Development of a composite indicator to prioritize districts for implementation of human immunodeficiency virus programmes in Maharashtra,India

A key recommendation of the National AIDS Control Programme‐IV of India was to develop new strategies for geo‐prioritization of the human immunodeficiency virus (HIV) epidemic. We conducted this study to categorize the districts in Maharashtra (India) based on a multidimensional framework for geo‐prioritization of services. Programmatic data on trends of HIV prevalence, coverage of marginalized populations and vulnerability factors were included. A composite indicator based on these was developed, and the cumulative score was calculated for each district. HIV prevalence among general population has declined steadily from 0.60% in 2007 to 0.33% in 2017. The programme coverage was stable but inadequate for men who have sex with men (MSM). The coverage for female sex workers (FSWs) was inadequate and reduced over time. Nine districts were categorized as high priority, 13 as moderate priority and 11 were classified as low‐priority districts based on burden and vulnerability for HIV. The high‐priority districts were Pune, Solapur and Yavatmal for FSW interventions and Pune, Thane and Latur for MSM interventions. This multidimensional indicator is based on existing programmatic data, dynamic and can be made state‐specific. It is useful to categorize and prioritize districts for allocation of resources and geo‐prioritization of services in resource limited settings.     

Renal pyelic fusion with crossed solitary ureter: Case report and review of literature

Renal fusion anomalies are detected incidentally on imaging, with horseshoe kidney being the most common followed by crossed renal ectopia. We report a rare congenital anomaly of renal pyelic fusion with a solitary ureter. Both the renal units were in the normal position and location. This rare anomaly was associated with lumbar vertebral defects, neurogenic bladder, vesico‐ureteric reflux, upper tract dilatation and recurrent urinary tract infections.     

Synthesis of 1,7-bis(4-hydroxypenyl)-4-hydroxy-1,3-heptadiene-5-one, an antiplatelet diarylheptanoid from Alpinia blepharocalyx K. schum

A general and straight forward total synthesis of 1,7-bis(4-hydroxyphenyl)-3-hydroxy-1,3-heptadiene-5-one (5) starting from 4-methoxycinnamic acid (6) via ethyl 5-(4-methoxyphenyl)-3-hydroxy-2,4-pentadienoate (14) was accomplished in 19% overall yield.     

HIV-1 integrase inhibitors: 2005-2006 update

HIV-1 integrase (IN) catalyzes the integration of proviral DNA into the host genome, an essential step for viral replication. Inhibition of IN catalytic activity provides an attractive strategy for antiretroviral drug design. Currently two IN inhibitors, MK-0518 and GS-9137, are in advanced stages of human clinical trials. The IN inhibitors in clinical evaluation demonstrate excellent antiretroviral efficacy alone or in combination regimens as compared to previously used clinical antiretroviral agents in naive and treatment-experienced HIV-1 infected patients. However, the emergence of viral strains resistant to clinically studied IN inhibitors and the dynamic nature of the HIV-1 genome demand a continued effort toward the discovery of novel inhibitors to keep a therapeutic advantage over the virus. Continued efforts in the field have resulted in the discovery of compounds from diverse chemical classes. In this review, we provide a comprehensive report of all IN inhibitors discovered in the years 2005 and 2006.     

Crescent posterior fossa durotomy for occipito-marginal venous sinus preservation: A pilot study

Purpose

The standard approach of midline suboccipital craniectomy entails sacrifice of the Occipito—marginal sinus. We have attempted to preserve this venous channel by using a durotomy technique which preserves this system. In a pilot study initiative, two groups of patients using this technique versus the standard approach, were compared in terms of per and post operative benefits, morbidity and complications. The literature with reference to the anatomy and venous flow dynamics of the occipital and marginal sinuses and their significance has been reviewed. Similarly, literature regarding dural closure technique with reference to postoperative complications has also been reviewed.

Methods

In this novel approach, the dura is opened as a crescent to avoid damage to the occipital sinus. This technique was compared with the standard midline dural opening technique by random usage of both techniques in 24 patients.

Results

The ‘crescent’ approach has been found to reduce the need for duroplasty, with comfortable primary closure and to reduce the risk of postoperative pseudomeningocele.

Conclusions

This is a novel dural opening technique which attempts to preserve the normal venous flow physiology. In essence it helps in increased primary dural closures and reduction of Pseudomeningiocele/CSF leak as well as blood loss and venous hypertension.