Swimming-induced immersion pulmonary edema while snorkeling can be rapidly life-threatening: case reports.

It is well known that immersion pulmonary edema can be life-threatening for divers using a self-contained underwater breathing apparatus (scuba). Swimming-induced pulmonary edema in otherwise healthy individuals is not an object of dispute but its real severity is not well known and is probably underestimated. We report two cases of life-threatening acute respiratory distress while swimming and snorkeling, one of which is well documented for swimming-induced pulmonary edema. The interest of these case reports lies in the suddenness of these life-threatening events. Such accidents can mimic a loss of consciousness due to cardiac dysrhythmia and lead to drowning. In the case of swimming-induced pulmonary edema, the prognosis is far better than for a cardiac disorder, but it is also dependent on the efficiency of the supervision. Swimmers, divers, race organizers and supervising physicians should be given knowledge of this pathology and its potentially acute occurrence. Adequate organizational dispositions are mandatory to prevent swimming-induced pulmonary edema-related deaths.

Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers.

OBJECTIVES: To identify the contribution of Mycoplasma genitalium to the aetiology of cervicitis in sub-Saharan Africa and its relative importance in the overall burden of sexually transmitted infections among female sex workers (FSW). METHODS: The study population consisted of FSW recruited in Ghana and Benin during the initial visit of a randomised controlled trial. A questionnaire was administered, a pelvic examination carried out, and cervical samples obtained for detection of M genitalium, Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Clinical signs potentially indicating cervicitis were cervical discharge, pus on the cervical swab, bleeding after sampling, and inflammatory cervix. RESULTS: Among 826 FSW, 26.3% were infected with M genitalium. N gonorrhoeae was strongly and independently associated with each of the four signs of cervicitis (adjusted odds ratios (AOR): 4.1 to 6.0). The AOR for C trachomatis were intermediate (1.3-4.1) and the AOR for M genitalium were lower (between 1.6 and 1.8) but statistically significant (p< or =0.05) for each sign. CONCLUSIONS: M genitalium is weakly associated with signs of cervicitis in west African FSW but is highly prevalent.

Low prevalence of cervical infections in women with vaginal discharge in west Africa: implications for syndromic management.

OBJECTIVES: To measure prevalence and risk factors for cervical infections among a large sample of women consulting for vaginal discharge in west Africa and to evaluate its syndromic management through a two visit algorithm. METHODS: In 11 health centres in Bénin, Burkina Faso, Ghana, Guinée, and Mali 726 women who presented with a vaginal discharge without abdominal pain and who denied being a sex worker (SW) were enrolled. Cervical samples were tested for the detection of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with polymerase chain reaction (PCR) assays. All participants were treated with single dose (2 g) metronidazole and clotrimazole cream for 3 days. They were randomised to be told either to come back on day 7 only if there was no improvement in the discharge (group A), or to come back on day 7 regardless of response to treatment (group B). RESULTS: Overall, the prevalence of NG and CT was only 1.9% (14/726) and 3.2% (23/726) respectively. Risk factors previously recommended by the WHO were not associated with the presence of cervical infection, with the exception of the number of sex partners in the past 3 months. When taken together, these risk factors had a positive predictive value of only 6.4% to identify cervical infections. Prevalence of cervical infection was not higher in women who came back on day 7, regardless of the strategy used. Prevalence of NG/CT was lower in Ghana and Bénin (5/280, 1.8%), where comprehensive interventions for SW have been ongoing for years, than in the three other countries (27/446, 6.1%, p = 0.01). CONCLUSIONS: NG and CT infections are uncommon in west African women who consult for vaginal discharge and who are not SW. Syndromic management of vaginal discharge should focus on the proper management of vaginitis. The control of gonococcal and chlamydial infection should be redesigned around interventions focusing on sex workers.

Mycoplasma genitalium is not associated with adverse outcomes of pregnancy in Guinea-Bissau.

OBJECTIVE: To evaluate the impact of Mycoplasma genitalium on the outcome of pregnancy. METHODS: Cervical samples from women who had previously participated in a case-control study (designed to assess the impact of syphilis and HIV-2 on the outcome of pregnancy in Guinea-Bissau) were processed using a PCR assay to detect the presence of M genitalium. Controls were women who had delivered a term neonate with a birth weight over 2500 g. Cases were classified into four groups of mothers according to the outcome of pregnancy: stillbirths, spontaneous abortions, premature deliveries, and small for gestational age (SGA) babies. RESULTS: Among the 1014 women included in this study, 6.2% were infected with M genitalium. M genitalium infection was not significantly associated with any of the adverse outcomes of pregnancy studied. Odds ratios (OR) for premature or SGA delivery in the presence of M genitalium infection were 1.37 (95% CI 0.69 to 2.60) and 0.44 (95% CI 0.01 to 2.75), respectively. For abortions and stillbirths, OR were respectively 0.61 (95% CI 0.07 to 2.51) and 1.07 (95% CI 0.42 to 2.42). CONCLUSION: M genitalium appears not to have a deleterious impact on the outcome of pregnancy.

Aetiology of urethral discharge in Bangui, Central African Republic.

OBJECTIVES: To determine the aetiology of urethritis in Bangui, Central African Republic. METHODS: 410 men presenting with urethral discharge and 100 asymptomatic controls were enrolled. Urethral swabs were obtained and processed by gonococcal culture and polymerase chain reaction for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, and Ureaplasma urealyticum. RESULTS: In multivariate analyses, M genitalium and C trachomatis were significantly associated with urethral discharge when comparing cases of non-gonococcal urethritis (NGU) with controls. T vaginalis was also more common in cases than in controls, but this reached statistical significance only among cases in whom N gonorrhoeae was also detected. U urealyticum was not associated with urethritis. The gonococcus was found in 69% of cases of urethral discharge. M genitalium was the predominant pathogen in patients with NGU, being found in 42% (53/127) of such patients while C trachomatis was found in only 17% (22/127). T vaginalis was found in 18% (23/127) of patients with NGU, but also in 15% (43/283) of patients with gonococcal urethritis, and two thirds of patients with T vaginalis also had the gonococcus. Multiple infections were common. M genitalium caused a syndrome similar to chlamydial urethritis, with a less severe inflammation than in gonococcal infection. No behavioural or clinical characteristic could discriminate between the various aetiological agents. CONCLUSIONS: M genitalium is more prevalent than C trachomatis and is the most common cause of NGU in BANGUI: It causes a syndrome similar to chlamydial urethritis. T vaginalis is weakly associated with urethritis, and is often found along with other pathogens.

Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis.

OBJECTIVE: To determine the etiological role of pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in urethral discharge in West African men. METHODS: Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West African countries, and in 339 controls presenting for complaints unrelated to the genitourinary tract. Polymerase chain reaction analysis was used to detect the presence of N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum. FINDINGS: N. gonorrhoeae, T. vaginalis, C. trachomatis, and M. genitalium--but not U. urealyticum--were found more frequently in men with urethral discharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infections were common. Among patients with gonococcal infection, T. vaginalis was as frequent a coinfection as C. trachomatis. M. genitalium, T. vaginalis, and C. trachomatis caused a similar clinical syndrome to that associated with gonococcal infection, but with a less severe urethral discharge. CONCLUSIONS: M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syndromic approach. The optimal use of metronidazole in flowcharts for the syndromic management of urethral discharge needs to be explored in therapeutic trials.

[Analysis of hospital morbidity by motor vehicle accidents in public hospitals in Rio de Janeiro, Brazil]. / Análise da morbidade hospitalar por acidentes de trânsito em hospitais públicos do Rio de Janeiro, RJ, Brasil.

INTRODUCTION: Morbidity due to motor vehicle accidents was analysed in a descriptive study based on reports of hospitals with the objective to characterize their victims, types of injuries, and the health care provided. METHODS: The study was carried out in two municipal hospitals of Rio de Janeiro, Brazil. Motor vehicle accidents were defined as a run over, a collision, and "other traffic accidents". Data was collected from cases seen in May (Hospital 1) and June (Hospital 2) of 1996 by 7 teams that alternated in shifts of 12 hours, covering the collection 24 hours per day. The events were classified according to the victim or, when it was impossible, to the person who helped them or accompanied them to the hospital. RESULTS: In the study period, 320 cases were seen in Hospital 1 and 290 in Hospital 2. Most of the victims were men (69.3%) in both of hospitals and the most affected group was young adults between 20 to 39 years (60.5% in Hospital 1 and 47.5% in Hospital 2). Of all 610 cases, the main cause of injury was being run over (49.3%), followed by collisions (35.6%), and "other traffic accidents" (15.1%). CONCLUSIONS: The analysis of the cases distributions and the type of care required corroborates with the need of a better organization of hospital care teams, more completeness of hospital reports and emphasis on some aspects in prevention campaigns.

Improvement of clinical algorithms for the diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis by the use of Gram-stained smears among female sex workers in Accra, Ghana.

BACKGROUND: Screening for cervical infection is difficult in developing countries. Screening strategies must be improved for high-risk women, such as female sex workers. GOAL: To evaluate the sensitivity and specificity of screening algorithms for cervical infection pathogens among female sex workers in Accra, Ghana. STUDY DESIGN: A cross-sectional study among female sex workers was conducted. Each woman underwent an interview and a clinical examination. Biologic samples were obtained for the diagnosis of HIV, syphilis, bacterial vaginosis, yeast infection, Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis infection. Signs and symptoms associated with cervicitis agents were identified. Algorithms for the diagnosis of cervical infection were tested by computer simulations. RESULTS: The following prevalences were observed: HIV, 76.6%; N. gonorrhoeae, 33.7%; C. trachomatis, 10.1%; candidiasis, 24.4%; T. vaginalis, 31.4%; bacterial vaginosis, 2.3%; serologic syphilis, 4.6%; and genital ulcers on clinical examination, 10.6%. The best performance of algorithms were reached when using a combination of clinical signs and a search for gram-negative diplococci on cervical smears (sensitivity, 64.4%; specificity, 80.0%). CONCLUSIONS: In the algorithms, examination of Gram-stained genital smears in female sex workers without clinical signs of cervicitis improved sensitivity without altering specificity for the diagnosis of cervical infection.

[Characterization of the cases of domestic violence against women assisted in 2 public hospitals of Rio de Janeiro]. / Caracterização dos casos de violência doméstica contra a mulher atendidos em dois hospitais públicos do Rio de Janeiro.

This paper aims at: (a) to analyze the distribution of the cases of domestic violence against women (adolescent and adult) in relation to emergency care due to external causes; (b) to characterize the victims and the rendered care; (c) to analyze the circumstances in which events happened. In methodological terms, it tries to articulate the quantitative and qualitative approaches. The study was developed in two public hospitals of reference placed in the city of Rio de Janeiro. Of the 72 assisted women, most referred to the husband, the partner or the boyfriend as the aggressor (69.4%) and were beaten (70.4%) especially on the face and on the head. The study comes to the conclusion that the health services should provide a good clinical care and promote prevention's actions.

[Evaluation of counseling activities: analysis of a person-centered prevention perspective]. / Avaliação das ações de aconselhamento. Análise de uma perspectiva de prevenção centrada na pessoa.

This paper evaluates STD/HIV/AIDS counseling activities provided by the Brazilian National Health Care System (SUS). The following institutional health services were assessed: four anonymous testing and counseling centers, one clinic specializing in treatment for people with HIV, and five STD clinics. All the above are recognized as training centers by the Brazilian Ministry of Health (National STD/AIDS Control Program). The data were collected from March to September 1997. The counseling activities from these health services was compared with guidelines developed by the National STD/AIDS Control Program using a qualitative evaluation methodology. The main categories analyzed were: a) approaching the patient; b) active listening; c) effective communication; d) risk assessment and discussion of alternatives for risk reduction; and e) orientation concerning clinical aspects and treatment (treatment compliance and improved quality of life). The paper concludes by suggesting changes to improve counseling.

[Evaluation of orientation and serological support centers in the Brazilian Northeast]. / Avaliação dos Centros de Orientação e Apoio Sorológico/CTA/Coas da Região Nordeste do Brasil.

This article presents the results of an evaluation of Orientation and Serological Support Centers, or Anonymous HIV Testing Centers, in the Northeast of Brazil. Methodological triangulation was used to evaluate these health programs and services, including qualitative and quantitative methodology and pointing to the insufficiency of single-discipline reasoning to encompass phenomena in social organizations. The article also shows results from this triangulation experience, seeking to combine Social Sciences and Epidemiology. It describes the structure and dynamics of these services, analyzes the relationships, perceptions, and representations of the actors, presents a self-evaluation by the professionals, expounds on some quantitative results, and discusses some limits and problems, as well as proposals to overcome them.

Comparison of PCR protocols including positive controls for detection of Chlamydia pneumoniae in respiratory specimens.

In order to develop a practical approach for detection of Chlamydia pneumoniae by polymerase chain reaction (PCR) in clinical respiratory samples, positive controls for rDNA and major outer-membrane protein gene targets were constructed. Two PCR strategies detected chlamydial DNA in excess of 1000 copies per ml in the same 19 of 135 clinical specimens and identified PCR inhibitors in the same four samples.

[Evaluation of outpatient care for people with HIV/AIDS in Rio de Janeiro, from the user's perspective]. / Avaliação da assistência ambulatorial a portadores de HIV/AIDS no Rio de Janeiro, segundo a visão de seus usuários.

This article analyzes perceptions by people with HIV/AIDS towards five specialized units under the State Health Department, Rio de Janeiro, concerning the care provided there. The research was based on both quantitative and qualitative methods. Data from 228 questionnaires and 19 semi-structured interviews were analyzed. The results generally indicated a positive evaluation on the part of this group of health care users. One conclusion was that the positive evaluation was actually related to the quality of the services available to them. However, users seem to have low expectations toward the level of services public clinics generally provide.

Restriction endonucleases whose sites are predictable from the amino acid sequence offer an improved strategy for typing bovine rotaviruses.

Variation in the third base of a codon hampers genotypic characterization, particularly of RNA viruses. Some restriction endonucleases, however, have a recognition site with a variable base at the third position and will always cleave when a certain amino acid pair occurs (such as glycine-proline for Sau96I and glutamic or aspartic acid followed by serine usually for HinfI). We developed a restriction fragment length polymorphism (RFLP) procedure based on these enzymes for P-typing bovine group A rotaviruses (BRV). Employing this procedure 20 BRV local strains, isolated in tissue culture as well as the original faecal sample, could be typed in one of three patterns. More variability was observed when restriction endonucleases were employed whose cleavage sites cannot be predicted from the amino acid sequence (TaqI and Tsp509I). These RFLP results agreed with the PCR-VP4 typing assay, neutralization tests, and nucleotide sequence analysis. RFLP with Sau96I and HinfI provided quick and objective P-typing of strains and could detect multiple genotypes in the same sample.

Persistence of a 1930 swine influenza A (H1N1) virus in Quebec.

Two antigenically distinct H1N1 influenza A viruses were isolated during an outbreak of respiratory disease in Quebec swine in 1990/91. Analysis of haemagglutinin and partial nucleoprotein sequences indicated that one was a variant of the swine H1N1 influenza virus circulating in the American Midwest whereas the other was very similar to virus isolated from swine in 1930. The existence of this latter isolate supports the concept that influenza viruses can be maintained for long periods in swine, perhaps in geographically limited pockets. Serological evidence indicates that these distinct strains continued to circulate widely in south-central Quebec until at least 1993.