What Influences Linkage to Care After Home-Based HIV Counseling and Testing?

To maximize the benefits of test and treat strategies that utilize community-based HIV testing, clients who test positive must link to care in a timely manner. However, linkage rates across the HIV treatment cascade are typically low and little is known about what might facilitate or hinder care-seeking behavior. This qualitative study was conducted within a home-based HIV counseling and testing (HBHCT) intervention in South Africa. In-depth interviews were conducted with 30 HBHCT clients who tested HIV positive to explore what influenced their care-seeking behavior. A set of field notes for 196 additional HBHCT clients who tested HIV positive at home were also reviewed and analyzed. Content analysis showed that linkage to care is influenced by a myriad of factors at the individual, relationship, community, and health system levels. These factors subtly interact and at times reinforce each other. While some factors such as belief in test results, coping ability, social support, and prior experiences with the health system affect clients’ desire and motivation to seek care, others such as limited time and resources affect their agency to do so. To ensure that the benefits of community-based testing models are realized through timely linkage to care, programs and interventions must take into account and address clients’ emotions, motivation levels, living situations, relationship dynamics, responsibilities, and personal resources.     

Management of unilateral reflux by ipsilateral ureteroneocystostomy--is it sufficient?

The records of 105 patients who had undergone unilateral reimplantation for ipsilateral reflux were reviewed. Patient age, grade of preoperative reflux, completely duplicated collecting systems, preoperative findings of contralateral dilatation of the lower ureter or radiographic evidence of pyelonephritis had no predictive value in regard to the appearance of postoperative contralateral reflux. Of the 105 patients 16 had postoperative contralateral reflux: neurogenic problems were found later in 3, reflux resolved spontaneously within 18 months postoperatively in 9, 1 remains in followup and 3 have undergone repeat operations, for a rectified rate of treatment failure of 3 of 102 (2.9 per cent).     

Electrical coupling in smooth muscles. Is it universal?

There is strong experimental evidence for electrical coupling in all types of smooth muscle. In some publications, and particularly in physiological textbooks, smooth muscles are still divided into those that are electrically coupled and those that are not. In this article we review the evidence for the universal presence of coupling in smooth muscles and the underlying mechanism, which, in most cases, appears to be gap junctions. We propose a classification of smooth muscles based on the mechanisms that initiate their activity. The two main types of smooth muscle according to this classification are neurogenic (e.g., iris, arterioles, vas deferens) and myogenic (e.g., urinary bladder, intestine, most blood vessels).     

Solcoderm in the treatment of genital and perianal condylomata acuminata

Solcoderm, a new topical agent, was used in the treatment of genital and anal cutaneous condylomata in 11 patients. This is a relatively inexpensive form of treatment, which may be used in any office practice setting with no need for anesthesia and very few side effects. The success rate of 100% warrants its further use in the treatment of this disease entity.     

Polyorchism: A case report

BACKGROUND: Polyorchism is a rare anomaly whose genesis is unclarified, although several theories have been proposed. It is generally associated with other disorders but seldom with malignancy. CONCLUSIONS: When a supernumerary testicle is encountered intraoperatively, it should be removed.     

Do Temporal Eating Patterns Differ in Healthy versus Unhealthy Overweight/Obese Individuals?

This study examined whether the temporal patterns of energy and macronutrient intake in early and late eating windows were associated with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) among non-shift workers. A total of 299 overweight/obese non-shift workers (Age: 40.3 ± 6.9 years; 73.6% women; BMI: 31.7 ± 5.0 kg/m²) were recruited in the Klang Valley area of Malaysia. The biochemical parameters were determined from fasting blood samples, whereas information on dietary intake and timing was obtained from a 7-day diet history questionnaire. The midpoint of eating was used to determine the early and late windows. Compared to MHO non-shift workers (n = 173), MUO non-shift workers (n = 126) had lower energy intake from carbohydrates and protein during the early window. In contrast, MUO participants had greater energy intake from carbohydrates and fat during the late window. Participants with unhealthy metabolic status (regardless of their chronotypes) had similar temporal patterns of energy intake characterized by smaller energy intake during the early window and greater energy intake during the late window compared with participants with healthier metabolic status. Overall, the lowest percentile of energy intake during the early window was associated with an increased risk of MUO, after adjustment for potential confounders [odds ratio (OR) = 4.30, 95% confidence interval (CI) 1.41–13.11]. The greater the energy intake during the late window, the greater the risk of MUO (OR = 2.38, 95% CI 1.11–5.13) (OR = 2.33, 95% CI 1.03–5.32) (OR = 4.45, 95% CI 1.71–11.56). In summary, consuming less energy earlier in the day and more energy and carbohydrate later in the day was associated with a greater risk of MUO. Thus, a prospective study is needed to explore the potential role of chrono-nutrition practices in modifying risk factors to delay the transition of MHO to MUO.     

Light,electron, and confocal microscopic study of the mouse superior mesenteric ganglion

The superior mesenteric ganglion (S.m.g.), a sympathetic prevertebral ganglion, is an integrating center for gastrointestinal reflexes. Many details of its structure are still lacking. In the present study, mouse S.m.g. neurons were studied by light, electron, and confocal microscopy. Neurons had an average of 5–6 primary dendrites. Total dendritic length averaged 963 μm. Confocal microscopy and three-dimensional reconstructed images revealed cell body surface features, precise location where axons and dendrites emerged from it, cell body size, and extent of dendritic projection in three axes. Cell body diameter and dendritic projections were less in the dorsoventral than in the rostrocaudal or mediolateral axes. Cell body surface area and volume averaged 4,271 μm² and 4,908 μm³, respectively. Dendritic surface areas and volumes were 5–6 times larger. Two main neuron types (projecting caudally or rostrally) were distinguished. The former were found throughout the S.m.g., whereas the latter were found only in the cephalad region, comprising about 40% of neurons found there. Rostrally projecting neurons had fewer primary dendrites, fewer total dendritic branches, and shorter total dendritic length than caudally projecting neurons. There were regional differences in percentage of neurons responding to electrical stimulation of left or right hypogastric, lumbar colonic, or left splanchnic nerves but not in nerve fibers connecting the S.m.g. and celiac ganglion. A greater percentage of caudally than rostrally projecting cephalad neurons responded to stimulation of any nerve trunk. These results indicate that the mouse S.m.g. contains at least two distinct types of neurons that differ in their morphology and their source of preganglionic synaptic input. © 1996 Wiley-Liss, Inc.     

Interstitial cells of Cajal – their role in pacing and signal transmission in the digestive system

Interstitial cells of Cajal (ICC) are located in most parts of the digestive system. Although they were discovered over 100 years ago, their function began to be unravelled only recently. Morphological observations have led to a number of hypotheses on the possible physiological roles of ICC: (1) these cells may be the source of slow electrical waves recorded in gastrointestinal (GI) muscles; (2) they participate in the conduction of electrical currents, and (3) mediate neural signals between enteric nerves and muscles. These hypotheses were supported by experiments in which the ICC‐containing layer was removed surgically, or when ICC were ablated chemically, and as a consequence the slow waves were absent. Electrophysiological experiments on isolated cells confirmed that ICC can generate rhythmic electrical activity and can also respond to messenger molecules known to be released from enteric nerves. In mice mutants deficient in ICC, or in mice treated with antibody against the protein c‐Kit, slow wave activity was impaired. These results support the role of ICC as pacemaker cells. Physiological studies have shown that ICC in certain GI regions are important for signal transmission between nerves and smooth muscle. There is evidence that pathological changes in ICC may be associated with GI motility disorders. The full interpretation of the role of ICC in disease conditions will require much further study on the physiology and pharmacology of these cells.