Missed opportunities for participation in prevention of mother to child transmission programmes: Simplicity of nevirapine does not necessarily lead to optimal uptake, a qualitative study

Background  

The objective of this study was to examine missed opportunities for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa. A rapid anthropological assessment was used to collect in-depth data from 58 HIV-positive women who were enrolled in a larger cohort study to assess mother-to-child HIV transmission. Semi-structured interviews were conducted with the women in order to gain an understanding of their experiences of antenatal care and to identify missed opportunities for participation in PMTCT.     

Cardiovascular intervention for high-risk families: the Heart Smart Program

The Heart Smart Family Health Promotion Program is a multidisciplinary, school-based program for cardiovascular risk reduction among high-risk children and their families. As a program that includes young adults at high risk, it is adaptable to a clinical practice. Nineteen fourth and fifth graders were selected as probands for elevated risk factors after a general screening to identify families for an intervention program. Twenty-three parents participated in a 12-week program focused on eating, exercise, and smoking behavior changes enhanced by behavicral support strategies. Weekly sessions were held in the auditorium/cafeteria of the elementary school and consisted of orientation and presentations, cardiovascular (CV) screening with medical feedback, activities, self-monitoring, counseling, and contingency contracting. Information gathered before and after the program included medical history, CV health knowledge and relevant behavior, blood pressure, serum lipid and lipoprotein values, anthropometric measurements, and urine electrolyte excretion. Both children and parents showed positive changes in eating habits and physical activity and significant changes in knowledge and blood pressure levels, while the children halted their weight gain. We believe this multidisciplinary, behavior-oriented, school-based program can be an effective cardiovascular risk intervention adaptable for a clinical office practice.     

Immunodiagnosis of Entamoeba histolytica and Ascaris lumbricoides infections in Caucasian and aboriginal Australians

The immunodiagnostic efficiency of an indirect immunofluorescence test (IFAT) and in vitro lymphocyte proliferative responsiveness (cell mediated immunity test, CMIT) used to measure the immunological responses of individuals with known natural Entamoeba histolytica and Ascaris lumbricoides infections, was studied under survey conditions. E. histolytica was common among Aborigines from Cherbourg, Kowanyama and Central Australia, but it was not found in Brisbane Caucasians. The protozoan was selected for the study because it was prevalent and purified antigen was commercially available. Immunodiagnosis for A. lumbricoides was made using an antigen prepared by affinity chromatography. Diagnosis based on frequency distribution of immunological data gave valid assessment of the number of infected individuals in each population studied.     

Adenomyosis:common and uncommon manifestations on sonography and magnetic resonance imaging.

OBJECTIVE: The purpose of this presentation is to show the imaging findings of the common and uncommon variants of adenomyosis as seen on sonography and magnetic resonance imaging (MRI). METHODS: A 3-year database search was performed to identify women who had pelvic sonography and pelvic MRI within a 6-month interval. Images of these cases were retrospectively reviewed. RESULTS: Eighty women were identified. Adenomyosis was diagnosed on MRI, which was used as the reference standard, in 45 of these women. The correct diagnosis was made on sonography in 73% of the cases. CONCLUSIONS: Awareness of the spectrum of imaging features of adenomyosis is important to use sonography effectively for diagnosing this entity and to help avoid misdiagnosis.     

Present phage types and antibiotic susceptibility of salmonellae.

A total of 168 strains of Salmonella were isolated in the Command Pathology Laboratory (WC) Delhi Cantt during the year 1990. Out of this, 143 were Salmonella typhi, 17 Salmonella paratyphi A, 7 Salmonella typhimurium and 1 Salmonella manhattan. The commonest phage type and biotype of Salmonella typhi was type E1 and type 1 respectively. The dominant biotype of Salmonella paratyphi A was type I. There was a very high degree of multidrug resistance of most of the strains. But all the strains were sensitive to ciprofloxacin and norfloxacin.     

Comparison of survival in cardiac surgery at a Veterans Administration hospital and its affiliated university hospital

Survival data were reviewed for 3330 open cardiac procedures from 1975 through 1984 at the William S. Middleton Memorial Veterans Hospital, Madison, Wis, and the University of Wisconsin Hospitals and Clinics, Madison. Respective operative survivals were 98.6% and 98.7% for myocardial revascularizations with vein graft or internal mammary artery (CABG), 96.2% and 96.8% for CABG reoperation, 97.8% and 95.9% for aortic valve replacement, 96.3% and 90.3% for aortic valve replacement plus CABG, 100.0% and 94.9% for mitral valve replacement, and 100.0% and 82.9% for mitral valve replacement plus CABG. There were no significant differences in six-year survival curves between hospitals despite threefold differences in average annual caseload (88 vs 294). This suggest that residency-directed cardiac surgery programs can function equally as well at a Veterans Administration hospital as at an affiliated university hospital.     

Role of balloon angioplasty in the treatment of aortic coarctation.

Since the initial report of coarctation balloon angioplasty in 1982, several groups have used this technique for native coarctations in neonates, infants, and children and for postoperative recoarctations. However, recommendations for use of balloon angioplasty as a treatment procedure of choice are clouded by reports of aneurysm development at the site of coarctation. Here we review our experience as well as that published in the literature, including Valvuloplasty and Angioplasty of Congenital Anomalies Registry data, and present evidence in support of balloon angioplasty as a therapeutic procedure of choice for treating native and recurrent postoperative aortic coarctations. Balloon angioplasty of native aortic coarctations in 20 neonates and infants 1 year old or less reduced peak systolic pressure gradient across the coarctation from 40 +/- 12 mm Hg (mean +/- standard deviation) to 11 +/- 8 mm Hg (p less than 0.001); no patient required immediate surgical intervention. The residual gradient at follow-up (mean follow-up, 12 months) in 16 infants was 18 +/- 16 mm Hg, a significant improvement (p less than 0.01) compared with preangioplasty values. In none of the patients did an aneurysm develop. Recoarctation developed in 5 (31%) of the 16 infants and was successfully treated either by surgical resection (in 2) or by repeat balloon angioplasty (in 3). A comparison of mortality and recurrence rates between the balloon angioplasty and surgical groups was made with the help of data pooled from the literature published since 1980. The initial (7% versus 23%) and late (2% versus 25%) mortality and recoarctation (11% versus 18%) rates were higher (p less than 0.025) after surgical intervention than after balloon therapy. When only reports in which patients were operated on after 1979 were included in this type of analysis, the initial and late mortality rates remained higher (p less than 0.01) after operation than after angioplasty, and the recoarctation rates became similar (p greater than 0.1). Thirty-two children (greater than 1 year old) underwent balloon angioplasty of native coarctation with a resultant reduction in peak systolic pressure gradient from 48 +/- 19 mm Hg to 10 +/- 9 mm Hg (p less than 0.001), which continued to remain low (14 +/- 11 mm Hg; p less than 0.001) at follow-up catheterization in 24 children 13 months (mean) later. There were no immediate or late deaths. A small aneurysm developed in 1 patient (4%) but did not require intervention. Recoarctation developed in 2 patients (8%), and in both, repeat balloon angioplasty was performed with good results.(ABSTRACT TRUNCATED AT 400 WORDS)