News about Medicine - Part 5

Ventilation and Breathing Pattern during Sleep in Duchenne Muscular Dystrophy: Discussion

Ventilation and Breathing Pattern during Sleep in Duchenne Muscular Dystrophy: DiscussionIn a further report that included data from four of these six subjects, we showed that mean hypopnea and apnea duration (usually REM related) was prolonged by oxygen treatment. In the present study, however, mean Ve in REM sleep was similar on air and oxygen. Representative mean data obtained over six to ten minutes of each sleep stage give an overall picture of Ve rather than an analysis of individual disordered breathing events; minor differences between air and oxygen nights may have been obscured. Nevertheless, it is reassuring that oxygen desaturation can be greatly improved or abolished without an apparent adverse effect on overall ventilation. Here Read the rest of this entry »

Ventilation and Breathing Pattern during Sleep in Duchenne Muscular Dystrophy: Comparison to Normal Values

Variability of Data
The within-subject coefficient of variation values were similar on air and oxygen and only those from air are given in Table 2. A marked increase in variability of all respiratory measurements occurred in changing NREM to REM sleep, but especially in the frequency of ventilation, and all save Vt and AC were more variable in REM than wakefulness.
Comparison to Normal Values
A comparison with normal data, derived using similar MLR calibration of RIP in six restrained young healthy adult males, is presented in Figure 3. This illustrates the mean values of each variable during wakefulness, slow wave (S3/4) sleep, and REM sleep in the six subjects with Duchenne MD studied on air compared to these published normal data. Significant differences between the present data and those of Stradling et al were noted for Ve in NREM sleep (p<0.05) and abdominal contribution during wakefulness (p<0.01), slow wave sleep (p<0.01), and REM sleep (p<0.05). Mean Vt/Ti fell by 17.8 percent (air) and 20.9 percent (oxygen) from awake to NREM sleep, but by only 2.9 percent in the published normal results; the further fall from NREM to REM sleep was similar to normal. other Read the rest of this entry »

Ventilation and Breathing Pattern during Sleep in Duchenne Muscular Dystrophy: Results

Ventilation and Breathing Pattern during Sleep in Duchenne Muscular Dystrophy: ResultsData Analysis
Data from six to ten representative consecutive minutes of wakefulness, steady stage 2 non-REM (NREM) sleep (S2), stage 3/4 NREM (S3/4), and REM sleep were obtained for both air and oxygen nights and a mean ± SEM derived. The “minute to minute” within-subject coefficient of variation for each sleep stage was also derived from these data. Comparisons between means were made using the Student t test. life without allergy com
Daytime Pulmonary Function

The mean seated vital capacity of the six subjects was 1.48 L (range, 0.8 to 3.0 L) with a mean fall of 6.7 ( — 3.3 to 20 percent) when supine. The mean total lung capacity was 3.56 L (2.5 to 6.3 L). Residual volume ranged from 1.2 to 3.8 L (mean, 2.18 L) and functional residual capacity from 1.5 to 4.3 L (mean, 2.5 L). Maximum static mouth pressures were low in all subjects, the mean MIP being 37.5 (25 to 65 cm H20) and MEP being 29.2 (15 to 50 cm H20). Daytime blood gas tensions, however, were within normal limits (mean Po2, 14.5 kPa [13.2 to 17.9 kPa]; Pco2, 5.23 kPa [4.7 to 6.05 kPa]). Read the rest of this entry »

Ventilation and Breathing Pattern during Sleep in Duchenne Muscular Dystrophy: RIP Calibration

RIP Calibration
“Respibands” were taped securely to the chest (nipple level) and abdomen (umbilical level and below the costal margins). Immediately before “lights out” and with the patient in his preferred sleeping posture and prepared to sleep, volume-motion (VM) coefficients were obtained using computerized multiple linear regression (MLR) analysis as described by Stradling et al.s Briefly, RIP outputs from rib cage (RC) and abdomen (AB) together with the integrated spirometer signal (SP) from a pneumotachograph (Gould Godart BV) previously stabilized to eliminate drift and calibrated against a liter syringe were sampled within 20 ms of each other 150 times during a 20-second fixed period of quiet tidal breathing and were analyzed by MLR using a BBC “B” microcomputer programmed in Basic. The 150 raw data values for RC, AB, and SP were used in each calibration to calculate the VM coefficients (a and b), using the equation described by Armitage, te, (ax RC) + (bx AB) + e = SP (“e” representing errors arising from (1) the different voltages of the three variables, and (2) the offset attributable to the intercept of the plot of RIP volume: spirometer volume). more Read the rest of this entry »

Ventilation and Breathing Pattern during Sleep in Duchenne Muscular Dystrophy

Ventilation and Breathing Pattern during Sleep in Duchenne Muscular DystrophyWe have shown previously that recurrent episodes of central hypopnea and/or apnea with accompanying hypoxemia are common in subjects with advanced Duchenne muscular dystrophy (MD) during rapid eye movement (REM) sleep. There are, however, few reports quantifying the breathing pattern during wakefulness and sleep in patients with respiratory muscle weakness; such data can be obtained noninvasively using respiratory inductance plethysmography (RIP) that should help to characterize further the disordered breathing in sleep seen in subjects with Duchenne MD. In addition, the analysis of rib cage and abdominal contributions to breathing during wakefulness and sleep may shed light on the role of diaphragm dysfunction in the mechanism of REM-related oxygen desaturation in Duchenne MD. Acpurate and stable quantification of RIP data requires the subject to maintain a single posture and the equipment to be recalibrated following body movement. During sleep, therefore, reliable quantification is possible only for stationary or paralyzed subjects. Patients with advanced Duchenne MD are capable of only minimal body movement and require assistance to change their sleeping posture; they are thus ideally suited to RIP data analysis. We present ventilatory data obtained during overnight polysomnography from six acclimatized subjects with Duchenne MD randomized to air or oxygen on two consecutive nights. buy mircette birth control Read the rest of this entry »

The Tuberculosis Clinic: conclusion

The experience in this clinic, like that in developing countries and in recalcitrant patients, was highly successful in treating tuberculosis. In the general clinics, physicians only rarely used incorrect drug combinations. The problem was inconsistent follow-up and insufficient attention to compliance. These problems were solved more effectively at our medical center by nurse specialists than physicians. This has been reported by others in tuberculosis care. Another benefit of a specialized clinic may be saving the costs of retreatment. Although it is obvious that avoiding retreatment is important, estimation of its cost-effectiveness is difficult because it depends on the nature and infectivity of the patient with recurrence. In the tuberculosis clinic, about 9 percent of the patients were seen for repeated episodes of tuberculosis. Read the rest of this entry »

The Tuberculosis Clinic: Discussion

The Tuberculosis Clinic: DiscussionThis study was an attempt to compare the compliance aspects of the treatment and care of patients with tuberculosis in a specialty clinic with their treatment and care in general clinics in a teaching hospital. Although not a randomized prospective trial we felt there may be important lessons for those caring for patients with tuberculosis. We anticipated that more outpatients from the tuberculosis clinic than from the general clinics would have documentation of successful treatment, but we were surprised to learn that more than half (64 percent) of the records of the general clinics were incomplete. Most records showed neither the Start and stop dates of the medications nor evidence of compliance. The content of the progress notes varied with physicians and clinics. Failed appointments were frequent. Laboratory reports of sputum growth of M tuberculosis went unnoticed. The notation “chart unavailable” frequently appeared in the progress note, making it difficult for physicians to document progress. Read the rest of this entry »


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