Differences in testing, stigma, and perceived consequences of stigmatization among heterosexual men and women living with HIV in Bengaluru, India.

Approximately 2.4 million people in India are living with HIV. Gender inequality affects HIV prevention, detection, and management. The purpose of this paper was to describe gender differences in the experience of living with HIV in Bengaluru, India. A subsample of n = 313 (159 men and 154 women) from a larger cohort was used for these analyses. Participants were recruited through AIDS service organizations. They completed an interviewer-administered survey assessing HIV testing experience, types of stigma, and perceived consequences of stigmatization. The majority of men (67%) reported getting HIV tested because of illness, while women were more likely to be tested after learning their spouse's HIV-positive status (42%). More men (59%) than women (45%, p<0.05) were tested in private care settings. Men reported significantly higher mean levels of internalized stigma (men: M=0.71, SD = 0.63; women: M=0.46, SD = 0.55; p<0.001), whereas the women reported significantly higher scores for enacted stigma (men: M=1.30, SD = 1.69; women: M=2.10, SD = 2.17; p<0.001). These differences remained significant after controlling for potential socio-demographic covariates. Following their diagnosis, more women reported moving out of their homes (men: 16%; women: 26%; p<0.05). More men (89%) than women (66%; p<0.001) reported to have modified their sexual behavior after being diagnosed. These findings suggest that the experience of living with HIV and HIV stigma varies by gender in this population. Suggestions for a gender-based approach to HIV prevention and stigma reduction are provided.

A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy.

BACKGROUND: Although the literature suggests that non-steroidal anti-inflammatory drugs (NSAIDs) are effective in controlling post-operative pain in the paediatric population, physicians have been reluctant to utilise these medications after tonsillectomy due to concerns of increased bleeding rates. While many surgeons prescribe opioid analgesics postoperatively, these are associated with a number of potential adverse side-effects including nausea, vomiting, constipation, excessive sedation and respiratory compromise. OBJECTIVE OF REVIEW: To compare bleeding rates and severity between recipients of NSAIDs versus placebo or opioid analgesics for tonsillectomy. SEARCH STRATEGY: Two authors independently searched electronic databases including PubMed, OVID, EMBASE and Cochrane Review from inception to July 2012. The keywords used included: Adenotonsillectomy, Tonsillectomy, Analgesia, Bleeding, Perioperative and Postoperative. These were then combined in various combinations with specific NSAIDs. EVALUATION METHOD: A systematic review and meta-analysis of all randomised control trials comparing bleeding rates and severity between NSAIDs versus placebo or opioids post-tonsillectomy. RESULTS: A total of 36 studies met our inclusion criteria including 1747 children and 1446 adults. When all of the studies were combined in a meta-analysis using the most severe outcome, there was no increased risk of bleeding in those using NSAIDs after tonsillectomy. Use of NSAIDs in general [1.30 (0.90-1.88)] or in children [1.06 (0.65-1.74)] was not associated with increased risk of bleeding in general, most severe bleeding, secondary haemorrhage, readmission or need of reoperation due to bleeding. Similarly, there was no increased bleeding risk for specific NSAIDs in adults. In the studies looking at paediatric subjects, the overall odds ratio of bleeding was even lower than in the general population and not significant. This result is based on 18 studies, six of which had zero outcomes in either treatment arm. Similar to the general population analysis, there was no significant difference in any of the subanalyses: bleeds treated with reoperation, readmission or bleeds in children that could be managed conservatively. There were also no significant differences in the subanalyses of individual NSAIDs. Similarly, there was no significant difference in rates of bleeding in the subanalysis of studies that gave NSAIDs multiple times, for instance, both before and after surgery. CONCLUSIONS: These results suggest that NSAIDs can be considered as a safe method of analgesia among children undergoing tonsillectomy.

Effect of Fluoride Recharge on the Microleakage of Fluoride-Releasing Restorative Materials: An Ex Vivo Confocal Laser Scanning Microscopy Study.

Context: Success or failure of a restoration depends on its ability to bond to the tooth structure, to reduce microleakage, and to inhibit secondary caries. Fluoride-releasing materials have the inherent potential to release fluoride and are also capable of recharging themselves with topical agents. Aim: The aim of this study was to compare and evaluate the effect of fluoride recharge on microleakage of different restorative materials. Materials and Methods: Eighty extracted teeth were collected and split mesiodistally into 160 specimens. Class V cavities were prepared on buccal and lingual surfaces. Specimens were divided into four groups of 40 each based on the restorative material. Group I: Glass ionomer; Group II: Resin composite; Group III: Giomer; and Group IV: Alkasite. The restored teeth were stored in artificial saliva. Each group was divided into four subgroups for fluoride recharge and subsequent confocal laser scanning microscopy (CLSM) examination: (A) no fluoride recharge and CLSM examination after 24 h, (B) no fluoride recharge and CLSM examination after 3 weeks, (C) fluoride recharge once at third week followed by CLSM examination at 6 weeks, and (D) fluoride recharge twice at third week and sixth week followed by CLSM examination at 9 weeks. Statistical Analysis: Kruskal-Wallis and Mann-Whitney U tests were performed to analyze the obtained data. Results: A significant difference in microleakage was noted among resin composite and other groups except Cention-N, whereas no significant difference was noted pre- and post-fluoride recharge. Conclusion: Increased microleakage was noted post-fluoride recharge, although statistically not significant.

A Case Series of Delayed Proximal Ureteral Strictures After Nephron-Sparing Treatment of Renal Masses.

Background: Delayed proximal ureteral stricture (DPUS) after nephron-sparing treatment (partial nephrectomy [PN] and image-guided percutaneous ablation) of renal masses is a rare complication that occurs because of an unrecognized injury to the proximal ureter and/or its associated vascular supply. We present a multi-institutional series of patients who developed DPUS after nephron-sparing treatment and review relevant tumor characteristics, timing of DPUS presentation, presenting symptoms, and outcome of stricture management. Case Presentation: Between 2000 and 2019, nine patients (five PN and four ablation) were found to have DPUS diagnosed at an average of 9 (6-119) months after PN and 5.5 (1-6) after ablation. Average tumor size was 4.5 (2.9-7.3) cm and 3.6 (3-4.1) cm for those treated with PN and ablation, respectively. Nephrometry score was 8.3 (6-11) and 6.5 (5-8), respectively. For resected tumors, all were located in the lower pole, but uniformity was not found as far as medial vs lateral (3 vs 2), anterior vs posterior (2 vs 2, 1 N/A), and right vs left (3 vs 2). For ablated tumors, all four tumors were right sided, anterior, medial, and lower pole. Initial signs and symptoms include sepsis (2), flank pain (5), and asymptomatic hydronephrosis (2). Concomitant urinoma (2) and retroperitoneal abscess (1) was found on imaging. Initial management included ureteral stenting (5) and percutaneous nephrostomy tube (4). Three underwent nephrectomy. Two had spontaneous resolution of DPUS after a course of ureteral stenting. Conclusion: Potential risk factors associated with DPUS after nephron-sparing treatment, including medial and lower pole tumors, and particularly right-sided anterior masses for ablation and higher complexity nephrometry score for PN. Recognition of delayed symptoms and imaging abnormalities in the surveillance period should cue clinical suspicion to DPUS.

Pressure and temperature dependence of the chlorine NQR in caesium and sodium chlorates.

The (35)Cl nuclear quadrupole resonance (NQR) frequencies (nu(Q)) in caesium and sodium chlorates were measured as a function of temperature, from 77 to 300 K at different pressures up to 5.1 kbar, and the data were analysed to estimate the volume dependence of the electric field gradient (EFG), torsional frequency and also the contributions to the NQR frequency from static and dynamic effects. The variation of spin-lattice relaxation time with pressure at different temperatures was studied in the case of sodium chlorate and at room temperature in case of caesium chlorate. The pressure dependence of the spin-lattice relaxation time (T(1)) suggests that the relaxation is mainly due to the torsional motions.

A comparative In vivo efficacy of three spiral techniques versus incremental technique in obturating primary teeth.

BACKGROUND: The aim of this study was to evaluate the efficiency of four different obturating techniques in filling the radicular space in primary teeth. MATERIALS AND METHODS: This clinical trial was carried out on 34 healthy, cooperative children (5-9 years) who had 63 carious primary teeth indicated for pulpectomy. They were divided into four groups, such that in each group, a total of 40 canals were allotted for obturation with respective technique. The root canals of selected primary teeth were filled with Endoflas obturating material using either bi-directional spiral (Group 1); incremental technique (Group 2), past inject (Group 3) or lentulo spiral (Group 4) according to the groups assigned. The effectiveness of the obturation techniques was assessed using postoperative radiographs. The assessment was made for a depth of fill in the canal, the presence of any voids using Modified Coll and Sadrian criteria. The obtained data were analyzed by using ANOVA test and unpaired t-test. RESULTS: Bi-directional spiral and lentulo spiral were superior to other techniques in providing optimally filled canals (P< 0.05). The bi-directional spiral was superior to lentulo spiral in preventing overfill (P< 0.05). CONCLUSION: Based on the present study results, bi-directional spiral can be recommended as an alternate obturating technique in primary teeth.

Oral health status and treatment needs among 10126 school children in West Godavari district, Andhra Pradesh, India.

OBJECTIVES: Oral diseases are affecting a large percentage of children worldwide. This study with Indian Society of Pedodontics and Preventive Dentistry collaboration was taken up with the aim to evaluate the oral health status and treatment needs in school-going children of the West Godavari district, Andhra Pradesh, India. MATERIALS AND METHODS: This cross-sectional study was conducted among 10126 school children who were randomly selected from 32 schools in West Godavari district. To find the significance of the obtained number of cases for different age groups, Chi-square test of significance was used. RESULTS: The prevalence of dental conditions are as follows: Dental caries 63.5%, periodontal diseases 13.6%, dental anomalies 3.6%, dental trauma 3.2%, and orthodontic treatment 25.1%. Among the different age groups, 11-14 years age group has the highest prevalence of oral health problems. Females were more affected with dental caries (P = 0.17), orthodontic treatment needs (P = 0.12), and dental anomalies (P = 0.86) compared to males which was statistically insignificant. The highest prevalence of dental conditions in the case of females was observed during the age of 11-14 years, and in males, the peak was seen in the 15-18 years age group. CONCLUSIONS: This study demonstrated that school-going children in West Godavari district suffer from a high prevalence of dental conditions and have higher treatment needs.

Guineaworm control case study: planning a multi-strategy approach.

The planned global eradication of guineaworm (dracunculiasis) offers opportunities to learn about relatively complicated disease control situations. Unlike smallpox, which was eradicated over 10 years ago through immunization, the guineaworm problem has no one solution, but must rely on a variety of technologies to protect, treat or replace existing unsafe community water supplies which harbour the disease. Experiences in rural Nigeria have shown that a multi-strategy approach is necessary to account for differences in geographical settlement patterns, local culture and beliefs, geology of the area, economy of the villages and political clout of town leaders among the five major segments of the community. Through a self-help primary health care programme, residents of the Idere community were able to dig wells, produce and distribute cloth water filters bringing a reduction in disease incidence in some areas. It was also seen that generally low standards of living exacerbated by scattered outlying settlements made self-help difficult. Unfortunately occasional government and private efforts did not succeed because of a lack of community participation. Programme planners must involve the consumers in diagnosing these community characteristics and in planning, supervising and maintaining the resulting projects. The multi-strategy approach will help avoid wasted resources and false expectations that arise when project staff attempt to apply a "magic bullet" solution to a complex problem.

Evaluation of post-exposure vaccination against rabies in cattle.

Post-exposure vaccination of bovines against rabies with three anti-rabies vaccines viz. BHK21 cell culture inactivated vaccine. "Raksharab", Vero cell culture vaccine and Semple's vaccine was studied with different schedules of vaccination. The mean RFFIT and ELISA titres of animals vaccinated with Raksharab and Vero cell culture vaccine reached a peak 95 days post-exposure (dpe). The animals vaccinated with Semple's vaccine showed maximum RFFIT and ELISA titres on 40 dpe and the titres were lower than those induced by tissue culture rabies vaccines. All the calves vaccinated with Raksharab and Vero cell culture vaccine were protected. One out of six calves vaccinated with Semple's vaccine died of rabies on 16 dpe. All the control animals died of rabies between 14 and 22 dpe. Raksharab schedule of vaccination on days 0, 4, 7, 14, 28 and 90 dpe was effective when compared with other vaccines with similar and different schedules. Tissue culture rabies vaccine is superior to nervous tissue vaccine in eliciting satisfactory immune response required to protect animals exposed to virulent rabies virus.

Disorder in condensed matter systems: proton spin lattice relaxation study of the mixed systems of betaine phosphate and glycine phosphite, BPxGPI(1-x).

Proton NMR relaxation measurements have been carried out in the mixed system of antiferroelectric (AFE) betaine phosphate (BP) and ferroelectric (FE) glycine phosphite (GPI), BPxGPI(1-x), at 11.4 and 23.3 MHz from 300 to 100 K for x=0.3, 0.4, 0.5, 0.6, 0.7 and 0.8. The temperature dependence of spin lattice relaxation (SLR) time follows the BPP model in the parent compounds, while the Larmor frequency dependence of T1 in the mixed system is rather unusual. The T1 curve exhibits different slopes for the low-temperature wings at the two frequencies, which is a clear experimental evidence of the presence of different methyl groups with different activation energies (Ea), indicating disorder. For x=0.3 and 0.4, biexponential recovery of magnetization has been observed below 190 K, showing that the degree of disorder varies with the concentration. The temperature dependence of relaxation time data has been interpreted in terms of NH3, trimethyl ammonium and methyl group reorientations.

Analytical treatment of the variable-angle sample spinning nuclear magnetic resonance spectra in the presence of the second-order quadrupole interaction. Determination of the quadrupole parameters and the chemical shift tensor.

The analytical expressions for the transition probability of the central transition of the variable-angle sample spinning nuclear magnetic resonance (VAS NMR) spectrum for non-integral spins in the presence of second-order quadrupole interactions are derived on the basis of the stationary perturbation theory. The modulating parameters of the VAS NMR spectrum due to the time-dependent part of the quadrupole energy are found to be different (asymmetry parameter eta > 0.1) from those obtained from the average Hamiltonian theory. Using the conditions for saddle points and local maxima, it has been observed that there is a range of values for sample spinning angle beta around 32, 44 and 72 degrees to obtain the single peak; the range width can indicate the value of eta. Analytical expressions for the single-peak positions corresponding to beta around 32, 44 and 72 degrees are derived in terms of quadrupole parameters and chemical shift tensor. Further, we have described an analytical method to find the principal values of the chemical shift tensor in addition to the quadrupole parameters, using VAS NMR. As an illustration, the quadrupole parameters are computed for Na2MoO4 and Na2SO4 and compared with the values available in the literature (computed from wide-line NMR and magic-angle sample spinning (MAS) NMR data using the position of peaks and shoulders). For Na2MoO4 the principal values of the chemical shift tensor are found to be +17.5, -12 and -6.5 ppm. The present method is accurate and easy to apply as it involves only the positions of peaks and not of shoulders.(ABSTRACT TRUNCATED AT 250 WORDS)

Analytical expression for the magic-angle spinning nuclear magnetic resonance line shape in the presence of the second-order quadrupole interaction for the non-zero asymmetry parameter and large sample rotation frequency.

An analytical expression for the magic-angle spinning nuclear magnetic resonance (MAS NMR) line shape function for the non-zero asymmetry parameter and large sample rotation frequency has been derived using the time-independent part of the quadrupole transition energy based on the stationary perturbation theory. The averaging over Euler angles in the case of a powdered sample is also done analytically, which is so far implemented in the literature by a numerical simulation procedure. While the peak positions obtained from analytical and numerical averaging procedures agree well, the peak heights are significantly different, showing the need for an analytical solution for the averaging over Euler angles, as this would otherwise lead to erroneous values for the quadrupole parameters. The MAS NMR line shape function derived in this paper can be compared directly with the experimental MAS NMR spectrum for the large sample rotation frequency, and the values of the quadrupole parameters can be obtained. We have also described a method of evaluating the quadrupole parameters for the small sample rotation frequency, using the peak heights and peak separation of the central band of the experimental MAS NMR spectrum and the MAS NMR line shape function derived in the present paper. As an example, the quadrupole parameters for vitreous B2O3 are computed.

Training medical students.

PIP: Nigerian 4th year medical students from University of Ibadan spend 8 weeks training in primary health care and public health in the rural Ibarapa Community Health Programme in Oyo State, with ORT as part of the training. Their course of study there includes epidemiological projects, collecting data on diarrhea prevalence, cultural and behavioral practices, assessment and treating children with diarrhea, and teaching ORT to the community. Students worked on the ORT unit on a rotating basis, preparing ORS, monitoring children and talking to mothers. They learned that most mothers recognized diarrhea symptoms, 2/3 had heard about ORS, but less than 1/5 considered it a first step in managing diarrhea. Most would eliminate beans from the child's diet, substituting bland maize porridge. Talking with mothers made them realize that teething children put dirty objects into their mouths and that presence of visible children's feces is associated with diarrhea. Use of soap for hand washing, and availability of clean tap water, rather than well water, decreased incidence of diarrhea. After their training, medical students knew how to prepare ORS correctly, and understand its efficacy. This should increase the acceptance by the medical professionals of ORT as a desirable part of diarrhea control.^ieng

The health educator as a team leader in primary health care.

Health teams naturally vary in size and composition according to their goals and objectives. Leadership of these teams should also be based on these goals. The goals of community-based primary health care, local involvement, cultural relevance, effective use of local resources, imply an important leadership role for health educators. The experience in the Ibarapa Local Government Area in Nigeria shows that health educators can be effective leaders in guiding a primary health care work group through various stages of program development. The use of a flexible, contractual model of team formation fits in well with the health educator's abilities to coordinate various program inputs and serve as mediator between professionals and the communities they serve. The ultimate mark of the health educator's leadership skills is the incorporation of community members into the health team.

Health, illness, and immigration. East Indians in the United States.

East Indian immigrants to the United States represent the diversity in religion, language, and culture that exists in India, so it is difficult to make unequivocal statements about their health beliefs and behaviors. Despite the diversity, an understanding of Ayurvedic humoral concepts of health and illness provides a key to some pervasive and persistent ideas and practices. India has a pluralistic medical system in which Western medicine, which is increasingly popular for some ailments, is one option among many. Even those who are familiar with the "Western" medical system in India may find American medicine alien.