Health-related quality of life among people living with HIV/AIDS on highly active antiretroviral treatment: A questionnaire-based study

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization’s Quality of Life?HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years(mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson’s Chi-squared test showed no statistically significant (P > ?) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

A Prospective Study on Mycology of Eye Infection in a Tertiary Care Teaching Hospital

Background: Objectives: Fungi are commonly found in the environment and most of them are either commensals or nonpathogenic. Eye infections are caused by bacteria, viruses and less commonly by fungi, therefore not given much attention by the practitioners and also by ophthalmolog ists. In the last one - decade incidence of fungal eye infections has increased due to increase in the number of patients with poor immunity. Common conditions which impair the immunity are prolonged use of steroids and antibacterial broad - spectrum antibioti cs, use of immunosuppressive drugs in cancer patients, in patients with organ transplant and some infections like AIDS. Candida, Fusarium and Aspergillus are the fungi frequently found to be associated with fungal eye infections. Trauma is the most signifi cant predisposing factor particularly when accompanied by contamination with vegetable matter. Methods: Samples such as corneal scrapings, Conjunctival swab, Vitreous & Aqueous aspirates were collected aseptically and sent to microbiology laboratory for KO H wet mount examination and fungal culture. KOH preparation was examined directly under microscope and culture were done on SDA, incubated at 25° c for three weeks. Results: Males were more commonly infected (66.5%) as compared to females (33.5%) The overall positivity in direct microscopy ( KOH preparation) was 32% while positivity in culture was 51%.The most frequently isolated fungus was Fusarium (16) followed by A. flavus ( 07), A. fumigatus (06), Candida sp.(06) and Curvalaria (03) Conclusion: If medical therapy fails to control the infection, surgery should be considered to save the eye visual function before the progression of disease.

Cichorium intybus from India: GC-MS Profiling, Phenolic Content and in vitro Antioxidant Capacity of Sequential Soxhlet Extracted Roasted Roots

Abstract Research on the bio-activities and chemical composition of roasted C. intybus roots from India is very little. In present studies GC-MS analysis of volatile components of roasted C. intybus roots, phenolics and flavonoid content estimation and antioxidant potential of roasted C. intybus roots was carried out. Antioxidant potential was also evaluated using FRAP, DPPH, hydroxyl radical, nitric oxide and superoxide free radical scavenging method. Extracts were prepared by sequential Soxhlet extraction. GC-MS analysis of volatile components of roasted C. intybus root extracts revealed that 5-hydroxymethyl furfural was major volatile component in dichloromethane and methanol extract whereas lupeol and its derivative compounds were major constituents of hexane extract. Quantitative estimation for total phenols and flavonoids showed that the methanol extract of C. intybus roots contained highest phenolic and flavonoid content as compared to other extracts and also showed strong radical scavenging activities which were comparable with ascorbic acid used as standard. All extracts showed IC50 values less than 0.6 mg/mL furthermore, extracts of roasted C. intybus showed the high total antioxidant potential for the reduction of Fe3+ to Fe2+. The C. intybus roots possess good antioxidant capacity even after roasting and all the extracts showed good activities.

Eruptive pseudoangiomatosis - cherry angiomas with perilesional halo

Eruptive pseudoangiomatosis is a rare viral exanthem characterized by acute onset of hemangiomata-like lesions, however, histological findings are distinct from that of true angiomas. This entity has been reported from Europe, North America, Japan, and Korea till date. Here, we report 12 cases of eruptive pseudoangiomatosis from a tertiary care hospital in Punjab.

Eruptive pseudoangiomatosis - cherry angiomas with perilesional halo

Eruptive pseudoangiomatosis is a rare viral exanthem characterized by acute onset of hemangiomata-like lesions, however, histological findings are distinct from that of true angiomas. This entity has been reported from Europe, North America, Japan, and Korea till date. Here, we report 12 cases of eruptive pseudoangiomatosis from a tertiary care hospital in Punjab.

Study Of Clinical Outcomes In Patients With Severe Hepatic Injury: Experience At A Tertiary Care Centre.

Background: Management of liver trauma earlier used to be primarily surgical. With advancement in diagnostic modalities it has gradually shifted to non operative management. Methods: The present study was conducted on 40 patients with severe hepatic injuries (grade 3 onwards). All the patients were compared in terms of various methods adopted for their management and their clinical outcomes Results: Out of a total of 40 patients, maximum numbers of patients were in age group 18-24 years. 82.50 % patients had grade IV and rest had Grade V. 12 patients presented with shock on admission. Failure of NOM (non operative management) was seen in 25% of cases . The average requirement of blood transfusion in our study was 2.157 1.74 units. Average hospital stay in successful NOM cases was lower than in failed NOM. A total of 6 patients had to be operated upon in our study. Active bleed was seen on laparotomy in four patients with no evidence of any injury causing peritonitis. Conclusion: The success rates of non-operative management were significantly higher than the failures rates of non-operative management, without any significant incidence of complications and delayed laparotomies. Grade of liver injury or the amount of hemoperitoneum as detected on CT scan did not influence the outcome of non-operative management. Non-operative management is thus the gold standard in hemo-dynamically stable patients.

Management of Fingertip Injuries.

Abstract Fingertip injuries are one of the most common injuries sustained by human beings owing to various reasons as domestic, occupational, road traffic accidents or due to violence. The injury to the fingertip needs proper assessment and reconstruction so as to provide the proper tissue replacement.we describe our experience of 50 patients of fingertip injuries requiring reconstruction using one or other modality over a period of three years presenting to our hospital.

Pharmacokinetics of Nevirapine, Stavudine and Lamivudine in Indian HIV-infected Children Receiving Generic Fixed Dose Combinations.

Objective: To determine the trough and two hour plasma levels of nevirapine, stavudine, and lamivudine when administered in fixed dose combinations (FDC). Design: Cross sectional Setting: Tertiary care hospital in Northern India. Participants: 79 HIV-infected children receiving antiretroviral therapy with FDCs for more than month. Intervention: Two-point sampling (0 and 2 hours after the morning dose). Outcome measures: Plasma concentrations of all three drugs were simultaneously assayed by liquid chromatography/mass spectroscopy. Results: Majority (77%) of children were receiving fixed dose combination of stavudine, lamivudine, nevirapine in the ratio of 6:30:50mg. The median (IQR) trough and 2-hour plasma levels (µg/mL) of nevirapine, stavudine and lamivudine were 5.2 (4.0, 6.3) and 7.9 (6.0, 9.7); 0.1 (0.06, 0.16) and 1.1 (0.59, 1.6); 0.1 (0.02, 0.2) and 2.5 (1.4, 3.1), respectively. Very few children had sub-therapeutic plasma drug levels of stavudine (2.5%), lamivudine (7.6%) and nevirapine (10%). Inadequate viral suppression at 6 months follow up was significantly associated with initial high viral load, low CD4 percentage at the time of enrolment in study, and lower doses of lamivudine and stavudine. Conclusion: The currently available generic pediatric fixed dose antiretroviral combinations in India provide adequate drug exposure in majority of children.

Molecular understanding of lung cancers-A review

Lung cancer is considered to be the most common cancer in the world. The purpose of this paper is to review scientific evidence, particularly epidemiologic evidence of overall lung cancer burden in the world. And molecular understanding of lung cancer at various levels by dominant and suppressor oncogenes.

Pulmonary Manifestations in HIV Seropositive Patients and Their Correlation with CD4 Counts in a Tertiary Care Centre of North India.

The prolonged course of human immunodeficiency virus (HIV) infection is marked by a decrease in the number of circulating CD4+ T helper cells and persistent viral replication, resulting in immunologic decline and death from opportunistic infections. The study was conducted in HIV Seropositive Patients admitted in our hospital. Demographic profile of the patient was recorded along with history, examination, investigations and evaluated for pulmonary manifestations and correlated with the CD4 counts. Age of HIV positive cases ranged from 21 to 74 years, male: female ratio was 3:1. Commonest mode of transmission was heterosexual sex (77%) followed by IV drug abusers (13.3%). Commonest X- ray finding was Infiltrates (33.3%) followed by pleural effusion (8%) and miliary mottling (5.3%). Commonest pulmonary diagnosis was pulmonary tuberculosis in 22.6% cases, followed by pyogenic pneumonia in 14.67% and pneumocystis carinii pneumonia (PCP) in 5.3% cases. Extrapulmonary tuberculosis was present in 16% of the cases. Pulmonary tuberculosis and pyogenic pneumonia was present in over wide range of CD4 count but their incidence has increased as the CD4 count declined. The knowledge of the CD4 count level in HIV patients is extremely useful in making differential diagnosis and suggesting a diagnostic and therapeutic plan.

Pleomorphic adenoma of minor salivary gland: a case report

Introduction : World literature suggests salivary gland tumors account for less than 3% of the head and neck tumors and benign pleomorphic adenoma of minor salivary glands arising de novo is very rare.Objective,case report and Conclusion: A case of pleomorphic adenoma of minor salivary glands in the buccal mucosa in a 55 year-old female is discussed. It includes review of literature, clinical features, histopathology, radiological findings and treatment of the tumor, with emphasis on diagnosis. The salivary glands may present with a diverse range of lesions presenting a challenge to even the most experienced clinician and pathologist. Resection with surrounding dispensable normal tissues is the key to successful treatment of such tumors.

Loss of CD127 & increased immunosenescence of T cell subsets in HIV infected individuals.

Background & objectives: HIV infection is characterized by a perturbation in T cell homeostasis, leading to alteration in T cell subsets. In addition to alteration in differentiation, HIV infection also leads to change in T cell survival and regenerative capacity, as suggested by differential expression of CD127 and CD57. We evaluated the expression patterns of CD127 and CD57 on CD4 and CD8 effector, memory and naïve T cell subsets in HIV-infected and uninfected individuals. Methods: We characterized T cell subsets based on expression of these markers, and compared their expression pattern in HIV infected subjects and uninfected controls. We further assessed therapy generated changes in these subsets and expression of CD127 and CD57 on them. Results: There was a generalized decrease in naïve CD4 and CD8 T cells in HIV infected subjects. These changes in T cell subset distribution were related to antigen load. CD127 expression was significantly reduced in T cells from HIV infected subject. In association to this, HIV infected subjects had higher percentage of T cell subsets expressing CD57. Increased CD57 and reduced CD127 expression correlated with plasma viraemia and CD8 T cell activation state. Incomplete restoration of T cell subset proportions was observed, despite suppression of viral replication and increase in CD4 T cell counts. Further, the improvement was more pronounced in CD127 expression. Interpretation & conclusions: HIV infected subjects have reduced T cell regenerative capacity along with increased senescence, highlighting decreased proliferation and effector activities.

Co-dependency and Marital Adjustment in Depression.

Living with a depressed spouse can be burdensome as it poses the greater distress in the marital life. Present paper examines these aspects as marital adjustment and codependency in 30 subjects, 12 male and 18 female with depression. BDI, Marital Adjustment Questionnaire and Span-Fisher Co-Dependency scale were used to assess the marital adjustment and codependency. However, study could not pickup any statistically significant correlation between depression and marital adjustment, depression and codependency and marital adjustment and codependency.

Role of Yogic Exercises in Bipolar Affective Disorder and Schizophrenia.

The science of Yoga, is an old system of traditional relaxation involving the exercise and other prevailing healing practices originated in India. Philosophically, it is based on the union of mind, body, and spirit of the individual. Aim of the present study was to examine the efficacy of yogic exercises among psychiatric inpatients admitted in the ward for the severe mental illness. Method: Fifteen patients in the age range of 20-40 years, diagnosed as having Schizophrenia or Bipolar Affective Disorder (ICD-10 DCR criteria) were included and were given yogic exercises therapy for two months besides treatment and compared to a control of fifteen psychiatric inpatients with the same age, diagnosis and receiving same treatment. They were assessed using Brief Psychiatric Rating Scale (BPRS) and Social-Adaptive Function Evaluation (SAFE) scale. Results revealed significant improvement in the study group on various domains of SAFE compared to the control group after one month with continuation of therapy. It is apparent that Yogic exercises therapy may be effective in the improvement of adaptive functioning which in turn affected the psychological wellbeing of the patients. The study has clinical implications for effective use of this therapy in preventing relapse among the psychotic patients.

Yoga and Cognitive Behaviour Techniques for Academic Stress and Mental Wellbeing among School Students.

There are many stressors acting upon school children. Today in the era of increasing competitiveness,a child is overloaded with daily living stresses, and he lives a tight rope existence trying to cope up with the tremendous pressures from all institutions, whether it is school, family or society. These are resulting in various stress related ailments and psychological problems, which poses threat and challenges for the physical as well as mental wellbeing of the school going children. The present work was an attempt to measure one of the major source of stress,i.e. academic stress and mental wellbeing of a sample of school children and then to provide an intervention plan for a selected group of students who are having high academic stress and poor mental wellbeing. Certain specific Asanas, Mudras and Pranayams of Yoga were combined with some specific techniques of Cognitive Behaviour therapy (C.B.T.) to reduce the academic stress and to enhance the mental wellbeing of the selected group of school children. The results have shown a significant relief from academic stress and significant improvement in the mental wellbeing of these children. Detailed methodology and results are discussed in this paper. This paper highlights the efficacy of Yoga in combination with certain techniques of C.B.T. in enhancing overall wellbeing of school children.

Gut prolapse into the perineum in a case of sexual assault.

A six-year-old female victim of sexual assault, with grade IV perineal injury with massive intestinal prolapse out of the perineum, is reported to highlight the severity of injury during sexual assaults.

Gastric zygomycosis--an unusual cause of massive upper gastrointestinal bleed.

We report a 62-year-old man with cardiac failure and acute renal failure, who had massive hematemesis. Upper GI endoscopy showed a large gastric lesser curvature ulcer. Billroth II gastrectomy specimen showed fungal invasion. He received amphotericin B postoperatively, and recovered uneventfully.