Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-3 (of 3 Records) |
Query Trace: Tadros A[original query] |
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Severe monkeypox in hospitalized patients - United States, August 10-October 10, 2022
Miller MJ , Cash-Goldwasser S , Marx GE , Schrodt CA , Kimball A , Padgett K , Noe RS , McCormick DW , Wong JM , Labuda SM , Borah BF , Zulu I , Asif A , Kaur G , McNicholl JM , Kourtis A , Tadros A , Reagan-Steiner S , Ritter JM , Yu Y , Yu P , Clinton R , Parker C , Click ES , Salzer JS , McCollum AM , Petersen B , Minhaj FS , Brown E , Fischer MP , Atmar RL , DiNardo AR , Xu Y , Brown C , Goodman JC , Holloman A , Gallardo J , Siatecka H , Huffman G , Powell J , Alapat P , Sarkar P , Hanania NA , Bruck O , Brass SD , Mehta A , Dretler AW , Feldpausch A , Pavlick J , Spencer H , Ghinai I , Black SR , Hernandez-Guarin LN , Won SY , Shankaran S , Simms AT , Alarcón J , O'Shea JG , Brooks JT , McQuiston J , Honein MA , O'Connor SM , Chatham-Stephens K , O'Laughlin K , Rao AK , Raizes E , Gold JAW , Morris SB . MMWR Morb Mortal Wkly Rep 2022 71 (44) 1412-1417 As of October 21, 2022, a total of 27,884 monkeypox cases (confirmed and probable) have been reported in the United States.(§) Gay, bisexual, and other men who have sex with men have constituted a majority of cases, and persons with HIV infection and those from racial and ethnic minority groups have been disproportionately affected (1,2). During previous monkeypox outbreaks, severe manifestations of disease and poor outcomes have been reported among persons with HIV infection, particularly those with AIDS (3-5). This report summarizes findings from CDC clinical consultations provided for 57 patients aged ≥18 years who were hospitalized with severe manifestations of monkeypox(¶) during August 10-October 10, 2022, and highlights three clinically representative cases. Overall, 47 (82%) patients had HIV infection, four (9%) of whom were receiving antiretroviral therapy (ART) before monkeypox diagnosis. Most patients were male (95%) and 68% were non-Hispanic Black (Black). Overall, 17 (30%) patients received intensive care unit (ICU)-level care, and 12 (21%) have died. As of this report, monkeypox was a cause of death or contributing factor in five of these deaths; six deaths remain under investigation to determine whether monkeypox was a causal or contributing factor; and in one death, monkeypox was not a cause or contributing factor.** Health care providers and public health professionals should be aware that severe morbidity and mortality associated with monkeypox have been observed during the current outbreak in the United States (6,7), particularly among highly immunocompromised persons. Providers should test all sexually active patients with suspected monkeypox for HIV at the time of monkeypox testing unless a patient is already known to have HIV infection. Providers should consider early commencement and extended duration of monkeypox-directed therapy(††) in highly immunocompromised patients with suspected or laboratory-diagnosed monkeypox.(§§) Engaging all persons with HIV in sustained care remains a critical public health priority. |
Pilot study of markers for high-grade anal dysplasia in a southern cohort from the Women's Interagency HIV Study (WIHS)
Lahiri CD , Nguyen ML , Mehta CC , Mosunjac M , Tadros T , Unger ER , Rajeevan MS , Richards J , Ofotokun I , Flowers L . Clin Infect Dis 2019 70 (6) 1121-1128 BACKGROUND: Anal cancer rates have increased, particularly in HIV-positive (HIV+) women. We assessed factors associated with anal precancer in HIV+ and at-risk HIV-negative (ARHIVN) women from the Atlanta Women's Interagency HIV Study Cohort. METHODS: All participants underwent high resolution anoscopy, anal cytology (AC) and had anal (AS) and cervical (CS) samples collected. Specimens were tested for 37 HPV types and for FAM19A4 and microRNA124-2 promoter methylation. Binary logistic regression and multivariate analysis were conducted with histologic anal high grade squamous intraepithelial lesion (A-HSIL) as the dependent variable. RESULTS: Seventy-five women enrolled: 52(69%) were HIV+ with three-fourths having undetectable viral load, 64(86%) were black, with mean age 49+/-8 years. Forty-nine (65%) AC samples were abnormal, and 38(51%) of AS were positive for at least one of 13 high-risk HPV (hrHPV) types. Thirteen (18%) anal biopsies identified A-HSIL. Hypermethylation of FAM19A4 and/or microRNA124-2 was found in 69 (95%) AS and 19(26%) CS. In multivariate analyses, the odds of having A-HSIL were over 6 times higher in women with anal hrHPV (aOR 6.08, 95% CI 1.27-29.18, p=0.02) and with positive cervical methylation (aOR 6.49, 95% CI 1.66-25.35, p=0.007), but not significantly higher in women with positive anal methylation. CONCLUSIONS: Anal hrHPV and promoter hypermethylation in the cervix show promise as biomarkers for anal cancer screening in HIV+ and ARHIVN women. Greater understanding of gene silencing by promoter hypermethylation in anal carcinogenesis is needed. |
Age-group differences in human papillomavirus types and cofactors for cervical intraepithelial neoplasia 3 among women referred to colposcopy
Gargano JW , Nisenbaum RA , Lee DR , Ruffin MT , Steinau M , Horowitz IR , Flowers LC , Tadros TS , Birdsong G , Unger ER . Cancer Epidemiol Biomarkers Prev 2011 21 (1) 111-21 BACKGROUND: Recommendations for high risk human papillomavirus (HR-HPV) testing as an adjunct to cytology for cervical cancer screening differ by age group, because HR-HPV tests lack adequate specificity in women aged <30. Here, we assess age-group differences in HPV types and other risk factors for cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) versus CIN0-2 in women from four colposcopy clinics. METHODS: Women ages 18-69 (n=1658) were enrolled and completed structured interviews to elicit data on behavioral risk factors prior to their examinations. HPV genotyping was performed on exfoliated cervical cell samples. We estimated relative risks (RR) for HPV types and cofactors for CIN3+, overall and stratified by age group. RESULTS: After 2 years of follow-up, we identified 178 CIN3+, 1305 CIN0-2, and 175 indeterminate outcomes. Non-vaccine HR-HPV types were only associated with CIN3+ among women ≥30 (RR=2.3, 95% CI 1.5-3.4; <30: RR=0.9). Among all HR-HPV positive women, adjusting for age, significant cofactors for CIN3+ included current smoking (RR=1.5), former smoking (RR=1.8), regular Pap screening (RR=0.7), current regular condom use (RR=0.5), and parity ≥5 (RR=1.6, p-trend for increasing parity=.07). However, the parity association differed by age group (≥30: RR=1.8, p-trend=.008; <30: RR=0.9, p-trend=.55). CONCLUSIONS: Subgroup variation by age in the risk of CIN3+ points to the importance of the timing of exposures in relation to CIN3+ detection. IMPACT: Future screening strategies need to consider natural history and secular trends in cofactor prevalence in the pursuit of appropriately sensitive and specific screening tools applied to appropriate age groups. |
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