Clinic In India Research Articles

Proposed legislation for assisted reproduction technology clinics in India

Proposed legislation for assisted reproduction technology clinics in India

The use of preimplantation genetic diagnosis in sex selection for family balancing in India

This paper describes the use of preimplantation genetic diagnosis (PGD) in sexing embryos for family balancing in a private IVF clinic in India from April 1999 to April 2001. Embryos were biopsied and analysed on day 3, cultured in sequential media and then transferred on day 4 or day 5 after morphological selection of the best embryos. From a total of 42 cycles started, 14 clinical pregnancies and nine live births have been achieved so far, with five ongoing pregnancies. The benefits of delayed transfer 24–48 h after the embryo biopsy are that PGD centres could use the extra time available to confirm the diagnosis or introduce additional diagnostic tests for the same embryo. The selection of blastocysts for transfer should also permit the transfer of fewer embryos, thus reducing the risk of multiple gestations and increasing the pregnancy rate as a consequence of the expected higher implantation rate. This is the first report of the use of PGD in sex selection for family balancing in India, where couples place a premium on having baby boys, and the social and ethical aspects of the use of this technology in this setting are briefly discussed.

A longitudinal study of male buprenorphine addicts attending an addiction clinic in India.

There is a lack of longitudinal studies of buprenorphine dependence, an important opioid dependence in several countries. We investigated the course and outcome of buprenorphine dependence in an Indian clinic-attending cohort. Retrospective longitudinal study. An addiction clinic in northern India. Ninety-four male patients with buprenorphine dependence, registered for treatment between 1987 and 1993. Follow-up analyses were conducted for the 52 patients (55% of the index cohort) who completed more than a year of follow-up. In 48% of these 52 patients data were obtained from their clinical records of follow-up, while 52% were contacted specifically to obtain the required data on follow up. Baseline demographic and clinical variables; time spent in various phases of use or abstinence; outcome at the latest follow up; transition to other drugs during follow-up period. Over an average follow-up duration of 3 years, 56% of the time was spent in dependent use, 12% in non-dependent use and 32% in abstinence. By the end of follow-up, 6% of patients were dead (annual death rate 1.9%), 33% were unchanged and 61% were classified as "improved". The proportion of patients with "improved" outcome increased over the years. Patients with poor outcome had shorter follow-up and hospital stay, and had used pentazocine and/or antihistaminic injections in the buprenorphine "cocktail" more often than those with better outcome. Thirty-two patients shifted to other drugs over the years, notably heroin or polydrug use. These "transition" patients had a family history of drug use more often, started their drug career earlier, had marital and legal complications more often, spent more time in dependent phase of drug use, underwent multiple hospital admissions but stayed for a shorter period and faced more deaths, when compared to those who did not shift. In clinic-attending male patients with buprenorphine dependence who were followed-up although dependent pattern of use of the drug continued for a long time in their career, there was a slow but progressive improvement. Transition to other drugs was associated with a worse course and outcome as compared to being stable on buprenorphine.

Syndromic management of vaginal discharge among women in a reproductive health clinic in India.

To examine the performance of the syndromic approach in the management of vaginal discharge among women attending a reproductive health clinic in New Delhi, India. Women who sought services from the clinic and who had a complaint of vaginal discharge were interviewed, underwent a pelvic examination, and provided samples for laboratory investigations of bacterial vaginosis, candidiasis, syphilis, trichomoniasis, and Chlamydia trachomatis and Neisseria gonorrhoeae infections. Data analysis focused on the prevalence of infection and on the performance of the algorithm recommended by the national authorities for the management of vaginal discharge. The most common infection among 319 women was bacterial vaginosis (26%). At least one sexually transmitted infection was detected in 21.9% of women. The prevalence of C trachomatis infection was 12.2%; trichomoniasis 10%; syphilis 2.2%; N gonorrhoeae was not isolated. An algorithm based on risk assessment and speculum assisted clinical evaluation was not helpful in predicting cervical infections associated with C trachomatis (sensitivity 5% and PPV 9%). This algorithm was sensitive (95%) though not specific (22%) in selecting women for metronidazole therapy effective against bacterial vaginosis or trichomoniasis, and overtreatment was a problem (PPV 38%). The sensitivity, specificity, and PPV of this algorithm for the treatment of candidiasis were 46%, 98%, and 88% respectively. The cost per case assessed using the algorithm was $2 and the cost per infection correctly treated was $4.25. The prevalence of cervical infection associated with C trachomatis was high among these "low risk" women. The syndromic approach is not an efficient tool for detecting this condition, and alternative approaches to evaluation and intervention are required. The syndromic management of vaginal discharge among women seeking family planning and other reproductive health services should focus on vaginal infections, thus enhancing quality of care and addressing women's concerns about their health.

The ophthalmologist and the global impact of the AIDS epidemic LV Edward Jackson Memorial Lecture

○ PURPOSE: To document the ocular disorders seen in patients known to be infected with human immunodeficiency (HIV) virus at a referral eye clinic in India. ○ METHODS: The first 100 individuals known to be HIV-positive at a referral eye clinic between 1993 and 1998 were enrolled in a prospective study. They underwent complete ocular and systemic evaluation. ○ RESULTS: Most of the patients (76%) were in the 20- to 40-year age group. Heterosexual exposure to commercial sex workers was the most common risk factor (70%) for HIV infection. Cytomegalovirus (CMV) retinitis (17%) and HIV retinopathy (15%) were the most common HIV-associated ophthalmic lesions. Pulmonary tuberculosis (67%) and oropharyngeal candidiasis (66%) were the most commonly associated systemic infections. Ocular involvement was most common in children who contracted the disease through perinatal transmission (66.7%) and in homosexual patients (60%). Ocular involvement was comparatively less common in patients who contracted the disease through blood transfusions (33%) or exposure to commercial sex workers (24.3%). ○ CONCLUSIONS: This study shows that the spectrum of ocular lesions associated with HIV infection in India is different from that seen elsewhere in the world. The prevalence of CMV retinitis and HIV retinopathy is lower in India, and there have been no cases of ocular Kaposi sarcoma. Adnexal infections, albeit rare, were seen in our series. The nonavailability and cost of therapy influenced the visual prognosis in these patients.

Ocular lesions associated with HIV infection in India: a series of 100 consecutive patients evaluated at a referral center

PURPOSE: To document the ocular disorders seen in patients known to be infected with human immunodeficiency (HIV) virus at a referral eye clinic in India. METHODS: The first 100 individuals known to be HIV-positive at a referral eye clinic between 1993 and 1998 were enrolled in a prospective study. They underwent complete ocular and systemic evaluation. RESULTS: Most of the patients (76%) were in the 20- to 40-year age group. Heterosexual exposure to commercial sex workers was the most common risk factor. See also pp. 1–8. (70%) for HIV infection. Cytomegalovirus (CMV) retinitis (17%) and HIV retinopathy (15%) were the most common HIV-associated ophthalmic lesions. Pulmonary tuberculosis (67%) and oropharyngeal candidiasis (66%) were the most commonly associated systemic infections. Ocular involvement was most common in children who contracted the disease through perinatal transmission (66.7%) and in homosexual patients (60%). Ocular involvement was comparatively less common in patients who contracted the disease through blood transfusions (33%) or exposure to commercial sex workers (24.3%). CONCLUSIONS: This study shows that the spectrum of ocular lesions associated with HIV infection in India is different from that seen elsewhere in the world. The prevalence of CMV retinitis and HIV retinopathy is lower in India, and there have been no cases of ocular Kaposi sarcoma. Adnexal infections, albeit rare, were seen in our series. The nonavailability and cost of therapy influenced the visual prognosis in these patients.

Risk Factors and Clinical Presentation of Acute Primary HIV Infection in India

Most previous studies of clinical presentation and risk factors in early human immunodeficiency virus (HIV) infection have relied on retrospective analyses and referred seroconverters, and thus were subject to possible bias. To apply a method based on measurement of prevalent HIV-1 p24 antigenemia for identification of risk factors for newly acquired HIV infection and to describe the signs and symptoms of acute HIV infection. Nested case-control study in Pune, India. HIV antibody-negative persons attending 2 sexually transmitted disease (STD) clinics between May 1993 and June 1996. Prevalent p24 antigenemia, risk factors for HIV infection, and clinical symptoms of acute primary HIV infection. Of 3874 HIV antibody-negative persons tested, 58 (1.5%) were p24 antigen positive at initial presentation to the clinics. Unprotected sexual contact with a commercial sex worker (CSW) was reported by 39 (77%) of the 51 p24 antigenemic men, compared with 131 (51 %) of 255 control men (adjusted odds ratio [AOR], 3.4; 95% confidence interval [CI], 1.2-9.6; P=.02). The presence of an active genital ulcer at the time of screening was found in 46 (79%) of the 58 p24 antigenemic men and women, compared with 137 (47%) of the 290 control subjects (AOR, 4.2; 95% CI, 2.0-9.0; P<.001). Signs and symptoms independently associated with p24 antigenemia in HIV antibody-seronegative persons included fever, which was reported by 28 (48%) of the 58 p24 antigenemic subjects, but only 52 (18%) of the 290 control subjects (AOR, 4.7; 95% CI, 2.4-9.0; P<.001). Joint pain was reported by 10% of subjects recently HIV infected, compared with 2% of the control subjects (AOR, 6.5; 95% CI, 1.7-24.8; P=.006). Night sweats were reported by 9% of the p24 antigenemic, but only 1% of the control subjects (AOR, 9.1; 95% CI, 1.7-47.6; P=.009). Overall, fever, joint pain, and/or night sweats were reported in 27 (47%) of the 58 subjects with recent HIV infection. This systematic case-control study of p24 antigen screening in HIV-seronegative patients attending STD clinics in India identified unprotected sex with a CSW and a genital ulcer as independent risk factors associated with newly acquired HIV infection. In addition, p24 antigen positivity identified recent fever, night sweats, and arthralgias as symptoms that may be predictive of recent HIV infection. In a study of patients attending STD clinics in India, screening for p24 antigen in HIV antibody-negative persons was found to be a reliable and effective research method for determining recent risk behavior and identifying clinical signs of acute primary HIV infection.

Incidence and Predictors of Human Immunodeficiency Virus Type 1 Seroconversion in Patients Attending Sexually Transmitted Disease Clinics in India

The first estimates of the seroincidence of human immunodeficiency virus type 1 (HIV-1) and of the risk factors for seroconversion in a cohort of high-risk patients attending sexually transmitted disease (STD) clinics in India are reported. Between 1993 and 1995, 851 HIV-1-seronegative persons were evaluated prospectively every 3 months for HIV infection and biologic and behavioral characteristics. The overall incidence of HIV-1 was 10.2/100 person-years (95% confidence interval, 7.9-13.1). The incidence among commercial sex workers (CSWs) was 26.1/100 person-years, compared with 8.4 among non-CSWs. Recurrent genital ulcer disease and urethritis or cervicitis during the follow-up period were independently associated with a 7- (P < .001) and 3-fold (P = .06) increased risk of HIV-1 seroconversion, respectively. Because of the association of recurrent ulcerative and nonulcerative STDs with HIV-1 seroconversion in this setting, behavioral and biologic measures directed at the prevention and control of STDs would be expected to greatly reduce the transmission of HIV-1 infection in similar high-risk groups.

Characteristics of a Child Inpatient Population with Hysteria in India

This study examined the rate, correlates, and clinical outcome of childhood hysteria in a sample of inpatients in India. For comparison, the rate of this disorder among outpatients was computed. Data were derived from case records of inpatient (n = 143) and outpatient admissions (n = 640) during a 1-year interval at the Child and Adolescent Psychiatry Unit of the National Institute of Mental Health and Neurosciences, Bangalore, South India. The diagnosis of hysteria was made in 30.8% (n = 44) of the inpatient and 14.8% (n = 95) of the outpatient samples. The inpatients with hysteria were mostly postpubertal, their gender distribution was approximately even, and pseudo-seizure was the most frequent presentation. These inpatients had a brief duration of illness at admission and short-term outcome was generally positive. Children with hysterical symptoms form a notable proportion of cases in child guidance and psychiatry clinics in India. It could be that, in this culture, having a "medical" illness is one of the more acceptable means of seeking psychiatric help. The use of a structured and intensive inpatient treatment package appeared to bring about rapid symptom remission. Some of the present findings could be the basis to explore subtypes of childhood hysteria.

A decade of de‐addiction clinics in India

A decade of de‐addiction clinics in India

Old Men

Ad Libitum1 September 1984Old MenABRAHAM VERGHESE, M.D.ABRAHAM VERGHESE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-101-3-407_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptI will never forget the face of the wizened old farmer as he stood in the rural clinic. He wore only a loincloth and carried a cane. He had been waiting patiently and now, as his turn came, he saluted me by bringing his palms together and bowing gently, his eyes lowered. It was not an obsequious gesture but a dignified salute. The clinic in India was miles from any sort of sophisticated care, my armamentarium consisted of my senses for diagnosis, and a scabicidal ointment and a plentiful supply of vitamin A and sulfa tablets for treatment. My compounder... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1984Volume 101, Issue 3Page: 407-407KeywordsOintmentsVitamin A Issue Published: 1 September 1984 PDF downloadLoading ...

Carcinoma of breast associated with pregnancy and lactation.

Out of 840 cases of breast carcinoma seen over a period of ten years, 18 were found to be associated with pregnancy and lactation. According to the mode of onset and presentation of the disease, these patients were divided into four groups. The average age of these patients was 31.9 years old. Thirteen out of 18 patients presented in a very advanced stage of the disease. In a short period, involvement of liver was noticed in 8, brain in 3, and bones and lung in 2 each. The disease was bilaterally simultaneous in two patients. The acceleration of growth was noticed during second and third trimesters of pregnancy as well as during lactation. The termination of pregnancy in three patients did not alter the clinical course of the disease.

Socio‐demographic correlates of schizophrenia, affective psychoses and neuroses in a clinic in India

Of a total of 5,343 patients seen during four calendar years at the adult psychiatric outpatients’clinic of a teaching hospital in India, patients with schizophrenia, affective psychoses and neuroses were compared with one another regarding distribution of socio‐demographic variables. Women with an urban background and higher socio‐economic status were proportionately more numerous amongst neurotics. Schizophrenics were youngest and more often single. Patients with affective psychoses were older, usually married, had the lowest educational level and most often a rural background, and were from relatively lower socio‐economic strata. Also the Sikh religion and Jat caste were significantly more preponderant amongst affective psychotics. This finding is consistent with the reported distribution of ABO blood groups in affective psychotics and in Jat Sikhs, and suggests a genetic basis for the greater representation of Jats and Sikhs amongst affective psychotics.