Prediction of endometrial pathology by measuring endometrial thickness with TVS in women with breast cancer on tamoxifen.

Background: Tamoxifen is given in women with breast cancer who underwent surgery and is receptor positive. As Tamoxifen increases the risk of endometrial carcinoma to 2% a screening technique such as transvaginal sonography is essential to identify women at risk of endometrial cancer. Aim: To identify endometrial pathology in women using tamoxifen after surgery for breast cancer Material and methods: Fifty women on tamoxifen for breast cancer attending the department of radiotherapy were screened once in six months by history taking, clinical examination and measuring endometrial thickness with TVS. Endometrial biopsy for histology was performed in women with endometrial thickness more than 11 mm Observation: Endometrial biopsy was performed in ten women who were found to have endometrial thickness > 11 mm. Out of ten, four had normal endometrium, three had simple hyperplasia one was found to have complex endometrial hyperplasia without atypia and two were reported to have inadequate endometrium. Conclusion: Routine screening with TVS is not a cost effective measure as tamoxifen induces subepithelial stromal hypertrophy resulting in minimal tissue yield on endometrial biopsy. Therefore bleeding should remain the primary trigger for investigation of women on tamoxifen.

Contact with HIV prevention programmes & willingness for new interventions among truckers in India.

Background & objectives: Systematic data on existing coverage and willingness for HIV prevention strategies among truckers are not readily available in India. The present study aimed to further the understanding on contact of truckers with existing HIV prevention services and to assess willingness for new HIV prevention strategies. Methods: A total of 1,800 truck drivers and helpers aged 16-65 yr passing through Hyderabad were approached to assess contact made with HIV prevention programmes, history of previous HIV testing and their acceptance for circumcision, oral HIV testing, new medications to control HIV (PrEP) and telephonic counselling. Dried blood samples were collected on filter paper and tested for HIV. Multiple logistic regression was performed for analysis of association between contact with HIV prevention programme and socio-demographic, sexual risk behaviour variables and work characteristics. Results: A total of 1,602 (89%) truckers gave interview and provided blood sample. Forty five truckers tested positive for HIV resulting in HIV prevalence of 2.8 per cent (95% CI 2.0-3.6%). Only 126 truckers (7.9%; 95% CI 6.5-9.2%) reported ever being contacted by staff providing HIV prevention interventions. Previous HIV testing was reported by19 per cent (95% CI 17.3-21.2%). Those reporting contact with HIV prevention programmes ever were more likely to have undergone HIV testing (odds ratio 3.6, 95% CI 2.4-5.4). The acceptance for pre-exposure prophylaxis (PrEP) was 87 per cent, oral HIV testing 98 per cent, and telephonic counselling 82 per cent, but was only 9 per cent for circumcision.Truckers who reported having sex with a man and those who halted regularly at dhabas were significantly more willing to undergo circumcision for HIV prevention (odds ratios 2.7, 95% CI 1.4-5.4 and 2.1, 95% CI 1.3-3.2, respectively). Interpretation & conclusions: Our findings showed that truckers had low contact with HIV prevention programmes, suggesting a need for urgent measures to reach this population more effectively. The willingness for new HIV interventions was high except for circumcision. These findings could be used for further planning of HIV prevention programmes for truckers in India

GC-MS Analysis of Bioactive Components of Aerial parts of Fluggea leucopyrus Willd. (Euphorbiaceae).

The present investigation was carried out to analyze the active constituents present in aerial parts of Fluggea leucopyrus (Euphorbiaceae). Fourteen compounds were identified by Gas Chromatography-Mass Spectrometry (GC-MS) analysis. The prevailing compounds were hexadecanoic acid ethyl ester (46.06%), lupeol (13.62%), vitamin E (8.70%), linoleic acid ethyl ester (5.78%), a-sitosterol (5.66%), 9,12- octadecadienoic acid (Z,Z)-, 2- hydroxy-1- (hydroxymethyl) ethyl ester (3.98%), stigmasterol (3.94%), phytol (2.70%), nonadecane, 2-methyl- (2.27%).

Leptospirosis in a midland rural area of Kerala State.

BACKGROUND & OBJECTIVE: Leptospirosis has been repeatedly reported from the State of Kerala since 1989 and is one of the commonest diseases among the 14 notifiable diseases in the district level communicable disease surveillance system. As there are no field studies on human leptospirosis in Kerala, we undertook this seroepidemiological study of leptospirosis in the two hamlets of Ernakulam district in Kerala to identify locally prevalent serogroups, and to understand local epidemiological features of the disease. METHODS: Blood samples were collected for five consecutive years from persons willing to subject themselves for the study from the selected areas (Kunnackal and Kunnakkurudy hamlets). Animal studies were conducted among samples from rodents captured from the area by the human volunteers themselves. Antibody titres were determined by microscopic agglutination test (MAT). The investigators inspected all the houses and surrounding land of the study subjects in this period. RESULTS: Of the 385 persons enrolled, 29.6 per cent showed evidence of past leptospiral infection. Many locally prevalent serogroups and changing patterns of prevalence in humans were identified in the five consecutive years of the study. The major serogroups were autumnalis, louisiana, australis, and grippotyphosa. Rodents showed 11 per cent seropositivity. Bandicoota indica showed the highest seropositivity (44.4%). INTERPRETATION & CONCLUSION: Our findings showed that the physical environment of the study area was favourable for prolonged survival of leptospires. Farming practices exposed the human volunteers to soil and surface water and leptospirosis is endemically present here. Majority of seropositive individuals in the community had only subclinical infection. Rodents were abundant and contributed to enzootic and endemic prevalence of leptospirosis.

Emergency department based HIV screening: an opportunity for early diagnosis in high prevalent areas.

The Emergency Medicine Department (EMD) is an ideal place for public health interventions and provides ready access to the health care system, offering a great opportunity for HIV testing and counselling. Between 2003 and 2005, rapid test was requested for 59.39% of 10,752 cases from EMD, where as ELISA was requested for 40.61%. Of the 317 HIV reactive cases, available medical records of 249 were reviewed for epidemiological and clinical information. Nearly 42% of total reactive cases detected in our Institute were from EMD. Three percent (317/10,752) were diagnosed as HIV reactive, 1.52% of the total samples were reactive by rapid test and the other 1.43% by ELISA. Two and half percent (163/6386) of those who had rapid testing and 3.53% (154/4366) who had ELISA testing, were identified as HIV reactive. All these cases were diagnosed within a mean EMD stay of 2.5 days. Eighty-five percent of HIV reactive individuals were unaware of their reactive status. Additional 53 cases of asymptomatic spouses were diagnosed as HIV reactive, thus making it possible to seek early treatment for HIV infection. The study emphasizes the importance of offering HIV testing to all patients who present to emergency department.

Prevalence of central nervous system cryptococcosis in human immunodeficiency virus reactive hospitalized patients.

Central nervous system cryptococcosis is an important cause of mortality among human immunodeficiency virus (HIV) reactive patients. A retrospective study was conducted on a total of 1,863 HIV reactive hospitalized patients suspected of cryptococcal meningitis. Three hundred and fifty-nine cerebrospinal fluid specimens of these cases were screened for various cryptococcal investigations. Thirty-nine out of 359 (10.86%) showed a definite diagnosis of cryptococcosis with a mortality rate of 25.64%. Prevalence of cryptococcal meningitis in the total HIV reactive cohort was 2.09%. Concurrent cryptococcal meningitis and tuberculosis was seen in 33.3% cases. A high index of clinical suspicion and routine mycological surveillance is required to help an early diagnosis and appropriate therapy, as majority of patients respond well to therapy if treated early.

Western blot profile in HIV infection.

BACKGROUND: Although the overall sensitivity and specificity of the western blot (WB) test for detection of antibodies to various viral proteins is high, there has been a substantial difference in the timing of the appearance of antibody bands and their intensities during different stages of HIV infection. AIMS: Mapping different band patterns of Western blot results and correlating them with stages of HIV infection. METHODS: We performed a retrospective study with 1,467 HIV-1 infected cases confirmed by WB test between January 2002 to July 2005, with the objective of mapping different band patterns of western blot results and determining whether the presence or absence of certain bands was associated with any specific stage of HIV infection. For the interpretation of the WB results in this study, the guidelines recommended by NACO, India were followed. RESULTS: Reactivity with all the bands was the most commonly observed WB pattern, occurring in 92.91% (1363/1467) of cases, whereas the other 7.09% showed uncommon band patterns. Of all individual bands, p31 band was the most frequently missing one, absent in 7.09% cases. On classifying the WB reactive cases by the WHO clinical staging system, 38.45% (564/1467) were in Stage 1, 47.99% (704/1467) in stages 2 and 3 and 13.56% in stage 4. Correlation of CD4 cell counts with the various uncommon band patterns showed that only 5.56% (4/72) had counts in the 200-500 cells/microl range, whereas 45.83% and 48.61% had counts of < 200 and> 500 cells/microl respectively. CONCLUSION: Interpretation of the WB band pattern in combination with clinical features may be occasionally useful in predicting the stage of HIV infection.

The association of t (13q, 14q) with Down's syndrome and its inheritance.

Cytogenetic analysis of the first child of an older couple afflicted with Down's syndrome revealed a Robertsonian translocation between the chromosomes 13, 14 in addition to trisomy 21. His mother was found to be a carrier of this translocation with no history of abortion.