Total and CD4+ T- lymphocyte count correlation in newly diagnosed HIV patients in resource-limited setting

Few clinical settings in resource-limited countries perform CD4+ T-lymphocyte counts required as a baseline test for antiretroviral therapy. We investigated CD4 count in newly diagnosed HIV-infected patients attending our treatment centre and evaluated suitability of total lymphocyte count (TLC) as a surrogate marker for CD4+T-lymphocyte count required as a yardstick for initiating antiretroviral therapy. Usefulness of TLC as a surrogate marker for CD4+T-lymphocyte counts <200, ≤350 and <500cells/µL for HIV-positive patients in our facility was evaluated by 180 pairs of TLC and CD4 counts from 180 newly diagnosed HIV-infected patients and results were compared by linear regression and Spearman’s correlation analytical tools. Approximately 72.8% of our patients were diagnosed late as revealed by CD4 count ≤350cells/µL. An overall good correlation was noted between TLC and CD4+Tcell counts (r=0.65, slope=0.69), m ean total lymphocyte count of 1.04 ± 0.81, 1.39 ± 1.06 and 1.57 ± 1.13 x 10⁹/L correspond to CD4 lymphocyte counts of <200, ≤350 and < 500cells/µL respectively. When considering initiating HAART for HIV-infected Nigerian clients, TLC can be considered as an inexpensive and easily accessible surrogate marker for predicting CD4+T-lymphocyte at two clinically important CD4 thresholds of CD4 count of ≤350 cells/µL and <500cells/µL

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Utilization of pap smear in the prevention of cervical cancer among female health workers at a Nigerian Tertiary Health Facility

Context: Cervical carcinoma is a preventable disease, yet it remains the leading genital tract malignancy among women in sub-Saharan Africa.Objective: To assess awareness, knowledge and utilization of Pap smear as a screening modality for cancer of the cervix among female health workers at Federal Teaching Hospital Ido-Ekiti.Materials and Methods: This was a descriptive cross sectional study, conducted using quantitative methods. A pretested, selfadministered questionnaire was used to collect data; all consenting female health workers in the institution were recruited. Ethical approval was obtained from IRB; data analysis was done using SPSS 18,Results: A total of 378 questionnaires were sufficiently filled for analysis, 305 (80.7%) respondents were aware of cancer of the cervix, majority knew it could be prevented and 95.8% demonstrated knowledge on methods of screening for its precursor lesions though only 30.7% were aware of availability of service in their center. Knowledge about Pap smear and type of family was significantly associated, so also were the level of education, professional designation and duration of work experience; utilization of Pap smear screening services was significantly associated with age, marital status and type of marriage; others were educational status, cadre of work and professional experience. It is of note that only 75 (19.8%) of those that were aware of pap smear as a strategy had ever done it; and a number of respondents were not willing to do test even at no cost.Conclusion: The respondents demonstrated good knowledge about available cervical cancer screening services but had poor attitude to utilization of Pap smear screening services. Only a few were willing to perform the test even at no cost to them, reasons for this need to be further evaluated and addressed.Keywords: willingness, utilization, cervical cancer, Pap smear, female health worker