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Measurement of quality of life is crucial to assess the full impact of antiretroviral therapy on patient morbidity. No quality of life instruments have been validated in an Asian HIV-infected patient population, but it is important to do so given the increasing involvement of the region in clinical trials. We set out to validate the Medical Outcomes Study HIV Health Survey (MOS-HIV) in HIV infected patients in Singapore. Clinically stable outpatients were asked to complete the 30-item MOS-HIV (English or Chinese translation). Patients were also asked about the frequency of selected disease symptoms, and clinical and demographic data were recorded from the case sheet. 163 patients (90% Chinese, 96% male, mean age 38 years, mean CD4 count 159 cells/mm(3)) participated in the study and completed the questionnaire to a satisfactory standard. The questionnaire showed good internal consistency (Cronbach's alpha >0.7 in all cases). There were significant differences in quality of life scores between Centers for Disease Control disease stages, and significant correlations with CD4 count and symptom score, confirming the discriminant validity of the MOS-HIV. Factor analysis revealed two components corresponding to physical and mental health which were similar to those of studies in Western countries except that pain was more closely related to mental than physical health. Linear regression analysis identified symptom burden as the major predictor of physical and mental health. We concluded that the MOS-HIV is a valid measure of quality of life in this HIV patient population in Singapore, and is therefore likely to be useful in future clinical trials in the region. In the era of chronic HIV disease, close attention to symptoms (disease or drug-related) is warranted due to their major adverse influence on mental and physical aspects of quality of life.
Int J STD AIDS 2002 Jul
PMID:Validation of the Medical Outcomes Study HIV Health Survey as a measure of quality of life in HIV-infected patients in Singapore. 1217 64

The representative from the International Planned Parenthood Federation (IPPF) at the 15th Asian Parliamentarians' Meeting addressed the issue of negative consequences of the failure to meet the goals set at the ICPD. Global statistics on sexual and reproductive health are as follows: millions of women and men do not have access to safe and reliable family planning methods; thousands of women continue to die in pregnancy and childbirth; many suffer pain, ill health and permanent disability as a result of pregnancy and childbirth complications; up to 20 million unsafe abortions are performed on women, of whom 70,000 die every year; many young women and girls become unfactionally pregnant and lose the chance of an education and employment; pregnancy and childbirth are major killers of young women aged 15-19 years; a significant proportion of young women contract an STD; 70% of the world's 1.3 billion people living in absolute poverty are women. These women are also at risk during pregnancy and are least able to protect themselves from violence and rape, STDs and HIV/AIDS, unsafe abortion, and sexual exploitation. In conclusion, all the above concerns need support in moving governments toward better service organization and more frankness in a field where life and death are dangerously close to one another.
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PMID:Failure to meet ICPD goals will affect global stability, health of environment, and well-being, rights and potential of people. 1234 6

Quality of life (QoL) changes among 56 adult patients living with HIV/AID (PHA) were assessed following two years of care in which most had received highly active antiretroviral therapy (HAART). The sample was stratified by initial disease stage; subjects were classified 'asymptomatic' if they had no HIV-related constitutional symptoms, 'symptomatic' if they had at least one symptom, and 'AIDS' if symptomatic with a history of opportunistic infections and/or CD4 count less than 200 cells/ micro L. For the overall group, changes in mean QoL (Medical Outcomes Study Short-Form-36 [SF-36]) ratings were non-significant, irrespective of initial disease stage or prior HAART exposure. Although overall there were health status improvements over the two-year period, clinical changes were generally unrelated to changes in QoL ratings. Patients with better immunologic/virologic outcomes showed slight improvements in mean QoL ratings, while those with poorer clinical outcomes showed slight deterioration. These within-group changes over time were statistically non-significant. The corresponding between-group differences in changes in SF-36 social and psychological dimensions were significant. Statistically significant differences among the three disease stage groups on a number of subscales at baseline (Physical Function, Body Pain, Vitality, Role Limitations due to Physical Problems) became non-significant (i.e. nullified) at follow-up. Significant increases in mean number of symptoms for the asymptomatic and symptomatic groups were not associated with two-year changes in QoL ratings. Overall, wellbeing was moderately stable over the two-year follow-up period, although somewhat affected by symptom changes and immunologic/virologic outcome. The study results contrast with pre-HAART longitudinal research, in which deterioration in all areas of QoL occurred.
Int J STD AIDS 2002 Oct
PMID:Evaluating health-related wellbeing outcomes among outpatient adults with human immunodeficiency virus infection in the HAART era. 1239 38

We reported a study undertaken in a Sexually Transmitted Disease care unit in Antsiranana amongst two groups of patients: 299 prostitutes and 350 STD patients (204 women and 146 men). The 20-29 years old age group represented 50.3% of the patients. A 12 days average delay between appearance of first symptoms of STD and the visit to the care unit was recorded. The most important clinical signs were cervicovaginal discharge (83%), pelvic pains (67%), and pruritus (53%) in women, urethral discharge and urination pain (64%) in men. Among prostitutes on a routine visit, 22.7% had at least one STD clinical sign. Syphilis serology by TPHA showed a high prevalence among prostitutes (39%) and STD patients (32%). Direct examinations emphazed the major importance of gonorrhoea in more than 70% of STD patients, both men and women, and trichomonasis in women (22%). Chlamydia investigation could not be done. HIV antibodies were recorded in 4 prostitutes (1.3%) and in none of the STD patients. 79.3% of prostitutes and 39.4% of STD patients had at least 2 partners a week and 47.5% of prostitutes used a condom "every time" and only 21.1% STD patients "sometimes" used it. The role of STD care units must be reinforced for information, education and counselling of the population in a non medical context.
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PMID:[Epidemiological approach for sexually transmitted diseases in Antsiranana (north Madagascar). Between prevention and treatment, the choice of a strategy against sexually transmitted diseases]. 1246 7

The aetiological importance of Chlamydia (C.) trachomatis in non-gonococcal urethritis (NGU) is undisputed. Mycoplasma (M.) genitalium has been shown to be strongly associated with NGU and with mucopurulent cervicitis and also with acute endometritis independent of C. trachomatis. In this prevalence study we examined 946 patients, 445 women and 501 men, attending the STD clinic, for M. genitalium as well as C. trachomatis and Neisseria gonorrhoeae. M. genitalium was detected in urethral samples from 17 (13.4 per cent) of 127 men with both symptoms and signs of urethritis and from 2 (1.3 per cent) of 160 men without (p < 0.001). Corresponding figures for M. genitalium in the women were 15 (11 per cent) of 136 women with symptoms and signs of urethritis or cervicitis compared to 3 (2.2 per cent) of 139 women without (p = 0.005). Examinations of partners of female and male index patients indicated that M. genitalium is sexually transmitted. Some M. genitalium infected patients had a history of irregular vaginal bleeding, lower genital tract pain, epididymitis and arthritis. Investigation of the aetiological role of M. genitalium in salpingitis, epididymitis and sexually acquired arthritis is urgently needed.
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PMID:[Chlamydia-like symptoms can have another etiology. Mycoplasma genitalium--an important and common sexually transmitted disease]. 1252 71

An increasing number of women with vulval problems and pain attend Olafiaklinikken, the centre for sexually transmitted infection (STI) in Oslo. The aim of the study was to investigate the prevalence of long-standing vulval problems and entry dyspareunia in a consecutive sample of STI-clinic visitors in Oslo. A self-administered questionnaire was distributed before and independent of the consultation. Response rate was 89.6% (502/560). Mean and median age were 25.9 and 24.0 years respectively, range 16-65 years. Vulval soreness, burning, dryness and fissures present for at least three months were reported by 23.1% (116/502), entry dyspareunia by 6.9% (34/494). Independent risk factors for dyspareunia were a history of >/=4 treatments for vulvovaginal candidiasis during the last year, reported by 34.6%, odds ratio (OR) 4.45, 95% confidence interval (CI) 1.81-11.0, and a history of bacterial vaginosis, reported by 42.4%, OR 2.34, 95% CI 1.11-4.92. Contraceptive methods, hygienic habits, a history of STIs, depression or sexual abuse were factors unrelated to longstanding symptoms. Investigation with regard to longstanding vulval problems and entry dyspareunia is required for a certain group of sexually transmitted disease-clinic visitors in Oslo, and referral to a special service for vulva patients would be beneficial for selected patients.
Int J STD AIDS 2003 Dec
PMID:Longstanding vulval problems and entry dyspareunia among STD-clinic visitors in Oslo-results from a cross-sectional study. 1467 85

The objective of the study was to determine the association of neurocognitive impairment with health-related quality of life (HRQoL) in patients receiving highly active antiretroviral therapy (HAART). Seventy subjects were cross-sectionally analysed with a standardized neuropsychological test battery and a questionnaire including an Italian translation of the MOS-HIV Health Survey. The presence of neurocognitive impairment was significantly associated with lower HRQoL scores: pain (P = 0.03), physical functioning (P = 0.01), role functioning (P = 0.01), social functioning (P = 0.029), mental health (P = 0.001), energy (P = 0.036), health distress (P = 0.002), cognitive functioning (P = 0.05), current health perception (P <0.001), physical health summary score (PHS) (P = 0.005), mental health summary score (MHS) (P = 0.002). Years of education (odds ratio [OR] 0.79; 95% confidence interval [CI] 0.65-0.96), PHS (OR 0.71; 95% CI 0.54-0.95) and MHS (OR 0.67; 95% CI 0.51-0.88) were also associated with cognitive impairment. Neurocognitive impairment in patients receiving HAART was associated with reduced HRQoL. Identifying cognitive impairment may provide motivation for additional treatment to help patients to compensate for deficits in functioning.
Int J STD AIDS 2004 Apr
PMID:Neurocognitive impairment influences quality of life in HIV-infected patients receiving HAART. 1507 20

The objective of the study was to review the indications for scrotal ultrasound scans and to assess the impact on patient management. We therefore performed a retrospective analysis. Case notes of all males referred for a scrotal ultrasound between April 1998 and March 2001 were studied. Data were extracted for the following: age, presenting complaints, physical findings on examination, results of a full sexual screen, treatment, ultrasound result and the designation of the person requesting the scan. All data were tabulated and summated using 'Windows Excel' software. One hundred and fifteen men were referred for an ultrasound in this period of time. None had an ultrasound more than once. Of these, 25 subjects could not be included as they either failed to attend for their scan (n=8) or their notes could not be traced (n=17). Twelve subjects were excluded as they did not fit the selection criteria (n=12). Median age was 30 years (Range 19-61 years). The commonest reason for referral was testicular pain (n=43) followed by testicular lump (n=19). The commonest abnormality on examination was an inflamed epididymis (n=18). Forty-two of the ultrasound scans were normal. A testicular mass was detected in only five of the 78 patients (6.4%), of which one was a malignancy (1.2%). A direct referral to a urologist for further management was made in only nine patients. Scrotal ultrasound for pain has limited impact on patient management apart from reassuring a worried patient. However, it remains an important investigation in the management of a suspected testicular lump.
Int J STD AIDS 2004 May
PMID:What is the role of scrotal ultrasound scans in genitourinary medicine? 1511 97

The cause of category III A prostatitis, chronic prostatitis/chronic male pelvic pain syndrome category A (CP/CPPS A), is uncertain. Treatments for it are based on consensus opinion rather than on scientific data. Our aim was to examine the effect of zafirlukast, a leucotriene antagonist, on the symptoms of CP/CPPS A in our genitourinary (GU) medicine unit. CP/CPPS A was diagnosed by comparative white cell counts of split urine (Stamey) analysis or by finding an excess of polymorphs in expressed prostatic fluid. Symptom change was assessed by the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). Patients were given zafirlukast or placebo for four weeks in a random double-blind fashion. All patients also received doxycycline. In all, 31 patients were asked to participate and 17 entered the study. No difference in outcome could be shown between the active (10) and placebo (seven) patients. Zafirlukast cannot be demonstrated to be useful in the symptomatic treatment of CP/CPPS A. The problems of recruitment into this study (in spite of a large number of patients with prostatic type pain being seen in our unit) suggest that multicentre treatment trials using non-invasive diagnostic techniques such as the CPSI (rather than single GU medicine units diagnosing CP/CPPS A by uncomfortable direct prostatic testing) are likely to be the most effective and objective methods of undertaking treatment trials in the CP/ CPPS A field in the future.
Int J STD AIDS 2005 Mar
PMID:Treatment of category III A prostatitis with zafirlukast: a randomized controlled feasibility study. 1582 18

The Brazilian Ministry of Health (STD and Aids Program) invited specialists to make up an informative guide to deal with HTLV patients. Among the different topics, the neurological aspects associated to HTLV were contemplated. A suspected case should include changes in force and reflexes, distal paresthesiae and autonomic dysfunction. The investigation of such case should be based on the syndrome shown by the patient. For patients with spinal cord syndrome, magnetic resonance imaging or myelography as well as spinal fluid studies should be carried out. For patients with neuropathic or myopathic syndrome, electroneuromyography and CPK dosing should be done, and for those with autonomic syndrome, a search for postural hypotension, ultrasonography of urinary tract and urodynamic studies should be requested. The treatment may be symptomatic (spasticity, neurogenic bladder, intestinal constipation and neuropathic pain) and specific to be carried out in specialized centers.
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PMID:[Guide of clinical management of HTLV patient: neurological aspects]. 1605 17


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