Smoking cessation programme in hospitalised patients due to acute respiratory disease.

BACKGROUND: Hospital environment is generally propitious to smoking cessation for several reasons, such as a legal ban on smoking in hospital facilities, greater vulnerability facing acute illness and the continuous contact with healthcare professionals. AIMS: To evaluate the effectiveness of intensive smoking cessation intervention during hospital admission due to acute respiratory disease and a 6-month follow up after hospital discharge. METHODS: This prospective study included patients admitted at our Pulmonology Department due to acute respiratory disease - active smokers who consented to participate in smoking cessation counselling programme - between January and December 2019. After hospital discharge, the patients completed a 6-month follow up. Statistical analysis was performed with spss system version 24.0, using univariate analysis with Chi-squared and t-test. RESULTS: We included 30 patients, 86.7% male, with a mean age of 58.6 ± 13.6 years. The mean length of stay was 10 ± 11 days. The mean smoking time was 40.3 ± 14.4 years and the mean smoking load 40 ± 26 pack-year units. The mean level of nicotine dependence, measured by the Fagerström test, was 4.3 ± 2.8. None of the patients accepted smoking cessation pharmacological therapy. After hospital discharge, 19 patients were seen in consultation, 11 of whom maintained smoking cessation at 6 months, determining an overall smoking cessation rate of 36.7%. There was a statistically significant difference in the smoking cessation successful group regarding the motivation to quit smoking and the Richmond test compared to the unsuccessful group. CONCLUSION: Smoking cessation counselling behaviour programmes during hospitalisation, with regular follow up after hospital discharge, contribute to an increase in smoking cessation rate.

RECURRENT SLEEP PARALYSIS - FEAR OF SLEEPING.

OBJECTIVE: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. CASE: description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. COMMENTS: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.

Recurrent sleep paralysis - fear of sleeping / Paralisia do sono recorrente - medo de dormir

ABSTRACT Objective: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. Case description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. Comments: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.

RESUMO Objetivo: Relatar um caso de paralisia do sono isolada e recorrente (PSIR), uma parassonia benigna com episódios inquietantes e assustadores de paralisia do sono. Descrição do caso: Descreve-se um caso de PSIR de uma adolescente de dezesseis anos que buscou cuidados médicos devido a sintomas de ansiedade. A paralisia do sono e as alucinações auditivas e táteis associadas haviam começado três anos antes, com agravamento no último ano, causando medo de dormir. Os episódios eram extremamente perturbadores, gerando um impacto negativo no sono, desempenho escolar e vida social da paciente. Condições médicas foram excluídas e começou um tratamento com um inibidor seletivo da recaptação de serotonina, com resolução completa dos sintomas. Comentários: Queixas relacionadas ao sono são frequentemente subvalorizadas. Portanto, os médicos devem perguntar aos seus pacientes sobre problemas relacionados com o sono durante a avaliação clínica.

[Massive Upper Airway Bleeding: A Rare Case of Aortobronchial Fistula]. / Hemorragia Maciça na Via Aérea Superior: Um Caso Raro de Fístula Aorto-Brônquica.

Clinical presentation of haemoptysis and haematemesis often generates confusion, becoming a difficult task to determine the source of upper airway bleeding. Aortobronchial fistula is a rare entity, but has been a reported complication in patients that have undergone aortic vascular surgery. A high clinical suspicion is fundamental to making this diagnosis. A 69 year old male, with a previous diagnosis of chronic gastritis, is admitted to the emergency room for vomiting blood. In the first 24 hours after admission, the patient develops respiratory insufficiency after an episode of massive bleeding from his mouth. A computed tomography is performed, which shows a descending thoracic aortic aneurism and signs of aortobronchial fistula. Urgent thoracic endovascular repair was performed. Early symptoms of aortobronchial fistulae are nonspecific which complicates the diagnosis and can lead to treatment delay. The use of bronchoscopy in these cases is controversial.

A apresentação clínica de hemoptise e hematemese gera muitas vezes confusão. Nessas situações, a determinação da proveniência do sangue presente na via aérea superior pode tornar-se uma tarefa difícil. A fístula aorto-brônquica é uma entidade rara, mas tem sido descrita em doentes submetidos a cirurgia vascular da aorta torácica. A suspeita clínica é fundamental. Os autores apresentam o caso de um doente de 69 anos, sexo masculino, com o diagnóstico prévio de gastrite crónica que foi admitido por vómitos hemáticos. Após 24 horas na enfermaria, o doente apresentou um novo episódio de hemorragia maciça complicado com insuficiência respiratória. A tomografia computorizada do tórax mostrou um aneurisma da aorta torácica descendente e sinais de fístula aorto-brônquica que motivaram a realização de cirurgia endovascular urgente. Os sintomas iniciais da fístula aorto-brônquica são inespecíficos dificultando o diagnóstico, o que pode conduzir a um atraso na instituição do tratamento adequado. A realização de broncoscopia nestes casos é controversa.

Obstructive sleep apnea and diabetes mellitus.

BACKGROUND: There is convincing evidence that obstructive sleep apnea (OSA) is highly associated with impaired glucose metabolism. OBJECTIVES: Analyze the prevalence of OSA in type 1 and type 2 diabetes mellitus (DM) patients. Evaluate the influence of OSA on glycemic control. METHODS: The adult patients with diabetes mellitus (DM) followed in the department of internal medicine were referred to our Sleep Unit. A home respiratory polygraphy was then performed on all patients with body mass index (BMI) <40 kg/m(2). The glycemic control was assessed by the value of glycated hemoglobin (Hba1c) in the previous 3 months. RESULTS: A total of 46 patients were studied (20 men and 26 women), the mean age was 50±15 years and mean BMI was 28.6±4.9 kg/m(2). The mean Hba1c was 8.3±1.2. Twenty three patients had type 2 DM and 23 patients had type 1 DM. Twenty nine patients (63.0%) had OSA and 8.7% had severe OSA (AHI>30/h). The mean CT90 was 5.3±12.5 and the mean AHI was 13.6±18.3. The mean AHI was similar between type 1 and type 2 DM (15.7±24.5 Vs 11.6±8.9; p=0.46). The AHI was not correlated with the BMI. Type 2 DM patients with poor glycemic control (HbA1c>7.5%) had a significantly higher mean AHI (14.3±9.0 vs 6.4±6.2; p=0.038). This difference did not remain significant after adjustment for BMI (p=0.151). CONCLUSIONS: The prevalence of OSA in type 1 DM is similar to that found in type 2 DM. We note the high prevalence of OSA in younger patients with type 1 DM.

Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation.

The Chiari malformation type I (CM-I) has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.

Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation / Malformação de Chiari e síndrome de apneia central do sono: eficácia do tratamento com servoventilação adaptativa

The Chiari malformation type I (CM-I) has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.

A malformação de Chiari tipo I (MC-I) tem sido associada a distúrbios respiratórios do sono, sobretudo à síndrome de apneia central do sono. Apresentamos o caso de uma paciente do sexo feminino de 44 anos de idade com MC-I que foi encaminhada à nossa unidade de sono por suspeita de apneia do sono. A paciente havia sido submetida a cirurgia descompressiva 3 anos antes. A gasometria arterial mostrou hipercapnia. A polissonografia revelou um índice de distúrbio respiratório de 108 eventos/h, sendo todos os eventos apneias centrais. Foi iniciado tratamento com servoventilação adaptativa e houve resolução da apneia central. Este relato demonstra a eficácia da servoventilação no tratamento da síndrome de apneia central do sono associada à hipoventilação alveolar em uma paciente com MC-I previamente submetida a cirurgia descompressiva.