Low cost CCD camera protection against neutron radiation damage

At a radiotherapy department cancer patients are treated with high energy electron and photon beams. These beams are produced by a linear accelerator. A closed circuit television system is used to monitor patients during treatment. Although CCD cameras are rather resistant to stray radiation, they are damaged by the low flux of neutrons which are produced by the linac as a side effect. PVC can be used to reduce damage to CCD cameras induced by neutron radiation. A box with 6 cm thick walls will extend the life of the camera at least by a factor of two. A PVC neutron shield is inexpensive. PVC is easy to obtain and the box is simple to construct. A similar box made out of PE will not reduce neutron damage to a CCD camera. Although PE is a good medium to moderate faster neutrons, thereby reducing some of the bulk defects, it will not capture thermal neutrons which induce surface damage.     

Use and neglect of best-practice HIV/AIDS programme guides by South African companies

Numerous guidelines set out best-practice policies for HIV/AIDS interventions in the workplace. This study analysed 14 recognised codes and guidelines to gain an understanding of the theoretical consensus regarding the key components of best-practice workplace HIV/AIDS interventions. Nine key components of best practice were drawn from the analysis; interviews aimed to verify these components by determining the extent to which HIV/AIDS practitioners in South Africa share a similar understanding of best practice. Participants in a research questionnaire and semi-structured interviews included managers responsible for company HIV/AIDS programmes, HIV/AIDS experts, consultants, and disease management service providers. There was a high level of agreement between the practitioners who were interviewed and the codes and guidelines that were analysed concerning what best practice entails. However, reported usage of the recognised codes and guidelines to inform workplace HIV/AIDS interventions was low. Although large companies in South Africa may recognise certain interventions as examples of best practice, it appears that these are not being readily implemented. This appears to be partly because the cost-benefit of a recommended intervention is not immediately apparent or conclusive, and also because the concept of best practice with respect to workplace HIV/AIDS interventions is not yet fully accepted.     

Preliminary investigation of adherence to antiretroviral therapy among children in Aminu Kano Teaching Hospital,Nigeria

Treatment of HIV with highly active antiretroviral therapy (HAART) has resulted in declining morbidity and mortality rates from HIV-associated diseases, but concerns regarding access and adherence are growing. To determine the adherence level and the reasons for non-adhering to antiretroviral therapy (ART) among children attending the clinic for infectious diseases at Aminu Kano Teaching Hospital in Nigeria, a cross-sectional study using the selfreport tool was carried out among 40 children with HIV infection who had been on ART for at least six months. Thirty-two patients (80%) were 95% or more adherent to their medications. The most common reasons for nonadherence were running out of medicines and the inability to purchase more due to financial constraints; other barriers were non-availability and inaccessibility to medications. Eighty-five percent of the paediatric patients took their medications at the same time everyday, and scheduled appointments were kept by 87.5%. The social class of the patients did not significantly affect adherence level. The level of adherence to ART was comparable to levels reported from other developing and developed countries. The cost of ART, and availability and accessibility to medications were the most significant barriers to adherence. Expanded access to subsidised antiretroviral drugs should improve adherence — and consequently treatment outcomes — for patients receiving this treatment in resource-poor settings.     

HIV- and AIDS-related (mis)perceptions and (non)responses of school principals in the Eastern Cape,South Africa

Despite various HIV and AIDS training programmes offered for educators by the South African Department of Education, little has been achieved at the level of management in terms of creating a wider understanding of the social and cultural complexities of the condition and its impact on the quality of teaching and learning. Specifically, there is a lack of developmental programmes to help school principals provide leadership that can ensure that teachers and children who live in a context affected by the disease will still find themselves in a school environment of quality, care and compassion. With this in mind, we conducted a qualitative research enquiry among a sample of 12 school principals in the Eastern Cape Province in order to discover their perceptions about the impacts of HIV and AIDS on their schools and to learn how they have responded to the corresponding challenges. Our intention was to use the findings primarily to inform the development of an academic programme and short courses to empower school principals and leadership in this regard, but the findings may also be relevant as a guide for research on a larger scale.     

OICPC Therapeutic Highlights

We continue the series of basic information on therapies, summarised from the Oxford International Centre for Palliative Care Advanced Courses on Pain and Symptom Management held in Newcastle and Oxford during June-July 1999.     

Impact of Patient Follow-Up on Weight Loss after Bariatric Surgery

Background: Postoperative follow-up after bariatric surgery is important. Because of the need for adjustments, follow-up after gastric banding may have a greater impact on weight loss than after Roux-en-Y gastric bypass.We reviewed all patients at 1 year after these two operations. Methods: During the first year after surgery, laparoscopic adjustable gastric banding (LAGB) patients were followed every 4 weeks and Roux-en-Y gastric bypass (RYGBP) patients were followed at 3 weeks postoperatively and then every 3 months.The number of follow-up visits for each patient was calculated, and 50% compliance for follow-up and weight loss was compared. Results: Between October 2000 and September 2002, 216 LAGB and 139 RYGBP operations were performed. Of these patients, 186 LAGB patients and 115 RYGBP patients were available for 1-year follow-up. Age and BMI were similar for each group. Overall excess weight loss (EWL) after LAGB was 44.5%. 130 (70%) returned 6 or less times in the first year and achieved 42% EWL. 56 patients (30%) returned more than 6 times and had 50% EWL (P=0.005). Overall %EWL after RYGBP was 66.1%. 53 patients (46%) returned 3 or less times in the first year, achieving 66.1% EWL. 62 patients (54%) returned more than 3 times after surgery and achieved 67.6% EWL (P=NS). Conclusion: Patient follow-up plays a significant role in the amount of weight lost after LAGB, but not after RYGBP. Patient motivation and surgeon commitment for long-term follow-up is critical for successful weight loss after LAGB surgery.     

Minimally Invasive Gastric Bypass in a Morbidly Obese Patient with Myasthenia Gravis

Associated or rare diseases, such as myasthenia gravis, introduce a challenge to the perioperative management of severely obese patients undergoing bariatric surgery. We report the surgical management and unique anesthetic approach to a 55-year-old morbidly obese woman with a complex past medical history that included myasthenia gravis, who underwent laparoscopic gastric bypass. Her myasthenia was controlled on pyridostigmine and her greatest concern was the potential need for postoperative mechanical ventilation. While the laparoscopic surgical approach was ideal to reduce pain and the adverse effects on ventilatory mechanics associated with open upper abdominal surgery, a combined inhalational and intravenous anesthetic without muscle relaxants resulted in satisfactory surgical conditions, and allowed for immediate postoperative extubation followed by an uneventful postoperative course. Continued perioperative anticholinesterase administration may have facilitated this successful outcome. We conclude that a diagnosis of myasthenia gravis does not mandate postoperative mechanical ventilation following laparoscopic gastric bypass.     

Perioperative Management and Monitoring of a Super-obese Patient

Anesthetic management of super-obese patients is inferred from evidence which has been based on obese or morbidly obese patients. We present the perioperative management and monitoring of a 44-year-old 232-kg patient (BMI 70) admitted for laparoscopic gastric bypass surgery. Awake fiberoptic endotracheal intubation preceded induction with propofol and rocuronium. Anesthesia was maintained with desflurane and remifentanil. Desflurane was titrated on BIS values, whereas remifentanil was based on hemodynamic monitoring (invasive arterial pressure and HemoSonic™). Rocuronium was administered based on ideal body weight and recovery of twitch tension. Safe and rapid extubation in the operating theatre was made possible by the use of short-acting agents coupled with continuous intraoperative monitoring. Recovery in the post-anesthesia care unit was uneventful, pain was managed with meperidine, and after 5 hours the patient was discharged to the surgical ward. Oxygen therapy and SpO2 monitoring were continued overnight. No desaturation episodes were recorded. Pain was managed with I.V. drip of ketorolac and tramadole.     

Placenta increta; conservative management – a successful outcome. Case report and literature review

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and Doppler assessment, followed by interval manual removal of placenta.