Differences in HIV-related knowledge, attitudes, and behavior among psychiatric outpatients with and without a history of a sexually transmitted infection

HIV infection among the mentally ill is estimated to be at least eight times the prevalence in the general population. Psychiatric patients may also be disproportionately vulnerable to other sexually transmitted infections (STIs), but this has not been well studied. We sought to characterize the prevalence and correlates of STIs in a sample of psychiatric outpatients (N=464). Over one-third of the sample (38%) reported a lifetime history of one or more STIs. Multivariate analyses showed that, relative to those without an STI history, patients with a lifetime STI history were more knowledgeable about HIV, expressed stronger intentions to use condoms, and perceived themselves to be at greater risk for HIV. However, those with a past STI were also more likely to report sex with multiple partners and reported more frequent unprotected sex in the past 3 months. Treatment for an STI may increase HIV knowledge and risk reduction motivation, but does not necessarily lead to changes in sexual risk behavior among psychiatric patients. Findings highlight the need for STI/ HIV risk reduction interventions in psychiatric settings, particularly for patients with high-risk profiles.     

Complex Congenital Heart Malformation Including Transposition of the Great Vessels,Presenting as Sudden Unexplained Infant Death

Transposition of the great vessels (TGV) is a common congenital heart defect that is difficult to diagnose before birth. Antenatal diagnosis is associated with increased survival. Unusual features such as anomalous pulmonary artery origin may delay cyanosis, decreasing clinical suspicion. A three‐week old female infant who had never been cyanotic presented for forensic autopsy due to onset of unresponsiveness at home. History included risk factors for TGV and signs of heart enlargement that were not recognized during life. Cardiac pathology consultation identified D‐type TGV with additional rare anomalies. TGV may present as sudden unexplained infant death (SUID) for forensic autopsy if variant features prevent development of cyanosis. Cardiac pathology consultation is helpful in clarifying these features.     

Human Cutaneous Myiasis by the Australian Sheep Blowfly,Lucilia cuprina (Diptera: Calliphoridae), in Oklahoma

This case report describes an incident of myiasis in Oklahoma City, Oklahoma. Paramedics treated a 53‐year‐old man in the field when he suffered cardiac arrest. He was intubated by the paramedics and transported to an emergency room, where he received two stents and a balloon pump. He was found to have a GCS of three and remained in the hospital for 7 days before passing away. After his death, the breathing tube was removed, revealing the presence of several maggots. On closer inspection, the dipteran larvae were found in both the oral and nasal cavities. Four of these larvae were reared to adulthood and identified as Lucilia cuprina (Weidemann) (Diptera: Calliphoridae), commonly known as the Australian sheep blowfly, by the Biology Department of the University of Oklahoma. Based on the fly's life cycle and rate of development, the infestation is suspected to be hospital acquired.