Prostate Cancer Screening, Detection and Treatment Practices, Among Sub-Saharan African Urologists

Introduction: Prostate cancer is reported to be the leading cancer in men in Sub-Saharan Africa (SSA) and the number of prostate cancer deaths is expected to double in the next 20 years. Despite the importance of this public health issue in SSA, there remains relatively limited information about practices related to prostate cancer treatment in this population. Objective: We conducted a survey of 28 urology practices in SSA to evaluate the scope of available screening, detection and treatment. Materials and Methods: Screening was more commonly reported as a part of general medical care in South Africa (SA) compared with East or West (EW) Africa. However, use of digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA) were used at similar rates for screening in all locations. Screening is primarily focused in men over age 50 and those with symptoms. Routine screening was the primary reason for screening use in SA, while symptoms were the primary reason for screening use in EW. Financial and cultural barriers to screening were more commonly reported in EW than SA. Similar detection approaches were used in all regions, with free PSA and PSA velocity being more commonly used in SA than EW. Six core biopsies were more commonly used in EW and 12 core biopsies were more common in SA. Trans urethral ultrasounds and bone scans were more commonly used in SA than EW. Treatment options were similar in all regions, with brachytherapy less likely to be used in EW than SA. Results: The descriptive data suggest that differences in patterns of screening, detection and treatment exist across Africa. Differences by geography may also reflect differences in SES and racial composition of the populations in each region.Key Words: Prostate cancer, Screening and Detection, Practice guidelines, Sub-Saharan Afric

Why HIV Positive Patients on Antiretroviral Treatment and/or Cotrimoxazole Prophylaxis Use Traditional Medicine: Perceptions of Health Workers, Traditional Healers and Patients: A Study in Two Provinces of South Africa

The study explored the perceptions, knowledge and attitudes of patients, health workers and traditional healers about the use of traditional medicine and Anti Retroviral Therapy (ART). The study explored the perceptions, knowledge and attitudes of patients, health workers and traditional healers about the use of traditional medicine and Anti Retroviral Therapy (ART), using an exploratory qualitative design in two provinces of South Africa: an urban township health facility in the Western Cape, and a rural district hospital in KwaZulu-Natal (KZN) with antennal HIV rate of 32% and 28%’respectively. In-depth interviews were conducted with 14 participants: six HIV patients on ART and using Traditional Medicine(TM), two doctors, two nurses and four traditional healers. Two focus group discussions - one at each site - were held with community health workers who work with HIV-positive patients (Western Cape [5] and in KZN [4]). Patient said to have used Traditional Healing Practices (THP) before they were diagnosed with HIV, and some who have been diagnosed with HIV continue using TM in conjunction with ART and/or Cotrimoxazole prophylaxis. Patients preferred not to disclose THP to health professionals because of lack of support and understanding. Patients utilize THP because of family expectations, privacy and confidentiality, especially when they have not disclosed their HIV status. Healthcare professionals had strong negative opinions about THP, especially for HIV-positive patients. Traditional healers supported the patient’s rationale for THP use. This study revealed a need to better understand factors involved in patients’ choosing to use THP concurrently with ART

Relationships between habitat and recruitment of three species of damselfish (Pomacentridae) at Heron Reef, Great Barrier Reef

Recruitment of coral-reef fish species varies widely on a range of spatial scales, but the extent to which this variation is related to variability in habitat structure is unclear. We examined relationships between the recruitment of three species of damselfish (Pomacentrus moluccensis Bleeker, P. wardi Whitley and P. amboinensis Bleeker) and microhabitat structure (composition of the substrata) across six broad habitat zones at Heron Reef. Comparison of the distribution of recruits with the availability of substratum types along 10x2-m belt transects indicated that recruits of all three species utilised the substrata non-randomly. However, despite the distinct patterns of microhabitat use exhibited by each species, relationships between the density of recruits and the availability of preferred substrata were poor. We suggest that spatial stochasticity in larval supply and/or post-settlement mortality weakens relationships between recruitment and microhabitat availability. Univariate and multivariate analyses indicated significant differences in the recruitment of each species and in overall recruitment among habitat zones, and these differences may reflect large-scale variation in larval supply and/or rates of post-settlement mortality. Based on combined recruitment data, there was little evidence to suggest that areas of patchy coral reef received more or less recruitment than comparable areas of contiguous reef. Furthermore, recruitment to lagoonal patch reefs did not differ from recruitment to nearby sections of the reef slope offering a similar habitat with respect to depth and characteristics of the substratum

The Shapes of Cooperatively Rearranging Regions in Glass Forming Liquids

The shapes of cooperatively rearranging regions in glassy liquids change from being compact at low temperatures to fractal or ``stringy'' as the dynamical crossover temperature from activated to collisional transport is approached from below. We present a quantitative microscopic treatment of this change of morphology within the framework of the random first order transition theory of glasses. We predict a correlation of the ratio of the dynamical crossover temperature to the laboratory glass transition temperature, and the heat capacity discontinuity at the glass transition, Delta C_p. The predicted correlation agrees with experimental results for the 21 materials compiled by Novikov and Sokolov.Comment: 9 pages, 6 figure

Dual-source CT for chest pain assessment

Comprehensive CT angiography protocols offering a simultaneous evaluation of pulmonary embolism, coronary stenoses and aortic disease are gaining attractiveness with recent CT technology. The aim of this study was to assess the diagnostic accuracy of a specific dual-source CT protocol for chest pain assessment. One hundred nine patients suffering from acute chest pain were examined on a dual-source CT scanner with ECG gating at a temporal resolution of 83 ms using a body-weight-adapted contrast material injection regimen. The images were evaluated for the cause of chest pain, and the coronary findings were correlated to invasive coronary angiography in 29 patients (27%). The files of patients with negative CT examinations were reviewed for further diagnoses. Technical limitations were insufficient contrast opacification in six and artifacts from respiration in three patients. The most frequent diagnoses were coronary stenoses, valvular and myocardial disease, pulmonary embolism, aortic aneurysm and dissection. Overall sensitivity for the identification of the cause of chest pain was 98%. Correlation to invasive coronary angiography showed 100% sensitivity and negative predictive value for coronary stenoses. Dual-source CT offers a comprehensive, robust and fast chest pain assessment

The Origin of Black Hole Entropy in String Theory

I review some recent work in which the quantum states of string theory which are associated with certain black holes have been identified and counted. For large black holes, the number of states turns out to be precisely the exponential of the Bekenstein-Hawking entropy. This provides a statistical origin for black hole thermodynamics in the context of a potential quantum theory of gravity.Comment: 18 pages (To appear in the proceedings of the Pacific Conference on Gravitation and Cosmology, Seoul, Korea, February 1-6, 1996.

Electrocerebral Recovery During the Intracarotid Amobarbital Procedure: Influence of Interval Between Injections

Purpose and Methods : During the intracarotid amobarbital procedure (IAP) at the University of Michigan, continuous scalp EEG monitoring guides the timing for presentation of memory items and postinjection testing. Most of our patients have undergone bilateral injections. The interval between injections varied from 22 to 60 min, depending on the test and recovery time, as well as the time to catheterize the second side. After noting a trend toward prolonged electro-graphic recovery following the second injection, we tested our clinical impression that recovery of the second hemisphere may be influenced by (a) the time between injections and (b) which hemisphere is injected first (epileptogenic or nonepileptogenic). To study these questions, we analyzed EEG recovery data from 48 consecutive IAPs. Approximately half the patients had the epileptogenic side injected first. Results : We found that (a) electrographic recovery after the second injection is prolonged if the interval between bilateral injections is less than 40 minutes and (b) electrographic recovery is more rapid after injection of the epileptogenic hemisphere. Conclusions : We now recommend waiting at least 45 min between injections. The pathophysiology of more prolonged amobarbital effect on the nonepileptogenic hemisphere than on the epileptogenic hemisphere remains unclear.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65275/1/j.1528-1157.1997.tb00067.x.pd

Urban Heat Island and Vulnerable Population. The Case of Madrid

The Urban Heat Island effect shows the differences among temperatures in urban areas and the surrounding rural ones. Previous studies have demonstrated that temperature differences could be up to 8 °C during the hottest periods of summer in Madrid , and that it varies according to the urban structure. Associated to this effect, the impact of temperature increase over dwelling indoor thermal comfort seems to double cooling energy demand . In Madrid, fuel poor households already suffering from inadequate indoor temperatures can face important overheating problems and, as a consequence, relevant health problems could become more frequent and stronger. This poses an increment in mortality rates in risk groups that should be evaluated. This research is aimed at establishing the geospatial connection between the urban heat island and the most vulnerable population living in the city of Madrid. Hence, those areas most in need for an urban intervention can be detected and prioritized