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P505 Awareness about HIV and practices followed by the beauticians of Nagpur City, India
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Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
of late toxicity was similar between the two groups. The complete response rate was 87.7% and 86.7% for groups I and II, respectively. Five-year overall and cancer-specific survival rates were, respectively, 49.7% and 61.1% in group I, and 57.4% and 68.8% in group II, indicating no significant survival benefit with concurrent chemoradiotherapy. Performance status, comorbidity index and tumor size were significant prognostic factors for overall survival, whereas tumor size was the only significant prognostic factor for cancer-specific survival. Conclusions: This analysis showed no benefit of concurrent chemoradiotherapy with respect to overall and cancer-specific survival in elderly women. A prospective study is needed to determine the role of concurrent chemoradiotherapy in this population. P501 The importance of gender specific medicine in a changing demographic R. Wiborny Objectives: Because of the increase of elderly women in the Western industrial nations, the dosage and route of administration of the most frequently used drugs in this group will be analysed. Material and Methods: The Cochrane databases, Medline, Austrian statistics and WHO data have been used for this paper. Results: Drug side effects in women are approximately 1.6 times higher. The difference is due to bioavailability, metabolism, elimination and biological effects. Conclusion: Because of the expected high number of elderly women by the end of the 21st century, the dosage and route of administration of drugs will be of great importance. P502 HIV prevalence and behavior study among pregnant women in Georgia T. Asatiani1 , Z. Bokhua1 , L. Shengelia. 1 State Medical University,
2
Objectives: To study HIV prevalence and unsafe sexual behavior among pregnant women in Georgia. Settings: 7 largest towns of Georgia (Tbilisi, Batumi, Zugdidi, Kutaisi, Gori, Rustavi, Telavi). Materials and Methods: Two thousand pregnant women were selected using cluster-sampling methodology according to the WHO guideline on second-generation surveillance on HIV. Trained interviewers gynecologists conducted counseling, in depth interviews and HIV blood testing during antenatal care. Results: Our study identified only 15 (0.75%) HIV positive pregnant woman. However, risk behavior is left much to be desired; 0.6% of women were drug users and among them 0.1% intravenous users, past history of STD was revealed in 19%. Some information on contraceptives had 85% of respondents, but only 40% used it. Some information about HIV/AIDS had 87% and 46% had correct information on more specific issues, like transmission routes of HIV, clinical features, prevention of mother to child transmission, ARV treatment, newborn feeding. Conclusion: Study showed that in Georgia more oriented educational campaign directed to this group of population is essential. P503 Psychosexual analysis of HIV positive individuals S. Ghike Introduction: If an individual finds HIV positive he/she are signing three deaths physical, psychological & social. HIV testing can serve as behavioral intervention. It promotes immediate decrease in sexual partners, increase use of condom and is associated with many psychiatric & psychological problems to the individual.
Objectives: 1. To analyze psychological problems in HIV positive individuals; 2. To analyze common psychiatric conditions associated with HIV positive individuals; 3. To asses their sexual behavior & problems. Material and Method: Location: Rural based tertiary care hospital. Study design: Observational cross sectional prospective study. Study period: Study was carried out over a period of five months from 1st July 2008 to 30th November 2008. One to one detail interview in close room was taken for 11 /2 –2 hrs or more per individual with a structured questionnaire with 12 arms. – Total participants in study 66; – Age sex no bar couples included; – Confidentiality maintained; – Data analyzed; Observation and Result: Maximum were in the reproductive age group. 88% were heterosexual while 12% were bisexual majority 100% had positive attitude toward sexual behavior prior to HIV positive status which later became negative in 82%. Frequency of sexual contact reduced significantly after knowing their HIV status, with libido in 87% & desire only in 13%. 91% wanted counselor to disclose their HIV status to their partner & 67% continued their sexual relations after knowing their positive status. 75% said sex is for recreational. 64% opted for MTP due to social reason. 64% were not interested in having children after knowing they are HIV positive even after knowing they are HIV positive only 55% were practicing stage sex & 45% were not. Common psychiatric & psychological problems noted were depression 79%, suicide 76%, anger 27%, loss of faith in partner 87%, mood changes 76%, worry about children 73%. Conclusion and Recommendations: 1. Prior to HIV positive status 100% individuals had a positive attitude towards psychosexual behavior which was seen only in 12% after knowing their HIV positive status; 2. There was significant decrease in sexual relation (87% libido) after knowing their HIV status; 3. 64% were not interested in having children after knowing HIV positive status; 4. Many psychiatric problems were noted in positive individuals like depression 79%. Suicidal tendency 76%. Loss of faith in partner 87% etc.; 5. Sad part is even after knowing that they are positive only 55% were practicing safe sex. Significance of the study: As mind governs body, & psychological health also determines physical health. There is urgent need to change the attitude of the society & HIV positive individuals as only 100% positive attitude towards life make everyone’s life 100% successful. P505 Awareness about HIV and practices followed by the beauticians of Nagpur City, India L. Shrikhande, L. Shrikhande. Shrikhande laser & Endoscopy Centre, Nagpur, India Today, external looks are being given more importance & as a result beauty parlours have mushroomed in both urban & rural areas of India. These beauty parlours can be a potential source of HIV infection if they don’t follow standard practices. The risk of transmitting a serious disease such as hepatitis B and C and HIV can occur when using razors, scissors or clippers, which can abrade the skin and/or cut accidentally. Contaminated instruments can transfer infection directly to the blood of another individual (for example, the operator or next client) if that individual has open cuts, sores or broken skin. Aims and Objectives: To know Knowledge, Attitude & Practices followed by beauticians of Nagpur City. To create awareness & to motivate them to bring about a behavioural change.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Material and Methods: Study design: Descriptive Cross sectional study. Setting: Beauty Parlours in Nagpur city (Maharashtra) India. Sample size: 100 beauty parlours selected at random. Participation was voluntary & Confidentiality was maintained. Semi-structured questionnaire in vernacular language (English, Hindi, Marathi) were given. Study duration: 1/8/2008 to 30/11/2008. Outcome variables: Current knowledge, attitudes and practices followed by beauty parlours. Observation and Results: Out of total 100 beauticians 72 were female & 28 were male. Maximum participants were in the age group of 25–35 yrs. 48 were educated up to 12th std & rest were not even 12th pass. 34% were aware that beauty care procedures may lead to spread of HIV infection. 46% were just cleaning the equipment by simple washing. 6% of them were sterilizing their equipment and ridiculously one of them gave the answer as washing & sun drying. 32% of them were aware that they are also at risk. 36% of them were aware that they have a role in the prevention of HIV. 16% were aware that in foreign countries beauticians are actively involved in the prevention of spread of HIV infection. 68% were willing for active participation in the prevention of HIV & spread of awareness regarding HIV infection. Conclusion: There is a need to increase HIV/AIDS awareness in beauticians. P506 Steven-Johnson syndrome seen in a HIV positive pregnant patient: a case report H. Sulayman1 , I. Wanoyi1 , A. Ramadan1,2 , Z. Aliyu3,5 , M. Bushi4,6 . 1 Obstetrics & Gynaecology, Specialist Hospital Jalingo, Taraba State, Nigeria, 2 Obs & Gynaecology Al Azhar University Cairo, Egypt, 3 Medicine, Haematology & Oncology, Howard University Hospital, USA, 4 National Eye Centre Kaduna, 5 Department of Medicine, Specialist Hospital Jalingo, Taraba State, Nigeria, 6 Department of Ophthalmology, Specialist Hospital Jalingo, Taraba State, Nigeria Stevens-Johnson syndrome (SJS) is a rare but potentially lifethreatening systemic disorder characterized by vesicobullous lesions involving the skin and mucous membranes. Drugs reactions and immunologic injury represent the major aetiopathogenesis of the syndrome. Complications of the disease include dehydration, sepsis and death. The incidence of SJS is about one per million. SJS is seen as a complication of HIV drug treatment especially Sulphanomide based prophylaxis and increasingly with Nevirapine. Curiously, SJS is extremely rare in pregnancy. The potential morbidity of the disease in a gravid state is rather staggering. We present Mrs A.I, a 27 year old Gravida3 para2+0 housewife who was admitted with features of SJS at 24 weeks gestation. The patient was diagnosed as HIV seropositive in another hospital and was placed on Nevirapine, Zidovudine and Lamivudine and Septrin prophylaxis for a low CD4 count was 128 cells/ml. She developed extensive vesicobullous lesions involving nearly 90% of her skin and mucous membranes on the sixth day of treatment. She was hypoxic, tachycardic, tachypnic with an admitting PCV of 15%. Her management included immediate withdrawal of Septrin, Nevirapine and intensive care support with supplemental oxygen, assiduous fluid and electrolyte control, upfront short term high dose intravenous Methylpredisolone, topical analgesics, antibiotics, and blood transfusion. The patient had minimal eye complaints (Muco-purulent discharge and exfoliative dermatitis of the eyelids, and a presenting visual acuity of 6/9 (BE). These were essentially managed with antibiotic ointments and drops. The patient required two weeks of hospitalization with a dramatic and full recovery. The patient has been seen twice for follow up and remains stable. A repeat CD4 count showed a value of 235 cell/ml and the patient was commenced on Zidovudine, Lamivudine and Lopinavir boosted Ritonavir. The pregnancy continued without any complications. An obstetric scan done at 28 weeks gestation showed a grossly normal feotus. The patient continued antenatal care in our
S557
centre. At ffollow up four weeks after discharge; she had minimal ocular complications of mild dry eyes, minimal symblepharon (BE) and superficial keratitis (LE), which were effectively managed. Her visual acuity became 6/6 (BE}. Mrs. A.I had a spontaneous vertex delivery of a live male baby at 36 weeks weighing 2.8 kg with good APGAR Scores. Both baby and mother are doing fine. The prognosis of SJS has improved through early detection, prompt hospitalization, and immediate cessation of offending agents. Aggressive supportive and intensive care in a specialized thermal unit if available form the major part of the management in this life-threatening condition. Immune modulation with the use of high dose short term steroids, intravenous immune globulin, and cyclosporine remain attractive therapeutic options. Unequivocal efficacy data on these agents however remain limited. Our case illustrates the potential benefits of high dose short term steroids use and raises the curious questions of the potential interaction between Niverapine and Septrin in increasing the risk for SJS akin to the well validated cases of Lamotrigine and Valproic acid and SJS. P507 Women’s sexual dysfunction during the first year after child birth M. Ahmad Shirvani, M. Bagheri-Nesami, M. Bavand. Mazandaran University of Medical Sciences Background: sexual change throughout transition to motherhood is a psychosocial crisis. Majority of mothers slowly return to prepregnancy levels during 1 year postpartum. This study evaluated the impact of child birth on the maternal sexual health and associated risk factors. Methods: A group of 521 women attending the health services were randomly recruited in a cross sectional study in the north of Iran. All of them were during the first postnatal year, speak Persian and be agreeing to participate in study. The exclude criteria were (a) loss of baby, (b) living far from husband, and (c) serious psychological and medical diseases. A questionnaire of maternal characteristics and a 19 item questionnaire of female sexual disorder index were used. Sexual function categorized by total score (2–36) as 3 groups: normal (>24), moderate (13–24) and severe dysfunction (≤12). Results: Of the 490 responding women, 118 were in the first 3 months, 120 in 4th –6th , 118 in 7th –9th and 134 in 10th –12th months.Totally 4.9% didn’t have sexual activity after child birth and 52.9% have delayed sexuality over 45 days postpartum, that reasons were fear of pain (8.6%), fear of pregnancy (2.4%), no interest (3.5%), high fatigue (2.2%) and bleeding (0.6%). So 4.9% had severe and 47.8% had moderate sexual disorder (SD). The rate of severe SD was highest in the first 3 months postpartum. The majority had moderate SD early months postpartum (first three months, 46.6%; fourth to sixth months, 50%), while in most women sexuality was normal over 6th month (7th –9th months, 58.5%; 10th –12th months, 50%). Higher age and child number with lower passed time from delivery and breastfeeding duration, problem of baby, medical disease and fatigue were associated with SD (p < 0.05). Conclusion: sexual health problems are very common in the early after childbirth. Conversation with health professionals and note to risk factors in routine postnatal health services are needed.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
of late toxicity was similar between the two groups. The complete response rate was 87.7% and 86.7% for groups I and II, respectively. Five-year overall and cancer-specific survival rates were, respectively, 49.7% and 61.1% in group I, and 57.4% and 68.8% in group II, indicating no significant survival benefit with concurrent chemoradiotherapy. Performance status, comorbidity index and tumor size were significant prognostic factors for overall survival, whereas tumor size was the only significant prognostic factor for cancer-specific survival. Conclusions: This analysis showed no benefit of concurrent chemoradiotherapy with respect to overall and cancer-specific survival in elderly women. A prospective study is needed to determine the role of concurrent chemoradiotherapy in this population. P501 The importance of gender specific medicine in a changing demographic R. Wiborny Objectives: Because of the increase of elderly women in the Western industrial nations, the dosage and route of administration of the most frequently used drugs in this group will be analysed. Material and Methods: The Cochrane databases, Medline, Austrian statistics and WHO data have been used for this paper. Results: Drug side effects in women are approximately 1.6 times higher. The difference is due to bioavailability, metabolism, elimination and biological effects. Conclusion: Because of the expected high number of elderly women by the end of the 21st century, the dosage and route of administration of drugs will be of great importance. P502 HIV prevalence and behavior study among pregnant women in Georgia T. Asatiani1 , Z. Bokhua1 , L. Shengelia. 1 State Medical University,
2
Objectives: To study HIV prevalence and unsafe sexual behavior among pregnant women in Georgia. Settings: 7 largest towns of Georgia (Tbilisi, Batumi, Zugdidi, Kutaisi, Gori, Rustavi, Telavi). Materials and Methods: Two thousand pregnant women were selected using cluster-sampling methodology according to the WHO guideline on second-generation surveillance on HIV. Trained interviewers gynecologists conducted counseling, in depth interviews and HIV blood testing during antenatal care. Results: Our study identified only 15 (0.75%) HIV positive pregnant woman. However, risk behavior is left much to be desired; 0.6% of women were drug users and among them 0.1% intravenous users, past history of STD was revealed in 19%. Some information on contraceptives had 85% of respondents, but only 40% used it. Some information about HIV/AIDS had 87% and 46% had correct information on more specific issues, like transmission routes of HIV, clinical features, prevention of mother to child transmission, ARV treatment, newborn feeding. Conclusion: Study showed that in Georgia more oriented educational campaign directed to this group of population is essential. P503 Psychosexual analysis of HIV positive individuals S. Ghike Introduction: If an individual finds HIV positive he/she are signing three deaths physical, psychological & social. HIV testing can serve as behavioral intervention. It promotes immediate decrease in sexual partners, increase use of condom and is associated with many psychiatric & psychological problems to the individual.
Objectives: 1. To analyze psychological problems in HIV positive individuals; 2. To analyze common psychiatric conditions associated with HIV positive individuals; 3. To asses their sexual behavior & problems. Material and Method: Location: Rural based tertiary care hospital. Study design: Observational cross sectional prospective study. Study period: Study was carried out over a period of five months from 1st July 2008 to 30th November 2008. One to one detail interview in close room was taken for 11 /2 –2 hrs or more per individual with a structured questionnaire with 12 arms. – Total participants in study 66; – Age sex no bar couples included; – Confidentiality maintained; – Data analyzed; Observation and Result: Maximum were in the reproductive age group. 88% were heterosexual while 12% were bisexual majority 100% had positive attitude toward sexual behavior prior to HIV positive status which later became negative in 82%. Frequency of sexual contact reduced significantly after knowing their HIV status, with libido in 87% & desire only in 13%. 91% wanted counselor to disclose their HIV status to their partner & 67% continued their sexual relations after knowing their positive status. 75% said sex is for recreational. 64% opted for MTP due to social reason. 64% were not interested in having children after knowing they are HIV positive even after knowing they are HIV positive only 55% were practicing stage sex & 45% were not. Common psychiatric & psychological problems noted were depression 79%, suicide 76%, anger 27%, loss of faith in partner 87%, mood changes 76%, worry about children 73%. Conclusion and Recommendations: 1. Prior to HIV positive status 100% individuals had a positive attitude towards psychosexual behavior which was seen only in 12% after knowing their HIV positive status; 2. There was significant decrease in sexual relation (87% libido) after knowing their HIV status; 3. 64% were not interested in having children after knowing HIV positive status; 4. Many psychiatric problems were noted in positive individuals like depression 79%. Suicidal tendency 76%. Loss of faith in partner 87% etc.; 5. Sad part is even after knowing that they are positive only 55% were practicing safe sex. Significance of the study: As mind governs body, & psychological health also determines physical health. There is urgent need to change the attitude of the society & HIV positive individuals as only 100% positive attitude towards life make everyone’s life 100% successful. P505 Awareness about HIV and practices followed by the beauticians of Nagpur City, India L. Shrikhande, L. Shrikhande. Shrikhande laser & Endoscopy Centre, Nagpur, India Today, external looks are being given more importance & as a result beauty parlours have mushroomed in both urban & rural areas of India. These beauty parlours can be a potential source of HIV infection if they don’t follow standard practices. The risk of transmitting a serious disease such as hepatitis B and C and HIV can occur when using razors, scissors or clippers, which can abrade the skin and/or cut accidentally. Contaminated instruments can transfer infection directly to the blood of another individual (for example, the operator or next client) if that individual has open cuts, sores or broken skin. Aims and Objectives: To know Knowledge, Attitude & Practices followed by beauticians of Nagpur City. To create awareness & to motivate them to bring about a behavioural change.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Material and Methods: Study design: Descriptive Cross sectional study. Setting: Beauty Parlours in Nagpur city (Maharashtra) India. Sample size: 100 beauty parlours selected at random. Participation was voluntary & Confidentiality was maintained. Semi-structured questionnaire in vernacular language (English, Hindi, Marathi) were given. Study duration: 1/8/2008 to 30/11/2008. Outcome variables: Current knowledge, attitudes and practices followed by beauty parlours. Observation and Results: Out of total 100 beauticians 72 were female & 28 were male. Maximum participants were in the age group of 25–35 yrs. 48 were educated up to 12th std & rest were not even 12th pass. 34% were aware that beauty care procedures may lead to spread of HIV infection. 46% were just cleaning the equipment by simple washing. 6% of them were sterilizing their equipment and ridiculously one of them gave the answer as washing & sun drying. 32% of them were aware that they are also at risk. 36% of them were aware that they have a role in the prevention of HIV. 16% were aware that in foreign countries beauticians are actively involved in the prevention of spread of HIV infection. 68% were willing for active participation in the prevention of HIV & spread of awareness regarding HIV infection. Conclusion: There is a need to increase HIV/AIDS awareness in beauticians. P506 Steven-Johnson syndrome seen in a HIV positive pregnant patient: a case report H. Sulayman1 , I. Wanoyi1 , A. Ramadan1,2 , Z. Aliyu3,5 , M. Bushi4,6 . 1 Obstetrics & Gynaecology, Specialist Hospital Jalingo, Taraba State, Nigeria, 2 Obs & Gynaecology Al Azhar University Cairo, Egypt, 3 Medicine, Haematology & Oncology, Howard University Hospital, USA, 4 National Eye Centre Kaduna, 5 Department of Medicine, Specialist Hospital Jalingo, Taraba State, Nigeria, 6 Department of Ophthalmology, Specialist Hospital Jalingo, Taraba State, Nigeria Stevens-Johnson syndrome (SJS) is a rare but potentially lifethreatening systemic disorder characterized by vesicobullous lesions involving the skin and mucous membranes. Drugs reactions and immunologic injury represent the major aetiopathogenesis of the syndrome. Complications of the disease include dehydration, sepsis and death. The incidence of SJS is about one per million. SJS is seen as a complication of HIV drug treatment especially Sulphanomide based prophylaxis and increasingly with Nevirapine. Curiously, SJS is extremely rare in pregnancy. The potential morbidity of the disease in a gravid state is rather staggering. We present Mrs A.I, a 27 year old Gravida3 para2+0 housewife who was admitted with features of SJS at 24 weeks gestation. The patient was diagnosed as HIV seropositive in another hospital and was placed on Nevirapine, Zidovudine and Lamivudine and Septrin prophylaxis for a low CD4 count was 128 cells/ml. She developed extensive vesicobullous lesions involving nearly 90% of her skin and mucous membranes on the sixth day of treatment. She was hypoxic, tachycardic, tachypnic with an admitting PCV of 15%. Her management included immediate withdrawal of Septrin, Nevirapine and intensive care support with supplemental oxygen, assiduous fluid and electrolyte control, upfront short term high dose intravenous Methylpredisolone, topical analgesics, antibiotics, and blood transfusion. The patient had minimal eye complaints (Muco-purulent discharge and exfoliative dermatitis of the eyelids, and a presenting visual acuity of 6/9 (BE). These were essentially managed with antibiotic ointments and drops. The patient required two weeks of hospitalization with a dramatic and full recovery. The patient has been seen twice for follow up and remains stable. A repeat CD4 count showed a value of 235 cell/ml and the patient was commenced on Zidovudine, Lamivudine and Lopinavir boosted Ritonavir. The pregnancy continued without any complications. An obstetric scan done at 28 weeks gestation showed a grossly normal feotus. The patient continued antenatal care in our
S557
centre. At ffollow up four weeks after discharge; she had minimal ocular complications of mild dry eyes, minimal symblepharon (BE) and superficial keratitis (LE), which were effectively managed. Her visual acuity became 6/6 (BE}. Mrs. A.I had a spontaneous vertex delivery of a live male baby at 36 weeks weighing 2.8 kg with good APGAR Scores. Both baby and mother are doing fine. The prognosis of SJS has improved through early detection, prompt hospitalization, and immediate cessation of offending agents. Aggressive supportive and intensive care in a specialized thermal unit if available form the major part of the management in this life-threatening condition. Immune modulation with the use of high dose short term steroids, intravenous immune globulin, and cyclosporine remain attractive therapeutic options. Unequivocal efficacy data on these agents however remain limited. Our case illustrates the potential benefits of high dose short term steroids use and raises the curious questions of the potential interaction between Niverapine and Septrin in increasing the risk for SJS akin to the well validated cases of Lamotrigine and Valproic acid and SJS. P507 Women’s sexual dysfunction during the first year after child birth M. Ahmad Shirvani, M. Bagheri-Nesami, M. Bavand. Mazandaran University of Medical Sciences Background: sexual change throughout transition to motherhood is a psychosocial crisis. Majority of mothers slowly return to prepregnancy levels during 1 year postpartum. This study evaluated the impact of child birth on the maternal sexual health and associated risk factors. Methods: A group of 521 women attending the health services were randomly recruited in a cross sectional study in the north of Iran. All of them were during the first postnatal year, speak Persian and be agreeing to participate in study. The exclude criteria were (a) loss of baby, (b) living far from husband, and (c) serious psychological and medical diseases. A questionnaire of maternal characteristics and a 19 item questionnaire of female sexual disorder index were used. Sexual function categorized by total score (2–36) as 3 groups: normal (>24), moderate (13–24) and severe dysfunction (≤12). Results: Of the 490 responding women, 118 were in the first 3 months, 120 in 4th –6th , 118 in 7th –9th and 134 in 10th –12th months.Totally 4.9% didn’t have sexual activity after child birth and 52.9% have delayed sexuality over 45 days postpartum, that reasons were fear of pain (8.6%), fear of pregnancy (2.4%), no interest (3.5%), high fatigue (2.2%) and bleeding (0.6%). So 4.9% had severe and 47.8% had moderate sexual disorder (SD). The rate of severe SD was highest in the first 3 months postpartum. The majority had moderate SD early months postpartum (first three months, 46.6%; fourth to sixth months, 50%), while in most women sexuality was normal over 6th month (7th –9th months, 58.5%; 10th –12th months, 50%). Higher age and child number with lower passed time from delivery and breastfeeding duration, problem of baby, medical disease and fatigue were associated with SD (p < 0.05). Conclusion: sexual health problems are very common in the early after childbirth. Conversation with health professionals and note to risk factors in routine postnatal health services are needed.