Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India

Background

Literature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV)-infected patients from developing countries is sparse. The objective of this study was to document the spectrum and determine the frequency of various opportunistic infections (OIs) and non-infectious opportunistic diseases, in hospitalised HIV-infected patients from north India.

Methods

One hundred and thirty five consecutive, HIV-infected patients (age 34 ± 10 years, females 17%) admitted to a tertiary care hospital in north India, for the evaluation and management of an OI or HIV-related disorder between January 2000 and July 2003, were studied.

Results

Fever (71%) and weight loss (65%) were the commonest presenting symptoms. Heterosexual transmission was the commonest mode of HIV-acquisition. Tuberculosis (TB) was the commonest OI (71%) followed by candidiasis (39.3%), Pneumocystis jiroveci pneumonia (PCP) (7.4%), cryptococcal meningitis and cerebral toxoplasmosis (3.7% each). Most of the cases of TB were disseminated (64%). Apart from other well-recognised OIs, two patients had visceral leishmaniasis. Two cases of HIV-associated lymphoma were encountered. CD4+ cell counts were done in 109 patients. Majority of the patients (82.6%) had CD4+ counts <200 cells/μL. Fifty patients (46%) had CD4+ counts <50 cells/μL. Only 50 patients (37%) received antiretroviral therapy. Twenty one patients (16%) died during hospital stay. All but one deaths were due to TB (16 patients; 76%) and PCP (4 patients; 19%).

Conclusions

A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India. Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

     

Risk Factors for Suicide in Wives of Military Personnel

Background

An increasing trend in attempted and completed suicide amongst wives of serving personnel was observed.

Methods

A questionnaire designed to elicit the known risk-factors for suicide, suicide attempts and suicidal ideation by women in the Indian context was administered to 222 wives of Indian military personnel living in a garrison with their husbands.

Result

A large number (28%) of the sample were child-less. Alcoholism in husband was reported by 22 women and domestic violence by four. Six had been bereaved in the past year. Chronic illness was reported by 10 women and psychiatric illness by four.

Conclusion

Wives of military personnel may need targeted community interventions focusing on the risk factors for suicide.Key Words: Suicide: Community, Risk-factors, Wives of military personnel     

Risk factors for suicide in wives of military personnel

Background: An increasing trend in attempted and completed suicide amongst wives of serving personnel was observed.     

Effects of temperature on granulocyte preservation

With the increasing use of granulocyte transfusion it is becoming important to determine if granulocytes can be preserved for a few days. If so, the optimum storage conditions must be identified. We studied the function in vitro of granulocytes collected as they would be for transfusion by continuous-flow centrifuge leukapheresis (CFCL) and filtration leukapheresis (FL). Granulocytes collected by CFCL maintained normal ability to phagocytose and kill bacteria after 48 hr and normal chemotaxis after 24 hr of storage at 20 degrees--24 degrees C. Neither 1 degrees--6 degrees C nor 37 degrees C were as effective in preserving chemotactic response. Agitation of the granulocyte suspension during storage caused reduced bacterial killing and chemotaxis. Granulocytes collected by FL functioned very poorly after 24 hr storage at all temperatures studied. These studies suggest that it may be possible to store CFCL granulocytes at 20 degrees--24 degrees C for 24 hr. FL granulocytes should not be stored at all.     

Evaluation of larvicidal activity of the aerial extracts of a medicinal plant,Ammannia baccifera (Linn) against two important species of mosquitoes,Aedes aegypti and Culex quinquefasciatus

ObjectiveTo analyze the larvicidal effect of the aerial extracts of Ammannia baccifera on two important mosquito species, Aedes aegypti and Culex quinquefasciatus.MethodsThe larval mortality of fourth instar larvae of A. aegypti and C. quinquefasciatus after 24h and 48h of treatment were observed separately in control 50, 100, 150, 200, 250, 300, 350, 400, 450 and 500 mg/L concentrations of the aerial extracts (methanol, ethyl acetate, chloroform) of A. baccifera.ResultsBased on the probit analysis, the 24h and 48h aerial methanol extract of A. baccifera LC₅₀value of C. quinquefasciatus was found to be in 164.00 mg/L and 107.00 mg/L and LC₉₀values for C. quinquefasciatus was found be in 310.00 and 261.00 mg/L. The 24h and 48h aerial part of methanol extract of A. baccifera LC₅₀value of A. aegypti was found be in 226.00 mg/L and 186.00 mg/L and LC₉₀values was found be in 476.00 and 309.00 mg/L.ConclusionsThe results indicate that the A. baccifera could be effectively used for the control of mosquito larvae and the possibility of exploiting for the development of commercial larvicides a plant widely occurring in India.     

INFLAMMATORY FIBROID POLYP OF PROXIMAL ILEUM CAUSING RECURRENT INTUSSUSCEPTION

SUMMARY A 64-year-old female presented with episodes of small bowel obstruction. Ultrasound and barium meal showed a polypoidal lesion in the proximal segment of small bowel. The patient underwent emergency surgery because of signs of impending acute intestinal obstruction. Pathology showed characteristic features of an inflammatory fibroid polyp (IFP) which is an important though rare benign cause of small bowel obstruction. We document clinical and pathological aspects of this case.     

STUDY OF GLOMERULAR FUNCTIONS IN NEONATES

Glomerular function of neonates (25 full term and equal number of preterm neonates) at birth, on day seven and day fourteen were estimated by endogenous Creatinine clearance (CCr). The Preterm were divided into three groups viz. Group I (Gestation age (GA) 30-32 weeks), Group II (GA 33-34 weeks) and Group III (GA 35-36 weeks). Group IV consisted of 25 term neonates. Serum creatinine (in mg/dl) in all the groups of preterm ranged from 0.92 ± 0.153 to 1.204 ± 0.154 and in term neonate from 0.562 ± 0.175 to 1.148 ± 0.247 showing that the levels were inversely proportional to the period of gestation. Besides the Serum Creatinine levels in all groups of Preterm as well as term neonates were found to fall significantly (p < 0.001) during the first and second week. Glomerular filtration rate (GFR) in Group I were 16.603 ± 2.519, 19.786 ± 2.078 and 23.720 ± 2320 on day one, seven and fourteen respectively showing progressive improvement during the first two weeks. The GFRs were also found to be directly proportional to the GA. In addition the levels of GFR were found increasing significantly during the second week compared to that on day seven in all the groups of preterm neonates. GFR''s in Group I & II on all the three occasions were significantly lower (p < 0.001) than those of term counterparts, however the GFR on the first day in Group III neonates was lower than group IV, the difference was insignificant (p > 0.05). The increase in GFR in Group I on the three occasions was linear but insignificant (p > 0.05). The rise was more rapid & significant (p < 0.001) during the second week in Groups II & III. On the contrary the rate of improvement of GFR in full terms was quite rapid during the first week and gradual over the second week of life.KEY WORDS: GFR preterm & term neonates, Serum creatinine     

Bone impregnated hip screw in femoral neck fracture: Clinicoradiological results

Background:

Femoral neck fractures are treated either by internal fixation or arthroplasty. Usually, cannulated cancellous screws are used for osteosynthesis of fracture neck of femur. The bone impregnated hip screw (BIHS) is an alternative implant, where osteosyntehsis is required in femoral neck fracture.

Materials and Methods:

The BIHS is a hollow screw with thread diameter 8.3 mm, shank diameter 6.5 mm and wall thickness 2.2 mm and holes in the shaft of the screw with diameter 2 mm, placed in a staggered fashion. Biomechanical and animal experimental studies were done. Clinical study was done in two phases: Phase 1 in a group of volunteers, only with BIHS was used in a pilot study and phase 2 comparative study was done in a group with AO cannulated screws and the other group treated with BIHS.

Results:

In the phase 1 study, out of 15 patients, only one patient had delayed union. In phase 2, there were 78 patients, 44 patients in BIHS showed early union, compared to the rest 34 cases of AO cannulated screws Out of 44 patients with BIHS, 41 patients had an excellent outcome, 2 had nonunions and one implant breakage was noted.

Conclusions:

Bone impregnated hip screw has shown to provide early solid union since it incorporates the biomechanical principles and also increases the osteogenic potential and hence, found superior to conventional cannulated cancellous screw.