Dhat syndrome: A culture-bound sex neurosis of the orient

The Indian Dhat syndrome is a culture-bound symptom complex. The clinical picture includes severe anxiety and hypochondriasis. The patient is preoccupied with the excessive loss of semen by nocturnal emissions. There is a fear that semen is being lost. and mixed in urine. A study was carried out to investigate the cultural basis of the Dhat syndrome. One hundred and seven respondents from the general public were interviewed. A vignette describing an individual having nocturnal emissions was read aloud to the respondents. Attitudes toward nocturnal emission, its causes, and its management were investigated. A large segment of the general public from all socioeconomic classes believed that semen loss is harmful. Seminal fluid is considered an elixir of life both in the physical and in the mystical sense. Its preservation guarantees health, longevity, and supernatural powers. This belief is more frequent in lower socioeconomic classes. The susceptible individual reacts to the prevalent belief system and to the fears of semen loss. The symptoms usually disappear if the misconceptions about semen loss are effectively dealt with. It is expected that with increasing literacy and progress in sex knowledge the syndrome will become less common.     

Screening for HIV infection by health professionals in India

BACKGROUND: Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS: We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS: A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION: There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.     

Major molecular markers in pancreatic ductal adenocarcinoma and their roles in screening, diagnosis, prognosis, and treatment

Pancreatic cancer is notorious for its late presentation, early and aggressive local invasion, metastatic potential, and poor outcome. It presents at a clinically advanced stage that precludes the possibility of surgical resection in most cases and shows constitutive resistance to chemotherapy and radiotherapy in others. As a result, mortality from this disease parallels its incidence rates.Recent breakthroughs in the molecular biology of pancreatic cancer have assisted in translational research, giving hope for individualized therapy and better disease management. Molecular biology tools are guiding early diagnosis, the assessment of prognosis, and isolation of novel, more effective therapeutic targets.This review discusses the signature mutations of pancreatic cancer, implications of these mutations to pancreatic cancer biology, their linked pathways, and recent advances in their understanding as biomarkers as diagnostic, prognostic, and therapeutic tools in dealing with this disease.     

Evaluation of the current management protocols for prophylaxis against Pneumocystis jiroveci pneumonia and other opportunistic infections in patients living with HIV/AIDS

Opportunistic infections (OIs) are a leading cause of mortality and morbidity in patients living with HIV/AIDS. Data on the proper administration of prophylactic regimes for the prevention of OIs in such patients are scarce. A total of 205 confirmed HIV-infected patients were enrolled in the study from the inpatient wards and outpatient services. The treatment given to them for the prevention of Pneumocystis carinii (jiroveci) pneumonia was compared with the established guidelines and the proportions of those receiving proper treatment were calculated. Primary prophylaxis was seen to be satisfactory in the case of P. carinii (jiroveci) pneumonia. The prophylaxis was not given properly for tuberculosis and other common OIs. Secondary prophylaxis was up to the mark. Prophylaxis in AIDS patients seems to be a major problem area and a lot of efforts need to be directed toward it since patients suffering from AIDS are bound to have a downhill course despite provision of all available treatment options.     

ED50 of desflurane for laryngeal mask airway removal in anaesthetised adults

Previous estimates for the end‐tidal concentration of desflurane that allows removal of the laryngeal mask airway in 50% of anaesthetised adults (ED50) have ranged from 2.1% to 5.3%. To assess which value is correct, we studied 32 female patients (aged 30–50 years) undergoing intracavity caesium implants for cervical carcinoma under general anaesthesia. Anaesthesia was induced with propofol 2–3 mg.kg^?1 and maintained with desflurane in a 50% nitrous oxide‐oxygen mixture. At the end of surgery, a predetermined target end‐tidal desflurane concentration (starting at 4%) was maintained for 10 min using Dixon’s up‐down method and the laryngeal mask airway was removed. The target end‐tidal concentration in the next patient was increased or decreased by 0.5% depending upon the response of the previous patient. Removal of the laryngeal mask airway without coughing, clenching, biting, movement or any adverse airway event during or within 1 min after removal was considered to be successful. We found that the laryngeal mask airway can be successfully removed in 50% (ED50) and 95% (ED95) of the anaesthetised adults at end‐tidal desflurane concentrations of 2.4% (95% CI 1.3–2.9) and 3.8% (3.1–9.6), respectively.     

Intra-articular clonidine vs. morphine for post-operative analgesia following arthroscopic knee surgery (a comparative evaluation)

In a prospective, double-blind, randomised study, 30 ASA I patients were allocated to three groups in an attempt to find out the best post-operative analgesic following arthroscopic knee surgery under epidural anaesthesia. Group I patients received 5 mg of preservative-free morphine in 20 ml of normal saline, group II patients received 150 μg of clonidine in 20 ml of normal saline and group III patients received 20 ml of normal saline only. The post-operative pain was evaluated by a visual analogue scale and the need for rescue analgesic was assessed post-operatively for 12 h. We conclude that intra-articular administration of 150 μg of clonidine gives a longer lasting pain relief post-operatively (4-12 h) as compared to 5 mg of preservative-free morphine (3 h). No side effects were noted with either of the drugs.