Prevalence of dysmenorrhoea and its management strategies among females: a cross-sectional study in the tribal district, Koraput

Background: Menstruation is a major and frequently incapacitating health problem that affects women all over the world. Tribal communities often possess unique cultural, socioeconomic, and healthcare disparities, which can affect the experience of dysmenorrhea in these populations. This paper presents an exploration of dysmenorrhea's prevalence, impact, and management among tribal women Methods: A cross-sectional study design was adopted with a total of 341 participants with an age range between 15 to 49. A semi-structured questionnaire was administered to identify the prevalence of dysmenorrhoea, menstrual characteristics, and strategies to manage dysmenorrhoea. Data collection was done for the period of 4 months (March 2020 to June 2020) and analysed using SPSS version 16. Results: The study revealed a high prevalence of dysmenorrhea among tribal women (69.25%). The most common symptoms. A multivariable logistic regression analysis revealed that a significant association was found between dysmenorrhoea and the presence of a family history of dysmenorrhoea (AOR: 2.01; 95% CI: 1.18-3.42; p=0.009), the odds of developing dysmenorrhoea was 2.01 times higher among the female presence of a family history of dysmenorrhoea than absent and dysmenorrhoea with the presence of the clot (AOR: 2.99; 95% Cl: 1.81-4.94; p=0.000), the odds of developing dysmenorrhoea was 2.99 times higher among the female it history of present clot it than absent. Conclusions: According to this study, tribal women are not well-prepared to deal with dysmenorrhea. The current findings not only clarify the detrimental effects of social stigma on menstrual health literacy, but they also have significant implications for evaluating and reforming current menstrual education standards.

Role of homoeopathy of Ayush in dengue fever

In 21st century, dengue came to the limelight. Earlier, it was taught that this is one of the eruptive fevers in human beings where in dengue, the eruption appears typically on the 6th day of the fever. Knowledge and approaches to dengue took a paradigm shift in 21st century. It came to be clubbed under the National Vector Borne Disease Control Program. A mosquito borne single stranded RNA virus is the leading cause of arthropod borne viral diseases like dengue globally. All the types of dengue virus are capable of inducing severe diseases like dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). No one wants to be in DHF or DSS stage as these are mortal stages while other stages are morbid. A vector borne disease (VBD) transmitted by mosquito has no specific cure in modern medicine. To add to that, the issue of platelet transfusion that is made universal because of the inherent panic does more harm than good. It is here that homoeopathy has a role to play therapeutically. The article discusses the disease and the related physiology as well as pathology that goes inside the body during an episode of dengue fever. Along with the diagnosis and management approaches, the article elicits the role of homoeopathy through a suggested treatment protocol. Through the inherent properties of homoeopathy such as cost effectiveness, clinical effectiveness and zero side effects, the article proposes large scale application of homoeopathy at all levels.

‘G’ followed by ‘H’-gout follows homoeopathy

Currently in modern medicine, it is seen that taking a uric acid reducing drug during an attack of gout actually prolongs the pain and discomfort. So, the learning is that one need not worry about high uric acid levels during an acute flair of gout. What actually someone needs is an anti-inflammatory that reduces the inflammation caused by the crystals of uric acid that build up in the joints when someone has gout. This anti-inflammatory drug is ‘colchicine’. Homoeopathy has been using the drug ‘colchicum autumnale’ for last 233 years since its discovery in 1790 by Dr. Samuel Hahnemann (1755-1843). It also uses its active principle ‘colchicine’ for the last 233 years. It is quite striking to see that the modern medicine is realizing the importance of ‘colchicine’ currently. The same ‘colchicine’ was advised to be used as an anti-inflammatory to reduce the markers like C-reactive protein, LDH, D-dimer and homocysteine. During the COVID-19 peak, again the homoeopathic Colchicine came to the rescue. The current article examines the use of homoeopathy in gout and uric acid problems and again at a larger issue with the protein metabolism and the kidney heath. Integration of homoeopathy at large scale will help the nation to protect its members from protein metabolism disorders, kidney health and gout as well.

Live experience of community health workers on respectful maternity care in rural Odisha, India: a phenomenological study

Background: Every woman deserves respectful maternity care, throughout her journey to motherhood. However, disrespectful maternity care is prevalent in various settings. It has an effect on the utilization of services. It can be more explored from the witness of maternity. The aim of this study was to explore the experience of accredited social health activists on respectful maternity care in Odisha, India. Methods: A qualitative exploratory study was conducted among 24 ASHAs with more than two years of experience to gain a deeper understanding of the phenomenon. This study was conducted in three distinct Odisha districts, India. Results: Two main themes emerged: Community health workers’ experiences and perception towards disrespectful care, and Factors contributing to irrational care. Participants explained that verbal abuse was the most common use of health care providers. The consequences of such abusive behavior hinder the effective and efficient performance of their role, especially when it comes to their role in the facility. The study highlighted major gaps in the behavior and attitudes of healthcare providers at the facility level. Conclusions: Despite the lack of knowledge and training related to RMC, ASHAs acknowledged the abusive and disrespectful behavior of health care providers not only towards the child-bearing women but also towards the accompanying person, i.e., ASHA or a member of the family. Such mistreatment often acts as a barrier to the use of public health services, such as the institutional delivery of child-bearing mothers. A need for orientation and training on RCM among healthcare professionals, along with appropriate monitoring of implementation.

What they know about their work, barriers, and challenges faced by the community health workers while performing their multiple roles: mixed method study in India

Background: Accredited social health activist (ASHA) forms the backbone of National Health Mission (NHM) as they are the important link between the community and the health system, her services become very crucial for the success of NHM. They are occupied by multiples roles, responsibilities and they are expected to perform at optimum level. Aim was to assess the knowledge and practice of ASHA workers regarding their work responsibilities and to explore the barriers and challenges faced by them while performing their multiple roles. Methods: An explanatory mixed-methods study was conducted among community health workers (ASHA) of having at least one years of experience at Uttarakhand, India with 150 ASHAs for quantitative and 14 for qualitative. Purposive sampling was employed for both the approaches. Results: Quantitative approach shown that almost 91% of ASHA are having the knowledge about the importance of colostrum milk followed by importance of Anganwadi center (83%), immunization (79%), general health (70%), and birth preparedness (69%). The core thematic areas in qualitative result represented as personal, psychological, economic, social and environmental factors. They showed a level of unhappiness and distress related to their work overload and incentives. Conclusions: In general, ASHAs are having adequate knowledge about their job responsibilities, there is more training needed about maintaining the records and documentation process. There is immediate need to overcome the barriers and challenges they are facing, which can hamper their performance level.

Effect of remdesivir on mortality rate, need of intubation and mechanical ventilation in COVID-19 positive patients: a retrospective observational study

Background: The symptoms of SARS-CoV-2 infection vary widely, from asymptomatic disease to pneumonia and life-threatening complications, including acute respiratory distress syndrome, multisystem organ failure, and ultimately, death. Remdesivir has broad spectrum of activity against members of several virus families, including filoviruses and coronaviruses. Remdesivir is a potent inhibitor of SARS-CoV-2 replication in human nasal and bronchial cells. Methods: This is a prospective and observational study conducted in patients of either gender, age more than 18 years with confirmed diagnosis of COVID-19 by RT-PCR. A predesigned, pretested and semi structured questionnaire containing socio demographic details like age, sex, BMI, comorbidities, findings of systemic examination of the cases, dose and duration of Remdesivir received and adverse effect due to therapy was used to collect the data. Results: Mean age of the patients were 56.19±10.93 years. Male patients were 66% and 34% patients were female. After receiving the remdesivir, 43% of the patients needed bag mask and 27% of the patients maintained on room air oxygen. Non-invasive ventilation required in 19% of the patients and 11% of the patient required mechanical ventilation. s14% of the patients needed admission in the ICU. 3.5% of the patients were died and 96.5% patients were discharged from the hospital. Conclusions: Remdesivir reduces the need of non-invasive oxygenation and mechanical ventilation. Mortality was seen in 3.5% patients, henceforth remdesivir, is an effective drug for moderate to severe COVID-19, if given in early stages of infection.

Effect of remdesivir on mortality rate, need of intubation and mechanical ventilation in COVID-19 positive patients: a retrospective observational study

Background: The symptoms of SARS-CoV-2 infection vary widely, from asymptomatic disease to pneumonia and life-threatening complications, including acute respiratory distress syndrome, multisystem organ failure, and ultimately, death. Remdesivir has broad spectrum of activity against members of several virus families, including filoviruses and coronaviruses. Remdesivir is a potent inhibitor of SARS-CoV-2 replication in human nasal and bronchial cells. Methods: This is a prospective and observational study conducted in patients of either gender, age more than 18 years with confirmed diagnosis of COVID-19 by RT-PCR. A predesigned, pretested and semi structured questionnaire containing socio demographic details like age, sex, BMI, comorbidities, findings of systemic examination of the cases, dose and duration of Remdesivir received and adverse effect due to therapy was used to collect the data. Results: Mean age of the patients were 56.19±10.93 years. Male patients were 66% and 34% patients were female. After receiving the remdesivir, 43% of the patients needed bag mask and 27% of the patients maintained on room air oxygen. Non-invasive ventilation required in 19% of the patients and 11% of the patient required mechanical ventilation. s14% of the patients needed admission in the ICU. 3.5% of the patients were died and 96.5% patients were discharged from the hospital. Conclusions: Remdesivir reduces the need of non-invasive oxygenation and mechanical ventilation. Mortality was seen in 3.5% patients, henceforth remdesivir, is an effective drug for moderate to severe COVID-19, if given in early stages of infection.

Evaluation of Anti-Depressant Potential of Medicinal Ghrita

This article aims to evaluate the possible antidepressant effect of the Ghrita prepared from the combination of these plants and to provide probable scientific explanations for using medicated Ghrita (ghee) in Ayurvedic system of medicine. Herbs for Ghrita like Marsilea quadrifolia, Lawsonia inermis, Mimosa pudica, Piper betle were collected freshly during the month of June. One part Kalka (herb bolus), 4 parts pure cow ghee, and 16 parts Dravadravya were used to make Ghrita (Swarasa). Anti-depressant potential of the Ghrita was evaluated by forced swimming, tail suspension, locomotor activity, rota-rod test (motor co-ordination), elevated plus maze (EPM) model, and hole board test were used to assess the Ghrita's anti-depressant potential. According to the Irwin schedule, Gritha medication reduces alertness but has no effect on other parameters, but imipramine treatment reduces responsiveness, alertness, grooming, and writing reflexes to some extent. Following 14 days of therapy with medicinal Ghrita, the immobility time in the forced swim test and the tail suspension test were reduced by 29% and 42%, respectively. In the rotarod test, it had no significant effect on muscle gripping ability when compared to control animals, whereas imipramine produced a significant result. It was observed that the medicinal Gritha significantly (p<0.05) decreases the locomotor activity in actophotometer test and head dips counts in hole board test as compared to control at the end of 14 days study in a 5 minute observation. Ghrita increased the number of entries in the elevated plus maze by 50% and the time spent in the open arm by 72%. The results of this investigation suggest the possible antidepressant potential of medicinal Ghrita.

Prevalence of Hepatitis B and Hepatitis C Virus Infection in Patients with Advanced Renal Failure: A Tertiary Care Centre Study from North Indian Population

Abstract: Viral hepatitis (Hepatitis B Virus (HBV) & Hepatitis C Virus (HCV)) related liver disease is a leading cause of morbidity and mortality especially in the patients with advanced renal failure who are treated with dialysis, and this is due to high number of blood transfusion sessions and/or cross contamination from the dialysis circuits. Aims & Objectives: This study aimed to determine the prevalence of HBV and HCV infections in patients with advanced renal failure (ARF). Materials & Methods: A cross-sectional study was done in joint collaboration of Department of Nephrology and Department of Gastroenterology, KGMU, Lucknow, from June 2018 to June 2020 among, CRF patients. Clinical data such as age, gender, duration of dialysis; number of transfusions, Serum sample was collected from each patient. Serological markers for HBV and HCV were determined with ELISA by using commercial diagnostic kits. HCV-RNA and HBV-DNA were determined quantitatively by polymerase chain reaction (PCR) assay. Results: A total 934 patients with advanced renal failure attended the nephrology OPD. Out of 934 patients, 65 (6.96%) patients screened positive for HBV/HCV infection. The results of this study also showed that the prevalence of viral hepatitis infection in the haemodialysis (HD) and without HD patients is 8.25% and 6.3% respectively. Conclusion: It has been found that viral infections, particularly HBV and HCV infections are common in advanced renal failure patients who are on HD.

The correlation of cardiovascular risk factors and angiographic findings with serum vitamin D levels in patients undergoing coronary angiography

Background: Studies regarding correlation of various conventional risks factors for Coronary Artery Disease (CAD) are many. Keeping in mind the scarcity of studies regarding Vit-D Deficiency (VDD), a new risk factor in CAD, present study was conducted to correlate Vit-D level with conventional risk factors and Coronary Angiography (CAG).Methods: Hundred adult patients admitted to Medicine and Cardiology undergoing CAG with suspected or established CAD were kept in study. Patients having renal, hepatic, parathyroid disease, osteomalacia and patients taking drugs interfering with Vitamin D (Vit-D) metabolism were excluded. After detailed history and thorough clinical examination, routine investigations and 25-(OH) D level was estimated. Subsequently patients underwent CAG. Statistical analysis by Mann Whitey test and Chi-square Test was done and inference was drawn.Results: 100 patients in different age groups had hypertension (HTN) in 53, diabetics mellitus (DM) 39, dyslipidemia 62, smokers 38 and family history of CAD 19. CAG showed normal coronaries in 4, Single Vessel Disease (SVD) in 30, double vessel diseases (DVD) 43 and triple vessel disease (TVD) 22. Vit-D level <20ng/ml i.e. Vit-D deficiency (VDD) in 68, 20-30ng/ml i.e. Vit-D insufficiency (VDI) in 22 and >30ng/ml (normal) in 10. VDD was profound in 51-60 and 61-70 years age groups. Statistical correlation of VDD was not significant with conventional risk factors, but statistically significant correlation of VDD was observed with dyslipidemia and CAG findings in our study.Conclusions: Like earlier studies we observed significant correlation of Vit-D levels with CAD. Though dyslipidemia was significantly correlated with VDD, correlation of other conventional risk factors like age, sex, HTN, DM, smoking and family history was not found. We conclude from this study presence of significant association of VDD with severe CAD. DVD and TVD by CAG were common with low Vit-D levels.

Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

Background: Organophosphorus Compounds (OPC) are main cause of accidental and suicidal poisoning in agrarian countries like India. Aim was to study the clinical profile of OPC-Poisoning and correlate it with the electrocardiographic (ECG) changes and electrolyte abnormalities.Methods: Hundred consecutive cases admitted to Medicine Department underwent clinical examination, ECG, electrolytes, Acetyl Choline Esterase (AChE) estimation from time to time and Paradeniya Organophosphorus Poisoning (POP) score at the time of admission. All these parameter with duration of hospital stay and outcome were statistically analysed using X2 test, Fisher exact test, and inference was drawn.Results: In hundred OPC-Poisoning patients [Male (n=48), Female (n=52), M: F ratio 0.92:1] with mean age of 37.78�.95 years, commonest poison was cholropyrifos+cypermethrin and was mostly suicidal (96%). Common symptoms were sweating (48%), salivation, blurring of vision, breathlessness and signs were smell of poison (90%), tachypnea, altered sensorium, miosis and fasciculation. POP scoring found 41% of patients in mild, 26% in moderate and 33% in sever grade of poisoning. Hospital stay ranged from 4-18 days. Complications were pulmonary Edema (PE) in 28%, Respiratory Failure (RF) 18%, Aspiration Pneumonia (AP) 15% and Intermediate Syndrome (IS) 4%. 10 died out of 42 patients who had complications and the cause of death was RF in 4, Ventricular Fibrillation (VF) 2 and IS in 2. ECG finding showed sinus tachycardia (31%), prolonged corrected QT (QTc) interval (28%), sinus bradycardia (25%), ST-T changes (17%) and Premature Ventricular Contraction (PVC) in 4% which degenerated to VF in 2%. 24 patients were Hypokalemic from which 16 developed complications.Conclusions: Similar to earlier studies we observed poisoning which was suicidal. QTc prolongation and Hypokalemia are associated with high morbidity and mortality in OPC-Poisoning.

Sudarshan Kriya yoga improves quality of life in healthy people living with HIV (PLHIV): results from an open label randomized clinical trial.

background & objectives: Improving quality of life (QOL) of healthy people living with HIV (PLHIV) is critical needing home-based, long-term strategy. Sudarshan Kriya yoga (SKY) intervention is acknowledged for its positive impact on health. It is hypothesised that SKY would improve PLHIV’s QOL, justifying an evaluation. Methods: In this open label randomized controlled pilot trial, 61 adult PLHIV with CD4 count more than 400 cells/μl and Karnofsky scale score above 70 were enrolled. Those with cardiac disease, jaundice, tuberculosis, or on antiretroviral therapy/yoga intervention were excluded. All were given standard care, randomized to SKY intervention (31: I-SKY) and only standard of care in control (30: O-SOC) arms. The I-SKY participants were trained for six days to prepare for daily practice of SKY at home for 30 min. A validated 31-item WHOQOL-HIVBREF questionnaire was used to document effect in both arms from baseline to three visits at 4 wk interval. Results: Baseline QOL scores, hypertension and CD4 count were similar in both arms. An overall 6 per cent improvement of QOL scores was observed in I-SKY group as compared to O-SOC group, after controlling for baseline variables like age, gender, education and occupation (p=0.016); 12 per cent for physical (p=0.004), 11 per cent psychological (p=0.023) and 9 per cent level of independence (p=0.001) domains. Improvement in I-SKY observed at post-training and in the SKY adherence group showed increase in these two domains. Conclusions: A significant improvement in QOL scores was observed for the three health related QOL domains in SKY intervention arm. This low cost strategy improved physical and psychological state of PLHIV calling for upscaling with effective monitoring for sustainability of quality of life.

Comparative Evaluation of Simultaneous Bone Marrow Aspiration and Trephine Biopsy - Experience From Routine Hematology Practice.

Background: A bone marrow evaluation encompasses bone marrow aspirate (BMA) and bone marrow biopsy (BMB) along with a review of peripheral smear examination. However, due to variations in practice, bone marrow core biopsy is not performed for all patients. Aim: To compare the diagnostic utility of simultaneous BMA and BMB and to study the concordance rate between the two. Material and methods: All BMA and BMB that were simultaneously done between January 2008 and December 2010 in a multispecialty hospitals were reviewed and analyzed in detail. Results: Four hundred sixty-six aspiration and biopsy slides were reviewed. The commonest indication was anemia (40.3%) followed by pyrexia of unknown origin (36.2%); 15.2% aspirates and 6.4% biopsies were inadequate. The overall concordance rate between aspirates and biopsy was found to be 62.8%. Concordance was highest for acute and chronic leukemias, metastatic deposits, multiple myeloma and tuberculosis and least for lymphoproliferative disorders, myelofibrosis and marrow hypoplasia. Trephine biopsy was useful for patients’ with multiple myeloma, acute leukemias, lymphoproliferative disorders, myelofibrosis, marrow hypoplasia, osteitis fibrosa cystica and metastasis. BMB and BMA could detect tuberculous granulomas in 85.17% and 57.14% cases, respectively. However, parasitic infections (kala-azar, malaria) could be diagnosed exclusively in BMA. Conclusions: BMA and BMB are important, useful complementary diagnostic tools giving a higher diagnostic yield when used in conjunction.

Clinical response of newly diagnosed HIV seropositive & seronegative pulmonary tuberculosis patients with the RNTCP Short Course regimen in Pune, India.

Background & objectives In the Revised National Tuberculosis Control Programme (RNTCP) in India prior to 2005, TB patients were offered standard DOTS regimens without knowledge of HIV status. Consequently such patients did not receive anti-retroviral therapy (ART) and the influence of concomitant HIV infection on the outcome of anti-tuberculosis treatment remained undetermined. This study was conducted to determine the results of treatment of HIV seropositive pulmonary tuberculosis patients with the RNTCP (DOTS) regimens under the programme in comparison with HIV negative patients prior to the availability of free ART in India. Methods Between September 2000 and July 2006, 283 newly diagnosed pulmonary TB patients were enrolled in the study at the TB Outpatient Department at the Talera Hospital in the Pimpri Chinchwad Municipal Corporation area at Pune (Maharashtra): they included 121 HIV seropositive and 162 HIV seronegative patients. They were treated for tuberculosis as per the RNTCP in India. This study was predominantly conducted in the period before the free ART become available in Pune. Results At the end of 6 months of anti-TB treatment, 62 per cent of the HIV seropositive and 92 per cent of the HIV negative smear negative patients completed treatment and were asymptomatic; among smear positive patients, 70 per cent of the HIV-seropositive and 81 per cent of HIV seronegative pulmonary TB patients were cured. Considering the results in the smear positive and smear negative cases together, treatment success rates were substantially lower in HIV positive patients than in HIV negative patients, (66% vs 85%). Further, 29 per cent of HIV seropositive and 1 per cent of the HIV seronegative patients expired during treatment. During the entire period of 30 months, including 6 months of treatment and 24 months of follow up, 61 (51%) of 121 HIV positive patients died; correspondingly there were 6 (4%) deaths among HIV negative patients. Interpretation & conclusions The HIV seropositive TB patients responded poorly to the RNTCP regimens as evidenced by lower success rates with chemotherapy and high mortality rates during treatment and follow up. There is a need to streamline the identification and management of HIV associated TB patients in the programme with provision of ART to achieve high cure rates for TB, reducing mortality rates and ensuring a better quality of life.

Dietary supplies of iodine & thiocyanate in the aetiology of endemic goitre in Imphal East district of Manipur, north east India.

Background & objectives: The present investigation was undertaken to study the iodine nutritional status of school children of Imphal east district in Manipur where endemic goitre persists during post-salt iodization phase along with the investigation of the factors responsible for the occurrence of goitre endemicity. Methods: A total of 1,286 children (6-12 yr) were clinically examined for goitre from study areas of Imphal east district. A total of 160 urine samples were collected and analyzed to measure urinary iodine and thiocyanate levels. Iodine content was measured in 140 salt samples and 16 drinking water samples. Results: Overall goitre prevalence was about 30 per cent (grade 1-24.7%; grade 2-5.3%) and median urinary iodine level was 17.25 μg/dl. The mean urinary thiocyanate level was 1.073 + 0.39 mg/dl. Iodine/thiocyanate ratio (μg/mg) was in the ranges from 15.65 to 22.34. The mean iodine content in drinking water samples was 2.92 + 1.75 μg/l and 97.8 per cent of edible salts had iodine level above 15 ppm at the consumption point. Interpretation & conclusion: Our findings showed that in spite of no biochemical iodine deficiency, iodine deficiency disorders (IDD) is a serious public health problem in Imphal east district of Manipur. The consumption pattern of certain plant foods containing thiocyanate (or its precursors) was relatively high that interfere with thyroid hormone synthesis resulting in the excretion of more iodine. Thus, the existing dietary supplies of thiocyanate in relation to iodine may be a possible aetiological factor for the persistence of endemic goitre in the study region during post salt iodization period.

Dietary supplies of iodine & thiocyanate in the aetiology of endemic goitre in Imphal East district of Manipur, north east India.

BACKGROUND & OBJECTIVE: The present investigation was undertaken to study the iodine nutritional status of school children of Imphal east district in Manipur where endemic goitre persists during post-salt iodization phase along with the investigation of the factors responsible for the occurrence of goitre endemicity. METHODS: A total of 1,286 children (6-12 yr) were clinically examined for goitre from study areas of Imphal east district. A total of 160 urine samples were collected and analyzed to measure urinary iodine and thiocyanate levels. Iodine content was measured in 140 salt samples and 16 drinking water samples. RESULTS: Overall goitre prevalence was about 30 per cent (grade 1-24.7%; grade 2-5.3%) and median urinary iodine level was 17.25 microg/dl. The mean urinary thiocyanate level was 1.073 +/- 0.39 mg/dl. Iodine/thiocyanate ratio (microg/mg) was in the ranges from 15.65 to 22.34. The mean iodine content in drinking water samples was 2.92 +/- 1.75 microg/l and 97.8 per cent of edible salts had iodine level above 15 ppm at the consumption point. INTERPRETATION & CONCLUSION: Our findings showed that in spite of no biochemical iodine deficiency, iodine deficiency disorders (IDD) is a serious public health problem in Imphal east district of Manipur. The consumption pattern of certain plant foods containing thiocyanate (or its precursors) was relatively high that interfere with thyroid hormone synthesis resulting in the excretion of more iodine. Thus, the existing dietary supplies of thiocyanate in relation to iodine may be a possible aetiological factor for the persistence of endemic goitre in the study region during post salt iodization period.

Antiretroviral drug resistance testing.

While antiretroviral drugs, those approved for clinical use and others under evaluation, attempt in lowering viral load and boost the host immune system, antiretroviral drug resistance acts as a major impediment in the management of human immune deficiency virus type-1 (HIV-1) infection. Antiretroviral drug resistance testing has become an important tool in the therapeutic management protocol of HIV-1 infection. The reliability and clinical utilities of genotypic and phenotypic assays have been demonstrated. Understanding of complexities of interpretation of genotyping assay, along with updating of lists of mutation and algorithms and determination of clinically relevant cut-offs for phenotypic assays are of paramount importance. The assay results are to be interpreted and applied by experienced HIV practitioners, after taking into consideration the clinical profile of the patient. This review sums up the methods of assay currently available for measuring resistance to antiretroviral drugs and outlines the clinical utility and limitations of these assays.

Rate of hospitalization and inpatient care costs for HIV-1-infected patients in Pune, India.

BACKGROUND: The transition of human immunodeficiency virus (HIV) infection to acquired immune deficiency syndrome (AIDS) has begun in India, and an increase in AIDS-related hospitalizations and deaths is an anticipated challenge. We estimated the rates of hospitalization and inpatient care costs for HIV-1-infected patients. METHODS: Data were analysed on 381 HIV-1-infected persons enrolled in a HIV-1 discordant couples' cohort between September 2002 and March 2004. Inpatient care costs were extracted from select hospitals where the study patients were hospitalized and the average cost per hospitalization was calculated. RESULTS: A majority of the patients were in an advanced state of HIV-1 disease with the median CD4 counts being 207 cells/cmm (range: 4-1131 cells/cmm). In all, 63 participants who did not receive antiretroviral therapy required hospitalization, 53 due to HIV-1-related illnesses and the remaining 10 due to worsening of pre-existing conditions. The overall HIV-1-related hospitalization rate was 34.2 per 100 person-years (95% CI: 26.94-42.93). The median duration of HIV-1-related hospitalization was 10 days (range 2-48 days) and the median cost was Rs 17,464 (range: Rs 400-63,891). CONCLUSION: It is necessary to strengthen the inpatient care infrastructure and supporting diagnostic set-up, and work out economically optimized treatment algorithms for HIV-1-infected patients. Although this analysis does not cover all costs and may not be generalizable, these baseline data might be a useful reference while planning related studies accompanying the government-sponsored programme to roll out antiretroviral therapy to AIDS patients.