International journal of STD & AIDS
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There are many challenges in providing genitourinary medicine services in prison. A review of current service arrangements is overdue. Developing a national standard for sexual health in prison must be a priority. Clinical governance arrangements underpinned by better health informatics and reliable measures of outcomes are key in developing this strategy.
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The commissioning of health services for all prisoners in publicly run prisons in England was transferred to local Primary Care Trusts in April 2006, pledging to provide an equivalent standard of health care as that in the community. We reviewed our experience of providing a specialist in-reach HIV service by performing a retrospective case notes review of all HIV-positive prisoners who accessed care from the prison genitourinary medicine service in three London prisons. ⋯ This is the first study to look at how well HIV services are being provided during this transitional period of commissioning health services and provides insight into the challenges facing prison health-care providers. Good HIV outcomes are possible in prison but frequent transfers within the prison system and lack of effective HIV training among prison staff represent barriers to good care.
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The aim of this study was to investigate safety and impact of temporary external lumbar drainage for continuous release of cerebrospinal fluid among patients with HIV-associated cryptococcal meningitis and elevated intracranial pressure (ICP). We conducted a retrospective cohort study among patients with cryptococcal meningitis in whom temporary external lumbar drains were placed to reduce intractable elevated ICP between January 2002 and December 2005. Patients were followed for three months after the procedure. ⋯ The overall mortality rate was 5.6% in this cohort of 54 patients. In conclusion, the incidence of nosocomial infection of external lumbar drains is low. In resource-limited settings, the use of temporary external lumbar drainage is a safe and effective management strategy for intractable elevated ICP in HIV-infected patients with cryptococcal meningitis.
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Meta Analysis
Azithromycin vs. benzathine penicillin G for early syphilis: a meta-analysis of randomized clinical trials.
The World Health Organization estimates that at least 12 million people are infected with syphilis in the world. Southeast Asia accounts for 5.8 million; Africa accounts for 3.5 million. There has been controversy in using the two kinds of antibiotics for early syphilis. ⋯ Cure rate (OR=1.37), 95% CI (1.05, 1.77) and the risk difference for cure rate between the two drugs were statistically significant. Although the gastrointestinal adverse effect of azithromycin is five times more than the adverse effect of penicillin G benzathine, the differences are not significant. Azithromycin achieved a higher cure rate than penicillin G benzathine in a long follow-up.
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Lymphogranuloma venereum in the United Kingdom was detected in 2004, following the introduction of enhanced surveillance. This report describes a previously undiagnosed case, detected retrospectively in a sample obtained in 2003 from a male patient with high-risk behaviour, indicating that this previously rare disease in Europe, was present in the UK in 2003.