Screening for HIV infection by health professionals in India.

BACKGROUND: Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS: We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS: A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION: There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.

Emphysematous pyelonephritis.

Emphysematous pyelonephritis is a severe form of acute pyelonephritis, characterised by fever, abdominal pain, nausea and vomiting, associated with intraparenchymal and perirenal gas production. It is often diagnosed radiologically, by plain films of abdomen, ultrasonogram and/or CT scan and often needs surgical drainage. We report a case which could be diagnosed clinically because of extensive surgical emphysema in a diabetic patient which was successfully managed by a combined medical and surgical approach.

Kinetics and mechanism of tolerance induction on acclimation of Villorita cyprinoides (Hanley) to copper and zinc.

The typical euryhaline clam Villorita cyprinoides (Hanley) was acclimated to copper and zinc at salinity 13 × 10-3 and < 1× 10-3 (fresh water). Acclimation enhanced the lethal tolerance, as denoted by dose-survival curves, which was more pronounced after zinc acclimation. In fresh water copper acclimation sensitized the organisms. The copper accumulation trend was significantly changed consequent to metal acclimation, especially after zinc acclimation, indicating some tissue metal regulatory effect. Acclimation to copper equiped the organism to survive for longer periods with increased body burden of copper, while zinc acclimation supressed the uptake of the more toxic ion copper. The earlier report of increased uptake of zinc by this organism during combined exposure with copper is corelated in the present context. The role of metallothionein like protein in providing protection against metal toxicity, the environmental implication of acclimation phenomena are indicated.

Raynaud's phenomenon and gangrene following snake envenomation.

Local necrosis and gangrene at the site of the bite are commonly observed after snake envenomation. However, Raynaud's phenomenon and gangrene occurring in a limb other than that bitten by the snake is encountered rarely. So far, there is only one report of such an episode in literature. Here we are reporting a case of patient with snake bite on the right foot following which he developed Raynaud's phenomenon of the left upper limb and dry gangrene of the tips of the left index and middle fingers. The snake was identified as Russel's viper.