Nocturnal enuresis—theoretic background and practical guidelines

Nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds are central in the pathogenesis of enuresis. An underlying mechanism on the brainstem level is probably common to these mechanisms. Enuretic children have an increased risk for psychosocial comorbidity. The primary evaluation of the enuretic child is usually straightforward, with no radiology or invasive procedures required, and can be carried out by any adequately educated nurse or physician. The first-line treatment, once the few cases with underlying disorders, such as diabetes, kidney disease or urogenital malformations, have been ruled out, is the enuresis alarm, which has a definite curative potential but requires much work and motivation. For families not able to comply with the alarm, desmopressin should be the treatment of choice. In therapy-resistant cases, occult constipation needs to be ruled out, and then anticholinergic treatment—often combined with desmopressin—can be tried. In situations when all other treatments have failed, imipramine treatment is warranted, provided the cardiac risks are taken into account

Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK

This is the final version. Available on open access from the European Respiratory Society via the DOI in this recordBackground Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey. Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.Engineering and Physical Sciences Research Council (EPSRC

Teste cardiopulmonar do exercício na prática clínica Cardiopulmonary stress testing in clinical practice

O teste cardiopulmonar do exercício (CPX) apresenta-se como uma metodologia de grande utilidade diagnóstica e prognóstica. O presente estudo teve por objetivo demonstrar que os dados obtidos em laboratório fora do ambiente hospitalar comportam-se como os dados descritos na literatura, com aplicabilidade na prática clínica em nosso meio. METODOLOGIA: Trata-se de um relato de experiência, através da análise retrospectiva dos casos. O CPX foi realizado em condições de laboratório controladas, com bocal e clipe nasal, protocolo de rampa em esteira rolante e eletrocardiograma de 13 canais. RESULTADOS: Entre os 261 testes, 53,3% eram em homens, idade média de 48,2 ± 14,3 anos; ativos (45,2%) ou sedentários (34,5%). A capacidade aeróbia máxima foi superior e com declínio significativo para cada década de aumento na faixa etária entre os homens, enquanto nas mulheres o declínio significativo ocorreu entre os 30 e 60 anos. As mulheres apresentaram maior distribuição (p = 0,0006) nas classes funcionais "em programa de treinamento ou bem treinadas e motivadas". O consumo de oxigênio pico (<img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2) foi significativamente superior nos testes máximos, mas o <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 do limiar anaeróbio (<img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2LA) não apresentou diferenças significativas, quando o teste obtido foi máximo ou submáximo. A capacidade funcional, avaliada pelo <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2LA como porcentagem do <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 máximo previsto, comparado à porcentagem do <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 máximo atingido, classificou mais indivíduos com compromisso circulatório (p = 0,002) ou com menor aptidão física em comparação com pacientes ativos ou em programa de treinamento (p < 0,00001), exceto quando entre 50,0 e 59,0%, em que o critério empregado não influenciou a classificação funcional (p = 0,221). Não haver atingido 85,0% do <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 máximo previsto foi a causa mais comum de anormalidade, mais freqüente e significativo entre as mulheres. CONCLUSÃO: Os dados obtidos são comparáveis aos descritos na literatura, sugerindo que o CPX é uma metodologia factível, que poderia ser empregada rotineiramente na prática clínica em nosso meio.<br>Cardiopulmonary stress testing (CPT) is a very useful tool to determine the diagnosis and prognosis in clinical practice. The objective of this study is to demonstrate that data obtained in a laboratory outside the hospital are similar to those described in the literature. METHODOLOGY: Patients were submitted to CPT, treadmill ramp protocol, and 13 lead electrocardiogram to evaluate CPT in the clinical practice. RESULTS: Among 261 CPT, 53.3% were male, mean age 48.2 ± 14.3 years, with active (45.2%) or sedentary (34.5%) lifestyle. Male patients showed higher maximal aerobic capacity (<img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max) and a significant decrease of <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 for each ten years of increment in age, but it decreased from 30 to 69 years in females. Females showed a significant higher (p = 0.0006) distribution in functional classes described as "in training programs or well trained and high motivation". A <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max was superior in maximal effort tests, but anaerobic threshold (<img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2AT) did not show differences between maximal or submaximal tests. The functionalcapacity evaluated by <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2AT as a fraction (%) of the <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max predicted in comparison to the fraction of the <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max measured was more rigorous, which implies a higher number of patients with circulatory impairment (p = 0.002) and also with lower physical capacity as opposed to active patients or patients under training programs (p < 0.00001); however, between 50.0% and 59.0% of the patients could be classified equally by one or the other criteria (p = 0.221). The more frequent abnormality in CPT was that it did not achieve 85.0% of the <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max predicted, more significant for females. CONCLUSION: Despite the limitations, this experience indicates that CPT data are reproducible in a laboratory outside the hospital, suggesting that CPT may be applied in clinical practice