Will I? won't I? Why do men who have sex with men present for post-exposure prophylaxis for sexual exposures?

Background: Failures of post-exposure prophylaxis following sexual exposure (PEPSE) to prevent seroconversion have been reported and are often associated with ongoing risk exposure. Understanding why men who have sex with men (MSM) access PEPSE on some occasions and not others may lead to more effective health promotion and disease prevention strategies Methods: A qualitative study design using semi-structured interviews of 15 MSM within 6 months of them initiating PEPSE treatment at an HIV outpatient service in Brighton, UK. Results: PEPSE seeking was motivated by a number of factors: an episode that related to a particular sexual partner and their behaviour; the characteristics of the venue where the risk occurred; the respondent’s state of mind and influences of alcohol and recreational drug use; and their perceived beliefs on the effectiveness of PEPSE. Help was sought in the light of a “one-off” or “unusual” event. Many respondents felt they were less likely to behave in a risky manner following PEPSE. Conclusion: If PEPSE is to be effective as a public health measure, at risk individuals need to be empowered to make improved risk calculations from an increased perception that they could be exposed to HIV if they continue their current behaviour patterns. The concern is that PEPSE was sought by a low number of MSM implying that a greater number are not using the service based on failure to make accurate risk calculations or recognise high-risk scenario

Evaluation of outcome following paracervical infiltration with or without saline and adrenaline during vaginal hysterectomy

Background: Paracervical infiltration is used in vaginal hysterectomy to facilitate dissection. Use of paracervical infiltration however can be associated with local ischemia and infection. We did a study to find out its benefits during vaginal hysterectomy.Methods: It was a prospective case control study. Patients were divided into two groups. In the first group, no paracervical infiltration was given. In the second group paracervical infiltration was given before hysterectomy. The operating time, blood loss and postoperative infection were noted in each group.Results: The operating time was slightly higher in vaginal hysterectomy group without infiltration (p=0.025) The operating time in laparoscopic assisted vaginal hysterectomy group was not significant (p=0.0296). There was significant difference in Hemoglobin after surgery in both groups (p value 0.614 for vaginal hysterectomy and 0.173 for laparoscopic assisted vaginal hysterectomy). There was no case of infection in both groups.Conclusions: From our study, we concluded that paracervical infiltration offers no distinctive advantage during vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy.

QMLE: a methodology for statistical inference of service demands from queueing data

Estimating the demands placed by services on physical resources is an essential step for the definition of performance models. For example, scalability analysis relies on these parameters to predict queueing delays under increasing loads. In this paper, we investigate maximum likelihood (ML) estimators for demands at load-independent and load-dependent resources in systems with parallelism constraints. We define a likelihood function based on state measurements and derive necessary conditions for its maximization. We then obtain novel estimators that accurately and inexpensively obtain service demands using only aggregate state data. With our approach, and also thanks to approximation methods for computing marginal and joint distributions for the load-dependent case, confidence intervals can be rigorously derived, explicitly taking into account both topology and concurrency levels of the services. Our estimators and their confidence intervals are validated against simulations and real system measurements for two multi-tier applications, showing high accuracy also in the presence of load-dependent resources

Comparison between paracervical and intracervical block before procedures on uterine cavity and cervical dilatation

Background: Procedures like dilatation and curettage and manual vacuum aspirations are one of the commonest procedures conducted in the outpatient Department of Obstetrics and Gynecology. Objective of present study was to find out whether intracervical block is as effective as paracervical block in patients undergoing cervical dilatation and procedures on uterine cavity.Methods: Patients undergoing dilatation and curettage or manual vacuum aspiration were given either paracevrical block or intracervical block. The pain during cervical dilatation and curettage or manual vacuum aspiration were assessed on a 10 cm visual analogue scale.Results: Mean visual analogue score during dilatation was comparable in both groups. Mean visual analogue score were comparable during dilatation in both groups before curettage or manual vacuum aspiration. Mean visual analogue scores during manual vacuum aspiration or curettage was also comparable with both groups. One patient had a serious side effect of convulsion during paracervical block.Conclusions: Intracervical block is preferable to paracervical block during procedures like cervical dilatation and on procedures on uterine cavity as intracervical block requires less technical precision than paracervical block

Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)

Background: The objective of the study was to study the use of electrocautery selectively for cardinal uterosacral ligament complex during NDVH.Methods: We performed a series of NDVH where electrocautery was used selectively for the uterosacral cardinal ligament complex. Rest all stumps were clamped, divided and ligated.Results: We did a series of 21 cases using this technique and found this as a very effective method of doing NDVH. There were no major complications.Conclusion: Selective use of electrocautery for uterosacral and cardinal ligament complex makes NDVH easy

Carbon turnover in the water-soluble protein of the adult human lens.

PurposeHuman eye lenses contain cells that persist from embryonic development. These unique, highly specialized fiber cells located at the core (nucleus) of the lens undergo pseudo-apoptosis to become devoid of cell nuclei and most organelles. Ostensibly lacking in protein transcriptional capabilities, it is currently believed that these nuclear fiber cells owe their extreme longevity to the perseverance of highly stable and densely packed crystallin proteins. Maintaining the structural and functional integrity of lenticular proteins is necessary to sustain cellular transparency and proper vision, yet the means by which the lens actually copes with a lifetime of oxidative stress, seemingly without any capacity for protein turnover and repair, is not completely understood. Although many years of research have been predicated upon the assumption that there is no protein turnover or renewal in nuclear fiber cells, we investigated whether or not different protein fractions possess protein of different ages by using the (14)C bomb pulse.MethodsAdult human lenses were concentrically dissected by gently removing the cell layers in water or shaving to the nucleus with a curved micrometer-controlled blade. The cells were lysed, and the proteins were separated into water-soluble and water-insoluble fractions. The small molecules were removed using 3 kDa spin filters. The (14)C/C was measured in paired protein fractions by accelerator mass spectrometry, and an average age for the material within the sample was assigned using the (14)C bomb pulse.ResultsThe water-insoluble fractions possessed (14)C/C ratios consistent with the age of the cells. In all cases, the water-soluble fractions contained carbon that was younger than the paired water-insoluble fraction.ConclusionsAs the first direct evidence of carbon turnover in protein from adult human nuclear fiber cells, this discovery supports the emerging view of the lens nucleus as a dynamic system capable of maintaining homeostasis in part due to intricate protein transport mechanisms and possibly protein repair. This finding implies that the lens plays an active role in the aversion of age-related nuclear (ARN) cataract

Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi.

In Malawi, maternal mortality remains high. Existing maternal death reviews fail to adequately review most deaths, or capture those that occur outside the health system. We assessed the value of community involvement to improve capture and response to community maternal deaths