ABSTRACT
Background: Pericardial effusion in clinical practice is commonly under diagnosed or missed especially minimal to moderate effusion. Aim and objectives: To study the clinical and etiological profile of pericardial effusion and to recognize radiological, electrocardiographic and echocardiographic features that are characteristic of pericardial effusion and to analyze pericardial fluid in various etiologies. Materials and methods: It was prospective study in patients presenting with pericardial effusion in department of Medicine and Cardiology. Total of 30 patients who presented with pericardial effusion based on clinical criteria and confirmed by echocardiography were included in the study. Results: The causes of pericardial effusion in this study were Tuberculosis (33.33%), Uremia (20%), Viral /Idiopathic (16.67%), Bacterial (10%), Malignancy (10%), Hypothyroidism (3.33%), and post MI with ischemic cardiomyopathy (3.33%), SLE (3.33%). 3 cases (10%) were HIV positive among viral causes,1 patient had tuberculous pericarditis. ECG findings of low voltage complexes were present in 90% of patients and electrical alternans was seen mainly in tamponade cases. Chest X-ray finding of cardiomegaly was present in 90% patients with pleural effusion in 13.3% patients. ADA levels elevated in all 10 patients of tuberculous effusion with 100% sensitivity and among them smear for AFB was positive in 3 patients. Increased levels of ADA>60U/L was associated with increased incidence of effusive constrictive pericarditis in TB effusion. Pericardial fluid IFN-ᵞ increased greater than 200 pg/L, tuberculous etiology showed 100% sensitivity and specificity. In all 10 patients of M Manjusha, B. Manoj Kumar, N. Venkat Rajaiah, P. Narayana. Study of characteristic of pericardial effusion and to analyze pericardial fluid in various etiologies. IAIM, 2017; 4(10): 221-229. Page 222 2Dimensional echocardiographic findings of right atrial, right ventricular collapse and left atrial collapse was seen predominantly in tamponade cases. Pericardiocentesis showed hemorrhagic effusion in malignancy and uremia, serous and serofibrinous in tuberculosis and purulent in pyogenic effusion. In 3 cases of pyogenic effusion, culture revealed Staphylococcus aureus in 2 patients and Klebsiella pneumonia in 1 patient. Among 3 cases of HIV, one patient had ADA >40 and smear for AFB positive suggesting tuberculous etiology and other 2 cases were directly due to HIV. In HIV with tubercular effusion the patient presented with cardiac tamponade. Conclusions: ADA>40U/L is diagnostic of tuberculous effusion which showed 100% sensitivity and specificity. Increase of ADA>60 U/L is associated with effusive constrictive pericarditis which has poor prognosis. IFN-ᵞ is increased >200pg/l in all patients of tuberculous etiology showing 100% sensitivity and specificity
ABSTRACT
Background: Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiological syndrome comprising of seizures, disturbed vision, altered mental function and headache in various combinations developing over hours. The most common risk factor being abrupt or accelerated hypertension, renal failure, immunosuppressive therapy, eclampsia, autoimmune disease and infections. MRI Brain is the gold standard for diagnosis PRES generally has a favorable prognosis, but neurological sequale and even fatalities can occur in some cases. Aim: The Aim of the study was to Review the clinical and neuroimaging findings in patients diagnosed with Posterior reversible encephalopathy syndrome (PRES). Material and methods: This was a Prospective study done for duration of 2 years from December 2014 to November 2016 in the Department of Neurology, Gandhi Medical College, Hyderabad, Telangana, a tertiary care teaching hospital in south India. The study group patients were selected from pool of inpatients and out patients from various specialities and subspecialities as neurology, internal medicine, obstetrics and gynecology, pediatrics and nephrology. Results: A total of 60 PRES patients included in the study. In the present study age group varied from 15 years to 65 years. Majority of cases 50% (30/60) were among 26-35 years age group. This was in accordance with majority of pregnant population in our series. Female to male ratio was 4:1. Highest incidence of cases i.e., 40% (24 /60) was with eclampsia, followed by autoimmune disease in 20% cases (12/60). 90% patients had predominant parieto-occipital hyper intense lesions on MRI. M Manjusha, Veena Narisetty, Sateesh Kumar Kamera, Dhairyawan Pokalkar. To study clinical and neuroimaging findings in posterior reversible encephalopathy syndrome (PRES). IAIM, 2017; 4(11): 137-143. Page 138 Conclusion: In the present study the mean age of presentation was 32 years and higher prevalence (85 %) was seen in females. Eclampsia is the commonest cause of PRES. Majority of patients are hypertensive with mean BP being 182/112 mm hg while normotensive PRES seen in sepsis