Evaluation of the effect of different surface treatments on the bond strength of non-precious alloy‒ceramic interface: An SEM study.

Background. Dental porcelain has excellent esthetics in combination with biocompatibility and is one of the most commonly used restorative materials. Its low tensile strength remains a major drawback. The porcelain-fused-to-metal restorations have been introduced to increase the fracture resistance of dental porcelain. The aim of this study was to evaluate the effect of different surface treatments on the bond strength of a non-precious alloy to ceramic. Methods. The present cross-sectional observational study was conducted with forty samples of cobalt‒chromium that were fabricated with porcelain interposed between the two metal test pieces. The metal was subjected to combinations of different surface treatments. The samples group A (n=10) were not subjected to any surface treatments. Group B samples underwent sandblasting and surface grinding. Group C samples were subjected to sandblasting, surface grinding and degassing; and group D samples underwent sandblasting, surface grinding, ultrasonic cleaning and degassing. The tensile bond strength was measured in a universal testing machine, and a scanning electron microscope (SEM) was used to obtain images of the samples after surface treatment to determine the surface irregularities and after the debonding of the samples for the type of the bond failure. ANOVA was used for the statistical analysis. Results. The results showed significant variations in the tensile bond strength between the four groups (F=251.05, P=0.000). The SEM images of group A showed no surface irregularities; group C samples exhibited surface irregularities more than those in group B. Group D had the highest surface irregularities. SEM evaluations showed a statistically significant difference in the type of bond failure (P<0.001). Conclusion. Based on the results of this study, it can be concluded that the surface treatments on the metal increased the bond strength of the metal‒ceramic interface significantly. A combination of sandblasting, surface grinding and ultrasonic cleaning, followed by degassing, resulted in the highest tensile bond strength.

First impression of teeth design on others: A facial and personality analysis in the Central Indian population.

BACKGROUND: Facial features and personality types vary with different geographical boundaries, culture, and ethnicity. The impression created by teeth design differs with the face and personality of males and females. AIMS: This study evaluated the dominant facial and personality types and their correlation among males and females in Central Indian population. SUBJECTS AND METHODS: The full-face photographs of 120 people, with a broad smile and visible dentition, were calibrated to generate a facial map with digital software. The participants filled a personality questionnaire. Facial form and personality type were classified as a combination of strong, dynamic, delicate, and calm. Descriptive and inferential statistics using Chi-square and Kappa tests. RESULTS: The dominant facial form was calm (66.67%, 71.67%) with the second dominant facial form being dynamic (50%, 51.67%) both for males and females respectively. While the dominant personality type was dynamic (50%), the second dominant personality type was calm (35%, 30%) for both males and females. Kappa analysis showed moderate agreement between the dominant facial and personality types (P = 0.41 in males, P = 0.10 in females). The software used was SPSS 22.0 version and P < 0.05 is considered as the level of significance. CONCLUSIONS: A varying number of combinations are essential in characterizing the face. The personality type has a predominance of one type over other. The interpretation of these combinations in dentistry can help to select appropriate tooth forms and design a harmonious smile.

Comparative Evaluation of the Effect of Chemical Disinfectants and Ultraviolet Disinfection on Dimensional Stability of the Polyvinyl Siloxane Impressions.

CONTEXT: Infection control is an important concept in the present day practice of dentistry. Disinfection of dental impressions is part of the daily routine in a dental clinics. After disinfection, it is important that impressions remain dimensionally stable. AIM: The purpose of this study was to compare the effect of chemical disinfectants and ultraviolet (UV) disinfection on the dimensional stability of the polyvinyl siloxane impressions. OBJECTIVES: The objective of the study is (1) To evaluate the effect of chemical disinfectant (2% glutaraldehyde and 1% sodium hypochlorite) and UV disinfectant on the dimensional stability of polyvinyl siloxane impression material. (2) Comparative evaluation of the dimensional discrepancy between the cast poured from the polyvinyl impressions material, that is subjected to chemical disinfectant and UV disinfectant to that of cast poured from impressions that were nondisinfected. MATERIALS AND METHODS: A customized tray was fabricated to make impressions. Impressions were divided into four groups, 10 samples were disinfected with 2% glutaraldehyde for 20 min, 10 samples were disinfected with 1% sodium hypochlorite for 20 min, 10 samples were disinfected with UV light for 20 min, and 10 samples were not subjected to disinfection which served as control group. All the samples were poured after 30 min in die stone. Measurements were recorded using traveling microscope of 0.001 accuracy. Statistical analysis used in this study was the one-way ANOVA test. RESULTS: The result showed significant dimensional changes in samples disinfected with 2% glutaraldehyde and 1% sodium hypochlorite, whereas samples disinfected with UV disinfectant unit showed no significant dimensional changes when compared with control group samples. Within the chemical groups, impressions disinfected with 1% sodium hypochlorite showed more discrepancy in the dimensions when compared to the 2% glutaraldehyde disinfected group. CONCLUSIONS: UV light disinfectant can be safely used to disinfect impressions as compared to chemical disinfectants in clinical prosthodontic procedures.

Does the social environment moderate associations of the built environment with Latinas' objectively-measured neighborhood outdoor physical activity?

Favorable perceptions of the built and social neighborhood environment may promote outdoor physical activity (PA). However, little is known about their independent and interactive effects on neighborhood-specific outdoor PA. We examined associations of perceived built and social neighborhood environment factors, and their interactions, with objectively-measured neighborhood outdoor moderate-to-vigorous physical activity (MVPA) among a sample of Latina women in San Diego, CA. Analyses included baseline data collected in 2011-2013 from 86 Latinas with ≥ 2 days of combined accelerometer and global positioning system data and complete survey measures. We examined objective neighborhood outdoor MVPA within 500-meter home buffers. Generalized linear mixed models examined associations of 3 perceived built (e.g., sidewalk maintenance) and 3 social environmental (e.g., safety from crime) factors with engaging in any daily neighborhood outdoor MVPA. Models tested interactions between the built and social environmental factors. Although the perceived neighborhood environmental factors were not significantly related to daily neighborhood outdoor MVPA, we found 2 significant interactions: perceived sidewalk maintenance x safety from crime (p = 0.05) and neighborhood aesthetics x neighborhood social cohesion (p = 0.03). Sidewalk maintenance was positively related to daily neighborhood outdoor MVPA only among Latinas that reported low levels of safety from crime. Neighborhood aesthetics was positively related to daily neighborhood outdoor MVPA only among Latinas with high neighborhood social cohesion. Findings suggest several built and social environmental factors interact to influence Latinas' neighborhood outdoor MVPA. Interventions are needed targeting both built and social neighborhood environmental factors favorable to outdoor PA in the neighborhood.

HIV-infected CD4+ T Cells Use T-bet-dependent Pathway for Production of IL-10 Upon Antigen Recognition.

Interleukin (IL)-10 has been implicated in persistence of pathogens in a number of chronic infections. Infected CD4+ cells upon reactivation with HIV antigens were also shown to produce IL-10, which might contribute to their persistence. Hence, it is crucial to determine mechanisms regulating IL-10 production after activation with HIV antigens for devising effective blocking strategies. In this study, ERK-, T-bet- and FoxP3-dependent pathways were evaluated for their possible roles in IL-10 production by infected CD4+ cells after reactivation with HIV Env. Intracellular and secreted IL-10 levels were determined by flow cytometry and Bioplex assay after treating PBMCs with PD98059, tipifarnib and cyclosporin A for blocking of ERK-, T-bet-and FoxP3-dependent pathways, respectively. Baseline levels of T-bet, pERK were higher in P24+ CD4+ cells as compared to uninfected CD4+ cells, which increased further after activation with Env. Inhibition of T-bet resulted in 2.3-fold reduction of IL-10 expression whereas ERK and FoxP3 inhibition failed to cause suppression of IL-10 expression. Conversely, IL-10 secreted by PBMCs was inhibited maximally after ERK inhibition suggesting its role in regulation of cytokine secretory pathway. IFN-γ was found to be suppressed after treatment with inhibitors of all these pathways. Thus, the study highlighted need for IL-10 blockade along with the use of antigens for therapeutic vaccinations or latency reversal and identified the T-bet-dependent pathway as an important pathway regulating IL-10 production by infected CD4+ cells. However, simultaneous blockade of IFN-γ precludes use of inhibitor of this pathway as an IL-10 blocking strategy.

Sunitinib in patients with imatinib-resistant gastrointestinal stromal tumor: A single center experience study.

AIM: The outcome of patients with advanced gastrointestinal stromal tumor (GIST) has improved with the use of imatinib. Despite high response rates with this drug resistance eventually develops in nearly all patients. We present an analysis of prospectively collected data on sunitinib efficacy and safety in patients with imatinib-resistant GIST. SUBJECTS AND METHODS: Between November 2006 and October 2007, patients with GIST were accrued in an approved sunitinib patient access protocol. Key eligibility criteria included tumor resistance to imatinib and/or patient intolerance to this drug. Patients received sunitinib at a starting dose of 50 mg once daily for 4 weeks in a 6 week cycle, with standardized dose modification titrated to toxicity. Patients were continued on sunitinib until disease progression or unacceptable toxicity. The endpoints were safety, overall survival (OS) and objective response rate (ORR). RESULTS: Fifteen patients, all of whom had imatinib resistance and none intolerance, with median age of 48 (26-69) years, were treated on the protocol. The most common sites of primary disease were small intestine (40%), stomach (26.7%) and retroperitoneal (26.7%). A median of 10 (1-47) cycles of sunitinib were delivered, 9 (60%) patients required dose reductions due to toxicity whereas dose delay of > 2 weeks was required in only one (6.7%) patient. There were no toxicity-related drug discontinuations. Hypothyroidism (n = 4; 26.7%) and hand-foot syndrome (n = 3; 20%) were the most common toxicities. There were no complete and 4 (26.7%) partial responses while prolonged disease stability was seen in 8 (53.3%) patients. At a median follow-up of 81 months in surviving patients, the median progression-free and overall survivals were 15.5 and 18.7 months, respectively. CONCLUSIONS: Sunitinib appears to be an effective and well-tolerated treatment for Indian patients with imatinib-resistant GIST with outcomes similar to that reported previously. Adverse effects can be reasonably well managed using a dose modification strategy.

Influences of different environmental parameters on the sorption of trivalent metal ions on bentonite: batch sorption, fluorescence, EXAFS and EPR studies.

The presence of long-lived radionuclides in natural aquatic systems is of great environmental concern in view of their possible migration into biospheres of mankind. Trivalent actinides such as (241/243)Am can contribute a great deal to radioactivity for several thousand years. This migration is significantly influenced by various factors such as pH, complexing ions present in aquatic environments, and the sorption of species involving radionuclides by sediments around water bodies. Clay minerals such as bentonite are known to be highly efficient in radionuclide retention and hence are suitable candidates for backfill materials. This study presents experimental results on the interaction of Eu(iii) and Gd(iii) (chemical analogs of Am(iii) and Cm(iii)) with bentonite clay under varying experimental conditions of contact time, pH, and the presence of complexing anions such as humic acid (HA) and citric acid (cit). The sorption of HA on bentonite decreased with increasing the pH from 2 to 8, which was attributed to electrostatic interactions between HA and the bentonite surfaces. The sorption of Eu(iii) on bentonite colloids showed marginal variation with pH (>95%). However, a decrease in Eu(iii) sorption was observed in the presence of HA beyond pH 5 due to the increased aqueous complexation of Eu(iii) with deprotonated HA in the aqueous phase. The complexation of Eu(iii) with citrate ions was studied using Time Resolved Laser induced Fluorescence Spectroscopy (TRLFS) to explain the sorption data. Extended X-ray absorption fine structure (EXAFS) and electron paramagnetic resonance (EPR) investigations were carried out to understand the local chemical environment surrounding Eu(iii) and Gd(iii) (EPR probe) sorbed on bentonite under different experimental conditions. Surface complexation modelling shows the predominant formation of ≡XOEu(+2) (silanol) up to pH < 7, and beyond which ≡YOEu(OH)(+) (aluminol) is responsible for the quantitative sorption of Eu(iii) onto bentonite in the studied pH range.

Optical properties of ammonium uranyl fluoride characterized by photoluminescence and photoacoustic spectroscopy.

PL and PAS studies were performed on uranyl compounds viz. uranium oxalate, uranium fluoride and ammonium uranyl fluoride. PL and PAS spectrum of ammonium uranyl fluoride is being reported for the first time. Ammonium uranyl fluoride is blue shifted with respect to uranyl fluoride, as a result of ammonium bonding. The vibronic separations were determined in the excited state and the ground state using excitation/PA spectra and emission spectra respectively. Fluorescence decay data could be fitted only with biexponential decay in all of these compounds indicating the presence of two different environments in these compounds. Low temperature luminescence leads to enhancement in emission intensity and lifetime value. The temperature dependence studies of average fluorescence lifetimes of ammonium uranyl are described in this paper. Based on this studies activation energy value for ammonium uranyl fluoride at which (3)∏ and (1)Σ potential surfaces will cross is calculated.

Crystallographic site swapping of La3+ ion in BaA'LaTeO6 (A' = Na, K, Rb) double perovskite type compounds: diffraction and photoluminescence evidence for the site swapping.

Double perovskite type compounds of the formula BaA'LaTeO6 (A' = Na, K, Rb) were synthesized by solid state route and their crystal structures were determined by Rietveld analysis using powder X-ray diffraction and neutron diffraction data. Na compound crystallizes in the monoclinic system with P21/n space group whereas, K and Rb compounds crystallize in Fm3m space group. All the three compounds show rock salt type ordering at B site. Crystal structure analysis shows that La ion occupies A site in Na compound whereas, it occupies B site in K and Rb compounds according to the general formula of AA'BB'O6 for a double perovskite type compound. Effect of this crystallographic site swapping of the La ion was also observed in the photoluminescence study by doping Eu(3+) in La(3+) site. The large decrease in the intensity of the electric dipole ((5)D0-(7)F2) transition in the Rb compound compared to the Na compound indicates that Eu(3+) ion resides in the centrosymmetric octahedral environment in the Rb compound.

Photoluminescence studies on the complexation of Eu(III) and Tb(III) with acetohydroxamic acid (AHA) in nitrate medium.

UREX process has been proposed for selective extraction of U(VI) and Tc(VII) from nitric acid medium (∼1M HNO3) using tri-n-butyl phosphate (TBP) as extractant and retaining Pu, Np and fission products in the aqueous phase. The feasibility of the use of luminescence spectroscopy as a technique to understand the complexation of trivalent f-elements cations viz. Eu(III) and Tb(III) with acetohydroxamic acid (AHA) in nitric acid medium has been examined. The luminescence lifetimes for the 1×10(-3)M Eu(III) and AHA complex system decreased with increased AHA concentration from 116±0.2µs (no AHA) to 1.6±0.1µs (0.1M AHA) which was attributed to dynamic quenching. The corrected fluorescence intensities were used to calculate the stability constant (log K) for the formation of 1:1 Eu(3+)-AHA complex as 1.42±0.64 under the conditions of this study. By contrast, the Tb(III)-AHA system at pH 3 (HNO3) did not show any significant variation in the life times of the excited state (364±9µs) suggesting the absence of dynamic quenching. The spectral changes in Tb(III)-AHA system showed the formation of 1:1 complex (log K: 1.72±0.21). These studies suggest that the extent of AHA complexation with the rare earth elements will be insignificant as compared to tetravalent metal ions Pu(IV) and Np(IV) under UREX process conditions.

Detection of dengue virus 4 from central India.

BACKGROUND & OBJECTIVES: Dengue is an important arboviral disease. All four dengue virus serotypes are reported to be circulating in India. It is also known that different serotypes, genotypes and clades of genotype determine outbreak severity. Dengue affected children are known to have serious disease outcome. We carried out this study to give reliable diagnosis of dengue infection in children and to detect circulating serotype in central India. METHODS: Samples collected from paediatric patients suspected to have dengue fever were subjected to IgM and IgG ELISA to determine dengue virus infection. Samples collected within 0-5 days of onset of illness and positive by IgM ELISA were tested by nested reverse transcription polymerase chain reaction (nRT-PCR). The PCR products were sequenced and analyzed. RESULTS: Of the 89 samples tested, 18 and 7 were positive for dengue IgM and IgG, respectively. Dengue activity was observed in both Jabalpur city and adjoining rural settings. One sample found positive by nRT-PCR was further sequenced to confirm dengue virus 4 as aetiological agent. INTERPRETATION & CONCLUSIONS: Our findings demonstrated dengue virus infection in children and adolescent in central India. Because of continuous changing epidemiology, it is important to monitor dengue virus activity at both serological and molecular level in this part of the country for better patient care and management.

EPR evidence for the restricted mobility of NO2 in gamma irradiated thorium nitrate pentahydrate Th(NO3)4·5H2O.

Electron paramagnetic resonance (EPR) studies were conducted on gamma irradiated polycrystalline sample of thorium nitrate pentahydrate, Th(NO(3))(4)·5H(2)O, in the temperature range of 100-300 K. The most prominent species with triplet hyperfine structure in the EPR spectrum was identified as NO(2). The EPR spectrum gave evidence for the stabilization of NO(2) in at least three different sites slightly differing in spin Hamiltonian parameters (Site(1): g(x)=2.0042, g(y)=1.9911, g(z)=2.0020, A(x)=54.20 G, A(y)=48.50 G and A(z)=65.25 G; Site(2): g(x)=2.0042, g(y)=1.9911, g(z)=2.0020, A(x)=54.20 G, A(y)=48.50 G and A(z)=67.85 G; Site(3): g(x)=2.0045, g(y)=1.9911, g(z)=2.0015, A(x)=54.20 G, A(y)=49.05 G and A(z)=72.45 G). The EPR spectra for Site(1) revealed molecular dynamics of NO(2) from a slow motion region to fast motion region as the sample temperature was varied from 100 to 300 K. This led to a change in EPR spectrum from orthorhombic to axial, indicating preferred rotation of NO(2) molecule about the O-O bond direction. However, the NO(2) molecule at Site(2) was found to be rigid throughout the entire temperature range. The differences in the mobility of NO(2) molecules occupying the two sites could be attributed to the fact that in one case NO(2) was bonded to thorium or water and in the other case it was weakly bound. The NO(2) bound to thorium through two oxygen atoms or bound to thorium on one side through one oxygen atom and hydrogen bonded to water on the other side remains rigid throughout the entire temperature range, while NO(2) situated at interstitial sites or adsorbed on the surface exhibits mobility with increase in temperature above 100K.

Direct determination of metallic impurities in graphite by EDXRF.

Energy dispersive X-ray fluorescence (EDXRF) methods have been developed for the direct determination of 14 trace metallic impurities in graphite powder without any need for sample dissolution. Using synthetic standards, calibration curves were established for different elements after optimizing the spectrometer parameters. Two synthetic samples were analyzed to evaluate the performance of the developed analytical methods. The estimates for most of the analytes were in good agreement with the added amounts. Three graphite powder samples were analyzed by the present method as well as by D.C. arc emission spectrometric technique for comparison and the agreement between the analyte values determined, using both methods was good. Samples in pellet form were analyzed using a separate calibration with standards in pellet form. The present method is rapid, as it alleviates the need for any chemical treatment and gives good precision.

Rare-earth doped gadolinia based phosphors for potential multicolor and white light emitting deep UV LEDs.

Gadolinium oxide host and europium/dysprosium/terbium doped gadolinium oxide nanoparticles were synthesized using the sonochemical technique. Gadolinium oxide nanocrystals were also co-doped with total 2 mol% of Eu(3+)/Dy(3+),Eu(3+)/Tb(3+),Dy(3+)/Tb(3+), and also Eu(3+)/Dy(3+)/Tb(3+) ions, by the same method. The nanoparticles obtained were characterized using powder x-ray diffraction (XRD), transmission electron microscopy (TEM), and selected area electron diffraction (SAED) techniques. The size of the particles ranged from 15 to 30 nm. The triple doped samples showed multicolor emission on single wavelength excitation. The photoluminescence results were correlated with the lifetime data to get an insight into the luminescence and energy transfer processes taking place in the system. On excitation at 247 nm, the novel nanocrystalline Gd(2)O(3):RE (RE = Dy, Tb) phosphor resulted in having very impressive CIE chromaticity coordinates of x = 0.315 and y = 0.316, and a correlated color temperature of 6508 K, which is very close to standard daylight.

Interaction of Eu3+ with N,N,N',N'-tetraoctyl diglycolamide: a time resolved luminescence spectroscopy study.

N,N,N',N'-tetraoctyl diglycolamide (TODGA) has been identified as one of the promising extractants for the partitioning of minor actinides from high-level nuclear waste solutions. Solvent extraction studies have shown that stoichiometry of the extracted species of Eu(3+) with TODGA depend on the nature of diluent. Time resolved luminescence spectroscopy (TRLS) has been employed to investigate the complexation of Eu(3+) with TODGA under different experimental conditions. The effects of different experimental parameters such as aqueous phase acidity, nature of diluent, and TODGA concentration on the luminescence lifetime of Eu(3+) ions have been investigated. The lifetime measurements of the complexed fraction of Eu(3+) with TODGA suggested the absence of water molecules in the inner coordination sphere of the metal ion in different solvents. In ethanol-water (60/40%) mixture, the complexation of Eu(3+) with TODGA under varying ligand-to-metal ratios suggested the formation of 1:1, 1:2, and 1:3 species, viz., Eu(TODGA)(3+), Eu(TODGA)(2)(3+), and Eu(TODGA)(3)(3+), respectively. The conditional stability constants logbeta(1), logbeta(2), and logbeta(3) were calculated as 6.1+/-0.5, 10.8+/-0.7, and 14.3+/-0.6, respectively. The nature of diluent did not influence the luminescence spectra of Eu(3+) in the presence of TODGA.

Spectroscopic investigation on europium complexation with humic acid and its model compounds.

Time resolved fluorescence spectroscopy (TRFS) of Eu(III) (an analogue of trivalent actinides) complexation with humic acid (HA) and its model compounds, namely phthalic acid (PA), mandelic acid (MA) and succinic acid (SA) has been carried out at varying concentration ratios of ligand to metal ion. The emission spectra were recorded in the range of 550-650nm by exciting at an appropriate wavelength. The intensity of the 616nm peak of Eu(III) was found to be sensitive to complexation. The ratio of the intensities of 616 and 592nm peaks was used to determine the stability constants of Eu-phthalate, Eu-mandelate and Eu-succinate complexes. In the case of model compounds, the life-time was found to increase with increasing ligand to metal ratio (L/M) indicating the decrease in quenching of the fluorescence by coordinated water molecules with increasing complexation. On the other hand in the case of HA, the life-time was found to be constant at least up to L/M of 5, indicating the formation of outer sphere complex. Beyond L/M=5 the life-time value was found to increase which can be attributed to the binding of the metal ion to the higher affinity sites in the HA macromolecule.

Time resolved fluorescence spectroscopy of Eu(III) complexation with alpha-hydroxy isobutyric acid.

Complexation of Eu(III) with alpha-hydroxy isobutyric acid (HIBA), a model compound of humic acid, has been studied by time resolved fluorescence spectroscopy. The ratio of fluorescence intensity of the two peaks at 616 and 592 nm (I(616/592)) was found to increase with increasing ligand to metal ratio. The I(616/592) data was used to deduce the stability constant of Eu-HIBA complexes of the type ML(i) (i=1-3). The formation of multiple ligand complexes was also corroborated by lifetime data which was found to increase with increasing [HIBA]/[Eu] ratio thus indicating replacement of coordinated water molecules by HIBA.

Effect of structure, particle size and relative concentration of Eu(3+) and Tb(3+) ions on the luminescence properties of Eu(3+) co-doped Y(2)O(3):Tb nanoparticles.

Eu(3+) co-doped Y(2)O(3):Tb nanoparticles were prepared by the combustion method and characterized for their structural and luminescence properties as a function of annealing temperatures and relative concentration of Eu(3+) and Tb(3+) ions. For Y(2)O(3):Eu,Tb nanoparticles annealed at 600 and 1200 °C, variation in the relative intensity of excitation transitions between the (7)F(6) ground state and low spin and high spin 4f(7)5d(1) excited states of Tb(3+) is explained due to the combined effect of distortion around Y(3+)/Tb(3+) in YO(6)/TbO(6) polyhedra and the size of the nanoparticles. Increase in relative intensity of the 285 nm peak (spin-allowed transition denoted as peak B) with respect to the 310 nm peak (spin-forbidden transition denoted as peak A) with decrease of Tb(3+) concentration in the Y(2)O(3):Eu,Tb nanoparticles heated at 1200 °C is explained based on two competing effects, namely energy transfer from Tb(3+) to Eu(3+) ions and quenching among the Tb(3+) ions. Back energy transfer from Tb(3+) to Eu(3+) in these nanoparticles is found to be very poor.

High rates of syphilis among STI patients are contributing to the spread of HIV-1 in India.

BACKGROUND: Recent syphilis outbreaks have raised concern regarding the potential enhancement of HIV transmission. The incidence of syphilis and its association with HIV-1 infection rates among a cohort of sexually transmitted infection (STI) clinic attendees was investigated. METHODS: 2732 HIV-1 seronegative patients attending three STI and one gynaecology clinic, were enrolled from 1993-2000 in an ongoing prospective cohort study of acute HIV-1 infection in Pune, India. At screening and quarterly follow up visits, participants underwent HIV-1 risk reduction counselling, risk behaviour assessment and HIV/STI screening that included testing for serological evidence of syphilis by RPR with TPHA confirmation. Patients with genital ulcers were screened with dark field microscopy. RESULTS: Among 2324 participants who were HIV-1 and RPR seronegative at baseline, 172 participants were found to have clinical or laboratory evidence of syphilis during follow up (5.4 per 100 person years, 95% CI 4.8 to 6.5 per 100 person years). Independent predictors of syphilis acquisition based on a Cox proportional hazards model included age less than 20 years, lack of formal education, earlier calendar year of follow up, and recent HIV-1 infection. Based on a median follow up time of 11 months, the incidence of HIV-1 was 5.8 per 100 person years (95% CI 5.0 to 6.6 per 100 person years). Using a Cox proportional hazards model to adjust for known HIV risk factors, the adjusted hazard ratio of HIV-1 infection associated with incident syphilis was 4.44 (95% CI 2.96 to 6.65; p<0.001). CONCLUSIONS: A high incidence rate of syphilis was observed among STI clinic attendees. The elevated risk of HIV-1 infection that was observed among participants with incident syphilis supports the hypothesis that syphilis enhances the sexual transmission of HIV-1 and highlights the importance of early diagnosis and treatment of syphilis.

Low HIV-1 incidence among married serodiscordant couples in Pune, India.

Unlike commercial sex workers and patients attending sexually transmitted infection (STI) clinics, married couples are not typically targeted for HIV risk reduction programs in India. Thus, married partners of HIV-infected persons are at particularly high risk for HIV infection. Between September 2002 and November 2004, 457 HIV-1 sero-discordant, married couples were enrolled in a one-year prospective study of HIV transmission in Pune, India. The HIV incidence among uninfected partners was 1.22 per 100 person-years (95% CI 0.45-2.66), which is much lower than what has been previously reported among discordant couples in Africa. This may be due to higher rates of condom use, lower rates of STIs and higher CD4 T lymphocyte counts, among the Indian HIV sero-discordant couples.