Pulmonary Arterial Hypertension in Patients Infected with the Human Immunodeficiency Virus.

It is important to recognize and treat human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) because of the associated morbidity and mortality. With the introduction of antiretroviral therapies (ART), improved survival has changed the focus of treatment management from immunodeficiency-related opportunistic infections to chronic cardiovascular complications, including HIV-PAH. The 2018 6th World Symposium of Pulmonary Hypertension recommended a revised definition of PAH that might result in a greater number of patients with HIV-PAH; however, the implication of this change is not yet clear. Here, we review the current literature on the diagnosis, management, and outcomes of patients with HIV-PAH.

Recent Trends in Infective Endocarditis Among Patients with and Without Injection Drug Use: An Eight-Year Single Center Study.

BACKGROUND: Infective endocarditis (IE) is associated with considerable morbidity and mortality. Given the opioid crisis and emergence of drug-resistant organisms, we sought to examine annual trends in hospitalization rates for IE and potential epidemiologic shift in the causative microorganisms among patients with and without injection drug use (IDU). METHODS: This was a single-center retrospective cohort study of hospitalized adults with IE. Annual trends in hospitalization rates were calculated (2011-2018), and patient characteristics and clinical outcomes were compared according to IDU status. RESULTS: Our cohort of 244 hospitalized patients with IE had a subset of 112 with IDU. The annual hospitalization rate for IE increased almost four-fold and was most notable among patients with IDU. The highest increase occurred in patients with Staphylococcus aureus-associated IE. Patients with IDU were younger, and more likely to be women with tricuspid valve vegetations and have IE due to methicillin-sensitive and methicillin-resistant Staphylococcus aureus. Patients without IDU were more likely to have central venous catheters with mitral and aortic valve vegetations and have IE due to Streptococcus and coagulase-negative Staphylococcus species. Patients without IDU had a higher requirement for cardiac surgery and higher 90-day mortality. Age was the only independent variable associated with 90-day mortality. CONCLUSIONS: The rising incidence of IE in younger and older persons is driven in part by the opioid public health crisis and higher prevalence of indwelling central venous catheters, respectively. Timely treatment of opioid use disorders and stewardship surrounding use of central venous catheters is urgently needed.

La utilidad del monitoreo holter con saturación de oxígeno en la valoración de pacientes con sospecha de apnea del sueño / The utility of holter monitoring with oxygen saturation in the evaluation of patients with suspected sleep apnea

Justificación: los trastornos respiratorios asociados con el sueño son frecuentes. Entre ellos la apnea del sueño ocupaun lugar importante como problema de salud, pues está asociada con la aparición de arritmias, trastornos metabólicos,hipertensión arterial y cardiopatía isquémica. La detección tiene cierto grado de dificultad, puesto que métodos comola polisomnografía pueden ser complejos y costosos. El objetivo de este trabajo es presentar la experiencia con el usodel monitoreo ambulatorio de la saturación de oxígeno de 24 horas (OxyholterR), como método de detección inicial depacientes con este síndrome.Metodología: estudio descriptivo de los principales hallazgos en los registros de OxyholterR realizados en el Centro CardiológicoIntegral entre el año 2005 y 2013, en pacientes con sospecha clínica de apnea del sueño. Por lo tanto se analizóla presencia de las alteraciones en la saturación de oxígeno nocturno según edad y sexo. Y se clasificó dichas alteracionescon base en la duración e intensidad. Se analizó la presencia de arritmias durante los periodos de sueño.Resultados: en 494 estudios, la edad promedio general fue de 65 años, la distribución por género fue: 279 (56 %) hombresy 215 (43 %) mujeres. Un 10 % (51 casos) de los estudios fueron normales, un 90 % (443 casos) mostró alteración significativaen la saturación y en estos, el tiempo con saturación de O2 baja fue menor de 30 minutos en 43 % de los pacientes ymayor de 30 minutos en 57 % de los pacientes. En un 33 % la disminución en la saturación fue leve (Saturación O2 80-88%),en un 39 % moderada (Saturación O2 70-79 %) y en un 28 % severa (Saturación O2<69 %). De los casos con saturaciónnocturna baja, en 88 (20 %) se documentaron arritmias de predominio nocturno...

Justification and Objective: The respiratory abnormalities that may occur during the sleep period are frequent. Sleepapnea has an important place as a health problem, because of the association with arrhythmias, metabolic abnormalities,hypertension and ischemic hearth. To diagnosis this condition is not easy because of the complexity and cost of themethods, like the polisomnography. The objective of this paper is to present the experience with the Ambulatory HolterMonitoring with 24 hours Oxygen Saturation (OxyholtherR), as an initial diagnosis method for this condition.Methodology: descriptive study of the main findings in the OxiholtherR in the ¨Centro Cardiológico Integral¨ betweenthe year of 2005 and 2013. The study analyzed the presence of oxygen saturation abnormalities during the night periodaccording to the age, gender, and weight. This abnormalities were classify base on the severity and the time in which thedesaturation lasted.Results: we analyzed 494 studies, the age in general average was 65 years, 279 (56 %) were mans and 215 (43 %) women.A 10 % (51 cases) had a normal oxygen saturation level. Of the 443 (90 %) studies that show a significant decrease insaturation, 43 % had this decrement for a period of time less than 30 minutes and 57 % extended for more than 30minutes until 10 hours. In 33 % of the group with abnormalities show mild decrease in saturation levels (saturation 80 to88 %), 39% had moderate decrease (saturation 70-79 %) and 28 % show saturation level below 69 % (severe). In the 443cases with nocturnal low oxygen saturation, 88 patients (20 %) had arrhythmias in the same nocturnal period...