Survival Outcomes of Vietnamese People with HIV after Initiating Antiretroviral Treatment: Role of Clinic-Related Factors.

Given the rapid development of HIV clinics in Vietnam, this study evaluates the infrastructure surrounding this expansion, identifying clinic-related factors that impact survival outcomes. A retrospective longitudinal study was conducted among people living with HIV (PLWH) who initiated antiretroviral therapy (ART) between 2011 and 2015 among 62 ART clinics in 15 provinces. The mortality rate during the 717674.1 person-years of observation (PYO) was 0.29/100 PYO. Location in rural areas (versus urban) and in Central Vietnam (versus Northern Vietnam) were associated with higher risk of mortality. The risk was lower among clinics that had peer-educators. As Vietnam's HIV/AIDS program continues to expand, this data supports increasing resource allocation for rural clinics, incorporation of ART with the community's existing healthcare infrastructure in its efforts to decentralize, and integration of services to reflect patients' anticipated needs.

Rectal Squamous Cell Cancer.

Squamous cell carcinoma occurring in the rectum is one of the rare malignancies that has been discovered. Most squamous cell carcinomas that surface in the gastrointestinal tract tend to occur in either the esophagus or the anal canal. However, the rare incidence of rectal squamous cell carcinomas has raised quite a few questions on the hypothetical etiologies, prognosis, and optimal treatment sequence of such a disease course in modern medicine. In this report, we present the case of a 63-year-old gentleman who came to the clinic with change in bowel habits such as constipation and bright red blood in his stool. Colonoscopy revealed a 4.1 cm polyp in the distal rectum, which upon biopsy was confirmed to be a well-differentiated keratinizing squamous cell carcinoma. This case allows us to engage in discussions over potential etiologies and current treatment management for such a rare malignancy.

Patient assessment of bowel function during and after pelvic radiotherapy: results of a prospective phase III North Central Cancer Treatment Group clinical trial.

PURPOSE: To evaluate patient assessment of long-term effect of pelvic radiotherapy on bowel function. PATIENTS AND METHODS: As part of a prospective randomized trial evaluating the impact of sucralfate on bowel function in patients receiving pelvic radiotherapy, patient-assessed bowel function data were collected during radiotherapy and again at 4 weeks and 1 year after completion of radiotherapy. RESULTS: The number of bowel movements per day increased up to week 4 and then slowly decreased. At 1 year, the mean number of bowel movements per day had increased from 1.75 to 2.09 and the median from 1 to 2. All measures of adverse bowel function worsened during radiotherapy. Frequency of bowel movements and symptoms of frequency, nocturnal bowel movements, cramping, and bleeding returned close to baseline values by 1 year. Symptoms of urgency, clustering, and measures of incontinence were all persistent at 1 year. The mean increase in bowel function score at 1 year was 0.74 (range, -5 to 7). CONCLUSION: Pelvic radiotherapy is associated with a slight increase in bowel movement frequency and decrease in several patient-reported measures of adverse bowel function. Several measures of adverse function persisted at 1 year.