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https://www.readbyqxmd.com/read/28916122/myasthenia-gravis-and-crisis-evaluation-and-management-in-the-emergency-department
#1
Jamie Roper, M Emily Fleming, Brit Long, Alex Koyfman
BACKGROUND: Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC). OBJECTIVE: This review discusses risk factors, diagnosis, management, and iatrogenic avoidance of MC. DISCUSSION: MC can affect any age, ethnicity, or sex and can be precipitated with any stressor, infection being the most common...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28903915/obesity-modulates-diaphragm-curvature-in-subjects-with-and-without-copd
#2
Aladin M Boriek, Michael A Lopez, Cristina Velasco, Azam A Bakir, Anna Frolov, Shari Wynd, Tony G Babb, Nicola A Hanania, Eric A Hoffman, Amir Sharafkhaneh
BACKGROUND: Obesity is a common co-morbidity of COPD and has been associated with worse outcomes. However, it is unknown whether the interaction between obesity and COPD modulates diaphragm shape and consequently its function. The body mass index has been used as a correlate of obesity. We tested the hypothesis that the shape of the diaphragm muscle and size of the ring of its insertion in Non-COPD and COPD subjects are modulated by BMI. METHODS: We recruited 48 COPD patients with post-bronchiodilator FEV1/FVC < 0...
September 13, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
https://www.readbyqxmd.com/read/28890403/sex-differences-in-respiratory-muscle-activation-patterns-during-high-intensity-exercise-in-healthy-humans
#3
Reid A Mitchell, Michele R Schaeffer, Andrew H Ramsook, Sabrina S Wilkie, Jordan A Guenette
Although women experience greater ventilatory constraints and have a higher work of breathing during exercise, they are less susceptible to diaphragm fatigue compared to men. The mechanisms for diaphragmatic fatigue resistance in women is unknown but may be related to sex differences in respiratory muscle recruitment. Accordingly, the purpose of this study was to determine if electromyography (EMG) of the diaphragm (EMGdi) and extra-diaphragmatic inspiratory muscles differ between sexes during exercise. Forty subjects (21M:19F) completed a constant load cycling test at 85% of maximum work rate until exhaustion, while instrumented with an oesophageal electrode catheter to measure EMGdi and surface electrodes to measure EMG of the sternocleidomastoid (EMGscm) and scalene (EMGsca) muscles...
September 7, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28877974/exertional-dyspnoea-in-pulmonary-arterial-hypertension
#4
Daniel Dumitrescu, Olivier Sitbon, Jason Weatherald, Luke S Howard
Dyspnoea is a principal presenting symptom in pulmonary arterial hypertension (PAH), and often the most distressing. The pathophysiology of PAH is relatively well understood, with the primary abnormality of pulmonary vascular disease resulting in a combination of impaired cardiac output on exercise and abnormal gas exchange, both contributing to increased ventilatory drive. However, increased ventilatory drive is not the sole explanation for the complex neurophysiological and neuropsychological symptom of dyspnoea, with other significant contributions from skeletal muscle reflexes, respiratory muscle function, and psychological and emotional status...
September 30, 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/28872419/impact-of-scoliosis-severity-on-functional-capacity-in-patients-with-adolescent-idiopathic-scoliosis
#5
Bruna M A Saraiva, Geferson S Araujo, Evandro F Sperandio, Alberto O Gotfryd, Victor Z Dourado, Milena C Vidotto
The aim of this study is to evaluate the walked distance and physiological responses during Incremental Shuttle Walk Test (ISWT) in patients with different degrees of adolescent idiopathic scoliosis (AIS). METHOD: We evaluated 20 healthy teenagers and 46 with AIS were divided into two groups: AIS > 45° and AIS < 45º. The volunteers performed an ISWT and the following physiological responses were quantified: oxygen consumption (VO2), tidal volume (VT) and ventilation (VE) and the walked distance (ISWD)...
September 5, 2017: Pediatric Exercise Science
https://www.readbyqxmd.com/read/28862962/inspiratory-muscle-training-is-associated-with-improved-inspiratory-muscle-strength-resting-cardiac-output-and-the-ventilatory-efficiency-of-exercise-in-patients-with-a-fontan-circulation
#6
Karina Laohachai, David Winlaw, Hiran Selvadurai, Ganesh Kumar Gnanappa, Yves d'Udekem, David Celermajer, Julian Ayer
BACKGROUND: Patients with a Fontan circulation have reduced exercise capacity and respiratory muscle strength. Inspiratory muscle training (IMT) improves exercise capacity and quality of life in adults with heart failure. We assessed whether 6 weeks of a home-based program of IMT improves inspiratory muscle strength and the ventilatory efficiency of exercise in adolescent patients with a Fontan circulation. METHODS AND RESULTS: Twenty-three adolescent participants (aged 16±2 years) with a Fontan circulation underwent 6 weeks of IMT for 30 minutes daily...
August 21, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28839004/ventilation-and-neurochemical-changes-during-%C3%A2%C2%B5-opioid-receptor-activation-or-blockade-of-excitatory-receptors-in-the-hypoglossal-motor-nucleus-of-goats
#7
Thomas M Langer, Suzanne E Neumueller, Emma Crumley, Nicholas J Burgraff, Sawan Talwar, Matthew Robert Hodges, Lawrence G Pan, Hubert V Forster
Neuromodulator interdependence posits that changes in one or more neuromodulators are compensated by changes in other modulators to maintain stability in the respiratory control network. Herein, we studied compensatory neuromodulation in the hypoglossal motor nucleus (HMN) after chronic implantation of microtubules unilaterally (n=5) or bilaterally (n=5) into the HMN. After recovery, receptor agonists or antagonists in mock cerebrospinal fluid (mCSF) were dialyzed during the awake and NREM sleep state. During day studies, dialysis of the µ-opioid inhibitory receptor agonist DAMGO (100 µM) decreased pulmonary ventilation (V̇I), breathing frequency (f), and genioglossus (GG) muscle activity, but did not alter neuromodulators measured in the effluent mCSF...
August 24, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28830913/risk-factors-for-respiratory-decompensation-among-healthy-infants-with-bronchiolitis
#8
Nina M Dadlez, Nora Esteban-Cruciani, Asama Khan, Lindsey C Douglas, Yi Shi, William N Southern
BACKGROUND: Although most children with bronchiolitis only require supportive care, some decompensate and require ventilatory support. We examined predictors of respiratory decompensation among hospitalized children to identify which patients may benefit from expectant monitoring. METHODS: We examined children ≤24 months old with bronchiolitis admitted to the general infant and toddler floor. Children with pneumonia or comorbidities were excluded. Demographic and clinical characteristics were abstracted from a clinical database and medical records...
August 22, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28818154/physiology-based-modeling-may-predict-surgical-treatment-outcome-for-obstructive-sleep-apnea
#9
Yanru Li, Jingying Ye, Demin Han, Xin Cao, Xiu Ding, Yuhuan Zhang, Wen Xu, Jeremy Orr, Rachel Jen, Scott Sands, Atul Malhotra, Robert Owens
STUDY OBJECTIVES: To test whether the integration of both anatomical and nonanatomical parameters (ventilatory control, arousal threshold, muscle responsiveness) in a physiology-based model will improve the ability to predict outcomes after upper airway surgery for obstructive sleep apnea (OSA). METHODS: In 31 patients who underwent upper airway surgery for OSA, loop gain and arousal threshold were calculated from preoperative polysomnography (PSG). Three models were compared: (1) a multiple regression based on an extensive list of PSG parameters alone; (2) a multivariate regression using PSG parameters plus PSG-derived estimates of loop gain, arousal threshold, and other trait surrogates; (3) a physiological model incorporating selected variables as surrogates of anatomical and nonanatomical traits important for OSA pathogenesis...
August 14, 2017: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/28790008/compensatory-effects-following-unilateral-diaphragm-paralysis
#10
Obaid U Khurram, Gary C Sieck, Carlos B Mantilla
Injury to nerves innervating respiratory muscles such as the diaphragm muscle results in significant respiratory compromise. Electromyography (EMG) and transdiaphragmatic pressure (Pdi) measurements reflect diaphragm activation and force generation. Immediately after unilateral diaphragm denervation (DNV), ventilatory behaviors can be accomplished without impairment, but Pdi generated during higher force non-ventilatory behaviors is significantly decreased. We hypothesized that 1) the initial reduction in Pdi during higher force behaviors after DNV is ameliorated after 14 days, and 2) changes in Pdi over time after DNV are associated with concordant changes in contralateral diaphragm EMG activity and ventilatory parameters...
August 5, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28766156/a-primer-on-nerve-agents-what-the-emergency-responder-anesthesiologist-and-intensivist-needs-to-know
#11
Keith Candiotti
PURPOSE: The purpose of this review article is to familiarize first responders, anesthesiologists, and intensivists with the medical management of patients exposed to nerve agents. SOURCE: This review is based on the current medical literature available to the general medical community. PRINCIPAL FINDINGS: Nerve agents are some of the deadliest substances known to humanity. Though they kill primarily via muscle paralysis, which leads to respiratory arrest, these agents affect virtually every organ system in the body...
August 1, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28743311/hypercapnic-respiratory-failure-during-pregnancy-due-to-polymyositis-related-respiratory-muscle-weakness-a-case-report
#12
Husain Shabbir Ali, Ibrahim Fawzy Hassan, Saibu George, Abdalrazig Elsadig Fadlelmula
BACKGROUND: Polymyositis is a rare medical disorder complicating pregnancy. Ventilatory muscle weakness leading to respiratory failure is an uncommon manifestation of this autoimmune disease. We report a case of life-threatening hypercapnic respiratory failure due to polymyositis-related respiratory muscle weakness in a pregnant woman. CASE PRESENTATION: A 31-year-old, African woman in her second trimester of pregnancy presented to the emergency department with fever, shortness of breath and muscle weakness...
July 26, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28738382/advanced-concepts-in-the-pathophysiology-of-obstructive-sleep-apnea
#13
David P White
The primary pathological event in the disorder obstructive sleep apnea (OSA) is the partial or complete closure of the pharyngeal airway during sleep in an individual with a widely patent airway during wakefulness. This yields an apnea or hypopnea with resulting hypoxia and hypercapnia, and most often requires an arousal to terminate the event. These events occur in a repetitive manner during sleep, yielding intermittent hypoxia and sleep fragmentation with their associated adverse effects on the health and quality of life of the afflicted individual...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28687271/number-of-thoracotomies-predicts-impairment-in-lung-function-and-exercise-capacity-in-patients-with-congenital-heart-disease
#14
Jan Müller, Peter Ewert, Alfred Hager
OBJECTIVE: Many patients with congenital heart disease (CHD) require surgery to ensure survival into adulthood. But history of previous thoracotomies is associated with respiratory muscle weakness, impairments in chest wall compliance, and moderately to severely impaired lung function. This study evaluated the impact of thoracotomies on functional outcome in patients with CHD. PATIENTS AND METHODS: In total 1372 adolescents and adults with CHD (32.4±11.5 years, 624 female), who underwent spirometry and cardiopulmonary exercise testing in our institution from January 2010 to August 2015, were analyzed...
July 4, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28663381/a-study-of-clinical-and-physiological-relations-of-daily-physical-activity-in-precapillary-pulmonary-hypertension
#15
Marios Panagiotou, Martin Kevin Johnson, Zafeiris Louvaris, Julien Steven Baker, Alistair Colin Church, Andrew J Peacock, Ioannis Vogiatzis
Daily physical activity is reduced in precapillary pulmonary hypertension (PH) but the underlying mechanisms are inadequately explored. We sought to investigate clinical and physiological relations of daily physical activity and profile differences between less and more active patients with precapillary PH. A prospective, cross-sectional study of 20 patients with precapillary PH who undertook a) a comprehensive clinical assessment, b) a preliminary treadmill test, c) 7-day monitoring of daily walking intensity with triaxial accelerometry and d) a personalized treadmill test corresponding to the individual patient mean daily walking intensity with real-time physiological measurements...
June 29, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28640773/salivary-mitochondrial-dna-copy-number-is-associated-with-exercise-ventilatory-efficiency
#16
Yang Chen, Helene Z Hill, Gudrun Lange, Michael J Falvo
Chen, Y, Hill, HZ, Lange, G, and Falvo, MJ. Salivary mitochondrial DNA copy number is associated with exercise ventilatory efficiency. J Strength Cond Res 31(7): 2000-2004, 2017-Mitochondrial DNA copy number (mtDNAcn) is an index of mitochondrial content and is responsive to changes in exercise training volume. Therefore, assessment of mtDNAcn may help to optimize exercise prescription and aid in athlete monitoring. Although previous work has assessed mtDNAcn derived from skeletal muscle and blood using invasive approaches, no study has examined salivary mtDNAcn and its relationship with sport performance...
July 2017: Journal of Strength and Conditioning Research
https://www.readbyqxmd.com/read/28636505/the-effect-of-aerobic-interval-training-and-continuous-training-on-exercise-capacity-and-its-determinants
#17
Nele Pattyn, Paul J Beckers, Véronique A Cornelissen, Ellen Coeckelberghs, Catherine De Maeyer, Geert Frederix, Kaatje Goetschalckx, Nadine Possemiers, Dirk Schepers, Emeline M Van Craenenbroeck, Kurt Wuyts, Viviane M Conraads, Luc Vanhees
Objective We aimed to investigate (1) the effects of aerobic interval training (AIT) and aerobic continuous training (ACT) on (sub)maximal exercise measures and its determinants including endothelial function, muscle strength and cardiac autonomic function, and (2) the relationship between exercise capacity and these determinants. Methods Two-hundred coronary artery disease (CAD) patients (58.4 ± 9.1 years) were randomized to AIT or ACT for 12 weeks. All patients performed a cardiopulmonary exercise test and endothelial function measurements before and after the intervention; a subpopulation underwent muscle strength and heart rate variability (HRV) assessments...
June 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28630772/severe-rhabdomyolysis-due-to-presumed-drug-interactions-between-atorvastatin-with-amlodipine-and-ticagrelor
#18
Iouri Banakh, Kavi Haji, Ross Kung, Sachin Gupta, Ravindranath Tiruvoipati
Atorvastatin and ticagrelor combination is a widely accepted therapy for secondary prevention of ischaemic heart disease. However, rhabdomyolysis is a well-known rare side effect of statins which should be considered when treatments are combined with cytochrome P450 3A4 enzyme inhibitors. We report a case of atorvastatin and ticagrelor associated severe rhabdomyolysis that progressed to multiorgan failure requiring renal replacement therapy, inotropes, intubation, and mechanical ventilation. Despite withdrawal of the precipitating cause and the supportive measures including renal replacement therapy, creatinine kinase increased due to ongoing rhabdomyolysis rapidly progressing to upper and lower limbs weakness...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28624507/effect-of-pyridostigmine-on-in-vivo-and-in-vitro-respiratory-muscle-of-mdx-mice
#19
Gabriela de Cássia Sousa Amancio, Andrea Grabe-Guimarães, Dridi Haikel, Johan Moreau, Neila Marcia Silva Barcellos, Alain Lacampagne, Stefan Matecki, Olivier Cazorla
The current work was conducted to verify the contribution of neuromuscular transmission defects at the neuromuscular junction to Duchenne Muscular Dystrophy disease progression and respiratory dysfunction. We tested pyridostigmine and pyridostigmine encapsulated in liposomes (liposomal PYR), an acetylcholinesterase inhibitor to improve muscular contraction on respiratory muscle function in mdx mice at different ages. We evaluated in vivo with the whole-body plethysmography, the ventilatory response to hypercapnia, and measured in vitro diaphragm strength in each group...
September 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28623885/monitoring-the-electric-activity-of-the-diaphragm-during-noninvasive-positive-pressure-ventilation-a-case-report
#20
Fabia Diniz-Silva, Anna Miethke-Morais, Adriano M Alencar, Henrique T Moriya, Pedro Caruso, Eduardo L V Costa, Juliana C Ferreira
BACKGROUND: In patients with post-extubation respiratory distress, delayed reintubation may worsen clinical outcomes. Objective measures of extubation failure at the bedside are lacking, therefore clinical parameters are currently used to guide the need of reintubation. Electrical activity of the diaphragm (EAdi) provides clinicians with valuable, objective information about respiratory drive and could be used to monitor respiratory effort. CASE PRESENTATION: We describe the case of a patient with Chronic Obstructive Pulmonary Disease (COPD), from whom we recorded EAdi during four different ventilatory conditions: 1) invasive mechanical ventilation, 2) spontaneous breathing trial (SBT), 3) unassisted spontaneous breathing, and 4) Noninvasive Positive Pressure Ventilation (NPPV)...
June 17, 2017: BMC Pulmonary Medicine
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