Ana Dias

Impacto da umidificação aquecida com pressão positiva automática em vias aéreas na terapia do síndroma de apneia obstrutiva do sono

OBJECTIVE To study the impact that heated humidification instituted in the beginning of automatic positive airway pressure (APAP) therapy has on compliance with and the side effects of the treatment. METHODS Thirty-nine treatment-naïve patients with obstructive sleep apnea were randomized into two groups to receive APAP using one of two modalities: with heated humidification (APAPwith group); and without heated humidification (APAPw/o group).Patients were evaluated at 7 and 30 days after APAP initiation. The following parameters were analyzed: compliance with treatment (mean number of hours/night); side effects (dry nose or mouth, nasal obstruction and rhinorrhea); daytime sleepiness (Epworth sleepiness scale score) and subjective comfort (visual analog scale score). Patients were also evaluated in terms of residual apnea-hypopnea index (AHI), as well as mean pressures and leaks registered in the ventilators. RESULTS There were no differences between the two groups in terms of mean age (APAPwith: 57.4 +/- 9.2; APAPw/o: 56.5 +/- 10.7 years), AHI (APAPwith: 28.1 +/- 14.0; APAPw/o: 28.8 +/- 20.5 events/hour of sleep), baseline Epworth score (APAPwith: 11.2 +/- 5.8; APAPw/o: 11.9 +/- 6.3) and initial nasal symptoms. Compliance was similar in both groups (APAPwith: 5.3 +/- 2.4; APAPw/o: 5.2 +/- 2.3 h/night). There were no differences in any of the other parameters analyzed. CONCLUSIONS The introduction of heated humidification at the beginning of APAP therapy provided no advantage in terms of treatment compliance or side effects of treatment.

Restless legs syndrome.

Restless legs syndrome (RLS) is a chronic sensorimotor disorder, with a negative impact in the quality of life and sleep architecture. Despite its reported high prevalence, remains under-recognized and under-treated. The diagnosis is based on the presence of four essential criteria, three supportive clinical features, and other three associated features. The primary or idiopathic RLS is the most common presentation form, but it is very important to exclude other RLS secondary forms and other differential diagnosis. The physiopathology of the idiopathic RLS remains unclear, however changes in the dopamine pathway have been proposed, and justifies the use of dopaminergic agents as first line treatment. Iron therapy, opioids, anti-epileptics (gabapentin) and benzodiazepines are others non-dopaminergic options of treatment in selected patients.

Miliary tuberculosis: A 10 years´ experience of an infectious pulmonology unit in Portugal

Introduction: Miliary tuberculosis (MTB) represents almost 1-3% of all Tuberculosis cases and remains a potentially lethal disease if not diagnosed and treated timely. Formerly it was considered a childhood disease, but nowadays it is also recognized as a condition of adults, especially in immunosuppressed patients with HIV infection or by the use of biological agents and immunosuppressive drugs. Objective: describe the clinical presentation and outcomes of hospitalized patients with MTB. Methods: retrospective study over 10 years in patients admitted with MTB Results: 53 patients were included. Mean age: 44 years; 77,4% males; 71,7% Caucasians and 28,3% Blacks. The comorbidities were: HIV infection (66%), alcoholism (28%), smoking (26%), hepatitis C (25%), drug addiction (23%) and malnutrition (23%). On admission, patients presented anemia (62%), hyponatremia (34%), acute renal failure (17%) and pancytopenia (7,5%). Beyond the micronodular pattern (91%), the patients presented with alveolar pattern (13,2%), reticular pattern (5,7%) and cavitation (3,8%). 51% patients had acid-fast bacillus sputum negative. In addition to lung location, 43% had Tuberculosis in another organ. The adverse reactions occurred in 28,5% (n=15) cases, 80% of them with hepatotoxicity. In HIV subgroup, adverse reactions occurred in 31,4%, 77,8% of them had CD4 count Conclusions: This study highlights the importance of HIV infection and risk behaviors in triggering MTB and points out the adverse reactions, prolonged hospitalization and in-hospital mortality as characteristic attributes of this condition.