18 research outputs found
Sexually transmitted infections in India: Current status (except human immunodeficiency virus/acquired immunodeficiency syndrome)
Sexually transmitted infections (STIs) are more dynamic than other infections prevailing in the community. It is important that such dynamic epidemiological changes in STIs are acknowledged and kept track of in a vast and populous developing country like India, particularly in this HIV era. It is with this aim that the authors have reviewed the relevant literature in STI epidemiology in India during the past 25 years. Admittedly, there has been heterogeneity of data to account for the subcontinental dimension of this country. But a basic pattern in the changing epidemiology is discernible. Like the developed countries, in India too the bacterial STIs like chancroid and gonorrhea are declining, while viral STIs like HPV and herpes genitalis are on an upswing. The overall decline in the prevalence of STIs has to be interpreted with caution, however. This may partially reflect the improved facilities of treatment in the peripheral centres that obviates the need of many patients in attending the STD clinics in the tertiary centres. Also, the improved pharmacotherapy of many of the bacterial STIs may result in partial clearance and non-reporting of many of these infections
Relapse in leprosy
Leprosy is unique in terms of the nature of the causative organism (
Mycobacterium leprae ), the chronicity of the disease, its prolonged
treatment and the definitions of "cure" and "relapse." The principal
mode of assessing the efficacy of therapeutic regimens in leprosy is
the "relapse rate." There are wide variations in estimates of relapse
rates after the World Health Organization (WHO) multidrug therapy in
different regions. The important predisposing factors for relapse
include the presence of "persister" bacilli, monotherapy,
inadequate/irregular therapy, presence of multiple skin
lesions/thickened nerves and lepromin negativity. The conventional
methods of confirming activity or relapse in an infectious disease
(demonstration and/or culture of the etiologic agent) have limited
utility in leprosy because of the difficulty in demonstrating bacilli
in paucibacillary (PB) cases and absence of a method of in vitro
cultivation of M. leprae. Bacteriological parameters are useful in
multibacillary (MB) leprosy, whereas in PB leprosy, the criteria for
relapse depend primarily on clinical features. Although there are no
widely available serologic tests for leprosy other than in a research
setting, various immunological tests may be useful for monitoring
patients on chemotherapy as well as for confirming suspected cases of
relapse. The main differential diagnoses for relapse are reversal
reactions, erythema nodosum leprosum and
reactivation/resistance/reinfection. The most reliable criteria for
making an accurate diagnosis of relapse include clinical,
bacteriological and therapeutic criteria. Additional ones that may be
used, depending on the setting, are histopathological and serologic
criteria. Relapsed cases of leprosy should be identified and put back
on chemotherapy as soon as possible to prevent further disability and
transmission of infection. Factors that should be considered in
choosing an appropriate regimen are the type of leprosy (PB or MB),
previous treatment and drug resistance. Occasionally, clinicians may
need to use their judgement to modify the standard WHO treatment
regimens according to the scenario in each patient
Diet in dermatology: Revisited
Diet has an important role to play in many skin disorders, and
dermatologists are frequently faced with the difficulty of separating
myth from fact when it comes to dietary advice for their patients.
Patients in India are often anxious about what foods to consume, and
what to avoid, in the hope that, no matter how impractical or difficult
this may be, following this dictum will cure their disease. There are
certain disorders where one or more components in food are central to
the pathogenesis, e.g. dermatitis herpetiformis, wherein dietary
restrictions constitute the cornerstone of treatment. A brief list,
although not comprehensive, of other disorders where diet may have a
role to play includes atopic dermatitis, acne vulgaris, psoriasis
vulgaris, pemphigus, urticaria, pruritus, allergic contact dermatitis,
fish odor syndrome, toxic oil syndrome, fixed drug eruption, genetic
and metabolic disorders (phenylketonuria, tyrosinemia, homocystinuria,
galactosemia, Refsum′s disease, G6PD deficiency, xanthomas, gout
and porphyria), nutritional deficiency disorders (kwashiorkar,
marasmus, phrynoderma, pellagra, scurvy, acrodermatitis enteropathica,
carotenemia and lycopenemia) and miscellaneous disorders such as
vitiligo, aphthous ulcers, cutaneous vasculitis and telogen effluvium.
From a practical point of view, it will be useful for the dermatologist
to keep some dietary information handy to deal with the occasional
patient who does not seem to respond in spite of the best, scientific
and evidence-based therapy