Comparison of the effects of continuous positive airway pressure,oral appliance and exercise training in obstructive sleep apnea syndrome

OBJECTIVE:

There are several treatments for obstructive sleep apnea syndrome, such as weight loss, use of an oral appliance and continuous positive airway pressure, that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome. Few studies have evaluated the effectiveness of a physical training program compared with other treatments. The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters, quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments.

METHODS:

Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were randomly assigned to three groups: continuous positive airway pressure (n = 9), oral appliance (n = 9) and physical exercise (n = 7). Polysomnographic recordings, blood samples and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance. Clinicaltrials.gov: NCT01289392

RESULTS:

After treatment with continuous positive airway pressure or an oral appliance, the patients presented with a significant reduction in the apnea-hypopnea index. We did not observe changes in the sleep parameters studied in the physical exercise group. However, this group presented reductions in the following parameters: T leukocytes, very-low-density lipoprotein and triglycerides. Two months of exercise training also had a positive impact on subjective daytime sleepiness.

CONCLUSIONS:

Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures. Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index.     

Ausência de associação entre os polimorfismos do gene interleucina-18 e artrite reumatoide

ObjectiveTo assess the association of the polymorphisms of the interleukin-18 (IL-18) gene with rheumatoid arthritis (RA) and with risk factors for cardiovascular diseases (CVD).MethodsThis sample comprised 97 patients with RA and 151 healthy controls. In the patients, risk factors for CVD were analyzed, such as cholesterol levels, arterial hypertension, smoking habit, C-reactive protein (CRP) level, and rheumatoid factor. DNA was extracted and the single nucleotide polymorphisms (SNP) at the ?607C/A and ?137G/C positions of the IL-18 gene were assessed in both groups. The Hardy-Weinberg equilibrium (HWE) was calculated and the odds ratio (OR) test performed, considering a 95% CI and P < 0.05.ResultsThe frequencies of the ?607A allele in patients with RA and in controls were 0,443 and 0.424, respectively, and of the ?137C allele, 0.304 and 0.291, respectively. The genotype frequencies were in HWE, except for controls in the ?137 locus (P = 0.006). Association of the polymorphisms of the IL-18 gene was found with neither RA nor risk factors for CVD, including cholesterol level and CRP (P > 0.05). In addition, more smokers were found among patients with RA as compared with controls (OR = 1.691; P = 0.088), and the CRP levels were slightly higher in patients who smoked than in patients who did not (OR = 2.673; P = 0.061).ConclusionsIn this sample of patients with RA in the South of Brazil, association of the polymorphisms of the IL-18 gene was observed with neither RA nor risk factors for CVD.     

Digital atlas of the zebra finch (Taeniopygia guttata) brain: A high‐resolution photo atlas

We describe a set of new comprehensive, high‐quality, high‐resolution digital images of histological sections from the brain of male zebra finches (Taeniopygia guttata) and make them publicly available through an interactive website ( http://zebrafinch.brainarchitecture.org/ ). These images provide a basis for the production of a dimensionally accurate and detailed digital nonstereotaxic atlas. Nissl‐ and myelin‐stained brain sections are provided in the transverse, sagittal, and horizontal planes, with the transverse plane approximating the more traditional Frankfurt plane. In addition, a separate set of brain sections in this same plane is stained for tyrosine hydroxylase, revealing the distribution of catecholaminergic neurons (dopaminergic, noradrenergic, and adrenergic) in the songbird brain. For a subset of sagittal sections we also prepared a corresponding set of drawings, defining and annotating various nuclei, fields, and fiber tracts that are visible under Nissl and myelin staining. This atlas of the zebra finch brain is expected to become an important tool for birdsong research and comparative studies of brain organization and evolution. J. Comp. Neurol. 521:3702–3715, 2013. © 2013 Wiley Periodicals, Inc.     

Anxiety,depression and suicidal ideation in patients with rheumatoid arthritis in use of methotrexate,hydroxychloroquine, leflunomide and biological drugs

Objective

This paper aims to investigate the prevalence of anxiety, depression and suicidal ideation in patients with rheumatoid arthritis taking different drugs to control the disease.

Methods

The study included 105 patients with rheumatoid arthritis who were treated with methotrexate, leflunomide, hydroxychloroquine and biological drugs. All patients were assessed using the Mini International Neuropsychiatric Interview, the Beck Scale for Suicide Ideation and the Hospital Anxiety and Depression Scale.

Results

Difference was statistically significant (p < 0.001) for both depression and anxiety as to suicidal ideation among groups of patients according to the medication used. Furthermore, the value reached by those patients taking biological drugs was alarming with higher scores for all measures, including suicide ideation. The patients using methotrexate and leflunomide reported lower scores on suicidal ideation than those using hydroxychloroquine and biological drugs. Patients using leflunomide showed less mental health impairment than other groups.

Conclusion

Greater scores for depression, as a comorbidity of rheumatoid arthritis, increase the rate of suicidal ideation and depression also can worsen general pain, hardships, treatment denial, and prognosis, as well as cause a faster reduction in quality of life. Patients taking biologic DMARDs (drugs known as disease-modifying drugs) had the highest rates of depression, anxiety and suicidal ideation among all patients studied. The current analysis showed that psychiatric aspects such as depression, anxiety and even suicide ideation, may differ between groups of patients with arthritis according to the drug used, serving as an alert to the importance of considering also this factors in therapeutic decisions.     

Effectiveness of the endotracheal tube cuff on the trachea: physical and mechanical aspects

Introduction

The inflation pressure of the endotracheal tube cuff can cause ischemia of the tracheal mucosa at high pressures; thus, it can cause important tracheal morbidity and tracheal microaspiration of the oropharyngeal secretion, or it can even cause pneumonia associated with mechanical ventilation if the pressure of the cuff is insufficient.

Objective

In order to investigate the effectiveness of the RUSCH® 7.5 mm endotracheal tube cuff, this study was designed to investigate the physical and mechanical aspects of the cuff in contact with the trachea.

Methods

For this end, we developed an in vitro experimental model to assess the flow of dye (methylene blue) by the inflated cuff on the wall of the artificial material. We also designed an in vivo study with 12 Large White pigs under endotracheal intubation. We instilled the same dye in the oral cavity of the animals, and we analyzed the presence or not of leakage in the trachea after the region of the cuff after their deaths (animal sacrifice). All cuffs were inflated at the pressure of 30 cmH₂O.

Results

We observed the passage of fluids through the cuff in all in vitro and in vivo experimental models.

Conclusion

We conclude that, as well as several other cuff models in the literature, the RUSCH® 7.5 mm tube cuffs are also not able to completely seal the trachea and thus prevent aspiration of oropharyngeal secretions. Other prevention measures should be taken.     

Impact of multidrug resistance on the management of bacterial infections in cirrhosis

Patients with cirrhosis have an increased risk of infection and differently from other complications, that over the years are improving in their outcomes, infections in cirrhotic patients are still a major cause of hospitalization and death (up to 50% in-hospital mortality). Infections by multidrug-resistant organisms (MDRO) have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related impact. About one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent years. MDR infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection resolution. An adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects, such as the type of infection (spontaneous bacterial peritonitis, pneumonia, urinary tract infection and spontaneous bacteremia), bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition (community acquired, healthcare associated or nosocomial). Furthermore, regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological epidemiology. Antibiotic treatment is the most effective measure to treat infections caused by MDRO. Therefore, optimizing antibiotic prescribing is critical to effectively treat these infections. Identification of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce mortality. On the other hand, the supply of new agents to treat these infections is very limited. Thus, specific protocols that include preventive measures must be implemented in order to limit the negative impact of this severe complication in cirrhotic patients.