Orthopedic surgery is a field of surgery whose objective is to solve various disorders of the skeletal and locomotor system or lessen your symptoms. The problems it treats usually affect mainly the bones, cartilaginous structures or joints.

Thus, there are numerous injuries in which orthopedic surgery is used, which can be divided according to the parts of the body they affect. Thus, for example, in the feet, orthopedic surgery is performed on metatarsalgia, valgus of the big toe, pes cavus, flat feet and hammer toes.

In the case of people with hand injuries of the scaphoid rupture type, carpal tunnel injury, De Quervain’s syndrome, thumb osteoarthritis (rhizarthrosis), stenosing tenosynovitis (snapping finger), can also resort to this specialty to solve their problem.

if we talk knee, are the operations of the meniscus or ligaments and osteoarthritis of the knee the most common; While in the shoulder is the rotator cuff; and in the hiphip osteoarthritis.

Within orthopedic surgery, emergency surgery It is considered a subspecialty. In this case, it is a type of surgery that deals with the emergency treatment of patients with traumatic injuries.

Regarding the convenience of contacting an orthopedist in cases of the aforementioned pathologies, on many occasions it can be highly recommended for the patient, since it will be this professional who will assess the need or not for a surgical intervention.

The fact that this specialist is also a surgeon makes it possible for him to resort to the intervention directly when he deems it appropriate.

Sport practice

Many times, traumatology and orthopedic surgery are specialties that walk hand in hand.

They range from clinical assessment, diagnosis, prevention, treatment by surgical means and adequate rehabilitation to the care of patients with congenital and acquired diseases, deformities and traumatic and non-traumatic functional alterations of the musculoskeletal system and its associated structures. .

Based on this, the practice of sports and its relationship with medicine have attracted the attention of many professionals towards traumatology and orthopedic surgery.

While is true that many orthopedic surgeons are drawn to sportsit should be clear that these professionals deal with more than just sports injuries.

Specifically, yeswith specialists seeking to restore normal function to a deformed, diseased, or injured part of the musculoskeletal system, and methods of physical rehabilitation.

For his part, heSports medicine is the medical specialty that studies fitness to practice sport, working both on the prevention and treatment of pathologies derived from its practice.

Thus, this specialty is responsible for the care, advice, diagnosis and treatment necessary to play sports safely.

But, to understand sports medicine, it is best to know the disciplines on which it is based.

The first is the prevention and treatment of injuries related to the practice of any of the sports disciplines, as well as the cControl and monitoring of your performance and the treatment of diseases such as hypertension, diabetes, obesity, heart disease with the prescription of physical exercise.

Another of the key aspects after a sports medicine treatment is that which has to do with the rehabilitation of injuries or interventions.

In this recovery process, postoperative physiotherapy plays a fundamental role in the recovery of a patient after surgery.

Regarding its benefits, it should be noted that it accelerates recovery after surgical interventions, which is why there are many doctors and surgeons who prescribe rehabilitation after a postoperative period.

Between the Advantages of going to a physiotherapista, specialists point to a risk minimization and faster recovery.

In addition, postoperative physiotherapy works on mobility and flexibility. Although not all postoperative procedures are the same, in almost all of them you have to rest.

Thus, postoperative physiotherapy sessions are aimed at retraining the mobility of the intervened areawith exercises scheduled according to the patient and with the appropriate rhythm for an effective recovery.

Another advantage of going to a physiotherapist during a rehabilitation process is that the techniques applied can calm postoperative pain.

In fact, the General Council of Colleges of Physiotherapists of Spain (CFCFE) recalls that physiotherapy is an essential discipline in the physical and emotional recovery of patients with postoperative pain. Its application has a significant improvement in patients with minor surgeries and in patients with long-term operations.

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Source:

Wong IH, et al. Screw fixation has better outcomes than button fixation for glenoid reconstruction: Matched analysis. Presented at: Arthroscopy Association of North America Annual Meeting. May 19-21, 2022; San Francisco.

Disclosures:
Wong reports receiving research support from Aesculap/B. Braun, Arthrex Inc., Linvatec and Smith & Nephew; and being a paid presenter or speaker for Bioventus, DePuy, Linvatex and Smith & Nephew.


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SAN FRANCISCO - Although both button and screw fixation improved outcomes in patients with more than 15% glenoid bone loss, results presented here showed button fixation had a higher recurrence rate.

“We’re getting poor results from this button fixation in the literature,” Ivan H. Wong, MD, FAANA, said in his presentation here. “We need to assess postoperative rehabilitation compliance, as well as what the risk factors are for this failure, before we do more with button fixation.”

Wong and colleagues compared the Western Ontario Shoulder Instability Index (WOSI), recurrent instability occurrence and incidence of revision surgery among patients with more than 15% glenoid bone loss who underwent either screw fixation or button fixation. Researchers also performed a CT scan analysis.

Ivan H. Wong

Ivan H. Wong

Patients who underwent screw fixation had better outcome scores at more than 2-year follow-up, with 100% and 56% of patients in the screw and button fixation groups, respectively, meeting the minimal clinically important difference for the WOSI, according to Wong. He added patients in the screw fixation group had no recurrence vs. a 39% recurrence rate in the button fixation group. Results showed seven patients in the button fixation group underwent revision surgery and two patients in the screw fixation group underwent hardware removal.

“When you look at those that failed button vs. those that didn’t fail button, ... you can see those that are successful with button had a normal-sized glenoid, almost 30 mm,” Wong said.

Editor’s note: The story was updated on May 20, 2022, to include more information on the patients enrolled in the study.

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Research is limited, but there may be a connection between asthma and ankylosing spondylitis (AS). Understanding each condition could lead to better symptom management.

AS is a form of inflammatory arthritis that affects several areas of the body, including the lungs.

Asthma is a chronic condition that affects the airways in the lungs. It causes inflammation in the airways that can make them narrower. When this occurs, a person can experience difficulty breathing.

People living with AS may be at a higher risk of developing asthma. In addition, AS can negatively affect the lungs, causing breathing issues.

Health experts do not fully understand the relationship between asthma and AS. There is also little research into potential connections between the two conditions.

The authors of a 2015 study set out to determine whether AS may increase the likelihood of asthma. For this purpose, they utilized a comprehensive Taiwan database.

They found that individuals living with AS have an increased risk of having asthma. They also note that within the study group, people living with AS had a 1.74-fold increase in the risk of asthma, compared with the control group.

According to their findings, the following groups were more likely to develop asthma:

  • females
  • people aged 50–64 years
  • individuals without comorbidities

The authors of a 2016 study associate both asthma and AS with Th2 and Th17 cells, which make up part of the immune system.

They found that people living with AS had a 1.31 greater risk of developing asthma within 10 years of receiving an AS diagnosis.

In addition to potentially leading to the development of asthma, AS can affect a person’s lungs and breathing in general.

AS can cause tightness due to decreased mobility and expansion in the chest. The tightness can make it more difficult to take a deep breath.

In some cases, the inflammation that experts associate with AS can also affect the lungs themselves. The inflammation can cause damage to the lungs, which can lead to pulmonary fibrosis. Pulmonary fibrosis can make breathing more difficult and slowly worsens over time.

Currently, no research into the connection between asthma and developing AS is available. However, some evidence suggests a person living with asthma may have an increased risk of rheumatoid arthritis (RA), another rheumatic condition.

In a 2017 review of studies, the researchers looked at how asthma affects an individual’s likelihood of developing RA. They found that living with asthma increases the risk of rheumatoid disease, possibly due to underlying inflammation in asthma.

Additional research is necessary to fully explore the connection between asthma and rheumatoid conditions, such as RA and AS.

Managing asthma and AS at the same time can be challenging.

In part, this can be due to asthma making it more difficult to breathe during exercise. Exercise is a common recommendation to help find relief from AS symptoms, such as pain and stiffness.

Managing asthma effectively may allow a person to continue exercise as a management technique for AS.

Treatment for asthma often involves a combination of long-term care, and acute care when an attack occurs. Some common asthma treatments include:

  • short-acting inhalers
  • biologics
  • allergy shots
  • inhaled long-acting bronchodilators
  • leukotriene modifiers
  • corticosteroids, either inhaled or oral

Treatment for AS may involve the use of medications, physical therapy, or surgery, in addition to some lifestyle changes. The first-line treatment is nonsteroidal anti-inflammatory drugs, which can help with both inflammation and pain.

In more active cases, a doctor may recommend biologics for the management of AS symptoms and to help prevent disease progression and damage. They might also recommend surgery to help restore mobility and joint function.

A person should let a doctor know if they are living with both conditions so that the doctor can help tailor a treatment plan to better address both conditions.

To help with asthma and AS, a person may also wish to consider taking steps such as:

  • noting and recording triggers
  • trying to use stress management techniques
  • reaching or maintaining a moderate body weight
  • engaging in regular exercise
  • getting quality sleep regularly

A diagnosis of either asthma or AS may indicate an increased risk of the other condition developing.

The two conditions may share a connection related to inflammation and the immune system. However, more research is necessary to explore the exact link.

People can make certain lifestyle changes to help improve both their asthma and AS. In addition to taking steps to treat each condition individually, they can also try to exercise regularly, reduce stress, and work with a doctor to manage symptoms.

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Qualified dog first aider Patricia Gardiner says canine first aid is often overlooked but it could save your pet's life, and urges every owner to learn the six steps to perform CPR

Dog CPR
First aiders are urging pet parents to master CPR

Experts are calling for pet owners to learn dog first aid so they are equipped in emergencies.

While human CPR is well-taught, there is far more to be done to ensure that people are just as clued up on CPR for their dogs.

To change this, p et insurance provider Animal Friends has teamed up with Dog First Aid Training to demonstrate how to perform CPR on a dog.

Patricia Gardiner, qualified dog first aider at Animal Friends, said: "It is so important that people upskill themselves on dog first aid, including dog-specific CPR.

"These skills are so often overlooked however they could save yours, or another dog's life!"







Dog first aid training is so important if you own a pet
(

Image:

Getty Images)

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1. Safety first

If you come across a dog which is unconscious and they are unresponsive to words or cues, be sure to approach from the head area so they can see you if they wake up.

It's also a good idea to call the dog's name so they can hear you approaching.

2. Check for signs of life

Gently touch the dog's back with your foot to check for signs of life before kneeling beside them.

Check the dog's pulse by locating the femoral artery. If you are not certain that you can find the femoral artery, put your hand on the dog's chest to feel if there is a heartbeat.

3. Begin the compressions

If there is no pulse or heartbeat, you'll need to start chest compressions straight away.

For most dogs, you will need them to be lying on their right-hand side so that you have access to the left side of the chest.

The only exception to this is barrel-chested dogs such as the bulldog - they will need to be on their back and compressions will be done on the heart.

Hand placement is key! If the dog is under 10kg, place your hands directly on the heart.

If the dog is over 10kg, place your hands on the highest part of the rib cage - this is dome shaped between the front and back legs.

You are aiming to complete 100-120 compressions per minute and the pressure of each compression should be done to around one-third of the dog's body depth.

To maintain the correct rhythm, you can do this to the beat of songs such as 'Who Let the Dogs Out' by Baha Men, or 'Staying Alive'.







You can do it to the beat of 'Who Let the Dogs Out'
(

Image:

Getty Images/iStockphoto)

3. A, B, C

After two minutes of continuous compressions, you will need to complete three more checks.

A - Airway - open the dog's mouth, pull the tongue forward and check if there is anything obstructing the airway. Remove any obstructions.

B - Breathing - hold your hand in front of the dog's nose to check if you can feel breath. Look to see if the dog's chest is rising and falling.

C - Circulation - check for a femoral pulse or heartbeat again.

If you don't find a pulse and the dog is not breathing, initiate the compression system of 30 compressions and two rescue breaths and repeat three times.

4. Perform rescue breaths – mouth to snout

These are delivered mouth to snout. Close the dog's mouth so that the air gets to the lungs.

Place your mouth on the dog's nose and deliver a breath big enough to see the chest rise and fall as if the dog was breathing for themselves.

Allow the breath to come out and then deliver the second rescue breath.







It could save your dog's life in an emergency
(

Image:

Getty Images/Image Source)

5. Breathing and compression routine

Once you have delivered 30 compressions and two breaths and repeated this routine three times, check for a pulse and breathing.

Continue with this cycle for up to 20 minutes.

You can watch Animal Friends and Dog First Aid's full step-by-step video to perform dog CPR online.

Do you have a story to tell? Contact [email protected].

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A toddler who suffered horrific burns to almost half of his body after his house caught on fire has been 'recovering incredibly well' after it was feared he wouldn't survive. 

Elijah Whitton, two, has been fighting for his life in hospital since May 1 after his family home on the NSW-Victoria border was engulfed in flames.

In an update to Elijah's GoFundMe page, set up to help the family pay for his mounting hospital costs, sister Alyia Whitton said the toddler was finally turning a corner.

'He is recovering incredibly well ... his swelling has reduced and his skin has improved,' Ms Whitton wrote on Tuesday. 

'His breathing tube has been removed and he is now breathing on his own. Both of his eyes have opened.'

Pictured, two-year-old Elijah Whitton

The two-year-old's eyes and mouth swelled up

Elijah Whitton (pictured) is slowly on the mend as he fights for his life after he suffered burns to 42 per cent of his body in a house fire on May 1

'He is recovering incredibly well ... his swelling has reduced and his skin has improved, Alyia Whitton (pictured with the toddler), wrote in an update to his GoFundMe page

'He is recovering incredibly well ... his swelling has reduced and his skin has improved, Alyia Whitton (pictured with the toddler), wrote in an update to his GoFundMe page

Elijah is also adapting well to some skin grafting surgeries to his face and lower body.   

'He is still getting used to the new changes, he has been a bit more agitated since coming out of surgery, which is expected,' Ms Whitton said.

Police said the house fire was sparked by the family's clothes dryer leaving Elijah, who was trapped inside the home, to sustain third-degree burns to 42 per cent of his body. 

When the two-year-old (pictured) was pulled from the blaze his left leg was still on fire. He was airlifted to the Royal Children's Hospital in Melbourne, where he remains

When the two-year-old (pictured) was pulled from the blaze his left leg was still on fire. He was airlifted to the Royal Children's Hospital in Melbourne, where he remains

The toddler was airlifted 566km to the Royal Children's Hospital in Melbourne after the blaze destroyed the family home.

Emergency services were called to the Ruby St property in the border town of Wentworth just after 3pm on May 1 as fire engulfed the home.  

Ms Whitton said Elijah's left leg was still on fire when her mother pulled the trapped toddler out of the house.  

'Elijah was trying to make his way out of the fire, when our mother pulled him further away from the fire,' Ms Whitton told Daily Mail Australia. 

'Elijah’s left leg was still in flames when my mum put his leg out with water nearby.'

Although the cause of the fire is still unknown, it is believed that the family's clothes dryer (pictured) malfunctioned, causing an 'explosion'

Although the cause of the fire is still unknown, it is believed that the family's clothes dryer (pictured) malfunctioned, causing an 'explosion' 

Surgeons placed the two-year-old in an induced coma and rushed him into wound debridement surgery - a procedure that removes dead skin from burn areas.    

Police are investigating the cause of the fire but believe the family's clothes dryer malfunctioned, causing an explosion.

A nearby jerry-can full of petrol also ignited, escalated the ferocity of the fire. 

Ms Whitton said her 12-year-old brother Jacob Alassani, who was at home during the incident, heard the explosion and alerted their mum. 

'He instantly understood the severity of the house fire and went outside and took the safety precautions of turning the electricity off,' Ms Whitton said. 

Elijah was scheduled for a third wound debridement surgery on Thursday, where doctors will continue his skin grafting procedure.

The boy is expected to remain in hospital for several months.

Ms Whitton set up the GoFundMe page to assist her family with ongoing medical bills and Elijah's future rehabilitation costs.  

'Elijah is considered a trauma patient and we have been told that it is only the beginning of his journey to recovery,' Ms Whitton wrote earlier this month. 

'As it is still early days into his recovery we ask if Elijah could be kept in your thoughts and prayers.

'We would greatly appreciate any form of donation to help with Elijah's medical bills and his recovery including physical and emotional rehabilitation.' 

The fund has received more than 500 donations to date, smashing past their $30,000 goal.

Elijah's big sister, Alyia Whitton (pictured bottom right) set up a GoFundMe page to assist her family with ongoing medical bills and future rehabilitation costs for Elijah (pictured being held, bottom left)

Elijah's big sister, Alyia Whitton (pictured bottom right) set up a GoFundMe page to assist her family with ongoing medical bills and future rehabilitation costs for Elijah (pictured being held, bottom left)

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The latest study released on the Global Emphysema Drug- Market by AMA Research evaluates market size, trend, and forecast to 2027. The Emphysema Drug- market study covers significant research data and proofs to be a handy resource document for managers, analysts, industry experts and other key people to have ready-to-access and self-analyzed study to help understand market trends, growth drivers, opportunities and upcoming challenges and about the competitors.

Key Players in This Report Include:

GlaxoSmithKline (GSK) (United Kingdom) , Novartis AG (Switzerland), Merck & Co. (United States) , Abbott Laboratories (United States),  Boehringer Ingelheim (Germany), AstraZeneca (United Kingdom) , Roche Holding AG (Switzerland), Teva Pharmaceutical Industries (Israel), Vectura Group (United Kingdom), Pfizer (United States)

Download Sample Report PDF (Including Full TOC, Table & Figures) @ www.advancemarketanalytics.com/sample-report/186604-global-emphysema-drug–market

Definition:

Emphysema is a lung situation that motives shortness of breath. Emphysema is a disorder of the lungs that commonly develops after many years of smoking. Both continual bronchitis and emphysema belong to a crew of lung ailments recognised as persistent obstructive pulmonary ailment (COPD). Emphysema tends to have an effect on adults, in particular these who are over the age of forty Emphysema assaults lung tissue, which reasons a breakdown over time.

Market Trend:

  • New Products that Comprises improved Capabilities Launched by Leading Players

Market Drivers:

  • Increased Smoking, Increased Air Pollution, and Presence of Chronic Lungs Diseases

Market Opportunities:

  • Technological Advancement in the Treatment
  • Introduction of Generic Drugs in Developing Countries

The Global Emphysema Drug- Market segments and Market Data Break Down are illuminated below:

by Drugs (Aclidinium Bromide Oral Inhalation, Albuterol and Ipratropium, Alpha One-proteinase inhibitor, Indacaterol, Others), Therapy (Pulmonary Rehabilitation, Nutrition Therapy, Supplemental Oxygen), End-users (Hospitals, Specialty Clinics, Others), Medications (Bronchodilators, Inhaled Steroids, Antibiotics), Surgery (Lung Volume Reduction Surgery, Lung Transplant), Diagnosis (Imaging Test, Lab Test, Spirometry, Others), Symptoms (Loss of appetite, Depression, Problems having sex, Sleep problems, Blue lips or nail beds, Fatigue, Frequent lung infections, Morning headaches, Weight loss, Others)

Global Emphysema Drug- market report highlights information regarding the current and future industry trends, growth patterns, as well as it offers business strategies to help the stakeholders in making sound decisions that may help to ensure the profit trajectory over the forecast years.

Have a query? Market an enquiry before purchase @ www.advancemarketanalytics.com/enquiry-before-buy/186604-global-emphysema-drug–market

Geographically, the detailed analysis of consumption, revenue, market share, and growth rate of the following regions:

  • The Middle East and Africa (South Africa, Saudi Arabia, UAE, Israel, Egypt, etc.)
  • North America (United States, Mexico & Canada)
  • South America (Brazil, Venezuela, Argentina, Ecuador, Peru, Colombia, etc.)
  • Europe (Turkey, Spain, Turkey, Netherlands Denmark, Belgium, Switzerland, Germany, Russia UK, Italy, France, etc.)
  • Asia-Pacific (Taiwan, Hong Kong, Singapore, Vietnam, China, Malaysia, Japan, Philippines, Korea, Thailand, India, Indonesia, and Australia).

Objectives of the Report

  • -To carefully analyze and forecast the size of the Emphysema Drug- market by value and volume.
  • -To estimate the market shares of major segments of the Emphysema Drug-
  • -To showcase the development of the Emphysema Drug- market in different parts of the world.
  • -To analyze and study micro-markets in terms of their contributions to the Emphysema Drug- market, their prospects, and individual growth trends.
  • -To offer precise and useful details about factors affecting the growth of the Emphysema Drug-
  • -To provide a meticulous assessment of crucial business strategies used by leading companies operating in the Emphysema Drug- market, which include research and development, collaborations, agreements, partnerships, acquisitions, mergers, new developments, and product launches.

Buy Complete Assessment of Emphysema Drug- market Now @ www.advancemarketanalytics.com/buy-now?format=1&report=186604

Major highlights from Table of Contents:

Emphysema Drug- Market Study Coverage:

  • It includes major manufacturers, emerging player’s growth story, and major business segments of Emphysema Drug- market, years considered, and research objectives. Additionally, segmentation on the basis of the type of product, application, and technology.
  • Emphysema Drug- Market Executive Summary: It gives a summary of overall studies, growth rate, available market, competitive landscape, market drivers, trends, and issues, and macroscopic indicators.
  • Emphysema Drug- Market Production by Region Emphysema Drug- Market Profile of Manufacturers-players are studied on the basis of SWOT, their products, production, value, financials, and other vital factors.
  • Key Points Covered in Emphysema Drug- Market Report:
  • Emphysema Drug- Overview, Definition and Classification Market drivers and barriers
  • Emphysema Drug- Market Competition by Manufacturers
  • Impact Analysis of COVID-19 on Emphysema Drug- Market
  • Emphysema Drug- Capacity, Production, Revenue (Value) by Region (2021-2027)
  • Emphysema Drug- Supply (Production), Consumption, Export, Import by Region (2021-2027)
  • Emphysema Drug- Production, Revenue (Value), Price Trend by Type {Payment Gateway, Merchant Account, Subscription Management,}
  • Emphysema Drug- Manufacturers Profiles/Analysis Emphysema Drug- Manufacturing Cost Analysis, Industrial/Supply Chain Analysis, Sourcing Strategy and Downstream Buyers, Marketing
  • Strategy by Key Manufacturers/Players, Connected Distributors/Traders Standardization, Regulatory and collaborative initiatives, Industry road map and value chain Market Effect Factors Analysis.

Browse Complete Summary and Table of Content @ www.advancemarketanalytics.com/reports/186604-global-emphysema-drug–market

Key questions answered

  • How feasible is Emphysema Drug- market for long-term investment?
  • What are influencing factors driving the demand for Emphysema Drug- near future?
  • What is the impact analysis of various factors in the Global Emphysema Drug- market growth?
  • What are the recent trends in the regional market and how successful they are?
  • Thanks for reading this article; you can also get individual chapter wise section or region wise report version like North America, Middle East, Africa, Europe or LATAM, Southeast Asia.

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Chronic Obstructive Pulmonary Disease is a broad term used for defining progressive lung diseases like emphysema, refractory asthma, chronic bronchitis and some other forms of bronchiectasis. The symptoms of Chronic Obstructive Pulmonary Disease are so common that sometimes people fail to understand that they are suffering from Chronic Obstructive Pulmonary Disease and consider it as normal cold, cough and symptoms of aging. Symptoms are sometimes not even visible in the early stages of disease and the disease remains undiagnosed for a long time.

The symptoms of Chronic Obstructive Pulmonary Disease include wheezing, tightness in the chest, frequent coughing and increased breathlessness. Chronic Obstructive Pulmonary Disease can be treated using different types of drugs and therapies including oxygen therapy and pulmonary rehabilitation programs. In case of extreme severity of Chronic Obstructive Pulmonary Disease surgery is recommended which includes lung volume reduction surgery, lung transplant and bullectomy.

According to the data of British Lung Foundation approximately 1.2 billion people were suffering from Chronic Obstructive Pulmonary Disease in the U.K. alone in 2011. Also according to the COPD Foundation approximately 30million Americans were suffering from Chronic Obstructive Pulmonary Disease in 2013. Chronic Obstructive Pulmonary Disease is one of the leading causes of death worldwide. This data demonstrates the ever increasing demand of Chronic Obstructive Pulmonary Disease treatment worldwide and hence also shows the potential that the Chronic Obstructive Pulmonary Disease therapeutics market holds.

Chronic Obstructive Pulmonary Disease Therapeutics Market: Drivers and Restraints

The most important factors that are expected to drive the growth of the Chronic Obstructive Pulmonary Disease market includes the ever increasing number of cases of Chronic Obstructive Pulmonary Disease globally. Also the change in the lifestyle is responsible for increasing the habits like smoking and increase in the number of genetic disorders which in turn are responsible for raising the number of Chronic Obstructive Pulmonary Disease patients.

For more insights into the market, request a sample of this [email protected] www.futuremarketinsights.com/reports/sample/rep-gb-4337

Other factors that can boost the revenue from the Chronic Obstructive Pulmonary Disease therapeutics market are rising expenditures on healthcare that is leading to the adoption of Chronic Obstructive Pulmonary Disease treatments in the emerging economies. Increase in the level of awareness has also lead to the early diagnosis of the Chronic Obstructive Pulmonary Disease so that people can go for the treatment of the disease.

Factors that can limit the growth of the therapeutic enzymes in the forecast period include the fact that not all the patients who are suffering from Chronic Obstructive Pulmonary Disease are aware of the fact that they are suffering from the disease and therefore do not go for the treatment of the disease. Also sometimes people get to know about their disease when the disease can’t be cured by only medication and therapies and surgery becomes mandatory. This factor can also lead to a slow growth in the revenue from the Chronic Obstructive Pulmonary Disease therapeutics market.

Chronic Obstructive Pulmonary Disease Therapeutics Market: Overview

Chronic Obstructive Pulmonary Disease therapeutics market is a growing market and is expected to see an even higher growth in the forecast period. Factors such as increase in the population suffering from Chronic Obstructive Pulmonary Disease worldwide and increasing awareness about Chronic Obstructive Pulmonary Disease are responsible for fueling the growth of the Chronic Obstructive Pulmonary Disease therapeutics market. Betterment of the healthcare infrastructure in Asia Pacific and Middle East and Africa is also responsible for the revenue growth of the Chronic Obstructive Pulmonary Disease therapeutics market in the forecast period.

Chronic Obstructive Pulmonary Disease Therapeutics Market: Region-wise Outlook

Chronic Obstructive Pulmonary Disease therapeutics market is in its growth phase and hence this market is expected to see very high growth in the emerging economies like Latin America and Asia Pacific due to high population growth in these regions. North America Chronic Obstructive Pulmonary Disease therapeutics market is the most developed market in terms of revenue, followed by Europe. Middle East and Africa are also expected to see higher growth due to growing advancement in the healthcare infrastructure.

Chronic Obstructive Pulmonary Disease Therapeutics Market: Key Market Participants

Some of the key participants of Chronic Obstructive Pulmonary Disease therapeutics market include Pfizer Inc, Adamis Laboratories Inc., GlaxoSmithKline plc.

The report covers exhaustive analysis on

  • Market Segments
  • Market Dynamics
  • Historical Actual Market Size, 2012 – 2014
  • Market Size & Forecast 2017 to 2027
  • Supply & Demand Value Chain
  • Market Current Trends/Issues/Challenges
  • Competition & Companies involved
  • Technology
  • Value Chain
  • Aircraft Refurbishing Market Drivers and Restraints

For Information On The Research Approach Used In The Report, Ask Analyst @ www.futuremarketinsights.com/askus/rep-gb-4337 

Regional analysis includes

  • North America
  • Latin America
  • Europe
  • Asia Pacific
  • Middle East & Africa

The report is a compilation of first-hand information, qualitative and quantitative assessment by industry analysts, inputs from industry experts and industry participants across the value chain. The report provides in-depth analysis of parent market trends, macro-economic indicators and governing factors along with market attractiveness as per segments. The report also maps the qualitative impact of various market factors on market segments and geographies.

Chronic Obstructive Pulmonary Disease Therapeutics Market: Segmentation

Chronic Obstructive Pulmonary Disease Therapeutics Market: Segmentation

Chronic Obstructive Pulmonary Disease therapeutics market can be segmented on the basis of components and end user.

On the basis of component

  • Drug Class
  • Bronchodilators
  • Steroids
  • Phosphodiesterase-4 inhibitors
  • Theophylline
  • Antibiotics
  • Delivery Systems
  • Oral
  • Inhalation

On the basis of end user

  • Hospitals
  • Private clinics
  • Out-patients

About FMI:

Future Market Insights (ESOMAR certified market research organization and a member of Greater New York Chamber of Commerce) provides in-depth insights into governing factors elevating the demand in the market. It discloses opportunities that will favor the market growth in various segments on the basis of Source, Application, Sales Channel and End Use over the next 10-years.

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(BPRW) Why Emphysema May Often Be Missed in Black Men

(Black PR Wire) Emphysema is missed more often in Black Americans than in white Americans, and now researchers report they have figured out why.

The investigators found that many Black men who were considered to have normal results after race-specific interpretations of a common lung function test called spirometry actually had emphysema when assessed using computed tomography (CT).

Spirometry measures how much air a person can exhale and inhale. It’s standard practice to interpret spirometry results using race-specific norms, resulting in a predicted lower limit of normal for FEV1 and FVC for Black patients, the study authors explained. FEV1 (forced expiratory volume in the first second) is the maximum amount of air a person can exhale in one second and FVC (forced vital capacity) is the maximum amount exhaled after breathing in deeply.

Black men and emphysema

Race-based correction of spirometry has no biological basis and comes from an old mistaken belief that Black people have smaller lungs, the study authors pointed out.

For the study, the researchers examined the results from more than 2,600 Black and white men who had lung CT scans at an average age of 50 and spirometry at an average age of 55.

The study showed that nearly 15% of the Black men with above-normal spirometry results based on race-based adjustments were found to have emphysema on CT scans, compared with just under 2% of white men.

“We found that significant racial disparities in emphysema prevalence occur predominantly among those with FEV1 between 80% and 120% of that predicted,” said study author Dr. Gabrielle Liu. She is a pulmonary and critical care fellow at Northwestern University’s Feinberg School of Medicine in Chicago.

“This suggests that the greatest potential for misclassification using race-specific equations occurs among Black adults who are at risk for disease and who could potentially benefit from risk factor modification,” said Liu, who was scheduled to present the findings May 15 at the American Thoracic Society annual meeting in San Francisco. Such findings are considered preliminary until published in a peer-reviewed journal.

“We feel these findings support reconsidering the use of race-specific spirometry reference equations in favor of race-neutral reference equations, and support further research into the utility and implications of incorporating CT imaging into the evaluation of those with suspected impaired respiratory health and normal spirometry,” Liu said in a meeting news release 

What is emphysema?

Emphysema involves the gradual destruction of lung tissue and is often associated with chronic obstructive pulmonary disease (COPD).

Emphysema affects the air sacs in your lungs. These typically stretchy/elastic sacs fill up with air, like a small balloon when you breathe in and deflate when you breathe out or the air goes out.

However, if you have emphysema, many of your sacs may become damaged, which will instead cause them to lose their shape and become floppy. Emphysema can also destroy the walls of the air sacs, which will create fewer and larger air sacs instead of many tiny ones making it harder for your lungs to move oxygen in and carbon dioxide out of your body.

While you may have no symptoms or only mild symptoms at first, as the disease progresses, your symptoms may include:

  • Frequent coughing or wheezing
  • A cough that produces a lot of mucus
  • Shortness of breath, especially with physical activity
  • A whistling or squeaky sound when you breathe
  • Tightness in your chest

If you have severe symptoms, such as trouble catching your breath or talking, call your health care provider, especially if your symptoms are getting worse or if you have signs of an infection, such as a fever.

Getting diagnosed

If you believe you may have emphysema, see a doctor. He or she will be able to make a diagnosis based off of: 

  • A medical history, which includes asking about your symptoms
  • A family history
  • Other tests, such as lung function tests, a chest x-ray or CT scan, and blood tests

 Although there is no cure for emphysema, treatments and lifestyle changes can help with symptoms, slow the progress of the disease, and improve your ability to stay active. Additionally, there are treatments available that can prevent or treat complications of the disease such as medicines, oxygen therapy, pulmonary rehabilitation, and surgery.

The content and opinions expressed within this press release are those of the author(s) and/or represented companies, and are not necessarily shared by Black PR Wire. The author(s) and/or represented companies are solely responsible for the facts and the accuracy of the content of this Press release. Black PR Wire reserves the right to reject a press release if, in the view of Black PR Wire, the content of the release is unsuitable for distribution.

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What Is Kazano?

Kazano (alogliptin and metformin) is an oral prescription drug used alone or together with other medications and diet and exercise to improve blood sugar control in adults with type 2 diabetes.

Kazano is available as an oral tablet belonging to a drug class called dipeptidyl peptidase-4 (DDP-4) inhibitors/biguanides. Kazano contains two ingredients that work together to help improve blood sugar control.

Alogliptin is a DPP-4 inhibitor. It works by increasing the amount of insulin in the body, which helps control blood sugar. Metformin is a biguanide. It works by decreasing the amount of glucose (sugar) that the liver makes. It also reduces the amount of sugar you absorb from food and helps the body respond better to insulin.

Kazano is available by prescription in tablet form.

Drug Facts

Generic Name: Alogliptin and metformin

Brand Name(s): Kazano

Drug Availability: Prescription

Therapeutic Classification: Dipeptidyl peptidase-IV inhibitors/biguanides

Available Generically: Yes

Controlled Substance: No

Administration Route: Oral

Active Ingredient: Alogliptin and metformin

Dosage Form(s): Tablet

What Is Kazano Used For?

The Food and Drug Administration (FDA) approved Kazano to improve blood sugar control in adults with type 2 diabetes inadequately controlled by metformin or are already being treated with alogliptin and metformin. It can also be used as part of triple combination therapy with pioglitazone and insulin. Use Kazano along with dietary and exercise measures.

Kazano is not indicated to treat type 1 diabetes or diabetic ketoacidosis (DKA). DKA is a life-threatening complication caused by a buildup of blood acids or ketones. DKA is more common in people with type 1 diabetes.

How to Take Kazano

If you are prescribed Kazano, read the prescription label and the information leaflet that comes with your prescription. Use Kazano exactly as directed by your healthcare provider, and do not skip doses. Do not change your dose unless your healthcare provider tells you to do so. Consult your healthcare provider if you have any questions.

Take Kazano with food to lessen stomach-related side effects. Swallow the tablet whole with water; do not chew, crush, cut, or break the tablet to take it. In addition to taking your medication as prescribed, continue to follow a diet and exercise plan. Test your blood sugar as directed by your healthcare provider. They may check your blood sugar levels and your hemoglobin A1C, a measure of blood sugar control over three months, and order blood tests to monitor how your kidneys are working.

You should also tell your healthcare provider if you are sick or plan to have surgery. In this case, they may need to change the dose of your medication.

Storage

Store this medication at room temperature, away from heat, direct light, and moisture. Keep this medication in its original labeled container and out of reach and sight of children and pets. Keep the bottle tightly closed when not in use.

How Long Does Kazano Take to Work?

A single dose of Kazano should reach its highest levels in the body within two or three hours. It may take up to 14 days to see significant changes in blood sugar levels. At the three-month mark, the A1C test can show how blood sugar has been controlled over three months.

What Are the Side Effects of Kazano?

Like other medications, Kazano can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or prescribing healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The most common side effects of Kazano are:

  • Cough and cold symptoms
  • Diarrhea
  • High blood pressure
  • Stomach problems, including nausea, vomiting, diarrhea, indigestion, discomfort, and gas
  • Appetite loss
  • Metallic taste in the mouth
  • Low blood sugar
  • Headache
  • Back pain
  • Weakness
  • Urinary tract infection (UTI)
  • Vitamin B12 deficiency
  • Rash
  • Ovulation induction (Kazano can stimulate ovulation, which can result in an unexpected pregnancy)

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, difficulty breathing, and require emergency medical attention. 
  • Stevens-Johnson syndrome: A life-threatening skin reaction can have symptoms of red or purple rash, blistering or peeling skin, fever, burning eyes, and sore throat. Stevens-Johnson syndrome requires emergency medical attention.
  • Lactic acidosis: A life-threatening complication that requires emergency medical attention. Symptoms may include muscle pain, difficulty breathing, stomach pain, vomiting, slow heart rate, or feeling cold, dizzy, tired, lightheaded, or weak. Even if your symptoms seem mild, get emergency medical attention.
  • Liver failure: Symptoms may include nausea, upper stomach pain, appetite loss, dark urine, yellowing of the skin or whites of the eyes, and fatigue.
  • Heart failure: Symptoms may include shortness of breath, fast weight gain, or swelling in the legs and feet.
  • Inflammation of the pancreas: Call your healthcare provider right away if you have severe upper stomach pain that spreads to the back, nausea, vomiting, appetite loss, or fast heartbeat.
  • Low blood sugar: Your healthcare provider will instruct you on how and when to test your blood sugar and what to do in the event of low blood sugar.
  • Megaloblastic anemia: This occurs when the bone marrow produces very large blood cells that crowd out normal, healthy ones. Symptoms may include pale skin, tiredness, and appetite loss.
  • Severe joint pain
  • Bullous pemphigoid: A rare skin condition that can cause fluid-filled blisters on the
  • stomach, chest, arms, legs, groin, or armpits (or in the mouth as sores).
  • Rhabdomyolysis (muscle breakdown, which can cause severe kidney damage or death)

Long-Term Side Effects

While many people tolerate Kazano well, long-term or delayed side effects are possible. Some long-term side effects can be mild, such as:

  • Infection
  • Sore throat
  • Appetite loss
  • Back and joint pain

Moderate long-term side effects can include: 

  • Vitamin B12 and folate deficiency
  • Increased liver enzymes
  • Liver problems
  • Metabolic acidosis (too much acid in the body): Symptoms can include tiredness, nausea, vomiting, and fast breathing.

Severe long-term side effects may include: 

  • Lactic acidosis
  • Stevens-Johnson syndrome
  • Inflammation of the pancreas
  • Megaloblastic anemia
  • Liver, heart, or kidney failure
  • Rhabdomyolysis
  • Pemphigus
  • Serum sickness (a reaction that can cause rash, fever, and muscle pain)

Report Side Effects

Kazano may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Kazano Should I Take?


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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):

    • For type 2 diabetes:

      • Adults—At first, 1 tablet (either alogliptin 12.5 milligrams [mg] plus metformin 500 mg or alogliptin 12.5 mg plus metformin 1000 mg) 2 times a day with food. Your doctor may adjust your dose as needed. However, the dose is usually not more than alogliptin 25 mg plus metformin 2000 mg per day.
      • Children—Use and dose must be determined by your doctor.

Modifications

You may need to use caution when taking Kazano if you are 65 years or older, especially if you have kidney problems. Healthcare providers will generally start Kazano at a lower dose, increasing slowly if needed, and monitor kidney function frequently.

Kazano is only approved in adults. It is not approved in children and adolescents under 18 years old.

People with liver problems or severe kidney problems should not take Kazano.

Kazano may stimulate ovulation, which can result in pregnancy. Discuss effective means of birth control with your healthcare provider if pregnancy is not desired. There is little data on Kazano and pregnancy or breastfeeding. If you are pregnant, planning to become pregnant, or breastfeeding, consult your healthcare provider.

Missed Dose

If you miss a dose of Kazano, take it as soon as you can. If it is almost time for the next dose, skip the missed dose. Do not take two doses together.

Overdose: What Happens If I Take Too Much Kazano?

Taking too much Kazano can cause low blood sugar or lactic acidosis.

What Happens If I Overdose on Kazano?

If you think you or someone else may have overdosed on Kazano, call your healthcare provider or the Poison Control Center (800-222-1222). 

If someone collapses or stops breathing after taking Kazano, call 911 immediately.

Precautions


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It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure. Symptoms of lactic acidosis include abdominal or stomach discomfort, decreased appetite, diarrhea, fast, shallow breathing, a general feeling of discomfort, muscle pain or cramping, and unusual sleepiness, tiredness, or weakness.

If symptoms of lactic acidosis occur, you should get immediate emergency medical help.

Pancreatitis (swelling and inflammation of the pancreas) may occur while you are using this medicine. Check with your doctor right away if you have a sudden and severe stomach pain, chills, constipation, nausea, vomiting, loss of appetite, fever, or lightheadedness.

If you are rapidly gaining weight, having shortness of breath, chest pain, extreme tiredness or weakness, irregular breathing, irregular heartbeat, or excessive swelling of the hands, wrist, ankles, or feet, check with your doctor immediately. These may be symptoms of a heart problem.

This medicine may cause serious allergic reactions, including anaphylaxis, angioedema, or certain skin conditions (eg, Stevens-Johnson syndrome). These reactions can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, blistering, peeling, or loosening of the skin, fever or chills, trouble breathing or swallowing, or any swelling of your hands, face, mouth, or throat while you are using this medicine.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine may cause hypoglycemia (low blood sugar). This is more common when this medicine is taken together with certain medicines. Low blood sugar must be treated before it causes you to pass out (unconsciousness). People feel different symptoms of low blood sugar. It is important that you learn which symptoms you usually have so you can treat it quickly. Talk to your doctor about the best way to treat low blood sugar.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual. High blood sugar can be very serious and must be treated right away. It is important that you learn which symptoms you have in order to treat it quickly. Talk to your doctor about the best way to treat high blood sugar.

There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says you have diabetes with a list of all your medicines.

It is important to tell the doctor in charge that you are taking this medicine if you are going to have any medical or surgical procedures.

This medicine may cause severe and disabling joint pain. Call your doctor right away if you have severe joint pain while using this medicine.

This medicine may cause bullous pemphigoid. Tell your doctor right away if you have large, hard skin blisters while you are using this medicine.

This medicine may cause some women who do not have regular monthly periods to ovulate. This can increase the chance of pregnancy. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Kazano?

Kazano is not appropriate for everyone. You should not take this medication if you are allergic to alogliptin, metformin, or any of the inactive ingredients in Kazano.

Kazano should not be used in:

  • People with liver disease or severe kidney disease (eGFR less than 30)
  • People with type 1 diabetes or DKA
  • People with metabolic acidosis or lactic acidosis
  • People who are severely dehydrated
  • Stress conditions, such as severe infections or surgery
  • People with sepsis (a life-threatening infection that occurs when the body damages its own tissues in response to an infection)
  • People with hypoxemia (low oxygen levels, due to certain heart or lung conditions)
  • Pregnancy or while breastfeeding

Kazano may be prescribed with caution in some people, only if the healthcare provider determines it is safe. This includes:

  • Older adults (aged 65 and older)
  • People with heart failure
  • People with alcohol use disorder
  • Women who do not ovulate and are of childbearing age
  • People with kidney problems
  • People who are at risk for low blood sugar or heart failure

What Other Medications May Interact With Kazano?

Before taking Kazano, tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter drugs and vitamins or supplements. 

Alcohol can interact with Kazano, increasing the risk of low blood sugar. Talk to your healthcare provider about how much alcohol is safe to consume.

Drugs classified as carbonic anhydrase inhibitors can lead to lactic acidosis if combined with Kazano. Examples of these drugs include:

When Kazano is taken with insulin or other drugs that lower blood sugar, a dosage adjustment may be required to reduce the risk of low blood sugar.

Some drugs increase blood sugar, so when combined with Kazano, you may require careful monitoring to control blood sugar levels. Examples of these drugs include:

  • Calcium channel blockers, such as Calan SR (verapamil)
  • Corticosteroids, such as prednisone
  • Dilantin (phenytoin)
  • Diuretics such as Microzide (hydrochlorothiazide) or Lasix (furosemide)
  • Estrogen
  • Isoniazid
  • Oral birth control pills
  • Phenothiazines, such as prochlorperazine or thioridazine
  • Thyroid medications

Other drug interactions may occur with Kazano. Consult your healthcare provider for a complete list of drug interactions.

What Medications Are Similar to Kazano?

Kazano contains two ingredients: alogliptin and metformin. Alogliptin is a DPP-4 inhibitor. It is also available as a single-ingredient drug under the brand name Nesina.

Other DPP-4 inhibitors include:

Another drug containing alogliptin is Oseni, which includes two ingredients: alogliptin and pioglitazone.

Metformin can also be found as a single-ingredient drug under brand names, such as Glumetza and Glucophage. It is also available as an extended-release tablet (Glucophage XR).

Other oral medications available to help control blood sugar in adults with type 2 diabetes include:

  • Glinides, such as repaglinide and nateglinide
  • SGLT2 inhibitors, such as Farxiga (dapagliflozin), Invokana (canagliflozin), and Jardiance (empagliflozin)
  • Sulfonylureas, such as Amaryl (glimepiride), Glucotrol (glipizide), Micronase (glyburide) 
  • Thiazolidinedione, such as Actos (pioglitazone)

There are also a variety of drugs that contain more than one ingredient, like Kazano.

Some people who have type 2 diabetes use injectable medications that are not insulin but can help control blood sugar. These drugs belong to a class called glucagon-like peptide-1 (GLP-1) agonists. Some examples of GLP-1 agonists are:

There is also an oral GLP-1 agonist available called Rybelsus (semaglutide). 

In some cases, people with type 2 diabetes may also need to use injectable insulin to help control blood sugar levels. There are different types of short-acting insulin and long-acting insulin.

This list is a list of drugs also prescribed for type 2 diabetes. It is NOT a list of drugs recommended to take with Kazano. Ask your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Kazano used for?

    Kazano is an oral medication that contains two ingredients: alogliptin and metformin. It is used along with diet and exercise to control blood sugar levels in adults with type 2 diabetes.

  • How does Kazano work?

    Kazano contains two ingredients. One ingredient, alogliptin, increases the amount of insulin in the body, helping to control blood sugar. The other ingredient, metformin, decreases the amount of sugar that your liver makes. Metformin also decreases how much sugar is absorbed from food and helps the body respond better to insulin.  

  • What drugs should not be taken with Kazano?

    Kazano can interact with certain drugs and alcohol (see interactions section for details). Before taking Kazano, talk to your healthcare provider about alcohol consumption and how much is safe for you. Tell them about all of your medications, including prescription and over-the-counter drugs, vitamins, and supplements.

  • How long does it take for Kazano to work?

    A dose of Kazano reaches its highest levels in the body within two to three hours. It may take up to two weeks to see significant changes in blood sugar levels. The healthcare provider will most likely order an A1C test about 90 days after starting Kazano to look at blood sugar control over three months.

  • What are the side effects of Kazano?

    Stomach problems, such as nausea, vomiting, diarrhea, discomfort, gas, and indigestion are common side effects of Kazano. Other common side effects include cough and cold symptoms, appetite loss, low blood sugar, headache, back pain, weakness, UTI, rash, and a metallic taste in the mouth. Kazano can stimulate ovulation, so women of childbearing age should discuss effective birth control with their healthcare provider if pregnancy is not desired.

    There are also some serious side effects, which are not common but require medical attention. People who experience symptoms of an allergic reaction, such as hives, difficulty breathing, or swelling around the face, lips, tongue, or throat, require emergency medical attention.

  • How do I stop taking Kazano?

    Your healthcare provider will advise you on how long to take Kazano. Do not stop taking the medication without guidance from your healthcare provider. 

How Can I Stay Healthy while Taking Kazano?

Before taking Kazano, discuss your medical history and all medication you take with your healthcare provider. Discuss alcohol use and safe amounts of alcohol consumption.

Follow your healthcare provider’s instructions on how to take Kazano. Carefully read the patient information about your prescription and talk to your healthcare team if you have any questions or concerns.

While taking Kazano, you may need to check your blood sugar. Ask your healthcare provider about the signs of low blood sugar, how to treat it, and how often you should check it. It can be helpful to prepare a diabetes kit or bag with supplies to take everywhere you go. You may want to include the following items:

  • Your blood sugar testing meter and extra supplies (e.g., strips, lancing device, lancets, alcohol wipes, batteries)
  • Emergency contact information
  • Glucagon (injection or nasal Baqsimi)
  • Low blood sugar treatments, such as glucose tablets and small juice boxes 

Wear a medical alert identification, such as a necklace or bracelet, at all times. This can alert responders that you have type 2 diabetes in the event of an emergency.

Kazano should be used along with diet and exercise to help improve blood sugar levels. Ask your healthcare provider about what diet and exercise regimen you should follow. You may want to see a registered dietician for help with dietary changes.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare professional. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Doctors link sleep apnea to heart failure. Repeated pauses in breathing during sleep may damage a person’s heart. Sleep apnea also commonly occurs in people with heart disorders. Managing the symptoms of one condition may help the other.

Sleep apnea is a type of disordered breathing in which a person repeatedly stops and starts breathing during their sleep. The most common type is obstructive sleep apnea, in which the upper breathing passage closes partially or totally when the person is sleeping.

Heart failure is a serious condition that develops when a person’s heart does not pump enough blood to meet their body’s needs.

Sleep apnea and heart failure share some similar symptoms, including difficulty falling or staying asleep, frequent nighttime urination, and waking with shortness of breath or gasping.

Treating sleep apnea can help improve health problems such as heart failure, and treating heart failure can help improve sleep apnea.

This article will look at sleep apnea’s link to heart failure and how managing sleep apnea can help a person stop heart failure from developing or worsening.

Sleep apnea is a type of sleep disorder in which a person repeatedly stops and starts breathing during their sleep.

Apnea causes breathing to stop for 10 seconds or more. The brain responds to apnea by waking up just enough to breathe. Usually, the person is not aware of these waking episodes that may last only a few seconds.

Types

The two main types of sleep apnea are obstructive sleep apnea (OSA) and central sleep apnea (CSA).

OSA is the most common type. OSA occurs when the throat muscles relax during sleep and collapse on themselves, blocking a person’s upper airway. The most common causes are obesity or unusual upper airway anatomy.

CSA occurs when a person’s brain does not send out signals to maintain normal breathing, or the body does not correctly receive those signals. CSA is common among people with heart failure.

Repeated stops in breathing temporarily reduce the supply of oxygen to a person’s heart and lungs. This repetitive lack of oxygen triggers the release of stress hormones, leading to stress on the heart. In addition, blood pressure might increase, putting further strain on the heart.

The American Heart Association (AHA) associates sleep restriction with inflammation, which they say can elevate the risk of damage to the heart. People with sleeping disorders such as sleep apnea are far more likely to have heart disease and heart disorders.

Sleep apnea may also increase a person’s risk for other health conditions, such as:

Treatment of sleep apnea is dependent on its cause. If other medical problems are present, sleep apnea symptoms may improve with the treatment of these conditions. For example, if obesity is causing OSA, weight loss may resolve sleep apnea.

Heart disease

Around 40–80% of people in the United States with cardiovascular disease also have OSA, yet it is underrecognized and undertreated.

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the U.S.

Heart disease refers to several types of heart conditions, including:

A 2018 review focusing on the relationship between OSA and heart failure states that OSA contributes substantially to the development and progression of heart failure.

Managing sleep apnea depends on how severe a person’s sleep apnea is. Sleep testing can determine the type of apnea and its severity. If people receive a diagnosis of sleep apnea, they may be able to make some helpful changes to their diet and lifestyle or require specific treatment.

Lifestyle changes

For mild OSA, a doctor may suggest a person adopts certain lifestyle changes, such as:

  • maintaining a moderate weight
  • staying physically active and getting regular exercise
  • limiting alcohol and caffeine consumption, where applicable
  • reviewing and changing medications that may cause sleep apnea
  • sleeping on one side
  • quitting smoking if the person smokes

Read on for tips on how to quit smoking.

Treatments

Besides lifestyle changes, doctors typically recommend continuous positive airway pressure (CPAP) machines to treat moderate to severe OSA. CSA is often more difficult to treat and may require more complex pressure delivery systems. It is best for people to receive this therapy through a sleep clinic.

The CPAP machine comprises a face or nose mask with a long flexible hose attached to the CPAP machine. It delivers pressurized air through the mask to keep a person’s airway open during their sleep.

Learn more about different CPAP masks.

Other sleep apnea management options include oral devices, upper airway stimulation, and surgery.

According to a 2020 report from the AHA, the prevalence of heart failure continues to rise over time. The report estimates that 6.2 million adults in America over the age of 20 had heart failure between 2013 and 2016, compared with about 5.7 million between 2009 and 2012.

Sleep apnea can occur alongside heart failure. Certain conditions and genetic and lifestyle factors can increase the risks.

Medical conditions that may increase a person’s chance of developing heart failure include:

  • diabetes
  • high blood pressure
  • obesity
  • conditions related to heart disease such as angina, atrial fibrillation, Marfan syndrome, and congenital heart defects

Behaviors that can increase a person’s risk for heart failure include:

  • smoking tobacco
  • eating foods high in fat and salt
  • not doing an adequate amount of physical activity
  • excessive alcohol intake

Heart failure is a serious medical condition. Doctors and other clinicians can help a person manage their heart failure.

Research suggests that CPAP use reduces the risk of death and hospitalization in people with both heart failure and OSA.

People who use CPAP regularly show improvements in physical functioning, mood, sleepiness, and pain and miss fewer workdays.

Sleep apnea treatment combined with heart failure treatment may reverse a person’s existing heart damage by improving cardiac function.

Sleep apnea is a sleep-related breathing disorder that doctors link to heart failure.

Heart failure is a serious condition that develops when a person’s heart does not pump enough blood to meet their body’s needs.

Treating sleep apnea can relieve some symptoms of heart failure and may stop the condition from worsening. In turn, if a person can manage symptoms of heart disease, this can reduce their risk of developing sleep apnea.

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The intensive care unit (ICU) may also be referred to as the critical care unit or the intensive care ward

Your loved one may be medically unstable, which means that his or her condition could change unexpectedly and may potentially rapidly become worse.

Normally, people who are very sick only need to stay in the ICU for a short period of time, until their illness becomes stable enough for transfer into the regular hospital ward.

In the meantime, you may want to know what to expect while your loved one is being cared for in the ICU.

You may also want to know under what circumstances you should anticipate that your loved one will be stable enough to be discharged from the ICU and admitted to a standard hospital ward.

Types of Intensive Care Units (ICU)

The ICU is a part of the hospital where patients receive close medical monitoring and care.

Some hospitals also have specialized ICUs for certain types of patients:

  • Neonatal ICU (NICU): Care for very young or premature babies.
  • Pediatric (PICU): For children who require intensive care.
  • Neurological ICU: Specialized care for neurologically unstable patients.
  • Cardiac Care Unit (CCU): Care for patients with serious or unstable heart problems.
  • Surgical ICU (SICU): Care for patients who are recovering from surgery.

Why Do Some People Need to Be Admitted to the ICU (intensive care unit)?

There are a number of different reasons that warrant admission to the ICU, and your loved one likely has one or more of these conditions:

  • Medically Unstable: Patients who are medically unstable who require close monitoring and frequent adjustments of medical therapy are often admitted to the ICU because it is a setting that is well suited for close monitoring and fast response.
  • Need Support for Breathing: Some patients have to be admitted to the ICU because they cannot breathe on their own and require respiratory support through a machine, such as a ventilator, to continue breathing. Many hospital wards cannot support the care of a patient who is on ventilator support for breathing. Intubation is the placing of a breathing apparatus for respiratory support. Removal of respiratory support, which is extubation, takes place when a patient is able to breathe independently.
  • Lower Level of Consciousness: If your loved one is unconscious, unresponsive or in a coma, he or she may require care in the ICU, particularly if he or she is expected to improve. People who are unconscious may have endured severe brain injury or very extensive medical problems, requiring close care to optimize the chances of recovery.

Need monitoring during a specific type of therapy: including those requiring inotropic support or vasodilators.

Type of Extra Care Provided 

The ICU allows health care providers, such as doctors, nurses, nursing assistants, therapists, and specialists, to provide a level of care that they may not be able to provide in another setting:

  • Close and Frequent Monitoring of Vital Signs: While in the ICU, patients are monitored more frequently than they can be in the regular hospital unit. Vital signs, such as heart rate, blood pressure, and respiratory rate, as well as parameters such as oxygen and carbon dioxide level, may be monitored continuously with electronic devices that are positioned for monitoring at all times. And, in addition to the continuous monitoring, nurses also may manually check vital signs more frequently in the intensive care unit than they would on the regular hospital ward.
  • Central Location Displays Vital Sign Values: While your loved one has continuous monitoring of vital signs, the blood pressure and heart rate readings will be visible on digital devices near the bed. In addition, many ICUs are also equipped with centrally located screens that display patients’ vital signs outside the room. This allows nurses to read several patients’ vital signs even when they are not in the patients’ rooms, and to become aware of important changes promptly.
  • Close Adjustment of Fluids, Electrolytes, and Medications: In addition to close medical monitoring, the ICU is a setting where patients are able to receive more frequent and complex fine-tuning of important therapies, such as intravenous fluids and electrolytes such as sodium, potassium, calcium, and magnesium. A number of powerful medications may produce unpredictable effects that require an immediate response. Such medications are preferably given in the ICU setting.
  • Can Have Some Procedures: Certain procedures that can be done at a patient’s bedside are not well suited for a regular hospital ward. For example, people who have a ventriculoperitoneal (VP) shunt may need some interventions that require a sterile environment to prevent infection, but that does not necessarily need to be done in the operating room. These types of procedures can be performed efficiently in the ICU while avoiding moving and disrupting the patient.
  • Semi-open Rooms: The rooms in an ICU are not typically closed off. While there may be curtains for privacy, patients are more visible and accessible to the nurses and doctors who staff the intensive care unit. This allows the healthcare staff to keep a closer watch on patients and to be able to carry out a faster response to any sudden problems.
  • Fewer Patients Per Nurse: Generally, the ICU is staffed with more nurses per patient than a regular hospital ward is. This allows each nurse to keep track of each patient’s many complexes and changing medical details and to administer more involved therapies to patients.
  • Nurses with ICU Training and Experience: Often, the nurses and nursing assistants who staff the ICU have specialized training and experience in caring for ICU patients. Sometimes, nurses even specialize in caring for patients in specialized ICUs such as the CCU or the PICU. In some ICUs, a head nurse who is particularly experienced in ICU care oversees patient care.
  • May Have Specialized ICU Doctors: Sometimes doctors who are specially trained in ICU care also staff the ICU. This is not always the case, however, and it depends on each specific hospital and situation. For example, if your loved one has had a serious heart condition requiring a stay in the CCU, he or she may be cared for by a doctor who specifically takes care of patients while they are in the CCU until discharge to the regular hospital unit, where another doctor will care for them. On the other hand, at some hospitals, the same doctor who cares for a patient in the CCU continues to care for that patient and manage the medical condition even after the patient becomes stable and is transferred to the regular hospital unit. And some hospitals have a system that combines both approaches.

More Restrictions for Visitors 

For a number of reasons, visitors are much more restricted in the ICU than in the regular hospital room.

Some of these reasons include:

  • Preventing the spread of infection
  • Maintaining quiet for other patients because they do not have privacy in the ICU
  • Allowing your loved one to rest and recover

Less space in the ICU

Allow staff to frequently check on patients—hospital staff may be able to delay medications or monitoring for half an hour or so until visitors leave on the regular floor, but cannot do so in the ICU.

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Glasgow Coma Scale (GCS): How Is A Score Assessed?

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Katie Guttenberg, MD

With rising costs for gas and food, 2 years of the COVID-19 pandemic, global uncertainty, and the ongoing war in Ukraine, it is hardly a surprise that more than 70% of American adults report feeling stressed.

The Stress in America survey, which was conducted by the American Psychological Association in partnership with The Harris Poll, also found that a growing number of Americans report money as a source of stress, peaking at two thirds of adults in 2022, the highest reported level in 7 years.

Confronted with multiple stressors, many Americans have adopted unhealthy behaviors. More than half of Americans report weight gain, with an average of 26 pounds in the past year.

Stress affects our emotional and physical well-being. Let's examine the body's response to stress and review techniques to reduce cortisol, known as the stress hormone.

The Stress Response

In 1953, Lewis and colleagues developed the first protocol for the perioperative management of patients with adrenal insufficiency. We now have a more nuanced understanding of cortisol production and the effects of stress on the hypothalamic-pituitary-adrenal axis.

A 2020 study sought to determine the best treatment modality for patients with adrenal insufficiency exposed to major stress. The authors measured cortisol production in nearly 300 participants with normal adrenal function exposed to a variety of stressors, including sepsis, major trauma, elective surgery, and the war in Afghanistan.

Serum cortisol was highest and most variable in patients with sepsis. Cortisol levels were elevated in military personnel within 4 weeks of deployment, and production appeared similar to that of surgical patients, illustrating the body's response to both emotional and physical stress.

Cortisol and the Sleep-Wake Cycle

The COVID-19 pandemic has disrupted our lives and our sleep. Cortisol production is closely tied to the sleep-wake cycle. Levels increase in the early morning and decrease in the evening. This pattern is often disrupted in shift workers, with a blunted response upon waking and increased cortisol production in the evening.

This may have implications for long-term health. One study found higher levels of cortisol in the hair of young shift workers compared with their day worker peers. Cortisol levels correlated with BMI. Levels were lowest in participants with a BMI < 25 and highest in participants with a BMI > 30. This highlights the important relationship between disrupted sleep at a young age, cortisol production, and obesity, increasing the risk for cardiovascular disease later in life.

The Impact of Stress on Health

The Whitehall II study, a large, prospective cohort study in the United Kingdom, explores the relationship between the work environment, stress, and health. A subset of participants was selected to evaluate the relationship between stress and hypertension. Salivary cortisol was measured after participants completed stress-inducing activities. Approximately 40% of participants demonstrated a significant increase in cortisol production, highlighting variability in the stress response. Participants with a heightened stress response were more likely to develop hypertension during the 3-year follow-up period.

A separate study found that Whitehall II study participants with higher evening cortisol levels were more likely to develop diabetes.

What can your patients (and you) do to combat stress?

Get Active — Exercise Builds Resilience

Like many Americans, physicians report high rates of burnout. Many medical schools have tried to address this issue by developing curricula that teach skills to cultivate resilience, particularly among postgraduate trainees.

Exercise is key to maintaining physical and emotional well-being and has been shown to moderate the body's response to psychosocial stress. Engaging in regular exercise leads to a reduced stress response to physical activity.

Repeated activation of the hypothalamic-pituitary-adrenal axis appears to prime the body for future stressors.

Martikainen and colleagues explored the relationship between physical activity and the stress response in healthy 8-year-old children. Children participated in the Trier Social Stress Test, which reliably induces stress with storytelling and mental arithmetic activities. Children with the highest levels of physical activity exhibited the smallest increase in salivary cortisol in response to stress. These findings appear to persist across the lifespan.

College students and older adults who participate in high levels of physical activity develop an adaptive response to stress, producing lower levels of cortisol compared with their less-active peers (Gerber et al; Pauly et al). These studies highlight the role that exercise plays in moderating the stress response and building emotional resilience.

Be Mindful — Meditation Reduces Stress

Practicing mindfulness in everyday life has been shown to reduce stress, but the effects of mindfulness on the body's physiologic response, including cortisol production, is unclear.

Most medical schools in the United States offer mindfulness-related activities, according to Barnes and colleagues. Nearly a third of schools embed these activities in their curriculum.

A 2021 study assessed the impact of two mindfulness-based interventions on heart rate and cortisol secretion. In focused-attention meditation, participants were instructed to center their attention on their breath. This activity improved concentration and reduced distraction.

In open-monitoring meditation, participants were instructed to be aware of their physical sensations and explore the impact of distracting thoughts and emotions on the body. These mindfulness-based interventions appear to have affected the body in different ways: Salivary cortisol levels decreased significantly following open-monitoring meditation, and heart rate decreased significantly following focused-attention meditation. In contrast, there was no difference in salivary cortisol levels following focused-attention meditation and no difference in heart rate following open-monitoring meditation.

Looking Ahead

In the past 70 years, we've gained a better understanding of the hypothalamic-pituitary-adrenal axis and the impact of stress on health. How can we apply this knowledge in daily life?

A group of researchers at UCLA developed a smartwatch that can measure cortisol levels in sweat. A growing number of Americans use smartwatches to monitor their activity, sleep, and a variety of health parameters, including heart rate and function as well as oxygen saturation. Expanding these capabilities to include cortisol levels has implications for patient care and possibly for everyday life, allowing us to gain insight into our body's response to stress and learn techniques to effectively manage the stress hormone.

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Improving physical fitness requires putting stress on your system during vigorous workouts. But the quest for peak performance often backfires—the psychophysiological distress caused by excessive exercise isn't good for you. Finding a "Goldilocks zone" where your daily workouts put enough stress on your body to improve fitness without overdoing it can be tricky.

 Chris Bergland

Chris Bergland finishing a Triple Ironman in the early 2000s.

Source: Chris Bergland

For example, when I was trying to get in shape for extreme events like the Triple Ironman (7.2-mile swim, 336-mile bike, 78.6-mile run), the risk of injury and burnout was extremely high. Monitoring fluctuations in my heart rate variability (HRV) was a way to make sure I wasn't overtraining.

The vagus nerve's ability to counteract the sympathetic nervous system's fight-or-flight stress response is reflected by higher HRV.

In addition to keeping tabs on how my nervous system responded to the previous day's stress load by using HRV, I also kept tabs on day-to-day mood changes. Through trial and error, it became clear that if I was really cranky and in a foul mood the morning after an intense training session, it meant I was on the verge of getting burned out from overtraining and needed to take it easy for a day or two.

As a retired extreme-distance athlete, I know from lived experience that doing too much exercise can be harmful to your psychological and physical well-being. Overtraining is every endurance athlete's Achilles heel. It's so easy for one's passion for sports and competition to become exercise fanaticism, which often leads to injuries or overwhelming psychological distress.

Overtraining, Low HRV, and Negative Moods Go Hand in Hand

New research (Alfonso and Capdevila, 2022) from the Universitat Autònoma de Barcelona (UAB) in Spain gives us fresh insights into the link between HRV, overtraining, and mood states. Their peer-reviewed findings were published on March 30 in the PeerJ journal.

Carla Alfonso and Lluis Capdevila of UAB's Laboratory of Sport Psychology found that if a bike workout was very intense and put too much stress on a cyclist's body, HRV plummeted the following morning. Alfonso and Capdevila also discovered that HRV levels correlated with cyclists' moods. Low HRV was correlated with negative mood states; higher HRV was associated with better mood states.

"The objective of the research was to explore the relation among three aspects: training, heart rate variability, and mood," Alfonso said in a news release. "With this study, we aimed to know when an athlete must rest, because their system is saturated, and when an athlete can train, with more or less intensity, because their body is ready to assimilate the training load."

The main takeaway from this pilot study is that HRV and mood states seem to rise and fall in tandem. For example, if a "weekend warrior" overdoes it on Sunday, odds are that they'll be cranky or in a bad mood Monday morning. Negative mood states the day after putting too much stress on your body by overtraining correlate with lower HRV.

 Axel_Kock/Shutterstock

This illustration shows the human brain and "wandering" vagus nerve. In the 1920s, a German-born researcher named Otto Loewi discovered that electrically stimulating the vagus nerve released a parasympathetic substance that slows heartbeats and calms the nervous system. Today, we refer to this vagus substance as acetylcholine. Loewi called it "vagusstoff."

Source: Axel_Kock/Shutterstock

Heart Rate Variability Reflects the Vagus Nerve's Response to Stress

The vagus nerve secretes an inhibitory substance directly onto the heart, slowing it down. Heart rate variability measures how effectively vagus nerve activity is creating healthy fluctuations between heartbeats. Higher HRV indicates that the body has a robust ability to tolerate and recover from stress. Conversely, lower HRV means that the vagus nerve is "frazzled" and isn't effectively inhibiting the sympathetic nervous system's fight-or-flight response, which revs up heartbeats and reflects a lower stress tolerance.

Otto Loewi won a Nobel Prize in 1936 for his discovery that stimulating the vagus nerve releases an inhibitory substance that slows heartbeats and calms the nervous system.

In the 1970s, my neurosurgeon father taught me about Loewi's vagus nerve research in the context of maintaining grace under pressure. My dad knew that "vagusstoff" was released during the exhalation phase of the breathing cycle. So, he used breathing exercises to stay calm during brain surgery and on the tennis court. (See "How 'Vagusstoff' (Vagus Nerve Substance) Calms Us Down.")

When I was a young tennis player, Dad coached me to take a quick inhalation through my nose followed by a long, slow exhalation through pursed lips to calm my nerves before every serve. A recent study found that one five-minute session of deep, slow-breathing exercise (four seconds in, six seconds out) increases vagal tone and reduces anxiety. Personally, I prefer an inhale-exhale ratio of four-second inhalations followed by eight-second exhalations.

On the basis of evidence-based research and lived experience, I know that longer exhalations are an easy way to hack your vagus nerve by triggering the release of vagusstoff. But, I also understand that the calming effect of these breathing exercises tends to be short-lived.

When the sympathetic nervous system is overstimulated by too much exercise, diaphragmatic breathing is just a bandage that gives you temporary relief. Rest is the best remedy for giving your vagus nerve and parasympathetic system a chance to bounce back.

To Sum Up: Excessive Exercise Reduces Vagus Nerve Tone as Indexed by Low HRV

HRV is an indispensable tool for keeping tabs on how your vagus nerve responds to exercise-induced stress and ensuring that you don't overtrain. Low HRV indicates that the fight-or-flight mechanisms of your sympathetic nervous system are in hyperdrive and that vagal tone is weak. Conversely, higher HRV shows that vagus nerve activity is robust and that your parasympathetic nervous system is handling stress well.

The latest research (2022) on HRV and overtraining reaffirms that low HRV is a warning sign that your vagus nerve may be "frazzled" from too much psychophysiological distress. If you don't have access to an HRV monitor, experiencing negative moods the day after exercising vigorously may be a sign that you should take it easy for the next 24 hours and give your system time to recuperate.

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Singer Elton John once said, ‘Music has healing power’. And this is something even medical science agrees with. On World Hypertension Day today, experts help us uncover the therapeutic side of music! Several studies suggest that the calming effect of music can help lower blood pressure. “Anything that helps us anchor in the present moment reduces stress and listening to calming music is one of them. As the stress levels reduce, the sympathetic drive (the fight or flight response that increases heart rate and blood pressure) reduces,” says Dr Sudhir Vaishnav, cardiologist.

In case of high blood pressure, the heart rate and breathing goes up. In such a situation, music therapy can help alleviate the stress levels, thus relieving the feeling of anxiety and stress. “This, in turn, brings down the heart rate to normal levels and ultimately results in a slight, but meaningful decrease in the blood pressure. The effect of music therapy is similar to breathing exercises that people commonly practice for anxiety and stress relaxation. Music therapy can also act as a diversion tactic from pain or negative situations,” says Dr Vivek Mahajan, consultant - cardiac surgery, Fortis Hospital, Kalyan.

Experts advice listening to soft, relaxing or classical music, as they help ease the heart rate, which, in turn, helps bring the blood pressure under control. “Studies that use music therapy prefer music that is quiet, comfortable and soothing. These include instrumental music pieces like flutes and pianos. The treatments also include natural sounds such as ocean waves or the chirping of birds or flowing water. These relieve the anxiety and stress while creating a relaxing atmosphere that diverts a patient’s attention and makes them feel good,” adds Dr Mahajan.

Loud music with fast beats, on the other hand, induces excitement and high heart rate. “Listening to disco or really fast-paced, loud music may have a paradoxical effect,” adds Dr Vaishnav.


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Introduction

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome that features chronic respiratory symptoms and structural pulmonary abnormalities leading to lung function impairment with persistent airflow limitation.1 A recent study indicated that the overall prevalence of spirometry defined for COPD was 8.6% of adults in China, including 11.9% of men aged 40 years or older. The acute exacerbation of COPD (AECOPD) is a key factor that affects the disease prognosis and leads to hospitalization. Thus, AECOPD-related morbidity and mortality should be given more attention.2,3 Pulmonary hypertension (PH) is a common and severe comorbidity of COPD that results in an increased risk of hospitalization, reduced exercise capacity, and shorter survival. Right-heart catheterization (RHC) is the “gold standard” for the diagnosis of PH. However, RHC related significant risks and its difficulty of placement limits this procedure in patients with PH. Echocardiography is a noninvasive method that is widely used to assess PH in patients with AECOPD.4 A tricuspid regurgitant jet ≥3 m/s tested by echocardiography is diagnosed as PH, which may lead to underdetermined diagnoses of PH.5 Moreover, pulmonary artery systolic pressure detected by echocardiography is poorly correlated with the mean pulmonary artery pressure (mPAP) in severe COPD. A main pulmonary artery to ascending aorta diameter ratio (PA/A) of greater than one has been reported to be a promising indicator for revealing PH.6,7 Furthermore, an increased ratio of PA/A was closely associated with the poor survival of patients with COPD, particularly in individuals with moderate-to-severe cases.8 Nevertheless, the impact of the PA/A ratio in AECOPD remains to be elucidated. In this present study, we aim to disclose the associations between the PA/A ratio and clinical outcomes in hospitalized patients with AECOPD.

Patients and Methods

Study Population

This retrospective observational study was conducted at the Yijishan Hospital affiliated with the Wannan Medical College and was approved by the Research Ethics Committee of Yijishan Hospital. The clinical data of patients was maintained with confidentiality and in compliance with the Declaration of Helsinki. Written informed consent from patients was waived due to the retrospective nature of this study. Consecutive AECOPD patients admitted to the Department of Respiratory Medicine and Respiratory Intensive Care Units (RICU) were reviewed from September 2017 to July 2021. Patients with advanced lung cancer, pneumothorax, stroke, pneumonia, diffuse interstitial lung disease, hemodialysis, or left-heart failure, as well as those who only accepted palliative therapy, or had a lack of chest computed tomography (CT) images, were excluded from the final analysis.

AECOPD is defined as COPD with an acute worsening of respiratory symptoms (typically cough, dyspnea, increased sputum volume, and/or sputum purulence) requiring additional treatments.9 Indications for RICU admission were made according to the expert consensus released in 2014 on AECOPD in China.10 In brief, these consisted of a significant increase in symptom intensity (severe dyspnea, changes in mental status, moderate or severe hypoxemia with or without hypercapnia), failure of an exacerbation to respond to initial medical management, hemodynamic instability, and a patient requiring mechanical ventilation (MV). The treatment success of AECOPD patients was defined as improvement in the clinical condition when discharged from the hospital. Conversely, treatment failure was thought to occur as an event of in-hospital death or deterioration of the clinical condition prior to discharge.

Demographic characteristics, including gender, age, the age-adjusted Charlson Comorbidity Index (aCCI), length of stay, body mass index (BMI) and in-hospital death, were collected. Laboratory tests, including an arterial blood gas analysis (pH value, oxygenation index, the ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen), PaCO2, and the blood lactate level), hemoglobin, blood red cell distribution width (RDW), D-dimer, brain natriuretic peptide (BNP), fibrinogen (Fib), and blood platelet (PLT), were initially recorded after admission. The percentage of ICU admissions requiring invasive MV (IMV) was also calculated. A chest CT was performed when the patient was admitted to the hospital. The procedure for measuring the pulmonary artery (PA) diameter and PA/A ratio determined by the chest CT conformed to a previous study.6 Briefly, the PA diameter and ascending aorta diameter were averaged from two perpendicular measurements at the PA bifurcation level collected from the same chest CT images, as shown in Figure 1.

Figure 1 Diameters of the PA and A were determined by CT scan at the PA bifurcation. (A) PA/A ratio < 1; (B) PA/A ratio > 1.

Abbreviations: A, aorta; PA, pulmonary artery.

Statistical Analysis

Continuous data were analyzed using a normal distribution test prior to further analysis. Continuous data are indicated as the mean (standard deviation [SD]) or median (inter-quartile range [25,75]). Categorical variables are presented as the number (n) or percentage. Continuous variables were analyzed using the independent t-test or the Mann-Whitney U-test, and categorical variables were analyzed using a Chi-square test. The logistic regression model was used as a multivariate analysis to reveal the independent risk factors of in-hospital worst outcomes in patients with AECOPD. The Kaplan–Meier survival method was used to analyze the effect of the PA/A ratio on outcomes of AECOPD patients. A Log rank test was applied to appraise the statistical differences between the two survival curves. A receiver operating characteristic (ROC) curve analysis was conducted to evaluate factors predicting an in-hospital worst outcome. A P value less than 0.05 was considered statistically significant. The statistical analyses were performed using SPSS for Windows (release 22.0, IBM Corporation, USA).

Results

As indicated in Figure 2, a total of 229 patients with AECOPD were reviewed. According to the inclusion criteria and exclusion criteria, 111 patients were excluded due to the condition being combined with advanced lung cancer (n = 10), pneumothorax (n = 4) stroke (n = 5), pneumonia (n = 29), diffuse interstitial lung disease (n = 7), hemodialysis (n = 6), left-heart failure (n = 19), palliative therapy (n = 23), and a lack of CT images (n = 10). Ultimately, 118 eligible individuals were reviewed in this study: 74 individuals with a PA/A ratio <1 and 44 individuals with PA/A ratio ≥1. The outcomes of 21 patients were treatment failures, and 97 patients were treatment successes when discharged from the hospital.

Figure 2 A flowchart of this study.

Characteristics of the AECOPD Patients with a PA/A Ratio <1 or a PA/A Ratio ≥1

The pH value in the PA/A ratio ≥1 group was significantly lower than that in the PA/A ratio <1 group (p = 0.026). Remarkably, the PA/A ratio ≥1 group had a significantly higher value of PaCO2, RDW, BNP, PA diameter, and RICU admissions, as well as worse outcomes than the PA/A ratio <1 group (P < 0.05). However, there were no significant statistical differences for the other indicators between the two groups (Table 1).

Table 1 Characteristics of AECOPD Patients with Different PA/A Ratio

Clinical Features of the AECOPD Patients with Treatment Failure

As indicated in Table 2, compared to the treatment success group, the treatment failure group had a much lower pH value (7.34 ± 0.11 vs 7.28 ± 0.13, respectively, p = 0.040) and less count of PLT (median 167 × 109/L vs 130 × 109/L, respectively, p = 0.018). The treatment failure group had higher levels of D-dimer and BNP compared with the improved group (P < 0.05). In addition, the percentage of RDW, rate of RICU admissions, and the proportion of IMV in the treatment failure group were significantly higher than that in the improved group (P < 0.05). Notably, the PA diameter and PA/A ratio were significantly increased in the treatment failure group than in the improved group (mean PA diameter: 3.71 vs 3.22, p = 0.001; mean PA/A ratio: 1.09 vs 0.89, p < 0.001).

Table 2 Characteristics of Treatment Success Group and Treatment Failure Group in Severe AECOPD

A PA/A Ratio ≥1 Was an Independent Risk Factor for Treatment Failure in AECOPD

The multivariate analysis indicated that the PA/A ratio ≥1 (OR value = 6.129, 95% CI: 1.665–22.565, p = 0.006) and IMV (OR value = 10.798, 95% CI: 2.072–56.261, p = 0.005) were two independent risk factors for treatment failure in patients with AECOPD. Although the RDW, D-dimer, PLT, and RICU admissions had observed significant differences between the two groups according to the univariate analysis, they did not reach significant statistical differences according to the multivariate analysis (Table 3). Additionally, the Kaplan–Meier survival analysis indicated that patients with a PA/A ratio ≥1 had worse outcomes than patients with a PA/A ratio <1 during hospitalization (HR = 5.277, 95% CI: 2.178–12.78, p < 0.001) (Figure 3).

Table 3 Multivariate Analysis for Risk Factors of Treatment Failure in AECOPD

Figure 3 Effect of the PA/A ratio on the outcomes of AECOPD patients.

Abbreviation: PA/A ratio: main pulmonary artery to ascending aorta diameter ratio.

Note: A Kaplan–Meier survival curve analysis was performed, and a Log rank test was used, and a P < 0.05 was considered statistically significant.

Predictors of Treatment Failure in Hospitalized Patients with AECOPD

Figure 4 displays the diverse ROC curve of the PA/A ratio, the PA value, the BNP, and the RDW for predicting treatment failure in hospitalized patients with AECOPD. Even though there were no significant statistical differences observed, the area under the curve (AUC) value of the PA/A ratio was numerically larger than that of the other indicators. The best cut-off value of the PA/A ratio for predicting treatment failure was 0.925. The sensitivity was 81.82%, and the specificity was 66.67% (Table 4).

Table 4 ROC Curve Analysis for Factors Predicting Treatment Failure

Figure 4 PA/A ratio, PA value, BNP, and RDW for predicting treatment failure in hospitalized patients with AECOPD.

Abbreviations: PA/A ratio, main pulmonary artery to ascending aorta diameter ratio; PA, main pulmonary artery; RDW, blood red cell distribution width; BNP, brain natriuretic peptide.

Note: The receiver operating characteristic (ROC) curve analysis was conducted to evaluate factors predicting in-hospital worst outcomes.

Discussion

The strengths of this study were its primary findings. First, patients with a PA/A ratio ≥1 had significantly higher PaCO2, RDW, BNP, PA diameters, RICU admission rates, and proportions of treatment failure. Second, the PA diameter and PA/A ratio were significantly increased in the treatment failure group compared with the treatment success group. Third, a PA/A ratio ≥1 was an independent risk factor for treatment failure in patients with AECOPD. The Kaplan–Meier survival analysis indicated that patients with a PA/A ratio ≥1 had worse outcomes than patients with a PA/A ratio <1 during hospitalization. Finally, the PA/A ratio may be a promising factor for predicting treatment failure in hospitalized AECOPD patients.

A previous study indicated that the relative pulmonary arterial enlargement (PA/A ratio >1 on CT scanning) predicted hospitalization for AECOPD, and a PA/A ratio >1 with increased blood troponin levels shared close associations with increased respiratory failure, ICU admission, and in-hospital mortality.11 Iliaz et al reported that the PA/A ratio was related to the frequency of hospitalizations and exacerbations due to COPD in one year after hospital discharge.12 However, the relationships between a PA/A ratio >1 alone and ICU admission or in-hospital mortality are still unclear. In the present study, we found that AECOPD patients with a PA/A ratio ≥1 had a decreased pH value and increased PaCO2 compared with patients with a PA/A ratio <1, implicating increased type II respiratory failure in patients with a PA/A ratio ≥1. A decreased pH value and increased PaCO2 may contribute directly to pulmonary vasoconstriction leading to a rise in pulmonary vascular resistance and pulmonary arterial pressure.13 In addition, we also disclosed a higher percentage of RICU admissions and a markedly increased rate of treatment failure in hospitalized AECOPD patients with a PA/A ratio ≥1. Thus, an increased PA/A ratio was associated with severity and worse outcomes in inpatients with AECOPD. Many studies have revealed that the RDW is a valuable biomarker for predicting pulmonary hypertension and its associated prognosis.14–16 In a previous study performed by our group, we indicated that the RDW shared positive relationships with the PA/A ratio in patients with pH secondary to COPD.17 Similar to previous studies, we found an increase in the RDW in AECOPD patients with a PA/A ratio ≥1. Likewise, the serum level of BNP was drastically elevated. BNP is an important indicator for identifying risk categories in PH. Increased BNP is related to a worse outcome of PH.18

In this study, we demonstrated that there was a decreased pH value, lower number of PLTs, and increases in the RDW, D-dimer, BNP, PA diameter, and PA/A ratio in AECOPD patients with treatment failure compared with the improved group. Patients with treatment failure also required more IMV supports and intensive care. It was reported that lower pH values were associated with short or long mortality in hospitalized AECOPD patients.19,20 RDW is an indicator that reflects the heterogeneity of red blood cell volume. Recently, RDW was found to be an independent negative prognostic factor closely associated with adverse outcomes in hospitalized AECOPD patients.21,22 Dysregulation of erythrocyte homeostasis and metabolic imbalance may account for significant changes in the RDW in AECOPD patients. However, the underlying pathophysiological mechanisms remain unknown.23 A hypercoagulable state is a feature of hospitalized AECOPD patients. An increased D-dimer level is not only an important independent risk factor for pulmonary embolism in inpatients with AECOPD but also a predictor of higher mortality in stable COPD patients.24,25 Cardiac failure is a frequent complication of AECOPD, deeply affecting exercise tolerance and life span in patients with COPD. BNP is widely used to evaluate heart function. BNP can be used to risk-stratify, and an elevated BNP is associated with a higher MV use and worse outcomes in AECOPD patients.26 An increased PA/A ratio is positively correlated with COPD severity. Previous studies have reported that pulmonary artery enlargement detected by CT is a risk predictor for a severe exacerbation of COPD.27,28 Intriguingly, the PA/A ratio is an important determinant of mortality in moderate-to-severe COPD.8 In our present study, we found that a PA/A ratio ≥1 was a strong independent risk-factor of in-hospital treatment failure in patients with AECOPD. In addition, the PA/A ratio might be a better predictor of in-hospital treatment failure compared with other indicators including the PA value, BNP, and RDW. Taken together, the results of the present study provide additional evidence for a close association between the PA/A ratio and the outcome of AECOPD.

In this study, AECOPD patients with a PA/A ratio ≥1 had markedly higher values of PaCO2, RDW, BNP, the PA diameter, ICU admission rates, and proportions of treatment failure and had worse outcomes during hospitalization. A PA/A ratio ≥1 was an independent risk factor for treatment failure in patients with AECOPD. The PA/A ratio may be a promising predictor for treatment failure. It is worth noting that there are several limitations in this study. First, the sample size was small, and this might lead to an interpretation bias in the final analysis. Further work is required to validate the initial conclusion for a larger sample size. Second, the PA/A ratio partially reflects a change in the pulmonary artery pressure. However, the association between the PA/A ratio and the pulmonary artery pressure was not assessed in this study. Finally, to reduce the chance of radioactive exposure, a dynamic change in the PA/A ratio during hospitalization was unclear.

Acknowledgments

We thank LetPub for its linguistic assistance during the preparation of this manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

The design of the study and collection, analysis, and interpretation of data were supported by the Anhui Provincial Key projects of the Natural Science Foundation for Colleges and Universities (KJ2021A0834).

Disclosure

The authors report no conflicts of interest in this work.

References

1. Celli BR, Wedzicha JA. Update on clinical aspects of chronic obstructive pulmonary disease. N Engl J Med. 2019;381:1257–1266. doi:10.1056/NEJMra1900500

2. Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet. 2018;391:1706–1717. doi:10.1016/S0140-6736(18)30841-9

3. Garcia-Sanz MT, Canive-Gomez JC, Senin-Rial L, et al. One-year and long-term mortality in patients hospitalized for chronic obstructive pulmonary disease. J Thorac Dis. 2017;9:636–645. doi:10.21037/jtd.2017.03.34

4. Nakayama S, Chubachi S, Sakurai K, et al. Characteristics of chronic obstructive pulmonary disease patients with pulmonary hypertension assessed by echocardiography in a three-year observational cohort study. Int J Chron Obstruct Pulmon Dis. 2020;15:487–499. doi:10.2147/COPD.S230952

5. Carpio AM, Goertz A, Kelly C, et al. Unrecognized pulmonary arterial hypertension in hospitalized patients. Int J Cardiovasc Imaging. 2021;37:1237–1243. doi:10.1007/s10554-020-02108-9

6. Iyer AS, Wells JM, Vishin S, et al. CT scan-measured pulmonary artery to aorta ratio and echocardiography for detecting pulmonary hypertension in severe COPD. Chest. 2014;145:824–832. doi:10.1378/chest.13-1422

7. Schneider M, Ran H, Pistritto AM, et al. Pulmonary artery to ascending aorta ratio by echocardiography: a strong predictor for presence and severity of pulmonary hypertension. PLoS One. 2020;15(7):e235716. doi:10.1371/journal.pone.0235716

8. Terzikhan N, Bos D, Lahousse L, et al. Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study. Eur Respir J. 2017;49:1602168. doi:10.1183/13993003.02168-2016

9. Zeng Y, Cai S, Chen Y, et al. Current status of the treatment of COPD in China: a multicenter prospective observational study. Int J Chron Obstruct Pulmon Dis. 2020;15:3227–3237. doi:10.2147/COPD.S274024

10. Cai BQ, Cai SX, Chen RC, et al. Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People’s Republic of China. Int J Chron Obstruct Pulmon Dis. 2014;9:381–395. doi:10.2147/COPD.S58454

11. Wells JM, Morrison JB, Bhatt SP, et al. Pulmonary artery enlargement is associated with cardiac injury during severe exacerbations of COPD. Chest. 2016;149:1197–1204. doi:10.1378/chest.15-1504

12. Iliaz S, Tanriverdio E, Chousein E, et al. Importance of pulmonary artery to ascending aorta ratio in chronic obstructive pulmonary disease. Clin Respir J. 2018;12:961–965. doi:10.1111/crj.12612

13. Morray JP, Lynn AM, Mansfield PB. Effect of pH and PCO2 on pulmonary and systemic hemodynamics after surgery in children with congenital heart disease and pulmonary hypertension. J Pediatr. 1988;113:474–479. doi:10.1016/S0022-3476(88)80631-0

14. Zuk M, Migdal A, Dominczak J, et al. Usefulness of Red Cell Width Distribution (RDW) in the assessment of children with Pulmonary Arterial Hypertension (PAH). Pediatr Cardiol. 2019;40:820–826. doi:10.1007/s00246-019-02077-4

15. Ulrich A, Wharton J, Thayer TE, et al. Mendelian randomisation analysis of red cell distribution width in pulmonary arterial hypertension. Eur Respir J. 2020;55:1901486.

16. Liu J, Yang J, Xu S, et al. Prognostic impact of red blood cell distribution width in pulmonary hypertension patients: a systematic review and meta-analysis. Medicine. 2020;99:e19089. doi:10.1097/MD.0000000000019089

17. Yang J, Liu C, Li L, et al. Red blood cell distribution width predicts pulmonary hypertension secondary to chronic obstructive pulmonary disease. Can Respir J. 2019;2019:3853454. doi:10.1155/2019/3853454

18. Hoeper MM, Pausch C, Olsson KM, et al. COMPERA 2.0: a refined 4-strata risk assessment model for pulmonary arterial hypertension. Eur Respir J. 2021;2102311. doi: 10.1183/13993003.02311-2021

19. Gayaf M, Karadeniz G, Guldaval F, et al. Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, BAP-65, PLR, NLR. Expert Rev Respir Med. 2021;15:845–851. doi:10.1080/17476348.2021.1901584

20. Chen L, Chen L, Zheng H, et al. Emergency admission parameters for predicting in-hospital mortality in patients with acute exacerbations of chronic obstructive pulmonary disease with hypercapnic respiratory failure. BMC Pulm Med. 2021;21:258. doi:10.1186/s12890-021-01624-1

21. Hu GP, Zhou YM, Wu ZL, et al. Red blood cell distribution width is an independent predictor of mortality for an acute exacerbation of COPD. Int J Tuberc Lung Dis. 2019;23:817–823. doi:10.5588/ijtld.18.0429

22. Epstein D, Nasser R, Mashiach T, et al. Increased red cell distribution width: a novel predictor of adverse outcome in patients hospitalized due to acute exacerbation of chronic obstructive pulmonary disease. Respir Med. 2018;136:1–7. doi:10.1016/j.rmed.2018.01.011

23. Salvagno GL, Sanchis-Gomar F, Picanza A, et al. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52:86–105. doi:10.3109/10408363.2014.992064

24. Wang J, Ym D. Prevalence and risk factors of pulmonary embolism in acute exacerbation of chronic obstructive pulmonary disease and its impact on outcomes: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25:2604–2616. doi:10.26355/eurrev_202103_25424

25. Husebo GR, Gabazza EC, D’Alessandro GC, et al. Coagulation markers as predictors for clinical events in COPD. Respirology. 2021;26:342–351. doi:10.1111/resp.13971

26. Vallabhajosyula S, Haddad TM, Sundaragiri PR, et al. Role of B-type natriuretic peptide in predicting in-hospital outcomes in acute exacerbation of chronic obstructive pulmonary disease with preserved left ventricular function: a 5-year retrospective analysis. J Intensive Care Med. 2018;33:635–644. doi:10.1177/0885066616682232

27. Yang T, Chen C, Chen Z. The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis. BMC Pulm Med. 2021;21:34. doi:10.1186/s12890-020-01374-6

28. Wells JM, Washko GR, Han MK, et al. Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med. 2012;367:913–921. doi:10.1056/NEJMoa1203830

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Tommy Armitage had to undergo open-heart surgery when he was born so that a stent could be fitted to help mitigate the impacts of Tetralogy of Fallot, which affects the blood flow through the heart

Tommy Armitage in Alder Hey with his dad Anthony
Tommy Armitage in Alder Hey with his dad Anthony

A baby boy is so fragile that a common cold landed him in hospital for two weeks.

Soon after Tommy Armitage was born in December 2019 at Oldham Hospital, he had to undergo open-heart surgery to insert a stent.

The tiny mental mesh works to keep an artery from closing or narrowing in the baby's heart, Liverpool Echo reported.

Just two months later, Tommy had to go back under the knife for a more extensive surgery where they discovered that part of his heart was "knackered".

Tommy's mum, Beckie, has opened up about what it was like looking after the newborn, who has a congenital defect called Tetralogy of Fallot which affects the blood flow through the heart.







Tommy's first few months were much more complicated than anticipated
(

Image:

Beckie Armitage)

The student nurse had been told when she was 18 weeks pregnant that Tommy would need an operation in his first year which would resolve the problem for good.

"When he was born it was a lot more complicated," she said.

"They didn't know how bad it was until he was born. He was born in Oldham, then taken to St Marys in Manchester but the consultant then spoke to Alder Hey because they won't do the surgery anywhere else.

"We then went to Alder Hey to have his first surgery.

"He had his stent in January. At the time we thought it might buy him some time and he might not even need his other surgery until he's 12 months but it didn't work.

"He was kept in hospital until March when he had another surgery.

"There are four major things that are wrong with the heart and when they opened him up they found that his coronary arteries were wrong, and his pulmonary artery was knackered.

"He had to have like a pipe to replace his pulmonary artery which will now need changing every few years as he gets older.

"He'll be going back to Alder Hey each time for three or four weeks at a time for open-heart surgery."

Going forward Tommy, now two-years-old, is constantly being observed.

Even a common cold is enough to land him in hospital, as he found out in November 2021.

The 28-year-old mum-of-three said: "He picked up a cold in a waiting room when we were sat next to a child who was full of cold and a couple of days later Tommy was really ill.

"We went to the hospital because he was struggling with breathing, his heart rate was through the roof, and his oxygen saturation was really low all because there was so much pressure on his heart.

"He was admitted and monitored and they said it was because of a common cold and he just took it so badly."

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Beckie's best friend Maria Cameron, who she has known since they were both 11-years-old, is now raising money for Ronald McDonald House Charity due to their support during the long stints Tommy had in hospital at Alder Hey.

Maria is taking part in a White Collar boxing match on May 29 with all the money raised through her GoFundMe going to charity.

The 29-year-old said: "It's not nice seeing your friend going through something that you're helpless with.

"You can't do anything to help the situation, all you can do is try and be positive.

"We try and do fun things and have days out with the girls to take her mind off things.

"She's helpless as well and it's her child. It's not nice but you have to support them as much as you can."

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A baby boy had to have open-heart surgery at just three weeks old after he was born with Tetralogy of Fallot.

Tommy Armitage was born in December 2019 in Oldham Hospital before being taken to St Marys in Manchester and then rushed to Alder Hey where he underwent open-heart surgery to insert a stent [tiny mental mesh that works to keep an artery from closing or narrowing] in the baby's heart. Just two months later, Tommy had to go back under the knife for a more extensive surgery where they discovered that part of his heart was "knackered".

Tommy's mum, Beckie, has now spoken about what it was like when he was firstborn. The student nurse told the ECHO : "He was diagnosed with Tetralogy of Fallot [a congenital defect that affects the blood flow through the heart] when I was 18 weeks pregnant. We were told he would have an operation between six and nine months and that would be it.

READ MORE:David Ungi suspected to be 'armed at all times' before Malaga arrest

"When he was born it was a lot more complicated. They didn't know how bad it was until he was born. He was born in Oldham, then taken to St Marys in Manchester but the consultant then spoke to Alder Hey because they won't do the surgery anywhere else. We then went to Alder Hey to have his first surgery.

"He had his stent in January. At the time we thought it might buy him some time and he might not even need his other surgery until he's 12 months but it didn't work.

"He was kept in hospital until March when he had another surgery. There are four major things that are wrong with the heart and when they opened him up they found that his coronary arteries were wrong, and his pulmonary artery was knackered.

"He had to have like a pipe to replace his pulmonary artery which will now need changing every few years as he gets older. He'll be going back to Alder Hey each time for three or four weeks at a time for open-heart surgery."



Anthony and Beckie Armitage with their children Tommy, two, Emily, six and Cody, nine
Anthony and Beckie Armitage with their children Tommy, two, Emily, six and Cody, nine

Going forward Tommy, now two years old, is constantly being observed, with even a common cold putting him in hospital, as he found out in November 2021. The 28-year-old mum-of-three said: "He picked up a cold in a waiting room when we were sat next to a child who was full of cold and a couple of days later Tommy was really ill.

"We went to the hospital because he was struggling with breathing, his heart rate was through the roof, and his oxygen saturation was really low all because there was so much pressure on his heart. He was admitted and monitored and they said it was because of a common cold and he just took it so badly."

Beckie's best friend Maria Cameron, who she has known since they were both 11 years old, is now raising money for Ronald McDonald House Charity due to their support during the long stints Tommy had in hospital at Alder Hey. Maria is taking part in a White Collar boxing match on May 29 with all the money raised through her GoFundMe going to charity.

The 29-year-old said: "It's not nice seeing your friend going through something that you're helpless with. You can't do anything to help the situation, all you can do is try and be positive. We try and do fun things and have days out with the girls to take her mind off things.

"She's helpless as well and it's her child. It's not nice but you have to support them as much as you can."



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At just three weeks old, a baby boy had to undergo open-heart surgery after he was born with a congenital heart defect.

Little Tommy Armitage was born with Tetralogy of Fallot, which affects normal blood flow through the heart. Tommy, who was born December 2019 in Oldham Hospital went to St Marys in Manchester and was then rushed to Alder Hey where he underwent open-heart surgery to insert a stent [tiny mental mesh that works to keep an artery from closing or narrowing] in his heart, reports the Liverpool Echo.

Sadly, just two months later Tommy had to undergo more surgery, and it was discovered that some of his heart was "knackered."

Mum Beckie, a student nurse, said: "He was diagnosed with Tetralogy of Fallot when I was 18 weeks pregnant. We were told he would have an operation between six and nine months and that would be it.

"When he was born it was a lot more complicated. They didn't know how bad it was until he was born. He was born in Oldham, then taken to St Mary's in Manchester but the consultant then spoke to Alder Hey because they won't do the surgery anywhere else. We then went to Alder Hey to have his first surgery.

"He had his stent in January. At the time we thought it might buy him some time and he might not even need his other surgery until he's 12 months but it didn't work.

"He was kept in hospital until March when he had another surgery. There are four major things that are wrong with the heart and when they opened him up they found that his coronary arteries were wrong, and his pulmonary artery was knackered.

"He had to have like a pipe to replace his pulmonary artery which will now need changing every few years as he gets older. He'll be going back to Alder Hey each time for three or four weeks at a time for open-heart surgery."

Tommy, now two, is constantly observed, and can end up in hospital for something as simple as the common cold, as they found out in November 2021.



Anthony and Beckie Armitage with their children Tommy, two, Emily, six and Cody, nine
Anthony and Beckie Armitage with their children Tommy, two, Emily, six and Cody, nine

The 28-year-old mum-of-three said: "He picked up a cold in a waiting room when we were sat next to a child who was full of cold and a couple of days later Tommy was really ill.

"We went to the hospital because he was struggling with breathing, his heart rate was through the roof, and his oxygen saturation was really low all because there was so much pressure on his heart. He was admitted and monitored and they said it was because of a common cold and he just took it so badly."

Beckie has known her best friend Maria Cameron since they were both 11, and she is now raising money for the Ronald McDonald House Charity, which allows families to stay close to hospitals if their children are spending time there. Tommy has long stays at Alder Hey.

Maria is taking part in a White Collar boxing match on May 29 with all the money raised through her GoFundMe going to charity.

The 29-year-old said: "It's not nice seeing your friend going through something that you're helpless with. You can't do anything to help the situation, all you can do is try and be positive. We try and do fun things and have days out with the girls to take her mind off things.

"She's helpless as well and it's her child. It's not nice but you have to support them as much as you can."



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(BPRW) Essential Oils that Help You Breathe Better

(Black PR Wire) Chronic obstructive pulmonary disease (COPD) refers to lung illnesses that make breathing challenging. It’s estimated that more than 11 million Americans have COPD. There’s no cure, but remedies can help ease symptoms, stop complications, and slow disease advancement.

Signs of COPD include shortness of breath, needing to clear your throat often, and frequent coughing. Individuals with COPD often have emphysema and chronic bronchitis

COPD can result from long-term exposure to pollutants or toxins, including the toxins found in cigarette smoke. Genetics may also play a part in developing COPD.

Primary therapies for COPD include:

  • Quitting smoking
  • Oxygen therapy
  • Drugs that widen your airway, including nebulizers and inhalers
  • Surgery

Home treatments and holistic therapies may also function to reduce your symptoms. Some research demonstrates that essential oils can treat COPD effectively when paired with traditional medical treatment.

COPD and essential oils

Research indicates essential oils may be useful in treating upper respiratory infections.

Upper respiratory infections include the common cold, sinusitis, and pharyngitis. These are acute disorders, meaning they endure for only a short period, generally a few weeks. By distinction, COPD is a chronic, lifelong condition. Nevertheless, both conditions concern inflammation of your bronchiole tubes.

Eucalyptus Oil

Eucalyptus oil has been used widely for centuries as a home remedy for respiratory conditions. Eucalyptus oil is also an anti-inflammatory and boosts your immune system. Using eucalyptus oil can kill destructive bacteria that worsen your COPD symptoms. It may also soothe your throat and chest and speed up healing.

Lavender Oil

Lavender oil is known for its calming scent and antibacterial effects.

Sweet Orange Oil

Orange oil has anti-inflammatory and anti-oxidant effects. In a study that likened a proprietary oil blend with eucalyptus oil and orange oil, orange oil demonstrated evident capabilities to help with COPD.

Bergamot Oil

Bergamot is another component of the citrus family. It’s famous for the way it smells and its ability to soothe the nervous system. Bergamot may work well to alleviate pain and soreness caused by the coughing symptoms during a COPD flare-up.

Frankincense and Myrrh

These two widespread, ancient essential oils have a long history of treating respiratory conditions. Research has shown their anti-inflammatory effects, and they have many other effects that may increase your health and help you feel better.

But what we know about how frankincense and myrrh help, particularly with symptoms of COPD, is primarily anecdotal. When other essential oils have been demonstrated to work for COPD, these two might rank lower on your list in terms of established remedies.

When to See a Physician

Individuals with COPD are at a more increased risk for other illnesses that affect their lungs, such as the flu and pneumonia. Even the common cold can put you at risk of further damaging your lung tissue. Don’t attempt to use essential oils to self-treat a COPD flare-up that stops you from breathing or results in shortness of breath. If you notice the following symptoms, you should seek out a medical professional within 24 hours: 

  • Presence of blood in your mucus
  • Green or brown mucus
  • Extreme coughing or wheezing
  • New symptoms like severe fatigue or difficulty breathing
  • Unexplained, sudden weight gain or weight loss (more than 5 pounds in a week)
  • Forgetfulness
  • Dizziness
  • Waking up short of breath
  • Swelling in your ankles or wrists

There’s no cure for COPD, but traditional treatment can be complemented by therapy with essential oils to control its symptoms. Research indicates that some essential oils can soothe symptoms, encourage healing, and boost your immune system to help prevent flare-ups for many people with COPD. You can shop for essential oils at your local pharmacy or online.

The content and opinions expressed within this press release are those of the author(s) and/or represented companies, and are not necessarily shared by Black PR Wire. The author(s) and/or represented companies are solely responsible for the facts and the accuracy of the content of this Press release. Black PR Wire reserves the right to reject a press release if, in the view of Black PR Wire, the content of the release is unsuitable for distribution.

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The most common method of intubation is ‘endotracheal’ intubation, which can take place

  • orotracheally: the tube enters through the patient’s mouth (most common method);
  • rhinotracheally: the tube enters through the patient’s nose (less common method).

Intubation: when is it used?

The main purpose of all types of intubation is to allow the breathing of a person who, for various reasons, is unable to breathe independently, which puts the patient’s life at risk.

Another objective of intubation is to protect the airway from possible inhalation of gastric material.

Intubation is performed in many medical conditions, such as:

  • in coma patients;
  • under general anaesthesia;
  • in bronchoscopy;
  • in endoscopic operative airway procedures such as laser therapy or the introduction of a stent into the bronchi;
  • in resuscitation on patients requiring respiratory support (e.g. in cases of severe Covid 19 infection);
  • in emergency medicine, particularly during cardiopulmonary resuscitation.

Alternatives to intubation

There are some alternatives to intubation, but they are undoubtedly more invasive and certainly not risk-free, for example

  • tracheotomy: this is a surgical procedure usually used on patients requiring long-term respiratory support; read more: Tracheotomy possibility of speaking, duration, consequences, when it is done
  • cricothyrotomy: is an emergency technique used when intubation is not possible and tracheotomy is impossible.

Types of tubes used in intubation

There are various types of endotracheal tubes for oral or nasal intubation; there are flexible ones or semi-rigid ones, with a specific shape and therefore relatively more rigid.

Most tubes have in common that they have an inflatable margin to seal the lower airway, which does not allow air to escape or secretions to be aspirated.

Intubation: why is it done during anaesthesia?

Intubation is done by the anaesthesiologist during a general anaesthesia, since – to bring about anaesthesia – the patient is given drugs that inhibit his breathing: the patient is not able to breathe independently and the endotracheal tube, connected to an automatic respirator, allows the subject to breathe correctly during surgery.

In operations of short duration (up to 15 minutes) breathing is supported with a face mask, the tracheal tube is used if the operation lasts longer.

Will I feel pain?

Intubation is always performed after the patient has been put to sleep, so you will not feel any pain caused by it.

After the procedure you will not remember either the placement of the tube or its removal (i.e. extubation) from the airway when the procedure is over. Slight discomfort in the throat is possible, and quite frequent, after extubation.

Throat pain after intubation: is it normal?

As just mentioned, after a patient has undergone intubation, he or she may experience some unpleasant symptoms, including:

  • sore throat
  • sensation of a foreign body in the throat;
  • difficulty swallowing solids and liquids;
  • discomfort when making sounds;
  • hoarseness.

These symptoms, although annoying, are fairly frequent and not serious, and they tend to disappear quickly, usually within a maximum of two days.

If the pain persists and is frankly unbearable, seek advice from your doctor.

Intubation techniques

Tracheal intubation can be performed using various techniques.

  • Traditional technique: consists of a direct laryngoscopy in which a laryngoscope is used to visualise the glottis below the epiglottis. A tube is then inserted with a direct view. This technique is performed in patients who are comatose (unconscious) or under general anaesthesia, or when they have received local or specific anaesthesia of the upper airway structures (e.g. using a local anaesthetic such as lidocaine).
  • Rapid sequence induction (RSI) (crash induction) is a variant of the standard procedure on patients under anaesthesia. It is performed when immediate and definitive airway treatment through intubation is required, and particularly when there is an increased risk of inhalation of gastric secretions (aspiration) that would almost inevitably lead to pneumonia ab ingestis. For RSI, a short-term sedative such as etomidate, propofol, thiopentone or midazolam is administered, followed shortly by a depolarising paralysing drug such as succinylcholine or rocuronium.
  • Endoscope technique: an alternative to intubation of the conscious (or lightly sedated) patient under local anaesthesia is the use of a flexible endoscope or similar (e.g. using a video-laryngoscope). This technique is preferred when difficulties are anticipated, as it allows the patient to breathe spontaneously, thus ensuring ventilation and oxygenation even in the event of a failed intubation.

Does intubation present risks and complications?

Intubation can cause damage to teeth, especially in the case of previously damaged teeth or difficult anatomical relationships.

In addition to the frequent annoying throat symptoms seen above, in rarer cases intubation can cause more serious damage to the tissues it passes through, even leading to haemorrhaging.

Intubation may present some unforeseen problems, especially in cases of unforeseen difficult intubation, which is rare but possible, where the patient’s anatomical features make correct positioning of the tube in the airway more problematic.

Fortunately, in these cases, the doctor has tools at his disposal to help him limit the risks to the patient as much as possible, such as videolaryngoscopes and fiberscopes, which make up for the unforeseen or anticipated intubation difficulties encountered.

More schematically, the early and late risks are as follows:

Early risks

  • dental injury
  • throat pain;
  • haemorrhage;
  • oedema of the glottic structures;
  • pneumomediastinum;
  • hoarseness;
  • phonatory difficulties;
  • tracheal perforation;
  • cardiovascular arrest from vagal stimulation.

Late risks

  • tracheal injury
  • chordal decubitus;
  • decubitus buccal structures, pharynx, hypopharynx;
  • pneumonia;
  • sinusitis.

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UK / Emergency Room, Paediatric Intubation: The Procedure With A Child In Serious Condition

Endotracheal Intubation In Paediatric Patients: Devices For The Supraglottic Airways

Shortage Of Sedatives Aggravates Pandemic In Brazil: Medicines For Treatment Of Patients With Covid-19 Are Lacking

Sedation And Analgesia: Drugs To Facilitate Intubation

Anxiolytics And Sedatives: Role, Function And Management With Intubation And Mechanical Ventilation

New England Journal Of Medicine: Successful Intubations With High-Flow Nasal Therapy In Newborns

Source:

Medicina Online



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