Percutaneous balloon mitral valvulotomy with transesophageal echocardiographic monitoring: experience in Khon Kaen University.

To study the results and complications of Percutaneous Balloon Mitral Valvulotomy with Transesophageal Echocardiographic monitoring in patients with symptomatic mitral stenosis. From November 1996 to November 1998, PBMV with TEE monitoring was performed in 107 patients with symptomatic mitral stenosis. There were 72 females and 35 males, aged 19 to 65 years (mean 37.63). The mitral valve was successfully dilated in 104 patients. Immediately after PBMV, there was significant reduction of mean mitral valve gradient (17.89 +/- 6.7 mm Hg to 6.21 +/- 3.02 mm Hg), mean left atrial pressure (26.67 +/- 6.61 mm Hg to 13.97 +/- 4.7 mm Hg), mean pulmonary artery pressure (35.21 +/- 13.03 mm Hg to 27.71 +/- 10.31 mm Hg). Mitral valve area was increased from 0.80 +/- 0.24 cm2 to 1.75 +/- 0.42 cm2 and cardiac output was increased from 3.84 +/- 0.97 L/min to 4.74 +/- 1.09 L/min. Mitral regurgitation was detected in 20 patients, severe mitral regurgitaion appeared in one patient. None of these patients required emergency surgery. Cardiac tamponade was detected in one case and resolved by pericardiocentesis. TEE was well tolerated and no complications of TEE were detected. PBMV aided by TEE is safe and well tolerated.

Clinical presentations and outcomes of TB among HIV-positive patients.

A retrospective cohort study reviewed the hospital records of 200 consecutive HIV patients and followed for 6 months period of TB treatment. Sociodemographic details, symptoms, and signs, results of investigations were recorded at the time of presentation, while diagnosis, and clinical outcomes were done at the end of the follow up period. The aim of the study was to determine the clinical manifestations and outcomes in tuberculosis among HIV-positive patients in Bamrasnaradura Hospital, Nonthaburi. Also, predictive factors for loss of follow up in these patients were determined. The results showed that extrapulmonary TB (58%) was more common, and lymphadenopathy (52%) was the most common sign on examination. Chest x-rays were positive in only 55% cases, while AFB examinations were positive in 48.5%. After 6 months, 30% patients were alive, 12% patients died, and 50% patients were lost to follow up. Factors such as low socioeconomic status (p<0.001), past history of TB (p<0.003) etc were statistically significant in predicting the likely loss of follow up and thus, nonadherence in TB management among HIV- positive patients. In conclusion, tuberculosis in HIV patients presents as extrapulmonary involvement more frequently. The diagnosis is more difficult in cases of HIV. Patients' noncompliance is the biggest problem in management of TB in these patients, but there are predictors which can help us identify the likely patients, and thus, improve their management and clinical outcomes.

Nonadherence in tuberculosis treatment among HIV patients attending Bamrasnaradura Hospital, Nonthaburi.

OBJECTIVE: To determine the clinical manifestations, outcome and nonadherence, in tuberculosis (TB) among HIV patients in Bamrasnaradura Hospital, Nonthaburi. DESIGN: A retrospective cohort study; hospital record files were reviewed over 11 months. A total of 200 consecutive HIV patients were entered and followed for a 6 months period of their TB treatment. Sociodemographic data, symptoms and signs and results of investigation tests were recorded at the time of presentation, while diagnosis, and clinical outcome were done at the end of the follow-up time. RESULTS: Extrapulmonary tuberculosis (58%) was more common than pure pulmonary involvement (42%). Lymphadenopathy (52%) was the commonest sign on physical examination. Chest X-rays were positive in 55 per cent cases, while AFB examination was positive in 48.5 per cent from the sputum and 46 per cent from lymph node aspirate specimens. After 6 months of treatment, 30 per cent patients were still alive, 12 per cent had died, and 50 per cent were lost to follow-up. Factors such as low socioeconomic status (p < 0.001), being newly diagnosed with TB (p < 0.001), past history of TB (p < 0.003), etc., were statistically significant in predicting the likely nonadherence in TB treatment among HIV patients. CONCLUSION: In HIV-infected individual, tuberculosis presents more often with extrapulmonary involvement, and the diagnosis is not difficult. While treatment of tuberculosis is successful, patients' compliance is the biggest problem in managing them.