Removing barriers to knowing HIV status: same-day mobile HIV testing in Zimbabwe

OBJECTIVES: We developed a mobile HIV voluntary counseling testing (VCT) strategy. Our aims were (1) to describe those using the services, (2) to assess the acceptability of such services, (3) to assess reasons for not testing previously, and (4) to compare those who used the services with those who did not to determine how to increase acceptability. METHODS: We provided free anonymous mobile VCT using 2 rapid HIV tests in 12 marketplaces in Epworth and Seke, Zimbabwe. Qualitative interviews were conducted to assess motivations for and barriers to testing. A subsample of HIV testers and individuals near testing vans who declined testing (nontesters) completed a questionnaire. RESULTS: A total of 1099 individuals participated in mobile VCT between March 2002 and August 2003. The proportion of participants infected with HIV was 29.2%. Overall, 98.8% of participants elected to receive HIV test results the same day. Reasons for not testing previously were often logistic (eg, inconvenience of hours [25.6%] and location [20.7%] or cost [8%]). Those who used the same-day mobile testing services (testers vs. nontesters) perceived themselves at higher risk for HIV infection (adjusted odds ratio [AOR] = 1.8) but were less likely to have known people with HIV (AOR = 0.49) or where to get tested (AOR = 0.57). CONCLUSIONS: Same-day HIV testing in community settings seems to be acceptable in sub-Saharan Africa. Barriers to HIV testing are often logistic and can be overcome with community-based strategies. These strategies need to be refined to address the needs of those not using mobile testing services.     

Preschoolers of Dysphoric Mothers

Dysphoric mothers rated their preschool children as having more internalizing and externalizing behavior problems than children of nondysphoric mothers. Observers rated the dysphoric mothers as having more negative affect during play interactions, although their children's affect was not rated more negatively. The dysphoric mother-infant dyads were also rated as having a poorer quality interaction. These data suggest that mothers' chronic dysphoria (75% were chronically dysphoric) has a negative impact on the mothers' perceptions of their children as well as the mothers' and children's interaction behavior.     

Physiological and molecular characteristics of rat hypothalamic ventromedial nucleus glucosensing neurons

To evaluate potential mechanisms for neuronal glucosensing, fura-2 Ca(2+) imaging and single-cell RT-PCR were carried out in dissociated ventromedial hypothalamic nucleus (VMN) neurons. Glucose-excited (GE) neurons increased and glucose-inhibited (GI) neurons decreased intracellular Ca(2+) ([Ca(2+)](i)) oscillations as glucose increased from 0.5 to 2.5 mmol/l. The Kir6.2 subunit mRNA of the ATP-sensitive K(+) channel was expressed in 42% of GE and GI neurons, but only 15% of nonglucosensing (NG) neurons. Glucokinase (GK), the putative glucosensing gatekeeper, was expressed in 64% of GE, 43% of GI, but only 8% of NG neurons and the GK inhibitor alloxan altered [Ca(2+)](i) oscillations in approximately 75% of GK-expressing GE and GI neurons. Insulin receptor and GLUT4 mRNAs were coexpressed in 75% of GE, 60% of GI, and 40% of NG neurons, although there were no statistically significant intergroup differences. Hexokinase-I, GLUT3, and lactate dehydrogenase-A and -B were ubiquitous, whereas GLUT2, monocarboxylate transporters-1 and -2, and leptin receptor and GAD mRNAs were expressed less frequently and without apparent relationship to glucosensing capacity. Thus, although GK may mediate glucosensing in up to 60% of VMN neurons, other regulatory mechanisms are likely to control glucosensing in the remaining ones.     

Role of models in understanding and interpreting clinical Doppler ultrasound

Mathematical and physical models are essential tools in both fundamental and clinically applied Doppler ultrasound research. In this paper we illustrate a variety of models and show how they can be used to understand and interpret clinical Doppler ultrasound signals, particularly from stenosed arteries. The physical models discussed include both steady and pulsatile flow systems, and also a flow visualization technique that can be used to interpret the Doppler signals at a fundamental hemodynamic level. The mathematical models deal with three different aspects of the Doppler signal: models that describe the mechanism of ultrasound scattering by blood, a model to stimulate the returned Doppler signal and a model that may be used to aid in the analysis of clinical recordings. Each of these models provides a more complete understanding of blood flow through normal and stenosed vessels and contributes to the interpretation of clinical Doppler signals.     

Single center experience with endoscopic management of vesicoureteral reflux in children

PURPOSE: Dx/HA copolymer was approved by the Food and Drug Administration in 2001 for the treatment of VUR in children. Published results have varied widely, prompting us to report our single center experience with 300 consecutive patients. MATERIALS AND METHODS: All patients undergoing Dx/HA injection (300 children, median age 5.4 years) at our institution were eligible for this study. We examined several parameters to determine which variables influence the success of Dx/HA injection, including preoperative reflux grade, bladder diverticula, neurogenic bladder, ureteral duplication, perioperative urinary tract infection, dysfunctional voiding, laterality of reflux and amount of Dx/HA injected. RESULTS: A total of 225 patients (75%) underwent postoperative studies, and, thus, were eligible for study inclusion. Reflux was cured in 144 patients (64%) and improved in 44 (20%). A total of 20 patients had ureteral duplication anomalies. Cure rates in this subgroup were significantly decreased compared to nonduplicated cases (40% vs 66%). Injection in low grade (I to II) reflux was significantly more successful than in high grade (III to IV) reflux (72% vs 54%). A total of 10 patients (8.3%) with unilateral reflux had development of de novo contralateral reflux. Of the patients who failed initial injection 10 (4%) underwent repeat injection, of whom 5 (50%) were cured after the second injection. Two patients (0.9%) had development of temporary ureteral obstruction. CONCLUSIONS: We report a large short-term single center experience with endoscopically injected Dx/HA. Although our cure rate of 64% was less than published rates for open surgery, the minimal morbidity and low complication rate of endoscopic treatment make it an attractive first line therapy for patients with VUR. Longer followup is required to better evaluate this technique.     

Management of acute mesenteric isxcaemia: A retrospective analysis

Aim-Background

Acute mesenteric ischaemia (AMI), although an uncommon condition with a difficult diagnosis, has a high rate of complications and is associated with a high mortality rate. We reviewed our experience of patients presenting with AMI in order to evaluate the current management and factors associated with survival in a tertiary care hospital.

Material and Methods

Clinical data of all patients who were diagnosed with AMI between 01 January 2012 and 30 June 2013 were retrospectively reviewed. Preoperative presentation, investigation, management and outcome in this group of patients were analyzed.

Results

Thirteen patients were included in the study, of whom twelve were male and one female, mean age 44.5 years ranging from 35 to 78 years. The cause of AMI was embolism in three patients (23.1%), and thrombosis in ten patients (76.9%). Abdominal pain was the most common presenting symptom (100%). Four patients (30.8%) had previous symptoms of chronic mesenteric ischaemia in the form of postprandial pain. Nine patients (69.2%) had been exposed to high altitude for more than two weeks, four of whom displayed a procoagulant state. Eleven patients underwent abdominal exploration and endovascular treatment. Percutaneous transcatheter balloon angioplasty was performed in two (15.4%) cases. Eight out of eleven patients (72.7%) who underwent exploratory laparotomy had major small bowel resections involving more than 200 cms of small bowel. However, none of these patients underwent any reconstructive procedures due to extensive thrombus within the SMA and late presentation. Six patients were submitted to second-look exploration within 48 hours, all of whom underwent repeat resections of the bowel. Laparostomies were performed in two patients. None of these patients had a primary anastomosis. End jejunostomy/ileostomy was performed with mucous fistula in all 11 patients. Two patients died within a month, and the 30-day mortality rate was 15.4%; severe sepsis with multiorgan failure was the cause of death in both patients. Four patients (30.8%) had permanent intestinal failure without intestinal adaptation requiring permanent total parenteral nutrition (TPN) with indications for intestinal transplant. The survival rate at one year was 69.2%. Two late deaths occurred owing to complications of TPN.

Conclusion

A relatively uncommon diagnosis, AMI is often identified late and invariably with complications. Exploratory laparotomy with resection of the bowel is the most viable option in such a situation. The individuals exposed to high altitude and displaying a procoagulant state that present with AMI tend to belong to a much younger age group than that reported in the literature. Short bowel syndrome is a frequent long-term complication in surviving patients. Administration of TPN in strict aseptic conditions, control of sepsis, intestinal adaptation and intestinal transplant will increase the long-term survival of these patients.     

Reassessing the diagnostic yield of saturation biopsy of the prostate

OBJECTIVE: Prostate biopsy remains the gold standard for detection of prostate cancer (PCa). This study was performed to determine whether saturation biopsy (>or= 24 cores) detects more prostate cancer than a standard 12-18 core office biopsy technique. METHODS: We conducted a nonrandomized cohort study of a consecutive series of prostate biopsies. The primary outcome assessed by both univariate and multivariate analysis was the detection of PCa, whereas the secondary outcomes of HGPIN (high-grade prostatic intraepithelial neoplasia) and ASAP (atypical small acinar proliferation) were also analyzed. RESULTS: From September 2005 to June 2006, a total of 469 patients undergoing prostate biopsy were included in this study. A standard office prostate biopsy was performed in 301 men, whereas 168 underwent a saturation biopsy. Age, body mass index (BMI), prostate volume, and family history of PCa were similar. However, patients in the saturation biopsy cohort were more likely to have had prior biopsies, higher prebiopsy PSA, longer PSA doubling times, and to carry more frequent diagnoses of HGPIN or ASAP (all p<0.05). After adjusting for covariates, saturation biopsy did not detect more abnormal pathology than standard office prostate biopsy, including PCa (OR, 1.2; p=0.339), HGPIN (OR, 1.4; p=0.368), or ASAP (OR, 2.2; p=0.201). CONCLUSIONS: Saturation biopsy does not appear to detect more abnormal prostate pathology than standard office biopsy of the prostate. This procedure may be associated with increased cost and patient morbidity.