RESUMO
Background : 20-30% of the Indian population suffers from at least one allergic disease that can have an adverse impact on the quality of life of the patients. Aim : To develop expert opinion-related guidance for the diagnosis and management of allergic disorders. Methodology : An advisory board meeting (hybrid mode) was conducted with 11panel members of the Indian Medical Association (IMA). The panel members discussed issues related to the management of allergic disorders based on the Delphi method. Result : Spirometry is helpful in selected patients of allergic rhinitis where the coexistence of asthma is suspected. In patients with urticaria second-generation antihistamines are preferred for both adults and children due to their low side effects, less drug-drug interaction, anticholinergic effects, longer duration of action, and higher safety. Diagnosis of allergic contact dermatitis can be made based on occupational and exposure history. In atopic dermatitis, patient education about lifestyle changes can prevent flare-ups. In patients with asthma, patients must be educated about the use of the peak flow meter. The diagnosis of food allergy can be made by correlating the food intake timing withthe patient history and the results of allergy testing. Allergic drug reactions can be treated with oral antihistaminic drugs, emollients, and if needed topical corticosteroids. Conclusion : The diagnosis of allergic disorders requires the clinician to consider the clinical presentation, patient history, presence of triggers, and comorbid conditions. Patient education and the new generation of antihistaminic drugs can improve the quality of life of patients with allergic disorders
RESUMO
Background & objectives: Failure to adhere to anti-retroviral therapy (ART) can lead to a range of unfavourable consequences impacting upon people living with HIV (PLH) and society. It is, therefore, paramount that ART adherence is measured in a reliable manner and factors associated with adherence are identified. Lack of such data from West Bengal necessitated undertaking the current study. Methods: Participants were included during August-October, 2011 from three Drop-In-Centres (DICs) from the three districts of West Bengal, India. ART-adherence was calculated by using formula based on pill-count and records collected from ART-card in possession of each of the 128 consenting adult PLH. Information on self-reported adherence, socio-demography, and adherence influencing issues was also collected through interviewer-administered questionnaire. Results: Of the 128 PLH, 99 (77%) and 93 (73%) PLH had ≥90 per cent and ≥95 per cent adherence, respectively to ART. Conversely, subjective reporting captured much higher proportion of PLH as ‘well adherent’; a finding having implications for ongoing ART programme. Factors, independently associated with poor adherence (<90%), were ‘7th to 12th month period of ART intake’ (adjusted OR=9.5; 90% CI 1.9 - 47.3; p=0.02) and ‘non-disclosure of HIV status to family members’ (adjusted OR=4; 90% CI 1.3 - 13; p=0.05. Results at 95 per cent adherence cut-off were similar. Interpretation & conclusions: Enabling environment, which would encourage people to disclose their HIV status and in turn seek adherence partners from families and beyond and ongoing adherence-counselling appear to be important issues in the programme. Relevance of these study findings in wider context is conceivable.