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Background and Objectives Patients with rheumatoid arthritis (RA) have greater psychological morbidity, despite that research in this area is scarce from developing countries. This study was aimed to assess the association of quality of life, social support, coping strategies, and psychological morbidity in patients with RA. Materials and Methods In this cross-sectional study, 40 patients with RA, who were not receiving steroids or disease modifying antirheumatic drugs, were recruited through purposive sampling. Social support questionnaire, coping strategy check list, and World Health Organization quality of life-BREF (WHOQOL-BREF) were administered to assess social support, coping, and quality of life, respectively. Results More than half of the patients had psychiatric disorders (60%), with depression being the commonest disorder (52.5%). Internalization coping and disease severity indicators like tender joints counts, swollen joints counts, pain, and disease activity were found as significant predictors for psychiatric disorders, while externalization coping, quality of life (all domains), and physical functions were found to protect against psychiatric morbidity. Conclusions Coping, quality of life, disease severity, and physical functions predicted the psychiatric disorders in RA. Multipronged interventions to enhance quality of life with promoting adaptive coping and timely treatment may further improve their mental health and overall disease course.
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Objectives: Enhancement of quality of life and social support havebecome important therapeutic goals among people living with HIV. However, research from developing countries is sparse in this area. Index study was aimed to assess association of social support, coping, and quality of life with psychological morbidity among people living with HIV. Materials and Methods: In this cross-sectional study, 100 people with HIV were recruited through purposive sampling who were not receiving antiretroviral therapy. To assess social support, coping, and quality of life social support questionnaire, coping strategy check list and World Health Organization quality of life-HIV BREF were administered, respectively. Results: Quality of life domain scores fell in the moderate category and spirituality, religion, and personal belief domain had maximum score. Educated, married, employed, and male subjects reported better quality of life. Females reported greater use of internalization and emotional outlet coping strategies. Low social support, lower quality of life (in all domains and total score), and greater use of internalization coping strategy were significantly associated with psychiatric morbidity. Conclusion: Internalization coping, low social support, and lower quality of life were associated with greater psychiatric morbidity. Therefore, to improve their mental health and overall course of HIV, multipronged interventions should be implemented for promoting the adaptive coping, social support and quality of life.
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Background: Disseminated Mycobacterium avium complex (MAC) and Mycobacterium tuberculosis infections have almost similar clinical presentations but require different therapeutic management. Materials & methods: A duplex PCR was designed based on the sequence variation between the genes encoding catalase-peroxidase (KatG) of M. avium complex and M. tuberculosis, so as to discriminate MAC, M. tuberculosis and mixed mycobacterial (MAC + M. tuberculosis) infections in HIV patients. Results: An accurate, single-step differential diagnosis of disseminated mycobacterial infections in HIV patients was achieved with specific detection of a single band each for M. avium (120 bp) and M. tuberculosis (90 bp) and two bands for the mixed (120 and 90 bp) infections. Conclusion:katG gene-based duplex PCR can facilitate quick differential diagnosis of disseminated MAC and M. tuberculosis infections in HIV patients.
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Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Técnicas de Tipagem Bacteriana/métodos , Infecções por HIV/complicações , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Tuberculose/microbiologia , Proteínas de Bactérias/genética , Catalase/genética , Estudos Transversais , Diagnóstico Diferencial , Humanos , Complexo Mycobacterium avium/genética , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Mycobacterium tuberculosis/genética , Tuberculose/diagnósticoRESUMO
Human leukocyte antigen (HLA) class I molecules of the human major histocompatibility complex (MHC) play an important role in modulating immune response. HLA class I molecules present antigenic peptides to CD8+ T cells and thereby play a role in the immune surveillance of cells infected with viruses. TAP1 and TAP2 are MHC-II-encoded genes necessary for the generation of a cellular immune response and polymorphism of these genes can influence the specificity of peptides preferentially presented by the MHC class I molecules and the outcome of the immune response. Several studies implicated genetic variation in TAP genes to various immune-mediated and infectious diseases. To determine the correlation between HIV-1 infection and the TAP1 and TAP2 genes polymorphisms, we performed PCR-RFLP assay of these genes in 500 HIV-1 seropositives and the matched seronegative individuals. Statistical analysis of the data disclosed no correlation between TAP1 (C/T intron 7) gene polymorphism and HIV-1/AIDS disease. However, the current results demonstrated that the heterozygous A/G [OR (95% CI) 1.39 (1.06-1.83), P = 0.0171] and homozygous G/G [OR (95% CI) 3.38(1.56-7.46), P = 0.0010] variants of TAP2 (A/G exon 11) (T665A) gene are positively associated with an increased risk of HIV-1/AIDS infection. This case-control analysis might suggest a possible role of TAP2 (A/G exon 11) (T665A) gene in the susceptibility to HIV-1 infection and disease outcome among North Indian patients.
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Membro 3 da Subfamília B de Transportadores de Cassetes de Ligação de ATP/genética , Síndrome da Imunodeficiência Adquirida/genética , Apresentação de Antígeno/genética , Predisposição Genética para Doença , HIV-1 , Polimorfismo Genético , Membro 2 da Subfamília B de Transportadores de Cassetes de Ligação de ATP/genética , Membro 2 da Subfamília B de Transportadores de Cassetes de Ligação de ATP/imunologia , Membro 3 da Subfamília B de Transportadores de Cassetes de Ligação de ATP/imunologia , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Pseudogout is a form of acute calcium pyrophosphate deposition (CPPD) disease that typically afflicts the elderly. CPPD commonly involves larger joints, such as the knees, wrists, shoulders, and hips, and has been known to involve the spine. The authors report the case of a 66-year-old woman with a recent history of lumbar laminectomy and fusion who presented 5 weeks postprocedure with a clinical and radiographic picture consistent with multilevel skip lesions involving the cervical and thoracic spine, thoracic discitis, and epidural abscess. Serial blood cultures and repeat biopsy samples were sterile. Subsequent wrist and ankle erythema, pain, and swelling led to synovial fluid analysis, and pseudogout was diagnosed. She was treated with an interleukin-1 inhibitor with immediate symptom relief. To the authors' knowledge, this is only the second report of spinal pseudogout presenting with a clinical and radiographic picture consistent with discitis and epidural abscess. This report is the first to report skip lesions of pseudogout occurring throughout the spine that are uniquely remote from a recent lumbar surgery.
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Condrocalcinose/diagnóstico , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/diagnóstico , Doenças da Coluna Vertebral/diagnóstico , Fusão Vertebral , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Condrocalcinose/tratamento farmacológico , Condrocalcinose/etiologia , Condrocalcinose/patologia , Diagnóstico Diferencial , Feminino , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/patologia , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/patologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologiaRESUMO
BACKGROUND: Genetic variation in HLA genes influence the immune response and may thus contribute to differential development of tuberculosis (TB) in HIV-infected individuals. The study was designed to determine whether HLA polymorphisms influence the development of Mycobacterium tuberculosis infection in HIV-infected individuals. MATERIALS AND METHODS: Fifty HIV-positive individuals without TB (HIV+TB-), 50 HIV patients co-infected with TB (HIV+TB+) and 50 control subjects (HIV-TB-) were analyzed for HLA Class I and II polymorphisms. RESULTS: In HLA Class II, frequency of occurrence of DRB1*13 (OR 3.165, CI 1.176-8.518, P value 0.019), DRB5 (OR 2.253, CI 1.011-5.019, P value 0.045) and DQB1*06 (OR 2.705, CI 1.197-6.113, P value 0.016) were increased in HIV+TB+compared to HIV+TB-. HLA DQB1*02 (OR 0.436, CI 0.185-1.029, P value 0.05) on the other hand conferred a protective role. In HLA Class I, frequency of B*15 (OR 2.705, CI 1.040-7.036, P value 0.038) was increased, whereas B*51 (OR 0.148, CI 0.031-0.706, P value 0.007) was decreased in HIV+TB+group compared to HIV+TB-. These differences however were not significant when compared with healthy controls. CONCLUSION: HLA polymorphisms independently did not account for the susceptibility to either of the disease mostly, although they seem to play a role once the infection(s) has established in a particular individual. Further studies are needed on a larger sample size to confirm these observations.
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BACKGROUND: Relapsing polychondritis is a rare disease characterised by inflammation of cartilaginous and proteoglycan rich structures. As there are only a few published single centre case series from all across the world, we describe our experience with 26 patients at a tertiary centre in north India. METHODS: A retrospective study with all patients meeting Damiani and Levine's modification of McAdam's diagnostic criteria. Clinical details, investigations, disease activity assessment [(Relapsing Polychondritis Disease Activity Index (RPDAI)], treatment and outcomes were recorded. RESULTS: Ten men and sixteen women (median age 45 years) met the diagnostic criteria. Auricular chondritis (96%), arthritis (54%), hearing impairment (42%), ocular (42%), dermal (26%), cardiovascular (11%) and laryngotracheal involvement (11%) characterized the clinical presentations. The median RPDAI was 31 (range 9-66). Two patients died during observation. Overall survival was 92.3% (median survival 13.5 years). CONCLUSIONS: Apart from reduced laryngotracheal involvement, RP in India was clinically similar to recorded patterns elsewhere.
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Policondrite Recidivante/diagnóstico , Policondrite Recidivante/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Disseminated Mycobacterium avium-intracellulare complex (MAC) infection is considered as severe complication of advanced HIV/AIDS disease. Currently available various laboratory investigations have not only limited ability to discriminate between MAC infection and tuberculosis but are also laborious and time consuming. The aim of this study was, therefore, to design a molecular-based strategy for specific detection of MAC and its differentiation from Mycobacterium tuberculosis (M. tb) isolated from the blood specimens of HIV patients. A simple PCR was developed based on the amplification of 120-bp katG-N gene corresponding to the first 40 amino acids of N-terminal catalase-peroxidase (KatG) protein of Mycobacterium avium that shows only ~13% sequence homology by clustal W alignment to N-terminal region of M. tb KatG protein. This assay allowed the accurate and rapid detection of MAC bacteremia, distinguishing it from M. tb in a single PCR reaction without any need for sequencing or hybridization protocol to be performed thereafter. This study produced enough evidence that a significant proportion of Indian HIV patients have disseminated MAC bacteremia, suggesting the utility of M. avium katG-N gene PCR for early detection of MAC disease in HIV patients.
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Proteínas de Bactérias/genética , Infecções por HIV/complicações , Técnicas de Diagnóstico Molecular/métodos , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Peroxidases/genética , Reação em Cadeia da Polimerase/métodos , Adulto , Bacteriemia/diagnóstico , Estudos de Casos e Controles , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Complexo Mycobacterium avium/genética , Estudos Prospectivos , Sensibilidade e Especificidade , Fatores de TempoRESUMO
BACKGROUND: Mucocutaneous diseases are among the first-recognized clinical manifestations of acquired immune deficiency syndrome. They function as visual markers in assessing the progression of human immunodeficiency virus (HIV) infection. Given the relative ease of examination of skin, its evaluation remains an important tool in the diagnosis of HIV infection. OBJECTIVE: To determine the pattern of mucocutaneous manifestations in HIV-positive patients and to correlate their presence with CD4 counts. MATERIALS AND METHODS: This cross-sectional study included 352 HIV-infected patients seen at PGIMER, Chandigarh, India, over a period of 1 year. The patients were screened for mucocutaneous disorders by an experienced dermatologist. The patients were classified into different stages according to the World Health Organization clinical and immunological staging system. RESULTS: The most prevalent infection was candidiasis, seen in 57 patients (16.2%). Prevalence of candidiasis, dermatophytosis, herpes simplex, herpes zoster, molluscum contagiosum (MC), seborrheic dermatitis, adverse drug reaction, nail pigmentation, xerosis and diffuse hair loss differed statistically according to the clinical stages of HIV infection. There was a statistically significant association between immunological stages of HIV infection and dermatophytosis. CONCLUSION: Results of our study suggest that mucocutaneous findings occur throughout the course of HIV infection. Dermatoses like MC and dermatophytosis show an inverse relation with CD4 cell count, and these dermatoses can be used as a proxy indicator of advanced immunosuppression to start highly active anti-retroviral therapy in the absence of facilities to carry out CD4 cell count.
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Systemic lupus erythematosus (SLE) is a chronic and complex autoimmune disease characterized by the production of autoantibodies against a spectrum of nuclear antigens. RANTES and its receptor CCR5 have been associated with the pathogenesis of SLE. The objective of this study is to analyze autoantibodies (DNA/RNA), allelic distribution of RANTES and the association of levels of RANTES and its receptor CCR5 in SLE patients in North Indian region. The RANTES-403 and RANTES-28 polymorphism in the promoter region of RANTES gene was studied in 80 patients and 80 healthy controls. The levels of chemokine RANTES, its receptor CCR5, anti-dsDNA, and anti-SSA antibodies levels were determined. Disease activity was assessed with the systemic lupus erythematosus disease activity index (SLEDAI) score. All the parameters were studied for statistical analysis by using t test (graph pad prism) and correlation by SPSS data. PCR-RFLP performed showed 28C/C and the 403G/G genotypes in both patients and controls, but no other genotypes such as 28C/G, 28G/G and 403A/G, 403A/A were found. Patients had higher levels of RANTES (1840.48 ± 739.42 vs. 835.44 ± 70.48 pg/ml; P < 0.0001) and its receptor CCR5 expression (26.49 ± 0.16 vs. 24.72 ± 3.02 %; P < 0.05) compared to controls. The levels of autoantibodies anti-dsDNA and anti-SSA were also higher in patients than controls. The patients showing elevated anti-dsDNA had negative correlation with SLEDAI score (P < 0.05) while borderline patients were not found to be correlated. In case of anti-Ro/anti-SSA antibody levels, the borderline patients showed a moderately significant negative correlation as compared to controls than patients with elevated autoantibody (P < 0.01). The levels of RANTES and CCR5 were also higher in case of patients than controls. But there was no significant correlation of RANTES and CCR5 with disease activity. We were unable to find an association of RANTES polymorphism with SLE in North Indian population in our sample. No significant difference in allele distribution of RANTES-28 and RANTES-403 in the sample of 160 individuals was detected. Of the two autoantibodies studied, anti-Ro/anti-SSA levels in borderline lupus patients appeared as an important parameter for monitoring/diagnosis of lupus patients.
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Autoanticorpos/genética , Quimiocina CCL5/genética , Lúpus Eritematoso Sistêmico/genética , Receptores CCR5/genética , Adulto , Idoso , Autoanticorpos/sangue , Autoanticorpos/imunologia , Feminino , Genótipo , Humanos , Índia , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Multidrug resistant (MDR) and extensively-drug resistant (XDR) tuberculosis (TB) are a serious threat to the national TB control programs of developing countries, and the situation is further worsened by the human immunodeficiency virus (HIV) pandemic. The literature regarding MDR/XDR-TB is, however, scanty from most parts of India. We carried out this study to assess the prevalence of MDR/XDR-TB in new and previously treated cases of pulmonary TB and in HIV seropositive and seronegative patients. METHODS: Sputum and blood specimens were obtained from 2100 patients suspected of pulmonary tuberculosis and subjected to sputum microscopy and culture for TB, and HIV serology at our tertiary care centre in north India. The culture positive Mycobacterium tuberculosis isolates were subjected to drug susceptibility testing (DST) for first line anti-tuberculosis drugs, and the MDR isolates were further subjected to second line DST. Various parameters of the patients' were analyzed viz. clinical presentation, radiology, previous treatment history, demographic and socioeconomic data and microbiology results. RESULTS: Of the 2100 patients, sputum specimens of 256 were smear positive for acid-fast bacilli (AFB), 271 (12.9%) grew Mycobacterium spp., and M. tuberculosis was isolated in 219 (10.42%). Of the 219 patients infected with M. tuberculosis, 20.1% (44/219) were found to be seropositive for HIV. Overall, MDR-TB was observed in 17.4% (39/219) isolates. There were 121 newly diagnosed and 98 previously treated patients, of which MDR-TB was found to be associated with 9.9% (12/121) and 27.6% (27/98) cases respectively. There was significantly higher association of MDR-TB (12/44, 27.3%) with HIV seropositive patients as compared to HIV seronegative patients (27/175, 15.4%) after controlling previous treatment status, age, and sex (odd's ratio, 2.3 [95% CI, 1.000-5.350]; p-value, 0.05). No XDR-TB was found among the MDR-TB isolates. CONCLUSION: The present study demonstrated a high prevalence of drug resistance amongst pulmonary TB isolates of M. tuberculosis from north India as compared to the WHO estimates for India in 2010, though this could possibly be attributed to the clustering of more serious or referred cases at our tertiary care centre. The prevalence of MDR-TB in HIV seropositive patients was significantly higher than seronegative individuals. The study emphasizes the need to monitor the trends of drug resistance in TB in various populations in order to timely implement appropriate interventions to curb the menace of MDR-TB.
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Infecções por HIV/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/virologia , Adolescente , Adulto , Idoso , Antituberculosos/farmacologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Feminino , Infecções por HIV/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise Multivariada , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Estudos Prospectivos , Fatores Socioeconômicos , Escarro/microbiologia , Escarro/virologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
An altered redox status and increased lymphocyte apoptosis have been implicated in the development of systemic lupus erythematosus (SLE). In this study, we evaluated the relationship between glutathione (GSH) depletion, reactive oxygen species (ROS) and, the progression of apoptosis and their association with SLE severity. Significant low levels of intracellular glutathione, total thiol and altered redox state (GSH/GSSG) were found in SLE patients, in which lymphocyte apoptosis and activated caspase-3 expression in the lymphocytes were remarkably increased. The severity of disease was positively allied with the increased levels of lymphocyte apoptosis and caspase-3, but negatively with the decreased levels of total thiol, depleted intracellular glutathione and altered redox state (GSH/GSSG). The lymphocyte apoptosis and activated caspase-3 expression were negatively associated with intracellular levels of GSH and redox state and positively associated with the elevated levels of multiple oxidative stress markers; ROS and lipid peroxidation measured as malondialdehyde (MDA). These results suggest that GSH depletion and elevated oxidative stress trigger apoptosis and may be coupled with the severity of the disease.
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Glutationa/imunologia , Peroxidação de Lipídeos/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Linfócitos/imunologia , Estresse Oxidativo/imunologia , Espécies Reativas de Oxigênio/imunologia , Adulto , Apoptose/imunologia , Caspase 3/imunologia , Caspase 3/metabolismo , Feminino , Glutationa/sangue , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/patologia , Linfócitos/patologia , Masculino , Malondialdeído/sangue , Malondialdeído/imunologia , Espécies Reativas de Oxigênio/sangue , Índice de Gravidade de DoençaRESUMO
Cardiovascular involvement occurring in 20-30% patients is the second most common cause of mortality in patients with relapsing polychondritis. Aortic insufficiency occurs as a result of aortic root dilatation rather than primary valvular involvement. We are reporting a patient of relapsing polychondritis with aortic root dilatation, in whom institution of early and aggressive therapy successfully prevented the progression of aortic insufficiency.
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Aorta/efeitos dos fármacos , Doenças da Aorta/tratamento farmacológico , Dilatação Patológica/tratamento farmacológico , Policondrite Recidivante/tratamento farmacológico , Aorta/patologia , Doenças da Aorta/complicações , Doenças da Aorta/patologia , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/patologia , Insuficiência da Valva Aórtica/prevenção & controle , Azatioprina/uso terapêutico , Ciclofosfamida/uso terapêutico , Dilatação Patológica/complicações , Dilatação Patológica/patologia , Substituição de Medicamentos , Quimioterapia Combinada , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Policondrite Recidivante/complicações , Prednisolona/uso terapêuticoRESUMO
INTRODUCTION: Rheumatoid arthritis (RA) patients taking disease-modifying antirheumatic drugs (DMARDs) may experience treatment failure due to adverse effects or a lack of efficacy/resistance. The purpose of this study was to evaluate the prescription patterns, the incidence and reasons for failure, and the time to treatment failure of DMARDs in RA patients. METHODS: The medical records of patients visiting the Rheumatology Clinic were scrutinised retrospectively in order to extract the relevant data, including demographics, clinical and laboratory investigations and drug usage, for analysis. RESULTS: More than 60% of the 474 eligible patients were started on a combination of DMARDs. Hydroxychloroquine (HCQ) (79.7%) and methotrexate (MTX) (55.6%) were the most common DMARDs prescribed initially. There was a significant difference in survival times among the various treatment groups (p ≤ 0.001). Adverse effect was the main reason for treatment failure of sulfasalazine (SSZ) (88.9%) and MTX (75%), while addition or substitution DMARDs was more common for those taking HCQ (72.2%). Adverse event was reported as the most significant predictor of treatment failure. The most commonly reported adverse effects were bone marrow suppression and hepatotoxicity. CONCLUSION: A combination of DMARDs was used to initiate therapy in more than 60% of RA patients, with HCQ and MTX being prescribed most frequently. Adverse effects accounted mainly for treatment failures with MTX and SSZ, while lack of efficacy was responsible for major treatment failures with HCQ.
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Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Adulto , Antirreumáticos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de TratamentoRESUMO
BACKGROUND: India has the third largest HIV-1 epidemic with 2.4 million infected individuals. Molecular epidemiological analysis has identified the predominance of HIV-1 subtype C (HIV-1C). However, the previous reports have been limited by sample size, and uneven geographical distribution. The introduction of HIV-1C in India remains uncertain due to this lack of structured studies. To fill the gap, we characterised the distribution pattern of HIV-1 subtypes in India based on data collection from nationwide clinical cohorts between 2007 and 2011. We also reconstructed the time to the most recent common ancestor (tMRCA) of the predominant HIV-1C strains. METHODOLOGY/PRINCIPAL FINDINGS: Blood samples were collected from 168 HIV-1 seropositive subjects from 7 different states. HIV-1 subtypes were determined using two or three genes, gag, pol, and env using several methods. Bayesian coalescent-based approach was used to reconstruct the time of introduction and population growth patterns of the Indian HIV-1C. For the first time, a high prevalence (10%) of unique recombinant forms (BC and A1C) was observed when two or three genes were used instead of one gene (p<0.01; pâ=â0.02, respectively). The tMRCA of Indian HIV-1C was estimated using the three viral genes, ranged from 1967 (gag) to 1974 (env). Pol-gene analysis was considered to provide the most reliable estimate [1971, (95% CI: 1965-1976)]. The population growth pattern revealed an initial slow growth phase in the mid-1970s, an exponential phase through the 1980s, and a stationary phase since the early 1990s. CONCLUSIONS/SIGNIFICANCE: The Indian HIV-1C epidemic originated around 40 years ago from a single or few genetically related African lineages, and since then largely evolved independently. The effective population size in the country has been broadly stable since the 1990s. The evolving viral epidemic, as indicated by the increase of recombinant strains, warrants a need for continued molecular surveillance to guide efficient disease intervention strategies.
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Evolução Biológica , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/classificação , HIV-1/genética , Adulto , Teorema de Bayes , Estudos de Coortes , Feminino , Genes Virais/genética , Geografia , Infecções por HIV/genética , Humanos , Índia/epidemiologia , Masculino , Epidemiologia Molecular , Filogenia , Dinâmica Populacional , Prevalência , Recombinação Genética/genéticaRESUMO
Cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality in patients with AIDS. A retrospective analysis of records of HIV-infected individuals registered in the Immunodeficiency Clinic of a tertiary care hospital and research institute was carried out. Records of 6900 HIV-infected individuals who were enrolled in the clinic between January 2002 and March 2011 were analyzed. Records of 6900 HIV-infected individuals were screened. Ninety-one were diagnosed with cryptococcal meningitis (1.32%). In 68 individuals cryptococcal meningitis was the presenting illness. Nine patients developed meningitis within 6 months of starting antiretroviral treatment (ART). Six patients were receiving ART for more than 6 months at the time of diagnosis. The remaining eight patients were not on ART at the time of development of meningitis. The mean baseline CD4 count of patients was 77.7 ± 61 (range, 4-259, n=91) cells/mm(3). Seventy-four patients had a CD4 value of less than 100 at the time of diagnosis of cryptococcal meningitis. Eleven of these ninety-one patients had a relapse of cryptococcal meningitis while receiving a maintenance dose of fluconazole. During follow-up 37 died, two were lost to follow-up, while 52 patients were on regular ART. Mortality due to cryptococcal meningitis amounted to 0.54% (37/6900). There was no correlation between survival and duration of ART at the time of cryptomeningitis (Pearsons χ(2)=0.241, p=0.884). There was a significant difference in the CD4 counts of the HIV-infected individuals who died with cryptomeningitis and those who survived (Pearson's χ(2)=9.1, df=4, p=0.05). The frequency of cryptococcal meningitis was 1.32%. Cryptococcal meningitis leads to high mortality in HIV patients. Management of cryptococcal infection remains a key facet of AIDS care in India.
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Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Síndrome da Imunodeficiência Adquirida/mortalidade , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Meningite Criptocócica/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Distribuição por Idade , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Prontuários Médicos , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/etiologia , Meningite Criptocócica/imunologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Adulto JovemRESUMO
Snakebites are estimated to affect more than 2.5 million people annually, of whom more than 100,000 die. Viper bites cause various systemic symptoms such as: coagulopathy; haemolysis; acute renal failure; a generalized increase in capillary permeability; rhabdomyolysis; and neurotoxicity. Wide spectrums of vascular complications are seen. We report the case of a patient developing gangrenous changes in a lower limb along with the development of perinepheric and retroperitoneal haematoma with acute cortical necrosis of the kidneys.
Assuntos
Gangrena/etiologia , Hematoma/etiologia , Necrose do Córtex Renal/etiologia , Mordeduras de Serpentes/complicações , Viperidae , Animais , Humanos , Rim/patologia , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/patologia , Mordeduras de Serpentes/diagnósticoRESUMO
BACKGROUND: Worldwide, the stigma and discrimination impede HIV-AIDS programs across the continuum of prevention to care. We studied stigma and related issues in HIV-positive subjects. MATERIALS AND METHODS: At a tertiary care hospital in North India, we studied 100 HIV-positive outpatients not receiving antiretroviral therapy. The subjects self-administered 'Tanzania Stigma Indicator and Community Endline-Individual Questionnaire'. Psychiatric morbidity was screened with General Health Questionnaire (GHQ-I2 Hindi) and diagnosed with Structured Clinical Interview for DSM-IV (SCID). RESULTS: A typical subject was middle aged (25-44 years, 77%), school non-completer (63%), village dweller (61%), and male (59%). Only 35 subjects could differentiate between HIV and AIDS, and only 24 were aware of antiretroviral therapy. Unprotected sex, sharing injections, and blood transfusions were reported spontaneously as possible sources of transmission by 56-79% subjects each. About 80% of subjects reported no fear in touching HIV-positive subjects or their objects. Avoiding injections, being faithful to uninfected partner, avoiding blood transfusions, using condoms, and avoiding sharing razors/blades were reported spontaneously as HIV preventive measures by 40 to 26 subjects each. Half of the subjects blamed self for contracting HIV. Only 38 subjects reported others behaving differently with HIV-positive subjects. HIV status disclosure was reported by 98 subjects (73 to family or relatives). Urban subjects reported higher primary stigma and shame or blame. Psychiatric disorders, present in 45 subjects, showed no association with stigma items. CONCLUSIONS: The subjects had a limited knowledge, especially of treatment aspects. Stigma showed no association with psychiatric disorders. The study reflects a strong need for public health measures to enhance awareness and knowledge about HIV/AIDS.
RESUMO
People living with HIV/AIDS (PLHA) while availing anti-retroviral therapy (ART) services face administrative and procedural problems in hospitals which affect their level of satisfaction with service providers. There is very little information available regarding quality of services provided at ART centers in India. Hence this study was conducted between July 2007 and December 2008 at ART Center, Chandigarh to analyse the user's perception about quality of services provided and factors associated with satisfaction level. For this prospective cross-sectional study, 100 PLHA were randomly recruited at ART Center. Exit interviews were conducted with structured questionnaire containing four groups of questions and questions on waiting time and satisfaction level. A scoring system was devised. The satisfaction level was cross matched with group questions. Mean age of 100 PLHA was 36.46 years (SD = 8.46), 22% were females, 55% from rural background and 67% educated above primary level. The mean group scores of four groups of questions were: Information, access and guidance (58.8%), Interaction with service providers (92.96%), Physical facilities (70.85%), Confidentiality, discrimination and grievance redressal (70.31%). Eighty-eight per cent rated satisfaction level as satisfactory or above (30% very satisfactory, 58% satisfactory), 10% indifferent and 2% dissatisfied. Factors found to be associated with satisfaction level were patient provider interaction (p=0.002) [behaviour of staff (p=0.005)], physical facilities (p=0.005) [cleanliness (0.002), drinking water (0.006)], confidentiality (p=0.004), waiting time to meet the doctor (p=0.03) and total time spent in hospital (p < 0.001). Problem areas identified were low availability of signage, low awareness of grievance redressal system, sanitation/toilets, drinking water, waiting time to meet the doctor (mean = 53.3 minutes), and "total time spent in hospital" (mean = 143 minutes). Study provided user's perspective about quality of ART services provided in a tertiary care hospital of India and revealed the factors associated with PLHA satisfaction level. Better quality ART Services can be provided to PLHA by addressing these factors.