Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era

Human immunodeficiency virus infection (HIV) has been associated with cardiac dysfunction that, if present, can negatively affect morbidity and mortality of HIV-infected patients. Unfortunately, many of the studies on this topic were performed before the highly active antiretroviral therapy (HAART) was established. Thus, we performed a comprehensive meta-analysis to critically appraise the incidence of cardiac dysfunction in HIV-infected pauci symptomatic patients. Medline, Cochrane Library, and Biomed Central were systematically screened for studies reporting on systolic and/or diastolic dysfunctions in HIV pauci-symptomatic patients. Baseline treatment and cardiac imaging data were appraised and pooled with random effect methods computing summary. At pooled analysis, including a total of 2242 patients from 11 studies, an overall average incidence of traditional cardiovascular risk factors was observed, while a low rate of previous coronary artery disease was reported. Incidence of systolic and diastolic left ventricular dysfunction was 8.33 (95 CI: 2.2014.25) and 43.38 (95 CI: 31.7355.03), respectively. Diastolic dysfunction was graded as first [31.85 (95 CI: 24.8543.73)], second [8.53 (95 CI: 2.1214.93)], and third degree [3.02 (95 CI: 1.784.27)]. At multivariate analysis, a high sensitivity C-reactive protein level 5 mg/L, active tobacco smoking and previous history of myocardial infarction were predictors of left ventricular systolic dysfunction [odd ratio 1.70 (95 CI: 1.032.77); 1.57 (95 CI: 1.032.34); and 15.90 (95 CI: 1.94329.00), respectively]. Hypertension (OR 2.30; 95 CI: 1.204.50) and older age (OR 2.50 per 10 years increase; 95 CI: 1.703.60) were predictors of left ventricular diastolic dysfunction (Figure 3). Systolic and diastolic dysfunction represent a common finding in pauci symptomatic HIV-infected patients, regardless to HAART

Cutaneous Metastasis from Cervical Spinal Chordoma: Case Report and Literature Review

Chordomas are rare primary tumors of the bone that arise from embryonic notochord. They are locally aggressive tumors with high tendency for post-surgical recurrence. On the contrary, distant metastases are rare. When occurring, they involve lungs, liver, lymph nodes, and bones. Skin and subcutaneous tissue involvement is even rarer and usually occurs by direct extension of the primary tumor or by local recurrence. Then, distant cutaneous metastasis from chordoma is an exceptional finding, with less than 20 cases reported in the literature. All the cutaneous metastases described derive from sacral chordomas, except for two cases in which the source of metastasis are skull-base chordomas

Atherosclerotic coronary plaque regression and the risk of adverse cardiovascular events: A meta-regression of randomized clinical trials

Introduction: Atherosclerotic coronary plaques represent the main substrate for coronary artery disease (CAD), and changes in plaque volume, investigated with intravascular ultrasound (IVUS), have been used as surrogate end-points in several clinical trials. However, no conclusive data are available to support the exploitation of IVUS-based plaque changes as a measure of clinically meaningful treatment's effect. Methods: Biomed Central, CENTRAL, and Medline/PubMed were searched for randomized clinical trials investigating IVUS variations of plaque and reporting clinical events. End-points of interest were major adverse cardiovascular events (MACE, a composite of death, myocardial infarction [MI] or revascularization), and the rates of MI or revascularization combined. Meta-regression analysis was performed to appraise the association between plaque changes and clinical events during follow-up. Results: Eleven studies (2 focusing on patients with ACS) with 7864 patients were included. After a median follow-up of 18 months, percentage of atheroma volume (PAV) was 0.50 (95% confidence interval -0.25; 1.00), with a 15.0% (95% CI 9.6%; 22.5%) rate of MACE and a 14.1% (95% CI 10.2%; 19.5%) rate of MI or revascularization. Rates of plaque volume regression were significantly associated with the incidence of MI or revascularization (Beta = 6.3; p = 0.006) but not with MACE (Beta = 0.42; p = 0.208). Conclusion: Regression of atherosclerotic coronary plaque volume may represent a surrogate for myocardial infarction and repeat revascularization but not for MACE. These results derive largely from stable patients, and should consequently be applied only to this population. (C) 2012 Elsevier Ireland Ltd. All rights reserved