Assessment of Isoniazid Preventive Therapy and Incidence of Tuberculosis among People Living with Human Immunodeficiency Virus Seeking Care in an Anti-retroviral Therapy Center, Puducherry.

BACKGROUND: One in three deaths among people living with human immunodeficiency virus (PLHIV) is due to Tuberculosis. Isoniazid preventive therapy (IPT) was implemented in antiretroviral therapy (ART) center Puducherry in July 2017. OBJECTIVES: We have determined the proportion of PLHIV who were eligible, initiated, completed IPT and also the incidence of tuberculosis before and after implementation of IPT. MATERIALS AND METHODS: It was a facility based longitudinal descriptive study. All PLHIV, aged 10 years and above, seeking care in ART Centers was included. The number of PLHIV eligible, initiated and completed IPT was summarized as proportion with 95% CI. RESULTS: Among the registered PLHIV (999), the proportion of PLHIV those were found eligible for IPT was 93% [95% CI (91.24%-94.67%)] and initiated on IPT was 92% [95% CI (90.20%-93.95%)]. Completion rate of IPT was 96.3% [95% CI (94.59%-97.63%)]. CONCLUSION: Initiation of IPT was relatively less among newly registered PLHIV as compared to older cohort of PLHIV.

Degloving injuries of the abdominal wall.

OBJECTIVE: To stress the local, regional and global impact of degloving injuries of abdominal wall based on which the surgeon can design the management protocol. METHOD: A retrospective series of seven cases who met with high velocity run-over accidents between the year 2002 to 2007. All patients were clinically examined and the findings confirmed radiologically, which guided the management. RESULTS: Out of the seven patients treated, six survived. All patients had open degloving injury of abdominal wall and in different areas of the lower limbs, while three had an additional closed degloving in the back, thighs and gluteal regions. All of them had pelvic fractures of various types. Three patients had peritoneal injury, of whom one had additional diaphragmatic injury. None of them had hollow viscus perforation or injury to solid viscera despite the varied severity of injuries to the abdominal wall, pelvic bone and diaphragm. CONCLUSION: Degloving injuries of the abdominal wall are rarely encountered in our practice. The associated morbidity and mortality are very high. However, the prognosis can be improved by successful revival and rehabilitation of these patients, which is possible by early resuscitation, recognition of all bony and soft tissue injuries, early debridement and coverage.

Three cases of Arcanobacterium pyogenes-associated soft tissue infection.

Arcanobacterium pyogenes is an established but often unrecognized human pathogen. A. pyogenes may also be misidentified as Arcanobacterium haemolyticum, which gives remarkably similar results in conventional biochemical tests. In this study, we have reported three cases of wound infections associated with A. pyogenes and also on the bacteriological characteristics which are relevant for identification of these isolates. The negative reverse CAMP test, the ability to produce acid from xylose and to hydrolyse gelatin and the positive beta-glucuronidase test clearly differentiated A. pyogenes from other closely related species. All three isolates were uniformly susceptible to penicillin, ampicillin, amoxicillin-clavulanic acid, ceftriaxone and gentamicin, variably susceptible to tetracycline and erythromycin and uniformly resistant to cotrimoxazole. Only a few confirmed cases have been reported throughout the world and therefore the diagnostic evaluation of this organism is emphasized.

Milker's callus.

Calluses are a diffuse area of hyperkeratosis occurring as a normal physiological response to chronic, excessive pressure or friction on the skin. They can be distinctive occupational stigmata when they occur on the hands. Herein we report the occurrence of calluses of the thumb in professional milkers as an occupational dermatosis.