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Missed Opportunities? Beneficial Uses of Illicit Drugs
Published in Ross Coomber, The Control of Drugs and Drug Users, 2020
Lester Grinspoon, James B. Bakalar
Asthma is a breathing disorder that arises when bronchial muscles go into spasm and the pathway to the lungs is blocked by mucus and swelling. A number of antiasthmatic drugs are available, but they all have drawbacks — limited effectiveness or side effects. Because marihuana dilates the bronchi and reverses bronchial spasm, cannabis derivatives have been tested as antiasthmatic drugs. Smoking marihuana would probably not be a good way to treat asthma because of chronic irritation of the bronchial tract by tars and other substances in marihuana smoke, so recent researchers have sought a better means of administration. THC in the form of an aerosol spray has been investigated extensively (Tashkin et al., 1975; Tashkin et al., 1977). Other cannabinoids such as cannabinol and cannabidiol may be preferable to THC for this purpose. An interesting finding for future research is that cannabinoids may affect the bronchi by a different mechanism from that of the familiar antiasthmatic drugs.
The Surgical Management of Snoring and Obstructive Sleep Apnoea
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Bhik Kotecha, Mohamed Reda Elbadawey
Sleep-related breathing disorder (SRBD) encompasses a broad clinical spectrum of recurring partial or complete obstruction of the upper airway. This ranges from simple or primary snoring to severe obstructive sleep apnoea (OSA). Patients who have symptoms suggestive of OSA but do not have objective parameters in a sleep study confirming the condition can be classified as having upper airway resistance syndrome (UARS). These patients may have sleep fragmentation but do not have significant oxygen desaturation events or many obstructive events. A definition of apnoea, hypopnea and the apnoea-hypopnea index (AHI) is covered in Chapter 74, Obstructive sleep apnoea: medical management.
Classification of sleep disorders
Published in S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, Sleep and Psychosomatic Medicine, 2017
The diagnosis rests upon a sleep symptom of difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening and, mainly for pediatric age groups, resistance to going to bed and difficulty in sleeping without a caregiver intervention. The symptoms occur 3 times per week for at least 3 months and have daytime consequences such as fatigue/malaise, cognitive impairment, mood lability, daytime sleepiness or social, family, academic or occupational impairment. Psychophysiological insomnia and other insomnia disorders of the ICSD-2 are mentioned in the text description of the disorder. Objective testing by polysomnography is not required for diagnosis, but should be considered if features suggest a concurrent sleep-related breathing disorder. There is the inclusion of shortterm insomnia disorder with similar diagnostic criteria, as chronic insomnia disorder applies to insomnia that is less than 3 months in duration. Excessive time in bed and short sleeper are included as isolated symptoms and normal variants, not as specific disorders.
Usefulness of preoperative point-of-care ultrasound measurement of the lateral parapharyngeal wall to predict difficulty in mask ventilation
Published in Baylor University Medical Center Proceedings, 2022
Nikita Mehta, Esther Lee, Madeline Pence, Wyatt Nice, Ryan Keneally, Raymond Pla, Anita Vincent, Eric Heinz
Patient characteristics such as age, BMI, and history of a sleep breathing disorder may provide some indication that MV will be difficult in the patient; however, these are not always reliable predictors.3 Similarly, clinical assessments of difficult airway, including the classic Mallampati score and thyromental distance, are diagnostically poor predictors of difficult airways, with sensitivities ranging from 42% to 81% and specificities ranging from 66% to 84%.11,12 Data from multiple studies show that ultrasonographic measurements of airway structures improve the ability to predict difficult airways.13–15 When these ultrasonographic measurements are combined with clinical examination findings, the diagnostic accuracy improves significantly, with sensitivities of 100%.16 These results suggest that the success of both MV and laryngoscopy relies on a complex interplay between different anatomical structures and that no single test can predict a difficult clinical scenario.
Pathophysiology and clinical evaluation of the patient with unexplained persistent dyspnea
Published in Expert Review of Respiratory Medicine, 2022
Andi Hudler, Fernando Holguin, Meghan Althoff, Anne Fuhlbrigge, Sunita Sharma
Dysfunctional breathing describes breathing disorders in which chronic changes in breathing pattern result in dyspnea and other symptoms in the absence of or of greater magnitude than explained by physiological respiratory or cardiac disease that is present [42]. These conditions may present alone, as a somatic manifestation of psychological conditions, or as a manifestation of underlying disease and in any individual there may be more than one of these factors at play [43]. The most important identifying criterion to identify dysfunctional breathing is the presence of breathlessness after potential pathology has been objectively ruled out or optimized by pharmacologic treatment [44]. Although there is no diagnostic gold standard for dysfunctional breathing, experts from the European Respiratory Society proposed a subclassification of this condition, including hyperventilation syndrome, periodic sigh breathing, thoracic dominant breathing, forced abdominal expiration, and thoraco-abdominal dissociation [42]. CPET can be useful in suggesting a diagnosis of dysfunctional breathing by detecting some of these erratic breathing patterns and abnormal ventilation responses to an increasing exercise load. While not necessarily diagnostic, their presence can suggest the possibility of dysfunctional breathing if they occur in an otherwise normal CPET [45]. Having a positive response to respiratory retraining and supportive management would affirm a functional breathing disorder as the etiology of dyspnea [46].
Therapeutic effects of modafinil in ischemic stroke; possible role of NF-κB downregulation
Published in Immunopharmacology and Immunotoxicology, 2019
Hasan Yousefi-Manesh, Amir Rashidian, Sara Hemmati, Samira Shirooie, Mohammad Amin Sadeghi, Nazanin Zarei, Ahmad Reza Dehpour
Ischemic stroke is considered as one of the most leading causes of serious disabilities all over the world [1]. Interruption of brain blood flow is the main reason for hypoxia and deprivation of vital nutrients such as glucose. Most of the neurological defects are consequences of detrimental molecular mechanisms such as elevated amounts of inflammatory mediators in various regions of CNS and generation of reactive oxygen species (ROS) which occur in the reperfusion period after relieving stroke [2]. Neocortex and CA1 pyramidal neurons of the hippocampus are the most vulnerable neurons to the oxidative stress in the course of the disorder. Oxidative stress further induces apoptotic pathways which eventually activates caspase-3 protein. Caspase-3 triggers cellular proteolysis and DNA fragmentation, and its upregulation can be considered an indicator of an apoptotic cell in hippocampi of rats. Degeneration of neurons in cortex impairs the motor functions post-stroke while hippocampal degeneration leads to memory dysfunctions [3]. Obesity, hypercholesteremia, etc. are well-known risk factors in population. Recent studies have introduced new risk factors such as sleep and breathing disorder which should be considered in susceptible patients [4].