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Thoracic Medicine

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Sleep Medicine

Latest News

The Wall Street Journal reported recently on the topic of sleep deprivation as to which cities around the World are the most and least sleep deprived. Brisbane leads the way with the earliest bed time and earliest wake up time.

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According to new research, risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours.

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As we get older there is a strong relationship between reduced amount and quality of sleep. Recent research has found specific cluster of neurons that have linked insomnia and more sleep fragmentation. The reduction of these neurons can be from normal aging but has also been seen in Alzheimers disease.

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A bedtime routine might sound like something that's only necessary for the grade-school set, but following a nightly schedule can greatly improve the sleep of adults, too. Sleep experts recommend establishing a bedtime routine, both to calm and relax you as you get ready to sleep and so you aren't inadvertently giving yourself jet lag.

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Researchers at NYU Langone Medical Center and elsewhere, using a mouse model, have recorded the activity of individual nerve cells in a small part of the brain that works as a "switchboard," directing signals coming from the outside world or internal memories. Because human brain disorders such as schizophrenia, autism and post-traumatic stress disorder typically show disturbances in that switchboard, the investigators say the work suggests new strategies in understanding and treating them.

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The death rate from asthma in Australia has fallen by almost 70 per cent since the 1980s, according to a new report released by the Australian Institute of Health and Welfare

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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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