Evaluation and comparison of Tranquility and AutoSet T autotitrating CPAP machines.

The objective of this study was to determine the effectiveness of two autotitrating continuous positive airway pressure (auto-CPAP), the Tranquility (Respironics, Inc., Murrysville, PA, U.S.A.) and the AutoSet T (ResMed Corp., Poway, CA, U.S.A). Patients with obstructive sleep apnea syndrome (OSAS) underwent attended auto-CPAP titration with either the Tranquility or AutoSet T machine. The auto-CPAP machine was given a performance score between 0 and 9. A score of 3 or lower indicated that autotitration had to be discontinued. Sixty patients were studied, 35 patients with the Tranquility machine and 25 patients with the AutoSet T machine. The mean age was 55.4 years, whereas the mean body mass index (BMI) was 32.7. The mean respiratory disturbance index (RDI) was 37.5, and the mean arousal index before use of auto-CPAP was 41.4. The two treatment groups were comparable in age, BMI, RDI, and arousal index. The mean performance scores for the Tranquility and AutoSet T machines were not statistically different. Autotitration with the Tranquility machine had to be discontinued in 10 of the 35 patients (29%), whereas with the AutoSet T machine, autotitration was discontinued in 11 of the 25 patients (44%). Despite advances in auto-CPAP machines, there remains a large minority of patients with OSAS in whom these machines do not accomplish treatment goals. At this time, these machines are not a substitute for in-laboratory CPAP titration polysomnograms.     

Depression in sleep disorders clinics

Purpose  The purpose of this paper was to determine the incidence of depression in our sleep disorders clinics (and it’s relation to patient characteristics) and to determine whether the incidence of depression varies in patients with and without sleep apnea. Methods  The Beck Depression Inventory (BDI) was administered to evaluate patients for depression. We reviewed records of all new patients between November, 1995 and May, 1996 and determined their BDI scores and polysomnogram (PSC) results. Patients were divided based on their respiratory disturbance index (RDI); a cut off value of 15 was chosen. Patients were re-divided based on the BDI score (13 or greater suggestive of depression). The age, sex, body mass index (BMI), BDI or RDI (as appropriate) and arousal indices were compared. Results  Sixty-three patients were enrolled; 29% were depressed. BDI scores and PSG data were available in 42 patients. Those with a high RDI had significantly lower BDI scores and higher arousal indices. Those with a high and low BDI scores were not significantly different in any of the parameters evaluated. Conclusions  Symptoms of depression are commonly seen in a sleep clinic. In patients with symptoms suggestive of SA but with low RDI scores, a diagnosis of depression should be entertained. The presence of depression, however, should not negatively influence a decision to perform PSG. Presented in part at the 19th Annual Meeting of the Associated Professional Sleep Societies, Washington, D.C., May, 1996.     

Ureteric pellet causing non-functioning kidney

This case report describes a young man with bilateral flank pain for one year following a gunshot trauma to abdomen. On ureteroscopy a pellet was found in the right ureter.     

Silent myocardial infarction and antiphospholipid antibody syndrome

We describe a case of 18-year-old woman followed for 3 years for systemic lupus erythematosis (SLE) complicated of a nephrectomy. Having like only factor of cardiovascular risk a balanced arterial hypertension. The patient was hospitalized because of choreo-athetosic's movement. We discovered fortuitously during this hospitalization an inferior myocardial necrosis as well as a mitral regurgitation. Coronary angiography was normal and the ventriculography showed an akinesy in the inferior territory. Biology made it possible to pose the diagnosis of antiphospholipid antibody syndrome (APS) on (SLE). We suppose that surgery started myocardial necrosis and underline through this case interest of early identification and appropriate treatment of APS as well as a narrow monitoring particularly in young patients candidates to surgery.     

Epidemiological and evolutionary characteristics of heart failure in patients with left bundle branch block – A Moroccan center-based study

Background

In patients with heart failure, left bundle branch block (LBBB) seems to be associated with an increased risk of cardiovascular mortality.

Purpose

The purpose of this study is to determine the in-hospital outcome of congestive heart failure patients with LBBB versus those without.

Methods

We conducted a prospective observational study at the Department of Intensive Care and Rhythmology at the Mohammed V Military Hospital of Rabat, where 330 patients were admitted for heart failure between January 2008 and September 2012. Screening out patients with missing data yielded a cohort of 274 patients. Among the 274 patients, only 110 had LBBB and a left ventricular ejection fraction lower than 50%. We randomly selected a subset of 110 patients diagnosed as non-LBBB to ensure a significant statistical comparison between LBBB and non-LBBB patients. We therefore considered two groups in our analysis: 110 heart failure (HF) patients with LBBB and 110 HF patients without LBBB. Patients with incomplete records were excluded.

Results

Male gender was dominant in both groups (82.7% vs. 66.7%, p = 0.005). Patients with LBBB had a higher prevalence of idiopathic dilated cardiomyopathy (39.1% vs. 4.8%, p < 0.001); and a higher prevalence of previous hospitalization for heart failure (64.5% vs. 23.3%, p < 0.001). The left ventricular ejection fraction was significantly lower in the group with LBBB (25.49% vs. 39.53%, p < 0.001). Age, cardiovascular risk factors, rhythmic and thromboembolic complications did not significantly differ. In patients with LBBB, 61.8% received cardiac resynchronization therapy performed both during the index hospital stay (50.9%) and previously (10.9%). Hospital outcome was marked by 20 in-hospital deaths in the group with LBBB and eight deaths in the group without LBBB (p = 0.008).

Conclusion

Our analysis emphasizes increased in-hospital mortality and higher disease severity, over a short period of stay, in heart failure patients with left bundle branch block.     

Heart and sports: modifications of electrocardiogram,late potentials and echocardiography. Study of 75 sportsmen and 46 witnesses

The authors report the results of prospective study, which compared 75 sports subjects and 45 witnesses. All subjects were male, the differentiating parameter being the type of sport practiced. This work analysed surface Electrocardiogramme, thransthoracic echocardiography and high amplification ECG. The statistical study used the student test t compare means and the Chi2 test for the percentages, the signification limit was fixed to 5%. Clinically, our two series didn't show a significant statistical difference, concerning: age, weight, height or arterial pressure. On the electrocardiographical level, the sport's men have a lower cardiac frequency (p = 0.005), a larger PR space (p = 0.05), an important Sokolow parameter (p < 0.005), and repolarisation disorders represented, essentially by negative T waves (p = 0.02) and an upper movement of ST segment in V2-V3 (p < 0.005). Echocardiography showed a dilatation of the right cavities: right auricular (p = 0.0125) and right ventricular (p = 0.025). Move over, it has been showed that the sport's men left ventricular walls were tabor (septal wall, p = 0.0125), (posterior wall, p = 0.025), despite a difference in the values of the left ventricular telediastolic diameter (4 mm average in the two series). The signification limit was not reached and it was also showed that the left auricular was also dilated (p = 0.025). The study of the delayed Potentials, tried to bring an explication to certain sudden deaths of sport's men which are to date unexplained and which could have a rhythmical origin? It is also to be noted that sport's men present more delayed ventricular Potentials. However, the statistical signification was not reached (p = 0.07).