A study of clinical profile of cardiac dysfunction in patients with HIV infection

Background: HIV infection is a major health problem across the entire world including India. The introduction of anti-retroviral therapy (ART) have led to a significant reduction in opportunistic infections and hence increased life expectancy of HIV-infected individuals. This resulted in an increase in prevalence of cardiovascular diseases among these individuals. Aim was to study the clinical profile of cardiac dysfunction in patients with HIV infection and to find whether CD-4 influence on the disease pattern and severity.Methods: This study was a cross sectional study conducted in Sixty HIV infected patients who attended Anti-Retroviral Therapy Centre, Government Medical College, Thiruvananthapuram, Kerala, India during a period of fifteen months. Patients underwent a thorough clinical examination and other relevant investigations including CD-4 count, ECG and transthoracic echocardiography.Results: In our study it was found that cardiac involvement is common even in asymptomatic HIV infected patients. Cardiac manifestations observed were left ventricular diastolic dysfunction (25%), left ventricular hypertrophy (15%), dilated cardiomyopathy (15%), pericardial effusion (13.3%) and mild pulmonary artery hypertension (10%). Cardiac involvement is more common in those with low CD-4 count. Among these conditions Concentric Left Ventricular Hypertrophy had a statistically significant correlation with CD-4 count.Conclusions: We observed that some form of cardiac involvement was common even in asymptomatic HIV infected patients and cardiac involvement was inversely associated with CD-4 Count of the patient. Transthoracic echocardiography is a good non-invasive tool for the early detection of cardiac abnormalities. Cardiac involvement can be easily overlooked in these patients as symptoms can be attributed to associated co morbid illnesses, so every HIV infected patients should undergo a thorough clinical examination and relevant cardiac evaluation at the time of diagnosis and periodically to decrease cardiac associated morbidity and mortality

Cardiac troponin T estimation post elective stent implantation and prediction of early and late outcomes

Background: Coronary artery disease (CAD) is a major cause of mortality and morbidity. Per Cutaneous Interventions (PCI) is emerging as the mainstay of treatment for CAD. Periprocedural myocardial necrosis, which can range from a low-level elevation of cardiac biomarkers to a large myocardial infarction, is an important complication of PCI. There are conflicting reports regarding peri-procedural biomarker elevation and adverse outcome. It is in this context we have undertaken this study to assess the prognostic significance of cardiac troponin T elevation after elective stent implantation.Methods: The study population included 100 consecutive patients who underwent elective PCI with stent implantation in cardiology unit of Medical College, Trivandrum. Serial cardiac enzyme levels were measured in all patients undergoing the procedure. CPK was measured at 8 hrs, 16 hrs and 24 hrs and Troponin T was measured at 8hrs and 24 hrs. post PCI. In hospital events were documented and patients were on follow up for a period of 1 year. Primary endpoints of death, myocardial infarction, recurrent ischemia leading to revascularization were noted.Results: In our study population of 100 patients there were 87 males and 13 females. Among them 50% had unstable angina, 18% had exertional angina and 32% were post myocardial infarction patients. In this group of hundred patients 79% had single vessel disease, 18% had two vessels and 3% had triple vessel disease. A total of 103 stents were deployed. Mean CPK levels were CPK-1 (80.11+36.19), mean CPK-2 (83.91± 34.8) and mean CPK-3 (86.32+57.80). Mean Troponin T-1 was 0.04+0.1 and mean Troponin-2 was 0.06+0.145. In this study, we compared late onset angina with Troponin and CPK positivity and found that both Troponin-1 & Troponin-2 had significant correlation with late onset angina.Conclusions: Periprocedural Troponin T is more sensitive than CPK in predicting late events. Thrombus containing lesions and bifurcation lesions were significantly associated with elevation in Troponin T. No significant Troponin T elevations were noted in patients with diabetes mellitus and those containing calcified lesions. Drug eluting stents were associated with a relatively lesser Troponin T elevations but not statistically significant

Predictors of angiographic restenosis in patients with coronary artery disease who have undergone percutaneous coronary intervention with drug eluting stents

Background: Percutaneous transluminal coronary angioplasty (PTCA) is now widely accepted as a nonsurgical revascularization procedure for selected patients with CAD. In-stent restenosis (ISR) is a frequent complication after PCI which limits its long-term efficacy. Identification of those clinical and angiographic characteristics that may predict the risk of restenosis is extremely important to eliminate restenosis. In this context we conducted this study to assess the profile of patients with drug eluting stents - ISR with an emphasis on demographic characteristics, risk factors, mode of presentation and coronary angiographic characterization.Methods: This study was a Case control study based on the catheterization registry of all patients who have undergone PCI with DES during the period from October 2012 to April 2015. All patients who have undergone PCI with DES and repeat coronary angiogram for evaluation of symptoms and detected to have ISR during same period were taken as case and age matched patients who had previously undergone PCI with DES and repeat coronary angiogram for evaluation of symptoms between 1/10/2012 to 30/4/2015 and detected to have fully patent stents were taken as control.Results: A total of 26 patients were detected to have ISR during the study period as per the study protocol with equal number of age matched controls. The most common presentation of ISR was as chronic stable angina (70%). Binary logistic regression analysis of 6 factors namely diabetes, hypertension, lesion type, stent diameter, stent length and stent overlap found significant in univariate analysis, showed only the lesion type to be statistically significant with p value of 0.023.Conclusions: Patients who have undergone PCI with DES particularly for complex lesions, diabetics with longer stents, lesser diameter stents and overlapping stents need to be meticulously followed up to rule out the possibility of restenosis, as in a small number of patients the presentation could be ACS with comparatively bad prognosis

COVID-19 Vaccine Effectiveness in Preventing Severe Infections and Mortality among Patients in Kerala, India.

ABSTRACT Background: India has a top status among world countries, related to the COVID-19 mortality that had crossed the 3-lakh level. The second wave of COVID19 had ravaged the world countries, created havoc of the highest order, leaving many hapless, thanks to the low availability of oxygen, ICU facilities, vaccines and counselling prospects. There is a lack of information about how COVID-19 vaccines have affected mortality in specific geographic areas. Method: A Retrospective record-based design. Patients were matched for age, sex, ethnicity, co-morbidities and grouped into fully immunized, partially immunized and non-immunized. The primary outcome was in-hospital deaths and secondary outcome was severe covid infections. (Severe covid infections are defined as Category C in WHO and ICMR classification) Results: Vaccines administered in standard dosage confer considerable benefit by reducing severe illness, hospitalization and death. This is clearly visible by the lower proportions of those with hypoxia, high levels of markers, those requiring ICU support and death in vaccinated individuals. The type of vaccine administered did not have any influence on the severity and outcome of illness. Conclusion: The second wave that peaked in May 2021 would have been less disastrous had more people been vaccinated. Without a reimagined vaccination strategy, reaching the desired full vaccination status was a difficult endeavor. The signs are unmistakable that a combined approach involving swift vaccination and scientific measures to curb transmission holds great promise. A zero covid world looks less imminent. But humans can make the microbe less lethal

Study to assess the changing pattern of clinical profile and determine the prognosis in hepatic encephalopathy

Background: Hepatic encephalopathy (HE) is a common complication of liver disease that requires intensive care management. The prevalence of HE is increasing during recent period. The most important factors of HE are alcohol consumption, chronic hepatitis, hepatotoxic drugs and unhealthy changes in life style. There were only relatively few studies from our region on the changing profile of hepatic encephalopathy under the background of life style changes. This study was conducted with the aim to detect the changing pattern of clinical profile, precipitants and to assess the prognosis of patients with hepatic encephalopathy.Methods: This was a prospective study for a period of 18 months since January 2012 at Academy of Medical Sciences, Pariyaram, Kannur, a tertiary care centre situated in the northern part of Kerala. Patients admitted in the medical and gastroenterology wards and intensive care units that fulfilled the inclusion criteria were enrolled in this study.Results: Among the 76 patients with HE, 60 were suffering from CLD and 16 due to acute liver failure. The common etiologies for HE in CLD patients were Alcoholic cirrhosis (63%), Cryptogenic cirrhosis (17%) and cirrhosis due to chronic HBV (10%) and HCV hepatitis (7%) respectively. Among the CLD patients at the start of observation majority were in Child Pugh class B and C. Based on West Haven grading most of them had Grade 2 and 3 HE. Majority with Grade 1, 2 and 3 improved where as those with Grade 4 and Grade 3 in Child Pugh class C worsened. The common precipitants of HE were GI bleed, dyselectrolemia, constipation and infections. Among these precipitants a statistically significant association for a worse outcome was present only with infection. Leptospirosis and deliberate self-harm due to ingestion of hepatotoxic rodenticide and paracetamol were the leading cause of hepatic encephalopathy in acute liver failureConclusions: In present study HE was most commonly seen in patients with alcoholic liver disease. Cryptogenic cirrhosis associated with other life style diseases was the second common condition. Among all precipitating factors infection appeared as a statistically significant factor predicting a worse outcome. Health education among alcoholic patients and life style modifications to prevent cryptogenic cirrhosis are of paramount importance in curtailing the increase in incidence of HE in this region

Analysis of cerebrospinal fluid adenosine deaminase level in tuberculous meningitis and validation of sensitivity and specificity

Background: Tuberculous meningitis is an important cause of morbidity and mortality in developing countries especially in India. The mortality associated with tuberculous meningitis is very high if not detected early and meticulous treatment is not given. CSF analysis and imaging are the most commonly used tools for diagnosis of meningitis. But these are often inadequate in making a definitive diagnosis. CSF Adenosine Deaminase estimation (ADA) is useful in differentiation of tuberculous meningitis from non-tuberculous meningitis. Though few studies have proved efficacy of Adenosine Deaminase level for the diagnosis, studies to assess the sensitivity and specificity of ADA levels were limited. This study was conducted to assess its usefulness and to validate the sensitivity and specificity of ADA level in tuberculous meningitis (TBM).Methods: This was a prospective study conducted at Academy of Medical Sciences, Pariyaram for a period of 18 months from December 2013 to June 2015, Adenosine deaminase level was studied in the cerebrospinal fluid of 50 patients who got admitted with symptoms and signs of meningitis in the medical wards and intensive care units who fulfilled the inclusion criteria.Results: In this study 50 patients were diagnosed clinically and with CSF analysis as meningitis. The mean cerebrospinal fluid adenosine deaminase activity was 23.08+17.5in Tuberculous meningitis 3.8 +1.92U/l in Bacterial meningitis and 4.8+2.3U/l in Viral meningitis. The adenosine deaminase activity in Tuberculous meningitis cases were significantly higher than non-tuberculous meningitis. The sensitivity and specificity of this test for diagnosis of tuberculous meningitis was 90% and 100% respectively with ADA value of more than 10U/L.Conclusions: This study found out that estimation of CSF Adenosine level is a very useful test for the diagnosis of tuberculous meningitis. The sensitivity and specificity attained in this study were comparable to other studies. This study also found out that ADA estimation is very useful in distinguishing tuberculous and viral meningitis

A study of clinical profile of cardiac dysfunction in patients with HIV infection

Background: HIV infection is a major health problem across the entire world including India. The introduction of anti-retroviral therapy (ART) have led to a significant reduction in opportunistic infections and hence increased life expectancy of HIV-infected individuals. This resulted in an increase in prevalence of cardiovascular diseases among these individuals. Aim was to study the clinical profile of cardiac dysfunction in patients with HIV infection and to find whether CD-4 influence on the disease pattern and severity.Methods: This study was a cross sectional study conducted in Sixty HIV infected patients who attended Anti-Retroviral Therapy Centre, Government Medical College, Thiruvananthapuram, Kerala, India during a period of fifteen months. Patients underwent a thorough clinical examination and other relevant investigations including CD-4 count, ECG and transthoracic echocardiography.Results: In our study it was found that cardiac involvement is common even in asymptomatic HIV infected patients. Cardiac manifestations observed were left ventricular diastolic dysfunction (25%), left ventricular hypertrophy (15%), dilated cardiomyopathy (15%), pericardial effusion (13.3%) and mild pulmonary artery hypertension (10%). Cardiac involvement is more common in those with low CD-4 count. Among these conditions Concentric Left Ventricular Hypertrophy had a statistically significant correlation with CD-4 count.Conclusions: We observed that some form of cardiac involvement was common even in asymptomatic HIV infected patients and cardiac involvement was inversely associated with CD-4 Count of the patient. Transthoracic echocardiography is a good non-invasive tool for the early detection of cardiac abnormalities. Cardiac involvement can be easily overlooked in these patients as symptoms can be attributed to associated co morbid illnesses, so every HIV infected patients should undergo a thorough clinical examination and relevant cardiac evaluation at the time of diagnosis and periodically to decrease cardiac associated morbidity and mortality

Predictors of angiographic restenosis in patients with coronary artery disease who have undergone percutaneous coronary intervention with drug eluting stents

Background: Percutaneous transluminal coronary angioplasty (PTCA) is now widely accepted as a nonsurgical revascularization procedure for selected patients with CAD. In-stent restenosis (ISR) is a frequent complication after PCI which limits its long-term efficacy. Identification of those clinical and angiographic characteristics that may predict the risk of restenosis is extremely important to eliminate restenosis. In this context we conducted this study to assess the profile of patients with drug eluting stents - ISR with an emphasis on demographic characteristics, risk factors, mode of presentation and coronary angiographic characterization.Methods: This study was a Case control study based on the catheterization registry of all patients who have undergone PCI with DES during the period from October 2012 to April 2015. All patients who have undergone PCI with DES and repeat coronary angiogram for evaluation of symptoms and detected to have ISR during same period were taken as case and age matched patients who had previously undergone PCI with DES and repeat coronary angiogram for evaluation of symptoms between 1/10/2012 to 30/4/2015 and detected to have fully patent stents were taken as control.Results: A total of 26 patients were detected to have ISR during the study period as per the study protocol with equal number of age matched controls. The most common presentation of ISR was as chronic stable angina (70%). Binary logistic regression analysis of 6 factors namely diabetes, hypertension, lesion type, stent diameter, stent length and stent overlap found significant in univariate analysis, showed only the lesion type to be statistically significant with p value of 0.023.Conclusions: Patients who have undergone PCI with DES particularly for complex lesions, diabetics with longer stents, lesser diameter stents and overlapping stents need to be meticulously followed up to rule out the possibility of restenosis, as in a small number of patients the presentation could be ACS with comparatively bad prognosis

Metabolic syndrome and Non alcoholic fatty liver disease among asymptomatic adults in North Kerala

Background: Non-alcoholic fatty liver disease [NAFLD] is considered as the hepatic component of Metabolic syndrome (MS) and is a common cause of Chronic Liver Disease. Early identification of NAFLD in patients having metabolic syndrome is important in reducing the long-term morbidity.Methods: A cross sectional observational study of apparently healthy subjects attending routine health check in the hospital clinic between the age group of 18 years and 65 years for a period of six months was done. Data including medical history, anthropometric measurements, biochemical investigations and ultrasound scan abdomen were collected. Patients were categorised as metabolic syndrome based on IDF consensus criteria (2009) using population and country specific definition for waist circumference.Results: 168 consecutive subjects attending the clinic were studied out of which 75.60% (127) had NAFLD. Out of the study subjects, 80 (47.62%) had metabolic syndrome according to IDF 2009 criteria. There is a significant difference between the prevalence of NAFLD among subjects with and without metabolic syndrome (p=0.002). Logistic regression analysis showed that BMI and waist circumference were significantly contributing to the prediction model for the occurrence of NAFLD. Conclusion: Prevalence of NAFLD in those with metabolic syndrome is considerably higher than those who do not satisfy the criteria for metabolic syndrome. The study points to the importance of screening and aggressive life style intervention in patients with abdominal obesity to prevent the development of NAFLD and Metabolic Syndrome

Analysis of cerebrospinal fluid adenosine deaminase level in tuberculous meningitis and validation of sensitivity and specificity

Background: Tuberculous meningitis is an important cause of morbidity and mortality in developing countries especially in India. The mortality associated with tuberculous meningitis is very high if not detected early and meticulous treatment is not given. CSF analysis and imaging are the most commonly used tools for diagnosis of meningitis. But these are often inadequate in making a definitive diagnosis. CSF Adenosine Deaminase estimation (ADA) is useful in differentiation of tuberculous meningitis from non-tuberculous meningitis. Though few studies have proved efficacy of Adenosine Deaminase level for the diagnosis, studies to assess the sensitivity and specificity of ADA levels were limited. This study was conducted to assess its usefulness and to validate the sensitivity and specificity of ADA level in tuberculous meningitis (TBM).Methods: This was a prospective study conducted at Academy of Medical Sciences, Pariyaram for a period of 18 months from December 2013 to June 2015, Adenosine deaminase level was studied in the cerebrospinal fluid of 50 patients who got admitted with symptoms and signs of meningitis in the medical wards and intensive care units who fulfilled the inclusion criteria.Results: In this study 50 patients were diagnosed clinically and with CSF analysis as meningitis. The mean cerebrospinal fluid adenosine deaminase activity was 23.08+17.5in Tuberculous meningitis 3.8 +1.92U/l in Bacterial meningitis and 4.8+2.3U/l in Viral meningitis. The adenosine deaminase activity in Tuberculous meningitis cases were significantly higher than non-tuberculous meningitis. The sensitivity and specificity of this test for diagnosis of tuberculous meningitis was 90% and 100% respectively with ADA value of more than 10U/L.Conclusions: This study found out that estimation of CSF Adenosine level is a very useful test for the diagnosis of tuberculous meningitis. The sensitivity and specificity attained in this study were comparable to other studies. This study also found out that ADA estimation is very useful in distinguishing tuberculous and viral meningitis