The role of genetics in male sexual orientation was investigated by pedigree and linkage analyses on 114 families of homosexual men. Increased rates of same-sex orientation were found in the maternal ...uncles and male cousins of these subjects, but not in their fathers or paternal relatives, suggesting the possibility of sex-linked transmission in a portion of the population. DNA linkage analysis of a selected group of 40 families in which there were two gay brothers and no indication of nonmaternal transmission revealed a correlation between homosexual orientation and the inheritance of polymorphic markers on the X chromosome in approximately 64 percent of the sib-pairs tested. The linkage to markers on Xq28, the subtelomeric region of the long arm of the sex chromosome, had a multipoint lod score of 4.0 (P = 10$^{-5}$), indicating a statistical confidence level of more than 99 percent that at least one subtype of male sexual orientation is genetically influenced.
Summary
Objective The recent change of treatment policy for uncomplicated malaria from sulfadoxine‐pyrime‐thamine to artemether‐lumefantrine (AL) in Kenya was accompanied by revised malaria ...diagnosis recommendations promoting presumptive antimalarial treatment in young children and parasitological diagnosis in patients 5 years and older. We evaluated the impact of these age‐specific recommendations on routine malaria treatment practices 4–6 months after AL treatment was implemented.
Methods Cross‐sectional, cluster sample survey using quality‐of‐care assessment methods in all government facilities in four Kenyan districts. Analysis was restricted to the 64 facilities with malaria diagnostics and AL available on the survey day. Main outcome measures were antimalarial treatment practices for febrile patients stratified by age, use of malaria diagnostic tests, and test result.
Results Treatment practices for 706 febrile patients (401 young children and 305 patients ≥5 years) were evaluated. 43.0% of patients ≥5 years and 25.9% of children underwent parasitological malaria testing (87% by microscopy). AL was prescribed for 79.7% of patients ≥5 years with positive test results, for 9.7% with negative results and for 10.9% without a test. 84.6% of children with positive tests, 19.2% with negative tests, and 21.6% without tests were treated with AL. At least one antimalarial drug was prescribed for 75.0% of children and for 61.3% of patients ≥5 years with a negative test result.
Conclusions Despite different recommendations for patients below and above 5 years of age, malaria diagnosis and treatment practices were similar in the two age groups. Parasitological diagnosis was under‐used in older children and adults, and young children were still tested. Use of AL was low overall and alternative antimalarials were commonly prescribed; but AL prescribing largely followed the results of malaria tests. Malaria diagnosis recommendations differing between age groups appear complex to implement; further strengthening of diagnosis and treatment practices under AL policy is required.
Effets de la révision des recommandations de diagnostic de la malaria sur les pratiques de traitement de tous les groupes d’âge au Kenya
Objectif Le récent changement de la politique de traitement de la malaria non compliquée passant de la sulfadoxine‐pyriméthamine à l’artéméther‐luméfantrine (AL) au Kenya a été accompagné d’une révision des recommandations du diagnostic de la malaria promouvant le traitement antimalarique présomptif chez les jeunes enfants et le diagnostic parasitologique chez les patients de 5 ans et plus. Notre objectif était d’évaluer l’impact de ces recommandations spécifiées à l’âge, sur les pratiques courantes de traitement de la malaria, 4 à 6 mois après l’instauration du traitement AL.
Méthodes Etude transversale en grappes utilisant des méthodes d’analyse de la qualité des soins dans tous les services gouvernementaux de quatre districts kenyans. L’analyse a été limitée aux 64 services disposant de diagnostic de la malaria et d’AL, le jour de l’enquête. Les critères principaux d’évaluation étaient: traitements antimalariques en pratique pour les patients fébriles stratifiés selon l’âge, utilisation de tests de diagnostic de la malaria et résultat du test.
Résultats Les pratiques de traitement pour 706 patients fébriles (401 jeunes enfants et 305 patients de plus de 5 ans) ont étéévaluées. 43,0% des patients de plus de 5 ans et 25,9% des jeunes enfants ont subi des tests parasitologiques pour la malaria (87% par microscopie). AL a été prescrit pour 79,7% des patients de plus de 5 ans ayant un résultat positif pour le test, pour 9,7% de ceux ayant un résultat négatif et pour 10,9% de ceux sans test. 84,6% des jeunes enfants ayant un test positif, 19,2% de ceux ayant un test négatif et 21,6% de ceux sans test ont été traités avec AL. Au moins un médicament antimalarique a été prescrit pour 75,1% des jeunes enfants et 61,3% pour les enfants de plus de 5 ans ayant un résultat de test négatif.
Conclusions Malgré différentes recommandations pour les patients en‐dessous et au‐dessus de 5 ans, les pratiques de diagnostic et de traitement de la malaria étaient similaires dans les deux groupes d’âge. Le diagnostic parasitologique était peu utilisé chez les enfants plus âgés et les adultes et, les jeunes enfants étaient encore toujours testés. L’utilisation d’AL était globalement faible et des antimalariques alternatifs étaient couramment prescrits. Cependant, une prescription accrue d’AL suivait les résultats des tests de la malaria. Les recommandations divergentes pour le diagnostic de la malaria selon les groupes d’âge semblent complexes à appliquer. Un renforcement des pratiques de diagnostic et de traitement au sein de la politique de l’AL est nécessaire.
Efectos de las recomendaciones diagnósticas revisadas para el tratamiento de malaria en utilización para diferentes grupos de edades en Kenia
Objetivo El reciente cambio en Kenia de la política de tratamiento para malaria no complicada, de sulfadoxina‐pirimetamina a artemeter‐lumefantrina (AL), estuvo acompañada de una revisión en las recomendaciones para el diagnóstico de malaria, promoviendo un tratamiento antimalárico presuntivo en niños pequeños y el diagnóstico parasitológico en pacientes con cinco o más años de edad. Nuestro objetivo era evaluar el impacto de estas recomendaciones edad‐específicas en la práctica rutinaria del tratamiento, 4 a 6 meses después de la implementación del tratamiento con AL.
Métodos Estudio croseccional, encuesta con muestreo de agrupaciones utilizando métodos de evaluación de la calidad del cuidado en todos los centros gubernamentales en cuatro distritos Keniatas. El análisis estaba restringido a los 64 centros con diagnóstico de malaria y disponibilidad de AL el día de la encuesta. Las principales medidas de valoración eran las prácticas para pacientes febriles estratificados por edad, uso de pruebas de diagnóstico de malaria y resultados de las pruebas.
Resultados Se evaluaron las prácticas de tratamiento para 706 pacientes febriles (401 niños pequeños y 305 pacientes ≥5 años). Un 43.0% de los pacientes ≥5 años y un 25.9% de los niños fueron sometidos pruebas parasitológicas de malaria (87% por microscopía). Se prescribió AL a un 79.7% de los pacientes ≥5 años con resultados positivos en las pruebas, a un 9.7% con resultados negativos y a un 10.9% sin resultado. Un 84.6% de los niños que dieron positivos en las pruebas, un 19.2% de los que dieron negativo, y un 21.6% de aquellos que no fueron sometidos a una prueba fueron tratados con AL. Se prescribió al menos un medicamento antimaláricos a un 75.1% de los niños y a un 61.3% de los pacientes ≥5 años con un resultado negativo en la prueba.
Conclusiones A pesar de la diferencia en las recomendaciones para pacientes menores y mayores de 5 años, las prácticas de diagnóstico y tratamiento fueron similares en los dos grupos de edad. El diagnóstico parasitológico fue subutilizado en niños mayores y en adultos, y los niños pequeños seguían siendo sometidos a las pruebas. El uso de AL era bajo en general, y se prescribían antimaláricos alternativos de forma común; sin embargo la prescripción de AL seguía en gran medida los resultados de las pruebas para malaria. Parece compleja la implementación de recomendaciones para el diagnóstico de malaria con diferencias según el grupo de edad; es necesario fortalecer más las prácticas de diagnóstico y tratamiento bajo la política de AL.
In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and antimicrobial resistance among common invasive pathogens that might guide policy and practice.
A cross-sectional ...observational prevalence and etiology study of neonates with suspected sepsis admitted to the neonatal intensive care unit, University Teaching Hospital, Lusaka, Zambia, between October 2013 and May 2014. Data from blood cultures and phenotypic antibiotic susceptibility testing were compared with multivariate analysis of risk factors for neonatal sepsis.
Of 313 neonates with suspected sepsis, 54% (170/313) were male; 20% (62/313) were born to HIV-positive mothers; 33% (103/313) had positive blood cultures, of which 85% (88/103) were early-onset sepsis. Klebsiella species was the most prevalent isolate, accounting for 75% (77/103) of cases, followed by coagulase-negative staphylococci 6% (7/103), Staphylococcus aureus 6% (6/103), Escherichia coli 5% (5/103) and Candida species 5% (5/103). For Klebsiella species, antibiotic resistance ranged from 96%-99% for World Health Organization-recommended first-line therapy (gentamicin and ampicillin/penicillin) to 94%-97% for third-generation cephalosporins. The prevalence of culture-confirmed sepsis increased from 0 to 39% during the period December 2013 to March 2014, during which time mortality increased 29%-47%; 93% (14/15) of late-onset sepsis and 82% (37/45) of early-onset sepsis aged 4-7 days were admitted >2 days before the onset of symptoms. Culture results for only 25% (26/103) of cases were available before discharge or death. Maternal HIV infection was associated with a reduced risk of neonatal sepsis odds ratio, 0.46 (0.23-0.93); P = 0.029.
Outbreaks of nosocomial multiantibiotic-resistant infections are an important cause of neonatal sepsis and associated mortality. Reduced risk of neonatal sepsis associated with maternal HIV infection is counterintuitive and requires further investigation.
Background. The World Health Organization advocates 2–3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (SP IPTp). The optimal number of doses and the ...consequences of single-dose therapy remain unclear. Methods. Data were from a randomized, controlled study of human immunodeficiency virus-positive Zambian women comparing monthly versus 2-dose SP IPTp. We compared maternal and neonatal birth outcomes as a function of how many doses the mothers received (1 to ⩾4 doses). Results. Of 387 deliveries, 34 received 1 dose of SP. Single-dose SP was significantly associated with higher proportions of maternal anemia, peripheral and cord blood parasitemia, infant prematurity, and low birth weight. SP conferred dose-dependent benefits, particularly in the transition from 1 to 2 doses of SP. Women randomized to the standard 2-dose regimen were much more likely to receive only 1 dose than were women randomized to monthly IPT (relative risk, 16.4 95% confidence interval, 4.0–68.3). Conclusions. Single-dose SP was a common result of trying to implement the standard 2-dose regimen and was inferior to all other dosing regimens. At a programmatic level, this implies that monthly SP IPTp may ultimately be more effective than the standard regimen by reducing the risk of inadvertently underdosing mothers.
Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers.
To describe clinical manifestations and epidemiology of Zika virus disease in ...travelers exposed in the Americas.
Descriptive, using GeoSentinel records.
63 travel and tropical medicine clinics in 30 countries.
Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016.
Frequencies of demographic, trip, and clinical characteristics and complications.
Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain-Barré syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death).
Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable.
These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission.
Centers for Disease Control and Prevention, International Society of Travel Medicine, and Public Health Agency of Canada.
Dopaminergic genes are likely candidates for heritable
influences on cigarette smoking. In an accompanying article,
Lerman et al. (1999)
report
associations between allele 9 of a dopamine transporter ...gene
polymorphism (SLC6A3-9) and lack of smoking, late initiation of
smoking, and length of quitting attempts. The present investigation
extended their study by examining both smoking behavior and
personality traits in a diverse population of nonsmokers, current
smokers, and former smokers (
N
= 1,107). A
significant association between SLC6A3-9 and smoking status was
confirmed and was due to an effect on cessation rather than
initiation. The SLC6A3-9 polymorphism was also associated with low
scores for novelty seeking, which was the most significant
personality correlate of smoking cessation. It is hypothesized that
individuals carrying the SLC6A3-9 polymorphism have altered dopamine
transmission, which reduces their need for novelty and reward by
external stimuli, including cigarettes.
Because acute bacterial gastroenteritis is often inflammatory, rapid stool assays that detect intestinal inflammation might be used to distinguish between bacterial and nonbacterial gastroenteritis. ...We performed meta-analyses to determine the discriminatory power, in developed and in resource-poor countries, of rapid stool assays that test for lactoferrin, fecal leukocytes, fecal erythrocytes, and occult blood. In developed countries, the area under the summary receiver operating characteristic curve (AUC/SROC) was 0.89 for fecal leukocytes and 0.81 for occult blood. In resource-poor countries, the AUC/SROC was 0.79 for lactoferrin, 0.72 for fecal leukocytes, 0.63 for occult blood, and 0.61 for fecal erythrocytes. In developed countries, positive and negative likelihood ratios (LR+ and LR-, respectively) for fecal leukocytes were 4.56 and 0.32 when a threshold of >5 cells/high-power field was used, compared with 2.94 and 0.6 in resource-poor countries; for lactoferrin, LR+ was 1.34 and LR- was 0.17 in resource-poor countries when the threshold was an agglutination rating of “+” and a dilution of 1 : 50. In developing countries, rapid stool assays performed poorly, whereas in developed countries, tests for fecal leukocytes, lactoferrin, and occult blood were moderately useful and could identify patients who were more likely to benefit from empirical antibiotic therapy.
We report nine travellers with confirmed chikungunya virus infection, returning from tourist areas of Thailand to Sweden, Switzerland, the United Kingdom, Romania, Israel and France, diagnosed in ...January and February 2019. These sentinel tourists support the intensification of chikungunya virus circulation in Thailand and highlight the potential for importation to areas at risk of local transmission.
This cross-sectional randomized controlled study assessed the social acceptability of micronutrient fortified cooked lunch meals by schoolchildren in rural Himalayan villages of India, in a program ...where the cooking and the micronutrient fortification were done at school. Subjects were randomly assigned to treatment (91) and control (90) groups. The treatment group consumed a weighed amount of cooked lunch meals fortified with locally produced multi-micronutrient premix and the control group consumed a weighed amount of the same meals but without added micronutrient premix. After having eaten, subjects were asked to rate, on a 3-point Likert scale using "smiley" faces, the pleasantness of smell, taste, and overall satisfaction with the food. The mean age of study children was 7.96 ± 1.64 y and 48.6% were males. The average amounts of food consumed by the treatment and control groups were 345 ± 114 and 360 ± 102.4 g, respectively. Addition of the multi-micronutrient premix to school meals did not significantly affect the mean amount of food consumed by the schoolchildren (P > 0.05; independent sample t-test). No significant differences were seen between treatment and control groups in terms of ratings for taste, smell, and the general acceptance of the micronutrient fortified or the unfortified school meals. In conclusion, the addition of a multiple micronutrient premix to school meals was well liked by schoolchildren and did not adversely affect their food consumption.
Abstract
Background
Early detection of imported multidrug-resistant tuberculosis (MDR-TB) is crucial, but knowledge gaps remain about migration- and travel-associated MDR-TB epidemiology. The aim was ...to describe epidemiologic characteristics among international travellers and migrants with MDR-TB.
Methods
Clinician-determined and microbiologically confirmed MDR-TB diagnoses deemed to be related to travel or migration were extracted from GeoSentinel, a global surveillance network of travel and tropical medicine clinics, from January 2008 through December 2020. MDR-TB was defined as resistance to both isoniazid and rifampicin. Additional resistance to either a fluoroquinolone or a second-line injectable drug was categorized as pre-extensively drug-resistant (pre-XDR) TB, and as extensively drug-resistant (XDR) TB when resistance was detected for both. Sub-analyses were performed based on degree of resistance and country of origin.
Results
Of 201 patients, 136 had MDR-TB (67.7%), 25 had XDR-TB (12.4%), 23 had pre-XDR TB (11.4%) and 17 had unspecified MDR- or XDR-TB (8.5%); 196 (97.5%) were immigrants, of which 92 (45.8%) originated from the former Soviet Union. The median interval from arrival to presentation was 154 days (interquartile range IQR: 10–751 days); 34.3% of patients presented within 1 month after immigration, 30.9% between 1 and 12 months and 34.9% after ≥1 year. Pre-XDR- and XDR-TB patients from the former Soviet Union other than Georgia presented earlier than those with MDR-TB (26 days IQR: 8–522 vs. 369 days IQR: 84–827), while patients from Georgia presented very early, irrespective of the level of resistance (8 days IQR: 2–18 vs. 2 days IQR: 1–17).
Conclusions
MDR-TB is uncommon in traditional travellers. Purposeful medical migration may partly explain differences in time to presentation among different groups. Public health resources are needed to better understand factors contributing to cross-border MDR-TB spread and to develop strategies to optimize care of TB-infected patients in their home countries before migration.
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