Communication and the Decision Making Process among Couples with HIV/AIDS in Bulawayo, Zimbabwe

The study explores how HIV-positive couples negotiate and make reproductive and sexually related decisions. The broader aim of the paper is to understand how men and women with HIV make decisions about contraception and reproduction and what those decisions indicate about the realities of HIV-positive relationships. In line with the study’s aim to explore meanings related to the decision making process, a qualitative research approach was adopted. In-depth interviews were conducted with 15 couples in which at least one of them was HIV-positive. A critical interpretive analysis of the data was adopted in order to gain insight into decision making among the HIV-positive couples. The results indicate that decisions made were usually a result of negotiation and compromise between partners. However, women’s fertility and sexual preferences were found to be a major factor in determining the outcome of the decision making process. Couples who intended to have a child were found to be active decision makers while those who only desired or did not desire to have a child were mainly passive decision makers. The study concludes that women exercise significant power over contraceptive and reproductive decisions among both active and passive decision makers.

Surgical, Ultrasound Guided Drainage, and Medical Management of Tuboovarian Abscesses

Objective. To compare surgical, ultrasound guided drainage, and medical management of tuboovarian abscesses (TOA) and determine if different characteristics in patient presentation influence treatment and outcome. Methods. Retrospective cohort study of 158 patients admitted to Jackson Memorial Hospital between 2007 and 2012 with a TOA. Results. Patients treated with IV antibiotics (IV) alone were hospitalized for 5.59 days (SD 2.52), IV antibiotics and US guided drainage (IV/US) were hospitalized for 9.63 days (SD 7.58), and IV antibiotics and surgery (IV/surgery) were hospitalized for 8.14 days ((SD 3.9), (P<0.001)). A total of 52 patients were readmitted with TOA; 41.8% were treated with IV; 26.9% were readmitted with IV/US; 7.1% were readmitted with IV/surgery (P<0.022). Patients with a TOA measuring 0–8 cm were hospitalized for 5.97 days (SD 4.24), while those greater than 8 cm were hospitalized for 7.71 days ((SD 4.69), (P<0.029)). Patients treated with a triple antibiotic regimen were hospitalized for 8.42 days (SD 5.70) versus 5.8 days (SD 3.24) when receiving an alternative regimen (P<0.002). Conclusions. Longer hospitalization in patients treated uniformly with either triple antibiotics, ultrasound guided drainage, or surgery represents a delay in optimal treatment. Tailoring treatment plans based on patient presentation may allow for shorter hospital stays and improved morbidity.

Contexts of HIV-Related Risk Behaviors among Male Customers at Asian Massage Parlors in San Francisco

Based on focus groups for male customers who frequented Asian massage parlors in San Francisco, the present study described their sexual and drug use behaviors and attitudes toward practicing safe sex with Asian masseuses. A pervasive view among patrons was that they could engage in sex with masseuses without using a condom if they offered extra money. Their sexual behaviors with Asian masseuses were influenced by perceptions about vulnerability toward HIV/STIs, substance use behaviors, and masseuses’ initiation of condom use, which was often governed by unspoken rules at parlors. Customers perceived massage parlors as being a safe place compared with street sex venues. Some customers sought emotional attachment with Asian masseuses and expressed stereotypical views toward them as being docile and submissive. Culturally appropriate HIV/STI prevention programs (e.g., communication about and practicing 100% condom use) are needed to target both customers and Asian masseuses at multiple levels (individual, owner/manager, work environment, and community levels). Also, customers’ and masseuses’ perceptions toward relationships at massage parlors and power dynamics need further investigation to promote safe work environments and 100% condom use at massage parlors.

An Email Survey of Physician and Licensed Midwife Vaccination Practices in Washington State in 2011

Despite proven benefit to mothers and infants, influenza and Tdap vaccination for pregnant women remain suboptimal. We conducted an email survey for physicians (MDs) and licensed midwives (LMs) in Washington to assess vaccination practices. The Washington State Department of Health and University of Washington, Department of Obstetrics and Gynecology, created an electronic survey and sent it to 644 providers. We used chi-square statistic for comparisons, with Fisher’s exact test for cell size smaller than 5. We received responses from 121 (19%), 106 of whom provided prenatal or obstetric care: 81 MDs and 25 LMs. MDs were more likely than LMs to ask whether pregnant patients are current on vaccinations for influenza and pertussis (96% versus 56% and 84% versus 40%, resp., P<0.001) and to recommend influenza and pertussis vaccine during pregnancy (100% versus 20% and 86% versus 24%, resp., P<0.001). Significantly more MDs received influenza vaccine in the most recent season than did LMs (99% versus 20%, P<0.001). In this study, LMs were less likely to inquire about immunization status, recommend influenza and pertussis vaccines, or be vaccinated against influenza than MDs. Enhancing educational communication with LMs deserves further study and may provide an opportunity to improve immunization rates in pregnant women.

Targeted Screening for Latent TB Infection prior to Biologic Therapy to Improve Patient Safety and Reduce Costs: A Prospective Observational Study

Objective. Our current practice of screening for latent TB infection (LTBI) using universal T-SPOT assays is not in line with British Thoracic Society (BTS) recommendations. We set out to determine the clinical benefit and cost effectiveness of blanket TSPOT.TB (T-SPOT) testing as a screening tool for patients awaiting anti-TNF-α therapy. Methods. 130 consecutive rheumatology patients were investigated for LTBI before commencing anti-TNFα therapy at Gartnavel General Hospital, Glasgow, an area of low TB prevalence and high BCG vaccination. Chest radiograph and clinical interview were used to identify risk factors for LTBI. The annual risk of TB was calculated using tables from BTS recommendations and then compared to the risk of drug-induced hepatitis. All patients were given a T-SPOT according to current local policy. Indeterminate T-SPOTs were recorded and repeated. Results. For 130 patients, a total of 160 tests were required resulting in a cost of £24,000. 99 (76%) patients had no TB risk factors and a total of 22 repeat tests were required before returning negative results. This equates 121 T-SPOTs and potential cost savings of £18,150. Conclusion. In the absence of risk factors for TB and an abnormal chest radiograph, the use of T-SPOT as a first line test for LTBI may result in unnecessary risk of TB chemoprophylaxis-induced hepatitis, increased costs, and a delay in early anti-TNFα therapy.

Necrotizing Fasciitis: Diagnostic Challenges and Current Practices

Necrotizing fasciitis or necrotizing soft-tissue infections (NSTIs) are infrequent but highly lethal infections. They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. At onset, necrotizing fasciitis can be difficult to differentiate from cellulitis and other superficial infections of the skin. In fact, only 15% to 34% of patients with necrotizing fasciitis have an accurate admitting diagnosis. Early diagnosis and management with surgical debridement, antimicrobials, and supportive measures reduce mortality. Even with modern ICU care mortality ranges between 16 and 36%; this is related to delays in diagnosis and comorbidities. Various scoring systems have been developed which help in diagnosis and stratifying patients into risk groups. The present review deals with varied presentation, early diagnosis, and management of necrotizing fasciitis.

Lesson Learned from the Emergence of Influenza Pandemic H1N1 in 2009 in Indonesia: The Importance of Influenza-Like Illness (ILI) Surveillance

Background. In 2009 there were outbreaks of influenza pandemic H1N1 in Indonesia that were caused by different virus from the previous circulated H1N1. Further, the influenza-like illness (ILI) surveillance plays an important role in the early detection of influenza outbreaks in outpatients. To understand the disease burden of ILI in the community at the time of H1N1 pandemic 2009, a sentinel-based survey was performed. Methods. The nasal and throat swabs were obtained from 20 primary health centers of ILI sentinel in Indonesia in 2009. Identification of virus influenza pandemic H1N1 was carried out by real-time RT-PCR using primers that are specific for influenza A. Results. Out of 3254 ILI cases from community-based ILI surveillance in 2009, 11.03% cases were Influenza A positive and 42.59% cases were influenza pandemic H1N1. The first influenza pandemic HINI case was detected at week 15 in April, a case from the province of Banda Aceh, reaching a peak in August and ending at week 44 in November of 2009. Conclusion. The influenza pandemic H1N1 outbreak was detected in ILI surveillance network in Indonesia. This outbreak lasted for eight months which was the final wave of the influenza pandemic H1N1 in the world.

Genital Infections of HIV-Infected Women Assisted by a Specialized Service

The present study aimed at analyzing the persistence/recurrence of genital infections and its associated factors in HIV-infected women. Fifty-eight women treated for chlamydial infection, trichomoniasis, vulvovaginal candidiasis, and/or bacterial vaginosis (BV) and who had specimens collected for cure control up to one year after treatment were studied. Diagnoses were performed by the Gram staining method for cases of BV and candidiasis and by T. vaginalis culture and qualitative PCR for C. trachomatis. Antiretroviral therapy was used by 79.3% of patients, and 62.1% showed an undetectable HIV plasma load. The most frequent infection was BV with persistence/recurrence of 52.4%, which was associated with a longer time period between treatment and cure control (), postmenopausal period (), and having a steady partner (). Persistence/recurrence of vulvovaginal candidiasis was observed in 25%, trichomoniasis in 23.1%, and chlamydial infection in 10.5%. The latter was associated with inadequate treatment of the partner (). There was a tendency to higher persistence/recurrence of BV () and trichomoniasis () among patients with low T CD4+ lymphocyte counts. The majority of women in the present study showed good HIV-infection control and a vulnerable sexual behavior, which stress the importance of maintaining gynecological followup.

Supplemental Perioperative Oxygen (80% FIO2) for the Prevention of Surgical Site Infection after Emergency Cesarean Section

Objective. Cesarean section can be a lifesaving procedure. However, as with many surgeries, it is not exempt of complications. Surgical site infections generate higher costs, serious morbidity, and mortality. This study evaluates the benefits of perioperative oxygen to prevent surgical site infections. Methods. We conducted a randomized controlled trial to assess the effects of perioperative oxygen to prevent surgical site infection after emergency cesarean section. Patients were randomized to receive either oxygen (80% FIO2) during cesarean section plus two hours postsurgery or no supplemental oxygen. A sample of 326 patients was calculated for the primary outcome (163 in each group) and they were evaluated daily before leaving the hospital, at days 15 and 30. Results. Initially, 360 patients were enrolled, from which 17 were excluded (sample size: 343 (179 patients in the air group and 164 in the oxygen group)). We found no significant difference in the incidence of surgical site infection between these two groups at any of the evaluation times. Conclusion. In this study of patients with emergency cesarean section, we showed that the use of supplemental oxygen does not reduce the incidence of surgical site infection. This trial is registeres with ClinicalTrials.gov NCT01340534.

Sexual Practices and HIV Prevalence amongst Men Who Have Sex with Men at a Community-Based Voluntary Counseling and Testing Centre in Malaysia

We describe the sexual practices and condom usage of men who have sex with men (MSM) at a community-based anonymous voluntary counseling and testing centre in Kuala Lumpur, Malaysia. This study is a first for Malaysia in this context. 433 MSM clients disclosed their sexual practices and condom use in the preceding 6 months using a self-reported questionnaire during pre-HIV test counseling at the centre. The mean age was 29.7 years, and 356 were homosexuals while 77 were bisexuals. Forty tested HIV positive (9.2%). 387 (94.9%) of 408 clients had anal sex, 395 (97.8%) of 404 clients had oral sex, while 43 (18.4%) of 233 clients had vaginal sex which revealed that even men who identified themselves as homosexuals do practice vaginal sex. Having multiple sexual partners is common (mean 11.6 partners per client). 259 (59.8%) had unprotected sex within the last 6 months. Consistent condom use rates during vaginal, anal, and oral sex were 20%, 23.5%, and 1.3%, respectively. The odds ratio of testing HIV positive with inconsistent condom use during anal sex was 3.7 (). Clients who used condoms inconsistently during anal sex are more likely to be HIV positive.