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Thoracic Medicine

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Sleep Medicine

Latest News

New research confirms that sleep disturbances are linked to pain and depression, but not disability, among patients with osteoarthritis (OA).  Results from a new study found that poor sleep increases depression and disability, but does not worsen pain over time.

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Older women with disordered breathing during sleep were found to be at greater risk of decline in the ability to perform daily activities, such as grocery shopping and meal preparation, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of California, San Francisco.

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People with moderate to severe obstructive sleep apnoea may have an intrinsic inability to burn high amounts of oxygen during strenuous aerobic exercise, according to a new study led by researchers at University of California, San Diego School of Medicine.

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This webinar will be a clinical presentation in assessing a child who presents with snoring. Snoring is a very common presentation in childhood with some studies suggesting that up to 30% of children will snore at some point in their life. Within those that snore, there will be some who have obstructive sleep apnoea.

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Sleep apnoea may make it hard for you to remember simple things, such as where you parked your car or left your house keys, a small study suggests.

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Researchers believe that disrupted circadian clocks are the reason that shift workers experience higher incidences of type 2 diabetes, obesity and cancer. The body's primary circadian clock, which regulates sleep and eating, is in the brain. But other body tissues also have circadian clocks, including the liver, which regulates blood glucose levels.

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Atypical Mycobacterium

What is Atypical Mycobacterium Infection?

Mycobacteria is a type of bacteria that can cause infection within the body.  Atypical mycobacterium is any mycobacterium other than Tuberculosis mycobacterium.  The most common form of atypical mycobacterium, which also most commonly affects the lungs is the mycobacterium avium intracellulare complex.  Mycobacterium avium complex (MAC) has been isolated in freshwater and saltwater worldwide, with other common sources including aerosolized water, piper hot water systems, bathrooms, house dust, soil, birds, farm animals and cigarette components such as tobacco, filters and paper.  

What is MAC?

Mycobacterium avium complex (MAC) consists of two species— M avium and M intracellular -these species are difficult to differentiate.   It is thought that MAC is acquired by exposure to soil, air, or water, especially in temperate and sub tropical areas. People who are affected are usually those with low immune systems (patients with AIDS), or those suffering from chronic lung conditions (bronchiectasis, heavy smoking, or cystic fibrosis)  MAC causes 2 general patterns of lung disease, one pattern involves nodules and cavities, whilst the other involves nodules and bronchietasis.

How is MAC transmitted?

MAC is transmitted into the body through inhalation via the respiratory tract or digestion via the GI tract.  There is no known human to human transmission therefore the mycobacterium avium intracellular complex is considered NOT contagious.

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Treatment

Medication

Treatment can involve a range of drugs but often includes Rifampicin, Ethambutol and Clarithromycin.


Exercise

Regular daily exercise including walking, Yoga, Pilates, and strength training is highly recommended. MAC patients must remember that effort is required to maintain exercise due to chronic and sometimes extreme fatigue. It is very easy to become tired and not feel up to exercising. However, the continued plan will eventually contribute to improving daily quality of life.


Diet

Proper nutrition and adequate caloric intake to prevent weight loss and even encourage weight gain is helpful for MAC patients. Regular rest periods and sleep patterns assist to lessen fatigue. There may be some benefit for regular counseling visits and taking prescribed medications for depression and anxiety due to the stress of chronic illness. MAC patients can help themselves by maintaining a proactive stance and keeping up to date regarding current knowledge about the disease.


Seek Help

A major issue with MAC disease is fatigue or tiredness. Routines may need to be altered and assistance with activities of daily living may be required. Enlistment of others’ help and support is essential.


Keep on top of it!

Patients must pay attention to symptoms, take medications indefinitely, exercise regularly, and provide good nourishment to maintain a healthy weight. It is essential to envelope rigorous pulmonary hygiene, providing sputum cultures or getting bronchoscopes as needed. It is also important to avoid exposure to known infections, rest periodically as needed, and promote good sleep patterns. It is possible to maintain a good quality of life by following these suggestions.

MAC lung patients are initially treated for 15-18 months. Monthly follow up visits are recommended that include blood work. Less frequent testing is done via sputum samples, CT scans, chest films, and pulmonary function studies about every 6 months. Bronchoscopy may be required for those patients unable to produce sputum samples for culture.
Patients whose sputum remains culture positive for MAC after 12 months of drug treatment are considered treatment failures. Patients whose sputum cultures become negative for MAC almost always do so within 6 months of starting their drugs. If the condition worsens with symptoms or if the tests appear to change, then the physician would need to reevaluate the treatment plan and possibly consider another regimen of antibiotic therapy.

Lady Windermere Syndrome.

Mycobacterium avium complex (MAC) has also been associated with pulmonary infection and bronchiectasis in middle-aged women without a preexisting lung disease. Pulmonary MAC infection in this population is believed to be due to voluntary cough suppression that results in stagnation of secretions, which creates a suitable environment for growth of the organisms.

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