The Global Lung Initiative 2012 reference values reflect contemporary Australasian spirometry

We aimed to ascertain the fit of the European Respiratory Society Global Lung Initiative 2012 reference ranges to contemporary Australasian spirometric data. Z‐scores for spirometry from Caucasian subjects aged 4–80 years were calculated. The mean (SD) Z‐scores were 0.23 (1.00) for forced expirtory volume in 1 s (FEV₁), 0.23 (1.00) for forced vital capacity (FVC), ?0.03 (0.87) for FEV₁/FVC and 0.07 (0.95) for forced expiratory flows between 25% and 75% of FVC. These results support the use of the Global Lung Initiative 2012 reference ranges to interpret spirometry in Caucasian Australasians.     

The relation between atherosclerosis and the occurrence of postoperative delirium in vascular surgery patients

Old and frail patients undergoing vascular surgery seem at great risk of developing postoperative delirium (POD). The aim of this review was to identify risk factors for the development of POD in vascular surgery patients. Different aetiological factors have been identified, such as increased age, excessive blood transfusion, preoperative cognitive impairment and depression. Mounting evidence supports a role for inflammation and tobacco exposure in the development of POD. Vascular surgery patients differ from the general surgical population because they suffer from both loco-regional and systemic atherosclerosis. Although current scientific evidence cannot fully link both entities, evidence is growing that suggests a relationship between systemic and cerebrovascular atherosclerosis and the development of POD.     

Can we predict and prevent adverse events related to high-voltage implantable cardioverter defibrillator lead failure?

Background  

In 2007, great concern arose regarding failure of implantable cardioverter defibrillator (ICD) leads from several manufacturers.     

Blood Pressure Effects of Combined β-Blocker and Angiotensin-Converting Enzyme Inhibitor Therapy Compared With the Individual Agents: A Placebo-Controlled Study With Nebivolol and Lisinopril

J Clin Hypertens (Greenwich). 2012; 14:588–592. © 2012 Wiley Periodicals, Inc. Blood pressure (BP) reductions when combining blockers of the renin‐angiotensin system (RAS) and β‐blockers have generally not been shown to be greater than for individual agents, possibly because of overlapping mechanisms of action. The authors tested the additivity of the β‐blocker nebivolol, which has vasodilating activity, with the angiotensin‐converting enzyme inhibitor lisinopril in patients with stage 2 diastolic hypertension. The BP effects of placebo (n=93), nebivolol 5 mg to 20 mg daily (n=185), lisinopril 10 mg to 40 mg daily (n=189), and nebivolol 5 mg to 20 mg + lisinopril 10 mg to 40 mg (n=189) during 6 weeks of treatment were compared. The primary end point was change in diastolic BP (DBP). For the full cohort, baseline BP was 163.8/104.4 mm Hg, mean age was 49.2 years, 58% were men, 62% were white, and 34% were black. DBP fell by 17.2±10.2 mm Hg with the combination, greater than placebo (8.0±9.2, P<.0001), nebivolol (13.3±8.9, P=.0010), and lisinopril (12.0±9.8, P<.0001). For systolic BP, corresponding reductions were 19.2±19.8 mm Hg, 9.9±16.4 (P<.0001 vs combination), 14.4±14.1 (P=.0470), and 16.1±17.2 (P=.0704). Adverse event rates were similar in all groups. This study demonstrated the potential antihypertensive benefits of combining nebivolol with a RAS blocker.     

HIV patients treated with low-dose prednisolone exhibit lower immune activation than untreated patients

Background  

HIV-associated general immune activation is a strong predictor for HIV disease progression, suggesting that chronic immune activation may drive HIV pathogenesis. Consequently, immunomodulating agents may decelerate HIV disease progression.     

Acute Massive Pulmonary Thromboembolism Due to Acute Intoxication by Duloxetine: A Case Report

Duloxetine (Cymbalta) is a potent serotonin norepinephrine reuptake inhibitor used for the management of major depression and pain associated with diabetic peripheral neuropathy. Cymbalta delayed-release capsules contain Duloxetine HCl equivalent to 20, 30, 60?mg of Duloxetine. The ingestion of high quantities of Duloxetine may have serious outcomes such as venous thrombosis, causing cardiac respiratory arrest. The Authors outline a case report of an elderly woman, suffering from depression, found dead in her apartment. The cause of death was attributed to acute massive pulmonary thromboembolism due to acute intoxication of Duloxetine bought the day before. The thesis supported by the authors and confirmed by the data from other studies is that a massive intake of Duloxetine drug increases considerably the medication's side effects such as somnolence, dry mouth, fatigue, insomnia, dizziness, constipation, considerable increases in recumbent systolic and diastolic blood pressure, and a small decrease in heart rate.