Water quality improvement in Nepal: scaling up of a water safety plan (WSP)

In Nepal, 50 percent people have access to piped water supply system including 30 percent spring sources, 10 percent stream sources and 10 percent deep tube well. 30 percent of the people are using shallow hand pump systems and remaining 20 percent are still having traditional systems as primary source for domestic water. Spring sources are likely to be safe, however, equally prone to contamination due to poor sanitary condition around the source. Government has approved National Drinking Water Quality Standard and Directives which require all service providers to develop water quality improvement plan. Water Safety Plan(WSP) has been practiced in rural and urban towns since 2007 for continuous safety of water supply. Practical knowledge has been gained and guiding document has been prepared for service providers. Government of Nepal is planning to expand WSP in all 75 districts. This paper highlights WSP experiences and approach for scaling up

Presentation and outcome of hepatocellular carcinoma in HIV-infected patients: A U.S.–Canadian multicenter study

HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus coinfection. Limited data are available on those with hepatocellular carcinoma (HCC). A retrospective analysis from 1992 to 2005 in 6 centers identified 63 HIV-infected HCC patients. Controls were 226 consecutive HIV-negative HCC patients from four sites. HIV-positive patients were younger than controls (52 vs. 64 years, p < 0.001), more commonly had chronic hepatitis B or C (97% vs. 73%, p < 0.001), were more frequently symptomatic (51% vs. 38%, p = 0.048), had a higher median alfa-fetoprotein level (227 vs. 51 ng/ml, p = 0.005), but a similar mean Child–Turcotte–Pugh score (7.0 vs. 7.5, p = 0.05) and HCC staging score (Barcelona-Clínic-Liver-Cancer stages C + D in 50% vs. 58%, p = 0.24). HCC developed faster in HIV/HCV-coinfected than in HCV-monoinfected patients (mean, 26 vs. 34 years after HCV infection, p = 0.002). HIV-positive patients received proven therapy more often (48% vs. 31%, p = 0.017), but median survival was similar (6.9 vs. 7.5 months, p = 0.44). Independent factors predicting survival were symptomatic presentation (hazard ratio [HR], 0.437; p < 0.001), any proven therapy (HR, 2.19; p < 0.001), diagnosis after 01-Jan-2002 (HR, 1.52; p = 0.010), Barcelona-Clínic-Liver-Cancer stages C + D (HR, 0.491; p < 0.001), AST/ALT ⩾ 2.00 (HR, 0.597; p = 0.001), AFP ⩾ 400 ng/mL (HR, 0.55, p = 0.003), and platelets ⩾ 100,000/mm 3 (HR, 0.651; p = 0.012), but not HIV-serostatus ( p = 0.19). In HIV-infected patients without HCC therapy ( n = 33), median survival was longer with undetectable HIV RNA (<400 copies/mL) than with HIV viremia (6.5 vs. 2.6 months, p = 0.013). HIV-positive HCC patients are younger and more frequently symptomatic and infected with HCV or HBV than HIV-negative patients. Tumor staging and survival are similar. In untreated patients, undetectable HIV RNA independently predicts better survival