Exploring the association between erythema multiforme and HIV infection: some mechanisms and implications.

Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum, histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4 + T cells, it can also directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8 + T cells against epithelial cells. HIV infection may also trigger EM directly when CD8 + T cells recognize viral particles on epithelial cells due to the hyperactivation of CD8 + T-cells. The hyperactivation of CD8 + T cells was similar to that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM has been well established. This includes the administration of other drugs to HIV-infected individuals to manage opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This article highlights the potential direct and indirect role that HIV infection may play in the development of EM and the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity reactions leading to EM.

The burnout construct with reference to healthcare providers: A narrative review.

Burnout syndrome is a psychological response to long-term exposure to occupational stressors. It is characterized by emotional exhaustion, cognitive weariness and physical fatigue, and it may occur in association with any occupation, but is most frequently observed among professionals who work directly with people, particularly in institutional settings. Healthcare professionals who work directly with patients and are frequently exposed to work overload and excessive clinical demands, to ethical dilemmas, to pressing occupational schedules and to managerial challenges; who have to make complex judgements and difficult decisions; and who have relatively little autonomy over their job-related tasks are at risk of developing clinical burnout. In turn, clinical burnout among clinicians has a negative impact on the quality and safety of treatment, and on the overall professional performance of healthcare systems. Healthcare workers with burnout are more likely to make mistakes and to be subjected to medical malpractice claims, than do those who are burnout-naïve. Experiencing the emotional values of autonomy, competence and relatedness are essential work-related psychological needs, which have to be satisfied to promote feelings of self-realization and meaningfulness in relation to work activities, thus reducing burnout risk. Importantly, an autonomy-supportive rather than a controlling style of management decreases burnout risk and promotes self-actualization, self-esteem and a general feeling of well-being in both those in charge and in their subordinates. The purpose of this article is to discuss some of the elements constituting the burnout construct with the view of gaining a better understanding of the complex multifactorial nature of burnout. This may facilitate the development and implementation of both personal, behavioural and organizational interventions to deal with the burnout syndrome and its ramifications.

The diagnostic accuracy of the HIV 1/2/subtype O Tri-line rapid test compared with ELISA: A pilot study.

BACKGROUND: Accurate HIV diagnosis is essential for appropriate patient care. Rapid tests (RTs) are considered key to HIV screening and management. Some studies have found RTs to be comparable with the ELISA test whilst others have reported lower sensitivity. AIM AND STUDY DESIGN: The aim of this retrospective, descriptive study was to evaluate the sensitivity and specificity of the HIV 1/2/O Tri-line rapid test (HIV-TRT) device compared with ELISA. METHOD: The study sample comprised 45 records of patients who tested for HIV using the HIV-TRT device and ELISA. RESULTS: As compared with ELISA as the 100% gold standard, the sensitivity of the HIV-TRT was 80% (CI: 59%-93%) and specificity was 100% (CI: 83%-100%). ROC area of 0.9 at 95% CI was determined. CONCLUSION: The low sensitivity of HIV-TRT is a concern, since HIV screening in South Africa makes use of RTs.

First social impact bond for the SAMRC: A novel financing strategy to address the health and social challenges facing adolescent girls and young women in South Africa.

A social impact bond (SIB) is an innovative financing mechanism to attract investors to social programmes traditionally funded by governments. In this article, in celebration of the 50th anniversary of the South African Medical Research Council (SAMRC), the authors describe the SAMRC's first foray into this new world of financing through a SIB to improve the health and quality of life of adolescent girls and young women (AGYW). The AGYW SIB is in its preparatory phase and is scheduled for implementation in 2020. The authors describe the mechanism, including financial flows and the process of customising the SIB to meet the needs of AGYW, focusing on HIV prevention and treatment and the prevention and management of unintended pregnancies in schoolgoing AGYW. The authors outline an approach to designing the package of interventions, the metrics associated with such a programme and the business model. It is hypothesised that the proposed approach will lead to an improvement in programmatic outcomes, monitoring and evaluation tools and cost-effectiveness, and will develop key learning data for the future use of SIBs in health service delivery.