Severe osteoarticular involvement in isotretinoin-triggered acne fulminans: two cases successfully treated with anakinra.

Acne fulminans (AF) is a severe form of inflammatory and ulcerated acne associated with fever, malaise, joint swellings and polyarthralgia.1 Osteoarticular lesions are often described and can be radiologically indistinguishable from those observed in synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome.2,3 SAPHO is an autoinflammatory disease characterized by osteoarticular and cutaneous manifestations, the latter including nodular and fulminans acne, hidradenitis suppurativa and palmoplantar pustulosis.3 Thus, AF is considered part of the SAPHO spectrum.

Use of antenatal clinic surveillance to assess the effect of sexual behavior on HIV prevalence in young women in Karonga district, Malawi.

BACKGROUND: Antenatal clinic (ANC) surveillance is the primary source of HIV prevalence estimates in low-resource settings. In younger women, prevalence approximates incidence. Sexual behavior monitoring to explain HIV distribution and trends is seldom attempted in ANC surveys. We explore the use of marital history in ANC surveillance as a proxy for sexual behavior. METHODS: Five ANC clinics in a rural African district participated in surveillance from 1999 to 2004. Unlinked anonymous HIV testing and marital history interviews (including age at first sex and socioeconomic variables) were conducted. Data on women aged <25 years were analyzed. RESULTS: Inferred sexual exposure before marriage and after first marriage increased the adjusted odds of infection with HIV by more than 0.1 for each year of exposure. Increasing years within a first marriage did not increase HIV risk. After adjusting for age, women in more recent birth cohorts were less likely to be infected. CONCLUSIONS: Marital status is useful behavioral information and can be collected in ANC surveys. Exposure in an ongoing first marriage did not increase the odds of infection with HIV in this age group. HIV prevalence decreased over time in young women. ANC surveillance programs should develop proxy sexual behavior questions, particularly in younger women

Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata

As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline.METHODS/PRINCIPAL FINDINGS: As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1-4 years, and 38 in children aged 5-15. All-cause child mortality in infants and 1-4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1-4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets.CONCLUSIONS/SIGNIFICANCE: In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest

Adjusting the HIV prevalence for non-respondents using mortality rates in an open cohort in northwest Tanzania.

OBJECTIVE: To estimate HIV prevalence in adults who have not tested for HIV using age-specific mortality rates and to adjust the overall population HIV prevalence to include both tested and untested adults. METHODS: An open cohort study was established since 1994 with demographic surveillance system (DSS) and five serological surveys conducted. Deaths from Kisesa DSS were used to estimate mortality rates and 95% confidence intervals by HIV status for 3- 5-year periods (1995-1999, 2000-2004, and 2005-2009). Assuming that mortality rates in individuals who did not test for HIV are similar to those in tested individuals, and dependent on age, sex and HIV status and HIV, prevalence was estimated. RESULTS: In 1995-1999, mortality rates (per 1000 person years) were 43.7 (95% CI 35.7-53.4) for HIV positive, 2.6 (95% CI 2.1-3.2) in HIV negative and 16.4 (95% CI 14.4-18.7) in untested. In 2000-2004, mortality rates were 43.3 (95% CI 36.2-51.9) in HIV positive, 3.3 (95% CI 2.8-4.0) in HIV negative and 11.9 (95% CI 10.5-13.6) in untested. In 2005-2009, mortality rates were 30.7 (95% CI 24.8-38.0) in HIV positive, 4.1 (95% CI 3.5-4.9) in HIV negative and 5.7 (95% CI 5.0-6.6) in untested residents. In the three survey periods (1995-1999, 2000-2004, 2005-2009), the adjusted period prevalences of HIV, including the untested, were 13.5%, 11.6% and 7.1%, compared with the observed prevalence in the tested of 6.0%, 6.8 and 8.0%. The estimated prevalence in the untested was 33.4%, 21.6% and 6.1% in the three survey periods. CONCLUSION: The simple model was able to estimate HIV prevalence where a DSS provided mortality data for untested residents

Using HIV-attributable mortality to assess the impact of antiretroviral therapy on adult mortality in rural Tanzania.

BACKGROUND: The Tanzanian national HIV care and treatment programme has provided free antiretroviral therapy (ART) to HIV-positive persons since 2004. ART has been available to participants of the Kisesa open cohort study since 2005, but data to 2007 showed a slow uptake of ART and a modest impact on mortality. Additional data from the 2010 HIV serological survey provide an opportunity to update the estimated impact of ART in this setting. METHODS: The Kisesa Health and Demographic Surveillance Site (HDSS) has collected HIV serological data and demographic data, including verbal autopsy (VA) interviews since 1994. Serological data to the end of 2010 were used to make two estimates of HIV-attributable mortality, the first among HIV positives using the difference in mortality between HIV positives and HIV negatives, and the second in the population using the difference between the observed mortality rate in the whole population and the mortality rate among the HIV negatives. Four time periods (1994-1999, 2000-2004, 2005-2007, and 2008-2010) were used and HIV-attributable mortality estimates were analysed in detail for trends over time. A computer algorithm, InterVA-4, was applied to VA data to estimate the HIV-attributable mortality for the population, and this was compared to the estimates from the serological survey data. RESULTS: Among HIV-positive adults aged 45-59 years, high mortality rates were observed across all time periods in both males and females. In HIV-positive men, the HIV-attributable mortality was 91.6% (95% confidence interval (CI): 84.6%-95.3%) in 2000-2004 and 86.3% (95% CI: 71.1%-93.3%) in 2008-2010, while among women, the HIV-attributable mortality was 87.8% (95% CI: 71.1%-94.3%) in 2000-2004 and 85.8% (95% CI: 59.6%-94.4%) in 2008-2010. In the whole population, using the serological data, the HIV-attributable mortality among men aged 30-44 years decreased from 57.2% (95% CI: 46.9%-65.3%) in 2000-2004 to 36.5% (95% CI: 18.8%-50.1%) in 2008-2010, while among women the corresponding decrease was from 57.3% (95% CI: 49.7%-63.6%) to 38.7% (95% CI: 27.4%-48.2%). The HIV-attributable mortality in the population using estimates from the InterVA model was lower than that from HIV sero-status data in the period prior to ART, but slightly higher once ART became available. DISCUSSION: In the Kisesa HDSS, ART availability corresponds with a decline in adult overall mortality, although not as large as expected. Using InterVA to estimate HIV-attributable mortality showed smaller changes in HIV-related mortality following ART availability than the serological results

6sterreichische Wasser- und Abfallwirtschaft / Nanomaterialien in Forschung, Industrie und Umwelt \u2013 Fallbeispiele f\ufcr nanoskopische Referenzmaterialien

Synthetisch hergestellte Nanomaterialien sind in der Industrie bereits ein fester Bestandteil und haben zu neuen Produktentwicklungen gef\ufchrt. Auf der einen Seite versprechen Nanomaterialien aufgrund ihrer Gr\uf6 fe sowie spezifischen und chemisch sehr reaktiven Oberfl\ue4chen vielversprechende Anwendungsgebiete. Auf der anderen Seite lassen sich \ufcber deren potenzielle Auswirkungen auf Mensch und Umwelt derzeit kaum allgemeing\ufcltige Aussagen treffen. Die Sicherheitsbewertung dieser neuartigen Materialien, die sich aus mannigfaltigen Kompositionen zusammensetzen k\uf6nnen, wird dadurch erschwert, da nicht nur die chemische Spezies und die Menge bzw. Dosis entscheidend sind, sondern auch andere physikalisch-chemische Parameter, wie Partikelform, Struktur, spezifische Oberfl\ue4cheneigenschaften, Gr\uf6 fe und Gr\uf6 fenverteilung eine sehr wichtige Rolle spielen. So ist es auch derzeit eine Herausforderung, m\uf6gliche Transformationsprozesse, wie die Aggregation zu gr\uf6 feren Clustern oder Aufl\uf6sung in ionische Bestandteile, mit zu ber\ufccksichtigen und zugleich zwischen nanomaterialspezifischen und unspezifischen Effekten unterscheiden zu k\uf6nnen. Des Weiteren mangelt es derzeit vor allem an nanoskaligen Referenzmaterialien und an Nanomaterialien, die sich in komplexen Umweltproben wiederauffinden lassen. So m\ufcssen derzeit auch noch standardisierte Methoden und Testverfahren weiterentwickelt und angepasst werden. In Hinblick auf diese Herausforderungen werden in diesem Artikel unter anderem L\uf6sungsvorschl\ue4ge beschrieben, wie synthetische Nanomaterialien von ihren nat\ufcrlich vorkommenden Pendants unterschieden werden k\uf6nnen. Im gegenst\ue4ndlichen Artikel wird hierzu ein umweltrelevantes Anwendungsbeispiel n\ue4her erl\ue4utert.Engineered nanomaterials have established themselves as a staple in industry, and have paved the way for the development of new products. On one hand, their size and specific, highly chemically reactive surfaces make nanomaterials promising candidates in terms of their range of applications. On the other, it\u2019s virtually impossible to make any universally valid statements on their potential effects on human beings or the environment. The difficulty of assessing the safety of these innovative materials, which are often made of complex compositions, is compounded by the fact that not only the chemical species and the amount/dosage but also further physical-chemical parameters like the particle shape, structure, specific surface characteristics, size and size distribution are important aspects. As such, it is currently extremely difficult to take into account potential transformation processes like the aggregation into larger clusters or dissolution into ionic components, and to differentiate between nanomaterial-specific and nonspecific effects. In addition, nano-scale reference materials and nanomaterials that can be found in complex environmental samples are currently in short supply. Accordingly, the standardized methods and testing techniques currently in use must be refined and adapted. In response to these challenges, this article proposes new approaches to differentiating between synthetic nanomaterials and their naturally occurring counterparts, illustrating them on the basis of an environmentally relevant sample application

Evaluation of a village-informant driven demographic surveillance system in Karonga, Northern Malawi

This paper describes and evaluates the first demographic surveillance system (DSS) in Malawi, covering a rural population of 30,000. Unlike others, the Karonga DSS relies on trained village informants using formatted registers for the primary notification of vital events and migrations. Seven project enumerators subsequently collect detailed data on events notified by the village informants, using stringent identification procedures for households and individuals. Internal movements are traced systematically to augment event registration and data quality. Continuous evaluation of data collection is built into the methods. A re-census conducted after 2 years indicated that the routine system had registered 97% of 1,588 births, 99% of 521 deaths and 92% of 13,168 movements.demographic surveillance system, evaluation, INDEPTH network, Karonga, Malawi, methods, migration, village informant, vital registration