Clinical epidemiology, diagnosis and treatment of visceral leishmaniasis in the Pokot endemic area of Uganda and Kenya.

Between 2000 and 2010, Médecins Sans Frontières diagnosed and treated 4,831 patients with visceral leishmaniasis (VL) in the Pokot region straddling the border between Uganda and Kenya. A retrospective analysis of routinely collected clinical data showed no marked seasonal or annual fluctuations. Males between 5 and 14 years of age were the most affected group. Marked splenomegaly and anemia were striking features. An rK39 antigen-based rapid diagnostic test was evaluated and found sufficiently accurate to replace the direct agglutination test and spleen aspiration as the first-line diagnostic procedure. The case-fatality rate with sodium stibogluconate as first-line treatment was low. The VL relapses were rare and often diagnosed more than 6 months post-treatment. Post-kala-azar dermal leishmaniasis was rare but likely to be underdiagnosed. The epidemiological and clinical features of VL in the Pokot area differed markedly from VL in Sudan, the main endemic focus in Africa.

Evaluation of clinical and immunological markers for predicting virological failure in a HIV/AIDS treatment cohort in Busia, Kenya.

BACKGROUND: In resource-limited settings where viral load (VL) monitoring is scarce or unavailable, clinicians must use immunological and clinical criteria to define HIV virological treatment failure. This study examined the performance of World Health Organization (WHO) clinical and immunological failure criteria in predicting virological failure in HIV patients receiving antiretroviral therapy (ART). METHODS: In a HIV/AIDS program in Busia District Hospital, Kenya, a retrospective, cross-sectional cohort analysis was performed in April 2008 for all adult patients (>18 years old) on ART for ≥12 months, treatment-naive at ART start, attending the clinic at least once in last 6 months, and who had given informed consent. Treatment failure was assessed per WHO clinical (disease stage 3 or 4) and immunological (CD4 cell count) criteria, and compared with virological failure (VL >5,000 copies/mL). RESULTS: Of 926 patients, 123 (13.3%) had clinically defined treatment failure, 53 (5.7%) immunologically defined failure, and 55 (6.0%) virological failure. Sensitivity, specificity, positive predictive value, and negative predictive value of both clinical and immunological criteria (combined) in predicting virological failure were 36.4%, 83.5%, 12.3%, and 95.4%, respectively. CONCLUSIONS: In this analysis, clinical and immunological criteria were found to perform relatively poorly in predicting virological failure of ART. VL monitoring and new algorithms for assessing clinical or immunological treatment failure, as well as improved adherence strategies, are required in ART programs in resource-limited settings.

["It's harder": nurses' experiences of caring for patients with cancer recurrence]. / "Es más difícil": experiencias de las enfermeras sobre el cuidado del paciente con recidiva de cáncer.

OBJECTIVE: To examine the experiences and responses of nurses caring for patients with recurrence of cancer. MATERIAL AND METHODS: A qualitative cross-sectional study based on grounded theory. Data was collected, based on semi-structured interviews carried out in four cancer units of two hospitals in Navarra, after obtaining ethical approval. The sample consisted of 14 nurses. RESULTS: Providing care during cancer recurrence is described as a difficult situation, even more than in the first diagnosis of cancer. This is because nurses have to deal with the loss of patient hope in treatment and the fear of the possibility of the patient's death. To deal with this reality, nurses try to do their best to meet the emotional needs of the patient, at the same time as managing barriers including lack of time, workload, and inadequate training in psycho-oncology. CONCLUSIONS: The data show the difficulty nurses have in dealing with the emotional care of patients with recurrence. If the Health Service commitment is to offer holistic care to cancer patients and their families, there should be a corresponding commitment towards improving nursing training in psychosocial issues.