HIV: QUICK FACTSIntroductionThe human immunodeficiency virus (HIV) is a subgroup of retrovirus (lentivirus) that causes HIV infection. After a period of time, this infection leads to what is called acquired immunodeficiency syndrome (AIDS).

Epidemiology

According to the Centers for Disease Control and Prevention (CDC), from 2010-2015, the estimated rate of HIV infection in all 50 US states decreased from 14.2 per 100,000 population in 2010 to 12.3 per 100,000 population in 2015. In 2015, 39,513 individuals were diagnosed with HIV infection. From 2010 to 2014, the annual number of new HIV infections decreased by 9%.

Virology HIV-1 and HIV-2 are retroviruses in the Retroviridae family, Lentivirus genus. They are enveloped, diploid, single-stranded RNA viruses with a DNA intermediate.Upon entry into the target cell, the viral RNA genome is converted into double-stranded DNA by an enzyme, reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded enzyme, integrase. HIV contains three retroviral genes, namely gag, pol, and env.

Gag gene: Encodes group-specific antigen; the inner structural proteins
Pol gene: Encodes polymerase; it also contains integrase and protease
Env gene: Encodes the viral envelope, the outer structural proteins responsible for cell-type specificity. Glycoprotein 120, the viral envelope protein, binds to the host CD4+molecule
Pathophysiology

HIV infects vital cells in the human immune system, such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells and leads to cellular immune deficiency. This results in the development of opportunistic infections and neoplastic processes.

Mode of Transmission
Sexual intercourse: Unprotected sexual intercourse; especially receptive anal intercourse and different sexual partnersContact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids infected with the virus.Spread from an infected mother to her infant through breast milk. An HIV-positive mother can transmit HIV to her baby both during pregnancy and childbirth due to exposure to her blood or vaginal fluid.

Signs and Symptoms There are 3 categories of infection 

Category A: Asymptomatic HIV infection without a history of symptoms or AIDS-defining conditions
Category B: HIV infection with symptoms that are directly attributable to HIV infection
Category C: HIV infection with AIDS-defining opportunistic infections
Investigation

A high-sensitivity enzyme-linked immunosorbent assay (ELISA) should be used for screening.

Management

Start with antiretroviral therapy (ART) in all HIV-infected adults ready to start therapy. 
CD4 count is no longer a criterion for starting the therapy.
Use of nucleoside reverse transcriptase inhibitors and protease inhibitors.
For refractory cases, during the failing treatment regimen and before switching therapy, use rapid confirmation, perform resistance testing and reevaluate.

HIV - Quick Facts Need To Know!

Holi is one of the most enjoyable festivals in India. It is one that everyone looks forward to and is usually known as the festival of colours because we use colours and coloured water to douse our friends and family in a great display of pomp and show. Also, we tend to get doused and remain that way for many hours, mostly in the sun. As such, Holi can also take a toll on our skin by causing discolouration, rashes and insensitivity. So what should one do in order to avoid coming down with bad skin the day after Holi? Here are our secrets, which will leave you with shining skin even after you have had a great time at the festivities!

Hydration: It is very important to keep yourself well hydrated before you plunge into the festivities. Remember to drink lots of water and ensure that you have a bottle in hand so that you can easily fill up on fluids even as you enjoy yourself with all the sun rays and the colours. This will ensure that your skin does not become too dry.
Full sleeve clothing: Another good idea to keep your skin protected is to wear full-sleeved clothing so that you do not tan indiscriminately and you do not end up with too much discolouration and rashes on your skin. Wear light fabrics that will dry fast so that the water does not get absorbed by the clothing and into your skin. This will keep your skin relatively dry, even if you enjoy yourself for hours at an end. Avoid synthetics clothes and denim as they would stick to your skin. 
Organic colours: With the whole world going the organic way, why should our Indian festivals remain behind? So, you can now opt for organic colours that have been produced in a safe way with safe ingredients. These natural pigments will ensure that you do not have to scrub and endure rashes and irritation after the festival. It is a good idea to opt for such colours, which can be washed off easily and are bereft of synthetic materials that can harm the skin in the long run. This can also help in avoiding problems like eczema and other skin conditions.
Oil your hair: India is a land of rich cosmetic tradition. No matter which direction you look in, you will always find that you have a weapon of choice in terms of oils and other ingredients that are absolutely great for keeping your skin and hair in good shape. So our advice is to oil your hair well, preferably with coconut oil, olive oil, or vitamin E oil, so that the colours and the water does not get absorbed onto your scalp. This will also help in keeping your hair moisturised as the colours can make the strands very dry. Always oil the whole body before playing holi.
Lips: Apply plenty of lip balm before joining the play of colours.
Nails: Apply a thick coat of dark nail paint before Holi. 
It is important that you must apply oil behind your ears, between your finger tips and even near your fingernails. It is ideal that you don't wax or thread or do any facial treatment, at least, three-four days ahead of Holi.

Holi Special - 6 Tips to Keep Your Skin Rash Free!

Here are 6 signs to watch out for that could indicate 'You need to get your Ears tested':

1. Your TV is blaring: Do you often find people around you shouting above the TV sound complaining that it's too loud? When you find it hard to hear the TV at the average volume and find yourself turning up the sound, this could signify a hearing loss. Doctors are seeing a growing number of patients visiting them after prolonged exposure to loud music and sounds.

2. You find it hard to hear phone conversations: Do you find yourself asking the person on the other end of the phone line to 'repeat' themselves, or find yourself pressing the phone instrument right into your ear? If you are trying so hard to hear, you might find yourself missing out on bits of the conversation as focussing to clearly hear the conversation is exhausting work. Getting a hearing test might be a good option if this sounds like you.

3. You have trouble hearing in noisy environments: When you are out dining with friends or family at a busy restaurant or accompanying a friend shopping in a busy street, all that background noise makes it difficult to hear what the people are saying. People with hearing loss often have problems masking out background noise.

4. Family members telling 'you're going deaf'?: Trust the views of the people closest to you, they never lie about your health. Family members often are the first to sense signs of hearing loss as they find themselves repeating things to you or calling out louder to get your 'attention'.

5. You find yourself staying away from social occasions, family gatherings or avoid being the first to start conversations

6. You find yourself leaning closer to people to follow the conversation or staring at their lips trying to lip-read what's being said.

6 Signs you Need a Hearing Test

Nails are an important part of your physiology, although they are mostly used for either utilitarian purposes such as gripping or for beauty purposes such as nail decorations. Nails themselves can go through infections which need not have underlying causes and thus can cause damage to that part of the tissue. One such disorder of the nail is onycholysis.

What is onycholysis?
This is a disorder where the nail on the finger or the toes starts to separate from the skin below. This happens little by little and usually starts at the tip and then progresses backward. The further back it progresses, the more nail tissue it destroys. While the entire nail may not be detached from the nail bed, parts of it may chip off, showing the tissue underneath.

Symptoms of onycholysis:

Jagged border between the pink flesh of the nail bed and the yellow edge of the nail
Detached nails become opaque, yellow or may turn green in color
Nail may become irregular in shape and size
Bits and chunks of nails can break off easily
Primary causes for onycholysis:

Let's look at some of the primary causes of onycholysis:

Frequent trauma - if you have a profession or work at home where you constantly require tapping away, it might cause minute injuries to build up within the nails and the fingers. Tapping on keyboards is one area where you could get repetitive trauma like this.
Manicure problems - many salons may aggressively try to clean the underside of the nails and in the process, slowly dislodge the nail form the nail bed and cause onycholysis. This has known to be the case with many people.
Water immersion - if you have work where your nails are immersed in water for long periods of time, this could also affect the development of onycholysis.
Skin diseases - certain skin conditions can also end up giving onycholysis. Psoriasis and contact dermatitis are other conditions that may lead to onycholysis as a consequence.
Allergy to nail glue - many makeup artists and customers have complained that certain brands of nail glue can also cause allergies resulting in onycholysis.
Medications - medications meant for the treatment of other ailments within the body can have the unintended consequences of causing onycholysis.
Treatment-
The underlying problems need to be corrected which may cause onycholysis. Once the underlying problem is corrected, onycholysis usually corrects itself. The nail may take some time to re-grow but will grow back on its own eventually and may take 4 to 6 months to cover the entire affected area again.


All About Onycholysis

A stroke may be called a brain attack. It may happen to any person at any time. A stroke occurs when blood supply to the brain is cut off. The brain cells become oxygen deprived due to the stroke and eventually die. Dead brain cells result in brain dysfunction due to which patients lose control over muscle and memory.

Strokes can be mild to life threatening and requires immediate medical attention. Stroke requires advanced care and should be treated by extensively qualified and experienced medical experts. 

Neurosurgery satisfies all the required clauses for treatment of stroke and accounts for being one of the best ways for management of stroke. Renowned hospitals have a dedicated neurosurgical wing and a team of neurological specialists who know how to deal with stroke the best.

Vascular Neurology
This form of neurology focuses on patients who have undergone a stroke or have experienced symptoms of stroke. A multidisciplinary approach is taken for the prevention of recurrent cerebrovascular conditions.

Types of stroke

Ischemic stroke: This kind of stroke occurs when there is a blockage in a blood vessel, which supplies blood to the brain. This form of stroke is the more common. The underlying cause of this stroke is known as atherosclerosis, which is a condition where fatty deposits occur in the walls of the blood vessels and cause blockage in them.
Hemorrhagic stroke: This type of stroke occurs when a blood vessel gets weak and ruptures into the brain. This is caused by two types of weak blood vessels known as aneurysm and arteriovenous malformation.
Transient ischemic attack: This type of stroke is also known as a mini stroke. These attacks occur because of blood clots. The blockage caused is temporary or transient in nature.
Treatment of Ischemic stroke

Tissue Plasminogen Activator: This is one of the best ways to treat ischemic strokes. This medicine is given to the patient intravenously. It dissolves the blood clot and improves blood flow to the area of the brain which is affected. The medicine should be given within three to four hours after stroke symptoms appear.
Endovascular procedure: This is a process by which the blood clot is removed using a catheter, which gets inserted into the area of the blocked blood vessel. It helps in restoring blood flow to that area. 
Treatment of Hemorrhagic stroke

Endovascular procedure: Several endovascular techniques and methods are used so that the weakening of blood vessels is reduced and less bleeding is caused.
Surgical treatment: Different modes of neurosurgery may be undertaken to stop bleeding and for relieving pressure within the skull.

Role of Neurosurgery in Management of Stroke

Coughing is a common problem of the respiratory tract and often indicates a deeper problem. It can be very irritating and can affect eating habits and socialization. A cough which persists for more than 4 weeks is believed to be chronic in nature. Tuberculosis (TB) is the most common cause of chronic cough in India. TB is an airborne bacterial infection caused by the organism - 'Mycobacterium tuberculosis', that primarily affects the lungs, although other organs and tissues may be involved. Cardinal features are: 

Chronic cough with or without sputum.
Fever more in the night time. 
Poor appetite. 
Unintentional weight loss. 
Read on to know about other common causes of chronic cough and how to manage them.

Allergies: People with allergies usually have a chronic cough, which gets aggravated when exposed to the allergens such as pollen or environmental dust. Staying away from allergen provides relief. Antihistamines are also useful, which most people detected with allergies keep in handy. Inhalers might be required, if there is associated congestion or shortness of breath.
Asthma: This is a very common chronic condition, caused by inflammation and swelling of the lungs, in addition to wheezing and shortness of breath. Asthma patients often suffer from a chronic cough. An asthma attack usually happens during the night or early morning, and is triggered by colds, cigarette smoke, air pollutants or allergens, which can even include certain foods. Most asthmatics usually carry their steroids, inhalers, and bronchodilators, as the onset of attack can be unpredictable.
Bronchitis: This condition of inflammation of the bronchial region is very common among smokers and among the elderly. There is excessive mucus accumulation, which the body tries to clear via coughing. The lungs are weakened and therefore, the coughing is painful.
Gastroesophageal reflux disease (GERD): This is a problem of the digestive system, but regurgitation of food into the airway induces cough. GERD is a chronic issue and so most people also end up with a chronic cough. It is worse with sitting up than with sitting down. Treatment includes H2 blockers to suppress acid production and dietary changes including small, frequent meals and avoiding spicy food items.
Upper airway cough syndrome: There could be multiple problems in the upper airway, which leads to a constant postnasal drip. Here, there is constant dripping of the sputum into the air passage, which can lead to a chronic cough whenever there is impaired air flow. This can be caused by various forms of chronic sinusitis and rhinitis. People diagnosed with this condition usually resort to antihistamines and decongestants for relief.
Other causes: There are a number of other causes as noted below. Smoking, tuberculosis, congestive heart failure, pertussis or whooping cough, foreign body in the airway, cancer in the airway passage, chronic aspiration of foods, etc. can all lead to chronic cough.
The key is to identify the reason that is causing the chronic cough. Most people who are diagnosed are educated to handle it and carry the required medications including steroids, bronchodilators, and inhalers.

Suffering from Chronic Cough - How to Manage it?

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