ABSTRACT
Background: neurological manifestations affecting the nervous system at all stages of Human Immunodeficiency Virus [HIV] infection are common. Neurological complications occur in more than 40% of patients with HIV infection. They are the presenting feature of Acquired Immune Deficiency Syndrome [AIDS] in 10-20% of cases. At autopsy the prevalence of neuropathological abnormalities is 80%. Although an ongoing decline in HIV associated Central Nervous System [CNS] diseases has been observed in very recent years, the mortality from these diseases remains high
Objective: to study the type and frequency of different neurological involvements in patients with HIV infection at tertiary care hospital in Peshawar, KPK and to correlate them with CD4 counts
Study design, settings and duration: this retrospective observational study was carried at Lady Reading Hospital, Peshawar, KPK, Pakistan over a period of 8 years from May 2009 to June 2017
Subjects and Methods: a total of 100 HIV sero-positive patients of both genders, aged >18 years, showing clinical evidence of central nervous system [CNS] involvement were included. Their clinical manifestations, laboratory investigations, and neuroimaging were studied. Laboratory investigations along with magnetic resonance imaging [MRI], EEG and nerve conduction study of the brain/spine was also performed
Results: tuberculous meningitis was the most common presentation as secondary CNS illness [49%], followed by cryptococcal meningitis [16%] and cerebrovascular accidents [7%]. Furthermore, 6% had neurosyphilis, 5% had acquired immune deficiency syndrome [AIDS] associated dementia and peripheral neuropathy occurred in 17% of the patients. Headache was the most common neurological symptom seen in 42% of the patients. Seizures were noted in 35% of the patients. CD4 was significantly low in most of the patients with progressive multifocal leukoencephalopathy, HIV associated encephalopathy [HAD] and cryptococcal meningitis compared with other neurological manifestations. CD4 counts in tuberculous meningitis and HIV associated encephalopathy were 115/microl and 83/microl, respectively
Conclusion: CNS tuberculosis was the most common secondary infection seen in HIV patients followed by cryptococcal meningitis. A high index of clinical suspicion of neurological involvement in HIV patients helps in the early diagnosis and early institution of specific treatment, which in turn decreases the morbidity and mortality considerably. Early treatment and prophylaxis of neurological problems in HIV patients is very important to decrease the mortality rate
ABSTRACT
Introduction: Coronary Artery Disease (CAD) risk factors clustering has increases the morbidity and mortality of CAD. These factors are responsible for insulin resistance; it leads to the development of Metabolic Syndrome (MS), which later leads to the development of CAD. Endothelial dysfunction leads to CAD. EAT is the visceral adipose tissue (VAT) around the heart. It plays a major role in the development of MS. The aim of this study was to measure the EAT thickness through echocardiography in healthy adults and coronary artery disease patients and to determine its association with Body Mass Index (BMI) and waist circumference. Methodology: 156 diagnosed cases of CAD and age matched 157 asymptomatic individuals were recruited from Cardiology Department of Ziauddin Hospital for this case control study. Waist circumference and BMI were measured. Echocardiography was done for EAT thickness. Results: CAD group had significantly higher EAT thickness as compared to controls. There was no significant difference of EAT thickness with BMI. A weak positive association of EAT thickness with BMI was found. A significant difference of EAT thickness with waist circumference was found. There was weak association of EAT with waist circumference in CAD. Conclusion: The mean EAT thickness is significantly higher in CAD group of Karachi population. EAT thickness has weak positive association with BMI and waist circumference. Therefore, we can conclude that BMI and Waist Circumference are the indicators of generalized obesity while EAT thickness may be considered to be a true indicator of visceral obesity.
ABSTRACT
It is an emerging concept now a day that epicardial adipose tissue [EAT] thickness has an essential character in the progression for cardiac risk profile. It is now consider as a new and consistent cardiovascular risk factor. EAT thickness is the indicator for cardiac adiposity. It modifies the cardiac morphology and function. It has close anatomical relation to myocardium. It causes local paracrine interactions between myocardial tissues. It causes enlargement of left ventricle with its diastolic dysfunction. Measurement and assessment of epicardial adipose tissue thickness is now done by new method echocardiography. It appraises visceral adiposity and inflammation. Association of EAT location and its physiological or pathological importance requires advance research. EAT in future may replace waist circumference, as a marker of abdominal obesity. This article briefly discussion the structure of epicardial adipose tissue and its function. It also describes the method for its assessment
ABSTRACT
To determine the early effects of Coronary Artery Bypass Grafting [CABG] on regional left ventricular wall motion abnormality in patients undergoing surgery for proven Coronary Artery Disease [CAD]. Quasi-experimental study. Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi. from October 2005 to April 2006. Patients and Methods: A total of a 100 adult patients who underwent elective CABG were selected. Pre-operative echocardiography was done to note if segmental left ventricular wall motion at basal, mid and apical levels were normal, hypokinetic, akinetic, dyskinetic, or aneurysmal. Postoperative echocardiography was done between 4th and 6th day and change in left ventricular segmental wall motion was noted. Seventy-five patients [n=75] were included in the analysis. These results showed that effect of CABG on anterior segmental wall motion abnormalities was insignificant [p=.609], the effect on the anterior IVS showed deterioration of segmental wall motion and this effect was significant [p=.001], effect is insignificant on anteriolateral segmental wall motion abnormalities [p=.078], normal pre-operative segments in posterior wall showed stability [p=.664] while disappearance of dyskinetic, reduction in akinetic segments postoperatively and inferior wall motion have same effects as of posterior wall. Comparison of pre-operative and postoperative echocardiographic data revealed early improvement in segmental wall motion of posterior and inferior wall, while alterations in segmental wall motion of anterior, anterior-lateral and septal wall. Myocardial revascularization by CABG improves early left ventricular regional wall motion abnormalities where SVG is used as conduit for revascularization whereas no significant improvement occurs in early segmental wall motion in areas revascularized by LIMA