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Hyperhomocysteinemia has been considered an independent risk factor in the development of stroke. The present study was undertaken to evaluate serum homocysteine levels in patients with cerebrovascular accidents among the Manipuri population and to compare with the normal cases. Ninety-three cerebrovascular accident cases admitted in the hospital were enrolled for the study and twenty-seven age and sex matched individuals free from cerebrovascular diseases were taken as control group. Serum homocysteine levels were estimated by ELISA method using Axis homocysteine EIA kit manufactured by Ranbaxy Diagnostic Ltd. India. The finding suggests that hyperhomocysteinemia is associated with cerebrovascular accident with male preponderance, which increases with advancing age. However, whether hyperhomocysteinemia is the cause or the result of cerebrovascular accidents needs further investigations.

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Background. HIV patients on highly active antiretroviral therapy (HAART) containing protease inhibitors (PIs) had been often associated with lipodystrophy. However, there are only few studies on association of nucleoside and nonnucleoside reverse transcriptase inhibitors (NRTI and NNRTI) with lipodystrophy. Study Design. One hundred and one HIV male patients were categorised into ART naïve (n = 22), zidovudine (n = 22), stavudine (n = 18), tenofovir (n = 15), and PIs (n = 24) based HAART. Their clinicoepidemiological data had been entered in preformed pro forma. The body composition, using TANITA machine and metabolic parameters like lipid profile, blood sugars was analysed. Results. Clinically, lipoatrophy of face was most prevalent in HIV patients on stavudine (15 patients, 83.3%) and PIs (20 patients, 83.3%) based HAART. The mean BMI among study population was in normal range. Excess visceral fat was most prevalent among patients on PIs, 4 patients (16.7%). The waist-hip ratio was significantly higher in PIs (P = 0.01) based HAART. There was no significant difference among different study populations in terms of BMI (P = 0.917), body water (P = 0.318), body fat (P = 0.172), bone mass (P = 0.200), and muscle mass (P = 0.070). Hypertriglyceridiemia was found in stavudine, tenofovir, and protease inhibitors regimens. Low levels of high density lipoprotein (HDL) was found zidovudine, stavudine, and PIs regimens. Fasting and postprandial hyperglycaemia was found PIs and impaired glucose tolerance in stavudine regimen. Conclusion. Patients on PIs were associated with truncal obesity and lipoatrophy of face, along with dyslipidemia and hyperglycaemia. Stavudine based regimen is associated with hypertriglyceridiemia and low HDL along with lipoatrophy of face.

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<strong>Background:</strong>Knowledge of demographic profiles and baseline characteristics of HIV infected patients is essential for devising prevention strategies. Analysis of factors influencing improvement in CD4 cell count will help to determine prognosis and better implementation of ART.<p><strong>Objectives:</strong> This retrospective study was conducted on HIV patients in Manipur, to assess clinical profile and factors influencing baseline immunological status and response to ART.</p><p><strong>Methodology:</strong> 1231 patients were enrolled. Baseline demographic and laboratory parameters were recorded. CD4 cell counts were recorded at baseline and 6 months after ART initiation.</p><p><strong>Results:</strong> 66.3% patients were male, 74.6% aged 21-40 years, 65.6% were Hindus and 52.9% of urban residence. 17.5% patients had Haemoglobin ≤9 grams/dl. Prevalence of HIV-HBV and HIV-HCV coinfection was 3.4% and 20.5% respectively. Male sex (141.51±96.21 vs. 169.92±111.2 cells/mm³; p=0.001), age &gt;20 years and Haemoglobin ≤9 g/dl (127.5±99.5 vs. 153.8±99.1cells/mm³; p=0.001) were associated with lower baseline CD4 count. Females (219.01±187.2 vs. 161.79±153.35cells/mm³; p=0.001), age group 1-20 years and those without HIV-HCV coinfections (188.72±170.81 vs. 154.20±155.88 cells/mm³; p=0.004) had significant improvement in CD4 count at 6 months-post ART initiation. CD4 response in HIV-HBV coinfected patients was lower (188.59±170.65 vs. 162.39±139.8 cells/mm³; p=0.324) but not statistically significant.</p><p><strong>Conclusion:</strong> Majority of HIV patients in Manipur were - Males, Hindus, aged 21-40 years and of urban residence. Males, age &gt;20 years and haemoglobin ≤9 g/dl were associated with lower baseline CD4 count. HIVHBV/ HIV-HCV coinfection wasn't associated with lower baseline CD4 count. Females, age &lt;20 years and absence of HIV-HBV/HIV-HCV coinfections were associated with superior immunological response to ART.</p>

of examination was all normal. Blood routine examination showed hemoglobin of 9.2 g/dl, total leucocytes count of 17,790 cells/cu mm; neutrophil was 67% and lymphocyte was 30%. Erythrocyte sediment rate was 82 mm/1 st h. No abnormal cells are seen in peripheral smear. Urine routine examination was normal and urinary Bence-Jones proteins were absent. Blood chemistry showed serum creatinine of 4.3 mg/dl, urea of 131 mg/dl, serum calcium was 15.2 mg/dl and serum phosphorus was 5.9 mg/dl. Rheumatoid factor and antinuclear antibody were negative. Cerebrospinal fluid routine examination was normal with no malignant cells. X-ray skull and X-ray chest showed multiple punched out lesions [ Figure 2a and b]. Computed tomography of the spine showed multiple punched out osteolytic lesions over the vertebral body-dorsal 6 th , 8 th , 10 th , and lumbar second [ Figure 3]. Magnetic resonance imaging (MRI) brain showed an extra axial mass at the base of the skull measuring 3.5 × 2.3 cm involving the right side of clivus, dorsum sella, sphenoid, and right cavernous sinus causing the obliteration of cavernous sinus and its contents and extending up to right cerebellopontine angle, isointense in Tl-and T2-weighted images with gadolinium-diethylenetriamine pentaacetic enhancement [ Figure 4a and b]. Bone marrow aspiration showed 58% plasma cells with a good number of binucleated forms and flame cells [ Figure 5a]. Aspiration cytology of right sterno-clavicular joint swelling showed binucleated plasma cells suggestive of plasmacytoma [ Figure 5b]. Serum electrophoresis showed presence of narrow and moderately intense band in gamma fraction suggestive of M-Spike. After reaching the diagnosis of MM with multiple plasmacytoma, patient was treated with thalidomide 200 mg/day and dexamethasone. After 1 month, patient showed improvement clinically [ Figure 6]. ABSTRACT CASE REPORTCompression of cranial nerves (CNs) by an intracranial plasmacytoma is considered to be an unusual presentation of multiple myeloma (MM). Here, we report a case of right 3 rd , 6 th , 9 th , 10 th and 12 th CN involvement, which emphasizes the fact that multiple CN palsy can be the first presenting feature of MM.