Nocturnal giddiness in relation to nocturia and other symptoms and to medication in the elderly

The aim of this study was to evaluate the relation of nocturia, somatic diseases, symptoms, and medication to nocturnal giddiness in a group of elderly men and women. A questionnaire survey was undertaken among 10,216 elderly subjects. The mean (+/-S.D.) ages of the men and women were 73.0 +/- 6.0 and 72.6 +/- 6.7 years, respectively. Nocturnal giddiness was reported by 14.1% of the men and 9.1% of the women. Poor health was reported by 44.4% (P < 0.0001) of the men with nocturnal giddiness and by 14.0% of the men without, and among the women these figures were 45.5% and 20.0% (P < 0.0001), respectively. In a multiple logistic regression analysis significant independent correlates of nocturnal giddiness were: nocturnal micturition episodes >or=3 versus nocturia or=80 years versus <70 years (2.5; 1.7-3.6); eyesight, poor versus good (1.8; 1.4-2.4); hearing, poor versus good (1.4; 1.1-1.9); pain in the cervical spine (2.1; 1.5-2.8); spasmodic chest pain (1.5; 1.1-2.0); diabetes (1.6; 1.0-2.4); analgesics (1.8; 1.3-2.4); and diuretics (1.4; 1.1-21.8). Sex, irregular heartbeats, and sleep medication were deleted by the logistic model.     

Karyotype and in vitro-response to GM-CSF

Summary The influence of GM-CSF on bone marrow cultures from 13 patients with aplastic anemia, MDS and acute leukemia was studied in a short-term suspension culture system. In each case combined cytogenetic and proliferation analyses were performed with respect to the question, whether chromosome aberrations play a role in the in vitro response to GM-CSF and in order to search for stimulating effects on malignant cells. The responsiveness was compared of aplastic and myelodysplastic cultures on the one hand and of leukemic cells on the other. Our results show that myelodysplastic and aplastic cells display a tendency for reduced susceptibility to GM-CSF as compared to healthy controls, while in leukemic bone marrow the response to the growth factor was significantly enhanced, indicating a leukemia-specific response pattern. In the majority of leukemias analyzed, the presence of cytogenetically abnormal cells in cultures with excessive response to GM-CSF can be taken as a proof for stimulation of malignant cells. The significance of these findings for pathogenesis and prognosis in aplastic anemia, myelodysplasia and leukemia is discussed.Abbreviations CSF 1 colony-stimulating factor 1 (M-CSF) - CSF 1 R colony-stimulating factor 1 receptor (formerly c-fms) - CSF 2 colony-stimulating factor 2 (GM-CSF) - FGFA fibroblast growth factor, acidic - PDGFR platelet-derived growth factor receptor - RAEB refractory anemia with excess of blasts - RARS refractory anemia with ringed sideroblasts - PNH paroxysmal nocturnal haemoglobinuria Supported in part by: Deutsche Krebshilfe — Dr. Mildred Scheel-Stiftung, project M 18/86/Fo 1     

Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic

STUDY OBJECTIVES: To study the prevalence, risk factors, and gender differences in symptoms related to obstructive sleep apnea. A secondary objective was to study gender differences in relation to referral to a sleep clinic for sleep investigations. DESIGN AND SETTING: A questionnaire study in a representative sample of the general population. A second cohort included patients referred for sleep apnea investigation between 1991 and 2000 in the same geographic region. PARTICIPANTS: A representative sample of 5,424 subjects aged 20 to 69 years living in northern Sweden. Responses were obtained from 4,648 subjects (85.7%). RESULTS: Of the male respondents, 17.9% stated that snoring was a problem or said that they had relatives who were concerned about witnessed sleep apnea, and of the female respondents, 7.4%. The prevalence of snoring and witnessed apneas increased with age. In men, there was a peak prevalence rate at 55 to 59 years of age, while the corresponding figure in women the peak prevalence rate was at 60 to 64 years of age. Having snoring as a problem and relatives who were concerned about witnessed sleep apnea were independently associated with male gender, age, and current smoking. Snoring as a problem also was associated with higher education. Women who snored reported significantly more daytime sleepiness than did men who snored. The estimated number of subjects aged 20 to 69 years who had snoring as a problem or had relatives who were concerned about witnessed sleep apnea in the population was 21,160. During the previous decade, 3,955 subjects had been referred to sleep laboratories, so < 20% of the estimated number of symptomatic subjects in the population had been referred during this 10-year period. The referral rate ratio for men/women after correction for population and prevalence of symptoms was 1.25:1 (p = 0.012). CONCLUSION: Experiencing snoring as a problem or having relatives who are concerned about witnessed sleep apnea are common findings in the population. However, during the last decade, only about 20% of the subjects with snoring as a problem or with relatives who are concerned about witnessed sleep apnea were referred to sleep laboratories. Women were significantly underrepresented in sleep laboratory referrals, even though women who snored experienced more subjective daytime sleepiness than men.     

Platelet sensitivity to adenosine diphosphate and to prostacyclin in diabetic pregnancies

Platelet sensitivity to adenosine diphosphate (ADP) and to prostacyclin (PGI2) was studied in normal and diabetic pregnant women. The threshold concentrations of ADP inducing the second phase of aggregation were used to determine the platelet sensitivity to PGI2. The sensitivity of platelets to ADP increased in both groups in the second trimester, thereafter it decreased both in normal and diabetic pregnancies. In contrast, sensitivity to PGI2 increased in the last trimester of pregnancy. No difference could be observed between diabetic and normal groups. The similarity of the results between the two groups could be explained by the normoglycaemic state of well-controlled diabetic pregnant women.     

Catecholamines contribute to exertional dyspnoea and to the ventilatory response to exercise in normal humans

BACKGROUND: Exogenous catecholamine administration in humans stimulatesventilation. The present study was designed to investigate whetherincreased endogenous catecholamine release influences objectivemeasures of ventilation and subjective measures of breathlessnessin normal subjects. METHODS: Yohimbine, a pre-synaptic a₂ adrenoceptor antagonist, or placebowas administered to 10 normal male subjects in a double-blindcross-over fashion. Ventilation and metabolic gas exchange weremeasured during steady state exercise at 60% of previously determinedmaximal oxygen consumption. Venous lactate and noradrenalinewere measured during exercise. Subjects' sensation of breathlessnessand fatigue were recorded using visual analogue scales. RESULTS: Plasma noradrenaline was higher following yohimbine administration(at 6 min exercise; 4·58±0·56 nmol.l^–1vs 8·74±1·53; P<0·05). Oxygenconsumption was unchanged, but ventilation was greater throughoutexercise following yohimbine. The sensation of exertion wasgreater following yohimbine, and at any given level of ventilation,the sensation of exertion was greater. CONCLUSIONS: Yohimbine administration causes increased noradrenaline release.This is associated with an increased ventilatory response andan increase in the sensation of exertion during steady stateexercise. An increase in circulating noradrenaline might bea mechanism for both increased ventilation and pathologicalconditions of breathlessness such as chronic heart failure.     

Access and barriers to measures targeted to prevent malaria in pregnancy in rural Kenya

Objectives To evaluate barriers preventing pregnant women from using insecticide‐treated nets (ITN) and intermittent presumptive treatment (IPT) with sulphadoxine‐pyrimethamine (SP) 5 years after the launch of the national malaria strategy promoting these measures in Kenya. Methods All women aged 15–49 years were interviewed during a community survey in four districts between December 2006 and January 2007. Women pregnant in the last 12 months were asked about their age, parity, education, use of nets, ITN, antenatal care (ANC) services and sulphadoxine‐pyrimethamine (SP) (overall and for IPT) during pregnancy. Homestead assets were recorded and used to develop a wealth index. Travel time to ANC clinics was computed using a geographic information system algorithm. Predictors of net and IPT use were defined using multivariate logistic regression. Results Overall 68% of pregnant women used a net; 52% used an ITN; 84% attended an ANC clinic at least once and 74% at least twice. Fifty‐three percent of women took at least one dose of IPT‐SP, however only 22% took two or more doses. Women from the least poor homesteads (OR = 2.53, 1.36–4.68) and those who used IPT services (OR = 1.73, 1.24–2.42) were more likely to sleep under any net. Women who used IPT were more likely to use ITNs (OR = 1.35, 1.03–1.77), while those who lived more than an hour from an ANC clinic were less likely (OR = 0.61, 0.46–0.81) to use ITN. Women with formal education (1.47, 1.01–2.17) and those who used ITN (OR: 1.68, 1.20–2.36) were more likely to have received at least one dose of IPT‐SP. Conclusion Although the use of ITN had increased 10‐fold and the use of IPT fourfold since last measured in 2001, coverage remains low. Provider practices in the delivery of protective measures against malaria must change, supported by community awareness campaigns on the importance of mothers’ use of IPT.     

Sodium and responses to infused noradrenaline and angiotensin II in subjects predisposed to hypertension

A disturbed adrenergic dependent blood pressure regulation may represent a familial component in the pathogenesis of essential hypertension; its possible relation to sodium metabolism is presently unknown. Body sodium, the cardiovascular pressor reactivity to infused noradrenaline or angiotensin II, plasma levels of noradrenaline, adrenalin, renin, angiotensin II, aldosterone and atrial natriuretic peptide were measured on a low or high sodium diet in 10 normotensive young subjects without and 13 normotensive subjects with familial predisposition to hypertension. On the low sodium diet, the two groups did not differ significantly in the considered parameters, while blood pressure was slightly higher in predisposed subjects (+7/+7 mmHg). The change from the low to the high sodium diet was associated with a significant increase in supine systolic blood pressure in predisposed but not in non-predisposed subjects (P less than 0.05). Exchangeable sodium, body weight atrial natriuretic peptide and the pressor reactivity to infused adrenalin or angiotensin II increased significantly while plasma catecholamines, renin, angiotensin II and aldosterone levels were suppressed to a comparable extent in the two groups. The findings of this investigation confirm that sodium has an important regulatory effect on cardiovascular pressor responsiveness. The disturbed noradrenergic-dependent regulation of predisposed subjects is not explained by an abnormal adaptation of sympathetic dependent mechanisms or of other pressor factors to variations in dietary sodium intake.     

Interventions to respond to COVID 19 pandemic in Mumbai and way forward

With the emergence of COVID 19 pandemic, the approach used by Municipal Corporation of Greater Mumbai (MCGM) was based on all guidelines of COVID 19 prepared by Ministry of Health and Family Welfare (MoHFW). However, Mumbai undertook a special innovate model used in the mission Mumbai – Dharavi for COVID 19. Additionally, MCGM undertook a proactive approach of “chasing the virus” with its 4Ts: 1. Tracing 2. Tracking 3. Testing 4. Treating in high-risk slum clusters and it reflects the result of declining the incidence and case fatality due to COVID 19. Establishing public health surge capacities which include active surveillance, contact-tracing and follow-up besides early detection, isolation and management of cases are important steps for fighting the COVID 19 pandemic. Collaborating with all partners and setting up a Task force for establishing clinical management protocols was unmissable.