Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
Indian J Sex Transm Dis
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   2012| July-December  | Volume 33 | Issue 2  
    Online since October 9, 2012

 
 
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RESIDENTíS PAGE
Randomized double blind placebo control studies, the "Gold Standard" in intervention based studies
Shobha Misra
July-December 2012, 33(2):131-134
DOI:10.4103/0253-7184.102130  
Studies follow a hierarchy in terms of the quality of evidence that they can provide. Randomized double blind placebo control (RDBPC) studies are considered the "gold standard" of epidemiologic studies. And the same is discussed at length in this paper taking example of a real journal article employing this study design to answer the research question; "Does once daily dose of Valacyclovir reduce the risk of transmission of genital herpes in a susceptible partner?" RDBPC studies remain the most convincing research design in which randomly assigning the intervention can eliminate the influence of unknown or immeasurable confounding variables that may otherwise lead to biased and incorrect estimate of treatment effect. Also, randomization eliminates confounding by baseline variables and blinding eliminates confounding by co-interventions, thus eliminating the possibility that the observed effects of intervention are due to differential use of other treatments. The best comparison is placebo control that allows participants, investigators and study staff to be blinded. The advantage of trial over an observational study is the ability to demonstrate causality. Hope, this will be useful to neophyte researchers to understand causal hierarchy when critically evaluating epidemiologic literature.
  31 12,624 150
ORIGINAL ARTICLES
Audio-vestibular function in human immunodeficiency virus infected patients in India
Suma Susan Mathews, Rita Ruby Albert, Anand Job
July-December 2012, 33(2):98-101
DOI:10.4103/0253-7184.102115  
Objective: As the acquired immunodeficiency syndrome (AIDS) epidemic shows no signs of abating, the impact of AIDS is felt more in the developing countries due to socioeconomic reasons. The possibility of drug-induced ototoxicity also adds to the risk of audio vestibular dysfunction. We sought to determine if there was a difference between the audio-vestibular function in the asymptomatic human immunodeficiency virus (HIV) infected patients and patients with AIDS. Study Design: A prospective, cross-sectional study Setting: A tertiary care center in South India Materials and Methods: The audio-vestibular system of 30 asymptomatic HIV positive subjects (group 1) and 30 subjects with AIDS (group 2), and age-matched 30 healthy controls (group 3) were assessed using pure tone audiometry and cold caloric test. Results: Sixteen patients each, in group 1 and group 2 and four subjects in the control group were detected to have a hearing loss indicating significantly more HIV infected individuals (group 1 and 2) were having hearing loss (P=0.001). Kobrak's (modified) test showed 27% of patients in group 1 and 33% of patients in group 2 and none in the group 3 had a hypofunctioning labyrinth (P=0.001). Conclusion: It seems that the human immunodeficiency virus does affect the audio-vestibular pathway. There was a significant incidence of audio-vestibular dysfunction among the HIV infected patients, as compared to the control population (P=0.001) and no significant difference between the asymptomatic HIV seropositive patients and AIDS patients. Majority of the patients had no otological symptoms.
  6 5,789 59
Incidence of occupational exposures in a tertiary health care center
Amrita Shriyan, Roche R Annamma
July-December 2012, 33(2):91-97
DOI:10.4103/0253-7184.102111  
Introduction: Occupational exposure to Hepatitis B virus (HBV), human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) infection is a cause of concern to all health care workers (HCWs), especially those, in hospitals. Among the HCWs, nurses, interns, technicians, resident doctors and housekeeping staff have the highest incidence of occupational exposure. Aims: To analyze the cases of needle stick injuries and other exposures to patient's blood or body fluids among health care workers. Materials and Methods: A detailed account of the exposure is documented which includes incidence of needle stick injuries (NSI) and implementation of post-exposure prophylaxis (PEP) as per the hospital guidelines. We report a two-year continuing surveillance study where 255 health care workers (HCWs) were included. PEP was given to HCWs sustaining NSI or exposures to blood and body fluids when the source is known sero-positive or even unknown where the risk of transmission is high. Follow-up of these HCW's was done after three and six months of exposure. Results: Of the 255 HCWs, 59 sustained needle stick injuries and two were exposed to splashes. 31 of the NSI were from known sources and 28 from unknown sources. From known sources, thirteen were seropositive; seven for HIV, three for HCV and three for HBV. Nineteen of them sustained needle stick during needle re-capping, six of them during clean up, six of them while discarding into the container, 17 during administration of injection, eight of them during suturing, two occurred in restless patient, 17 during needle disposal. Conclusion: So far, no case of sero-conversion as a result of needle stick injuries was reported at our center.
  5 7,236 167
Evaluation of the usefulness of Treponema pallidum hemagglutination test in the diagnosis of syphilis in weak reactive Venereal Disease Research Laboratory sera
Manju Bala, Aman Toor, Meenakshi Malhotra, Monika Kakran, Sumathi Muralidhar, V Ramesh
July-December 2012, 33(2):102-106
DOI:10.4103/0253-7184.102117  
Background and Objectives: Biological false positive (BFP) reactivity by the Venereal Disease Research Laboratory (VDRL) test used for diagnosis of syphilis is a cause for concern. The use of the VDRL as a screening procedure is challenged by some studies. The aim of this study is to determine the prevalence of BFP reactions in different subject groups and to assess the usefulness of Treponema pallidum hemagglutination (TPHA) test in low titre VDRL reactive sera. Materials and Methods: A total of 5785 sera from sexually transmitted diseases (STD) clinic attendees, antenatal clinic attendees, husbands of antenatal cases, peripheral health centres attendees (representing community population) and from patients referred from different OPDs/wards were screened for BFP reactions by the VDRL test. Sera reactive in the VDRL test were confirmed by the TPHA test. Results: Out of 80 qualitative VDRL reactive sera, 68 had <1:8 titre on quantitation and TPHA was positive in 59 samples, indicating BFP reactivity in 0.2% in all the subject groups. BFP was nil in the community population. The male-to-female ratio of BFP reactions was 2:1. VDRL and TPHA positivity was highest (76%) in the age group of 20-29 years. The seroprevalence of syphilis varied from 0.4% to 3.5% in different patient groups. Conclusions: The results of this study highlight that the TPHA positivity was high (86.8%) in sera with VDRL titre less than 1:8. Therefore, for the diagnosis of syphilis, it is recommended that a confirmatory test such as TPHA should be performed on all sera with a reactive VDRL regardless of its titre.
  5 7,654 206
CASE REPORTS
Rare sweat gland tumors of vulva: Report of two cases
Rashmi Mahajan, Damodar Bang, Amit Nagar, Freny Bilimoria
July-December 2012, 33(2):124-127
DOI:10.4103/0253-7184.102128  
Syringomas and Fox-Fordyce disease are appendageal skin disorders. While syringomas represent an adenoma of the intraepidermal eccrine duct, Fox Fordyce disease occurs due to blockage of the apocrine sweat duct. In both conditions, extragenital sites are more frequently involved than the genitalia. We herein report two young females, one with syringomas on the face and vulva and the other with Fox Fordyce disease involving axilla, areola and vulva, thereby citing the importance of examination of genitalia in these disorders.
  3 18,122 73
Orbital tuberculosis manifesting as proptosis in an immunocompromised host
Shashank Banait, Jyoti Jain, PH Parihar, Vikas Karwassara
July-December 2012, 33(2):128-130
DOI:10.4103/0253-7184.102129  
Orbital tuberculosis is an extremely rare, potentially devastating state, when not effectively treated, can lead to grave sequelae. Proptosis can be the result of primary orbital pathology or systemic disease processes. (1, 2) Thyroid ophthalmopathy being commonest cause of proptosis .It can also be a manifestation of, diseases involving various structures of orbit and of superior orbital fissure or cavernous sinus. A case of orbital tubercular abscess presenting with proptosis and blindness in a young male 27 years is reported. Clinicians should suspect rare causes in an immuno- compromised host .(2, 3) The failure to diagnose these conditions can lead to unintended sequelae. Key Message: The patient who presents with proptosis must be evaluated to ascertain the causation. Preservation of vision is of paramount importance. On follow-up patients should be monitored for complications and remedied.
  2 3,737 45
Intraoral Burkitt's lymphoma in an HIV positive patient
Vidya Ajila, R Gopakumar, Shruthi Hegde, G Subhas Babu
July-December 2012, 33(2):118-120
DOI:10.4103/0253-7184.102126  
Burkitt's lymphoma is an aggressive form of Non-Hodgkin's lymphoma composed of malignant cells of B lymphocyte origin. Burkitt's lymphoma is a rarity in the Indian subcontinent. Though intraoral Burkitt's lymphoma in HIV positive individuals is very uncommon, its importance lies in the fact that it is often the first sign of the underlying immunosuppression. We present a case of Burkitt's lymphoma in right maxillary region which was the first manifestation of HIV in the patient.
  2 4,295 59
ORIGINAL ARTICLES
Comparison of syndromic diagnosis of reproductive tract infections with laboratory diagnosis among rural married women in Medak district, Andhra Pradesh
M. L.S. Prabha, G Sasikala, Sudha Bala
July-December 2012, 33(2):112-115
DOI:10.4103/0253-7184.102121  
Introduction: In developing countries, reproductive tract infections (RTI) commonly affect the quality of life. Many reproductive tract infections including sexually transmitted infections (STI) and cervical cancers remain asymptomatic for long periods. Syndromic case management (SCM) is the mainstay in the control of RTI/STI, especially at primary level, where laboratory diagnosis is not possible. However, lab diagnosis should be used when it is available. Objective: To assess the consistency of syndromic diagnosis with laboratory diagnosis. Materials and Methods: A total of 407 women were screened. Women were categorized according to Syndromic Diagnosis of RTI/STI based on history and clinical examination. Microbiological tests and Pap smears were done to confirm the diagnosis and compared with Syndromic Diagnosis. Results: Microbiologically, 33.14% were positive for at least one organism. Bacterial vaginosis was the most common finding (14%). Pap smear showed 32.9% inflammatory changes and 0.25% low-grade squamous intraepithelial lesion. Sensitivity and specificity of syndromic diagnosis with laboratory findings: Vaginal discharge syndrome with microbiological tests- (Se 58.9; Sp55.1%) Lower abdominal pain syndrome with microbiological tests-(Se 14.4%; Sp76.6%) Conclusion: The findings of this study highlight the wide variation of syndromic and laboratory diagnosis.
  2 4,153 223
REVIEW ARTICLE
Microbicides and HIV: A Review and an update
Smriti Naswa, YS Marfatia, T. L. N. Prasad
July-December 2012, 33(2):81-90
HIV is a pandemic which has continually posed challenges to the scientific society in large and to medical fraternity in particular in terms of treatment as well as prevention. The treatment is lifelong suppressive than curative; hence the importance has always been to prevention strategies. The strategies like abstinence, monogamy and consistent condom use have various societal and behavioural issues and HIV vaccine is still not at the horizon. In such a scenario, pre-exposure prophylaxis (PrEP) and microbicides have emerged as newer options of prevention. Microbicides are referred to as topical PrEP. They are compounds that can be applied inside the vagina or rectum to protect against sexually transmitted infections (STIs) including HIV. Microbicides can be vaginal and rectal and can be formulated as gels, foams, rings, hydrogels, silicone elastomer gels, diaphragm, quick-dissolve polyvinyl alcohol based films, and bioadhesive vaginal tablets. The microbicides have been divided into various categories based on where they disrupt the pathway of sexual transmission of HIV. The article highlights the classes of microbicides and various trials conducted on them. It also enumerates various approaches in pipeline like antimicrobial peptides, aptamers, flavonoids, small interfering RNAs and DNAs, and bioengineered lactic acid bacilli.
  2 7,326 458
LETTERS TO EDITOR
A study for sexual health awareness in adolescent population (13-18 years) attending dermatology OPD
Reshma P Gadkari, Gaurav Somani, Chitra S Nayak, Atul S Giri
July-December 2012, 33(2):148-149
DOI:10.4103/0253-7184.102140  
  1 2,669 88
ORIGINAL ARTICLES
Perceptions regarding barriers and facilitators to combination antiretroviral therapy adherence among people living with HIV/AIDS in Gujarat, India: A qualitative study
Sangita Patel, Rajendra K Baxi, Shilpa N Patel, Carol E Golin, Mansi Mehta, Harsh Bakshi, Kalpita Shingrapure, Ekta Modi, Priyanka Coonor, Kedar Mehta
July-December 2012, 33(2):107-111
DOI:10.4103/0253-7184.102119  
Objectives: To know the perceptions regarding barriers and facilitators to cART adherence among people living with HIV/AIDS ( PLWHA). Materials and Methods: To adapt U.S. based SAFETALK "prevention with positives" intervention to be culturally relevant in Gujarat, India in assisting PLWHA, a formative study was conducted. We conducted 30 in-depth interviews with PLWHA in the local language, assessing the experiences, perceived barriers, and facilitators to combination antiretroviral therapy (cART) among PLWHA in Gujarat. PLWHA were selected from the Voluntary Counseling and Testing Centre (VCTC) in Gujarat. To triangulate interview findings, we conducted two focus group discussions (FGDs) with medical and non-medical providers, respectively. Results: Travel and commuting to clinic, fear of possible physical reactions, high cost of ART from private practitioners, CD4 count being in normal limits and resistance to medication acted as barriers to cART adherence. Initiation of cART was facilitated by family members' suggestion, advice of treating doctors and counselors, appropriate counseling before starting cART, belief that cART would aid in living a better and longer life and due to lowering of the CD4 count. Interpretation and Conclusions: Our study suggests that several issues need to be considered when providing cART. Further research is needed to study interactions between patients and their health care providers.
  1 3,774 67
ABSTRACTS
Abstracts from the currecnt global literature Part I
Anubhav Garg, Asit Mittal, Lalit K Gupta, AK Khare
July-December 2012, 33(2):135-137
  - 2,570 45
Abtracts from the current global literature Part - II: HIV and metabolic syndrome
Ankit H Bharti, Kiran Chotaliya, YS Marfatia
July-December 2012, 33(2):138-140
  - 2,163 47
CASE REPORTS
Ileal Perforation in a patient with acquired immune deficiency syndrome
Atul Sharma, Rakesh K Sharma, Santosh K Sharma, Ankur Jhanwar
July-December 2012, 33(2):116-117
DOI:10.4103/0253-7184.102123  
Gastrointestinal involvement is common in patients of human immunodeficiency virus infection (HIV) and the acquired immunodeficiency syndrome (AIDS). Specific gastrointestinal disorders often correlate with degree of immunosuppression. In advance cases of HIV infection GI symptoms are usually part of systemic infection. In such scenario multiple infections are common so failure to diagnose a specific cause is not uncommon. We here present a case study of a patient with ileal perforation with tubercular etiology and its management
  - 3,220 48
Recurrent thrombosis in an HIV-1 infected child
Ira Shah
July-December 2012, 33(2):121-123
DOI:10.4103/0253-7184.102127  
Though thromboembolic complications in HIV infected patients have been described in literature, recurrent thrombosis is very rare. We present a six-year-old HIV infected boy who presented with recurrent thrombosis. He initially had renal artery thrombosis, then middle cerebral artery thrombosis and finally hepatic vein thrombosis that was fatal.
  - 2,936 36
LETTERS TO EDITOR
Tropical calcific pancreatitis in HIV patient
Sunil Kumar, Sanjay K Diwan, Vikram Kokate
July-December 2012, 33(2):144-145
DOI:10.4103/0253-7184.102134  
  - 2,335 29
Syphilitic aneurysm - A case report
Rupali S Shinde, S Nagarathna, Basappa G Mantur, RR Walvekar, Mahantesh V Parande, Aisha M Parande, KB Jhyaneshwar, MR Chandrashekhar
July-December 2012, 33(2):145-146
DOI:10.4103/0253-7184.102136  
  - 2,762 48
Study of syndromic management approach in the management of sexually transmitted diseases in rural population
Shitij S Goel, Shelly S Goel
July-December 2012, 33(2):146-147
DOI:10.4103/0253-7184.102137  
  - 2,717 116
Very low prevalence of hepatitis B and C Co-infection in HIV-positive medical inpatients in a tertiary care hospital in Agra (UP), Northern India
Goyal Ankur, Goyal Sapna, Lal Ankit, Agrawal Arti
July-December 2012, 33(2):147-148
DOI:10.4103/0253-7184.102139  
  - 2,460 45
PHOTO QUIZ
A case of a large verrucous swelling over the scrotum
Kamal Ahmed, Hardeep Singh, AS Kumar, Iqbal Ahmed
July-December 2012, 33(2):141-143
DOI:10.4103/0253-7184.102133  
  - 4,538 87
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