结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Summary Background Previous systematic reviews have identified a high prevalence of HIV infection in transgender women in the USA and in those who sell sex (compared with both female and male sex workers). However, little is known about the burden of HIV infection in transgender women worldwide. We aimed to better assess the relative HIV burden in all transgender women worldwide. Methods We did a systematic review and meta-analysis of studies that assessed HIV infection burdens in transgender women that were published between Jan 1, 2000, and Nov 30, 2011. Meta-analysis was completed with the Mantel-Haenszel method, and random-effects modelling was used to compare HIV burdens in transgender women with that in adults in the countries for which data were available. Findings Data were only available for countries with male-predominant HIV epidemics, which included the USA, six Asia-Pacific countries, five in Latin America, and three in Europe. The pooled HIV prevalence was 19·1% (95% CI 17·4–20·7) in 11 066 transgender women worldwide. In 7197 transgender women sampled in ten low-income and middle-income countries, HIV prevalence was 17·7% (95% CI 15·6–19·8). In 3869 transgender women sampled in five high-income countries, HIV prevalence was 21·6% (95% CI 18·8–24·3). The odds ratio for being infected with HIV in transgender women compared with all adults of reproductive age across the 15 countries was 48·8 (95% CI 21·2–76·3) and did not differ for those in low-income and middle-income countries compared with those in high-income countries. Interpretation Our findings suggest that transgender women are a very high burden population for HIV and are in urgent need of prevention, treatment, and care services. The meta-analysis showed remarkable consistency and severity of the HIV disease burden among transgender women. Funding Center for AIDS Research at Johns Hopkins and the Center for Public Health and Human Rights at the JHU Bloomberg School of Public Health.

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Worldwide burden of HIV in transgender women: a systematic review and meta-analysis

Cross-sectional study design is a type of observational study design. In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time. Unlike in case-control studies (participants selected based on the outcome status) or cohort studies (participants selected based on the exposure status), the participants in a cross-sectional study are just selected based on the inclusion and exclusion criteria set for the study. Once the participants have been selected for the study, the investigator follows the study to assess the exposure and the outcomes. Cross-sectional designs are used for population-based surveys and to assess the prevalence of diseases in clinic-based samples. These studies can usually be conducted relatively faster and are inexpensive. They may be conducted either before planning a cohort study or a baseline in a cohort study. These types of designs will give us information about the prevalence of outcomes or exposures; this information will be useful for designing the cohort study. However, since this is a 1-time measurement of exposure and outcome, it is difficult to derive causal relationships from cross-sectional analysis. We can estimate the prevalence of disease in cross-sectional studies. Furthermore, we will also be able to estimate the odds ratios to study the association between exposure and the outcomes in this design.

Methodology Series Module 3: Cross-sectional Studies.

Lever's Histopathology of the Skin

A 1.1 kb rice genomic DNA fragment, containing a chitinase gene under the control of the CaMV 35S promoter, was cloned into the rice transformation vector pGL2. After transformation of Indica rice protoplasts in the presence of polyethyleneglycol, plants were regenerated. The presence of the chimeric chitinase gene in T0 and T1 transgenic rice plants was detected by Southern blot analysis. Western blot analysis of transgenic plants and their progeny revealed the presence of two proteins with apparent molecular weights of 30 and 35 kDa that reacted with the chitinase antibody. Progeny from the chitinase-positive plants were tested for their resistance to the sheath blight pathogen, Rhizoctonia solani. The degree of resistance displayed by the transgenic plants to this pathogen correlated with the level of chitinase expression.

Genetic engineering of rice for resistance to sheath blight and other agronomic characters

Silicosis — Continued Silicosis is a chronic lung disease associated with the inhalation and pulmonary deposition of dust that contains crystalline silica. Through the Sentinel Event Notification System for Occupational Risks (SENSOR)* program, CDC's National Institute for Occupational Safety and Health (NIOSH) is assessing practical models for implementing state-based surveillance of silicosis and linking follow-up intervention activities to surveillance reports. From 1989 through 1992, the Ohio Department of Health (ODH) SENSOR program identified silicosis cases through reports of Bureau of Workers' Compensation (BWC) claims, physician reports, and death certificates. The addition in 1993 of hospital discharge reports as an ascertainment source resulted in a substantial increase in the number of silicosis case reports identified annually (Table 1). This report describes the investigation of a case of occupational silicosis in Ohio and summarizes the impact of hospital-based reporting on surveillance for silicosis in Case Report In September 1991, a case report † was sent to ODH by an infectious disease specialist who was treating a 55-year-old sandblaster with advanced silicosis and an associated Mycobacterium kansasii infection § (2). In January 1992, NIOSH and ODH conducted a joint investigation at the worker's place of employment—a metal preparation shop—to evaluate current levels of exposure to respirable crystalline silica and to screen co-workers for silicosis. The investigation detected excessive exposures to respirable crystalline silica (2–5). Chest radiology revealed radiographic abnormalities consistent with pneumoconiosis in four of 16 current and former workers *SENSOR is a program of cooperative agreements with state health departments to develop surveillance and intervention strategies for selected occupational conditions. The National Institute for Occupational Safety and Health currently supports SENSOR silicosis programs in seven states and Wisconsin). † Case reports should be submitted for persons with a physician's provisional diagnosis of silicosis, a chest radiograph interpreted as consistent with silicosis, or pathologic findings consistent with silicosis (1).

Current trends in

Background: Male sex workers (MSWs) have recently been recognized as an important risk group for sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) infection. Although there are global studies on MSWs, few such studies describe the behavioral patterns and STIs among this population in India. Methods: MSWs were evaluated at the Humsafar trust, a community based organization situated in suburban Mumbai, India. We report on the demographics, sexual behaviors, and STIs including HIV of these sex workers. Results: Of the 75 MSWs, 24 were men and 51 were transgenders. The mean age of the group was 23.3 (+ 4.9) years. About 15% were married or lived with a permanent partner. Of these individuals, 85% reported sex work as a main source of income and 15% as an additional source. All the individuals reported anal sex (87% anal receptive sex and 13% anal insertive sex). About 13% of MSWs had never used a condom. The HIV prevalence was 33% (17% in men vs 41% in transgenders, P = 0.04). The STI prevalence was 60% (58% in men vs 61% in transgenders, P = 0.8). Syphilis was the most common STI (28%) in these MSWs. HIV was associated with being a transgender (41 vs 17%, P = 0.04), age > 26 years (57 vs 28%, P = 0.04), more than one year of sex work (38 vs 8%, P = 0.05), and income < Rs. 2000 per month (62 vs 27%, P = 0.02). Conclusions: The MSWs have high-risk behaviors, low consistent condom use, and high STI/HIV infections. These groups should be the focus of intensive public health interventions aimed at reduction of risky sexual practices, and STI/HIV prevention and care.

Male sex workers: Are we ignoring a risk group in Mumbai, India?

This study systematically reviews the existing literature on sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) infection in the men who have sex with men (MSM) in India. After a comprehensive literature search of Medline (1950-June 2008), Embase (1980-June 2008), and the Cochrane Library (1950-June 2008), 12 published studies met the inclusion criteria. The link between sexual identity and sexual behavior is a complex phenomenon strongly embedded in a very specific context in India. MSM in India are an important risk group for acquiring STIs/HIV and effective culturally sensitive prevention programs should be designed for them. The combined estimate of HIV prevalence in the MSM population in India calculated from 5 included studies was 16.5% (95% confidence intervals: 11% to 22%). The review also identifies the lacunae in existing literature and provides future directions for research in the MSM community in India.

Men Who Have Sex with Men in India: A Systematic Review of the Literature

Summary

Background A combination of rifampicin, ofloxacin and minocycline (ROM) is one of the newer recommendations for treatment of leprosy. We performed a systematic review and a meta-analysis of studies that had evaluated the efficacy of ROM therapy in treatment of paucibacillary and multibacillary leprosy patients.



Methods  Studies were identified by searching the PubMed, Embase, LILACS and Cochrane databases. Data were abstracted from all relevant studies, and fixed effects models were used to calculate the summary estimate of effect in paucibacillary and multibacillary leprosy patients.



Results  Six studies comparing ROM therapy to multidrug therapy and eight studies that evaluated the effect of ROM therapy alone (no comparison group) were included in the review and meta-analysis. The combined estimate for single dose ROM vs. multidrug therapy in paucibacillary leprosy patients suggested that ROM was less effective than multidrug therapy in these patients [relative risk: 0.91, 95% confidence intervals (CI): 0.86–0.97]. However, the combined estimate for multiple doses of ROM vs. multidrug therapy in multibacillary leprosy patients suggested that ROM was as effective as multidrug therapy in reducing bacillary indices in these patients (proportion change: −4%, 95% CI −31% to 23%). No major side effects were reported in either the ROM or the multidrug treatment groups.



Conclusions  Single-dose ROM therapy was less effective than multidrug therapy in paucibacillary patients. However, there are insufficient data to come to a valid conclusion on the efficacy of multidose ROM therapy in multibacillary leprosy, and additional studies with ROM therapy in multibacillary leprosy are needed. Furthermore, multiple doses may be considered as another alternative even for paucibacillary patients, and randomised controlled trials of this therapy may be useful to understand its contribution in the treatment and control of leprosy.




Contexte:  L’association de rifampicine, ofloxacine et minocycline (ROM) est l’une des nouvelles recommandations pour le traitement de la lepre. Nous avons effectue une revue systematique et une meta-analyse des etudes qui ont evalue l’efficacite de la therapie ROM dans le traitement des patients atteints de lepre paucibacillaire et multibacillaire.



Methodes:  Les etudes ont ete identifiees par une recherche sur PubMed, Embase, LILACS et la base de donnees Cochrane. Les donnees ont ete extraites de toutes les etudes pertinentes et des modeles a effets fixes ont ete utilises pour estimer l’effet chez les patients avec une lepre paucibacillaire ou multibacillaire.



Resultats:  Six etudes comparant la therapie ROM a la multitherapie et 8 etudes evaluant l’effet de la therapie ROM seule (sans groupe temoin) ont ete incluses dans la revue et la meta-analyse. L’estimation combinee pour la dose simple ROM versus la multitherapie chez les patients avec une lepre paucibacillaire suggere que ROM est moins efficace que la multitherapie chez ces patients [risque relatif: 0,91; IC95%: 0,86 a 0,97]. Toutefois, l’estimation combinee pour des doses multiples de ROM versus la multitherapie chez des patients avec une lepre multibacillaire suggere que ROM est aussi efficace que la multitherapie dans la reduction des indices bacillaires chez ces patients (proportion de changement: -4%; IC95%: - 3 a 23). Aucun effet secondaire majeur n’a ete rapporte ni dans les groupes ROM ni dans ceux sous traitement multiple.



Conclusions:  La therapie ROM a dose simple est moins efficace que la multitherapie chez des patients paucibacillaires. Cependant, les donnees sont insuffisantes pour tirer une conclusion valide sur l’efficacite de la therapie ROM a doses multiples dans la lepre multibacillaire. Des etudes supplementaires sur la therapie ROM dans la lepre multibacillaire sont necessaires. Par ailleurs, les doses multiples peuvent etre considerees comme une autre alternative, meme pour les patients paucibacillaires et des essais randomises controles de cette therapie pourraient etre utiles pour comprendre leur contribution dans le traitement et le controle de la lepre.





Antecedentes:  La combinacion de rifampicina, ofloxacina, y minociclina (ROM) es una de las recomendaciones mas recientes para el tratamiento de la lepra. Hemos realizado una revision sistematica y estudios de meta-analisis para evaluar la eficacia de la terapia con ROM en el tratamiento de pacientes con lepra paucibacilar y multibacilar.



Metodos:  Los estudios se identificaron mediante busquedas en las bases de datos de PubMed, Embase, LILACS, y Cochrane. Se extrajeron datos de todos los estudios relevantes y se utilizaron modelos de efectos fijos para calcular el compendio de estimaciones del efecto en pacientes con lepra paucibacilar y multibacilar .



Resultados:  Se incluyeron, en la revision y en el meta-analisis, seis estudios comparando la terapia ROM frente a una terapia multifarmacos, y 8 estudios que evaluaron el efecto de la terapia ROM por si sola (sin grupo de comparacion). El calculo combinado de una dosis unica de ROM vs terapia multifarmacos en pacientes con lepra paucibacilar sugiere que ROM era menos efectiva que la terapia multifarmacos en estos pacientes [riesgo relativo: 0.91, 95% intervalos de confianza (IC): 0.86 a 0.97]. Sin embargo, el calculo combinado para dosis multiples de ROM vs terapia multifarmacos en pacientes con lepra multibacilar sugiere que ROM fue tan efectivo como la terapia multifarmacos a la hora de reducir los indices en estos pacientes (proporcion del cambio: -4%, 95% IC - 31% a 23%). No se reportaron efectos secundarios importantes en ninguno de los grupos.



Conclusiones:  La terapia ROM con una dosis unica fue menos efectiva que la terapia multifarmacos en pacientes con lepra paucibacilar. Sin embargo, no hay suficientes datos para llegar a una conclusion valida sobre la eficacia de la terapia ROM multidosis en pacientes con lepra multibacilar y se requieren estudios adicionales. Mas aun, las dosis multiples podrian considerarse como una alternativa inclusive para pacientes con lepra paucibacilar y los ensayos aleatorizados y controlados de esta terapia podrian ser utiles para entender su contribucion en el tratamiento y el control de la lepra.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-3156.2011.02873.x

Is there a role for rifampicin, ofloxacin and minocycline (ROM) therapy in the treatment of leprosy? Systematic review and meta‐analysis

Hematohidrosis is a very rare condition of sweating blood. A case of hematohidrosis is reported. There are only few reports in the literature.

Hemangi Jerajani

Papers

Current trends in

Male sex workers: Are we ignoring a risk group in Mumbai, India?

Men Who Have Sex with Men in India: A Systematic Review of the Literature

Is there a role for rifampicin, ofloxacin and minocycline (ROM) therapy in the treatment of leprosy? Systematic review and meta‐analysis

Hematohidrosis - a rare clinical phenomenon.