Background: Pneumocytis carinii pneumonia has generally been regarded to be an uncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa. The reason for this has not been clear but postulates included a lack of suitable pathogenic types in the African environment, diagnostic difficulties and the more commonly held belief that African HIV infected individuals were dying early from common non-opportunistic pathogens before severe degrees of immunosuppression occured. Recently a trend has emerged at the Mbagathi district hospital whereby an increasing number of HIV infected patients are empirically treated for Pneumocytis carinii pneumonia (PCP) based on clinical and radiological features. Objective: To determine the prevalence of PCP and clinical outcomes of HIV infected patients presenting at the Mbagathi District Hospital, Nairobi with the presumptive diagnosis of PCP. Setting: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya. Methods: Patients presenting with a sub-acute onset of cough and dyspnoea were eligible for the study if they were found to have bilateral pulmonary shadows and had negative sputum smears for AFBS. Consenting patients who had no contraindication to fiberoptic bronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopy procedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF was examined for cysts of P. carinii using toluidine blue stain and immunofluorescent antibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteria using routine procedures. Standard treatment with high dose cotrimoxazole was offered to all patients who were then followed up until discharge from hospital or death whichever came first. Results: Between June 1999 and August 2000 a total of 63 patients were referred for bronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure, four died before the procedure could be done, one was judged too sick to undergo the procedure and three had been on cotrimoxazole for longer than five days. Thus 51 patients underwent bronchoscopy. Pneumocytis carinii stain was positive in 19 (37.2%) while death occured in 16 (31.4%) of the 51 patients. There were more deaths in those without PCP but this difference was not statistically significant (odds ratio 0.68 (95% CI 0.35-1.32; P=0.2). Conclusion: PCP was found to be common in HIV infected patients presenting with clinical and radiological features of the disease. The mortality rate for patients with a presumptive diagnosis of PCP is high. This study suggests that cotrimoxazole preventive therapy may be a useful intervention in symptomatic HIV infected patients in Kenya for the prevention of PCP and may avert deaths from this disease.

Since the introduction of cisplatin-containing chemotherapy in the late 1970s, the standard chemotherapy protocol of cisplatin, etoposide and bleomycin has markedly improved the prognosis of testicular germ-cell cancer (TGCC).(1) Furthermore, subsequently developed salvage chemotherapy regimens, salvage surgery, highly stereotactic radiation therapy and progress in diagnostic modalities have further improved survival even with advanced-stage cancer and/or distant metastasis.(2-4) TGCC is known worldwide as a curable malignancy and with the medical progress described above, we would have expected to see equivalent prognostic improvements in Osaka, Japan. However, the 5-year prognoses of patients in Osaka diagnosed with testicular cancer (TC) were worse than those from the Surveillance Epidemiology and End Results (SEER) program, (5) possibly because of insufficient diffusion of the standard chemotherapy to smaller hospitals. (6) Following this previous report from the years 1975-1992, we have further updated the observation period of survival, analyzed the association between hospital procedure volume and survival and evaluated the centralization of patients' hospital referral using the Osaka Cancer Registry (OCR) database. Materials and MethodsData sources. Subjects with TC (ICD10, C62) were retrieved from the OCR database. The subjects included for survival analysis were reported cases diagnosed during 1993-1999, as the latest 5-year follow-up data in the OCR were cases diagnosed by 1999. Subjects with second primary testicular tumors were excluded from survival analysis as in the EUROCARE study. Categorization for hospital procedure volume and patients' hospital referral period. To evaluate the survival difference between hospitals, hospitals were categorized into three groups (A, B and C) according to patient procedure volume, in other words the number of patients treated. The three groups contained almost the same numbers of patients. To evaluate the hospital referral trend, the 12 years of 1990-2001, including the survival study period of 1993-1999, was divided into three consecutive 4-year periods.Relative survival. The Kaplan-Meier method was used for calculating survival and the 95% confidence interval. The starting point of survival time was defined as the date of the first diagnosis and the end-point was death from any cause. The closing date was defined as 5 years after the starting point. Cases lost to followup were censored at the latest date when they were confirmed as being alive. The expected survival was estimated by the Ederer II method, (8) using the survival probability in the general population similar to the subjects with respect to sex, age and calendar year. A survival probability table prepared by the National Cancer Center, (9) was used. Relative survival was calculated as the ratio of observed to expected survival.Hazard ratio. Prognostic factors of TGCC were analyzed using the Cox proportional hazards model. Independent variables were the hospital groups, clinical stage (distant/local...

Objective To evaluate the effects of localized irrigation with epinephrine saline after endoscopic retrograde cholangiopancreatography (ERCP). Patients and Methods

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A cross-sectional study was conducted to explore the potential association between work environment and/or stress coping ability, and depressive status among caregivers working for "group homes (GHs)" in Japan. In January 2010, 438 out of 700 caregivers working at GHs in Sapporo City returned completed questionnaires to us. The questionnaires consisted of the Center of Epidemiological Scales-Depression, items about worker's attributions, Ozeki's coping scale, and so on. An analysis using a logistic regression model was used to find the associations adjusting for gender and age. Subjects who were 45 yr or older, had a spouse, had job training, a standard workload and scored high in emotion-oriented coping were significantly associated with a decreased risk of depression. Subjects who were less proud of their job, less willing to continue care for the frail elderly and had fewer acceptances by their supervisors or colleagues for consultation were significantly associated with an increased risk of depression. This study supports our hypothesis that there can be possible variables among individual factors, work environment and/or coping style for stress which may modulate a risk on the depressive status of caregivers.