Surgical Management of Inguinal Hernias at Bugando Medical Centre in Northwestern Tanzania: Our Experiences in a Resource-Limited Setting.

Inguinal hernia repair remains the commonest operation performed by general surgeons all over the world. There is paucity of published data on surgical management of inguinal hernias in our environment. This study is intended to describe our own experiences in the surgical management of inguinal hernias and compare our results with that reported in literature. A descriptive prospective study was conducted at Bugando Medical Centre in northwestern Tanzania. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Statistical data analysis was done using SPSS software version 17.0. A total of 452 patients with inguinal hernias were enrolled in the study. The median age of patients was 36 years (range 3 months to 78 years). Males outnumbered females by a ratio of 36.7:1. This gender deference was statistically significant (P=0.003). Most patients (44.7%) presented late (more than five years of onset of hernia). Inguinoscrotal hernia (66.8%) was the commonest presentation. At presentation, 208 (46.0%) patients had reducible hernia, 110 (24.3%) had irreducible hernia, 84 (18.6%) and 50(11.1%) patients had obstructed and strangulated hernias respectively. The majority of patients (53.1%) had right sided inguinal hernia with a right-to-left ratio of 2.1: 1. Ninety-two (20.4%) patients had bilateral inguinal hernias. 296 (65.5%) patients had indirect hernia, 102 (22.6%) had direct hernia and 54 (11.9%) had both indirect and direct types (pantaloon hernia). All patients in this study underwent open herniorrhaphy. The majority of patients (61.5%) underwent elective herniorrhaphy under spinal anaesthesia (69.2%). Local anaesthesia was used in only 1.1% of cases. Bowel resection was required in 15.9% of patients. Modified Bassini's repair (79.9%) was the most common technique of posterior wall repair of the inguinal canal. Lichtenstein mesh repair was used in only one (0.2%) patient. Complication rate was 12.4% and it was significantly higher in emergency herniorrhaphy than in elective herniorrhaphy (P=0.002). The median length of hospital stay was 8 days and it was significantly longer in patients with advanced age, delayed admission, concomitant medical illness, high ASA class, the need for bowel resection and in those with surgical repair performed under general anesthesia (P<0.001). Mortality rate was 9.7%. Longer duration of symptoms, late hospitalization, coexisting disease, high ASA class, delayed operation, the need for bowel resection and presence of complications were found to be predictors of mortality (P<0.001). Inguinal hernias continue to be a source of morbidity and mortality in our centre. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem

Dynamic correlation between CTL response and viral load in primary human immunodeficiency virus-1 infected Koreans

<p>Abstract</p> <p>Background</p> <p>HIV-1 specific cytotoxic T lymphocytes (CTLs) have an important role as antiviral effector cells for controlling HIV-1 infection.</p> <p>Methods</p> <p>To investigate CTL response during the early stage of HIV infection, we measured immunity-related factors including CD4⁺T cell counts, CD8⁺T cell counts, HIV-1 RNA viral loads and IFN-γ secretion according to CTL response in 78 selected primary HIV-1-infected Koreans.</p> <p>Results</p> <p>The CTL response was strongly induced by HIV-1 specific Gag and Nef peptides (p = 0.016) compared with induction by Tat or Env peptides. These results suggest that the major antiviral factors inducing strong HIV-specific CTL responses are associated with the Gag and Nef viral regions in primary HIV-1 infected Koreans. The relationship between viral load and CTL response showed varying correlations with time following HIV infection. CTL response was inversely correlated with viral loads at preseroconversion stage I (r = -0.224 to -0.33) and changed to a positive correlation at the preseroconversion stage II (r = 0.132 to 0.854). Finally, it changed to an inverse correlation again after seroconversion until a viral set point was established on serological profiling (r = -0.195 to -0.407).</p> <p>Conclusions</p> <p>These findings demonstrate a dynamic correlation between viral load and subsequent CTL responses during early HIV infection.</p

Infection of CD8+CD45RO+ Memory T-Cells by HIV-1 and Their Proliferative Response

CD8+ T-cells are involved in controlling HIV-1 infection by eliminating infected cells and secreting soluble factors that inhibit viral replication. To investigate the mechanism and significance of infection of CD8+ T-cells by HIV-1 in vitro, we examined the susceptibility of these cells and their subsets to infection. CD8+ T-cells supported greater levels of replication with T-cell tropic strains of HIV-1, though viral production was lower than that observed in CD4+ T-cells. CD8+ T-cell infection was found to be productive through ELISA, RT-PCR and flow cytometric analyses. In addition, the CD8+CD45RO+ memory T-cell population supported higher levels of HIV-1 replication than CD8+CD45RA+ naïve T-cells. However, infection of CD8+CD45RO+ T-cells did not affect their proliferative response to the majority of mitogens tested. We conclude, with numerous lines of evidence detecting and measuring infection of CD8+ T-cells and their subsets, that this cellular target and potential reservoir may be central to HIV-1 pathogenesis

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Bibliometric Analysis of Digital Divide Using Web of Science

The digital divide refers to the gap between those people who have access to information and communication technologies (computer, cellphones, especially smart phones, digital hardware, software and internet) and those who don\u27t. Literature show that digital divide has been explored extensively in different perspectives. The main objective of the current study is to look at the bibliometric examination of research output on the Digital Divide literature published in the Web of Science from 1999 to 2021, using bibliometric and visualization techniques. Initially, minimum number of 14 keywords occurrences are selected in which 70 keywords out of 5127 finalized. For the Keywords analysis VOS-viewer were used. Five keywords “Digital Divide”, “Internet”, “ICT”, “Digital Inequalities” and “Digital Literacy” truly represent the nature of the current research. Finally, 2443 documents on Digital Divide indexed in the Web of Science database were analyzed, including Articles, Proceeding papers, Reviews, and book Chapters. Among all of them the most occurring document is Article (1632). For data analysis and bibliometric indicator extraction, the bibliometric method based on the R package, Excel, MS-Access, and VOS-viewer software packages were used. This study reveals the research work, productivity and publication of different authors on Digital Divide. Further, this work provided some pertinent information about the most productive countries, organizations, and authors, preferred types of researcher\u27s sources and authorship collaboration in Digital Divide research as well as prominent research\u27s citations and their use. Similarly, based on the data collected, the focus was on top-ranked publications. Leading countries, institutes, journals, articles, authorships, keywords, collaborative research networks, leading scholars, and keywords were all included in the analysis. Results show that the article “The digital divide as a complex and dynamic phenomenon” published in 2003 have the highest citation 546 published in the journal “Information Society”. It reveals that most of the articles on “Digital Divide” included in the current study have reasonable citation because the least cited article among top 20 had 216 citations. Further, collaboration of two authors, closely followed by one, three and four authors has been found regarding the publications on“Digital Divide”. Among top 20 most productive countries on “Digital Divide”, USA is the most productive country with 780 documents, followed by England and Spain with 186 and 161 respectively. Similarly, when looking at the leading research institutions “Tilburg University” appeared one of the highest productive institute have “Tilburg University” leads the research institute list with 26 publications in this area. Most prolific author in this field is “Jams J”, who published 23 articles. The highest bilateral collaboration has been observed between the United States and China. This study emphasis on the patterns of scholarly communication in the digital divide research. These trends would benefit scholars from a variety of fields by identifying the core areas, main authors, and core publications that produce this content. It also encourages scholars to do collaborative and multidisciplinary research on the digital divide in order to gain deep and practical knowledge.Leading countries, institutes, journals, articles, authorships, keywords, collaborative research networks, leading scholars, and a three-factor analysis of leading countries, institutions, and keywords were all highlighted in the analysis