Phenytoin is the oldest sedative antiepileptic drug and one of the most widely prescribed antiepileptic drug effective against all types of partial and tonic-clonic seizures except in absence seizures. Medication errors with phenytoin often occur and can be lifethreatening but have rarely been fatal, especially in adults. We here report a fatal case of phenytoin-induced encephalopathy in an adult due to inadvertent drug overdose and highlight the importance of clinicians educating the patients and caregivers regarding the toxic manifestations of phenytoin, so that toxicity can be recognized early and delay in therapeutic intervention can be avoided.

SummaryFemale sex workers (FSWs) are vulnerable to HIV infection. Their socioeconomic and behavioural vulnerabilities are crucial push factors for movement for sex work. This paper assesses the factors associated with the likelihood of movement of sex workers from their current place of work. Data were derived from a cross-sectional survey conducted among 5498 mobile FSWs in 22 districts of high in-migration across four states in southern India. A multinomial logit model was constructed to predict the likelihood of FSWs moving from their current place of work. Ten per cent of the sampled mobile FSWs were planning to move from their current place of sex work. Educational attainment, marital status, income at current place of work, debt, sexual coercion, experience of violence and having tested for HIV and collected the results were found to be significant predictors of the likelihood of movement from the current place of work. Consistent condom use with different clients was significantly low among those planning to move. Likewise, the likelihood of movement was significantly higher among those who had any STI symptom in the last six months and those who had a high self-perceived risk of HIV. The findings highlight the need to address factors associated with movement among mobile FSWs as part of HIV prevention and access to care interventions.

Long-distance truckers (LDTDs) are vulnerable to human immunodeficiency virus infection and other sexually transmitted infections due to the nature of their work, working environment, and frequent mobility. This paper examines and comments on the health care coverage provisioned under “Kavach” Project. Data from the Integrated Behavioural and Biological Survey, National Highway gathered from 2,066 LDTDs in Round 1 and 2,085 LDTDs in Round 2, who traveled in four extreme road corridors travelled by LDTDs in India, were used for analysis. Analysis reveals that service capacity in terms of socially marketed condoms per thousand LDTDs has increased from Round 1 to Round 2 (4,430 to 6,876, respectively). Accessibility coverage in terms of knowledge about the Khushi clinic has significantly decreased between Rounds 1 and 2 (60.9% to 54.6%; P<0.001). Acceptability coverage has increased between the two rounds (13.8% to 50.6%; P<0.001). Contact coverage has also increased between the rounds (12.7% to 22.3%; P<0.001). Effectiveness coverage for preventive and curative care has also increased significantly. This paper comments on the gaps in accessibility and acceptability of health care coverage and emphasizes the need for further studies to assess the contextual factors that influence the effectiveness and efficiency of interventions designed to address access barriers and to identify what combination of interventions may generate the best possible outcome.

Nearly 40 million people in Africa suffer from HIVIAIDS. African governments and international aid agencies have been working to combat this epidemic by vigorously promoting Highly Active Anti-Retroviral Therapy (HAART) programs. Despite the enormous subsidies offered by governments along with free Anti-RetroViral (ARV) drugs supplied by agencies, the introduction and implementation of HAART programs on a large scale has been limited by two fundamental problems: (a) lack of adherence to the ARV therapy regimen; (b) lack of accountability in drug distribution due to theft, corruption and counterfeit medication.In this paper, we motivate the case for SmartTrack, a telehealth project which aims to address these two problems facing HAART programs. The goal of SmartTrack is to create a highly reliable, secure and ultra low-cost cellphone-based distributed drug information system that can be used for tracking the flow and consumption of ARV drugs in HAART programs. In this paper, we assess the potential benefit of SmartTrack using a detailed needs-assessment study performed in Ghana, using interviews with 516 HIV-positive rural patients in a number of locations across the country. We find that a system like SmartTrack would immensely benefit both patients and healthcare providers, and can ultimately lead to improved patient outcomes and better accountability.

HgsDb, a database is developed to organize the data under a single platform to facilitate easy access for researcher to get information on migration and molecular risk assessment. In past, human beings migrate from one place to other over the globe in search of food and better habitat, where they got adapted. These adaptations are visible in the form of change in color, facial pattern, average height, eye shape, hair texture, etc. This leads to origin of different race of human being. The adaptations are remarkable when move from equator to either poles. There are hundreds of different haplogroups reported on both maternal and paternal sites. This database provides overview of seventy-six major Haplogroup of mt-DNA and Y-DNA with their sub classes supplemented with structural information of individual Haplogroup responsible for various factor such molecular risk assessment, migration and origin. They help genealogist to gain deep insight information about their maternal and paternal patterns. , we had collected data from open source such as National Center for Biotechnology (NCBI), to develop this database for providing information, which Will helps the medical biology, molecular biology, genealogy and for designing personalized medicine.Availabilitywww.gbpec.ac.in/research/HgsDb/

Background: Mobile males are vulnerable to HIV and are potential bridge for HIV transmission to their sex partners, including spouses. To understand how mobility accentuates vulnerability to HIV, we assessed the association of degree of male mobility with paid sex, alcohol use and condom use at all places visited by migrants in past two years. Methods: A cross-sectional survey was done among male migrant workers [n = 2991] in five high in-migration districts of Maharashtra in India during 2007-08. Results: Multivariate logistic regression analysis revealed that higher mobility [moving 3+ places in the past two years] was associated with "sexual debut" in paid sex [3.7% Vs 6.9%, AOR = 1.70, p < 0.001] and having sex with sex worker at the current place of destination [8.7% Vs 16.9%, AOR = 2.10, p < 0.001], at the previous place of destination [7.2% Vs 15.1%, AOR = 2.05, p < 0.001], and at the place of origin [0.6% Vs 1.6%, AOR = 2.31, p < 0.001]. However, higher mobility was associated with unpaid sex with non-marital female partners [28.4% Vs 37.2%, AOR = 1.48, p < 0.001] and less consistent condom use at the current place [26.6% Vs 23.4%, AOR = 0.45, p < 0.05] as well as at place of origin [12.2% Vs 7.2%, AOR = 0.48, p < 0.01]. In addition, alcohol use prior to sex was more among more mobile migrants relative to less mobile migrants at current place [6.1% Vs 11.2%, AOR = 1.82, p < 0.001] and previous place [7.0% Vs 13.0%, AOR = 1.77, p < 0.001] of destination. Conclusion: Findings suggest that compared to the less mobile, highly mobile men report higher HIV risk behaviours: paid sex, alcohol use prior to paid sex and inconsistent condom use, at all locations along the routes of mobility. Interventions need to target men who are highly mobile along the routes of mobility and not at destination sites alone.

Accessibility and frequency of use of health care services among female sex workers (FSWs) are constrained by various factors. In this analysis, we examined the correlates of frequency of using health care services under targeted interventions among FSWs. A sample of FSWs (N = 1,973) was obtained from a second round (2012) of Behavioral Tracking Survey, conducted in five districts of Andhra Pradesh, a high-HIV-prevalence state in southern India. We used negative binomial regression models to analyze frequency of utilization of health care services among FSWs. Based on our analysis, we suggest that various predisposing and enabling factors were found to be significantly associated with the visit to NGO clinics for treatment of any health problem, any sexually transmitted infection symptom, and the number of condoms received from the peer worker or condom depot. We suggest the need for further research with respect to various correlates of frequency of using health care among FSWs to develop effective intervention strategies in countries that have high HIV prevalence among FSWs and targeted interventions need more diligent implementation to reach the unreached.

Mobility among Female Sex Workers (FSWs) interrupts their demand for, and utilization of, health services under any intervention. Various strategic interventions are meant to provide access to care and reduce the incidence of HIV and other STIs among FSWs. This paper applies a bivariate probit regression analysis to explain the probability of mobile FSWs being reached by the system and being exposed to interventions jointly with a wide variety of characteristics of mobile FSWs in India. The data used are based on a cross-section survey among 5,498 mobile FSWs in 22 districts of four high HIV prevalence states in southern India. A majority of mobile FSWs (59%) were street-based and about 70 percent of them were members of SW organization and nearly half (46%) were highly mobile. The majority of them (90%) had been contacted by outreach workers from any system in the last two years in their current location and 94 percent were exposed to interventions in terms of getting free or subsidized condoms. Bivariate probit analysis revealed that comprehensive interventions are able to reach more vulnerable mobile FSWs effectively, e.g. new entrants, highly mobile, reported STIs, tested for HIV ever and serving a high volume of clients. The results complement the efforts of government and other agencies in response to HIV. However, the results highlight that specific issues related to various subgroups of this highly vulnerable population remain unaddressed calling for tailoring the response to the specific needs of the sub-groups.