Prevalence of Borrelia burgdorferi (Spirochaetales: Spirochaetaceae), Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae), and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) collected from recreational lands in the Hudson Valley Region, New York State.

ABSTRACT Blacklegged ticks, Ixodes scapularis Say, were collected from 27 sites in eight New York State counties from 2003 to 2006 to determine the prevalence and distribution of tick-borne pathogens in public-use areas over a 4-yr period. In total, 11,204 I. scapularis (3,300 nymphs and 7,904 adults) were individually analyzed using polymerase chain reaction to detect the presence of Borrelia burgdorferi (causative agent of Lyme disease), Anaplasma phagocytophilum (formerly Ehrlichia phagocytophila, causative agent of human granulocytic anaplasmosis), and Babesia microti (causative agent of human babesiosis). Overall prevalence of B. burgdorferi, A. phagocytophilum, and B. microti was 14.4, 6.5, and 2.7% in nymphs and 45.7, 12.3, and 2.5% in adult ticks, respectively. Rates varied geographically and temporally during the time period examined, and were related to measurements of tick density. Average rate ofpolymicrobial infection for nymphs and adults, respectively, was 1.5 and 8.5% overall, with 0.5 and 6.3% coinfection of B. burgdorferi and A. phagocytophilum, 1.0 and 1.5% B. burgdorferi and B. microti, and 0.05 and 0.6% A. phagocytophilum and B. microti. Thirty-three individual adult ticks from seven study sites in Westchester, Putnam, Dutchess, and Rockland counties tested positive for simultaneous infection with all three agents by multiplex polymerase chain reaction assay.

The association between adherence to oral anti-diabetic drugs and hypoglycaemia in persons with Type 2 diabetes.

AIM: To quantify the relationship between adherence to oral anti-diabetic drugs and incident hypoglycaemia in Type 2 diabetes. METHODS: Utilizing a claims database, we identified patients with Type 2 diabetes initiating metformin, sulphonylureas or thiazolidinediones and classified adherence over the next 6 months, creating markers of changes in therapy (switches/additions). We created nine mutually exclusive exposure groups, including: metformin ≥ 80% adherence; metformin < 80% adherence; sulphonylurea ≥ 80% adherence; sulphonylurea < 80% adherence; thiazolidinediones ≥ 80% adherence; thiazolidinediones < 80% adherence; switching to a new class; adding on therapy; and switching to two or more different classes of medication. We followed patients for incident hypoglycaemia medical visits and developed a Cox proportional hazards model to compare rates of hypoglycaemia across exposure groups. RESULTS: Adherence to monotherapy was high (86.0 ± 17.8% for metformin, 87.2 ± 17.5% for sulphonylureas and 87.8 ± 16.9 for thiazolidinediones). The incidence of hypoglycaemia ranged from 93.1 to 259.9 per 10 000 person-years in the nine exposure groups. Relative to metformin users with ≥ 80% adherence, those switching from any monotherapy to combination therapy had a 32% increased rate (hazard ratio 1.32; 95% CI 1.07-1.64) of hypoglycaemia. Thiazolidinediones users with ≥ 80% adherence had a decreased hazard rate (hazard ratio 0.67; 95% CI 0.46-0.98) relative to metformin users with ≥ 80% adherence. All other groups on oral anti-diabetic drugs, regardless of adherence, were not associated with hypoglycaemia CONCLUSIONS: We found that the relative rate of hypoglycaemia was highest in patients switching from monotherapy to combination therapy, while rates of hypoglycaemia in monotherapy users were largely unrelated to level of adherence.

Hard-rock mining exposures affect smokers and nonsmokers differently. Results of a community prevalence study.

The physiologic consequences of occupational dust exposure, their relation to smoking, and their reversibility with cessation of exposure remain controversial. To address these questions, we studied a random sample of male residents of Leadville, Colorado when the major employer, a hard-rock mine, had been closed for 5 to 11 months. Subjects were interviewed for respiratory symptoms and occupational history, underwent plethysmographic measurements of lung volume and airflow, and performed a single breath diffusing capacity procedure. Dyspnea was the only respiratory symptom exacerbated by mining exposures. Cumulative dust exposure, estimated with historic respirable dust measurements for mining job titles and weighted by time at the job, was associated with decreases in maximal expiratory flow rates when controlled for smoking, age, and height. However, determinations of plethysmographic lung volume that allowed calculation of flow rates at equivalent absolute lung volume indicated that dust effects differed in never-smokers and smokers. In never-smokers, dust exposure was associated with decreased lung volume, increased flow rates, and increased DLCO/VA. In smokers, dust exposure was associated with increased lung volume, lower flow rates, and lower DLCO/VA than that accounted for by smoking. We suggest that hard-rock mining exposures result in irreversible pulmonary function changes of airflow limitation in smokers and of a restrictive nature in never-smokers.

Neonatal rotavirus-associated necrotizing enterocolitis: case control study and prospective surveillance during an outbreak.

After the death of a premature infant from rotavirus-associated necrotizing enterocolitis, we instituted prospective surveillance for this disease in our neonatal intensive care unit. During the 4-month study period an additional six cases of necrotizing enterocolitis and eight cases of hemorrhagic gastroenteritis occurred. Rotavirus infection was documented in 11 of these 15 symptomatic infants, in comparison with only eight rotavirus infections in 147 asymptomatic or minimally symptomatic babies (P less than 0.0001). Stools from 110 nursery personnel tested during the outbreak did not contain rotavirus. However, 12 of 59 staff members had serum IgM antibody against rotavirus, suggesting recent infection. In a case-control study we compared babies with severe gastrointestinal illness with a control group randomly selected from asymptomatic babies in the nursery during the time of the outbreak. Univariate analysis found six categorical variables and nine continuous variables that were significantly associated with disease. Multivariate logistic regression analysis, however, found only birth weight (P less than 0.0001), rotavirus infection (P less than 0.0001), and age at time of first nonwater feeding (P less than 0.02) to be associated with gastrointestinal illness. This study provides further evidence for the role of infection in some cases of neonatal necrotizing enterocolitis and hemorrhagic gastroenteritis.