Is the Differentiated Service Delivery Model Suited to the Needs of People Living with HIV in Rwanda?

The primary goal of antiretroviral treatment is to improve the health of individuals with HIV, and a secondary goal is to prevent further transmission. In 2016, Rwanda adopted the World Health Organization's "treat-all" approach in combination with the differentiated service delivery (DSD) model. The model's goal was to shorten the time from HIV diagnosis to treatment initiation, regardless of the CD4 T-cell count. This study sought to identify perceptions, enablers, and challenges associated with DSD model adoption among PLHIV.This study included selected health centers in Kigali city, Rwanda, between August and September 2022. The patients included were those exposed to the new HIV care model (DSD) model and those exposed to the previous model who transitioned to the current model. Interviews and focus group discussions were also held to obtain views and opinions on the DSD model. The data were collected via questionnaires and audio-recorded focus group discussions and were subsequently analyzed.The study identified several themes, including participants' initial emotions about a new HIV diagnosis, disclosure, experiences with transitioning to the DSD model, the effect of peer education, and barriers to and facilitators of the DSD model. Participants appreciated reduced clinic visits under the DSD model but faced transition and peer educator mobility challenges.The DSD model reduces waiting times, educates patients, and aligns with national goals. Identified barriers call for training and improved peer educator retention. Recommendations include enhancing the DSD model and future research to evaluate its long-term impact and cost-effectiveness.

Physical and verbal workplace violence against nurses in Jordan.

AIMS: To explore the prevalence of physical and verbal workplace violence among nurses working in general hospitals in Jordan, and to investigate the relation between physical violence, verbal violence, anxiety about violence, and some certain demographic variables. BACKGROUND: Violence against nurses at the workplace is an alarming problem in both developed and developing countries. This study explicates physical and psychological workplace violence and its relation to anxiety about violence at workplace and to some demographic variables. METHODS: A cross-sectional correlational study was conducted on a convenience sample of nurses working in general hospitals in Jordan. RESULTS: A total of 468 nurses completed the questionnaire, 52.8% of the participants reported that they were physically attacked, and 67.8% were verbally attacked in the last 12 months. Of those who were physically attacked, 26.5% reported a physical violence with a weapon. The logistic regression analysis revealed that female nurses were 0.5 times less likely to report being physically attacked and were 1.5 times more likely to report being verbally abused than male nurses. DISCUSSION: Violence against nurses is highly prevalent in Jordan. More than half of the participants were victims of violence at their workplace during the last year. Verbal abuse was more common among females than males. NURSING IMPLICATIONS: Nurses are in the frontline of the healthcare system and their safety is a high priority. They need to be involved in the development and formulation of workplace violence policy decisions. CONCLUSIONS: Physical and verbal workplace violence in Jordan, like other countries, is a dangerous behavior that negatively affects general hospital nurses.

KNOWLEDGE, ATTITUDE AND USE OF PAIN RELIEF IN LABOUR AMONG WOMEN ATTENDING ANTE-NATAL CLINIC AT SHALOM COMMUNITY HOSPITAL, ATHI RIVER.

OBJECTIVE: To find out the knowledge, attitude and practice of pain relief methods during labour among mothers attending antenatal clinics at Shalom Community Hospital, Athi River, Kenya. DESIGN: Cross Sectional study. SETTING: Shalom Community Hospital, Athi River, Kenya. SUBJECTS: Two hundred and seven participants attending antenatal clinics at the facility were recruited. RESULTS: The median age of the participants was 28 years and a median parity of one. Most of the study participants, 89.4%, were not aware of any pain relief method during labour. Among the 10.6% patients that were of a pain relief method, 54% had gotten the knowledge from the doctors. All the patients had experienced pain in labour with 72% rating the pain as severe pain. Only 37% of the patients were offered a pain relief method and the intramuscular injectable was offered to all. Majority (88%) of those offered a form of pain relief rated the pain relief method as ineffective. A majority of the women 93% would use a pain relief method in the next labour with epidural method being the most preferred method. CONCLUSION: The level of knowledge of pain relief methods among mothers islow. There is need to integrate information on pain relief options in labour as part of antenatal services offered routinely. Epidural analgesia services should be enhanced.

Impact of Urbanization and Socioeconomic Factors on the Distribution of Cutaneous Leishmaniasis in the Center of Morocco.

BACKGROUND: Parasitic diseases, in particular leishmaniasis, are still a public health problem in several countries and in Morocco. METHODS: The data used are those of epidemiological surveillance collected in the registers of the prefectural epidemiology cell (PEC); however, the socioeconomic data were obtained from the High Commissioner for Planning. The Pearson correlation test was used to determine the correlation between the different variables. RESULTS: In total, 70 cases were recorded by the prefectural epidemiology cell (PEC) during the period from 2009 to 2015. 46% of the cases come from rural areas while 54% of the cases come from urban areas. The Pearson test shows the existence of a significant relationship between the number of cases recorded and the type of environment (r = 0.49, p value = 0.02), and population rate (R = 0.849 and p ≤ 0.001). However, in our case, the poverty rate does not influence CL's distribution. CONCLUSION: Our results show that the CL affects the majority of the municipalities with predominance of the urban environment, so the distribution of cases of this pathology is not influenced by the poverty; however, the urbanization and the number of inhabitants have a positive impact on the distribution of this scourge.

Adult intussusception : A 14-year retrospective study of clinical assessment and computed tomography diagnosis.

BACKGROUND AND STUDY AIMS: Intussusception in adults often remains unrecognized. Our aim was to report our experience with this entity to determine the usefulness of CT scan in its preoperative diagnosis. PATIENTS AND METHODS: The medical records and imaging studies of all patients ≥16 years of age with intussusception, who were managed at our hospitals, were retrospectively reviewed. RESULTS: 17 cases of adult intussusception (7 males, 10 females; mean age 35.9 years; age range of 16-78) were identified. The diagnosis was possible in all patients using CT scan. The underlying etiologies were colon cancer (n=2), lymphoma (n=2), small bowel polyps (n=2), jejunal lipoma (n=1), metastatic melanoma (n=1), Meckel's diverticulum (MD) (n=1) and idiopathic (n=1). In the remaining 7 patients, the intussusceptions were of the transitory form and were treated conservatively and no significant sequela occurred after a follow-up of 2-60 months. CT scan findings in transient cases characteristically showed that the intussusception was localized to the proximal intestine and all of them had a short segment (2-4 cm) of intussusception. CONCLUSIONS: The important role of the CT in the preoperative diagnosis of intussusception and characterizing its causes cannot be overemphasized. All transient cases had a short segment of intussusception.

[Surveillance of Leishmaniasis: Inventory and Seasonal Fluctuation of Phlebotomine Sandflies (Diptera: Psychodidae), at the Prefecture of Meknes (Center of Morocco)]. / Surveillance des leishmanioses : inventaire et fluctuation saisonnière des phlébotomes (Diptera : Psychodidae) à la préfecture de Meknès (centre du Maroc).

Phlebotomine sandflies are bloodsucking insects responsible for the transmission of leishmaniasis. The average annual incidence in Morocco, of this pathology, was approximately estimated in 2014 as 7.8 per 100.000 inhabitants according to the Moroccan health information service records. The study of the composition of the Phlebotomian community and its seasonal dynamics are essential for determining the appropriate and adequate means of control at the prefecture of Meknes in Central Morocco. It is with this in mind that two capture sessions per month using sticky paper traps were conducted at the sites of sandflies. A total of 982 sandflies were captured. The identification of the specimens found via the Moroccan key revealed a percentage of 73.3% belonging to the subgenus Paraphlebotomus, 6.3% to the Phlebotomus subgenus, 16.2% to Larroussius, and 4.2% of Sergentomia subgenus. Phlebotomus sergenti, vector of human cutaneous leishmaniasis, was found as the more abundant with 73.3% followed by Larroussius longicuspis with 8.2%. The largest number of species was harvested in July and September with, respectively, 44.8 ph/m2/night and 48.7 ph/m2/night. This study also unveiled that the two high-risk Leishmanian months are July and September, hence, the need to strengthen efforts to monitor and control this disease during the vector activity period.

Les phlébotomes sont des insectes hématophages vecteurs de la leishmaniose. L'incidence moyenne annuelle de cette affection au Maroc a été approximativement estimée en 2014 à 7,8 pour 100 000 habitants selon les registres du service de l'information sanitaire marocaine. L'étude de la composition du peuplement phlébotomienne et celle de la dynamique saisonnière des espèces locales sont indispensables pour déterminer les moyens de lutte contre cette pathologie. Dans cette optique, deux séances de capture par mois en utilisant des pièges adhésifs ont été effectuées pour déterminer les espèces phlébotomiennes et leurs fluctuations saisonnières dans la préfecture de Meknès au centre du Maroc. Neuf cent quatre-vingt-deux phlébotomes ont été identifiés, dont 73,3 % du sous-genre, Paraphlebotomus, 6,3 % du sous-genre Phlebotomus, 16,2 % du sous-genre Larroussius et 4,2 % du sous-genre de Sergentomia. Phlebotomus sergenti, vecteur de la leishmaniose cutanée humaine, est le plus abondant avec 73,3 % suivi par Larroussius longicuspis avec 8,2 %. Le maximum d'espèces a été récolté aux mois de juillet et septembre avec respectivement 44,8 et 45,8 phlébotomes/m2 par nuit (ph/m2 par nuit). Cette étude montre que les deux mois à haut risque leishmanien se situent en juillet et septembre, d'où la nécessité de renforcer les efforts de lutte contre cette maladie durant ces périodes.

Risk of infection and death among post-splenectomy patients.

OBJECTIVES: The true incidence of post-splenectomy sepsis remains undetermined. METHODS: An English literature review on post-splenectomy sepsis was undertaken by means of databases of MEDLINE for the period 1966-96. The data registered included age at splenectomy, indication for splenectomy, incidence of infection and death, interval between splenectomy and infection, and microbial aetiology. RESULTS: The reports include 19 680 patients having undergone splenectomy with a median follow up of 6.9 years. The incidence of infection after splenectomy was 3.2% and the mortality rate was 1.4%. Only 6942 reports were sufficiently detailed to allow useful analysis. The incidence of infection among children and adults was similar, 3.3% and 3.2%, respectively. However, the death rates among children were higher than adults (1.7% vs. 1.3%). The incidence of infection was highest among patients with thalassemia major (8.2%), and sickle-cell anaemia (7.3%). The highest mortality rates were observed among patients with thalassaemia major (5.1%), and sickle-cell anaemia (4.8%). CONCLUSION: The incidence of sepsis among post-splenectomy patients is low, however, it carries a high mortality rate especially among children with hematological disorders.

Infective endocarditis and occult splenic abscess caused by Brucella melitensis infection: a case report and review of the literature.

This report describes a patient with prosthetic aortic valve endocarditis caused by Brucella melitensis infection with an initial relapse after apparent recovery due to associated occult splenic abscess. In spite of a prolonged period of recovery (6 months) achieved with splenectomy and antibrucella antimicrobial therapy, a second relapse occurred and cure was achieved after replacement of the infected prosthetic valve and prolonged courses of antibrucella antimicrobial therapy. There is controversy on the optimal therapy of such cases, but this report suggests that successful management requires a combination of medical and early surgical therapy.

Quality of life, social support, and severity of psychiatric symptoms in Jordanian patients with schizophrenia.

The major purposes of this study were to examine levels and correlations of quality of life (QOL), social support, and severity of psychiatric symptoms as well as to identify the variables that best predict QOL among Jordanian patients with schizophrenia. Descriptive cross-sectional design was used to collect data from 160 patients selected through systematic random sampling from two psychiatric outpatient clinics. Results showed that the highest domain of QOL was the social relationship domain, and the highest source of social support was perceived from significant others. Severity of affective symptoms was the highest, and severity of positive symptoms was the lowest. QOL correlated positively with social support, patients' educational and income level, and employment; and negatively with severity of psychiatric symptoms, duration of untreated illness, and duration of treatment. Support from friends, duration of untreated illness, income level, and severity of affective symptoms predicted QOL and accounting for 47.3% of the variance.

Congenital chloride diarrhea presenting in newborn as a rare cause of meconium ileus.

Postpartum abdominal distention and meconium ileus may occur due to intestinal obstruction, Hirschprung disease or cystic fibrosis. However, other rare and challenging etiologies such as congenital chloride diarrhea (CCD) should be included in differential diagnosis of such presentation. We present a premature baby girl who had distended abdomen and lack of meconium immediately after birth. Surgical etiology was excluded and she was mistakenly suspected of having cystic fibrosis due to meconium ileus. CCD was diagnosed by recognition of watery diarrhea in association with hyponatremic, hypochloremic metabolic acidosis. Mutation analysis confirmed the diagnosis.

Osteoid osteoma of the odontoid process of the axis associated with atlanto-axial fusion.

Osteoid osteoma is a primary benign bone tumour with characteristic imaging and pathological features. In about 10% of the cases it involves the spine, especially the posterior elements. We report a pathologically proven case of osteoid osteoma of the odontoid process of the second cervical vertebra associated with atlanto-axial fusion. The case was diagnosed pre-operatively using plain radiography, multiplanar helical CT, contrast-enhanced MRI and radioisotope bone scanning.

Progressive pseudorheumatoid dysplasia: report of a family and review.

Progressive pseudorheumatoid dysplasia is an inherited skeletal dysplasia with radiographic changes notably in the spine, similar to spondyloepiphyseal dysplasia tarda. There is also articular cartilage involvement which gives it some clinical resemblance to rheumatoid arthritis. We report here on six subjects from one inbred family from Jordan. Based on previously published reports and this one, we review the clinical and radiological features and discuss the genetics and differential diagnosis of the disorder. We suggest the addition of the word "spondyloepiphyseal" to the name adopted by the International Working Group on Constitutional Diseases of Bone, to become "progressive pseudorheumatoid spondyloepiphyseal dysplasia". We also speculate on candidate genes for this disorder.

Indications and benefits of computed tomography in childhood bacterial meningitis.

Over a 5 year period, 58 children with acute bacterial meningitis underwent computed tomography (CT) of the head. The major stated indications were partial, complex, or prolonged seizures in children younger than 5 years (60 per cent) and prolonged fever in the case of those older than 5 years (60 per cent). Abnormal findings on CT scan were seen in 27 (47 per cent); the remaining 31 (53 per cent) patients had normal or only non-specific dilatation of spaces containing cerebrospinal fluid (CSF) or basilar enhancement. The commonest CT abnormalities were seen in those patients who presented with complex seizure disorders. The commonest abnormal findings were subdural collection (33 per cent) followed by hydrocephalus (7 per cent). Subdural collection was seen mainly in patients with Haemophilus influenzae bacterial meningitis (90 per cent) while hydrocephalus was mainly seen in tuberculous meningitis. Positive findings of obvious therapeutic clinical relevance were present in only six cases (10 per cent). From the study we concluded that head CT provides an accurate means of diagnosing intracranial complications of bacterial meningitis, but it must be used conservatively as it has limited therapeutic applications in children with complicated bacterial meningitis. Computed tomography is indicated mainly in children with persistent neurologic dysfunction like complex seizure disorder, and is of little value in children with prolonged fever alone.

Diagnostic value of vaso-seminal-vesiculography.

The site of obstruction was evaluated by seminal vesiculography in 24 cases of azoospermia with normal testicular biopsies. In 21 cases, obstruction was located at the level of the tail of the epididymis; in 2 cases ejaculatory duct was obstructed; and in 1 case the injected dye was arrested at the level of internal inguinal ring, at the site of previous hernia operation. Vesiculogram in 24 obstructed cases and 4 cases of chronic seminal vesiculities without obstruction showed one normal picture, four with catarrhal inflammation, and the rest with chronic interstitial vesiculities. Radiological study of a patient complaining of aspermia showed multiple congenital anomalies. The high incidence of chronic vesiculities and postinflammatory obstruction is attributed to underlying bilharziasis.