Sarcoidosis Presenting as an Intramedullary Spinal Cord Lesion

ABSTRACT:Objectives:Meige syndrome is a movement disorder that includes blepharospasm and oromandibular dystonias. Its etiology may be idiopathic (primary) or it may arise secondary to focal brain injury. Acute respiratory distress as a feature of such dystonias occurs infrequently. A review of the literature on Meige syndrome and the relationship between dystonias and respiratory compromise is presented.Methods:A 60-year-old woman suffered a cerebral anoxic event secondary to manual strangulation. She developed progressive blepharospasm combined with oromandibular and cervical dystonias. Neuroimaging demonstrated bilateral damage localized to the globus pallidus. Years later, she presented to the emergency department in intermittent respiratory distress associated with facial and cervical muscle spasms.Results and conclusions:Increasing frequency and severity of the disorder was noted over years. The acute onset of respiratory involvement required intubation and eventual tracheotomy. A partial therapeutic benefit of tetrabenazine was demonstrated.

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Meige Syndrome Secondary to Basal Ganglia Injury: A Potential Cause of Acute Respiratory Distress

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100052896 ◽

2001 ◽

Vol 28 (2) ◽

pp. 167-173 ◽

Cited By ~ 10

Author(s):

C. Adam Kirton ◽

Richard J. Riopelle

Keyword(s):

Basal Ganglia ◽

Respiratory Distress ◽

Movement Disorder ◽

Globus Pallidus ◽

Therapeutic Benefit ◽

Acute Onset ◽

Respiratory Compromise ◽

Respiratory Involvement ◽

Meige Syndrome ◽

Focal Brain Injury

ABSTRACT:Background:Meige syndrome is a movement disorder that includes blepharospasm and oromandibular dystonias. Its etiology may be idiopathic (primary) or it may arise secondary to focal brain injury. Acute respiratory distress as a feature of such dystonias occurs infrequently. A review of the literature on Meige syndrome and the relationship between dystonias and respiratory compromise is presented.Methods:A 60-year-old woman suffered a cerebral anoxic event secondary to manual strangulation. She developed progressive blepharospasm combined with oromandibular and cervical dystonias. Neuroimaging demonstrated bilateral damage localized to the globus pallidus. Years later, she presented to the emergency department in intermittent respiratory distress associated with facial and cervical muscle spasms.Results:Increasing frequency and severity of the disorder was noted over years. The acute onset of respiratory involvement required intubation and eventual tracheotomy. A partial therapeutic benefit of tetrabenazine was demonstrated.Conclusions:This case highlights two interesting aspects of Meige's syndrome: (1) Focal bilateral basal ganglia lesions appear to be responsible for this patient's movement disorder which is consistent with relative overactivity of the direct pathway from striatum to globus pallidus internal and substantia nigra pars reticularis; (2) Respiratory involvement in a primarily craniofacial dystonia to the point of acute airway compromise.

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Faculty Opinions recommendation of The relationship of fluid administration to outcome in the pediatric calfactant in acute respiratory distress syndrome trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718062404.793482199 ◽

2013 ◽

Author(s):

Daniel Sloniewsky

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Fluid Administration ◽

Relationship Of ◽

The Relationship

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Diabetes and COVID19: a bidirectional relationship

European Journal of Clinical Nutrition ◽

10.1038/s41430-021-00961-y ◽

2021 ◽

Author(s):

Ranjit Unnikrishnan ◽

Anoop Misra

Keyword(s):

Clinical Care ◽

Severe Disease ◽

Respiratory Involvement ◽

Pancreatic Damage ◽

Increased Risk ◽

Bidirectional Relationship ◽

Rapid Spread ◽

Relationship Of ◽

The Relationship ◽

New Onset

AbstractThe advent and rapid spread of the coronavirus disease-2019 (COVID19) pandemic across the world has focused attention on the relationship of commonly occurring comorbidities such as diabetes on the course and outcomes of this infection. While diabetes does not seem to be associated with an increased risk of COVID19 infection per se, it has been clearly demonstrated that the presence of hyperglycemia of any degree predisposes to worse outcomes, such as more severe respiratory involvement, ICU admissions, need for mechanical ventilation and mortality. Further, COVID19 infection has been associated with the development of new-onset hyperglycemia and diabetes, and worsening of glycemic control in pre-existing diabetes, due to direct pancreatic damage by the virus, body’s stress response to infection (including cytokine storm) and use of diabetogenic drugs such as corticosteroids in the treatment of severe COVID19. In addition, public health measures taken to flatten the pandemic curve (such as lockdowns) can also adversely impact persons with diabetes by limiting their access to clinical care, healthy diet, and opportunities to exercise. Most antidiabetic medications can continue to be used in patients with mild COVID19 but switching over to insulin is preferred in severe disease.

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Diabetes and COVID19: a bidirectional relationship

Nutrition and Diabetes ◽

10.1038/s41387-021-00163-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ranjit Unnikrishnan ◽

Anoop Misra

Keyword(s):

Clinical Care ◽

Severe Disease ◽

Respiratory Involvement ◽

Pancreatic Damage ◽

Increased Risk ◽

Bidirectional Relationship ◽

Rapid Spread ◽

Relationship Of ◽

The Relationship ◽

New Onset

AbstractThe advent and rapid spread of the coronavirus disease-2019 (COVID19) pandemic across the world has focused attention on the relationship of commonly occurring comorbidities such as diabetes on the course and outcomes of this infection. While diabetes does not seem to be associated with an increased risk of COVID19 infection per se, it has been clearly demonstrated that the presence of hyperglycemia of any degree predisposes to worse outcomes, such as more severe respiratory involvement, ICU admissions, need for mechanical ventilation and mortality. Further, COVID19 infection has been associated with the development of new-onset hyperglycemia and diabetes, and worsening of glycemic control in pre-existing diabetes, due to direct pancreatic damage by the virus, body’s stress response to infection (including cytokine storm) and use of diabetogenic drugs such as corticosteroids in the treatment of severe COVID19. In addition, public health measures taken to flatten the pandemic curve (such as lockdowns) can also adversely impact persons with diabetes by limiting their access to clinical care, healthy diet, and opportunities to exercise. Most antidiabetic medications can continue to be used in patients with mild COVID19 but switching over to insulin is preferred in severe disease.

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AN INVESTIGATION OF THE RELATIONSHIP BETWEEN CESAREAN SECTION BIRTH AND RESPIRATORY DISTRESS SYNDROME OF THE NEWBORN

American Journal of Epidemiology ◽

10.1093/aje/121.5.651 ◽

1985 ◽

Vol 121 (5) ◽

pp. 651-663 ◽

Cited By ~ 26

Author(s):

E. WHITE ◽

K. K. SHY ◽

J. R. DALING

Keyword(s):

Cesarean Section ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

The Relationship

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The relationship between positive end-expiratory pressure and cardiac index in patients with acute respiratory distress syndrome

Journal of Critical Care ◽

10.1016/j.jcrc.2013.06.021 ◽

2013 ◽

Vol 28 (6) ◽

pp. 992-997 ◽

Cited By ~ 1

Author(s):

Wassim H. Fares ◽

Shannon S. Carson

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Cardiac Index ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Positive End Expiratory Pressure ◽

The Relationship

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THE RELATIONSHIP OF AMNIOTIC FLUID VISCOSITY TO RESPIRATORY DISTRESS IN LAMBS

PEDIATRICS ◽

10.1542/peds.38.5.858 ◽

1966 ◽

Vol 38 (5) ◽

pp. 858-864

Author(s):

Arthur J. Moss ◽

Ovidio Rettori ◽

Norman S. Simmons

Keyword(s):

Cesarean Section ◽

Respiratory Distress ◽

Amniotic Fluid ◽

Fetal Distress ◽

In Utero ◽

Fluid Viscosity ◽

Lung Expansion ◽

Relationship Of ◽

The Relationship ◽

Length Of Gestation

The viscosity of amniotic fluid was measured in 52 ewes and the results correlated with the postnatal course of the lambs delivered by cesarean section. Viscosity was not related to length of gestation or to the immediate prepartum condition of the ewe, but a definite relationship was found between amniotic fluid viscosity (AFV) and the postnatal course of the fetus. Of 22 lambs considered viable, 9 failed to survive. In 10 of the 13 survivors, AFV was less than 1.6; whereas in the nonsurvivors, AFV varied between 1.6 and 4.4. All of the nonsurvivors experienced respiratory difficulty associated with copious amounts of extremely viscous secretions in the mouth and oropharynx. The substance responsible for the high AFV was a mucoprotein and was detectable in all samples with a viscosity of 1.24 or more but in none with a viscosity below 1.24. The data suggest the possibility that fetal distress may induce qualitative or quantitative alterations of fetal mucous secretions in utero which subsequently could impede lung expansion at birth.

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Treatment of COVID-19 pneumonia and acute respiratory distress with ramatroban, a thromboxane A2 and prostaglandin D2 receptor antagonist: A 4-Patient Case Series Report

10.21203/rs.3.rs-474882/v3 ◽

2021 ◽

Author(s):

Martin L. Ogletree ◽

Kate Chander Chiang ◽

Rashmi Kulshreshta ◽

Aditya Agarwal ◽

Ashutosh Agarwal ◽

...

Keyword(s):

Respiratory Distress ◽

Organ Failure ◽

Viral Infections ◽

Pulmonary Veins ◽

D2 Receptor ◽

Case Series ◽

Acute Onset ◽

Lipid Mediator ◽

Prostaglandin D2 ◽

Th2 Immune Response

Abstract COVID-19 associated pneumonia and acute respiratory distress syndrome are characterized by a lipid mediator storm with massive increases in lung and systemic thromboxane A2 >> prostaglandin D2. Thromboxane A2 is a potent vasoconstrictor of pulmonary veins >> arteries, and thereby promotes an increase in pulmonary capillary pressures, transudation of fluid into the alveolar space, pulmonary edema and ARDS. Thromboxane A2 also increases vascular permeability, contracts bronchial smooth muscle, triggers and amplifies platelet activation, and promotes a prothrombotic state. PGD2 promotes a Th2 immune response that is atypical for viral infections and inhibits antiviral defense by suppressing interferon λ expression. D-dimers, urinary 11-dehydro-TxB2, and IL-13, a Th2 cytokine, have emerged as key biomarkers of severity and organ failure in COVID-19. Ramatroban is an orally bioavailable, potent, dual antagonist of the thromboxane A2 (TPr) and PGD2 (DPr2) receptors. We report use of ramatroban in 4 COVID-19 outpatients, 22 to 87 years of age, with acute onset / worsening of respiratory distress and hypoxemia. All four patients experienced decrease in respiratory distress and increase in SpO2, within hours of the first dose and thereby avoided hospitalization. By the 5th day all 4 patients had complete resolution of respiratory distress and hypoxemia. Ramatroban (Baynas®, Bayer Yakuhin Ltd., Japan) has an established safety profile, having been indicated in Japan for the treatment of allergic rhinitis for over 20 years. As a broncho-relaxant, anti-vasospastic, anti-thrombotic and immunomodulator, ramatroban addresses the fundamental pathophysiologic mechanisms underlying respiratory and critical organ failure in COVID-19, and therefore merits urgent clinical trials that might impact the ongoing pandemic.

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The Role of Omega-3 Polyunsaturated Fatty Acids in the Treatment of Patients with Acute Respiratory Distress Syndrome: A Clinical Review

BioMed Research International ◽

10.1155/2015/653750 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

M. García de Acilu ◽

S. Leal ◽

B. Caralt ◽

O. Roca ◽

J. Sabater ◽

...

Keyword(s):

Fatty Acids ◽

Acute Respiratory Distress Syndrome ◽

Fatty Acid ◽

Polyunsaturated Fatty Acids ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Acute Onset ◽

Omega 3

Acute respiratory distress syndrome (ARDS) is defined as the acute onset of noncardiogenic edema and subsequent gas-exchange impairment due to a severe inflammatory process. Recent report on the prognostic value of eicosanoids in patients with ARDS suggests that modulating the inflammatory response through the use of polyunsaturated fatty acids may be a useful strategy for ARDS treatment. The use of enteral diets enriched with eicosapentaenoic acid (EPA) and gamma-linolenic acid (GLA) has reported promising results, showing an improvement in respiratory variables and haemodynamics. However, the interpretation of the studies is limited by their heterogeneity and methodology and the effect ofω-3 fatty acid-enriched lipid emulsion or enteral diets on patients with ARDS remains unclear. Therefore, the routine use ofω-3 fatty acid-enriched nutrition cannot be recommended and further large, homogeneous, and high-quality clinical trials need to be conducted to clarify the effectiveness ofω-3 polyunsaturated fatty acids.

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