HIV-related high-risk behavior and awareness regarding HIV among the male workers at a construction site in Karnataka

Background: Sexual behavior is an important determinant of sexually transmitted diseases transmission. It is essential to understand the HIV-related high-risk behavior among high-risk groups like migrants to design evidence-based intervention. Objectives: This study was undertaken to assess HIV-related high-risk behavior and awareness among male construction workers. Materials and Methods: A total of 404 male workers were enrolled in a cross-sectional study at a construction area in Karnataka. Behavioral Surveillance Survey questionnaire was used to collect information regarding sexual behavior and their knowledge regarding HIV/AIDS. Results: The mean age of workers was 25.6 ± 7.3 years. Among workers, 82.2% of them heard about AIDS and 66.8% (270) could tell at least two correct mode of transmission of HIV. Mean age of first sexual intercourse was 22 ± 9.4 years among married and 18.9 ± 2.8 years among unmarried. Nearly 25% and 56% had their first sexual intercourse <18 years among married and unmarried, respectively. Among married workers, 21.9% used condoms during last sexual intercourse with spouse and 10.8% used condoms with other partners. About 15.7% of them had multiple sexual partners. Among unmarried workers, 27.9% of them ever had sex and 22.2% of them used condom during last sexual intercourse. Nearly 30% of them had multiple sexual partners. Higher age, educational status, and high-income associated with better awareness. Conclusion: Knowledge regarding AIDS and sexual transmission was good. However, condom usage was found to be poor among the workers. In addition to that, multiple sexual partners which included commercial sex workers among both married and unmarried workers are an important risk factor for HIV. Adequate interventions should be done in this group to address this issue.

Frequency of Epstein - Barr virus infection as detected by messenger RNA for EBNA 1 in histologically proven gastric adenocarcinoma in patients presenting to a tertiary care center in South India.

Background: Epstein–Barr virus (EBV)‑associated gastric carcinoma is a relatively uncommon entity detected in approximately 10% of gastric adenocarcinoma. Objective: The purpose of this study is to estimate the frequency of EBV‑associated gastric carcinoma and also to assess the nature of presentation, any significant difference between this subgroup and EBV‑negative gastric adenocarcinomas with respect to age and sex predilection, lymph nodal status, site of presentation. Materials and Methods: We prospectively analyzed 100 cases of gastric adenocarcinoma who underwent either a partial or total gastrectomy during the period from March 2010 to August 2011. The tumour and the corresponding normal gastric tissue from the same patient were analyzed for the presence of Epstein–Barr nuclear antigen 1 (EBNA1) messenger ribonucleic acid (mRNA) by real‑time polymerase chain reaction (PCR). Result: EBV was detected in 6% cases of gastric adenocarcinoma. All the positive patients were males. The majority of cases involved the proximal stomach and there was variable lymph nodal involvement. Conclusion: Our study endorses that there is an association between EBV infection and gastric adenocarcinoma in the Indian population. There was no significant difference between this subgroup and EBV‑negative gastric adenocarcinomas with respect to age and sex predilection, lymph nodal status and site of presentation. Short‑term follow‑up of this subgroup of patients seems to indicate a good overall prognosis after appropriate treatment. However, a larger study with long‑term follow‑up is needed to further establish the role of EBV in gastric adenocarcinoma in this study population.

Duplex ultrasonography arteriography as first-line investigation for peripheral vascular disease

<p><b>INTRODUCTION</b>The gold standard for evaluation of the lower extremity arterial tree is catheter angiography. Duplex arterial-occlusive imaging or duplex ultrasonography arteriography, a noninvasive technique, is used as the first-line investigation in patients with peripheral vascular disease at our centre. Based on the results of duplex imaging, patients who require angiographic intervention then proceed with simultaneous catheter arteriography and intervention. This study aimed to compare the results of duplex imaging alone as the first-line investigation against the eventual results of catheter angiography, and to assess the impact of the former on patients' clinical outcomes.</p><p><b>METHODS</b>All cases involving patients who underwent duplex imaging followed by angiographic intervention, from May 2008 to February 2009, were discussed at weekly interdisciplinary meetings. Only patients who underwent lower limb imaging were included in the study. Those who were involved in grafts and stent surveillance studies, as well as those with incomplete duplex images were excluded.</p><p><b>RESULTS</b>During the study period, 113 duplex imaging studies of the lower limb followed by percutaneous transluminal angioplasty were performed at our hospital for peripheral vascular disease. The iliac artery was visualised in 40 images, but could not be visualised in 73 images. There was a potential change in management in three cases due to radiological differences between the duplex images and angiography films.</p><p><b>CONCLUSION</b>In our series, duplex imaging was found to be accurate enough to guide initial clinical management of patients with peripheral vascular disease. This modality is the preferred first-line investigation for such patients at our centre.</p>

An unusual injury from a toothbrush: a case report.

The use of toothbrushes has significantly improved oral hygiene. However, if brushing of the teeth is not done judiciously, it could result in severe trauma to the soft tissues of the oral cavity. This is particularly true in the young age group, since children tend to be very playful while brushing their teeth. This article describes the case report of a child who sustained a penetrating injury while brushing his teeth. A detailed plan for the management of such injuries is also presented.

Laparotomy for post chemotherapy residue in ovarian germ cell tumors.

BACKGROUND: Primary conservative surgery and cisplatin-based chemotherapy have resulted in high cure rates in malignant ovarian germ cell tumors. A significant proportion of advanced tumors may have post-chemotherapy residue and it is important to distinguish necrosis or fibrosis without viable tumor from persistent viable tumor and teratoma. AIMS: To evaluate the role of laparotomy in assessing the nature of post-chemotherapy residue in ovarian germ cell tumors. MATERIALS AND METHODS: Eighty-three patients with malignant ovarian germ cell tumors seen at Cancer Institute, Chennai between 1992 and 2002 were studied. Sixty-eight patients completed combination chemotherapy with cisplatin regimes, of whom 35 had radiological residual masses. Twenty-nine out of these 35 patients underwent laparotomy to assess the nature of the residue. RESULTS: On laparotomy, three patients had viable tumor, seven immature teratoma, three mature teratoma and 16 only necrosis or fibrosis. None of our patients with dysgerminoma, embryonal carcinoma, absence of teratoma element in the primary tumor and radiological residue of < 5 cm had viable tumor whereas all patients with tumors containing teratoma component initially had residual tumor. Absence of viable disease was higher in patients who had normalization of serum markers by two cycles of chemotherapy. CONCLUSION: Our study suggests that patients with absence of teratoma element initially, radiological residue of< 5 cm and normalization of serum markers after two cycles of chemotherapy do not require surgery to assess the nature of post-chemotherapy residue. However, laparotomy should be performed in patients with tumors that initially contain teratoma element and in those with sluggish tumor marker response after two cycles of chemotherapy since they have a high chance of having viable post chemotherapy residue.

Surgical presentation of melioidosis in India.

BACKGROUND: Melioidosis, the disease caused by Burkholderia pseudomallei, is common in Southeast Asia. It has also been reported from India, where some investigators feel it is under-diagnosed and under-reported. We report our experience with melioidosis presenting as abscesses at unusual sites. METHODS: All consecutive patients with culture proven B. pseudomallei, who presented to a single surgical unit between 1995 and 1998, were evaluated. RESULTS: Three patients presented with splenic abscesses and one with a soft tissue abscess in the neck. One patient developed septicaemia. All patients responded favourably to ceftazidime and/or co-trimoxazole which was started as soon as the diagnosis was confirmed. CONCLUSION: Melioidosis is under-diagnosed in India, probably due to a low index of suspicion of this disease among clinicians. It should be considered as a possibility when abscesses are encountered at unusual sites. The pus must then be cultured to identify the causative agent.

Diagnosis and management of gastrointestinal angiodysplasia.

Eighteen patients with gastrointestinal angiodysplasia were seen in a single surgical unit over a period of 8 years. The mean age at onset of symptoms was 33 years. The average duration of symptoms was 54 months (range 2 days-16 years). Three patients had gastric angiodysplasia, two had colonic angiodysplasia, both diagnosed endoscopically preoperatively. The remaining patients required further investigation, which included small bowel enema (SBE), erythrocyte tagged scan (ETC), selective visceral angiography and intraoperative enteroscopy (IOE). SBE was useful but not diagnostic in 3, ETC in 3 and angiography in 5. Four patients required IOE for a diagnosis. Follow up of 17 months is available on all patients. Four had recurrence of symptoms. One required re-exploration and resection of 3 feet of small bowel and right hemicolectomy, another is on hormonal therapy and maintaining normal haemoglobin. Two others are asymptomatic on oral iron therapy.

Prevalence of genital mycoplasma & ureaplasma infections in pregnancy & their effect on pregnancy outcome.

A cohort of 200 women with singleton pregnancies attending the antenatal clinic, were studied to determine the prevalence of genital mycoplasma and ureaplasma infections in pregnant women and the effect of infection on pregnancy outcome. Vaginal and endocervical swabs were taken at 26-30 wk and again at 36-38 wk of pregnancy and cultured for mycoplasma and ureaplasma. Forty (20%, 95% CI 14.5-25.6%) women were found to be infected with arginine metabolising mycoplasmas and 79 (39.5%, 95% CI 32.7-46.3%) with ureaplasma at either site or either time. The mean +/- SD birth weight of infants born to women infected with mycoplasma alone was 2879 +/- 471 g while that of infants born to women infected with ureaplasma alone was 2964 +/- 412 g. Mean +/- SD birthweight of infants born to women infected with both organisms was 2969 +/- 389 g while that of infants born to uninfected women was 2919 +/- 432 g. These differences were not statistically significant. The median gestation at delivery was 39 wk in the cohort; the differences among the groups were minor and statistically not significant. Thus, although genital mycoplasma/ureaplasma infections were frequent, no association was observed between infection and pregnancy outcome.