Concurrent cardiac sarcoidosis and obstructive sleep apnea presenting as arrhythmias

Background: Cardiac involvement is a rare and potentially fatal presentation of sarcoidosis. Obstructive sleep apnea may complicate sarcoidosis. Case presentation: We report a case of a sarcoidosis patient with cardiac involvement presenting with ventricular arrhythmias. Besides medical and invasive measures of therapy, the patient failed to respond fully. The patient was subjected to overnight polysomnography and diagnosed with concurrent obstructive sleep apnea syndrome. Following continuous positive airway pressure therapy, we observed a significant improvement of ventricular arrhythmias while methylprednisolone was further tapered. Conclusions: To our knowledge, this is the first report of cardiac sarcoidosis further implicated by OSAHS and presenting as ventricular arrhythmias that underlies the need for extensive testing in cardiac sarcoidosis in patients not responding to immunosuppressive therapy. © 2020 The Author(s)

Fixed dilated pupils in Covid-19 ARDS patients under rocuronium, reversed after discontinuation

Neuromuscular Blockade Agents (NMBA) are used in the management of moderate and severe Acute Respiratory Distress Syndrome (ARDS) patients. They have never been reported to present Central Nervous System adverse reactions. Shortage of cis-atracurium during the pandemic, led to the use of rocuronium. We report three patients with Covid-19 ARDS, who presented bilateral dilated, non-reactive pupils, after continuous rocuronium infusion. Brain CT findings were unremarkable and transcranial doppler tracings did not suggest brain edema or hemorrhage. NMBA's discontinuation led to reversal of the pupillary dilation. We believe that impairment of Blood-Brain-Barrier, due to Covid-19, led rocuronium access into the Central Nervous System, leading to this adverse effect. Clinicians should be aware of this adverse reaction when managing patients with Covid-19 ARDS warranting NMBA use. © 202

Brief review: Ergospirometry in patients with obstructive sleep apnea syndrome

This brief review summarizes the available literature on the intersection of obstructive sleep apnea syndrome (OSAS) and ergospirometry. Ergospirometry provides an assessment of integrative exercise responses involving pulmonary, cardiovascular, neuropsychological, and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system functions. Sleep disorders, including OSAS, often exacerbate problems in the operation of the autonomic nervous system, heart function, lung mechanics, anxiety, and muscle metabolism. Patients with OSAS have low aerobic capacity due to dysfunction of these systems, which often affect quality of sleep. Further research is necessary to elucidate the precise mechanisms through which ergospirometry can be useful in the assessment and early identification of patients with OSAS. © 2018 by the authors; licensee MDPI, Basel, Switzerland

Non-tuberculous mycobacteria as environmental risk factors for human infectious diseases – isolation of non-tuberculous mycobacteria from patients in the thessaly region (Central greece) and their correlation with sarcoidosis disease

Mycobacteria are organisms that are of great interest in the field of medicine, particularly those causing tuberculosis and leprosy (e.g., mycobacterium tuberculosis). Conversely, the nontuberculous mycobacteria (NTM) that have been found to be widely dispersed in the environment are considered potentially pathogenic for humans and animals. Recently, NTM found in patients were correlated with sarcoidosis disease. The aim of the present study is to identify atypical mycobacteria, isolated from various samples of patients, and examine their possible correlation with sarcoidosis disease, for the period of 2010 to2016. A total of 296 positive NTM patients (60% male) have been included in the study. Seventeen different NTM species were identified from the studied biological samples. The main species distribution among patients were as follows; M. fortuitum (n=107); M. gordonae (n=61); M. chelonae (n=44); M. intracellulare (n=27); M. avium (n=16) and M. abscessus (n=13). At the same period of time, a total of 124 sarcoidosis cases have been recorded from the same geographical area. The results of the present study showed that indeed there is a large dispersion of positive NTM patients in the environment. In addition, regarding the geographical distribution of positive NTM patients and patients with sarcoidosis disease in the same study area, there is evidence of a possible correlation between them. © 2017, Internet Scientific Publications, LLC. All rights reserved

The effect of physical strain on breeders patients with obstructive sleep apnea syndrome

Aim: The purpose of this study was to investigate the cardiopulmonary exercise testing (CPET) in breeders patients with obstructive sleep apnea syndrome (OSAS). Method: Thirty-two male participants (Age: 42.2 ± 7.3yrs, BMI: 29.5 ± 2.2 kg/m 2 ) underwent full overnight polysomnography (PSG) and were divided into two groups (OSAS group: n = 20 vs. Control group: n = 12). 72-hours after the PSG study, they were subjected to CPET. The Independent t-test was used to measure the differences between the groups. Pearson's correlation coefficient was used among the parameters of CPET and PSG study. Results: The results showed difference between the groups (OSAS vs. Control) during CPET in end-tidal, CO 2 pressure in the peak of the exercise (38.7 ± 3.0 vs. 35.4 ± 5.5 mmHg, p = 0.031) and mean arterial pressure (122.7 ± 10.6 vs. 113.7 ± 11.8 mmHg, p = 0.035). Correlation results showed differences between the physical strain and the polysomnography study in physical strain parameters “walking duration per day with the herd” and oxygen desaturation index during sleep (r = 0.370, p = 0.037) and minimum oxygen saturation during sleep (r=-.374, p = 0.035), in the parameter “milking duration” and apnea (r = 0.392, p = 0.048), AHI (r = 0.374, p = 0.035) and oxygen desaturation index during sleep (r = 0.434, p = 0.013). The physical strain parameter “working hours per day” wasn't related to any parameter of the polysomnography study. Conclusion: The daily physical activity may have a protective role during the course of the disease in patients with OSAS. © 2018 Elsevier B.V

The effect of exercise training on the quality of sleep in national-level adolescent finswimmers

Background: The purpose of the present study was to investigate whether the quality of sleep, in 91 national-level adolescent finswimmers, is affected by swimming style, swimming distance, and gender. Methods: Twenty-four hours before the opening of the National Championship, the participants recorded the training characteristics and answered the following two questionnaires: Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Score. Athletes were allocated to groups by gender, swimming style (monofin vs. bifin) and swimming distance (≤ 200 m vs. > 200 m). The dependencies between qualitative variables were estimated by chi-square test or Cramer’s V test with modification by Fisher’s exact test with cell frequencies less than 5. Binary logistic regression was used in the multi-factor model. Results: There was a difference in the variables of PSQI “usual getting up time” and “have pain during sleep” between the two swimming distance groups (≤ 200 m vs. > 200 m). By using a multi-factor model (χ2 = 13.541, p = 0.035), the variables of PSQI “usual getting up time” and “have pain during sleep” remained independent predictors of the swimming distance (p = 0.019, OR 1.75, 95% CI 1.09–2.81). Conclusion: The athletes swimming distances > 200 m experience more episodes of pain during sleep and get up earlier than athletes swimming shorter distances. © 2019, The Author(s)

8-Isoprostane levels in serum and bronchoalveolar lavage in idiopathic pulmonary fibrosis and sarcoidosis

Objective and design: Sarcoidosis and idiopathic pulmonary fibrosis (IPF) are both associated with deregulated inflammatory mechanisms partially triggered by aggravated oxidative stress. 8-Isoprostane has been proposed as a reliable marker of oxidative stress, linked to several pulmonary diseases. We aimed to explore differences in 8-isoprostane levels in IPF and sarcoidosis patients, and controls. Methods: We included 16 IPF and 55 sarcoidosis patients, as well as 17 controls in the study. 8-Isoprostane levels were measured in serum and in bronchoalveolar lavage (BAL). Results: Serum 8-isoprostane levels were increased in all patient groups vs controls (p < 0.001). The systemic 8-isoprostane concentrations were higher in sarcoidosis patients as compared to IPF subjects and controls (p = 0.017 and p < 0.001, respectively). IPF patients exhibited increased serum 8-isoprostane levels when compared to controls (p < 0.001). Sarcoidosis patients presented significantly increased 8-isoprostane BAL levels when compared to IPF patients (p = 0.002). Conclusion: Our data indicate that the level of oxidative stress, as reflected by 8-isoprostane concentrations, is enhanced in patients with sarcoidosis, and to a lesser extent, in IPF patients when compared to controls, suggesting a potential implication of redox imbalance in both diseases. (C) 2013 Elsevier Ltd. All rights reserved

Increased primary autoimmune thyroid diseases and thyroid antibodies in sarcoidosis: Evidence for an under-recognised extrathoracic involvement in sarcoido

Objective and Design: Sarcoidosis has been associated with thyroid diseases. However, until today no definite conclusions have been drawn. We aimed to assess the frequency of thyroid disorders and the levels of thyroid hormones and thyroid antibodies in 68 sarcoidosis patients and 75 controls. Additionally, we performed ultrasonography and fine-needle aspiration. Results: In this prospective case control study conducted in the University Hospital of Larissa, Greece, overt thyroid disease was present in 29.4% of patients and 16.1% of patients presented clinical autoimmune thyroid disease. Sarcoidosis patients had a significantly higher frequency of serological autoimmunity. Female patients had significantly increased frequency of positive TSH receptor antibodies (TRAbs) and antithyroid peroxidase antibodies (TPOAbs) when compared to gender-matched controls (40% vs 0%, p<0.001, and 28.8% vs 11.86%, p=0.029, respectively). The hypoechoic pattern of the thyroid was more frequent in female patients vs controls (p<0.001). Male patients had a higher frequency of TRAbs and hypoechoic pattern of the thyroid gland (43.4% vs 0%, p=0.002, and 39.1% vs 6.25%, p=0.021, respectively). Indices of thyroid autoimmune disease were significantly more frequent in sarcoidosis patients vs gender-matched controls. Increased TPOAbs were significantly associated with clinical autoimmune disease in sarcoidosis. Conclusions: Overall, the findings derived from this study suggest that thyroid disorders are frequent in sarcoidosis. This association may potentially be the result of increased thyroid antibodies

Increased primary autoimmune thyroid diseases and thyroid antibodies in sarcoidosis: evidence for an under-recognised extrathoracic involvement in sarcoidosis?

OBJECTIVE AND DESIGN: Sarcoidosis has been associated with thyroid diseases. However, until today no definite conclusions have been drawn. We aimed to assess the frequency of thyroid disorders and the levels of thyroid hormones and thyroid antibodies in 68 sarcoidosis patients and 75 controls. Additionally, we performed ultrasonography and fine-needle aspiration. RESULTS: In this prospective case control study conducted in the University Hospital of Larissa, Greece, overt thyroid disease was present in 29.4% of patients and 16.1% of patients presented clinical autoimmune thyroid disease. Sarcoidosis patients had a significantly higher frequency of serological autoimmunity. Female patients had significantly increased frequency of positive TSH receptor antibodies (TRAbs) and antithyroid peroxidase antibodies (TPOAbs) when compared to gender-matched controls (40% vs 0%, p<0.001, and 28.8% vs 11.86%, p=0.029, respectively). The hypoechoic pattern of the thyroid was more frequent in female patients vs controls (p<0.001). Male patients had a higher frequency of TRAbs and hypoechoic pattern of the thyroid gland (43.4% vs 0%, p=0.002, and 39.1% vs 6.25%, p=0.021, respectively). Indices of thyroid autoimmune disease were significantly more frequent in sarcoidosis patients vs gender-matched controls. Increased TPOAbs were significantly associated with clinical autoimmune disease in sarcoidosis. CONCLUSIONS: Overall, the findings derived from this study suggest that thyroid disorders are frequent in sarcoidosis. This association may potentially be the result of increased thyroid antibodies

Ultrasonographic Confirmation of Nasogastric Tube Placement in the COVID-19 Era

Background: Nasogastric tube (NGT) placement is a daily routine in the Intensive Care Unit (ICU), and misplacement of the NGT can cause serious complications. In COVID-19 ARDS patients, proning has emerged the need for frequent NGT re-evaluations. The gold standard technique, chest X-ray, is not always feasible. In the present study we report our experience with the use of ultrasonographic confirmation of NGT position. Methods: A prospective study in 276 COVID-19 ARDS patients admitted after intubation in the ICU. Ultrasonographic evaluation was performed using longitudinal or sagittal epigastric views. Examinations were performed during the initial NGT placement and every time the patients returned to the supine position after they had been proned or whenever critical care physicians or nurses considered that reconfirmation was necessary. Results: Ultrasonographic confirmation of correct NGT placement was feasible in 246/276 (89.13%) patients upon ICU admission. In 189/246 (76.8%) the tube could be visualized in the stomach (two parallel lines), in 172/246 (69.9%) the ultrasonographic whoosh test (“flash” due to air instillation through the tube, seen with ultrasonography) was evident, while in 164/246 (66.7%) both tests confirmed correct NGT placement. During ICU stay 590 ultrasonographic NGT evaluations were performed, and in 462 (78.14%) cases correct NGT placement were confirmed. In 392 cases, a chest X-ray was also ordered. The sensitivity of ultrasonographic NGT confirmation in these cases was 98.9%, specificity 57.9%, PPV 96.2%, and NPV 3.8%. The time for the full evaluation was 3.8 ± 3.4 min. Conclusion: Ultrasonographic confirmation of correct NGT placement is feasible in the initial placement, but also whenever needed thereafter, especially in the COVID-19 era, when changes in posture have become a daily practice in ARDS patients. © 2022 by the authors. Licensee MDPI, Basel, Switzerland