Chronic obstructive pulmonary disease and HIV: are we appropriately screening?

Individuals with human immunodeficiency virus (HIV) represent a population that is at a higher risk of developing chronic obstructive pulmonary disease (COPD). In this study, we sought to determine the effects of smoking on respiratory symptoms and diseases among HIV-positive patients and to determine if symptomatic patients are being appropriately screened for COPD. HIV-positive individuals completed a self-administered questionnaire. The effects of smoking on respiratory symptoms and diseases were reported as odds ratios (ORs). The COPD screening criteria were adapted from the Canadian Thoracic Society (CTS) guidelines. Two hundred and forty-seven participants were recruited. The median age was 49 years; 75% were male and 92% were on highly active antiretroviral therapy. Smokers represented 66% of the population. Smoking had a statistically significant effect on respiratory symptoms including wheeze (OR 4.8 [95% confidence interval (CI) 1.6–14.2]), phlegm production (OR 4.9 [95% CI: 2.2–10.5]), cough (OR 7.0 [95% CI: 3.0–16.2]), and dyspnea (OR 7.2 [95% CI: 1.7–31.2]). Smoking had a higher odds of respiratory diseases including COPD (OR 4.9 [95% CI: 1.1–21.9]) and bronchitis (OR 3.8 [95% CI: 1.9–7.7]). Among HIV-positive smokers, 40% met the CTS screening criteria, while only 12% self-reported a diagnosis of COPD. The burden of smoking in the HIV population is significant. HIV-positive smokers are more likely to report both respiratory symptoms and diseases than HIV-positive non-smokers. A discrepancy exists between patients who met the CTS screening criteria and those who were diagnosed with COPD, raising the concern for under-recognition and under-diagnosis of COPD in this population.     

Endoscopic imaging: How far are we from real-time histology?

Currently,in gastrointestinal endoscopy there is increasing interest in high resolution endoscopic technologies that can complement high-definition white light endoscopy by providing real-time subcellular imaging of the epithelial surface.These ’optical biopsy’ technologies offer the potential to improve diagnostic accuracy and yield,while facilitating real-time decision-making.Although many endoscopic techniques have preliminarily shown high accuracy rates,these technologies are still evolving.This review will provide an overview of the most promising high-resolution imaging technologies,including high resolution microendoscopy,optical coherence tomography,endocytoscopy and confocal laser endoscopy.This review will also discuss the application and current limitations of these technologies for the early detection of neoplasia in Barrett’s esophagus,ulcerative colitis and colorectal cancer.     

Rectal endosonography: just how good are we at its interpretation?

Background  

Endorectal ultrasound (ERUS) has become an integral part of the assessment of rectal tumors. It provides information about the depth of invasion and lymph node status which in turn is used in devising a management plan. It is important therefore that accurate interpretation of these studies is achieved. The aim of this study was to assess how accurately we interpret ERUS.     

From 1901 to 2022, how far are we from truly understanding the pathogenesis of age-related dementia?

GeroScience - From the first described AD case in 1901 to the current year 2022, understanding the pathogenesis of Alzheimer’s disease (AD) and dementia has undergone a long and tortuous...     

Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension: How can patients be better selected?

Chronic thromboembolic pulmonary hypertension (CTEPH) comprises organizing thrombotic obstructions in the pulmonary arteries by nonresolving thromboemboli, formation of fibrosis and remodeling of pulmonary blood vessels. Surgical pulmonary endarterectomy (PEA) is the therapy of choice for patients with surgically accessible CTEPH, which leads to a profound improvement in hemodynamics, functional class and survival. Select- ing the candidates that will benefit from surgery is still a challenging task. Criteria for surgical suitability have been described but the decision-making for or against surgical intervention remains still subjective. The optimal characterization of the reciprocal contribution of large vessel and small vessel disease in the elevation of pulmonary vascular resistance is crucial for the indication and outcome of PEA. Recently, Toshner et al intended to validate the partition resistance into small and large vessels compartments (upstream resistance:Rup) by the occlusion technique in the preoperative assessment of PEA. We discuss the advantages and disadvantages of Rup and compare it with other hemodynamic predictor to evaluate operative risk in CTEPH patients.     

Hypertension control: how well are we doing?

BACKGROUND: We compared blood pressure (BP) control in a recent cohort of hypertensive military veterans with BP control in a previous cohort and examined whether hypertension treatment practices, as defined by the frequency of antihypertensive medication dosage increases, have changed over time. METHODS: We abstracted 1999 outpatient chart data including visit type, BP measurements, comorbidities, and medication use for 981 randomly selected hypertensive veterans. We examined overall BP control and control in subgroups with diabetes mellitus and renal disease, and compared results with those of a sample of 800 veterans studied from 1990 to 1995. We also compared the frequency of antihypertensive medication dosage increases in the 2 samples. RESULTS: Mean BPs were significantly lower in 1999. The mean systolic drop was 3.1 mm Hg and reached 13.7 mm Hg for the subgroups with diabetes and renal disease. Even larger decreases were seen in mean diastolic BPs. In 1999, 57% of patients had BP measurements of 140/90 mm Hg or higher, vs 69% of patients in the 1990-1995 study (P<.001). In 1999, the BP control of patients with diabetes was similar to that of patients without diabetes, as 60% of the former had BP measurements of 140/90 mm Hg or higher. Patients with renal disease had better control than those without, however, as only 43% had BP measurements of 140/90 mm Hg or higher. When comparing samples, patients with diabetes, renal disease, or both had better BP control in 1999 than their counterparts in the 1990-1995 study (P<.003 in all cases). In 1999, more medical visits were associated with medication dosage increases than in the 1990-1995 study. CONCLUSIONS: Although overall BP control has improved, BP measurements still exceeded recommended levels in most patients. For patients with diabetes and renal disease BP was much better controlled in the more recent sample. However, BP control of patients with diabetes was similar to that of patients without diabetes, and not in agreement with the guideline-recommended tighter control. Thus, room for improvement remains, especially in this subgroup.     

Renovascular hypertension in 2007: Where are we now?

Hypertension in patients with renovascular disease poses a major clinical challenge. Renal arterial disease accelerates hypertension by activation of multiple pressor systems. Although younger individuals with fibromuscular lesions often respond well to angioplasty with minor associated risks, care must be taken in cases of complex vascular anomalies, such as renal artery aneurysms. More than 85% of patients referred for revascularization have atherosclerotic renal artery stenosis; most are older patients with preexisting hypertension, diabetes, and vascular disease. The benefits of stent revascularization in this group are controversial. Antihypertensive therapy works best with drugs that block the renin-angiotensin system; however, most patients require multiple agents. Detailed analysis of the literature and small prospective trials failed to identify major benefits with renal artery angioplasty as compared with intensive drug therapy. The CORAL study and others seek to randomly assign subjects with high-grade renovascular lesions to optimal medical management with and without stenting.