Bisher AKIL, MD

Archive for May 20th, 2009|Daily archive page

HIV infection, inflammation and heart disease

In Heart, HIV on May 20, 2009 at 5:22 pm

Growing evidence suggests that the risk for atherosclerosis is higher among HIV-infected individuals than among HIV-negative persons; potential explanations include deleterious effects of antiretroviral therapy (ART), virus-induced endothelial injury, and chronic inflammation. To examine the role of these factors, investigators studied carotid intima-media thickness (IMT; a measure of atherosclerosis) and C-reactive protein (CRP; a marker for systemic inflammation) levels in HIV elite controllers (infected patients who maintain undetectable viral loads without taking ART), untreated HIV-infected patients, HIV-infected patients on ART, and HIV-negative controls (total, 494 participants). The median carotid IMT was significantly higher in HIV-infected patients than in HIV-negative individuals, even after adjustment for cardiovascular risk factors. The median carotid IMT in elite controllers was significantly higher than that in HIV-negative individuals and was similar to that in untreated HIV-infected patients. The median CRP level was significantly higher in HIV-infected patients, including controllers, than in HIV-negative patients. Published in Journal Watch. Hsue PY et al. Role of viral replication, antiretroviral therapy, and immunodeficiency in HIV-associated atherosclerosis. AIDS 2009 Apr 22. Comments: these data and others seems to suggest that HIV infection by itself , not medications, cause inflammation maybe due to viral replication (with and without treatment for HIV); this inflammation can lead to atherosclerosis and heart disease. People with HIV infection should be screened for heart disease early and aggressively _BA

Exercises to help Sleep Apnea

In General Health on May 20, 2009 at 5:13 pm

Continuous positive airway pressure (CPAP) is tolerated poorly by many patients with obstructive sleep apnea (OSA). Certain patients have experienced positive outcomes with less-obtrusive interventions (e.g., mandibular advancement devices, weight reduction), and, now, Brazilian researchers introduce yet another alternative — oropharyngeal exercises. A study that published in May 2009 looked at oropharyngeal exercises to help OSA. Thirty-one patients with moderate OSA (apnea-hypopnea index, 15–30 events hourly) were randomized to weekly sessions that involved instruction in either oropharyngeal exercises (intervention group) or deep-breathing exercises (control group); patients repeated the exercises at home daily. A speech pathologist taught the intervention program, which involved repetitive exercises of the soft palate, tongue, and facial muscles, as well as breathing, speech, swallowing, and chewing exercises (video). At 3 months, mean apnea-hypopnea indexes were unchanged in the control group but had decreased significantly in the intervention group (from about 22 to about 13 events hourly). Sleepiness and sleep-quality scores also improved significantly only in the intervention group. Source: Published in Journal Watch. Guimarães KC et al. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2009 May 15; 179:962. Comments: although no diet, weight loss or improvement in over health has been studied in combination with these exercises, it seems that simply  reducing the size of the neck would help reduce sleep apnea._BA