Role of demographic and clinical factors in survival of HIV patients on antiretroviral therapy.

Our retrospective cohort study assesses the survival probability and identifies the demographic and clinical predictors of mortality in HIV patients taking antiretroviral therapy using an antiretroviral therapy centre data in Western India. Secondary data on 7532 registered HIV-infected individuals between September 2006 and January 2013 were analysed. The probability of survival at 75 months was 84.9%. Significant indicators of poor chances of survival were greater age, lower occupation class, lower CD4 count, poor functional status; higher stage of disease, lower weight, the presence and type of opportunistic infections, co-trimoxazole therapy and poor adherence to antiretroviral therapy. We thus find that, in addition to pre-ART, antiretroviral therapy clinical status and treatment adherence, socioeconomic status plays an important influence on ultimate survival of HIV patients on antiretroviral therapy.

Environment and psychosocial factors are more important than clinical factors in determining quality of life of HIV-positive patients on antiretroviral therapy.

Assessing quality of life (QOL) outcome helps to show the effect of antiretroviral therapy (ART) on the subjective perception of its benefits among patients with HIV. A cross-sectional assessment of QOL, using the World Health Organization WHOQOL-HIV, on 204 HIV patients taking ART in western India showed patients with HIV on ART as having the best QOL score in the spiritual domain and the worst in the environment domain. Patients who are single, highly educated, of higher occupational status, with no HIV-positive children, not undergoing frequent hospital admissions, with access to a counsellor for support, who are not stigmatised or discriminated against due to HIV status, who do not have guilt or suicidal ideas, and who are theist, tend to have a better QOL, irrespective of their clinical condition or ART regimen. Patients' personal perceptions and feelings, societal support or stigma, and sociodemographic status have a more significant influence on QOL than clinical variables.

Cross-sectional study on socio-demographic and clinical correlates of depression among human immunodeficiency virus-positive patients in Surat City, Western India.

INTRODUCTION: Surat has the highest incidence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in Gujarat, the main reason being its large migrant population. Mental health in HIV/AIDS has most often been a topic of neglect all over the world. This study attempts to assess the magnitude of depression and the socio-demographic and clinical variables associated with it in HIV-positive patients. METHODS: A cross-sectional study was conducted in 270 HIV-positive patients using Beck Depression Inventory (BDI; translated and validated in Gujarati and Hindi) along with a questionnaire for eliciting information on socio-demographic and clinical variables. RESULTS: The prevalence of depression among HIV-positive patients was 30% with 12.22% having mild depression; 14.07% with moderate depression and 3.7% with severe depression. Bivariate analysis showed that physical pain, physical illness, Cluster of Differentiation 4 (CD4)<300 cells/mm3, HIV positive spouse, discrimination at hospital, discrimination in society, government setup as the first place of HIV test and broken relationship with spouse after HIV disclosure were significantly associated with depression among the patients. On multiple logistic regression, discrimination at hospital, physical pain and CD4<300 cells/mm3 were found to be the significant predictors of depression among the patients. DISCUSSION: HIV-positive patients can be screened by counselors using easy-to-administer scales like BDI, which can be translated and validated into any regional language. A trained psychiatrist should be appointed at the Anti-Retroviral Therapy (ART) center to take care of the mental health issues of the patients.

Vaccine Wastage Assessment After Introduction of Open Vial Policy in Surat Municipal Corporation Area of India.

BACKGROUND: As per the vaccine management policy of the Government of India all vaccine vials opened for an immunization session were discarded at the end of that session, irrespective of the type of vaccine or the number of doses remaining in the vial prior to 2013. Subsequently, open vial policy (OVP) was introduced in 2013 and should reduce both vaccine wastage as well as governmental healthcare costs for immunization. This study evaluates the vaccine wastage after introduction of the OVP and its comparison with the previous study of vaccine wastage in Surat city before implementation of OVP. It needs to mention that the vaccine policy for this period under comparison was uniform except for the OVP. METHODS: Information regarding vaccine doses consumed and children vaccinated during immunization sessions of 24 urban health centers (UHCs) of Surat city were retrieved for the period of January 1st, 2014 to March 31st, 2014. The data were analyzed to estimate vaccine wastage rate (WR) and vaccine wastage factor (WF). In order to assess the impact of OVP, vaccine WR of this study was compared with that of previous study conducted in Surat city during January 1st, 2012 to March 31st, 2012. RESULTS: The vaccine WR for oral polio vaccine (OPV) has decreased from 25% to 13.62%, while the WRs for DPT, hepatitis B virus (HBV) and the pentavalent vaccine combinedly have decreased from 17.94% to 8.05%. Thus, by implementation of OVP, an estimated 747 727 doses of OPV and 343 725 doses of diphtheria, pertussis and tetanus toxoid vaccine (DPT), HBV and the pentavalent vaccines combinedly have been saved in Surat city of India in a year. CONCLUSION: The implementation of the OVP in Surat city has led to a significant lowering in the vaccine wastage, leading to savings due to lower vaccine requirements.

Follow-up Assessment of Under-nourished Children Under Integrated Child Development Services Scheme in Tapi District, India.

BACKGROUND: India shares the largest burden of under-nutrition in world. The aim of this study was to conduct follow-up assessment of under-nourished children attending anganwadi center (AWC). METHODS: This was a retrospective cohort study conducted in 50 AWC of Tapi district. Total 529 children aged 1-6 years diagnosed as under-nourished before 1 year were included. Pre-structured questionnaire was used for present day assessment of these children followed by Epi-info mediated analysis. RESULTS: Children of literate mothers had higher weight gain. Ninety percent of children attended anganwadi regularly, however 25% of children dropped out for more than 1 month. In 1 year, growth had faltered in 20% children and was stagnant in 63% of them. Children who were treated for under-nutrition; that completed course at Child Development and Nutrition Center; and whose parents were counseled about the under-nourished status of child had higher weight gain than their counterparts. CONCLUSIONS: Parents of under-nourished children must be counseled about the nutritional status of their child. In cases of under-nourished child, referral to higher center must be ensured by health worker. Supplementary feeding as a long-term solution to country's under-nutrition problem should be studied in detail with the alternative solutions.

Antenatal care registration and predicting factors of late registration among pregnant women.

The objective of antenatal care (ANC) is prevention, early recognition and treatment of pregnancy related ailments as well as general medical problems. It also provides an opportunity for reproductive health counselling. Early registration at an antenatal clinic is recommended. However, the majority of pregnant women are entered late into an antenatal care programme, especially in developing countries such as India. We explored the factors associated with late antenatal registration in a rural area of Gujarat State.

Port site and peritoneal metastases after laparoscopic cholecystectomy for incidentally found gallbladder carcinoma.

Gallbladder cancer is found in about 1-2% of patients after laparoscopic cholecystectomy and it is difficult to diagnose preoperatively. Laparoscopic cholecystectomy may disseminate gallbladder cancer to peritoneum and even port sites. Here, we present a case of a 59-year-old female patient operated for gallstone disease and her histopathology was suggestive of well-diffentiated gallbladder carcinoma (T1N0M0). Patient presented to us with port site and distant peritoneal metastases after 3 months.

Effect of zolpidem on the efficacy of continuous positive airway pressure as treatment for obstructive sleep apnea.

STUDY OBJECTIVE: Assess the effect of the hypnotic zolpidem on the efficacy of nasal continuous positive airway pressure for treatment of Obstructive Sleep Apnea. DESIGN: Randomized double blind placebo controlled, cross-over study. SETTING: Veterans Administration Medical Center. PATIENTS: 16 patients with severe obstructive sleep apnea (apnea+ hypopnea index > 30/hr), on CPAP therapy for at least 6 months. INTERVENTION: Three sleep studies were performed over three consecutive weeks. On night one the pressure level required to prevent apnea, hypopnea, and snoring was determined. On the second and third study nights, either placebo (P) or 10 mg of zolpidem (Z) was given (random order) and subjects slept on the CPAP level determined on the first night. MEASUREMENTS: Sleep architecture, apnea + hypopnea index, arterial oxygen saturation. RESULTS: The sleep architecture was similar on the placebo and zolpidem nights except for a decrease in the sleep latency ( P: 23.5 +/- 4.7; Z: 13.1 +/- 3.3 minutes, P < 0.02) and a small decrease in the arousal index (P < 0.03) on zolpidem nights. The was no significant difference between placebo and zolpidem nights in the apnea + hypopnea index (P: 4.8 +/- 1.4 versus Z : 2.7 +/- 0.47 events/hour), oxygen desaturation index (1.46 +/- 0.53 versus 0.81 +/- 0.29 desaturations/hour), or the lowest SaO2 (91.4 +/- 0.6 versus 91.0 +/- 0.7%). CONCLUSIONS: Acute administration of zolpidem 10 mg does not impair the efficacy of an effective level of CPAP in patients with severe obstructive sleep apnea.

Acquired methemoglobinemia: a rare but serious complication.

Topical and local anesthetics are employed during minor invasive procedures to increase patient tolerance and to reduce the need for intravenous sedation. A potentially fatal complication of these anesthetics is methemoglobinemia (Met-Hgb). Met-Hgb should be suspected in patients with cyanosis that does not respond to administration of oxygen and who have a discrepancy in oxygen saturation measured by pulse oximetry compared with the arterial partial pressure of oxygen (PaO2) determined by blood gas analysis. We present a patient who developed life-threatening Met-Hgb from the local anesthesia required during percutaneous endoscopic gastrostomy tube placement.