Accuracy of 64-slice coronary CT angiography in predicting percentage diameter stenosis.

OBJECTIVE: Aim of our study was to evaluate the diagnostic accuracy of 64-slice CT coronary angiogram in measuring the percentage diameter stenosis compared to invasive angiography. METHODS AND RESULTS: 100 consecutive patients with more than 50% stenosis in at least one major coronary artery measured by 64-slice CT angiogram were included in the study. Patients with atrial fibrillation, history of allergy to contrast agent, acute coronary syndrome, renal insufficiency, history of previous coronary bypass surgery or percutaneous transluminal coronary stent, heart rate more than 70 per minute at the time of scan in spite of beta-blocker therapy, and calcium score >2000 Agaston units were not included in the study. 15-segment American Heart Association classification was used, and segments were compared using qualitative angiography. 192 segments (12.80%) could not be assessed due to poor image quality. The major cause for poor image quality was dense calcification precluding the luminal assessment (60.42%). Comparing the maximal percentage diameter stenosis by 64-slice CT versus invasive angiogram, the Spearman correlation coefficient between the two modalities was 0.788 and p value was <0.001. Bland-Altman analysis showed a mean difference in percentage stenosis of 2.1 +/- 16.22%. A total of 91.97% (401 of 436) of segments were within 1.96 standard deviations. CONCLUSION: This study shows that 64-slice CT coronary angiogram is accurate in detecting percentage diameter stenosis compared to coronary angiogram if the image quality is good. Calcifications and motion artifacts are the main culprits of poor image quality.

Right atrial myxoma arising from the inferior vena cava.

A middle-aged man presented with recent-onset dyspnea and recurrent syncopal attacks at our institute. Echocardiography revealed a large mass arising from the inferior vena cava and prolapsing into the right atrium and ventricle. Histopathologic examination revealed the classic features of a myxoma. This report is of a rare case of a cardiac myxoma arising from the inferior vena cava.

Hepatitis B or hepatitis C co-infection in individuals infected with human immunodeficiency virus and effect of anti-tuberculosis drugs on liver function.

BACKGROUND: Tuberculosis (TB) and hepatitis are the two common co-infections in patients infected with human immunodeficiency virus (HIV). Anti-tuberculosis treatment (ATT) may have an effect on the liver enzymes in these co-infected HIV patients. AIMS: To determine the prevalence of Hepatitis B and C virus coinfection in HIV infected patients in Tamilnadu and assess effects of anti-tuberculosis drugs on their liver function. SETTINGS: HIV positive subjects referred to the Tuberculosis Research Centre, Chennai. MATERIALS AND METHODS: All HIV infected patients referred to the Tuberculosis Research centre, from March 2000 to May 2004, were screened for Hepatitis B surface antigen (HBsAg) & Hepatitis C virus (HCV) antibodies by enzyme linked immunoabsorbent assay (ELISA). HIV infection was confirmed using two rapid tests and one ELISA. Patients were given either short-course anti-tuberculosis treatment or preventive therapy for tuberculosis, depending on the presence or absence of active TB, if their baseline liver functions were within normal limits. None of these patients were on antiretroviral therapy during the study period. STATISTICAL ANALYSIS: Paired t-test was used to find the significance between baseline and end of treatment liver enzymes levels, while logistic regression was done for assessing various associations. RESULTS: Of the 951 HIV-infected patients, 61 patients (6.4%) were HBsAg positive, 20 (2.1%) had demonstrable anti HCV antibodies in their blood. Serial estimation of liver enzymes in 140 HIV patients (81 being co-infected with either HBV or HCV) showed that 95% did not develop any liver toxicity while they were on anti-tuberculosis treatment or prophylaxis. CONCLUSIONS: The prevalence of hepatitis B and C coinfection was fairly high in this largely heterosexually infected population supporting the use of more careful screening for these viruses in HIV positive persons in this region. Anti-tuberculosis therapy as well as TB preventive therapy can be safely employed in HIV and hepatitis coinfected patients, if baseline liver function tests are within normal limits.

Feasibility of Community DOT Providers for Tuberculosis Treatment in HIV infected individuals - A Pilot Study.

Background: This paper summarises our experiences about the role of community DOT providers in management of TB treatment in HIV infected persons in a mainly rural population of Tamilnadu. Objectives: To evaluate the feasibility of employing Community DOT providers for the treatment of tuberculosis in HIV infected persons, to study patients’ acceptance of Community DOT providers in the closely-knit village communities and to find out the attitude and awareness of DOT Providers on TB and DOT. Method: A total of 62 tuberculosis patients (58 males and 4 females) with HIV infection attending the Government Hospital for Thoracic Medicine, Tambaram and Chennai between July 1999 and July 2002 were selected for this study. Patients were given all the doses under supervision (clinic-based DOT) during the initial intensive phase and through Community DOT providers in the continuation phase. Data was collected both from the patients and their DOT providers about their views on DOT, advantages of DOTS, drug intake, treatment adherence, problems faced by the patients and their DOT Providers in addition to the level of awareness of Community DOT Providers on tuberculosis and DOTS. Results: Regarding treatment adherence, 95% of 62 patients had taken >75% of drugs and 39% had taken 100% drugs. DOT was appreciated both by the patients and their DOTS Providers since it is cost-effective and patient-friendly. Conclusions: Community contribution to TB care even among HIV infected population is feasible, affordable and costeffective. There is a need for greater health education and training on tuberculosis and DOTS for community DOT Providers.

A case of lipomatous hypertrophy of right ventricle.

Lipomatous hypertrophy is a condition that is being increasingly diagnosed with the advent of newer modalities. A middle aged lady was referred to us with recent onset dyspnea and palpitations. Echocardiography revealed diffuse thickening of the right ventricular free wall and outflow tract. Endomyocardial biopsy revealed this as a lipomatous hypertrophy involving the right ventricle. This is the first reported case of lipomatous hypertrophy involving the right ventricle.