Indian Journal Of Clinical Practice
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Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India
Get PDF: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are proneto opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs,particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and evenin different areas within the same country. Little information is available about the prevalence of OI in HIV patients fromdeveloping countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy amonginfected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies andspectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materialsand methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in NorthIndia. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemicalinvestigations and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were includedin the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis(TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and thethird most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low income, illiteracy,low socioeconomic status, initial 4 months since initiation of ART, CD4 count <200/mm3, body mass index of <18.5 kg/m², poorART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is thecommonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs acrossdifferent patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status ofpatients can influence the occurrence and outcome of these deadly infections
Extended Use of Ivabradine in Heart Failure with Preserved Ejection Fraction and Inappropriate Sinus Tachycardia
Get PDFIvabradine has been used for over a decade in managing chronic coronary syndromes and heart failure (HF) with reducedejection fraction (HFrEF). HF with preserved ejection fraction (HFpEF) accounts for 50% of the total HF cases carrying equalmortality and morbidity risk as HFrEF. Increased heart rate (HR) in such cases has been shown to be associated with poorclinical outcomes. Clinical conditions like inappropriate sinus tachycardia (IST) manifest with elevated HR without anyspecific triggers. Beta-blockers have been the preferred treatment of choice for both HFpEF and IST but are often ineffective orpresent with side effects due to their negative ionotropic effects. Ivabradine, through its inhibitory action on funny current(Ifc), reduces HR without altering the inotropic mechanism. Few case reports and small case series have documented itsextended use and efficacy in reducing HR in these cardiac conditions. In this article, we present two cases who needed HRcontrol, one with HFpEF and another case of IST syndrome. Ivabradine was successfully used in both these cases to controlthe elevated HR
Cross-Sectional Study to Find Out the Prevalence of Cardiovascular Diseases Through Detection of ECG Abnormalities in Undiagnosed Population Using a Handheld ECG Device, SanketLife Pro Plus
Get PDF: In India, cardiovascular diseases (CVDs) are now the main cause of sudden death. Statistics on prevalence or nationally representative surveillance statistics, however, are lacking. Aim: The objective of this cross-sectional study was to assess the ECG findings in general OPD patients not yet diagnosed with any CVD using SanketLife Pro Plus handheld ECG device. Materials and methods: The study data was extracted from a free ECG test camp, which was organized in the common OPD waiting area at Indraprastha Apollo Hospitals in New Delhi. Of the 100 persons screened, 78% had sinus rhythm and 13% had tachycardia. Apart from these, no other major findings were detected in the study population. One percent ST depression and 4% T-wave inversions were the significant findings of concern, suggestive of myocardial ischemia or infarction, especially in the undiagnosed population. Conclusion: Considering the sample size, even at a 1% incidence of major ECG abnormalities, the outcome is indicative of a possible underlying danger, which is avoidable with early detection and thorough awareness. A mass ECG screening along with collection of relevant data and appropriate research design may help to identify the population at risk. Besides the ECG screening, a stroke risk assessment should be done and prophylaxis must be given to the individuals who have been diagnosed with CVDs
Hepatic Granulomas: A Clinician’s Perspective
Get PDFHepatic granulomas are focal aggregates of transformed epithelioid histiocytes with or without multinucleated giant cells that are cuffed by lymphocytes and plasma cells. They represent delayed-type specialized cell-mediated immunity to a wide-spectrum of antigenic stimuli. Hepatic granulomas are found in up to 10% of liver biopsies and the causes are usually multifactorial. Different antigens like infectious agent, medication, foreign body and malignancy can initiate granuloma formation. Hepatic granulomas per se seldom cause architectural changes and often provide a clue to a systemic disease. Most often, to a practicing clinician, it is a combination of clinical presentation, laboratory parameters with information on the typical localization and characterization of the granuloma within the liver by the pathologist that often provides a clue to a definitive diagnosis
