ABSTRACT
Background: Target organ damage takes place early in course of hypertension. But, despite this, the disease remains inadequately controlled in majority of patients partly because of its asymptomatic nature. With incidence of hypertension on the rise, there have not been adequate studies in our country linking hypertensive target organ damage with microalbuminuria and creatinine clearance especially in asymptomatic patients. Aims: To find the relationship between microalbuminuria and reduced creatinine clearance with subclinical target organ damage in asymptomatic primary hypertensive patients. Material & Methods: 60 hypertensive patients were evaluated for mild renal dysfunction defined as 24 hour urine albumin(UA) > 30 mg/d and/or Creatinine Clearance (CCR) < 60 ml/min/1.73m2 .Target organ damage evaluated were retinopathy (direct fundoscopy) and Left ventricular hypertrophy (2D ECHO). Results: There was significant association between microalbuminuria (30 %) and reduced creatinine clearance (38%) with target organ damage i.e. left ventricular hypertrophy [p < 0.001 & p 0.001 respectively] and hypertensive retinopathy [p 0.005 & p 0.03 respectively]. Patients with urine microalbumin had 30 times risk [95% CI: 3.6-253,p 0.001] and those with reduced creatinine clearance had 5.9 times the risk [95% CI: 1.7-19.4, p 0.0035] of developing target organ damage. But when present together the risk increased to 39.4 times [95% CI: 2.2-703, p 0.0124]. Conclusions: Results show that a reduction in creatinine clearance and/or presence of microalbuminuria is a marker of subclinical organ damage in patients with primary hypertension. Microalbuminuria showed better association with target organ damage than reduced creatinine clearance.
ABSTRACT
Background: One of the most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients is tuberculosis. Increasing spread of HIV has become a major contributor in increasing the incidence of tuberculosis. Both the problems should be dealt with simultaneously to stop the future pandemic. Method: This is a retrospective study; 30 adult patients seropositive for HIV and having tuberculosis were included. Pleural fluid was collected for cell count, cell type and for analysis of sugar, proteins and chloride levels. Results: The prevalence of the disease was more in males compared to females. The tuberculin skin test was negative in most of the cases. Pleural effusion was unilateral in all except two patients and it was confined to the right side in many. The lymphocytes were predominant cells in the fluid. The sugar and proteins were lower than the normal blood levels, and the chlorides were increased. Conclusion: Extrapulmonary tuberculosis is very common mostly in the form of pleural effusion. Tuberculin skin testing and sputum AFB do not contribute much to the diagnosis. Analysis of pleural fluid in all seropositive cases of HIV with clinical features of tuberculosis is absolutely necessary.