This document describes a study that evaluated the correlation between CD4+ T-cell count and orofacial and systemic manifestations in 100 newly diagnosed HIV-positive patients in India. The patients were grouped based on their CD4+ count, and oral exams and medical histories were recorded. Results showed a significant correlation between lower CD4+ counts and more prevalent systemic manifestations like tuberculosis. Lower CD4+ counts also significantly correlated with more common oral manifestations like oral candidiasis. The study aims to evaluate CD4+ count as a prognostic marker for immune suppression in HIV patients.
THE IMPORTANCE OF SCIENCE AND THE ROLE OF GOVERNMENTS IN THE FIGHT AGAINST TH...Fernando Alcoforado
This article aims to emphasize the importance of using the scientific method in the search for a drug for the cure of people infected with the new Coronavirus and a vaccine to immunize the population, as well as coordinating action by governments to prevent the spread of viruses in order to safeguard the population's health and avoid its harmful effects on the economy.
33.Vohra P, Jamatia K, Subhada B, Tiwari RVC, Althaf MN, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care. 2019 Oct;8(10):3247-3252. doi: 10.4103/jfmpc.jfmpc_767_19. eCollection 2019 Oct. PubMed PMID: 31742150; PubMed Central PMCID: PMC6857402.
Vohra P, Jamatia K, Subhada B, Tiwari RV, Althaf MS, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care 2019;8:3247-52.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
THE IMPORTANCE OF SCIENCE AND THE ROLE OF GOVERNMENTS IN THE FIGHT AGAINST TH...Fernando Alcoforado
This article aims to emphasize the importance of using the scientific method in the search for a drug for the cure of people infected with the new Coronavirus and a vaccine to immunize the population, as well as coordinating action by governments to prevent the spread of viruses in order to safeguard the population's health and avoid its harmful effects on the economy.
33.Vohra P, Jamatia K, Subhada B, Tiwari RVC, Althaf MN, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care. 2019 Oct;8(10):3247-3252. doi: 10.4103/jfmpc.jfmpc_767_19. eCollection 2019 Oct. PubMed PMID: 31742150; PubMed Central PMCID: PMC6857402.
Vohra P, Jamatia K, Subhada B, Tiwari RV, Althaf MS, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care 2019;8:3247-52.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
Socio-demographic Characteristics of Clients Visiting Integrated Counseling and Testing Centre (ICTC) at SMS Medical College, Jaipur (Rajasthan) India-Human immunodeficiency virus (HIV) infection is a global pandemic and India counts for 10% of the global HIV burden and 65% of that in the South and South-East Asia. This study of clients of ICTC was carried out to know the association of HIV positivity with socio-demographic variables. Total 2412 clients have visited at ICTC of SMS Medical College, Jaipur, either voluntarily or referred by various department of this institute in ICTC in 1st quarter of 2009. They Overall HIV positivity was found 12.35% with a significant difference in voluntary and referred clients i.e. 83.59% v/s 8.36%. It was also found that HIV positivity is more in reproductive age group than extremes of ages, more in females than males, more in person who were married but presently single because of separation of spouse, divorce form spouse or death of spouse than the unmarried or married living with their spouses.
People Living with Human Immunodeficiency Virus in Hadhramout: Clinical Prese...asclepiuspdfs
The objective of the study was to determine the clinical features and outcome of patients living with human immunodeficiency virus (HIV) in Hadhramout and nearby governorates. Materials and Methods: This descriptive study was conducted in the antiretroviral therapy (ART) site at Ibn-Sina General Hospital, Mukalla, Hadhramout governorate. All 145 patients were enrolled in HIV treatment and care program from December 2008 to the end of December 2016 with confirmed HIV test. Data included all personal data, clinical staging, drugs taken, and outcomes. Patients were grouped according to the decades to five groups, ≤15 years, 16–30 years, 31–50 years, 51–70 years, and >70 years. Cases classify according to the antiretroviral drugs to ART group and Pre-ART group. The relevant data parameters were analyzed using SPSS statistical software version 21 and Excel 10. Results: A total of 145 cases, most adults (97.9%), males and females were104 (71.7%) and 41 (28.3%), respectively. Mean age was 36.46 years and 30–50 years the most affected age group (55.2%). Clinical Stages 3 and 4 were the common presentation in 73.8%, and most cases were from Mukalla city. Of the total cases, 74.5% were on ART 53.1 of them improved, pulmonary tuberculosis was found in 4 cases, and death cases were (18.5%), mostly due to late presentation and non-adherence, and mostly occurred in early 6 months of starting the ART. 37 patients were in a pre-treatment group (21.6%), where the mortality rate is 35.1%, mainly due to loss of follow-up. Conclusions: Most cases were adult males, young age and have had late presentation, where mortality is higher in the pre-treatment group due to loss of follow-up and in early 6 months of treatment.
Tarannum Yasmin1*, Krishan Nandan2
1Associate Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
2Assistant Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
*Address for Correspondence: Dr Tarannum Yasmin, Associate Professor, Department of Microbiology, Katihar
Medical College, Katihar, Bihar, India
Received: 15 September 2016/Revised: 03 October 2016/Accepted: 22 October 2016
ABSTRACT- INTRODUCTION- HIV/AIDS pandemic is responsible for the resurgence of Tuberculosis worldwide,
resulting in increased morbidity and mortality. Co-infection with HIV infection leads to difficulty in both the diagnosis
and treatment of Tuberculosis, increased risk of death, treatment failure and relapse.
OBJECTIVE- The present study highlights the correlation of Pulmonary Tuberculosis in HIV positive cases and its
association with CD4 count.
MATERIAL & METHODS- A total of 72 known case of HIV were screened for tuberculosis infection by clinical
examination, radiology & ZN staining.
RESULTS AND CONCLUSIONS- From our study 60 (83.33%) were diagnosed as tuberculosis and 12 (16.67%) were
negative. More common HIV infection in case of male 48 (66.67%). Out of 60 tuberculosis infection 53 (88.33%) were
diagnosed as Pulmonary Tuberculosis and 7 (11.67%) were diagnosed as Extrapulmonary Tuberculosis. The result of
study emphasizes that co-infection of tuberculosis in HIV/AIDS patient is a concern. There is direct correlation between
CD4 counts depletion and Pulmonary Tuberculosis in HIV/AIDS patients.
Key-words- Pulmonary Tuberculosis, HIV, AIDS, CD4 count
Adherence to Antiretroviral Therapy among HIVPositive Patients in Central Hos...Efe Clement Abel
Abstract: Adherence is the quantified level to which an individual follows a prescribed treatment and a low level of adherence to antiretroviral therapy(ART) adversely affects a patient’s treatment outcome and results in a rebound of plasma viraemia, development of resistant strains of HIV, more rapid immune deterioration, development of AIDS and death. This study is aimed at assessing the level of adherence to ART among HIV-positive patients assessing care in Central Hospital, Warri, Delta State, Nigeria. A descriptive cross-sectional study. Data were obtained using a semi-structured, interviewer-administered questionnaire and analysed using SPSS version 23. A total of 303 persons were recruited for the study. The mean age of respondents was 36.2±10.8years. Less than half of the subjects (45.5%) were adherent to their ART. Among the non-adherent subjects, the common reasons reported for missing doses of ART were forgetfulness (50.9%), too busy with other things (43.6%) and away from home (35.8%). This study showed that adherence to ART among the study population was poor. Forgetfulness, too busy with other things and being away from home were the most common reason for non-adherence. It is, therefore, recommended that; regular health education should be organised for HIV patients on ART on the importance of being adherent to their ART, regular assessment of adherence to ART should be carried out and a method of reminding patients who are non-adherent to ART on the need to take their ART as at when due should be considered as part of the routine services provided by ART centres.
Effects of ART on CD4 Count and Body Weight in HIV/AIDS Patients using Longitudinal Analysis in the Case of Debre Berhan Referral Hospital
http://dx.doi.org/10.21276/SSR-IIJLS.2020.6.4.5
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
60.Srinivasan S, Velusamy G, Munshi MAI, Radhakrishnan K, Tiwari RVC. Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans. J Contemp Dent Pract. 2020 Dec 1;21(12):1325-1330. PubMed PMID: 33893253.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Vohra, et al.: CD4 cells as a prognostic marker in HIV patients
Journal of Family Medicine and Primary Care 2432 Volume 9 : Issue 5 : May 2020
therapy (ART). Therefore, HIV infection is still a major health
concern in India.[2]
HIV is a retrovirus which affects the human
immune system. This virus hinders the body’s defense mechanism
by depletion of cluster of differentiation 4 (CD4) cells.[3]
When
newly produced CD4+ cells cannot replace the destroyed ones, it
results in shutting down of the immune system leading to AIDS.
As a result of the immunosuppression, people living with AIDS
become susceptible to systemic opportunistic infections and
malignancies. However, oral lesions are generally the primary sign
of HIV/AIDS infections. These oral lesion plays an important
in diagnosis as well as the prognosis of the disease because the
severity of the oral lesions correlates with the decrease in the
number of CD4+ cells count.[4,5]
Many studies have shown
discrepancies among these oral manifestations according to
development status and continents. It can be explained by the
disparity in health care system, availability of ART, transmission
route, gender, HIV stage, and deleterious habits. These specific
oral and systemic manifestations are widely documented as well
as correlated with CD4+ cells count in both developed and
developing countries.[6]
But, in certain parts of the developing
nations like India, the data is either negligible or none. Hence, we
conducted this cross‑sectional study among the newly diagnosed
HIV seropositive patients in Gujarat (western India). The goal
of the study was to evaluate the correlation between CD4+ cells
count with orofacial and systemic manifestations.
Materials and Methods
Hundred (100; 57 males and 43 females) newly diagnosed
HIV seropositive patients before starting ART were included
into this cross‑sectional study after the approval of institute
research ethical committee SUVEC/ON/20/2007 (dated
20‑08‑2007) along with approval taken from NACO to conduct
the study. Written informed consents were taken from all the
participants in their regional language. The patients were selected
from Outpatient Department of Infectious Disease (Dheeraj
General Hospital, Vadodara), Department of Oral Medicine and
Radiology (K. M. Shah Dental College and Hospital, Vadodara),
and NGOs (Non‑Governmental organizations) working for
HIV positive individuals in Vadodara. Participants were excluded
who were already started ART and who did not give informed
consent. The personal and medical history along with the
findings of Oral examination and Investigations were recorded
in the performa specially designed for this study. Patients
according to CD4+ cells count were clustered into three groups:
Group A: 0–200 cells/mm3
, Group B: 201–499 cells/mm3
,
and Group C: 500 cells/mm3
. A single examiner trained in
oral diagnosis examined and recorded all oral lesions. These
lesions were diagnosed according to presumptive criteria of
EEC Clearinghouse Classification.[7]
Statistical analysis was done
using SPSS (Statistical Package for Social Sciences) version 21.
Independent t‑test was used to find a correlation between CD4
cells count of males and females. Chi‑square test was used to
find a correlation between the systemic manifestations and
CD4+ cells count in different groups. It was also used to find
a correlation between the oral manifestations and CD4+ cells
count categories.
Results
The study group consisted of a total 100 HIV seropositive,
57 (57%) males and 43 (43%) females. The age range for
study group was from 6 years to 65 years with mean age of
34.14 ± 11.51 years. In study group, out of total 57 males,
40 (70%) were married, 12 (21%) unmarried, 4 (7%) divorced, and
1 (1.75%) widow, whereas out of total 43 females, 25 (58.13%)
were married, 5 (11.6%) unmarried, 2 (4.65%) divorced, and
11 (25.5%) were widows. The most common mode of HIV
transmission was unprotected sexual practices (70%) followed
by blood transfusion (18%), vertical transmission (9%), and
intravenous drug users (3%). In study group, mean CD4 cells
count in males was 253.51 ± 220.773, whereas it was
230.86 ± 153.327 in females. On applying independent t‑test, no
correlation was found between CD4+ cells count of males and
females (P‑value > 0.005). In study group of 100 patients, 55%
patients had CD4+ cells count below 200 (Group C), 34% had
CD4 cells count between 201 and 499 (Group B), and 11% had
CD4 cells count above 500 (Group A). Out of total 55 patients
in group C, 34 (61.8%) and 54 (99%) patients had systemic and
oral manifestations, respectively. In group B, out of 34 patients,
12 patients (35.2%) had systemic and 30 patients (88.2%) had
oral manifestations. Only 2 (18.1%) patients out of 11 had
systemic manifestations in group A with no oral manifestations
as shown in Table 1. On applying Chi‑square test, a significant
correlation (P‑value <0.05) of CD4 cells count was found with
the systemic and oral manifestations among three different
groups. Out of total 57 males, 21 (36.8%) had tuberculosis
followed by 3 (5.2%) cases of herpes zoster, 2 (3.5%) cases of
pneumonia, and 1 (1.75%) case of typhoid, jaundice, and malaria
each. Out of total 43 females, 13 (30.2%) cases had tuberculosis
and 2 (4.6%) cases of pneumonia, anemia, and typhoid each.
The most common systemic manifestation in both genders
was tuberculosis [Table 2]. In the study group of 100 subjects,
17 (20.2%) cases had candidiasis, 14 (16.6%) cases chronic
generalized periodontitis, 9 (10.7%) cases gingivitis, 7 (8.3%) cases
aphthous, 6 (7.1%) cases premalignant lesions and conditions,
Table 1: Gender-wise distribution of systemic and oral manifestations among different groups based on CD4 cells count
Groups CD4 cells count Males Females Total Systemic manifestations Oral manifestations
A >500 7 4 11 02 00
B 200-499 17 17 34 12 30
C <200 33 22 55 34 54
Total 57 43 100 48 74
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3. Vohra, et al.: CD4 cells as a prognostic marker in HIV patients
Journal of Family Medicine and Primary Care 2433 Volume 9 : Issue 5 : May 2020
4 (4.7%) cases recurrent aphthous ulceration and angular cheilitis
each, 3 (3.5%) cases erythema multiforme and hairy leukoplakia
each, 2 (2.3%) cases herpes zoster, herpes labialis, and periodontal
abscess each, and remaining others had single lesions like fissured
tongue, mucous patches of secondary syphilis, acute necrotizing
ulcerative periodontitis, linear gingival erythema, molluscum
contagiosum, and oral pemphigus. A brief comparison of oral
manifestations in HIV positive patients in our study and the
previous studies conducted in Asia is shown in Table 3. The most
common oral manifestation in males was found to be candidiasis
12 (21%) and chronic generalized periodontitis in 11 (19.2%)
cases with an average CD4 cells count of 322.46 ± 219.14 and
191.76 ± 120.05,respectively,whereasinfemales,thecommonoral
manifestations were candidiasis and aphthous ulcers in 5 (11.6%)
cases with an average CD4 cells count of 191.76 ± 120.05 and
130.08 ± 77.35, respectively. The most frequently encountered
Table 2. Gender-wise distribution of different systemic
manifestations
Systemic manifestations Male Female Total
Tuberculosis 21 13 34
Pneumonia 02 02 04
Anemia 00 02 02
Jaundice 01 00 01
Typhoid 01 02 03
Herpes 03 00 03
Malaria 01 00 01
Total 29 19 48
Table 3: A brief comparison of oral manifestations in HIV positive patients in our study and previous studies conducted
in Asia
Country
(Region)
Year Study
Sample
size
OC
%
CGP
%
CGG/ LGE
%
Aphthous
%
PMLs
%
AC
%
OHL
%
HZ
%
HSV
%
ANUP
%
ANUG
%
Oral
melanosis
%
Others
India (west) Present
study
100 17 14 10 7 6 4 3 2 2 1 1 10 9
India
(South)
2012 50 36 - - 6 2 18 2 4 - - - 28 -
India 2012 604 32.2 - - 4.4 - - - 3.3 - - - - -
India 2011 399 39.3 - - 2.5 - 4.3 11.5 0.3 2 5.3 8.5 19.5 -
India
(South)
2011 103 44 - - 4.9 - 5.8 17.5 1.9 - 3.9 9.7 35.9 -
India 2011 124 32 - - - - - 4 - - - - 31 -
India 2011 96 - - - 2.7 - 8.2 - 5.5 1.4 8.2 - 8.2 -
India 2010 321 11 17.3 - 4 - 0.6 2.8 - 3.1 - - 1.2 -
India
(South)
2009 200 - - - 5 - 9 18.5 1 2 7 9 33.5 -
India 2009 150 - - - - - - 2.6 - - - - 29.3 -
India
(South)
2007 100 16 - - 1 - 3 1 - - - - 29 -
India
(South)
2006 101 - - - 4.7 - 11.8 15.8 1.9 - 0.9 - 34.6 -
India 2004 1000 23.8 - - - - 7.9 3.3 3.3 0.9 - - 26.3 -
India 2004 410 36 - - 3 - 1 3 - 5 - - 3 -
India 2000 300 56 - - - - 7.7 3 - - - - - -
India 1997 96 81 - - 6 - - - - - - - - -
Thailand 2010 207 - 82 - 3.2 - - 2.5 - - - - 38.2 -
Thailand 2004 237 40 14.5 - 5 - 3.5 29.5 - - 0.5 1.5 - --
Thailand 2001 87 - - - - - 6.9 11.5 - 1 - - - -
Thailand 2001 364 39.6 - - - - 18.3 26.3 - - - - - -
Thailand 1997 41 76 - - - - - 7 - - - - - -
Thailand 1997 214 66 - - - - - 13 - - - - - -
Malaysia 1997 145 35.9 - - - - - 2.8 - - - - - -
Hong Kong 1999 32 - - - 27.4 - - 11 - 4.1 2.7 1.4 1.4 -
Japan 2000 110 15 - - - - - 1.8 - - - - - -
Singapore 2001 35 16 - - - - 5 - - - - - -
Iran 2011 200 22 - - - - - 3 - - 1.5 4 5.5 -
Iran 2010 100 - 44 - - - 17 4 - - - - 42 -
Cambodia 2002 101 - - - - - 12.9 45.5 4 7.9 - 27.7 - -
Georgia 2008 732 64 - - - - - 8 - 7 - - - -
Taiwan 2004 64 71.1 - - - - - 8 - - - - - -
Vietnam 2005 170 37.5 - - - - - 16.1 - - - - - -
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4. Vohra, et al.: CD4 cells as a prognostic marker in HIV patients
Journal of Family Medicine and Primary Care 2434 Volume 9 : Issue 5 : May 2020
variant of candidiasis was pseudomembranous candidiasis in
total 9 (52.9%) patients (5 males and 4 females), while 6 (35.2%)
patients (5 males, 1 female) had erythematous candidiasis and
only 2 (11.7%) patients (2 males) had hyperplastic type of
candidiasis [Table 4].
Discussion
Numerous studies had been conducted to find the correlation
of CD4+ cells count with the oral and systemic manifestations
in HIV positive patients. Results of these studies had established
CD4+ cells count as a diagnostic and prognostic marker for
the immunosuppression in these patients.[8‑11]
Oral cavity being
the most dynamic part of the whole body get predispose to
severe infections secondary to immunosuppression resulting
in various HIV associated oral manifestations.[12]
These oral
manifestations not only serve as an early sign of this infection
but also clinically correlates with CD4+ cells count.[13]
Numerous
studies have concluded that oral manifestations are of diagnostic
and prognostic importance.[10,11,13,14]
These oral manifestations
have shown discrepancies depending upon the regional/
geographical variations and over different period of time.[6,15]
Hence, we conducted this cross‑sectional study to evaluate
the correlation between CD4+ cells count with orofacial and
systemic manifestations among HIV seropositive patients in
the third‑largest Metropolis city of western Indian state of
Gujarat. In the present study, there were 57 (57%) males and
43 (43%) females. This male predominance was in accordance
with the findings of Ranganathan et al.[16]
but was in contrast to
the findings of Annapurna et al.,[10]
where female predominance
was present. In our study, there was no significant difference
in the average CD4+ cells count of males and females, which
was in contrast to the findings of the Ranganathan et al.[8]
Our
study reported a significant correlation between the systemic
manifestations and CD4+ cells count categories. There were
29 males and 19 females in which the systemic manifestations
were recorded. Out of 29 males, 21 (72.4%) had tuberculosis
followed by 3 (10.3%) cases of herpes zoster, 2 (6.8%) cases of
pneumonia, and 1 (3.4%) case of typhoid, jaundice, and malaria
each. Out of 19 females, 13 (68.4%) had tuberculosis and
2 (10.5%) cases of pneumonia, anemia, and typhoid each. The
most common systemic manifestation in HIV positive males and
females was tuberculosis (70.4%). This finding was congruent
to the previous studies conducted by Ranganathan et al.[8,16]
Our study also reported a significant correlation between the
oral manifestations and CD4+ cells count categories. The oral
manifestations were seen in 30 (88.2%) and 54 (99%) individuals
in Groups B and C, respectively, whereas no oral manifestations
were noted in Group A. A total of 84 (84%) patients had
oral manifestations. The common oral manifestations
recorded in males were, candidiasis (25%) followed by chronic
generalized periodontitis (22.9%), aphthous stomatitis (16.6%),
gingivitis (10.4%), and premalignant lesions (8.3%). The common
oral manifestations recorded in females were candidiasis (13.8%)
and aphthous stomatitis (13.8%) followed by chronic generalized
periodontitis (8.3%), gingivitis (11.1%), and premalignant
lesions (5.5%). A brief comparison of other oral manifestations
in HIV positive patients in our study and the previous studies
conducted in Asia[15]
is shown in Table 4. Unlike the previous
studies, there was no significant difference was found in the
prevalence of oral lesions in both sexes in our study.[16,17‑21]
The
most common oral manifestation in males and females was
found to be candidiasis (19.4%) with the average CD4 cells count
of 191 ± 120.05 and the most common variant of candidiasis
encountered was pseudomembranous type. These results are
consistent with findings of other investigators who examined
oral lesions and conditions associated with HIV positive
patients.[8,14,18‑26]
Conclusion
In our study, we concluded that the most common cause of HIV
among males was unprotected sexual practices with multiple
partners including commercial sex workers by heterosexual
route and most of women had acquired HIV infection from
their infected spouses. There was no significant difference in
the average CD4+ cells count of males and females. The most
common systemic manifestation of HIV positive patients in both
males and females was tuberculosis. Oral manifestations were
recorded in almost all HIV positive patients with CD4 cells count
below 500. There was equal prevalence of oral manifestations in
both genders. Most common oral manifestation in both males
and females was candidiasis with CD4+ cells count below 200.
Hence, we can conclude that oral manifestations/lesions are
the hallmarks of this infection. It directly reflects the extent
of systemic immunosuppression of the infected individual.
Therefore, oral physician should be capable to diagnose these
lesions and should provide guidance to the patient for the early
diagnosis and treatment of this life‑threatening infection.
Key message: Hence, we can conclude that the oral
manifestations/lesions are the hallmark of HIV infection. It
directly reflects the extent of systemic immunosuppression of
the infected individual. Therefore, oral and general physician
Table 4: Most common oral manifestation in males and females of HIV positive patients
Oral Manifestations Total (n=84) Males (n=48) Females (n=36) Avg CD4 cells Count Std Deviation
Candidiasis 17 12 5 191.76 120.05
Chronic Generalized Periodontitis 14 11 3 322.466 219.14
Aphthous 13 8 5 130.08 77.35
Melanosis 10 5 5 244.7 182.33
Gingivitis 9 5 4 553.4 273.96
Premalignant Lesions 6 4 2 221.857 99.8
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5. Vohra, et al.: CD4 cells as a prognostic marker in HIV patients
Journal of Family Medicine and Primary Care 2435 Volume 9 : Issue 5 : May 2020
should be capable to diagnose these lesions and should provide
guidance to the patient for the early diagnosis and treatment of
this life‑threatening infection which will help the patient. Early
diagnosis of the disease will help in primary care of diagnosed
HIV cases and also if the physician has the slightest suspicion
while screening the oral cavity, they can motivate the patient for
HIV testing and further investigations.
Acknowledgements
We are grateful to Kirpa foundation, Vadodara and Supratech
laboratories Ahmadabad for providing the CD4 cells count
reports.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient
consent forms. In the form, the patients have given their consent
for their images and other clinical information to be reported in
the journal. The patients understand that their names and initials
will not be published and due efforts will be made to conceal
their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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