Background : Globally, the spread of HIV/AIDS remains on the rise with young people at increased risk of infection. Sexual behavior change remains the most effective way of preventing further transmission. Aim: To gain the knowledge needed to develop appropriate interventions that will enable young people to adopt safe sexual practices. Materials and Methods: A cross-sectional study was conducted using structured questionnaires among 315 randomly selected students enrolled at a tertiary institution in Lagos State, Nigeria. Results: The mean age of the respondents was 23 years. Although the mean score of the participants' responses to ten HIV/AIDS knowledge questions was 8.3 of 10 points, 73.5% of them did not perceive themselves at risk of being infected. Majority (53.8%) had not changed their dating behaviors as a result of concerns for HIV/AIDS and 70.3% had multiple lifetime sexual partners. Those who perceived themselves at risk of infection are significantly (P = 0.019) more likely to always use condoms. Using the AIDS Risk Reduction Model (ARRM), it was found that the students are in the first stage of behavior change process: recognition of the problem. The low risk perception has prevented movement to the second stage of making commitment to change behavior. Conclusion: The awareness and knowledge of HIV/AIDS is high among tertiary education students in Lagos, Nigeria. However, risk perception is low with high-risk sexual behaviors. The failure to perceive HIV/AIDS as a personal risk has prevented commitment to behavior change. Interventions aimed at influencing risk perception are paramount to curb the spread of this dreaded disease.

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Context: The magnitude of intestinal parasitic infection in renal transplant recipients requires careful consideration in the developing world. However, there have been very few studies addressing this issue in Iran. Aim: This study was conducted to determine the prevalence of intestinal parasitic infections in renal transplant recipients in Iran. Materials and Methods: Stool specimens from renal transplant recipients and control groups were obtained between June 2006 and January 2007. The samples were screened for intestinal parasitic infections using direct smear, formalin-ether sedimentation, Sheather's flotation and modified Ziehl-Neelsen staining methods. Statistical Analysis Used: A comparison of the frequency of parasites between cases and controls was performed using Chi-square test. Subsequently, the Wilcoxon rank-sum test was used to compare multiple parasitic infections in cases and controls. P value <0.05 was considered significant. Results: Out of 150 renal transplant recipients, 33.3% (50), and out of 225 of the control group, 20% (45) were infected with one or more types of intestinal parasites. The parasites detected among patients included Entamoeba coli (10.6%), Endolimax nana (8.7%), Giardia lamblia (7.4%), Blastocystis spp. (4.7%), Iodamoeba butschlii (0.7%), Chilomastix mesnili (0.7%) and Ascaris lumbricoides (0.7%). Multiple infections were more common among renal transplant recipients group (P < 0.05). Conclusions: This study highlights the importance of testing for intestinal parasites among Iranian renal transplant recipients. Routine examinations of stool samples for parasites would significantly benefit the renal transplant recipients by contributing to reduce severity of infection. The results of this study emphasize the monitoring and stool examination for prevention of parasitic infections in renal transplant recipients.

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Context : Chikungunya is a re-emerging debilitating viral disease for which any specific cure or vaccine is not available. Aim : To study the impact of knowledge and practices on prevention of chikungunya. Settings and Design: Three primary health centers in rural area experiencing epidemic of chikungunya were selected for the study. Materials and Methods: The study was conducted in a coastal district of India, which was experiencing an epidemic of chikungunya during the study period. Patients above 18 years of age, attending out-patient department of three primary health centers, were included in the study. Patients diagnosed as case of chikungunya were taken as cases and those with other morbidity and having none of their relatives or friends suffering or had suffered in the last month from chikungunya were taken as controls. Sample size was 150 and controls were three times the number of cases. A pre-tested, open-ended questionnaire was used to collect information by face to face interview technique. Statistical Analysis Used: Percentage, proportions, and Chi-square were used for statistical analyses. Results: Controls who were not affected by chikungunya were having better knowledge and practices about the vector and methods of preventing the disease than the cases. Knowledge and practices were found to be skewed toward people having more number of years of schooling and higher per capita income. Striking differences between knowledge and practices were also observed among cases as well as controls. Conclusions: People who had knowledge about the vector and methods of preventing the disease and had put their knowledge into practice were less likely to be effected by chikungunya. In the absence of any specific cure or effective vaccine, health education can prove to be an important tool for the control of chikungunya epidemic.

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Background: Pakistan is one of the most populated countries with a population of 160 million; 67% are rural population but all the tertiary care facilities are concentrated in large cities. The Northern Areas is the most remote region with difficult terrain, harsh weather conditions and the tertiary care hospital at a distance of 600 km with traveling time of 16 h. The Aga Khan Medical Centre, Singul (AKMCS) is a secondary healthcare facility in Ghizer district with a population of 132,000. AKMCS was established in 1992 to provide emergency and common elective surgical care. It has strengthened the primary health service through training, education and referral mechanism. It also provided an opportunity for family physicians to be trained in common surgical operations with special emphasis on emergency obstetric care. In addition it offers elective rotations for the residents and medical students to see the spectrum of diseases and to understand the concept of optimal care with limited resources. Methods and Results: The clinical data was collected prospectively using international classification of diseases ICD -9 coding and the database was developed on a desktop computer. Information about the operative procedures and outcome was separately collected on an Excel worksheet. The data from January 1998 to December 2001 were retrieved and descriptive analysis was done on epi info-6. Thirty-one thousand seven hundred and eighty-two patients were seen during this period, 53% were medical, 24% surgical, 16% obstetric and 7% with psychiatric illness. Out of 1990 surgical operations 32% were general surgery, 31% orthopedic, 21% pediatric, 12% obstetric and 4% urological cases; 42% of operations were done under general anesthesia, 22% spinal, 9% intravenous (IV) ketamine, 6% IV sedation and 21% under local anesthesia. Six hundred and sixty-two were done in the main operation room including general surgery 337, obstetric 132, urological 67, pediatric 66 and orthopedic 66 cases; 64% of cases in the main operation room were done under general and 22% under spinal anesthesia. The commonest surgeries were exploratory laparotomy, caesarian sections, open prostatectomy, urological stone surgeries, appendectomy, hernia repairs and surgery for osteomyelitis. There were 21 surgical mortalities including six operative deaths, 15 non-operative deaths and 89% of the mortalities were unavoidable. The crude in-hospital mortality decreased significantly from 5.5% in 1992 to 1.1% in 2001 and the contributing factors were improved structure and process of care. Conclusion: The impact of a secondary care rural medical centre (AKMC) is very obvious from the clinical audit including accessibility, sustainability and quality of care. This could be a model of care in rural Pakistan where accessibility, affordability and quality of care is lacking.

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Echinococcosis is an infection of humans by the larval stage of Echinococcus granulosus, Echinococcus multilocularis or Echinococcus vogeli. Orbital hydatid cyst is extremely rare and has an incidence of 1% of all the hydatid cysts. We report a case of a 6-year-old boy presenting with a large orbital hydatid cyst causing abaxial proptosis with compressive optic neuropathy and a cyst in the liver. The cyst was successfully removed from the orbit through a combined anterio-superior trans-periosteal lateral orbitotomy. Following surgery, there was immediate reduction of proptosis and healing of exposure keratopathy. The role of computerized tomography (CT) scan in early diagnosis and advantages of the lateral orbitotomy approach are discussed.

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Ascaris lumbricoides is a common intestinal parasite in tropical and temperate regions. Although usually asymptomatic, infection can lead to biliary or intestinal obstruction and very rarely obstruction of the main pancreatic duct due to its smaller lumen. We report two cases of ascariasis in the main pancreatic duct, which is not a common site, presenting as acute pancreatitis and recovering uneventfully with conservative management.

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Background : Malaria has become a critical world health problem in recent years. Several factors have been responsible for increasing its incidence, such as wide usage of insecticides and drug resistance. It still remains as a matter of concern in Iran. It is under control in all parts, except in three southeastern provinces. Aim: Khorasan Razavi is one of the Iranian provinces with a lot of immigrants each year. Therefore, epidemiological study of the malaria is necessary in non-endemic provinces. Materials and Methods: This research was a descriptive study to evaluate epidemiological status of the malaria in April 2001-March 2008 using all patients' data from whole of the province. Results: Total recorded cases were 945 within 7 years. The highest incidence was observed in 2001 and the lowest in 2006. Plasmodium vivax was observed in 911 cases and 30 cases were positive for P. falciparum. Mixed species were seen in four cases. Malaria incidence had decreased since 2001. 34.6% of transmitted cases were local, 61% were transmitted from (other provinces) inside and outside the country, relapse cases formed 5.4% and transmitted routes of the rest of the cases were unknown. The highest incidence was observed in people of age 15 years and higher and mostly in men. Mashhad and Sarakhs cities had the highest incidence rate. Conclusion: Preventive efforts must be continually taken in spite of decreasing rate of the malaria.

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Cervical cancer is the second most common cancer in women worldwide, and the burden of the disease is disproportionately high in the developing world (>80%). With the advent of two new vaccines, "Gardasil" developed by Merck & Co. New Jersey, USA and "Cervarix" developed by GlaxoSmithKline (GSK) in Philadelphia, USA, the future holds newer promises for prevention and control of the disease. However, various regulatory and policy changes also may be required to be undertaken and the various new challenges need to be addressed.

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Aims and Objective : To ascertain the cytological diagnosis of metastatic lesions with special reference to clinicopathological analysis of primary site in cases of epithelial tumors. Materials and Methods: One hundred and seventy-one suspected metastatic lesions were aspirated with a 22-23-G needle and smears were fixed and stained. The cases in which the primary site was not evident at the time of initial presentation were subsequently subjected to thorough physical examination followed by radiological investigations for the search of the primary site. Histopathological examination was performed in 16 cases with inconclusive cytological impression. Results: Of the total 171 cases of metastatic lesions, 155 (90.6%) were diagnosed by fine needle aspiration biopsy and 16 (9.4%) were diagnosed by histopathology. Majority of the cases [81 (47.4%)] were observed in the fifth decade of life, followed by 76 cases (44.4%) in the sixth decade and 11 cases (6.4%) in the seventh decade of life. Lymph nodes were the most frequent site of metastasis [115 cases (67.3%)], with a majority in the cervical group. The oropharynx including the oral cavity and pharyngolarynx was observed to be the most common primary site in 55 cases (32.2%). Conclusion: An accurate pathologic assessment of the malignant tissues in conjunction with pertinent clinical data helps in the evaluation of metastatic cases.

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Background : Stroke among young adults (15-45 years) is an important problem worldwide. Most of the studies done in India are on ischemic stroke among young adults. There is paucity of information on all subtypes of strokes among young adults in India. So, this study was undertaken. Materials and Methods: This was a retrospective, record-based study. Cases of stroke identified from hospital records starting form January 1998 to June 2008 were considered for the study. There were 109 cases between 15 and 45 years, the information about which were recorded in a pre-tested semi-structured proforma. Analysis: The data were analyzed using SPSS version 12. Chi-square was used. " P" value of <0.05 was considered to be significant. Results: Ischemic stroke was the most common (56%), followed by hemorrhagic (22.9%) and embolic (22.1%). Age (>31 years), males, smoking, and hypertension were found to have significant association. Role of diabetes and homocysteine requires further investigation. The numbers were not adequate to test association with lipid profiles.

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Background: Local communities in tropical regions, mainly in Africa, have used traditional herbal medicines as means of preventing and treating malaria with unrealistic experimental analysis. Aims: The safety and effectiveness of traditional dosage forms of dried seed of Aristolochia elegans mast. Was therefore assessed on 20 respondents who had been using the seed of this medicinal plant for over 1-2 years against malaria. Toxicological and pharmacological properties of ethanol and ether crude extracts of dried seed were also examined on 45 male Balb c mice. Materials and Methods: The methods used were personal interview schedule to assess safety and effectiveness of traditional dosage, evaluation of documented information, extraction of test medicinal substance, investigation of pharmaco-toxicological properties and qualitative chemical analysis. Statistical analysis was performed using data master sheets and scientific calculator. Results: The effectiveness of this seed was highly encouraging against malaria as compared to conventional antimalarial drugs. According to the respondents, relapse of malaria could usually happen with the conventional antimalarial drugs at normal doses, whereas relapse of malaria was rarely happening with the seed of A. elegans at the traditional dose taken. There were no health disorders discovered in 20 respondents who had been using the seed of this medicinal plant for over 1-2 years against malaria. However, laboratory mice died with a single dose of crude extracts at 1000-5000 mg/kg within 4-9 days after the dose was given orally. Histopathological examination showed that both crude extracts caused severe damage to the kidney and liver of Balb c mice. Four out of 10 treated Balb c mice also developed hemorrhages in the stomach, which was a strong indication of carcinogenic property of this plant material. Conclusion: A person using this herbal preparation is therefore at a higher risk of getting stomach cancer and renal and hepatic diseases.

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Introduction: Typhoid fever still continues to be a major public health problem, particularly in developing countries. A simple, reliable, affordable, and rapid diagnostic test has been a long-felt need of the clinicians. We, therefore, prospectively evaluated the sensitivity and specificity of Typhidot (IgM), a serological test to identify IgM antibodies against Salmonella typhi. Materials and Methods: The study was carried out in the Department of Microbiology, Apollo Hospital, Bangalore between January 2009 and March 2009 on a total of 186 samples from clinically suspected febrile patients. Blood culture as well as Typhidot test was performed for each of the cases. Results: Out of 61 clinically diagnosed typhoid fever, 50 were blood culture positive for S. typhi all 50 were Typhidot (IgM) positive and 11 were missed out on both. The sensitivity, specificity, positive and negative predictive values of the test using blood culture as gold standard were 100%, 95.5%, 89.2%, and 100%, respectively for typhoid fever. Conclusion: Typhidot (IgM) test is rapid, easy to perform, and reliable for diagnosing typhoid fever, and useful for small, less equipped laboratories as well as for the laboratories with better facilities in typhoid endemic countries.

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