The introduction of highly active antiretroviral therapy(HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome.In developed countries,we have observed an approximately 30%...The introduction of highly active antiretroviral therapy(HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome.In developed countries,we have observed an approximately 30% reduction in the prevalence of human immunodeficiency virus(HIV)-associated cardiomyopathy,possibly related to a reduction of opportunistic infections and myocarditis.In developing countries,however,where the availablity of HAART is limited and the pathogenic impact of nutritional factors is significant,we have observed an approximately 32% increase in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure.Also,some HAART regimens in developed countries,especially those including protease inhibitors,have been shown to cause,in a high proportion of HIV-infected patients,an iatrogenic metabolic syndrome(HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis,even in young HIV-infected people.Careful cardiac screening is warranted for patients who are being evaluated for,or who are receiving,HAART regimens,particularly for those with known underlying cardiovascular risk factors.A close collaboration between car-diologists and infectious disease specialists is needed for decisions regarding the use of antiretrovirals,for a careful stratification of cardiovascular risk factors,and for cardiovascular monitoring of HIV-infected patients receiving HAART,according the most recent clinical guidelines.展开更多
Phosphodiesterase type-5 inhibitor(PDE5-i) drugs were first marketed in 1998(sildenafil) for 'on-demand' treatment of male erectile dysfunction(ED) of any origin.They selectively inhibit intrapenile PDE5 isoen...Phosphodiesterase type-5 inhibitor(PDE5-i) drugs were first marketed in 1998(sildenafil) for 'on-demand' treatment of male erectile dysfunction(ED) of any origin.They selectively inhibit intrapenile PDE5 isoenz yme which in turn increases intracellular cyclic guanosine monophosphate levels,thus resulting in prolonged relaxation of cavernosum smooth muscle cells and facilitating the erectile proce ss.Since 2003,two new molecules(tadalafil and vard e na fil) have been introduced,resulting in greater interest in these compounds and leading patients to ask for more prescriptions from their doctors.The vast use of PDE5-i in diabetic and cardiovascular ED patients led resea rchers to investigate their possible extra sexual effects.Several studies investigating their effects on endothelium,coronary and pulmonary circulation,inf erior oesophageal sphincter and kidney functions have appeared and,finally,sildenafil was approved for the treatment of pulmonary arterial hyperten s ion.Recent animal studies highlighted a possible interaction between chronic PDE5 inhibition and glucose homeostasis which occurs through a marked improvem ent of high fat diet induced insulin resistance.If this data is extended to humans,a new scenario will be opened for the chronic use of PDE5-i for sexual rehabilit ation along with cardiovascular and metabolic benefits.展开更多
AIM:To evaluate if indolent B cell-non Hodgkin's lymphoma(B-NHL) and diffuse large B-cell lymphoma(DLBCL) in hepatitis C virus(HCV) positive patients could have different biological and clinical characteristics re...AIM:To evaluate if indolent B cell-non Hodgkin's lymphoma(B-NHL) and diffuse large B-cell lymphoma(DLBCL) in hepatitis C virus(HCV) positive patients could have different biological and clinical characteristics requiring different management strategies.METHODS:A group of 24 HCV related B-NHL patients(11 indolent,13 DLBCL) in whom the biological and clinical characteristics were described and confronted.Patients with DLBCL were managed with the standard of care of treatment.Patients with indolent HCV-related B-NHL were managed with antiviral treatment pegylated interferon plus ribavirin and their course observed.The outcomes of the different approaches were compared.RESULTS:Patients with DLBCL had a shorter duration of HCV infection and a higher prevalence of HCV genotype 1 compared to patients with indolent B-NHL in which HCV genotype 2 was the more frequent genotype.Five of the 9 patients with indolent HCV-relatedB-NHL treated with only antiviral therapy,achieved a complete response of their onco-haematological disease(55%).Seven of the 13 DLBCL patients treated with immunochemotheraphy obtained a complete response(54%).CONCLUSION:HCV genotypes and duration of HCV infection differed between B-NHL subtypes.Indolent lymphomas can be managed with antiviral treatment,while DLBCL is not affected by the HCV infection.展开更多
文摘The introduction of highly active antiretroviral therapy(HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome.In developed countries,we have observed an approximately 30% reduction in the prevalence of human immunodeficiency virus(HIV)-associated cardiomyopathy,possibly related to a reduction of opportunistic infections and myocarditis.In developing countries,however,where the availablity of HAART is limited and the pathogenic impact of nutritional factors is significant,we have observed an approximately 32% increase in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure.Also,some HAART regimens in developed countries,especially those including protease inhibitors,have been shown to cause,in a high proportion of HIV-infected patients,an iatrogenic metabolic syndrome(HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis,even in young HIV-infected people.Careful cardiac screening is warranted for patients who are being evaluated for,or who are receiving,HAART regimens,particularly for those with known underlying cardiovascular risk factors.A close collaboration between car-diologists and infectious disease specialists is needed for decisions regarding the use of antiretrovirals,for a careful stratification of cardiovascular risk factors,and for cardiovascular monitoring of HIV-infected patients receiving HAART,according the most recent clinical guidelines.
文摘Phosphodiesterase type-5 inhibitor(PDE5-i) drugs were first marketed in 1998(sildenafil) for 'on-demand' treatment of male erectile dysfunction(ED) of any origin.They selectively inhibit intrapenile PDE5 isoenz yme which in turn increases intracellular cyclic guanosine monophosphate levels,thus resulting in prolonged relaxation of cavernosum smooth muscle cells and facilitating the erectile proce ss.Since 2003,two new molecules(tadalafil and vard e na fil) have been introduced,resulting in greater interest in these compounds and leading patients to ask for more prescriptions from their doctors.The vast use of PDE5-i in diabetic and cardiovascular ED patients led resea rchers to investigate their possible extra sexual effects.Several studies investigating their effects on endothelium,coronary and pulmonary circulation,inf erior oesophageal sphincter and kidney functions have appeared and,finally,sildenafil was approved for the treatment of pulmonary arterial hyperten s ion.Recent animal studies highlighted a possible interaction between chronic PDE5 inhibition and glucose homeostasis which occurs through a marked improvem ent of high fat diet induced insulin resistance.If this data is extended to humans,a new scenario will be opened for the chronic use of PDE5-i for sexual rehabilit ation along with cardiovascular and metabolic benefits.
文摘AIM:To evaluate if indolent B cell-non Hodgkin's lymphoma(B-NHL) and diffuse large B-cell lymphoma(DLBCL) in hepatitis C virus(HCV) positive patients could have different biological and clinical characteristics requiring different management strategies.METHODS:A group of 24 HCV related B-NHL patients(11 indolent,13 DLBCL) in whom the biological and clinical characteristics were described and confronted.Patients with DLBCL were managed with the standard of care of treatment.Patients with indolent HCV-related B-NHL were managed with antiviral treatment pegylated interferon plus ribavirin and their course observed.The outcomes of the different approaches were compared.RESULTS:Patients with DLBCL had a shorter duration of HCV infection and a higher prevalence of HCV genotype 1 compared to patients with indolent B-NHL in which HCV genotype 2 was the more frequent genotype.Five of the 9 patients with indolent HCV-relatedB-NHL treated with only antiviral therapy,achieved a complete response of their onco-haematological disease(55%).Seven of the 13 DLBCL patients treated with immunochemotheraphy obtained a complete response(54%).CONCLUSION:HCV genotypes and duration of HCV infection differed between B-NHL subtypes.Indolent lymphomas can be managed with antiviral treatment,while DLBCL is not affected by the HCV infection.
