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The purpose of this study was to assess the rate of acceptance of street-intercept syphilis screening and to identify barriers to screening among residents of 2 Houston communities with high rates of syphilis. Each of 691 people who participated in a street-intercept survey about syphilis was offered a free syphilis test immediately after completion of the survey. Acceptors of screening had blood drawn at the site of the interview, and blood samples were tested by rapid plasma reagin (RPR) and a confirmatory microhaemagglutination-Treponema pallidum (MHA-TP) for those with a positive antibody reaction on the RPR. On-street syphilis screening was accepted by 26% of the sample. The most common reason for refusal was not wanting to have blood drawn (19.5%). Among those screened for syphilis (n=148), seroprevalence was 19%, with 33% of women testing positive and 10% of men. The results of this study point to a need for increased case-finding, standard screening recommendations, and interventions targeting specific barriers to syphilis screening. [ABSTRACT FROM AUTHOR]

For people immunosuppressed by human immunodeficiency virus (HIV), we expect an increase in cancer incidence similar to that documented in transplant patients. We examined the cancer spectrum in an HIV-infected cohort, specifically malignancies not currently associated with acquired immunodeficiency syndrome (AIDS), in relation to the general population. Cancer incidence data for residents of Harris County, Texas, diagnosed between 1975 and 1994, were linked to HIV/AIDS registry data by Soundex code and date of birth to identify malignancies in an HIV-infected cohort of 14,986 persons. Incidence of cancer in this cohort was compared to the general population by standardized incidence ratio (SIR) analysis. From the HIV-infected cohort, 2289 persons (15%) were identified as having one or more malignancies, with 97% occurring in males. The linkage alone identified 29.5% of the malignancies, of which only 28.7% were diagnosed in males. Adjusting for age, HIV-infected men and women had incidences of cancer that were 16.7 [95% confidence interval (CI) 16.1-17.3] and 2.9 (95% CI 2.3-3.7) times that expected for the general population of Harris County, Texas. Besides Kaposi's sarcoma, non-Hodgkin's lymphoma, cervix cancer and brain lymphoma, non-AIDS related malignancies of Hodgkin's lymphoma, non-melanotic skin cancer in males and colon cancer in females, exhibited significant SIRs of 5.6 (95% CI 3.6-8.4), 6.9 (95% CI 4.8-9.5) and 4.0 (95% CI 1.1-10.2). Increased incidences of lung, prostate and breast malignancies were not seen in this HIV cohort. Persons infected with HIV appear to be at increased risk for the non-AIDS related malignancies, Hodgkin's lymphoma, non-melanotic skin cancer in males and colon cancer in females. [ABSTRACT FROM AUTHOR]

We aimed to investigate the prevalence of ulcerative sexually transmissible diseases (STDs) and hepatitis in crack users. We interviewed 435 crack users on site in crack houses in Houston, Texas and took blood for laboratory analysis. There was evidence of syphilis infection in 13%, herpes simplex virus-2 (HSV-2) in 61%, HIV in 12%, hepatitis B in 52%, and hepatitis C in 41% of cases. On DSM-III-R criteria, 12% were crack abusers and 84% crack dependent: over half reported previous treatment. Forty per cent reported also injecting. Sexual behaviour indicated a mean of 2.4 partners in the past month for men, 3.7 for women. Sexual behaviour was largely vaginal, although women also reported more than twice the level of oral sex of men. Significant multivariate predictors for HIV and hepatitis B and C were previous reported STD and injecting drug use (including sharing needles), while female gender for syphilis and HSV-2, and additionally condom use for HSV-2, were significant risks. These data confirm high rates of STDs in a crack house population as inferred from previous clinic-based and community studies, and the link between STDs, injecting and HIV. The high rates of STDs found should lead to considering STDs and substance abuse to be dual diagnoses in crack users and the integration of STD diagnosis and treatment into crack outreach and treatment programmes. [ABSTRACT FROM AUTHOR]

From local health department data, we determined the 1990-92 incidence of congenital syphilis (CS) in Harris County, Texas, USA, applying for the first time the Centers for Disease Control and Prevention (CDC) 1990 surveillance case definition to a population-based sample. We also evaluated factors that discriminated between women whose infants were or were not cases. The incidence of CS per 1000 live births was 3.2 in 1990, 4.6 in 1991 and 4.2 in 1992. Because of failure to apply part of the case definition, the local health department reported only 60% (418/694) of the cases that we identified. In the multivariate analysis, the significant factors for CS were lack of prenatal care and late latent syphilis. No factor identified high-risk women to target for special public health interventions. Improved laboratory services and better education of local providers and surveillance workers will solve some problems in the diagnosis and therapy of syphilis during pregnancy. Ambiguity in the CDC's case definition of CS needs correction. [ABSTRACT FROM AUTHOR]

Worldwide, the number of childbearing women infected with the human immunodeficiency virus (HIV) is rising. Early intervention can improve care for these women and reduce HIV transmission to their children. However, for intervention strategies to be effective, childbearing women at risk must be identified. HIV prevalence and risk factors vary widely from one region to another, and strategies for HIV testing must be tailored to local conditions. In this review, published data on HIV risk factors in pregnant women are presented by region, and implications for regional strategies for HIV testing in pregnant women are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Breast cancer survivors have reported worse health-related quality of life (HRQoL) outcomes on some subscales when compared with members of the general population. However, the increased attention to breast cancer survivorship should have improved the HRQoL of these survivors. Our aim was to examine whether physical and mental component scores (PCS-12 and MCS-12) using the Short Form (SF-12) questionnaire were different for racial/ethnic minorities, specifically for Black and Hispanic women relative to White women. Furthermore, we stratified the data by age group to evaluate these racial/ethnic differences in HRQoL of breast cancer survivors., Study Design: Cross-sectional study., Methods: Pooled cross-sectional analyses using data from the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the racial/ethnic differences in PCS-12 and MCS-12 scores of breast cancer survivors. Furthermore, stratified analyses by age group were conducted to evaluate racial/ethnic differences in HRQoL by the age of breast cancer survivors., Results: After adjusting for confounders, there was no association between race/ethnicity and PCS-12 scores. However, Hispanic breast cancer survivors had statistically significantly lower MCS-12 scores (by 1.9 points [95% confidence interval {CI}: -3.53 to -0.37]) when compared with White breast cancer survivors. For PCS-12, after stratifying by age, the adjusted analyses showed no significant differences in PCS-12 scores when White female breast cancer survivors were compared with the other racial/ethnic categories. On the other hand, Black female survivors aged <50 years had 4.3 points (95% CI: 0.46-8.13) higher MCS-12 scores when compared with their White counterparts, while Hispanic breast cancer survivors aged <50 years had 3.1 points (95% CI: -0.40-6.69) higher MCS-12 scores relative to White women. Furthermore, among female breast cancer survivors aged ≥50 years, Hispanic women had 3.2 points (95% CI: -4.98 to -1.40) lower MCS-12 scores than White women., Conclusion: Our study generated findings showing the racial/ethnic differences in HRQoL of breast cancer survivors and presented results stratified by age group. These findings provide the much-needed rationale for targeted and racial/ethnic-specific HRQoL improvement strategies among breast cancer survivors., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Setting: An inner city neighborhood in Houston, Texas, known for a high rate of drug use., Objective: To determine the prevalence of latent tuberculosis infection (LTBI) using the QuantiFERON-TB Gold (QFT-G) test, the TSPOT.TB test and the tuberculin skin test (TST) in drug users and to evaluate the performance of the QFT-G and TSPOT.TB tests vs. the TST., Design: Cross-sectional study. Bivariate and multivariate logistic regression analyses were used to determine risks associated with each test outcome., Results: The prevalence of LTBI in 119 drug users studied was 28% by TST and 34% by QFT-G and T-SPOT.TB. Kappa statistics indicated fair to moderate concordance between QFT-G and TSPOT.TB vs. TST. About one-fifth of the population that tested negative with TST was positive with either QFT-G or T-SPOT.TB. On multivariate analysis, the likelihood of testing QFT-positive or T-SPOT.TB-positive increased by 8% and 6%, respectively, for every year of age; TST positivity was associated with smoking crack at home; being Caucasian or having a history of alcohol use was positively associated with a positive T-SPOT.TB test., Conclusion: Interferon-gamma release assays (IGRAs) are superior to the TST in drug users with a higher prevalence of LTBI. Future studies need to assess the predictive value of IGRAs on the progression from LTBI to active TB in high-risk populations.

Background: Egypt has one of the highest prevalence rates of hepatitis C virus (HCV) infection in the world; however, the risk and attribution related to HCV in Egyptian patients with hepatocellular carcinoma (HCC) remains unknown., Goals: The current study was undertaken to estimate the risk of HCC in relation to HCV in Egypt., Study: Thirty-three patients with HCC and 35 healthy controls who had a similar socioeconomic status were prospectively enrolled at the University of Cairo National Cancer Institute., Results: Anti-HCV antibodies were present in 75.8% of the patients and in 42.9% of the controls (p = 0.01); hepatitis B surface antigen (HBsAg) was present in 15.2% of the patients and in 2.9% of the controls (p = 0.03). In addition, the sex-and age-adjusted odds ratio (OR) for anti-HCV antibodies was 5.1 (95% CI = 1.5-17.4) and for HBsAg was 13.2 (95% CI = 1.2-148.2). Concurrent Schistosoma mansoni and anti-HCV was associated with an OR of 10.3 (95% CI = 1.3-79.8), which was higher than that for anti-HCV (6.5; 95% CI = 1.6-26.6) and S. mansoni infection (0.2; 95% CI = 0.1-6.2) alone. Finally, we estimated the attributable fraction of HCC to HCV to be 64% in this study population and 48% in the general Egyptian population., Conclusions: Both HCV and hepatitis B virus infection increase the risk of HCC in Egyptian patients, whereas isolated Schistosoma infection does not. Because of the very high prevalence rate of HCV in the general Egyptian population, it accounts for most HCC cases in Egypt.

Goal: To describe a case of erythema elevatum diutinum (EED) that clinically mimicked extensive keloids., Objectives: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Describe the clinical presentation and lesion appearance in EED. 2. Discuss the electron microscopic and laboratory findings of EED. 3. Outline treatment options for EED. CME: This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine., Review Date: April 2001. This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Albert Einstein College of Medicine and Quadrant HealthCom, Inc. The Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Albert Einstein College of Medicine designates this educational activity for a maximum of 1.0 hour in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. This activity has been planned and produced in accordance with ACCME Essentials.

The central event in the cellular immune response to invading pathogens is the presentation of non-self antigenic peptides by major histocompatibility complex (MHC) class I molecules to cytotoxic T lymphocytes (CTLs). As peptide binding and transport proteins, MHC class I molecules have evolved distinct biochemical and cellular strategies for acquiring antigenic peptides, providing CTLs an extracellular representation of the intracellular antigen content. Whereas efficient generation of MHC class I binding peptides depends on the intracellular, immunoproteasome-mediated proteolysis machinery, translocation of peptides into the lumen of the endoplasmic reticulum requires the endoplasmic reticulum-resident, adenosine 5'-triphosphate (ATP) binding cassette transporter associated with antigen processing (TAP). Here we show, for the first time, that immunoproteasomes, TAP complexes, and MHC class I molecules are physically associated, providing an effective means of transporting MHC class I binding peptides from their sites of generation into the lumen of the endoplasmic reticulum for loading onto MHC class I molecules. In this review, we assess the current understanding of the functional regulation of immunoproteasomes and transporter associated with antigen processing.

A cross-sectional survey was conducted of sexually transmitted diseases (STDs) and risky behaviors among 407 drug abusers in treatment facilities in 1998. Infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus type 2 (HSV-2), and syphilis were detected by testing serum antibody levels; chlamydia and gonorrhea were detected by testing nucleic acid levels in urine. Logistic regression analysis was performed to measure associations. Prevalences of antibodies were as follows: to HSV-2, 44.4%; to HCV, 35.1%; to HBV, 29.5%; to HIV, 2.7%. The prevalence of syphilis was 3.4%; of chlamydia, 3.7%; and of gonorrhea, 1.7%. Of the 407 subjects, approximately 62% had markers for 1 of the STDs. HIV infection was associated with African American race, use of smokable freebase (crack) cocaine, and STD history. HBV infection was associated with age >30 years, injecting drugs, needle sharing, a history of treatment for drug abuse, and African American race. HCV infection was associated with an age >30 years, injecting drugs, and needle sharing, and HSV-2 infection with an age >30 years, female sex, and African American race. Syphilis was associated with a history of STDs. High prevalences of STDs among drug abusers indicate the need for integration of STD screening and treatment into drug treatment programs.

The long-term efficacy of hepatitis B vaccination among high-risk infants was determined in 805 vaccine responders, immunized at birth in Taiwan during 1981-1984 and followed to age 10 years, via life table survival and Cox multivariate analyses. At 10 years, cumulative persistence of antibody to hepatitis B surface antigen (anti-HBs) was 85%, and cumulative incidence of hepatitis B virus (HBV) infection was 15%. Three children became carriers. Twelve-month anti-HBs titer was the strongest predictor of efficacy. The higher the initial titer, the lower the risk of anti-HBs loss (relative risk [RR], 0.26 for titer of 100-999 mIU/mL; RR, 0.08 for titer >1000 mIU/mL; P<.001) and HBV infection (RR, 0.55 and 0.27; P<.05). Maternal hepatitis B e antigen positivity but not hepatitis B immunoglobulin dose or gender predicted greater antibody persistence to age 10 years. Because the level of antibody persistence remained high and few became carriers, booster revaccination within 10 years seems unnecessary.

We assessed the seroprevalence of antibodies to Trypanosoma cruzi among pregnant Hispanic women in Houston. Sera from 2,107 Hispanic and 1,658 non-Hispanic subjects were tested by ELISA for the presence of antibodies to T. cruzi. Twenty-two (0.6%) of 3,765 subjects had sera that were reactive. Seroreactivity was confirmed by hemagglutination assay. Eleven subjects had reactive sera, giving a confirmed seroprevalence of 0.3% (95% CI, 0-1%). Nine sera from Hispanic and two from non-Hispanic women were positive by hemagglutination assay, for a prevalence of 0.4% and 0.1%, respectively, during pregnancy. On the basis of these seroreactivity data, transplacental transmission of T. cruzi could occur in the continental United States. Screening for antibodies to T. cruzi during pregnancy would provide the potential for early intervention in congenital Chagas' disease.

Background: National and local syphilis rates have fallen since 1990. Accurate epidemiologic information about the distribution of syphilis during the waning years of an epidemic are important to health care organizations so that they can specifically target screening and intervention programs., Goals: To describe the epidemiology of syphilis in Houston, Texas, from 1991 through 1997., Study Design: Descriptive evaluation of morbidity surveillance data from the Houston Department of Health and Human Services., Results: Between 1991 and 1997, rates for syphilis fell 61%. Rates for primary and secondary syphilis fell 90% among men and women in all race/ethnicity groups; early latent rates fell 81% among blacks, 57% among Hispanics, and 50% among whites. Late latent rates were stable among blacks and whites and increased among Hispanics. The proportion of total cases identified as late latent disease increased from 16% in 1991 to 63% in 1997. Congenital syphilis rates have remained at approximately 2 per 1,000 live births since 1993., Conclusion: Syphilis continues to be a problem in Houston. The medical community and HIV/STD prevention programs need to be vigilant in actively screening high-risk individuals to identify syphilis at earlier stages of the disease and to prevent congenital syphilis.

The BRCA1 gene encodes a tumor suppressor that has been implicated in hereditary forms of breast and ovarian cancer. During S phase of the cell cycle, BRCA1 polypeptides are found in discrete nuclear bodies ('BRCA1 nuclear dots') together with HsRad51, a human homolog of the E. coli recA protein, and BARD1, a protein that interacts with BRCA1 to form a stable heterodimer. BARD1 is structurally similar to BRCA1 in that both molecules harbor an amino-terminal RING domain and two carboxy-terminal BRCT domains. Here we describe the amino acid sequence and expression pattern of murine Bard1. A comparison of the mouse and human sequences reveals that the recognizable protein motifs of BARD1 are well conserved, including the RING domain, the three tandem ankyrin repeats, and, to a lesser extent, the two BRCT domains. However, the remaining sequences of BARD1 display a markedly lower degree of phylogenetic conservation, comparable to those reported for BRCA1 and BRCA2. Moreover, murine Bard1 retains the ability to associate in vivo with BRCA1, and its expression pattern in adult mice mirrors that of Brca1, with elevated levels of RNA transcripts found in the testes and spleen. These data suggest that BRCA1 and BARD1 have co-evolved to participate in a common pathway of tumor suppression.

Although the pathogenesis of hepatocellular carcinoma (HCC) remains poorly understood, hepatitis B virus and dietary aflatoxin exposures are established etiological factors for this disease. We conducted a pilot study of 28 patients with HCC and 110 healthy controls matched for age, sex, and ethnicity to determine whether constitutional genetic instability, based on the quantification of mutagen-induced chromatid breaks in cultured lymphocytes, modifies an individual's risk of HCC development. The mean numbers of bleomycin-induced breaks per cell for cases and controls were 0.92 and 0.55, respectively (P < 0.0001). For benzo(a)pyrene diol epoxide (BPDE) sensitivity, the values were 0.90 for cases and 0.46 for controls (P < 0.0001). Nearly 68% of the cases but only 27% of the controls exhibited bleomycin sensitivity (i.e., had > or = 0.68 breaks per cell). Eighty % of the case group but only 22% of the control group exhibited BPDE sensitivity (i.e., had > or = 0.58 breaks per cell). On multivariate analyses, both bleomycin sensitivity and BPDE sensitivity were associated with significantly elevated risks for HCC, with odds ratios (95% confidence intervals) of 5.63 (2.30, 13.81) and 14.13 (3.52, 56.68), respectively. For individuals who were sensitive to both assays, the risk was 35.88. A synergistic interaction between the bleomycin sensitivity and BPDE sensitivity in HCC risk was suggested. These preliminary findings suggest that differences in host factors related to the predisposition to chromosome breakage, the capacity for DNA repair, or both may be involved in HCC development by influencing the predisposition of hepatitis B virus integration into human DNA or that the carcinogens induced DNA damage susceptibility. A larger study is needed to confirm these intriguing results.

In 1993, the Centers for Disease Control and Prevention (CDC) expanded the surveillance case definition of AIDS to include all individuals showing immune suppression, measured by absolute CD4 lymphocyte count or CD4/CD8 ratio, as well as those presenting with the 23 clinical conditions from previous case definitions or with three new indicator conditions (pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer). The greatest impact of the expanded definition is the dramatic increase in cases reported in 1993, largely due to a backlog of 1992-diagnosed cases that meet the new criteria. Texas reported a 136% increase in cases in 1993 compared with 1992. Despite a drop between 1993 and 1994, the number of reported cases increased 75% overall between 1992 and 1994. Most cases reported in 1993 and 1994 fall under the 1993 expanded surveillance case definition (59% and 60%, respectively). More than 90% of all cases reported under the new definition are classified under immunologic criteria. The Department of Health and Human Services (DHHS) Public Health Region 4 was the most affected, with a 213% increase in reported cases between 1992 and 1993, and a 163% increase between years 1992 and 1994. In Texas, the new definition shows the greatest impact among women, blacks, and "other" ethnic groups, persons 20 through 29 years of age, and cases attributable to heterosexual contact. From 1992 to 1993, cases reported in Texas increased 161% among females, 171% among blacks, 219% among persons 15 through 19 years old, and 189% among cases citing heterosexual contact. The new definition has successfully identified population subgroups affected most recently by the epidemic. The inflated growth in cases caused by the expanded case definition carries implications for program administrators and health care providers in both allocating resources and targeting prevention efforts.

Background and Objectives: Since 1990, rates of syphilis in the United States have steadily declined. However, the South still records disproportionately high rates of syphilis infection., Goal: The objective of this study is to describe the epidemiology of early syphilis in Houston, TX, the largest urban center in the South, in 1994 and 1995., Study Design: The study is cross-sectional and descriptive, and uses data collected by Disease Intervention Specialists on the Interview Form 73.54 from interviews with men and women diagnosed with early syphilis., Results: Early syphilis in Houston is highly concentrated in a "belt" that extends north to south in a line just east of the city center. Although sex-specific rates of early syphilis are roughly equal, men are 3.5 times more likely than women to be diagnosed with primary syphilis, whereas women are nearly 2 times more likely than men to be diagnosed with secondary syphilis and 1.5 times more likely to be diagnosed with early latent syphilis., Conclusion: Routine surveillance data indicate that young, African-American men and women in Houston's inner-city neighborhoods are disproportionately affected by syphilis. Particular efforts must be made to reach women, who are detected and treated at later stages of the disease than men.

The hereditary breast and ovarian cancer gene, BRCA1, encodes a large polypeptide that contains the cysteine-rich RING motif, a zinc-binding domain found in a variety of regulatory proteins. Here we describe a novel protein that interacts in vivo with the N-terminal region of BRCA1. This BRCA1-associated RING domain (BARD1) protein contains an N-terminal RING motif, three tandem ankyrin repeats, and a C-terminal sequence with significant homology to the phylogenetically conserved BRCT domains that lie near the C terminus of BRCA1. The BARD1/BRCA1 interaction is disrupted by BRCA1 missense mutations that segregate with breast cancer susceptibility, indicating that BARD1 may be involved in mediating tumour suppression by BRCA1.

During the course of a population-based epidemiologic study of congenital syphilis, we found discrepancies and problems of validity in the case definitions of congenital syphilis of the Centers for Disease Control and Prevention and other experts. We analyzed these problems and determined their impact on case classification in our study. The most important problem that we found was the case definitions' lack of a valid scientific basis for the classification of symptom-free infants born to mothers who have been treated for syphilis but have uncertain infection status (286 infants in our study). The classification of these infants is based on diagnostic tests whose sensitivity and specificity are unknown. In our study, we found that results of some tests were rarely positive and that values for others were similar to those in uninfected infants. We believe that symptom-free infants of treated mothers of uncertain infection status should be classified as cases, pending the development of better diagnostic tests for congenital syphilis. The economic impact of treating these infants can be lessened by obtaining fewer diagnostic tests and by use of one injection of penicillin rather than a 10- to 14-day course, an approach suggested by a literature review. Use of infants' diagnostic tests to classify any other group of symptom-free infants does not seem appropriate, even though this is often recommended.