Microvascular endothelial function and regional differences in vasodilation in the human cutaneous microcirculation in primary open angle glaucoma

Objective:Blood flow in the optic nerve head and finger skin are related in subjects with a primary vascular dysregulation (PVD). Since PVD may also occur in glaucoma, the aim of this study was to investigate the responses of the microcirculatory blood flow at the finger and forearm skin to iontophoresis of endothelial-dependent (acetylcholine - ACh) and endothelial-independent (sodium nitroprusside - SNP) vasodilators in primary open angle glaucoma (POAG). Design and Methodology: We studied 22 patients with POAG and 27 control subjects. The vasodilator responses to iontophoresis of ACh and SNP performed at the finger and forearm skin were determined, with skin microcirculatory blood flow being expressed as cutaneous red cell flux (RCF) as measured by Laser Doppler Flowmetry. Results: ACh and SNP induced significant increases in RCF from baseline (p<0.001) at both the finger and forearm skin sites in POAG patients and controls, but there was no difference in vasodilation between the subject groups. Within controls and POAG patients, for both ACh and SNP, the baseline RCF was higher in the finger than in the forearm skin (p<0.05). The vasodilatory response to ACh in the finger was also higher than in the forearm skin (p<0.05) i controls and POAG. The mean vasodilatory response to SNP in the finger was higher than in forearm skin (p<0.05) in controls and POAG. Conclusions: The vasodilatory responses to acetylcholine in POAG suggest normal microvascular endothelial function. The higher baseline RCF and vasodilatory responses in the finger than in forearm skin sites may reflect the difference in vascularity between these sites.

The role of fathers in overweight prevention: an analysis of a Caribbean cohort.

BACKGROUND: Family-based strategies to reduce the risk of overweight in childhood are needed in the Caribbean. AIM: To investigate the associations between parental characteristics and risk of overweight and explore possible mechanisms. METHODS: Data from a parenting intervention were analysed. Parental characteristics were obtained by questionnaire at enrolment. At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods. The association of parents' characteristics with risk of infant overweight was assessed using random-effects logistic regression. Four focus groups among mothers in Jamaica were conducted to explore mechanisms. RESULTS: Overall, 20.6% of infants were 'at risk of overweight'. Fathers were present in 52% of households. Fathers' presence [OR (95% CI) 0.60 (0.37-0.96)] was associated with reduced risk of overweight independent of socioeconomic status. Mothers reported that fathers encouraged healthier practices. CONCLUSION: Fathers may be important agents of change in intervention strategies to prevent childhood overweight.

Chronic obstructive pulmonary disease is missed in asthmatics in specialty care in Trinidad, West Indies.

SETTING: Underdiagnosis of chronic obstructive pulmonary disease (COPD) in asthmatics attending specialty care in Trinidad, West Indies. OBJECTIVE: To determine the prevalence of COPD in diagnosed asthmatics receiving specialty respiratory care. DESIGN: In a cross-sectional study, 258 asthmatics were screened for lung function measures to examine forced expiratory volume after 1 second (FEV1), forced vital capacity (FVC) and post-bronchodilator FEV1/FVC (COPD was defined as FEV1/FVC < 70 per cent). RESULTS: Of 165 patients evaluated (response rate 64.0 per cent), 53 (32.1 per cent, 95 per centCI 25.0-39.2) had a study diagnosis of COPD and a mean FEV1/FVC of 60.12 +/- 1.2. Proportionally, more males had COPD (50.9 per cent) than asthma (24.1 per cent, P < 0.001). Patients with COPD were 10 years older than asthmatics (P < 0.001). Persons with asthma who smoked were more likely to have COPD (56.0 per cent) (OR 3.26, 95 per cent CI 1.36-7.80, P = 0.006). In both sexes, FEV1/FVC was lower among older people (P < 0.001), with a greater effect (OR 2.75, 95 per cent CI 1.00-7.56, P < 0.01) seen among men in this cross-sectional study. CONCLUSIONS: One third of diagnosed asthmatics in specialty care also have COPD. Lung function was lower among older persons. Early spirometric evaluation of elderly asthmatics who smoke can determine the presence of COPD and facilitate appropriate management.

Chronic obstructive pulmonary disease is missed in asthmatics in specialty care in Trinidad, West Indies.

SETTING: Underdiagnosis of chronic obstructive pulmonary disease (COPD) in asthmatics attending specialty care in Trinidad, West Indies. OBJECTIVE: To determine the prevalence of COPD in diagnosed asthmatics receiving specialty respiratory care. DESIGN: In a cross-sectional study, 258 asthmatics were screened for lung function measures to examine forced expiratory volume after 1 second (FEV1), forced vital capacity (FVC) and post-bronchodilator FEV1/FVC (COPD was defined as FEV1/FVC < 70%). RESULTS: Of 165 patients evaluated (response rate 64.0%), 53 (32.1%, 95%CI 25.0-39.2) had a study diagnosis of COPD and a mean FEV1/FVC of 60.12 +/- 1.2. Proportionally, more males had COPD (50.9%) than asthma (24.1%, P < 0.001). Patients with COPD were 10 years older than asthmatics (P < 0.001). Persons with asthma who smoked were more likely to have COPD (56.0%) (OR 3.26, 95%CI 1.36-7.80, P = 0.006). In both sexes, FEV1/FVC was lower among older people (P < 0.001), with a greater effect (OR 2.75, 95%CI 1.00-7.56, P < 0.01) seen among men in this cross-sectional study. CONCLUSIONS: One third of diagnosed asthmatics in specialty care also have COPD. Lung function was lower among older persons. Early spirometric evaluation of elderly asthmatics who smoke can determine the presence of COPD and facilitate appropriate management.