Search Results (187)

Background and Clinical Significance: Obstructive sleep apnea (OSA) is a common comorbidity in patients with cardiac and metabolic disorders. The coexistence of central sleep apnea with Cheyne–Stokes breathing (CSA-CSB) in heart failure patients, especially those with preserved ejection fraction (HFpEF), represents a diagnostic and therapeutic challenge. Data on continuous positive airway pressure (CPAP) failure and successful adaptation to servo-ventilation (ASV) in the context of complex comorbidities remain limited. Case Presentation: We present the case of a 74-year-old male with a history of type 2 diabetes mellitus, paroxysmal atrial fibrillation, HFpEF, essential hypertension, and bladder carcinoma. He was referred for pre-operative OSA screening, reporting excessive daytime sleepiness, insomnia, and witnessed apneas. Initial respiratory polygraphy revealed severe sleep-disordered breathing with dominant CSA-CSB and moderate OSA. Laboratory investigations also revealed severe iron-deficiency anemia, which was managed with parenteral iron supplementation. The patient underwent CPAP titration, which led to modest improvement and residual high apnea–hypopnea index (AHI). After persistent symptoms and an inadequate CPAP response, an ASV device was initiated with significant clinical and respiratory improvement, demonstrating normalization of hypoxic burden and optimal adherence. Conclusions: CSA-CSB in HFpEF patients with anemia poses unique therapeutic difficulties. This case highlights the importance of individualized diagnostic and therapeutic strategies, including transitioning to ASV in CPAP-refractory cases, which can lead to improved adherence, reduced hypoxia, and better overall outcomes in high-risk patients. Full article

Background and Aims: The majority of individuals with COVID-19 developed acute symptoms. Post-COVID-19 syndrome refers to the signs and symptoms of COVID-19 that persist for more than 12 weeks. The present study was conducted to estimate the prevalence and risk factors for post-COVID-19 syndrome in the Omani population. Methods: This is a cross-sectional study that was conducted at the University Hospital Center (UHC). All patients diagnosed with COVID-19 (through polymerase chain reaction PCR testing) between March 2020 and March 2022 were included. Eligible participants were interviewed through a phone call, informed about the study procedure, and invited to participate in the study. Results: The study enrolled 265 COVID-19 patients, of whom 156 (59.2%) were females and 204 (77.3%) had been vaccinated. The overall prevalence of post-COVID-19 syndrome was 48.5%. The most common symptom was fatigue (71, 26.9%), followed by joint pain (44, 16.7%). The other symptoms included loss of taste/smell (34, 12.9%), cough (32, 12.1%), palpitation (25, 9.5%), and hair loss (27, 10.2%). Unvaccinated patients showed a higher incidence of fatigue (p = 0.03) and loss of smell/taste (p = 0.01) on univariate analysis. Females were at high risk for the development of various symptoms, including fatigue, muscular pain, breathing difficulty, cough, chest pain, palpitation, headache, and hair loss. Multivariate analysis showed that female gender is a significant independent predictor (odds ratio: 3.1; p = 0.00) for the development of post-COVID-19 syndrome. Conclusions: The prevalence of post-COVID-19 syndrome among the Omani population was high, highlighting the need for targeted interventions to manage long-term symptoms in vulnerable groups. Full article

Pneumonia is a respiratory condition caused by various microorganisms, including bacteria, viruses, fungi, and parasites. It manifests with symptoms such as coughing, chest pain, fever, breathing difficulties, and fatigue. Early and accurate detection is crucial for effective treatment, yet traditional diagnostic methods often fall short in reliability and speed. Chest X-rays have become widely used for detecting pneumonia; however, current approaches still struggle with achieving high accuracy and interpretability, leaving room for improvement. PneumoNet, an artificial intelligence assistant for X-ray pneumonia detection, is proposed in this work. The framework comprises (a) a new deep learning-based classification model for the detection of pneumonia, which expands on the AlexNet backbone for feature extraction in X-ray images and a new head in its final layers that is tailored for (X-ray) pneumonia classification. (b) GPT-Neo, a large language model, which is used to integrate the results and produce medical reports. The classification model is trained and evaluated on three publicly available datasets to ensure robustness and generalisability. Using multiple datasets mitigates biases from single-source data, addresses variations in patient demographics, and allows for meaningful performance comparisons with prior research. PneumoNet classifier achieves accuracy rates between 96.70% and 98.70% in those datasets. Full article

Obstructive sleep apnea (OSA) is the most prevalent sleep disorder caused by breathing difficulties, characterized by repeated episodes of airway blockage while sleeping. Various interventions have been used to improve the symptoms and overall health of individuals with OSA. However, few studies have focused on the impact of exercise on OSA. Objectives: The objective of this review was to evaluate the impact of exercise on individuals with OSA, providing an update on the exercise management of OSA. Methods: This review examined the current literature, including experimental studies and systematic reviews with meta-analysis, that investigated the impact of exercise (oropharyngeal exercises, respiratory muscle training, and therapeutic exercise training) in OSA patients. Studies were identified by searching databases (PubMed, CHINAL, EBSCO) using the following keywords: obstructive sleep apnea, OSA, exercise, oropharyngeal exercises, respiratory muscle training. Inclusion criteria were based on the PICO framework. Results: Forty-three studies were included in this review following the original search, all of which investigated the effects of exercise interventions in OSA. Most of the studies observed various significant health-related improvements following exercise interventions; however, none of them combined or compared all these exercise regimes together. In addition, there is limited information regarding the impact of exercise on sleep architecture. Conclusions: Overall, the findings suggest that exercise, regardless of its regime, benefits individuals with OSA. Full article

Background/Objectives: Research on oral dysfunctions as contributing factors to obstructive sleep apnea (OSA) is needed to prevent and treat OSA. This study aimed to explore the association of OSA with oral dysfunction and examine its impact on nutrient intake, physical activity, and handgrip strength. Methods: This cross-sectional study analyzed data from the Eighth cycle Korea National Health and Nutrition Examination Survey (KNHANES, 2019–2021). The OSA group included diagnosed individuals and those over 40 years with symptoms such as snoring, fatigue, or witnessed breathing pauses during sleep. The non-OSA group included individuals not meeting these criteria. Using 1:1 propensity score matching to control for confounders (sex, age, lifestyle factors), 7636 participants were included. Oral dysfunction was assessed based on chewing problems, complaints of chewing discomfort, and speech difficulties. Nutrient intake, physical activity, and handgrip strength were analyzed using the Rao–Scott χ² test, complex sample t-test, and complex sample logistic regression. Results: The OSA group demonstrated significantly more oral dysfunction elements than the non-OSA group (p < 0.001). Higher energy intake was observed in the OSA group, with no significant differences in macronutrient intake. Physical activity levels were similar between groups; however, OSA participants without oral problems had higher handgrip strength (p < 0.05). Regression analysis showed increased OSA risk correlated with greater oral dysfunction and lower protein intake. Conclusions: This study revealed a strong association between oral dysfunction and OSA risk. Focusing on the assessment and early intervention of oral dysfunctions that influence OSA risk factors may aid in the early detection and prevention of OSA. Full article

Aim: This study aimed to determine the oral health profile of children with autism spectrum disorder and to analyze the impact of their oral health status on their personal quality of life and the quality of life of their families. Materials and Methods: A cross-sectional online study was conducted on 121 parents. A self-structured questionnaire was used to collect data on sociodemographic characteristics, parents’ perceptions of their child’s oral health, oral hygiene practices, and access to dental care. Additionally, the Parental–Caregiver Perceptions Questionnaire (P-CPQ-16, 16 items) and the Family Impact Scale (FIS-8, 8 items) were employed. The data were analyzed descriptively and using the Mann–Whitney U test and the Kruskal–Wallis H test. Results: No significant differences were found in FIS-8 and P-CPQ-16 scores between parents and children based on their sociodemographic characteristics. However, a significant association was observed between P-CPQ-16 and FIS-8 total scores and the type of used dental care (general dental practice vs. adapted practice and general anesthesia, p ≤ 0.001), dental visit frequency (regular vs. occasional, p < 0.05), child cooperation level during dental visits (cooperative vs. uncooperative, p ≤ 0.001), and dental care access challenges (p < 0.05). Parents reported a high prevalence of poor oral health in their children: the experience of tooth decay (48.1%), malocclusion (47.1%), bruxism (38.8%), bad breath (34.7%), and toothache (28.8%) in the previous 12 months. Most children brushed their teeth daily (89.3%), often with the help of their parents (44.6%). The most frequently reported difficulty in maintaining oral hygiene was the children’s unwillingness to cooperate (62.8%). Conclusions: Poor perceived oral health in children with autism spectrum disorder is significantly linked to a lower quality of life for both them and their families, especially when access to dental care is difficult and there is a lack of cooperation. Addressing these barriers and the high prevalence of oral health problems through tailored strategies is critical to improving children’s well-being. Full article

Background/Objectives: The main goal of this study was to determine whether ductal constriction in the third trimester of a pregnancy during fetal echocardiography examination has an impact on the neonatal clinical condition during the first days after birth. Methods: A retrospective study was based on 348 newborns who were examined during their fetal life in the third trimester of a pregnancy in our fetal cardiology center. They were divided into two groups: the study group (n = 49): neonates with “normal heart anatomy” (NHA), assessed by fetal echocardiography (ECHO) examination and prenatally diagnosed ductal constriction (NHA-DC); and the control group (n = 299): NHA neonates without DC (NHA-NDC). Results: Prenatally, DC was associated with other functional abnormalities, such as myocardial hypertrophy, cardiomegaly, tricuspid regurgitation, pericardial effusion and abnormal flow through foramen ovale. Neonates with prenatally diagnosed DC in 43% of cases presented with elevated neonatal bilirubin levels requiring phototherapy treatment (p < 0.006). In the study group 27% of neonates showed signs of breathing difficulties in the first hours of life (p < 0.001). Neonates with a prenatal diagnosis of DC were hospitalized longer than neonates with a normal heart study (NHS) (p < 0.001). Conclusions: Neonates with a prenatal diagnosis of ductal constriction are prone to having transient respiratory problems (up to 27%) and mild neonatal hyperbilirubinemia (in presented series up to 43%). Gestational diabetes can be associated with ductal constriction. Full article

Background: Individuals with maxillofacial deformities are concerned not only with their facial appearance but also experience dysfunctions of the stomatognathic system, including mastication, swallowing, speech, and breathing. These impairments may lead to negative psychological responses and a reduced quality of life. Aim: The aim of this study was to assess the quality of life and analyse reported dysfunctions of the stomatognathic system in orthognathic patients prior to surgical intervention. Material and methods: The study group (SG) comprised 63 patients with maxillofacial deformities scheduled for orthognathic surgery. The control group (CG) consisted of 70 patients with malocclusions undergoing orthodontic treatment who did not meet the criteria for surgical intervention. Quality of life was assessed in all participants using the Orthognathic Quality of Life Questionnaire (OQLQ), along with a self-reported questionnaire evaluating the presence of stomatognathic system dysfunctions (SS). Results: Significant differences were observed between the study groups regarding all quality-of-life indicators for orthodontic and orthognathic patients. Patients in the SG more frequently reported difficulties in the specified stomatognathic system functions compared to those in the CG. No statistically significant differences were found between SG patients with Class II and Class III malocclusions in terms of OQLQ scores or the frequency of reported SS dysfunctions. Regarding sex differences, women reported a lower overall quality of life and scored lower in social dimensions related to facial deformity and aesthetics compared to men. No significant correlations were observed between the age of orthognathic patients and quality-of-life assessment. Conclusions 1. Orthognathic patients exhibit a poorer quality of life and a higher prevalence of stomatognathic system dysfunctions compared to patients with malocclusions who do not require surgery. The type of skeletal deformity in surgical patients does not influence quality of life or the frequency of stomatognathic dysfunctions. 2. Unlike age, the patient’s sex is a significant factor in the quality of life before orthognathic surgery. Full article

Crude oil spills create environmental hazards, leading to air pollution and respiratory health risks in under-five children due to their developing organs. This study compares ambient air quality (AAQ) and the respiratory health (RH) of under-five children in crude oil-impacted and less-impacted communities. The study involved 450 under-five children (mean age: 3 years) from three Niger Delta communities: Bodo, K-Dere, and Beeri. AAQ was measured using sensors, and RH was assessed through interviewer-administered questionnaires between July and October 2022. Mean concentrations of pollutants, including PM_2.5, PM₁₀, TVOCs, and HCHO, were consistently higher in Bodo and K-Dere (oil-impacted communities) compared to Beeri (less-impacted community), with levels frequently exceeding both WHO and national standards. These concentrations were highest near spill sites and during evening periods, highlighting localized and temporal factors influencing air pollution. Respiratory symptoms such as cough, difficulty breathing, and persistent nasal congestion were significantly more prevalent among children in oil-impacted communities. Logistic regression analysis indicated a higher likelihood of respiratory issues in these communities, with odds ratios ranging from 2.53 to 14.18 for various symptoms. Elevated air pollution from crude oil spills correlates with a higher prevalence of respiratory conditions in children from impacted communities, underscoring the need for public health interventions in these areas. Full article

Background/Objectives: Premature infants frequently experience feeding difficulties due to the disrupted coordination of sucking, swallowing, and breathing, increasing the risk of airway compromise. In adults with dysphagia, cold liquids can enhance swallowing by stimulating sensory receptors in the pharyngeal mucosa. We previously demonstrated that short-duration feeding with cold liquid significantly reduces dysphagia in preterm infants; however, the impact of an entire feeding with cold milk remains unexplored. This study aimed to evaluate the safety of cold milk feedings in preterm infants with uncoordinated feeding patterns and their impact on their feeding performance. Methods: Preterm infants with uncoordinated feeding patterns (n = 26) were randomized to be fed milk at either room temperature (RT) or cold temperature (CT) using an experimental, randomized crossover design. We monitored axillary and gastric content temperatures, mesenteric blood flow, and feeding performance. Results: There were no significant differences in mesenteric blood flow Doppler measurements or axillary body temperatures between the CT and RT feeding conditions. However, a reduction in gastric content temperatures of 3.6 °F and 2.7 °F was observed at one and thirty minutes following CT feeding, respectively. No evidence of cold stress, increased episodes of apnea or bradycardia, gastric residuals, or emesis was noted in infants during or after the CT feeding condition. Feeding performance outcomes did not differ significantly regarding milk transfer rate (p = 0.781) or proficiency (p = 0.425). However, the quality score on the Infant-Driven Feeding Scale (IDFS) showed a significant improvement following CT feeding (p = 0.001). Conclusions: Cold milk feeding can be a safe therapeutic option for preterm infants. This underscores the potential for further comprehensive investigations to evaluate cold milk feeding as an effective therapeutic strategy for managing feeding and swallowing difficulties in preterm infants. The study was registered at clinicaltrials.org under #NCT04421482. Full article

Processed Fu-Zi (the lateral roots of Aconitum carmichaeli) is beneficial for the cardiac system, but, because it contains toxins, raw Fu-Zi produces arrhythmia and breathing difficulties. C₁₉ diester diterpenoid alkaloids (DDAs), including aconitine, mesaconitine, and hypaconitine, are toxic Aconitum alkaloids found in Fu-Zi and can be hydrolyzed to nontoxic monoester diterpenoid alkaloids (MDAs), including benzoylaconine, benzoylmesaconine, and benzoylhypaconine. In this study, six processed Fu-Zi decoction pieces and herbal medicines were analyzed. The highest DDA contents were found in Shengfupian, the raw Fu-Zi samples. A processing quality index (Grades A to D) was established to evaluate the processing quality of Fu-Zi. The data demonstrated that few Fu-Zi decoction pieces did not conform to the government regulation. The results of testing the inorganic elements showed that the calcium content increased by approximately 5 to 30 fold compared to raw Fu-Zi due to substances assisting with processing. Raw Fu-Zi processed by boiling, without additional substances, may have a decreased DDA content. This study provides a method of determining the quality status of pieces of Fu-Zi decoction and establishes a processing quality index for pieces of Fu-Zi decoction and herbal medicine. Furthermore, our results suggest that it is not necessary to use additional substance to assist with the processing of Fu-Zi. Through the established processing quality index, Fu-Zi may be used more safely and may demonstrate a greater consistency in quality. Full article

Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An episode of sudden wheezing can also raise the suspicion of a foreign body in the lower respiratory tract. The clinical findings depend on the type, size, and localization of the foreign body and include persistent cough, localized airway resistance, localized or diffuse wheezing, and difficulty breathing. A bronchoscopy is the procedure of choice for the removal of foreign bodies. Flexible bronchoscopy is increasingly being used as the initial diagnostic procedure in children with an uncertain history of choking, in the absence of physical and radiological lung changes, and in chronic complaints requiring the exclusion of a foreign body in the airways. Thus, the aim of this study was to describe our clinical experience with lower respiratory tract foreign body extraction in children over a period of five years. Materials and Methods: Over a 5-year period, 154 patients under the age of 18 underwent a bronchoscopy due to a suspected foreign body in the lower respiratory tract. Of these patients, 92% had an incident leading to acute respiratory distress, and 8% had no definite data on such an event in the anamnesis. Results: A foreign body in the respiratory tract was found in and extracted from 50 patients, and foreign bodies were absent in 104 of the cases. Conclusions: If a foreign body enters the lower respiratory tract, immediate and adequate actions are required to solve the problem. A bronchoscopy should be conducted in every suspected case of foreign body aspiration. Full article

Air pollution is a major health-related environmental challenge that affects many aspects of people’s daily lives. For amateur endurance athletes/exercisers, air pollution can cause, apart from the common health issues, reduced performance capacity during training and races. The most significant inconveniences that these amateur athletes/exercisers have to deal with, are related to breathing difficulty, increased heart rate, cough or respiratory problems, and eye or nose discomfort. The aim of this study is to create a psychometric scale that estimates the nuisance/discomfort that amateur endurance athletes/exercisers (triathlon, cycling, running, swimming) feel during their training, under conditions of increased air pollution, and to see how this is linked to demographic characteristics. The main overall purpose is the identification of possible correlation between air pollution and reduced athletic performance, as well as between air pollution and the wellbeing of amateur endurance athletes/exercisers, and to thus enable recommendations on training in a polluted environment. To this aim, a questionnaire was developed, initially through a pilot stage. The fully developed scale was provided to two hundred and ninety-two (292) amateur endurance athletes/exercisers for an exploratory factor analysis to be carried out. The exploratory factor analysis indicated three (3) factors accounting for 37.11% of the overall variance. The first factor “Physical discomfort” included nine (9) questions, the second factor “Lack of discomfort” five (5) questions, and the third factor “No general discomfort” six (6) questions. The degree of reliability was satisfactory, since Cronbach’s a coefficient was 0.841 for the first factor, 0.642 for the second, and 0.766 for the third factor. Subsequently, fluctuation analysis (ANOVA), multivariate fluctuation analysis (MANOVA), and Pearson’s r coefficient were used to indicate correlations between the independent variables and the three factors identified. Correlation between discomfort due to air pollution and the place of residence, as well as the presence or absence of allergies, was indicated. On the other hand, there were no significant statistical differences between gender, type of sport, the volume of training, the presence or not of respiratory problems, and smoking. Overall, the scale can be considered both valid and reliable. Full article

Long COVID, or post-acute sequelae of SARS-CoV-2 infection, includes a variety of enduring symptoms that endure beyond the acute phase of the illness, impacting multiple facets of patients’ psychological and physical health. The persistent symptoms encompass fatigue, breathing difficulties, musculoskeletal pain, and cognitive impairments, which can significantly affect daily functioning and overall quality of life. The objective of this study was to create and validate the accuracy of the Post-COVID Cognitive Impairment Scale, which is used to evaluate cognitive impairments resulting from a COVID-19 infection. This study was conducted in Iran between January and September 2023. It consisted of three phases: developing the scale, evaluating its content validity with experts, and validating its structure with 454 participants using exploratory and confirmatory factor analysis. The exploratory factor analysis revealed two variables, namely memory and attention, which accounted for 40.38% of the variation. Confirmatory factor analysis verified the model’s fit, with indices indicating satisfactory alignment: CMIN/DF = 2.80, RMSEA = 0.06, SRMR = 0.05, CFI = 0.93, and TLI = 0.92. The factor loadings were statistically significant (p < 0.001), and Cronbach’s Alpha values indicated strong internal consistency (working memory = 0.81, attention = 0.80). These results affirm the Post-COVID Cognitive Impairment Scale is a valid and reliable instrument for evaluating cognitive deficiencies in individuals with long COVID. Its application in clinical and research environments aids in the prompt detection and tracking of the treatment of such impairments. Full article

Background/Objectives: Patients with advanced cancer often present to the emergency department (ED) with pain and distressing symptoms that are not systematically evaluated. The current study investigated the association of symptom severity with the diagnosis of delirium and short-term survival. Methods: In this secondary analysis of a prospective randomized study of delirium among advanced cancer patients in the ED, in which symptoms were assessed by the MD Anderson Symptom Inventory (MDASI), we analyzed the distribution of MDASI item scores by 90-day mortality (Kolmogorov–Smirnov), the association of MDASI item scores with short-term mortality (logistic regression models), and the symptoms in those with or without delirium (Mann–Whitney U test or chi-square test). Results: Of the 243 patients included, 222 (91.4%) had complete MDASI scores. The MDASI median symptom scores for pain, fatigue, and interference with work were the highest. A significant difference in MDASI item score distribution with 90-day mortality was observed for fatigue (p = 0.018), shortness of breath (p < 0.001), difficulty remembering (p = 0.038), lack of appetite (p = 0.035), drowsiness (p < 0.001), feeling sad (p = 0.031), and interference with walking (p < 0.001). In multivariable logistic regression models, shortness of breath (adjusted OR 1.15, 95% CI 1.04–1.26, p = 0.005) and drowsiness (adjusted OR 1.17, 95% CI 1.05–1.33, p = 0.008) were associated with 90-day mortality, adjusting for age, race, performance status, and cancer type. The median total MDASI score was significantly higher in patients with delirium than in those without (88, IQR 83–118 vs. 80, IQR 55–104; p < 0.001). Conclusions: Patients with advanced cancer presenting to the ED had severe symptoms, some of which were associated with shorter survival. These findings underscore the necessity of systematic symptom assessment, focusing on shortness of breath, drowsiness, fatigue, difficulty remembering, lack of appetite, feeling sad, and feeling distressed, to enhance clinical decision-making and improve the care of patients with advanced cancer. Additional longitudinal studies are needed to evaluate the improvement in symptoms and quality of life for these patients. Full article