A total of 2515 people attending a large military hospital in Saudi Arabia was studied clinically, serologically, and (when appropriate) radiologically for evidence of treponematosis. The indications are that non-venereal endemic syphilis (bejel) is prevalent among the nomadic communities living in rural areas. In contrast, venereal syphilis is much less common, and is found almost exclusively in urban populations. Some of the high risk regions for bejel have been identified, and many people from these locations complained of persistent pain in the legs, which was often associated with radiological evidence of osteoperiostitis of the long bones. Bejel also seems to have become clinically "attenuated" within the last 30 years, with the majority of seroreactors having latent disease. A hypothesis suggesting a reason for this change is put forward, and ways of controlling the infection are outlined.
We studied 16 children aged 18 months or less who had severe primary protein-calorie malnutrition. All were admitted to one urban pediatric teaching hospital for treatment of failure to thrive between Jan 1, 1980, and Aug 30, 1984. The definitions of malnutrition were based on those of the Wellcome Trust. The patients had no evidence of medical causes for their conditions and grew rapidly when they were refed in the hospital. Eight were products of teenage pregnancies. Eleven patients were receiving public aid, and four had no third-party coverage. All were markedly below the fifth percentile in weight for length; their mean percentage of expected weight for age was 0.55. The mean hospital stay was 18.5 days. Severe primary protein-calorie malnutrition does exist in the United States. Thorough nutritional evaluation in children with failure to thrive is indicated, and malnutrition should be a reportable condition in the United States.
Abstract We sought to assess appropriateness of antiretroviral therapy (ART) reported by clients of an HIV/AIDS case management organization and identify variables associated with appropriate ART receipt. A total of 295 such clients were mailed a survey asking them to identify antiretroviral medications they were taking.Of them 220 (75%) returned surveys; 201 (93%) were taking antiretrovirals. Of these, 159 were on appropriate and 36 on inappropriate ART, as determined by guidelines created by the CDC, the International AIDS Society (USA Panel), and the Panel on Clinical Practices for Treatment of HIV Infection. In unadjusted analyses, age, sex, race, sexual orientation, history of injection drug use, history of sexual risk, and HIV knowledge were associated (p≤0.10) with appropriate ART and entered into one of two logistic regression models. The first model indicated that women (p=0.003) and heterosexuals (p=0.001) were less likely to receive appropriate ART than men and gay/bisexuals (and variables interacted, p=0.001). HIV knowledge – a proxy indicator determined by self-report of a CD4 cell count and viral load – was added to variables retained in first model to create a second model. Only sexual orientation was retained in this second model (p=0.02, in the same direction as in the first model), and those with less versus more HIV knowledge (p=0.04) were found to be less likely to receive appropriate ART (and variables interacted, p=0.04). Findings suggest that heterosexual men are less likely than women who, in turn, are less likely than gay/bisexual men to receive appropriate ART. HIV-related knowledge appears to increase likelihood of receiving appropriate ART and it attenuates the effect of sex. Acknowledgments We thank the clients from ActionAIDS, Inc., who participated in this survey. We also thank Kevin J. Burns, LCSW, and Kevin R. Conare, Director of Client Services and Executive Director, respectively, at ActionAIDS, Inc., without whose involvement this study could not have been completed. This study was funded by the Research Foundation of the University of Pennsylvania. Dr. Holmes was supported by a grant from the National Institute of Allergy and Infectious Diseases (AI01482).
Many enteric pathogens are thought to enter a viable but nonculturable state when deprived of nutrients. Virulent strains of the enteric pathogen Vibrio parahaemolyticus are rarely isolated from their low-nutrient aquatic environments, possibly due to their nonculturability. Host factors such as bile may trigger release from dormancy and increase virulence in these strains. In this study, the addition of bile or the bile acid deoxycholic acid to estuarine water-cultured bacteria led to an increase in the direct viable count and colony counts among the virulent strains. This effect was not demonstrated in the nonvirulent strains, and it was reversed by extraction of bile acids with cholestyramine. Bile-treated V. parahaemolyticus had lower levels of intracellular calcium than untreated cells, and this effect coincided with an increase in the number of metabolically active cells. Chelation of intracellular calcium with BAPTA/AM (R. Y. Tsien, Biochemistry 19:2396-2402, 1980) produced similar results. Addition of bile to V. parahaemolyticus cultures in laboratory medium enhanced factors associated with virulence such as Congo red binding, bacterial capsule size, and adherence to epithelial cells. These results suggest that a bile acid-containing environment such as that found in the human host favors growth of virulent strains of V. parahaemolyticus and that bile acids enhance the expression of virulence factors. These effects seem to be mediated by a decrease in intracellular calcium.