Natl Med J India
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Review
Syndromic management of sexually transmitted infections: A critical appraisal and the road ahead.
The syndromic approach has been the cornerstone of management of sexually transmitted infections (STIs) in developing countries. This strategy has had a considerable impact in decreasing the burden of STI in society. It offers the advantages of treating the infection at the first visit itself, reducing the risk of complications, non-reliance on laboratory diagnostics, and easy integration into the primary healthcare system. ⋯ Supplementing the syndromic approach with point-of-care tests and simple laboratory tests where available can improve its results. Further, healthcare professionals should be imparted training for optimum patient care. This narrative review critically appraises the syndromic approach to STIs, discusses the challenges that it faces, and offers suggestions to improve its performance.
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Thromboangiitis obliterans (TAO) or Buerger disease is a recurring progressive segmental vasculopathy that presents with inflammation and thrombosis of small and medium arteries and veins of the hands and feet. The exact cause remains unknown, with tobacco use (primarily smoking but also smokeless tobacco) being highly associated with the disease. The diagnosis is clinical and the lack of a diagnostic gold standard is a deterrent to diagnosing it in patients with atypical presentations. Obliterative endarteritis occurs perhaps due to a mixture of thrombosis and inflammation. The diagnostic sensitivity and specificity of D-dimer as a biomarker for thrombosis is well reported from its use in other areas such as deep vein thrombosis. Identification of a biomarker linked to the causation yields a diagnostic adjunct with a role in therapeutic decision-making, aiding diagnosis in atypical presentation, monitoring disease activity and gauging response to therapy. ⋯ D-dimer levels are considerably elevated in patients with TAO. This indicates an underlying thrombotic process and suggests its potential role as a diagnostic adjunct. It also leads us to hypothesize a potential therapeutic benefit of anticoagulants in this disease.
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All ethics committees (ECs) that review and monitor clinical trials in India must be registered with the regulatory authority. We ascertained the status of registration and re-registration of ECs till December 2017. ⋯ A low proportion of registrations ofECs from eligible academic health institutions raises concern about adherence to regulatory guidelines and conduct of clinical trials in India. The lower re-registration of ECs helps in the identification of factors which should be addressed to facilitate clinical research in India.
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Case Reports
An unusual case of isolated right-sided infective endocarditis masquerading as non-resolving pneumonia.
Right-sided infective endocarditis in non-intravenous drug abusers and non-immunocompromised patients is rare. The diagnosis is difficult as it can present as a respiratory illness leading to delays in diagnosis and development of complications, which can be fatal. The standard Duke criteria may not be adequate for diagnosis. We present a patient with isolated right-sided infective endocarditis mimicking right lower lobe non-resolving pneumonia who did not respond to antitubercular therapy.