An evaluation of PMTCT and follow-up infant HIV testing in KwaZulu-Natal, South Africa

ABSTRACT AN EVALUATION OF PMTCT AND FOLLOW-UP INFANT HIV TESTING IN KWAZULU- NATAL, SOUTH AFRICA. Juliana Chen. Edendale Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa. (Sponsored by Brian Forsyth, Department of Pediatrics, Yale University School of Medicine). Background: The primary cause of pediatric HIV infection is mother-to-child transmission, which can be reduced significantly by interventions that include highly active antiretroviral therapy (HAART) and antiretroviral (ARV) prophylaxis. Prevention of mother-to-child transmission (PMTCT) programs serve as critical entry points for the provision of HIV testing and treatment, though often remain poorly implemented and underutilized. Such programs are especially critical in resource-limited settings that have a heavy burden of HIV infection. Methods: Data were collected via retrospective medical record review of pregnant women who accessed antenatal services at a public sector PMTCT program from December 2006 to June 2007. A supplementary review of pregnant women with no prior history of HIV testing was conducted to evaluate HIV testing at delivery. Finally, an analysis of infant PCR testing was conducted to assess rates of follow-up testing among HIV-exposed infants. Results: High rates of testing reveal that half of women presenting for antenatal care were HIV positive. Rates of repeat testing during pregnancy and testing at delivery were low. There were high rates of ARV prophylaxis among mothers and infants, though less than two-thirds of eligible mothers initiated HAART. At most, only half of HIV-exposed infants returned for HIV testing by twelve weeks of age. Of those tested, over 16% were found to be HIV positive. Discussion: Despite significant enrollment in PMTCT and high acceptance of HIV testing in pregnancy, gaps in service delivery and/or failures in documentation result in multiple missed opportunities. An inability to link mother-infant pairs, poor follow-up of HIV-exposed infants, and a lack of coordination of services further limit overall PMTCT program effectiveness. More effective regimens will have limited success without fundamental improvements in service delivery. Improved training and protocols for care, as well as the development of uniform data collection tools, are critical to overall PMTCT program effectiveness

Advancing Dietetic Practice through the Implementation and Integration of Smartphone Apps

As the burden of obesity and its related chronic diseases grows, dietitians have integral roles in providing individualised medical nutrition therapy. Smartphone mobile health (mHealth) applications (apps) have potential to support and extend reach of dietetic services. This thesis examines how mHealth apps could be implemented and integrated by dietitians to advance nutrition care. Based on a narrative review of current evidence, the novel mobile Nutrition Care Process grid was developed, providing dietitians with best-practice guidance for using mHealth apps across the nutrition care process. Surveying dietitians internationally revealed that 62% used mHealth apps in their practice, although primarily as an information resource and for patient self-monitoring rather than as an integral part of the nutrition care process. Similarly, the public used commercial health and fitness apps, such as MyFitnessPal, to track health behaviours. However, individuals performed suboptimally when using MyFitnessPal to track dietary intake, with the app underestimating mean energy intake by -1863kJ (SD=2952kJ, P=0.0002) compared to 24-hour recalls. Qualitative feedback from dietitians, the public and patients are presented to guide app developers in designing quality mHealth apps. A behavioural analysis was conducted using the COM-B model and intervention recommendations were formulated to facilitate uptake of mHealth apps into dietetic practice. These recommendations were incorporated into a two-phase intervention comprising of an educational and training workshop and a 12-week phase where dietitians used an integrated commercial app platform with their patients. The intervention was found to be feasible to deliver and improved dietitians’ mHealth app self-efficacy. There is translational potential for this intervention to equip the profession with greater capability, opportunity, motivation and self-efficacy to use mHealth apps in dietetic practice and in patient nutrition care

Gabapentin for pain management after osmotic dilator insertion and prior to dilation and evacuation: A randomized controlled trial.

ObjectiveTo evaluate if gabapentin 600 mg reduces pain after osmotic dilator placement the day before a dilation and evacuation (D&E) procedure.Study designWe conducted a double-blind, placebo-controlled, randomized (stratified by vaginal parity) trial among women undergoing osmotic dilator placement before D&E at 15-23 5/7 weeks gestation. Subjects received gabapentin 600 mg or placebo 30 min before dilator placement, with re-dosing 8 h later. We assessed pain after dilator placement using a numeric rating scale (NRS; scale 0-10) at 5 min, 2, 4, and 8 h, and at presentation for D&E. The primary outcome was median NRS pain score change from baseline to 8 h after dilator placement. Secondary outcomes included gabapentin-related side effects and analgesic use.ResultsOf 121 randomized women, we excluded three subjects (allergic reaction [placebo], randomization error, no NRS data), leaving 60 gabapentin and 58 placebo subjects. Of 110 (93%) women who provided 8-hour data, median pain score changes from baseline did not differ between gabapentin and placebo groups overall (2 vs. 2.5, p = 0.52), in vaginally nulliparous women (2 vs. 4, p = 0.10) or in parous women (2 vs. 1.5, p = 0.37). We found no statistically significant differences in median pain score change from baseline to any timepoint overall or when stratified by parity. Beginning at 2 h after dilator placement, more gabapentin than placebo users experienced dizziness (29/53[55%] vs. 11/53[21%], p = 0.001) and tiredness (34/54[63%] vs. 17/54[31%], p = 0.002). The proportion of women using narcotics did not differ between gabapentin (35/60[58%]) or placebo (40/58[69%]) users (p = 0.26).ConclusionsGabapentin does not reduce pain with overnight osmotic dilator placement prior to D&E and causes drug-related side effects.Implications statementWomen experience pain, mostly mild to moderate, with overnight cervical dilator placement at 15-23 5/7 weeks gestation. About 2/3 of women will use a limited quantity of narcotics if provided. Gabapentin does not decrease the pain with or following dilator placement and does not decrease narcotic use

Online language learning to develop english reading and listening skills in university students: a pilot stuy in Hong Kong

The range of technological applications in different educational contexts makes it necessary for continued inquiry into online language learning (OLL), especially in relation to its impact on different learner populations whose perception and acceptance of OLL can vary across settings. This pilot study involved 66 Chinese students in a Hong Kong university and examined their OLL experience in online reading and listening activities. Results of the study suggest the easy availability of internet resources can greatly enhance students’ OLL experience, while raising four challenges in the areas of online materials development, student motivation, pedagogy-technology interface, and intercultural communicative competence. Possible ways of tackling such challenges are outlined. The article concludes with a view that successful OLL needs to be predicated on a tripartite framework of hardware, software and humanware

Cytotoxic and genotoxic investigation on barbatimão [Stryphnodendron adstringens (Mart: ) Coville, 1910] extract

Stryphnodendron adstringens (Mart.) Coville, 1910 is a small tree, distributed widely throughout the Cerrado region of Brazil and named "barbatimão" by the Tupi-Guarani tribes, which presents astringent properties. Its ethnopharmacological uses comprise, among others, anti-inflammatory and wound healing action, and it is used in the treatment of diarrhea and gynecological problems. The phytotherapeutic use of 'barbatimão' is largely related to its tannin content, which is abundant in its bark. The main goal of the present study was to evaluate the cytotoxic, mutagenic, and genotoxic potential of the lyophilized solution of the stem bark of S. adstringens, using the Ames test, the SOS-Inductest and the SOS-Chromotest. S. adstringens presented cytotoxic activity in all tested systems, did not present mutagenic activity detectable by the Ames test and SOS-Chromotest, and showed some genotoxic effect on the SOS-Inductest. However, the metabolization of the extract by S9 fraction attenuated its genotoxic and cytotoxic activities.Stryphnodendron adstringens (Mart.) Coville, 1910 é uma pequena árvore amplamente distribuída nas regiões de cerrado do Brasil, chamada de "barbatimão" pelas tribos Tupi-Guarani, que apresenta propriedade adstringente. Seu uso etnofarmacológico compreende, entre outros, efeitos antiinflamatório e cicatrizante, sendo empregada no tratamento de diarréias e problemas ginecológicos. Grande parte das aplicações do fitoterápico de barbatimão está relacionada aos taninos, abundantes em sua casca. O objetivo do presente trabalho foi avaliar os potenciais citotóxico, mutagênico e genotóxico da solução liofilizada da casca de S. adstringens, utilizando Teste de Ames, SOS-Induteste e SOS-Cromoteste. S. adstringens apresentou atividade citotóxica em todos os sistemas testados, não apresentou atividade mutagênica detectável pelo teste de Ames e SOS-Cromoteste e mostrou certo efeito genotóxico no SOS-Induteste. Porém, a metabolização do extrato pela fração S9 atenuou suas atividades genotóxica e citotóxica

Identification of hepta-histidine as a candidate drug for Huntington's disease by in silico-in vitro- in vivo-integrated screens of chemical libraries.

We identified drug seeds for treating Huntington's disease (HD) by combining in vitro single molecule fluorescence spectroscopy, in silico molecular docking simulations, and in vivo fly and mouse HD models to screen for inhibitors of abnormal interactions between mutant Htt and physiological Ku70, an essential DNA damage repair protein in neurons whose function is known to be impaired by mutant Htt. From 19,468 and 3,010,321 chemicals in actual and virtual libraries, fifty-six chemicals were selected from combined in vitro-in silico screens; six of these were further confirmed to have an in vivo effect on lifespan in a fly HD model, and two chemicals exerted an in vivo effect on the lifespan, body weight and motor function in a mouse HD model. Two oligopeptides, hepta-histidine (7H) and Angiotensin III, rescued the morphological abnormalities of primary neurons differentiated from iPS cells of human HD patients. For these selected drug seeds, we proposed a possible common structure. Unexpectedly, the selected chemicals enhanced rather than inhibited Htt aggregation, as indicated by dynamic light scattering analysis. Taken together, these integrated screens revealed a new pathway for the molecular targeted therapy of HD

Avaliação da atividade mutagênica e genotóxica de Ginkgo biloba L. pelo teste do micronúcleo em camundongos

Ginkgo biloba L. é uma planta medicinal amplamente utilizada pela população mundial para o tratamento de insuficiência cerebral, doenças vasculares e outras enfermidades. No presente trabalho foi avaliada a atividade clastogênica e/ou aneugênica do extrato das folhas de Ginkgo biloba L. (EGb 761) pelo teste de micronúcleo em eritrócitos policromáticos da medula óssea de camundongos. Grupos de cinco animais foram tratados com extrato EGb 761 por via gavage com doses de 50 mg/kg, 100 mg/kg e 200 mg/kg. Para todas as doses utilizadas, a freqüência de eritrócitos policromáticos micronucleados (EPCMN) foi avaliada no tempo de 24 horas pós-tratamento. A preparação citológica foi realizada de acordo com a metodologia de Heddle. citotoxidade foi avaliada pela relação de eritrócitos policromáticos e normocromáticos (EPC/ENC). Os resultados mostraram que o EGb 761 não provocou aumento significativo (p>0,05) na freqüência de EPCMN em relação ao grupo controle negativo. Não foi observada citotoxicidade para todas as concentrações utilizadas (P>0,01) em relação ao grupo controle negativo. Dessa maneira, pode-se sugerir que EGb 761 não apresentou atividade mutagênica e/ou citotóxica nas condições experimentais executadas