Background Epidemiological evidence suggests HIV-infected individuals are at increased risk of lung cancer, but no data exist since large CT screening trials routinely exclude HIV-infected participants. Methods From 2006–2013, we conducted the first lung cancer screening trial of 224 HIV-infected current/former smokers to assess the CT detection rates of lung cancer. We also used 130 HIV-infected patients with known lung cancer to determine radiographic markers of lung cancer risk using multivariate analysis. Results Median age was 48 years with 34 pack-years smoked. During 678 person-years, one lung cancer was found on incident screening. Besides this lung cancer case, eighteen deaths(8%) occurred, but none were cancer-related. There were no interim diagnoses of lung or extrapulmonary cancers. None of the pulmonary nodules detected in 48 participants at baseline were diagnosed as cancer by study end. The heterogeneity of emphysema across the entire lung as measured by CT densitometry was significantly higher in HIV-infected subjects with lung cancer than in those without (p≤0.01). On multivariate regression, increased age, higher smoking pack-years, low CD4 nadir, and increased heterogeneity of emphysema on quantitative CT imaging were all significantly associated with lung cancer. Conclusions Despite a high rate of active smoking among HIV-infected participants, only one lung cancer was detected in 678 patient-years. This was probably due to the young age of participants suggesting that CT screening of high-risk populations should strongly consider advanced age as a critical inclusion criterion. Future screening trials in urban American must also incorporate robust measures to ensure HIV patient compliance, adherence, and smoking cessation.

We studied the serovar distribution of Chlamydia trachomatis in patients with clinical eye disease in Western Australia. Most disease occurred in indigenous communities and was caused by trachoma serovars Ba and C. Serovar Ba was genetically homogeneous throughout Western Australia and identical to strains previously described in indigenous communities in Northern Territory. This finding probably results from movement of these populations, and suggests that a widely coordinated, rather than local or regional, approach is needed to control trachoma in mobile populations. Serovar C strains within Western Australia were homogeneous but distinct from those in Northern Territory, possibly because of inherent differences in transmissibility or differences in population movements among communities carrying the different serovars. Genital serovars were occasional causes of eye diseases in infants, adolescents, and adults in trachoma-endemic areas. These serovars should be considered in the differential diagnosis of acute follicular conjunctivitis in these groups.

Sepsis is associated with high morbidity and mortality worldwide. Although, it is not the major reason for intensive care unit admissions during pregnancy, several physiological changes that occur during pregnancy limit the ability of the pregnant woman to compensate for the derangements produced by severe sepsis, often resulting in severe organ dysfunction. Moreover, there are several disorders peculiar to the pregnant state, including preeclampsia, placental abruption, amniotic fluid embolism and postpartum haemorrhage, all of which can produce potentially life-threatening organ failure and may be present concurrently with sepsis contributing to maternal mortality. Evidence-based guidelines advocate assessment and monitoring aimed at early recognition and treatment of sepsis. Early goal-directed therapy, adequate blood glucose control, and corticosteroid replacement when indicated are improving outcomes in patients with severe sepsis, although most of these have not been validated in pregnancy.

A: Case 3; CT image showing multiloculated hepatic lesions (arrow), central cystic changes and necrosis. B: Case 2; CT image showing irregular lesions (arrows) through both left and right hepatic lobes.