An assessment of the understanding of the offer of routine HIV testing among pregnant women in rural Zimbabwe

The objective of this study is to assess the understanding of routine offer of HIV testing among women using antenatal care (ANC) services in a rural African district. A descriptive cross-sectional survey was conducted in Murewa district, Zimbabwe, among women consecutively enrolled during their first ANC visit in 10 health centres offering prevention of mother-to-child transmission (PMTCT) of HIV services including routine offer of HIV testing. Ninety-three (64%) of the 146 respondents had received some form of education on the importance of HIV testing before visiting the health centre on the day of their interview. Almost all respondents (n=139; 95%) felt that the information provided during the group education was sufficient to make a decision on whether or not they should have an HIV test. HIV testing uptake was high with 136 (93%) women being tested for HIV on the day of the interview. Of these, 128 (94%) were aware that they had been tested for HIV when interviewed before the time of receiving results. Fifty percent (n=67) of the women who accepted HIV testing directly after group education as part of their routine ANC blood tests were not aware, however, of the possibility of opting for individual pre-test counseling. The study found that in Zimbabwe, implementation of routine offer of HIV testing allowed women using ANC services to make an informed conscious decision to undertake an HIV test as part of the PMTCT package of services. There is a need to emphasize the availability of further individual pre-test counseling if necessary since a selected subgroup of women may still benefit from it.

A clinical prediction rule for pulmonary tuberculosis in emergency departments

SETTING

University-affiliated hospital located in an area with a high incidence of pulmonary tuberculosis (PTB).

OBJECTIVE

To develop a clinical prediction rule (CPR) based on information obtainable on admission, to permit rapid identification of patients with PTB.

DESIGN

Information from patients with respiratory symptoms who attended the emergency department of Cayetano Heredia Hospital, Lima, Peru, was collected prospectively. Clinical symptoms, past medical history, demographic data and results of chest X-rays (CXRs), sputum smear and culture in Löwenstein-Jensen media were obtained. Based on logistic regression, we constructed a scoring system to predict PTB.

RESULTS

A total of 345 patients were enrolled in the study, including 109 (31%) culture-proven PTB cases. In logistic regression analysis, we found age, previous history of PTB, weight loss, presence of cavities, upper lobe infiltrate and miliary pattern on CXR as independent predictors of PTB. We designed a scoring system with these variables, taking into account their statistical weight. The score attained 93% sensitivity and 42% specificity.

CONCLUSION

The CPR that was developed performed well in our population. It merits further validation in other settings. It should not, however, replace, but should complement sputum microscopy when deciding on isolation, and it does not preclude microbiology in making a definitive diagnosis.

From spin flip excitations to the spin susceptibility enhancement of a two-dimensional electron gas

The g-factor enhancement of the spin-polarized two-dimensional electron gas was measured directly over a wide range of spin polarizations, using spin flip resonant Raman scattering spectroscopy on two-dimensional electron gases embedded in Cd(1-x)Mn(x)Te semimagnetic quantum wells. At zero Raman transferred momentum, the single-particle spin flip excitation, energy Z*, coexists in the Raman spectrum with the spin flip wave of energy Z, the bare giant Zeeman splitting. We compare the measured g-factor enhancement with recent spin-susceptibility enhancement theories and deduce the spin-polarization dependence of the mass renormalization.

Community-based assessment of infant feeding practices within a programme for prevention of mother-to-child HIV transmission in rural Zimbabwe

OBJECTIVE

To describe the infant feeding practices and attitudes of women who used prevention of mother-to-child transmission of HIV (PMTCT) services in rural Zimbabwe.

DESIGN

A cross-sectional study including structured interviews and focus group discussions was conducted between June 2003 and February 2004.

SETTING

The study took place in Murambinda Mission Hospital (Buhera District, Manicaland Province), the first site offering PMTCT services in rural Zimbabwe.

SUBJECTS

The interviews targeted HIV-infected and HIV-negative women who received prenatal HIV counselling and testing and minimal infant feeding counselling, and who delivered between 15 August 2001 and 15 February 2003. The focus groups were conducted among young and elderly men and women.

RESULTS

Overall, 71 HIV-infected and 93 HIV-negative mothers were interviewed in clinics or at home. Most infants (97%) had ever been breast-fed. HIV-negative mothers introduced fluids/foods other than breast milk significantly sooner than HIV-infected mothers (median 4.0 vs. 6.0 months, P = 0.005). Infants born to HIV-negative mothers were weaned significantly later than HIV-exposed infants (median 19.0 vs. 6.0 months, P = 10(-5)). More than 90% of mothers reported that breast-feeding their infant was a personal decision, a third of whom also mentioned having taken into account health workers' messages.

CONCLUSION

The HIV-infected mothers interviewed were gradually implementing infant feeding practices recommended in the context of HIV. Increased infant feeding support capacity in resource-limited rural populations is required, i.e. training of counselling staff, decentralised follow-up and weaning support.

[Diffusion of hydroxyl ions from calcium hydroxide in the dentinal tubules]

The aim of this study was to compare hydroxyl ions diffusion from various calcium hydroxide forms: Hycal (1), Roeko points (2) and aqueous suspension placed in the pulpar chamber (3) or in the root canal (4). These experiments were conducted with bovine incisors in order to obtain quantitative evaluation. 540 lateral cavities, deep and superficial, were created in root dentin to measure the hydroxyl ions diffusion with a color indicator, the Blue epsilon With Hycal and aqueous suspension the diffusion of the OH- is obtained in the superficial cavities situated in the coronal part at 14 days (1 = 72%; 3 = 44%; 4 = 100%, (n=18)). In the apical part of the canal this phenomenon is never complete at 21 days (1 = 17%; 3 = 22%; 4 = 17%, (n=18)). No diffusion was observed with the Roeko points (the first generation).

Improved knowledge and practices among end-users of mother-to-child transmission of HIV prevention services in rural Zimbabwe

OBJECTIVE

To evaluate the influence of a prevention of mother-to-child transmission of HIV advocacy and mobilization campaign on awareness and knowledge levels within the community.

METHOD

We used a knowledge, attitudes and practices survey to collect baseline data in November 2002 and again in July 2004 for evaluation purposes.

RESULTS

A total of 351 women attending healthcare services were interviewed each time. The proportion of women aware of the service increased from 48.0% in 2002 to 82.8% in 2004 (OR = 4.9, 95% CI 3.3-7.3, P = 0.001). Exclusive breastfeeding was identified as a mother-to-child transmission risk factor by 27.1% in 2002 and by 55.8% of respondents in 2004 (OR = 2.9, CI 2.1-4.2, P = 0.001). Although most interviewees agreed that the prevention of sexual transmission of HIV was the best strategy for prevention of mother-to-child transmission of HIV (88.3% in 2002 and 96.4% in 2004), few reported having ever used a male condom (24.8% in 2002 vs. 29.8% in 2004, P = 0.16).

DISCUSSION

Prevention of mother-to-child transmission of HIV strategies at both individual and community level were still insufficiently understood and applied. Targeted educational messages and communication for social change need to be combined. Knowledge, attitudes and practices surveys can be used to monitor programme progress.

Shaping ability of two rotary instruments in simulated canals: stainless steel ENDOflash and nickel-titanium HERO Shaper

AIM

To compare the shaping ability of two rotary instruments in simulated curved canals: stainless steel ENDOflash Files (KaVo, Biberach, Germany) and the recently introduced nickel-titanium HERO Shaper instruments (Micro-Mega, Besançon, France).

METHODOLOGY

Simulated root canals with 35 degree curves in resin blocks were prepared to size 30, .04 taper (HERO Shaper) using a crowndown technique or size 30, .02 taper (ENDOflash) using a rotary motion and a rotation speed of 400 or 250 rpm respectively. In both groups, irrigation was performed with 1 mL distilled water after each instrument size and Glyde (Dentsply Maillefer, Ballaigues, Switzerland) were used. Canals (n = 17 per group) were scanned before, during and after preparation. The assessment of preparation shape was carried out with a computer image analysis program. Material removal was measured at seven points beginning 1 mm from the end-point of the canal. Statistical analysis was performed using Wilcoxon's test and Fisher's exact test (P < 0.05).

RESULTS

No instrument fractures, apical blockage or loss of working length (WL) occurred. More zips (10 vs. 4) and more strippings (17 vs. 0) were created with ENDOflash compared with the HERO Shaper. There were significant differences in terms of the amount of resin removed on the inner wall of the curvature obtained with the two instruments (P < 0.0001). On average, HERO Shaper instruments removed material more evenly on the outer and inner wall of the curvature. Considering the different points of measurement, there were significant differences between the two systems both on the inner and outer walls at WL-1, 2, 5 and 6 mm (P < 0.05). The HERO Shaper had a more centred enlargement compared with the ENDOflash.

CONCLUSIONS

Stainless steel rotary ENDOflash instruments did not perform as well as HERO Shaper instruments and created an increased risk of root canal transportation. Nickel-titanium rotary HERO Shaper instruments maintained the original curvature significantly better.

Long-term results of botulinum toxin for the treatment of chronic anal fissure: prospective clinical and manometric study

BACKGROUND

The aim of this prospective trial was to analyse the effectiveness and morbidity of chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up.

METHODS

One hundred consecutive patients with chronic anal fissures were treated by chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter. Clinical and manometric results were recorded.

RESULTS

No major complications were found; initial incontinence at the 2-month review (6%) spontaneously reversed at 6 months. There was a tendency of progressive recurrence over time, with an overall healing after 3 years of 47%. We found a group of patients with clinical (symptoms longer than 12 months and presence of a sentinel pile before treatment) and manometric factors (persistently elevated mean resting pressure, percentage of time with slow waves, and number of patients or percentage of time with ultra slow waves after treatment) associated with a higher recurrence of anal fissures.

CONCLUSION

Since it avoids the greater risk of incontinence associated with surgical sphincterotomy, we recommend the use of botulinum toxin as the first therapeutic approach for patients with chronic anal fissure and risk factors for incontinence; despite the higher rate of recurrence associated with this treatment. In patients with factors related to recurrence, re-injection with higher doses of botulinum toxin or complementary medical-surgical treatment should be considered.

Spin excitations of the spin-polarized electron gas in semimagnetic quantum wells

Collective and single-particle spin-flip excitations of a two-dimensional electron gas in a semimagnetic Cd(1-x)Mn(x)Te quantum well are observed by resonant Raman scattering. Application of a magnetic field splits the spin subbands and a spin polarization is induced in the electron gas. Above 1 T the collective modes, which disperse with the in-plane wave vector, dominate the spectra. The local spin-density approximation provides a good description of our results and enables us to confirm that the energy of the low wave vector collective mode is given by the bare Zeeman energy.

Albendazole sulphoxide enantiomers in pregnant rats' embryo concentrations and developmental toxicity

Three single oral doses (8.5, 10, and 14 mg/kg) of a racemic formulation of albendazole sulphoxide (ABZSO) were administered to pregnant rats on day 10 of gestation. Mother plasma and embryo concentrations of ABZSO enantiomers and albendazole sulphone (ABZSO(2)) were determined 9 h after administration. The (-)-ABZSO enantiomer showed higher peak concentrations in both maternal plasma and embryo than the (+) enantiomer. An increase in embryo concentrations of ABZSO enantiomers and ABZSO(2) was only observed when dose rose to 14 mg/kg. There was an increase in resorption when the dose increased, but significant differences were only found in the higher dose group when compared with the other groups. The incidence of external and skeletal malformations (mostly of the tail, vertebrae and ribs) rose significantly in the 10 mg/kg group, producing almost 20% and 90% of malformed fetuses, respectively, and gross external and skeletal abnormalities in the thoracic region and limbs were also found.

HIV prevention in Latin America: reaching youth in Colombia

The aim of this paper is to describe and evaluate a school-based peer education programme on HIV primary prevention implemented in urban marginal districts of three cities of Colombia from 1997 to 1999. Its main objective was to promote risk awareness and safe sexual behaviours among urban youth populations. Methodology included the collection of baseline information through qualitative methods (focus groups and in-depth interviews), a knowledge, attitudes and practices (KAP) survey, a health education intervention, and post-intervention data collection. Direct beneficiaries were adolescents 10 to 19 years of age, and secondary school teachers of 6th to 9th grades. Main strategies used were peer education and classroom sessions conducted by trained teachers. Short-term results suggest that the programme had a positive effect on knowledge and attitudes related to HIV/AIDS (as the mean knowledge summary indicator among adolescents and secondary school teachers increased 24% and 21%, respectively). The main outcome has been the development of a sex education programme, emphasizing the role of schools in the promotion of sexual and reproductive health. Mass education by a combination of interventions and events at school level, backed up by effective interpersonal communication such as peer education, classroom teaching and community actions are effective primary prevention strategies for HIV sexual transmission and should be more extensively considered.

Flow-independent nitric oxide exchange parameters in healthy adults

Currently accepted techniques utilize the plateau concentration of nitric oxide (NO) at a constant exhalation flow rate to characterize NO exchange, which cannot sufficiently distinguish airway and alveolar sources. Using nonlinear least squares regression and a two-compartment model, we recently described a new technique (Tsoukias et al. J Appl Physiol 91: 477-487, 2001), which utilizes a preexpiratory breath hold followed by a decreasing flow rate maneuver, to estimate three flow-independent NO parameters: maximum flux of NO from the airways (J(NO,max), pl/s), diffusing capacity of NO in the airways (D(NO,air), pl x s(-1) x ppb(-1)), and steady-state alveolar concentration (C(alv,ss), ppb). In healthy adults (n = 10), the optimal breath-hold time was 20 s, and the mean (95% intramaneuver, intrasubject, and intrapopulation confidence interval) J(NO,max), D(NO,air), and C(alv,ss) are 640 (26, 20, and 15%) pl/s, 4.2 (168, 87, and 37%) pl x s(-1) x ppb(-1), and 2.5 (81, 59, and 21%) ppb, respectively. J(NO,max) can be estimated with the greatest certainty, and the variability of all the parameters within the population of healthy adults is significant. There is no correlation between the flow-independent NO parameters and forced vital capacity or the ratio of forced expiratory volume in 1 s to forced vital capacity. With the use of these parameters, the two-compartment model can accurately predict experimentally measured plateau NO concentrations at a constant flow rate. We conclude that this new technique is simple to perform and can simultaneously characterize airway and alveolar NO exchange in healthy adults with the use of a single breathing maneuver.

[Influence of socioeconomic factors on the pesticides poisoning, Brazil]

OBJECTIVE

The indiscriminate use of pesticides has been contributing for the environmental quality degradation, as well as it increases the occupational exposures to these products, determining a serious public health problem in rural areas. The purpose of this study was to evaluate the exposures of rural workers of Rio de Janeiro State to anticholinesterasic pesticides, through the analyses of the acetylcholinesterase from red cells (AChE) and plasmatic butyrilcholinesterase (BChE) levels. Social-economic factors, such as the educational level of these workers, can strongly influence this situation, reason why the impact of some social-economic indicators and practices of pesticides' use in the human contamination status for rural areas were also evaluated.

METHODS

The evaluation of rural workers exposure to pesticides was performed to a random sample of 55 workers among the 300 inhabitants of the study area - five communities of Magé county, RJ. The AChE and BChE activities were determined to these workers. The enzymatic activities were evaluated according to the Ellman's method modified by Oliveira-Silva. Social-economic and pesticides use data were collected by a structured interview. The possible role of social-economic and pesticide use indicators as determinants of the worker's contamination was estimated by multivariate statistic techniques, using the enzymatic activity as the dependent variable and the social-economics pesticides use indicators as independent variables.

RESULTS AND CONCLUSIONS

The data showed distinct results concerning the incidence of excessive exposure, according to the enzymatic indicator used. In the studied sample, a result of 3.0 % was found for the BChE values, and 41.8 %, according to AChE. Individuals with at least one positive enzymatic indicator result were considered as "intoxicated". When these data were compared to the social-economic and pesticides use factors, it was showed the importance of educational level in the prevalence of intoxication. The others indicators studied did not showed any significant and evident correlation.

The Golgi complex is a microtubule-organizing organelle

We show that the Golgi complex can directly stimulate microtubule nucleation in vivo and in vitro and thus behaves as a potent microtubule-organizing organelle in interphase cells. With the use of nocodazole wash-out experiments in hepatic cells, we found that the occurrence of noncentrosomal, early stabilized microtubules is highly correlated with the subcellular localization of Golgi membranes. With the use of in vitro reconstituted microtubule assembly systems with or without cytosol, we also found that, in contrast to centrosomally attached microtubules, the distal ends of Golgi-attached microtubules are remotely stabilized in a way that requires additional cytosolic component(s). Finally, we demonstrate that Golgi-based microtubule nucleation is direct and involves a subset of gamma-tubulin bound to the cytoplasmic face of the organelle.

Effects of unfractionated and low molecular weight heparins on plasma levels of hemostatic factors in patients with acute coronary syndromes

BACKGROUND AND OBJECTIVES

Unfractionated heparin (UFH) and enoxaparin (low molecular weight heparin) constitute fundamental therapies in the treatment of patients with acute coronary syndrome (ACS). Since enoxaparin appears to offer clinical advantages over UFH in managing ACS, markers of thrombin generation, endothelial function and acute phase response could manifest different responses to UFH or enoxaparin. The purpose of the present study was to investigate the effect that treatment with either UFH or enoxaparin has on plasma hemostatic markers in 24 patients with ACS.

DESIGN AND METHODS

The patients were randomized to receive 5,000 IU intravenous bolus and continuous infusion of 18 IU/Kg/h UFH (n=11) or 1 mg/kg/12h subcutaneous enoxaparin (n=13). The plasma levels of fibrinogen (Fg), prothrombin fragment 1+2 (F1+2), thrombin antithrombin complex (TAT), von Willebrand factor (vWF), tissue factor (TF) and tissue factor pathway inhibitor (TFPI) were assayed at admission and 6, 12, 24 and 48 hours after heparin treatment.

RESULTS

Upon admission, UFH and enoxaparin patients showed a significant increase in all the hemostatic parameters measured with respect to the levels in the control subjects. In comparison with the baseline levels of the UFH- and enoxaparin-treated patients, Fg showed a significant increase at 48 h and TFPI at 6, 12 and 24 hours. However, at 48 hours TFPI levels were not significantly higher than the basal values. There were no significant changes in F1+2, TAT, vWF or TF.

INTERPRETATION AND CONCLUSIONS

Markers of thrombin generation, endothelial function and acute-phase reactants manifest a similar response to UFH and enoxaparin. An increase in thrombin generation may be a result of persistently activated inflammatory and endothelial processes, despite UFH and enoxaparin treatment.