Promotion of couples' voluntary HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents

OBJECTIVES

Hypothesising that couples' voluntary counselling and testing (CVCT) promotions can increase CVCT uptake, this study identified predictors of successful CVCT promotion in Lusaka, Zambia.

DESIGN

Cohort study.

SETTING

Lusaka, Zambia.

PARTICIPANTS

68 influential network leaders (INLs) identified 320 agents (INAs) who delivered 29 119 CVCT invitations to heterosexual couples.

INTERVENTION

The CVCT promotional model used INLs who identified INAs, who in turn conducted community-based promotion and distribution of CVCT invitations in two neighbourhoods over 18 months, with a mobile unit in one neighbourhood crossing over to the other mid-way through.

PRIMARY OUTCOME

The primary outcome of interest was couple testing (yes/no) after receipt of a CVCT invitation. INA, couple and invitation characteristics predictive of couples' testing were evaluated accounting for two-level clustering.

RESULTS

INAs delivered invitations resulting in 1727 couples testing (6% success rate). In multivariate analyses, INA characteristics significantly predictive of CVCT uptake included promoting in community-based (adjusted OR (aOR)=1.3; 95% CI 1.0 to 1.8) or health (aOR=1.5; 95% CI 1.2 to 2.0) networks versus private networks; being employed in the sales/service industry (aOR=1.5; 95% CI 1.0 to 2.1) versus unskilled manual labour; owning a home (aOR=0.7; 95% CI 0.6 to 0.9) versus not; and having tested for HIV with a partner (aOR=1.4; 95% CI 1.1 to 1.7) or alone (aOR=1.3; 95% CI 1.0 to 1.6) versus never having tested. Cohabiting couples were more likely to test (aOR=1.4; 95% CI 1.2 to 1.6) than non-cohabiting couples. Context characteristics predictive of CVCT uptake included inviting couples (aOR=1.2; 95% CI 1.0 to 1.4) versus individuals; the woman (aOR=1.6; 95% CI 1.2 to 2.2) or couple (aOR=1.4; 95% CI 1.0 to 1.8) initiating contact versus the INA; the couple being socially acquainted with the INA (aOR=1.6; 95% CI 1.4 to 1.9) versus having just met; home invitation delivery (aOR=1.3; 95% CI 1.1 to 1.5) versus elsewhere; and easy invitation delivery (aOR=1.8; 95% CI 1.4 to 2.2) versus difficult as reported by the INA.

CONCLUSIONS

This study demonstrated the ability of influential people to promote CVCT and identified agent, couple and context-level factors associated with CVCT uptake in Lusaka, Zambia. We encourage the development of CVCT promotions in other sub-Saharan African countries to support sustained CVCT dissemination.

[Management of upper obstetrical brachial plexus palsy. Long-term results of non-operative treatment in 22 children]

INTRODUCTION

Treatment of obstetrical brachial plexus palsy (OBPP) is always debated, especially for upper plexus palsy. Some authors perform early surgical treatment in case of absence of biceps contraction at the age of 3 months. Others prefer to wait until the age of 6 months before considering a surgical procedure when no suspicion of root avulsion is found. We think that a conservative approach with intensive rehabilitation program can obtain good functional outcome for patients who will recover biceps function spontaneously between 3 and 6 months, and that it is not necessary to perform surgery at 3 months. To argue our choice, we have compared the long-term outcome of two groups of children with upper OBPP conservatively treated regarding the age of biceps recovery (before or after 3 months).

PATIENTS AND METHODS

Twenty-two patients with non operated upper roots birth palsy, followed in Timone's Hospital of Marseille by a multidisciplinary team, have recovered a biceps contraction between 1 and 8 months and were retrospectively included in this study. All children underwent an intensive rehabilitation program since birth, performed by a specialized physiotherapist. Patients were reviewed, and their shoulder function was assessed using Mallet score. The score was analysed regarding the age of biceps recovery.

RESULTS

The mean follow up was 8.2 years. Nine children recovered a biceps contraction at 3 months of age or before; the mean global Mallet score was 4.11. Thirteen children recovered a biceps contraction after 3 months of age (between 3 and 8 months); the mean global Mallet score was 3.92. The difference was not statistically significant.

CONCLUSION

This study shows that global shoulder function is comparable for two groups. The children who did not recover a biceps contraction at 3 months of age had a global shoulder function as good as the one who recovered biceps function earlier. We think our intensive rehabilitation program allowed us to avoid a useless early surgery. Surgical plexus treatment was indicated for children who did not have biceps contraction after 6 months of age.

9 EVALUATION OF FERTILITY TRAITS OF HOLSTEIN CATTLE IN ARGENTINA

Impaired fertility is the primary reason for culling in the United States (26.5% of all disposals) and fertility rates have steadily declined during the past 30 years. The objectives of this study were 1) estimate genetic parameters and evaluate genetic correlations for fertility traits based on data from milk recording programs, and 2) evaluate genetic fertility trends in Holstein cattle in Argentina. Data representing 3 282 843 lactations and 1 622 088 animals (cows and bulls from 1936 to 2007) were used for the analysis and obtained from official records maintained by the Argentinean Holstein Association (ACHA). Lactations were standardized to 305 DIM for milk, protein, and fat. Days open (DO), calving interval (CI), age to first calving (AFC), and daughter pregnancy rate (DPR) were selected for genetic parameter estimation. Daughter pregnancy rate was calculated as described by (Kuhn et al. 2004 J. Dairy Sci. 87, 2277–2284). Animal models by lactation for each fertility trait included contemporary group (dairy herd and calving year), calving month, animal effect, milk production as a covariate, and error term. Multiple-trait derivative-free restricted maximum likelihood (MTDFREML) was used to estimate covariance components. Solutions for fixed effects, breeding values, and sampling variances (accuracies) were obtained for each trait. The fertility index ($F = –0.28 × AFC ± 4.9 × CI) was calculated using the economic rates as reported by (Gonzalez-Recio et al. 2004 J. Dairy Sci. 87, 3053–3061). First lactation/parities were utilised for estimating correlations among BLUPs for DO, CI, DPR, AFC, and $F. In general, moderate and high genetic correlations were observed (from 0.238 to 0.999; P < 0.001). Days open and calving interval showed high negative associations with DPR (–0.999, –0.648) and $F (–0.612, Q0.981). Results from the correlation analysis suggest that CI and $F are qualified indicators of fertility in lactating dairy Holstein and relate well with all the other traits. The index, $F, benefits by including AFC as a measure of initial reproductive efficiency followed by the inclusion of CI which measures success of inseminations. Genetic trend for AFC showed a decrease of 2.76 days per year between 1970 and 2000 for sires. Similarly, trends for CI resulted in decreases of 0.45 days per year between 1970 and 2000 for sires. During the same period, DPR increased by 0.02 percent per year in sires. Using current dollars values, $F increased 2.99 dollars per year for sires. Results indicate progress in the genetic trend for fertility traits in the Holstein population of Argentina, with higher improvement in sires compared with dams. Trends visually showed faster improvement after 1980, possibly due to extensive importation of US and Canadian bulls and semen (72% of bulls born after 1986) and selection for productive life introduced in 1993. Supported by Asociacion Criadores de Holando Argentino (ACHA).

[Autologous fat grafting in radiated tissue prior to breast prosthetic reconstruction: is the technique reliable?]

BACKGROUND

Prosthetic breast reconstruction is critical in the radiated breast. The main purpose of this study was to determine whether fat grafting prior to breast reconstruction could improve thoracic tissue trophicity enough to perform a simple prosthetic reconstruction, avoiding a flap procedure.

PATIENTS AND METHODS

A total of 25 patients who had undergone a modified radical mastectomy followed by radiotherapy were retrieved. Fat was injected according to Coleman's technique. Prosthetic reconstruction was performed three to six months after the fat grafting procedure. Reconstruction of the nipple-areola complex was performed 3 months after implant positioning. Median follow-up interval was two years. Patient satisfaction was ascertained with a self-assessment questionnaire. Three independent blinded physician observers judged preoperative and postoperative photographs to determine the quality of reconstruction.

RESULTS

The mean refined fat injected volume was 160ml. In all cases except two, a unique fat grafting procedure was necessary. Prosthetic reconstruction was achieved in 23 cases. The technique failed in two cases and breast reconstruction was achieved by a latissimus dorsi flap with implant. During the follow-up interval, two complications occurred in two patients presenting with fat necrosis and oil cysts. The mean number of total surgical procedures was 2.5 per patient. Quality of reconstruction was judged as good by both physicians and patients.

CONCLUSIONS

Autologous fat grafting in radiated tissue prior to breast reconstruction is a safe and reliable technique. In selected cases, a simple prosthetic reconstruction can be achieved avoiding a flap procedure.

21 GENETIC APPROACH TO IMPROVE FERTILITY IN CATTLE

In spite of the economic importance of fertility and increased knowledge of reproductive biology in the cow, efficiency of reproductive performance has continued to decline in dairy cattle. Improvements in fertility through genetic selection may be a possible approach to increase reproductive efficiency in dairy cattle. Although progress may be slow because of low heritabilities, ignoring fertility in genetic improvement programs has contributed to the current fertility problems. The objectives of this study were to (1) estimate genetic parameters and breeding values for fertility traits based on data from milk recording programs on a Holstein population and (2) develop a multi-trait selection index (dollar fertility value; $F) based on estimated breeding values. Data representing 3,282,843 lactations and 1,622,088 animals (cows and bulls from 1936 to 2007) were used for the analysis and obtained from official records maintained by the Argentinean Holstein Association (ACHA). Data were collected from official milk records, and lactations were standardized to 305 DIM for milk, protein, and fat. Gestation period was considered to be 282 days and restrictions were applied to ensure the quality of data (days open <40 and >350 days; calving interval <300 and >600 days; and contemporary groups with <25 lactations were eliminated). Days open (DO), calving interval (CI), age to first calving (AFC), and daughter pregnancy rate (DPR) were traits chosen for genetic parameter estimation. Daughter pregnancy rate was calculated from DO as PR = 0.25 × (233 DO); Kuhn et al. 2004 J. Dairy Sci. 87, 2277-2284. Animal models by lactation for each fertility trait included contemporary group (dairy herd and calving year), calving month, animal effect, milk production as a covariate and error term. Multiple-trait derivative-free restricted maximum likelihood (MTDFREML) was used to estimate covariance components (Boldman et al. 1995 ARS, USDA). Solutions for fixed effects, breeding values, and sampling variances (accuracies) were obtained for each trait. The proposed selection index ($F) included AFC and CI, with economic weights from -0.28 and -4.9 $/year per cow for AFC and CI, respectively (Gonzalez-Recio et al. 2004 J. Dairy Sci. 87, 3053-3061). Heritabilities for DO and DPR ranged from 2 to 7%; CI ranged from 3 to 8%; and AFC was 16%. Predicted transmitting ability values across different lactations ranged from -18.5 to 15.8 days, -23.15 to 16.0 days, -4.0 to 4.6%, and -120.3 to 76.2 days for DO, CI, DPR, and AFC, respectively. Values for $F ranged from -$89.16 to $147.12 in this Holstein population. Results indicate substantial variation in fertility traits, suggesting that genetic selection may be effective in improving declines in fertility. Asociacion Criadores Holando Argentino (ACHA).

Two rare cases of association of thumb hypoplasia and polydactyly of the homolateral foot

This paper presents two cases of radial deficiency and thumb aplasia associated with polydactyly of the homolateral foot and a supernumerary toe resembling a thumb. To our knowledge, this association of malformations has not been described previously.

Inferring maps of forces inside cell membrane microdomains

Mapping of the forces on biomolecules in cell membranes has spurred the development of effective labels, e.g., organic fluorophores and nanoparticles, to track trajectories of single biomolecules. Standard methods use particular statistics, namely the mean square displacement, to analyze the underlying dynamics. Here, we introduce general inference methods to fully exploit information in the experimental trajectories, providing sharp estimates of the forces and the diffusion coefficients in membrane microdomains. Rapid and reliable convergence of the inference scheme is demonstrated on trajectories generated numerically. The method is then applied to infer forces and potentials acting on the receptor of the toxin labeled by lanthanide-ion nanoparticles. Our scheme is applicable to any labeled biomolecule and results show its general relevance for membrane compartmentation.

Blood volume expansion with hyperoncotic colloids deteriorates allograft function in a canine model of renal transplantation

PURPOSE

We investigated the effects of acute maximal hydratation with hemoce (H) and dextran-40 (D40) on the postoperative graft function, following renal transplantation (RT) in a canine model.

METHODS

After induction of anesthesia with pentobarbital (5 mg/kg), 18 beagle dogs were randomized to receive either saline solution to increase the central venous pressure (CVP) to 5 mm Hg (GI); H solution to increase the CVP to 10 mm Hg (GII); or D40 to achieve 15 mm Hg (GIII), before reperfusion. A pulmonary artery catheter was used to measure CVP, mean pulmonary artery pressure, and cardiac output (CO). The surgical procedure consisted of autotransplantation of the dog's left kidney an hour prior to cold ischemia with University of Wisconsin solution, followed by contralateral nephrectomy. Diuresis, creatinine (Cr), and BUN levels were measure at 24 hours before RT, as well as 24, 48, and 72 hours after the procedure.

RESULTS

Only in the treated groups did cardiac filling pressures and CO increase as a result of hydration. Only in the GI group did serum Cr and blood urea nitrogen significantly peak at the second postoperative day while it continued to increase at two (GII) and three (GIII) times greater than GI on the third day. Histological examination showed osmotic nephrosis like-lesions only among treated grafts.

CONCLUSION

We concluded that maximal hydration with H and D40 colloid deteriorated postoperative graft function after RT. We believe that in the future the effects of any colloid solution should be tested in an animal model in the fashion as we have described, in order to know which one, and at what dose, is the safest to improve kidney allograft outcome.

Les séquelles vélopharyngées dans les fentes labioalvéolopalatovélaires. Pharyngoplastie par Lipostructure® du pharynx

Advancing the posterior pharyngeal wall is a classic technique to treat velopharyngeal insufficiency. Injection of autologous fat behind the posterior pharyngeal mucosa according to the Coleman Lipostructure technique is a recent development. The authors report their experience in six cases using this modification. The preoperative work-up was performed by a speech therapist with a physical examination and measurement of the nasal air loss was performed using an aerophonometer. Fat was harvested either on the abdominal wall or on a buttock and then centrifuged. Fat injection was performed using a curved blunt cannula under the mucosa of the lateral and posterior pharyngeal walls. Injecting fat is an autologous graft of fat tissue: after a postoperative period of three months, the volume of fat becomes permanently stable. In five out of the six patients who presented moderate velopharyngeal insufficiency, speech improvement was significant. The single failure was a patient with bilateral cleft lip and palate sequels after previous pharyngoplasty using the Orticochea procedure. Treatment of moderate velopharyngeal insufficiency using fat injection is an efficient method. The advantages are its innocuousness and that scaring of the pharynx is avoided.

Mise au point sur la prise en charge chirurgicale du mélanome malin cutané. Revue de la littérature

Nowadays managing a cutaneous malignant melanoma can concern different kind of physicians: dermatologists, general or plastic surgeons The primary surgical procedure is a major step of the treatment. Biopsy must be total to properly determine the thickness of the tumor in case of malignancy. Wide local excision of the scar is often necessary to decrease the local and general recurrence rates. Wide local excision must be performed conforming to its own surgical rules. Managing tumor located on the face or limb extremities is a matter of plastic surgery. Sentinel node biopsy has succeeded to elective lymph node dissection. This procedure allows research of lymphatic spreading of the disease. Practice of sentinel node biopsy must be achieved in a protocolar way. Topography of the lesion can modified achievement and results of this procedure. Prognosis benefit of sentinel biopsy is now clear. Elective lymph node dissection is only performed in case of invaded sentinel node or clinically invaded lymph nodes. Local or locoregional recurrences mainly respond to surgical treatment using wide excision. However, alternative solutions are being evaluated (isolated limb perfusion).

Ischemic Preconditioning and Kidney Transplantation: In Vivo Nitric Oxide Monitoring in a Rat Ischemia-Reperfusion Experimental Model

Direct nitric oxide measurement in live tissue would help us to understand its role in ischemia-reperfusion injury and its relationship to ischemic preconditioning (IP). We constructed four experimental groups of ischemia-reperfusion in the rat kidney: G1 were controls; G2, 1 hour of renal ischemia; G3 and G4: one or two 15/10 minute cycles, respectively, of IP prior to 1 hour of ischemia. Real-time in vivo nitric oxide measurements were compared with functional parameters of kidney damage at 24 hours. The peaks of nitric oxide production in the IP periods increased less in the rising curve of nitric oxide production during the 1 hour ischemia time. No improvement in the IP groups was observed based on serum creatinine levels at 24 hours.

[Surgical treatment of lymphatic malformations]

Lymphatic malformations remain a therapeutic challenge. Many treatments by the past led to poor success. The wide variety of clinical presentations makes it difficult to outline specific management programs. Often, diagnosis or complication circumstances as infection, bleeding, airway obstruction, or handicap force acting. Thus, a specific follow-up joined to a multidisciplinary analysis are the key of well-planned surgery. Through our experience and a review of literature, we will describe principles of lymphatic malformations surgery and specific technics for specific locations.

[Venous malformations: clinical characteristics and differential diagnosis]

Venous malformations (VM) are localized defects of blood vessels that are due to vascular dysmorphogenesis. These slow-flow lesions can affect any tissue or organ. Clinically, a cutaneous VM is characterized by a bluish mass that is compressible on palpation. Phleboliths are commonly present. Symptoms depend on location and size. VM are often sporadic and isolated, however, they can be associated with other malformations and be part of a syndrome; Klippel-Trenaunay (capillary-lymphatico-venous malformation with limb hypertrophy) is the most common. Glomuvenous malformation (GVM) is another type of venous anomaly. In contrast to VM, GVM is often painful on palpation and not compressible. Clinical diagnosis of VM is often made in the presence of a bluish cutaneous lesion: however, other lesions can mimick VM. The most frequent anomalies are a blue naevus, a hemorrhagic lymphatic malformation, a sub-cutaneous hemangioma or even the presence of dilated superficial normal veins due to underlying venous stenoses. This chapter will detail the clinical characteristics of venous anomalies and their differential diagnosis.

[Cutaneous hemangioma: clinical aspects]

Infantile cutaneous hemangioma is a benign vascular tumour present at 10% of the infants. It forms part of the group of the vascular tumours in the classification of International Society for Vascular Anomalies (ISSVA). Clinical diagnosis is easy in its triphasic typical form with a phase of sometimes brutal postnatal growth, a phase of stabilization and a phase of slow secondary regression. Classically, it is presented in the form of a mass or stains cutaneous red, of a subcutaneous mass or, generally, of a mixed form associating the two aspects.

Traitement chirurgical des malformations capillaires

Capillary malformations do not demand mostly any therapeutics. For aesthetic reasons, family or child can demand a treatment to ease even to remove the unsightly character of the lesion. In this context, the means employees must be simple and not engender aftereffects more unaesthetic than the lesion. The pulsed dye laser fulfils perfectly this conditions by improving the color of the lesion without touching the texture of the skin. However it's a treatment requiring many sessions over 2-3 years. Surgery keeps an interest for the treatment of capillary malformations resistant to laser (in particular on the limbs) or to treat soft tissues hyperplasia met in certain cervicofacial locations. The surgery uses the whole techniques of plastic surgery classified from the most simple to the most complicated: excision-suture in one time or iterative, excision and coverage by a skin graft, use of skin expansion techniques with local flaps.

Les malformations lymphatiques : aspects cliniques et évolution

Lymphatic malformations (LM) are the most frequent vascular malformations. There are three types of lesions involving lymphatic development that must be included in LM: vascular anomalies and knots (truncal malformations [TLM]); cystic anomalies, superficial or deep, uni- or multicystic (extratruncal malformations [ETLM]) and hemolymphatic anomalies which combine venous, arterial, or capillary malformations with LM. ETLM can be ubiquitously distributed but most are located in the cervical or axillary regions. Most ETLM are diagnosed at birth and in 80-90% of the cases before the age of 2. The clinical aspects are extremely variable: superficial ETLM (vesicular) and deep ETLM, localised or diffuse, mono- or multicystic. TLM are generally located on a lower limb with neonatal lymphatic oedema (often in a polymalformation context). All forms of the hemolymphatic combination can be identified. They are generally located on the limbs and are often unilateral. They are usually sporadic but can also be can be found in polymalformation syndromes (Klippel-Trénaunay, Parkes-Weber, Protée, Maffucci). ETLM generally tend to increase in volume and spread with age with stabilisation at puberty. They do not tend to spontaneously regress. Specific local complications can have serious consequences. They are linked to haemorrhaging, infections and compression phenomena. There can also be complications such as skeletal and soft tissue hypertrophy.

Traitement chirurgical des malformations artérioveineuses

MAV surgery remains still today one of most difficult in the surgery of vascular malformations. Embolisation the most selective possible follow-up of a surgical removal carrying the totality of the nidus is the only effective treatment. Usually, MAV of small size, quiescent, should not be operated, the surgery being reserved for the evolutionary or complicated forms. This surgical procedure must allow the complete eradication of the lesion without which the cure is not possible. The incomplete removal causes repetition, sometimes aggravation with, sometimes, life threatening problems.

Indications des lasers dans le traitement des malformations lymphatiques

Cutaneous dermatologic lesions of LM, in type of superficial, translucent, localized or diffuse vesicles, are accessible to laser treatment. The useful lasers are essentially laser CO(2), and rarely pulsed dye laser and the Nd: YAG. Treatment by laser allows to obtain the ablation of vesicles by limiting aftereffects (scare) and so to dry up the transcutaneous lymphatic liquid. However laser has no action on the deep constituent of the LM and it's why medium and long term recurrences are inevitable. Finally, the indication of the laser must be retained only as a supplement to the surgery and has to be done by experimented persons.

Les complications des hémangiomes

Hemangioma (HMG) is a benign tumour of the child generally evolving to spontaneous regression. Sometimes this evolution can become complicated in a more or less serious way according to its localization or of its importance. If local complications are, in the most of cases, without gravity, complications of a general nature like thrombopenia or cardiac failure may compromise the vital prognosis. There are in addition serious forms where, according to its localization or its importance, the HMG can compromise the aesthetic, or functional even vital outcome.

Hibernoma of the antero-lateral thigh

Hibernoma is a rare benign tumour of brown fat. In most cases it presents as a voluminous slow-growing mass in the regions where remnants of brown fat can remain in adults. We report a case of a hibernoma on the thigh and present the diagnostic and therapeutic elements of this type of tumour, whose differential diagnosis of liposarcoma.