HIV/AIDS among pastoralists and refugees in north-east Africa: a neglected problem

The eight member states (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention, care and treatment programmes since the late 1980s, the IGAD Regional HIV & AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour, vulnerability, HIV prevalence and interventions, under the headings pastoralists, refugees, IGAD and north-east Africa for the period 2001–2014. Of the 214 documents reviewed, 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia, Kenya, Somalia and Uganda and from 1% to 5% among refugees in Sudan, Kenya and Uganda. Socioeconomic, cultural, logistic, infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore, interventions must extend beyond the health sector and improve the livelihood of these populations.     

Advanced Pediatric Neurosonography Techniques: Contrast‐Enhanced Ultrasonography,Elastography, and Beyond

Recent technical advances in neurosonography continue broadening the diagnostic utility, sensitivity, and specificity of ultrasound for detecting intracranial abnormalities bed side. The clinical and functional applications of neurosonography have significantly expanded since the 1980s when transcranial Doppler sonography first allowed anatomic and hemodynamic delineation of the intracranial vessels through the thin temporal skull. In the past few years, contrast‐enhanced ultrasonography, elastography, 3D/4D reconstruction tools, and high‐resolution microvessel imaging techniques have further enhanced the diagnostic significance of neurosonography. Given these advances, a thorough familiarity with these new techniques and devices is crucial for a successful clinical application allowing improved patient care. It is essential that future neurosonography studies compare these advanced techniques against the current “gold standard” computed tomography and magnetic resonance imaging to assure the accuracy of their diagnostic potential. This review will provide a comprehensive update on currently available advanced neurosonography techniques.     

The benefit of combinations of oximes for the reactivating and therapeutic efficacy of antidotal treatment of sarin poisoning in rats and mice

The influence of the combinations of oximes on the reactivating and therapeutic efficacy of antidotal treament of acute sarin poisoning was evaluated in this study. The ability of two combinations of oximes (HI-6 + trimedoxime and HI-6 + K203) to reactivate sarin-inhibited acetylcholinesterase and reduce acute toxicity of sarin was compared with the reactivating and therapeutic efficacy of antidotal treatment involving single oxime (HI-6, trimedoxime, K203) using in vivo methods. Studies determining percentage of reactivation of sarin-inhibited blood and tissue acetylcholinesterase in poisoned rats showed that the reactivating efficacy of the combination of oximes involving HI-6 and K203 is slightly higher than the reactivating efficacy of the most effective individual oxime in diaphragm and brain but the difference between them is not significant. The ability of combination of oximes involving HI-6 and trimedoxime to reactivate sarin-inhibited acetylcholinesterase roughly corresponds to the reactivating effects of the most effective individual oxime in blood as well as tissues. Moreover, both combinations of oximes were found to be as efficacious in the reduction of acute lethal toxic effects in sarin-poisoned mice as the most effective individual oxime. A comparison of reactivating and therapeutic efficacy of individual oximes showed that the oxime HI-6 is markedly more effective than the oxime K203 and trimedoxime. Based on the obtained data, we conclude that the antidotal treatment involving chosen combinations of oximes does not significantly influence the ability of the most effective individual oxime (HI-6) to reactivate sarin-inhibited rat acetylcholinesterase and to reduce acute toxicity of sarin in mice.     

The Effectiveness of Media Use in Health Education: Evaluation of an HIV/AIDS Radio Campaign in Ethiopia

ABSTRACT

An effective vehicle to change behaviors is entertainment education. To demonstrate entertainment education effects, researchers must first indicate that participants have been exposed to their program. Exposure to effective programs has been associated with increases in knowledge about program topics, attitude change, and self-efficacious perceptions. The purpose of this study was to develop and test a new exposure technique that accurately and precisely determines direct exposure levels to Ethiopia's Journey of Life. Overall, the study found very high listenership, storyline recall, liking of the program, and strong desire to change behavior while maintaining low error rates in terms of verbatim recall of storylines and reported listenership to a fictitious program.     

Evaluation of the Potency of Two Novel Bispyridinium Oximes (K456, K458) in Comparison with Oxime K203 and Trimedoxime to Counteract Tabun‐Induced Neurotoxicity in Rats

The ability of two newly developed bispyridinium oximes (K456, K458) to reduce tabun‐induced acute neurotoxic signs and symptoms was compared with oxime K203 and trimedoxime using the functional observational battery. The neuroprotective effects of the oximes studied combined with atropine on rats poisoned with tabun at a sublethal dose (200 μg/kg i.m.; 85% of LD₅₀ value) were evaluated. Tabun‐induced neurotoxicity was monitored by the functional observational battery and automatic measurement of motor activity at 2 hr after tabun challenge. The results indicate that all tested oximes combined with atropine enable tabun‐poisoned rats to survive till the end of experiment. Both newly developed oximes (K456, K458) combined with atropine were able to decrease tabun‐induced neurotoxicity in the case of sublethal poisonings although they did not eliminate all tabun‐induced acute neurotoxic signs and symptoms. Their ability to decrease tabun‐induced acute neurotoxicity was slightly higher than that of trimedoxime and oxime K203, but the difference in neuroprotective efficacy among all oximes studied is not large enough to make a decision about replacement of commonly used oximes (especially trimedoxime and obidoxime) in the treatment of acute tabun poisonings.     

Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection,fetal hydronephrosis,urinary tract ultrasonography and voiding cystourethrography,Barcelona, Spain,June 2007

We present here a few basic proposals for algorithms and procedures for imaging the paediatric genitourinary tract based on initial discussion at a paediatric uroradiology symposium and proposals of the ESUR Paediatric Uroradiologic Guidelines Subcommittee. These recommendations were developed in the light of new knowledge that might influence existing guidelines. Regional, individual and local flexibility and variability should be preserved in order to make these recommendations applicable throughout Europe. They should help standardize dedicated imaging not only in terms of a quality measure to ensure state-of-the-art patient care, but also in forming a common basis for multi-institutional research. There is an urgent need for these guidelines in order to advance our understanding of the subject and to gain evidence and improve imaging efficacy. Our session worked towards establishing an agreement on imaging indications in common paediatric urological conditions, respecting the ALARA principle, and patient safety and care, and taking into account state of the art knowledge and efficacy aspects. We started the task with a reassessment of (1) imaging in urinary tract infection in infants and children, (2) postnatal imaging in mild-to-moderate neonatal hydronephrosis, (3) how to perform voiding cystourethrography, and (4) procedural recommendations for paediatric urosonography. This list is incomplete, and future recommendations will be developed, discussed and presented at forthcoming meetings. This work is presented on behalf of the ESUR Paediatric Guideline Subcommittee and ESPR Paediatric Uroradiology Working Group     

Pneumococcal cellulitis]

Streptococcus pneumoniae as a cause of cellulitis is rarely reported in children and adults. We report on an infant with facial cellulitis due to pneumococci and review already described cases since 1975. The main features of this infection, underlying diseases and problems of diagnostics and therapy are discussed.     

Sonomorphology and involution of the normal urachus in asymptomatic newborns

Background. The number of reports on the sonomorphology of the urachus or urachal remnants in neonates and the pattern of involution is limited. Objective. To determine whether a sonographically visible urachus in the first months of life is a pathologic condition and whether postnatal involution can be demonstrated by ultrasound. Materials and methods. A total of 102 asymptomatic infants (premature and term newborns) were examined with a high-resolution 7.5-MHz linear transducer between 0 and 60 days of age. In 70 infants, a second examination followed 3–5 months later. Results. In all infants, the urachus could be identified on the first examination. Different morphological types were differentiated. There was no difference between premature and term newborns in the morphology of the urachus. Spontaneous involution of the urachus was observed in all infants receiving a second examination, and they most often showed a fusiform urachal remnant at the apex of the bladder. Conclusion. Involution of the urachus is not complete at birth and can be followed up sonographically in the first months of life. This knowledge should prompt a new strategy in young infants with a discharging umbilicus or even an infected urachus. Instead of early surgery, a conservative approach under sonographic control seems reasonable, because there is a chance of spontaneous involution and any abnormal development can be detected by ultrasound. Received: 25 August 1997 Accepted: 13 October 1997