Background: Cardiovascular causes contribute towards the large proportion of increased morbidity and mortality,in patients ofChronic renal failure. Cardiac disease is the major cause of death in dialysis population. Methods: The present study was undertaken for documentation of various cardiovascular abnormalities in sixty patients with Chronic Kidney Disease at Government Medical College Patiala, using Electrocardiography and Echocardiography as investigation procedures.The present study is a descriptive -cross sectional study and data collected was analysed by frequency, percentage, chi-square test and by using p value. Results: ECG was normal in 15 out of 60 cases of CKD(25%), LVH present in 20 out of 60(33.33%), Left axis deviation in 9 out of 60(15%), Conduction disturbances in 10 out of 60(16.67%), Ischemia in 12 out of 60(20%), Arrhythmias in 2 out of 60(3.33%) and P-mitrale was found in 4 out of 60 cases(6.67%). The most common ECG change associated with cases with CKD was LVH (33.33%).The most common abnormality found on echo in CKD cases under study was LVH(56.67%) followed by Diastolic Dysfunction(38.33%). Conclusion: Left ventricular hypertrophy is the commonest abnormality observed in CKD both on ECG and Echocardiography. Echocardiography is a more sensitive diagnostic procedure to detect left ventricular hypertrophy. After LVH most common abnormality found on Echocardiography is Left ventricular diastolic dysfunction. Pericardial effusion and conduction abnormalities are more common in patients of CKD on hemodialysis.

Background: Since the availability of highly potent anti-retro viral drugs, the management of the human immunodeficiency virus infection has significantly improved and has increased the patient's survival rate. This increased longevity has unmasked many complications like dyslipidaemias which place them at higher risk of developing atherosclerotic vascular disease. The present study was conducted to compare the prevalence of Dyslipidaemia and Carotid Atherosclerosis among newly diagnosed HIV Reactive patients and Those on ART for 6 months. Methods: This descriptive-cross sectional study was conducted among 200 subjects who attended Medicine OPD, ART Centre and admitted in various medical Wards of Rajindra Hospital, Patiala over a period of 2 years from November 2014 to October 2016. 100 newly diagnosed HIV reactive subjects as per NACO guidelines but not on ART of age 20 years and above were included in Group A while 100 subjects of similar age group on ART for 6 months included in group B. The subjects having thyroid disease, Diabetes Mellitus, Hypertension and those on hypolipidemic drugs were excluded from the study. Lipid profile was estimated biochemically and CIMT was measured using high resolution B mode ultrasonography system. Data generated from the study was analyzed according to standard statistical methods. Non normaldistribution variables were applied MannWhitney rank sum testand normal distributed variables by't' test. Pearson product-moment correlation coefficient was applied to measure the correlation between two variables. Result: The study observed a significant higher levels of Serum Total Cholestrol (TC) (182.13+24.88 mg/dl Vs 160.69+18.49 mg/dl), Triglycerides (TG) (162.70+26.15 mg/dl vs 141.23+22.99 mg/dl), Low density lipoprotein cholesterol (LDL¬-c) (110.72+22.76 mg/dl vs 94.30+16.89 mg/dl), Very low density lipoprotein(VLDL-c)(32.54+5.23 mg/dl vs 28.21+4.62 mg/dl), High density lipoprotein cholesterol (HDL¬-c)(39.66+3.36 mg/dl vs 38.18+3.83 mg/dl) and CIMT(0.93+0.145 mm vs 0.85+0.138 mm) among subjects on ARTas compared to newly diagnosed HIV reactive subjects. Conclusion: It is evident from our study that there was significantly greater prevalence of dyslipidemia in HIV reactive patients on ART as compared to newly diagnosed HIV reactive patients though it was there in both. Our study also suggested the role of HAART in the development of carotid atherosclerosis in HIV patients. HAART has dramatically reduced the morbidity and the mortality in HIV infected patients but we should not overlook these possible complications related to dyslipidemia and carotid atherosclerosis. Hence, a periodical screening and long term follow up of all the HIV patients who are on ART should be done to assess and timely detect risks associated with them.

Background: Cardiovascular involvement is common in HIV reactive patients, although are clinically quiescent. Echocardiography in HIV reactive patients is important tool in recognizing these cardiac abnormalities. Methods: The study was conducted in 150 HIV reactive patients attending antiretroviral therapy centre and wards of the hospital. Echocardiography was done using GE Vivid 3 Milwaukee using 2.5 MHz variable frequency transducer and CD4+ count was measured by FACS (Flourescent Activator Cell Sorter). Patients with age <15 years, congenital heart disease, preexisting valvular heart disease, hypertension and diabetes mellitus were excluded from study. Patients were divided into three groups according to CD4+ counts: group 1 with CD4+ count <200, group 2 with 201-350 and group 3 with > 350 CD4+ cells. Data so collected was statistically analysed and correlation with CD4+ count was studied. Results: Out of 150 patients, echocardiographic involvement was shown in 62 (41.3 %) patients. Most common echocardiographic abnormality was diastolic dysfunction in 26 % (most of the patients had grade 1 diastolic dysfunction), followed by pericardial effusion in 8.6 %. 6.7% had systolic dysfunction and 5.3% had features of dilated cardiomyopathy. The mean CD4+ count in patients with grade 1 diastolic dysfunction and systolic dysfunction was significantly lower than in patients without diastolic dysfunction and systolic dysfunction (166.9 versus 210.65). Same was true with patients having pericardial effusion and dilated cardiomyopathy. Pulmonary hypertension was seen in 5.8 % of patients. Conclusion: The prevalence of echocardiographic manifestations in HIV reactive patients was quiet high. High index of clinical suspicion of cardiac involvement and its recognition in HIV patients at all stages help in early diagnosis and treatment which in turn will decrease morbidity and mortality.

Nonsecretory myeloma, which comprises 1-5% of all myelomas, is a variant of plasma cell myeloma. It is defined as symptomatic myeloma without detectable monoclonal immunoglobulin levels on serum or urine immunofixation electrophoresis. It often poses diagnostic dilemma with no clear features of the disease. Our case report examplifies such a diagnostic dilemma. We report a case of nonsecretory plasma cell myeloma that manifested as nonspecific backpain and lytic skull lesions. Due to the inability to detect monoclonal immunoglobulin on serum or urine immunofixation electrophoresis it was difficult to establish an early, accurate diagnosis. A high index of suspicion must be borne in mind when excluding multiple myeloma as a cause of pain, pathological fracture or osteolytic lesion. Misdiagnosing or mislabeling symptomatic myeloma patients results in the delay of their systemic treatment. Therefore, comprehensive imaging studies, the detection of free light chains, and histopathological confirmation from different sites and time points are necessary.

Background: Long term uncontrolled hyperglycemia, which is indicated by HbA1c levels, is strongly suspected of promoting atheogensis.An accurate marker for assessing the risk of stroke is the carotid artery intima-media thickening (IMT), assessed by Doppler ultrasound. Increased common carotid artery IMT is correlated with silent cerebral infarcts.This study aimed to show the association between marker of uncontrolled long term hyperglycemia (HbA1C) and marker of atherosclerosis (Carotid intima media thickness [CIMT]) in ischemic stroke patients. Methods: This study was conducted In Deptt. of Medicine, Rajindra hospital Patiala in collabroration with Deptt. Of Radiology and Deptt. of Biochemistry. Results: This study included a total number of 75 patients admitted in various ward of Medicine Deptt. Rajindra Hospital Patiala.CIMT was found to be significantly increased in the patients having diabetics mellitus than non diabetic patients. Conclusion:There is seen a positive correlation of HbA1C with CIMT in our study which included only the ischemic stroke patients.