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Sleep apnea syndrome and heart failure—mechanisms and consequences

therapy ( 58 ) Effects of CPAP therapy in CSA and HF patients was first evaluated in CANPAP study (Canadian Positive Airway Pressure Trial for Patients with Congestive Heart Failure and Central Sleep Apnea) ( 59 ), a large, prospective, multicenter study. Because of poor patients, compliance (about 3.6 h/night) and variable effects with CPAP therapy ( 60 ), a newer therapy was developed, called adaptive pressure support servo-ventilation (ASV), a synchronized form of positive pressure ventilation. Compliance and efficiency of this therapy was followed in several

Open access
Is Chronic Kidney Disease Reversible?

Abstract

Chronic kidney disease, no matter the aetiology, has a progressive evolution and a negative prognosis. The rapidity of nephrons loss and deterioration of renal function depends on the aetiology of the kidney disease, the prompt diagnosis, efficiency of the treatment and the patient compliance to the treatment, diet and suitable lifestyle. The therapeutic control of the mechanisms of progression have also demonstrated that it could be possible to attenuate or even to stop the evolution towards kidney failure.

Open access
Comprehensive Lifestyle Interventions in Obstructive Sleep Apneea

Abstract

There is a complex link between obesity and obstructive sleep apneea (OSA), and there are new guidelines for comprehensive lifestyle interventions (CLI) for weight loss, with beneficial results on obese patients with OSA. A structured algorithm is proposed, step by step, according to BMI. All these recommendations are evidence based, a large meta-analysis is further discussed as an evidence base.

Implications in clinical practice outline: the effectiveness of lifestyle changes in reducing OSA outcomes, higher efficiency for complex interventions on male patients with severe OSA, duration of the intervention and combination with CPAP usage are not statistically correlated with lifestyle interventions effects on OSA. Different types of food affect sleep quality, high fat diets and processed meat are correlated with OSA. Higher adherence to Mediterranean Diets, that is very common used in CLI is a predictor for OSA outcomes improvement. Metabolic bariatric surgery MBS, indicated for a specific group of patients will ameliorate OSA. Building a long term partnership with the patients with OSA and obesity will ensure adherence to therapeutically measures and finally good results in improving quality of life.

Open access
The Secret of Preserved Quality of Life in Elderly Patients with Peripheral Artery Disease and Decreased Ankle-Brachial Index

Summary

Objective. In lower limb peripheral artery disease the most commonly used method for the assessment of the main arterial system is represented by the determination of ankle-brachial index (ABI). The post-occlusive reactive hyperaemia (PORH) is a controversial method used for the evaluation of primary collateral circulation. The follow-up of these patients has an underestimated part, their quality of life. The aim of this study is to evaluate this and highlight the importance of the PORH in the sight of optimal treatment.

Method. 34 patients diagnosed with lower extremity artery disease, receiving conservative treatment, the ankle-brachial index was defined with a Doppler Bistos BT-200, 8 MHz device, the PORH was evaluated with a Bidop ES-100V, an instrument which sends information for a Smart-V-Link software. To assess the quality of life we used the VascuQol-6 test.

Results. The age (mean ± SD) of the patients was 67.24±9.51, 52.92% were active smokers. A significant positive correlation was found between PORH and the results of VascuQol-6 test (p=0.02, r=0.38) and an inverse correlation between ABI <0.5 and VascuQol-6 >12. We noticed a significant difference between the VascuQol-6 result at smokers and non-smokers (p=0.02).

Conclusions. The quality of life can be acceptable at patients with significant stenosis on the main artery and decreased ankle-brachial index due to presence of the collateral artery system with a maintained ability of vasodilatation represented by PORH. The efficiency of the treatmet is based on quitting smoking, starting programs which are helping patients to quit smoking would be useful.

Open access
Novel Oral Anticoagulants, A Subject in Continuing Debate

, pharmacokinetics and pharmacodynamics, and safety and efficacy in phase 1 subjects. AmJ Emerg Med. 2016;34(11S):26-32. 14. Choo WK, Fraser S, Padfield G et al. Dabigatran improves the efficiency of an elective direct current cardioversion service. Br J Cardiol 2014;21:29–32. 15. Cappato R, Ezekowitz MD, Klein AL et al. Rivaroxaban vs. vitamin K antagonists for cardioversion in atrial fibrillation. Eur Heart J. 2014;35(47):3346-55. 16. Sakabe M, Yoshioka R, Fujiki A. Low APTT and BMI predicts the occurrence of ischemic stroke in patients with Atrial Fibrillation

Open access