Echocardiographic patterns in treatment-na?ve HIV-positive patients in Lagos,south-west Nigeria

Introduction

Cardiovascular abnormalities are common in HIV-infected patients, although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naïve patients.

Methods

One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls were matched for age, gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities, and CD₄ count was measured in all patients.

Results

The cases comprised 57 females (57.0%) and 43 males (43.0%), while the controls were 28 females (56.0%) and 22 males (44.0%) (χ² = 0.01; p = 0.913). The mean age of the cases was 33.2 ± 7.7, while that of the controls was 31.7 ± 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000), including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (χ² = 32.10; p = 0.000) and dilated cardiomyopathy in 5% (five); none of the controls had either complication. One patient each had aortic root dilatation, mitral valve prolapse and isolated right heart dilatation and dysfunction.

Conclusion

Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.     

B超检测对慢加急性肝衰竭大鼠模型诊断的价值

目的 探讨慢加急性肝衰竭大鼠模型肝脏B超检测与病理学及血清学指标ALT、AST、TBIL的关系.方法 30只SD大鼠随机分为正常对照组(n=15)、模型组(n=15).模型组通过四氯化碳(CCl4)诱导致肝硬化后给以D-氨基半乳糖(D-GalN)及脂多糖(LPS)打击,建立慢加急性肝衰竭大鼠模型.采用B超监测大鼠肝脏及腹部,生化仪器检测血清中丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL),HE染色观察肝脏的病理变化.结果 模型组B超阳性结果13例,血清中ALT、AST、TBIL各项指标均明显升高,肝脏病理损伤为100％,其中达到肝衰竭的有12例,B超检测阳性且病理损伤达到肝衰竭有11例.B超检测结果与病理学(r=0.786,P=0.000 1)、血清学(r=1,P=0.000 1)结果呈正相关.结论 B超检测的结果与病理学、血清学的结果有很高相关性,能够反映肝脏的损伤程度,B超检测可以作为活体筛选肝硬化、肝衰竭模型大鼠的诊断指标之一.     

2种肠内营养途径及护理在老年ICU机械通气患者中的应用

目的：比较2种肠内营养途径在老年ICU机械通气患者中的应用效果,为此类患者实施肠内营养支持提供依据。方法采用病例对照研究,使用鼻胃管和鼻肠管2种肠内营养支持途径及护理措施,各选取25例老年ICU机械通气患者,对比分析2组目标营养剂量达到时间,第2、3、4周患者营养改善情况,以及并发症发生率。结果鼻肠管喂养组达到目标营养剂量的时间短于鼻胃管喂养组,两组比较差异具有统计学意义（P＜0．05）;喂养后4周后2组患者总蛋白、血清前白蛋白、转铁蛋白量均有改善,且鼻肠管组改善结果显著优于鼻胃管组（P＜0．05）;鼻肠管组喂养相关并发症发生率显著低于鼻胃管组（P＜0．05）。结论老年ICU机械通气患者进行鼻肠管喂养并采取有效护理措施,更易达到目标营养剂量,且发生腹胀、误吸等并发症的概率较低。     

Monitoring of the neonate undergoing MR imaging: technical considerations. Work in progress

Instrument monitoring of vital signs in neonates undergoing magnetic resonance (MR) imaging can be difficult because of the unique environmental restrictions imposed by the imager. The authors present their experience with monitoring more than 50 newborn infants and discuss the interaction of monitoring devices with the MR imager. Several MR-compatible monitors allow continuous evaluation of body temperature, heart rate, blood pressure, and auscultation of heart sounds and respiration in mechanically ventilated infants. Signal-to-noise (S/N) ratio measurements taken during imaging of the head of an infant with these monitors in place did not differ appreciably from the ratio obtained during imaging without monitors. Tip angles should be optimized to account for widely varying head size among neonates, since adverse monitoring effects are significantly compounded by improper tip angle adjustment.     

Threatened abortion: sonographic distinction of normal and abnormal gestation sacs

In an attempt to determine whether sonographic evaluation alone can distinguish normal from abnormal gestation sacs, a retrospective analysis was performed of ultrasound (US) scans from 168 women with threatened abortion. Gestation sacs were judged to be abnormal on the basis of specific sonographic criteria including large size (greater than or equal to 25 mm mean sac diameter) without an embryo; distorted shape; thin (less than or equal to 2 mm), weakly echogenic, or irregular choriodecidual reaction; absence of a double decidual sac; and low position. Two criteria - large sac and distorted shape - had 100% specificity and were called major criteria. The remaining criteria were individually less specific, although 100% specificity was achieved when three or more of these minor criteria were demonstrated. When one major or three minor criteria were present, 53% of abnormal gestations were correctly identified without any false-positive diagnoses. The authors conclude that experienced sonographers can reliably identify many abnormal gestation sacs on a single examination.     

An autologous fibrinogen-based adhesive for use in otologic surgery

Successful middle ear surgery requires the availability of a safe, effective bonding material. Side effects caused by synthetic materials have led to the use of biologic adhesives; however, they carry the risk of transmission of infectious disease if they are prepared from pooled human blood. A procedure for the production of an autologous fibrinogen-based adhesive using polyethylene glycol to precipitate the fibrinogen-factor XIII component from plasma is described. This procedure requires 40 ml of whole blood and approximately 3 hours' preparation time, and it can be performed in any blood bank with the facilities for sterile techniques. This adhesive has been used successfully for otologic surgery in 12 patients, and further study of the use of this biologic adhesive for other microsurgical techniques should be undertaken.