Effects of obesity and gender on exercise capacity in urban children.

BACKGROUND: The prevalence of childhood and adolescent obesity has been rising steadily over the last few decades and is now considered one of the most important issues worldwide. OBJECTIVE: The goal of this study was to investigate the influence of body mass on fitness in a healthy cohort of urban children and adolescents and to evaluate the difference in the cardiovascular responses, as measured by heart rate and endurance time, elicited with exercise in each gender. METHODS: This observational study was conducted in an exercise laboratory. Participants were healthy boys and girls aged 4 to 18 years. The study evaluated heart rate and endurance time during exercise testing on a treadmill. Outcome measures were endurance time and heart rate. RESULTS: The study comprised 303 boys and 222 girls ranging in age from 4 to 18 years (mean [SD], 12.2 [3.48] years). Obese children had a significantly lower endurance time than nonobese children (boys, P < 0.0001; girls, P = 0.0001). The mean (SEM) decrease in endurance time for obese versus nonobese children was 1.90 (0.38) minutes for boys and 1.52 (0.39) minutes for girls. A decrease in mean endurance time of 0.69 minute for each unit increase in BMI was noted. Obese boys and girls performed at a higher heart rate than their nonobese counterparts, although there was no statistically significant difference in maximum heart rate achieved by obese and nonobese children (boys, P = 0.71; girls, P = 0.79). CONCLUSIONS: Endurance time was significantly decreased in these obese boys and girls, and they performed at a higher heart rate earlier in exercise than nonobese children. There was no significant difference in maximum heart rate between obese and nonobese children.

Simple scoring system for early management of heparin-induced thrombocytopenia.

This study was performed to develop a simple scoring system to aid in the early clinical management of patients suspected of heparin-induced thrombocytopenia (HIT) with regard to decisions for continued heparin therapy. The system was designed to arrive at low (0) or possible (1) probability scores without knowledge of laboratory test results (except platelet counts) to avoid delays. As the safest clinical approach is to discontinue heparin, intermediate and high scores were combined. Critically ill VA hospital patients (n = 100) with a ≥30% fall in platelet count were assessed by platelet aggregation (PA), (14)C-serotonin release assay ((14)C-SRA), and GTI ELISA. In this population, 53% were scored 1 and of these 43% were positive by laboratory test. Emphasizing the decision to discontinue heparin, the clinical signs of HIT were paramount for the immediate determination of a diagnosis of HIT without dependence on a positive laboratory test.

Pediatric pulmonary arterial hypertension--a review.

Pulmonary arterial hypertension (PAH) afflicts thousands of children worldwide. The pathophysiology involves intravascular proliferation and remodeling leading to an increase in pulmonary vascular resistance which if left untreated results in right heart failure and death. Signs and symptoms are subtle as the disease progresses to irreversible lung damage. There is no cure for PAH, however newer methods of treatment can successfully manage these patients and delay progression of the disease process.

Diabetes--a silent disorder.

The earliest diagnosis of diabetes is a mandate to arrest the worldwide epidemic of diabetes. The insulin assay with the oral glucose tolerance provides the earliest diagnosis. The pathology of diabetes occurs in those with normal blood sugars. With earliest diagnosis, the 'diabetes epidemic' can be arrested and then reversed.

Digoxin and reduction of heart failure hospitalization in chronic systolic and diastolic heart failure.

In the Digitalis Investigation Group trial, digoxin-associated decrease in the combined end point of heart failure (HF) hospitalization or HF mortality was significant in systolic but not in diastolic HF. To assess whether this apparent disparity could be explained by differences in baseline characteristics and sample size, we used propensity score matching to assemble a cohort of 916 pairs of patients with systolic and diastolic HF who were balanced in all measured baseline covariates. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of the effect of digoxin on outcomes separately in systolic and diastolic HF, at 2 years (protocol prespecified), and at the end of 3.2 years of median follow-up. HF hospitalization or HF mortality occurred in 28% and 32% of patients with systolic HF (HR digoxin vs placebo 0.85, 95% CI 0.67 to 1.08, p = 0.188) and 20% and 25% in those with diastolic HF (HR 0.79, 95% CI 0.60 to 1.03, p = 0.085) receiving digoxin and placebo, respectively. At 2 years, HRs for this combined end point were similar for systolic HF (0.72, 95% CI 0.55 to 0.95, p = 0.022) and diastolic HF (0.69, 95% CI 0.50 to 0.95, p = 0.025). Digoxin also decreased 2-year HF hospitalization in systolic HF (HR 0.73, 95% CI 0.54 to 0.97, p = 0.033) and diastolic HF (HR 0.64, 95% CI 0.45 to 0.90, p = 0.010). In conclusion, as in patients with systolic HF, digoxin was equally effective in those with diastolic HF, who constitute half of all patients with HF, yet have few evidence-based therapeutic options.

A brief history of scientific geriatric cardiology.

Comprehensive therapists need awareness of the long period of neglect of the elderly cardiac patient, its improvement in the last third of a century, and a look to the future.

Human sexual intercourse.

The comprehensive therapist needs to view human sexual intercourse comprehensively to avoid its hazards and to promote its benefits for all patients.

Alcohol consumption: benefit versus peril.

Like medication, alcohol has benefits in appropriate small doses and has perils in greater doses. Comprehensive therapists need to understand both!

Wine, beer, and spirits metabolism.

Comprehensive therapists regularly encounter patients consuming alcoholic beverages. It remains important that they understand how the body deals with its consumption, whether temperate and intemperate.

Pulmonary arterial hypertension.

Better recognition of primary pulmonary hypertension can produce better treatment by comprehensive therapists.

Effects of discontinuation of digoxin versus continuation at low serum digoxin concentrations in chronic heart failure.

Discontinuation of digoxin is associated with worsening heart failure (HF) symptoms. However, the long-term effects of discontinuation of digoxin therapy on mortality and morbidity in HF have not been well studied. Of the 7,788 participants in the Digoxin Investigation Group trial, 3,365 received digoxin before randomization. During the trial, digoxin was continued in 1,666 patients and discontinued in 1,699 patients. Using multivariable Cox regression analyses, we first determined the effect of discontinuation of digoxin on mortality and hospitalization during 39.7 months of median follow-up. Of the 1,666 patients continued on digoxin, 457 had low (0.5 to 0.9 ng/ml) and 340 had high (>or=1.0 ng/ml) serum digoxin concentrations (SDC) after 1 month of therapy and of the 1,699 patients whose digoxin was discontinued, 1,674 were alive at 1 month. We examined the effects of continuation of digoxin at low or high SDC. Compared with continuation of long-term digoxin therapy, discontinuation of digoxin was associated with a significant increase in all-cause hospitalization (adjusted hazard ratio [AHR] 1.18, 95% confidence interval [CI] 1.09 to 1.28, p <0.0001) and HF hospitalization (AHR 1.35, 95% CI 1.20 to 1.51, p <0.0001), but had no effect on all-cause mortality (AHR 1.06, 95% CI 0.95 to 1.19, p = 0.272). In contrast, continuation of digoxin at low SDC was associated with a reduction in all-cause mortality (AHR 0.75, 95% CI 0.63 to 0.90, p = 0.002), all-cause hospitalization (AHR 0.80, 95% CI 0.70 to 0.91, p = 0.001), and hospitalization for HF (AHR 0.60, 95% CI 0.50 to 0.73, p <0.0001). In conclusion, continuation of long-term digoxin therapy at low SDC was associated with reduction in mortality and hospitalization in ambulatory patients with chronic HF receiving background therapy with angiotensin-converting enzyme inhibitors and diuretics.

Thromboembolism in cancer patients: pathogenesis and treatment.

In this review we summarize the causes of cancer related thrombosis as well as modern treatment approaches. Malignancy as a risk factor for thromboembolism is becoming increasingly recognized by clinicians caring for these patients. The probability of thrombosis occurring in an individual patient is dependent on several factors, including accompanying medical problems, the type of cancer, the clinical stage, performance status, and the treatment modalities employed. Thrombophilia with a history of thromboembolism is important as well. The overall risk of thrombosis is sevenfold that of noncancer patients. Though much has been learned about the pathogenesis of cancer-related thrombosis, we are in fact just beginning to understand the cross-talk between cancer cells and their related microenvironment, and such investigations are likely to increase our knowledge of cancer-related thrombosis mechanisms. Research in these areas may also suggest new strategies for cancer prevention, metastasis suppression, and new treatments. Drugs used in cancer therapy are increasingly recognized to directly contribute to the thrombotic tendency. Few studies provide data on the optimal management of cancer patients with thrombosis. It has been learned that retreating with the same drug can be very hazardous. In general the approach to prevention of thrombosis is the same as for noncancer patients, recognizing that specific cancer types and stage can place a patient in a high-risk category. Initial coumadin therapy fails in a significant number of patients with cancer. Recognition of the cancer patients at highest risk for coumadin failure is challenging. Low-molecular-weight heparins appear to be more effective in such situations where coumadin is likely to fail or has failed, but these drugs are thought to be costlier. Newer agents such as Factor Xa inhibitors and TF inhibitors are currently under investigation and may be found useful in the management of cancer-related thrombosis.

Pain, analgesics, and the cardiovascular system.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most used medications in the world. Ordinarily considered to be safe and effective when used according to labeling instructions, their safety for patients with cardiovascular disease is now being reassessed.

The classical vs nonclassical NSAIDs: can the reduction in pain overcome the thrombotic risk?

The advent of cyclooxygenase-2 inhibitors has been both a blessing and a curse for pain management. An in-depth understanding of the biological molecules in the arachidonic acid metabolism may alleviate pain without risk.

Unstable angina treatment: 2006 update.

Properly treated, unstable angina and non-Q wave myocardial infarction have low hospital mortality, but if untreated, mortality is high. Symptoms and labs usually suffice for diagnosis. Abnormal physical findings are rarely helpful and often absent. Careful surveillance and management, including invasive management in selected cases, substantially reduce long-term risks.