Epicardial Adipose Tissue Thickness and its Corelation with Metabolic Risk Parameters in People Living with HIV: A RIMS Study.

CONTEXT: Epicardial fat envelopes the coronary vessel adventitia without fascial separation, thus pathologic inflammation in the fat may promote the growth of atherosclerotic plaque in coronary arteries in an 'outside-in' fashion. Epicardial fat is quantitatively increased in HIV compared to un-infected people. AIMS: 1. To assess Epicardial Adipose tissue (EAT) by Computed tomography (CT) in PLHIV receiving first line ART (antiretroviral therapy) 2. To correlate EAT with metabolic risk parameters. MATERIAL AND METHODS: 215 HIV-infected patients aged >18 years on first line ART were included in the cross sectional study. EAT thickness were measured by CT scan. Metabolic parameters were measured based on metabolic syndrome criteria. STATISTICAL ANALYSIS USED: Data analysis was done using IBM SPSS version ver. 21. Probability value of less than 0.5 was taken as significant. ETHICAL ISSUES: The study was carried out after obtaining approval from the Institutional Ethical Committee (IEC), Regional Institute of Medical Sciences, Imphal. RESULTS: Half of the patients were found to have EAT thickness of 8.1-9 mm and 12.6% of cases had EAT of >9 mm. Mean epicardial thickness was 8.3 mm ± 0.7 mm for whole population. Triglyceride and high density lipoprotein (HDL) were also found to have positive correlation with EAT thickness (rp= 0.364, P = 0.04 and rp= 0.343, P = 0.05 respectively). CONCLUSION: Epicardial adipose tissue thickness is increased in PLHIV receiving highly active anti retroviral therapy (HAART) and positively co-related with parameters of metabolic syndrome such as waist circumference, HDL cholesterol and triglyceride level.

Human immunodeficiency virus-associated stroke: an aetiopathogenesis study.

OBJECTIVE: To describe the nature of human immunodeficiency virus (HIV) associated stroke and further establish its etiopathogenesis METHODS: A retrospective study of 19 patients of HIV associated stroke, admitted in Regional Institute of Medical Sciences, Imphal between November 2010 and November 2011. History was taken stressing importance on mode of transmission of HIV, risk factors for stroke, antiretroviral treatment (ART) and regimen. All necessary haematological, serological and neuroradiological investigations, cerebrospinal fluid (CSF) examination were undertaken in relevant cases. A final diagnosis of stroke aetiology was made with the corroborative evidence of clinical examination and investigational data. RESULTS AND OBSERVATIONS: Out of the 19 patients of Stroke in HIV, male-female ratio was 1.1:1.The mean age at presentation was 39.47 +/- 8.1 yrs (Range 28-60). Only 3 (15.78%) patients were on ART and other 16 (84.42%) patients were ART naive. In 15 out of 1.9 patients (78.94%) stroke was the first presentation of HIV infection. 3 patients (16.67%) had recurrent cerebrovascular accident (CVA). Computerised tomography (CT) Brain revealed Infarction in 17 patients (89.47%), 1 patient (5.26%) had Haemorrhage and 1 patient (5.26%) had both haemorrhage and infarction. 9 (47.36%) patients had an associated opportunistic infection (OI) in the central nervous system (CNS). In 52.64% patients who had no Ols in the CNS, further work up revealed no aetiology in 3 cases (15.78%) and Indeterminate aetiology (HIV associated coagulopathy and HIV vasculopathy) in 7 (36.84%) patients. Mean CD4 cell count in HIV and Stroke patients was found to be 178.3 +/- 115.38 cells/mm3. CONCLUSION: Stroke is being reported more often as the first presentation of HIV infection. Thus it is worthwhile to screen for HIV infection in the work up for stroke in the young, and after confirmation of HIV infection, should further proceed to establishing an aetiopathogenesis for Stroke in HIV.

Penicillium morneffei, an emerging AIDS-related pathogen--a RIMS study.

Twenty-seven HIV-infected patients with penicilliosis were included to study the clinical, laboratory and therapeutic features of HIV-infected patients with disseminated Penicillium marneffei infection. Diagnosis was based on microscopy and culture. CD4 counts were assessed by flow cytometry. Males (23 out of 27) predominated while the ages ranged from 20 to 54 years (mean 31.5 years). The most common manifestations were fever, weight loss, anaemia and skin lesions. CD4 counts were low in all the patients. The response to treatment with intravenous amphotericin B followed by itraconazole was excellent. Penicillium marneffei has become an important opportunistic pathogen of HIV infection in Manipur. Penicilliosis should be considered in a susceptible patient with a non-specific febrile illness, a low CD4 count and molluscum contagiosum-like skin lesions. Early diagnosis and treatment improve survival.

Primary testicular lymphoma--A case report.

Primary lymphoma of the testis is more commonly seen in the elderly age group. A 45-year-old Hindu male with histopathological diagnosis of non-Hodgkin's lymphoma of the right testis presented after orchiectomy of the right testis. The patient was put on two cycles of chemotherapy consisting of cyclophosphamide, vincristine, adriamycin and prednisolone at 3- weekly interval followed by external radiation therapy. During follow-up after 7 years he developed left facial nerve palsy and left sided haemiparesis. On CT scan of the brain multiple space occupying lesions were seen in both the hemispheres of the brain. He was put on cranial radiation therapy with intrathecal methotrexate injections. He responded favourably with the treatment.

Polycythaemia vera.

A rare case of polycythaemia vera occurring in a 60-year-old female has been reported here, along with a brief discussion.