Highly active antiretroviral treatment and health related quality of life in South African adults with human immunodeficiency virus infection: A cross-sectional analytical study

Background  

Health Related Quality of Life (HRQoL) is an important outcome in times of Highly Active Antiretroviral Treatment (HAART). We compared the HRQoL of HIV positive patients receiving HAART with those awaiting treatment in public sector facilities in the Free State province in South Africa.     

Formal clinical primary health care training. Does it make a difference?

Throughout South Africa, primary clinical care is mainly provided by nurses. In line with this, most professional nurses of the former Bloemfontein local authority completed a one year "Advanced Diploma in Health Assessment, Diagnosis and Treatment" course at the University of the Free State. This study aimed to compare the clinical competencies of nurses who obtained this diploma with those who did not. The primary objective was to assess the clinical management of one chronic and one acute disease (diabetes mellitus and acute respiratory tract infections in adults, respectively) for these two groups of nurses. Relationships between quality of care and nurses' and clinics' characteristics were also examined since they could be predictors of quality of care, independent of the influence of training. We reviewed records of 286 consecutive visits for adults with diabetes and 293 consecutive visits for adults with an acute respiratory tract infection (ARTI). Nurses completed questionnaires on nurse characteristics, while the researchers obtained the information about the clinics. Recording of important generic (for ARTIs) and disease-specific steps (for diabetes) in patient management were assessed. Results for patients of "trained" and "non-trained" professionals were compared and adjusted for nurses', clinics' and patients' characteristics. There was generally little evidence of patients being thoroughly managed. Formal training was marginally associated with better care for ARTIs (p = 0.06) but not for diabetes (p = 0.47). Other factors associated with more thorough care were years of experience in curative primary health care (p = 0.006) and additional nursing degrees for ARTIs (p = 0.03) and the presence of enrolled or assistant nurses at the clinic for diabetes (p = 0.06). Fixed clinics generally performed better than mobile and satellite clinics.     

Isolated zygomycosis in a bought living unrelated kidney transplant

We report the first case of zygomycosis by Absidia corymbifera, only localized in an unrelated living donor kidney that was bought and transplanted in India. Zygomycosis was diagnosed 2.5 months post-transplantation, in the clinical setting of rapid transplant failure, following an episode of cytomegalovirus (CMV) colitis, CMV nephritis, and acute rejection. Treatment consisted of transplantectomy. One year later, the patient is doing well, without clinical or serological evidence of persistent mycotic or virological infections. We speculate that this isolated mycotic infection originated with the donor or was due to the poor hygienic conditions in the operating theater or surgical ward. Another possibility is that this isolated renal involvement resulted from a subclinical pulmonary infection with hematogenous dissemination to the kidney in a manner comparable to renal tuberculosis. The patient received no amphotericin and was cured with transplantectomy alone.     

I. Increase in bone marrow CFU-S and CFU-C after in vivo phytohaemagglutinin (PHA) administration in mice

An absolute increase in bone marrow CFU-S was observed within 4 hours after intraperitoneal administration of 3 mg PHA-M or 250 microgram PHA-P. At that time, there was no increase in spleen CFU-S, while a pronounced decrease in the number of circulating CFU-S was noted. A two to fourfold increase in bone marrow CFU-C was found within 12 hours after intraperitoneal administration of a similar dose of PHA-M or PHA-P. Addition of PHA-M or PHA-P at small concentrations resulted in a marked inhibition of granulocytic colony formation whereas macrophage colony growth became depressed only at very high concentrations.     

Episcleral melanoma as a complication of ocular melanocytosis

BACKGROUND: Primary episcleral melanoma is exceedingly rare. We report a case of primary episcleral melanoma in an eye with ocular melanocytosis. METHODS: Interventional case report with presentation of clinical photographs and histopathology. RESULTS: A 62-year-old man with long-standing ocular melanocytosis presented with a new, raised, darkly pigmented lesion on the episclera. Clinical examination and ultrasound biomicroscopy showed no evidence of intraocular mass or nevus. Lamellar scleroconjunctivectomy of the lesion was performed, and histopathologic analysis revealed episcleral melanoma with no evidence of intra- or extra-ocular extension. He was later treated with cryotherapy to the surgical bed. Continued observation shows no evidence for intraocular tumor or recurrence of episcleral tumor. CONCLUSIONS: Primary episcleral melanoma is a previously unreported complication of ocular melanocytosis, and should be considered in the differential diagnosis in patients with ocular melanocytosis and pigmented nodules on the ocular surface.