Factors affecting disclosure of HIV-positive serostatus among people living with HIV/AIDS attending an antiretroviral therapy center of Eastern India.

BACKGROUND: HIV serostatus disclosure plays an important role in reducing the risk of HIV transmission. However, its negative effects may include rejection, assault, separation, divorce, stigma, and discrimination. OBJECTIVES: This study was undertaken to find out the proportion of HIV-positive serostatus disclosure to any family member and different factors influencing disclosure among people living with HIV/AIDS (PLWHA). METHODS: A cross-sectional study was conducted among all patients aged 18-49 years with confirmed HIV infection registered at the antiretroviral therapy center of a tertiary care hospital in eastern part of Uttar Pradesh, India, for the duration of 1 year, from July 2017 to June 2018. RESULTS: Most of the respondents were aged 30-49 years (79.9%), male (63.2%), married (85.4%), rural residents (60.4%), Hindu (96.5%), literate (84%), employed/driver (61.8%), and belonged to lower/lower middle class (62.6%). The rate of disclosure of HIV-positive status to any family member was quite high in this study (238/288 or 82.6%), among which 92.9% (221/238) to the spouse only. The number of sexual partners before disclosure, educational status, and socioeconomic status of the respondents were found to be independent predictors of disclosure of HIV-positive status to any family member (P < 0.05). CONCLUSIONS: This study indicates the need of giving more emphasis on creating awareness regarding the importance of HIV serostatus disclosure to any family member, especially to spouse, and encourage all PLWHA in the community to disclose their status. Effective strategies also need to be evolved that will target those not likely to disclose their status to anybody.

Association of Thyroid Dysfunction and Autoimmunity in Pregnant Women with Diabetes Mellitus.

PURPOSE: This study was undertaken to find out the proportion of women with thyroid dysfunction in pregnancy complicated by diabetes mellitus; to find out the association, if any, of thyroid dysfunction and of antithyroid peroxidase (anti-TPO) antibodies during pregnancy in women with pregestational (PGDM) and gestational diabetes mellitus (GDM); and to find out the maternal and perinatal outcomes of pregnancies complicated by both diabetes mellitus and thyroid dysfunction. METHODS: A cross-sectional observational study was conducted in a tertiary care teaching hospital in Kolkata, India, for a period of 1 year. Sixty-four pregnant women with diabetes, both PGDM and GDM, were recruited from the antenatal clinic. They were managed and followed up till 6 weeks postpartum. Their plasma glucose levels were estimated, and thyroid function was evaluated periodically. All relevant data were recorded and analyzed statistically. RESULTS: Most (81.25%) women had GDM. Forty percent women suffered from some form of thyroid disorder, mostly (37.5%) hypothyroidism. Thyroid dysfunction was not associated with the type of diabetes mellitus (GDM or PGDM) (p > 0.05). The higher rate of anti-TPO titers was observed in pregnancies with PGDM compared to pregnancies with GDM; however, this difference was not statistically associated (p > 0.05). All pregnant women with combined endocrinopathy delivered by cesarean section, and the most common neonatal complication observed was jaundice. CONCLUSIONS: Thyroid disorders are quite common during pregnancy complicated by diabetes mellitus. The study findings warrant routine screening for thyroid abnormalities in diabetic pregnant women. These women have increased rate of maternal and neonatal complications.

Perinatal Outcome of the Second Twin at a Tertiary Care Center in India.

PURPOSE: This cross-sectional observational study was undertaken to assess perinatal outcome of the second twin in respect to gestational age, presentation, mode of delivery, and birth weight. METHODS: Seventy women with confirmed twin pregnancy were admitted and managed in a tertiary care teaching hospital in Kolkata, India from May 2008 to April 2009. All relevant data were recorded and analyzed statistically by simple proportions and χ2 test. RESULTS: Women with frequent antenatal visits had highly favorable perinatal outcome than those with fewer or no visits in this hospital (p < 0.001). Higher perinatal mortality was observed among preterm than term (p < 0.01) cases, and among low birth weight than normal babies (p < 0.05). Second twins in vertex-vertex presentation encountered higher perinatal mortality compared to those in vertex-nonvertex and nonvertex-other presentations (p < 0.05). Perinatal outcome was unfavorable when both delivered vaginally than for both cesarean deliveries and cesarean after first vaginal delivery (p < 0.01). Preterm labor was the most frequently observed maternal complication. Birth asphyxia and perinatal mortality were common among second than first twins. CONCLUSIONS: Gestational age, presentation, mode of delivery, and birth weight are the significant determinants of perinatal outcome of the second twin. Women with frequent antenatal care show favorable outcome. The second twin is at higher risk of perinatal morbidity and mortality than the first twin.

Clinico-pathological features of gynecological malignancies in a tertiary care hospital in eastern India: importance of strengthening primary health care in prevention and early detection.

BACKGROUND: This cross-sectional observational study was undertaken to establish clinico-pathological characteristics of patients with gynecological malignancies, focusing mainly on symptoms, histological type and stage of the disease at presentation, in a tertiary care setting in Eastern India. MATERIALS AND METHODS: In the gynecology out-patient clinic of a tertiary care hospital in Kolkata, India, the patients with suggestive symptoms of gynecological malignancies were screened. Their diagnoses were confirmed by histopathology. One hundred thirteen patients with histopathologically confirmed gynecological malignancies were interviewed. RESULTS: The most frequently reported symptoms by the patients with histopathologically confirmed gynecological malignancies were excessive, offensive with or without blood stained vaginal discharge (69.0%), irregular, heavy or prolonged vaginal bleeding (36.3%) and postmenopausal bleeding (31.9%). The majority of the patients (61.0%) had squamous cell carcinoma on histopathological examination, followed by adenocarcinoma (30.1%). Nearly half of the patients (48.7%) were suffering from the Federation Internationale des Gynaecologistes et Obstetristes (FIGO) stage III, followed by stage II (40.7%) malignancy. CONCLUSIONS: This study highlights that most of the patients with gynecological malignancies present late at an appropriate health care facility. Ovarian cancer may often have non-specific or misleading symptomatic presentation, whereas cervical cancer often presents with some specific symptoms. These observations point to the need for increasing awareness about gynecological malignancies in the community and providing easily accessible adequate facilities for early detection and treatment of the disease by optimal use of available resources, i.e. strengthening the primary health care system.

Gynecological malignancies: epidemiological characteristics of the patients in a tertiary care hospital in India.

BACKGROUND: This cross-sectional observational study was undertaken to identify the epidemiological characteristics of patients with gynecological malignancies in India, in relation to gynecological cancer risk. METHODS: In the gynecology out-patient clinic of a tertiary care hospital in Kolkata, India, the patients with suggestive symptoms of gynecological malignancies were screened. One hundred thirteen patients with histopathologically confirmed gynecological malignancies were interviewed. RESULTS: More than two-thirds of the cases (69.0%) occurred in the age range of 35-64 years and the same proportion of patients was from rural areas. Almost all the patients were "ever-married" (96.5%). More than half (54.9%) were illiterate/just literate. Nearly two-thirds (64.6%) were parity 3 or higher. Among the 18 patients with history of multiple sexual partners of the husband, 94.4% (17) were suffering from cervical malignancy, along with all the 3 patients with history of STD syndromes (sexually transmitted diseases) of their husbands. No one had given a history of condom use by her husband. Most of the patients (91.1%) used old / reused cloth pieces during menstruation. CONCLUSIONS: There is a need to increase awareness among women and the broader community about different epidemiological factors that may be responsible for increased risk of gynecological malignancies.

Simple ovarian cysts in postmenopausal women: scope of conservative management.

OBJECTIVE: This study was done to evaluate/investigate the natural history of simple ovarian cysts in postmenopausal women and to determine the risk for malignant transformation of these cysts. STUDY DESIGN: Ultrasound reports of all the postmenopausal women who attended St. Francis Hospital and Medical Center, Hartford, USA from January 1997 to April 2010 with an ultrasound diagnosis of simple cysts of ovary were reviewed retrospectively. A total of 619 patients with 743 simple ovarian cysts were evaluated. It was found that 305 out of 619 patients (49.27%) were lost in follow-up. Therefore, 314 patients (50.73%) with 378 cysts could be followed further by ultrasound study. RESULTS: One hundred and seventy-five (46.30%) of the 378 cysts that could be followed further had spontaneous resolution and 166 cysts (43.91%) persisted unchanged over the follow-up period. Thirty cysts (7.94%) turned into complex cysts and four cysts (1.06%) significantly increased in size. One cyst significantly decreased in size, though it did not resolve. Only one patient developed papillary serous carcinoma (high grade) of the ovary. This occurred three years after her last ultrasound for simple cyst surveillance. CONCLUSION: Simple ovarian cysts during the menopause can be followed conservatively because their risk for malignant transformation is low. The majority of these cysts either resolve spontaneously or persist unaltered on follow-up.

Knowledge and health care-seeking behavior in relation to gynecological malignancies in India: a study of the patients with gynecological malignancies in a tertiary care hospital of Kolkata.

This cross-sectional observational study was undertaken to find out the knowledge about gynecological malignancies and health care-seeking behavior of patients with gynecological malignancies. In a gynecology out-patient clinic in Kolkata, India, the patients with the suggestive symptoms of gynecological malignancies were screened out. Their diagnoses were confirmed by histopathology. One hundred thirteen patients with histopathologically confirmed gynecological malignancies were interviewed. Eleven patients (9.7%) knew that white discharge or bleeding per vagina was the early symptom and 38 (33.6%) patients knew that gynecological malignancies were treatable. Fifty-six patients (49.5%) had discussed about their symptoms first with their husbands. Most of the patients (91 patients or 80.5%) had visited a private health facility first for their symptoms. Educational level of the patients was found to be inversely associated with the time of presentation at this hospital. This study highlights the need to increase the awareness about gynecological malignancies among women and the community.

Symptomatology of gynecological malignancies: experiences in the gynecology out-patient clinic of a tertiary care hospital in kolkata, India.

BACKGROUND: This cross-sectional observational study was undertaken in a gynecology out-patient clinic to identify the symptoms suggestive of gynecological malignancies followed by histopathological confirmation of their diagnoses and to determine the proportion of the histopathologically confirmed cases specific to sites. METHODS: In a gynecology out-patient clinic in Kolkata, India, patients with symptoms suggestive of gynecological malignancies were screened to identify possible cancer cases. Diagnoses were confirmed by histopathology. One hundred thirteen patients with histopathologically confirmed gynecological malignancies were interviewed further. RESULTS: This study shows that 5.3% of the overall outpatients or nearly one-fourth (23.7%) of the patients with the symptoms suggestive of gynecological malignancies was histopathologically confirmed as having gynecological malignancies. Most of the patients (87.0%) with the symptoms suggestive of gynecological malignancies reported excessive, offensive with or without blood stained vaginal discharge, followed by irregular, heavy or prolonged vaginal bleeding (61.4%). The commonest histopathologically confirmed gynecological malignancy was cervical cancer (61.9%), followed by ovarian cancer (23.9%). CONCLUSIONS: This study highlights the need to increase the awareness about the symptoms of gynecological malignancies among women and the community. Health care personnel have a major role to identify the warning symptoms early for further investigation of the possible cases of gynecological malignancies.

A study on domestic violence against adult and adolescent females in a rural area of west bengal.

BACKGROUND: Globally, domestic violence against females is common across culture, religion, class and ethnicity. There are various reasons for domestic violence and it might have serious health outcomes. OBJECTIVES: The study was undertaken to determine the prevalence, characteristics, reasons and the socio-demographic correlates of domestic violence, if any, and to find out the perceptions of the females to cope with the act of violence and to overcome the situation. MATERIALS AND METHODS: A cross-sectional observational study was undertaken by interviewing 141 adult and adolescent females residing in a village of West Bengal, with the help of a pre-designed and pre-tested questionnaire. Data were analyzed statistically by simple proportions and tests of significance (Chi-square test). RESULTS: Out of 141 respondents, 33 (23.4%) adult and adolescent females in this village were exposed to domestic violence in the past year. Among the demographic characteristics, statistically significant maximum prevalence was observed among 30-39 years age group, illiterate and unmarried females. For most of the females who were exposed to domestic violence, their husbands acted as the perpetrators (72.73%) and they reported slapping as the specific act of physical assault (72.73%). Majority of the respondents reported that opportunity of education (31.9%), being economically productive (31.9%) and better family income (23.4%) would help them to overcome the situation. CONCLUSION: This study emphasizes the need for justified female empowerment and this calls for multidisciplinary approach to develop public health measures, which would most effectively address the problem of domestic violence.