Search PubMed⌕ Search

Biomedical subjects

S Aiyer

Publications and source records attributed to S Aiyer.

7 recordsLinked to original sources
PubMed2002

Home-made gun injury: spontaneous version and anterior migration of bullet.

We report a unique case of a self-inflicted brain injury using an ingenious home-made gun with spontaneous anterior migration of the intact bullet. On admission, the patient was fully conscious with no neurological deficits. Computed tomography (CT) confirmed a penetrating missile injury with transventricular across midline trajectory and multi-lobe injury with the bullet lodged in the occipital lobe. Serial CT revealed spontaneous version with anterior migration of the bullet from the occipital lobe to finally come to rest in the ipsilateral frontobasal region. The bullet was removed via a left supra-orbital craniotomy. The patient experienced good outcome. Home-made gun injuries, although uncommon today, represent a special form of missile injury with unique low velocity terminal ballistics. As these weapons are seen infrequently today, surgeons should be alerted to their existence as patients with this form of injury usually have a good prognosis if vital brain structures are spared.

Adult↗
PubMed1998

Maternal viral load, CD4 cell count and vertical transmission of HIV-1.

HIV load and CD4 cell numbers were measured among 95 HIV infected women during pregnancy in order to determine their value as prognostic markers for transmission of virus from mother to infant. Among the 94 live births, 13 children were infected with HIV, 69 were uninfected and 12 were of unknown infection status. HIV RNA levels, as measured by nucleic acid sequence based amplification, were significantly higher (P < 0.001) in women who transmitted virus than among those who did not transmit and maternal viral load was a stronger predictor of transmission than CD4 cell number. The predicted rate of transmission relative to maternal HIV RNA was 2% at 1,000 copies, 11% at 10,000 copies and 40% at 100,000 copies/ml. Little variation in viral load occurred during pregnancy and there was an association between viral load and prematurity, the mean gestation at delivery decreasing by 1.3 weeks for every 10-fold increase in maternal HIV RNA (P = 0.007). This study demonstrates that a high level of maternal HIV RNA is a risk factor for transmission of virus to the infant and maternal viral load is of more value as a prognostic marker for transmission risk than CD4 cell number. High viral load is also associated with premature delivery. Maternal viral load is therefore a useful marker on which to base management decisions during pregnancy.

CD4 Lymphocyte Count↗
PubMed1996

Significance of placental damage in vertical transmission of human immunodeficiency virus.

The significance of physical breaches of the trophoblastic layer of the placenta in transmission of HIV from mother to infant was evaluated in 17 HIV-infected pregnant women. Samples of peripheral blood were obtained from the women during pregnancy and at delivery, at which time a small piece of placental tissue was obtained from a random site and immediately placed into fixative. Blood samples were obtained from infants at or shortly after birth and thereafter at approximately 3-month intervals, until the age of 18 months, in order to determine their HIV infection status. HIV RNA and p24 antigen were quantified in maternal plasma and CD4 cells enumerated. Paediatric diagnosis was conducted using polymerase chain reaction, virus isolation, detection of p24 antigen, and measurement of class-specific antibodies. Placental damage was quantified and evaluated using transmission electron microscopy. Maternal viral load was low, with a mean RNA copy number of 8,237 per millilitre of plasma (range 230-37,233 copies/ml). Only two women were p24-antigenaemic, and CD4 numbers ranged from 0.09 to 2.8 x 10(9)/l. There was evidence of breaks in the trophoblastic surface to the depth of the basement membrane in all 17 placentas, and perivillous fibrinoid deposits were also observed to a varying degree in all samples. However, none of the 13 infants available for follow-up had evidence of infection with HIV. Superficial damage to the trophoblastic surface of the placenta, with exposure of the basement membrane and potential exposure of CD4-expressing cells, does not appear to be a significant factor in the transmission of HIV from mother to infant during pregnancy.

Female↗