Genital herpes clinically underestimated because symptoms or sign occur only in some infection detected serologically. Prevalence of HSV subtypes in microbial etiology of Genital Ulcer Disease (GUD) in men, their association with clinical sign, complex of GUD and high-risk behavior were assessed. One hundred men with first episodes of genital ulcers were prospectively studied for serological evidence of syphilis (RPR and TPHA; T.pallidum IgM and IgG antibodies) and Polymerase Chain Reaction (PCR) proven chancroid and herpes. Demographic and epidemiological data were obtained in a standard interview. Positive syphilis serology observed in 11 cases, H. ducreyi detected in 65 cases and Herpes Simplex Virus in 13 cases. Among the PCR proven infections HSV type-2 detected in 7 cases, HSV type-1 in 4 cases and both HSV type-1 & 2 in 2 cases. Most of the HSV infections (92.3%) found as mixed infection with H. ducreyi. There was one PCR detected genital herpes case that was clinically undetermined. Among the PCR proven HSV infections clinical sign complex of genital herpes observed in one case, which had mixed microbial etiology. HSV infection was more prevalent in married than unmarried men (25.0% vs. 8.3%; P<0.05) and associated with early age promiscuous activity, multiple sexual partner, and sex with commercial sex workers and past infection with STDs. Presence of underdiagnosed HSV infection in men with GUD stress on the need for clinical suspicion of multiple infections. Patient with GUD should be carefully evaluated for HSV infection. Medicine Today 2010 Volume 22 Number 02 Page 55-61 DOI: http://dx.doi.org/10.3329/medtoday.v22i2.12430

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Introduction: Chronic hepatitis B virus (HBV) infection is a major health problem because of its worldwide distribution and its potential adverse sequel, including acute-on-chronic liver failure (ACLF), liver cirrhosis and hepatocellular carcinoma. Short term prognosis of patients with spontaneous severe acute exacerbation of CHB leading to ACLF- like presentation is extremely poor, with mortality ranging from 30% to 70%. Therefore, early and rapid reduction of HBV DNA is the essence of therapy in ACLF-B. Methods: Patients with spontaneous reactivation of HBV [(ALT >5 × upper limit of normal or >2 × baseline) and HBV DNA >20,000 IU/ml] were randomized to Tenofovir mono therapy (300 mg/day) or Tenofovir plus Telbivudine (600 mg/day) dual therapy along with standard medical treatment. Clinical and biochemical parameters were evaluated at baseline, 1 week, 4 weeks and at 3 months. Virological evaluation was done at baseline and at 3 months. Primary end point was reduction of HBV DNA. Secondary end point was reduction of liver related complication, therapy related adverse effects and survival at 3 months. Results: 27 patients were enrolled and 15 of them received mono therapy with Tenofovir and 12 patients received dual therapy (Tenofovir plus Telbivudine). Baseline parameters in two groups had no significant difference. Both groups significantly improve s. bilirubin, ALT, INR, CTP score and MELD score. Only MELD score showed significant improvement in patient with dual therapy at 3 months in comparison of mono therapy. 11 patient on Tenofovir mono therapy (n=15) showed undetected HBV DNA (91.7%) at 3 month and one patient had detectable HBV DNA (<2,000 IU/ml). 10 patients on dual therapy (n=12) had undetectable HBV DNA (100%). Patients receiving dual therapy showed significant improvement in AKI on follow up compared to those on Tenofovir mono therapy. Among 5 deaths, 3 had received mono therapy with Tenofovir and 2 had received dual therapy. Predictors of mortality were high S. bilirubin (25.8±7.8), HBV DNA (5.18±1.17 log10 IU/ml), MELD score (33.0±4.2) and CTP score (12.2±0.8). Conclusion: In spontaneous reactivation of hepatitis B presenting as acute on chronic liver failure, combination of Telbivudine plus Tenofovir is potentially safer with less risk of Tenofovir related nephrotoxicity and hence improved outcomes. Bangladesh Crit Care J March 2022; 10 (1): 48-51