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Constrictive pericarditis: clinical and pathophysiologic characteristics.

Constrictive pericarditis is an uncommon disorder with various causes. Although most often idiopathic, it may also occur after cardiovascular surgery, radiation therapy, and tuberculosis, especially in developing countries. The encasement of the heart by a rigid, nonpliable pericardium results in characteristic pathophysiologic effects, including impaired diastolic filling of the ventricles, exaggerated ventricular interdependence, and dissociation of intracardiac and intrathoracic pressures during respiration. Constrictive pericarditis typically presents with chronic insidious signs and symptoms of predominantly systemic venous congestion. Notoriously difficult to diagnose and distinguish from restrictive cardiomyopathy (RCM), the use of cardiac catheterization, echocardiography (transthoracic and transesophageal), central venous (hepatic and pulmonary) and transvalvular Doppler measurements, and magnetic resonance imaging should secure the diagnosis in most cases, eliminating the need for diagnostic thoracotomy. Although medical treatment may temporarily alleviate symptoms of heart failure, patients do poorly without pericardiectomy.

Animals↗

Complications of HIV disease and antiretroviral therapy.

As antiretroviral treatment regimens become more potent and easier to administer, differences in the rates of adverse events and complications associated with treatment will increasingly drive decisions regarding the selection of therapy. This year's Conference on Retroviruses and Opportunistic Infections featured a wide range of research directed toward understanding the pathogenesis, treatment, and long-term consequences of complications associated with HIV infection and the use of antiretroviral therapy in both resource-limited settings and in the developed world. This review will summarize information on complications of antiretroviral therapy in resource-limited settings, hepatitis C virus, tuberculosis, and discussion of metabolic, cardiovascular, and renal complications.

AIDS-Related Opportunistic Infections↗

Asian/Pacific Islander American nurses workforce: issues and challenges for the 21st century.

The trend of high incidence of lung cancer, cardiovascular disease, Hepatitis B, and tuberculosis among the Asian/Pacific Islander Americans (APIAs) will significantly affect the increased need for culturally competent care for this particular ethnic group. There is a need to increase the numbers of Asian/Pacific Islander American nurses in the future workforce to meet the health needs of this heterogenous and diversified population. Current workforce data on the Asian/Pacific Islander American nurses is misleading, since data collection aggregates all APIAs into a single category, with disregard to the various subgroupings of this large ethnic group.

Asian↗

Heart disease: the greatest 'risk' factor of them all.

By the turn of the last century, flying in the face of over a hundred years of research and clinical observation to the contrary, medicine abandoned the link between infection and atherogenesis; not because it was ever proven wrong, but because it did not fit in with the trends of a medical establishment convinced that chronic disease such as heart disease must be multifactorial, degenerative and non-infectious. Yet it was the very inability of 'established' risk factors such as hypercholesterolemia, hypertension and smoking to completely explain the incidence and trends in cardiovascular disease that resulted in historically repeated calls to search out an infectious cause, a search that began more than a century ago. Today, half of US heart attack victims have acceptable cholesterol levels and 25% or more have none of the "risk factors" associated with heart disease, including smoking, high blood pressure or obesity, most of which are not inconsistent with being caused by infection. Even the case of the traditionalist's latest 2003 JAMA assault to 'debunk' what they call the "50% risk factor myth" falls woefully short under scrutiny. In one group 30% died of heart disease with a cholesterol of at least 240 mg/dl, a condition which also existed in 21% who did not die during the same period. And the overlap was obvious throughout the so-called risk categories. Under such scrutiny, lead author Greenland conceded that if obesity, inactivity and elevated cholesteriol in the elderly are included, just about everyone has a risk factor and he likened the dilemma of people who do or do not wind up with heart disease akin to the susceptibility of people who are exposed to tuberculosis but do not get the disease. In Infections and Atherosclerosis: New Clues from an old Hypothesis? Nieto stressed the need to extend the possible role of infectious agents beyond the three infections which have in recent years been the focus of research: Cytomegalovirus (CMV) Chlamydia pneumoniae and Helicobactor pylori. Mycobacterial disease shares interesting connections to heart disease. Not only is tuberculosis the only microorganism to depend on cholesterol for its pathogenesis but CDC maps for cardiovascular disease bear a striking similarity to those of State and regional TB case rates. Ellis, Hektoen, Osler, McCallum, Swartz, Livingston and Alexander-Jackson all saw clinical and laboratory evidence of a causative relationship between the mycobacteria and heart disease. And Xu showed that proteins of mycobacterial origin actually led to experimental atherosclerosis in laboratory animals Furthermore present day markers suggested as indicators for heart disease susceptibility such as C-Reactive Protein (CRP), interleukin-6 and homocysteine are all similarly elevated in tuberculosis. It therefore behooves us to explore the link between heart disease and typical and atypical tuberculosis.

Comorbidity↗