Douglas C. Johnson

Obstructive Sleep Apnea Is a Risk Factor for Stroke and Atrial Fibrillation

1helps with the assessment of risk for stroke and thromboembolism in patients with atrial fibrillation (AF). Unfortunately, the Euro Heart Survey did not evaluate patients for obstructive sleep apnea (OSA), which we believe is a signifi cant risk factor. OSA is believed to increase the risk of stroke through endothelial damage and hypercoagulability as well as to increase the risk of AF. OSA with an apnea-hypopnea index (AHI) . 5 is an independent risk factor for stroke, with a hazard ratio of 1.97 when adjusted for race, sex, smoking, alcohol use, BMI, diabetes, AF, hypertension, and lipids. 2 In a metaanalysis of studies on stroke and sleep apnea, we found that 72% of patients with stroke and transient ischemic attack (TIA) have OSA with an AHI . 5, and 38% have OSA with an AHI . 20. 3 Further, we cite studies fi nding that treatment with continuous positive airway pressure (CPAP) reduces the rate of recurrent stroke and mortality in patients with OSA. Among the Sleep Heart Health Study cohort, 4.8% of patients with OSA (AHI . 5) have AF compared with only 0.9% of patients without OSA. 4 OSA increases the 12-month recurrence of AF after cardioversion from 53% of patients without OSA to 82% of patients with untreated OSA vs 42% of those treated with CPAP.

Tracheostomy tube manometry: evaluation of speaking valves, capping and need for downsizing

Introduction:u2002 Readiness to speak is a major problem for many tracheostomized patients. Evaluation for tracheostomy tube capping or speaking valve is often subjective.

Obstructive Sleep Apnea and Prolonged Mechanical Ventilation

Patients with prolonged mechanical ventilation have a high one year mortality, with recognized contributing factors including COPD, cardiac failure, renal failure, and respiratory muscle weakness.[1][1] The study by Diaz-Abad et al[2][2] shows that obstructive sleep apnea (OSA) is very common among

Correct Diffusing Capacity of Lung for Carbon Monoxide and Carbon Monoxide Transfer Coefficient in Considering Respiratory Function in Patients With Stable Anorexia Nervosa

We read with great interest the case report by Sergew et al (November 2009) 1 wherein they reported a case of TB that presented in an unusual fashion as sepsis and ARDS. There are, in our opinion, a couple of issues to be answered. First, although the authors have mentioned the role of adenosine deaminase (ADA) in ascitic fl uid for the diagnosis of TB as the etiology in the discussion of the case report, we wonder why this simple bedside investigation was not done in the case described. ADA levels in ascitic fl uid have been suggested as a useful, noninvasive screening test in the diagnosis of peritoneal TB. 2 Although not diagnostic, ADA levels in serous fl uids, when considered in collaboration with the clinical scenario, can guide the clinician to clinch an early diagnosis and start the required anti-TB therapy in time. Second, the standard treatment regimen for a fresh case of TB consists of four drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol. Use of potent second-line drugs such as quinolones and an aminoglycoside (amikacin in this case) at the initial phase is not recommended. Inadequate drug regimens promote the selection of drug-resistant strains, which magnify the threat of drug-resistant TB. 3 As the incidence of multidrugresistant TB and extensively drug-resistant TB is steadily increasing throughout the world, judicious use of antitubercular therapy is recommended to keep the drug resistance to a minimum.

Association of Chronic Mountain Sickness With Abnormal Pulmonary Microcirculation : Importance of Adjusting Predicted Diffusing Capacity of the Lung for Carbon Monoxide for Altitude, Hemoglobin, and Lung Volume

Finsterer and Stöllberger present some interesting comments on our article about cardiac and sternocleidomastoid muscle involvement in Duchenne muscular dystrophy (DMD) studied by MRI. 1 We underestimated neither the importance of clinical neurologic and cardiac examination, nor the use of the currently applied techniques in the assessment of DMD patients. Although the technologic progress is of great value, there is no doubt that the patient’s clinical evaluation remains the cornerstone of medicine. In this article, our purpose was not to underestimate the value of traditionally used approaches; instead, we emphasized the important role of a new technology in the early detection of subclinical cases. The same fi ndings were assessed by other authors, 2 4 and recently more MRI articles have emphasized the importance of the technique in the early detection of subclinical lesions in DMD patients. 5 , 6 This is to be expected because MRI has the ability to detect little changes very early in different tissues. We should also emphasize that DMD patients can nowadays have different clinical presentations, depending on the early use of angiotensin-converting enzyme inhibitors and or defl azacort, the patient’s supportive treatment, close cardiac and neurologic evaluation, and so forth. Cardiac involvement is not necessarily found in all patients at the time of ambulation loss. Additionally, ECG changes are not necessarily found in all DMD patients. 7