Obstructive sleep apnea and ischemic heart disease in southwestern US veterans: implications for clinical practice

This study describes associations between obstructive sleep apnea (OSA), intake of food rich in antioxidant nutrients, and ischemic heart disease (IHD) in military veterans. Subjects were male veterans (n=211), 54 to 85 years of age, and enrolled in primary care clinics at the Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, AZ. Measures included the SAVAHCS Minority Vascular Center Questionnaire, the Sleep Heart Health Study Sleep Habits Questionnaire, the Arizona Food Frequency Questionnaire, height, weight, and blood pressure. Veterans with OSA were significantly more likely to be obese, to have elevated systolic blood pressure and physician-diagnosed IHD, more likely to undergo coronary angiography, and less likely to consume foods rich in cardioprotective antioxidants compared to veterans without OSA. After adjusting for confounding variables, the association between OSA and IHD remains significant [adjusted OR=2.99, confidence interval (CI)=1.07–8.42]. These data reinforce the importance of recognizing OSA within the veterans affairs health care system and suggest that early detection of OSA may improve veterans' health and well-being and reduce associated medical costs. This study was presented as a poster at the 17th Annual American Professional Sleep Society Meeting, Chicago, IL, USA June 3–8 2003     

Manganese superoxide dismutase activity and incidence of hepatocellular carcinoma in patients with Child-Pugh class A liver cirrhosis: a 7-year follow-up study.

AIMS: To evaluate possible modifications in the manganese superoxide dismutase (MnSOD) activity during neoplastic transformation of a cirrhotic liver and to find out whether its assessment may have predictive value to identify cirrhotic patients at a higher risk of hepatocellular carcinoma (HCC). METHODS: Seventy-one consecutive subjects with Child-Pugh class A liver cirrhosis were recruited. At the time of enrolment, HCC was diagnosed in 20 cirrhotic patients. The 51 cirrhotic patients without HCC were followed up for the occurrence of tumour by 6-monthly screening for 7 years. During follow-up, 16 patients developed HCC. Seventy healthy subjects formed the control group. MnSOD activity was assayed spectrophotometrically. RESULTS: Serum MnSOD activity was significantly lower in 70 healthy subjects compared with 51 cirrhotic patients and 20 cirrhotic patients with HCC. Cirrhotic patients who developed HCC during follow-up showed significantly higher values of MnSOD activity than HCC-free patients. The best cut-off of MnSOD activity was 0.40 U/ml. At this cut-off, chi2 analysis revealed that MnSOD activity was significantly different between the HCC-free cirrhotic patients and cirrhotic patients who developed HCC. CONCLUSION: The present findings suggest that during neoplastic transformation of cirrhotic liver, an increase in MnSOD activity may occur already during the precancerous phase, making this enzyme a probable malignancy-associated parameter.     

IncA/C Plasmid Carrying blaNDM-1, blaCMY-16, and fosA3 in a Salmonella enterica Serovar Corvallis Strain Isolated from a Migratory Wild Bird in Germany

A Salmonella enterica serovar Corvallis strain was isolated from a wild bird in Germany. This strain carried the IncA/C₂ pRH-1238 plasmid. Complete sequencing of the plasmid was performed, identifying the bla_NDM-1, bla_CMY-16, fosA3, sul1, sul2, strA, strB, aac(6′)-Ib, aadA5, aphA6, tetA(A), mphA, floR, dfrA7, and merA genes, which confer clinically relevant resistance to most of the antimicrobial classes, including β-lactams with carbapenems, fosfomycin, aminoglycosides, co-trimoxazole, tetracyclines, and macrolides. The strain likely originated from the Asiatic region and was transferred to Germany through the Milvus migrans migratory route.     

Atrial fibrillation in heart failure: drug therapies for rate and rhythm control

Pharmacological treatment of atrial fibrillation in the context of heart failure poses numerous challenges. Management decisions are limited by contraindications to several drugs and the paucity of robust clinical trials that provide evidence-based guidance. This review proposes a structured action plan for managing atrial fibrillation coexisting with heart failure that considers published clinical guidelines and integrates recent data derived from substudies of randomized trials, including the atrial fibrillation and congestive heart failure (AF-CHF) trial. Areas of uncertainty, such as target heart rates in atrial fibrillation and upstream therapies, are also discussed.