A cross-sectional study of the factors influencing adherence to antiretroviral therapy among adults with human immunodeficiency virus infection in a tertiary care hospital in Puducherry, India.

Context: Combating human immunodeficiency virus/acquired immunodeficiency syndrome epidemic has been possible due to advances in prevention strategies and Antiretroviral therapy (ART). Optimal adherence to ART is a major factor in achieving the desired immunological, virological, and patient well-being outcomes. Several socio-demographic, patient, treatment, and health-care system-related factors influence nonadherent behavior to ART. Aims: This study was planned to assess (1) ART adherence level, (2) factors and reasons associated with nonadherence, and (3) impact of suboptimal adherence on treatment outcomes. Settings and Design: This was a cross-sectional analytical study of 300 patients in a tertiary care hospital in Puducherry, India. Methods: Random sampling was used to collect data from patient treatment cards and a predesigned structured questionnaire. The pill count method was used to calculate adherence level. Statistical Analysis Used: Nonadherence was chosen as a dependent variable and factors affecting adherence were chosen as independent variables. Test for significance was carried out by Chi-square test and Fisher's exact test. Results: Optimal adherence was seen in 68.3%. Factors significantly associated with nonadherence were lower education level, high prior CD4 count, irregular follow-up, missing doses in the past, and being late for pharmacy pill refills. Adherence was positively associated with mean increase in CD4 count over 6 months. Conclusions: In our study, the adherence rate is suboptimal which can lead to failure of ART. Nonadherence was associated with a decrease in CD4 count overtime. Most of the factors significantly affecting ART adherence were patient behavior related. These factors can be used for target intervention during reinforcement adherence counseling.

Patterns of Occupational Exposure to Human Immunodeficiency Virus and Post-Exposure Prophylaxis Among Health Care Personnel in a Tertiary Care Institute in South India - A Retrospective Case Series.

Background: Post-exposure prophylaxis (PEP) for occupational human immunodeficiency virus (HIV) exposure involves the comprehensive measures used to prevent transmission of blood-borne pathogens such as HIV, hepatitis B virus, and hepatitis C virus through various strategies such as first aid, counseling, risk assessment, relevant laboratory investigations with informed consent, the provision of short-term anti-retroviral drugs, and follow-up testing. Aim and Objectives: We sought to investigate the patterns and causes of occupational exposure in health care workers (HCWs) in our institute and the usage of PEP in our center, a tertiary care hospital in south India. Materials and Methods: The study involved a retrospective analysis of data extracted from the records of PEP usage from the anti-retroviral treatment (ART) center attached to the dermatology, venereology and leprosy out-patient department of a tertiary care center in south India. The data were extracted into a pre-designed proforma and analyzed using descriptive statistics. Results: A total of 352 health care professionals reported to the ART center for PEP from 2010 to 2020. One hundred and thirty-four patients took only the first dose as the source patient later tested to be HIV-negative. Among the 218 remaining patients, 84 were male and 134 were female patients. Only 56 health care workers started the regimen within 2 hours. One hundred and thirty-four patients completed the full course of PEP. Most HCWs (n = 68, 31%) sustained the exposure while doing a procedure on the patient followed by re-capping a needle (n = 64, 29%). Gastritis and drowsiness were the most common adverse effects. Limitations and Conclusions: The study was limited by the retrospective nature of data collection and the lack of detailed interviews with HCWs. Knowledge about PEP, needle safety training, and training of early first aid measures should be increased among health care workers.

Leg ulcers in active lepromatous leprosy associated with cryoglobulinaemia.

A 40-year-old male agricultural labourer presented with active lepromatous leprosy and painful leg ulcers of 2 months' duration. Biopsy from the ulcer showed nonspecific changes. Raised erythrocyte sedimentation rate and positive rheumatoid factor made us suspect underlying cryoglobulinaemia. Presence of cryoprecipitate in the serum, demonstration of cryoglobulins by serum electrophoresis and raised cryocrit were compatible with cryoglobulinaemia as the cause of atypical leg ulcers in this case. The ulcers healed with bed rest, aspirin and specific anti-leprosy treatment. Though 95% of lepromatous leprosy patients can have cryoglobulinaemia, the presence of atypical ulcers as seen in our patient has not previously been related to the presence of cryoglobulinaemia.

Cutaneous anthrax: an endemic outbreak in south India.

Although human anthrax has become rare, endemic outbreaks still occur in tropical countries, parts of South America and Europe. We report 23 cases of cutaneous anthrax due to an endemic outbreak of animal and human anthrax in South India. These patients were admitted to our hospital between July 1998 and July 2001. Children outnumbered adults and most of them had lesions on the exposed sites. The majority of patients reported the death of infected animals in the neighbourhood without any direct contact with dead animals. Hence, vector borne transmission was suspected in most of the cases. Diagnosis was confirmed by the presence of a typical ulcer with eschar, Gram-stained smears from ulcers and epidemiological evidence. Except for one fatal case, all patients responded to treatment.

Leg ulcers in active lepromatous leprosy associated with cryoglobulinaemia

A 40-year-old male agricultural labourer presented with active lepromatous leprosy and painful leg ulcers of 2 months' duration. Biopsy from the ulcer showed nonspecific changes. Raised erythrocyte sedimentation rate and positive rheumatoid factor made us suspect underlying cryoglobulinaemia. Presence of cryoprecipitate in the serum, demonstration of cryoglobulins by serum electrophoresis and raised cryocrit were compatible with cryoglobulinaemia as the cause of atypical leg ulcers in this case. The ulcers healed with bed rest, aspirin and specific anti-leprosy treatment. Though 95 per cent of lepromatous leprosy patients can have cryoglobulinaemia, the presence of atypical ulcers as seen in our patient has not previously been related to the presence of cryoglobulinaemia.

An Indian case of keratoderma hereditarium mutilans (Vohwinkel's syndrome) associated with ichthyosiform dermatosis.

Keratoderma hereditarium mutilans (KHM) or Vohwinkel's syndrome (VS) is usually inherited as an autosomal dominant disease, but a recessive type has occasionally been described. We report a 19-year-old male born to consanguineous parents, who presented with KHM associated with generalized ichthyosiform dermatosis. On examination, his generalized ichthyosiform dermatosis was accompanied by severe 'honey comb' like palmoplantar keratoderma and marked hyperhidrosis. Bilateral fifth toes showed complete constricting bands just distal to the metatarsophalangeal joints leading to pseudoainhum. The histopathologic examination of a biopsy from the sole showed hyperkeratosis, marked parakeratosis, hypergranulosis, acanthosis, and a few mononuclear cells in the papillary dermis, consistent with the diagnosis of KHM. Several hereditary disorders may show varying degrees of hyperkeratosis and constriction of digits; their differentiating features are discussed. This case is reported for its rarity and interesting associated findings.

Citología neural por aspiración con aguja (FNAC) en lepra

La lepra es, sobre todo, una enfermedad de los nervios periféricos y se requiere una técnica más sencilla que a biopsia neural para evaluar el compromiso neural, especialmente en lepra neurítica pura (PN). Este trabajo fue diseñado para evaluar el papel de la FNAC en el diagnóstico y clasificación de la lepra. Se efectuó un estudio prospectivo en 25 pacientes con lepra clínicamente activa y al menos un nervio periférico sensitivo engrosado. Los aspirados neurales se evalúan por May-Grunwald-Giemsa y tinción Fite. Se realizan tests de la lepromina, frotis cutáneos (SSS), y biopsias cutáneas (excepto en casos PN) y biopsias neurales y con FNAC. El FNAC neural en 23 casos (92%) proporciona aspirados y se comparan con valor diagnóstico. Basados en estos resultados, se desarrolló un criterio citológico para la interpretación de aspirados neurales y los casos se clasifican como paucibacilares (18), BB(2), LL(1) y no-diagnósticos (2). Todos los casos PN en lepra son comparables con la patología neural y el criterio citológico propuesto puede ser útil en la clasificación de los aspirados neurales.

Amyloidosis cutis dyschromica in two siblings.

Amyloidosis cutis dyschromica (ACD), a rare distinct type of primary cutaneous amyloidosis was noted in two siblings: a 25-year-old male and his brother aged 20 years. It was characterized by reticulate hyperpigmentation with hypopigmented spots seen almost all over the body without any papulation. This familial disorder has been reported mostly from Japan. Our report of familial ACD is probably the first from India.

Citología neural por aspiración con aguja (fnac) en lepra

La lepra es, sobre todo, una enfermedad de los nervios periféricos y se requiere una técnica más sencilla que la biopsia neural para evaluar el compromiso neural, especialmente en lepra neurítica pura (PN). Este trabajo fue diseñado para evaluar el papel de la FNAC en el diagnóstico y clasificación de la lepra. Se efectuó un estudio prospectivo en 25 pacientes con lepra clínicamente activa y al menos un nervio periférico sensitivo engrosado. Los aspirados neurales se evalúan por May-Grunwald-Giemsa y tinción Fite. Se realizan tests de la lepromina, frotis cutáneos (SSS), y biopsias cutáneas (excepto en casos PN) y biopsias neurales y con FNAC. El FNAC neural en 23 casos (92 por ciento) proporciona aspirados y se comparan con valor diagnóstico. Basados en estos resultados, se desarrolló un criterio citológico para la interpretación de aspirados neurales y los casos se clasifican como paucibacilares (18), BB (2), BL(2), LL (l) y no diagnósticos (2). Todos los casos PN en lepra son comparables con la patología neural y el criterio citologico propuesto puede ser útil en la clasificiación de los aspirados neurales (AU)

Fine needle aspiration cytology (FNAC) of nerves in leprosy.

Leprosy is primarily a disease of the peripheral nerves and a technique that is simpler than nerve biopsy is required to evaluate nerve involvement, especially in pure neuritic (PN) leprosy. This study was designed to evaluate the role of FNAC of the nerve in the diagnosis and classification of leprosy. A prospective study was carried out on 25 patients with clinically active leprosy and at least one thickened peripheral sensory nerve. Nerve aspirates were evaluated by May-Grunwald-Giemsa and Fite's staining. Lepromin test, slit skin smears (SSS), skin biopsies (except PN cases) and nerve biopsies were performed and compared with FNAC. FNAC of nerve from 23 cases (92%) yielded diagnostic aspirates. Acid fast bacilli were observed in six cases by FNAC. FNAC and nerve pathology were equally comparable with the other parameters evaluated. Based on the results, cytological criteria were developed for interpreting nerve aspirates and the cases were classified as paucibacillary (18), BB (2), BL (2), LL (1) and non-diagnostic (2). All PN cases showed diagnostic paucibacillary type cytology. FNAC of the nerve yields diagnostic aspirates in leprosy comparable with nerve pathology and the proposed cytological criteria may be useful in classification of nerve aspirates.

Alkaptonuric ochronosis presenting as palmoplantar pigmentation.

We describe a 37-year-old woman who presented with palmoplantar pigmentation, thickening and pitting of 4 years duration. Bluish pigmented patches were seen over the sclera of her eyes. Her lumbar spine showed typical calcification of the intervertebral discs. Addition of Benedict's reagent to a urine sample of the patient gave rise to greenish brown precipitate and brownish black supernatant. Alkalinization of urine turned it black. A biopsy of the palmar lesion demonstrated irregular breaking up, swelling and homogenization of collagen bundles in the reticular dermis. Yellow-brown (ochre coloured) pigment was seen lying within the collagen bundles and also freely in the deeper dermis confirming our clinical diagnosis of alkaptonuric ochronosis. To the best of our knowledge this is probably the second report of alkaptonuria presenting with palmoplantar pigmentation.