Prediction of obstructive sleep apnea in patients presenting to a tertiary care center

The objective of this prospective observational clinical study is to derive and validate a diagnostic model for prediction of obstructive sleep apnea (OSA) in subjects presenting with non-sleep-related complaints in a tertiary care center in north India. We included 102 subjects (group I, range 31–70 years) presenting to the hospital with non-sleep-related complaints. None of the subjects had any significant comorbid illness such as respiratory or congestive cardiac failure. All subjects underwent detailed evaluation including polysomnography (PSG). Various parameters were compared between the cases (apnea–hypopnea index, AHI ≥15/h) and controls (AHI <15/h). Using multivariate logistic regression analysis, a diagnostic model for prediction of OSA was derived. Subsequently, using similar selection criteria, 104 subjects (group II, range 32–68 years) were included for validation of the newly derived diagnostic model. Body mass index [BMI; OR (95% CI), 1.14(1.1–1.2)], male gender 5.0(1.4–27.1), relative-reported snoring index (SI) 2.8(1.7–5.0), and choking index (ChI) 8.1(1.4–46.5) were significant, independent predictors of OSA. Diagnostic model was computed as where, gender: 0=female, 1=male and SI, ChI, BMI are actual values. The diagnostic model had an area under the receiver operator characteristics curve of 89.6%. A cutoff of 4.3 for the score was associated with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 91.3, 68.5, 70.5, and 92.3%, respectively. Misclassification rate with the application of the diagnostic model on group II subjects was 13.5% (14/104). Sensitivity, specificity, PPV, and NPV of the model for predicting OSA in this group were 82, 90.7, 89.1, and 84.5%, respectively. BMI, male gender, SI, and ChI are independent predictors of OSA. Diagnostic model derived from these parameters is useful for predicting presence of OSA and screening subjects for PSG.     

A multiple-baseline evaluation of the treatment of food phobia in a young boy

A multiple-baseline design was used to evaluate the effectiveness of a behavioral treatment program using modeling, graduated exposure, and contingency management to treat food phobia in a 4-year-old boy. In addition, a treatment component involving time-out and re-introduction of the initial request to consume the target food was added to reduce vomiting behavior that developed during the course of treatment. The volume and range of foods consumed by the participant increased, and observer-rated anxiety and vomiting decreased over the course of treatment. The results of this controlled evaluation suggest that this treatment program was responsible for the observed changes, which were maintained at 6-month follow-up.     

Choking,asphyxiation and the insular seizure

The insular cortex is located deep within the Sylvian fissure, and has rich connections. We describe two patients with focal epilepsy arising from this area, with symptoms of choking and strangulation during consciousness. Clinicians should be aware of this unusual presentation and that interictal electroencephalography can be normal.     

行为疗法治疗一例罕见的窒息恐惧症：病例报告及文献复习

概述：窒息恐怖症是一种较少见的恐怖症,是心理性吞咽困难的病因之一。患者往往在耳鼻喉科就诊,之后被转诊到精神科。如果诊断不及时、治疗不恰当,那么它会严重影响患者的身心健康。我们报告一个20岁的女性患者,表现为窒息恐怖症,接受行为治疗。此外,我们还讨论了这种罕见的焦虑障碍的鉴别诊断和治疗策略。     

新生儿窒息相关产科因素探讨

目的探讨与新生儿窒息相关的产科因素,以减少新生儿窒息的发生率。方法选取笔者所在医院2006年3月~2010年8月分娩的100例新生儿,采用回顾性研究方法进行调查研究。选取产妇的分娩方式以及妊娠并发症作为新生儿发生窒息的相关因素。结果剖腹产比起阴道助产可以显著降低新生儿窒息的发生率;羊水少、脐带异常以及头位难产等显著增加了新生儿窒息的发生率。结论产妇的生产方式以及妊娠并发症是影响新生儿窒息发生的重要因素,可在产前进行全面监护并及时采取措施以减少新生儿窒息的发生率。     

右美托咪定对全身麻醉下甲状腺手术患者呛咳反应的影响

目的 探讨右美托咪定对全身麻醉下甲状腺手术患者呛咳反应的影响.方法 分析2015年10月至2017年3月本院收治的全身麻醉下实施甲状腺部分切除术患者80例,按照随机数字法分为观察组与对照组,各40例;对照组使用咪达唑仑进行围术期镇静,观察组使用右美托咪定;比较干预后两组恢复自主呼吸时间、拔管时间及麻醉恢复总时间,并统计两组呛咳发生率及呛咳评分.结果 观察组恢复自主呼吸时间、拔管时间及麻醉恢复总时间分别为(11.4±1.5) min,(18.2±1.9) min和(35.5±3.2)min,均显著短于对照组的(15.5±1.9) min,(26.9±2.6) min和(40.9±3.6) min(均P＜0.05);观察组呛咳发生率为27.5％,低于对照组的92.5％ (P＜0.05);观察组呛咳评分为(1.5±0.2)分,低于对照组的(3.1土0.4)分(P＜0.05).结论 对于甲状腺手术患者,围术期使用右美托咪定,能有效促进患者术后恢复,早期拔除气管导管,且减少呛咳反射发生率.     

Prevalence of Dysphagia in Acute and Community Mental Health Settings

The incidence of dysphagia in the population with mental health disorders may be higher as a result of a number of factors including the nature of the psychiatric disorder, effects of psychiatric medications, co-occurring neurologic conditions, and institutionalization and behavioral changes associated with the mental illness. This study aimed to determine the prevalence of dysphagia among adults with mental health disorders (MHDs) who attend acute and community mental health settings. Sixty attenders at a local area psychiatric service were assessed using a simple swallowing screening test. Subjects presented with a variety of mental health disorders and were attending an acute inpatient unit, day hospital, or long-term care setting. Thirty-two percent of those assessed demonstrated overt signs of oropharyngeal dysphagia. There was an increased prevalence in the inpatient unit (35%); the lowest prevalence of dysphagia was in those attending the day hospitals (27%). Thirty-one percent of those attending long-term care settings also had dysphagic symptoms. Twenty-three percent of individuals with schizophrenia in the total group had oropharyngeal dysphagia; this figure rose to 31% in the inpatient unit. Twenty-seven percent of individuals with bipolar affective disorder (BPAD) demonstrated overt signs of oropharyngeal dysphagia. Each of these individuals with BPAD was in an inpatient setting. The results of this study provide evidence to suggest that there is an increased incidence of dysphagia in those with mental health disorders. Of particular interest is the marked proportion (approximately one third) of those attending acute and long-term care settings with dysphagia. Possible contributing factors are discussed.