Lípidos anormales e inmunidad adquirida Síndrome de Deficiencia: Asociación de Suero Lípidos con estatus de VIH / Abnormal Lipids and Acquired Immune Deficiency Syndrome: Association of Serum Lipids with HIV Status

Context and Aim: Hematological abnormalities are amongst the most common complications of infection with HIV.There have been quite a few studies on the alterations in lipid profile, too, though the results have largely been inconclusive. The present study was carried-out to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Materials and Methods: The present study was designed as a cross-sectional, hospital-based study to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Evaluation of lipid profile was done using Erba EM 360, an automated analyzer powered by a diffraction grating photometer while CD4 cell counts were evaluated using Partec Cyflow Counter. Statistical analysis used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and posthoc Games-Howell test. p-value of <0.05 was considered statistically significant. Results: The levels of total cholesterol and low-density lipoproteins (LDLs) were significantly decreased while triglycerides and very low density lipoproteins (VLDLs) were significantly increased in the HIV infected and AIDS patients when compared with the sero-negative controls. Conclusion: Total cholesterol, LDLs, triglycerides and VLDLs were significantly altered in the HIV infected and AIDS patients when compared with the sero-negative controls.

Before reaching the last mile'- Knowledge, attitude, practice and perceived barriers related to tuberculosis directly observed therapy among ASH A workers in Central India: a mixed method study

Introduction: Community-based direct observed treatment [DOT] providers are an important bridge for the national tuberculosis programme in India to reach the unreached. The present study has explored the knowledge, attitude, practice and barriers perceived by the community-based DOT providers. Methods: Mixed-methods study design was used among 41 community-based DOT providers [Accredited Social Health Activist [ASHAs]] working in 67 villages from a primary health center in Raisen district of Madhya Pradesh, India. The cross-sectional quantitative component assessed the knowledge and practices and three focus-group discussions explored the attitude and perceived barriers related to DOT provision

Result: 'Adequate knowledge' and 'satisfactory practice' related to DOT provision was seen in 14 [34%] and 13 [32%] ASHAs respectively. Only two [5%] received any amount of honorarium for completion of DOT in last 3 years. The focus-group discussions revealed unfavourable attitude; inadequate training and supervision, non-payment of honorarium, issues related to assured services after referral and patient related factors as the barriers to satisfactory practice of DOT

Conclusion: Study revealed inadequate knowledge and unsatisfactory practice related to DOT provision among ASHAs. Innovations addressing the perceived barriers to improve practice of DOT provision by ASHAs are urgently required

Prevalence and Predictors of Unmet Needs among the Elderly Residents of the Rural Field Practice Area of a Tertiary Care Centre from Northern India

Background: Surrogate markers simple enough to be used by primary care workers have not been closely investigated by the community experts in rural Uttar Pradesh. We assessed the physical disabilities in activities of daily living (ADL) and unmet need in physical disabilities among rural elderly. Predictors of unmet needs in physical disabilities among the elderly were also identified. Methods: A community based cross-sectional study was conducted among elderly residents of the rural field practice area of a tertiary care centre in rural Uttar Pradesh. Three hundred and thirty five (335) participants aged 60 years and above from 9 villages were selected using the Probability Proportional to Size (PPS) sampling technique. Study tools were the proforma regarding socio-demographic details, socio-economic status and Stanford Health Assessment Questionnaire. Multivariate logistic regression analysis was performed to identify predictors of unmet needs. Results: 185 (55.2%) had physical disability in one or more activity limitation. Gender wise elderly females had more physical disability in one or more ADL categories than elderly males (66.8% vs. 42.0%). Almost one third (32.5%) of subjects had unmet need for one or more physical disabilities. the predictors of unmet needs that were identified in the study were female gender (P = 0.046), elderly aged 70 years and above (P = 0.032), those living alone (P = 0.035), low monthly family income (P = 0.044), financially fully dependent elderly (P = 0.0002), and those having 3 or more physical disabilities (P = 0.033). Conclusions: The findings of the study highlight that large number of needs of the disabled are still unmet. Greater, targeted efforts are needed to identify at-risk elderly people living in the community. These predictors would act as surrogate markers and can be easily used by primary care workers to plan and provide services to the elderly people in rural communities.

Recurrent Peripheral Giant Cell Granuloma: A Case Report.

Abstract: Peripheral Giant Cell Granuloma is a non-neoplastic, tumor-like, reactive lesion occurring exclusively on gingiva/alveolar crest. It is thought to arise from the periodontal ligament or periosteum. Clinically, it bears resemblance to pyogenic granuloma, peripheral ossifying fibroma and many other peripheral soft tissue lesions seen in the oral cavity, thereby making histopathology mandatory for the diagnosis of this lesion. The lesion although being relatively common still carries a lot of ambiguity. The ambiguity is in terms of its etiology, growth potential, biological behavior (recurrence), histogenesis of its cells as well as its treatment. The entity further holds significance because of its notorious behavior and its high tendency to recur. The present paper describes a case report on recurrent peripheral giant cell granuloma with a comprehensive insight of the literature on its clinical and histological aspects. Special attention has been given on the histogenesis of its cells and treatment of this lesion.

Frenectomy Using Diode Laser.

The labial frenum may impede oral hygiene and result in diastema between anterior teeth and traction of the attached gingiva. High coronal attachment is generally associated with a hypertrophy of the frenum. Labial frenectomy is a common surgical procedure in the field of oral surgery 1. Labial frenectomy is a procedure usually done for orthodontic reasons. Surgical removal of the frenum during puberty has been recommended for these patients 2. This article clinically evaluates the efficacy of a diode laser in removing the frenum in 10 patients using a diode laser at a power setting of 1.5 W or less in a continuous mode. The role of laser surgery in the oral cavity is well established. The use of diode laser in frenectomy has many advantages like no bleeding, no need for suture placement, and placement of orthodontic brackets that can be done on the same day itself.

The Relationship between Periodontal Disease and Glycemic Status of Type Ii Diabetic Patients in Indian Population.

Introduction: Diabetes mellitus is a clinically and genetically heterogeneous group of disorders affecting the metabolism of carbohydrates, lipids, and proteins. Diabetes mellitus (DM) and chronic periodontitis are common chronic diseases in adults in the world population. The association between periodontal disease and diabetes has long been hypothesized. Considering confirmation of treatment of periodontal disease positively influencing the glycemic control of Diabetes mellitus patients of great public importance because periodontal disease is both preventable and curable, the current study was planned. Improving periodontal health in a diabetic patient might improve their metabolic control and thereby decrease the associated morbidity and mortality. Aims and Objectives: To reveal whether the suggested association between periodontal disease and diabetes could be found in a Type 2 Diabetic Indian population, the present study was undertaken. Materials and Methods: This clinical study was carried out at the Department of Periodontology, Saraswati Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani. For assessing the effect of the periodontal treatments on metabolic control, no change in the medication or diet was made for the selected three groups during the study period. None of the groups received any additional guidance in managing their diabetic status. Statistical Analysis: The Student t-test was used to test the differences of age, sex and diabetic control methods between the treatment and control groups. The changes of PI, PPD, CAL and BOP values from baseline to 3rd month and 6th month within both groups were compared using unpaired t test. The significance of the metabolic parameters within the groups was assessed by unpaired t test. ANOVA were used to test changes from baseline and differences between the groups for any of the continuous variables assessed. Results: Results of this study showed that non-surgical periodontal treatment with and without antibiotic therapy (doxycycline) is associated with improved glycaemic control in type 2 DM patients and reduction of clinical parameters of periodontal infection, confirming the existing interrelationship between Diabetes mellitus and periodontal disease. Conclusion: The interrelationships between periodontitis and diabetes provide an example of systemic disease predisposing to oral infection, and once that infection is established, the oral infection exacerbates systemic disease. An improved communication between dentists / periodontists and physicians / endocrinologists is therefore warranted to work together to improve the management of Diabetic patients.

Immediate Implant Placement in Fresh Extraction Site: A Case Report.

Successful placement of dental implant into fresh extraction socket in single rooted tooth region has been reported. In cases of immediate implant placement in the single rooted tooth, initial primary stability is important to achieve predictable outcome. It is also suggested that the implant should be placed into minimum of 3 mm of solid bone apical to extraction site. The single stage approach preserves site morphology by protecting and supporting existing hard and soft tissues. Clinical success appears to be attributed to several important features of the technique which will be discussed in this case report. In the case presented, clinical and radiographic findings after implant placement confirmed a satisfactory treatment result.

Colposcopy: Gynecological vision in viewing oral lesions.

Context: The diagnosis of malignant and potentially malignant epithelial lesions of the oral mucosa cannot be based solely on clinical fi ndings. The histologic evaluation of a representative biopsy specimen thus becomes necessary. The site for biopsy however is always a subjective choice that sometimes raises doubts about its representativeness. So far, no simple and reliable method is available for the selection of the most appropriate area for biopsy. Colposcopy is helpful in the selection of these sites of epithelial dysplasia depending upon the vascular patterns. Aims: This study was planned to assess the role of Colposcopic examination in the selection of biopsy site in patients with varying grades of oral epithelial dysplasia at various sites. Settings and Design: One hundred and eighty patients between the ages of 30 and 60 years clinically diagnosed with leukoplakia and carcinoma buccal mucosa were included in the study. Materials and Methods: For each of the subjects, a thorough clinical examination followed by Colposcopic assessment was carried out for the selection of biopsy site from the involved mucosa. The histopathological fi ndings were then compared in the two cases and results analyzed. Statistical Analysis Used: The statistical analysis was performed using a paired t-test. Results: In our study, sensitivity and specifi city for the selection of biopsy site by Colposcopic examination was found to be higher for leukoplakia than for carcinoma buccal mucosa. Conclusions: It was concluded that Colposcopic examination was found to be signifi cant in the selection of biopsy site for leukoplakia while clinical criterion was found to be more appropriate for carcinoma buccal mucosa cases.

Gender perceptions and barriers towards their practice in underserved areas among medical students: a multicenter study

Objective: to understand and explore the perceptions of medical students towards their intention to practice in underserved areas and to identify the barriers restricting them to take up rural service

Material and Methods: 12738 medical undergraduate students from five different medical institutions were requested to fill questionnaires during May 2012 to April 2013. SPSS version 17 was used for analysis. Unpaired t test and Chi-square [x[2]] test were applied

Results: majority 1719 [64.6%] were not willing to practice in rural area. Rural-background students were more likely to indicate willingness for rural practice [p<0.001]. 'Easy/stress free life' and 'being respected as a doctor' were gender wise statistically significant potential benefits of working in a rural area. Connectivity problems, absenteeism of support staff, available living facilities, distant hometown, social life, low recognition of work, prestige of the job, sense of fulfilment, lack of good physical work environment, security problems and lack of recreational facilities were found to be statistically significant [p<0.001 ]. Seventy seven percent of males and almost seventy five percent of females identified "low salary" as an underlying factor

Conclusion: in spite of having positive view towards the importance of rural health care, certain aforementioned barriers prevent medical students to serve in rural areas. The findings can be utilized to design or modify the specific strategies to tackle the crisis of doctors in rural India

Phenytoin-Folate Interactions: How Far is Safe Folate Supplementation in Phenytoin Treated Epileptic Patients.

Chronic administration of phenytoin has been associated to have a number of adverse effects. Falling serum folate levels is one such most often reported adverse drug sequelae of long term phenytoin usage. Folates administered at pharmacological doses, on the other hand, have been blamed for a decrease in the serum concentration of phenytoin, severe enough to precipitate seizures. This review substantiated with references from various studies focuses on the folic acidphenytoin interaction and discusses the feasibility of using folate supplements to avoid such inadvertent drug sequelae in epileptic patients kept on chronic treatment with phenytoin.

Choroidal melanoma

Choroidal melanoma is the most common primary intra-ocular malignant tumor and second most common site of ten malignant melanoma sites in the body. Current diagnosis of choroidal melanoma is based on both the clinical experience of the specialist and modern diagnostic techniques such as indirect ophthalmoscopy, A-and B-ultrasonography scans, fundus fluorescein angiography, and transillumination. Invasive studies such as fine needle aspiration cytology can have significant morbidity and should only be considered if therapeutic intervention is indicated and diagnosis cannot be established by any other means. Several modes of treatment are available for choroidal melanoma. Multiple factors are taken into account when deciding one approach over other approaches, such as visual acuity of the affected eye, visual acuity of the contralateral eye, tumor size, location, ocular structures involved and presence of metastases. A comprehensive review of literature available in books and indexed journals was done. This article discusses in detail epidemiology, diagnosis, current available treatment options, and prognosis and survival of choroidal melanoma

Novel biochemical markers: early detection and prevention of malignant transformation a pilot study

The role of oxygen free radicals in the initiation, promotion and progression of carcinogenesis and the protective role of anti-oxidant defenses has been the subject of much speculation in the recent past with conflicting reports in the literature. In recent years, increasing experimental and clinical data have provided compelling evidence for the involvement of oxidative stress in a large number of pathological states including cancers. The aim of this study was to measure the concentration of serum total proteins and albumin as potent anti-oxidants in the sera of patients diagnosed with speckled leukoplakia, one of the oral pre-cancerous lesions reported to have significantly high malignant transformation rates and welldifferentiated oral squamous cell carcinoma. The study consisted of sera analysis of total protein and albumin levels in patients with speckled leukoplakia and histologically proven, well-differentiated oral squamous cell carcinoma. One way analyses of variance [ANOVA] was used to test the difference between groups. To find out which of the two groups' means were significantly different; post-hoc test of Scheffe was used. The study revealed variations in sera levels of albumin to be statistically significant. The results obtained emphasize the need for more studies with larger sample sizes to be conducted before a conclusive role for sera levels of total protein and albumin could be drawn as markers of transition from the various oral pre-cancerous lesions and conditions to frank oral squamous cell carcinoma.

Serum total protein, albumin and advanced oxidation protein products (AOPP) - implications in oral squamous cell carcinoma

Background: The role of oxygen free radicals in the initiation, promotion and progression of carcinogenesis and the protective role of anti-oxidant defenses have been the subject of much speculation in the recent past with confl icting reports in the literature. Objectives: The aim of this study was to measure the concentration/levels of serum total proteins, albumin and advanced oxidation protein products as markers of oxidative stress in sera of patients with an oral pre-cancerous lesion and frank oral cancer. Materials and methods: The study consisted of sera analysis of 30 new patients of histologically proven well-differentiated, oral squamous cell carcinoma and 10 patients, clinically diagnosed with a potentially malignant epithelial lesion, speckled leukoplakia, aged between 40 to 60 years, in addition to 25 healthy controls. One way analyses of variance were used to test the difference between groups. The normality of data was checked before the statistical analysis was performed. Results: The study revealed variations in sera levels of albumin and advanced oxidation protein products to be statistically signifi cant (p < 0.001). Conclusion: The results obtained emphasize the need for more studies with larger sample sizes to be conducted before a conclusive role could be drawn in favour of sera levels of total protein, albumin and advanced oxidation protein products as markers of diagnostic signifi cance and of the transition from the various oral pre-cancerous lesions and conditions into frank oral cancers.

Serum folic acid levels in epilepsy patients before and after phenytoin therapy

Background & Objectives: Low serum folate level is often reported as an adverse drug sequela of long term phenytoin usage seen with prolonged duration of phenytoin therapy. There is no previous study to prospectively track the serum folate level with usage of phenytoin, which is the objective of this study. Methods: Twenty-fi ve patients between the ages of 18-50 years diagnosed to have epilepsy and planning to start phenytoin were recruited in this study. Assessment of serum folic acid was done by chemiluminiscent method prior to the start of phenytoin and after 6 months of treatment. The serum folate level of 10 age and sex matched healthy control was also taken. Results: The average serum folate level was 7.48 + 2.04 ng/mL prior to the start of phenytoin therapy, which fell to 3.9 + 1.95 ng/mL after 6-month of phenytoin therapy (p-value <0.001). The average serum folate level for the age and sex matched 10 control samples was 14.46 + 2.81 ng/mL. Conclusion: A signifi cant fall of serum folic acid levels is seen in epilepsy patients after 6 months treatment with phenytoin.

Primary sebaceous gland carcinoma of the bulbar conjunctiva without involvement of eyelid: a clinical dilemma

Sebaceous gland carcinoma usually arises from the meibomain or Zeis glands within the eyelid, but tumor arising primarily from the conjunctiva, especially bulbar conjunctiva, is a rarity. We hereby report a case of a50-year-old female who presented with a painless mass in the inferior limbus, encroaching the cornea and hanging over the lower eyelid without involving it. Imprint cytology was suggestive of adenosquamous carcinoma. management consisted of wide local excision, cryotherapy to tumor bed, and topical 5-fluorouracil [5-FU] 1% preoperatively and postoperatively. Histopathologic analysis was in favor of sebaceous gland carcinoma. This case suggests that although sebaceous gland carcinoma commonly originates as a lid tumor, it can present as a bulbar conjunctival mass. Topical 5-FU is a viable and efficient cost-effective alternative for neo-adjuvant and adjuvant treatment of sebaceous gland carcinoma