Cardiac complications in people living with human immunodeficiency virus/acquired immunodeficiency syndrome and their association with CD4+ T-cell count - A cross sectional study.

INTRODUCTION: Cardiac complications of HIV infection tend to occur late in the disease or are associated with related therapies and are therefore becoming more prevalent as therapy and longevity improve. MATERIALS AND METHODS: The study was undertaken to study the common cardiovascular complications in Indian HIV patients and to their association with the CD4+ T-cell count. OBSERVATIONS AND CONCLUSION: Prevalence of cardiac abnormality in our study was 24%. The abnormalities included LVDD (22%), pulmonary hypertension (12%), DCMP (12%), pericardial effusion (7%), left ventricular systolic dysfunction (5%), and right ventricular dysfunction (1%).

Lipid profile in high risk children aged 2-10 years.

A case-control study was conducted to study the Lipid profile of high risk children (age 2-10 years). There was a significant elevation of total cholesterol (P<0.001) and LDL (P< 0.001). Early dietary and lifestyle modifications can prevent this cascade.

Prevalence of peripheral arterial disease in a cohort of diabetic patients.

BACKGROUND: The aim of this study was to determine the prevalence of peripheral diseases in diabetics of different age groups, the role of color Doppler in peripheral arterial disease in diabetics, and to compare the prevalence of peripheral arterial disease (PAD) in diabetics taking different therapy modalities. METHODS: In a hospital-based prospective study conducted over 19 months, we screened 100 consecutive type 2 diabetic patients and 50 consecutive nondiabetic patients matched for demographics and ethnicity. History, physical examination and color Doppler results were analyzed. The degree of stenosis in PAD was graded according to Jager's criteria. RESULT: The prevalence of PAD was 8% in controls and 24% in diabetics. There were 60 subjects (60%) greater than 50 years of age in the diabetic population and 36 (72%) subjects in the nondiabetic group. There was male preponderance with 70% of diabetic patients and 60% of nondiabetic patients being male. According to mode of therapy, the prevalence of PAD was found to be 20% in diabetics taking oral hypoglycemic agents and insulin, 27.2% on oral hypoglycemic agents, and 25% on insulin therapy. CONCLUSION: This study suggests that there is a higher prevalence of PAD in diabetics as compared with controls. The prevalence of PAD is directly proportional to the duration of diabetes and age of the person. The prevalence of PAD is not a function of treatment modality. The stenosis associated with PAD in diabetics is generally infrapopliteal.

Exercise ECG testing using different protocols in asymptomatic healthy young subjects.

Thirty four healthy young male subjects performed symptom limited exercise on Bruce protocol on treadmill machine. Hyperventilation induced labile repolarisation ST-T abnormalities were observed in 2 whereas exercise induced ST changes (upsloping ST depression in 4 and horizontal ST depression in 1) were observed in 5 additional candidates. Changes were unaccompanied by symptoms or signs and quickly reverted back to normal within 30 sec. of cessation of exercise and hence were 'probable false positives'. Sixty-eight age and sex matched volunteers (including former 34) when exercised on Master's stepper, failed to reveal any change probably due to the lack of continuous ECG monitoring device.

Complications of treadmill testing.

Complications occurring in 2,400 treadmill tests are reported, out of which 2107 (87.8%) were on males and 292 (12.2%) on females. The total number of patients with complications was 29 (1.2%) and the types were: acute MI in 2, ventricular tachycardia (sustained) in 3, nonsustained in 7 with ventricular couplets in 3 patients, atrial tachyarrhythmias in four of AVNRT in 2, EAT in 2, SVT with abberancy in 1, SVT (undifferentiated) in 3, bradyarrhythmias in form of sinus bradycardia in 4, hypotension in 4 and AV block in 2. There were no deaths. Only 8 (0.33%) patients required treatment-2 each of acute MI, sustained VT, AVNRT and hypotension, though only 4 of them were hospitalised (2 each of acute MI and VT) and subsequently discharged. Highest incidence of complications was seen in post MI patients (2.01%) followed by those with typical anginal pain (1.9%) and they had more serious problems in form of MI and sustained VT. 55.17% patients with complications were positive for provocative ischaemia as compared to 22.75% positivity in the total. Although 14 (38.2%) patients developed complications at workload of 4-6 METS but 2 achieved load of 10 METS also. Complications were seen mostly during exercise and also during recovery only.

Valproate sodium in epilepsy. A clinical trial including monitoring of drug levels.

Sodium valproate was used as monotherapy in 90 cases with epilepsy who had at least one fit per week, irrespective of the type of seizures. The effect of the drug was evaluated on the basis of change in seizure frequency. Serum valproic acid levels were estimated by homogenous enzyme immunoassay. All the patients with absence (5/5) and myoclonic (3/3) seizures and 80% (42/53) of cases with generalized tonic-clonic seizures, became seizure free. Six of ten patients with only tonic seizures became seizure free. An average daily dose of 19.6 mg/kg provided a mean valproic acid level of 81.4 micrograms/ml in all seizure free patients. No correlation could be established between valproate dose and serum levels. Mild transient side effects were noted. No haematologic abnormality or hepatotoxicity was observed. Valproate sodium effectively controlled seizures in a majority of patients with partial seizures. Serum level monitoring helps to establish an optimal dose to keep the patient seizure free. No correlation could be established between side effects and serum levels.