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   An association between HIV infection and pulmonary arterial hypertension was first reported in 1991. ►   In population studies in which ECHO was used to estimate PA pressure, the incidence of PH ~0.5 % among patients with HIV infection ►   a rate 6 to 12 times as high as in the general population. ►   prevalence has not changed since 1991 despite the introduction of HAART    The occurrence of pulmonary arterial hypertension is independent of the CD4 cell count, but it appears to be related to the duration of HIV infection.    Many of these patients also have foreign-body emboli as a result of the use of intravenous drugs or portal hypertension due to a concomitant infection with hepatitis B or C.    Still under discussion if HIV does directly infect endothelial cells, the mech...

The US Food and Drug Administration (FDA) has approved lubiprostone ( Amitiza , Sucampo Pharmaceuticals Inc/Takeda Pharmaceuticals USA Inc), the first oral treatment for opioid-induced constipation in adults with chronic noncancer pain. This was a Supplemental New Drug Application that received a priority review. This is the third indication for this drug, which is already approved in the United States for the treatment of chronic idiopathic constipation in adults, also at a dose of 24 μg twice daily, and irritable bowel syndrome with constipation in women 18 years of age and older, at a dose of 8 μg twice daily. Approval was based on results from 12-week phase 3 studies in patients taking opioids, including morphine, oxycodone, and fentanyl, for chronic noncancer pain, and a long-term open-label safety study, a release from the companies notes. Two of the phase 3 studies met the overall efficacy endpoint, although a third study did not, they add. The effectiveness of this dru...

Pre-ductal and post-ductal pulse O2 saturation (SpO2) monitors (to detect R → L shunting at ductus arteriosus). A difference of ≥10% suggests marked pulmonary hypertension or PDA dependent leison. Pre-ductal and post-ductal pulse O2 saturation (SpO2) can be used as screening for cyanotic heart disease for NB befor discharge hom fro postnatal ward. For preductal circulation usually the spo2 probe applied right hand ,however recent studies showd the left UE can be used for preductal circulation assessement. The post ductal circulation applied at at lower extremities.

A 73 year old female scheduled for a left femoral to popliteal arterial bypass graft to treat claudication. She has type 2 diabetes which is well controlled on oral agents, mild chronic kidney disease with a baseline creatinine of 1.4 mg/dL, and a history of coronary artery disease. She had an inferior myocardial infarction five years ago. She did not have revascularization and has done well with medical management since that time. Her functional capacity is limited due to the claudication; she is able to walk less than a block, but does not experience angina or dyspnea, only claudication. On examination, her blood pressure is 140/80. Her pulse is 74 beats per minute and regular. The rest of the physical examination is non-contributory other than diminished pulses in her left lower extremity. Her medications include lisinopril, hydrochlorothiazide, aspirin, atorvastatin, metoprolol, metformin and glipizide. An electrocardiogram reveals normal sinus rhythm with Q waves in lead 3 ...

Most Brugada Syndrome (BrS) patients tolerated anesthesia without untoward disease-related complications.  Propofol and local anesthetics carry a theoretical risk of arrhythmogenic potential in BrS patients, but clear evidence is lacking. However, awareness of their potential to induce arrhythmias warrants caution, especially with propofol infusions.  Bupivacaine causes depression of the rapid phase of depolarisation and remains bound to sodium channels longer than other local anaesthetic agents and should be avoided in BrS patients. Regional  anaesthetic techniques, especially peripheral nerve  blocks, may be considered using limited doses and  local anaesthetic adjuncts. Drugs that block sodium channels such as  procainamide and flecainide are contraindicated.  Beta-adrenergic blockade and alpha-receptor  stimulation (norepinephrine and methoxamine)  can augment ST elevation in BrS,  whereas beta-adrenergic stimulation minim...

You are asked to see a 54-year-old man for preoperative risk assessment. He is being considered for repair of an umbilical hernia. He has been told he has liver problems in the past secondary to alcohol abuse and chronic hepatitis C, but he has not sought medical care in several years. He denies the use of alcohol for the past 5 years. He takes no medications. On examination, his blood pressure is 105/77 mm Hg, his pulse is 92 and regular. He is alert and oriented with mild scleral icterus. Gynecomastia and spider angiomata are noted. His abdomen is protuberant with a large umbilical hernia and possible ascites; no hepatomegaly or splenomegaly noted. His neurologic examination is normal. His laboratory tests reveal Sodium 133 mmol/L, Creatinine 1.9 mg/dL, Total Bili 2.3 mg/dL, INR 2.2, Albumin 2.7 g/dL, Platelets 110,000. An ultrasound of the abdomen reveals a cirrhotic liver with moderate ascites. His Child-Turcotte-Pugh (CTP) score is c...

INDICES THAT PREDICT SUCCESSFUL VENTILATOR DISCONTINUATION Respiratory rate <30 breaths per minute Tidal volume >5 ml/kg or >325 mL FVC <15 mL/kg (predicts success) Minute ventilation <15 L/min — Normal 5 – 6 L/min — Patient unlikely to wean if > 15 L/min Maximum inspiratory pressure (PImax) < -30 cmH20 — Measure of respiratory muscle strength — Normal -90 to -120 cmH2O Rapid shallow breathing index (RSBI) = f/VT <105 b/min/L — the ratio of respiratory rate : tidal volume — often used in conjunction with SBT to determine if it should continue — some evidence that its use in protocols delays ventilator discontinuation P0.1/PImax > 0.3 — P0.1 is pressure at the airway opening 0.1 s after start of inspiratory flow — Correlates with central respiratory drive P0.1 x f/VT <300 CROP index (compliance, respiratory rate, oxygenation, maximum inspiratory pressure index) >13 — Cdyn x PImax x (PaO2/PAO2)/f — >13 good ...