Improved HIV testing coverage after scale-up of antiretroviral therapy programs in urban Zambia: Evidence from serial hospital surveillance

Background: We evaluated changing HIV testing coverage and prevalence rates before and after expanding city-wide antiretroviral therapy (ART) programs in Lusaka, Zambia.Methods: We conducted serial cross-sectional surveys on the University Teaching Hospital medical ward to assess HIV prevalence among inpatients of unknown status in 2003 and 2006. Willing participants received counseling and dual HIV rapid tests. We compared the proportion of inpatients receiving their test results in 2003 (off-the-ward testing) to 2006 (on-the-ward).Results: In 2003, none of 103 inpatients knew their HIV status or took ART; 99.0% (102/103) agreed to testing. In 2006, 49.3% (99 of 201) patients knew they were HIV-infected and were on ART; of those with unknown status, 98.0% (100/102) agreed to testing. In 2003, only 54.9% (56/102) received posttest counseling and 98.2% (55/56) learned their status. In 2006, 99.0% (99/100) received post-test counseling and 99.1% (98 of 99) learned their status. In 2003, 62.8% (64 of 102) of status- unknown inpatients who agreed to testing were seropositive by dual rapid test, compared to 48.0% (48 of 100) of status-unknown inpatients in 2006. When including inpatients who already knew their seropositive status plus those unknowns who tested seropositive, the proportion of inpatients that was seropositive in 2006 was 73.1% (147 of 201), higher than in 2003.Conclusions: After ART program expansion, inpatients in 2006 were far more likely than their 2003 counterparts to know their HIV status and to be taking ART. In both years, 63-73% of medical inpatients were HIV-infected and 98.5% of inpatients agreed to testing. On-the-ward testing in 2006 avoided the 2003 problem of patient discharge before learning of their test results. Hospital-based HIV testing is an essential clinical service in high prevalence settings and can serve further as a surveillance system to help track the community impact of outpatient AIDS services in Africa.Keywords: HIV, testing, surveillance, Zambi

Velamentous cord insertion: a rare cause of emergency caesarean section

Pregnancies complicated with velamentous cord insertion (VCI) are at risk of adverse perinatal outcome. Placental and umbilical cord assessment should be performed during routine obstetric ultrasound. We report a case of velamentous cord insertion that was not identified antenatally. A 28-year-old primigravida at 40 weeks gestation presented in active phase of labour. Intrapartum, cardiotocography (CTG) tracing was pathological. Thus, decision was made for emergency caesarean section and a velamentous cord insertion was found. Despite a favourable outcome, this case highlighted the importance of antenatal diagnosis of VCI and thus preventing catastrophic outcome

Tuning of reduced graphene oxide thin film as an efficient electron conductive interlayer in a proven heterojunction photoanode for solar-driven photoelectrochemical water splitting

Although bismuth vanadate (BiVO4) has shown excellent photoelectrochemical (PEC) properties and is a good candidate of photoanode materials, the solar-driven PEC water splitting performance is still remained below its full potential due to the fast recombination and sluggish charge mobility of photogenerated charge carriers. Previously, we have communicated a proven Type II staggered vanadium pentoxide (V2O5)/BiVO4 heterojunction photoanode that could improve the photocurrent density. This study aimed to examine the effect of introducing an rGO thin film as an efficient electron conductive interlayer in a proven V2O5/BiVO4 heterojunction photoanode, and subsequently tuning the rGO film thickness in achieving the optimum PEC performance. The resultant ternary photoanode structure of V2O5/rGO/BiVO4 was characterised by using field emission-scanning electron microscopy (FE-SEM), high resolution-transmission electron microscopy (HR-TEM), UV–vis spectroscopy, X-ray diffractometer (XRD), Raman spectroscopy and photoluminescence (PL) measurements. Results showed that the interlayer rGO thin film arising from the sequential drop cast and electrochemical reduction of 320 μL ultrasonicated GO solution resulted in the optimal photocurrent density of 2.1 mA/cm2 at 1.5 V vs. Ag/AgCl. Furthermore, the chemical physics surrounding the photogenerated charge carrier transfer for heterojunction V2O5/BiVO4 was validated for the structure with and without the rGO interlayer. In particular, the electrochemical impedance spectroscopy (EIS) was used to measure multiple resistances at the FTO/semiconductor, semiconductor/semiconductor and semiconductor/electrolyte interfaces. Additionally, the charge transfer (Kt) and recombination (Kr) rate constants for the heterojunction V2O5/BiVO4 with the rGO interlayer were quantified using intensity modulated photocurrent spectroscopy (IMPS). Finally, the PEC H2 evolution rate from the ternary V2O5/rGO/BiVO4 photoanode was measured to be 32.7 μ mol/hr, which was about 3-fold higher than the bare V2O5/BiVO4 heterojunction photoanode

Intracystic haemorrhage in a non-endometriotic Mullerian vaginal cyst: an unexpected phenomenon

We report a case of rare, Mullerian vaginal cyst with intracystic haemorrhage in the absence of endometrial components. To date, this is the second case reported in the literature. A 51-year-old post-menopausal woman with history of anterior vaginal wall cyst was misdiagnosed to have cystocele. The cyst was excised and the content was old blood mixed with mucous. Histopathological examination revealed a Mullerian vaginal cyst without endometrial component. Thus, diagnosis and management of vaginal cyst was revisited and discussed

Probabilistic Clustering of Time-Evolving Distance Data

We present a novel probabilistic clustering model for objects that are represented via pairwise distances and observed at different time points. The proposed method utilizes the information given by adjacent time points to find the underlying cluster structure and obtain a smooth cluster evolution. This approach allows the number of objects and clusters to differ at every time point, and no identification on the identities of the objects is needed. Further, the model does not require the number of clusters being specified in advance -- they are instead determined automatically using a Dirichlet process prior. We validate our model on synthetic data showing that the proposed method is more accurate than state-of-the-art clustering methods. Finally, we use our dynamic clustering model to analyze and illustrate the evolution of brain cancer patients over time

Network model of immune responses reveals key effectors to single and co-infection dynamics by a respiratory bacterium and a gastrointestinal helminth

Co-infections alter the host immune response but how the systemic and local processes at the site of infection interact is still unclear. The majority of studies on co-infections concentrate on one of the infecting species, an immune function or group of cells and often focus on the initial phase of the infection. Here, we used a combination of experiments and mathematical modelling to investigate the network of immune responses against single and co-infections with the respiratory bacterium Bordetella bronchiseptica and the gastrointestinal helminth Trichostrongylus retortaeformis. Our goal was to identify representative mediators and functions that could capture the essence of the host immune response as a whole, and to assess how their relative contribution dynamically changed over time and between single and co-infected individuals. Network-based discrete dynamic models of single infections were built using current knowledge of bacterial and helminth immunology; the two single infection models were combined into a co-infection model that was then verified by our empirical findings. Simulations showed that a T helper cell mediated antibody and neutrophil response led to phagocytosis and clearance of B. bronchiseptica from the lungs. This was consistent in single and co-infection with no significant delay induced by the helminth. In contrast, T. retortaeformis intensity decreased faster when co-infected with the bacterium. Simulations suggested that the robust recruitment of neutrophils in the co-infection, added to the activation of IgG and eosinophil driven reduction of larvae, which also played an important role in single infection, contributed to this fast clearance. Perturbation analysis of the models, through the knockout of individual nodes (immune cells), identified the cells critical to parasite persistence and clearance both in single and co-infections. Our integrated approach captured the within-host immuno-dynamics of bacteria-helminth infection and identified key components that can be crucial for explaining individual variability between single and co-infections in natural populations