1,721,014 research outputs found
Resolution of daytime and night-time respiratory symptoms but persistent sleep apnea in severe asthma with the add-on of benralizumab
No full textINTRODUCTION: The relationship between asthma and obstructive sleep apnea (OSA) is a widely debated topic in the scientific literature with the controversy surrounding the bi-directional nature of the correlation. CASE PRESENTATION: We report the case of a 59-year-old male being affected by severe allergic eosinophilic asthma and severe OSA (apnea-hypopnea index [AHI] 32 ev·hr(-1)). Due to a clinical worsening of asthma (aggravation of dyspnea, chest constriction and night-time respiratory symptoms), despite the optimal therapy for asthma and recurrent administration of systemic corticosteroids, we have added-on treatment with benralizumab (monoclonal anti-interleukin 5 antibody). After eight months, the patient reported an improvement in asthma control (asthma control test [ACT]= 25 points), in pulmonary function and a good control of nocturnal symptoms of both diseases (i.e., wheezing, snoring, etc.). Then, the follow up polysomnography (PSG) was performed resulting in a high reduction of OSA severity (~18% AHI) even if obstructive events persisted and almost resolution of nocturnal hypoxemia. So, a trial with positive airway pressure (PAP) was proposed to the patient, who declined. CONCLUSIONS: In consideration of our experience, we suggest that the nocturnal profile of patients with severe asthma should be always studied by a sleep investigation to prevent the negative effects of interaction with OSA. However, further studies on larger samples are needed to better understand the pathophysiological mechanisms underlying the beneficial effects of benralizumab on obstructive events during sleep
Crisis resource management applied to non-intubated video-assisted thoracoscopic surgery
No full textPrograms for non-intubated video-assisted thoracoscopic surgery have increasingly become available everywhere. Less invasiveness and quicker recovery are the main advantages. However, issues could arise. The principles of crisis resource management (CRM) must be observed for the proper prevention and management of all these potentially life-threatening crises. Additionally, they want to use clinical simulation as a method to create various scenarios that would enhance teamwork. This paper’s goal is to evaluate and summarize simulation-based CRM training programs for a specific surgery, including the management of certain surgical and medical critical scenarios
Causes, management and treatment of empyema
No full textInfections in the pleural space have been a significant problem since ancient times and continue to be so today, with an incidence of 52% in patients with post-pneumonia syndrome. Typically, these effusions require a combination of medical treatment and surgical drainage, including debridement and decortication. researchers have been studying the use of intrapleural fibrinolytics in managing complicated pleural effusions and empyema, but there is still ongoing debate and controversy among clinicians. Empyema has traditionally been considered a surgical disease, with antibiotics and chest tube drainage being the initial treatment modality. However, with advances in minimally invasive procedures such as video-assisted thoracoscopic surgery (VATS) and the use of intrapleural fibrinolytics, medical management is now preferred over surgery for many cases of empyema. Surgical options, such as open thoracotomy, are reserved for patients who fail conservative management and have complicated or chronic empyema. This comprehensive review aims to explore the evolution of various management strategies for pleural space infections from ancient times to the present day and how the shift from treating empyema as a surgical condition to a medical disease continues
Novel Wearable Device for Non-Invasive Management of Positional Sleep Apnea: A Proof-of-Concept
No full textObstructive Sleep Apnea (OSA) is a serious health condition characterized by repetitive airway collapses during sleep, which can lead to cardiovascular and metabolic complications if untreated. Positional OSA (POSA), a subtype triggered by specific sleeping positions, presents additional therapeutic challenges. This paper introduces a novel wearable device designed to treat POSA non-invasively. The system employs a microcontroller, inertial sensors, and a quiet piezoelectric pump to dynamically adjust a pillow based on the user's position. When the patient lies supine, the pillow inflates to encourage a lateral position, reducing nocturnal respiratory events. Experimental tests demonstrate the system's low latency and minimal noise levels, making it a comfortable alternative to conventional OSA treatment, but also aiming to become the first-line treatment for POSA. The proposed device offers an effective, portable, and adaptable solution for patients seeking non-intrusive treatment options for sleep apnea. Future developments include integrating remote monitoring capabilities to enhance usability and clinical effectiveness
Baseline plethysmographic signal of arterial pulse during polysomnography: a potential insight into venous return and its clinical implications
No full textPulse oximetry is based on the technique of photoplethysmography. It is known that the pulsatile arterial component can provide a range of information, such as arterial blood oxygen saturation, the response to fluid infusion, and the nature of respiratory events during sleep. Until now, little importance has been given to the venous component of the plethysmographic signal, which is non-pulsatile but subject to volumetric variations in relation to changes in endopleuric pressure. Respiratory-induced intensity variations contained in the baseline of the photoplethysmographic signal have been well documented. We hypothesize that in polysomnography, variations in the baseline of the plethysmographic signal (referred to as the BPS, baseline plethysmographic signal) reflect variations in venous return induced by respiration, and that these variations present morphological aspects that could have clinical utility in the interpretation of polysomnographic signals, particularly regarding respiratory effort associated with respiratory events, their nature (central or obstructive), and the hemodynamic alterations associated with them. This article presents a selection of polysomnographic traces and images with physiopathological considerations that support our hypothesis
Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAHS): state of the art
No full textObstructive sleep apnoea-hypopnoea syndrome (OSAHS) is an extremely common sleep-related breathing disorder (SRBD) characterised by complete or partial collapse of the upper airways. These nocturnal phenomena cause high-frequency hypoxemic desaturations (or intermittent hypoxia, IH) during sleep and alterations in gas exchange. The result of IH is the development or worsening of cerebro-cardio-vascular, metabolic and other diseases, which cause a high risk of death. Hence, OSAHS is a multifactorial disease affecting several organs and systems and presenting with various clinical manifestations involving different medical branches. Although it has been estimated that about one billion individuals worldwide are affected by OSAHS, this SRBD remains underestimated also due to misinformation regarding both patients and physicians. Therefore, this review aims to provide information on the main symptoms and risk factors for the detection of individuals at risk of OSAHS, as well as to present the diagnostic investigations to be performed and the different therapeutic approaches. The scientific evidence reported suggest that OSAHS is an extremely common and complex disorder that has a large impact on the health and quality of life of individuals, as well as on healthcare expenditure. Moreover, given its multifactorial nature, the design and implementation of diagnostic and therapeutic programmes through a multidisciplinary approach are necessary for a tailor-made therapy for each patient
Real life experience of molnupiravir as a treatment of SARS-CoV-2 infection in vaccinated and unvaccinated patients: a letter on its effectiveness at preventing hospitalization
No full textBACKGROUND: The SARS-CoV-2 pandemic has prompted clinicians to develop an early and effective treatment of viral infections. To date, vaccines, monoclonal antibodies, and antivirals are the cornerstone of therapy for SARS-CoV-2. AIFA approved the prescription of molnupiravir on 30/12/2021. Molnupiravir is a prodrug that causes the accumulation of errors in the viral genome. METHODS: We prescribed molnupiravir to a total of 74 patients in a range between 26 and 96 years old and followed-up them for 30 days. 10 patients affected by idiopathic pulmonary fibrosis (IPF) were treated. RESULTS: The follow-up showed that all of the treated patients presented a regression of symptoms. No patients were hospitalized and/or showed sequelae after the infection by SARS-CoV-2, even though the examined population was older and with more co-morbidities than other patients treated with different antivirals. CONCLUSION: Molnupiravir is safe and well-tolerated by patients with high-risk of progression to severe COVID. No patients were hospitalized or showed sequelae, including all patients affected by IPF
Management options for excessive daytime sleepiness in patients with obstructive sleep apnea
No full textIntroduction: Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) associated with the risk of accidents at work or while driving. OSA treatment decreases EDS, but some patients remain sleepy despite optimal control of OSA. Patients who do not tolerate or refuse OSA treatment may be symptomatically treated for EDS. Solriamfetol and pitolisant are wake-promoting agents (WPA) recently approved for use in sleepy OSA patients accepting or refusing OSA treatment. Areas covered: This narrative review provides updated information on: how to assess EDS in OSA patients, epidemiology, and management of residual EDS in treated OSA patients and the results of recent studies using new WPAs in patients accepting or refusing CPAP treatment. Literature was accessed from PubMed between 1 December 2024 and 6 January 2025. Expert opinion: The new WPAs are useful drugs with a favorable safety profile to be included as a possible therapeutic option for sleepy OSA patients. However, it is still uncertain which subgroups of patients should be treated for the symptom of EDS while maintaining a low-risk profile in terms of the consequences of OSA on health. Until such data is available, use of WPA in OSA patients should be managed by Sleep Specialists
Local Anesthetic Thoracoscopy: A Focus on Indications, Techniques and Complications
No full textThe main purpose of this narrative review is to educate general practitioners about a crucial pleural procedure, namely local anesthetic thoracoscopy (LAT), and to provide established respiratory physicians with an expert opinion-based summary of the literature. This narrative review focuses on the indications, technical aspects and complications of LAT, highlighting its safety and high degree of diagnostic sensitivity for patients who present with an unexplained pleural effusion and have a high pre-test probability of cancer
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