A Follow-Up Study on Survival Trend of AIDS Patients Reported at ART Center in Delhi & Variation According to Age, Sex, Stages & Mode of Transmissions.

Incubation period of HIV to AIDS is a vital tool that plays an important role in estimating the longevity or survivability of the HIV infected patients. However, death of AIDS patients when considered as end point becomes meaningful while finding the actual survivability of an individual. The present study is focused in analyzing the data on 343 AIDS patients who were recommended to undergo treatment in the ART centre followed up for a period of 6 years. The study included a cohesive treatment of censored observations based on lost to follow-up, deaths, recovered and alive cases till the end of study as well as uncensored observations. On the basis of diagnosed AIDS cases, the estimates of survivability under various conditions have been obtained. This paper also incorporates the trend of survivability for the reported AIDS patients with respect to age, sex, stages and mode of transmission across these 6 years. Kaplan Meier estimation method and Cox proportional hazard model were applied to determine the effect of various covariates that may be responsible for the death of the AIDS patients, survival pattern.

Epstein–Barr virus-induced haemophagocytic syndrome.

Haemophagocytic syndrome or haemophagocytic lymphohistiocytosis is a disorder of histiocytes that has sepsis-like features, combined with haemophagocytosis, cytopenias, hyperferritinaemia, hypercytokinaemia and splenomegaly. Diagnostic, therapeutic and prognostic guidelines are available for childhood (familial) haemophagocytic syndrome. The disorder is diagnosed less frequently among adults than children. We report a case of Epstein–Barr virus-induced haemophagocytic syndrome in a 23-year-old man, who responded to treatment with steroids and chemotherapy.

Thyrotoxic myo-neuropathy.

Myopathy is an important complication of thyrotoxicosis. Neuropathy is a less commonly reported complication, and is often subclinical. Here we report a patient of throtoxic myopathy with sub-clinical entrapment neuropathy. This case is reported to emphasise the importance of NCV to look for neuropathy.

A Study of Cardiovascular Risk Factors in Delhi, India.

Acute myocardial infarction (AMI) is a leading cause of mortality and disability of adults in urban and rural India, and occurs at younger age than in western populations. In this paper an attempt has been made to determine the risk factors for non- fatal AMI among Indian men and women and to study the difference in proportion of risk factors by taking non- AMI group along with healthy group as controls. Mantel Haenzel test showed that while comparing AMI with non-AMI group, diabetes mellitus (p<0.05), family history of MI (p<0.0001) and smoking (p<0.0001) are significantly associated with AMI after adjusting the effects of hypertension. The same test was carried out in comparing AMI with healthy group which showed that diabetes mellitus (p<0.05), family history of MI (p<0.0001) and smoking (p<0.0001) are significantly associated with AMI after adjusting the effects of hypertension. Similarly, while comparing CVD group with healthy group, family history of MI (p<0.0001) and smoking (p<0.0001) are significantly associated with CVD after adjusting the effects of hypertension. Stepwise logistic regression showed that while comparing AMI cases with non- AMI controls, arrhythmias (odds ratio (OR) = 5.196, p < 0.0001), angina (OR = 3.599, p < 0.0001), CHF (OR = 3.121, p<0.0001), hypertension (OR=2.717, p<0.0001), smoking (OR=1.993, p<0.0001) and family history of MI (OR=1.819, p<0.01) were important risk factors for a first myocardial infarction. Moreover, while comparing AMI cases with healthy controls, family history of AMI (OR=15.925, p<0.0001), smoking (OR=2.806, p<0.001), hypertension (OR=2.718, p<0.0001), gender (OR=2.410, p<0.01) and age (OR=2.410, p<0.05) were important predictors of AMI; and while comparing CVD cases (AMI and non-AMI) with healthy group, family history of MI(OR=10.377,p<0.01), hypertension (OR=8.237, p<0.01) and smoking (OR=4.454, p<0.01), were important predictors of cardiovascular disease.

Evaluation of the WHO clinical case definition of AIDS among children in India.

The need of a clinical case definition (CCD) for Acquired Immunodeficiency Syndrome (AIDS) was felt by public health agencies to monitor diseases resulting from human immunodeficiency virus (HIV) infection. To test the statistical significance of the existing World Health Organization (WHO) CCD for the diagnosis of AIDS in areas where diagnostic resources are limited in India, a prospective study was conducted in the Paediatrics department at Dr. Ram Manohar Lohia Hospital, New Delhi. 360 cases between 18 months-12 years of age satisfying WHO case definitions of AIDS were included in the study group. Informed consent was taken from the parents. The serum of patients was subjected to ELISA to conform the diagnosis of HIV infection. Our study detected 16.66% (60) of HIV prevalence in children visiting paediatrics outpatient clinic. 20% cases manifested 3 major and 2 minor signs. This definition had a sensitivity of 73.33%, specificity of 90.66%, positive predictive value (PPV) of 61.11% and negative predictive value (NPV) of 94.44%. On using stepwise logistic regression analysis weight loss, chronic fever > 1 month and total lymphocyte count of less than 1500 cells/mm3 emerged as important predictors. Cases showing 2 major and 2 minor signs were 86 (23.89%) with a sensitivity and specificity of 86.66% and 88.66% respectively. Based on these findings, we propose a clinical case definition based on 13 clinical signs and symptoms for paediatric AIDS in India with better sensitivity and PPV than the WHO case definition but with almost similar specificity. Thus multicentric studies are further required to modify these criteria in Indian set up.