1,721,070 research outputs found
Apnées du sommeil: un question de fluid?
No full textRésumé La prévalence des apnées obstructives du sommeil est plus élevée chez les patients présentant une rétention hydrosodée, telle que l’insuffisance cardiaque chronique (ICC), que dans la population générale. Chez les patients en ICC, les apnées centrales, rares en population générale, sont également fréquentes. Quoique la physiopathologie des apnées centrales et obstructives soit multifactorielle, ces observations suggèrent que la rétention des fluides contribue au développement des deux types d’apnées chez ces patients. En particulier, l’excès de fluide accumulé dans les jambes pendant le temps passé en position verticale peut être redistribué selon un axe caudorostral en position allongée, tout au long de la nuit. Une partie de ces fluides peut atteindre le cou, augmentant la pression tissulaire autour des voies aériennes supérieures et prédisposant aux apnées obstructives. Chez les patients en ICC, les fluides peuvent également s’accumuler au niveau des poumons entraînant une hyperventilation à l’origine d’une baisse de la PaCO2 au-dessous du seuil apnéique, conduisant à l’apparition d’apnées centrales. Cet article a pour but de faire le point sur les différentes études ayant exploré le rôle du transfert de fluide dans la genèse des apnées tant obstructives que centrales
Nouvelles règles pour scorer les événements respiratoires du sommeil chez l’adulte: rapport de l’American Academy of Sleep Medicine 2013.
No full textObesity and sleep disorders: A bidirectional relationship
Full text linkAims: Obesity and sleep disorders are highly prevalent conditions with profound implications for public health. Emerging evidence highlights a bidirectional relationship between these two conditions, with each exacerbating the other in a complex interplay of behavioral, physiological, and hormonal mechanisms. Sleep deprivation and poor sleep quality contribute to energy imbalance through dysregulation of appetite hormones (e.g., leptin and ghrelin), increased caloric intake, and reduced physical activity. Conversely, sleep disorders such as obstructive sleep apnea syndrome (OSAS), insomnia, and restless leg syndrome (RLS) are significantly more common in individuals with obesity. Data synthesis: This review explores the pathophysiological mechanisms underlying this relationship, including the roles of inflammation, autonomic dysregulation, and neuroendocrine pathways. Sleep loss exacerbates metabolic syndrome components, including insulin resistance and dyslipidemia, further perpetuating weight gain. Similarly, obesity-induced sleep disorders lead to pro-inflammatory states, vascular dysfunction, and sympathetic overactivation, compounding cardiometabolic risks. Specific conditions like OSA and RLS are examined as models of this interdependence, emphasizing their shared pathways and clinical implications. Conclusions: The bidirectional link between obesity and sleep disorders underscores the importance of integrating sleep assessment and management into obesity treatment strategies. Addressing this relationship could mitigate the progression of cardiometabolic comorbidities and improve overall health outcomes. Moreover, the intertwined dynamics between obesity, sleep disorders, and mental health—mediated by inflammatory pathways, hormonal dysregulation, and neurobehavioral factors—highlight the critical need for integrated treatment approaches targeting physical, psychological, and sleep-related dimensions to enhance health and quality of life
Home treatment of infection-related acute respiratory failure in kyphoscoliotic patients on long-term mechanical ventilation
No full textBACKGROUND: In patients with kyphoscoliosis, long-term mechanical ventilation improves chronic
alveolar hypoventilation during spontaneous breathing, improves quality of life, decreases the need
for hospitalization, and improves survival. In these patients respiratory infection can precipitate
acute respiratory failure (ARF) that requires hospitalization. OBJECTIVE: To study the possibility
of home treatment of infection-related ARF in kyphoscoliotic patients on long-term mechanical
ventilation. METHODS: During a period of 4 years, 8 kyphoscoliotic patients (3 women, 5 men,
mean SD age 61 10 y, mean Cobb angle 84 7°), who had been using overnight mechanical
ventilation (delivered by either volume-limited [4] or pressure-limited [4] ventilators) for
31 32 months, developed infection-related ARF. Seven patients agreed to be treated at home, with
an increase of the daily duration of mechanical ventilation to > 20 hours, and antibiotics. Blood
oxygen saturation was monitored via pulse oximetry during mechanical ventilation and overnight,
to determine whether to add or increase supplemental oxygen. A nurse, a general practitioner, and
a chest specialist made scheduled visits to each patient. RESULTS: All 7 patients were successfully
treated at home. In 2 patients supplemental oxygen flow was slightly increased. Two patients who
had not previously been receiving supplemental oxygen received supplemental oxygen for a few
days. The patients progressively decreased the daily duration of mechanical ventilation, according
to their ability to breathe comfortably without mechanical assistance, under the supervision of the
medical staff, and they all returned to their baseline (pre-ARF) condition in 4 weeks. CONCLU-
SION: In kyphoscoliotic patients on long-term mechanical ventilation, home treatment of infection-
related ARF is possible and effective, provided there is adequate collaboration by the patients and
their relatives, and staff well-trained in mechanical ventilation and other aspects of the home care
of these patients
Targeting volume overload and overnight rostral fluid shift: A new perspective to treat sleep apnea
No full textSleep apnea is a common condition associated with increased morbidity and mortality. Continuous positive airway pressure and oral appliances are efficient for treating sleep apnea; however, they are often poorly tolerated. Therefore, alternative therapies are needed. Overnight rostral fluid shift has been implicated in the pathogenesis of sleep apnea, particularly in conditions associated with fluid overload. Fluid shift predisposes to both obstructive and central sleep apnea, with the type of sleep apnea being related to whether the fluid shifts from the legs into the neck or chest, respectively. The amount of fluid that shifts from the legs to the upper part of the body at night is correlated with the severity of sleep apnea. As a result of this observation, it has been suggested that the prevention of overnight fluid shift may reduce sleep apnea severity. It has recently been shown that interventions targeting fluid overload and daytime fluid accumulation in the legs consistently attenuate nocturnal fluid shift and sleep apnea, as greater reductions in fluid shift are correlated with greater reductions in sleep apnea severity. This review will focus on interventions that counteract fluid shift, such as diuretics, ultrafiltration/dialysis, physical activity, compression stockings and salt/fluid restriction, which have been shown to have effi- cacy in reducing sleep apnea severity
Planificación Estratégica A. J. & J. A. Redolfi S. R. L
No full textEl presente trabajo se aplica a la empresa A. J. & J. A. Redolfi S. R. L una empresa perteneciente al segmento mayorista del retail, que comercializa variados productos en la zona pampeana desde mediados del siglo pasado. Tecnológicamente postergada y con un mascado desaprovechamiento de sus ventajas competitivas, se encuentra en un periodo de estancamiento, por lo que se propuso presentar una estrategia empresarial La penetración y el cambio tecnológico, como estrategia y digitalización, logística integral y actualización como plan de acción para el próximo trienio, junto con la capacitación prometen un incremento del 15% de los ingresos para el 2023. Todo ello basado en un modelo contemporáneo de Dark Store. La misión, visión y valores de la compañía serán los pilares fundamentales de la estrategia diseñada en conjunto, logrando así una eficiencia en las actividades cumpliendo con su objetivo general
Planificación Estratégica A. J. & J. A. Redolfi S. R. L.
No full textEn el siguiente reporte de caso sobre la empresa A. J. & J. A. Redolfi S. R. L. ubicada en la localidad de James Craik, de la provincia de Córdoba, Argentina, se realizó un plan estratégico para lograr el objetivo de mejorar la organización interna, reducir tiempos de operaciones, satisfacer a los clientes, agilizar procesos y mejorar la rentabilidad de la empresa. Se planteo implementar una estrategia organizativa en unidades de negocio, generando una mejor organización dentro de la empresa y así incrementar la rentabilidad de la misma. En este caso los planes de acción se concentraron en mejorar el crecimiento de cada una de las unidades de negocio. En la inversión se tiene un costo total equivalente a $17.048.906, con un rendimiento de la inversión del 419%
Reporte de Caso A. J. & J. A. Redolfi. S. R. L. Comunicación interna
No full textEl siguiente Trabajo Final de Grado corresponde al reporte de casos de la empresa A. J. &
J. A. Redolfi. S. R. L. ubicada en James Craik, de la provincia de Córdoba, Argentina. El mismo,
corresponde al sector alimenticio con 50 años de trayectoria. Se diagnosticaron como deficiencias
internas la ausencia de canales de comunicación y una desarticulación entre las áreas. Por
consiguiente, trae como resultado una débil cultura organizacional, lo que impacta en los objetivos
organizacionales.
Frente a este panorama, se propuso un plan de comunicación interna atendiendo las
problemáticas existentes; y a su vez, a las necesidades del entorno inmerso en la era comunicacional
y proliferación de los avances tecnológicos
Postural lung volume reduction, expiratory flow limitation, and orthopnoea in diaphragmatic weakness: Preliminary observations
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