Tumor-to-tumor metastasis (T2Tmets) is an established entity but often overlooked and underdiagnosed. Merely 84 such cases are reported in literature till date. The authors here describe a 65-year-old man presenting with first episode of focal seizure and incidentally turned out to be a case of adenocarcinoma of lung metastatic to a meningioma. The diagnosis of T2Tmets was based solely on histopathological criteria. Recent advent of brain imaging revolutionized its diagnosis and it has moved from the realm of thologists to that of radiologists. In our case, diagnosis was also established by immunohistochemistry.
Background: HIV infection causes direct endothelial dysfunction or damage and premature atherosclerosis. HIV induced endothelial dysfunction may manifest as peripheral arterial disease (PAD). Understanding PAD scenario and its relation with antiretroviral therapy (ART) may help to improve quality of life and to prevent critical limb ischemia or amputation. Till date no follow up study has shown the effect of ART on PAD. This study explores association of ART with changes in PAD status and severity.Methods & Materials: In this ART clinic based cohort study conducted at a tertiary care hospital in eastern India, 193 consecutive ART eligible HIV positive patients of age between 18-49 years underwent ankle brachial pressure index (ABPI) measurement before ART initiation and after one year of receiving ART to examine the effect of ART on PAD. ABPI values less than 0.9 or more than 1.4 at rest were taken as abnormal.Results: Prevalence of PAD before the initiation of ART was 30.57%. The prevalence dropped to 12.95% after 6 months and to 3.62% after 1 year of treatment. Mean age of the patients whose ABPI improved was lower than those in whom low ABPI persisted (p value 0.05). ABPI improvement was significant among people who were asymptomatic, belonged to urban population, had normal BMI, good functional status, lower WHO stage and who had no history of tuberculosis (p value< 0.05).
Conclusion:Prevalence of PAD decreased significantly after one year of ART. Routine ABPI measurement and early initiation of ART may reduce PAD morbidity and improve quality of life.
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