Key historical landmark research malpractice scandals that shocked the international community (Nazi doctors' experiments, Tuskegee study, Jewish chronic disease experiments, Krugman's Willowbrook hepatitis study) were the origin of the institution of ethics review prior to carrying out research involving humans. Nonetheless, it is plausible that unethical research is ongoing or may have been conducted in recent times that has escaped public notice, especially in the vulnerable low-and middle-income country contexts. The basic constitution of these committees at some point has not been clearly defined, with most scientists declaring political maneuvers at times. These committees today are characterized by bureaucratic bottlenecks, financial interests, inadequate training in research ethics, and lack of control and coordination of their functions. Compulsory and adequate research ethics training for researchers and ethical committee members could guarantee trust, and appreciation of the utmost importance of the latter. The independence of protocol review
The use of combined Anti-Retroviral Therapy (cART) has been revolutionary in the history of the fight against HIV-AIDS, with remarkable reductions in HIV associated morbidity and mortality. Knowing one's HIV status early, not only increases chances of early initiation of effective, affordable and available treatment, but has lately been associated with an important potential to reduce disease transmission. A public health priority lately has been to lay emphasis on early and wide spread HIV screening. With many countries having already in the market over the counter self-testing kits, the ethical question whether self-testing in HIV with such kits is acceptable remains unanswered. Many Western authors have been firm on the fact that this approach enhances patient autonomy and is ethically grounded. We argue that the notion of patient autonomy as proposed by most ethicists assumes perfect understanding of information around HIV, neglects HIV associated stigma as well as proper identification of risky situations that warrant an HIV test. Putting traditional clinic based HIV screening practice into the shadows might be too early, especially for developing countries and potentially very dangerous. Encouraging self-testing as a measure to accompany clinic based testing in our opinion stands as main precondition for public health to invest in HIV self-testing. We agree with most authors that hard to reach risky groups like men and Men Who Have Sex with Men (MSM) are easily reached with the self-testing approach. However, linking self-testers to the medical services they need remains a key challenge, and an understudied indispensable obstacle in making this approach to obtain its desired goals.
Pulmonary embolism is a complication of pulmonary tuberculosis that has received little emphasis in the literature. We describe a 52 year old male, with no risk factors for thromboembolic disease referred to our service for an in depth clinical review for cardiomegaly and dyspnea on exertion. Echocardiography and CT scans revealed dilated heart cavities and bilateral proximal pulmonary emboli respectively and a cavitation in the apical lobe of the right lung. Bronchial aspirate and culture revealed the presence of mycobacterium tuberculosis. There was no evidence of malignancy. Elsewhere, a clinical review and a lower limb ultrasound showed no evidence of deep venous thrombosis. Clinical course on anti - tuberculosis and anti - coagulant therapies was remarkably favorable. Clinicians need to be conscious of the risk of developing thromboembolic disease in patients treated for tuberculosis, in especially high prevalence settings like ours.
Background: Despite numerous health promotion interventions lately conducted, the human immunodeficiency virus (HIV) remains a major cause of morbidity and mortality in sub-Saharan Africa. It is reported that military personnel have a higher prevalence of HIV, compared with the general population. Condom use remains a cheap, easy-to-use, and effective device to prevent the spread of HIV. Growing evidence, however, suggests its underuse among the military personnel. Methods: The current cross sectional study included 325 consenting male and female soldiers from 8 different battalions. Characteristics of the study participants were summarized using frequencies and proportions. Associations between the studied variables were investigated using the Chi-square test of independency; P values < 0.05 were considered statistically significant. Results were presented in the form of tables and graphs. Data analysis was conducted using SPSS version 20.0. Results: Only 28% of the participants used condom during the last unsafe sexual contact. Over 85% of them reported that condoms were always available. Half (50%) of the participants were ashamed to buy condoms. The most commonly reasons for not using condoms were drunkenness (37.5%), trust in the sexual partner (26.5%), tobacco smoking (11.1%), not interested to use a condom (8.9%), and dislike/refusal of condom use by the partner. Main reasons of inconsistent use of condoms included drunkenness, shyness to buy condoms and unavailability in the respective battalions. Trust in sex partners, condom use/sex related stigma, and alcohol abuse were the major determinants of inconsistent condom use during unsafe sexual relations among Cameroonian soldiers. Conclusions: Unprotected sexual practice amongst Cameroonian soldiers was high. Despite the reported high availability of condoms (85%), only 28% of the study respondents used condoms during their last sexual intercourse with different partners. Consistent condom use was sub-optimal among Cameroonian military staff.
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