Perspectives on HIV self-testing among key and affected populations in Kenya

Background: Kenya's Key and Affected Populations (KAP) ­ men who have sex with men (MSM), female sex workers, peoplewho inject drugs (PWID), and young women aged 18-24 ­ often experience stigma and discrimination in Kenyan health care settings due to their identity and/or behaviors, which can deter facility-based testing for HIV. Kenya has promoted self-testing as a means to reach these communities. Objectives: To identify KAP perspectives on self-testing and place our findings within Kenya's human rights and legal context. Methods: We conducted 4 focus group discussions (FGD) and 16 in-depth interviews (IDI). One FGD was conducted with each of the following communities: MSM, female sex workers, PWID, and young women aged 18-24. 1-4 IDI were conducted with each KAP community, and 1-3 IDI were conducted with health professionals working on HIV care in each study site. The semi-structured question guideline included one question soliciting opinions on self-testing. Results: KAP support self-testing in concept, however prevailing concerns among participants included access to pre- and posttest counseling services, as well as risk for harms (self-inflicted and otherwise) that might result from a positive result. Conclusion: Kenya should ensure that human rights are promoted and respected through implementing rights-based policies and practices for HIV self-testing, including pre- and post-test counseling.

Clinical profile and outcome of adult COVID-19- related consults at the University of the Philippines - Philippine General Hospital Emergency Department

@#Background. Scarcity of early local clinical data of COVID-19 proved to be a major challenge as its course rapidly evolved over time. The information gathered from this study can be used in improving awareness and understanding a novel disease particularly in detecting demographic trends, vulnerable clinical profiles and potential clusters in order to be abreast on how the virus behaves in the local setting. Objectives. 1) To describe the clinical profile of COVID-19 adult consults at the University of the Philippines- Philippine General Hospital (UP-PGH) during the early months of the outbreak 2) To determine their association with the COVID-19 results and final outcome Methods. A retrospective medical record review was done on COVID-19-related consults of patients aged 19 years and above from 01 January to 30 June 2020 at the emergency department (ED). Statistical analyses were done using Chi-squared and Fisher’s exact test using STATA V15.1 with 95% level of significance (p<0.05). Results. The median age of the 901 COVID-19-related consults at the ED was 46 years; 55.49% were males mostly belonging to the age group below 60 years. Almost all were Filipinos (99.44%), majority residing in the city of Manila (64.93%) and only 2.22% had a history of travel outside the country. The most common chief complaint was fever (32.47%) followed by cough (27.58%) and shortness of breath (25.75%). Most had their onset of symptoms from 1-7 days (79.80%) before ED arrival and 86.07% (n=210) were COVID-positive after performing the confirmatory test. Patients with confirmed COVID-19 mostly resided in cities of the National Capital Region (p=0.046), either presented with fever or asymptomatic but with exposure to COVID patients (Fisher’s Exact test; p<0.001) and onset of symptoms was 4-5 days (p=0.007). Those identified with poor prognosis were those aged 60 years and older (p<0.001), with complaint of shortness of breath (Fisher’s exact test; p<0.001) and with delayed symptom presentation of 6 days or more (p=0.037). Conclusion. The COVID-19-related consults at UP-PGH during the first 6 months of the pandemic were mostly males, Filipinos, belonging to the less than 60 years age group (median age=46 years), residing in the city of Manila and no history of travel outside the country. The most common presenting complaint was fever and onset of symptoms was typically 1-7 days before ED arrival. The positive RT-PCR result was significantly associated to patients residing in Metro Manila, either presenting with fever or no symptoms but with exposure to COVID patients, and with onset of symptoms of 4-5 days. Older age (60 years old and above), shortness of breath and delayed symptom presentation of 6 days of more were also found to have significant association with poor prognosis. As not much is known of the behavior and course of COVID-19 particularly at the local setting, it is therefore crucial to be aware of emerging trends to respond adequately and achieve optimal outcomes.

Clinical practice guidelines on the diagnosis and treatment of gastroesophageal reflux disease (GERD)

In the last two decades gastroesophageal reflux disease (GERD), initially thought to be a disease only common  in the West, is described  increasingly in Asia, including the Philippines. A recent local report indicated that the prevalence of erosive esophagitis (EE), a common complication of GERD, has more than doubled, i.e., 2.9% to  6.3%,  between the two time periods of 1994-1997 and 2000-2003, respectively. GERD causes recurrent annoying symptoms which are common  reasons  for  clinic  visits  and consultations thus, it is the objective of these guidelines to provide both primary care physicians  (PCPs) and specialists a current, evidence-based, country-specific recommendations for the optimal management  of  GERD.  These  guidelines  are  intended   to   empower   PCPs   to   make   a   clinic-based diagnosis of GERD, to start an empiric acid-suppressive therapy in the appropriate patient,and direct them to select which GERD patient may need to undergo investigations to ascertain further the diagnosis of GERD or to assess outcomes of therapy. We acknowledge that studies published in the future may influence the impact on our confidence on the recommendations enumerated in  these guidelines thus, we commit to update this document when it is deemed appropriate.

Cambios en la ocupación de los adultos mayores reciéntemente jubilados / Influence of retirement on the occupation of recently retired elders

El presente estudio tiene como objetivo comprender cómo el proceso de jubilación influye en el desempeño ocupacional de los adultos mayores recientemente jubilados. Para ello, se indaga sobre conceptos relacionados con la jubilación y cómo se entiende ésta desde las distintas disciplinas. A su vez, es necesario comprender el concepto de ocupación para poder asociar el desempeño ocupacional que adoptan los jubilados en las diversas áreas de desempeño (Actividades de la Vida Diaria, Productividad y Esparcimiento) desde el enfoque del Modelo de Ocupación Humana. Para identificar esta correlación fueron efectuadas entrevistas en profundidad a participantes de ambos sexos, que tuvieran como máximo tres años de retiro laboral. Las entrevistas fueron diseñadas utilizando un instrumento de evaluación creado a partir del OPHI-II. Los resultados obtenidos permiten observar que el proceso de jubilación no provocaría un desequilibrio ocupacional y que estos individuos lograrían adaptarse a dicho proceso, creando una nueva estructura en sus vidas y permitiéndoles alcanzar el nivel de competencia en las distintas ocupaciones en las que se involucran.

The objective of the present study is to understand how the retirement process influences the occupational performance of the recently retired elders. To achieve this, retirement related concepts are studied and analysed from the point of view of different disciplines. The comprehension of the “occupation” concept is also needed, to be able to associate the occupational performance that retired elders adopt in different areas (Activities of Daily Living, Productivity and Play Activities) with the approach given by the Model of Human Occupation. To be able to identify this relation, several interviews were done to participants of both sexes and that were retired for no more than three years. The interviews were designed using an evaluation instrument created from the OPHI-II. The results of this study show that the retirement process does not cause an occupational unbalance, and that these individuals are able to adapt to the process, creating a new structure in their lives and allowing them to reach a competent level in the different occupations in which they are involved.

Conjugation by mosquito pathogenic strains of Bacillus sphaericus

A mosquito pathogenic strain of Bacillus sphaericus carried out the conjugal transfer of plasmid pAMß1 to other strains of its own and two other serotypes. However, it was unable to conjugate with mosquito pathogens from three serotypes, with B. sphaericus of other DNA homology groups or with three other species of Bacillus. Conjugation frequency was highest with a strain having an altered surface layer (S layer). Cojugal transfer of pAMß1 was not detected in mosquito larval cadavers. B. sphaericus 2362 was unable to imobilize pUB110 for transfer to strains that had served as recipients of pAMß1. These observations suggest that it is unlikely that genetically engineered B. sphaericus carrying a recombinant plasmid could pass that plamid to other bacteria.

Bacillus sphaericus mosquito pathogens in the aquatic environment

The fate of Bacillus sphaericus spores in the aquatic environment was investigated by suspending spores in dialysis bags in fresh and seawater. Spore viability was lost more rapidly in seawater. Neither B. sphaericus nor B. thuringiensis israelensis (B.t.i.) spores mixed with pond sediment appeared to attach to the sediment. However, rapid decrease in B.t.i. toxicity suggested attachment of parasporal bodies to sediment. B. sphaericus toxin settled more slowly and less completely. B. sphaericus spores fed to larvae of four aquatic invertebrates were mostly eliminated from the animal gut in less than one week. An exception was the cranefly (Tipula abdominalis) where spores persisted in the posterior gut for up to five weeks.

Un índice clínico simple para evaluar la Enfermedad de Crohn Perianal

Se evalúa la efectividad de un nuevo índice en la predicción de resultados quirúrgicos en el CROHN perianal. Fueron estudiados cuarenta pacientes con Crohn perianal y 14 de otra etiología com grupo control. En el índice se evaluaron 7 parámetros: dolor perianal, prurito, trastorno de locomoción, actividad social y sexual, actividad de la enfermedad, dolor al defecar e incontinencia y función esfinteriana. A cada parámetro se le dio puntaje de 1 a 10 de acuerdo con su severidad y el puntaje fue llenado antes y después del tratamiento por el mismo pacientes. Los pacientes de ambos tipos de patologías agruparon de acuerdo con el tratamiento recibido. El mayor grupo fue el de drenaje de abscesos. Al analizar cada parámetro individualmente, hubo significado estadístico en todos menos en la actividad social y sexual. El análisis de tods los parámetros en conjunto mostró significado estadístico en ambos grupos de pacientes (p<0.001 y p<0.01). Tomando separademente los parámetros de actividad y los parámetros de función esfinteriana, los resultados fueron similares en ambos grupos (p<0.001 y p<0.01 respectivamente). Tres pacientes con enfermedad de Crohn perianal se manejaron médicamente. El numero fue insuficiente para valorar el índice

Enfermedad de Crohn: un criterio para resección

Los pacientes con enfermedad de Crohn usualmente tienen estrecheces intestinales de varios grados de severidad, pero no se sabe con certeza el diámetro mínimo al cual dichas estrecheces causan cambios en la presion intraluminal y en el flujo. El propósito de este trabajo fue el de examinar la relación existente entre el diámetro de la estrechez y la presión intraluminal, para así determinar cuales estrecheces requieren intervención quirúrgica. En un modelo experimental, segmentos de intestino humano fueron perfundidos con soluciones problema de diferente viscosidad (sol. salina, aceite de autos), y la presión intraluminal fue medida utilizando un transductor con un sistema de amplificador-impresora. Estrecheces de diámetro conocido fueron construidas a lo largo del segmento intestinal y los cambios en la presión intraluminal y el flujo se obtuvieron y analizaron. Cuando el diametro de la estrechez fue menor de 0.6 cms, hubo un aumento significativo de la presión desde una basal de 7.3 cms de H2O hasta una presion media de 13 cms de H2O (x²=p0.01)y esto se acompaño de una caida en el flujo intraluminal de 1.4 ml/min. a 0.9 ml/min (x²=p.0.05). Al utilizar la solución de mayor viscosidad, el diámetro crítico en el cual se produjeron cambios significativos de flujo/presión, fue por debajo de 0.95 cms. Estrecheces con diámetros menores a este, requieren dilatación y tratamiento quirúrgico para prevenir obstrucción. Los cambios en la viscosidad y el contenido intraluminal, alteran este equilibrio