Effects of Multi-Month Dispensing on Clinical Outcomes: Retrospective Cohort Analysis Conducted in Kenya.

Multi-month dispensing (MMD) has been widely adopted by national HIV programs as a key strategy for improving the quality of HIV care and treatment services while meeting the unique needs of diverse client populations. We assessed the clinical outcomes of clients receiving MMD in Kenya by conducting a retrospective cohort study using routine programmatic data in 32 government health facilities in Kenya. We included clients who were eligible for multi-month antiretroviral therapy (ART) dispensing for ≥ 3 months (≥ 3MMD) according to national guidelines. The primary exposure was enrollment into ≥ 3MMD. The outcomes were lost to follow-up (LTFU) and viral rebound. Multilevel modified-Poisson regression models with robust standard errors were used to compare clinical outcomes between clients enrolled in ≥ 3MMD and those receiving ART dispensing for less than 3 months (< 3MMD). A total of 3,501 clients eligible for ≥ 3MMD were included in the analysis, of whom 65% were enrolled in ≥ 3MMD at entry into the cohort. There was no difference in LTFU of ≥ 180 days between the two types of care (aRR 1.1, 95% CI 0.7-1.6), while ≥ 3MMD was protective for viral rebound (aRR 0.1 95% CI 0.0-0.2). As more diverse client-focused service delivery models are being implemented, robust evaluations are essential to guide the implementation, monitor progress, and assess acceptability and effectiveness to deliver optimal people-centered care.

Diode array detection and simultaneous quantitation of the coeluting atenolol-related synthetic route impurities, PPA-Diol.

The diode array multichannel detector is used to acquire spectral information at specified intervals in the elution profile of atenolol and its related impurities for post-chromatographic data analysis. The applicability of a number of peak homogeneity testing methods, including spectral normalization, absorbance ratio, chromatographic derivatives, and spectral suppression (SS), are assessed for suitability in simultaneous determinations of the coeluting atenolol-related synthetic impurities, PPA-Diol. Spectral suppression displays a superior performance in comparison to all the other techniques in that both qualitative and quantitative information are acquired on the system.

Hydroquinone neuropathy following use of skin bleaching creams: case report.

A 30-year old black woman presented with gradual onset of weakness of the legs associated with burning sensation in the feet for two months. She had been using two hydroquinone based skin bleaching creams (MGC by M. G. C. International, MEKAKO by Anglo Fabrics BOLTON Ltd) for about four years. Her BP was 80/40 mm Hg supine with un-recordable diastolic pressure on standing. She had decreased power (Grade 3/5), loss of deep tendon reflexes and impairment of deep sensation in the lower limbs. A complete blood count, urinalysis, serum electrolytes, serum creatinine and uric acid were all normal. Oral GTT, VDRL and brucella tests were negative. Chest and abdominal radiographs did not show any abnormalities. A diagnosis of peripheral neuropathy with autonomic neuropathy possibly due to hydroquinone toxicity was made and she was advised to stop using hydroquinone based skin bleaching creams. Four months later she was asymptomatic, her BP was 120/80 mmHg supine and standing, and neurological examination was normal. The case raises the question of whether hydroquinone based skin bleaching creams could be a cause of peripheral neuropathy and underscores the need for research on hydroquinone based skin bleaching creams and neuropathy particularly in black women involved in the sale and/or use of skin bleaching creams.

Prevalence of human immunodeficiency virus infection: its impact on the diagnostic yields in exudative pleural effusions at the Kenyatta National Hospital, Nairobi.

This was a descriptive cross-sectional study carried out at Kenyatta National Hospital (KNH), Nairobi, among consecutively admitted adult patients with exudative pleural effusions over a one year period. The aim of the study was to determine the prevalence of human immunodeficiency virus (HIV) infection in these patients and to compare the diagnostic yields from the pleural fluid and pleural biopsy between the HIV seropositive and HIV seronegative patients. Sixty six patients were studied, with a mean age of 33.8 (+/- SD = 15.6) years and a male to female ratio of 1.6:1. Overall, 27 patients(40.9%) were found to be HIV seropositive. The commonest cause of exudative pleural effusions, overall, was tuberculosis (78.8%) followed by neoplasms (7.6%). Comparing the aetiology of exudative pleural effusion in HIV seropositive and HIV seronegative patients, tuberculosis was still the commonest cause accounting for 42.3% and 57.7% of the cases in each of the groups respectively. Conversely, 42.3% of patients with tuberculous pleural effusions were HIV seropositive. There was no significant difference in yields from pleural fluid, pleural biopsy culture and histology in the diagnosis of tuberculosis in the two patient groups. The only two patients with empyema were HIV seropositive and the bacterial isolates were Salmonella typhimurium and Pseudomonas aeruginosa. Kaposi's sarcoma was the cause of exudative pleural effusion in the one HIV seropositive patient with a malignant effusion. The only patient with a parapneumonic effusion was HIV seronegative. No fungi were isolated.

PIP: 66 adult patients of mean age 33.8 years with exudative pleural effusions were studied to determine the prevalence of HIV infection and compare the diagnostic yields from the pleural fluid and pleural biopsy between the HIV-seropositive and HIV-seronegative patients. The patients were consecutively admitted to Kenyatta National Hospital (KNH) over a 1-year period and of male:female ratio 1.6:1. 27 patients were found to be HIV seropositive. Tuberculosis (TB) and neoplasms were the most common causes of exudative pleural effusions, responsible for 78.8% and 7.6% of cases, respectively. Comparing the etiology of exudative pleural effusion in HIV-seropositive and HIV-seronegative patients, TB remained the most common cause, accounting for 42.3% and 57.7% of cases in each of the groups, respectively. 42.3% of the patients with TB pleural effusions were HIV seropositive. No significant difference was identified in the yields from pleural fluid, pleural biopsy culture, and histology in the diagnosis of TB in the 2 patient groups. The only 2 patients with empyema were HIV seropositive and the bacterial isolates were Salmonella typhimurium and Pseudomonas aeruginosa. Kaposi's sarcoma was the cause of exudative pleural effusion in the 1 HIV-seropositive patient with a malignant effusion. The only patient with a parapneumonic effusion was HIV seronegative. No fungi were isolated.