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Donovanosis is a chronic genital ulcerative disease caused by the intracellular Gram-negative bacterium Klebsiella granulomatis, reported more frequently in people living with HIV/AIDS (PLHA). Here we present a case of relapsing donovanosis in a PLHA on second line antiretroviral therapy who had episodes of transient unexplained decrease in CD4 counts associated with rapid growth of the lesion and non-responsiveness to treatment followed by clinical resolution coinciding with recovery of the CD4 count.

Millions of people participate in online peer-to-peer support sessions, yet there has been little prior research on systematic psychology-based evaluations of fine-grained peer-counselor behavior in relation to client satisfaction. This paper seeks to bridge this gap by mapping peer-counselor chat-messages to motivational interviewing (MI) techniques. We annotate 14,797 utterances from 734 chat conversations using 17 MI techniques and introduce four new interviewing codes such as chit-chat and inappropriate to account for the unique conversational patterns observed on online platforms. We automate the process of labeling peer-counselor responses to MI techniques by fine-tuning large domain-specific language models and then use these automated measures to investigate the behavior of the peer counselors via correlational studies. Specifically, we study the impact of MI techniques on the conversation ratings to investigate the techniques that predict clients' satisfaction with their counseling sessions. When counselors use techniques such as reflection and affirmation, clients are more satisfied. Examining volunteer counselors' change in usage of techniques suggest that counselors learn to use more introduction and open questions as they gain experience. This work provides a deeper understanding of the use of motivational interviewing techniques on peer-to-peer counselor platforms and sheds light on how to build better training programs for volunteer counselors on online platforms., Accepted at CSCW 2022

Type 2 leprosy reaction (T2LR), or Erythema Nodosum Leprosum (ENL), often poses a therapeutic challenge to clinicians and commonly requires long courses of steroids for control. While immunosuppressants are known to achieve control and lower steroid dependence in T2LR, the prospect of managing a severe T2LR in conjunction with COVID-19, with the concern of worsening COVID-19 with long-term immunosuppression has not previously been encountered. We report a case of severe T2LR treated with oral steroids and methotrexate, with COVID-19 infection acquired during hospital stay, and a favourable outcome achieved despite the continued use of immunosuppressants. We discuss the possible reasons for this both in terms of the drug pharmacodynamics and the immunological profile of T2LR.

ImportanceWith worldwide emergence of recalcitrant and resistant dermatophytosis, itraconazole is increasingly being used as the first-line drug for treatment of tinea corporis/cruris (TCC). Apparent inadequacy with low doses has led to empirical use of higher doses and antifungal combinations.ObjectiveTo compare cure rates, treatment durations, safety profiles, and relapse rates of itraconazole 100, 200, and 400 mg/d for the treatment of TCC.Design, Setting, and ParticipantsThis double-blind randomized clinical trial included adult patients with treatment-naive TCC involving at least 5% body surface area. Patients were recruited from the dermatology outpatient department of a tertiary care hospital in New Delhi, India between March 1, 2020, and August 31, 2021.InterventionsPatients were randomized to 1 of the 3 treatment groups. Biweekly blinded assessments were performed until cure or treatment failure. Posttreatment follow-up of at least 8 weeks was conducted to detect relapses.Main Outcome and MeasuresCure rates, treatment durations, safety profiles, and relapse rates were assessed. Secondary outcomes included comparison of rapidity of clinical response and cost-effectiveness between groups.ResultsOf the 149 patients assessed, the mean (SD) age was 34.3 (12.2) years, 69 patients (46.4%) were women, and 80 patients (53.6%) were men. The difference in cure rate between the 100- and 200-mg groups was statistically nonsignificant (hazard ratio [HR], 1.44; 95% CI, 0.91-2.30; P = .12), while the difference between the 100- and 400-mg groups (HR, 2.87; 95% CI, 1.78-4.62; P P = .002) was statistically significant. Mean (SD) treatment durations were statistically significantly different between the 100- and 400-mg groups (7.7 [4.7] weeks vs 5.2 [2.6] weeks; P = .03) and between the 200- and 400-mg groups (7.2 [3.8] weeks vs 5.2 [2.6] weeks; P = .004), but the difference between the 100- and 200-mg groups was not statistically significant. A total of 55 patients (47.4%) relapsed after treatment. Relapse rates were comparable across groups. No patient discontinued treatment due to adverse effects. Treatment with the 200-mg dose incurred a 63% higher cost and 400 mg a 120% higher cost over 100 mg in achieving cure.Conclusions and RelevanceIn this randomized clinical trial, high overall efficacy was observed among the 3 itraconazole doses for treatment of TCC, but with prolonged treatment durations and considerable relapse rates. Treatment with the 200- and 100-mg doses did not differ significantly in efficacy or treatment durations, while 400 mg scored over the other 2 on these outcomes. Considerable additional cost is incurred in achieving cure with the 200- and 400-mg doses.Trial RegistrationClinical Trials Registry of India Identifier: CTRI/2020/03/024326

Rank reversal in Analytic Hierarchy Process (AHP) due to introduction or removal of a new alternative is well documented in literature. However, rank reversal due to the aggregation of benefit and cost criteria has not been addressed with requisite rigour. This paper demonstrates a new type of rank reversal in AHP which can arise due to the method (ratio or difference) and approach (sum 1 or sum 2) used to aggregate the benefit and cost criteria. Numerical examples, mathematical analyses and computer simulations have been used for demonstration of results. It is found that considering the benefit and cost criteria separately (sum 2 approach) while aggregating them can yield irrational ranking. It is also demonstrated that ratio method of aggregation is untenable in additive variants of AHP as it yields identical ranking in sum 1 and sum 2 approaches. Difference method of aggregation considering the benefit and cost criteria together (sum 1 approach) is most logical and sound in additive variants of AHP. The results also counter the notion that multiplicative AHP is immune to rank reversal between ratio and difference methods of aggregation. Besides, sum 1 and sum 2 approaches produce different raking of alternatives in multiplicative AHP irrespective of the method of aggregation. Outcome of this research will be helpful while choosing the appropriate method and approach for aggregation of benefit and cost criteria in different variants of AHP.

The knowledge of breast cancer risk factors and screening practices in a community is largely influenced by the practising gynaecologist in that area. We assessed the understanding and knowledge of gynaecologists about breast cancer: screening, risk factors, clinical signs, management and common benign breast diseases. This cross-sectional study was carried out in Uttar Pradesh, India, from April to September 2017. One hundred and fifty-two gynaecologists were assessed using a self-designed and validated questionnaire to assess the knowledge of risk factors, clinical signs, screening practices and management of breast cancer as well as common benign breast diseases. Further, the results were compared based on their education: undergraduates (UGs; no residency experience in obstetrics and gynaecology) versus postgraduates (PGs; residency experience in obstetrics and gynaecology). 67 and 82.2% of gynaecologists possess excellent to very good knowledge of risk factors and clinical signs of breast cancer, respectively. The knowledge of PGs seems to be better than UGs (p

Free radicals or reactive oxygen indices give rise to oxidative injury, which is a fundamental mechanism underlying a number of disease like diabetes, cancer, neurodegenerative disorders. Deleterious effects of reactive oxygen species can be nullified by using different natural antioxidants derived from plants Indigofera tinctoria is such plant. This study was planned in order to trace and determine the antioxidant capability of Indigofera tinctoria. All the reagents and chemicals used in this study were obtained from reliable firms. The plant extracts were subjected to phytochemical screening, quantitative assays and antioxidant profiling. The results suggested that plant extracts contained all pharmacologically important phytoconstituents in appreciable amounts and having excellent antioxidant capabilities.

The core of every microprocessor, digital signal processor (DSP), and data processing application-specific integrated circuit(ASIC) is its data path. At the hearts of data paths and addressing units are arithmetic units, such as a comparators , adders, and multipliers. In this paper, a 4-input decimal adder has been developed using 90 nm CMOS technology. The schematic of decimal adder is designed and simulated for its behavior using DSCH-3.1 The layout of simulated adder is created using Verilog based netlist file which is further simulated using Micro wind 3.1 to analyze the performance. The result shows that designed decimal adder has consumed 0.603mW power. Keywords-Adders, ALU,ASIC, Carry Look Ahead Adders, CMOS, Decimal Addition, DSP .