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Joshi B.,National Health Research Institute | Chauhan S.,National Health Research Institute | Pasi A.,National Health Research Institute | Kulkarni R.,National Health Research Institute | And 10 more authors.
Indian Journal of Medical Research | Year: 2014

Background & objectives: National Anti-retroviral treatment (ART) programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV) on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV. Methods: Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them. Results: suboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR-1.341, CI-1.080-1.665), on ART for less than 6 months (OR-1.540, CI- 1.280-1.853), male gender (OR for females -0.807, CI- 0.662-0.982), tribals (OR-2.246, CI-1.134-4.447), on efavirenz (EFA) regimen (OR- 1.479, CI - 1.190 - 1.837), presence of anxiety (OR- 1.375, CI - 1.117 - 1.692), non-disclosure of HIV status to family (OR- 1.549, CI - 1.176 - 2.039), not motivated for treatment (OR- 1.389, CI - 1.093 - 1.756), neglect from friends (OR-1.368, CI-1.069-1.751), frequent change of residence (OR- 3.373, CI - 2.659 - 4.278), travel expenses (OR- 1.364, CI - 1.138-1.649), not meeting the PLHIV volunteer/community care coordinator at the ART center (OR-1.639, CI-1.330-2.019). Interpretation & conclusions: To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement.

Raja J.V.,Dr Syamala Reddy Dental College Hospital and Research Center | Khan M.,Government Dental College Research Institute | Banu A.,Bowring and Lady Curzon Hospital | Bhuthaiah S.,Seva Clinic
Journal of Oral Pathology and Medicine | Year: 2013

Background: Alteration in gustatory function among patients with human immunodeficiency virus (HIV) infection is sparsely studied and provides contradictory findings. The objectives of the study were to evaluate taste perversion in HIV-infected subjects and compare taste acuity between patients with and without Highly active antiretroviral therapy (HAART). Materials and Methods: Fifty HIV-infected subjects aged 25-55 years were selected and divided into two subgroups: patients with HAART and patients without HAART. Control group included 50 healthy, age-, sex-, gender-, and socioeconomic status-matched individuals. Taste complaints were recorded on a structured questionnaire, and formal taste testing was carried out with triadic forced choice whole-mouth, above-threshold taste test for four tastants - sweet, salt, sour, and bitter. Taste identification, detection threshold, and intensity of tastant were recorded. Results: Twenty-four (48%) among study group complained of taste perversion when compared to none among the control group (P < 0.001). During taste testing, identification and intensity scores were lower, while detection threshold scores for four tastants were higher in study group than in control group (P < 0.05). Among those patients with taste complaints, 16 were with HAART, while eight were without HAART (P = 0.043). Formal taste testing revealed greater taste perversion for sour and bitter tastants among patients with HAART medication. Conclusion: The results document significant taste losses in HIV-infected subjects, and HAART contributes considerably to such taste perversion.© 2012 John Wiley & Sons A/S. All rights reserved.

Banu A.,Bangalore Medical College and Research Institute | Nagraj E.R.,Siddhartha Medical College | Vidyadevi M.,Bowring and Lady Curzon Hospital
Journal of Clinical and Diagnostic Research | Year: 2012

Endophthalmitis is a grave complication of ocular trauma. We report here a case of acute post-traumatic endophthalmitis following a penetrating injury caused by an opportunistic organism, Corynebacterium jeikeium. The patient was treated with intra-vitreal antibiotics like ceftazidime and vancomycin to control the infection.

Agadi J.B.,Bowring and Lady Curzon Hospital | Raghav G.,Bowring and Lady Curzon Hospital | Mahadevan A.,National Institute of Mental Health and Neuro Sciences | Shankar S.K.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Neuroscience | Year: 2012

Sensitivity, specificity, and diagnostic yield of the superficial peroneal nerve (SPN)/peroneus brevis muscle (PBM) biopsy in 43 patients with clinically suspected vasculitic neuropathy was studied. Biopsies were classified as "definite", "suspicious" or "possible" in accordance with established criteria. Vasculitis was detected in 27 patients (21 with non-systemic vasculitis, and six with systemic vasculitis). In patients with "definite" vasculitis (n = 13), the sensitivity of SPN/PBM biopsy was 76.4% with 100% specificity. By including patients suspicious for vasculitis (n = 10), sensitivity increased to 85.1% but the specificity dropped to 87.5%. The overall diagnostic yield of SPN biopsy in those patients with definite vasculitis was 76.9% (10/13), and 53.8% (7/13) for muscle biopsy. The addition of muscle biopsy increased the diagnostic yield by 23%. Asymmetric nerve fiber loss, Wallerian degeneration and presence of hemosiderin were statistically significant markers of probable vasculitis. Muscle tissue was more likely to show hemosiderin (85.7%) than a nerve biopsy (71%). A combined SPN/PBM biopsy offers excellent diagnostic yield in the diagnosis of vasculitic neuropathy. © 2012 Elsevier Ltd. All rights reserved.

Kabbin J.S.,Bowring and Lady Curzon Hospital | Vijaya D.,Bowring and Lady Curzon Hospital | Meundi M.D.,Bangalore Medical College | Leelavathy B.,Bowring and Lady Curzon Hospital
Journal of Clinical and Diagnostic Research | Year: 2012

Background: The mycological study of Pityriasis versicolor by doing Potassium hydroxide (KOH) wet mount preparations and cultures is simple, but both the techniques have their own limitations. The isolation of the organism is very difficult because it is lipophilic and it needs special media to grow, which takes time. The present study suggests that the Calcoflour white stain can be used for the preliminary identification of the fungal elements, so that clinicians can start with the treatment. Aim: The aim of this study was to know the advantage of Calcofluor white staining versus the conventional methods which are used for the demonstration of the fungi in cases of Pityriasis versicolor. Methods: Over a period of one year, from October 2004 to November 2005, a total of 100 clinically diagnosed cases of Pityriasis versicolor were referred from the Department of Dermatology to the Department of Microbiology, Bowring and Lady Curzon Hospital which is attached to the Bangalore Medical College and Research Institute, Bangalore. Skin scrapings from affected lesions were processed by doing KOH preparations, Calcoflour white staining and cultures. Results: Out of the 100 cases which were studied, the maximum number of cases were in age group of 12 to 21 yrs (51%). Males 71(71%) were affected more than females 29(29%). 98(98%) samples were positive for the fungi by Calcoflour white staining, 92(92%) by the KOH preparation and 46(46%) by culture. Conclusion: Calcoflour white staining picked up an additional four samples which were reported as negative by the KOH preparation and the culture. Two other samples were reported to be positive by Calcoflour white staining and culture and to be negative by the KOH preparation. Calcoflour white staining is a rapid, simple, sensitive and highly reliable method for identifying fungi, as it provides a good definition of the fine fungal structures and a better contrast from the background debris, cells and tissue fragments.

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