Lung Function of Children at Three Sites of Varying Ambient Air Pollution Levels in Uganda: A Cross Sectional Comparative Study.

Air pollution is a major cause of sub-optimal lung function and lung diseases in childhood and adulthood. In this study we compared the lung function (measured by spirometry) of 537 Ugandan children, mean age 11.1 years in sites with high (Kampala and Jinja) and low (Buwenge) ambient air pollution levels, based on the concentrations of particulate matter smaller than 2.

Effects of Cognitive Behavioral Therapy for Insomnia on Sleep, Symptoms, Stress, and Autonomic Function Among Patients With Heart Failure.

: Insomnia is common among patients with stable heart failure (HF) and associated with inflammation and altered autonomic function. : The purposes of this study were to examine the effects of cognitive behavioral therapy for insomnia (CBT-I) on the Hypothalamic Pituitary (HPA) Axis, autonomic function, inflammation, and circadian rhythmicity and the associations between these biomarkers and insomnia, sleep characteristics, symptoms, functional performance, and sleep-related cognitions. : We conducted a subanalysis of a pilot randomized controlled trial (RCT, NCT02827799) whose primary aim was to test the effects of CBT-I on insomnia.

Mechanisms of reduced sleepiness symptoms in heart failure and obstructive sleep apnea.

Patients with both heart failure and obstructive sleep apnea often have poor, repeatedly disrupted sleep, and yet they frequently do not complain of excessive daytime sleepiness. Understanding this lack of perceived sleepiness is crucial for the case identification and treatment of obstructive sleep apnea in the heart failure population at high risk of this disease, especially given the association between untreated obstructive sleep apnea and mortality among patients with heart failure. In this review, we present epidemiologic evidence concerning the lack of sleepiness symptoms in heart failure and obstructive sleep apnea, explore possible mechanistic explanations for this relationship, assess the benefits of treatment in this population, discuss implications for clinical practice and explore directions for future research.

Practical approach to detection and management of acute kidney injury in critically ill patient.

Background: Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. This paper provides a critical review of the etiologies of AKI and a systematic approach toward its diagnosis and management with emphasis on fluid volume assessment and the use of urine biochemical profile and microscopy in identifying the nature and the site of kidney injury.

Materials And Methods: The search of PubMed and selection of papers had employed observational designs or randomized control trials relevant to AKI.

Effects of Cognitive Behavioral Therapy for Insomnia on Sleep-Related Cognitions Among Patients With Stable Heart Failure.

Objective/background: Cognitive behavioral therapy for insomnia (CBT-I) improves insomnia and fatigue among chronic heart failure (HF) patients, but the extent to which sleep-related cognitions explain CBT-I outcomes in these patients is unknown. We examined the effects of CBT-I on sleep-related cognitions, associations between changes in sleep-related cognitions and changes in sleep and symptoms after CBT-I, and the extent to which cognitions mediated the effects of CBT-I.

Participants: Stable New York Heart Association Class II-III HF patients (total n = 51; n = 26 or 51.

Chitinase-3-like protein-1 (YKL-40) as a marker of endothelial dysfunction in obstructive sleep apnea.

Background: Obstructive sleep apnea (OSA) is a highly prevalent disorder affecting 15-24% of adults and triples the risk for hypertension independent of other risk factors. The exact mechanisms of endothelial dysfunction and variable susceptibility to hypertension in OSA are not entirely clear. No biomarker to date has been found to be associated with hypertension in OSA.

The emerging role of microRNAs in hypoxia-induced pulmonary hypertension.

Purpose: The aim of this review is to discuss hypoxia-induced pulmonary hypertension (PH) and the role of microRNAs (miRNAs).

Background: Acute global hypoxia causes pulmonary vasoconstriction and increased pulmonary arterial blood pressure. Chronic exposure to sustained or intermittent hypoxia as in high altitude residents, chronic obstructive lung disease and sleep-disordered breathing can lead to pulmonary hypertension (PH) and right ventricular dysfunction.

Modafinil and sleep architecture in an inpatient-outpatient treatment study of cocaine dependence.

Objective: To determine whether the increase in slow-wave sleep associated with modafinil treatment in chronic cocaine users mediates improved clinical outcomes.

Method: 57 cocaine dependent participants were randomized to receive modafinil 400mg or placebo daily during a period of inpatient treatment followed by six weeks of outpatient treatment. Participants underwent polysomnographic sleep recording during inpatient treatment prior to and after starting modafinil.

The State of Ambient Air Quality in Two Ugandan Cities: A Pilot Cross-Sectional Spatial Assessment.

Air pollution is one of the leading global public health risks but its magnitude in many developing countries' cities is not known. We aimed to measure the concentration of particulate matter with aerodynamic diameter <2.5 µm (PM2.

Time Spent in Lateral Sleep Position and Asymmetry in Glaucoma.

Purpose: To explore sleep position in asymmetric primary open-angle glaucoma (POAG) with a focus on low pressure glaucoma (LPG).

Methods: Sleep laboratory videos of 54 POAG patients were examined for lateral sleep. Then, 29 LPG patients (intraocular pressure [IOP] < 22 mm Hg) with an intereye visual field index (VFI) asymmetry of more than 5% continuously recorded their sleep position at home for 2 nights by using a portable device.

Pulmonary hypertension in obstructive sleep apnea: is it clinically significant? A critical analysis of the association and pathophysiology.

The development of pulmonary hypertension is a poor prognostic sign in patients with obstructive sleep apnea (OSA) and affects both mortality and quality of life. Although pulmonary hypertension in OSA is traditionally viewed as a result of apneas and intermittent hypoxia during sleep, recent studies indicate that neither of these factors correlates very well with pulmonary artery pressure. Human data show that pulmonary hypertension in the setting of OSA is, in large part, due to left heart dysfunction with either preserved or diminished ejection fraction.

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure.

Background: Chronic insomnia is common among patients with heart failure (HF) and may contribute to fatigue and poor function. However, to date there have been no randomized controlled trials focused on treatment of insomnia or daytime symptoms in this population.

Objectives: The purpose of this study was to examine the preliminary efficacy, feasibility, and acceptability of a self-management intervention (cognitive behavioral therapy [CBT-I]) for insomnia among patients with stable HF.

Obstructive sleep apnea: a new preventive and therapeutic target for stroke: a new kid on the block.

Stroke is the second leading cause of death worldwide and a major cause of mental and physical impairment. Numerous studies have identified risk factors for stroke, including hypertension, atrial fibrillation, diabetes, and smoking. However, even after considering these well-recognized risk factors, there is substantial variation in stroke rates and stroke-related outcomes.

Assessment of preload and fluid responsiveness in intensive care unit. How good are we?

Early recognition and treatment of acute circulatory failure and tissue hypoperfusion are paramount for improving the odds of survival in critically ill patients. Fluid volume resuscitation is the mainstay intervention in redistributive and hypovolemic shock. Correct identification of a patient who would benefit from fluid administration allows optimization of hemodynamics and avoids ineffective or even deleterious volume expansion that may result in worsening of gas exchange and pulmonary edema in fluid unresponsive patients, in whom inotropic and/or vasopressor support should preferentially be used.

Common High Altitudes Illnesses a Primer for Healthcare Provider.

Exposure to high altitude imposes significant strain on cardiopulmonary system and the brain. As a consequence, sojourners to high altitude frequently experience sleep disturbances, often reporting restless and sleepless nights. At altitudes above 3,000 meters (9,800 ft) almost all healthy subjects develop periodic breathing especially during NREM sleep.

Sleep in asthma.

Many patients with asthma experience worsening of symptoms at night. Understanding the mechanism of nocturnal asthma and the factors that exacerbate asthma during sleep would lead to better management of the condition.

Obstructive sleep apnea and hypertension: a critical review.

Obstructive sleep apnea (OSA) is a prevalent sleep disorder which is characterized by recurrent upper closure with oxygen desaturation and sleep disruption. OSA increases the risk of vascular disorders in the form of stroke, myocardial infarction, congestive heart failure, and hypertension. The mechanisms underlying the vascular disorders are several and include intermittent hypoxia with release of cytokines, angiogenic inhibitors, free radicals, and adhesion molecules.

Increased plasma YKL-40/chitinase-3-like-protein-1 is associated with endothelial dysfunction in obstructive sleep apnea.

Purpose: Obstructive sleep apnea (OSA) is a common disorder affecting 15-24% of the adults and is associated with increased risk of hypertension and atherosclerosis. The exact mechanisms underlying hypertension in OSA are not entirely clear. YKL-40/Chitinase-3-like protein-1 is a circulating moiety with roles in injury, repair and angiogenesis that is dysregulated in atherosclerosis and a number of other diseases.

The impact of gender on timeliness of narcolepsy diagnosis.

Study Objectives: To examine the impact of gender in narcoleptic patients on timeliness of diagnosis, symptomology, and health and lifestyle impairment.

Methods: This is a cross-sectional study of 109 consecutive patients (68 women) with newly diagnosed narcolepsy with and without cataplexy, from a University sleep disorders center. Consecutive patients were administered an 8-page questionnaire at the time of their diagnosis regarding sleep habits, medications, and medical conditions, lifestyle impairments, as well as details regarding narcolepsy-related symptoms.

Diagnosis and management of sleep disorders in posttraumatic stress disorder:a review of the literature.

Objective: International and societal conflicts and natural disasters can leave physical and mental scars in people who are directly affected by these traumatic experiences. Posttraumatic stress disorder (PTSD) is the clinical manifestation of these experiences in the form of re-experiencing the trauma, avoidance of trauma-related stimuli, and persistent symptoms of hyperarousal. There is growing evidence that sleep disruption that occurs following trauma exposure may in fact contribute to the pathophysiology of PTSD and poor clinical outcomes.

Endothelial dysfunction and hypertension in obstructive sleep apnea - Is it due to intermittent hypoxia?

Background: Obstructive sleep apnea (OSA) is a prevalent disorder causing hypertension. Endothelial dysfunction appears to underlie development of hypertension. It is not known whether hypoxia during sleep is necessarily the prerequisite process for endothelial dysfunction and hypertension in OSA.

Assessment and management of cerebral edema and intracranial hypertension in acute liver failure.

Acute liver failure is uncommon but not a rare complication of liver injury. It can happen after ingestion of acetaminophen and exposure to toxins and hepatitis viruses. The defining clinical symptoms are coagulopathy and encephalopathy occurring within days or weeks of the primary insult in patients without preexisting liver injury.

Retinal vascular tortuosity in obstructive sleep apnea.

Purpose: Endothelial dysfunction and vascular disease are common in obstructive sleep apnea (OSA). We sought to examine the retinal vascular manifestations of OSA.

Methods: Nine consecutive patients with OSA underwent ophthalmic examination regardless of any ocular complaints.

Activation of heme oxygenase and suppression of cGMP are associated with impaired endothelial function in obstructive sleep apnea with hypertension.

Background: Obstructive sleep apnea (OSA) is a highly prevalent disorder that increases the risk of systemic hypertension and cardiovascular diseases. Heme oxygenase (HO) has been shown to be upregulated in patients with OSA and its overexpression in mice causes hypertension. End products of HO are carbon monoxide (CO) and bilirubin.