The Relationship Between Sexual Behavior Stigma and Depression Among Men Who have Sex with Men and Transgender Women in Kigali, Rwanda: a Cross-sectional Study.

To evaluate the role of sexual behavior stigma as a determinant of depressive symptoms among men who have sex with men (MSM) and transgender women (TGW) in Kigali, Rwanda. MSM/TGW aged ≥18 years were recruited using respondent-driven sampling (RDS) between March-August, 2018. Mental health was assessed using the Patient Health Questionnaire (PHQ-9). Sexual behavior stigma from friends and family, healthcare workers, and community members was assessed using a validated instrument. Multinomial logistic regression models were used to determine the association between sexual behavior stigma and depressive symptoms and depression. Secondary analyses further compared depression and depressive symptoms among MSM and TGW. Among the 736 participants included, 14% (106/736) identified as TGW. Depression 8.9% (RDS-adjusted, 7.6%; 95% CI, 4.6-10.6) and mild/moderate symptoms of depression 26.4% (RDS-adjusted, 24.1%; 95% CI, 19.4-28.7) were common and higher among TGW compared to MSM (p < 0.001). Anticipated (41%), perceived (36%), and enacted (45%) stigmas were highly prevalent, and were also significantly higher among TGW (p < 0.001). In multivariable RDS-adjusted analysis, anticipated (relative risk ratio (RRR), 1.88; 95% CI, 1.11-3.19) and perceived (RRR, 2.06; 95% CI, 1.12-3.79) stigmas were associated with a higher prevalence of depressive symptoms. Anticipated (RRR, 4.78; 95% CI, 1.74-13.13) and enacted (RRR, 3.09; 95% CI, 1.61-5.93) stigmas were also associated with a higher prevalence of depression. In secondary analyses, the significant differences between MSM and TGW were lost after adjusting for stigma. These data demonstrate a high burden of depressive symptoms and depression among MSM/TGW in Kigali. Conceptually, stigma is a likely antecedent of mental health stress among MSM and TGW suggesting the potential utility of scaling up stigma mitigation interventions to improve the quality of life and mental health outcomes among sexual and gender minority communities in Rwanda.

Effect of probiotic (Saccharomyces cerevisiae) supplementation on immune response in Trypanosoma brucei brucei infected rats.

The immunomodulatory effect of the probiotic (Saccharomyces cerevisiae) on Trypanosoma brucei brucei infected rats was studied. Thirty (30) rats divided into five groups (A-E) of 6 rats each were used for the study. Groups A, B and C rats received feed supplemented with S. cerevisiae (at 0.08, 0.12 and 0.16/kg of feed, respectively) for the duration of the study. Groups D and E diets were not supplemented. All the rats in the 5 groups were immunized with 0.3 ml of 10% sheep red blood cells (SRBC) at day 7 pre-supplementation, and booster doses given every 14 days thereafter. On day 28 post supplementation (PS), rats of groups A-D were infected with 1 × 10(6) of T. brucei brucei intraperitoneally. Supplementation resulted in increases in antibody titres to SRBC which later declined following T. brucei brucei infection, but remained higher than the pre supplementation titres. At termination of the study (i.e. day 49 PS) supplemented groups had significantly (p<0.05) higher antibody titres than either the infected or the non infected controls. The total and differential leucocyte counts followed a similar pattern with initial increases in counts following supplementation followed by reductions after T. brucei brucei infection. Supplementation also resulted in decline in parasitaemia with significant difference between the supplemented groups and the un-supplemented controls on day 42 post infection. The results are indication that probiotics can be used to ameliorate the immunosuppressive effect of T. brucei brucei infections.

Pattern of contraceptive use among women with sickle cell disease in Ibadan, South-west Nigeria.

A cross-sectional study was conducted at the University College Hospital, Ibadan, Nigeria between January and April 2009. The purpose of this study was to determine the pattern of contraceptive use among females of reproductive age, with sickle cell (SC) disease, attending various clinics at the University College Hospital, Ibadan, Nigeria. It is evident in this study that even although contraceptive awareness in this group of patients is high, the prevalence of contraceptive use is very low which is comparable with the general population. This is largely due to perceived fear of real and imagined side-effects associated with some contraceptive methods and also relative lack of access to commodity sources. It is therefore suggested that there is need for effective enlightenment and health education targeted at this vulnerable group of women to dissipate unreal fears about contraception. Also, the provision of a contraceptive-friendly environment, especially at various clinics attended by sickle cell disease patients, to facilitate their access to contraceptive commodities will go a long way to enhance their uptake of contraception while preventing unwanted pregnancies along with other benefits in this susceptible group of women. The need for child spacing as well as limiting family size among sickle cell disease patients cannot be over emphasised.

Continuous hypopharyngeal pH measurements in spontaneously breathing anesthetized outpatients: laryngeal mask airway versus tracheal intubation.

We measured the hypopharyngeal pH to compare the incidence of regurgitation associated with the laryngeal mask airway (LMA) and the tracheal tube (TT) in spontaneously breathing, anesthetized patients. Sixty outpatients scheduled for elective peripheral surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA (n = 28) or a TT (n = 32) for airway management. A 4-mm pH electrode was placed in the hypopharynx, and pH values were continuously collected and stored in a portable pH data logger system until the end of the operation. There were no episodes of hypopharyngeal regurgitation (pH < 4) detected during the course of measurement. At no time did the hypopharyngeal pH value decrease below 5.5. The hypopharyngeal pH values in both groups were similar, ranging between 5.5 and 7.5, with median values of 5.7 and 6.2 in the LMA and TT groups, respectively. The pH in any given patient did not vary more than 1.0 unit from the initial value recorded at the start of the operation. We conclude that continuous monitoring of the hypopharyngeal pH in spontaneously breathing, anesthetized outpatients failed to detect evidence of pharyngeal regurgitation.