Role of Computed Tomography in the Evaluation of Craniocerebral Trauma

The aim of this study was to assess prognostic significance of CT in the outcome of patients of head injury, to evaluate the different traumatic lesions in trauma to the head, correlation between skull fractures and intracranial lesions, and establish that CT has significant role in management of patients with head injury. Methods: The present study was carried out on 100 patients of head injury, referred to the Department of Radiodiagnosis, Civil Hospital, Aizawl. Adults from the age of 18 years onwards, patients with a history of road traffic accident, fall or assault and in-patient cases were included. Pediatric cases, penetrating injuries and out-patient cases were excluded. All these patients were clinically assessed and grouped according to the Glasgow Coma Scale before the procedure was conducted. CT findings were reported directly from the monitor and frequency distribution of craniocerebral lesions, types of fractures, association of fractures with various lesions, comparison of skull fractures with conventional radiographs, density pattern and distribution of lesions noted and correlated with mortality. Results: Oedema and contusions were the two most commonly encountered lesions. Fractures formed the next major group accounting for 81% of lesions. Linear fractures were seen in 64% patients while depressed fractures were seen in 12% patients. Outcome was poor in patients with midline shift more than 5 mm (45% mortality). Conclusions: We concluded that this fast, simple, inexpensive, highly effective and safe imaging modality should be considered the first imaging of choice in acute head injury as it forms the cornerstone for rapid and effective diagnosis.

Effect of antiretroviral therapy on progression of endothelial dysfunction in acquired immune deficiency syndrome patients

Background: Though the natural history of Human Immunodeficiency Virus (HIV) infection in many patients has been dramatically altered through the use of antiretroviral therapy, this treatment paradigm of chronic chemotherapy may not be sustainable given the short and long-term toxicities of these medications. Currently, there is lack of data in the Indian literature regarding study of endothelial dysfunction in HIV patients. The purpose of our research was to study the effect of anti-retroviral therapy on the progression of endothelial dysfunction in HIV/AIDS patients.Methods: The study comprises a total number of 30 adult HIV positive patients of both sex with confirmed HIV seropositivity and CD 4+T cell count < 200/µl. None of these patients had ever received anti retroviral therapy (ART). These patients were subjected to detailed clinical examination and markers of endothelial dysfunction - Flow mediated vasodilatation (FMD) of brachial artery, S. Nitrite and C-reactive protein (CRP) were performed before starting ART. Study group patients were started on ART, they received triple drug ART (Lamivudine 150 mg BD, Stavudine 30 mg BD, Nevirapine 200 mg BD). In patients on ART after a period of 6 months, markers of endothelial dysfunction - FMD, S. Nitrite and CRP tests were reassessed.Results: FMD (4.08±3.58) and S. Nitrite (20.83±13.75) were also depressed after six months of anti retroviral therapy. Also, patients showed more CRP positivity and higher titres after ART. CD 4+T cell count before ART (124.16±84.46) and after ART (186.63±70.96). This rise in count was statistically significant.Conclusions: HIV patients who are receiving ART demonstrate a number of metabolic abnormalities with more severe depression in markers of endothelial function.

Prevalence of endothelial dysfunction in acquired immune deficiency syndrome patients and its correlation with degree of immunodeficiency

Background: Number of factors play a role in endothelial dysfunction observed in AIDS patients, which can lead to atherosclerosis along with cardiovascular mortality and morbidity. Human immunodeficiency virus (HIV), the etiologic agent of AIDS causes several vascular disorders characterized by an evident activation and perturbation of endothelial cells. Currently, there is lack of data in the Indian literature regarding study of endothelial dysfunction in HIV patients. The purpose of our research was to study the prevalence of endothelial dysfunction in HIV/AIDS patients.Methods: The study comprises a total number of 60 adult HIV positive patients of both sex (male and female) with confirmed HIV seropositivity. The patients were divided into two groups of 30 each, depending on the degree of immune dysfunction (CD 4 cell counts). Group I- patients with CD 4+T cell count>200/µl and group II-patients with CD 4+T cell count<200/µl. These patients were subjected to detailed clinical examination and markers of endothelial dysfunction-flow mediated vasodilatation (FMD) of brachial artery, S. nitrite and C-reactive protein (CRP) were performed.Results: The defect in endothelial function was most prevalent in patients with more severe immunosuppression. FMD of brachial artery was decreased in patients with CD 4+T cell count < 200/µl (7.07±2.89, p=0.00). S. nitrite was also significantly lower in group II patients (26.43±15.38), and these patients also showed more CRP positivity and higher CRP titres ranging from 1.2 mg/dl to 9.6 mg/dl.Conclusions: The defect in endothelial function was most prevalent in patients with more severe immunosuppression. FMD of brachial artery was decreased in patients with CD 4+T cell count <200/µl (7.07±2.89, p=0.00). S. nitrite was also significantly lower in group II patients (26.43±15.38), and these patients also showed more CRP positivity and higher CRP titres ranging from 1.2 mg/dl to 9.6 mg/dl.