Whenever a trial is conducted, there are three possible explanations for the results: a) findings are correct (truth), b) represents random variation (chance) or c) they are influenced by systematic error (bias). Random error is deviation from the 'truth' and happens due to play of chance (e.g. trials with small sample, etc.). Systematic distortion of the estimated intervention effect away from the 'truth' can also be caused by inadequacies in the design, conduct or analysis of a trial. Several studies have shown that bias can obscure up to 60% of the real effect of a healthcare intervention. A mounting body of empirical evidence shows that 'biased results from poorly designed and reported trials can mislead decision making in healthcare at all levels'. Poorly conducted and reported RCTs seriously compromise the integrity of the research process especially when biased results receive false credibility. Therefore, critical appraisal of the quality of clinical research is central to informed decision-making in healthcare. Critical appraisal is the process of carefully and systematically examining research evidence to judge its trustworthiness, its value and relevance in a particular context. It allows clinicians to use research evidence reliably and efficiently. Critical appraisal is intended to enhance the healthcare professional's skill to determine whether the research evidence is true (free of bias) and relevant to their patients.

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Viral infections in pregnancy are a major cause of morbidity and mortality for both mother and fetus. Viral STIs occur as surface infection and then gradually infect immunologically protected sites. Therefore, these are asymptomatic, hidden and hence underdiagnosed, persistent and difficult to treat. HSV, HPV, HBV, HIV and CMV (cytomegalovirus) are the common ones. Most of these are transmitted during intrapartum period. Proper screening, identification and treatment offered during prenatal period may help in preventing their complications. Twenty five percent of women with a history of genital herpes have an outbreak at some point during the last month of pregnancy. Acyclovir is the accepted efficacious and safe therapy for HSV in pregnancy. Globally, HPV infection is the most common sexually transmitted infection. Neonatal transmission can occur in the absence of clinically evident lesions. HPV 6 or 11 may lead to Juvenile Onset Recurrent Respiratory Papillomatosis (JORRP). TCA, liquid nitrogen, laser ablation or electrocautery can be used to treat external genital HPV lesions at any time during pregnancy. Cesarean section is recommended only if the lesions are obstructing the birth canal. Mother to child transmission (MTCT) in HIV accounts for 15-30% during pregnancy and delivery, and a further 5-20% of transmission occurs through breastfeeding. HBV infection during pregnancy does not alter the natural course of the disease. In women who are seropositive for both HBsAg and HBeAg, vertical transmission is approximately 90%. Pregnancy is not a contraindication for HBV vaccination. Cytomegalovirus (CMV) is the most common intrauterine infection. Cytomegalic inclusion disease (CID) is the most severe form of congenital CMV infection. Treatment is supportive.

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Objectives: To identify the reproductive health issues associated with adolescence and their readiness to avail services like Adolescent Friendly Clinic (AFC) among rural school going children. Materials and Methods: A quantitative survey was carried out using a self-administered structured questionnaire among 768 (428 boys and 340 girls) students from 15 schools by systematic random sampling from schools (3 schools from 5 talukas). Focus group discussions, 5 each with adolescent boys and girls and teachers were held. Results and Discussion: Only 31% of the boys and 33% of the girls mentioned that they had heard about contraception. More than half of the adolescent boys and girls knew correctly about various modes of transmission of HIV/AIDS. A large proportion of boys and girls have mentioned changes in the opposite sex such as increase in height, change in voice, breast development, and growth of facial hair, growth of hair in private parts, onset of menstruation in girls, etc. Nearly 70% of adolescents were ready to use AFC. Teachers perceived that adolescents become curious about the changes taking place in them, but they lack information and opportunities for open-discussions to get answers to their queries related to reproductive health. They are willing to take help from teachers but teachers are not equipped with knowledge nor are they comfortable discussing these issues with their students. Recommendations: Information on the human reproductive system and related issues on reproductive health need special attention. Teachers' sensitization to "adolescent health care" is required.

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A 15-year-old boy from a child center presented with a three-month history of a growth in the perianal region. There was a history of repeated peno-anal sexual exposures. On examination there was a fleshy, hyperpigmented, verrucous plaque around the anal verge. The Venereal Disease Research Laboratory Test was reactive in a titer of 1 : 64. Lesional biopsy showed marked epidermal hyperplasia without koilocytes, with a dermal infiltrate composed of lymphocytes, plasma cells and histiocytes. Patient was treated with parenteral penicillin with complete healing of the plaque. This is a rare presentation of secondary syphilis showing condyloma lata resembling condyloma acuminata.

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The clinical effect of imiquimod stems from cytokine-induced activation of the immune system. A randomized study was conducted to study the efficacy and safety of daily applications of 5% imiquimod cream in female patients with external genital warts and molluscum contagiosum (MC). The clearance rate of lesions was 75% in genital MC patients and 50% in patients with genital warts. Erythema was the commonest adverse reaction seen in 24% patients with the use of 5% imiquimod. Other side effects were excoriation seen in 16% patients, erosions in 10% patients, excoriation in 6% patients and pain was seen in 4% patients.

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Herpes Zoster (HZ) lesions are well known to heal with keloids. As immunity plays an important role in the development of abnormal scars and keloids, the latter is unusual in HIV where immunity is low. We report a rare case of recurrent HZ in an HIV-positive male where the lesions have healed with formation of keloids in both episodes. Within 50 days of last episode, he had an attack of herpes progenitalis.

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Objectives: To estimate the prevalence of RTI/STI among women in urban and rural areas of Surat and analyze the influence of socioeconomic, socio-demographic and other determinants possibly related to RTI/STI. Method: A community-based cross-sectional study. Women aged 15-49 years (n = 102) were interviewed and underwent a gynecological examination. Specimens were collected for laboratory diagnosis of chlamydia, gonorrhea, trichomonas, bacterial vaginosis (BV), candidiasis, hepatitis B, HIV, and syphilis. Results: Out of 51 women in rural areas, 27 (53%) and among 51 women in urban areas, 35 (69%) were identified having RTI/STI. In total, the prevalence of trichomoniasis was found to be 41% by culture, 22% by wet mount, and 16% by Gram staining among urban women, while trichomoniasis among rural women was found to be 27% by culture, 18% by wet mount, and 14% by Gram staining. The prevalence of candidiasis was found to be 14% among urban women and 12% among rural women. By using Gram staining Nugent's criteria, the prevalence of bacterial vaginosis was found to be 24% among urban women and 25% among rural women. The prevalence of syphilis was found to be 2% by VDRL both among urban as well rural women.

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Dermatopathic lymphadenitis is a rare entity described in patients with Human immunodeficiency virus infection. Here we present a case of dermatopathic lymphadenitis in a 50-year-old female who was HIV positive and did not have any obvious skin lesions. Fine needle aspiration cytology of the lymphnode showed a lymphoproliferative lesion and a subsequent biopsy showed atypical lymphoid proliferation showing prominent T-zone. Immunohistochemistry showed features of dermatopathic lymphadenitis.

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Retroviral infection is known to cause varied manifestation of any disease. We report a 27-year-old female who presented with non-healing painful ulcer in the left hand of 6 months' duration. The patient was diagnosed as pyoderma gangrenosum and treated with immunosuppressant drugs. One month later, she developed perianal vesicles and Tzanck smear from the vesicles showed multinucleated giant cells. A workup for sexually transmitted disease revealed HIV 1 Elisa to be positive. Diagnosis of herpetic ulcer was made and treated with famciclovir and hand ulcer gradually healed in 25 days. We report this case to highlight the occurrence of herpetic ulcer in an unusual site in a HIV patient and may lead to misdiagnosis of pyoderma gangrenosum

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Homeostasis of the skin is very important, which is achieved by a thin acid film - the acid mantle. Human skin has an acid mantle of pH 4-6. It prevents invasion by pathogenic organisms, acting as a first-line defence and helping in a disease-free existence. The vaginal mucosa has a similar acid mantle. Here, the natural acidic pH is maintained by lactic acid, an integral part of the vaginal ecosystem. This can be easily lost due to the lack of awareness of local care or various aggressive hygiene practices in addition to various diseases. Gentle cleansing along with good moisturization can go a long way in keeping the vulva healthy.

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Context: Papular pruritic eruptions (PPEs) are a commonly seen dermatological manifestation in children with Human Immunodeficiency Virus (HIV) stage 2 disease, whereas recurrent upper respiratory tract infection (URTI) (>2 episodes in 6 months) is the most common presenting illness in this category. Papular pruritic eruptions has been associated with progressive HIV disease in adults though it is categorized in early stage. Aim: To evaluate PPE as a clinical marker for progressive pediatric HIV. Setting and Design: In Pediatric HIV/AIDS clinic, Medical College, Kolkata, a prospective longitudinal hospital-based observational study was carried out. Materials and Methods: A total of 108 children in WHO stage 2 HIV disease aged between 2 and 12 years were selected, of which 58 had recurrent URTI without PPE and another 50 had PPE with or without secondary bacterial infection. Clinico-immunological deterioration was compared between the groups in terms of progression to undernutrition, WHO clinical stage 4 disease, severe immunodeficiency, need for initiation of Highly Active Anti Retroviral Therapy (HAART) and mortality over a period of 2 years. Statistical Analysis: SPSS statistical software version 10 was used. P value, relative risk (RR) with 95% Confidence Interval (CI), sensitivity and specificity was estimated. P < 0.05 was considered significant. Results: Significantly higher incidence (P < 0.001) of clinico-immunological progression of disease at a significantly shorter time period (P < 0.05) was found in those with PPE in comparison to those without PPE. Papular pruritic eruption has high sensitivity, specificity and positive predictive value as a clinical marker for severe immunodeficiency. Conclusion: Papular pruritic eruption could be a useful clinical marker of progressive HIV disease in children.

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