A study of cutaneous manifestations in HIV infected persons.

Skin is one of the major target organs during all stages of HIV. The present study is conducted to know the dermatological manifestations among 181 HIV positive patients over a period of 17 months ie, from 01-03-2006 to 31-08-2007 at Mandya Institute of Medical Sciences, Mandya. Of these 181 patients, skin diseases were seen in 82 patients (45.3%), 41 patients had only one dermatological disease, 25 had two, 10 had three and 6 patients had more than four diseases. It was observed that a total of 45.3% patients among the study group developed mucocutaneous manifestations. Therefore early recognition of mucocutaneous lesions will help in early diagnosis and better management of HIV/AIDS patients.

The role of angioplasty for non-Q wave myocardial infarction: the impact of diabetes on outcomes.

Understanding of the mechanisms, outcomes and treatment of non-Q wave myocardial infarction (NQMI) has evolved. Coexisting diabetes poses additional challenges. We studied baseline characteristics, in-hospital and one-year outcomes for NQMI patients having percutaneous transluminal angioplasty.

Incidence of factor V Leiden in patients with acute myocardial infarction.

The genetic defect of coagulation factor V known as factor V Leiden produces a resistance to degradation by activated protein C (APC) and increases the risk of venous thromboembolism. The data on arterial thrombosis associated with APC resistance are still not clearly defined. We conducted a study in patients presenting with acute myocardial infarction (MI) to assess whether factor V Leiden increases the risk of arterial thrombosis. We studied 109 patients who had a diagnosis of acute MI (69 males and 40 females, aged 25-91 years), and 112 controls. The study population was identified by characteristic ECG changes and elevation of serum CK-MB, whereas the control subjects were anonymous healthy blood donors with no known history of coronary artery disease. Blood samples from the patients and controls were analyzed for the factor V Leiden mutation by DNA analysis, using the polymerase chain reaction. Heterozygous factor V Leiden mutation was found in 9 of 109 (8%) MI patients and 5 of 112 (4%) control subjects (P =.42). In conclusion, this study shows no evidence of an association between factor V Leiden and acute MI.

Gender-related risk factors and outcomes for non-Q wave myocardial infarction patients receiving in-hospital PTCA.

BACKGROUND: We analyzed the risk factors and outcomes associated with non-Q wave myocardial infarction (MI) in females and males. We studied 376 consecutive patients N 275 males (73%) and 101 females (27%) N who presented with non-Q wave MI and had percutaneous transluminal coronary angioplasty (PTCA) prior to discharge during the period between January 1992 and February 1996. RESULTS: Females were significantly older (68 +/- 10 years vs. 61 +/- 11 years; p < 0.001) and had more hypertension (67% vs. 51%; p < 0.01). Males had a slightly lower ejection fraction (47 +/- 11%) compared to females (50 +/- 10%; p < 0.001). Angioplasty was equally successful for women and men (96% vs. 97%; p = NS) with a statistically significant smaller number of lesions dilated per patient in females (1.38 vs. 1.51; p < 0.04). There were no significant differences in unstable angina, prior coronary artery bypass graft (CABG) surgery, saphenous vein graft PTCA, single vessel versus multiple vessel disease or history of prior MI. In-hospital complications (i.e., the need for CABG or repeat PTCA, recurrent MI, and stroke) were not statistically significant for either females or males. There was a trend for a higher in-hospital death rate in females after a non-Q wave MI, but it was not statistically significant (4% vs. 1%; p = 0.058). However, at one-year follow-up females had a significantly worse survival rate than men (89% vs. 95%; p < 0.04), although event-free survival rate was similar (61% female, 66% male; p = NS). CABG was performed less commonly in women by the end of one year (p < 0.02) than in men, while the performance of PTCA was similar. CONCLUSIONS: Although women with non-Q wave MI presented with more risk factors than men, in-hospital revascularization was equally successful with few complications and morbid events and similar event-free outcome at one year. However, one year mortality was worse for women, suggesting a need for more aggressive follow-up evaluation and treatment. For both women and men, this aggressive percutaneous revascularization strategy resulted in much better outcome than previously reported for medical treatment of non-Q wave MI.

One-year outcomes of diabetic versus nondiabetic patients with non-Q-wave acute myocardial infarction treated with percutaneous transluminal coronary angioplasty.

Risk factors and outcomes associated with non-Q-wave myocardial infarction (MI) in diabetics and nondiabetics were analyzed for 376 consecutive patients, 77 with diabetes (20%) and 299 nondiabetics (80%), who had non-Q-wave MI and had percutaneous transluminal coronary angioplasty (PTCA) performed before discharge from hospital during the period from January 1992 to February 1996. Diabetics were slightly older (64 +/- 10 years vs 61 +/- 12 years, p <0.053), had more prior coronary artery bypass grafting (CABG) surgery (27% vs 12%, p <0.001), and hypertension (77% vs 49%, p <0.001). There was no significant difference in unstable angina, saphenous vein graft PTCA, single versus multiple vessel disease, or history of MI. PTCA success rates for diabetics versus nondiabetics were similar (96% vs 97%, p = NS). In-hospital complications such CABG, recurrent MI, repeat PTCA, stroke, and death were not statistically significant between the 2 groups. At 1-year follow-up, survival in diabetics (92%) was similar to nondiabetics (94%, p = NS), although event-free survival (PTCA, CABG, MI, death) was worse in diabetics (55% vs 67% for nondiabetics, p <0.05). Although diabetic patients with non-Q-wave MI represent a cohort with more risk factors for poor outcome, aggressive in-hospital revascularization with PTCA results in an excellent short-term outcome as well as 1-year survival similar to the nondiabetic patients. However, total events at 1-year follow-up are more common in the diabetic patients, suggesting that more aggressive screening and therapy in follow-up may be warranted, and that a diabetic with non-Q-wave MI will require increased utilization of cardiovascular resources in the first year after the event.

Variability of indices of hypoxemia in adult respiratory distress syndrome.

OBJECTIVE: To determine the usefulness of indices of hypoxemia in assessing patients with the adult respiratory distress syndrome (ARDS). DESIGN: Retrospective analysis of previously published data that describe the distributions of ventilation and pulmonary blood flow in ARDS. SETTING: University research laboratory. PATIENTS: Sixteen patients with ARDS. INTERVENTIONS: The FIO2 was varied between 0.21 and 1.0 in a computer model of gas exchange, based on a 50-compartment model of ventilation/perfusion inhomogeneity plus true shunt and deadspace. The indices of hypoxemia that were calculated as a function of inspired oxygen concentration included PaO2/FIO2, arterial/alveolar ratio (PaO2/alveolar PO2), the alveolar-arterial PO2 difference (P[A-a]O2), respiratory index (P[A-a]O2/PaO2), and venous admixture. MEASUREMENTS AND MAIN RESULTS: The PaO2/FIO2 ratio in patients with moderate shunts (< 30%) varied considerably with alteration in FIO2. At both extremes of FIO2, the PaO2/FIO2 in these patients was substantially greater than at intermediate FIO2. Patients with larger shunts (> 30%) had greater PaO2/FIO2 ratios at low FIO2, but the PaO2/FIO2 ratios decreased to relatively stable values at FIO2 values of > 0.5. In all patients, PaO2/FIO2 remained relatively stable at FIO2 values of > or = 0.5 and PaO2 values of < or = 100 torr (< or = 13.3 kPa). Other PO2-based indices exhibited less stability as FIO2 was varied. If hypoxemia resulted from true shunting, venous admixture was found to be stable at all FIO2 values. However, approximately one half of patients had clinically important hypoxemia resulting from mismatching of ventilation and blood flow. In these patients, venous admixture varied substantially with change in FIO2, and the degree of variation was proportional to the fraction of cardiac output perfusing gas exchange units with ventilation/perfusion ratios of < 0.1. CONCLUSIONS: All indices of hypoxemia are affected by changes in FIO2 in patients with ARDS. PaO2/FIO2 ratio exhibits the most stability at FIO2 values of > or = 0.5 and PaO2 values of < or = 100 torr (< or = 13.3 kPa), and is a useful estimation of the degree of gas exchange abnormality under usual clinical conditions. Venous admixture varies substantially with alteration of FIO2 in patients who have clinically important ventilation/perfusion abnormalities. Under these circumstances, venous admixture is a poor indicator of the efficiency of pulmonary oxygen exchange, even if venous admixture is calculated from measured arterial and venous oxygen content values. Estimated venous admixture, based on an assumed arterial-venous oxygen content difference, is even more unreliable.