Search

Background: Pleural effusions constitute one of the most frequent pathologies encountered in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Bleomycin and talc are commonly used for pleurodesis, but cost prohibitive, therefore we aimed to retrospectively compare the efficacy and safety of sodium hydroxide (NaOH) with bleomycin for pleurodesis. Methods: Case records of pleurodesis using bleomycin and NaOH from 2002 to 2013 were reviewed. Standard of care for pleurodesis for recurrent pleural effusions at MCH was developed using the materials available. NaOH remained the agent of choice until 2006 when bleomycin became available. Clinical data regarding general complications, rate of success and lung expansion were noted for every patient who underwent pleurodesis at MCH during this time frame. Results: Review of pleurodesis at MCH revealed 24 cases using bleomycin and 23 cases using NaOH as the sclerosing agent. Patient characteristics were balanced between the two groups with majority of pleural effusions malignant in etiology. Conclusions: There was no statistically significant difference between the use of bleomycin and NaOH as defined by lung expansion. General complications were observed less frequently in 2 (10%) of patients treated with NaOH compared with 8 (38%) of patients using bleomycin. Only three patients presented with recurrent pleural effusion after pleurodesis with NaOH. NaOH may offer a low cost alternative sclerosing agent for resource limited areas.

Background Mozambican healthcare workers have high rates of latent and active tuberculosis, but occupational screening for tuberculosis is not routine in this setting. Furthermore, the specificity of tuberculin skin testing in this population compared with interferon gamma release assay testing has not been established. Methods This study was conducted among healthcare workers at Maputo Central Hospital, a public teaching quaternary care hospital in Mozambique. With a cross sectional study design, risk factors for tuberculosis were assessed using multivariable logistic regression. The care cascade is reported for participants who were prescribed six months of isoniazid preventive therapy for HIV or highly reactive testing for latent tuberculosis infection. The agreement of interferon-gamma release assay results with positive tuberculin skin testing was calculated. Results Of 690 screened healthcare workers, three (0.4%) had active tuberculosis and 426 (61.7%) had latent tuberculosis infection. Less education, age 35–49, longer hospital service, and work in the surgery department were associated with increased likelihood of being tuberculosis infected at baseline (p

Background Sexually transmitted infections (STIs) increase the risk of HIV transmission and are present at high rates among men who have sex with men (MSM). Adherence to HIV/STI testing guidelines is low in the United States. Testing programs that utilize rapid self-administered HIV/STI tests improve testing rates, though multiple factors influence their uptake. Methods MSM were recruited at an HIV/STI testing and treatment program in 2014 and provided consent, demographics, risk behaviors, HIV/STI test preferences, and perceived testing barriers via an online questionnaire. Comparisons of testing preferences and barriers were made based on age, risk group, and HIV serostatus using the Fisher exact test. Results HIV testing preferences included rapid oral test (71.1%), home test location (78.5%), electronic delivery of HIV-negative test results (76.4%), and direct provider notification for HIV-positive test results (70%), with respondents age >45 years being significantly more likely to prefer home testing (P = .033). STI testing preferences included self-collection of specimens (73.2%), home test location (61%), electronic delivery of negative STI test results (76.4%), and direct provider notification for positive STI test results (56.6%) with no significant differences between age, HIV serostatus, or risk groups. The most frequently reported HIV and STI testing barrier was lack of known prior HIV/STI exposure (57.3% for HIV, 62.9% for STI) with respondents age Conclusions Although additional research is needed, increasing resources directed specifically toward home testing has the potential to translate into improved uptake of rapid HIV/STI testing. Efforts to improve convenience in testing programs must be balanced with the need for continued educational outreach.

Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 –July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25–49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p

Background Many families arrive at the United States–Mexico border seeking asylum. Jewish Family Service and the San Diego Rapid Response Network operate a shelter in San Diego that provides shelter, food, clothing, legal services and travel coordination for asylum-seeking families. Two local federally qualified health centers provide on-site urgent care. Methods In late December 2018, the County of San Diego expanded public health efforts by conducting health screenings of guests upon entry to the shelter with the goal of identifying health issues requiring urgent or emergent evaluation and preventing the spread of communicable disease. University of California San Diego Health physicians contracted by the County of San Diego Health and Human Services Agency (HHSA) nurses and ancillary staff provide daily on-site services to all shelter entrants including: health screening for diseases of public health significance, treatment and/or referral of urgent conditions, and medical clearance for shelter entry or medical isolation as needed. Official tracking of screening outcomes from January 2 to April 24, 2019 were collected using standardized surveys and analyzed for program evaluation and surveillance purposes. Results During that time a total of 9,124 asylum-seekers were screened, averaging 81 guests daily, identifying: 42 influenza-like illness, 645 lice, 330 scabies, 8 varicella, and 0 hepatitis A cases. Chest radiography for suspected tuberculosis was performed for 29 guests. Only one chest x-ray was abnormal. Sputum specimens for acid-fast stain (n = 3) and nucleic acid testing (n = 2) were all negative and no tuberculosis cases were diagnosed. Emergency department referrals were made for Conclusion Coordination among local partner agencies resulted in early identification of communicable and acute health conditions prior to shelter entry allowing evaluation, treatment and off-site isolation, and minimizing stress on the emergency medical services system. This approach provides a successful model for health screening of asylum-seeking families arriving at the United States–Mexico border. Disclosures All authors: No reported disclosures.

Background Repeated chest X-rays serve as an essential screening tool to identify and describe new or stable (i.e., unchanged) lung abnormalities suggestive of pulmonary tuberculosis (TB) disease. The time for which a patient’s chest X-ray has not demonstrated appreciable change prior to treatment, or pretreatment chest X-ray stability duration, has been considered clinically useful in distinguishing inactive from active disease at four or 6 months. This relationship, however, has not been previously quantified. Methods This study relied on retrospective medical record review to assess the relationship of documented pretreatment chest X-ray stability duration thresholds relative to four and 6 months with a future clinical or culture-confirmed (Class 3) diagnosis of pulmonary TB disease. Multivariable logistic regression quantified this association among 146 patients who were evaluated and started on treatment for pulmonary TB disease in the San Diego County tuberculosis clinic between May 2012 and March 2017. Results After adjusting for age and Class B1 TB, Pulmonary status, a CXR stability duration of 4 months or more was not significantly associated with a Class 3 pulmonary TB diagnosis (adjusted odds ratio [AOR], 0.830; 95% confidence interval [CI], 0.198–3.48). Results were similar for the 6-month cut-point after adjusting for age and Class B1 Pulmonary status (AOR, 0.970; 95% CI, 0.304–3.10). Compared with less than 4 months, CXR stability durations of four to 6 months (AOR, 0.778; 95% CI, 0.156–3.89) and greater than 6 months (AOR, 0.875; 95% CI, 0.187–4.10) were also not significantly associated with a Class 3 TB diagnosis after adjusting for covariates. Conclusion Repeated chest X-rays remain a valuable tool for clinicians identifying and describing new or unchanged lung abnormalities suggestive of pulmonary TB disease. This study found no statistically significant association between pretreatment chest X-ray stability duration and subsequent TB disease diagnosis, with a wide range of estimates compatible with the data, suggesting the stability duration cut points relative to four and 6 months may not be as informative as previously understood. Disclosures All authors: No reported disclosures.

Transplantation of human skin on immunodeficient mice that support engraftment with functional human immune systems would be an invaluable tool for investigating mechanisms involved in wound healing and transplantation. Nonobese diabetic (NOD)-scid interleukin-2 gamma chain receptor (NSG) readily engraft with human immune systems, but human skin graft integrity is poor. In contrast, human skin graft integrity is excellent on CB17-scid bg (SCID.bg) mice, but they engraft poorly with human immune systems.Human skin grafts transplanted onto immunodeficient NSG, SCID.bg, and other immunodeficient strains were evaluated for graft integrity, preservation of graft endothelium, and their ability to be rejected after engraftment of allogeneic peripheral blood mononuclear cells.Human skin transplanted onto NSG mice develops an inflammatory infiltrate, consisting predominately of host Gr1(+) cells, that is detrimental to the survival of human endothelium in the graft. Treatment of graft recipients with anti-Gr1 antibody reduces this cellular infiltrate, preserves graft endothelium, and promotes wound healing, tissue development, and graft remodeling. Excellent graft integrity of the transplanted skin includes multilayered stratified human epidermis, well-developed human vasculature, human fibroblasts, and passenger leukocytes. Injection of unfractionated, CD4 or CD8 allogeneic human peripheral blood mononuclear cell induces a rapid destruction of the transplanted skin graft.NSG mice treated with anti-Gr1 antibody provide a model optimized for both human skin graft integrity and engraftment of a functional human immune system. This model provides the opportunity to investigate mechanisms orchestrating inflammation, wound healing, revascularization, tissue remodeling, and allograft rejection and can provide guidance for improving outcomes after clinical transplantation.

Patient: Female, 18 Final Diagnosis: Simultanous presentation of Kaposi Sarcoma and Lymphoma Symptoms: — Medication: — Clinical Procedure: — Specialty: Oncology Objective Rare disease Background: KSHV/HHV-8 is associated with Kaposi’s sarcoma (KS) as well as with a few categories of lymphoproliferative diseases, mostly occurring in patients with HIV infection/AIDS. Although the association between lymphomas and Kaposi’s sarcoma has been described, the simultaneous presence of the 2 entities within the same organ is rare and mainly associated with HIV/ AIDS. Case Report: We report a case of simultaneous occurrence of Kaposi‘s sarcoma and large B-cell lymphoma in the same lymph node in a 18-year-old African woman who was HIV-negative. We found concurrent infection with Kaposi’s sarcoma herpes virus (KSHV) and Epstein-Barr virus (EBV), confirmed by PCR amplification of DNA obtained from distinct tumor areas selected in the paraffin block. Conclusions: The possibility of occurrence of 2 lesions with distinct features in the same organ may be unexpected for pathologists performing fine-needle aspiration cytology (FNAC) evaluation but must be considered, even in HIV-negative individuals, despite its rare occurrence, as was demonstrated by this case.