Monitoring the renal arterial Doppler flow velocity indices, the resistive index and pulsatility index, with ultrasound may help predict renal dysfunction. However, such monitoring has been done intermittently by transcutaneous ultrasound in the postoperative intensive care setting. In the operating room, transesophageal echocardiography (TEE) is an alternative to transcutaneous ultrasound for obtaining indices of renal perfusion. However, it is difficult to locate the right kidney using TEE. We propose a new technique to locate the left kidney that, in our experience, is simple and easy to perform. We believe, starting from a transgastric left ventricular short-axis view, turning left to locate the abdominal aorta, and following it to the origin of the left renal artery may help locate the left kidney faster than previously described techniques. We also propose a new technique to monitor these Doppler indices using TEE during the intraoperative period.

Background:In a developing country, infectious disease remains the most important cause of fever, but the noncommunicable diseases, like malignancy, are fast becoming important differential diagnoses. An important clinical problem is the cases labeled as fever of unknown origin (FUO), which often evade diagnosis.Objective:The present study was undertaken to find the cause of FUO in a tertiary care hospital of eastern India.Materials and Methods:This is a prospective study of inpatients, with regard to both clinical signs and investigations.Results:The main diagnosis in the end was tuberculosis, closely followed by hematological malignancy. A substantial number of cases remained undiagnosed despite all investigations. The provisional diagnosis matched with the final in around two thirds of the cases. While for younger patients leukemia was a significant diagnosis, for older ones, extra-pulmonary tuberculosis was a main concern.Interpretation:In India, infectious disease still remains the most important cause of fever. Thus the initial investigations should always include tests for that purpose in a case of FUO.Conclusion:Geographic variations and local infection profiles should always be considered when investigating a case of FUO. However, some of the cases always elude diagnosis, although the patients may respond to empirical therapy.

Our trial demonstrates the superior therapeutic effects of nandrolone in male AWS patients, including the androgen deficient.

A 35 year-old male presented with left sided weakness for past 3 months, along with progressive deterioration in higher mental faculties, vision and audition. Clinical and investigational information suggested the diagnosis of an acute demyelination involving various areas of the brain. He was seropisitive for HIV and had good cellular immunity at the time of our assessment. We present this case to highlight the association of Multiple Sclerosis (MS) with HIV, either during seroconversion or early during course of this infection.

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We aimed to study the prevalence and determinants of non compliance to intensive phase anti tubercular treatment (ATT) in 111 HIV-TB coinfection patients, attending the APEX Referral Center for HIV/AIDS at Medical College, Kolkata with a specially-designed, semi-structured, pre-tested questionnaire. Compliance was defined as taking ≥95% of the total scheduled doses of anti-TB medicines during the intensive phase. Data was collected on socio-demographic parameters, disease information, patient's knowledge and barriers to treatment. The prevalence of non-compliance to ATT in HIV-TB coinfection patients was found to be 40.5% (95% C.I. = 30.5, 50.5). Multivariate logistic regression analysis showed that absence of proper counseling, lack of knowledge about correct route of TB transmission, visiting quacks during ATT and the urge to leave treatment once patient started feeling better were the significant determinants of non-compliance. "No Counseling" increased chances of non- compliance (adjusted O.R.) 47.12 times (95% C.I. = 7.99, 195.27); thereby being the single most influential variable towards the outcome. The present study finds an alarmingly high prevalence of non-compliance to ATT among HIV-TB coinfection patients. The results clearly indicate that adequate counseling about this coinfection and the importance of compliance, along with better patient-friendly orientation of DOTS programme is urgently needed. Collaborative TB-HIV activities are essential to ensure better ATT compliance in coinfection patients.

New-onset seizures are frequent manifestations in patients infected with Human Immunodeficiency Virus (HIV). We describe the clinical and radiological findings in an 25yr old AIDS patient presenting with new onset seizures as the primary manifestation of cerebral toxoplasmosis and Non Tuberculous Mycobacterial [NTM] co-infection. Cranial computed tomography showed a subtle ventricular dilatation whereas magnetic resonance imaging disclosed prominent temporal horn. Toxoplasma tachyzoites and rapidly growing mycobacteria were recovered from CSF. Seizures were complex partial in nature and refractory to antiepileptic therapy. Key-Words: Non tuberculous Mycobacteria, toxoplasmosis, HIV, seizures. Case ReportA 25 year old male came into the fold of our care in May 2008, in an unconscious state along with involuntary movements and complex partial seizures involving the right upper limb and the right side of face, for the past 3 days. History revealed presence of low grade evening fever with remission during the night spread over the last 6 months. He was treated for pulmonary tuberculosis 3 years back and the ATD regimen was duly completed. He had a history of exposure to commercial sex. There was no history of weight loss, oral or genital ulcers, headache, vomiting or visual disturbances and no past history suggestive of a seizure disorder.The general survey revealed enlarged cervical lymph nodes and hyperpigmented papules and plaques, distributed over all four limbs (Figure 1). All his vitals were within normal range. A detailed CNS examination revealed rigidity of both right upper and lower limbs. The deep reflexes were exaggerated on the right side while the plantar response was bilaterally flexor. There was no involvement of the cranial nerves, sensory or autonomic systems. The bladder and bowel control was unaffected. Ophthalmoscopy was within normal limits. Meningeal signs were positive. Abdominal exam revealed a firm nontender hepatomegaly. All other systems were apparently unaffected.Baseline investigations documented normal haemogram, blood sugar, urea and creatinine values. The Liver Function Test showed a serum bilirubin level of 0.6mg/dL (direct bilirubin of 0.4mg/dL), total protein of 8.3mg/dL (albumin 3.7mg/dL, globulin 4.3mg/dL), SGOT 108IU, SGPT 76IU and Alkaline Phosphate 430 IU. An ultrasound of abdomen revealed enlarged liver size with normal echo-texture. He was tested positive for Anti HIV -1 antibodies (ELISA),which was confirmed by western blot. His CD4 count was 46 cells / cumm. CT and MRI scans were essentially normal except for enlarged ventricles (Figures 2 and 3). The CSF study revealed a cell count of 5 cells/ cumm (all lymphocytes). The sugar and protein level in CSF were 38mg/dL and 84 mg/dL respectively. A smear drawn from CSF showed plenty of acid fast bacilli by ZN staining and toxoplasma tachyzoites on Giemsa stain.We initiated CAT 2 antitubercular regimen along with pyrimethamine and co-trimoxazole. He was also started on IV phenytoin and oral oxcarbamazepine was added to his anti...

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