Barriers to colorectal cancer screening in Ghana: a qualitative study of patients and physicians.

PURPOSE: The incidence of colorectal cancer (CRC) in Ghana has increased eightfold since the 1960s. In 2011, national guidelines were set forth recommending all patients aged 50-70 years old undergo annual CRC screening with fecal occult blood testing (FOBT), but adherence to these guidelines is poor and screening rates remain low for unclear reasons. METHODS: We performed semi-structured interviews with 28 Ghanaians including physicians (n = 14) and patients (n = 14) from the Komfo Anokye Teaching Hospital in Kumasi, Ghana, to better understand the factors driving screening adherence and perceived barriers identified in an earlier quantitative study. RESULTS: Participants reported sociocultural factors such as reliance on alternative medicine or religion, lack of education, and financial burden as community-level barriers to CRC screening. At the system level, screening was limited by insufficient access to FOBT as well as a perceived lack of national prioritization. This was described as inadequate efforts from the Ministry of Health regarding national education as well as lack of incorporation of CRC screening into the National Health Insurance Scheme. CONCLUSION: Several community- and system-level barriers exist to widespread screening of CRC in Ghana. A multi-level approach will be required to improve rates of CRC screening and ultimately reduce the burden of CRC in Ghana.

[Microglial activation and GFAP astroglial immunopositivity in drug abusers]. / Aktivace mikroglie a GFAP imunopozitivita astroglie u toxikomanu

INTRODUCTION: The neurotoxicity brought about by application of toxic and psychotropic substances is accompanied by an activation of astroglial and microglial cells in the brain. MATERIALS AND METHOD: We investigated clinically 42 patients addicted to psychotropic substances (hospitalised in the Motol Teaching Hospital). The NSE, S1OOB, and manganese concentrations in the blood were measured in the patients. In 14 deceased patients with drug evidence in the hair indicating a chronic abuse of addictive substances, the brain tissue glial cells were immunohistochemically labelled with antibody against CD68 and GFAP. RESULTS: In 8 hospitalised patients, there were increased NSE, S100B values in the blood (p < 0.05). Manganese in the blood was increased (3,03±1,9 µg/l, p < 0,05) in all patients. In deceased persons, the CD68 positivity of microglial cells and neurophagy have been proved. GFAP positive astroglial cells have been evidenced in the gray and white matter. CONCLUSION: The CD68 and GFAP positive glial cells in brain tissue can be a pathomorphological correlate of neurotoxicity in chronic abusers. The neurotoxicity can be monitored with NSE and S100B markers of damaged neuronal cells.

[Viral hepatitis at the beginning of the 21st century--value of liver biopsy in the context of development of new non-invasive diagnostic methods and in relation to the modern therapy of chronic viral hepatitis]. / Virové hepatitidy no zacátku 21. století--význam jaterní biopsie v kontextu rozvoje neinvazivních diagnostických metod a ve vztahu k moderní lécbe chronických virových hepatitid.

The rapid progress in the development of virostatic agents over the past 15 years has changed chronic viral hepatitis from causally incurable diseases to diseases that may be treated or even cured. But, the treatment is a long-term process and it remains very expensive. Therefore, it is important to establish the correct diagnosis with the exact stratification of the disease (in terms of serological findings, regarding the activity of the inflammation and alterations of liver parenchyma) to determine the appropriate treatment schedule. The text includes an overview of histopathological classifications of chronic hepatitis from the clinical perspective; we discuss the contribution of liver biopsy in the era of the development of non-invasive diagnostic methods for determining the degree of alteration of liver parenchyma (elastography in particular). Furthermore, the principles of modern therapy of the most common chronic viral hepatitis (i.e. B and C) are summarized with emphasis on situations where the histopathological examination of liver tissue plays a role in the indication or affects the treatment schedule.

[Infectious diseases in problem drug users hospitalized in the infectious ward of the Motol University Hospital in 2002-2005]. / Infekcní onemocnení problémových uzivatelu drog hospitalizovaných na infekcním oddelení FM Motol v období 2002-2005.

BACKGROUND: To survey infectious diseases in intravenous drug users and to provide basic information on disease course in this subpopulation. MATERIAL AND METHODS: A retrospective study of all inpatient intravenous drug users, from 2002 to 2005. The obtained data were sorted according to the main diagnosis and final results of chronic infections were achieved by outpatient follow-up. RESULTS: Out of 436 cases of intravenous drug users in our group, 44 % (191/436) were patients admitted with acute viral hepatitis, 16 % (67/436) with soft-tissue or skin infections, 7 % (29/436) with respiratory infections, 4 % (18/436) with urogenital infections and 4 % (19/436) with sepsis. Progression to chronic hepatitis B occurred in 3 % (4/125) of cases, fulminant course of acute hepatitis B was observed in 1.6 % (2/125) of cases. Spontaneous clearance of hepatitis C virus was demonstrated in 46 % (11/24) of subjects. The most frequent pathogens responsible for bacterial infections in drug users were Staphylococcus aureus (53 %, 27/51) and Streptococcus pyogenes (22 %, 11/51). In the infectious endocarditis group, right heart valves were affected in 78 % (7/9), left heart valves in 11 % (1/9) and bilateral lesions were seen in 11 % (1/9) of cases. Two (22 %, 2/9) endocarditis patients died (one with tricuspid and the other with aortic valve involvement). Patients with the main diagnosis other than hepatitis were screened and 71 % of them were found positive for anti-HCV, 57 % for anti-HBc total and 32 % for anti-HAV total. CONCLUSIONS: During the analyzed period, no HIV-positive drug users were found. The findings are in striking contrast to data published abroad. Treatment of drug users is often complicated by low compliance with the treatment and hospital regimens and/or by a frequent lack of follow-up treatment. Despite this fact, no significant variations in the course or results of infectious diseases in drug users were found in comparison to the general population.

[Infectious diseases of drug users in the Czech Republic]. / Infekcní komplikace uzivatelu drog v Ceské republice.

BACKGROUND: Prevalence of drug users in Czech Republic remains stable in the last years (about 22 to 38 thousands). Two thirds of drug users administer the drug intravenously, what is the most risky way of application. It is also why the number of infectious diseases in that community has not decreased. METHODS AND RESULT: 435 of drug users were hospitalised between 2002 and 2005 at the Infectious Centre for Drug Users of the Teaching Hospital Motol. Most patients were screened for viral hepatitis and HIV infections, regardless the diagnose during hospitalisation. Patients were hospitalized with the diagnose acute viral hepatitis in 44% (191/436), skin and soft tissue infection in 15% (67/436), chronic hepatitis in 15% (65/436), respiratory infections in 7% (31/436), urogenital infections in 4% (19/436), and sepsis in 4%. Remaining 9% (39/436) of diagnoses represented the less frequent infections. Analysis has shown that 44% of patients acquired hepatitis B and 50% of them are infected with hepatitis C virus. Soft tissue infections, sepsis and infectious endocarditis were caused by sensitive strains of Staphvloco ccus aureus and Streptococcus pyogenes from the group A. CONCLUSIONS: Viral hepatitis is the most frequent infectious disease of drug users practising intravenous application in the Czech Republic. Thanks to the extensive vaccination against hepatitis B, the decreased incidence can be expected in the coming years.

Detection of group A streptococcal antigen directly from throat swabs with a ten-minute latex agglutination test.

Results obtained with the Culturette brand 10-Minute Group A Strep ID system were compared with culture results to measure the ability of this system to detect group A streptococci directly from more than 800 throat swabs. Our study showed a sensitivity of 92.4% and a specificity of 92.8% for this acid extraction, latex agglutination method when compared with anaerobic culturing for group A streptococci. The results suggest that the 10-Minute Group A Strep ID method may prove to be a useful, very rapid and easy method for diagnosing group A streptococcal pharyngitis directly from throat swabs. Further studies are suggested to determine whether this diagnostic method could stand alone or would have to be used in conjunction with culture.