Sandip Mukherji

Predictors of first line antiretroviral therapy failure and burden of second line antiretroviral therapy

BACKGROUND As HIV steps into the third decade, there are more number of patients living on lifelong (antiretroviral therapy) ART and facing the threat of drug resistance with subsequent treatment failure. The aim of this study was to determine predictors of first-line ART failure with the objectives to estimate the burden of 2nd line ART. METHODS A retrospective 5-year cohort of HIV patients who were initiated on first line ART in 2008-09 was studied. Patients were followed from the time of ART initiation. Kaplan-Meier methods and Cox proportional hazards regression models were used to estimate probabilities and predictors of first line ART failure. RESULTS Of the total of 195 patients initiated on first line ART, 15 patients were switched to second line ART yielding 7.69% failure rate. During the 7178 person-years of follow-up, the incidence of first line ART failure was 2.09 per 1000 person-years. The Kaplan-Meier survival analysis gave a mean survival time of 55.6 months. BMI, CD4 count at ART initiation and presence of opportunistic infections were significant predictors of first line ART failure. The burden of second line ART patients by the end of 5 years of first line ART is expected to be 151 patients. CONCLUSION Though the first line ART failure is quite low in this study, we still need to be vigilant for lower BMI, low baseline CD4 count and occurrence of opportunistic infections to efficiently manage failures on first line ART.

The zika virus threat: Should India worry?

The explosive spread of Zika virus (ZIKV) has warranted a great attention from national and international health agencies worldwide, including the World Health Organization, thus declaring the situation as a Public Health Emergency of International Concern in February this year. The virus bears a phenotypic and clinical resemblance to dengue, along with the vector Aedes aegypti . The abundance of vector along with favorable environmental conditions makes India a “ZIKV receptive” area, with just the virus itself missing from the epidemiological triad. High level of awareness regarding factors about re-emergence of the ZIKV decades after its discovery and preventive and control measures against the vector remains the cornerstone for planning, implementing, and monitoring surveillance activities against ZIKV and other emerging and re-emerging infections.

Reproductive health awareness among adolescent girls of a government school in an urban slum of Pune City

Introduction: Reproductive health of adolescent girls is crucial in determining the health of future generations. For ensuring informed decisions by adolescents regarding their sexuality and reproductive health, National AIDS Control Organisation has introduced life skills education in school curriculum. However, there exist many roadblocks in implementation from theory to practice. Hence, the present study was conducted to assess the reproductive health awareness and most preferred source of information. Materials and Methods: This was a descriptive cross-sectional study among girls of classes VI–XII of a Government High School in an urban slum of Maharashtra. Two hundred and fifty girls participated; 39 questionnaires were incomplete, hence 211 responses were analyzed. All girls were educated about reproductive health and life skills issues after the study. Results: Mean age of the participant girls was 14.9 ± 1.75 years. The level of awareness improved significantly with increase in class of respondent (P 0.05). Eighty percent of them were unaware of the appearance of secondary sexual characteristics in both the genders. Less than 30% of the girls were aware of contraceptives. Regarding effects of premarital sex, 57% of the participants were concerned about bringing a bad name to themselves and their family, while reproductive tract infections (9%), HIV/AIDS (29%), were cited as other ill effects. Seventy percent felt comfortable discussing or confiding regarding reproductive health issues with friends rather than parents, teachers, or medical professionals. Conclusion: Knowledge and awareness about reproductive and sexual health issues among adolescent girls was dismal.

Drug prescription behavior in a Teaching Hospital of Western Maharashtra

Context: To identify drug prescription behavior and thus, guide further actions to recommend evidence-based module for learning in postgraduate curriculum. Aims: To determine drug prescribing behavior of postgraduate residents. Settings and Design: Retrospective historical data-based cross-sectional study in a tertiary care, multispecialty teaching hospital. Materials and Methods: Calculation of sample size and sampling procedure was based on standard recommendations of the World Health Organization for investigation of drug use in health facilities. A sample size of 1200 was selected from a sampling frame of 86,213 prescriptions using systematic random sampling. Statistical Analysis Used: The data were entered in MS Excel and analyzed for determining core drug use prescription indicators, namely, average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed. Additional indicators suggestive of drug prescribing behavior such as polypharmacy, type of drug prescribed, department wise distribution, percentage of prescription forms with patient identification details, and demographic characteristics of outpatient department attendees were also calculated. Results: A total of 4096 drugs were prescribed in 1200 prescriptions. Thus, an average of 3.41 (±2.07) drugs per encounter was prescribed. Generic name was used for prescribing 2008 (49.02%) drugs. Antibiotics and injectable were prescribed in 222 (18.5%) and 48 (4%) prescriptions, respectively. Polypharmacy was seen in 286 (23.8%) of prescriptions. Conclusions: Such detailed studies can contribute vital inputs for the development of evidence-based training modules for rational drug use even at the institutional level. Availability and accessibility of essential drugs at affordable prices can be achieved with rationale use of drugs.

Assessing the assessors: Use of statistical tests to find out the inter examiner reliability of examiners in a post graduate medical examination

Context: A robust evaluation system is the backbone of any education system. There are different methods of evaluating answer sheets in a subjective exam such as glance and grade method, scoring pattern system, and training the examiners on model answers before evaluation. However, inter-examiner reliability varies with each of these methods. Aim: The present study was done to find out the inter-examiner reliability in a postgraduate (PG) exam with a glance, grade, and assess method. Materials and Methods: This was a cross-sectional study conducted done during a PG examination in community medicine in a medical college setting. There were four independent assessors who rated 8 PG students over 36 different items in four theory exams. The examiners were blinded during evaluation of answer sheets. Statistical Analysis Used: Reliability statistics, inter- and intra-class correlation coefficients, Pearsons correlation coefficient, and Spearmans rho coefficient between assessors were calculated. Results: There was a significant difference in the mean scores (P < 0.001) of different assessors. However, there was significant reliability and correlation between the assessors (P < 0.05). Pearsons correlation coefficient varied between 0.736 and 0.893 and Spearmans rank coefficient varied between 0.741 and 0.891 this could be due to the fact that the assessors were experienced teachers. Conclusions: Glance and grade method of assessing PGs has good reliability between the assessors. However, the scores can vary significantly between different assessors.

Atlas of Occupational Health and Disease

It was during the Industrial revolution when public attention was drawn to the various occupational diseases and work-related health hazards. Clinicians showed a growing deal of interest in the subject in the 20th century, following the footsteps of such doyens as Thomas Legge and Donald Hunter. However, to actually visit workplaces to acquaint oneself with the hazards remains a luxury for most clinicians. This book has an array of photographs of workplaces and work-related diseases, which tries to provide a realistic pictorial substitute. It is ideal for the trainee and occupational health physicians, and serves as a concise textbook as well as an illustrative reference for almost all occupational disorders and their causes. The book has the chapters arranged as per the ninth edition of Hunters Diseases of Occupations, and can be read in conjunction with this reference book. This book is recommended as a reference book for any library.