Knowledge, attitude and practice of home-based care for HIV/AIDS patients by their family/ caregivers at Jimma Town

BACKGROUND: About 1.5 million people are currently living with HIV/AIDS in Ethiopia-one of the largest HIV infected populations in the world. The current prevalence rate of infection is estimated at 4.4% nationally. Hospital bed occupancy rate due to AIDS has reached over 50% in urban hospitals creating a severe burden to the health service system in the country, or else US $3.4 million is needed in order to increase their bed capacity. Here arises the need to look for a better way of caring for people living with HIV/AIDS. Home care would thus offer the only feasible option for this need as it can mobilize the considerable reservoir of caring and sympathy that exists within a community beyond that of cost cutting. The study was conducted to determine the knowledge, attitude and practice of family/caregivers regarding home-based care for people living with HIV/AIDS. METHODS: This was a cross-sectional community-based study conducted among 274 family/caregivers who were giving care for people living with HIV/AIDS in urban setting of Jimma town from June - August 2005. A structured and pre-tested questionnaire was used to collect data on socio-demographic characteristics, knowledge and attitude towards home based care practice. Data collection was done by interviewing family/caregivers at their respective houses and analyzed using SPSS for windows version 11.0. RESULTS: Over three fourth of the studied subjects (91.6%) were knowledgeable about home based care and 88.7% showed favorable attitude. Ninety two point eight percent agreed that home is a better place for the care of PLWHA than hospital. Single caregivers were about four times more likely to be knowledgeable about home care as compared to their counterparts (OR = 3.98 (95% CI: 0.50, 88.08), but the finding was not statistically significant (p > 0.05). Neighbors and friends were two times more likely to have favorable attitude towards HBC as compared to family members, OR = 1.96 (95% CI: 0.74, 5.21) but, the finding is not statistically significant (p > 0.05). CONCLUSION: The study highlighted that the majority of family members/caregivers have good knowledge and favorable attitude towards HBC and over half favored this care. Therefore, appropriate use of the above promising findings and experience of innovative approaches of HBC from other countries is recommended for further, more organized and effective home-based care practice.     

Coblation assisted endoscopic juvenile nasopharyngeal angiofibroma resection

To provide additional support for the use of coblation in the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) tumors. Coblation radiofrequency has been recently described in endoscopic sinus surgery for polyp and tumor resection from the sinuses to the skull base. This is a case series from our institution in which we safely and successfully treated three adolescent boys with JNA using the coblation assisted technique. The first case was the smallest of the cases (Radkowski stage IB) and was embolized pre-operatively. The second and third cases, both larger in size (Radkowski stage IIC and IIB) did not undergo pre-operative embolization. The total surgical times were 105, 160, and 150 min and the estimated blood losses were 150, 400, and 130 mL, respectively. This yielded a blood loss per minute rate of only 1.4, 2.5, and 0.9 mL/min for the respective cases. None of the three patients required post-operative blood transfusion, nasal packing, or hospitalization of greater than one day. Follow-up showed no complications and no recurrence in these patients. Coblation assisted transnasal endoscopic resection of JNA is a feasible technique that can dissect through and debulk JNA tumor, despite its extreme vascularity. The surgery can be performed with minimal morbidity and low intraoperative blood loss, even with non-embolized tumors up to Radkowski IIC. These finding further support complete resection of JNA tumors using minimally invasive coblation assisted techniques.     

Effect of complementary feeding behaviour change communication delivered through community‐level actors on infant growth and morbidity in rural communities of West Gojjam Zone,Northwest Ethiopia: A cluster‐randomized controlled trial

Attaining the recommended level of adequacy of the infants'' diet remains a serious challenge in developing countries. On the other hand, the incidence of growth faltering and morbidity increases significantly at 6 months of age when complementary foods are being introduced. This trial aimed to evaluate the effect of complementary feeding behaviour change communication delivered through community‐level actors on infant growth and morbidity. We conducted a cluster‐randomized controlled trial in rural communities of Ethiopia. Trial participants in the intervention clusters (eight clusters) received complementary feeding behaviour change communication for 9 months, whereas those in the control clusters (eight clusters) received only the usual care. A pre‐tested, structured interviewer‐administered questionnaire was used for data collection. Generalized estimating equations regression analyses adjusted for baseline covariates and clustering were used to test the effects of the intervention on infant growth and morbidity. Infants in the intervention group had significantly higher weight gain (MD: 0.46 kg; 95% CI: 0.36–0.56) and length gain (MD: 0.96 cm; 95% CI: 0.56–1.36) as compared with those in the control group. The intervention also significantly reduced the rate of infant stunting by 7.5 percentage points (26.5% vs. 34%, RR = 0.68; 95% CI: 0.47–0.98) and underweight by 8.2 percentage points (17% vs. 25.2%; RR = 0.55; 95% CI: 0.35–0.87). Complementary feeding behaviour change communication delivered through community‐level actors significantly improved infant weight and length gains and reduced the rate of stunting and underweight.     

Neurotransmitter-mediated regulation of CNS myelination: a review

In addition to treatments aimed at preventing or limiting damage to myelin and oligodendrocytes, there is a crucial need for repair strategies in human demyelinating disorders. There is increasing evidence that besides growth factors, neurotransmitters can regulate different steps of the oligodendrogliogenesis. The present review on neurotransmitter receptor expression and function in the oligodendrocyte lineage emphasizes the concept that in this lineage cell proliferation and differentiation can be controlled through the modulation of the functional state of channel proteins and receptors, such as the delayed K+ rectifier, the AMPA/kainate, dopamine or muscarinic receptors, and, most likely, others yet to be found. We anticipate that a better understanding of the neurotransmitter-mediated neuronal oligodendroglial communication network opens prospects in the field of central nervous system (CNS) myelin repair, allowing the recruitment of the myelinating machinery that is known to remain present but quiescent in the CNS of multiple sclerosis patients.     

Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity

Background: Since the first laparoscopic adjustable gastric banding (LAGB) operation on September 1, 1993, there have been important publications related to this procedure. The majority of the articles reported surgical technique and short-term results. Long-term results of LAGB are lacking. The authors report long-term data (at least 4 years) from 3 major bariatric centers in Belgium that perform LAGB routinely. Methods: The 3 centers applied the same patient selection criteria, the same standard surgical technique, the same laparoscopic band (Lap-Band?) and the same follow-up program. 763 patients have been enrolled. Sex ratio was 22% male/78% female. Mean age was 34 years, and mean preoperative BMI was 42 kg/m². Results:The follow-up rate was 90%, and the minimum follow-up time was 4 years. The average BMI after 4 years was 30 kg/m². Early complications were: gastric perforation 4 (0.5%); large bowel perforation 1 (0.1%); bleeding 1 (0.1%); and conversion to open 10 (1.3%). Late complications were: erosion 7 (0.9%); total food intolerance 59 (8%); access port problems 20 (2.5%); re-operations 80 (11.1%); death 1 (0.1%). Conclusion: Long-term results of LAGB have been rarely reported, although publications on the procedure are copious. Our long-term data found that BMI evolution is good, the complication and re-operation rates are acceptable and the overall long-term results of the Lap-Band? system are good.     

Immunostimulatory effects of polar glycopeptidolipids of Mycobacterium chelonae for inactivated rabies vaccine

Humoral and cellular immune responses were analyzed with Fuenzalida-Palacios rabies vaccine associated with pGPL-Mc, polar glycopeptidolipids extracted from Mycobacterium chelonae, aiming at its use as adjuvant. These results were compared to those obtained with BCG, a well-known immunostimulator, under the same conditions. Rabies vaccine plus pGPL-Mc (2.5 mg/kg) induced a significant increase in serum neutralizing activity, in vitro lymphocyte proliferation (spontaneous, specific and mitogen stimulation) and delayed type hypersensibility. In addition, pGPL-Mc, as well as BCG, enhanced the vaccine potency. Our results support further studies to encourage the use of pGPL-Mc as an immunostimulator of veterinary vaccines, before consideration for human vaccines.     

Identification of PSF, the polypyrimidine tract-binding protein-associated splicing factor, as a developmentally regulated neuronal protein.

The polypyrimidine tract-binding protein-associated splicing factor (PSF), which plays an essential role in mammalian spliceosomes, has been found to be expressed by differentiating neurons in developing mouse brain. The sequence of a fragment of mouse PSF was found to be remarkably similar to that of human PSF. Both the expression of PSF mRNA in cortex and cerebellum and PSF immunoreactivity in all brain areas were high during embryonic and early postnatal life and almost disappeared in adult tissue, except in the hippocampus and olfactory bulb where various neuronal populations remained PSF-immunopositive. Double-labeling experiments with anti-PSF antibody and anti-neurofilaments or anti-glial fibrillary acidic protein antibodies on sections of cortex, hippocampus, and cerebellum indicate that PSF is expressed by differentiating neurons but not by astrocytic cells. In vitro, mouse PSF was found to be expressed by differentiating cortical and cerebellar neurons. Radial glia or astrocyte nuclei were not immunopositive; however, oligodendrocytes differentiating in vitro were found to express PSF. The restricted expression of PSF suggests that this splicing factor could be involved in the control of neuronal-specific splicing events occurring at particular stages of neuronal differentiation and maturation.     

Maternal nutritional status mediates the association between maternal age and birth outcomes

Young maternal age during pregnancy is linked with adverse birth outcomes. This study examined the role of maternal nutritional status in the association between maternal age and small for gestational age (SGA) delivery and birth length. We used data from a birth cohort study in Ethiopia, involving women who were 15–24 years of age and their newborns. A mediation analysis was fitted in a sample of 1,422 mother infant dyads for whom data on birth length were available, and 777 dyads for whom gestational age and birth weight was measured. We used commands, medeff for the mediation analysis and medsens for sensitivity analysis in STATA 14. Maternal nutritional status, measured by mid‐upper arm circumference, mediated 21% of the association between maternal age and birth length and 14% of the association with SGA delivery. The average direct effect (ADE) of maternal age on birth length was (β = 0.45, 95% CI [0.17, 0.99]) and the average causal mediated effect (ACME) was (β = 0.12, 95% CI [0.02, 0.15]). We also found an ADE (β = 0.31, 95% CI [0.09, 0.47]) and an ACME of (β = 0.05, 95% CI [0.003, 0.205]) of maternal age on SGA delivery. The sensitivity analysis suggests an unmeasured confounder with a positive correlation of 0.15 and 0.20 between the mediator and the outcome could explain the observed ACME for birth length and SGA, respectively. We cannot make strong causal assertions as the findings suggest the mediator partly explained the total effect of maternal age on both outcomes.