CONTEXT: Financial catastrophe can arise from huge out-of-pocket (OOP) expenditure on HIV-related care and treatment. Despite the huge burden of HIV and high poverty headcount ratio in Nigeria, there is dearth of information on the OOP expenditure among People Living with HIV (PLHIV). AIMS: This study aims to assess OOP expenditure on HIV/AIDS services among PLHIV in Nigeria. SUBJECTS AND METHODS: The study was a cross-sectional survey of PLHIV accessing HIV/AIDS services in health facilities across five states in Nigeria. A multi-stage sampling approach was adopted, and two pretested questionnaires were used for the assessment. Descriptive analysis was conducted using SPSS version 16. RESULTS: A total of 485 PLHIV accessing care in 26 health facilities were surveyed. About 59.9% of the respondents were employed while 50.4% PLHIV were the main breadwinner for their household. The average annual personal income was N357, 516 ($2,235) and the annual household income was N586, 584 ($3,666). The proportions of household expenditure on healthcare food and transport were 23.0%, 33.5% and 13.1%, respectively. The average annual expenditure for HIV care was N84, 480 ($528). The proportion of the household income used for HIV care was 14.5%. CONCLUSIONS: OOP expenditure for HIV related services among PLHIV in Nigeria seems to be catastrophic. There is a need for policy response toward financial protection for PLHIV and abolishment of user-fee where it exits.

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CONTEXT: Leptospirosis is the disease which has worldwide occurrence, but the incidence is more in tropical countries. Disease outbreaks depend on the climatic factors which allow better survival of bacteria. AIMS: The aim of the study was (1) to study the seasonal pattern of leptospirosis cases and with rainfall and relative humidity and (2) to forecast the leptospirosis cases' occurrence based on the model. SUBJECTS AND METHODS: Retrospective time series analysis was carried out of leptospirosis cases registered in Ratnagiri, Maharashtra, during January 2011 to December 2015. STATISTICAL ANALYSIS: Patterns of occurrence of monthly cases and patterns of monthly rainfall and relative humidity were studied using cross-correlation function, autocorrelation function, partial autocorrelation function, and simple seasonal model (selected by expert modeler) were applied using SPSS version 20. RESULTS: A significant seasonal pattern is noted in the leptospirosis cases' occurrence. Cross-correlation function shows a significant highest correlation 1 month lag between the occurrence of heavy rainfall and outbreak of cases. SPSS expert modeler used to forecast the cases and could predict the 80% variability. CONCLUSIONS: Seasonal pattern of cases of leptospirosis was observed along with the correlation of rainfall. This forecasted model could be used by health administrators effectively to arrange the adequate resources on time to manage the outbreaks.

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BACKGROUND: Family functionality is a patient-oriented medical outcome of care that is emerging in scientific literature. It is a family-related factor that influences medication adherence and glycemic control, yet it is not easily recognized by clinicians. AIM: The study was aimed at determining the role of family functionality on medication adherence and glycemic control among ambulatory type 2 diabetic patients in a primary care clinic in Nigerian. MATERIALS AND METHODS: A clinic-based descriptive study was carried out on 120 type 2 diabetic Nigerians who were on treatment for at least 3 months at the primary care clinic in Nigeria. Family functionality and medication adherence were assessed in the previous 3 months and 1 month preceding the study using General Functioning Subscale of the Family Assessment Device and interviewer-administered questionnaire on self-reported adherence to therapy, respectively. Glycemic control was assessed in the previous 1 month. RESULTS: The age of the study participants ranged from 27 to 81 years and there were 37.5% males and 62.5% females. Healthy family function, medication adherence, and glycemic control rates were 90.8%, 72.5%, and 61.7%, respectively. Family functionality was significantly associated with household family (P = 0.048), medication adherence (P = 0.031), and glycemic control (P = 0.022). The most significant demographic predictor of family functionality was household family (odds ratio = 5.19 (3.31–7.01); P = 0.029). The type 2 diabetic patients in household families were five times more likely to have functional families compared to their counterparts who were from nonhousehold families. CONCLUSION: Family functionality was significantly associated with household family, medication adherence, and glycemic control. Assessment of family functionality should be part of reason for encounter during consultation with diabetic patients in order to unravel family factors that can positively or negatively influence medication adherence and glycemic control.

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BACKGROUND: Vision loss and age-related eye diseases are major global public health problems. The burden of visual impairment worldwide varies depending on the methods of assessment. The need for local data on the prevalence of visual impairment in adults coupled with limited resources necessitated the conduct of the study in a limited geographical area. METHODS: A cross-sectional study was conducted in the field practice area of Department of Community Medicine of a Medical College. Study patients included adults aged ≥18 years, identified through purposive sampling. A semi-structured questionnaire was used to collect sociodemographic data. Snellen's chart for distant vision; reduced Snellen's chart for near vision and Ishihara chart for color vision was used. Data were analyzed using SPSS software version 15. RESULTS: The study included 411 patients. Nearly 40% of the patients were ≥50 years. Among the patients, 195 (47.4%) had H/o refractive error, 78 (19%) had H/o hypertension, 56 (13.6%) had H/o diabetes, and 43 (10.5%) had H/o cataract. The most common ocular morbidity was arcus senilis 113 (27.5%) and cataract 28 (6.8%). Using Snellen's distant vision chart low vision (<6/18) was present among 91 (22.1%) and 15 (3.6%) had <3/60. Forty percent had low near vision (<N9) and 12 (2.9%) were blind (<N36) by Snellen's near vision chart. Abnormal color vision by Ishihara chart was seen among 3%. The prevalence of distant and near visual impairment was more among unemployed/retired (51.3%; 62.5%), aged ≥60 years (54.7%; 74.2%) and those with H/O chronic diseases (Diabetes –44.6%; 69.6% and hypertension – 48.1%; 65.4%). CONCLUSIONS: Farsightedness was detected among a quarter of the population, while impaired near vision was detected among two.fifths of the study group. Nearly 7% of patients had cataract and were referred for further evaluation. Advancing age and the presence of comorbidities were significant determinants of visual impairment.

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Malignancies in the renal pelvis are rare and few cases have been described in the literature till date. They present in various morphologies which cause diagnosis dilemma due to their close resemblance to other benign and malignant lesions. Histopathology has a major role in diagnostics since recognition of the morphological variant is important for prognostic and treatment stratification. We report a case of urothelial carcinoma of the renal pelvis with extensive glandular differentiation in a 48-year-old male.

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BACKGROUND: Acetaminophen (Paracetamol) is a widely used over-the-counter analgesic and an antipyretic drug known to inhibit cyclooxygenase II enzyme paramount in the prostaglandin synthesis and essential for normal male reproductive function. α-tocopherol (Vitamin E), an antioxidant has been used in the management of a number of conditions including infertility. However, there is a dearth of information on the role of α-tocopherol in the management of testicular dysfunction. This study was designed to investigate the ameliorative effect of α-tocopherol in acetaminophen-induced testicular dysfunction. MATERIALS AND METHODS: Adult male Wistar rats were randomly allotted into groups; Control 1 (vehicle 1; received 0.2 ml of olive oil), Control 2 (vehicle 2; received 0.2 ml of distilled water), acetaminophen- treated (ACE-treated; received 500 mg/kg b. w), α-tocopherol-treated (AT-treated; received 100 mg/kg b. w), and α-tocopherol + acetaminophen-treated (AT + ACE-treated). The treatment lasted for 14 days, and the administration was given orally. The body weight change was monitored using animal weighing balance (Olympia SCL66110 model, Kent Scientific Corporation, Torrington, CT06790, USA), semen analysis and biochemical assay were performed. RESULTS: The results showed a significant increase in body weight gain and significant alteration of spermatozoa integrity in the acetaminophen-treated group when compared to the vehicle-treated groups. These alterations were associated with decreased hypophyseal-gonadotropic hormones, testosterone, and increased testicular tissue oxidative redox status. Concomitant administration of α-tocopherol during treatment with acetaminophen ameliorated the alterations. CONCLUSION: The present study demonstrates that administration of α-tocopherol during treatment with acetaminophen preserves testicular function. This might be due to its antioxidative effect and enhancement of hypophyseal-gonadotropic hormone secretion.

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INTRODUCTION: Infections due to carbapenemase-producing Enterobacteriaceae have been increasingly reported worldwide and are causing significant health concerns. In this study, we investigated the occurrence of New Delhi metallo-beta-lactamase (NDM) carbapenemase-producing Enterobacteriaceae (CPE) in Enterobacteriaceae isolates from Hospital Tengku Ampuan Afzan (HTAA) and verified the presence of associated carbapenemases genes. MATERIALS AND METHODS: Standard antimicrobial susceptibility testing was performed to analyze the isolates' susceptibility pattern. Modified Hodge test was used to detect carbapenemase production. Genes associated with CPE were detected by standard polymerase chain reaction amplification with a series of established primers, followed by DNA sequencing. RESULTS: Out of 259 Enterobacteriaceae isolates, four Klebsiella pneumoniae isolates (1.5%) were found to be phenotypically carbapenem-resistant. NDM-1 carbapenemase was detected in three of the four isolates. Two of them were recovered from blood and the third strain was isolated from a urine sample. The three isolates were found to be resistant to all β-lactams antibiotics and the majority of other nonβ-lactam antibiotics. Meanwhile, all the isolates were susceptible to polymyxin B. They also carried other β-lactamase genes along with the bla_NDMgene. Nucleotide sequence of the bla_NDM-1gene showed no base variation with other NDM-1 sequences from the NCBI nucleotide database. CONCLUSION: The presence of NDM-producing K. pneumoniae in the HTAA is alarming and of serious concern due to the high-level resistance of this gene and the risk of an outbreak occurrence. Further studies to detect the genetic relatedness and clonality of these resistance organisms are highly recommended.

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BACKGROUND: Undetectable plasma human immunodeficiency virus type 1 (HIV-1) viral load means the virus load is lower than the detection limit of the assay used, but it does not imply the absence or clearance of the virus from the blood. This study was undertaken to analyze the various characteristics of HIV-1 seropositive antiretroviral therapy (ART)-naïve individuals with undetectable plasma viral load (PVL). MATERIALS AND METHODS: The present cross-sectional study was conducted on 82 treatment-naïve individuals in a tertiary care teaching institute in Northeast India, from October 2014 to September 2016. PVL was determined by COBAS^® TaqMan^® HIV-1 test version 2.0, and CD4+ T-lymphocytes' count (CD4 count) was estimated by Fluorescent-Activated Cell Sorter Count™ System. Statistical Package for the Social Sciences software version 16.0 was used for all statistical analyses. Variables were expressed as median, interquartile range, and percentage. P < 0.05 was considered statistically significant. RESULTS: PVL was not detectable in 8.5% of ART-naïve individuals whose data contributed to these analyses. All the participants were clinically asymptomatic (100%), educated (100%) and majority of them were married (71.4%), and unemployed (85.7%). The CD4 counts ranged from 453 to 1225 cells/μL, with a median CD4 count of 706 cells/μL. The median CD4 count was 776 cells/μL and 671 cells/μL in the males and females, respectively (P = 1.00). CONCLUSIONS: ART-naïve HIV-1 seropositive individuals with undetectable PVL have a normal CD4 count and no significant gender difference in the median CD4 count.

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INTRODUCTION: Since its discovery in 1980, extended-spectrum beta-lactamases (ESBL) have been prevalent throughout the world. Several new and more complicated resistance mechanisms have emerged and have driven the focus away from ESBLs. The present study was conducted to know the isolated prevalence and resistance profile of ESBL-producing Gram-negative uropathogens and outline an empirical therapy for management of urinary tract infections. MATERIALS AND METHODS: A study was conducted over a period of 3 months (April to June 2015) in the microbiology department of our 500-bedded tertiary care referral hospital. Urine specimens were processed as per standard guidelines. Antimicrobial susceptibility and ESBL detection were performed by Kirby–Bauer Disc diffusion method and results were interpreted as per CLSI 2015 guidelines. Production of other beta-lactamases was not studied. Klebsiella pneumoniae ATCC 700603 (ESBL positive) and Escherichia coli ATCC 25922 (ESBL negative) strains were used as quality control. P <0.05 was considered statistically significant. RESULTS: Of the 111 Gram-negative urinary isolates, 60 were ESBL positive (54%). ESBL prevalence was highest in E. coli (73.3%), followed by Klebsiella spp. (11.7%), Morganella spp. (6.7), Proteus mirabilis (5%), Pseudomonas spp. (1.6%), and Citrobacter spp. (1.6%). Most of the ESBL isolates were from outpatient department (OPD) (76.7%) while only 23.3% were from inpatient department (IPD), P < 0.0001, which was extremely significant. When compared to IPD, OPD isolates were found to be more resistant to fluoroquinolones and cotrimoxazole. CONCLUSION: ESBLs can cause therapeutic failure even when host appears to be susceptible in vitro. Hence, it is important to know its prevalence and antimicrobial susceptibility profile to formulate appropriate antibiotic policy.

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Neurofibroma in the head-and-neck region is a rare entity. It can occur either as a solitary, slowly progressive tumor or as part of neurofibromatosis. We here report three cases of neurofibroma in the head-and-neck region. Case 1 is a 20-year-old female with a solitary neurofibroma in trachea. Case 2 is a 35-year-old male with neurofibromatosis type 1 and spontaneous hemorrhage in the neurofibroma of the facial region. Case 3 is a 25-year-old female with a solitary neurofibroma in the left posterior triangle of the neck. Multiple neurofibroma in the head-and-neck region may occur in the skin as part of neurofibromatosis and as solitary lesions in intratracheal to posterior triangle region of the neck.

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The simultaneous presence of hypodontia and hyperdontia is a rare condition in general population posing a diagnostic dilemma to dental practitioners. Its etiology is still not exactly known. It can result in several clinical problems which may require a multidisciplinary approach and long-term dental care. The growing knowledge about this condition emphasizes that concomitant anomalies should be excluded when hypodontia or hyperdontia is diagnosed. Presented here is an unusual case of bimaxillary concomitant hypodontia and multiple supernumerary teeth with Talon cusps as an associated dental anomaly.

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Moyamoya disease is a chronic nonatherosclerotic, noninflammatory cerebrovascular disease characterized by slow progressive stenosis of the intracranial vessels. The clinical presentations of moyamoya disease differ considerably for both children and adults. Interestingly, moyamoya disease continues to remain as an “unsolved mystery” till date, and its occurrence in the nonendemic region of the upper part of Brahmaputra Valley is rare. In this context, the author wishes to report the clinical study of an 18-year-old young adolescent boy exhibiting sudden-onset dizziness, severe excruciating headache, vomiting, abnormal behavior, and urinary and fecal incontinence.

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Abdominal cocoon formation is a chronic condition which usually presents with intermittent bowel obstruction and is typically described with benign conditions. In developing countries like India, where tuberculosis is endemic, abdominal cocoon in young patients without any other known chronic disease is mostly associated with abdominal tuberculosis. Abdominal cocoon secondary to malignant causes has been reported but is extremely rare, mostly in association with ovarian thecomas. Abdominal cocoon secondary to abdominal tuberculosis has been described only in few reports. We present a case of young female who presented with abdominal cocoon which was subsequently proven to be secondary to diffusely infiltrative gastric carcinoma.

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INTRODUCTION: Bronchial asthma is one of the most common chronic diseases in the world affecting around 5% of the world's population. More simple and inexpensive tools are required to assess asthma control, especially in resource-poor countries where pulmonary function tests are not feasible. The effectiveness of asthma control test (ACT) in assessing asthma control and its correlation with asthma severity is unknown. AIM: The aim of this study is to evaluate the effectiveness of ACT in assessing asthma control and its relation to the severity of asthma by comparing with a global initiative for asthma (GINA) classification. MATERIALS AND METHODS: In a tertiary care hospital, 106 bronchial asthma patients were enrolled. All patients underwent clinical evaluation, spirometry to assess the severity according to the GINA classification and were given ACT questionnaire to assess asthma control. Patients were further followed by two visits 3 months apart. Correlation between the ACT and GINA classification was assessed at each visit. RESULTS: ACT was able to give sensitivity of 82.3%, specificity of 69.4%, positive predictive value (PPV) was 56%, and negative predictive value (NPV) was 89.2% at the first visit (P < 0.05). At the second visit, the sensitivity of the ACT increased to 85.71%, and specificity to 96.77%, PPV was 94.73%, and NPV was 90.90% (P < 0.05). At the third visit, the sensitivity of ACT was 92%, specificity of ACT was 85.18%, PPV was 85.71%, and NPV was 92%, (P < 0.05). CONCLUSIONS: ACT with high sensitivity, specificity, and PPV, could be a potential alternative diagnostic tool in assessing asthma severity even without aid of a spirometer or a peak flow meter.

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