Revista Portuguesa de Pneumologia (English Edition)最新文献

Introduction

Obstructive Sleep Apnea (OSA) is characterized by recurrent episodes of apnea and hypopnea, secondary to collapse of the upper airways during sleep. OSA is frequently associated to cardiovascular complications. In Portugal, its magnitude is unknown.

Methods

In 2014 a cross-sectional study was performed using the Portuguese General Practitioner (GP) Sentinel Network (Rede Médicos Sentinela). Participants GP reported all OSA cases diagnosed and registered in their lists of users on the 31 December 2013.

Frequency of OSA has been estimated by sex and age. OSA patients were also characterized by method of diagnosis, treatment, and underlying conditions.

Association between risk factors and severe OSA (odds ratio) was calculated using a logistic regression model adjusting confounding.

Results

Prevalence of OSA on the population aged 25 years or more was 0.89% (95 CI: 0.80–1.00%); it was higher in males 1.47% (95 CI: 1.30–1.67%) and in those aged between 65 and 74 (2.35%). Most had severe OSA (48.4%). Hypertension (75.9%), obesity (74.2%) and diabetes mellitus (34.1%) were the most frequent comorbidities. Being a male (OR: 2.6; 95 CI: 1.2–5.8) and having obesity (OR: 4.0; 95 CI: 1.8–8.6) were associated with an increased risk of severe OSA.

Conclusion

Found frequency of OSA was lower than other countries estimates, which may be explained by differences on case definition but can also suggest underdiagnosis of this condition as reported by other authors.

Delay in diagnosis or treatment of ocular tuberculosis can result in loss of vision. However, due to the fact that early diagnosis is rarely achieved, there are still a broad variety of diagnostic and treatment approaches.

Our aim was to reach a consensus on the management of diagnosis and treatment of ocular tuberculosis.

Methods

Critical appraisal of the literature and expert opinion on diagnosis and treatment of ocular tuberculosis.

Results and conclusion

The currently recommended method for ocular TB diagnosis is screening for tuberculosis in any uveitis of unknown etiology, recurrent or not responding to conventional therapy; in ocular findings highly suggestive of ocular TB and before immunosuppression (particularly biologic agents). TB screening in these cases includes tuberculosis skin testing and interferon gamma testing, along with complete medical history, ophthalmologic evaluation and chest imaging. Positively screened patients should be treated for active tuberculosis with 4 drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) for 6–9 months. Patients should be reviewed at the end of the initiation phase (two months) and at the end of the overall treatment (6–9 months).

Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways.

We aimed to study the presence and relationship of SB in a OSAS population.

Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles.

From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3 ± 11.3 years, and apnea hypopnea index of 11.1 ± 5.7/h. Through specific questionnaire 55.6% had SB criteria. Orofacial examination (only feasible in 3) confirmed tooth wear in all. 77.8% had polygraphic SB criteria (SB index > 2/h). Mean SB index was 5.12 ± 3.6/h, phasic events predominated (72.7%). Concerning tooth grinding episodes, we found a mean of 10.7 ± 9.2 per night. All OSAS patients except two (77.8%) had more than two audible tooth-grinding episodes. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (R = 0.755, p = 0.019 and R = 0.737, p = 0.023 respectively, Pearson correlation).

Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS. We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (R = −0.632 and R = −0.611, p > 0.05, Pearson correlation).

This pilot study shows that SB is a very common phenomenon in a group of mild OSAS patients, probably being secondary to it in the majority of cases. The new portable device used may add diagnostic accuracy and help to tailor therapy in this setting.

Background

An inspiratory capacity to total lung capacity (IC/TLC) ratio of ≤25% has emerged as a better marker of mortality in chronic obstructive pulmonary disease (COPD) patients. The relationship among the IC/TLC ratio to lower extremity skeletal muscle function remains unknown.

Methods

Thirty-five men with moderate to severe COPD were divided into those with IC/TLC ≤ 25% (n = 16) and >25% (n = 19). The subjects were tested for thigh muscle mass volume (MMT), maximal strength, power output of the lower extremities, and physical activity.

Results

Total MMT in the IC/TLC < 25% group was significantly lower (413.91 ± 89.42 cm³) (p < 0.001) than in the IC/TLC > 25% group (575.20 ± 11.76 cm³). In the IC/TLC ≤ 25% group, maximal strength of the lower extremities and muscle peak power output of the lower extremities were 36–56% lower (p < 0.01) than among the patients in the IC/TLC > 25% group.

Conclusion

IC/TLC ≤ 25% is associated with reduced maximal strength and peak power output of the lower extremities. IC/TLC ≤ 25% may have an important clinical relevance as an index to determine peripheral muscle dysfunction.

Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). However, it is not known to what extent DM affects the outcome in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) treated with second-line anti-TB drugs.

The objective of this study was to compare the microbiological evolution (sputum smear and culture conversion) and final outcomes of MDR/XDR-TB patients with and without DM, managed at the national TB reference centre in Mexico City.

Results

Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (e.g. MDR-TB with additional resistance to one injectable drug or a fluoroquinolone, 12.2%) and 6 (6.7%) with XDR-TB. Out of these, 49 (54.4%) had DM and 42 (86%) were undergoing insulin treatment.

No statistically significant differences were found in treatment outcomes comparing DM vs. non-DM MDR-TB cases: 18/32 (56.3%) of DM cases and 19/24 (79.2%) non DM patients achieved treatment success (p = 0.07). The time to sputum smear and culture conversion was longer (although not statistically) in patients without DM, as follows: the mean (±SD) time to sputum smear conversion was 53.9 (±31.4) days in DM patients and 65.2 (±34.8) days in non-DM ones (p = 0.15), while the time to culture conversion was 66.2 (±27.6) days for DM and 81.4 (±37.7) days for non-DM MDR-TB cases (p = 0.06).

Conclusions

The study results support the Mexican National TB programme to strengthen its collaboration with the DM programme, as an entry point for TB (and latent TB infection) screening and management.