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Thoracic Medicine

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Sleep Medicine

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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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Sarcoidosis

WHAT IS Sarcoidosis?

Sarcoidosis causes small inflammatory masses or nodules (known as granulomas) to form mainly in the lungs and chest lymph glands but can affect the eyes, liver, heart and brain as well. Granulomas are groups of immune cells, which are normally part of the body’s defence system.  These granulomas might alter the structure or function of the organs involved.  Often there are no symptoms, however some people may have a cough or chest discomfort, tiredness, breathlessness, dry mouth, sore eyes and skin rashes.  Some patients develop tender, red lumps on their shins or ankles called erythema nodosum.

Sarcoidosis and the lungs

The lungs are affected in about 9 out of every 10 sarcoidosis patients – however still not all will show symptoms.  It is thought that Sarcoidosis of the lungs starts with inflammation of the alveoli – the tiny gas exchanging units of the lungs.   Alveolitis either clears up naturally or leads to granuloma formation.  Eventually fibrosis can form causing the lung to stiffen – making breathing even more difficult.   About 20-30% of people with Sarcoidosis will develop some kind of permanent lung damage.

 WHAT causes SARCOIDOSIS?

The cause of Sarcoidosis is not yet known – despite extensive world-wide research.   Occasionally Sarcoidosis runs in families and most commonly affects people between the ages of 20-40, however much younger and older people have been known to have the disease.  How Sarcoidosis spreads from one part of the body to another is also currently being studied.  Sarcoidosis can appear suddenly and/or severely and subside after a short amount of time.  Sometimes symptoms can come on slowly and subtly and last or recur over a long time span.

how is SARCOIDOSIS diagnosed?

Sarcoidosis is usually diagnosed through biopsy of the affected organ; however it can sometimes be diagnosed by x-rays, blood tests and a detailed patient history.  The following are the main tools your doctor will use to diagnose you:

  • Chest x-ray – look for cloudiness (pulmonary infiltrates) or swollen lymph glands
  • CT scan – provides an even more detailed look at the lungs and lymph glands than an x-ray
  • Breathing test – measures how well your lungs are functioning
  • Bronchoscopy – involves passing a tube down the airways to provide a better look at what is happening inside your lungs.   The doctor can also take a small biopsy to check for granulomas and rule out other infection.

how is sarcoidosis treated?

Most cases of Sarcoidosis get better over 1-3 years, and may not need any treatment at all.  The granulomas can go away by themselves. Most people with Sarcoidosis can lead a normal, active life.

Treatment, when needed generally falls under 2 categories – maintenance of good health and drug treatment.  Maintenance of good health involves:
  • Getting regular check-ups with your doctor
  • Eating a well-balanced diet
  • Getting 6-8 hours of sleep per night
  • Exercising regularly and maintaining your weight
  • Quitting smoking
  • Avoiding dust, gases and harsh chemicals that can irritate your airways
  • Occasionally people with Sarcoidosis will have high blood or urine levels of calcium – if your doctor has told you this relates to you, it may help to avoid excess calcium in your diet and avoid excessive sunlight (i.e. daily sunbathing). 

Drug treatments are used to relieve symptoms, reduce the inflammation of affected tissues, reduce the impact of granuloma development and possibly prevent the development of lung fibrosis and other irreversible organ damage.  Drug treatments include prednisolone and corticosteriods – both of which have side effects if used for an extended period of time, however often the benefits outweigh the risks. 

Other drug combination treatments may be available, speak to your doctor to find out what treatment is right for you. Unfortunately there are no treatments able to reverse the fibrotic damage Sarcoidosis may cause on the lungs.

 

 

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