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Background The severity of AIDS and the social and personal implications of HIV makes the epidemiological study of HIV more difficult. Surveillance studies remain the mainstay of understanding the trends of HIV infection. In this study, we aimed to determine the trend in the prevalence of HIV in the antenatal women attending our hospital situated in the western region of India over the period of the last nine years and the ART adherence and the viral loads of the cluster of positive patients identified from this antenatal HIV testing. Methodology A retrospective study was conducted by collecting data for nine years from January 2015 to December 2023 from the PPTCT (Prevention of Parent to Child Transmission) Centre and ART (Anti-Retroviral Treatment) Centre of the hospital. All pregnant women attending antenatal clinics and being admitted to the labor room are counseled for HIV testing as per the National AIDS Control Organisation (NACO) guidelines of India. The data of the total antenatal women counseled for HIV testing and who tested HIV positive were collected. The HIV prevalence rate was derived and the trend of HIV prevalence in antenatal women attending the hospital was determined over the study period. The data on ART adherence and the viral load of these HIV-positive women detected antenatally and their seropositive spouse and children were collected and analyzed. Results A total of 22,584 antenatal women were counseled for HIV testing during the study period. No women opted out and there was 100% testing of these 22,584 antenatal women for HIV. Fifty antenatal women tested positive for HIV, resulting in an overall HIV prevalence of 0.22% (50/22,584) during the study period. There was a declining trend of HIV prevalence among antenatal women from 2020 to 2023 (from 0.37% to 0.19%). Of the 50 seropositive antenatal women, 42 remained booked at our ART Centre for treatment. Thirty (71%) women are still adhered to taking ART. Of their 20 seropositive spouses, 14 (70%) have remained adhered to ART. Twenty-eight (93%) female patients on ART and 13 (93%) spouses on ART have suppressed viral loads. Two children of these seropositive mothers had tested HIV positive. ART adherence and suppressed viral load were seen in both seropositive children. Conclusion The study reflects a decline in antenatal seroprevalence in recent years in our region. The antenatal HIV prevalence trends have major implications on mother-to-child transmission and these positive antenatal cases serve as index cases bringing the testing opportunity for the so-called identified as the non-high-risk population. ART adherence of positive female patients, after the completion of the antenatal period, remains the challenge in our region, which requires improvement in the outreach activities and increased motivation and awareness of these patients regarding the importance of taking lifelong ART.
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Background Cervical cancer is the fourth most common cancer in women globally. It is one of the leading causes of cancer deaths in females in India. Cervical cancer has a long latent precancerous period from index human papillomavirus (HPV) infection to potential cancer development, making screening one of the most effective methods of cancer prevention. Despite the national cancer prevention programme for cancer cervix, with defined guidelines for cervical cancer screening by the auxiliary nurse midwives (ANM) and nurses, cervical cancer screening is very limited in India. In this study, we aim to assess the knowledge, attitude, and practices related to cervical cancer and screening methods among the nursing staff in a tertiary care hospital attached to a medical teaching institute. Methodology A cross-sectional study was conducted by a semi-structured questionnaire in a tertiary care hospital in Morbi, situated in the western region of India, between November and December 2023. Female nursing staff of the hospital in the age of 20 to 60 years were included as study participants. The study was approved by the Institutional Ethical Committee. Results In the study, 64.9% of participants were in the age group of 20-29 years, and 52.6% were unmarried, forming a major portion of the study group being of young age. Of the participants, 70.1% identified cancer of the cervix as a major public health problem. Only 28.8% of the participants had adequate and comprehensive knowledge of cervical cancer screening. Though 92.8% of the participants knew of Pap smear as a cervical cancer screening method, only 12.4% of participants were aware of the visual inspection with acetic acid (VIA) and 2% were aware of HPV testing as a tool for cervical cancer screening. Only 5.2% of the study participants had themselves been screened for cervical cancer. Of the participants, 87.6% had never taken a Pap smear, and 95.8% of participants had never taken VIA of any woman. A total of 32.3% of participants gave the reason of not having adequate skills to perform VIA as the reason for not ever having screened the patient with VIA. A total of 6.2% of participants had been trained in cervical screening methods formally. Conclusion The limited knowledge of the nursing staff of cervical cancer and its screening and low self-screening prevalence among healthcare professionals highlight the need to increase awareness of cervical cancer and screening to bring the impetus to training and result-driven implementation of screening programmes for cervical cancer in India.
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Thromboangitis obliterans or Buerger's disease is a segmental inflammatory condition of small and medium-sized arteries and veins. It is commonly seen in males with age under 45 years and with a current or recent history of tobacco use, and in smokers. It is sporadic in young women. This report describes a primigravida with dry gangrene in both upper and lower limbs because of Buerger's disease. The primary diagnosis of the disease occurred first time in pregnancy at the 17th week of gestation with the patient reporting dry gangrene and pain in the digits and confirmed with a non-invasive Doppler study. The patient was screened for autoimmune diseases, diabetes mellitus, and the presence of hypercoagulable disorders. Echocardiography and arteriography were performed to rule out any source of emboli. The case report aims to discuss a rare diagnostic and therapeutic dilemma in the case of a pregnant woman presenting with gangrene without any history of tobacco addiction.
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Mifepristone is a progesterone and glucocorticoid receptor antagonist. Medical abortion with mifepristone and prostaglandin has revolutionized the abortion process extending abortion care to the doors of females. From as low as 2 mg/day to doses extending to 600 mg, from daily dosing to single dosage treatment, mifepristone has a wide perspective in the treatment of various pathologies. Cervical dilatation and myometrial contractility have made the utility of mifepristone feasible for second-trimester termination of pregnancy and induction of labor awaiting Food and Drug Administration approvals. Its anti-progesterone action on the menstrual cycle has a new dimension of use as a contraceptive, as well as use as a menstruation inductive agent. Its role in endometriosis, ectopic pregnancy, and adenomyosis requires more intensive research. Apoptotic action of mifepristone, interference of heterotypic cell adhesion to the basement membrane, cell migration, growth inhibition of various cancer cell lines, decreased epidermal growth factor expression, suppression of invasive and metastatic cancer potential, increase in tumor necrosis factor, downregulation of cyclin-dependent kinase 2, B-cell lymphoma 2, and Nuclear factor kappa B have opened its potential to be explored as anti-cancer treatment and its effects on leiomyoma. The drug needs to be studied more for the prospectus of its anti-glucocorticoid actions in a wider dimension beyond its acquiescence for the treatment of Cushing syndrome.