Intracranial hypertension in Africans with cerebral malaria

The causes of death and neurological sequelae in African children with cerebral malaria are obscure. Intracranial pressure (ICP) was monitored and cerebral perfusion pressure (CPP) calculated in 23 Kenyan children with cerebral malaria. Four children had severe intracranial hypertension (ICP > 40 mm Hg, CPP < 40 mm Hg): two died, one with an ICP of 158 mm Hg and signs of transtentorial herniation, the other one with an ICP of 42 mm Hg and cardiorespiratory arrest. The other two survived with severe neurological sequelae. Nine had intermediate intracranial hypertension (ICP > 20 mm Hg, CPP < 50 mm Hg) and 10 had mild intracranial hypertension (maximum ICP 10-20 mm Hg); all survived without severe sequelae. Mannitol controlled the ICP in children with intermediate intracranial hypertension, but it did not prevent the development of intractable intracranial hypertension in children with severe intracranial hypertension. Intracranial hypertension is a feature of Kenyan children with cerebral malaria and severe intracranial hypertension is associated with a poor outcome.     

Mortality and diabetes from a population based register in Yorkshire 1978-93

OBJECTIVE: To investigate mortality of children diagnosed with insulin dependent diabetes mellitus (IDDM) and to identify common factors before death. DESIGN: Follow up of a population based cohort of children diagnosed with IDDM to ascertain deaths. SETTING: Children were diagnosed in Yorkshire but followed up throughout the United Kingdom. SUBJECTS: From the Yorkshire Children's Diabetes Register details of 1854 children aged 0-16 years (1978-93) were submitted to the NHS Central Register. MAIN OUTCOME MEASURE: Notification and causes of death. RESULTS: 98.3% of cases were traced and 26 deaths identified. Follow up ranged from 1-18 years (median 9.3 years), providing 17,350 person-years of IDDM. Fifteen deaths (58%) were attributed to diabetes or its complications; 11 (42%) were unrelated and included one suicide. For mortality from all causes, the standardised mortality ratio (SMR) of 247 (95% confidence interval (CI) 163 to 362) was significantly increased for those under 34 years. The largest number of deaths (n = 10) occurred in the 15-19 year age range, with an SMR of 442 (95% CI 209 to 802). Case note examination showed a clear tendency towards poor diabetic control, and worries over control were expressed before death by health care professionals. CONCLUSIONS: Despite advances in treatment, IDDM still carries an increased mortality for young people, particularly in the "transition" age range.     

Raising Awareness for Lung Cancer Prevention and Healthy Lifestyles in Female Scholars from a Low-Income Area in Bogota,Colombia: Evaluation of a National Framework

This study aims to determine the effects of an educational intervention, based on the Colombian guidelines for educational communication in the framework of cancer control, for raising lung cancer prevention-related awareness, and improving healthy lifestyles in female scholars from a low-income area in Bogota, Colombia. Uncontrolled trial conducted in 243 female scholars (mean age 14 years ± 1.5 SD). Two 90 min educational sessions were carried out in March 2015 according to the Colombian guidelines for educational communication in the framework of cancer control. Posters and other educational materials were created by scholars after the intervention. All participants completed a self-reported questionnaire—The Cancer Awareness Measure—at pre and post-intervention, as well as 1, 3, and 6 months after the intervention. Smoking prevalence (8.2% at baseline) was reduced by 3.7% at 6 months follow-up (p < 0.005). The scholars exhibited low to moderate awareness of both warning signs and risk factors for lung cancer at baseline. These variables showed statistically significant improvements at 6 months follow-up (p < 0.005). Similar improvements were also found for physical activity, high-fat diet, and fruits and vegetable intake. This evaluation of the Colombian guidelines for educational communication in the framework of cancer control raised awareness towards lung cancer prevention, reduced smoking, and improved other healthy-lifestyle-related factors in a group of female scholars from a low-income area in Bogota, Colombia. Further randomized controlled studies are needed.     

HIV vulnerability and the erasure of sexual and gender diversity in Abidjan,Côte d'Ivoire

ABSTRACT

In the fight against concentrated HIV epidemics, men who have sex with men (MSM) are often framed as a homogeneous population, with little attention paid to sexual and gender diversity and its impact on HIV vulnerability. This article draws on ethnographic research conducted in Abidjan, Côte d'Ivoire among les branchés – a local term encompassing several categories of same-sex desire and practice. In the context of increased HIV prevention programming targeting Ivoirian sexual and gender minorities, such diversity is effectively erased. This obfuscation of difference has particularly negative impacts for travestis, who may be at higher risk for HIV infection, though research and prevention efforts in which they are grouped with ‘MSM’ render them underrepresented and make their vulnerability difficult to quantify. Branchés whose class and/or ethnic backgrounds compound their stigmatised status as sexual and gender minorities also bear the burden of this exclusion. Furthermore, some branchés deploy ‘MSM’ as a form of self-identification, further complicating who such categories represent. By highlighting the ways in which constructions of gender and sexuality within HIV/AIDS programming obscure complex social realities, I aim to reorient thinking around the development of purposeful HIV programming that engages the complexity of sexual and gender minority experience.     

Implant radiography and radiology

The practitioner placing dental implants has many options with respect to pre-implant radiographic assessment of the jaws. The advantages and disadvantages of the imaging modalities currently available for pre-implant imaging are discussed in some detail. Intra-oral and extra-oral radiographs are generally low dose but the information provided is limited as the images are not three-dimensional. Tomography is three-dimensional, but the image quality is highly variable. Computed tomography (CT) has been the gold standard for many years as the information provided is three-dimensional and generally very accurate. However, CT examinations are expensive and deliver a relatively high radiation dose to the patient. The latest imaging modality introduced is cone beam volumetric tomography (CBVT) and this technology is very promising with regard to pre-implant imaging. CBVT generally delivers a lower dose to the patient than CT and provides reasonably sharp images with three-dimensional information. A comparison between CT and CBVT is provided. Magnetic resonance imaging is showing some promise, but the examinations are not readily available, generally expensive and bone is not well imaged. Magnetic resonance imaging is excellent for demonstrating soft tissues and therefore may be of great use in identifying the inferior dental nerve and vessels. All of the above technology is of little value if the information required is not obtained and so information is also provided on imaging of some of the vital structures. Of particular interest is the inferior dental canal, incisive canals of the mandible, genial foramina and canals, maxillary sinus and the incisive canal and foramen of the maxilla.     

Immunocompetent cells in oral candidiasis of HIV-infected patients: an immunohistochemical and electron microscopical study

OBJECTIVE: The purpose of this study was to elucidate the pathogenesis of oral candidiasis, a common cause of discomfort and social impairment among HIV-infected individuals.
STUDY DESIGN, MATERIALS AND METHODS: The oral mucosal immune system cells were analysed by immunohistochemistry and electron microscopy in biopsies from five erythematous and four pseudomem-branous candidiasis cases and were compared with those from seven HIV-positive and 10 HIV-negative controls without candidiasis.
RESULTS: The superficial lamina propria and basal epithelial layer was populated by CD1a⁺ Langerhans cells with infiltration of CD8⁺ lymphocyteS. Within the submu-cosa are CD36⁺ dendritic macrophages and lymphocytes, although CD4⁺ subsets were absent from the infiltrate. The expression of human leukocyte antigen system, DR locus (HLA-DR) and leukocyte specific adhesion molecules was low in erythematous, yet more marked in pseudomembranous candidiasiS. In the pseudomembra-nous form, CD14⁺ leukocytes were found in the basal epithelial layer. Langerhans cells were significantly more numerous and were richer in dendrites and Birbeck granules in erythematous than in pseudomembranous can-didiasis.
CONCLUSIONS: Candidiasis is associated with alterations in the number and differentiation of lymphocytes and dendritic cells, being more severe in the pseudo-membranous than erythematous form. We propose that these alterations play a role in the pathogenesis and evolution of the disease.     

Peripheral giant cell granuloma: a clinical study of 77 cases from 62 patients, and literature review

OBJECTIVES: The aim of this study was to identify the principle clinical features of the peripheral giant cell granuloma (PGCG), and to recognise clinical features of PGCG that are poorly defined.
DESIGN: We reviewed retrospectivety 77 cases of PGCG from 62 patients, from our files with respect to incidence, sex, patient age, race, clinical symptoms and signs, radio-graphic features and recurrence following excision.
RESULTS AND CONCLUSIONS: Our results were largety in agreement with previous reports, although there is wide variation in the results published between series. In addition, some clinical features of PGCG are poorly defined. Little is known about the retative incidences of PGCG and central giant cell granuloma. An association between PGCG and tooth loss may exist, but is poorly defined, and not all PGCG that involve edentulous areas follow recent tooth loss. Information about PGCG recurrence after excision is limited, and does not necessarily follow incomplete excision. Despite the large number of reported cases of PGCG, clarification of some clinical features is required, and may hetp formulation and interpretation of future laboratory-based research into this poorly understood lesion.