Usefulness of hemoglobin and albumin as prognostic markers for highly active antiretroviral therapy for HIV-1 infection.

Background: Usefulness of hemoglobin and albumin as prognostic markers for highly active anti-retroviral therapy for HIV-1 infection. Introduction: Anemia and hypoalbuminemia are common complications in human immunodeficiency virus (HIV) infection. We aimed to investigate the changes in hemoglobin and albumin levels in response to highly active antiretroviral therapy (HAART). Further, we evaluated the appropriateness of using hemoglobin and albumin as HIV disease progression markers. Materials and Methods: A prospective longitudinal study of 122 subjects was carried out. Pre-treatment, one year, and two year post-treatment hemoglobin, and albumin levels were correlated with respective CD4+ T cell counts. The sensitivity, specificity, and positive predictive value of each marker against CD4+ T cell counts were calculated in order to establish the appropriateness of use of these parameters as surrogate disease progression and prognostic markers. Results: Mean hemoglobin and albumin levels pre-, one, and two year post HAART were 9.7 g/dL, 12.1 g/dL, and 13.1 g/dL, respectively, P = 0.001; albumin: 3.7 gm%, 4.4 gm%, and 4.7 gm%, respectively, P = 0.001. There was a positive correlation between hemoglobin, albumin, and CD4+ T cell count at pre-treatment, one year, and two year post-treatment visit. Both albumin and hemoglobin had high sensitivity when compared to CD4+ T cell counts. Conclusions: Hemoglobin and albumin levels were found to increase after initiation of HAART. Hemoglobin and albumin were seen to be a strong prognostic marker of HIV disease progression at pre-, one, and two year post-treatment. Therefore, hemoglobin and albumin may be used together along with CD4 + T cell counts in HIV management, particularly in resource-poor settings.

4-year review of keratoplasty in Pakistan

From January 1, 1985 to December 31, 1988, we performed penetrating keratoplasty on 54 Pakistani patients, 38 men and 16 women, at the Postgraduate Medical Institute, Peshawar. The age of the donors ranged from 14 to 91 years and that of the recipients from 12 to 65 years. The time between enucleation and the surgery was 26 hours minimum and 72 hours maximum. Autografts were used in two patients. The size of the graft ranged from 5.5 mm to 10 mm with an average of 7 mm. Corneal scarring [35 cases, due to healed bacterial ulcer, small pox, measles, trachoma, or trauma], keratoconus [eight cases], aphakic or pseudophakic bullous keratopathy [three cases], dry eye syndrome [two cases], chemical burn [two cases], active bacterial corneal ulcer [two cases], corneal dystrophy [one case], or sclerokeratitis [one case] were the reasons for keratoplasty. After a followup period of six months to four years, 23 [42.6%] grafts remained clear. The lack of donor material of good quality, a large percentage of high risk recipient eyes, and technical surgical limitations [e.g. non-availability of viscoelastic material, fine sutures, etc.] resulted in 57.4% failure rate. Only four [7.4%] cases showed late rejection, which was successfully managed in two of them. Of the eight eyes with keratoconus, seven retained clear grafts

Assessment of prognosis in myocardial infarction: norris coronary prognostic index versus QRS scoring system

40 patients with acute myocardial infarction were studied. They were divided into five subgroups on the basis of Norris Coronary Prognostic Index [CPI], and into two subgroups, i.e., Group A or high risk group and group B or low risk group on the basis of LVEF calculated from QRS scoring system. They were followed up for one year and mortality rate was noted in each subgroup of the two methods. There were total eight deaths [20%] and QRS scoring system was able to predict correctly [100%] to segregate all these patients into group A. While Norris CPI method was unable to segregate clearly these patients into prognostically different subgroups. Mortality rate did not show linear relationship with the CPI score or its individual factors. The prediction of prognosis by QRS scoring system was statistically significant, while by Norris CPI was insignificant. QRS scoring system is superior to Norris CPI and can be used reliably to predict the prognosis after acute myocardial infarction. Hence ECG can provide important indirect quantitative information about left ventricular function

Infarto do miocárdio de localizaçäo anterior: valor prognóstico do índice de Gaasch / Myocardial infarction of anterior localization: prognostic value of the Gaasch index

Trinta doentes (28 do sexo masculino), com idade média 55 + ou - 12 anos, com seguimento de 13 a 25 meses (média 20 meses), acometidos de infarto do miocárdio de localizaçäo anterior, anteriormente estudados, foram submetidos a novos ecocardiograma e a reavaliaçäo clínica. Quatro doentes (13,3%) morreram de causa cardíaca (grupo A). Os sobreviventes (83,3%) formaram o grupo B e o foram divididos em sintomáticos (28%-grupo I) e assintomáticos (72%-grupo II). Compararam-se as variáveis ecocardiográficas dos grupos A e B, tendo havido diferenças significativas no que respeita ao índice de Gaasch (IG). A comparaçäo entre os grupos I e II, revelou diferenças estatisticamente significativas em relaçäo ao diâmetro diastólico, à distância E-septo e ao IG. Conclui-se que o IG forneceu a única diferença estatisticamente significativa entre os grupos A e B (p < 0,02), sendo 3,2 um valor discriminativo entre os grupos A e B os grupos I e II (p < 0,001), constituindo uma variável ecocardiográfica com valor prognóstico nos doentes com infarto do miocárdio de localizaçäo anterior, apesar do seguimento ter sido só de 20 meses