Sandra Weibel

Prevalence of obstructive lung disease in HIV population: A cross sectional study

BACKGROUND Observational studies have suggested an association between HIV infection and emphysema. AIMS The primary aim of this study was to estimate the prevalence of obstructive lung disease in HIV-infected patients seen in an outpatient infectious disease clinic. The secondary aim was to estimate the prevalence of Obstructive Lung Disease (OLD) in smokers and non smokers in this population. METHODS This was a prospective cross-sectional study. Consecutive patients who were seen for routine HIV care underwent spirometry and answered the St. Georges Respiratory Questionnaire (SGRQ). Further, we collected information from the charts on demographics, co-morbidities, CD4 cell count, and HIV viral load (current, baseline, etc). RESULTS This study included 98 HIV-infected patients with mean age of 45 years, (SD: 11) and 84% male. They were seen from November 2008 to May 2009 at Thomas Jefferson University in Philadelphia. According to established criteria, spirometry results were classified as normal in 69% and obstructive in 16.3%. Among those who never smoked, the prevalence of obstructive lung disease on spirometry was 13.6%. The prevalence of obstruction in HIV patients with a history of smoking was 18.5%. Current and ever smokers comprised 21.4% and 55% of the patients respectively. The mean SGRQ total score was 7. The mean SGRQ score in active smokers was 17 and 15 in those subjects with a prior history of smoking. The mean SGRQ score among patients with obstruction in spiromerty was 27.7 in patients with obstruction on spirometry. CONCLUSION This urban population of HIV-infected persons has a relatively high prevalence of obstructive lung disease as assessed by spirometry. Furthermore, the high prevalence of obstructive lung disease in never smokers may suggest a possible association between HIV infection and emphysema. In addition the SGRQ total score was comparatively higher in patients with obstruction on spirometry. Our data suggests that potentially all patients with HIV should be screened a for OLD.

Use of Methotrexate in sarcoid-associated optic neuropathy

OBJECTIVE To demonstrate the possible beneficial effects of methotrexate (MTX) therapy for patients with sarcoid-associated optic neuropathy (SAON). DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Three patients diagnosed with SAON who received MTX. Two patients had tissue biopsies consistent with sarcoidosis, and 1 patient had clinically diagnosed sarcoidosis based on laboratory and radiographic studies. All 3 patients developed side effects with corticosteroid treatment of their optic neuropathy. INTERVENTION Patients were treated with weekly doses of oral MTX and monitored with neuro-ophthalmic, medical, and laboratory examinations. MAIN OUTCOME MEASURES Visual acuity, automated perimetry, and reduction of oral prednisone therapy. RESULTS After initiation of MTX, all 3 patients showed an improvement or stabilization of visual acuity. All patients had a decrease in their corticosteroid requirements, and all had improved or stabilized visual field deficits. One of the 3 patients developed leukopenia that necessitated a reduction of the methotrexate dose. CONCLUSION Methotrexate may be effective for SAON as an adjunct to corticosteroid therapy or as an alternative for corticosteroid-intolerant patients. Oral MTX reduced the corticosteroid requirements of 3 patients with SAON, and all 3 demonstrated stable or improved visual function.

Tobacco smoking as a chronic disease: Notes on prevention and treatment

Tobacco use represents a rare confluence of interesting circumstances. Elements of inheritable risk combine with powerful neuropharmacology and a ubiquitous environmental exposure and result in an epidemic that claims over 430,000 lives and costs us over

Preoperative Evaluation of Patients with Lung Cancer Undergoing Thoracic Surgery

100 billion annually. It is the single most important remediable public health problem in the United States. Most smokers want to quit smoking and a simple advice from a physician can increase the likelihood of doing so. Moreover, there are a number of pharmacologic and behavioral therapies that are proven to be effective in smoking cessation. Yet, there is an apparent reluctance among physicians to address smoking cessation, perhaps due to a sense of frustration or low self-efficacy. Physicians play an important role in smoking cessation, and intensive interventions are necessary to improve their participation and efficacy. Teaching practical smoking cessation techniques within medical school curricula, with an opportunity for standardized practice and self-evaluation, may be an effective strategy to improve physician practice in this area. Since most smokers try their first cigarette before the age of 18, and youth smoking is on the rise, targeted interventions aimed at preventing initiation and encouraging cessation of smoking among youth are needed. For all tobacco users, a better understanding of the pharmacology and physiology of nicotine addiction may translate into targeted and individualized treatment and prevention strategies, which may improve success rates dramatically. To better control this epidemic, and to meet the nations public health goals for the year 2010 [145], local tobacco control interventions need to be multifaceted and well integrated into regional and national efforts [146]. Because of the physicians unique societal role with respect to tobacco, doctors may indeed find it possible to impact public opinion and significantly reduce the toll of tobacco by acting at the public health and public policy levels [147]. Those interested in engaging in the public health debate can do more than relay facts about tobacco and health. Involvement in tobacco-control issues provides the opportunity to impact the environmental influences promoting smoking among patients, and is likely to be synergistic with efforts to help smokers quit within the office. Physicians who take steps to engage in local public health initiatives are likely to magnify the effects of their efforts at the bedside [148, 149].

Clinical and Radiologic Distinctions Between Secondary Bronchiolitis Obliterans Organizing Pneumonia and Cryptogenic Organizing Pneumonia

Surgery is currently the only potentially curative treatment modality for patients with early-stage non–small-cell lung cancer. Because of a high prevalence of chronic obstructive pulmonary disease in patients with lung cancer, they represent a special subset of patients for whom preoperative evaluation of cardiopulmonary status is especially important. The goal of preoperative evaluation of patients with lung cancer is to assess whether the neoplasm is surgically resectable and to estimate the risk of perioperative morbidity and mortality. Screening spirometry should be obtained in all patients. If the preoperative FEV1 is less than 60% of the predicted normal, predicted postoperative FEV1 (PPO-FEV1) should be estimated based upon the preoperative value and the functional contribution of the lung to be resected. Patients with PPO-FEV1 of more than 40% of predicted normal can tolerate pneumonectomy. In patients who appear borderline candidates for surgery based on static lung function criteria, cardiopulmonary exercise testing with measurement of maximum oxygen consumption (V̇O2max) can further help stratify patients in terms of their risk for perioperative mortality or complications of surgical resection.