Counseling Psycho-motor Program to Life Adaptation for Breast Cancer Women "Before and After Mastectomy"

Background: Breast cancer a form of major health and psychological crisis that affect women and its impact is similar to trauma, the patient psychological and social in a bad state. The main aim of this study was to assess the impact of the psycho-motor program to life adaptation for breast cancer women "before and after mastectomy". The participants were 45 female patients, recruited from the oncology department of the University Hospital in the Beni Suef Governorate. Data were collected on one tool consisting of three parts, sociodemographic questionnaire, post/traumatic stress disorder (PTTSD) questionnaire, and the psychological pressures questionnaire. Results indicated that, the highest statistically significant association was between psycho-motor program and life adaptation for breast cancer women "before and after mastectomy". Keywords: Counseling, Psycho-motor, Adaptation, Breast cancer, Mastectomy

Human Immunodeficiency Virus -1 and Hepatitis B Virus Co-Infections among Injecting Drug Users in Malindi, Kenya

Currently no published data addressing the burden of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infection among injecting drug users (IDUs) in Kenya exists. These two viruses share similar routes of transmission, with illicit drug use by injection being the major route of infection. Injecting drug use is a rapidly growing problem in coastal towns of Kenya and the problem is aggravated by sex tourism.This study aimed at determining the prevalence of HBV in HIV positive IDUs and correlating the findings with socio-demographic factors of the study population.A cross-sectional study was conducted using structured questionnaires and laboratory testing of blood samples. Surface antigens for HBV (HBsAg) and anti-HIV antibodies were screened using rapid kits followed by Enzyme Linked Immunosorbent assay tests on positive samples using Hepanostika and Vironostika test kits, for HIV and HBV, respectively. The CD4+ T-cell count was determined by flow cytometry.The prevalence of HIV/HBV co-infection was 14.3% (13/91) with a mean age of 33.2 (SD ± 8.1) years. The mean CD4+ cell count in the HIV/HBV co-infected individuals was significantly lower than HIV mono-infection. Needle sharing and duration of active injection of drugs were significantly associated with HIV/HBV co-infections.This study concludes a potentially high prevalence of HBV/ HIV co-infection in injecting drug users in Malindi, Kenya. With limited evidence on IDU prevalence and its consequences in sub-Saharan Africa, the results of this study highlight the need for a more refined policy on HIV treatment strategy among IDUs. There is a further need for triple testing for HIV, HBV and HCV among suspected IDUs and other associated risk groups like the commercial sex workers before commencement of treatment. Keywords: Injecting drug users, HIV-1, HBV, viral co-infection, Malindi, Keny

Performance of selected HIV testing centers in a HIV Proficiency Testing Scheme in Kenya: a case study

Background: The Proficiency Testing (PT) for Human Immunodeficiency Virus (HIV) using Lateral flow assays provides an avenue for participating institutions/individuals to assess their technical competence in testing for HIV using LFAs that are recommended in the National HIV Testing Algorithm (NHTA) in Kenya. It also provides confidence to the participating institutions and potential users of their services besides giving the institutions an opportunity for improvement. Objective: To determine the performance of selected HIV testing centers in a HIV PT Scheme in Kenya Methods: Fifty one participants (51) in Kenya were selected from 7 sites (Kisumu, Mombasa, Kilifi, Nairobi and Malindi) to participate in this PT round. The sites comprised both private sector and institutions that do not participate in the National HIV referral Lab-PT scheme. They were provided with panels containing six samples to analyze using the current NHTA in Kenya. Obtained results were sent to our laboratory electronically. Results: Eighty nine percent (89.0%) of the panels were correctly identified by the participants as positive or negative. Of the 11.0% errors, 74.2% were committed in one or more test result obtained while 12.9% committed in failure to follow NHTA. Two minor errors repeated by participants were; failure to record the final results in spite of obtaining correct tests and correct reactive results with the first and second test kits but in conclusion the participant recorded negative (12.9%). Root cause analysis revealed that the error committed by participants were as a result of failure to observe the kit manufactures’ instructions and NHTA guidelines. Conclusion: The results of this PT Scheme enhance the need for constant training of personnel conducting HIV testing and Counseling in Kenya on proper techniques of carrying out HIV testing using Lateral flow assays in the NHTA. Key words: HIV, Proficiency Testing, errors, false negative, false positive

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Prevalence, awareness and risk factors associated with Hepatitis B infection among pregnant women attending the antenatal clinic at Mbagathi District Hospital in Nairobi, Kenya

Introduction: hepatitis B Viral Infection (HBV) remains one of the leading cause of morbidity and mortality globally accounting for 38-53% of chronic liver diseases and about 686,000 deaths annually. The prevalence of HBV is 9-20% in Sub-Saharan Africa, and in Kenya it is 5-30% among the general population and 9.4% among pregnant women. This study was aimed at identifying the prevalence, awareness and risk factors associated with HBV infections among pregnant women attending Antenatal clinic (ANC) at Mbagathi District hospital, Nairobi. Methods: this was a cross-sectional study involving 287 pregnant women enrolled for three months (September to December 2014) from Nairobi and neighbouring counties. A structured questionnaire that captured social, demographic and explanatory variables was administered to the study participants. Blood samples were also drawn from the participants and tested for HBV using Enzyme-Linked Immunosorbent Assay (ELISA) system. Results: the study established that the prevalence of HBV infections among pregnant women attending antenatal clinic at Mbagathi District Hospital was 3.8% with highest infection rate among the 20-24 years age group. Seventy six (60.8 %) of the participants reported sexual encounters in less than a month before the interview of which 5 (7.6%) reported encounters involving other partners apart from their spouses.HBV awareness among the study participants was 12.2%. Before the interview, those with at least tertiary education (Mean =1.33, SD = 1.131), were more informed about HBV infection as compared to those with primary and secondary education (Mean = 0.63, SD = 0.722; (Mean =0.31, SD= 0.664). In regards to assessment of the risk factors; type of family (χ² =19.753 df2 p<0.01), parity (χ² =7.128 df2 p<0.01), History of abortions (χ²=9.094 df1 p<0.01), early age (11-15 years) at first sexual encounter (χ² =8.185 df1 p<0.01) were significantly associated with HBV positivity. Conclusion: the prevalence of HBV infection among pregnant women attending Antenatal clinic (ANC) at Mbagathi District hospital, Nairobi was lower (3.8%) than the prevalence among pregnant women nationally (9.4%). These women also showed a low level of HBV awareness (12.2%.).The Pan African Medical Journal 2016;2

Anti-bacterial efficacy of alcoholic hand rubs in the Kenyan market, 2015

Abstract Background Hand hygiene is known to be effective in preventing hospital and community-acquired infections. The increasing number of hand sanitizer brands in Kenyan hospitals and consumer outlets is of concern. Thus the main aim of this study was to evaluate the anti-bacterial efficacy and organoleptic properties of these hand sanitizers in Kenya. Methods This was an experimental, laboratory-based study of 14 different brands of hand sanitizers (coded HS1-14) available in various retail outlets and hospitals in Kenya. Efficacy was evaluated using standard non-pathogenic Escherichia coli (ATCC 25922), Staphylococcus aureus (ATCC 25923) and Pseudomonas aeruginosa (ATCC 27853) as per the European Standard (EN). The logarithmic reduction factors (RF) were assessed at baseline and after treatment, and log reduction then calculated. Ten and 25 healthy volunteers participated in the efficacy and organoleptic studies respectively. Results Four (28.6%) hand sanitizers (HS12, HS9, HS13 and HS14) showed a 5.9 reduction factor on all the three bacteria strains. Seven (50%) hand sanitizers had efficacies of <3 against all the three bacteria strains used. Efficacy on E. Coli was higher compared to the other pathogens. Three hand sanitizers were efficacious on one of the pathogens and not the other. In terms of organoleptic properties, gel-based formulations were rated far higher than the liquid based formulations brands. Conclusion Fifty percent (50%) of the selected hand sanitizers in the Kenyan market have efficacy that falls below the World Health Organization (WHO) and DIN EN 1500:2013. Of the 14 hand sanitizers found in the Kenyan market, only four showed efficacies that were comparable to the WHO-formulation. There is a need to evaluate how many of these products with <3 efficacy that have been incorporated into the health system for hand hygiene and the country\u2019s policy on regulations on their usage

Co-Infection Burden of Hepatitis C Virus and Human Immunodeficiency Virus among Injecting Heroin Users at the Kenyan Coast.

Injection drug use is steadily rising in Kenya. We assessed the prevalence of both human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) infections among injecting heroin users (IHUs) at the Kenyan Coast.A total of 186 IHUs (mean age, 33 years) from the Omari rehabilitation center program in Malindi were consented and screened for HIV-1 and HCV by serology and PCR and their CD4 T-cells enumerated by FACS.Prevalence of HIV-1 was 87.5%, that of HCV was 16.4%, co-infection was 17.9% and 18/152 (11.8%) were uninfected. Only 5.26% of the HIV-1 negative injectors were HCV positive. Co-infection was higher among injectors aged 30 to 40 years (20.7%) and among males (22.1%) than comparable groups. About 35% of the injectors were receiving antiretroviral treatment (ART). Co-infection was highest among injectors receiving D4T (75%) compared to those receiving AZT (21.6%) or TDF (10.5%) or those not on ART (10.5%). Mean CD4 T-cells were 404 (95% CI, 365 - 443) cells/mm3 overall, significantly lower for co-infected (mean, 146; 95% CI 114 - 179 cells/mm3) than HIV mono infected (mean, 437, 95% CI 386 - 487 cells/mm3, p<0.001) or uninfected (mean, 618, 95% CI 549 - 687 cells/mm3, p<0.001) injectors and lower for HIV mono-infected than uninfected injectors (p=0.002). By treatment arm, CD4 T-cells were lower for injectors receiving D4T (mean, 78; 95% CI, 0.4 - 156 cells/mm3) than TDF (mean 607, 95% CI, 196 - 1018 cells/mm3, p=0.005) or AZT (mean 474, 95% CI -377 - 571 cells/mm3, p=0.004).Mono and dual infections with HIV-1 and HCV is high among IHUs in Malindi, but ART coverage is low. The co-infected IHUs have elevated risk of immunodeficiency due to significantly depressed CD4 T-cell numbers. Coinfection screening, treatment-as-prevention for both HIV and HCV and harm reduction should be scaled up to alleviate infection burden

CD4 Counts across various categories of heroin injectors.

<p>CD4 T-cells are compared between treatment arms of injectors (A). ¶ Counts are significantly lower for the D4T- arm than for the AZT arm (p = 0.004), TDF (p = 0.005) or the ART- (p<0.001) arm and lower for the sub-optimal ART than ART- (p = 0.023) arm. All subjects in the ‘ART-’ arm were not infected (NI) by either virus. Mean CD4 counts are compared between infection statuses (B). These are significantly lower for co-infected than HIV-1 mono infected injectors as shown. §Shows significantly lower CD4 counts for HIV mono-infected than NI injectors (p = 0.002). CD4 data is compared between age groups of the different infection statuses (C). No significant (NS) difference was observed. *Co-infected injectors had much lower CD4 levels compared to other infection categories in any age group. Only one injector was HCV mono-infected (horizontal bar in the >30–40 years category). CD4 Counts were not significantly different between genders of injectors (D). ART, antiretroviral treatment; CTX, cotrimoxazole (septrin); ART-, No ART; Uk, unknown ART status; Sub, sub optimal ART.</p

CD4 T-cell counts compared by various categories of heroin injectors who were screened for both HIV and HCV.

<p>Legend of table:</p><p>^† P-value is significant at level shown comparing mean CD4 between infection statuses or between treatment arms.</p><p>^a No qualifying subjects.</p><p>^b Confidence Interval (CI) is not applicable. ART, antiretroviral treatment. Only one subject (aged 31-40yrs, CD4 T-cells of 287 counts/mm³) was HCV mono-infected, and is excluded from this table. Sub-optimal ART cases are IHUs with unexplained use of single-drug ART regimen.</p><p>CD4 T-cell counts compared by various categories of heroin injectors who were screened for both HIV and HCV.</p