Response to first line HAART using CD4 cell counts: experience in a University Hospital in Kingston / Respuesta a la terapia TARGA de primera línea usando conteos CD4: experiencia en el Hospital Universitario en Kingston

OBJECTIVES: To assess the extent to which the current practice for first line therapy concurs with the recommended guidelines and to examine the response of treatment naïve patients to first line Highly Active Antiretroviral Therapy (HAART) at the University Hospital of the West Indies, using CD4 cell counts. METHODS: Over a three-month period, a cross-sectional study design was instituted and data were collected on all patients on HAART at the University Hospital ofthe West Indies (UHWI) outpatient HIV clinic. Information was collected by reviewing patient medical records using data collection sheets. The data obtained from the medical records included: age, gender, date of diagnosis of HIV, date at which HAART was commenced, CD4 cell counts prior to the commencement of antiretrovirals, the initial HAART regimes and subsequent CD4 cell counts. RESULTS: A total of 165 persons who met the criteria of being on HAART therapy were enrolled in the study. The average time span between diagnosis of HIV and commencement of antiretroviral therapy was 1.92 years and the range for this was 0 to 12.29 years. The average CD4 count prior to initiation of HAART was 186 cells/mm³. The most common regime used at the UHWI for first line therapy was combivir and efavirenz, n = 78 (47.3%), followed by combivir and nevirapine, n = 29 (17.6%). The average difference between the initial CD4 count prior to the initiation of HAART and first repeated CD4 count was 102 cells/mm³. The mean time between the first and repeated CD4 cell counts was 376 days. CONCLUSION: The recommended guidelines were adhered to for the majority of patients initiated on antiretrovirals at the UHWI. The treatment outcomes achieved at the UHWI were similar to those achieved in developed countries. This gives substantial evidence in support of international efforts to make antiretroviral therapy available in developing countries.

OBJETIVOS: Evaluar hasta que punto la práctica actual de la terapia de primera línea concuerda con las normas recomendadas y examinar la respuesta al tratamiento por parte de los pacientes nunca antes sometidos a la terapia antiretroviral altamente activa, (TARGA) en el Hospital Universitario, usando conteos de células CD4. MÉTODOS: Por un periodo de tres meses, se instituyó un diseno de estudio transversal, y se recogieron datos de todos los pacientes sometidos a TARGA en la clínica de VIH para pacientes externos en el Hospital Universitario de West Indies (UHWI). La información fue obtenida revisando las historias clínicas de todos pacientes, usando hojas de recogida de datos. Los datos obtenidos de las historias clínicas incluían: edad, género, fecha de diagnóstico de VIH, fecha de comienzo de TARGA, conteo de células CD4 antes del comienzo de los antiretrovirales, los regimenes iniciales de TARGA y los subsecuentes conteos de células CD4. RESULTADOS: Un total de 165 personas que satisfacían los criterios de la terapia TARGA fueron enroladas en el estudio. El tiempo promedio que medió entre el diagnóstico de VIHy el comienzo de la terapia antiretroviral fue 1.92 anos, en tanto el rango para esta fue de 0 a 12.29 anos. El conteo promedio de conteo de CD4 antes del comienzo de TARGA fue 186 células/mm3. El régimen más común usado en UHWIpara la terapia de primera línea fue combivir y efavirenz, n = 78 (47.3%), seguido por el combivir y nevirapine, n = 29 (17.6%). La diferencia promedio entre el conteo inicial de CD4 antes del comienzo de TARGA y elprimer conteo repetido de CD4 fue 102 células/mm3. El tiempo promedio entre los primeros conteos CD4 y los repetidos fue 376 días. CONCLUSIÓN: Se siguieron las normas recomendadas en relación con la mayoría de los pacientes iniciados en el tratamiento con antiretrovirales en UHWI. Los resultados del tratamiento logrados en UHWI fueron similares a los logrados en los países desarrollados. Esto ofrece sólidas evidencias en apoyo a los esfuerzos internacionales por poner la terapia antiretroviral a disposición de los países en vías de desarrollo.

Analyse de 315 biopsies malignes dans un hopital rural au Benin

L'Hopital Evangelique de Bembereke (HEB) est un hopital rural de 75 lits au nord du Benin. L'HEB offre aux malades un service de chirurgie generale. Depuis 1975; deux hopitaux en Europe (au Royaume-Uni et Suisse) fournissent un support histopathologique pour les biopsies chirurgicales. Pour cette recherche; les auteurs ont etudie les resultats de toutes les biopsies des tumeurs malignes depuis le commencement de ce service d'anatomo-pathologie

Motor responses of the upper esophageal sphincter and body to intraluminal acid

1.It is known that contraction of the upper esophageal sphincter (UES) and secondary peristalsis protect the airway and clear the esophhagus of refluxed gastric contents. However, the exact nature of the stimulus and the role of acid remain controversial. 2. Secondary peristalsis and UES responses were measured following the intraluminal infusion of 0.1 N hydrochloric acid and equiosmolar NaCl solutions in seven normal volunteers. The protocol consisted of three phases: infusion of increasing volumes (1, 3, 5 and 7 ,l per min), infusion of a given volume (7 ml per min) at different stimulation sites and balloon distension. 3. At the proximal esophagus the UES response to both solutions was similar, rising from a basal resting pressure of 30 mmHg to 70 mmHg for both HCL (range 60-85 mmHg) and NaCl (55-85 mmHg). The magnitude of the response decreased as the distance from the UES increased. The level of response decreased to 40 mmHg for both NaCl and HCl (range 30-60 mmHg) at the distal esophagus. These responses were also volume dependent. When the solutions were infused at 7 ml/min into either the proximal or distal esophagus, the sphincter pressure increased with increased with volume to 65 mmHg for HCL (range 50-85 mmHg) and 60 mmHg for NaCl (range 50-80 mmHg). Secondary peristalsis was also induced by two solutions. The level of response agaim decreased as the distance from UES increased. This response was also volume dependent. Esophageal distension by a balloon positioned 10 cm below the sphincter induced secondary induced secondary peristalsis and sphincter response identical to those induced by the infusion of fluid. 4. These results indicate that the principal stimulus for recruitment of the esophageal motor clearance mechanism is intraluminal distension and not necessarily the pressure of intraluminal acid

A community-based study of gastrointestinal helminth and protozoan infection in Western Jamaica

A study of gastrointestinal parasitic infection was conducted in four communities in the Parish of Westmoreland, Jamica. All blood smears (n=1,025) werw negative and 63,7% of stool specimens (n=696) contained ova/cysts of one or more of 7 helminth and 9 protozoan spcecies. Trichuris and Giardia were the most prevalent species. Prevalence was markedly age-dependent, with infection occuring most commonly in children. It is concluded that gastreointestinal parasitic infections persist at intensity and prevalence levels likely to have a significant impact on community health