A survey of positive airway pressure therapy preparedness and outcomes following Hurricane Irma in patients with obstructive sleep apnea.

STUDY OBJECTIVES: Clinical benefit from positive pressure therapy is dependent on treatment adherence. Extreme weather events, such as floods, hurricanes, and tornadoes, can contribute to nonadherence by electricity loss and mandatory evacuation. We aimed to evaluate the concerns and behaviors of regular positive airway pressure users surrounding the extreme weather event Hurricane Irma. METHODS: A questionnaire on positive pressure concerns surrounding Hurricane Irma was completed by 117 patients with pre-hurricane objectively confirmed treatment adherence as defined by Medicare. Responses were tabulated to identify concerns and behavior in preparation for and after Hurricane Irma. Cloud-based monitoring, available on 50 (43%) cases, was used to determine the effect of self-reported electricity loss on treatment adherence before and after the storm. Quantitative use data pre- and post-Hurricane Irma was compared by t test with P < .05 considered statistically significant. RESULTS: Post-hurricane 78 (67%) patients were unable to use treatment with mean duration of 4.3 days. Of these, snoring, choking, and sleepiness were reported in 64%, 19%, and 42%, respectively. Loss of electricity was identified as the cause of missed treatment in 71 patients. In those with cloud monitoring, mean 14-day pre- and post-hurricane use differed by 8 minutes (P =.056). Cloud-monitored cases with loss of electricity had a decline in mean use of 33 minutes for the first 7 days post-hurricane. There was a trend towards increased use post-hurricane in those that retained electricity. Many patients expressed dissatisfaction with the availability of preparedness guidelines. CONCLUSIONS: Although common, loss of electricity was not the sole disruptor of positive pressure use after extreme weather events. Regular users of positive airway pressure experience both disruption in patterns of use and concerns regarding preparedness for extreme weather events.

Systemic Sclerosis Associated Interstitial Lung Disease: New Directions in Disease Management.

A subgroup of patients with systemic sclerosis (SSc) develop interstitial lung disease (ILD), characterized by inflammation and progressive scarring of the lungs that can lead to respiratory failure. Although ILD remains the major cause of death in these individuals, there is no consensus statement regarding the classification and characterization of SSc-related ILD (SSc-ILD). Recent clinical trials address the treatment of SSc-ILD and the results may lead to new disease-altering therapies. In this review, we provide an update to the diagnosis, management and treatment of SSc-ILD.

Role of Obstructive Sleep Apnea in Cognitive Impairment.

Obstructive sleep apnea (OSA) is a prevalent sleep related breathing disorder characterized by repetitive collapse of the upper airways leading to intermittent hypoxia and sleep disruption. Clinically relevant neurocognitive, metabolic and cardiovascular disease often occurs in OSA. Systemic hypertension, coronary artery disease, type 2 diabetes mellitus, cerebral vascular infarctions and atrial fibrillation are among the most often cited conditions with causal connections to OSA. Emerging science suggest that untreated and undertreated OSA increases the risk of developing cognitive impairment, including vascular dementia and neurodegenerative disorders, like Alzheimer's disease. As with OSA, cardiovascular disease and type 2 diabetes mellitus, the incidence of dementia increases with age. Given our rapidly aging population, dementia prevalence will significantly increase. The aim of this treatise is to review current literature linking OSA to dementia and explore putative mechanisms by which OSA might facilitate the development and progression of dementia.

Severe abdominal pain and diarrhea - unusual multiple myeloma presentation with a severe prognosis: a case report.

BACKGROUND: Multiple myeloma is a hematologic disease with high mortality rates all over the world. The diagnosis has always been challenging since the first case was reported in 1844. For that reason the diagnostic criteria have evolved over years to include the features of the disease more comprehensively. Unusual presentations are infrequent and a diagnostic challenge. For this reason we report this rare case in which diarrhea and abdominal pain were the initial presenting symptoms of multiple myeloma with a plasmacytoma. CASE PRESENTATION: An 87-year-old Hispanic man with a past medical history of hypertension, diabetes, and constipation, presented to an emergency department complaining of severe generalized abdominal pain and profuse diarrhea for 3 days. A physical examination revealed generalized pallor and dehydration but no signs of abdominal peritoneal irritation. Laboratory tests revealed neutrophilia and an elevated total protein. He received intravenously administered fluids and antibiotics. His abdominal pain became localized in the infraumbilical area and a small mass was palpated on the right lower quadrant on subsequent examination. An abdominal computed tomography scan showed a tumor lesion surrounded by fluid collection and a computed tomography-guided biopsy of the lesion confirmed it to be a plasmacytoma. A bone marrow biopsy revealed plasmatic cell augmentation but his beta-2 microglobulin levels were inconclusive. The diagnosis of multiple myeloma was finally confirmed with urine immunofixation. Bortezomib was initiated to decrease disease progression, but unfortunately 4 days later he developed acute pulmonary edema, had a cardiac arrest, and died. CONCLUSIONS: This case illustrates the protean initial manifestations of multiple myeloma and the importance of an accurate diagnosis. Our patient's initial presentation with gastrointestinal complaints is rare and the plasmacytoma location is even rarer, providing a challenging diagnostic problem. Prompt recognition of multiple myeloma is critical to institute appropriate therapy and prevention of disease progression.