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OBJECTIVES: To compare the clinical, radiological and cerebrospinal fluid (CSF) findings, at hospital admission, among adult patients with tuberculous meningitis (TBM) with or without HIV infection and to identify the factors that predict adverse outcome at six months. METHODS: A total of 82 adult patients with TBM were included (40 HIV-positive and 42 HIV-negative). Several clinical (duration of illness, Glasgow Coma Scale score, presence of high temperature, headache, cranial nerve or sphincter abnormality, seizures and endocrine dysfunction), radiological (presence of hydrocephalus, cerebral infarction and oedema, meningeal enhancement, granuloma) and cerebrospinal fluid parameters (glucose, protein, lactate, lymphocytes, neutrophils and adenosine deaminase values) were recorded along with CD4 count in the peripheral blood. Statistical analysis was performed using the chi-square test. Individual variables were evaluated as prognostic factors for adverse outcome in both groups by calculating the relative risk of association for each. RESULTS: Temperature more than 38.33ºC was more common in the HIV-negative group while seizures, hydrocephalus, cerebral infarction and low CD4 count occurred significantly more commonly in the HIV-positive group. Hydrocephalus had strong association with severe neurological deficit and seizure with death in both the groups. CONCLUSION: Several clinical and laboratory features of TBM in patients who are HIV-positive are distinctly different from those without HIV infection; some of these have an association with the probability of adverse outcome.

OBJETIVOS: Comparar los hallazgos clínicos, radiológicos y del líquido cefalorraquídeo (LCR) entre pacientes adultos con meningitis tuberculosa (MTB) con o sin infección de VIH en su ingreso al hospital, e identificar los factores que predicen la evolución clínica adversa en seis meses. MÉTODOS: Un total de 82 pacientes adultos con MTB fueron incluidos (40 VIH positivos y 42 VIH negativos). Se registraron varios parámetros: clínicos (duración de la enfermedad, puntuación de la Escala de Coma de Glasgow, presencia de alta temperatura, dolor de cabeza, anormalidad del esfínter o nervio craneal, o anormalidad del esfínter, convulsiones y disfunción endocrina); radiológicos (la presencia de hidrocefalia, infarto cerebral, edema, realce meníngeo, granuloma); y del líquido (glucosa, proteína, lactato, linfocitos, neutrófilos, y valores de adenosina deaminasa), junto con un conteo de CD4 en la sangre periférica. Se realizó un análisis estadístico usando la prueba de chi-cuadrado. La variable individual se evaluó como factor pronóstico de la evolución clínica en ambos, calculando el riesgo relativo de asociación para cada uno. RESULTADOS: Una temperatura de más de 38.33ºC fue más común en el grupo VIH negativo, mientras que convulsiones, hidrocefalia, infarto cerebral, y bajo conteo de CD4 ocurrieron significativamente más normalmente en el grupo VIH positivo. La hidrocefalia estuvo fuertemente asociada con un déficit neurológico severo y la convulsión con la muerte en ambos grupos. CONCLUSIÓN: Varias características clínicas y de laboratorio del MTB en pacientes que son VIH positivos, difieren claramente de aquellos con infección por VIH. Algunas de estas características se hallan asociadas con la probabilidad de una evolución clínica adversa.

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OBJECTIVES: To compare the clinical, radiological and cerebrospinal fluid (CSF) findings, at hospital admission, among adult patients with tuberculous meningitis (TBM) with or without HIV infection and to identify the factors that predict adverse outcome at six months. METHODS: A total of 82 adult patients with TBM were included (40 HIV-positive and 42 HIV-negative). Several clinical (duration of illness, Glasgow Coma Scale score, presence of high temperature, headache, cranial nerve or sphincter abnormality, seizures and endocrine dysfunction), radiological (presence of hydrocephalus, cerebral infarction and oedema, meningeal enhancement, granuloma) and cerebrospinal fluid parameters (glucose, protein, lactate, lymphocytes, neutrophils and adenosine deaminase values) were recorded along with CD4 count in the peripheral blood. Statistical analysis was performed using the chi-square test. Individual variables were evaluated as prognostic factors for adverse outcome in both groups by calculating the relative risk of association for each. RESULTS: Temperature more than 38.33 degrees C was more common in the HIV-negative group while seizures, hydrocephalus, cerebral infarction and low CD4 count occurred significantly more commonly in the HIV-positive group. Hydrocephalus had strong association with severe neurological deficit and seizure with death in both the groups. CONCLUSION: Several clinical and laboratory features of TBM in patients who are HIV-positive are distinctly different from those without HIV infection; some of these have an association with the probability of adverse outcome.

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OBJECTIVES: To assess the prevalence and the spectrum of psychosocial morbidity and its correlation with various social and disease-related factors in children with beta thalassemia major. STUDY DESIGN: Sixty children with transfusion-dependent beta thalassemia major were included in the study group who fulfilled these inclusion criteria: 1) age 5 to 15 years; 2) both parents alive and living together; 3) negative for human immunodeficiency virus; and 4) no family history of any chronic illness or psychological illness. The control group consisted of 60 children of matched age group and social background. A semi-structured interview and 2 preformed questionnaires (Pediatric Symptom Checklist [PSC] and Childhood Psychopathology Measurement Schedule [CPMS]) were used to assess psychosocial morbidity. RESULTS: The mean score of the PSC was 11.63 +/- 3.79 (range, 7-24) in children with thalassemia, compared with 5.78 +/- 2.572 (range, 2-13) in the control group (P < .001). The mean score of the CPMS was 11.63 +/- 3.6 (range, 6-25) compared with 6.08 +/- 2.8 (range, 1-14) in the study and the control group, respectively (P < .001). Among the children with thalassemia, 54% had a mean CPMS score > or = 10 (which is considered significant for psychopathological disorders), compared with 8.3% in the control group (P < .001). CONCLUSION: Children with thalassemia have significantly higher psychosocial morbidity. Psychosocial aspects need to be addressed in the overall treatment of children with thalassemia to prevent the development of clinically manifest psychological disease.

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Background: SIMPLE II was a multi-centre, prospective registry study aimed at investigating the safety andefficacy of the Infinnium™ (Sahajanand Medical Technologies Pvt. Ltd, India) paclitaxel-eluting stent forthe treatment of single de novo lesions in the native coronary arteries.Methods: One hundred and three patients with symptomatic coronary artery disease were treated for singlede novo native coronary artery lesions using the Infinnium™ stent (paclitaxel concentration1.4 mcg/mm2 released over 48 days) in a multi-centre, prospective study performed on 3 continents (Asia,Europe and South America). The primary safety endpoint was major adverse cardiac events at 30 days(MACE 30d) and efficacy was assessed by in-stent binary restenosis as measured by quantitative coronaryangiography (QCA) at six-month follow-up. A clinical follow-up was scheduled at nine months.Results: The mean patient age was 58.5 years; 70.9% were males; 43.7% had unstable angina and 38.8%previous myocardial infarction. Risk factors included hypertension in 62.1%, hypercholesterolemia in52.4%, current smoking in 32.0% and diabetes in 28.2%. Stent implantation was successful in all patients,with more than one stent being implanted in 9 patients (8.7%). Hierarchical MACE 30d was 2.9%. At ninemonths, 101 patients had clinical follow-up (1 patient had died and 1 refused). There was one death(1.0%), one Q-wave myocardial infarction (Q MI) (1.0%), three non-Q MIs (2.9%), one clinically-driven targetlesion Coronary Artery Bypass Grafting (CABG) (1.0%), and one clinically-driven target lesion repeatpercutaneous coronary intervention (re-PCI) (1.0%). The overall event-free rate at nine months was 93.2%.QCA revealed in-stent and in-segment late loss of 0.38±0.49 mm and 0.18±0.46 mm, resulting in binaryrestenosis rates of 7.3% and 8.3%, respectively. There was one case of late stent thrombosis in the patientexperiencing the Q MI and subsequent re-PCI...

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A review of sixty-five cases of cocaine addiction, treated at St. Ann's Hospital between 1985 and 1986, was conducted. Patients' ages ranged from 14 to 43 years with a male preponderance of five to one. The mean age of admission was 26 years. Female presented at a younger age, with a shorter history of drug use, than males. Thirty-nine patients (60 percent) were Afro-Trinidadians, twelve (18 percent) were Indo-Trinidadians and the remainder (22 percent) Mixed Trinidadians. Fifty-four patients (83 percent) were gainfully employed prior to admission. Women were more than likely to have been unemployed. Twenty-seven patients (42 percent) had been involved in drug-related crimes. Polydrug abuse was the common practice: fifty-nine (91 percent) concomitantly used marijuana and forty-one (63 percent) alcohol. Only three patients (5 percent) were pure cocaine users. No patient admitted to homosexuality and although promiscuity was a common finding, no association has been found with AIDS at the present time (AU)

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