International journal of clinical practice. Supplement (Int J Clin Pract Symp Suppl)

Publications in this journal

• Article: Determinants of pulmonary hypertension in young adults.

  Maya Guglin, Swathy Kolli, Ren Chen
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  ABSTRACT: Background:  Risk factors of pulmonary hypertension (PH) are poorly understood. The objective of this study was to identify the determinants of PH in young adults. Methods:  We analysed a limited access dataset from the CARDIA (Coronary Artery Risk Development in Young Adults) study provided by the National Heart, Lung and Blood Institute. Pulmonary arterial pressure was assessed by the Doppler pulmonary artery acceleration time (PAAT). Socio-demographic characteristics, self-reported clinical variables, echocardiographic variables, pulmonary function tests, systemic blood pressure and body mass index calculated from height and weight were used in multivariate analysis. Results:  There were 4171 study subjects, mean age 24.9 ± 3.6 years, retained in year five with echocardiographic data available after five years of follow-up. The prevalence of severe PH (PAAT ≤ 70 ms) and mild to moderate PH (PAAT = 109.9-70.01 ms) was 1.1% and 14% respectively. Multivariate analysis revealed that body mass index (β = -1.09, p < 0.0001), female gender (β = 6.25, p < 0.0001), age (β = -0.30, p = 0.02), African American race (β = -2.57, p = 0.007), physical activity (β = 0.005, p = 0.002), current smoking (β = -3.42, p = 0.001), left atrial dimension (β = -2.97, p = 0.009) and diastolic dysfunction (β = -13.06, p = 0.006) were statistically significant variables predicting PH. Conclusion:  In this large, observational study of young adults, pulmonary hypertension, as assessed by echocardiography, is common. Diastolic dysfunction, obesity, physical inactivity and smoking are associated with elevated pulmonary arterial pressure in young adults.
  International journal of clinical practice. Supplement 10/2012;
• Article: Clinical implications of haemoptysis in patients with pulmonary arterial hypertension.

  Jose Cantu, Degang Wang, Zeenat Safdar
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  ABSTRACT: Introduction:  Pulmonary arterial hypertension (PAH) is a disabling disease that may result in haemoptysis. Patients with congenital heart disease associated PAH (CHD-APAH) may have a survival advantage when compared with patients with other types of PAH presenting with haemoptysis. The effects of aetiology and subsequent management choice of haemoptysis in PAH patients is not well-defined. Methods:  We conducted outcome analysis in CHD-APAH vs. all other subtypes of PAH patients presenting with haemoptysis to The Methodist Hospital. Twenty-one patients were identified, 13 patients in the CHD-APAH group and eight patients in the non-CHD group. We evaluated outcomes related to treatment (bronchial artery embolisation (BAE) vs. conservative management), hospital length of stay, mortality rates and survival in this cohort. Results:  The CHD-APAH and non-CHD groups had similar baseline demographic, haemodynamic and laboratory values except BMI was higher in the non-CHD group and haematocrit was higher in the CHD-APAH group. Twenty-eight-day mortality (0% vs. 31%) and 1-year mortality (0% vs. 54%) was lower in the CHD-APAH patients as compared with non-CHD group. A statistically significant difference was found in the survival rate in favour of CHD-APAH group for the total follow-up period (p = 0.02). Although not statistically significant, patients treated with BAE had shorter length of stay (4.0 days ± 4.0 vs. 13.7 days ± 22.5; p = 0.26). There was recurrent haemoptysis in 43% of patients treated with BAE. Conclusion:  Haemoptysis in PAH patients is a serious event with a high mortality rate. CHD-APAH seems to confer a survival advantage, independent of therapy utilised. Termination of haemoptysis with BAE is rapid with relatively few complications except for frequent re-bleeding episodes. Further studies are needed to determine the risk factors that may predispose PAH patients to excessive mortality from haemoptysis and to identify an optimal therapeutic modality.
  International journal of clinical practice. Supplement 10/2012;
• Article: A Beginning's End.

  Stephen C Mathai, Mardi Gomberg-Maitland
  International journal of clinical practice. Supplement 10/2012;
• Article: Insulin pumps.

  John C Pickup
  International journal of clinical practice. Supplement 02/2012;
• Article: Preface.

  Moshe Phillip, Tadej Battelino
  International journal of clinical practice. Supplement 02/2012;
• Article: Continuous glucose monitoring in 2011.

  Tadej Battelino, Bruce W Bode
  International journal of clinical practice. Supplement 02/2012;
• Article: Diabetes technology and treatment in the paediatric age group.

  Shlomit Shalitin, H Peter Chase
  International journal of clinical practice. Supplement 02/2012;
• Article: Type 1 diabetes mellitus: immune intervention.

  Jay S Skyler
  International journal of clinical practice. Supplement 02/2012;
• Article: New medications for the treatment of diabetes.

  Satish K Garg, Jay S Skyler
  International journal of clinical practice. Supplement 02/2012;
• Article: Diabetes technology and the human factor.

  Alon Liberman, Bruce Buckingham, Moshe Phillip
  International journal of clinical practice. Supplement 02/2012;
• Article: Management of pulmonary hypertension and Down syndrome.

  P King, R Tulloh
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  ABSTRACT: Down syndrome (DS) is strongly associated with pulmonary hypertension, but there are many causes requiring a multi-disciplinary approach to the problem. Nearly half of children with DS have upper airway obstruction and the same proportion have congenital heart disease, both of which may cause pulmonary hypertension. Additional problems include pulmonary hypoplasia, structural lung disease and gastro-oesophageal reflux. It is no longer acceptable to ignore these symptoms as early treatment may be preventative.
  International journal of clinical practice. Supplement 12/2011;
• Article: Quality initiatives and models of care in patients with pulmonary arterial hypertension: the time has come!

  Robert Schilz, Harrison W Farber
  International journal of clinical practice. Supplement 12/2011;
• Article: Screening pulmonary hypertension patients for depression.

  Deborah H McCollister
  International journal of clinical practice. Supplement 12/2011;
• Article: Portopulmonary hypertension: a disease in search of multi-centre cooperation.

  Sonja Bartolome
  International journal of clinical practice. Supplement 12/2011;
• Article: Venienti occurrite morbo: knowledge and prevention of errors in radiology.

  M J Sangwaiya, M K Kalra, M Roddie
  International journal of clinical practice. Supplement 10/2011;
• Article: Coronary CT angiography and CT myocardial perfusion--challenges still ahead.

  S K Venkatesh
  International journal of clinical practice. Supplement 10/2011;
• Article: Early cross-sectional imaging for patients with acute abdominal pain: systematic review of randomised clinical trials.

  R Gohil, R Agha, T Y Tang, S R Walsh
  International journal of clinical practice. Supplement 10/2011;
• Article: Myocardial perfusion imaging by computed tomography: today and tomorrow.

  R P Marcus, K Nikolaou, D Theisen, M F Reiser, F Bamberg
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  ABSTRACT: Cardiac perfusion along with imaging of coronary artery stenosis is an important tool in assessing the degree of coronary artery disease (CAD) and decision-making regarding further treatment. SPECT, PET, echocardiography and cardiac magnetic resonance imaging are clinically established techniques to evaluate myocardial perfusion and viability with a high diagnostic accuracy and relatively few unwanted side effects. However, none of these modalities Glose can reliably assess the extent and morphology of CAD, features which also have implications as well as for patient management. In contrast, cardiac CT has emerged over the last years as a reliable tool to visualise coronary atherosclerotic plaque and stenosis, nearly unaffected by heart rate and carrying a relatively low radiation exposure; however, without allowing an adequate assessment of myocardial perfusion. Given the great promise of a combined cardiac CT examination to assess morphology and function, much research has recently been focused on the development of CT-based myocardial perfusion imaging techniques. In this article, we review recent developments in cardiac CT with respect to myocardial perfusion imaging, especially the two main techniques, first-pass and dynamic CT acquisitions.
  International journal of clinical practice. Supplement 10/2011;
• Article: Coronary computed tomography--present status and future directions.

  P Apfaltrer, U J Schoepf, R Vliegenthart, G W Rowe, J R Spears, C Fink, J W Nance
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  ABSTRACT: The use of coronary computed tomography angiography (cCTA) is growing rapidly, in large part because of fast-paced technical innovations that have increased diagnostic accuracy while providing new opportunities for radiation dose reduction. cCTA using recent generation CT scanners has been repeatedly shown to have excellent negative predictive value for ruling out significant coronary stenosis in comparison with invasive coronary angiography (ICA) and is now accepted for this use in selected populations. Current work is increasingly focused on evaluating and optimising radiation dose reduction techniques, the cost-effectiveness of cCTA implementation, and the impact of cCTA on patient management and outcomes. In addition, the potential value of emerging applications, such as atherosclerotic plaque characterisation and myocardial perfusion and viability assessment, are undergoing intense investigation.
  International journal of clinical practice. Supplement 10/2011;