Quality and quantity of antenatal HIV counselling in a PMTCT programme in Mombasa, Kenya

A recent report from a PMTCT implementation study in Mombasa, Kenya, points at an important gap between the efficacy in clinical trial circumstances and the effectiveness of PMTCT programmes when implemented in real life. Hence, the quality and quantity of antenatal HIV counselling in a routine setting were appraised. The counsellors' social and communicative skills, duration and topics covered during pre- and post-test counselling sessions were assessed by means of the VCT assessment tools published by UNAIDS. A total of 14 group educational sessions, 66 pre-test counselling sessions and 50 post-test counselling sessions were observed and assessed. In general, the frequency and duration of the counselling was low. Crucial topics such as window period and partner involvement and follow-up support were covered haphazardly. The counsellor's social and communicative skills were given high marks, yet information was rarely repeated or summarized. The limited time dedicated to women receiving antenatal VCT contrasts with the heavy and comprehensive load of health information and advice they are supposed to receive. Ample pre- and post-test counselling including follow-up should be pursued for optimal effectiveness of PMTCT. We propose a number of health system interventions preceded and guided by ongoing audit.     

Hepatectomy with total vascular exclusion. Anatomical principles based on 64 dissections

Intra-operative hemorrhage is the main surgical risk during liver resections. Nowadays hepatectomies for large or posterior liver tumors close to the hepatocaval junction can benefit from total hepatic vascular exclusion (HVE) involving portal triad exclusion and clamping of the inferior vena cava (IVC) below and above the liver. Anatomical aspects of HVE have been studied in 64 subjects by segmental occlusive phlebographies of the IVC, injection of corrosive substances into the hepatocaval network, biometry of the retrohepatic IVC and serial sections of injected livers. A total HVE should exclude the right suprarenal and phrenic veins. Clamping of the suprahepatic IVC depends on the termination of the left inferior phrenic vein. Clamping of the subhepatic IVC must be retrohepatic: the right lobe of the liver has to be mobilized to free the right border of the retrohepatic IVC into which flows the right suprarenal vein 40 +/- 20 mm above the right renal vein and under the superior right hepatic vein. Both suprahepatic and retrohepatic clamps excluding the retrohepatic portion of the IVC (46.6 +/- 13 mm) and the hepatocaval junction should come in contact behind the IVC without overlapping.     

Genotoxic stress leads to centrosome amplification in breast cancer cell lines that have an inactive G1/S cell cycle checkpoint

Centrosome amplification plays a key role in the origin of chromosomal instability during cancer development and progression. In this study, breast cancer cell lines with different p53 backgrounds were used to investigate the relationship between genotoxic stress, G(1)/S cell cycle checkpoint integrity, and the development of centrosome amplification. Introduction of DNA damage in the MCF-7 cell line by treatment with hydroxyurea (HU) or daunorubicin (DR) resulted in the arrest of both G(1)/S cell cycle progression and centriole duplication. In these cells, which carry functional p53, HU treatment also led to nuclear accumulation of p53 and p21(WAF1), retinoblastoma hypophosphorylation, and downregulation of cyclin A. MCF-7 cells carrying a recombinant dominant-negative p53 mutant (vMCF-7(DNp53)) exhibited a shortened G(1) phase of the cell cycle and retained a normal centrosome phenotype. However, these cells developed amplified centrosomes following HU treatment. The MDA-MB 231 cell line, which carries mutant p53 at both alleles, showed amplified centrosomes at the outset, and developed a hyperamplified centrosome phenotype following HU treatment. In cells carrying defective p53, the development of centrosome amplification also occurred following treatment with another DNA damaging agent, DR. Taken together, these findings demonstrate that loss of p53 function alone is not sufficient to drive centrosome amplification, but plays a critical role in this process following DNA damage through abrogation of the G(1)/S cell cycle checkpoint. Furthermore, these studies have important clinical implications because they suggest that breast cancers with compromised p53 function may develop centrosome amplification and consequent chromosomal instability following treatment with genotoxic anticancer drugs.     

Electrode placement in ECT: cognitive effects

Forty patients suffering from a major depressive disorder, for whom electroconvulsive therapy (ECT) was clinically indicated, were assigned to one of three electrode placement groups: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparisons of these groups in terms of cognitive status showed that the BF placement, which avoided both temporal regions, spared both verbal and nonverbal functions. These differential effects, which were independent of the degree of clinical depression, were not, however, evident three months after the last ECT.     

Hemodynamic effects of portal triad clamping in humans

The hemodynamic effects of portal triad clamping (PTC) were studied in 48 adult patients scheduled for elective liver resection. Prior to hepatic resection the effects of a short period of PTC (3-5 min) were evaluated in all 48 patients: mean arterial pressure increased 21%, whereas pulmonary capillary wedge pressure and cardiac index decreased 10 and 17%, respectively. Systemic vascular resistance increased 48%. In 34 patients a liver resection was performed during PTC and hemodynamic measurements were repeated throughout the duration of liver ischemia, which ranged from 14 to 68 min. Hemodynamic changes occurred in the first 3 min and persisted thereafter. After releasing the clamp, hemodynamic parameters returned to initial values in 3 min. These results confirm that PTC does not induce the cardiovascular collapse in humans that it does in common laboratory animals and demonstrate that humans tolerate PTC for periods up to 1 hr.     

Could Vitamin D Supplements Be a New Therapy for Heart Failure? Possible Pathogenic Mechanisms from Data of Intervention Studies

Vitamin D deficiency may play a role in the pathogenesis of chronic heart failure (HF), but whether giving patients supplements to raise vitamin D into the normal range improves their survival is not clear. It has been demonstrated that vitamin D deficiency is common in patients with HF, especially the elderly, in obese and in dark skinned people, and that low vitamin D levels are associated with adverse outcome. The epidemiological data have been confirmed by experimental data, which show that knockout mice for the vitamin D receptor developed myocardial hypertrophy and dysfunction. Data from interventional studies are scarce and discordant, and more research is urgently needed to confirm whether add-on supplementation therapy with vitamin D has a role in the management of patients with chronic HF.     

Examining Lifetime Episodes of Sadness, Help Seeking, and Perceived Treatment Helpfulness Among US Latino/as

This study investigated episodes of sadness, help seeking for episodes of sadness, and perceived treatment helpfulness among Latino/as. Specifically, we examined whether gender, ethnicity, and other socio-cultural variables predicted episodes of sadness, help seeking, and treatment helpfulness. Data were taken from the National Latino Asian American Study which included service use questions for episodes of sadness. We stratified the data by service provider and used multiple logistic regressions as analytic strategy. Latinas had higher rates of episodes of sadness than Latinos, and everyday discrimination was positively associated with sadness. Acculturation was associated with more help seeking. Puerto Ricans had the highest rates of help seeking, and Mexican-Americans the lowest. Discrimination was the strongest predictor of treatment helpfulness from any professional as individuals with discriminatory experiences found services less helpful. Interventions need to address cultural factors but more focus needs to be placed on policies that seek to eliminate inequalities.     

Clinical outcome and memory function with maintenance electroconvulsive therapy: a retrospective study

Although maintenance electroconvulsive therapy (ECT) appears to be the logical choice for the prevention of relapses and recurrences in patients with refractory depression who have responded to a course of ECT, the perception of ECT's negative effect on memory continues to limit its wider use. This retrospective study of depressed patients maintained on ECT after an initial course revealed that maintenance ECT was effective in sustaining clinical improvement, particularly in patients who showed a satisfactory clinical response to the initial course of ECT, and that memory difficulties were limited and tolerable.