High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India

<p>Abstract</p> <p>Background</p> <p>The risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection. In addition, the feasibility and utilization of post-exposure prophylaxis (PEP) programs in these settings are unclear. Therefore, we examined the rate and characteristics of occupational exposure to HIV and the utilization of PEP among health care workers (HCW) in a large, urban government teaching hospital in Pune, India.</p> <p>Methods</p> <p>Demographic and clinical data on occupational exposures and their management were prospectively collected from January 2003–December 2005. US Centers for Diseases Control guidelines were utilized to define risk exposures, for which PEP was recommended. Incidence rates of reported exposures and trends in PEP utilization were examined using logistic regression.</p> <p>Results</p> <p>Of 1955 HCW, 557 exposures were reported by 484 HCW with an incidence of 9.5 exposures per 100 person-years (PY). Housestaff, particularly interns, reported the greatest number of exposures with an annual incidence of 47.0 per 100 PY. Personal protective equipment (PPE) was used in only 55.1% of these exposures. The incidence of high-risk exposures was 6.8/100 PY (n = 339); 49.1% occurred during a procedure or disposing of equipment and 265 (80.0%) received a stat dose of PEP. After excluding cases in which the source tested HIV negative, 48.4% of high-risk cases began an extended PEP regimen, of whom only 49.5% completed it. There were no HIV or Hepatitis B seroconversions identified. Extended PEP was continued unnecessarily in 7 (35%) of 20 cases who were confirmed to be HIV-negative. Over time, there was a significant reduction in proportion of percutaneous exposures and high-risk exposures (p < 0.01) and an increase in PEP utilization for high risk exposures (44% in 2003 to 100% in 2005, p = 0.002).</p> <p>Conclusion</p> <p>Housestaff are a vulnerable population at high risk for bloodborne exposures in teaching hospital settings in India. With implementation of a hospital-wide PEP program, there was an encouraging decrease of high-risk exposures over time and appropriate use of PEP. However, overall use of PPE was low, suggesting further measures are needed to prevent occupational exposures in India.</p

A rare case of acquired hepatocerebral degeneration in cirrhosis

Hepatic encephalopathy is the most common neurologic complication of cirrhosis of the liver, while acquired hepatocerebral degeneration (AHD) is an underestimated neurologic manifestation. It is characterized by parkinsonism, ataxia, and neuropsychiatric symptoms. It is an underdiagnosed cause of psychomotor retardation in patients with chronic parenchymal liver disease with portosystemic shunting. Manganese deposition in the basal ganglia has been proposed as a mechanism for AHD. Here, we report a case of AHD in a patient with chronic parenchymal liver disease who responded to dopamine agonist

Clinical Profile of Cryptococcal Meningitis in Patients Living with HIV Infection: An Experience from Western India

Background: Cryptococcal meningitis (CM) is an important public health problem, and causes around 10%–30% mortality among people living with HIV/acquired immune deficiency syndrome (AIDS). Combination therapy with Amphotericin B and Fluconazole has improved the outcomes. Objectives: The purpose of this study is to determine clinical presentation, hospital course, response to treatment, complications, and recurrence of CM. Materials and Methods: An observational study from a tertiary care center. From the diagnosed cases of CM, demographic data, clinical profile, investigations, treatment received, complications, and recurrence on follow-up were noted. Results: Twenty patients diagnosed to have CM with HIV infection were analyzed. 12 patients (60%) had CM as the presentation of AIDS. The prevalence of unmasked immune reconstitution inflammatory syndrome (IRIS) (30%) was more than paradoxical IRIS (10%). Fever (85%), headache (90%), and altered sensorium (40%) were the most common symptoms. Mean CD4 in our study was 119.3. Cerebrospinal fluid (CSF) analysis showed oligocellular response in 12 patients. CSF cryptococcal antigen test and fungal culture were positive in all cases. Most common finding on neuroimaging was meningeal enhancement (60%) followed by cryptococcomas (26%). 17 patients survived, whereas 3 patient died during treatment. Three patients had relapse of CM, all of them were noncompliant to maintenance fluconazole therapy. Conclusion: Considering variable presentation of CM in HIV-infected individuals and the presence of high load of undiagnosed cases, high suspicion is required for clinching early diagnosis which might improve the outcome

Clinicohistopathological correlation and Helicobacter pylori status in patients with functional dyspepsia

Background: Functional dyspepsia (FD) is a condition of immense clinical significance. Helicobacter pylori may be responsible for FD in a subset of patients. Materials and Methods: Upper gastrointestinal endoscopy was done in sixty patients of FD fulfilling ROME III criteria, and gastric and duodenal biopsies were taken. Duodenal histopathological findings and H. pylori status were correlated with the symptomatology. Standard treatment was given according to the H. pylori status, and the response was analyzed using 6-point Likert scale. Results: Sixty percent of cases were infected with H. pylori. 72.5% of cases with predominant epigastric pain were H. pylori-positive. 96.5% patients with early satiety had duodenal eosinophilia and duodenitis. Epigastric pain was significantly associated with H. pylori, and early satiety was associated with duodenal eosinophilia and duodenitis. Sixty-five percent of cases had increased duodenal intraepithelial lymphocyte count. 88.8% cases showing no response to treatment had duodenal eosinophilia. Conclusion: H. pylori infection constitutes an important subset of FD patients. H. pylori infection, duodenitis, and duodenal eosinophilia contribute to symptom generation. H. pylori eradication can provide symptomatic relief. A duodenal biopsy can identify an important subset of patients with duodenal eosinophilia and duodenitis which can be a contributor for poor treatment response and can be clinically amenable to new treatment avenues

Innovative solutions to reform geriatric oral health in India: Alliance for healthy aging

Geriatric population is showing an increasing trend, owing to the increased awareness as well as improved healthcare facilities and access. The aging Indian population of the modern-day has diverse and more complex dental needs, unlike the olden-days. Hence, the authors propose innovative strategies to cater to the dental needs of the increasing geriatric population in India. Barriers for provision of geriatric dental care in India are elucidated, which are lack of geriatric training, access problems and financial issues. Approaches to confront these barriers have been explained. The increasing and compounding dental needs of the aging Indian population requires multifaceted and contemporary strategies

Tuberculosis Risk among Medical Trainees, Pune, India

During 2012–2013, at a public hospital in Pune, India, 26 (3.9%) cases of tuberculosis were reported among 662 medical trainees, representing an estimated incidence of 3,279 cases/100,000 person-years. Three of these infections were isoniazid-resistant, 1 was multidrug-resistant, and 1 occurred in a trainee who had fulminant hepatitis after starting treatment for TB

TB Risk Perceptions among Medical Residents at a Tertiary Care Center in India

Setting. Government tertiary health care center in India. Objective. To understand the perceptions of medical residents about their risk of developing TB in the workplace. Design. Cross-sectional study in which a semistructured questionnaire which included an open-ended question to assess their main concerns regarding TB in workplace was used to collect data. Results. Out of 305 resident doctors approached, 263 (94%) completed a structured questionnaire and 200 of these responded to an open-ended question. Daily exposure to TB was reported by 141 (64%) residents, 13 (5%) reported a prior history of TB, and 175 (69%) respondents were aware of TB infection control guidelines. A majority reported concerns about acquiring TB (78%) and drug-resistant TB (88%). The key themes identified were concerns about developing drug-resistant TB (n=100; 50%); disease and its clinical consequences (n=39; 20%); social and professional consequences (n=37; 19%); exposure to TB patients (n=32; 16%); poor infection control measures (n=27; 14%); and high workload and its health consequences (n=16; 8%). Conclusion. Though many resident doctors were aware of TB infection control guidelines, only few expressed concern about lack of TB infection control measures. Doctors need to be convinced of the importance of these measures which should be implemented urgently

High risk for latent tuberculosis infection among medical residents and nursing students in India.

Defining occupational latent tuberculosis infection (LTBI) risk among healthcare workers is needed to support implementation of prevention guidelines. Prospective cohort study of 200 medical residents and nursing students in India was conducted May 2016-December 2017. Tuberculin skin test (TST) and QuantiFERON TB Gold Test-in-tube (QFT-GIT) were performed at study entry and 12 months. Primary outcome was incident LTBI (≥10mm TST induration and/or ≥0.35IU/mL QFT-GIT) at 12 months; secondary outcomes included baseline LTBI prevalence and risk factors for incident and prevalent LTBI using Poisson regression. Among 200, [90 nursing students and 110 medical residents], LTBI prevalence was 30% (95% CI, 24-37); LTBI incidence was 26.8 (95% CI, 18.6-37.2) cases per 100 person-years and differed by testing method (28.7 [95% CI, 20.6-38.9] vs 17.4 [95% CI, 11.5-25.4] cases per 100 person-years using TST and QFT-GIT, respectively). Medical residents had two-fold greater risk of incident LTBI than nursing students (Relative Risk, 2.16; 95% CI, 1.05-4.42). During study period 6 (3%) HCWs were diagnosed with active TB disease. Overall, median number of self-reported TB exposures was 5 (Interquartile Range, 1-15). Of 60 participants with prevalent and incident LTBI who were offered free isoniazid preventive therapy (IPT), only 2 participants initiated and completed IPT. High risk for LTBI was noted among medical residents compared to nursing students. Self-reported TB exposure is underreported, and uptake of LTBI prevention therapy remains low. New approaches are needed to identify HCWs at highest risk for LTBI