Exploring the Clinical Variables among Drug-Dependent HIV-Positive Patients: Implications for Treatment Strategies

This study explored the profile of HIV positive patients seeking treatment at a tertiary care addiction treatment facility. A retrospective study was done to collet detailed information on clinical characteristics: drug use (type, age of initiation, duration), general medical condition and past treatment history. The study included 138 patients with mean (SD) age 30.2 (8.3) years. Opioid dependence with injecting drug use (IDU) was diagnosed in 97% of the patients. The median age of injecting onset was 24.5 years (IQR 20-31 years). The most frequently injected substances were pheniramine (60.1%) and buprenorphine (59.4%). Past treatment seeking was reported by 57% patients and interestingly they were less likely to present any medical condition (2 =69.611, p < 0.001). Variability in the age of onset of drug use indicates the need for broad based approach to prevent IDU and motivation to seek treatment may lead to better health conditions.

What are the options to implement an undergraduate medical exit examination in India?

Medical education and assessment processes in India are expected to undergo a paradigm shift with the introduction of the National Medical Commission Act, 2019. The Government of India intends to introduce a national exit test (NEXT) which is supposed to act as a single examination for graduation from medical school, granting licence to practice modern medicine, and allocating postgraduate residencies. As the nature, scope and stakes of these are different, various options regarding the content and conduct of the examination require careful consideration. We explore the options for implementation of this examination on a national scale. These options include theoretical (multiple assessment methods) with clinical examinations, multiple-choice question (MCQ)-based examination with separate clinical examination, only an MCQ-based examination, and multistep examination including screening followed by mixed assessment methods and clinical evaluation. We discuss the possible strengths and challenges of different options of implementing NEXT, and the caveats of the options.

Dealing with requests for faith healing treatment.

Faith healing practices are common in the Indian subcontinent, for remedying physical as well as psychiatric disorders. Patients and/ or their family members often resort to such treatment, especially when dissatisfied with the usual medical care or when the patient has a terminal illness. The application of the principles of medical ethics varies across cultures and time, and with the ethical principles to which a society subscribes. This write-up explores the various options available to healthcare professionals faced with patients and/or their family members who express a wish for faith healing services. The options discussed include outright rejection of faith healing practices, maintaining a distance or neutrality, endorsing such practices, and exploring the belief system of the patient and/or the family members. The various options are viewed from the lens of the principles of medical ethics.

Surreptitious use of disulfiram.

Disulfiram is one of the most important drugs used in the management of alcohol use disorders . It is of significance as a treatment modality especially in low and middle income countries like India, as it is a cheaper pharmacological option compared to other medications like naltrexone and acamprosate.

Suicidal behaviour in adolescents: what can be done?

Adolescents in India form a major proportion of the population. This age group encounters many stressful events which are more specific to this age group like need to perform in exams, compete for various professional courses, broken love affairs etc. Besides this is the age group for onset of major psychiatric disorders. All these factors make this population very vulnerable to suicidal behaviours. However, there is limited data with regard to suicidal behaviour in this population from India. There is an urgent need to study the various factors associated with suicidal behaviour and how suicidal behaviour can be prevented in this age group.