BackgroundMRSA infections are becoming more prevalent throughout the HIV community. MRSA infections are a challenge to both physicians and patients due to limited choice of therapeutic options and increased cost of care.ObjectivesThis study was aimed to determine the prevalence of colonization and co-resistance patterns of MRSA species among HIV positive pediatric patients in the Amhara National Regional State, Northwest Ethiopia.MethodsCulture swabs were collected from the anterior nares, the skin and the perineum of 400 participants. In vitro antimicrobial susceptibility testing was done on Muller Hinton Agar by the Kirby-Bauer disk diffusion method, using 30 μg cefoxitin (OXOID, ENGLAND) according to the recommendations of the Clinical and Laboratory Standards Institute. Methicillin sensitivity/resistance was tested using cefoxitin. Data was analyzed by descriptive statistics and logistic regression model using Epi Info 7.Results S. aureus was detected in 206 participants (51.5%). The prevalence of MRSA colonization in this study was 16.8%. Colonization by S. aureus was associated with male gender (OR = 0.5869; 95% CI: 0.3812–0.9036; p-value = 0.0155), history of antibiotic use over the previous 3 months (OR = 2.3126; 95% CI: 1.0707–4.9948; p-value = 0.0329) and having CD4 T-cell counts of more than 350 x 106 cells / L (OR = 0.5739; 95% CI = 0.3343–0.9851; p-value = 0.0440). Colonization by MRSA was not associated with any one of the variables. Concomitant resistance of the MRSA to clindamycin, chloramphenicol, co-trimoxazole, ceftriaxone, erythromycin and tetracycline was 7.6%, 6%, 5.25%, 20.9%, 23.9% and 72.1%, respectively.ConclusionHigh rates of colonization by pathogenic MRSA strains is observed among HIV positive pediatric patients in the Amhara National Regional state.

BackgroundSchizophrenia is understood to be a heterogeneous brain condition with overlapping symptom dimensions. The negative symptom dimension, with its protean cognitive manifestations, responds poorly to treatment, which can be a particular challenge in countries where clozapine therapy is not available. Preliminary data indicate that minocycline may be beneficial adjunct in the treatment of schizophrenia: positive, negative, and cognitive symptoms.In this study we aim to assess the efficacy of adjunctive minocycline to alleviate symptoms of schizophrenia in patients who have failed to respond to a therapeutic trial of antipsychotic medications.MethodsThe study is a parallel group, double-blind, randomized, placebo-controlled trial. Participants will be adults (aged 18 years and above) with first episode or relapse episode of schizophrenia of under 5 years’ duration. Patients who failed to show adequate therapeutic response to at least one antipsychotic medication given for a minimum of 4 weeks will be recruited from a psychiatry hospital in Addis Ababa and a psychiatry clinic in Butajira, Ethiopia. A total of 150 participants (75 in each arm) will be required to detect a five-point mean difference between the intervention arms adjusting for baseline symptom severity, at 90% power and 95% confidence. Patients in the intervention arm will receive minocycline (200 mg/day orally) added on to the regular antipsychotic medications participants are already on. Those in the placebo arm will receive an inactive compound identical in physical appearance to minocycline. Intervention will be offered for 12 weeks. Diagnosis will be established using the operational criteria for research (OPCRIT). Primary outcome measure will be a change in symptom severity measured using the positive and the negative syndrome scale for schizophrenia (PANSS). Secondary outcome measures will include changes in severity of negative symptoms, proportion achieving remission, and level of functioning. Whether changes are maintained post intervention will also be measured (PANSS). Key assessment for the primary outcome will be conducted at the end of trial (week 12). One post-intervention assessment will be conducted 4 weeks after the end of intervention (week 16) to determine sustainability of change.Trial registrationClinicaltrials.gov identifier: NCT01809158.

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Introduction: The association between restless leg syndrome (RLS) and CV outcomes remains controversial in the general population, and the impact of RLS among patients with coronary artery disease (CAD) is unknown. Hypothesis: We examined our hypothesis that RLS symptoms would be associated with incident adverse CV outcomes in patients with CAD. Methods: We inquired about the presence and frequency of RLS symptoms in 3,176 patients enrolled in the Emory Cardiovascular Biobank (mean age 64, 62% male, 23% Black, and 75% with obstructive CAD), who were prospectively followed for death, myocardial infarction (MI), revascularization, and hospitalization for heart failure (HF). Multivariate Cox proportional hazard models were used to examine the association between RLS symptoms and adverse outcomes after adjustment for demographic and clinical risk factors. Results: Of the total, 914 (28.8%) and 482 (15.2%) patients reported mild (rare or sometimes) and moderate/severe (often to almost always) symptoms of RLS, respectively. Female sex (Odds ratio [OR] 2.11, P<0.001), higher body mass index (OR 1.12 per 5kg/m2, P=0.007), diabetes (OR 1.43, P=0.003), and beta blocker use (OR 1.35, P=0.013) were independently associated with moderate-severe symptoms of RLS compared to no symptoms. During a median 3.2-year follow-up, 991 patients suffered at least1 adverse event. Those with moderate/severe symptoms had significantly higher adjusted risk of death/MI (Hazard ratio [HR] 1.30 [1.02 - 1.66]), death/MI/revascularization (HR 1.22 [1.02 - 1.45]), and death/MI/revascularization/hospitalization for HF (HR 1.23 [1.04 - 1.45]). Those with mild symptoms had similar risks to those with no symptoms. Conclusions: Among patients undergoing cardiac catheterization, moderate or severe symptoms of RLS are associated with significantly higher risk of adverse CV outcomes, independent of traditional risk factors. This is the first study to demonstrate an independent adverse impact of RLS symptoms in CAD patients.