Alveolar echinococcosis (AE) is a life-threatening parasitic disease caused by the zoonotic cestode Echinococcus multilocularis. Our goals were to confirm infection, identify species and analyze biogeographical origin of metacestode tissues from a suspected human AE case in Saskatchewan, Canada. We conducted PCR targeting the nad1 mitochondrial gene for E. multilocularis and the rrns ribosomal RNA gene for E. granulosus and conducted haplotype analysis at the nad2 locus. Our analysis confirmed AE and indicated that sequences matched infected Saskatchewan coyotes and European E3/E4 haplotypes. The patient had no travel history outside North America. This suggests autochthonous transmission of a European-type strain.
Background: An individual is considered HIV positive when a confirmatory HIV-1/HIV-2 differentiation test returns positive following an initial reactive antigen/antibody combination screen. Falsely reactive HIV screens have been reported in patients with various concomitant infectious and autoimmune conditions. Falsely positive confirmatory HIV differentiation assays are seen less frequently, but have been observed in cases of pregnancy, pulmonary embolism, and malaria. Case presentation: A healthy 27 year-old man was referred after a reactive ADVIA Centaur® HIV Ag/Ab screen and positive Bio-Rad Geenius™ HIV 1/2 Confirmatory assay, suggesting HIV-1 infection. The patient's HIV viral load was undetectable prior to initiation of antiretroviral therapy, and remained undetectable on subsequent testing after initiation of antiretroviral therapy. Both Centaur® and Geenius™ tests were repeated and returned reactive. As this patient was believed to be at low risk of acquiring HIV infection, samples were additionally run on Genscreen™ HIV-1 Ag assay and Fujirebio Inno-LIA™ HIV-1/2 score, with both returning non-reactive. For confirmation, the patient's proviral HIV DNA testing was negative, confirming the initial results as being falsely positive. The patient disclosed that he had been using a variety of anabolic steroids before and during the time of HIV testing. Discussion and conclusions: The erroneous diagnosis of HIV can result in decreased quality of life and adverse effects of antiretroviral therapy if initiated, hence the importance of interpreting the results of HIV testing in the context of an individual patient. This reports suggests a potential association between the use of anabolic steroids and falsely-reactive HIV testing.
Numerous contraceptive options are available in Canada, but studies show that Canadian women most often use the following three methods: condoms (54%), oral contraceptives (44%), and withdrawal (12%). 1 Typical failure rates of these methods are 18%, 9%, and 22%, respectively. These statistics may be linked with the finding that one third of Canadian women have at least one induced abortion in their lifetime. Contraceptive failure is lower among long-acting and permanent contraceptive options, primarily because user adherence is taken out of the equation. However, Canadian women appear reluctant to use long acting options such as intrauterine devices (IUDs), perhaps because of associated adverse events. For example, some 20% of women discontinue IUDs within the first year of use due to pelvic pain, irregular bleeding, or spontaneous expulsion. 2 DMPA (Depo-Provera) is often discontinued because of weight gain commonly experienced by its users. 3 Thus, there remains a need for novel contraceptive choices for women who are unable to use the formulations currently available in Canada. One promising alternative not yet available in Canada is Nexplanon, an etonogestrel (progestin only) implant inserted into the inner, upper arm. In adults, its efficacy is higher than that of oral contraceptives and IUDs, at >99% (efficacy studies in women under 18 years of age are not yet available). 4 Effectiveness lasts up to three years, and the approach for insertion is less invasive than IUDs. Side effects are similar to other contraceptive methods, with the most common being breakthrough bleeding, depression, and mood swings. Abnormal bleeding is the most common reason for discontinuation, but notably, more than three quarters of women retain their implant for two years or more. Nexplanon is also more cost effective than both OCP and hormonal or copper IUDs, as seen from a study in France. 5 The combination of superior effectiveness, a simpler and less invasive insertion, and increased cost effectiveness makes Nexplanon a preferable alternative to contraceptive options otherwise available to Canadian women. However, the manufacturer of Nexplanon (Merck) recently failed to satisfy Health Canada's requirements for new contraceptive devices, and it is uncertain whether the company will reapply for approval. 6 Another unavailable but promising contraceptive option is Cerazette, a progestin only pill (POP) that uses desogestrel as its active ingredient. POPs are important options among women who prefer or require a non-estrogen containing contraceptive, due to either medical contraindications to estrogen, patient preference, side effect profile, or physiologic states such as breastfeeding. Most POPs function by thickening the uterine mucus lining. However, Cerazette also prevents ovulation in 97% of cycles. 7 What makes Cerazette truly stand out, however, is its margin for timing variabilities. Most POPs must be taken within a 3 hour window each day to 21.
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