Eating sweets without the wrapper: perceptions of HIV and sexually transmitted infections among street youth in western Kenya

Street-connected youth in Kenya are a population potentially at risk of HIV transmission, yet little is known about their perceptions and experiences of sexually transmitted infections (STIs), despite their living in an HIV endemic region. We sought to elucidate the language and sociocultural factors rooted in street life that impact on street-connected young people’s knowledge of and perceptions about the prevention and transmission of STIs, and their diagnosis and treatment, using qualitative methods in western Kenya. We conducted a total of 25 in-depth interviews and 5 focus-group discussions with 65 participants aged 11–24 years in Eldoret, Kenya. Thematic analysis was conducted and data were coded according to themes and patterns emergent until saturation was reached. In general, street-connected young people knew of STIs and some of the common symptoms associated with these infections. However, there were many misconceptions regarding transmission and prevention. Gender inequities were prominent, as the majority of men described women as individuals who spread STIs due to unhygienic practices, urination and multiple partners. Due to misconceptions, gender inequity and lack of access to youth-friendly healthcare there is an urgent need for community-based organisations and healthcare facilities to introduce or augment their adolescent sexual and reproductive health programmes for vulnerable young people.     

Initial Rhythm and Resuscitation Outcomes for Patients Developing Cardiac Arrest in Hospital: Data From Low-Middle Income Country

Background

Health care resource allocation remains challenging in lower middle income countries such as Kenya with meager resources being allocated to resuscitation and critical care. The causes and outcomes for in-hospital cardiac arrest and resuscitation have not been studied.

Panel 2.6: mental and psychosocial effects of the Tsunami on the affected populations

This is a summary of the presentations and discussion of Panel 2.6, Mental and Psychosocial Effects of the Tsunami on the Affected Populations of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to mental and psychological aspects as pertaining to the damage created by the Tsunami. It is presented in the following major sections: (1) responses; (2) needs assessment; (3) coordination; (4) gap filling; (5) capacity building; (6) stakeholder agreement; and (7) conclusions and recommendations. In the responses discussion, issues included: (1) psychosocial support services; (2) mental health services; and (3) the Thai response. Subsections in the stakeholder agreement section include: (1) public-private partnerships; and (2) preparedness.     

A new dimension in vesicovaginal fistula management: an 8-year experience at Ramathibodi hospital

OBJECTIVE: Vesicovaginal fistula is mostly iatrogenic in origin and causes devastating medical, social, psychogenic and hygienic consequences. The aetiology has changed since the nineteenth century, becoming more associated with hysterectomy rather than other obstetric procedures, which were common in the past. We studied the causes, clinical presentations and management of vesicovaginal fistula in our institute during 1998 to 2005. METHODS: From 1998 to 2005, 45 patients were treated in our hospital, of whom 35 were referred from other hospitals after failed surgery. All the medical records were reviewed. Fistulae, clinical presentation, clinical findings, means of treatment and clinical outcome as well as complications were noted. RESULTS: The most common cause of a fistula in our study was post laparoscopic hysterectomy that comprised 28 cases (62.2%). Transabdominal hysterectomy caused fistula in 10 cases (22.2%) and vaginal hysterectomy only four cases (8.8%). Most cases of vesicovaginal fistulae after laparoscopic hysterectomy presented with early urinary leakage, of which 35.7% presented within 1 week and 50% in the second week. Most of the patients after transabdominal hysterectomies (90%) had leakage in the second week. All patients were treated with surgical repair, 19 cases by a transvaginal approach and 26 cases by a transabdominal repair. Seventeen cases in the transvaginal group and 25 cases in the transabdominal group were dry after the first operation. The rest of both groups were dry after the second operation. After 38 months of follow-up, no complication or incontinence was noted. CONCLUSION: Vesicovaginal fistula is still a serious iatrogenic consequence and causes suffering in the physical, emotional and social functioning of patients. The study found that the condition is now more frequently associated with laparoscopic hysterectomy. Successful closure of the fistula requires an accurate and timely repair using procedures that exploit basic surgical principles. With the appropriate surgical expertise, all patients can be cured of this distressing condition.     

Efficacy of tamsulosin in the treatment of lower urinary tract symptoms (LUTS) in women

OBJECTIVE: We attempted to determine whether tamsulosin is an efficacious therapy for the treatment of lower urinary tract symptoms (LUTS) in women. METHODS: A total of 140 women, aged 27-69 years old with LUTS entered a randomized double-blind study comparing tamsulosin (70) versus placebo (70) for 1 month. The outcome variables were mean change from baseline of International Prostate Symptom Score (IPSS), mean change from baseline of mean and maximum urinary flow rate and any adverse effects. RESULTS: Mean change from baseline of IPSS (standard deviation, SD) were -5.6 (6.3) in the tamsulosin group and -2.6 (6.1) in the placebo group. The difference was statistically significant (p = 0.008). Mean change from baseline of mean urinary flow rate (SD) was 0.7 (2.7) mL/second in the tamsulosin group and -0.5 (2.6) mL/second in the placebo group. The difference was also statistically significant (p = 0.013). However, the difference in mean change from baseline of maximum urinary flow rate between the two groups was not statistically significant (p = 0.506). There were two patients in the tamsulosin group who experienced dizziness and asthenia. No other adverse effect was detected. CONCLUSION: Tamsulosin is more efficacious than placebo in the treatment of LUTS in women.     

Evidence for the interaction of protein kinase C and melanocortin 3-receptor signaling pathways

The melanocortin-3 receptor, MC3-R, is abundant in the brain and is activated by gamma-2-melanocyte stimulating hormone (gamma-2-MSH). We have previously reported the translocation of protein kinase C (PKC) in spontaneous hypertensive rat (SHR) brain synaptosomes treated with gamma-2-MSH. In this study, the expression of PKA and the related PKB in SHR brain synaptosomes was analyzed. PKA was detected in total synaptosomal fractions but not in particulate fractions, whereas PKB was not detected in either fraction. We next tested the hypothesis that the PKC pathway is involved in MC3-R signaling in a neuronal, CAD, cell line. Mobilization of intracellular Ca2+ was analyzed by dual fluorescence imaging of Fura-2AM loaded MC3-R transfected cells. An increase in intracellular Ca2+ was observed upon treatment with gamma-2-MSH. A MC3-R-green fluorescent protein (GFP) fusion protein was expressed and shown to localize mainly to the plasma membrane in the soma and to neurites in differentiated CAD cells. Treatment with gamma-2-MSH led to a punctate appearance and co-immunoprecipitation of the receptor fusion protein with protein kinase C-gamma (PKC-gamma). Differentiation of some neuronal cells has been shown to be associated with changes in the expression levels of protein kinase C isoenzymes. Induction of CAD cell differentiation was associated with down-regulation of the atypical PKC-zeta and protein kinase B (PKB/Akt1), that was less pronounced in MC3-R transfected cells. However, the levels of classical PKC isozymes, PKC-alpha, PKC-gamma, and PKC-beta were unchanged. These studies therefore indicate a role for PKC isozymes in gamma-2-MSH/MC3-R receptor signaling and in neuronal cell differentiation.