International Consensus Statement on Obstructive Sleep Apnea

BACKGROUND

Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).

METHODS

Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.

RESULTS

The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.

CONCLUSION

This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Atrioesophageal Fistula After Atrial Fibrillation Ablation: A Case Report

Atrioesophageal fistula is a rare, potentially fatal complication of atrial fibrillation ablation that is often missed by clinicians. We report the case of a patient who presented with infectious symptoms 4 weeks after undergoing atrial fibrillation ablation. Our case emphasizes that prompt diagnosis and surgical intervention are crucial to reduce the high morbidity and mortality rates associated with this highly concerning complication.

A multi-disciplinary approach to the management of intra-venous and intra- cardiac leiomymatosis: a case report

Introduction: Leiomyoma is one of the most common benign smooth muscle tumor of the uterus which on rare occasions may grow into the vessels and extend up till the Inferior Vena cava or the heart and hence be referred to as Intra-Venous Leiomyomatosis and Intra-Cardiac Leiomyomatosis respectively.Case Report: We herein report a rare presentation of leiomyoma in a 46 year old female who presented with complaints of shortness of breath on exertion associated with palpitations for the past 1 year with a history of irregular menstrual bleeding. Ultrasonography of the abdomen and pelvis revealed an enlarged, distorted uterus with multiple intramural fibroids. A trans-thoracic echocardiography was then performed which showed a large right atrial mass. To investigate further, a contrast enhanced computed tomography was performed covering entire chest and upper abdomen. It showed a large lesion in right atrium of heart measuring 6x5cm.

Unidentified Recurrent Acute Compartment Syndrome of the Right Upper Limb

Acute compartment syndrome (ACS) is a surgical emergency that requires urgent fasciotomy to prevent irreversible sequelae. Symptoms usually include intense pain, tenderness in the affected area, tingling or burning sensation, and in severe cases, numbness or weakness and limb amputation due to ischemia from compression of the blood vessels, respectively. This case report describes a 19-year-old female who presented with complaints of severe pain and swelling in her right forearm. On examination, no bite marks, blisters, or skin necrosis were noted except for several surgical scars from her previous surgeries for the same condition, i.e., compartment syndrome. Upon thorough examination, including relevant investigation and clinical judgment, she was diagnosed with acute compartment syndrome, for which she underwent fasciotomy. There was no basic underlying pathology found in her case, making it an unidentified case of acute compartment syndrome.

In Vitro Comparison of Pushout Bond Strength of ProRoot MTA, Biodentine and TheraCal

Background

One problem encountered in vital pulp therapy is the dislodgment of biomaterial as the result of the application of mechanical condensation forces for the final restoration of the cavity or occlusal loads.

Material and Methods

In this in vitro, experimental study, 90 dentin discs were prepared with Gates Glidden drills to have a 1.3 mm canal diameter. The specimens were divided into nine groups (n=10). ProRoot MTA, Biodentine, and TheraCal were applied in groups 1-3, 4-6, and 7-9, respectively. The PBS was measured after 15 minutes, four hours, and three days and mode of failure was determined.

Results

The interaction effect of time and material on PBS was statistically significant (P<0.003). The PBS of Biodentine and ProRoot MTA significantly increased over time (P=0.000). At 15 minutes and four hours, the PBS of TheraCal was higher than that of Biodentine and ProRoot MTA (P=0.000). Our results showed the predominant type of bond failures in Biodentine and Theracal groups was cohesive, whereas it was adhesive for ProRootMTA.

Conclusions

Theracal showed higher values of bond strength than Biodentine and ProRootMTA at 15 minutes & four hours and may thus be better options for single session of VPT.

Key words:Biodentine, Mineral Trioxide Aggregate, Pushout Bond Strength, TheraCal.

The nociceptive and anti-nociceptive effects of white mineral trioxide aggregate

AIM

To assess the nociceptive and antinociceptive effects of white mineral trioxide aggregate (WMTA) using the orofacial formalin test in rats.

METHODOLOGY

Rats (n = 10 in each group) were separately injected into the ipsilateral upper lip with either 40 microL of a 2.5% formalin solution and eugenol (50 mg kg(-1)) or WMTA (5, 10 and 20 mg dissolved in 0.2 mL saline) alone. In a second experiment to evaluate antinociception effects, 15 min prior to formalin injection, rats were pre-treated with either white ProRoot MTA (20 mg dissolved in 0.2 mL saline) or eugenol. The time each rat spent rubbing the injected site with its paw, as an index of nociception, was recorded for a period of 45 min.

RESULTS

Administration of 40 microL white ProRoot MTA (5, 10 and 20 mg per 0.2 mL) alone did not produce any significant nociceptive response. Moreover, prior treatment with WMTA caused significant (P < 0.001) inhibition of formalin-induced nociception. Injection of eugenol (50 mg kg(-1)) provoked the first phase of a nociceptive response, although its intensity was reduced compared with that produced by formalin. Pre-treatment with eugenol significantly (P < 0.0001) inhibited the induction of nociception by formalin. Comparison of the behavioural responses observed in WMTA and eugenol-treated rats alone or in combination with formalin revealed that WMTA did not only induce pain behaviour but also prevented formalin-induced nociception.

CONCLUSION

White mineral trioxide aggregate, when compared with eugenol, was more effective in treating nociceptive pain in the orofacial formalin test.

Macronutrient intake of elderly people in the Padang area,West Sumatra, Indonesia

We examined the macronutrient intake of residents in Padang area, West Sumatra, Indonesia. The daily energy intake (1130±420 kcal) of elderly people in a rural traditional group was significantly lower than that in an urbanised "modernised" group (1700±460 kcal) (p<0.01). Even in young urbanised people (younger than 60 years old), 44.2% were below 2000 kcal per day. In the case of elderly people, in rural and urbanised groups 90%, and 33% of the respondents were below 1500 kcal per day, respectively. As for individual nutrients, the daily protein intake of elderly people in both the urbanised and rural groups was rather low. However, daily fat intake and carbohydrate intake of the younger people in the urbanised group were adequate, but those in the elderly group were not. In the case of the rural elderly group, macronutrient and energy intake were extremely low. To improve dietary habits and nutrient intakes of people in the Padang area, rural elderly people need a greater energy intake and an increased intake of all macronutrients.