Minerva medica
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Comparative Study
[After the 2001 European Society of Cardiology Guidelines: is it possible to reduce the number of patients with syncope to be hospitalized?].
The aim of this paper was to evaluate how many patients with syncope should be hospitalized according to the 2001 European Society of Cardiology (ESC) Guidelines on the management of syncope. ⋯ The implementation of the ESC Guidelines on Syncope is technically feasible. Nevertheless, even when the Guidelines are strictly observed, a high percentage of patients with syncope has still to be hospitalized. Our data suggest that new criteria should be established for a safe Emergency Department discharge of the patients with syncope, particularly of those with structural heart disease or abnormal ECG.
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Sleep has effects on breathing, including changes in respiratory control, airways resistance and muscular contractility. These sleep-related modifications in the respiratory system do not induce adverse effects in healthy subjects, but may cause problems in patients with chronic obstructive pulmonary disease (COPD). Hypo-ventilation causes the most important gas-exchange alteration during sleep in COPD patients, leading to hypercapnia and hypoxemia, especially during rapid-eye-movement (REM) sleep. ⋯ Nocturnal oximetry is recommended to evaluate gas exchange during sleep in COPD patients. Sleep studies are usually indicated when there is a possibility of sleep apnea or obesity-hypoventilation syndrome. The role of non-invasive mechanical ventilation in managing COPD patients with nocturnal hypoventilation is discussed.
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Most sleep disorders result from complex interactions between genes and the environment. Modern molecular techniques are increasingly applied to determine the contribution of genes to sleep and its disorders. The genetic basis of circadian rhythms has been explored using Drosophila and rodent models. ⋯ In this case, animal models have provided important clues to a human disorder with complex genetics. The study of the role of genes in the obstructive sleep apnoea syndrome is likely to provide important clues to a phenotype associated with respiratory, cardiovascular, and metabolic dysfunction. This brief review will present the role of genetic factors in the obstructive sleep apnoea syndrome, restless leg syndrome, narcolepsy, and circadian rhythm disorders.
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The aim of the present investigation was to evaluate the usefulness of tizanidine hydrochloride in the treatment of myofascial pain of the masticatory muscles. ⋯ Given the absence of papers on the use of tizanidine hydrochloride in the treatment of myofascial pain of the masticatory muscles, the present investigation could provide some preliminary data about its possible efficacy. Randomized and controlled clinical trials are needed to confirm these results.
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Diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) are serious acute decompensations of type 1 and 2 diabetes mellitus due to various degrees of insulin deficiency and increased levels of counterregulatory hormones. They are characterized by hyperglycemia and hyperosmolarity in HHS, and by hyperglycemia and ketoacidosis in DKA with major electrolyte imbalance; both can co-exist. Precipitating factors can usually be identified. ⋯ Treatment consists of appropriate rehydration, intravenous insulin therapy and potassium supplementation. Careful monitoring of the patient's clinical and biochemical status throughout treatment is critical. Excess mortality still occurs, particularly for HHS, emphasizing the importance of patient education and regular follow-up to prevent these potentially fatal complications.