Risk of Adverse Cardiovascular Outcomes in Postmenopausal Women with Inflammatory Bowel Disease.

BACKGROUND: Individuals with inflammatory bowel disease (IBD) who lack traditional cardiovascular disease (CVD) risk factors, such as young females, are observed to experience adverse CVD outcomes. Whether women with IBD have increased CVD risk after the menopause transition is unclear. METHODS: We conducted a survival analysis of Women's Health Initiative (WHI) participants and excluded those with missing IBD diagnosis, model covariate data, follow-up data, or a baseline history of the following CVD outcomes: coronary heart disease (CHD), ischemic stroke, venous thromboembolism (VTE), peripheral arterial disease (PAD). Risk of outcomes between IBD and non-IBD women was performed using Cox proportional hazard models, stratified by WHI trial and follow-up. Models were adjusted for age, socio-demographics, comorbidities (e.g., hypertension, diabetes, hypercholesterolemia, etc.), family history, and lifestyle factors (e.g., smoking, alcohol, physical activity, body mass index, etc.). RESULTS: Of 134,022 WHI participants meeting inclusion criteria, 1367 (1.0%) reported IBD at baseline. Mean baseline age was 63.4 years. After adjusting for age and other confounders, no significant difference was observed between IBD and non-IBD women for the risk of CHD (HR 0.96, 95% CI 0.73-1.24), VTE (HR 1.11, 95% CI 0.81-1.52) or PAD (HR 0.64, 95% CI 0.28-1.42). After adjusting for age, risk of ischemic stroke was significantly higher (HR 1.41, 95% CI 1.06-1.88) in IBD than non-IBD women. With further adjustment, the excess risk of ischemic stroke among IBD women was attenuated and no longer statistically significant (HR 1.31, 95% CI 0.98-1.76). CONCLUSIONS: Among postmenopausal women with IBD, risk of ischemic stroke may be higher than in non-IBD women.

Major risk factors for leprosy in a non-endemic area of the United States: A case series.

Approximately 200 cases of leprosy are reported each year in the United States, and about 175 of the cases are diagnosed for the first time. Florida contributes a large number of reported cases each year and is showing an increasing incidence. Studies from other southern U.S. states demonstrate infection with the same strain of Mycobacterium leprae, confirming human armadillo exposure as the main risk factor. In contrast, cases from Florida show no clear risk factor. We present three cases (two foreign born and one autochthonous case) from Hillsborough county Florida, that were reported from this non-endemic area during the past five years. The first case was a 35-year-old male from Mexico, with history of exposure from a Haitian inmate, who presented with multiple erythematous non-tender cutaneous lesions and numbness in both hands. Biopsy confirmed borderline lepromatous leprosy. The second case was a 34-year-old male, from Florida who presented with sparse annular non-supporative lesions on left cheek with one-month duration and denied leprosy or armadillo exposure. Biopsy confirmed the diagnosis of borderline tuberculoid leprosy. The third case was a 38-year-old female, from Puerto Rico who presented with disseminated painless plaques, edema of the hands with numbness and paresthesia. She denied leprosy or armadillo exposure. The biopsy confirmed borderline lepromatous leprosy with erythema nodosum leprosum. Our case series demonstrates that a history of armadillo exposure is not always present. Other risk factors need to be considered when leprosy is a possible diagnosis in a patient.

Pulmonary fibrosis: a disease of alveolar collapse and collagen deposition.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a relentless form of fibrotic lung disease with a median survival of approximately 3 years after diagnosis and a mortality rate that surpasses that of many types of cancer. The pathophysiology of IPF is complex as there are likely different stages of disease occurring simultaneously in the lung. Areas covered: Some scientists consider IPF as primarily an epithelial driven disease in which dysfunctional surfactant-producing cells take an etiological precedent. Others focus on the augmented deposition of collagen within the interstitium as the primary inciting event causing fibrosis. An increase in collagen deposition augmenting the tensile strength of the pulmonary interstitium fits with the well-known restrictive nature of fibrotic lung diseases; however, it fails to explain the creation of cystic 'honeycombing' lesions and the preference of such lesions for the peripheral and basilar lung parenchyma. Expert opinion: In this paper, we will review both ideas and propose incorporating them into a single pathophysiological chain-of-events that could account for all the features that characterize IPF, allowing us to envision new therapeutic approaches to improve patient outcomes.