High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC.

OBJECTIVES: With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. METHODS: Utilizing an electronic medical record (EMR) database from the DC Cohort study - a multicentre prospective cohort study of HIV-infected outpatients - we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. RESULTS: Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49-51] had hypertension, 13% (95% CI: 12-14) had diabetes, 48% (95% CI: 47-49) had dyslipidaemia, and 35% (95% CI: 34-36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, and comorbidities were more prevalent among older patients (all P < 0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immunovirological parameters were associated with metabolic comorbidities. CONCLUSIONS: These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.

An outbreak of cryptosporidiosis linked to a foodhandler.

In September and October 1998, a cryptosporidiosis outbreak occurred on a Washington, DC, university campus. In a case-control study of 88 case patients and 67 control subjects, eating in 1 of 2 cafeterias was associated with diarrheal illness (P<.001). Morbidity was associated with eating dinner on 22 September (odds ratio, 8.1; 95% confidence interval, 3.4-19.5); weaker associations were found for 6 other meals. Cryptosporidium parvum was detected in stool specimens of 16 (70%) of 23 ill students and 2 of 4 ill employees. One ill foodhandler with laboratory-confirmed C. parvum prepared raw produce on 20-22 September. All 25 Cryptosporidium isolates submitted for DNA analysis, including 3 from the ill foodhandler, were genotype 1. This outbreak illustrates the potential for cryptosporidiosis to cause foodborne illness. Epidemiologic and molecular evidence indicate that an ill foodhandler was the likely outbreak source.

Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation.

We retrospectively reviewed the results of 97 patients with anterior cruciate ligament reconstructions using an arthroscopically assisted two-incision technique without extraarticular augmentation at an intermediate followup of 5 to 9 years postoperatively. Evaluation included detailed history, physical examination, functional testing, KT-1000 arthrometer measurements, multiple scoring systems, and radiographs. The results were compared with those from a previous study that evaluated a smaller patient cohort using the identical surgical technique at a 2- to 4-year followup. The postoperative physical examination and KT-1000 arthrometer results were statistically improved when compared with preoperative findings. A negative pivot shift result was noted in 83% of patients, and a 1+ result in 17% of patients. Seventy percent of patients had < 3 mm difference on manual maximum side-to-side testing. Functional testing averaged less than 2% asymmetry for vertical jump, single-legged hop, or timed 6-meter hop. The Tegner activity level was significantly improved from prereconstruction ratings and similar to preinjury ratings. The mean Lysholm score was 87. The modified Hospital for Special Surgery scores resulted in good or excellent results in 82% of the patients (mean, 87 points). The mean Noyes sports function score was 89, and the reoperation rate for a symptomatic knee flexion contracture was 12%. Ninety-seven percent of patients indicated that they would undergo the procedure again. When compared with this same population at 2 to 4 years, we saw no deterioration in scoring scale results.

Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Minimum two-year follow-up evaluation.

We conducted a retrospective, minimum 2-year follow-up study to evaluate the effectiveness of a single-incision endoscopic anterior cruciate ligament reconstruction technique using patellar tendon autograft without extraarticular augmentation and followed by accelerated rehabilitation. One hundred three patients were evaluated (mean followup, 36 months; range, 24 to 55). There were significant improvements in physical examination test results (Lachman, anterior drawer, and pivot shift) postoperatively, and 94 patients (91%) had negative pivot shift results. KT-1000 arthrometric testing showed a significant reduction in manual maximum anterior translation and side-to-side differences at followup. Good range of motion was achieved. Patients with asymmetric prone heel heights usually had hyperextension in the contralateral knee. Functional tests showed 4% to 6% differences in side-to-side comparisons for a timed single-legged hop, single-legged hop for distance, and vertical jump. Postoperatively, the results of the Tegner scale were similar to preinjury scores. The mean results of the Hospital for Special Surgery scale (90), Lysholm score (89), and Noyes sport function score (90) were all excellent or good. Only 5 patients (5%) required reoperations for flexion contractures. Ninety-six patients (93%) reported they were "mostly" or "completely" satisfied, and 98 (95%) would recommend the procedure to others. These results demonstrated encouraging outcome using this single-incision technique.

Population-based monitoring of an urban HIV/AIDS epidemic. Magnitude and trends in the District of Columbia.

OBJECTIVE: To assess the extent of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic in the District of Columbia and demonstrate an approach to monitoring HIV infection and projecting AIDS incidence at a community level. DESIGN: Backcalculation methods to reconstruct HIV incidence from AIDS incidence in subgroups. Results were compared with directly measured HIV seroprevalence in selected sentinel populations: childbearing women, civilian applicants for military service, and hospital patients admitted for conditions unrelated to HIV infection. RESULTS: Between the start of the epidemic in 1980 and January 1, 1991, one in 57 District of Columbia men aged 20 to 64 years was diagnosed with AIDS. Unlike the plateau projected for the nation, AIDS incidence for the District of Columbia was projected to increase by 34% between 1990 and 1994. Models of HIV infection incidence suggested two broad epidemic waves of approximately equal size. The first occurred in men who have sex with men and peaked during the period from 1982 through 1983. The second began in the mid-1980s in injecting drug users and heterosexuals. We estimated that among District of Columbia residents aged 20 to 64 years, 0.3% of white women, 2.9% of white men, 1.6% of black women, and 4.9% of black men were living with HIV infection as of January 1, 1991. These estimates are broadly consistent with survey data: among black childbearing women in their 20s, HIV prevalence doubled to 2% between the fall of 1989 and the spring of 1991; from military applicant data, we estimated that over 5% of black men born from 1951 through 1967 were HIV-positive; in the sentinel hospital, HIV prevalence rates among male patients aged 25 to 34 years were 11.3% in white men and 16.9% in black men. CONCLUSION: Backcalculation and surveys yielded quantitatively consistent estimates of HIV prevalence. Many injecting drug users and heterosexuals in the District of Columbia were infected after January 1, 1986. Similar monitoring of the epidemic in other localities is needed to focus efforts to reduce the incidence of HIV transmission.

Longitudinal attrition of the peroneus brevis tendon in the fibular groove: an anatomic study.

There has been little research concerning the attrition of the peroneus brevis tendon since Meyer's observation in 1924. The purpose of our dissections was to establish the incidence of the attrition of the peroneus brevis tendon at the fibular groove, and observe the anatomical relationship of the tendon attrition to the bony anatomy of the distal fibula. One hundred and twenty-four fresh human cadavers ankles from 65 cadavers were dissected under loupe magnification. When attrition of the peroneus brevis was found, the extent of attrition was measured, and anatomic proximity of the tendon to distal fibular groove was observed. Evidence of other tendon attrition as well as the depth of the fibular groove was observed. Specimens which revealed attrition of the peroneus brevis were sketched and photographed. Attrition of the peroneus brevis tendon was found in 14 ankles (11.3% of specimens). The attrition was limited only to the peroneus brevis tendon, and in no specimens was the peroneus longus involved. The degree of tendon attrition varied from simple splaying out of the peroneus brevis in the fibular groove to longitudinal splits in the peroneus brevis tendon with significant fraying of the remaining halves of the tendon. The longitudinal ruptures in the peroneus brevis tendon averaged 1.9 cm (range 1-4 cm). In all cases, the central portion of the longitudinal split was centered over the distal tip of the fibula in the fibular groove. In no case was a complete rupture of the peroneus brevis tendon noted. There was gross evidence of chronic inflammation and synovitis in those ankles with attrition of the peroneus brevis tendon.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital variations of the peroneus quartus muscle: an anatomic study.

There has been little research concerning this muscle since the 1920s, when Hecker described this muscle to be present in (13%) of his dissections of cadaver legs. The purpose of our dissections was to establish the incidence of the peroneus quartus muscle, its origins, and insertions. One hundred and twenty-four legs from 65 fresh human cadavers were dissected under loupe magnification. When the peroneus quartus tendon was found, its origin, insertion, and anatomic relationship to the peroneus longus and peroneus brevis were observed. All specimens were sketched and photographed. The peroneus quartus muscle was present in 27 legs (21.7% of specimens). Its origins, insertions, and size varied. In 17 legs (63%) the muscle originated from the muscular portion of the peroneus brevis, and inserted on the peroneal tubercle of the calcaneus. The peroneal tubercle was hypertrophied at the insertion in most cases. The results of this study in general show that there was much higher incidence of the peroneus quartus muscle than Hecker claimed. Its course, origin, and insertion varied. Its tendon can be used for reconstructive procedures about the lateral aspect of the ankle, especially in anterior dislocation of the peroneal tendons and reconstruction of lateral ligaments.

Hepatitis B virus transmission between children in day care.

We investigated two situations involving hepatitis B virus exposure among children in day care. In the first a 4-year-old boy who attended a day care center developed acute hepatitis B; another child at the center, who had a history of aggressive behavior (biting/scratching), was subsequently found to be a hepatitis B carrier. No other source of infection among family and other contacts was identified and no other persons at the center became infected. In the second situation a 4-year-old boy with frequently bleeding eczematous lesions was discovered to be a hepatitis B carrier after having attended a day care center for 17 months. Testing of contacts at the center revealed no transmission to other children or staff (representing 887 person months of exposure). Nationwide surveillance data showed that for the period 1983 to 1987, 161 children 1 to 4 years of age were reported with acute hepatitis B. After children with known hepatitis B risk factors were excluded, 25% (7 of 28) of children with known day care status were reported as day care attendees, a percentage comparable to national estimates of day care attendance by this age group. This is the first reported case of hepatitis B virus transmission between children in day care in the United States. Although it appears that day care transmission of hepatitis B is infrequent, further studies are needed to define the risk more accurately.

Comparisons of black and white smoking-attributable mortality, morbidity, and economic costs in the District of Columbia.

Cigarette smoking is generally considered to be the most important preventable cause of death in the United States. To determine the public health impact of smoking in the District of Columbia, the DC Commission of Public Health calculated smoking-attributable mortality, morbidity, and economic costs in this predominantly black population. In 1985, an estimated 933 district residents died from smoking-related diseases, resulting in 3535 years of potential life lost. Cigarette smoking contributed to approximately 13.5% of all District deaths in 1985 (N = 6921) and accounted for 30% of all deaths of persons over age 20, far exceeding the affect of other potentially preventable causes of mortality. Black residents, especially black men, shared a disproportionately greater burden of smoking-attributable mortality when compared with white residents. These smoking-attributable deaths resulted in over $110 million in direct medical and indirect morbidity and mortality costs to District of Columbia residents. The results indicate that cigarette smoking is a major contributing cause of the black-white disparity in health status in the District of Columbia.

Vertebral body and posterior element morphology: the normal spine in middle life.

Multiple morphologic parameters were studied in 50 normal adult vertebral columns ranging in age from 20 to 40 years at the time of death. Posterior element morphology is highly variable and largely unpredictable. Minimum pedicle diameters ranged from 1.8 mm at T6 to 6.4 mm at L5, and did not correlate with any more readily measured vertebral dimensions. Penetration of 5 mm screw threads through pedicle cortex can be expected to occur routinely in the lower thoracic spine, and in a lesser but significant number of lumbar vertebrae.

A multistate outbreak of gastrointestinal illness caused by enterotoxigenic Escherichia coli in imported semisoft cheese.

In September 1983, three clusters of gastrointestinal illness with similar symptoms affected 45 persons in Washington, D.C., after office parties. The illness lasted a mean of 4.4 days and was characterized by watery diarrhea (91%), abdominal cramps (80%), headache (38%), nausea (38%), and subjective fever (20%). Illness was strongly associated with having eaten imported French Brie cheese one to six days before onset of illness (P less than .0001 by Fisher's two-tailed exact test). After publicity about these outbreaks, additional cheese-associated cases were identified over an eight-week period in Illinois, Wisconsin, Georgia, and Colorado. Stool specimens from ill persons in four states yielded Escherichia coli serotype O27:H20. These organisms produced heat-stable enterotoxin and had similar plasmid profiles. When commercially distributed foods are contaminated, enterotoxigenic E. coli can cause widespread disease even in a developed country, and the disease can easily escape correct diagnosis.

Respiratory illness in conference participants following exposure to rug shampoo.

Persons participating in a conference in a major city motel experienced transient mild respiratory illness associated with their presence in the motel conference rooms. The illness was characterized by coughing, sneezing, sore throat, headache, eye irritation, and other symptoms of exposure to a respiratory irritant. Investigation incriminated a chemical shampoo used to clean the conference room rugs approximately one week earlier. Repeated cleaning of the rugs to remove excess cleaning compound eliminated the problem. Excessive application of the shampoo, coupled with a poorly ventilated environment, apparently produced a chemical concentration sufficient to cause clinical illness.

Shigella surveillance in a large metropolitan area: assessment of a passive reporting system.

A passive disease report card (DRC) surveillance system failed to detect an epidemic of diarrheal disease caused by a newly identified drug-resistant strain of Shigella sonnei. The DRC system inaccurately described both the population at risk and the geographic location of cases. Specific limitations of the DRC system, including problems of underreporting and ascertainment bias, were complicated by the absence of timely data analysis and feedback to providers.

Tularemia pneumonia in Washington, DC. A report of three cases with possible common-source exposures.

In June 1978, three cases of tularemia pneumonia occurred in persons residing in the Washington, DC, area. The patients, all men, became ill three to four days after a brief session training their hunting dogs in an undeveloped wooded area adjacent to a housing complex. One of the dogs, which later died, had captured a wild rabbit during the training session. All three men had handled the rabbit while familiarizing their dogs with the rabbit's scent. The men had no other common exposure that was a likely source of infection.

Vacuum ultraviolet plasma arc radiation source for the 300-1000-a wavelength region.

A plasma arc radiation source is described which can produce continuum radiation in the 300-1000-A range from discharges in the gases He, Ne, Ar, Kr, Xe, H(2), and their mixtures. The radiation is emitted from a dc self-stabilized plasma arc column having a core temperature of about 18,000 K. The spectra of major interest are due to ion-electron recombination to the ground state of the neutral atom. These continua extend to wavelengths shorter than the first ionization threshold. For helium, the useful continuum extends from 504 A to approximately 350 A. The arc column is observed along its cylindrical axis of symmetry through a small opening in the anode. The radiation source was developed for use in the measurement of cross sections in the vacuum uv using continuously scanning photoelectric spectrometers. The application of the source to measurements in krypton near 500 A is described.