Introduction: PMTCT under NACP-III cover ex-posed children born to sero-positive mothers. Baby’s sero-status could be confirmed only at 18 months. Under EID, by DBS and/or WB collection, DNA-PCR can be performed earl...Introduction: PMTCT under NACP-III cover ex-posed children born to sero-positive mothers. Baby’s sero-status could be confirmed only at 18 months. Under EID, by DBS and/or WB collection, DNA-PCR can be performed earlier, with subsequent ART-linkage and 18-months-con- firmation. In Ahmedabad, with 55,000 annual pre- gnancy-HIV-testing, sero-prevalence is 0.27%. Methodology: Entry-points in EID are at 6 weeks, 6 months or 12 months. Cohort of 213 exposed children since EID roll-out (June 2010-December 2011) at all tertiary care hospitals under Ahme-dabad Municipal Corporation was assessed for sero-positivity-prevalence, DBS validity and assessment of baby’s sero-status-determinants. De-identified, secondary data were captured under routine public-health-program. Necessary permissions taken. Results: 144 HIV sero-positive deliveries took place. 213 exposed children were enrolled in EID. Cumulatively, 18 (8.45%) were tested positive at all entry-points. Out of sero-positives confirmed at 18 months, 60% children’s mothers were detected either in second or third trimester. In 40%, mothers remained undiagnosed intra-partum. Mothers were not on ART intra-partum in 80% (RR 1.8). Peri-partum ARV prophylaxis-single-dose-Nevirapine (sdNVP) was not given in 60%. [RR 18, CI 3.69 to 87.70 at 95% (p < 0.0003)]. In 60%, mode of delivery was vaginal, deliveries were handled in emergency. History of exclusive breastfeeding was in 60%. Discussion: Rise in yield of sero-positivity with age, highest proportion of sero-positivity and highest number of entrants at 6 weeks call for efforts targeted towards increasing earliest EID uptake clubbed with immunization visits. Feasibility, validity and early-ART-linkage to reduce mortality are features of DBS. Results justify its use in national program. Earliest pregnancy-HIV detection, HIV-testing for emergency deliveries, intra-partum sdNVP to both mother and baby, ART-linkage of eligible mothers and following infant feeding guidelines remain cornerstone of PMTCT success.展开更多
Severe cutaneous hypersensitivity reactions to anti-tuberculosis medication are rare and have been attributed mainly to thiacetazone. A case of streptomycin-induced Steven-Johnson Syndrome in a patient with TB-HIV co-...Severe cutaneous hypersensitivity reactions to anti-tuberculosis medication are rare and have been attributed mainly to thiacetazone. A case of streptomycin-induced Steven-Johnson Syndrome in a patient with TB-HIV co-infection which ended in death is reported.展开更多
Anal cancer, especially squamous cell carcinoma (SCC) variety, is evolving with rising incidence globally. This is due to the increasing adoption of risky life styles and social habits even in populations with rare oc...Anal cancer, especially squamous cell carcinoma (SCC) variety, is evolving with rising incidence globally. This is due to the increasing adoption of risky life styles and social habits even in populations with rare occurrences previously. This case report aims to expose risk factors exhibited by a patient recently managed for anal cancer in our facility before his demise. Early exposure to bisexual orientation, receptive anal intercourse and multiple sexual partners, are notable high risk factors for the development of anal SCC. The permissive role of smoking, illicit drug and alcohol use enhances the disease occurrence. Acquisition of human immune-deficiency virus (HIV) sero-positive status further reduces the body’s immune competence and enhances early age of onset as well as accelerates development of anal SCC. Proper history exploring the risk factors, physical/anorectal examination and histological analysis, are vital for proper diagnosis and staging which guides appropriate treatment with chemo-radiation as mainstay.展开更多
文摘Introduction: PMTCT under NACP-III cover ex-posed children born to sero-positive mothers. Baby’s sero-status could be confirmed only at 18 months. Under EID, by DBS and/or WB collection, DNA-PCR can be performed earlier, with subsequent ART-linkage and 18-months-con- firmation. In Ahmedabad, with 55,000 annual pre- gnancy-HIV-testing, sero-prevalence is 0.27%. Methodology: Entry-points in EID are at 6 weeks, 6 months or 12 months. Cohort of 213 exposed children since EID roll-out (June 2010-December 2011) at all tertiary care hospitals under Ahme-dabad Municipal Corporation was assessed for sero-positivity-prevalence, DBS validity and assessment of baby’s sero-status-determinants. De-identified, secondary data were captured under routine public-health-program. Necessary permissions taken. Results: 144 HIV sero-positive deliveries took place. 213 exposed children were enrolled in EID. Cumulatively, 18 (8.45%) were tested positive at all entry-points. Out of sero-positives confirmed at 18 months, 60% children’s mothers were detected either in second or third trimester. In 40%, mothers remained undiagnosed intra-partum. Mothers were not on ART intra-partum in 80% (RR 1.8). Peri-partum ARV prophylaxis-single-dose-Nevirapine (sdNVP) was not given in 60%. [RR 18, CI 3.69 to 87.70 at 95% (p < 0.0003)]. In 60%, mode of delivery was vaginal, deliveries were handled in emergency. History of exclusive breastfeeding was in 60%. Discussion: Rise in yield of sero-positivity with age, highest proportion of sero-positivity and highest number of entrants at 6 weeks call for efforts targeted towards increasing earliest EID uptake clubbed with immunization visits. Feasibility, validity and early-ART-linkage to reduce mortality are features of DBS. Results justify its use in national program. Earliest pregnancy-HIV detection, HIV-testing for emergency deliveries, intra-partum sdNVP to both mother and baby, ART-linkage of eligible mothers and following infant feeding guidelines remain cornerstone of PMTCT success.
文摘Severe cutaneous hypersensitivity reactions to anti-tuberculosis medication are rare and have been attributed mainly to thiacetazone. A case of streptomycin-induced Steven-Johnson Syndrome in a patient with TB-HIV co-infection which ended in death is reported.
文摘Anal cancer, especially squamous cell carcinoma (SCC) variety, is evolving with rising incidence globally. This is due to the increasing adoption of risky life styles and social habits even in populations with rare occurrences previously. This case report aims to expose risk factors exhibited by a patient recently managed for anal cancer in our facility before his demise. Early exposure to bisexual orientation, receptive anal intercourse and multiple sexual partners, are notable high risk factors for the development of anal SCC. The permissive role of smoking, illicit drug and alcohol use enhances the disease occurrence. Acquisition of human immune-deficiency virus (HIV) sero-positive status further reduces the body’s immune competence and enhances early age of onset as well as accelerates development of anal SCC. Proper history exploring the risk factors, physical/anorectal examination and histological analysis, are vital for proper diagnosis and staging which guides appropriate treatment with chemo-radiation as mainstay.
