Psychological distress and substance abuse in Jamaican youths living with HIV/AIDS / Distrés psicológico y abuso de sustancias en los jóvenes jamaicanos con VIH/SIDA

OBJECTIVE: Current epidemiological research indicates that HIV/AIDS endures and continues to be a significant vulnerability among adolescents and youths despite the increased access to antiretroviral drugs and the reduction in the global progression of the disease. This study examined the association between substance use and psychological distress within the Jamaican population of youths coping with the illness. METHOD: This is a cross-sectional survey that utilized a correlational design. The sample population consisted of 62 youths, age range 15-25 years, living with HIV/AIDS. Sociodemographic information was gathered through interviews and self-report scales were used to measure depression, anxiety, stress and substance use. Chi-square was used to assess the relationship between the variables under study: psychological distress and substance use. RESULTS: More than half the sample were heterosexuals who contracted the virus through consensual intercourse. The average age of respondents was 21.29 years and slightly more than half were female (56.5%). The majority of respondents were single (54.8%), unemployed (73%), heterosexual (69.4%) youths with a secondary level education (63%). There was a statistically significant relationship between psychological distress and substance use (χ2 = 7.3959, df = 3, p = 0.047). CONCLUSION: The emotional needs of youths living with HIV/AIDS are just as important as their medical needs.

OBJETIVO: La investigación epidemiológica actual indica que el VIH/SIDA perdura y sigue siendo un aspecto de vulnerabilidad significativa entre los adolescentes y jóvenes, a pesar del aumento del acceso a medicamentos antirretrovirales y la reducción de la progresión global de la enfermedad. Este estudio examinó la asociación entre el uso de sustancias y el distrés psicológico dentro de la población jamaicana de jóvenes que luchan con la enfermedad. MÉTODO: Este es un estudio transversal que utilizó un diseño correlacional. La muestra poblacional consistió de 62 jóvenes, años rango 15-25 años viven con el VIH/SIDA. Se recogió información sociodemográfica a través de entrevistas y se usaron escalas de autoreporte para medir la depresión, la ansiedad, el estrés, y el uso de sustancias. El chi-cuadrado fue utilizado para evaluar la relación entre las variables objeto de estudio: el distrés psicológico y el uso de sustancias. RESULTADOS: Más de la mitad de la muestra estuvo formada por heterosexuales que contrajeron el virus a través de relaciones sexuales consensuales. La edad promedio de los encuestados fue 21.29 años, y poco más de la mitad eran mujeres (56.5%). La mayoría de los encuestados eran solteros (54.8%), desempleados (73%), jóvenes heterosexuales (69.4%) con una educación de nivel secundario (63%). Hubo una relación estadísticamente significativa entre el distrés psicológico y el uso de sustancias (χ2 = 7.3959, df = 3, p = 0.047). CONCLUSIÓN: Las necesidades emocionales de los jóvenes que viven con el VIH/SIDA son tan importantes como sus necesidades médicas.

Umbilical hernia in adults: day case local anaesthetic repair.

INTRODUCTION: The waiting times for elective surgery of Umbilical hernia (UH) in adults are unacceptably long in some cases. During this period, irreducibility and strangulation are possible. We operate on adult patients under local anaesthesia (LA) as day cases to avoid this delay and describe our experience in this paper. AIMS: The aims of our study were to look at the age and sex distribution, body weight, type and amount of local anaesthetic used, morbidity, admission and readmission rates, and waiting times of adult patients operated on for UH under LA. MATERIALS AND METHODS: It was a retrospective study covering a 4 year period from July 1996 to June 2000 including all adult patients undergoing the above procedure under the care of a single consultant general surgeon. A standard Mayo repair using non absorbable material was used without a mesh or a drain. RESULTS: 32 patients with UH were operated on under LA, 23 males and 9 females with a median age of 51 years (range 20 to 86 years). The body weight ranged from 63 to 120 (median 87) kg. The average duration of the procedure was 30 (range 22-40) minutes. Sedation was needed in 4 patients. Two patients developed wound infections, one superficial and one deep. There was no mortality. The median period of follow-up was 24 (range 4-48) months and there was no recurrence. The median waiting time for the operation was 6 weeks. CONCLUSIONS: Day case local anaesthetic repair of UH in adults seems to be safe and feasible with an acceptable morbidity. Suture repair in the right patient has excellent results and the waiting times are acceptable.

Leprosy neuropathy: correlation of clinical and electrophysiological tests.

This report describes the neurological and electrophysiological examination of 35 subjects with leprosy (average duration of symptoms 3.4 years, average time since diagnosis 7.5 months). Clinical examination in the distribution of non-dominant median and ulnar nerves was performed with the following clinical methods: touch sensation with 0.05 gm. Monofilament nylon, thermal sensation with a thermal sensitivity testing device, voluntary muscle testing and nerve palpation. At least one abnormality was found in 22 ulnar and 13 median nerves (63% and 37%, respectively). Nerve palpation was the most frequent clinical abnormality, while the other methods had similar frequencies of abnormality. Electrophysiological studies were performed on the ipsilateral side of the leprosy subjects and on 32 age-matched normal subjects. Electrophysiological responses from the leprosy subjects were evaluated by criteria established from normal subject data. Abnormal or absent responses were found in 21/35 ulnar sensory, 12/35 ulnar motor, 9/35 median sensory and 6/35 median motor responses among the leprosy subjects. The most important electrodiagnostic findings were: (i) low sensory amplitudes and (ii) drops in amplitude and NCV over the across-elbow segment of the ulnar nerve. Both clinical and nerve conduction abnormalities were positively associated with duration of leprosy symptoms. The four clinical methods were compared for concordance with nerve conduction data by cross-tabulation. The two sensory measures, monofilaments and the thermal sensitivity device, had the highest concordances. Usefulness of clinical tests for nerve damage in leprosy may vary depending on whether the purpose is for diagnosis, patient education or clinical follow-up.

An evaluation of the probe hydridization method for large scale population studies of HIV-1 strain variation in Uganda

A strategy was developed for a long-term; large scale study of HIV-1 genetic variation in Uganda. Our approach was based on the premisethat DNA sequencing is costly and time consiming with respect to screening largenumbers of specimens. We adopted a dot-blod hybridization method using oligonucleotide probes specific for HIV-1 subtypes A and D in the envC2V3 region to screen for HIV-1 subtypes in Uganda. Specicimens which could not be subtyped in this way were sequenced directly. Genomic DNA from 72 HIV-1 seropositive subjects were amplified by PCR in the envC2V3 region. The results of dot-blot hybridization indicated that 40 were subtype A and 29 were subtype D. The remaining three specimens could not be typed due to either non-binding to probes of both subtypes or non specific binding. Hybdridization results were compared with results obtained by sequence phylogenetic analysis. Sequences were generated from 50 DNA specimens and analysis in the C2V3 region showed that 29 were subtype A and 21 were subtype D. Sequences were also generated from the immuno-dominant env gp41 region (384bp fragment) from specimens for which C2V3 sequences were not available. Phylogenetic analysis of these sequences indicated that 8 were subtype A and 8 were subtype D. Regardless of the region of the HIV genome under study sequence data fully supports the subtype assignment derived from hybridization data. Our findings suggest that probe hybridization using A and D subtype specific probes will be effective for large scale screening og the HIV-infected populationin Uganda. Application of this method should lead to significant savings in cost and time for large; population-based investigations

An evaluation of the probe hydridization method for large scale population studies of HIV-1 strain variation in Uganda

A strategy was developed for a long-term; large scale study of HIV-1 genetic variation in Uganda. Our approach was based on the premisethat DNA sequencing is costly and time consiming with respect to screening largenumbers of specimens. We adopted a dot-blod hybridization method using oligonucleotide probes specific for HIV-1 subtypes A and D in the envC2V3 region to screen for HIV-1 subtypes in Uganda. Specicimens which could not be subtyped in this way were sequenced directly. Genomic DNA from 72 HIV-1 seropositive subjects were amplified by PCR in the envC2V3 region. The results of dot-blot hybridization indicated that 40 were subtype A and 29 were subtype D. The remaining three specimens could not be typed due to either non-binding to probes of both subtypes or non specific binding. Hybdridization results were compared with results obtained by sequence phylogenetic analysis. Sequences were generated from 50 DNA specimens and analysis in the C2V3 region showed that 29 were subtype A and 21 were subtype D. Sequences were also generated from the immuno-dominant env gp41 region (384bp fragment) from specimens for which C2V3 sequences were not available. Phylogenetic analysis of these sequences indicated that 8 were subtype A and 8 were subtype D. Regardless of the region of the HIV genome under study sequence data fully supports the subtype assignment derived from hybridization data. Our findings suggest that probe hybridization using A and D subtype specific probes will be effective for large scale screening og the HIV-infected populationin Uganda. Application of this method should lead to significant savings in cost and time for large; population-based investigations