ABSTRACT
Background: Human Immunodeficiency Virus (HIV) infection is a global pandemic, India has second largest burden of HIV illness. Nervous system is most frequent and serious target of HIV infection. Aim: The main aim of our study was to evaluate the occurrence of various neurological manifestations in HIV positive patients and to correlate them with CD4 count at the time of presentation. Materials and methods: This prospective study was carried out for a period of 2 years from January 2014 to December 2016 in the Department of Neurology, Gandhi Hospital, Hyderabad, India. Those patients, who satisfied the inclusion criteria (>18 year of age; HIV positive; any gender) were included in our study. Patients who were HIV positive but having non neurological medical conditions were excluded. Those with various neurological symptoms were subjected to thorough neurological examination, whenever indicated neuroimaging, CSF analysis, NCS, Toxoplasma serology were done. CD4 count was done in all patients. KameraSateesh Kumar, VeenaNarisetty, P. Chandra Shekar, Changala Praveen, AlluriNeeraja. A clinical study of neurological manifestations in HIV positive patients in a tertiary care hospital of Telangana, India. IAIM, 2018; 5(1): 42-49. Page 43 Results: Our study enrolled a total of 1011 HIV positive patients, out of them 354(35%) patients had neurological manifestations. Among them, 239 (67.51%) were male and115 (32.48%) were female. We analyzed patients presented with various neurological symptoms, 187(52%) patients presented with parasthesias. CD4 count was done to all patients. Out of 354 patients, 188 (39.4%) patients had low CD4 count (<200μL). NCS was abnormal in 182 (51.4%) patients. Axonal sensory neuropathy was the most common abnormality found in 82 (45.0%) patients. The most common neurological manifestation was peripheral neuropathy, seen in 166 (46.8%) patients. Conclusion: HIV infection can affect all levels of the neuronal axis. Neurological manifestations are common in 4th decade of life and males affect more than females. Peripheral neuropathy was the most common neurological manifestation and Tuberculosis was the prominent infectious etiology. Neurological manifestations are seen with low CD4 count and there is a significant correlation between them hence can be stated that, these are the manifestations of the late stage of the disease.
ABSTRACT
Background: Chronic Kidney Disease (CKD) is a major public health problem in developed and developing countries, leading to decreased quality of life across the globe. Aim: The clinical and electrophysiological features of peripheral neuropathy in patients with chronic renal failure. The correlation of various biochemical and hematological parameters to that of uremic peripheral neuropathy. Materials and Methods: It was a prospective cross sectional study in 50 Patients admitted with advanced stages of chronic kidney disease. Results: 50 CKD male patients were 30 (60%), female patients were 20 (40%). Among 20 females, 13 (65%) patients had ENMG evidence of polyneuropathy. Polyneuropathy was evident in 78%. Twenty one patients (42%) had clinical symptoms suggestive of polyneuropathy. In 8 patients (16%), it was only detected electrophysiologically. Motor conductions of the tibial, peroneal, median and ulnar nerves showed significant abnormalities in distal motor latency, compound motor action potential (CMAP) amplitude CV among the studied group. In patients with neuropathy there is predominant decrease in CMAP amplitudes with relatively decreased conduction velocity, and prolonged distal latency. Significant abnormalities were found in the peak latency, sensory nerve action potential (SNAP) amplitude and conduction velocity (CV) of the sural, median, ulnar nerves. In patients with neuropathy SNAP amplitudes were decreased significantly with relatively decreased conduction velocity. F wave parameters of peroneal, tibial nerves were abnormal in 30 (60%), and of P. Chandra Shekar, Veena Narisetti, K .Sateesh Kumar, CH. Praveen. To study the spectrum of peripheral neuropathy in chronic kidney disease patients. IAIM, 2017; 4(11): 90-98. Page 91 median 17 (34%), ulnar 16 (32%). We have observed that lower limb involvement is more common compared to upper limb. Sural nerve involvement is seen in all patients with electrophysiological evidence of neuropathy. Conclusion: It can be concluded that axonopathic nature of polyneuropathy with predominant decrease in CMAP and SNAP was confirmed.
ABSTRACT
RNA interference (RNAi) pathways regulate self-renewal and differentiation of embryonic stem (ES) cells. Argonaute 2 (Ago2) is a vital component of RNA-induced silencing complex (RISC) and the only Ago protein with slicer activity. We generated Ago2-deficient ES cells by conditional gene targeting. Ago2-deficient ES cells are defective in the small-RNA-mediated gene silencing and are significantly compromised in biogenesis of mature microRNA. The self-renewal rate of Ago2-deficient ES cells is affected due to failure of silencing of Cdkn1a by EScell- specific microRNAs (miRNA) in the absence of Ago2. Interestingly, unlike Dicer- and Dgcr8-deficient ES cells, they differentiate to all three germ layers both in vivo and in vitro. However, early differentiation of Ago2-deficient ES cells is delayed by 2–4 days as indicated by persistence of higher levels of self-renewal/ pluripotency markers during differentiation. Further, appearance of morphological and differentiation markers is also delayed during the differentiation. In this study we show that Ago2 is essential for normal self-renewal and differentiation. Also, our data suggest that self-renewal and differentiation of ES cells are regulated by both siRNA and miRNA pathways.