The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

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This study suggests that there is a higher prevalence of PAD in diabetics as compared with controls. The prevalence of PAD is directly proportional to the duration of diabetes and age of the person. The prevalence of PAD is not a function of treatment modality. The stenosis associated with PAD in diabetics is generally infrapopliteal.

BackgroundThis study aimed to describe the pulmonary hemodynamic changes during the course of pregnancy and to observe any significant effects on symptomatology and outcome of pregnancy due to these changes.MethodsA total of 75 patients were recruited for the study, 60 pregnant women from first trimester to third trimester and 6 weeks of puerperium for the study group and 15 non-pregnant patients. All the subjects were interrogated about their complaints like excessive cough, exertional dyspnea, palpitations, orthopnea, syncope, exertional chest pain and lower extremity edema along with their duration. Baseline investigations, echocardiography (ECG) and Doppler echo were done.ResultsThe commonest symptoms were palpitations (40%), exertional dyspnea (35%) and lower extremity edema (47%). Palpitations and dyspnea were also present in control group. Right axis deviation was the next most common abnormality in study group (12.3% patients). Pulmonary blood flow was decreased by more than 50% of predelivery value at the end of puerperium. Fall in pulmonary vascular resistance returned to base line values. Increased pulmonary artery pressure was seen during the pregnancy, which was not statistically significant.ConclusionDuring pregnancy, though the pulmonary blood flow increases significantly, the pulmonary artery pressure remains unchanged due to substantial fall in pulmonary vascular resistance in early gestation.

Objectives: To study the renal disease in newly diagnosed HIV infected hospitalized patients and to look for possible correlation of CD4 count with prevalence of renal disease. Materials and Methods: The prospective study was conducted in Department of Medicine/Endocrinology in tertiary care health center in western U.P during the study period of one year. The patients were evaluated clinically and biochemically after obtaining the informed consent. Result: The study was conducted on 100 HIV/AIDS patients, out of which 68 (68%) were males and 32 (32%) females with a Highest incidence of HIV/AIDS (51%) in the age group of 25-35 years. Microalbuminuria was present in 20 (20%) HIV patients with majority (60%) being in the age group 25-35 years. Prevalence of microalbuminuria among males was 55% and among females 45%. Microalbuminuria was further evaluated by calculating the ratio of microalbumin to urinary creatinine, 83% patient had ratio >10 mg/mmol and 17% had this ratio <10 mg/mmol. The ratio of microalbumin to urinary creatinine >10 mg/mmol was 60% in age 25-35 year, 25% in the age group of 36-45 year followed by 15% in the age group of 45-55 year patients. Chi-square test was used to calculate the significance of the correlation between CD4 counts with the presence of microalbuminuria in HIV patients. There was a significant correlation between CD4 count <200/μL and presence of microalbuminuria (p =0006). Statistically significant proteinuria (30-300 mg/24 hour) was found in 15 patients with CD4 count <200/μL of those patients found positive for microalbuminuria. Protein/ creatinine ratio was <0.2 in 18 patients, 2 had ratio in the range of 0.2-3.5 and none in the nephrotic range (>3.5). Conclusion: Study evaluation shows that there is statistically significant microalbuminuria in HIV/AIDS infected patients and this is more prevalent in patients with CD4 count <200/μL as compared to patients with CD4 count >200/μL in keeping with previous studies. The routine laboratory measurements like serum creatinine and proteinuria fail to recognize the patients with early renal involvement. In view of the high prevalence of renal dysfunction among hospitalized HIV infected patients, it is recommended to use microalbuminuria as routine screening tests in those who are HIV positive. DOI: http://dx.doi.org/10.3126/ajms.v6i3.11376  Asian Journal of Medical Sciences Vol.6(3) 2015 58-62

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