Thoracic ultrasound for TB diagnosis in adults and children.

Thoracic ultrasound is an appealing alternative to chest radiography for the diagnosis of TB. Based on research experience conducting thoracic ultrasound for adults and children in South Africa, three key considerations for potential scale-up were identified. First, thoracic ultrasound requires a comprehensive training programme for novice users; artificial intelligence may be used to simplify training and interpretation. Second, a robust ultrasound device is needed with good subpleural resolution and a probe suitable for children. Third, comprehensive scanning of the lungs is time-intensive, and shorter scanning protocols may be more feasible in clinical practice.

L'échographie thoracique est une alternative attrayante à la radiographie pulmonaire pour le diagnostic de la TB. En prenant appui sur l'expérience acquise lors d'études ayant utilisé l'échographie thoracique chez l'adulte et l'enfant en Afrique du Sud, trois considérations clés pour une éventuelle utilisation accrue de cet outil ont été identifiées. Premièrement, tout nouvel utilisateur d'un échographe thoracique doit suivre un programme de formation exhaustif. L'intelligence artificielle pourrait être utilisée pour simplifier la formation et l'interprétation des résultats. Deuxièmement, un échographe de qualité est nécessaire, avec une bonne résolution sous-pleurale et une sonde adaptée à l'enfant. Troisièmement, une scannographie exhaustive des poumons est chronophage ; des protocoles de scannographie plus courts pourraient être plus faciles en pratique clinique.

On the use of naturalistic methods to examine safety-relevant behaviours amongst children and evaluate a cycling education program.

School-based cycling education programs aim to improve cycling safety and participation amongst children. Available research suggests that typical programs, which focus on bicycle manoeuvring skills, have limited effects on behaviour observed on a track or planned route. The current study uses theoretically more valid, naturalistic cycling data, to evaluate Safe Cycle, a program that incorporates hazard and self-awareness training. Soon after Safe Cycle was delivered at treatment schools, research bicycles instrumented with a rearward- and a forward-facing camera were loaned to six children from treatment schools and six children from (waitlist) control schools. In each group half the children were in Year 6, and half were in Year 7/8. Each child was instructed to ride the research bicycle instead of their own bicycle for the 1-2 weeks that they had a research bicycle. Video data were reduced using a purpose-designed coding scheme that identified whether participants performed specific safety-relevant behaviours in appropriate circumstances. While the participants controlled their bicycles well, gave way appropriately to traffic at intersections, and stopped at red lights, participants frequently removed one or both hands from the handlebars, and seldom signalled turns, conducted over-shoulder-checks when changing lanes, or looked in multiple directions at intersections (except when crossing a road). While aspects of design and small sample sizes limited evaluation findings, this research demonstrated the feasibility and potential of naturalistic data to support cycling education program evaluation. Further, the study substantially extended available naturalistic study of children's cycling behaviour to highlight behaviours which might be targeted by cycling safety initiatives.

"We have to try and have this child before it is too late": missed opportunities in client-provider communication on reproductive intentions of people living with HIV.

Men and women living with HIV with access to ARVs are living longer, healthier lives that can and often do include bearing children. Children occupy a key space in men and women's personal and social lives and often play a fundamental role in maintaining these relationships, irrespective of illness concerns. Couples living with HIV need to balance prevention needs and ill-health while trying to maintain healthy relationships. Health-care providers serving the reproductive needs of HIV-affected couples need to consider the social and relational factors shaping reproductive decisions associated with periconception risk behaviors. This paper based on qualitative research at three hospital sites in eThekwini District, South Africa, investigates the childbearing intentions and needs of people living with HIV (PLHIV), and the attitudes and experiences of health-care providers serving the reproductive needs of PLHIV, and client and provider views and knowledge of safer conception. This research revealed that personal, social, and relationship dynamics shape the reproductive decisions of PLHIV, and "unplanned" pregnancies are not always unintended. Additionally, conception desires are not driven by the number of living children; rather clients are motivated by whether or not they have had any children with their current partner/spouse. Providers should consider the relationship status of clients in discussions about childbearing desires and intentions. Although many providers recognize the complex social realities shaping their clients' reproductive decisions, they have outdated information on serving their reproductive needs. Appropriate training to enable providers to better understand the relationship and social realities surrounding their clients' childbearing intentions is required and should be used as a platform for couples to work together with providers toward safer conception. The adoption of a more participatory approach should be employed to equalize client-provider power dynamics and to ensure clients are more involved in decision-making about reproduction and conception.

Cardiovascular disease (CVD) risk factors: a patient’s perspective

OBJECTIVES: To identify CVD risk factors present in patients presenting with stroke; to assess knowledge of patients on risk factors for CVD; and to identify management methods employed (prior to admission) by patients to deal with these risk factors. DESIGN AND METHODS: This study used a cross-sectional, incident case design. All patients admitted to the hospital, within a 6 week period, given an initial diagnosis of stroke by the attending physician, were eligible for the study. Patients were recruited using consecutive sampling. Data on patient risk awareness and management methods were gathered using a survey. Data on risk factors present in patients were collected using patient records. RESULTS: A total of 102 patients were interviewed. The two major risk factors present in patients were hypertension (80.2%) and diabetes (57.8%). 83.3% of patients identified hypertension as a risk factor and 78.8% identified diabetes. However, 32.2% of hypertensive patients and 40.5% of diabetics reported not taking medication despite being awareness of their risk. Similarly 81.3% of patients knew lack of exercise was a risk factor, but only half were exercising frequently in the past 2 years. CONCLUSION: In this study, hypertension and diabetes were found to be the two major risk factors present in stroke patients. While patient knowledge about risk factors was high, their management of their risk factors as well as general knowledge about stroke prevention were lacking. This could be helpful in formulating public health strategy, if supported by larger population based studies.

Sarcoidosis in a 42 year old AfroCaribbean male who presented with pulmonary embolism: a case report and review of literature.

We present a case of a 42 year old Afro-Caribbean man presenting with pulmonary embolism and gastroesophageal reflux disease, Transbrachial lung biopsy revealed non-caseating granulomata and on the basis of excluding other conditions, the patient was also diagnosed with sarcoidosis. The only identifiable risk factor for his pulmonary embolus was obesity. A literature review is performed of cases with similar presentations. We propose that sarcoidosis may be a contributing factor in enhancing this prothrombotic predisposition

HIV Protective Strategies Among College Students in Durban; South Africa

There is growing concern about the high level of HIV infection among young people in South Africa. The aim of the study is to examine the HIV protective strategies used by college students with specific emphasis on variations by race group. The data for the study come from a self-administrated survey that was conducted with 3 000 college students in Durban in order to understand the strategies they use to protect themselves against the risk of HIV infection. Overall; students perceived a far greater risk of pregnancy than HIV infection. The results show that abstinence is the most common protective factor among Indian and White students. Among African students; there is great concern about HIV but abstinence is less common. Among sexually active men and women; the majority report having more than one sexual partner (with the exception of Indian females). Female students among all groups were more likely than male students to report that they were faithful to their partners. In Africans the contrast is stark: 25 for women versus 6 for men. Condoms are the most commonly used method by students but are not used in every sexual encounter. Consistent condom use was highest among Indian males (46) and lowest among White females (13.7). More effort needs to be directed at promoting correct and consistent condom use in order to avoid the negative consequences associated with unprotected sexual intercourse including unwanted pregnancy and HIV/AIDS

Women's experiences of maternal and child health and family planning services in KwaZulu-Natal.

The increasing recognition that millions of women and children die every year as a result of the poor health of the mother coupled with inadequate care before, during, and after delivery, has highlighted the importance of seeking women's views of health services in order to contribute to improving their health. The purpose of this paper is to shed more light on women's views of health services by exploring their experiences of maternal and child health and family planning services in Cato Manor in KwaZulu-Natal. The findings suggest that the majority of women were unclear about the purpose of antenatal care. Most women had little or no knowledge about the required number of antenatal care visits. In addition, few women reported that they were offered a comprehensive range of contraceptive services during their visit. In most cases, they were only given information on a limited number of family planning methods. However, the majority of women expressed overall satisfaction with the services. Discontent mainly rose from the long waiting period, duration of the consultation and limited contraceptive counselling. In order to ensure sustainable improvements in women's health increasing involvement of men is also important.

Ethnicity and sexual lifestyles among college students in a high-risk environment, Durban, South Africa.

The aim of the study is to examine the protective behavioural strategies used by college students in response to high levels of HIV infection, with a particular emphasis on ethnic variations. The data for the study are drawn largely from self-completed questionnaires among college students in Durban. The results suggest that abstinence is most common protective factor among Indian and white students. However, among African students, abstinence is less common, particularly for men, despite the fact that concern about HIV is high in this group. Among the sexually active, the majority have more than one sexual partner. However, condom use among all sexually active students is high. Almost 70% reported using condoms at last sexual intercourse but consistent use remains elusive.

Delayed development of a biloma in an infant following hepatic injury / Desarrollo retardado de un biloma en un infante luego de un daño hepático

A case report is presented of an infant who developed a biloma over three months after major hepatic injury and after almost complete healing. A brief literature review is given to highlight unusual features of this case.

Se presenta el caso de un infante que desarrolló un biloma en tres meses, tras sufrir un serio daño hepático y luego de una curación casi completa. Se ofrece una breve revisión de la literatura a fin de destacar las características poco usuales de este caso.

Delayed development of a biloma in an infant following hepatic injury.

A case report is presented of an infant who developed a biloma over three months after major hepatic injury and after almost complete healing. A brief literature review is given to highlight unusual features of this case.

A barium chemobezoar in an infant / Quimobezoar de bario en un neonato

A case report is presented of an infant who developed a large barium concretion proximal to a jejunal anastomosis. A brief literature review outlines the issues involved in the indications for, and choice of, contrast material for use in the precise radiological diagnosis of upper intestinal obstruction in infants.

Se presenta el reporte de un caso de un neonato que desarrolló una concreción grande de bario cercana a una anastomosis yeyunal. Una breve revisión de la literatura esboza los problemas involucrados en las indicaciones y selección del material de contraste para uso en un diagnóstico radiológico preciso de la obstrucción intestinal superior en los neonatos.

A barium chemobezoar in an infant.

A case report is presented of an infant who developed a large barium concretion proximal to a jejunal anastomosis. A brief literature review outlines the issues involved in the indications for, and choice of, contrast material for use in the precise radiological diagnosis of upper intestinal obstruction in infants.

The quality of integrated reproductive health services: perspectives of clients in KwaZulu-Natal, South Africa.

The focus of family planning programmes has shifted away from an emphasis on controlling fertility towards helping individuals achieve their reproductive goals. This article seeks to expand knowledge about the quality of integrated services from the perspective of clients at health facilities in KwaZulu-Natal. The results from 300 structured interviews with clients visiting health facilities found that overall quality of services was relatively high. However, the quality of services varied somewhat between rural and urban areas. Clients visiting urban health facilities reported greater satisfaction with services than clients visiting rural health facilities. The interviews with clients suggests that existing efforts to integrate services has had limited success. Clients were rarely offered an expanded range of services during their visit. In most cases, clients only received services for which they presented at the health facility.

Lymphoscintigraphic evaluation of chronic lower limb oedema.

Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), venography, lymphoscinti-graphy (LS) and contrast lymphography are frequently utilized in the evaluation of lower limb oedema but no clinical data from the Caribbean have been published on the role of LS despite its well-recognized clinical application. The successful clinical application of CT, colour doppler sonography and MRI in differentiating the various causes of lower limb oedema is well understood. Lymphoscintigraphy has found less acceptability especially in the Caribbean where nuclear imaging techniques are only now currently being developed. This paper describes the initial experience with this technique in 15 patients over a five-year period and discusses its value when lower limb lymphoedema is suspected. Scintigrams were analyzed for visualization of lymph vessels and lymph nodes, dilatation of lymphatic vessels, collaterals and dermal back flow. Lymphoscintigrams were classified as normal (n = 5) or consistent with lymphoedema (n = 10). Failure to visualize lymphatic vessels occurred in two cases of suspected primary lymphoedema. In the remaining eight cases of secondary lymphoedema, a positive study based on altered lymphatic flow and anatomy was recorded. An alternative explanation was offered in three out of five cases in which a normal lymphoscintigram was obtained.

Lymphoscintigraphic evaluation of chronic lower limb oedema

Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), venography, lymphoscinti-graphy (LS) and contrast lymphography are frequently utilized in the evaluation of lower limb oedema but no clinical data from the Caribbean have been published on the role of LS despite its well-recognized clinical application. The successful clinical application of CT, colour doppler sonography and MRI in differentiating the various causes of lower limb oedema is well understood. Lymphoscintigraphy has found less acceptability especially in the Caribbean where nuclear imaging techniques are only now currently being developed. This paper describes the initial experience with this technique in 15 patients over a five-year period and discusses its value when lower limb lymphoedema is suspected. Scintigrams were analyzed for visualization of lymph vessels and lymph nodes, dilatation of lymphatic vessels, collaterals and dermal back flow. Lymphoscintigrams were classified as normal (n = 5) or consistent with lymphoedema (n = 10). Failure to visualize lymphatic vessels occurred in two cases of suspected primary lymphoedema. In the remaining eight cases of secondary lymphoedema, a positive study based on altered lymphatic flow and anatomy was recorded. An alternative explanation was offered in three out of five cases in which a normal lymphoscintigram was obtained

The initial Trinidad experience with Cine MRI in clinical cardiology.

We describe the initial Trinidad experience with Magnetic Resonance Imaging (MRI) and Cine MRI as a diagnostic tool in clinical cardiology. Six patients from the following categories were referred for Cine MRI evaluation: congenital heart disease, valvular heart disease, aortic diseases, cardiomyopathy and intracardiac mass. All patients underwent echocardiography. MRI and Cine MRI were performed on all patients using a Siemens Magnetom 1.0 Tesla MR system at MRI Trinidad and Tobago Ltd. Selected patients underwent Angiography and/or computed tomography (CT) scanning. Clinical data and images of the six patients evaluated are described. MRI and Cine MRI provided excellent anatomical and functional details of the heart and aorta in five patients with dissection of the aorta, aneurysm of the ascending aorta, suspected left ventricular apical thrombus, infiltrative cardiomyopathy and arrhythmogenic right ventricular dysplasia. Technical difficulty was experienced with one patient who had a congenital defect (common atrium). In this study, Cine MRI provided excellent images in all but one patient. This new noninvasive technique enhanced diagnostic capabilities and facilitated management in patients with certain cardiovascular diseases.

The initial Trinidad experience with Cine MRI in clinical cardiology

We describe the initial Trinidad experience with Magnetic Resonance Imaging (MRI) and Cine MRI as a diagnostic tool in clinical cardiology. Six patients from the following categories were referred for Cine MRI evaluation: congenital heart disease, valvular heart disease, aortic diseases, cardiomyopathy and intracardiac mass. All patients underwent echocardiography. MRI and Cine MRI were performed on all patients using a Siemens Magnetom 1.0 Tesla MR system at MRI Trinidad and Tobago Ltd. Selected patients underwent Angiography and/or computed tomography (CT) scanning. Clinical data and images of the six patients evaluated are described. MRI and Cine MRI provided excellent anatomical and functional details of the heart and aorta in five patients with dissection of the aorta, aneurysm of the ascending aorta, suspected left ventricular apical thrombus, infiltrative cardiomyopathy and arrhythmogenic right ventricular dysplasia. Technical difficulty was experienced with one patient who had a congenital defect (common atrium). In this study, Cine MRI provided excellent images in all but one patient. This new noninvasive technique enhanced diagnostic capabilities and facilitated management in patients with certain cardiovascular diseases.

Obstacles to negotiating dual protection: perspectives of men and women.

This article presents findings from a qualitative study on the perspectives of sexually active men and women about the risks of unwanted pregnancy and HIV/AIDS. The study found that there is a high level of awareness of the risk of unwanted pregnancy and HIV/AIDS. Knowledge of condoms as a method of preventing pregnancy and HIV/AIDS is also relatively good. However, there are many real and perceived barriers to condom use especially in stable sexual relationships. In stable long-term relationships, resistance to condom use was found to be strongly related to its association with STIs (including HIV/AIDS). Men and women do not see the need for condoms in stable, ongoing sexual relationships if a more effective method is used for pregnancy prevention. Condom use in such relationships may be seen as a clear sign of infidelity. These attitudes represent a major obstacle to the use of condoms as a dual method of protection.