Are partners of HIV-infected people being tested for HIV? A mixed-methods research from Gujarat, India.

Setting: Four selected antiretroviral therapy (ART) centres of Gujarat State, India, which accounts for 8% of the human immunodeficiency virus (HIV) burden in India. Objectives: 1) To assess the proportion of people living with HIV (PLHIV) whose partners were not tested for HIV; 2) to assess sociodemographic and clinical characteristics of index cases associated with partner testing; and 3) to understand perceived facilitators and barriers to partner testing and make suggestions on how to improve testing from the perspective of the health-care provider. Design: A mixed-method design with a quantitative phase that involved reviewing the programme records of married PLHIV enrolled during 2011-2015, followed by a qualitative phase of key informant interviews. Results: Of 3884 married PLHIV, 1279 (33%) did not have their partners tested for HIV. Factors including index cases being male, illiterate, aged >25 years, belonging to key populations, substance use and being in advanced clinical stages were more likely to be associated with partner non-testing. Non-disclosure of HIV status (due to fear of marital discord) and lack of awareness and risk perception were the key barriers to testing. Conclusion: One third of PLHIV did not have their partners tested for HIV. Several factors were identified as being associated with the non-testing of partners, and solutions were explored that need to be implemented urgently if we are to achieve the 90-90-90 targets and end HIV.

Contexte : Quatre centres du traitement antirétroviral (TAR) sélectionnés de l'état de Gujarat, qui compte pour 8% du poids du virus de l'immunodéficience humaine (VIH) en Inde.Objective : Nous avons voulu 1) évaluer la proportion de personnes vivant avec le VIH (PVVIH) dont les partenaires n'ont pas été testés pour le VIH ; 2) évaluer les caractéristiques sociodémographiques et cliniques du cas index associées au test du partenaire ; et 3) comprendre les facilitateurs et les contraintes perçus au test du partenaire et faire des suggestions pour améliorer les tests du point de vue des prestataires de soins de santé.Schéma à plusieurs methods: La phase quantitative a impliqué de retrouver dans les archives du programme les PVVIH mariés enrôlés entre 2011 et 2015 ; la phase qualitative a ensuite consisté en entretiens avec des informateurs clés.Résultats: Sur 3884 PVVIH mariés, 1279 (33%) n'ont pas fait tester leurs partenaires pour le VIH. Les facteurs comme le fait que le cas index soit un homme, illettré, d'âge >25 ans, appartenant à des populations clés, utilisant des drogues, étant à un stade avancé de la maladie, ont été plus susceptibles d'être associés à l'absence de test du partenaire. Le non divulgation du statut VIH (due à la peur d'une discorde maritale) et le manque de connaissances et de perception des risques ont été les obstacles majeurs au test.Conclusion : Un tiers des PVVIH n'ont pas fait tester leurs partenaires pour le VIH. Plusieurs facteurs associés à l'absence de test des partenaires ont été identifiés et des solutions ont été recherchées. Elles doivent être mises en œuvre d'urgence si nous voulons atteindre les cibles de 90­90­90 et mettre fin au VIH.

Marco de referencia: Cuatro centros de tratamiento antirretrovírico (TAR) en el estado de Guyarat, que representa el 8% de la carga de morbilidad por el virus de la inmunodeficiencia humana (VIH) de la India.Objetivos: 1) Examinar la proporción de personas positivas frente al VIH cuyas parejas no cuentan con la prueba diagnóstica del VIH; 2) analizar las características socioeconómicas y clínicas del caso inicial que se relacionan con la práctica de la prueba diagnóstica en la pareja; y 3) comprender los elementos facilitadores y los obstáculos percibidos a la prueba del VIH en las parejas y las propuestas encaminadas a mejorar su utilización, desde el punto de vista de los profesionales de salud.Métodos: Se aplicó un modelo de métodos mixtos con una etapa inicial cuantitativa, que comportó el examen de los registros del programa de las personas positivas frente al VIH casadas inscritas del 2011 al 2015, seguida por una etapa cualitativa durante la cual se realizaron entrevistas a informantes clave.Resultados: De las 3884 personas positivas frente al VIH casadas, 1279 parejas no contaban con la prueba del VIH (33%). Las características del caso inicial que se asociaron con mayor frecuencia a la falta de prueba diagnóstica de la pareja fueron el sexo masculino, el analfabetismo, la edad más de 25 años, el hecho de pertenecer a una población clave, el consumo de sustancias psicoactivas y un estadio clínico avanzado de la enfermedad. Los principales obstáculos a la práctica de las pruebas fueron la negativa a divulgar su situación frente al VIH (por temor a una discordia conyugal) y la falta de sensibilización y percepción de los riesgos.Conclusión: En un tercio de las personas positivas frente al VIH, no se había practicado a su pareja la prueba diagnóstica de la infección. Se reconocieron diversos factores vinculados con esta situación y se analizaron las soluciones. La aplicación de estas medidas es urgente con el fin de cumplir con las metas 90­90­90 y eliminar la infección por el VIH.

Postharvest treatments of fresh produce.

Postharvest technologies have allowed horticultural industries to meet the global demands of local and large-scale production and intercontinental distribution of fresh produce that have high nutritional and sensory quality. Harvested products are metabolically active, undergoing ripening and senescence processes that must be controlled to prolong postharvest quality. Inadequate management of these processes can result in major losses in nutritional and quality attributes, outbreaks of foodborne pathogens and financial loss for all players along the supply chain, from growers to consumers. Optimal postharvest treatments for fresh produce seek to slow down physiological processes of senescence and maturation, reduce/inhibit development of physiological disorders and minimize the risk of microbial growth and contamination. In addition to basic postharvest technologies of temperature management, an array of others have been developed including various physical (heat, irradiation and edible coatings), chemical (antimicrobials, antioxidants and anti-browning) and gaseous treatments. This article examines the current status on postharvest treatments of fresh produce and emerging technologies, such as plasma and ozone, that can be used to maintain quality, reduce losses and waste of fresh produce. It also highlights further research needed to increase our understanding of the dynamic response of fresh produce to various postharvest treatments.

A multicenter cross-sectional study of mental and physical health depression in MHD patients.

Depression is ranked fourth among the disabling diseases affecting people worldwide and is the most common psychological problem in patients with End Stage Renal Disease (ESRD). The aim of this study is to assess the physical and emotional health status of renal dialysis patients, based on the SF-36 scale in relation to their economic status. Sixty maintenance hemodialysis patients, with a mean age of 40±13 years were included in this cross-sectional study using the SF-36 scale. It comprises 36 questions regarding physical and mental functions, body pain, vitality, etc. An SF-36 score of 50 or less was considered as moderate to severe depression and 51-100 as mild depression to good health. 56.81% of the patients who are below poverty line under dialysis had moderate to severe depression with regard to their health status. A physical health score of up to 50 was seen in 63.63% of patients below poverty line 63.63% (P= 0.16). A mental health score of 0-50 was observed in 61.63% of the cohort studied (P = 0.22). Among the patient with diabetes (28.33%) 55.56% had depression. Dialysis duration was directly associated with deteriorating physical health status and inversely proportional to their mental health status (P<0.05). There are problems in other regular activities due to depressed physical and mental health. The factors that were identified in this study that influence depression such as poverty status, increasing age, vintage and frequency of dialysis and treatment with erythropoietin dosage should be addressed and treated accordingly to improve the quality of life. Improving self-esteem with fruitful employment opportunities, concerted rehabilitation by professionals and easing of economic burden by private-public partnership is an achievable goal.

Primary plasma cell leukemia: clinical and laboratory presentation, gene-expression profiling and clinical outcome with Total Therapy protocols.

To determine whether primary plasma cell leukemia (PPCL) remains a high-risk multiple myeloma feature in the context of contemporary therapy and gene-expression profiling (GEP), we reviewed records of 1474 patients with myeloma, who were enrolled in Total Therapy protocols or treated identically off protocol. A total of 27 patients (1.8%) were classified as having PPCL. As a group, these patients more often had low hemoglobin, high beta-2-microglobulin, high lactate dehydrogenase, low albumin and cytogenetic abnormalities. Among 866 patients with GEP results, the PPCL group more often had disease that was classified as high risk, and in CD-1 and MF molecular subgroups. Regardless of the therapeutic protocol, patients with PPCL had shorter median overall survival (OS; 1.8 years), progression-free survival (PFS; 0.8 years) and complete response duration (CRD; 1.3 years) than the remainder, whose clinical outcomes had improved markedly with successive protocols. Multivariate analyses of pretreatment parameters showed that PPCL was a highly significant independent adverse feature linked to OS, PFS and CRD. In GEP analyses, 203 gene probes distinguished PPCL from non-PPCL; the identified genes were involved in the LXR/RXR activation, inositol metabolism, hepatic fibrosis/hepatic stellate-cell activation and lipopolysaccharide/interleukin-1-mediated inhibition of RXR function pathways. Different treatment approaches building on these genomic differences may improve the grave outcome of patients with PPCL.

Comparison of sublingual, vaginal, and oral misoprostol in cervical ripening for first trimester abortion.

OBJECTIVES: To compare the effectiveness and tolerability of misoprostol as a cervical ripening agent in first trimester abortion through three different routes of administration before surgical evacuation (SE). MATERIALS AND METHODS: It was a hospital based prospective randomized open labeled parallel study. A total of 150 randomly selected married women were divided in three groups for sublingual (S/L), vaginal and oral 400 µg of misoprostol single dose administration. The drug was administered 3-4 h before SE in the S/L and vaginal groups and 12 h before the procedure in the oral group. Efficacy was assessed on the basis of time taken for ripening, dilatation achieved, duration of the procedure, intra-operative blood loss, and pain score. The tolerability was noted on the basis of side effects. RESULTS: The mean time taken for cervical ripening was less in sublingual administration (3.7±1.2 hr) as compared to the vaginal and oral routes. The S/L group had significant cervical dilatation (P<0.001) and the duration of SE was less as compared to the vaginal and oral routes. However, the mean intraoperative blood loss was more in sublingual as compared to the vaginal and oral groups. The intra-operative pain score of the S/L group was significantly lower (1.9±1.1, P<0.05) as compared to the vaginal (2.6±1.7) or oral route (3.3±1.7). Loose motions and nausea/vomiting were more with the S/L and oral routes while blood loss was more in the vaginal route. CONCLUSION: Administration of misoprostol by the sublingual route is better than the oral and vaginal routes for cervical ripening.

Knowledge, attitude and practices regarding swine flu among para-medical workers in a tertiary care hospital in Pondicherry.

Para-medical workers (PMWs) are first contacts for suspected Swine flu patients and also the media to spread key messages regarding its prevention and control strategies. Present study was conducted to ascertain knowledge, attitude and practices regarding Swine flu among para-medical workers in a tertiary care hospital. A hospital based cross-sectional study was conducted among PMWs during May-July, 2010. KAP regarding Swine flu was collected through pre-designed questionnaire and information on attitude towards Swine flu was also collected through FGD-free list analysis. Data was analysed using Epi_Info and Anthropac software. A total of 237 PMWs responded. Majority of the PMWs knew about signs and symptoms (89.03%), mode of transmission (91.56%) and route of transmission (91.98%) of Swine flu. Television (67.51%) was the major source of information. 75.53% and 58.65% PMWs respectively knew about organ of the body chiefly affected and type of specimen to be collected during Swine flu. 196 (82.7%) and 191 (80.59%) PMWs respectively knew about availability of vaccine and treatment against Swine flu. 94.09% PMWs stated that extra precautions such as use of face mask, frequent handwashing, use of gloves etc. should be taken while handling any suspected Swine flu case and 73.84% PMWs do take such precautions. 80.17% PMWs opined that epidemic of Swine flu can be halted at current stage. In the present study, PMWs possessed good knowledge, attitude and practices regarding Swine flu and this fact should be utilized while designing and guiding containment strategies against existing Swine flu epidemic.

Neuroses among Armed Forces Personnel.

BACKGROUND: The phenomenon of "Military Family Syndrome" has been hotly debated. Mental disorders are however, important causes of morbidity in the armed forces. METHODS: A cross sectional study was carried out on 600 randomly selected troops and families in a large military station. General Health Questionnaire 12 (GHQ-12) was used as a screening test for neuroses. Neuroses was defined as score of three and above on the GHQ-12. RESULT: Overall prevalence of neuroses was 31.34% with 95% confidence interval between 27.41% and 35.55%. Gender did not have any effect on prevalence of neuroses nor did marital status. The soldiers in the age group of 25-36 years were most affected. Neuroses was more common in the lower ranks and among troops who belonged to arms. Among wives, age, rank and type of service (whether from arms or services) of husband were not associated with neuroses. CONCLUSION: There is a need for preventive psychological services in the armed forces. Leadership and man-management sensitive to changing needs of the soldier should be promoted.

Outbreak of Rubella Among Cadets in an Academy.

BACKGROUND: Rubella is traditionally considered a childhood disease, but has the potential to cause outbreaks in closed community of young adults. The present paper describes one such outbreak in a military training establishment. METHOD: The cases of rubella outbreak were identified by clinical features (fever, rash and lymphadenopathy) and confirmed by detection of high titre of anti-rubella IgM antibodies by enzyme-linked immunosorbent assay. Initial serum samples were also tested for antibodies against measles, scrub typhus and dengue. Salient epidemiological features of the outbreak were studied. RESULT: 163 cadets were admitted in the local military hospital within two months. The cases presented with fever, coryza, lymphadenopathy and maculopapular rash. 117 (71.78%) of the samples showed presence of anti-rubella IgM antibodies. CONCLUSION: Rubella outbreaks in military communities have the potential to adversely affect military training/operations. The need for administration of vaccination against rubella in such population may be reviewed.

Epidemiological Investigation of an Outbreak of Enteric Fever.

BACKGROUND: Ninety five cases of enteric fever among military recruits from a regimental training centre at Maharastra were admitted to the local military hospital in a few weeks time. METHODS: A descriptive epidemiological study and detailed site survey was undertaken. Blood culture, antibiotic sensitivity test (ABST) with serotyping and phage typing of the isolates were done. RESULT: A total of 95 cases occurred from 31 March 2003 to 17 May 2003. Blood culture for Salmonella enterica serovar Typhi was positive in 60 (63.16%) cases. All the isolates showed same serotype - 9, 12: d: Vi and all belonged to phage type E1 biotype 1 indicating single source outbreak. There was one fatality. There was clustering in time and place indicating a common source outbreak. Exploration of water pipeline supply revealed sewage contamination due to pipeline passing close to a overflowing manhole. ABST revealed multi-drug resistance. CONCLUSION: The outbreak of enteric fever occurred due to sewage contamination of drinking water pipeline.

HIV Prevention in the Armed Forces: Perceptions and Attitudes of Regimental Officers.

BACKGROUND: Involvement of commanders and regimental officers is believed essential for a successful human immunodeficiency virus (HIV) infection prevention programme in the armed forces. METHODS: A structured questionnaire was sent to 40 different Information, Education and Communication (IEC) nodes to elicit the perception and attitude of regimental officers/commanders. From each station, 40 regimental officers/commanders were randomly selected and information from 1002 valid and completed questionnaires was analysed. RESULTS: Less than 50% could correctly assess the burden of HIV/AIDS in the armed forces. Only 41.19% felt HIV/AIDS is a problem serious enough to adversely affect operational efficiency. Majority had communicated with the troops on the subject of HIV/AIDS. The perceived threat of HIV being a problem in own unit was low. Though condom was often advocated, the felt need of condom in the unit was not commensurate with this advocacy. There were statistically significant differences in the perception and attitude among the three services. Only 7.08% of the officers emphasised the need of maintaining confidentiality while dealing with a HIV positive soldier. CONCLUSION: Energetic advocacy on HIV prevention including condom promotion involving the regimental officers is indicated. Wider dissemination of surveillance figures generated at AIDS Control Organisation (ACO) is needed for apprising them about the menace of HIV in the armed forces.

Infection-associated haemophagocytosis: the tropical spectrum.

Reactive proliferation and inappropriate activation of mature histiocytes with haemophagocytosis (HP) may occur in association with a wide variety of infections, neoplasms, collagen vascular diseases, and acquired and inherited immunodeficiency states. The association with infections is particularly important because overwhelming HP can obscure the typical clinical features of the primary disease and negatively affects outcome. A high index of suspicion is required for early recognition of associated HP as the cause of cytopenias. Institution of specific therapy is crucial for survival. This study highlights the wide spectrum of tropical diseases that can have associated reactive HP. Thirty cases with documented prominent HP on bone marrow aspiration smears were reviewed. Twenty-one (69%) of the marrows were from patients who had common tropical infections: malaria, typhoid and visceral leishmaniasis and 11 of 15 patients (73%) who were followed up improved on specific infection-directed and supportive measures. The presence of severe HP in bone marrow smears correlated with marked cytopenias. Recognition of HP in this geographical region should stimulate the search for one of these infections as early institution of specific therapy is crucial for patient survival.

Cubitus varus--correction by distraction osteogenesis.

Cubitus varus deformity in thirty children was corrected by gradual medial opening wedge osteotomy. The osteotomy was stabilized and distracted by simple external fixator-cum-distractor. The patients of both sexes and age from 6 to 14 years, had varus deformity from 17 degrees to 43 degrees. We achieved good to excellent results in 28 cases as regards to correction of deformity and range of motion at elbow joint. None of the cases had neurological deficit or permanent stiffness. One case had fair result due to under-correction and another case had a poor result as osteotomy united before correction. The main complication faced was superficial pin-site infection particularly in summer season and a in fatty children but was managed by good pinsite dressing and care. The technique has been found to be quite effective, technically simple, cosmetically acceptable and with little, if any, lazy S deformity.

Isolated cardiac aspergillosis.

A 40-year-old man, a known case of Wolff-Parkinson-White syndrome, was admitted to the hospital in an unconscious state. In spite of medical treatment, the patient died within two hours of admission. At autopsy, the deceased was found to have aspergillosis involving the interatrial septum, aortic valve and root of the aorta. The rest of the organs were unremarkable. The patient did not show any obvious signs of being immunocompromised. We report this case of isolated cardiac aspergillosis in an apparently healthy individual.

AN INTRODUCTION TO ESSENTIALS OF BIO-MEDICAL WASTE MANAGEMENT.

The issue of biomedical waste management has assumed great significance in recent times particularly in view of the rapid upsurge of HIV infection. Government of India has made proper handling and disposal of this category of waste a statutory requirement with the publication of gazette notification no 460 dated 27 July 1998. The provisions are equally applicable to our service hospitals and hence there is a need for all the service medical, dental, nursing officers, other paramedical staff and safaiwalas to be well aware of the basic principles of handling, treatment and disposal of biomedical waste. The present article deals with such basic issues as definition, categories and principles of handling and disposal of biomedical waste.

Disseminated histoplasmosis with reactive hemophagocytosis: aspiration cytology findings in two cases.

Two cases of disseminated histoplasmosis associated with reactive hemophagocytic syndrome are described. The clinical presentation was with prolonged unexplained fever and hepatosplenomegaly. On a strong clinical possibility of tuberculosis, antitubercular treatment was initiated in both patients. Lymph node (case 1), splenic (case 2), and bone marrow aspiration, however, showed sheets of proliferating histiocytes, and intracellular and extracellular histoplasma organisms. Aspiration cytology was thus valuable in establishing the final diagnosis. The patients had a fulminant clinical course and died of hemorrhagic shock within 48 hr of hospital admission before specific therapy could be initiated. Histoplasmosis can mimic tuberculosis clinically. There is a need for an increased awareness of the clinicopathological spectrum of histoplasmosis, especially its rarer manifestations as hemophagocytic syndrome. In suspected cases, aspirations from the lymph node, liver, and spleen can be performed safely and should be utilized for early diagnosis.