AIDS in India: recent trends in opportunistic infections.

The first case of AIDS in India was reported in 1986. Subsequently, a surveillance system was developed in 1987. The data from this surveillance activity suggest that the HIV infection has now spread to the general population and to all parts of the country, except Arunachal Pradesh in North-eastern India. With the changing scenario of the AIDS epidemic, a host of opportunistic infections add to the present endemic state of some already existing infections like tuberculosis. This report analyses the AIDS cases in India, reported to the National AIDS Control Organization over the years between 1986 to 1997. A total of 3,551 AIDS cases had been reported till 31st May 1997. Tuberculosis (pulmonary and extrapulmonary) is the major opportunistic infection affecting 62% of the cases followed by candidiasis seen in 57% of the patients. In 1997, of the 390 AIDS cases analysed, tuberculosis (pulmonary and extrapulmonary) accounted for 56.5% of the total cases whereas candidiasis was seen in 61% of the cases. An increasing trend was observed with tuberculosis from 58% in 1986-1992 to 68.5% in 1995. No trend could be established in the case of candidiasis, though, a high prevalence of 66% was seen in the cases between 1986 and 1992. An increase was also observed in cases of PCP, cerebral toxoplasmosis and Kaposi sarcoma. In the AIDS cases, chronic diarrhea (76%), weight loss (87%) and fever (85%) appeared to be the major presenting symptoms. But, of the 390 AIDS cases reported in 1997, only 47% of them were suffering from chronic diarrhea. With increase in the number of AIDS cases, India is burdened with a dual epidemic of HIV/AIDS and tuberculosis. The National AIDS Control Organization in India, is involved in training clinicians and laboratory personnel in the diagnosis and management of the AIDS cases. With better diagnosis of the opportunistic infections, especially diarrhea, in AIDS patients, a better picture will emerge regarding the opportunistic infections which would help clinicians and health planners to tackle the AIDS epidemic in a more effective manner.

Interactions of praseodymium and neodymium with nucleosides and nucleotides: absorption difference and comparative absorption spectral study.

The interactions of praseodymium(III) and neodymium(III) with nucleosides and nucleotides have been studied in different stoichiometry in water and water-DMF mixtures by employing absorption difference and comparative absorption spectrophotometry. The 4f-4f bands were analysed by linear curve analysis followed by gaussian curve analysis, and various spectral parameters were computed, using partial and multiple regression method. The magnitude of changes in both energy interaction and intensity were used to explore the degree of outer and inner sphere coordination, incidence of covalency and the extent of metal 4f-orbital involvement in chemical bonding. Crystalline complexes of the type [Ln(nucleotide)2(H2O)2]- (where nucleotide--GMP or IMP) were characterized by IR, 1H NMR, 31P NMR data. These studies indicated that the binding of the nucleotide is through phosphate oxygen in a bidentate manner and the complexes undergo substantial ionisation in aqueous medium, thereby supporting the observed weak 4f-4f bands and lower values for nephelauxetic effect (1-beta), bonding (b) and covalency (delta) parameters derived from coulombic and spin orbit interaction parameters.

Mitral stenosis and aortic regurgitation in rheumatoid arthritis.

A patient of rheumatoid arthritis having mitral stenosis and aortic regurgitation is reported. Our findings are based on clinical and echocardiographic study.

Assessment of left ventricular function in chronic severe anaemia. An echocardiographic study.

Left ventricle (LV) performance was assessed by echocardiography (2-D and M-mode) in 30 patients with chronic severe anaemia and an equal number of age and sex matched healthy controls. Patients with anaemia were divided into two groups: those with tachycardia (pulse rate more than 100 per min) and those without. LV performance indices computed were LV ejection fraction (LVEF), % fractional shortening (FS), cardiac index (CI) and stroke volume index (SVI). In patients of anaemia with tachycardia, LVEF was 48.6 +/- 8.41 (mean +/- SEM) vs 71.6 +/- 4.96 among controls. Percentage FS was 19.93 +/- 4.21 vs 36.0 +/- 4.5, CI 5.46 +/- 1.2 vs 3.1 +/- 0.78 l/min/m2, and stroke index 48.6 +/- 12.2 vs 41.5 +/- 10.7 ml/beat/m2. In patients without tachycardia, LVEF was 55.1 +/- 8.86, percentage FS 23.6 +/- 5.42, CI 2.87 +/- 0.526 and stroke index 41.34 +/- 12.1. These findings suggest that LV performance was depressed in both groups of patients with anaemia but LV function was better in patients without tachycardia.

Interaction of some fluorinated nucleic acid components with praseodymium: an absorption spectral approach.

Absorption difference and comparative absorption spectrophotometric studies on praseodymium(III) and fluorouracil, fluorocytosine, fluoroadenine, fluorothymine, fluorouridine, fluorocytidine, fluoroadenosine and fluorothymidine systems at pH approximately 5.5 and in different stoichiometries in 80% DMF medium have been carried out. Magnitudes of spectral parameters, viz. Coulombic (Fk), spin-orbit (zeta 4f), nephelauxetic (beta), bonding (b), intensity (T lambda Judd-Ofelt), and oscillator strength (P) and their variation have provided information on the binding mode of these biomolecules in terms of outer and inner sphere complexation, degree of covalency and extent of 4f orbital involvement. Preliminary ultrasonic studies have indicated that these biomolecules behave as structure breakers, hence weak ligands in aqueous medium, while strengthening water structure in semi-nonaqueous medium. The analysis of the isolated solid complexes has suggested octa- and nona-coordination for praseodymium(III) in fluorinated nucleic bases and fluorinated nucleoside complexes.

Neurological manifestations associated with bronchogenic carcinoma.

Neurological manifestations of bronchogenic carcinoma were studied in 50 cases, 42% of whom showed neurological abnormalities with 6% having more than one type. Recurrent laryngeal nerve paralysis (20%) was the commonest, phrenic nerve paralysis (2%), paraneoplastic syndrome (12%), Pancoast's syndrome (10%) and metastatic involvement of central nervous system (4%) were other neurological manifestations. No evidence of encephalitis, motor neurone disease, myelopathy, Eaton-Lambert syndrome, myositis and drug-induced peripheral neuropathy was found in this study.

Portal hypertension therapy with oral propranolol. A short-term study.

Thirty patients were evaluated in a blind fashion to study the effect of oral propranolol on portal hypertension of varied aetiology. The dose of oral propranolol (administered to 15 patients) was adjusted to reduce the resting heart rate by approximately 25%. Splenic pulp pressure served as the parameter for portal pressure. A matched group of 15 control subjects on placebo was also studied. The mean portal pressure in the propranolol group fell from 3.49 to 2.69 kPa saline (P less than 0.001) as compared to the control group where the mean pressure increased from 3.57 to 3.63 kPa saline. The propranolol group showed improvement in clinical symptomatology with a significant reduction in body weight and abdominal girth in patients with ascites. A significant positive correlation (r = 0.78; p less than 0.007) was obtained between the fall in portal pressure and the initial levels. Thus, oral propranolol proved useful in the conservative management of portal hypertension of varied aetiology.

Prognostic significance of exercise testing three weeks after myocardial infarction.

Treadmill exercise test was performed in 50 patients aged 35-60 years, 3 weeks after myocardial infarction. Thirty-two had anterior and 18 had inferior wall transmural myocardial infarction. Cardiac events like angina, reinfarction and sudden death were more common in patients with positive stress test. Thus treadmill testing in the early postinfarction period is of great prognostic value.

Treadmill exercise testing in asymptomatic chronic smokers to detect latent coronary heart disease.

The treadmill exercise test has been performed in 50 chronic smokers and 50 non-smokers (93 males and 7 females) who were not having any clinical or electrocardiographic manifestation of ischemic heart disease. The test was positive in 18% chronic smokers and 4% in non-smokers, the chances of positivity of stress test was 4-5 times greater in chronic smokers than in non-smokers. The duration of smoking and number of/cigarettes/bidis smoked per day were directly proportional to the incidence of a positive stress test. There was no significant difference in the incidence of a positive exercise test amongst purely cigarette smokers (17.64%), purely bidi smoker, (16.16%), and in both bidi and cigarette smokers (20%). The study, therefore, suggests that chronic heavy smoking is more frequently associated with asymptomatic ischemic heart disease, as compared to non-smokers and stress testing of persons with coronary risk factors important for detection of latent IHD.