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Medscape
13-06-2025
- Health
- Medscape
Rapid Rx Quiz: Sleep Apnea Devices
CPAP (continuous positive airway pressure), along with other devices such as APAP (automatic positive airway pressure) and BiPAP (bilevel positive airway pressure), have been the mainstay in treating obstructive sleep apnea (OSA) for decades. Despite their proven effectiveness, patients can struggle with discomfort or intolerance of these treatments, which can lead to suboptimal adherence. As a result, alternative devices have been developed to address the needs of individuals who cannot tolerate traditional therapy, offering other approaches to maintaining airway patency and managing related health outcomes. What do you know about devices for sleep apnea? Test yourself with this brief quiz. Current clinical practice guidelines from the AASM recommend the use of either APAP or CPAP in OSA treatment in adults. No clinically meaningful differences were found in outcomes of APAP treatment vs CPAP treatment, and benefits and harm were similar between the two modalities. Patient tolerance and symptom response should guide the choice of one over the other. APAP or CPAP are recommended over BiPAP for initial treatment of OSA in adults. BiPAP might provide an expiratory pressure that is too low to prevent obstructive breathing. However, BiPAP therapy for OSA might be appropriate in certain patients, such as those who have not responded to treatment with APAP and CPAP or those who require very high pressures (> 20 cm H2O). Learn more about sleep-disordered breathing and CPAP. According to current guidelines from the AADSM, patients should be seen by their dentist for a follow-up evaluation within 30 days after appliance insertion. During the first year, patients should be re-evaluated every 6 months, and at least once annually after that to assess treatment efficacy and adherence. At these visits, the treating dentist should use the same standardized tools and questionnaires employed during the initial evaluation to monitor symptoms and treatment response. Adjustment of the oral appliance depends on several factors, including the patient's mandibular range of motion, OSA severity, comfort, and observed changes in symptoms. A collaborative protocol between the treating dentist and the patient's medical provider should be in place to support objective and coordinated assessment. Learn more about oral appliance therapy for OSA. The implantable hypoglossal nerve stimulator received US Food and Drug Administration (FDA) approval in 2014 for the treatment of moderate to severe OSA in patients who have not responded to or cannot tolerate PAP therapy. As hypoglossal nerve stimulation has been shown to be most efficacious in those with a BMI < 32, an adult with moderate OSA and a BMI of 28 probably would be a good candidate for this treatment approach. Hypoglossal nerve stimulation has not been approved in patients aged < 18 years, so a boy aged 15 years would not be a candidate. Also, the stimulator is contraindicated in patients with central sleep apnea. The safety of hypoglossal nerve stimulation has not been established in pregnant patients and should not be undertaken. Learn more about upper airway evaluation in snoring and OSA. An external tongue muscle stimulator device was cleared by the FDA in 2020. Intended for use 20 min/d for 6 weeks and then twice per week subsequently, the device requires far less patient time commitment than some other OSA therapy devices. The tongue muscle stimulator is designed to be used while awake for 20-minute increments. It is indicated for snoring and mild OSA and is not indicated to treat OSA with an apnea-hypopnea index (AHI) > 15. The device is approved only for adults aged ≥ 18 years. Learn more about macroglossia. EPAP devices are noninvasive, valve-based devices for the treatment of mild to moderate OSA. They function by creating resistance during expiration, generating back pressure that helps keep the upper airway open during sleep. Unlike CPAP therapy, which provides constant pressure during both inhalation and exhalation, EPAP devices are passive and provide pressure only during expiration. These devices do not require batteries or power sources. They resemble nasal pillows, like those used with many CPAP machines. Unlike oral appliances, EPAP devices do not require custom fitting. Monthly calibration is also not needed. Learn more about pathologic conditions associated with OSA.
The Journal
18-05-2025
- Politics
- The Journal
Russia launches one of biggest drone attacks on Ukraine since war began
RUSSIA OVERNIGHT INTO Sunday launched one of its most intense drone attacks on Ukraine since the beginning of its full-scale invasion in 2022. Russia fired a total of 273 exploding drones and decoys overnight, Ukraine's air force said. Of those, 88 were intercepted and a further 128 lost, likely having been electronically jammed. The attacks targeted the country's Kyiv, Dnipropetrovsk and Donetsk regions. Advertisement Firefighters put out the fire following Russia's drone attack in the Kyiv region, Ukraine, Sunday, 18 May AP AP According to Kyiv regional governor Mykola Kalashnyk, a 28-year-old woman was killed in a drone attack on the region and three other people, including a four-year-old child, were wounded. The number of drones fired exceeds Russia's previous largest known single drone attack of the war, when Russia pounded Ukraine with 267 drones on the eve of the war's third anniversary. The barrage came after the first direct talks between Moscow and Kyiv in years on Friday failed to yield a ceasefire. Russian President Vladimir Putin spurned Ukrainian President Volodymyr Zelenskyy's offer to meet face-to-face in Turkey after he himself proposed direct negotiations, although not at the presidential level, as an alternative to a 30-day ceasefire urged by Ukraine and its western allies, including the US. US President Donald Trump said he plans to speak by phone to Putin tomorrow, followed by Zelenskyy and leaders of various Nato countries, about ending the war in Ukraine.
The Journal
17-05-2025
- The Journal
Ten prisoners escape from New Orleans jail through hole in cell wall
TEN MEN BROKE out of a New Orleans jail in an audacious overnight escape yesterday by fleeing through a hole behind a toilet and scaling a wall while the lone guard assigned to their cell pod was away getting food, authorities said. Seven of the escapees, including suspects charged with murder, remain on the lam following the breakout that the local sheriff says may have been aided by members within the department. Surveillance footage, shared with media during a news conference, showed the escapees sprinting out of the facility – some wearing orange clothing and others in white. The Orleans Parish jail. They scaled a fence, using blankets to avoid being cut by barbed wire, and then some could be seen sprinting across the nearby interstate and into a neighbourhood. A photograph obtained by The Associated Press from law enforcement shows the opening behind a toilet in a cell that the men escaped through. Above the hole are scrawled messages that include 'To Easy LoL' with an arrow pointing at the gap. Their breach went unnoticed for more than seven hours until a morning headcount revealed the missing inmates. Officials later confirmed the escape was aided by defective locks and possibly inside help. One inmate, Kendall Myles, was caught in the French Quarter after a short chase. Advertisement Two others – Robert Moody and Dkenan Dennis – were also apprehended by yesterday evening. The remaining escapees, aged 19 to 42, shed their uniforms and fled into nearby neighbourhoods. Some of the escapees, Keith A Lewis, Dkenan Dennis, Gary C Price, Robert Moody, Kendell Myles, and Corey E Boyd AP AP The jail, which houses 1,400 inmates, has long suffered from staffing shortages and poor infrastructure. Sheriff Susan Hutson said the facility is only 60% staffed, with persistent issues such as broken locks and unsecured housing for high-risk inmates. The escape sparked widespread criticism from officials. District Attorney Jason Williams called it 'a complete failure,' and Attorney General Liz Murrill labelled the delay in public notification 'beyond unacceptable.' Three jail staff members have been suspended, and authorities are investigating whether any helped facilitate the escape. One of the fugitives, Derrick Groves, was convicted of two murders linked to a 2018 Mardi Gras shooting and is considered dangerous. Law enforcement has since been working with local and federal agencies to recapture the men and protect witnesses potentially at risk. New Orleans police are also using facial recognition and a city-wide camera network to track the escapees. The jail has been under federal oversight since 2013, following a court ruling declaring its conditions unconstitutional.
Time of India
22-04-2025
- Health
- Time of India
Vatican releases first images of Pope Francis in open coffin
AP AP Pope Francis's body is laid out in state inside his private chapel at the Vatican, Monday, April 21, 2025. (Vatican Media via AP, HO) How did Pope Francis die? Live Events Cardinals begin funeral planning Burial at Basilica of St Mary Major Final message and legacy (You can now subscribe to our (You can now subscribe to our Economic Times WhatsApp channel On Tuesday, the Vatican released the first official images of Pope Francis lying in an open coffin, marking the beginning of mourning rites following his death. The solemn photos, published by the Holy See, show the late pontiff in red liturgical vestments and a bishop's mitre, with a rosary gently resting between his folded images were taken inside the chapel of the Domus Santa Marta—the Vatican guesthouse where Pope Francis lived throughout his papacy and where he died on Monday. Vatican Secretary of State Cardinal Pietro Parolin is seen praying over the visuals formed part of the ritual to formally confirm his death. According to Vatican officials, his passing was certified using electrocardiographic thanatography at 7:35 a.m. local time on 21 who was 88, died after suffering a cerebral stroke that left him in a coma and triggered irreversible heart failure. Dr Andrea Arcangeli, head of the Vatican's Directorate of Health and Hygiene, confirmed the cause in a medical report, which also highlighted the Pope's long-standing health conditions: Type II diabetes, high blood pressure, chronic respiratory issues, and a history of bilateral Pope had recently been hospitalised for five weeks with pneumonia. He returned to his apartment and had resumed limited public engagements. His final public appearance was on Easter Sunday, where he offered blessings from the Popemobile in St Peter's Square but was too frail to his death officially confirmed, cardinals gathered in the Vatican on Tuesday morning to initiate the process for the Pope's funeral, burial, and the eventual election of a new pontiff. The Congregation of Cardinals began its first formal meeting at 9 a.m. in the Synod new guidelines issued by Pope Francis himself, the funeral must occur within six days of death. Public viewing of his body at St Peter's Basilica may begin as early as a departure from papal tradition, Francis requested a modest burial at the Papal Basilica of St Mary Major in Rome—rather than at St Peter's Basilica. He will become the first pope in nearly 150 years to be buried outside St Peter's, following the example of Pope Pius decision reflects Francis' long devotion to the Marian icon Salus Populi Romani, housed in the basilica's Pauline Chapel. After every foreign visit, Francis made a point to stop there and pray before the Byzantine painting of the Virgin Mary holding the infant returned there one last time on 12 April. His will, dated 29 June 2022, stated, 'I wish my last earthly journey to end at this very ancient Marian shrine.''The tomb must be in the earth; simple, without particular decoration,' he wrote, adding there should be no mention of his papal title.'With lively hope in eternal life, I offer the suffering of the last part of my life for peace in the world and brotherhood among peoples.'Pope Francis was born Jorge Mario Bergoglio in Buenos Aires, Argentina. He became the first Latin American pope in March 2013. His papacy spanned over a decade marked by attempts at Church reform, outreach to the poor, and efforts to bridge global his autobiography Hope, he wrote, 'The Vatican is the home of my final service, not my eternity.'His Easter Sunday appearance—waving from the same balcony where he was first introduced to the world twelve years ago—now serves as a poignant end to a life of faith, simplicity, and service.(With inputs from Agencies)
