Search

The objective of this study was to clinically evaluate and compare the efficacy of the vestibular incision subperiosteal tunnel access (VISTA) technique using Bio-Gide (Geistlich) membrane enhanced with GEM 21S (Osteohealth) with periosteal pedicle graft (PPG) using a coronally advanced flap. Multiple gingival recession sites in 15 individuals were randomly assigned either to experimental site A (VISTA) or experimental site B (PPG) in a split-mouth design. The clinical parameters were recorded at baseline and 9 months postoperatively. Repeated measures analysis of variance with post hoc Bonferroni correction and paired t test were used to assess statistical significance (P < .05). Mean recession depth significantly decreased from 4.21 ± 1.08 mm (presurgery) to 0.61 ± 0.92 mm (9 months) with VISTA (87.37 ± 17.78% root coverage) and from 4.17 ± 1.18 mm (presurgery) to 1.16 ± 0.92 mm (9 months) with PPG (71.84 ± 19.25% root coverage). Width of keratinized tissue and clinical attachment gain were significantly higher in the VISTA group compared with the PPG group. Within the limits of the study both VISTA and PPG groups resulted in a significant amount of root coverage. The VISTA technique was less invasive and required minimal time and clinical maneuvering. It also resulted in a superior esthetic outcome. [ABSTRACT FROM AUTHOR]

The need to increase the predictability of periodontal regeneration has encouraged clinicians and researchers to employ cell-stimulating proteins in combination with osteoconductive scaffolds, based on the principles of tissue engineering. The purpose of this clinical and radiographic study was to compare the regenerative potential of the combination of β-tricalcium phosphate (β-TCP) and recombinant human platelet-derived growth factor BB (rhPDGF-BB) in the grafting of intraosseous defects with the established technique of bone grafting with β-TCP alone. A total of 30 sites from 15 patients with infrabony defects in two different quadrants were selected, and the sites were randomly divided into test sites (rhPDGF + β-TCP) and control sites (β-TCP alone) using a split-mouth design. Clinical parameters, including probing pocket depth, clinical attachment level, and gingival recession, were recorded at baseline, 6 months, and 9 months. Radiographic evaluation was carried out to evaluate defect fill, change in alveolar crest height, and percentage of defect fill at baseline, 6 months, and 9 months. Both the experimental groups showed statistically significant reduction in probing pocket depth and gain in clinical attachment level. On intergroup comparison, sites treated with rhPDGF + β-TCP demonstrated a significantly greater pocket depth reduction (P < .05) and greater gain in clinical attachment level (P < .01). Mean percentage defect fill was significantly greater in test sites as compared with control sites at 6 and 9 months (P < .01). rhPDGF + β-TCP-treated sites demonstrated a significant gain in mean alveolar crest height at 6 and 9 months (P < .05), while β-TCP-treated sites demonstrated crestal resorption. Both groups demonstrated potential in enhancing periodontal regeneration; however, on comparison between the two groups, the results obtained by rhPDGF + β-TCP were significantly better with respect to both clinical and radiographic parameters. [ABSTRACT FROM AUTHOR]

Objective: The present study was carried out as a multicenter, randomized controlled, split-mouth clinical trial to evaluate the efficacy of locally delivered lycopene on periodontal health and gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG) in smokers and nonsmokers compared with periodontally healthy control subjects. Method and Materials: One hundred ten subjects including 50 smokers, 50 nonsmokers, and 10 controls participated in this study. Subjects in the smoker and nonsmoker groups had contralateral sites treated with lycopene gel and a placebo. Clinical parameters included recording site-specific measures of plaque, gingivitis, probing depth, and clinical attachment level. GCF 8-OHdG values were analyzed using a commercially available ELISA kit. Results: Compared with the placebo, lycopene-treated sites in smokers and nonsmokers showed significant reductions in probing depths and gain in the clinical attachment levels. However, there was no statistically significant difference in the clinical parameters when lycopene-treated sites in smokers and nonsmokers were compared, except for the reduction in the 8-OHdG levels. The 8-OHdG levels at 1 week and 3 months in sites treated with lycopene in the smoker and nonsmoker group were comparable with those in the periodontally healthy control group. Conclusion: The gel formulation was effective in increasing clinical attachment and reducing gingival inflammation, probing depth, and oxidative injury compared with the placebo in smoking and nonsmoking subjects. [ABSTRACT FROM AUTHOR]

Background: Of the occupational hazards experienced by dental professional worldwide, work-related musculoskeletal disorders (WRMSDs) are quite common. Research in the past has recognized that musculoskeletal disorders in dentistry contribute considerably to sick leave, reduced productivity, and dentist attrition. Considering the magnitude of these disorders, an attempt has been made to determine the prevalence and associated factors of various WRMSD.Aim: The aim of this study was to investigate the prevalence of self-reported, work-related musculoskeletal problems regarding the perception of pain, over the preceding 12 months and also to identify associated factors which might influence pain among dentists.Subjects and Methods: A self-administered questionnaire was personally handed over to a select sample of practicing dentists in Visakhapatnam, Andhra Pradesh. The survey was performed using the Nordic Musculoskeletal Questionnaire.Results: This study revealed musculoskeletal pain with a frequency of 56% in the neck, 39% in the hand, 32% in the lower back, and 18% in the shoulder regions. Chi-square test showed a significant association between pain in the neck and gender, age, height, and weight (P < 0.05). Pain in lower back was associated with gender, body mass index (BMI), height, and experience (P < 0.05). Pain in the hand was only related to the experience of the dentist (P < 0.05).Conclusion: Within the limits of the study, the prevalence of WRMSD among dentists in Visakhapatnam, especially involving the neck, hand, lower back, and shoulders, is high. Gender, age, height, and weight, BMI and experience were found to be related with musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Elasmolomus sordidus (F.), commonly called sesame seed bug, which is a severe pest of sesame during the preharvest stage and storage. In sesame storage warehouses, it is found hiding inside the gaps of arranged bag stacks during day time and it flies out and feeds on the seeds during night time. Studies were conducted for 8 weeks in a private sesame warehouse in Virudhunagar district of Tamil Nadu, India, to find out whether TNAU- UV light trap attracts E. sordidus during night hours. The studies showed that TNAU - UV light trap was found effective for mass trapping adults of E. sordidus. The weekly mean of E. sordidus adults trapped per UV light trap during the experimental period was 380.38±15.13. [ABSTRACT FROM AUTHOR]

Powdery mildew is an important disease in blackgram which causes severe yield loses. Screening of 15 lines along with LBG 17 resistant check for powdery mildew under artificial inoculation identified 3 lines having 0-2% plant disease incidence and grouped under 0-1 disease score. PCR reactions using different primers with genomic DNA of these lines resulted in identification of three resistant sources with specific amplification for resistance to powdery mildew at 900bp with OPT16 primer. Considering the powdery mildew reaction and resistance linked RAPD marker, it was possible to identify the new resistance sources in a short time and they could be utilized in breeding programme or for direct release. [ABSTRACT FROM AUTHOR]

In the past few years, SHGs have been receiving large loans from banks under the SHG-Bank Linkage Programme. According to NABARD (2007), SHGs that were linked to banks for credit during 2006-2007, have received an average loan of Rupees 58,079 per SHG. The SHGs established earlier received a loan of Rupees 1,00,000 to 3,00,000. The present article focuses on how the SHGs have utilised these large loans, repaid them and the changes which have occurred at the household and SHG levels. [ABSTRACT FROM AUTHOR]

Socioeconomic development of mankind and well-being depend on the environment and the way in which development influences the environment. Thus, environment and development are interdependent. In fact, economic development is closely linked with the development of resources. These resources can be classified into three categories: public goods, semi-public goods (also known as common property resources) and private goods. In poor countries common property resources make a valuable contribution to the sustainable livelihoods of rural populations. The impact of globalisation on the commons shows various patterns of ownership, control, use and misuse. The commons were subjected to degradation as well as conservation in the process of centralized management in India. After the reform period, the administration of natural resources was given significant attention by specialized departments such as the Forest Department and the Revenue Department. All the land, apart from private land, was regarded as state property and controlled by the state. This paper highlights the need to examine the common property resources sector in the context of wider economic policy reform processes in the Indian economy. [ABSTRACT FROM AUTHOR]

The Annular Solar Eclipse (ASE) occurred on December 26, 2019, which was visible at most of the South Indian subcontinents with greater than 80% obscurity, particularly during the morning hours, and it played a crucial role in the atmospheric dynamics. For the first time, the ground-based measurements have used to investigate the fluctuations of air temperature, relative humidity, atmospheric pressure, wind speed and direction, UV-A radiation, and turbulence parameters on solar eclipse day over a semi-arid region, Anantapur, in Southern India. The Surface Layer (SL) meteorological parameters have abruptly changed on eclipse day (December 26, 2019) as compared to the control day (December 27, 2019). During eclipse day, the near-surface air temperature was significantly decreased (1.12 °C), and relative humidity increased (14.63%) after 60 min of the beginning of the eclipse, which mainly due to cooling the surface. The atmospheric pressure has reduced by 0.9 hPa during the eclipse period, and the winds speed also reduced to 0.92 ms−1 due to the stabilization of Atmospheric Boundary Layer (ABL) and cooling in the SL. The turbulence parameters, including those are Sensible Heat Flux (SHF), Momentum Flux (MF), and Turbulent Kinetic Energy (TKE) have also reduced from 99.37 to 0.91 Wm-2, 0.38 to 0.03 Nm−2, and 1.47 to 0.37 m2s-2, respectively during the eclipse day, which mainly due to eclipse cooling effect diminishing the turbulence in Atmospheric Surface Layer (ASL). The lowest values (0.18 ms−1) of friction velocity were observed during the eclipse day, and the Monin–Obukhov stability parameter showed a significant variation in the atmospheric from weakly unstable to neutral conditions during the eclipse day. The vertical wind speed showed downdrafts during the eclipse and even after the eclipse due to subsidence of air. The investigation revealed that the ABL dynamic process and turbulence processes are affected due to cut off of solar radiation and make the SL cooling. • The significant reduction of temperature has noticed during the eclipse. • The UV–A radiation showed 16.85 Wm-2 decreased at the maximum phase of the eclipse. • The TKE has reduced to 0.37 m2s-2 due to the turbulence weakening on the eclipse day. • The stability parameter reached zero at the peak phase of ASE during the eclipse day. [ABSTRACT FROM AUTHOR]

Background & objectives Cancer is a leading cause of death worldwide and constitutes a public health priority. Delays in diagnosis and treatment of cancer can adversely impact survival, recovery, and cost of treatment. The objective of this study was to estimate the proportion seeking timely care among those having early warning signals for oral, breast or cervical cancer and to explore the facilitators and barriers to early detection. Methods The study was conducted among 241 participants, including those having early signals for selected cancers and women who underwent opportunistic cervical cancer screening in the selected health facilities. Information regarding symptom appearance, presentation to any registered medical practitioner, confirmatory diagnosis, and treatment initiation were obtained from medical records. In-depth Interviews (IDIs) were conducted among six participants to explore facilitators and barriers to cancer detection. Results Among 7300 people screened using the Community Based Assessment Checklist (CBAC), 128 (1.7%) had warning signals for any one of the cancers. The percentage of people who sought medical care for oral, breast and cervical cancer symptoms were 80 per cent, 82 per cent and 57 per cent, respectively. Among those who underwent opportunistic cervical cancer screening in health centres (113), the screen positivity rate was 11 per cent, and adherence to referral for confirmation was 80 per cent. The median pre-diagnostic and diagnostic delays for the three cancers were 79 [Interquartile range (IQR): 44-126] and 27 (IQR: 13-73) days. One individual was diagnosed with oral cancer, and the treatment delay was 27 days. Facilitators identified for early seeking of care were encouragement by family and low-cost treatment at public facilities. Major barriers identified were neglect of symptoms by participants and their responsibilities towards family. Interpretation & conclusions Although very few people were identified to have early warning symptoms using CBAC, a substantial proportion of them sought medical care and underwent confirmatory diagnosis. Screen positivity rate and treatment-seeking behaviour were better among women undergoing opportunistic cervical cancer screening in the health centres. Measures need to be taken to improve health literacy among people to reduce diagnostic delay for cancers.

Purpose: Colorectal cancer (CRC) in young adults is a rising concern in developing countries such as India. This study investigates clinicopathologic profiles, treatment patterns, and outcomes of CRC in young adults, focusing on adolescent and young adult (AYA) CRC in a low- and middle-income country (LMIC)., Methods: A retrospective registry study from January 2018 to December 2020 involved 126 young adults (age 40 years and younger) with CRC. Patient demographics, clinical features, tumor characteristics, treatment modalities, and survival outcomes were analyzed after obtaining institutional ethics committees' approval., Results: Among 126 AYA patients, 62.70% had colon cancer and 37.30% had rectal cancer. Most patients (67%) were age 30-39 years, with no significant gender predisposition. Females had higher metastatic burden. Abdominal pain with obstruction features was common. Adenocarcinoma (65%) with signet ring differentiation (26%) suggested aggressive behavior. Limited access to molecular testing hindered mutation identification. Capecitabine-based chemotherapy was favored because of logistical constraints. Adjuvant therapy showed comparable recurrence-free survival in young adults and older patients. For localized colon cancer, the 2-year median progression-free survival was 74%, and for localized rectal cancer, it was 18 months. Palliative therapy resulted in a median overall survival of 33 months (95% CI, 18 to 47). Limited access to targeted agents affected treatment options, with only 27.5% of patients with metastatic disease receiving them. Chemotherapy was generally well tolerated, with hematologic side effect being most common., Conclusion: This collaborative study in an LMIC offers crucial insights into CRC in AYA patients in India. Differences in disease characteristics, treatment patterns, and limited access to targeted agents highlight the need for further research and resource allocation to improve outcomes in this population.

Hepatitis B is a major co-infection among people with HIV (PWHIV) worldwide. There is a paucity of data on HBV genetic diversity in India, which would be useful for targeted preventive and management interventions. To characterize the distribution of HBV genotypes and sub-genotypes, samples of 180 HIV-HBV co-infected individuals from a study previously conducted to estimate the prevalence of HBV co-infection were analyzed. Nested PCR using type-specific primers was used to identify the various HBV genotypes. Partial HBV S sequences were generated for a subset of samples using Sanger sequencing. Mutation analysis was done using the online HBVseq program. PCR based genotyping documented D (69.4 %) and A (5.6 %) to be the major genotypes in the study population. Infection with multiple genotypes was observed in 25 % co-infected individuals. D2, D5, A2, and A1 were the sub-genotypes detected. Mutations 184K and 173L were identified. HBV genotypes/ sub-genotypes play a pivotal role in the clinical outcome of chronic hepatitis B (CHB). Therefore, monitoring of CHB cases is needed to track disease progression, including early detection of hepatocellular carcinoma., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: India has a diverse cultural heritage, with a wealth of indigenous folk games that are culturally ingrained. Due to the ease of acquisition, low costs, and widespread acceptability, this form of games can be incorporated to facilitate and improve physical fitness among children with neurodevelopmental disabilities. Hence this study focuses on the analysis of the therapeutic benefits of traditional Indian folk games. Objective: To explore the therapeutic benefits of traditional Indian folk games. Methodology: Ten traditional Indian folk games were selected through purposive sampling and videotaped on skilled players. Each game was analyzed by two observers based on an operationalized conceptual model by using a six-point Likert scale. Results: Functional domains of the game have been identified and listed by using the operationalized conceptual model. Conclusion: Folk games encompass a variety of functions and can potentially be used for therapeutic purposes in children with neurodevelopmental disabilities.

The prevalence of mosquito vector borne diseases and the resistance of mosquitoes to conventional pesticides have been of important public concern to the mosquito endemic countries. Present study was conducted to identify the native bio-larvicidal potential of the entomopathogenic nematodes; Steinernema siamkayai (KPR-4) Heterohabditis indica (KPR-8), Steinernema glaseri and Steinernema abbasi. The isolated nematodes were subsequently cultured and evaluated their larvicidal potential against the larvae of Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus. Among the tested four different nematode species, the S. abassi exerted the highest mortality against A. aegypti (97.33%), the H. indica (KPR-8) against A. stephensi (97.33%) and the S. siamkayai (KPR-4) against C. quinquefasciatus (98.67%). The maximal mosquito-larvicidal property of EPNs was found with the LC 50 and LC 90 values (IJs/larvae): S. abbasi = 12.47 & 54.35 on A. aegypti; H. indica KPR-8 = 19.88 & 66.81 on A. stephensi and S. siamkayai KPR-4 = 16.69 & 58.97 on C. quinquefasciatus, respectively. The presently generated data on the molecular and larvicidal characteristics of the entomopathogenic nematodes form an important baseline data that upon further research would lead to the development of eco-friendly mosquito-control agent., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: Development of an easy to use tool for the assessment of Developmental Coordination Disorder that is applicable to Indian children., Methods: The steps for instrument development were followed stringently. In order to ensure the robustness of the tool, psychometric properties were determined with 127 children attending various schools. The Winsteps program was used to analyze data for a Rasch model analysis., Results: The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) analysis showed an acceptable limit. The real item separation reliability of 4.84 demonstrates that the items of this tool create a well-defined variable., Conclusion: This study met the objectives that it attempted to. The final tool consists of two versions- the Assessment Battery for Children with coordination Disorder-Short Version (ABCD-SV) consisting of 12 items, and the ABCD-FV consisting of 20 items. ABCD fulfills criterion A and B of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria for Developmental Coordination Disorder (DCD).

We compared the pharmacokinetics of rifampicin (RMP) during daily and intermittent (thrice weekly) anti-tuberculosis treatment in human immunodeficiency virus infected tuberculosis patients. Patients treated with a thrice-weekly regimen had significantly lower plasma peak concentration, area under the time concentration curve from 0 to 24 h and higher oral clearance of RMP than those treated with the daily regimen. The median values were respectively 3.7 and 6.4 μg/ml (P < 0.001), 20.7 and 29.4 μg/ml.h (P = 0.03) and 21.7 and 15.3 ml/min (P = 0.03).

A commercially important fish, wahoo Acanthocybium solandri (Cuvier, 1832) (Scombridae), was collected to study the infestation of parasites from Parangipettai landing center, Tamil Nadu, southeast coast of India for a period of one year from January to December 2011. A total of 644 fish were captured and screened for parasites. Off 644 fish, 270 were infested by a parasitic copepod Lernaeenicus seeri Kirtisinghe, 1934 (Siphonostomatoida: Pennellidae) on the body surface. It is a mesoparasite, since the head and neck are inserted and attached to the muscle by making a wound/hole on the body and the rest of the parasite body with the egg sacs hanging outside. Prevalence was recorded as 42.29% with mean and maximum intensity at 3.22 and 33, respectively. Seasonal study showed that the prevalence was highest (62.82 %) during postmonsoon. Simultaneously, some of the fish (n = 144) were internally observed for the presence of parasites and we found that 101 fish were infested with an endoparasite digenean Hirudinella ventricosa (Pallas, 1774) (Hirudinellidae) in the stomach. Prevalence was recorded as 70.9%, and mean intensity of 1.62 and maximum intensity of 3 were also noted. The overall percentage of both copepod and digenean infestation were recorded as 60.42%. The infestation was high in postmonsoon season for both parasites. This is the first record of L. seeri from Indian waters and the second record of occurrence worldwide. Significant interactions were observed between season and infestation of both parasites (P<0.05).

We examined the occurrence of odontoma in the marine fish Sphyraena jello sourced from 3 different landing centers (Cuddalore, Parangipettai and Nagapattinam) in Tamil Nadu (southeast India). A total of 19783 fishes were examined for odontoma presence, of which 2393 were affected with odontoma. The overall prevalence was 12.1% among the 3 stations. Fish landed at Parangipettai showed the highest peak prevalence of odontoma (16.8%) during the pre-monsoon, followed by Nagapatinam (9.1%) during summer 2011. The tumour lengths in premaxilla, supermaxilla and dentary bone were 1.1-3.6, 1.4-5.9 and 1.2-4.1 cm, respectively, and tumour widths were 0.3-1.9, 0.7-3.1 and 0.5-1.9 cm. Higher prevalence (0.206%) of tongue tumour along with odontoma was observed at Nagapattinam whereas it was lower (0.162%) at Cuddalore. Odontoma histopathology showed dense fibrous tissue with fine teeth roots. TEM analysis showed virus-like particles associated with odontoma. Radiography of the odontoma showed that the tumour masses were bony in nature and tissues were merged with upper and lower jaw.

Setting: Rifabutin (RBT) is reported to be as effective as and to have less inducing effect on cytochrome P450 enzymes than rifampicin against tuberculosis (TB). The optimal dose of RBT during ritonavir (RTV) co-administration remains a matter of debate., Objective: To study the pharmacokinetics of 150 mg RBT thrice weekly during concomitant atazanavir/RTV administration in human immunodeficiency virus (HIV) infected TB patients., Methods: This observational study was conducted in 16 adult HIV-infected TB patients being treated for TB with an RBT-containing regimen and an antiretroviral therapy regimen with RTV; the dose of RBT was 150 mg thrice weekly. Serial blood draws were performed at pre-dosing and at 1, 2, 4, 6, 8, 12 and 24 h after the drug was administered. Plasma RBT was estimated using high-performance liquid chromatography., Results and Conclusions: Peak RBT concentration was below the lower therapeutic limit (<0.3 μg/ml) in seven patients, while 10 patients had trough concentrations below the minimal inhibitory concentration against Mycobacterium tuberculosis (0.06 μg/ml), suggesting that the RBT dosage may be inadequate. Prospective studies in different settings are required to arrive at the proper therapeutic dose for RBT to be used during co-administration with RTV.

Background: The incidence, manifestations, outcome and clinical predictors of paradoxical TB-IRIS in patients with HIV and culture confirmed pulmonary tuberculosis (PTB) in India have not been studied prospectively., Methods: HIV+ patients with culture confirmed PTB started on anti-tuberculosis therapy (ATT) were followed prospectively after anti-retroviral therapy (ART) initiation. Established criteria for IRIS diagnosis were used including decline in plasma HIV RNA at IRIS event. Pre-ART plasma levels of interleukin (IL)-6 and C-reactive protein (CRP) were measured. Univariate and multivariate logistic regression models were used to evaluate associations between baseline variables and IRIS., Results: Of 57 patients enrolled, 48 had complete follow up data. Median ATT-ART interval was 28 days (interquartile range, IQR 14-47). IRIS events occurred in 26 patients (54.2%) at a median of 11 days (IQR: 7-16) after ART initiation. Corticosteroids were required for treatment of most IRIS events that resolved within a median of 13 days (IQR: 9-23). Two patients died due to CNS TB-IRIS. Lower CD4(+) T-cell counts, higher plasma HIV RNA levels, lower CD4/CD8 ratio, lower hemoglobin, shorter ATT to ART interval, extra-pulmonary or miliary TB and higher plasma IL-6 and CRP levels at baseline were associated with paradoxical TB-IRIS in the univariate analysis. Shorter ATT to ART interval, lower hemoglobin and higher IL-6 and CRP levels remained significant in the multivariate analysis., Conclusion: Paradoxical TB-IRIS frequently complicates HIV-TB therapy in India. IL-6 and CRP may assist in predicting IRIS events and serve as potential targets for immune interventions.

In this study, a massive infestation of the sea snake Enhydrina schistosa by the cymothoid isopod Nerocila serra, commonly parasitizing fishes, is reported for the first time from India. This isopod was found attached on the different parts of the body of the snake. According to the month, the parasitic prevalence ranged from 30.8 to 55.3%, increasing during the monsson period. It was higher in female than in male snakes.

Study Design: This study was carried out as a postal survey., Objectives: The aim of this study was to ascertain employment after paraplegia in India., Setting: This study was conducted in India., Methods: The study was conducted by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organisations. Data analysis was carried out by using descriptives., Results: The return rate was 46% (276/600) and the employment rate was 41% (114/276). Among 114 subjects who were employed, 68 (59.6%) were living in centres run by armed force and 46 (40.4%) were living in specialised centres or under the region of non-governmental organisations., Conclusions: Individuals who were employed were living either in centres run by armed force or in specialised centres. None of the individuals living in community was employed.

Study Design: A postal survey., Objective: To ascertain the incidence of pain in individuals with paraplegia in India and to associate it with demographic characteristics., Setting: India., Method: The study was done by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organizations. Data analysis was done by using non-parametric tests of association., Results: The return rate was 46% (276/600). Fifty-seven percent of individuals complained of pain. Of this, pain in the back and chest ranked the highest (30.1%), followed by pain below the level of lesion (6.9%), pain in the shoulder and upper limb (4.7%) and neck (0.4%). Fifteen percent of individuals complained of pain at multiple sites. We found a significant association of pain with age, duration since injury and ambulation., Conclusion: More than half of the subjects complained of pain in the study. Pain was found to be associated with age, duration since injury and ambulation. As pain has a dramatic effect on a subjects' quality of life, there is a need to evaluate it in detail and treat accordingly with preventive, rehabilitative or surgical procedures.

Background: Estimation of CD4 cell count remains the primary monitoring tool in assessing efficacy or failure of Anti Retroviral Therapy (ART) under national program conditions in India., Aims: To study the average trajectory of CD4 cell count after two years of initiation of potent ART and to find the determinants of CD4 progression over time., Settings and Design: A prospective cohort study under program conditions. Materials and Methods : Adult ART naïve patients, receiving drug regimens consisting of two NRTIs and one NNRTI were studied for CD4 progression. Laboratory monitoring included the baseline and follow-up CD4 cell count, hemoglobin level and absolute lymphocyte count estimation. The change in CD4 cell count, hemoglobin and bodyweight was calculated from the baseline to the latest follow up measurements. Statistical Analysis : Survival curve using Life table methods was plotted. Comparison between survival curves was done using Tarone-Ware statistics. Generalized estimating equation with exchangeable correlation structure was done to find the risk factors for CD4 progression. Results : Among 7,934 HIV positive patients in the ART program, one-year cohort of 714 adult patients who had completed two consecutive follow-up CD4 values were assessed. Those with baseline CD4 < 100 had cumulative probability of survival 85%, 82%, 82% and 82% at 12, 24, 36 and 42 months respectively. Those who had baseline CD4 count between 100-199 had cumulative probability of survival 96%, 93%, 92% and 90% at 12, 24, 36 and 42 months respectively (P < 001). Lower the CD4 count ( 100) lower the hemoglobin values. Conclusions : CD4 progression continues two years after ART in patients who had base level > 100 cells. Early initiation of ART is necessary before CD4 crashing to < 100 cells for increasing the survival function.

Background: Highly Active Antiretroviral Therapy (HAART) was introduced in National AIDS Control Programme in 2004 to reduce the morbidity and mortality among those affected with HIV/AIDS. Tuberculosis, being an important coinfection, its emergence/occurrence in post-HAART period has potential implications., Objective: Primary objectives were to study the incidence of post-HAART tuberculosis in HIV patients and to identify the possible risk factors. It was also intended to understand the clinical and immunological profile of this important condition., Methodology: Eligible adults and adolescents with HIV disease enrolled on HAART at Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai, from April, 2004 to March, 2007, formed the study population. They were monitored and screened for the occurrence of tuberculosis after commencing HAART. Clinical details and immunological profile of these patients were analysed., Results: Two hundred and sixty-two patients (5.1%) of 5099 patients followed-up for one to four years were found to have Post HAART TB with 100-person year risk of 2.83. Post HAART TB occurred predominantly in men (67.6%) and in 31-44 years age group (69.8%) with 100-person year risk being 3.26 and 2.83 respectively. Pulmonary, Extra-pulmonary and disseminated tuberculosis were found to occur in the frequencies of 78%, 16% and 6% respectively. A total of 144 patients (54.9%) developed tuberculosis within six months and this number increased to 202 (77%) by 12 months. 230 patients (87.7%) had base level CD4 cell count < 200 / mm3., Conclusion: Tuberculosis was found to occur pre-dominantly in adult male patients with HIV during the first year after the initiation of HAART. Significantly, occurrence of Post HAART TB remained almost the same (5%) among patients treated for TB prior to the initiation of HAART.

Background & Objective: Human immunodeficiency virus (HIV) is severely affecting the poorly educated and economically disadvantaged in Indian society. When children start developing clinical manifestations, needing treatment, they have to travel long distances for accessing care and support at tertiary institutions. This places an extra burden on patients, who are already struggling to cope with their illness. Sufficient data are needed for the government to evolve appropriate policy for providing care to the children affected with HIV. We undertook this study to present the socio-demographic characteristics, signs and symptoms, clinical profile, distance travelled and follow up pattern of HIV positive children who accessed care for the first time in a referral hospital at Chennai, India., Methods: Electronic medical records from patients diagnosed with HIV between 2002 and 2004 at the Government Hospital for Thoracic Medicine (GHTM) in Tambaram (Chennai) in India were analyzed to understand care-seeking behaviours. Demographic variables such as age, sex, education and occupation, data on clinical manifestations were examined together with geographic information., Results: At GHTM 1,768 new paediatric patients accessed care from 2002 to 2004. Children aged less than 5 yr were 49.9 per cent; 1115 children had (63%) tuberculosis. Significantly, 14.9 and 20.6 per cent children had extra-pulmonary TB and disseminated TB respectively. Lower respiratory infection (15.8%), Pneumocystis carinii pneumonia (15.20%), oral/oesophageal candidiasis (13.5%), wasting (6.1%) and diarrhoeal disorders (3.5%) were the common clinical manifestations. In all 47 per cent children traveled between 200-400 km from home and 14 per cent travelled over 400 km., Interpretation & Conclusion: Our findings showed that tuberculosis should be regarded as the indicator disease for HIV infection in children, especially when they have clinical manifestations of progressive, non pulmonary and disseminated disease. The primary and secondary health care centres should have the trained capacity to diagnose and treat HIV disease and opportunistic infections so as the children to have much needed care and support nearer to their residence.

Study Design: Postal survey from August 2004 to May 2006., Objective: To ascertain the morbidity trends in individuals with paraplegia in India and to find its association with demographic characteristics., Settings: India., Methods: The questionnaire was mailed to the identified individuals (n=600) whose addresses were obtained from the medical records section of our hospital and by contacting non-government organizations (NGOs), working for individuals with paraplegia in various cities. The causes of morbidities surveyed were respiratory complications, use of catheter, pressure sores, spasticity, postural hypotension, pain and fractures. Data were analysed using nonparametric test of association (Goodman Kruskal Tau)., Results: A total of 276 (46%) individuals responded. Of all the morbidities studied, pain was the leading cause (57.2%) followed by spasticity (39.1%), pressure sore (28.3%), postural hypotension (10.1%), respiratory complications, and fractures (5.8%). We found significant associations between various morbidities and demographics and between morbidities themselves., Conclusion: The most common cause for morbidity was pain. Ambulation reduced the incidence of secondary complications.

Study Design and Subjects: Retrospective descriptive analysis of data of patients with spinal injuries admitted to a tertiary referral medical center from January 1, 2003 to December 31, 2004., Objectives: To identify the demographic profile of patients with spinal injuries admitted in this hospital., Setting: Medical records department, Kasturba Hospital, Manipal, Karnataka, India., Methods: A total of 207 patients with traumatic and non-traumatic spinal injuries were included in the study. The patient characteristics that were included were age groups, neurologic status, mode and neurological level of injury, management and recovery pattern., Results: Ratio of men to women who sustained spinal injuries was 3.6:1. The maximum number of patients was in the age range of 20-39 years. The different levels of spine that sustained injuries were cervical spine (36.2%), thoracic spine (34.3%) and lumbar spine (29.5%). There were 118 patients with neurological deficit. Mechanisms of injury recorded were fall from height (58.9%), fall of weight (7.2%), motor vehicle accidents (21.3%) and non-traumatic causes (12.6%). Of these 207 spinal injury patients, 74.4% were managed conservatively, whereas 25.6% patients were managed surgically., Observation: This study gives a preliminary overview of the characteristics of patients with spinal injuries in this hospital.

Objectives: To study the incidence and risk factors for failure of treatment with antiretroviral therapy among adults in the national treatment program in India, and to estimate the possible number of persons living with human immunodeficiency virus (HIV) who will need a second-line treatment regimen in the next 3 and 3.5 years., Design and Setting: Data of a cohort of HIV-positive adult patients, who were enrolled in the government-sponsored antiretroviral therapy program, were obtained from the electronic medical record system of the largest HIV care center in India and subjected to analysis., Main Outcomes: Treatment failure defined by the World Health Organization criteria, assessed immunologically on the basis of CD4 T cell count, with a minimum period of 12 months of follow-up and with a minimum of two CD4 T cell follow-up measures., Results: The cumulative incidence of treatment failure in the 1370 adult patients included in the study was 3.9% (95% confidence interval [CI] 2.9 to 4.9). Men had a 3.5 (1.6 to 7.4) times significantly greater risk of treatment failure. Patients who had negative changes in absolute lymphocyte count, hemoglobin concentration and body weight had 3.1 (1.6 to 6.2), 3.2 (1.6 to 6.2), and 3.5 (1.9 to 6.4) times significantly greater risk of treatment failure. In India, after 2007, by 2, 3, and 3.5 years, respectively, an estimated 16 000, 35 000, and 51 000 patients receiving antiretroviral therapy are likely to require second-line treatment., Conclusion: Monitoring of hemoglobin concentration, absolute lymphocyte count, and body weight during follow-up emerged as inexpensive predictors of treatment failure in a resource-poor setting. A significant number of patients will need second-line therapy as a result of failure of their first-line antiretroviral therapy regimen in 3 and 3.5 years in India, and therefore the development of an appropriate policy for second-line drugs is urgently needed.

The autonomy of patients in making medical decisions is increasingly recognised globally, but is not fully adhered to in India. Information is the first step for a patient to be able to make a decision on his or her health care. The objective of this survey was to ascertain patients' perspectives on the amount of information given to them by health professionals. The results of interviews with 222 patients show that perspectives vary, often according to the diagnosis. The amount of information given and the manner in which it is given are often not acceptable to the patient.

We studied the effect of rifampicin on steady-state pharmacokinetics of nevirapine and the impact of increasing the dose of nevirapine on its peak (Cmax) and trough (Cmin) levels in 13 HIV-infected patients on regular antiretroviral treatment with nevirapine-containing regimens (200 mg twice daily). A baseline pharmacokinetic study was conducted and repeated after 1 week of daily rifampicin (450/600 mg). The study was repeated in 7 of 8 patients who had subtherapeutic Cmin nevirapine levels after increasing nevirapine dose to 300 mg twice daily. Liver function was monitored. Rifampicin caused significant reductions in Cmax (42%), Cmin (53%), and exposure (46%) of nevirapine (P <.01). The Cmin of nevirapine fell below the therapeutic range of 3 microg/ml in 8 of 13 patients. An increase of nevirapine to 300 mg twice daily raised Cmin to therapeutic range in all 7 patients without exceeding the toxic level of 12 microg/mL. There were no clinical or laboratory adverse events. Our findings suggest that decreased bioavailability of nevirapine because of rifampicin coadministration could be overcome by increasing the dose of nevirapine from 200 to 300 mg twice daily without short-term adverse events. Further studies to evaluate the long-term safety of higher dose of nevirapine are required.