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Background cutaneous involevemtn is an important extrapulmonary manifestation of tuberculosis. It is a paucibacillary condition and has diverse clinical presentations. Sufficient data is not available regarding role of GeneXpertMTB/RIF in cutanoues tuberculosis. Methods in this study, BacT/Alert3D and response to antitubercular therapy were taken as gold standard and performance of GeneXpertMTB/RIF was evaluated against it in clinically and histopathologically suspected cases of cutaneous tuberculosis. Results forty seven patients were included in the study of which commonest presentation was scrofuloderma (42.6%) followed by lupus vulgaris (40.4%). Granulomatous inflammation on histopathology was seen in 75.5% patients on skin biopsy. Sic patients had extracutaneous focus of tuberculosis. In 14 (29.79%), culture of skin biopsy was positive for M. tuberculosis and all showed complete response to ATT in 6 months. GeneXpertMTB/RIF detected M. tuberculsois in 4 samples. Conclusion GeneXpertMTB/RIF is not a reliable tool for diagnosis of cutaneous tuberculosis. Clinic-histopathological correlation along with response to ATT is needed for confirmation of diagnosis of cutaneous tuberculosis.

Psoriasis is a common chronic inflammatory skin disease affecting >125 million individuals worldwide. The therapeutic course for the disease is generally designed upon the severity of the disease. In the present study, the gene expression profile GSE78097, was retrieved from the National Centre of Biotechnology (NCBI)-Gene Expression Omnibus (GEO) database to explore the differentially expressed genes (DEGs) in mild and severe psoriasis using the Affy package in R software. The Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathways of the DEGs were analysed using clusterProfiler, Bioconductor, version 3.8. In addition, the STRING database was used to develop DEG-encoded proteins and a protein-protein interaction network (PPI). Cytoscape software, version 3.7.1 was utilized to construct a protein interaction association network and analyse the interaction of the candidate DEGs encoding proteins in psoriasis. The top 2 hub genes in Cytohubba plugin parameters were validated using immunohistochemical analysis in psoriasis tissues. A total of 382 and 3,001 dysregulated mild and severe psoriasis DEGs were reported, respectively. The dysregulated mild psoriasis genes were enriched in pathways involving cytokine-cytokine receptor interaction and rheumatoid arthritis, whereas cytokine-cytokine receptor interaction, cell cycle and cell adhesion molecules were the most enriched pathways in severe psoriasis group. PL1N1, TLR4, ADIPOQ, CXCL8, PDK4, CXCL1, CXCL5, LPL, AGT, LEP were hub genes in mild psoriasis, whereas BUB1, CCNB1, CCNA2, CDK1, CDH1, VEGFA, PLK1, CDC42, CCND1 and CXCL8 were reported hub genes in severe psoriasis. Among these, CDC42, for the first time (to the best of our knowledge), has been reported in the psoriasis transcriptome, with its involvement in the adaptive immune pathway. Furthermore, the immunoexpression of CDK1 and CDH1 proteins in psoriasis skin lesions were demonstrated using immunohistochemical analysis. On the whole, the findings of the present integrated bioinformatics and immunohistochemical study, may enhance our under-standing of the molecular events occurring in psoriasis, and these candidate genes and pathways together may prove to be therapeutic targets for psoriasis vulgaris.

Global economic digitization continues to advance at exponential speed. This development is in sharp contrast to the financial sector and payment systems that still operate on legacy infrastructure that lacks the flexibility to serve those technology needs. Further, the emergence of Decentralized Finance demonstrates the capacity to disrupt the financial sector, impact national sovereignty, and affect established monetary transmission channels. Hence, it is no surprise that nation-states and tech-firms alike are now building new digital infrastructures that circumvent the legacy practices. Central banks, in particular, are racing to explore the issuance of Central Bank-issued Digital Currencies (CBDCs) in an attempt to rediscover the very essence and use of fiat cash. In the past decade, the Bank of Canada (BoC) has emerged as an international thought leader on CBDCs. In early 2020, the BoC issued a contingency plan for the potential introduction of a CBDC and later that spring ran a global competition among universities to sample arm length’s designs. Being a finalist in this competition, this manuscript presents a design proposal for a Central Bank Digital Loonie (CBDL) based on careful academic research of the possible technological, legal, and economic components of such an unprecedented and historic expedition. We propose a two-phased approach. In the first phase, the BoC introduces a centralized platform as a public-good infrastructure that establishes digital cash and ensures global/domestic interoperability. In this phase, e-KYC-based authentication leverages existing private/public sector solutions but also safeguards users' privacy/data against third-party commercial interests while complying with AML/CFT. In the second phase, the BoC will expand the platform to an enterprise-level permissioned blockchain. This shared resource will transform CBDLs into "programmable e-money" within a “social operating system” that will enable Canadians to operate, innovate, compete, and thrive in this new global digital economy.

Leprosy type 1 reaction (T1R) is a cell-mediated inflammatory reaction which involves skin and peripheral nerves in leprosy. Lesions with T1R have higher production of IL-17 cytokine from CD4

The increase in air pollution over the years has had major effects on the human skin. Various air pollutants such as ultraviolet radiation, polycyclic aromatic hydrocarbons, volatile organic compounds, oxides, particulate matter, ozone and cigarette smoke affect the skin as it is the outermost barrier. Air pollutants damage the skin by inducing oxidative stress. Although human skin acts as a biological shield against pro-oxidative chemicals and physical air pollutants, prolonged or repetitive exposure to high levels of these pollutants may have profound negative effects on the skin. Exposure to ultraviolet radiation has been associated with extrinsic skin aging and skin cancers. Cigarette smoke contributes to premature aging and an increase in the incidence of psoriasis, acne and skin cancers. It is also implicated in allergic skin conditions such as atopic dermatitis and eczema. Polyaromatic hydrocarbons are associated with extrinsic skin aging, pigmentation, cancers and acneiform eruptions. Volatile organic compounds have been associated with atopic dermatitis. Given the increasing levels of air pollution and its detrimental effects on the skin, it is advisable to use strategies to decrease air pollution.

Background: Metabolic syndrome worsens complications in psoriasis patients by predisposing them to cardiovascular diseases. Psoriasis has been widely associated with metabolic syndrome; however, it has still not been proven owing to a limited number of studies and some of those reporting conflicting results. Objective: Psoriasis has reportedly been associated with metabolic syndrome; however, it has yet not been established beyond doubt owing to conflicting literature. The present meta-analysis of observational studies aims to evaluate the prevalence of metabolic syndrome in psoriasis patients and establish an inferring point that psoriasis patients are certainly susceptible to metabolic syndrome. The study will benefit clinicians to assess and monitor psoriasis patients for several associated comorbid conditions and in its treatment. Methods: A systematic web search for ‘Psoriasis’, ‘Metabolic Syndrome’, ‘Hypertension’, ‘Plasma Glucose’, ‘Dyslipidaemia’, ‘Waist Circumference’ was performed, collecting all original observational studies on humans up to April 30, 2018. Depending on the inclusion and exclusion criteria, articles were screened for eligibility. Due to the presence of significant heterogeneity, the Odds Ratio (OR) was calculated using a random-effect model with Der-Simonian and Laird method. The statistical heterogeneity was determined using I2 statistics. Comprehensive Meta-Analysis Software, Version 3 was used to perform all the analysis. Results: Sixty-three studies encompassing 15,939 psoriasis patients and 103,984 controls were included in this meta-analysis. Among them, 30.29 % of psoriasis patients were reported with metabolic syndrome in comparison to 21.70 % of subjects in the control group. The present study clearly indicates an increased prevalence of metabolic syndrome among psoriasis patients (OR: 2.077 [95% CI, 1.84 - 2.34]). Conclusions: The findings support the fact that psoriasis patients have a higher incidence of metabolic syndrome. Our study also recommends that psoriasis patients should be regularly monitored for metabolic syndrome complications and its associated risk factors such as hypertension, raised triglyceride, lowered HDL Cholesterol, increased fasting plasma glucose, and waist circumference.

Anomalous origin of the left coronary artery arising from the opposite sinus of Valsalva (ALCAOS) has a reported incidence of 0.024% - 0.044%. The trans-septal (subpulmonic) subtype typically has a benign medical course with excellent prognosis. A 52-year-old man presented to the ER with lateral

Psoriasis is an immune mediated inflammatory skin disease with complex etiology involving interplay between environmental and genetic risk factors as disease initiating event. Enhanced understanding on genetic risk factors, differentially expressed genes, deregulated proteins and pathway-targeted therapeutics have established multiple axis of psoriasis pathogenesis. So far, loci in 424 genes are reported to be associated with psoriasis alongside copy number variations and epigenetic alterations. From clinical perspective, presence of specific genetic trigger(s) in individual psoriasis patient could aid in devising a personalized therapeutic strategy. Therefore, the review presents an updates on reported genomic alterations and their subsequent course of cutaneous inflammations that potentially drive to psoriasis.

Canadian and American securities market regulators have differing approaches to enforcement. In this article, we present the results of an empirical study comparing a highly salient aspect of securities enforcement—insider trading—in Canada and the United States. We reach a number of important findings. First, adjusting for trading volume, Canada has a greater intensity of enforcement when compared to the U.S. Second, Canadian securities regulators primarily concern themselves with insider trading in Canadian companies, while the SEC brings more enforcement actions involving insider trading in companies incorporated outside the U.S. Third, we do not find significant differences in the fraction of actions involving multiple traded companies between Canada and the U.S. However, we do see that U.S. investigations involve a significantly greater number of defendants and that the SEC is more than twice as likely to pursue tippers or tippees (although we observe no significant difference in the likelihood that top insiders will be pursued). Fourth, we find that U.S. cases are significantly more likely to result in a criminal referral leading to prosecution. Fifth, we find that settlements are more likely in the U.S. Finally, in terms of monetary penalties, we find no significant difference between the two countries. However, we do find that Canada is more likely to apply a bar as a sanction, but if a bar is applied, the U.S. is more likely to make the bar permanent. These findings neither demonstrate a need for systemic reform in either jurisdiction nor suggest that centralized regulation is necessarily better from an enforcement perspective. But, they do provide insight into the differing points of regulatory emphasis in two jurisdictions. From a comparative perspective, our research thus allows securities regulators to begin to evaluate whether their enforcement approach is optimal on the basis of quantitative data.

Introduction Bacterial vaginosis (BV) is the most common cause of vaginal discharge worldwide including India. Syndromic diagnosis and management is used across the country for STIs/RTIs. Aims of the study were 1) to evaluate the prevalence of BV based on Nugent’s, Amsel’s and modified Amsel’s criteria 2) to analyse concordance between self- and physician collected swabs for the three different criteria. Methods Study included 550 females attending STI/RTI clinics with abnormal vaginal discharge during the study period of January 2015 to May 2016. Self-collection of swabs was done by patients after instructions followed by physician collection under speculum examination. The samples were analysed by Nugent’s, Amsel’s and modified Amsel’s criteria for diagnosing BV. Results Based on Nugent scoring, 79 (14.3%), 95 (17.3%), 376 (68.4%) patients were found to be BV positive (+), intermediate and BV negative (-) respectively. However, using Amsel’s criteria only 67 (12.2%) patients were observed to be BV+ and 483 (87.8%) were BV-. As modified Amsel’s criteria diagnoses BV+ even when only two out of four Amsel’s criteria are fulfilled, it could detect 96 BV+ cases (17.5%). All the above results were obtained using the physician-collected samples. Sensitivity for diagnosing BV by self-collected samples using Nugent score, Amsel’s criteria and modified Amsel’s criteria was 91.1%, 98.5% and 97.9%, while specificity was 100%, 99.6% and 99.6%, positive predictive value 100%, 97.1% and 97.9% and negative predictive value was 98.5%, 99.8% and 99.6% respectively. High concordance of self-collected samples was established by the Cohen’s Kappa value of 0.890, 0.975, and 0.993 for Nugent scoring, Amsel’s criteria and Modified Amsel’s criteria respectively. Conclusion Apart from Nugent’s scorimg, Amsel’s and modified Amsel’s criteria were equally consistent methods of diagnosis. Establishing reliability of self-collected samples for diagnosing BV shall pave way for validation of syndromic diagnosis even at peripheral health centres.

Introduction Vaginal discharge (VD), a common gynaecological complaint, is often associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and Trichomonas vaginitis (TV). Prevention and control of these STIs/RTIs require understanding of demographic patterns and risk factors. Moreover, diagnosis in resource constrained settings can be facilitated using self-collected vaginal swabs, provided the reliability of the method is established. Aims were to establish the (1) association of sexual, demographic and hygienic practices for the above infections and (2) reliability of self-obtained over clinician-collected vaginal swabs for diagnosis. Methods A total of 550 females aged 18–45 years (median: 32) attending two NACO designated STI/RTI clinics (Jan 2015-May 2016) with abnormal vaginal discharge were evaluated for relevant risk factors using a questionnaire. Swabs were self-collected by patients after instructions and subsequently by a physician under speculum examination. They were then examined by standard bedside tests, Gram staining, wet mount and culture. Results BV, VVC and TV were observed in 79 (14.4%), 144 (26.2%) and 3 (0.5%) patients respectively. VVC coexisted with BV in 58 (10.5%) patients. C. albicans was isolated in 84 (58.33%) VVC cases. Prevalence of VD was higher in rural (p>0.5) and illiterate (p>0.5) patients. BV was strongly associated with douching (odds ratio 8.26) and moderately with use of condoms (odds ratio 1.6), whereas VVC showed minimal association. Use of cloths instead of sanitary pads was also a risk factor for BV (odds ratio 1.3) and with a minimal impact on VVC. Highly concordant self vs physician-collected results established the reliability of self-collected samples with Cohen’s Kappa values of 0.95 (BV), 0.99 (VVC) and 1.0 (TV). Conclusion Avoiding douching, using condoms and sanitary pads help in reducing the risk of acquiring VD. Reliability of self-collected swabs for diagnosis shall go a long way in strengthening National STI/RTI Program, especially in resource constrained settings.

Positivity of microscopy and culture was greater (P < 0.0001) in men with urethral discharge syndrome (65.8%) than in women with vaginal/cervical discharge (0.5%), indicating that basic diagnostic tests may not be cost-effective for diagnosis of vaginal/cervical discharge syndrome. Microscopy when compared with culture showed sensitivity, specificity, positive predictive value and negative predictive value of 95.4%, 77.6%, 84.6%, and 95.3%, in men, whereas in women, it was 77.8%, 99.9%, 92.1%, and 99.9%, respectively.

ObjectivesSelf-collected vaginal swabs can facilitate diagnosis of vaginal discharge (VD) in resource-limited settings, provided reliability of the method is established. The aim of this study was to evaluate the concordance between self-collected and physician-collected vaginal swabs for aetiological diagnosis of VD and to determine the prevalence of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonas vaginitis (TV).MethodsA total of 550 females (median age: 32 years; range: 18–45 years) attending two sexually transmitted infection/reproductive tract infection (STI/RTI) clinics with VD from January 2015 to May 2016 were included in the study after obtaining written informed consent. Swabs were self-collected by patients after instructions and subsequently by a physician under speculum examination. Samples were processed for standard bedside tests, Gram staining, wet mount and culture (gold standard) according to the national guidelines. Concordance between the two methods was determined by the Cohen’s kappa value.ResultsBV, VVC and TV were diagnosed in 79 (14.4%), 144 (26.2%) and 3 (0.5%) patients, respectively. VVC coexisted with BV in 58 (10.5%) patients. There was no coinfection of TV with BV or VVC.Candida albicanswas isolated in 84 (58.3%) VVC cases. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of self-collected swabs for diagnosing BV was 91.1%, 100%, 100% and 98.5%, respectively, while for theC. albicansVVC and TV, sensitivity, specificity, PPV and NPV all were 100% as compared with physician-collected swabs. Highly concordant results were obtained between two methods by the Kappa values of 0.95 (BV), 0.99 (VVC) and 1.0 (TV).ConclusionThe comparative performance of self-collected and physician-collected vaginal swabs establishes self-collection of samples for BV, VVC and TV as a viable alternative tool in the management of STIs/RTIs, especially in peripheral and resource-constrained settings. This would be effective in implementing the diagnostic approaches for STIs/RTIs in community-based surveillance studies at national or regional level and therefore strengthening the National STI/RTI Control Programme.

Circumcision is one of the oldest and the most controversial surgical procedures performed worldwide and is almost universal among Muslim and Jewish men. Most medical institutions in various countries agree that although there may be health benefits, there is no medical justification for routine circumcision in neonates or children. It should be performed only for established medical reasons and should not be universally recommended. There are modern techniques that provide safer, simpler, quicker, and cheaper alternatives to the traditional means of circumcision with good functional and cosmetic results. Female genital mutilation (FGM) includes procedure that alters or injures female genital organs for nonmedical reasons. Various degrees of FGM are prevalent, the most mutilating one being infibulation. There are numerous gynecologic and obstetrical complications with infibulation. FGM also plays a significant role in facilitating the transmission of HIV infection through numerous mechanisms. Health care providers have an important role to play in the eradication of this practice. Increased professional and public awareness about such a practice is required.

This study compares the status of auditors’ legal liability to third parties in seven countries. It analyzes recent legislation, regulation, and case law as well as pronouncements from national accounting and auditing bodies. With the increasing internationalization of capital markets and audit firms, an understanding of auditor liability on a global basis is important. Our findings show that common law countries (the United States, Canada, the United Kingdom, Australia, and New Zealand) have enacted legislative reforms that directly or indirectly increased auditors’ liability. In contrast, civil law countries (Germany and France) did not mandate legislative or regulatory reforms.

Dasatinib, a dual Src/Abl tyrosine kinase inhibitor, has significant antileukemic effects against various imatinib mesylate-resistant BCR/ABL mutants. Despite well-documented inhibitory effects of dasatinib on BCR/ABL kinase, the exact downstream cellular events leading to generation of its potent antileukemic effects remain to be defined. We provide evidence that p38 Map kinase (MAPK) pathway is activated leading to increased upregulation of mixed lineage kinase 3, MKK3/6, MSK1, and Mapkapk2, upon treatment of BCR/ABL expressing cells with dasatinib, including cells expressing various imatinib-resistant mutants, except for T315I. Our data demonstrate that such dasatinib-dependent activation of p38 MAPK and its effectors plays a critical role in the generation of antileukemic responses, since pharmacological inhibition of p38 or siRNA-mediated knockdown of its expression reverse dasatinib-mediated apoptosis, cell cycle arrest, and anti-proliferative effects. p38 MAPK inhibition also reversed dasatinib-induced suppression of CML patient-derived leukemic colony-forming units progenitor growth in vitro, as well as BCR/ABL expressing KT-1 cell-derived leukemic progenitor growth. Altogether, our findings suggest a critical role for p38 MAPK pathway in the generation of antileukemic effects of dasatinib, and raise the possibility that development of novel means to enhance p38 MAPK activation in BCR/ABL expressing cells may be an approach to promote antileukemic responses and, possibly, reverse T315I mutation-mediated resistance.

Enron offers a prime case study to explore the many failures of the modern corporation to treat its employees even-handedly, ethically and with respect. Employees make significant personal investments into the corporations they work for, but employee interests are rarely of concern to directors. This paper analyses several theories on the nature and purpose of the corporation and argues that the interests of stakeholders other than shareholders ought to be legally recognised in the corporation. The paper examines three theories on employees and employment, and argues that the human capital theory is most meaningful and best reflects the role of the employee when that employee is analyzed in a broad social, political and economic context. The authors evaluate reforms, such as stakeholder statutes, which have been implemented in various jurisdictions, and set out specific amendments that ought to be implemented to recognise the status of the employee as an important stakeholder in the modern corporation.

In response to a Private Member’s Resolution calling upon the Ontario Securities Commission to conduct a consultation on corporate social responsibility and environmental, social and governance reporting standards and to adopt an enhanced standardized reporting framework, the Hennick Centre for Business and Law and Jantzi-Sustainalytics undertook a multi-stakeholder consultation process in respect of requirements regarding corporate social disclosure standards. This report to the Minister of Finance reflects a synthesis of the views that emerged from that process. The recommendations herein complement those contained in the Commission’s report to the Minister of Finance, dated December 18, 2009 (regarding environmental and governance disclosure), as well as those reflected in OSC Staff Notice 51-716. They reflect a growing demand for improved social performance disclosure to facilitate better governance and decision-making on the part of issuers, investors and other stakeholders.

In Legal Determinants of External Finance, Rafael La Porta, Florencio Lopez-de-Silanes, Andrei Shleifer, and Robert Vishny (“LLSV”) argue that the reason that some countries have bigger capital markets than others can be traced to the legal origin of the country, i.e. whether it is a common law or a civil law jurisdiction. This paper explores the LLSV thesis in the context of Canada, which is a common law jurisdiction that also is home to Quebec which has a civil law tradition.Three issues are examined in this paper: first, how and why Canada fared relatively well in the recent financial crisis; second, why Canada has not yet created a national securities regulator; and third, how Quebec, a civil law jurisdiction, operates within an overarching common law framework, and the implications of this cross-fertilization of systems.These three issues are explored by examining the development of various investor protection laws and structures over time in Canada (as opposed to examining investor protection laws at a point in time, as the LLSV studies do), and also by providing context to explain why certain rules and structures have been adapted and others, while economically efficient, may have been rejected. In Canada, as in many other jurisdictions, securities laws and securities structure have an impact on investor protection, as do banking laws and the banking regulatory framework and business culture. Not all investor protection mechanisms are located in the corporate statutes, as LLSV assumes. LLSV did not explore securities law rules, securities law structures, or banking laws. As well, the Canadian system is both structured in such a way and has evolved in such a way that investor protections are fairly consistent between the common law and civil law provinces, even when the civil law statute does not necessarily mimic the common law statute.

Pension fund managers have devised ways to effectively skirt the rule that limits them to acquiring no more than 30 percent of the shares eligible to vote for the directors of a corporation. It’s time for regulators to enforce the rule or eliminate it entirely, thereby giving pension funds a voice commensurate with their equity stake.

The purpose of this consultation (to take place in Toronto, Canada on December 7, 2009) is to elicit the views of informed stakeholders in a review of reporting and disclosure requirements under Ontario securities legislation for corporate “social” performance. In particular, the Consultation paper considers whether existing reporting and disclosure requirements on corporate social performance are adequate. If change is advisable, the question becomes what regulatory or other measures merit consideration. The Consultation is in response to a private member’s resolution introduced by the Honorable Laurel Broten (Etobicoke-Lakeshore), and passed unanimously by the Ontario Legislature (the “Resolution”). In part, the Resolution calls on the Ontario Securities Commission to conduct a consultation on corporate social responsibility and environmental, social and governance reporting standards, and to adopt an enhanced standardized reporting framework for both quantitative and qualitative social and environmental information to ensure that corporate disclosures are understandable, comparable, and outcome-focused. The Resolution called for a report, including policy recommendations, to be submitted to the Minister of Finance. The Consultation is being organized by the Hennick Centre for Business and Law at York University and Jantzi-Sustainalytics, with sponsorship from the Association of Chartered Certified Accountants.

Transcatheter closure of patent foramen ovale (PFO) is a promising alternative to surgical closure or anticoagulation therapy in patients with a history of cryptogenic stroke. Although a number of transcatheter closure devices have been developed and used outside of the United States, the two commonly used devices in the United States are the StarFLEX CardioSEAL and the Amplatzer Occluder. Several complications, both early and late, associated with the devices have been reported in 6-11% of patients. The rates of complication vary with the different devices. Complications include device-related thrombi, embolization, device malposition, fracture, air embolism, arrhythmias, pericardial effusion, need for surgical intervention and death. As reported in the literature, the incidence of longterm complications beyond 1 year is rare. We report a case of a very late presentation of CardioSEAL device arm fracture associated with left atrial thrombus 3 years after device implantation.

Sexually transmitted infections (STIs) a major public health problem in India show various trends in different parts of the country. However, there are limited data on the changing profile of laboratory proven STIs in the same clinic over the years. The present study was thus aimed to determine the changing trends of the profile of STIs and HIV seropositivity in STD clinic attendees over a 15 yr period, and also to detect change, if any, in the antimicrobial resistance pattern of Neisseria gonorrhoeae.The STIs were diagnosed clinically and confirmed by standard laboratory techniques. Socio-demographic data were collected through pre-designed proformae. The STI profile and HIV seropositivity were compared between 1990-1993 (A), 1994-1997 (B), 1998-2001 (C) and 2002-2004 (D). Antimicrobial resistance pattern of N. gonorrhoeae was determined by standard techniques and compared between the last three periods.Of the 78,617 STD attendees, 12,709 (16.2%) had STIs. During period A, genital discharges and during B, C and D, genital ulcerative diseases were predominant. Syphilis was the commonest STI. There was significant rise in the cases of syphilis, herpes progenitalis and genital warts and reduction in that of chancroid, lymphogranulomavenereum (LGV), donovanosis, candidiasis, trichomoniasis and bacterial vaginosis cases. The number of cases with primary syphilis diminished significantly (P0.001), with a concomitant rise in secondary and early latent syphilis. A rising trend was observed in the HIV seropositivity during the different periods. The association of HIV seropositivity was consistently more in patients presenting with genital ulcers specially syphilis, and rose significantly from A (0.6%) to C (8.8%), but became stationary during D. A drastic change in the antimicrobial resistance of N. gonorrhoeae from B to C and C to D and the emergence of less sensitive isolates to ceftriaxone during the later part of the study were observed.Our study showed a definite changing trend in the profile of STIs in the clinic attendees of a major STD centre during a 15 yr period. However, the significant rise in the cases of viral STIs and syphilis contrasted with reduction in the rest.

The asymptomatic nature of chlamydial genital infections coupled with the occurrence of severe sequelae in untreated patients, makes the laboratory evaluation of great importance in the diagnosis of the disease. Genital chlamydial infections are the leading cause of preventable sexually transmitted infections (STIs) worldwide, with 43 million new cases in Southeast Asia. The present study was designed to determine the prevalence of genital chlamydial infection in women attending a sexually transmitted disease (STD) outpatient department and to determine the association of the disease with other STIs. A total of 276 female patients with a complaint of genital discharge or ulcer were enrolled for the study. Genital discharge specimens (endocervical, vaginal, and urethral swabs) were collected from all the patients. The patients were investigated for the presence of antigen and antibody of Chlamydia trachomatis with the help of the Direct fluorescent Antibody test (DFA) and the Enzyme Linked Immunosorbant Assay (ELISA), respectively. Investigations for aetio-pathogens of other STIs were carried out using the standard methods. Chlamydial infection was found in 19.9% of the patients (10.1% by DFA technique and 10.9% by ELISA). Both the antigen and antibody were positive in only three (1.1%) cases. The overall incidence of other aetio-pathogens was low. In two (0.7%) cases multiple infections were seen. Chlamydia trachomatis was found to be most commonly associated with Candida albicans . However, there was no co-infection of Chlamydia trachomatis with Neisseria gonorrhoeae .

We report a case of massive posterior mitral annular calcification causing severe systolic anterior motion of the anterior mitral leaflet and dynamic left ventricular outflow tract obstruction. Mechanism of genesis of systolic anterior motion by this unusual mechanism is illustrated. Importance of recognizing this mechanism and its implications for surgical therapy are discussed. Our patient also had liquefaction necrosis of mitral annular calcification causing its extension into left ventricular myocardium mimicking a tumor.