Adherence to highly active antiretroviral therapy in a tertiary care hospital in West Bengal,India

INTRODUCTION

The introduction of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) has led to the reduction of mortality and the improvement of the quality of life of people living with HIV/AIDS (PLWHA). The present study was conducted to determine the pattern of adherence to HAART among PLWHA, and to assess the factor(s) affecting nonadherence, if any.

METHODS

This study was a hospital-based analytical, cross-sectional epidemiological study conducted between July and October 2011. A total of 370 adult HIV-positive patients registered in the Antiretroviral Therapy Centre of Burdwan Medical College and Hospital, West Bengal, India, were included. Nonadherence was defined as missing at least a single dose of medicine within the last four days. Data was analysed using the Statistical Package for the Social Sciences version 19.0 (IBM Corp, Armonk, NY, USA).

RESULTS

A total of 87.6% of patients were found to be adherent to HAART. Principal causes of nonadherence were forgetting to take medicine (70.2%), being away from home (65.2%), and busyness with other things (64.7%). Multivariate logistic regression analysis revealed that nonadherence was significantly associated with a positive family history of HIV/AIDS (odds ratio [OR] 16; 95% confidence interval [CI] 2.2–114.3; p = 0.01), occurrence of side effects with HAART (OR 9.81; 95% CI 1.9–51.7; p = 0.01) and employment (OR 5.93; 95% CI 1.5–23.2; p = 0.01).

CONCLUSION

Although overall adherence was high, the factors that affect nonadherence can be addressed with proper counselling and motivation of patients and their family members. Adherence to HAART could delay the progression of this lethal disease and minimise the risk of developing drug resistance.     

Gastric outlet obstruction with perforation. A rare presentation of left-sided adult Morgagni hernia

Adult presentation of congenital diaphragmatic hernia (CDH) is rare. Out of the three varieties of CDH, Morgagni hernia is the rarest of all. Though most of them are asymptomatic and may be incidentally detected, they may also present in the emergency setting with respiratory or gastrointestinal features like obstruction or strangulation. Gastric outlet obstruction is a rare manifestation of adult Morgagni hernia. We present a case of adult left-sided Morgagni hernia with features of gastric outlet obstruction complicated with perforation.     

Transtracheal jet ventilation

Transtracheal jet ventilation (TTJV) is a method of lung ventilation via a narrow-bore catheter placed percutaneously into the trachea, bypassing the upper airway and glottis. A pressurized jet of oxygen that entrains air is delivered to the lungs. This technique can be utilized in both elective and emergency situations. It is no longer recommended by the Difficult Airway Society (DAS) in the ‘Can't Intubate, Can't Oxygenate’ (CICO) situation, as a surgical technique is now recommended in this scenario (unless the practitioner is familiar with TTJV). In the non-CICO emergency situation, TTJV may be utilized to preoxygenate the patient and allow time to secure a definitive airway. Humidified high-flow nasal oxygenation is a more recently described technique that may allow preoxygenation and time for a transtracheal catheter to be placed, and even replace the need for TTJV. However, a jet ventilator should be immediately available in the event of failure of the nasal high-flow system. This article will examine the indications for TTJV and physiology behind its mechanism of action. We will also describe the equipment required, technique and potential complications.     

Response to Immunosuppressive Therapy in Acquired Aplastic Anaemia: Experience of a Tertiary Care Centre from Eastern India

The current study was conducted to assess response to immunosuppressive therapy (IST) in acquired aplastic anaemia (AA). It was a retrospective and prospective observational study. Patients were diagnosed as per standard international guidelines and IST was started as per standard protocol. Patients were followed up at 3 months and 6 months for assessment of response as per published standard guidelines. Total 76 cases were included in the study. The median age of the study population was 36 years with a range of 6–66 years with a male to female ratio of 2.04:1. Most common clinical presentation was pallor followed by bleeding. Commonest type of disease in the study group was severe AA. Among total 76 patients, 32 patients received Atgam and 44 patients received Thymogam. Within 3 months of ATG administration, 4 patients died and 1 patient was lost to follow up. At 3 months, 2 (2.63%) patients were on complete response (CR), 32 (42.10%) patients were in partial response (PR) and 37 (48.68%) patients were on no response (NR). Overall response (OR) at 3 months was 44.73%. At 6 months 5 (6.57%) patients were in CR, 43 (56.57%) patients in PR and 23 (30.26%) patients in NR; the OR was 63.14%. Overall response at 3 months was 44.73% and overall response at 6 months was 63.14%. The study revealed better overall survival for patients with ATGAM treatment than THYMOGAM treatment arm.     

Morpho butterfly-inspired optical diffraction,diffusion, and bio-chemical sensing

Morpho-butterfly is well-known for the blue colouration in its tiny wing scales and finds applications in colour filters, anti-reflecting coatings and optical devices. Herein, the structural optical properties of the Morpho peleides-butterfly wing scales were examined through light reflection, diffraction and optical diffusion. The light diffraction property from wing scales was investigated through experiments and computation modelling. Broadband reflection variation was observed from different parts of the dorsal wings at broadband light illumination due to tiny structural variations, as verified by electronic microscopic images. The periodic nanostructures showed well-defined first-order diffraction through monochromatic (red, green and blue) and broadband light at normal illumination. Polyvinyl alcohol (PVA) embedded with Morpho peleides-butterfly wing scales acts as an optical diffuser to produce soft light. Light diffraction and diffusion properties were measured by angle-resolve experiments, followed by computational modelling. The maximum optical diffusion property at ∼185° from the wing scales was observed using broadband light at normal illumination. Finally, Morpho peleides-butterfly based submicron nanostructures were utilized to demonstrate bio-inspired chemical sensing.

Morpho butterfly-inspired structures were used as optical devices (diffraction, diffusion, etc.). Their optical performance were modelled and studied, revealing their potential for real-life bio-sensing applications.     

Comparative Study on Structure of Exopolysaccharide and Capsular Polysaccharide Produced by Southern Ocean Origin Pseudoalteromonas sp. MB-16

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - A comparative study on the basic structural characteristics of exopolysaccharide (EPS) and capsular...     

Prevention of bone loss in survivors of breast cancer: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND: Few data are available on the safety and efficacy of once-weekly oral bisphosphonate therapy in breast cancer survivors. OBJECTIVE: Our objective was to determine whether risedronate, 35 mg weekly, is efficacious and safe in preventing bone loss associated with chemotherapy-induced menopause. DESIGN: The study was a randomized, double-blind, placebo-controlled clinical trial over 12 months. SETTING AND PARTICIPANTS: Participants included 87 newly postmenopausal women with status post chemotherapy, recruited from a breast cancer clinic in an academic medical center. INTERVENTION: Participants were randomly assigned to receive risedronate 35 mg/wk or placebo. MAIN OUTCOME MEASURES: The primary outcomes were the 12-month changes in spine and hip bone mineral density. Secondary outcomes included changes in markers of bone resorption (urine N-telopeptide cross-linked collagen type I) and formation (osteocalcin, N-terminal propeptide of type I procollagen, and bone-specific alkaline phosphatase). RESULTS: After 12 months, bone mineral density increased by 1.2% at the spine and 1.3% at the hip in women on risedronate vs. significant decreases for women in the placebo group of 0.9% at the spine and 0.8% at the hip (P < 0.01, difference between groups). N-telopeptide cross-linked collagen type I, a marker of bone resorption, decreased by 19.3%, and N-terminal propeptide of type I procollagen, a marker of bone formation, decreased by 26.6% in participants on active therapy compared with increases in the control group. Risedronate was well tolerated, and the retention rate was 95% at 1 yr. CONCLUSIONS: Risedronate once weekly prevented bone loss and reduced bone turnover in women with breast cancer treated with chemotherapy. Early measures to prevent bone loss should be considered in this cohort of breast cancer survivors.