Exploring the perceptions of patients with chronic respiratory diseases and their insights into pulmonary rehabilitation in Bangladesh.

Background: Chronic respiratory diseases (CRDs) require holistic management which considers patients' preferences, appropriate pharmacotherapy, pulmonary rehabilitation, and integrated care. We aimed to understand the perceptions of people with CRDs about their condition and pulmonary rehabilitation in Bangladesh. Methods: We conducted semi-structured interviews with a maximum variation sample of people with CRDs who had participated in a feasibility study of pulmonary rehabilitation in 2021/2022. A multidisciplinary team transcribed the interviews verbatim and analysed them in Bengali using a grounded theory approach. Results: We interviewed 15 participants with chronic obstructive pulmonary disease, asthma, or post-tuberculosis. The analysis revealed three themes. The first encompassed understanding CRDs: Patients characterised their condition by the symptoms (e.g. 'Hapani' meaning 'breathlessness') rather than describing a disease entity. Some believed occupation, previous infection, or family history to be a cause. The second theme included perceptions of pulmonary rehabilitation: Exercise was counterintuitive, as it exacerbated the breathlessness symptom that defined their disease. Views varied, though many acknowledged the benefits after a few sessions. Even with home-based programmes, participants described practical barriers to finding time for the sessions and adopted strategies to overcome the challenges. The third theme focused on implementation: Participants highlighted the need for raising awareness of CRDs and the potential of pulmonary rehabilitation in the community, adapting to the local context, and establishing an accessible resourced service. Conclusions: Understanding how patients and their communities perceive their condition and the barriers (both conceptual and logistical) to acceptance is the first step to embedding this highly effective intervention into routine health care services in Bangladesh with potential benefits for the increasing number of people living with CRDs in low- and middle-income countries.

VM-PATHI Correlates With Cognitive Function Improvement After Successful Treatment in Patients With Vestibular Migraine.

OBJECTIVE: To assess changes in cognitive function in vestibular migraine patients undergoing treatment. STUDY DESIGN: Prospective cohort. SETTING: Single-institution tertiary-care center. PATIENTS: Thirty-four patients with vestibular migraine were included in the study. Average age at diagnosis was 47.9 years. A majority of patients (91.2%) were female. INTERVENTIONS: Vestibular therapies included pharmacologic treatment (67.6%), mindfulness-based stress reduction (58.8%), vestibular physical therapy (20.6%), and lifestyle changes only (2.9%). MAIN OUTCOME MEASURES: Pretreatment and posttreatment questionnaires were collected including the Cognitive Failures Questionnaire (CFQ), Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI), and Dizziness Handicap Inventory. RESULTS: Median time between pretreatment and posttreatment questionnaire was 4.4 months (range, 2.8-15.6. mo). CFQ scores decreased in subjects who responded to treatment, as defined by those with a positive change in VM-PATHI score (average decrease, 6.5; p = 0.03). CFQ scores did not improve in subjects who had no improvement in their vestibular condition, as defined by no change or an increase in VM-PATHI score (average increase, 2.0; p = 0.53). Univariate linear regression showed that VM-PATHI score change was highly predictive of CFQ change ( p < 0.01, r2 = 0.36). Multivariate regression demonstrated that the VM-PATHI ( p = 0.03) and not the Dizziness Handicap Inventory ( p = 0.10) predicted changes in CFQ score. CONCLUSIONS: Self-reported cognitive dysfunction improves with successful treatment of vestibular migraine.

Relationship of vitamin D levels with clinical presentation and recurrence of BPPV in a Southeastern United States institution.

OBJECTIVE: To examine the relationship of 25hydroxyvitamin D serum levels with BPPV incidence and recurrence rates. METHODS: A retrospective cross-sectional, case-controlled study with follow-up phone survey was performed on patients diagnosed with BPPV between 05/2017-05/2020, who had available 25hydroxyvitamin D serology. Patients were seen at a multidisciplinary, vestibular-focused, neurotology clinic at a tertiary referral center. Controls consisted of subjects from the National Health and Nutrition Examination Survey (NHANES), and a locoregional age, sex, and race-matched group of patients from our institution. RESULTS: Our BPPV cohort consisted of 173 patients (mean age 66.2 ± 11.8 years), who were predominately female (75.7%) and Caucasian (76.3%). Almost all age subgroups (BPPV, NHANES, and locoregional groups) ≤60 years old had insufficient levels of vitamin D. However, the overall BPPV cohort had a significantly higher vitamin D level than the NHANES control (31.4 ± 16.5 v. 26.0 ± 11.2 ng/mL, d=0.474 [0.323, 0.626]). There was no significant difference when compared to the overall locoregional control (31.4 ± 20.5 ng/mL). Migraines were significantly correlated to increased BPPV recurrence rates on univariate (beta=0.927, p=0.037, 95% CI: [0.057, 1.798]) and multiple regression analyses (beta=0.231, 95% CI: [0.024, 2.029], p=0.045). Furthermore, patients with BPPV recurrences had significantly lower levels of vitamin D at initial presentation when compared to patients with no recurrences (29.0 ± 12.0 v. 37.6 ± 18.3 ng/mL, d=0.571[0.139,1.001]). CONCLUSION: Many BPPV patients in our cohort had insufficient vitamin D levels, and patients with BPPV recurrences had insufficient and significantly lower vitamin D levels than those without. As a readily available and affordable supplement, vitamin D may be used as an adjunct treatment but prospective studies should be done to confirm if it can prevent or reduce recurrence.

Interviewing and Counseling the Dizzy Patient with Focus on Quality of Life.

When interviewing a patient presenting with dizziness, it is imperative to both diagnosis and treatment for the clinician to identify the impact dizziness has on the patient's productivity, general function level and cognition. and cognition. Psychiatric comorbidities and concurrent sleep disturbances are common in this patient population and identification of these additional factors is important in implementing a holistic, multidisciplinary treatment plan and ultimately improves the patient's outcome.

Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings.

Pulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.

Transcutaneous Electrical Nerve Stimulation for Treatment of Tinnitus: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the treatment efficacy of transcutaneous electrical nerve stimulation (TENS) in patients with tinnitus. DATA SOURCES: PubMed, Scopus, Web of Science, and Cochrane Library were searched for the following concepts: "Transcutaneous Electric Nerve Stimulation" and "Tinnitus." STUDY SELECTION: Inclusion: 1) double- or single-blinded randomized controlled trials; 2) double- or single-blinded randomized comparison trials; 3) prospective or retrospective observational studies; and 4) case series. Exclusion: Non-English studies, nonhuman studies, case reports (n ≤ 5), and review articles. DATA EXTRACTION: Tinnitus Handicap Inventory (THI), the Visual Analog Scale (VAS), and perceived tinnitus suppression after treatment. Additional data collected included tinnitus laterality, duration of symptoms, location of electrode placement, time to follow-up, etiology of tinnitus, and treatment side effects. DATA SYNTHESIS: The literature search yielded 2941 unique articles. After reviewing 118 full-text articles, 17 studies reporting on 1,215 patients were included for final analysis. Four studies provided data available for meta-analysis of pre- and posttreatment THI and VAS (Cochrane Review Manager). TENS showed significant overall reduction on THI (-7.55 [-10.93 to -4.18], p < 0.0001) and VAS (-0.65 [-0.99 to -0.30], p < 0.0002). Subjective improvement of tinnitus was pooled across 13 studies using meta-analysis of proportions (MedCalc). Tinnitus suppression occurred in 40.0% [28.9-51.7%] patients. Among those who responded, 22.2% [12.2-29.7%] experienced complete suppression and 10.2% [0.2-31.9%] experienced persistent improvement at 3 months. CONCLUSIONS: TENS represents a safe and feasible treatment option for tinnitus and might be a worthy consideration among the spectrum of interventions developed for tinnitus.

[Mitral insufficiency related to a spasm of the left anterior descending artery. A case report]. / Insuffisance mitrale due à un spasme de l'IVA. A propos d'un cas.

We report the case of a female patient of 76 years old admitted to our hospital for a pre-operative assessment of a symptomatic mitral regurgitation (MR) whose transthoracic echocardiography revealed only a trivial regurgitation. The occurrence during hospital stay of an acute pulmonary edema contemporary to the occurrence of a huge MR permitted to suspect the diagnosis of a paroxystic ischemic MR. Angiographic and hemodynamic evaluation revealed only a non-significant atheromateous plaque located in the distal LAD. The infusion of Methylergometrine triggered a severe spasm at the site of that plaque, associated with a huge MR visualized by TTE with restricted movements of both leaflets, responsible for an acute pulmonary edema occurring on the table of the catheterization laboratory. Recovery was quickly obtained after intravenous injection of Nitroglycerin, which removed the spasm and valvular regurgitation. The diagnosis of paroxystic ischemic mitral regurgitation was confirmed and a treatment based on high dosage of calcium-blocker was decided. After a follow-up of more than one year, the patient remains asymptomatic and the regurgitation has never occurred.

Glutathione synthesis is essential for mouse development but not for cell growth in culture.

Glutathione (GSH) is a major source of reducing equivalents in mammalian cells. To examine the role of GSH synthesis in development and cell growth, we generated mice deficient in GSH by a targeted disruption of the heavy subunit of gamma-glutamylcysteine synthetase (gammaGCS-HS(tm1)), an essential enzyme in GSH synthesis. Embryos homozygous for gammaGCS-HS(tm1) fail to gastrulate, do not form mesoderm, develop distal apoptosis, and die before day 8.5. Lethality results from apoptotic cell death rather than reduced cell proliferation. We also isolated cell lines from homozygous mutant blastocysts in medium containing GSH. These cells also grow indefinitely in GSH-free medium supplemented with N-acetylcysteine and have undetectable levels of GSH; further, they show no changes in mitochondrial morphology as judged by electron microscopy. These data demonstrate that GSH is required for mammalian development but dispensable in cell culture and that the functions of GSH, not GSH itself, are essential for cell growth.

The effect of cimetidine on the pharmacodynamics of theophylline-induced seizures and ethanol hypnotic activity.

Due to its availability as an over-the-counter drug, the use of cimetidine is increasing, thus adverse interactions with other commonly used agents may also increase. The aim of this study was to investigate whether acute administration of cimetidine could alter the pharmacodynamics of theophylline neurotoxicity and the hypnotic action of ethanol. To examine these questions, rats received a dose of 77 mg/kg cimetidine followed by a constant infusion of either theophylline (1.2 mg/min.) or ethanol (16.3 mg/min.) until the onset of the pharmacological end point, maximal seizure or loss of righting reflex, where samples of blood and brain were obtained and assayed for either theophylline or ethanol. We report that cimetidine in doses that may cause pharmacokinetic interactions did not affect the concentration-effect relationship of either the stimulating action of theophylline or the depressant activity of ethanol. These outcomes emphasize the relative safety which patients using cimetidine in self-medication rely on.

Effects of folate supplementation in hyperhomocysteinemic pigs.

OBJECTIVES: The aim of this study was to evaluate the therapeutic effects of folic acid in the pig model of hyperhomocysteinemia. BACKGROUND: We have previously shown that pigs fed a methionine-rich diet develop hyperhomocysteinemia, arterial lesions and thrombotic events. Elevated homocysteine level is an independent risk factor for atherosclerosis that can be markedly lowered with daily folic acid administration. However, it is not known whether this treatment can prevent arterial lesions. METHODS: Three groups of pigs were studied: 8 control subjects received a standard diet; 8 received a methionine-rich diet for four months; 8 received a methionine-rich diet for 1 month and then the methionine-rich diet + 5 mg/day folic acid for 3 months. At month 4 after hemodynamic investigation, all the pigs were sacrificed. RESULTS: Control animals developed few usual vascular streaks. All the pigs fed a methionine-rich diet without folic acid treatment developed hyperhomocysteinemia (10.3+/-1.3 micromol/liter at basal state, 18.2+/-2.5 micromol/liter at one month and 14.6+/-3.8 micromol/liter at four months), hemodynamic abnormalities and diffuse arterial lesions with smooth muscle cell hyperplasia, endothelial alterations and elastic lamina dislocation. In this group, one pig died of venous thromboembolism and one of myocardial infarction. The pigs fed a methionine-rich diet + folic acid displayed similar arterial lesions and two had thrombotic events (one myocardial infarction and one pulmonary embolism), despite normalization of homocysteine levels (10.9+/-1.3 micromol/liter at basal state, 19.5+/-2.5 micromol/liter at one month and 11.4+/-3.8 micromol/liter at four months). CONCLUSIONS: In the pig model of hyperhomocysteinemia, 5 mg/day folic acid did not prevent arterial lesions or thrombotic events.

[Neurologic accident of decompression: a new indication of transesophageal echocardiography]. / Accident neurologique de décompression: une nouvelle indication de l'échocardiographie transoesophagienne.

Decompression sickness in a 33-year-old SCUBA diver led to neurological lesions with brain damage. The existence of a patent foramen ovale detected with a transoesophageal contrast echocardiography suggested paradoxal gas embolism. This observation emphasizes the intest of transoesophageal contrast echocardiography in decompression sickness as discussed in the literature. Its widely utilization would permit a better understanding of the pathophysiology of decompression sickness. It also may help the physician in deciding whether or not to authorize further diving.

Normalization of cardiac structure and function after regression of cardiac hypertrophy.

Previous studies have shown regression of left ventricular hypertrophy after pharmacologic treatment of hypertensive patients; however, the impact of regression of left ventricular hypertrophy on systolic function and on left and right ventricular diastolic function remains controversial and is difficult to assess because previous studies have not included concurrently studied age-matched control groups. Left ventricular mass, systolic function, and left and right ventricular diastolic function were assessed in 27 hypertensive patients, aged 43 +/- 6 years, by echocardiographic and Doppler studies before and 1, 3, 5, and 7 months after treatment. Left ventricular mass and ventricular function were concurrently evaluated in 27 age-matched normotensive subjects. Treatment with antihypertensive agents resulted in a significant (p < 0.001) reduction in diastolic blood pressure of 15 mmHg, measured at 1 month and sustained throughout the study. In response to hemodynamic unloading, left ventricular mass index decreased from 129 +/- 30 gm/m2 at baseline to 105 +/- 26 (p < 0.05) and 88 +/- 14 gm/m2 (p < 0.05) at 1 and 3 months of treatment, respectively, and remained unchanged over the subsequent 4 months. After 3 months of treatment, left ventricular mass index was similar in treated hypertensive and control subjects. Systolic function, assessed in terms of the relationship between shortening fraction and end-systolic wall stress, was unchanged throughout the treatment period and was no different from that in control subjects. However, patients with an initially depressed shortening fraction experienced a greater increase in shortening fraction during treatment compared to those with an initially normal shortening fraction (11% +/- 4% vs 5% +/- 5%, p < 0.01) and showed an improvement in the relationship between shortening fraction and end-systolic wall stress during treatment. Ventricular filling dynamics improved during the first 3 months of treatment, after which they were unchanged. Ventricular filling dynamics were similar in treated hypertensive patients and control subjects. In conclusion, sustained hemodynamic unloading of the left ventricle results in normalization of left ventricular mass, systolic function, and left and right ventricular diastolic filling dynamics, compared to those in age-matched control subjects.

[Comparative study of effects of diltiazem, nifedipine and their combination on exercise stable angina]. / Etude comparative des effets du diltiazem, de la nifédipine et de leur association dans l'angor stable d'effort.

Diltiazem and Nifedipine could be synergic. The aim of this study was to investigate the benefits of their association. Eighteen patients, 15 men and 3 women, average age 61 +/- 6 years, with stable angina on effort, were studied. Eight patients had single vessel disease and 10 patients had multivessel disease. The patients underwent a randomised double-blind trial with 4 successive treatment periods each lasting one week: placebo; 360 mg/day of Diltiazem; 60 mg/day of Nifedipine; 180 mg/day of Diltiazem with 30 mg/day of Nifedipine. The benefits were evaluated clinically, by exercise stress testing and with drug plasma concentrations at the end of each sequence. The results at the end of the 3 treatment periods were significantly better than with placebo. Diltiazem was significantly better than Nifedipine with respect to the development of angina during exercise testing (1 patient compared with 7 patients) and to maximum load (118.3 +/- 33.3 watts compared with 105.9 +/- 35.4 watts) (p less than 0.05). The association of the two drugs did not give better results than Diltiazem alone. Compared with placebo, the total duration of exercise testing and the duration of 1 mm ST depression were significantly longer during the 3 treatment sequences but there were no significant differences between each of them. Secondary effects were significantly more common with Nifedipine (7 patients) and with the drug association (9 patients) than with Diltiazem alone (3 patients) or placebo (1 patient). Plasma concentrations of Diltiazem were 328 +/- 35 ng/l with the 360 mg/day dosage and 137 +/- 52 ng/l with the 180 mg/day dosage.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of hay fever by Allerglobuline: a randomized double-blind study.

Eighty patients suffering from documented hay fever have been entered in a double-blind randomized study with the purpose of evaluating the efficacy of Allerglobuline, a 10% human immunoglobulin preparation of placental origin, in the treatment of hay fever. The placebo was a 10% human albumin solution. The treatment started 6 weeks before the customary onset time of the clinical symptoms. It included a course of ten pre-seasonal intramuscular injections, with 1 vial (5 ml) given twice a week, and followed by a booster injection of 1 vial on 15 June and 30 June during the grass pollen season. As the two groups of patients were similar, it was possible to demonstrate a significant symptomatic relief of rhinitis and conjunctivitis in the treated group, compared with the control group (P less than 0.0001), and an improvement of the respiratory symptoms. Symptomatic improvement was already apparent at the onset of the pollen season and persisted during the following weeks. An appreciable reduction in the consumption of antihistamines could also be shown (P less than 0.0001). Furthermore, a lesser increase in the total IgE level and in the specific cereal and grass pollen RAST could be demonstrated. This treatment can be seriously considered for the management of severe pollen allergy, particularly in those cases that show a poor response to immunotherapy.