Lifetime measurement of the first excited 5/2+ state in 133Cs using NaI(Tl) and LaBr3(Ce) detectors.

We report a new high-precision lifetime measurement of the first excited 5/2+ state of 133Cs using NaI(Tl) and LaBr3(Ce) detectors. The time difference between the coincident decays of two successive states was measured using fast-timing electronics. The 356-keV (1/2+→5/2+) gamma transition was tagged by the successive 81-keV (5/2+→7/2+) transition of 133Cs. The half-life of the first excited 5/2+133Cs state was measured as T1/2=6.283±0.004 (stat.) ±0.011(syst.) ns.

Factors affecting tuberculosis health message recall 2 years after active case finding in Blantyre, Malawi.

SETTING: Urban slums, Blantyre, Malawi. OBJECTIVE: To explore tuberculosis (TB) community-wide active case finding (cwACF) recall and accompanying messaging 2 years after the intervention. DESIGN: This mixed-methods study used population-weighted random cluster sampling to select three cwACF-receiving and three non-cwACF-receiving neighbourhoods in Blantyre. Qualitative data were collected using 12 focus group discussions (community peer-group members) and five in-depth interviews (TB officers) with script guides based on the concepts of the Health Belief Model (HBM). Thematic analysis was used to explore transcripts employing deductive coding. Questionnaires completed by focus group participants were used to collect quantitative data, providing a 'knowledge score' evaluated through univariate/multivariate analysis, analysis of variance and multiple linear regression. RESULTS: Community peer-group participants (n = 118) retained high awareness and positive opinions of cwACF and recognised the relationship between early diagnosis and reduced transmission, considering cwACF to have prompted subsequent health-seeking behaviour. TB-affected individuals (personal/family: 47.5%) had significantly higher knowledge scores than unaffected individuals (P = 0.039), but only if resident in cwACF-receiving neighbourhoods (P = 0.005 vs. P = 0.582), implying effect modification between exposures, albeit statistically under-powered (P = 0.229). CONCLUSION: Consistent with epidemiological evidence and HBM theory, cwACF may have a permanent impact on knowledge and behaviour, particularly in communities with a high prevalence of TB-affected individuals. Behaviour change strategies should be explicitly included in cwACF planning and evaluation.

TB and HIV stigma compounded by threatened masculinity: implications for TB health-care seeking in Malawi.

SETTING: Urban Blantyre, Malawi. OBJECTIVE: To understand why men with tuberculosis (TB) in the community remain undiagnosed. DESIGN: A multi-method qualitative study applying a modified grounded theory approach. Data were gathered from March 2011 to March 2012 from 134 men and women taking part in 1) focus group discussions with community members (n = 6) and health care workers (n = 2), and 2) in-depth interviews with TB patients (n = 20, females n = 14) and chronic coughers (n = 20, women n = 8). Data were analysed inductively to identify, refine and consolidate, and verify emerging concepts and themes. RESULTS: Two emerging themes highlighting compound stigma in this high human immunodeficiency virus (HIV) prevalence, low-income setting are presented. First, cough or any illness that portended a 'serious' condition were accompanied by portrayals of cough, TB and HIV as being interchangeable. Chronic coughers and TB patients described their illness in ways that foregrounded bodily decimation and rupture of social life and masculine identity. Second, 'resistance strategies' entailed resisting classification as (seriously) ill by evading or ambivalently approaching health care, or acknowledging the 'ill' status then actively pursuing health-appropriate behaviours, including changing lifestyle or adopting non-normative gender roles. CONCLUSIONS: Managing patients requires 1) going beyond syndromic management based on vital signs and clinical indicators to recognising and intervening on health care-seeking related tensions to retain individuals in care, and 2) understanding and addressing TB stigma as it manifests and affects men and women differently in specific settings.

The second sputum sample complicates tuberculosis diagnosis for women: a qualitative study from Malawi.

SETTING: District hospital and peripheral health care facilities in Balaka District, Malawi. OBJECTIVE: To identify barriers encountered by women in submitting a second sputum sample. DESIGN: Focus-group discussions and semi-structured interviews. RESULTS: Women encounter barriers at several levels: personal, cultural, socio-economic and health care system. Personal, cultural and socio-economic barriers include the fear of a tuberculosis (TB) diagnosis, the perception and condition of the patient, the distance and cost of travel to a health care facility, the subordinate position of women in household decision-making and the social support that women receive. Barriers at the health care system level include high patient numbers, staff shortages, the duration of the TB diagnostic process as well as the uncaring attitude and poor communication of health care workers. These barriers may apply not only to the submission of the second sample, but to health care access in general. CONCLUSION: Women face multiple barriers in submitting a second sputum sample. These do not operate in isolation but instead compound each other. Although potential solutions to overcome these barriers are recognised, some have yet to be adopted. To improve TB case finding, innovative and community approaches should be adopted more rapidly.

Reasons for accepting or refusing HIV services among tuberculosis patients at a TB-HIV integration clinic in Malawi.

SETTING: In Malawi, human immunodeficiency virus (HIV) prevalence among newly registered tuberculosis (TB) patients is 60-70%. In 2008, an integrated TBHIV clinic was established at a central hospital in Zomba. Despite the integration of TB-HIV activities and improved HIV service uptake, unacceptably high proportions of HIV-positive TB patients are still not receiving antiretroviral therapy (ART). OBJECTIVE: To identify factors that motivate or discourage TB patients from accepting HIV services. DESIGN: Retrospective analysis of patients registered for TB treatment (not yet on ART) between April 2008 and March 2009; qualitative interviews of 99 patients on TB treatment. RESULTS: Of 1773 newly registered TB patients who were not already on ART at the time of TB registration, 86% accepted HIV testing and counselling. Among HIV-positive TB patients, 38% started ART during or after anti-tuberculosis treatment. Young adults aged 15- 24 years were least likely to initiate ART. Motivation for accepting ART during TB treatment included prospects of regaining good health and longer life, and counselling by health care providers. Barriers to ART uptake included not being offered ART, high CD4 count, drug stockouts and fear of drug toxicities/interactions. CONCLUSION: Several factors that undermine uptake of ART have been highlighted; targeted measures urgently need to be addressed by TB-HIV programmes to overcome these barriers.

A rare potentially treatable cause of bilateral optic disc swelling.

Rapid onset bilateral optic disc swelling generally indicates an intracranial problem-that is, papilloedema. However, when there is also visual loss, disease affecting the optic nerves themselves must be considered. We present the diagnostic problem of a patient with optic disc swelling and progressive visual loss. Investigations finally revealed hypocalcaemia secondary to primary hypoparathyroidism. With treatment a marked improvement in vision occurred. This reversible rare cause of optic disc swelling should not be forgotten.

Prevalence of hepatitis C infection in Malawi and lack of association with sexually transmitted diseases.

To investigate the role of sexual transmission for Hepatitis C virus (HCV) we studied its prevalence in sub-Saharan Africa where sexually transmitted diseases (STDs) are prevalent. Overall, HCV prevalence was 3.9% and similar in 206 STD patients, 127 dermatology patients, and 100 blood donors. No association with HIV or syphilis was observed. Despite high prevalence of STDs, sexual transmission does not appear to significantly contribute to HCV transmission in Malawi.

The use of a channel-cleaning brush for malfunctioning Tenckhoff catheters.

BACKGROUND: Tenckhoff catheter malfunction causes morbidity in some patients on continuous ambulatory peritoneal dialysis (CAPD). Various methods of treatment of malfunction have been described; we report our experience of the use of a channel-cleaning brush for this problem. METHOD: Ten patients on CAPD who developed catheter malfunction were identified. The causes of malfunction were catheter migration in one patient, catheter obstruction due to fibrin and clots in six, probable omental wrapping in one, and pain on draining of PD fluid in two patients. A channel-cleaning brush was manipulated repeatedly in and out of the catheters using aseptic technique and fluoroscopy guidance in an attempt to restore patency or dislodge the catheter to another site. RESULTS: CAPD was successfully re-established after this procedure in eight patients (80%), two catheters were removed from those patients in whom the use of the brush was unsuccessful. CONCLUSION: In this study a channel-cleaning brush was effective and safe in the treatment of Tenckhoff catheter malfunction.

Questionnaire study and audit of use of angiotensin converting enzyme inhibitor and monitoring in general practice: the need for guidelines to prevent renal failure.

OBJECTIVES: To determine the current pattern of use of angiotensin converting enzyme inhibitor and monitoring of renal function in general practice and to audit all admissions to a regional renal unit for uraemia related to use of these drugs. DESIGN: Postal questionnaire sent to 400 general practitioners; audit of clinical notes of all patients receiving these drugs in one large general practice; audit of all cases of uraemia (creatinine concentration >500 micromol/l) related to treatment presenting to hospital renal services over 12 months. SETTING: General practices in the North Wales health authority and one in central Manchester. Regional renal unit in Salford. MAIN OUTCOME MEASURES: Proportion of general practitioners who regularly monitored renal function before and after initiation of angiotensin converting enzyme inhibitors. Indications for treatment and details of monitoring of renal function in patients receiving these drugs. Incidence of related uraemia and evidence of comorbid disease, other aetiological factors, delayed detection, and patient outcome. RESULTS: 277 (69%) general practitioners replied; 235 (85%) checked renal function before but only 93 (34%) after the start of treatment, and 42 (15%) never checked renal function. Angiotensin converting enzyme inhibitors were prescribed for 162 patients from a total of 3625 aged >35 years (mean age 66.4 (SD 15.9) years). Monitoring of renal function occurred before treatment in 55 (45%) and after start of treatment in 35 (29%) of the 122 patients treated in general practice. Angiotensin converting enzyme inhibitors could be causally implicated in 9 (7%) of 135 admissions for uraemia (mean age 74.2 (7. 2) v 62.1 (2.1) years; P<0.01). 3 patients had renovascular disease and 6 had congestive cardiac failure with another intercurrent illness. Renal function had not been checked in any patient after the start of treatment; mean duration of illness before admission was 10.5 (3.2) days. Mean length of hospital stay was 20.9 (10.4) days; there were 8 survivors. CONCLUSION: Cases of uraemia related to treatment with angiotensin converting enzyme inhibitors are still encountered and are often detected late because of lack of judicious monitoring of renal function in vulnerable, often elderly, patients, especially at times of intercurrent illness. Guidelines for appropriate monitoring of renal function may help to minimise the problem.

Two different techniques and outcomes for insertion of long-term tunnelled haemodialysis catheters.

BACKGROUND: Renal Units employ different techniques for insertion of long-term haemodialysis catheters into jugular veins, and we decided to ascertain the success rate and peri-insertion complications of two percutaneous methods in a District General Hospital. METHODS: Results of venous cannulation from two studies using different techniques were obtained and compared. Both studies were prospective and the procedures were performed by the same Clinician in patients with end stage renal failure. Patients were divided into two groups. Group A had venous catheters inserted under ultrasonographic guidance using a Site Rite portable machine and Group B were inserted 'blind'. The aseptic percutaneous Seldinger technique was used for catheterizations in both groups. RESULTS: The first attempt/pass venous cannulation success rate was 88.6% in Group A compared to 61.4% in Group B. Complications rate was significantly lower in Group A (P = 0.0048) than in Group B. CONCLUSION: In this study the ultrasonographic guided technique was better than the blind technique in jugular venous cannulations.

Survey of permanent central venous catheters for haemodialysis in the UK.

BACKGROUND: Venous catheter haemodialysis may be necessary in some patients without arterio venous fistulae on dialysis for end-stage renal failure. We conducted a survey to compare management of these catheters in different units in the UK. METHODS: Postal questionnaires were sent to nurses in charge of 81 renal units in the UK for a twelve month study period in 1994 to find out the type of catheter used, catheter after insertion care, the rate and management of exit site infections, and bacteraemia. RESULTS: (1) Total number of questionnaires returned 66 (81.5%). (2) 63.6% of renal units used double lumen Permcath catheters, 16.7% single lumen (Francis/Kimal, Gambro or Vascath), 10.6% use both double and single lumen catheters and 9.1% of renal units only use temporary polyurethane catheters. (3) Catheter exit site aseptic dressing technique was used in 84.8% of renal units, clean technique in 15.2%. 66.8% change dressings at each dialysis session, 22.7% weekly. The majority of renal units (63.6%) had one nurse to change the dressing, used Betadine as a cleaning agent and Mepore to cover the exit site. (4) 75.8% did not know the exact incidence of episodes of sepsis and/or exit site infections. Flucloxacillin was the antibiotic of choice for each catheter related sepsis episode. CONCLUSION: During this study period most renal units used Permcaths as first choice for long term catheter dialysis, the after insertion care of which varied. The number of episodes of sepsis was unknown. We suggest UK collection of data for all long term catheters and related problems for audit purposes.

Schistosomiasis control programme: ten year plan of action 1991-2000

This ten year plan aims at reducing the schistosomiasis problem through a cost-effective delivery system for diagnosis and treatment; by integrating control activities into existing health services and primary health care [PHC]; and also by raising the awareness of the communities through intensified health education; and training programmes for health workers