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BACKGROUND: Pulmonary embolism (PE) a consequence of hypercoagulability status associated with chronic obstructive pulmonary disease (COPD) and worsens its course. Recently, microRNAs (miRNAs) have been linked to PE in COPD settings. We aimed to measure expression levels of miRNAs145 and 126 in COPD patients with and without PE. METHODS: Herein, miRNA (145 and 126) expression levels were measured in 250 COPD patients with PE by quan-titative real-time PCR, and their data were compared with 300 COPD patients without PE. RESULTS: Our results showed that miRNA-145 expression was downregulated in COPD patients with PE compared to those without PE. The reverse was observed in miRNA-126 expression that was higher in COPD patients with PE than in those without PE. miRNA-145 correlated positively with FEV1/FVC and correlated negatively with D-dimer in all patients regardless of the presence of PE. In addition, miRNA-126 positively correlated with D-dimer and negatively correlated with FEV1/FVC in all studied COPD patients. CONCLUSIONS: Lower levels of miRNA-145 and higher levels of miRNA-126 associated with worse diagnosis PE in patients with COPD. Extensive studies are mandated to bring a better understanding of the role of these miRNAs in the mechanism of thrombosis in COPD patients.
Assuntos
MicroRNAs , Doença Pulmonar Obstrutiva Crônica , Embolia Pulmonar , Humanos , MicroRNAs/genética , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/genética , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/genética , Testes de Função RespiratóriaRESUMO
Although video polysomnography (vPSG) is not routinely recommended for the evaluation of typical cases of non-rapid eye movement (NREM) parasomnias, it can aid diagnosis of unusual cases, other sleep disorders and complicated cases with REM behaviour disorder (RBD), and in differentiating parasomnias from epilepsy. In this study, we aimed to assess vPSG findings in consecutive patients with a clinical diagnosis of NREM-parasomnia covering the whole phenotypic spectrum. Five hundred and twelve patients with a final diagnosis of NREM parasomnia who had undergone vPSG were retrospectively identified. vPSGs were analysed for features of NREM parasomnia and for the presence of other sleep disorders. Two hundred and six (40.0%) patients were clinically diagnosed with sleepwalking, 72 (14.1%) with sleep terrors, 39 (7.6%) with confusional arousals, 15 (2.9%) with sexsomnia, seven (1.4%) with sleep-related eating disorder, 122 (23.8%) with mixed phenotype, and 51 (10.0%) with parasomnia overlap disorder (POD). The vPSG supported the diagnosis of NREM parasomnia in 64.4% of the patients and of POD in 98%. In 28.9% of the patients, obstructive sleep apnea (OSA) or/and periodic limb movements during sleep (PLMS) were identified, most commonly in older, male, sleepy and obese patients. vPSG has a high diagnostic yield in patients with NREM parasomnia and should be routinely performed when there is diagnostic doubt, or in patients where there is a suspicion of OSA and PLMS.
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Movimentos Oculares/fisiologia , Parassonias/diagnóstico por imagem , Polissonografia/métodos , Gravação em Vídeo/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE OF REVIEW: One of the most common causes of excessive daytime sleepiness in clinical practice is obstructive sleep apnea syndrome (OSAS). So far, continuous positive airway pressure (CPAP) is the most effective treatment for OSA. Some of the patients do not improve on CPAP and remain sleepy despite using CPAP.This review provides updated information about the possible causes of residual sleepiness whilst using the CPAP in patients with OSAS. RECENT FINDINGS: Prevalence of OSAS has increased recently to 23.4% in women and 49.7% in men. Periodic limb movement, behaviorally induced insufficient sleep syndrome and depression are the most common causes of persistent sleepiness on CPAP. Residual sleepiness after exclusion of all possible causes is 6%. SUMMARY: There is still lack of sufficient evidence about the accurate characteristics and possible causes of this residual sleepiness and how to address this in large prospective studies.
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Distúrbios do Sono por Sonolência Excessiva , Pressão Positiva Contínua nas Vias Aéreas , Depressão , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Humanos , Prevalência , Estudos Prospectivos , Apneia Obstrutiva do Sono/terapiaRESUMO
Introduction: COVID-19 is a novel pandemic that has had a profound impact on global physical and psychological health. We aimed to investigate the impact of COVID-19 on stress, sleep quality, and insomnia among South Valley University students in Egypt during the quarantine period. Material and Methods: A questionnaire, including the Pittsburgh sleep quality index, the insomnia severity index, the perceived stress scale and COVID-19 fear index was distributed to the undergraduate students through the online platforms of South Valley University during the period of 1st to 15th June 2020. Results: Of a total respondent sample of 2,474 students, 24.5% had high-perceived stress levels, 31.3% had clinical insomnia, and about 80% were identified as generally poor sleepers by the PSQI. Being female, having a chronic disease, having a sleep disorder before the quarantine, or consuming caffeine were the main factors associated with high stress levels, clinical insomnia, and poor sleep quality. Also, levels of fear of COVID-19 were higher among people with high stress levels, clinical insomnia, and poor sleep quality. Conclusion: Considerable levels of stress and poor sleep quality were identified among undergraduate university students during the pandemic/home isolation period. The effect was more obvious among certain demographic groups and among the students who scored higher in the fear of COVID-19 scale.
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Coronavirus infectious disease 2019 (COVID-19) confirmed cases are characterized by T lymphopenia. Total apoptotic and cytotoxic T-lymphocyte antigen-4 (CTLA-4) expressing cells among CD4+/CD8+â cells were analyzed in 24 COVID-19 patients (16 out-patients and 8 in-patients) and 18 healthy volunteers using flow cytometry to detect their possible role in T lymphopenia. Hospitalized patients did not show significant difference compared to non-hospitalized patients. While the percentage and absolute count of CD4+/CD8+â cells were significantly reduced in COVID-19 cases compared to healthy control (Pâ <â .05), the proportion of apoptotic and CTLA-4 expressing CD4+/CD8+â cells were significantly up-regulated in COVID-19 patients (Pâ <â .05). In addition, apoptotic and CTLA-4+/CD4+â cells were directly related to dyspnea duration, chest CT score, ferritin, and C-reactive protein and inversely correlated with platelet count in COVID-19 patients. While apoptotic and CTLA-4+/CD8+â cells were directly related to lymphocyte count in COVID-19 patients. The apoptotic and CTLA-4+â cells were directly related to each other in CD4+/CD8+â cells (Pâ <â .05). White blood cells (WBCs) (×103/L), eosinophils (ratio and count), lymphocyte ratio, neutrophil ratio, neutrophil/lymphocyte ratio, neutrophil/CD4 ratio, neutrophil/CD8 ratio, CD4+â cells ratio, and CTLA-4+â cells percentage), and CD8+â cells (ratio, count, total apoptotic cell, and CD152â +â cells) were all found to be significantly altered in association with COVID-19. Total lymphopenia and depletion of CD4+/CD8+â cells are characterizing COVID-19 patients. Increased apoptosis and CTLA-4 expression in CD4+/CD8+â cells in COVID-19 and their correlations with reduced cell count and severity indicators as CRP and ferritin can be used for diagnosis and follow up of the clinical severity. Our current study proposes promising future diagnostic and therapeutic targets.
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COVID-19 , Doenças Transmissíveis , Linfopenia , Proteína C-Reativa , Linfócitos T CD4-Positivos , Linfócitos T CD8-Positivos , Antígeno CTLA-4 , Ferritinas , HumanosRESUMO
BACKGROUND: Non-REM parasomnias are not uncommon conditions in the general population. Current treatment options are based on small case series and reports. In this study, we aimed to present the clinical experience from a large cohort of patients. PATIENTS: Five hundred and twelve patients with Non-REM parasomnia or parasomnia overlap disorder (POD), who had undergone a video polysomnography and were exposed to treatment, were retrospectively identified. Treatment outcome was assessed based on patients' reports, and treatment approach on a locally accepted hierarchy of interventions. RESULTS: Forty percent of patients were diagnosed with sleepwalking, 23.8% with mixed-phenotype and 10% with POD. Ultimately, 97.2% reported adequate control of their symptoms. Moreover, 60.1% were treated with pharmacotherapy and 32.0% without, consistent across all phenotypes (p = 0.09). Benzodiazepines were the most common drugs prescribed (47.1%, p < 0.05). In the end, 37.7% of our patients were receiving a benzodiazepine as part of their successful treatment, 11.7% an antidepressant, 9.2% a z-drug, and 10.7% melatonin. Finally, 13.2%, 12.1%, and 5.8% of our patients reported good control of their symptoms with sleep hygiene, management of sleep-disordered breathing, and psychological interventions (cognitive behavioral therapy [CBT] or mindfulness-based stress reduction [MBSR]), as monotherapy, respectively. CONCLUSION: The treatment approach to effective treatment of the patients with Non-REM parasomnias or POD offering first sleep hygiene advice, next treatment of concurrent sleep disorders and management of other priming factors like stress and anxiety, and lastly pharmacotherapy for Non-REM parasomnia is supported by our results. Non pharmacological interventions were effective in one third of our patients, and CBT/MBSR and melatonin appeared promising new treatments.