Supporting rape survivors to adhere to post-exposure prophylaxis (PEP) to prevent HIV infection: The importance of psychosocial counselling and support

Eleven years after it was first mooted in 1996, the Criminal Law (Sexual Offences and Related Matters) Amendment Act (32 of 2007) came into effect in December 2007. Law-makers proudly lauded sections 28 and 29 of the Act, which set out how post-exposure prophylaxis (PEP) to prevent HIV infection should be made available to rape survivors.* These clauses are, however, neither particularly novel nor innovative, Cabinet having already approved (in April 2002) the provision of antiretroviral drugs to prevent HIV infection following rape. Subsequent to Cabinet's decision, a few studies were conducted examining various facets of providing PEP as part of a health response to rape.1-4 In theory, these findings should have provided legislators with some insight into what was required by rape survivors from a PEP service, particularly in relation to psycho-social support. This was not the case, as we will show in this article, which draws on unpublished findings from 67 interviews with rape survivors† exploring their adherence to PEP. Southern African Journal of HIV Medicine Vol. 9 (3) 2008: pp.24-2

Avascular necrosis of bone following renal transplantation

This study was undertaken to determine the incidence and clinical features of avascular necrosis of bone in 69 transplant recipients all of whom had a functioning allograft for a least 12 months. An attempt was also made to identify any potential predisposing factors. The patients were assessed by an orthopaedic surgeon. The diagnosis of avascular necrosis was tnade on the basis of radiographs and isotope bone scans. Fourteen patients (20,2%) developed avascular necrosis with a mean onset of 19 months post-transplantation.The hip joint was most commonly affected. The isotope bone scan was the most sensitive diagnostic tool; abnonnalities were detected before the onset of symptoms in 4 patients. Avascular necrosis was more common in Indian transplant recipients and was also associated with: (i) cadaver transplants; (ii) more frequent bouts of acute rejection (P < 0,05); and (iii) a greater incidence of other steroid-associated side-effects (P < 0,05).Alcohol conswnption and radiological evidence of osteoporosis were more prevalent in the avascular necrosis group (42,8% v. 29,0% and 28,5% v. 7,2% respectively). Avascular necrosis did not correlate with age, sex, renal function at 1 year or severe secondary hyperparathyroidism.This study suggests that corticosteroid therapy plays an important role in the pathogenesis of avascular necrosis. Excessive alcohol conswnption and osteoporosis also appear to be risk factors

Follow-up of kidney donors at a single center in South Africa

Background:There is a worldwide shortage of organ donors. Inour province, KwaZulu / Natal, this problem is morepronounced as the rate of cadaveric donation is verylow. Thus both patients and nephrology staff areunder pressure to seek living donors.Methods and results:We studied 135 living kidney donors in ten yearsperiod: 85 females and 50 males; 78 (57.8%) were ofIndian origin, 33 (24.4%) Black, 15 (11.1%) Whiteand 9 (6.7%) of mixed race groups. The majority ofdonors (57%) were siblings, while 14.8% wereparents, 6.7% children, 17.8% spouses and 3.7%were cousins. The mean age of donors was 34.2 years(range 21-56 years). Donors were hospitalised for amean peroid of 6.1 days (range 3-15). Post-operativecomplications were left lobe atelectasis and chestinfection in 11.1 %, other infections in 5.2%,pneumothorax in 2.2%, ileus in two cases, depressionin one and prolonged pain at the site of surgery in11.1%. Proteinuria was noted in three cases (0.26gm/d and 0.66 gm/d in two donors at 2 years and 0.27gm/d in the third case at 10 years).Blood pressure levels were virtually unchanged frompre-nephrectomy data.Conclusion:This study confirms that unilateral nephrectomy innormal individuals is associated with few major adverse effects and living donors in renal transplantation is a viable option

Youth and professional perspectives of mental health resources across eight countries

Introduction: Youth mental health support and services vary across sociocultural contexts. It is important to capture the perspectives of youth with lived experiences for planning needs-led interventions and services, especially in Global South Countries (GSC), with limited specialist resources and representative literature. Methods: The aim was to establish how youth with lived experiences of anxiety and depression viewed external support in different countries, and how these views were juxtaposed with those of professionals. We involved 121 youth aged 14–24 years and 62 professionals from different disciplines in eight countries, predominantly from the Global South. Two youth and one professional focus group was facilitated in each country. The data were analysed through a codebook thematic approach. Results: Youth across all countries largely valued informal support from family, peers and community, whilst those from GSC had limited access to structural support. They related lived experiences to therapeutic engagement and processes, in contrast with professionals who focused on outcomes and service delivery. Mental health awareness and integration of interventions with social support were considered essential by both youth and professionals, especially in disadvantaged communities. Conclusion: The mental health needs of youth in disadvantaged GSC communities can be best met through multi-modal interventions addressing these needs across their socioecology and positioned within a stepped care model. Youth with lived experiences should be involved in service planning, implementation and monitoring

The antibacterial properties of Malaysian tualang honey against wound and enteric microorganisms in comparison to manuka honey

<p>Abstract</p> <p>Background</p> <p>Antibiotic resistance of bacteria is on the rise, thus the discovery of alternative therapeutic agents is urgently needed. Honey possesses therapeutic potential, including wound healing properties and antimicrobial activity. Although the antimicrobial activity of honey has been effectively established against an extensive spectrum of microorganisms, it differs depending on the type of honey. To date, no extensive studies of the antibacterial properties of tualang (<it>Koompassia excelsa</it>) honey on wound and enteric microorganisms have been conducted. The objectives of this study were to conduct such studies and to compare the antibacterial activity of tualang honey with that of manuka honey.</p> <p>Methods</p> <p>Using a broth dilution method, the antibacterial activity of tualang honey against 13 wound and enteric microorganisms was determined; manuka honey was used as the control. Different concentrations of honey [6.25-25% (w/v)] were tested against each type of microorganism. Briefly, two-fold dilutions of honey solutions were tested to determine the minimum inhibitory concentration (MIC) against each type of microorganism, followed by more assays within a narrower dilution range to obtain more precise MIC values. MICs were determined by both visual inspection and spectrophotometric assay at 620 nm. Minimum bactericidal concentration (MBC) also was determined by culturing on blood agar plates.</p> <p>Results</p> <p>By visual inspection, the MICs of tualang honey ranged from 8.75% to 25% compared to manuka honey (8.75-20%). Spectrophotometric readings of at least 95% inhibition yielded MIC values ranging between 10% and 25% for both types of honey. The lowest MBC for tualang honey was 20%, whereas that for manuka honey was 11.25% for the microorganisms tested. The lowest MIC value (8.75%) for both types of honey was against <it>Stenotrophomonas maltophilia</it>. Tualang honey had a lower MIC (11.25%) against <it>Acinetobacter baumannii </it>compared to manuka honey (12.5%).</p> <p>Conclusion</p> <p>Tualang honey exhibited variable activities against different microorganisms, but they were within the same range as those for manuka honey. This result suggests that tualang honey could potentially be used as an alternative therapeutic agent against certain microorganisms, particularly <it>A. baumannii </it>and <it>S. maltophilia</it>.</p