Prognostic significance of serum albumin levels in acute ischemic stroke.

Objectives: Recent studies in acute ischemic stroke (AIS) have brought to light newer risk factors like serum levels of high sensitivity-C-Reactive Protein (hs-CRP), procalcitonin, homocysteine and albumin. Aim of our study is to objectively determine the short term prognostic value of serum albumin levels in AIS by correlating its levels with the clinical outcome. Methods: A cross-sectional study was carried out in Shri Sayajirao General Hospital, Vadodara over a period of 2 years where-in 108 cases of AIS were screened and 50 patients who met the inclusion criteria were studied. Patients presenting within 72 hours of onset and aged≥ 40 years were included in this study. Apart from routine investigations, serum albumin levels were done in all the patients. Results and Interpretation: Patients with a lower NIHSS score on admission had higher levels of serum albumin, and those with a higher National Institute of Health Stroke Scale (NIHSS) score had a lower level of albumin [P value <0.001]. Similarly, patients with a higher score on Barthel index after 1 week of admission had a higher serum albumin level, while those with lower score had lower albumin levels [P value <0.001]. Thus serum albumin level has a direct correlation with short term prognosis.

Cardiac & renal disease in HIV patients and their correlation with CD4 count.

Objectives: The introduction of Anti retroviral therapy (ART) for HIV disease has significantly modified the quality of life and lengthened survival of HIV infected patients. Cardiac and renal disease may be direct consequence of HIV infection, due to opportunistic infection or related to drug toxicity. Aim of our study is to determine prevalence of the cardiovascular and renal manifestations in HIV infected patients and their correlation to CD4 count. Methods: A cross sectional study was carried out over a period of 2 years at Shri Sayajirao General Hospital and Medical College Baroda. 200 consecutive HIV patients attending medical outpatient department and those admitted were screened using ECG, 2-D Echocardiography, urinary albumin, serum creatinine, serum cholesterol and sonography kidneys. CD4 count was done in all patients. Patients with echocardiography evidence of ischemic heart disease, left ventricular dysfunction, decreased ejection fraction, pericardial effusion and pulmonary hypertension were included in cardiac group. All patients with urinary albumin more than 3 gram, normal or enlarged kidney on ultrasound with or without raised creatinine were included under HIV associated nephropathy group. Renal biopsy was done in one such patient to establish the diagnosis. Results and Interpretation: Of total 200 patients screened, 20 patients had cardiac disease (10%), 22 renal disease (11%) while 2 had both. On further analysis in cardiac group, dilated cardiomyopathy (45%) was the most common. Similarly, among those with renal disease, HIV associated nephropathy (31.8%) was the most common. CD4 count showed that 27(67.5%) of 40 patients had CD4 count below 100.