Acquired hypogammaglobulinemia in HIV-positive subjects after liver transplantation.

INTRODUCTION: As more solid organ transplantations are performed in patients infected with human immunodeficiency virus (HIV), post-transplant complications in this population are becoming better defined. METHODS: Using serum samples from the Solid Organ Transplantation in HIV: Multi-Site Study, we studied the epidemiology of acquired hypogammaglobulinemia (HGG) after liver transplantation (LT) in 79 HIV-infected individuals with a median CD4 count at enrollment of 288 (interquartile range 200-423) cells/µL. Quantitative immunoglobulin G (IgG) levels before and after LT were measured, with moderate and severe HGG defined as IgG 350-500 mg/dL and <350 mg/dL, respectively. Incidence, risk factors, and associated outcomes of moderate or worse HGG were evaluated using Kaplan-Meier estimator and proportional hazards (PH) models. RESULTS: The 1-year cumulative incidence of moderate or worse HGG was 12% (95% confidence interval [CI]: 6-22%); no new cases were observed between years 1 and 2. In a multivariate PH model, higher pre-transplant model for end-stage liver disease score (P = 0.04) and treated acute rejection (P = 0.04) were both identified as significant predictors of moderate or worse HGG. There was a strong association of IgG levels <500 mg/dL with non-opportunistic serious infection (hazard ratio [95% CI]: 3.5 [1.1-10.6]; P = 0.03) and mortality (3.2 [1.1-9.4]; P = 0.04). These associations held after adjustment for important determinants of infection and survival among the entire cohort. CONCLUSION: These results suggest that a proportion of HIV-positive LT recipients will develop clinically significant HGG after transplantation.

Evaluation of new WHO diagnostic criteria for diabetes on the prevalence of abnormal glucose tolerance in a heterogeneous Nepali population--the implications of measuring glycated hemoglobin.

AIM OF THE STUDY: The present study was designed to (a) evaluate the implications of revised WHO diagnostic criteria on prevalence of abnormal glucose tolerance, (b) compare glycated hemoglobin level amongst healthy, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and diabetic subjects and (c) evaluate the assay of glycated hemoglobin in screening IGT, IFG from normal subjects. METHODOLOGY: Hospital based, cross-sectional study. Plasma glucose and glycated hemoglobin (gHb) were estimated by glucose oxidase and affinity chromatography method respectively. RESULTS: The crude prevalence of IFG, IGT and diabetes were 9%, 18% and 5.29% respectively with no significant difference between Mongol and non-Mongol population. Newly introduced IFG group falsely incorporate 12% diabetic subjects and fails to detect 83% IGT subjects as impaired glucose metabolism. The gHb level is raised in IGT and diabetic group but not in IFG group. CONCLUSION: The assay of gHb may be used to screen abnormal glucose tolerance but paired estimation of fasting glucose increases the reliability of diagnosis. The level of gHb in mild carbohydrate intolerance mostly depend on the level of rise in post prandial glucose (where the variation is wide, as in IGT) but not on the narrow variance in fasting plasma glucose level as found in IFG.

Assay of iodine deficiency status in three ecological regions of Nepal by a microdigestion method.

Iodine deficiency disorders (IDD) are a global public health problem. In continuation of the efforts to eliminate the iodine deficiency in different parts of the world, IDD surveys are being conducted to assess the status of iodine nutriture. A survey was conducted in Nepal in 1998 with assistance from UNICEF. We present the status of the iodine nutriture, as assessed from urinary iodine levels of casual samples by a micro-digestion method, in the three ecological regions: Terai (flat region), Hilly region (300-3,000 m altitude) and mountainous regions (>3,000 m altitude) of Nepal. Terai region is more affected, having iodine deficiency in 18.6% of the population. The hilly and mountainous regions were found to have 11.2% and 9% iodine deficient populations respectively. The study shows improvement in iodine deficiency status with respect to previous surveys yet it continued to be prevalent in the country as a major public health problem which requires strengthening of preventive measures.

Intravenous digital subtraction angiography and its use in amputation level consideration in the ischemic forefoot.

This case report utilizes a recently popularized method of radiologic examination for peripheral vascular disease. In a diabetic foot with osteomyelitis, ischemia, and gangrene we have assessed patent arterial supply in the distal arterial tree. This examination has allowed the authors to accurately predict wound healing potential preoperatively at a specific anatomic level.