A Study on Etiopathological Evaluation of Anaemia in Newly Diagnosed HIV-Infected Adults at a Tertiary Health Care Centre of Eastern India.

Background: Anaemia is a common feature among HIV infected people and has been uniformly demonstrated that the severity of anaemia increase the morbidity and mortality in PLWH independent of CD4 count. There are wide variations in the prevalence of anaemia from different countries all over the world and gender specific variation observed in different studies. Aims and Objectives: Aims of our study were to study the different types and the various etiologies of anaemia in newly diagnosed HIV infected adults. Also to find out the relation between absolute CD4 counts and severity of anaemia. Methods: Fifty newly diagnosed HIV infected adults with anaemia were included in the study. Study conducted from July 2014 to June 2015 at a tertiary care hospital and medical teaching institute in eastern India. Detailed medical history was taken, thorough physical examination was done and relevant routine laboratory investigations were done in all patients. Few special investigations were done in selected patients. Results: In this study 70 % of the patients belonged to the lower socio economic group and 58% of the cases were addicted to alcohol which is also a significant associated risk factor. The mean CD4 count was 170.1 with a standard deviation of 123.16. The mean Hb% of the population was 7.13 with a standard deviation of 1.27031492. The most common etiology found was anaemia of chronic disease (34%) and other etiologies were HIV induced myelodysplasia (32%), iron deficiency anaemia (16%), helminth infection (14%) and vitamin B12 deficiency leading to megaloblastic anaemia was seen in 4% cases. Conclusion: Anaemia of chronic disease is the most common etiology, which has correlation with disease activity.

Epidemiology of HIV infection among brothel-based sex workers in Kolkata, India.

A cross-sectional study was carried out during January-June 2004 to assess the status of HIV infection among brothel-based sex workers in Kolkata city, India. Six hundred and twenty-two sex workers, selected from six brothels, were included in the study to assess their HIV status, and 362 sex workers, a subset of the above population, were interviewed to study their risk behaviour and practices. Blood samples were collected from each sex worker for testing HIV by an unlinked anonymous method. The prevalence of HIV infection was 9.6%, but was much higher among younger sex workers aged 20 years or less (27.7%) compared to the older age group (8.4%). This difference was statistically significant, indicating an association of younger ages with HIV infection [p = 0.006 and odds ratio (OR) = 4.18; (95% confidence interval (CI) 1.2-13.8)]. HIV was not associated with duration of sex work, average number of clients entertained per day, condom use, practice of sex during menstruation, pre-coital examination of penis for visible ulcer/discharge, suffering from sexually transmitted infections, and entertaining clients outside the brothel. There was a big gap between the reported and the evaluated condom use by sex workers. The results suggest that there is a need to develop suitable HIV intervention strategies, considering the socioeconomic and cultural aspects of city sex workers, with a provision for continuous monitoring and evaluation.

Biomonitoring insecticide pollution using non-target soil microarthropods.

The scope of biomonitoring insecticide pollution in soil is discussed with the help of field and laboratory findings on the density, prey-predator ratio and fecundity of non-target microarthropod fauna. Field experiments were conducted in small plots with mustard, wheat and lady's finger crops and insecticides namely heptachlor 20EC (3.25 kg ai/ha = 16.25 lit/ha) and endosulfan 35EC (0.875 kg ai/ha = 2.5 lit/ha) applied at the seedling stages. Soil microarthropod population estimated at fortnightly intervals in the treated and untreated control plots revealed a general trend of adverse effect of the insecticides, prominently on the density and relative abundance of major prey groups like Collembola and Acari leading to notable decline in prey-predator ratio. Comparison of the percentage reductions of major taxonomic and trophic groups between pre-treatment and post-treatment intervals also demonstrated the ill effect of both heptachlor and endosulfan, notably on Collembola and the prey category. In the laboratory the survival success and fecundity of Cyphoderus javanus (Collembola) and Archegozetes longisetosus (Acari) were compared by exposing freshly emerged adults to sub-lethal concentrations of heptachlor and endosulfan for varying durations. The untreated control sets recorded high fecundity for both C. javanus and A. longisetosus, but chronic toxicity of the insecticides on adults confined to the treated soil resulted into very low fecundity. Even short duration exposure to heptachlor and endosulfan treated soil for 24 or 72 hours only was found to delay the egg-laying and decrease the fecundity of both the species. It is concluded that population responses and reproductive sensitivity in non-target soil microarthropods are potential eco-toxicological parameters for detecting pesticide pollution in soil and for ecological health assessment since the results are based on the bioactivity of toxicants.

A new method for isolation of leukocytes from the peripheral blood of amphibians [Bufo himalayanus, (Gunther)] and study of their surface morphology by scanning electron microscopy.

Using percoll as the density gradient, a new single step method to isolate leukocytes from the peripheral blood of amphibians (B. himalayanus) has been described. Isolated leukocytes were photographed under the scanning electron microscope and an attempt has been made to characterize the leukocyte population on the basis of surface morphology. Apart from regular blood cell types, B. himalayanus have slender, elongated and slightly curved leukocyte type cells in their peripheral blood. Such slender elongated cells were absent in the blood of a related species B. stomnaticus and hence could not be categorized under the known blood cell types.

Estimation of tear glucose level and its role as a prompt indicator of blood sugar level.

Tear glucose level was measured by glucose oxidase method to determine the relationship between tear glucose and corresponding blood glucose levels in 200 patients. It was observed that this test had a definite value in finding the hyperglycaemics semiquantitatively.

An unusual case of a retained metallic arrowhead in the orbit and sphenoidal sinus.

A case of retained metallic arrowhead in orbit and sphenoidal sinus through an unusual route is reported. The eyeball was removed because of a possible risk of sympathetic ophthalmia.

Revolutions in ophthalmology.

Cataract is the major cause of blindness worldwide. The transition of couching of cataract to most modem phaco-emulsification gained popularity with more scientific capsulorhexis. Ongoing research is taking place with laser technologies for removal of cataract. Surgery has an important role in advanced corneal diseases. Corneal transplantation is the most successful form. The refractive errors can be corrected by laser-assisted in-situ keratomileusis, intrastromal corneal rings and phacic intra-ocular lenses. Current research is going on to identify the gene responsible for glaucoma and once this is identified, medical therapy can be developed to control the disease. Thermocautery or photocoagulation and indenting the globe so as to bring the choroid nearer the break by scleral buckling forms the basis of modern surgery of retinal detachment. Vitreoretinal diseases, macular degeneration, diabetic retinopathy are no longer considered problematic. We are optimistic that more clinical breakthroughs are expected in the 21st century with new advances of ophthalmic researches.

Relationship of national highway with injecting drug abuse and HIV in rural Manipur, India.

Earlier study reported that about 1% of general population or urban Manipur was injecting drug users (IDUs). A study was conducted to observe the IDU prevalence in rural Manipur and the role of national highway (NH) in determining the IDU prevalence if any. It was also aimed to study the HIV prevalence among IDUs of different villages. Villages were startified in to 3 categories based on distance and communication facilities from the national highway, which cuts across the villages to the neighboring state, Nagaland. Villages close to NH had the highest IDU prevalence of 1.3% and remote villages had the least prevalence of 0.2% whereas villages in between the above mentioned two groups had a prevalence of 0.9%. It was surprisingly observed that HIV was uniformly distributed among the IDUs of all villages and ranged from 50-51%. This indicates that IDU prevalence at distance is predominantly determined by the presence of drug trafficking route/s like national highway whereas HIV prevalence is mainly determined by the needle sharing behaviour of IDUs.

A cross-sectional study on factors including HIV testing and counselling determining unsafe injecting practices among injecting drug users of Manipur.

In India, a steep increase in the prevalence of HIV (0% to 50% within six months) among the IDUs has been reported in Manipur, a north eastern state in 1990. In spite of large scale intervention program like educational campaign and widespread voluntary HIV testing in this state, the infection has quickly spread to the heterosexual population at large. The determinants of risk taking behaviors like sharing of unclean needle among the IDU population has been explored in this paper. A cross sectional study has been carried out among all of the 488 IDUs who attended any detoxification centers and prison during last two years at Imphal, the capital city of this state. Self reported behaviors based on the pre-scheduled interview were recorded and participation rate was satisfactory. The data was compared to a similar survey carried out by us in 1990. Although there has been decline in risk behavior among the IDUs, a logistic regression analysis reveals that unsafe needle sharing behavior is not influenced by the knowledge on HIV transmission, educational status or history of HIV testing or serostatus of the individual. The limitation of cross sectional nature of the study, bias due to collection of data in prison, self reported behavior, possible differences with street samples of the addict are discussed.

Clinical features of HIV infection in drug users of Manipur.

BACKGROUND. The human immunodeficiency virus was first detected in young intravenous drug users in Manipur in 1989 and it quickly reached a high prevalence in this group. Diagnostic facilities are scarce and it is thus important to suspect the presence of the infection by its clinical features. METHODS. We did a cross-sectional survey for 13 months among residents of different detoxification centres of Imphal, Manipur, to study the sensitivity, specificity and positive predictive values of different signs and symptoms occurring at the early phase of the infection. RESULTS. Most of the young injectors in this survey were found to be in the early phases (stage I 43%; stage II 32%; stage III 15% and stage IV 9.9%) of the World Health Organization clinical staging of human immunodeficiency virus infection and disease. Herpes zoster, oral candidiasis, pruritic papular eruptions, jaundice and lymphadenopathy had positive predictive values of 100%, 100%, 93%, 93% and 88% respectively. Cryptosporidial diarrhoea and tuberculosis (pulmonary and extrapulmonary) were also encountered. CONCLUSION. Intravenous drug users in Manipur who have human immunodeficiency virus infection suffer from different opportunistic infections which give rise to clinical features that are easily recognizable. It is important to be aware of these in areas which lack diagnostic facilities for confirming the infection.

Report of an outbreak of diarrhoeal disease caused by cholera followed by rotavirus in Manipur.

An outbreak of acute diarrhoeal disease between August and October 1985 in 3 districts of Manipur state was investigated amongst 9,29,077 population at risk. The overall attack rate and case fatality rate were 0.2% and 0.9% respectively. Hospital records revealed that 58.8% of cases occurred amongst older children above 5 years of age. V.cholera was isolated from 25.3% of cases sampled. Interestingly, increased frequency in weekly admission of cases amongst children during first two years of life increased in the beginning of October when the original peak of diarrhoeal outbreak was about to decline. The October peak was caused by rotavirus which could be detected from 50.0% of diarrhoeal children in this age group. This possibly reflected beginning of the usual rotavirus diarrhoea season in the locality.

Global review on ORT (oral rehydration therapy) programme with special reference to Indian scene.

This communication is an attempt to review the status and implementation of the Oral Rehydration Therapy in the programme for Control for Diarrhoeal Diseases. The Global and the Indian situations are separately discussed, with more emphasis on the latter. Use of Home Available Fluids (HAF), Salt Sugar Solution (SSS). Commercial packets of ORS and the Government supplied packets of ORS are also assessed.