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Background: The relationship among HIV, HPV, and development of CIN is complex and incompletely understood. Present study is undertaken to find out the prevalence and relationship of abnormal cervical cytology and HPV infection in HIV positive women.Methods: This was a cross-sectional, case control study conducted on 95 HIV seropositive and 95 seronegative women. Specimen was collected from the cervix for HPV DNA testing, subtyping and cytology.Results: HPV DNA positivity was higher in seropositive group (18.6% vs. 7.4%). Premalignant conditions were found only in seropositive group. At CD4 count <249 HPV DNA positivity was 53%, at 250-499 the percentage of HPV DNA positivity was 31% and at >500 HPV DNA positivity was 19%.Conclusions: Prevalence of abnormal cytology and HPV DNA positivity is higher amongst HIV positive women and there is an association between HPV DNA positivity with lower CD4 counts.
RESUMO
Introduction: Teaching hospital is one of the apex bodies of Indian hospital system, which is catering to much desired healthcare needs of both rural and poor urban society. Objectives: The study examines the status of Indian teaching hospitals both government and private in the changing global scenario by assessing the gaps in their management practices based on three core parameters, i.e. human resource management, quality improvement and patient safety, and communication and patient relation through their adherence to documentation and policy with respect to the expected norms nationally and internationally. The standards were chosen from Joint Commission of International Accreditation (JCIA) in concurrence with National Accreditation Board for Hospitals and Healthcare Providers (NABH) to ensure comprehensiveness and appropriateness to Indian environment. Design and settings: Eleven teaching hospitals were selected from the 6 divisions of Maharashtra (minimum 1 from smaller division and 2 or above from larger division). The medical superintendent was interviewed from each 11 hospital. The responses were given scores, such as 10, 5, 0 (full, partial, no compliance). Results: The overall scores for policy/documentation were 6.29 ± 1.96, 5.00 ± 3.06 and 2.95 ± 2.48 for HRM, quality and communication respectively, among teaching hospitals. Moreover, there were significant gaps among all 6 standards of human resource management (HRM) [F(5,60) = 24.217, p < 0.001], quality/ safety [F(5,60) = 21.524, p < 0.05] and communication [F(10,55) = 10.455; p < 0.05] on their own. Indeed, these hospitals were found to be significantly behind the global standards. Conclusion: Teaching hospitals comply with norms of staff, qualifications and department-wise infrastructure as part of Medical Council of India (MCI) regulations, which is prerequisite for global standards. So by designing hospital’s policies with inclusion of some cost-effective approaches, these hospitals can attain quality services.
RESUMO
M-mode echocardiography has been accepted as gold standard for measuring left atrial (LA) size. Electrocardiography (ECG) offers a simple, non-invasive, cost-effective and reproducible method to assess LA size and it is mostly in agreement with echocardiography though discrepancies exist. ECGs and echocardiograms were obtained in 100 consecutive patients suspected of having left atrial enlargement due to different underlying heart diseases. The diagnostic accuracy of six ECG criteria of LA enlargement were evaluated comparing with LA size in M-mode echo study. Various criteria were found to be poor to mildly sensitive (8% to 78%) but highly specific (85% to 100%) for left atrial enlargement. Morris Index (PTFV1) was found to be the best criterion having 76% sensitivity and 92% specificity. Combination of criteria enhances the sensitivity at the cost of specificity. Overall predictive index of electrocardiogram for left atrial enlargement is not encouraging.