercourse 24 hours prior to visit, and days after the initial visit were not significantly associated with free glycogen levels.
Cell-free glycogen concentrations can be very high, up to 3% of genital fluid, and are strongly associated with acidic vaginal pH. However, the fluctuations in glycogen levels in individuals and differences between individuals do not appear to be associated with estrogen.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Pre-exposure prophylaxis (PrEP) is efficacious to prevent HIV infection, however, uptake among young men who have sex with men (YMSM) is relatively low. The purpose of this study was to describe PrEP ...use and related factors in a representative sample of YMSM in two cities, Chicago and Houston. YMSM, ages 16–29, were recruited via respondent-driven sampling (RDS) from 2014 to 2016. Correlates of PrEP uptake were assessed in weighted multivariable logistic regression models. A total of 12.2% of participants (of 394) reported ever taking PrEP; Black YMSM had the lowest rates of uptake (4.7%) and Whites the highest (29.5%). In a multivariable regression model, having an HIV positive sex partner, reporting recent group sex, peer network size, and city (Chicago) were significantly and positively associated with use of PrEP, while Black race was negatively associated with it. Given evidence of racial/ethnic disparities in PrEP uptake in this study, further research is needed to identify potential mechanisms of action and points of intervention.
INTRODUCTION:The HIV epidemic continues to disproportionately affect men who have sex with men (MSM) in the United States, with over a third of new infections in MSM occurring in younger men. Very ...few studies have reported on HIV and sexually transmitted infection (STI) incidence and related risks among younger MSM, particularly among minors under 18 years of age.
METHODS:Data analyzed herein are from a longitudinal study of HIV risk among 450 very young MSM in Chicago aged 16 to 20, recruited via respondent-driven sampling and followed-up for 2 years, with annual HIV and STI testing. We report estimated cumulative HIV and STI incidence over the 24-month follow-up using Kaplan–Meier methods and evaluated associations with incident infections using Cox proportional hazards regression.
RESULTS:The final analytic sample was primarily non-white (83%); median age was 19; 25% of the sample was under age 18. Twenty-six new HIV infections were detected over 632 person-years of follow-up. HIV incidence was 4.11/100 person-years 95% confidence interval (CI)2.80 to 6.04 and STI incidence was 6.22/100 person-years (95% CI4.54 to 8.51). Cumulative HIV incidence over 24 months of follow-up was 7.32% (95% CI5.05 to 10.57), with higher incidence among racial/ethnic minorities. In multivariate analyses, non-white race and recent sexual partner concurrency were associated with both HIV and STI infection; HIV testing history and sex with an HIV-positive partner were associated with increased risk of HIV infection.
DISCUSSION:High rates of incident HIV infection and STIs among very young MSM and the relationship between incidence and race/ethnicity, concurrency and partner characteristics indicate potential focal points of future intervention and the need for continued vigilance.
Protective behaviors such as mask wearing and physical distancing are critical to slow the spread of COVID-19, even in the context of vaccine scale-up. Understanding the variation in self-reported ...COVID-19 protective behaviors is critical to developing public health messaging. The purpose of the study is to provide nationally representative estimates of five self-reported COVID-19 protective behaviors and correlates of such behaviors. In this cross-sectional survey study of US adults, surveys were administered via internet and telephone. Adults were surveyed from April 30-May 4, 2020, a time of peaking COVID-19 incidence within the US. Participants were recruited from the probability-based AmeriSpeak® national panel. Brief surveys were completed by 994 adults, with 73.0% of respondents reported mask wearing, 82.7% reported physical distancing, 75.1% reported crowd avoidance, 89.8% reported increased hand-washing, and 7.7% reported having prior COVID-19 testing. Multivariate analysis (p critical value .05) indicates that women were more likely to report protective behaviors than men, as were those over age 60. Respondents who self-identified as having low incomes, histories of criminal justice involvement, and Republican Party affiliation, were less likely to report four protective behaviors, though Republicans and individuals with criminal justice histories were more likely to report having received COVID-19 testing. The majority of Americans engaged in COVID-19 protective behaviors, with low-income Americans, those with histories of criminal justice involvement, and self-identified Republicans less likely to engage in these preventive behaviors. Culturally competent public health messaging and interventions might focus on these latter groups to prevent future infections. These findings will remain highly relevant even with vaccines widely available, given the complementarities between vaccines and protective behaviors, as well as the many challenges in delivering vaccines.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Medication adherence among HIV-infected individuals is critical to limit disease progression and onward transmission. Evidence indicates that among youth living with HIV (YLH), adherence is ...suboptimal and related to co-morbid psychosocial conditions. Cross-sectional data from 212 YLH, ages 16-29, collected between 2011-2014 in Chicago were analyzed to assess the relationship of multiple psychosocial conditions (e.g., depressive symptoms, anxiety symptoms, moderate/heavy marijuana use, moderate/heavy alcohol use, HIV-related stigma) to ART adherence (i.e., a "syndemic.") Adherence was regressed on an index of increasing numbers of psychosocial conditions, controlling for demographic and treatment factors as well as enrollment site. The mean age of participants was 24, 89% were male, 87% black, and 91% behaviorally infected. Psychosocial conditions were prevalent, including 38% and 34% with high depressive and anxiety symptoms, respectively, 54% and 25% with a moderate/high level of marijuana and alcohol use, respectively, and 46% reporting high HIV-related stigma. In regression analysis, the likelihood of ART adherence decreased with the number of syndemic conditions (linear dose response, p = 0.02) as did the odds of viral load suppression (p = 0.008). Interventions to address these conditions in concert with biomedical treatment as prevention for YLH are needed.
Persons who inject drugs (PWID) may be at risk of acquiring HIV and sexually transmitted infections (STIs) from risky sexual practices and elevated disease prevalence within their drug injection and ...sexual networks. We conducted a personal (egocentric) network study of young PWID (aged 18–30) from the Chicago metropolitan area. Logistic regression with generalized estimating equations evaluated associations between individual and network factors and sexual behaviors. Of 162 participants, 116 (71.6 %) were non-Hispanic White and 135 reported on 314 sexual network members. Multiplexity—having network members with overlapping roles as injection and sexual partners—was associated with more condomless vaginal sex (aOR 5.55; 95 % CI 1.62–19.0) and anal sex (aOR 6.79; 95 % CI 2.49–18.5) and less exchange sex among women (aOR 0.12; 95 % CI 0.03–0.40), adjusting for sociodemographic and sexual network characteristics. The contribution of individual and sexual network factors to HIV/STI transmission among young PWID warrants further research.
Youth of color (e.g., Black/African American and Latinx/Hispanic) are overrepresented in the juvenile justice system and experience greater health disparities compared to non-Hispanic White youth. ...Ethnic/racial discrimination (ERD) is a risk marker for poor mental health and behavioral outcomes among youth of color, and traumatic stress and emotion dysregulation have been implicated in these pathways. Despite the relevance of these factors for justice-involved youth of color, understanding of their interrelations within this demographic is lacking.
Participants were 173 recently arrested adolescents (86% African American; 45% girls; ages 13–18) on probation in a large Midwest city in the United States. Participants completed surveys assessing ERD, traumatic stress, emotion dysregulation, internalizing symptoms, and externalizing behaviors. Using linear regression and path analysis, this study tested the cross-sectional links among two types of ERD (i.e., interpersonal experiences and perceptions of group experiences), traumatic stress symptoms, emotion dysregulation, and internalizing symptoms and externalizing behaviors.
Interpersonal ERD (e.g., hearing racial insults) was associated with increased internalizing symptoms and externalizing behaviors; for internalizing symptoms, the relation was stronger for girls than boys. Gender differences were partially accounted for by traumatic stress symptoms and emotion dysregulation.
This study offers new insights into ERD experiences among juvenile justice-involved youth of color, gender differences in ethnic/racial discrimination experiences, and the potential value of gender-sensitive and culturally responsive programming in strengthening youths’ ability to cope with ERD.
BACKGROUNDReverse sequence screening for syphilis, in which an automatable treponemal assay (enzyme immunoassay EIA/chemiluminescence assay CIA) is performed first and followed by a nontreponemal ...test for reactive specimens, has been used increasingly in the United States. The EIA is objective, efficient, and believed to be more sensitive than the rapid plasma reagin (RPR) because treponemal antibodies appear before nontreponemal antibodies. We sought to compare the sensitivity of a commonly used EIA, the Trep-Sure EIA (TS-EIA), to the RPR in cases of suspected primary syphilis infection in our clinic.
METHODSA retrospective medical record review of patients with sexually transmitted infection clinic visits from January 2009 to December 2011 was conducted, and 52 patients met the following inclusion criteriasuspected primary syphilis symptoms, at least 1 positive syphilis test result at visit, and no history of syphilis. Sensitivity analyses compared the TS-EIA and RPR, using the reference standard of concordantly positive/reactive TS-EIA/RPR or positive fluorescent treponemal antibody absorption test (FTA-ABS) result. We considered equivocal TS-EIA results to be positive for sensitivity calculations because such results typically reflex to additional testing and therefore may still result in identifying new infections.
RESULTSTwenty-eight (53.8%) of the 52 patients had a positive or equivocal TS-EIA. Twenty-five (89.3%) of those were RPR reactive; the remaining 3 (10.7%) were RPR nonreactive, FTA-ABS positive. Forty patients (76.9%) had a positive RPR, including 15 patients (37.5%) with negative TS-EIA results; all 15 were FTA-ABS positive. Nine additional patients were TS-EIA negative and RPR nonreactive but had a positive FTA-ABS result. The RPR was significantly more sensitive than the EIA (76.9% vs. 53.8%, P = 0.005). Trep-Sure EIA positivity was also significantly associated with higher median RPR titer (P = 0.011).
CONCLUSIONSUse of the TS-EIA may result in underdetection of primary syphilis compared with the RPR. Further evaluation of the sensitivity of the TS-EIA in high-morbidity settings is warranted before the adoption of reverse sequence screening algorithms.