Objective
 Provider initiated testing and counseling (PITC) for HIV testing, which is not a mandatory HIV testing policy, to pregnant women was being introducing in many countries. The aim of this study was to assess impact and issues raised by the PITC approach for prevention of mother-to-child transmission (PMTCT) of HIV services at an antenatal clinic (ANC) in the capital of Cambodia.
Method
 Impact of the PITC approach on the acceptance of PMTCT services was determined by comparing quantitative data indicating the uptakes of PMTCT services during the first one year of PITC with the prior one year.
Results
 The acceptance rate of HIV testing dramatically increased from 35.9% (3,033/8,459) to 95.3% (7,780/8,162) (p<0.001), however the acceptance rate of post-test counseling after tested declined from 92.1% (2,793/3,033) to 73.9% (5,753/7,780) (p<0.001). The return rates of pregnant women tested with partners and without partners to post-test counseling were, respectively, 85.5% (1,913/2,237) and 69.7% (3,840/5,507) in PITC approach (p<0.001) although this difference was not significant in VCT approach.
Conclusions
 Although it can be agreed that the PITC approach was an effective strategy to increase the uptake of HIV testing, the remarkable declines of the post-test counseling acceptance lead concern about unexpected needs of counselors and the possibility of negative response to the HIV testing by their partners since the women tested without partners in PITC approach are less likely to return to post-test counseling compared to VCT approach. Further investigation on the reasons why some tested women didn’t receive post-test counseling is needed to find out strategies to keep or increase the acceptance of post-test counseling safely in the PITC approach. It was suggested that we still need to take into account the roles of counseling and partners’ involvement in careful consideration of women’s personal safety even in the implementation of PITC approach.

A 78-year-old man was diagnosed with adult T-cell leukemia/lymphoma (ATL) and was started on standard chemotherapy 1 year earlier. However, treatment was discontinued because of adverse drug reactions and worsening delirium. Thereafter, he remained stable and was followed up while receiving etoposide. He then visited our hospital because of acute abdominal pain and underwent surgery with a diagnosis of gastrointestinal perforation. Intraoperative observation showed a reddened, concentric wall thickening measuring 4 cm and a perforation site in the ileum, and thus partial resection of the small bowel was performed. The histological diagnosis was small bowel perforation due to tumor cell invasion. Two months postoperatively, he started a less intensive chemotherapy regimen along with palliative care, and died due to the primary disease approximately 5 months postoperatively. ATL involves systemic organs because of its high organ-affinity. Once it involves the gastrointestinal tract, various gastrointestinal symptoms can occur. Patients with ATL are at risk of developing gastrointestinal perforation at any time during the clinical course. Therefore, clinicians should be aware that once gastrointestinal perforation develops, the prognosis becomes extremely poor. Assessment of the disease state, early detection of gastrointestinal lesions, and prevention of opportunistic infections appear to be important in the management of patients with ATL.

Strenuous exercise induces upper respiratory tract infection (URTI), whereas moderate exercise prevents URTI. This study aimed to assess the incidence of URTI and the association between URTI episodes and exercise duration in Japanese collegiate athletes. A cross-sectional survey was conducted with 1,740 participants; 1,235 responses were eligible for analysis. Participants were classified into three groups: control group (weekly total exercise duration <60 min, n=405), exercise group (weekly total exercise duration >60 min, n=193), and athlete group (joined a sports club and weekly exercise frequency >5 days, n=637). We requested the following information from participants: basic characteristics, incidence of URTI symptoms (fever, runny or plugged nose, sore throat, and cough) or influenza for each month over the past year, day of the week exercise is typically performed, and duration of exercise per week. The incidence of URTI episodes per year was significantly lower in the athlete group (2.0 ± 2.4 episodes) compared to the control group (2.6 ± 2.4 episodes, p<0.001). The incidence of URTI episodes did not significantly differ between the control group and exercise group (2.9 ± 2.9 episodes, p=0.607). Although the frequency of URTI episodes and exercise duration were not significantly associated among male athletes (p=0.209), they were positively associated in female athletes (p=0.027). These results indicate that Japanese collegiate athletes experience fewer URTI episodes than non-athletes, but athletes who exercise for long durations may frequently experience URTI, particularly female athletes.